Volume 41 · Issue 06 · 2025

The incidence of brain metastases has been on the rise in recent years. At present, a multidisciplinary cooperative diagnosis and treatment model has gradually been formed. Neurosurgery should play a leading and central role in it. Neurosurgeons should face the role of surgical methods in the comprehensive diagnosis and treatment of brain metastases. At the same time, efforts should be made to improve the quality of surgery, rationally apply new technologies, and apply scientific research results to clinical transformation. This article systematically expounds the current status and value of surgical treatment of brain metastases, focusing on the improvement of new technologies in the diagnosis and treatment of brain metastases, aiming to improve the overall therapeutic effect of patients with brain metastases through surgical means and promote the continuous progress of diagnosis and treatment level in this field.

Glioma is a malignant primary brain tumor caused by the disorderly proliferation of neural stem cells or neural precursor cells driven by carcinogenic mutations^[1]。 Glioma accounts for 80% of malignant primary brain tumors and is the most important cause of death^[2]。 Among them, glioblastoma (GBM) is the most malignant glioma, and the median survival of patients<17 months^[3,4]。 The standard treatment regimen for GBM is the maximum degree of safe resection and postoperative adjuvant chemoradiotherapy, but the effect of prolonging the survival of patients with standard treatment regimen has reached a bottleneck^[5]。 Currently, tumor electric field therapy has been included in the standard treatment protocol for emerging GBM^[1]。 However, the median overall survival of patients after tumor electric field therapy was only prolonged by less than 3 months^[6]。 In conclusion, the treatment of glioma has not improved significantly in the past two decades^[7]。 In view of the current status of glioma treatment, it is common practice internationally to recommend patients to participate in suitable clinical trials as far as possible to seek possible effective treatment options. Drug sensitivity (drug sensitivity) detection based on tumor organoids has been gradually emerging in recent years. It has the characteristics of high accuracy and strong predictability. At present, it has been successfully used to assist the formulation of tumor treatment schemes such as colorectal cancer and rectal cancer, which can provide an important basis for clinical trial drugs. In the Guidelines for Integrated Diagnosis and Treatment of Brain Glioma of China Anti-Cancer Association (2024 Edition) (https: / /cacaguidelines.cacakp.com/pdflist/detail? id =415), "Chemotherapy under the guidance of in vitro drug susceptibility tests such as organoid models can be considered as a selective reference for individualized treatment" has been added. However, organoid drug susceptibility detection has not been used in the treatment of glioma on a large scale. At present, the centers for organoid drug susceptibility testing of glioma are scattered, and no large-scale multicenter cohort study has been retrieved, which limits the potential benefits of glioma patients in organoid drug susceptibility testing. The Glioma Professional Committee of China Anti-Cancer Association, in conjunction with a number of basic research and clinical diagnosis and treatment teams of glioma in China, summarized the existing application of drug sensitivity detection of glioma organoids at home and abroad by comprehensively searching and reviewing the research literature related to glioma organoids, and jointly formulated the Expert Consensus on the Application of Organoid Drug Sensitivity Detection in Precision Treatment of Glioma (First Edition) in combination with the specific needs of glioma diagnosis and treatment in China. It is intended to improve the understanding of clinical experts and scientific researchers in the field of glioma in China on organoid-guided precision treatment, standardize the quality control of glioma organoids, and promote the application of glioma organoids in the field of precision medicine.

To investigate the safety and efficacy of dual-fiber intraoperative magnetic resonance guided laser interstitial thermal therapy (LITT) in the treatment of large brain metastases.

The clinical data of 50 patients with brain metastases were prospectively included at Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from January 2022 to August 2024. According to the location, volume and morphological characteristics of the lesions to be ablated, LITT was performed by single fiber (single-fiber group) or dual fiber combination (dual-fiber group) ablation under real-time MRI monitoring, and the volume and ablation rate of each lesion were documented. The tumor progression at 1, 3 and 6 months after surgery was observed, and the local tumor control rate at 6 months after surgery was calculated.

A total of 61 lesions were intended to be ablated in the 50 patients, including 1 lesion in 40 cases, 2 lesions in 9 cases, and 3 lesions in 1 case. The lesion volume [M(Q₁, Q₃)] was 4.04 (1.49, 6.91) cm^3, including 43 lesions in the single-fiber group and 18 lesions in the dual-fiber group, whose volumes were 2.28 (0.82, 5.04) cm³ and 7.10 (5.46, 10.28) cm^3, respectively. The difference was statistically significant (Z=-4.61, P<0.001). All 61 lesions were successfully ablated, and no surgery-related complications were observed. Lesion ablation rate [M(Q₁, Q₃)] was 94.60% (92.40%, 98.75%), 94.20% (91.80%, 98.40%) in the single-fiber group and 95.95% (92.48%, 99.60%) in the dual-fiber group, and the difference was not statistically significant (Z=-0.92, P=0.358). The 6-month follow-up showed that the local tumor control rate was 62.5%(38/61), among which 60.5%(26/43) was in the single-fiber group and 66.7%(12/18) was in the dual-fiber group, the difference was not statistically significant (χ²=0.21, P=0.649).

Dual-fiber intraoperative magnetic resonance guided LITT enables large brain metastases to achieve ablation effects comparable to those of small lesions treated with a single fiber, without increasing surgery-related complications. It is safe and effective.

To investigate the intraoperative multimodal ultrasound imaging features of brain metastases.

A total of 51 patients who underwent surgical resection of brain metastases at the Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences between April 2019 and April 2024 were enrolled. All patients underwent multimodal ultrasound examination before dural opening, including 2-dimensional(2D) brightness imaging, vascular imaging [color Doppler (CD), power Doppler (PD), and microvascular imaging (MVI)], with 20 patients additionally undergoing shear wave elastography (SWE) and 10 undergoing intraoperative contrast-enhanced ultrasound (CEUS). Parameters from different ultrasound modalities were analyzed to compare imaging differences among tumor tissue, peritumoral edematous brain tissue, and normal brain tissue.

Among 51 patients, 2D brightness imaging revealed clear tumor boundaries (>90% demarcation) in 66.67% (34 cases), partial demarcation (50-90%) in 21.57% (11 cases), and poor demarcation (<50%) in 11.76% (6 cases). Peritumoral edema was observed in 68.63% (35 cases), and cystic degeneration in 56.86% (29 cases). CD, PD, and MVI detected tortuous, irregular intratumoral vessels in 31.37% (16 cases), 27.45% (14 cases), and 70.59% (36 cases), respectively, while compressed dilated vessels at tumor margins were identified in 17.65% (9 cases), 35.29% (18 cases), and 58.82% (30 cases), with statistically significant differences (all P<0.001). SWE demonstrated significant differences in median (Q₁, Q₃) elastic modulus among tumor tissue [10.55 (7.80, 13.78) kPa], peritumoral edematous tissue [5.56 (3.70, 7.82) kPa], and normal brain tissue [6.25 (4.63, 8.80) kPa] (H=12.45, P=0.002). CEUS clearly delineated tumor boundaries in all 10 cases, with significant differences in contrast signal intensity parameters (rise slope, time-to-peak, absolute peak intensity) among tumor tissue, peritumoral edematous tissue, and normal brain tissue (all P<0.01).

Intraoperative multimodal ultrasound techniques reveal distinct imaging features of brain metastases, peritumoral edematous tissue and normal brain tissue. Their combined use could enhance intraoperative precision in evaluating tumor morphology, vascularity and boundaries.

To evaluate the clinical efficacy of surgical resection of brain metastases based on multimodal imaging reconstruction technology.

A retrospective study was conducted on the clinical data of 83 patients with brain metastases who underwent surgical treatment in the Department of Neurosurgery at Peking University Third Hospital from November 2018 to October 2024. Preoperative examinations included thin-slice MRI of the head and CT scans of the head and face. Post-processing imaging techniques comprised fully automatic multimodal neuroimage fusion and registration, fully automatic 3D reconstruction of cranial structure models, and automatic segmentation and reconstruction of brain tumors, blood vessels, and nerve fiber tracts. Preoperative evaluation and surgical planning were performed based on preoperative imaging and multimodal reconstruction results. Tumor resection was assisted by neuronavigation and sodium fluorescein contrast. The extent of tumor resection and neurological function improvement were assessed. Neurological deficits were evaluated using the National Institutes of Health Stroke Scale score. A score increase of ≥1 point compared to preoperative levels indicated functional deterioration, while a decrease of ≥1 point indicated functional improvement.

Among the 83 patients, gross total resection was achieved in 76 cases (91.6%), subtotal resection in 4 cases (4.8%), and partial resection in 3 cases (3.6%). No surgery-related iatrogenic complications occurred. Six-month postoperative follow-up showed significant improvement in headache symptoms in all 16 affected patients. Among 28 patients with limb weakness, 22 improved, 5 showed no significant change, and 1 developed hemiplegia. All 13 patients with speech impairment showed significant improvement. Among 11 patients with ataxia, 6 improved, and 5 showed no significant change. Only 2 out of 8 patients with visual field defects improved. All 7 patients with preoperative seizures achieved complete remission postoperatively with oral antiseizure drugs.

The resection of brain metastases based on digital intelligent technology could achieve a high rate of gross total resection and a low incidence of surgery-related complications.

To investigate the clinico-immunological microenvironment characteristics of non-small cell lung cancer (NSCLC) brain metastases and their impact on the patient prognosis.

Clinical data of 77 adult NSCLC brain metastasis patients who underwent surgical treatment and were pathologically confirmed at the Department of Neuro-Oncology of Chongqing University Cancer Hospital from January 2020 to December 2022 were retrospectively analyzed. Multiplex immunohistochemistry (mIHC) was used to detect the proportions of CD68⁺ tumor-associated macrophages (TAMs), CD8⁺ T cells, CD4⁺ T cells, programmed cell death protein 1 (PD1)⁺ T cells, and CD4⁺ PD1⁺ double-positive T cells in tumor parenchyma and stroma. The X-tile software was employed to determine the optimal cutoff values for continuous variables, converting them into categorical variables. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the effects of clinical and immune microenvironment factors on the overall survival (OS) of patients. Kaplan-Meier survival curves were plotted based on identified influential factors, with log-rank tests performed for between-group comparisons.

Among the 77 patients, 59 (76.6%) had metastases in supratentorial location and 18 (23.4%) in infratentorial location. The predominant pathological type was adenocarcinoma (63 cases, 81.8%), followed by squamous cell carcinoma (12 cases, 15.6%), while sarcomatoid carcinoma was rare (2 cases, 2.6%). The mIHC results showed that the proportions of CD68⁺ TAMs, CD8⁺ T cells, and CD4⁺ T cells in the tumor stroma were higher than those in the tumor parenchyma, with statistically significant differences (all P<0.001). However, the proportion of PD1⁺ T cells in the tumor parenchyma was higher than that in the stroma (P<0.001). There was no statistically significant difference in the proportion of CD4⁺ PD1⁺ double-positive T cells between tumor parenchyma and stroma (P=0.360). The follow-up time for all patients was 18±1 months (range: 2-45 months), with 1-year and 2-year survival rates of 72.7% (56/77) and 28.6% (22/77), respectively. Multivariate Cox proportional hazards regression models analysis showed that squamous cell carcinoma pathology (HR=0.06, 95%CI: 0.01-0.38), postoperative comprehensive treatment (including at least one of chemotherapy, radiotherapy, targeted therapy, or immunotherapy) (HR=0.13, 95%CI: 0.06-0.29), and a higher proportion of CD4⁺ PD1⁺ double-positive T cells in the tumor parenchyma (HR=0.13, 95%CI: 0.04-0.41) were all protective factors for OS (all P<0.001). Kaplan-Meier survival curve analysis showed that patients with squamous and adenocarcinoma cell carcinoma had longer OS than those with sarcomatoid carcinoma (median values: not achieved, 27 and 3 months respectively, P<0.001); patients who received postoperative comprehensive treatment had longer OS than those who did not (median values: 37 and 8 months respectively, P<0.001); and patients with a higher proportion of CD4⁺ PD1⁺ double-positive T cells in the tumor parenchyma had longer OS than those with a lower proportion (median values: not achieved and 21 months respectively, P=0.001).

The immune microenvironment of NSCLC brain metastases exhibits significant spatial heterogeneity. Both patient′s tumour pathological type and whether or not received postoperative comprehensive treatment affect the patient′s prognosis. The proportion of CD4⁺ PD1⁺ double-positive T cells in the tumor parenchyma may be an important indicator for predicting patient prognosis.

To investigate the survival prognosis and influencing factors in patients with brain metastases undergoing En bloc resection.

Clinical data of brain metastasis patients treated with En bloc resection in the Department of Neurosurgery at Sun Yat-Sen University Cancer Center from January 2010 to December 2023 were retrospectively analyzed. Postoperative recurrence was observed. Kaplan-Meier survival curves were plotted, and Log-rank tests were used to compare survival outcomes across different groups. A multivariate Cox regression model was employed to identify factors influencing overall survival (OS).

A total of 342 patients were enrolled in this study. Postoperative neurological function improvement, deterioration, and no change were observed in 33.0% (113/342), 5.9% (20/342), and 61.1% (209/342) of patients after surgery, respectively. The local recurrence rate was 9.1% (31/342). The median OS for all patients was 29.9 months (range: 1.4-146.5 months). Log-rank tests revealed that multiple brain metastases, colorectal or melanoma primary tumors, the presence of extracranial tumors before surgery, and preoperative chemotherapy might be risk factors for patient survival prognosis (all P<0.05), while the use of fluorescein sodium staining technique during surgery, postoperative chemotherapy, and postoperative targeted therapy were protective factors for patient survival prognosis (all P<0.05). Multivariate Cox regression analysis demonstrated that single brain metastasis (HR=0.46, 95%CI: 0.30-0.70, P<0.001), intraoperative sodium fluorescein staining (HR=0.68, 95%CI: 0.47-0.99, P=0.045) and postoperative chemotherapy (HR=0.52, 95%CI: 0.36-0.74, P<0.001) were associated with longer OS. Conversely, larger tumor diameter (HR=1.02, 95%CI: 1.00-1.03, P=0.022), colorectal primary tumors (HR=2.79, 95%CI: 1.47-5.30, P=0.002) and preoperative chemotherapy (HR=1.78, 95%CI: 1.20-2.65, P=0.004) were associated with shorter OS. Preoperative extracranial tumors showed a borderline increased risk of mortality with no statistical significance (HR=1.40, 95%CI: 0.99-1.96, P=0.054).

En bloc resection has a minimal adverse impact on the neurological function of patients with brain metastases. Single brain metastasis, usage of fluorescein sodium staining technique during surgery and postoperative chemotherapy are associated with longer OS in patients with brain metastases. In contrast, larger tumor diameter, primary colorectal cancer and preoperative chemotherapy are associated with shorter OS in patients with brain metastases.

To explore the influencing factors of epileptic seizures after glioma surgery, construct and verify the random survival forest (RSF) prediction model for epileptic seizures after glioma surgery.

Based on the Chinese Glioma Genome Atlas (CGGA), patients with glioma who underwent tumor resection at the Neurosurgery Center of Beijing Tiantan Hospital Affiliated to Capital Medical University from July 2021 to October 2023 were retrospectively enrolled as research subjects. According to the presence or absence of postoperative epileptic seizures, the patients were divided into an epileptic seizure group and a non-epileptic seizure group. The clinical data of the two groups of patients were compared. The possible risk factors for postoperative epileptic seizures of glioma were screened out by univariate Cox analysis (P<0.2). All the 756 patients were randomly allocated to the training set and test set at a ratio of 7 ∶3 and a RSF prediction model was constructed. The prediction effect of the model was evaluated by the concordance index (C-index), Brier score, and receiver operating characteristic (ROC) curve, and the SHAP (SHapley Additive exPlanations) method was used for model visualization analysis to explore the influencing factors of postoperative epileptic seizures of glioma.

A total of 756 patients were included, of whom 234 (31.0%) developed postoperative epileptic seizures. The comparison between the two groups showed that there were significant differences in the presence or absence of epilepsy before surgery, tumor location, degree of resection, pathological type, alpha-thalassemia/mental retardation syndrome X-linked(ATRX) mutation status, and telomerase reverse transcriptase (TERT) promoter C228T mutation status between the two groups (all P<0.05). The results of univariate Cox analysis showed that the patient′s age, the presence or absence of epileptic seizures before surgery, the degree of resection of the tumor, pathological type, location, chromosome 1p/19q co-deletion, ATRX mutation status, TP53 mutation status, and TERT promoter C228T mutation status were all influencing factors for postoperative epileptic seizures in patients (all P<0.2). A total of 10 variables including these factors and anti-seizure drugs were used to construct a RSF model. The C-index of the model was 0.76, the Brier scores at 30, 60, and 180 days were 0.04, 0.07, and 0.17, and the areas under the ROC curve were 0.85, 0.84, and 0.82, respectively. The model performed well in terms of discrimination and calibration. The results of SHAP analysis showed that the top 8 key factors of the model were: the presence or absence of epileptic seizures before surgery, TERT promoter C228T mutation status, tumor location, tumor resection extent, ATRX mutation status, chromosome 1p/19q co-deletion, tumor pathological type, and patient′s age, suggesting that they were influencing factors for epileptic seizures after glioma surgery.

The RSF prediction model for postoperative epileptic seizures after glioma constructed based on clinical characteristics and molecular pathological features has good discrimination and calibration, and can be used to assess the risk of postoperative epileptic seizures in patients at different time points.

To explore the correlation between the semiology of the cingulate gyrus epilepsy and subregions of the cingulate gyrus.

A retrospective analysis was conducted on the clinical data of 43 patients who underwent stereotactic electroencephalogram at the Epilepsy Center of Sanbo Brain Hospital, Capital Medical University from March 2012 to June 2024, with the cingulate gyrus clearly identified as the epileptogenic zone, and were diagnosed with cingulate gyrus epilepsy through surgical operations and postoperative follow-up. We documented the characteristics of intracranial electroencephalogram and semiology of patients and conducted corresponding quantitative evaluations. We performed cluster analysis on the cortical epileptogenic area and semiology, and conducted Kendall correlation analysis on the correlation between the two.

The operations of all 43 patients were successfully completed. Among them, 21 patients(48.8%) underwent thermocoagulation ablation of the epileptogenic zone in the cingulate gyrus, and 22(51.2%) patients underwent epileptogenic zone resection. All 43 patients were followed up for more than one year after the operation. At the last follow-up, among the 43 patients, 39 cases (90.7%) had the Engel grade of Ⅰ, 3 cases (7.0%) were grade Ⅱ, and 1 case (2.3%) was grade Ⅲ. The correlation analysis between semiology and epileptogenic zone showed that the cingulate cortex could be divided into three groups. The cortex of group 1 mainly included the anterior cingulate gyrus, the medial side of the prefrontal lobe, the lateral side of the prefrontal lobe, and the anterior insular lobule. The related epileptic semiology included emotional aura, abdominal aura, type Ⅰ hypermotor behaviors, and the "chapeau de gendarme" sign. The cortex of group 2 mainly included the middle cingulate gyrus, the supplementary motor area, and the premotor area. The relevant epilepsy semiology included somatosensory auras, asymmetric tounus, and proximal tonus of the contralateral limb. The cortex of group 3 mainly included the posterior cingulate gyrus, the isthmus of the cingulate gyrus, the medial temporal lobe structure, the lateral temporal lobe structure, and the posterior insular lobule. The related semiology included vestibular aura, the feeling of "déjà vu", autonomic aura, absence seizure, oropharyngeal automatism, and trunk-bilateral proximal tonus.

The semiology of cingulate gyrus epilepsy has specific correlations with each subregion of the cingulate gyrus, which can provide a basis for the precise localization and treatment optimization of epilepsy.

To explore the correlation and predictive value of the significant increase of noninfectious serum procalcitonin (PCT) in early stage with the prognosis of patients with severe neurological diseases.

A retrospective study was conducted on 485 patients with severe neurological conditions admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Jiaxing University from January 2020 to June 2023. All patients were tested for serum PCT within 24 hours of onset. All patients were followed up for 3 months and grouped according to the Glasgow Outcome Scale, with grade Ⅳ-Ⅴ being the good outcome group and grade Ⅰ-Ⅲ being the poor outcome group. We then compared the rates of early significant increase in PCT between two groups of patients and used multiple logistic regression to analyze the correlation between early significant increase in PCT and the prognosis of critically ill neurological patients. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the efficacy of significant increase of early PCT in predicting the patient prognosis.

Among 485 patients, 99 cases (20.4%) showed a significant increase in early PCT, and the median value(Q₁, Q₃) was 3.1 (2.3, 4.2) ng/ml. After 3 months of follow-up, 182 patients (37.5%) had good outcome and 303 cases (62.5%) had poor outcome. The proportion of significant PCT increase in the poor outcome group was 27.4% (83 cases) and that in the good outcome group was 8.8% (16 cases), and the difference was statistically significant (P<0.001). After adjusting for confounding factors, multivariate logistic regression analysis showed that significant increase in PCT at early stage (OR=3.14, 95%CI: 1.65-20.36, P=0.003) and Glasgow Coma Scale (GCS) score at admission (OR=2.65, 95%CI: 1.20-7.04, P=0.017) were significantly correlated with 3-month prognosis. The AUC of GCS score predicting prognosis was 0.65 (95%CI: 0.60-0.70), the AUC of significant increase of early PCT predicting prognosis was 0.67 (95%CI: 0.62-0.72), and the AUC of combined prediction was 0.81 (95%CI: 0.77-0.85).

Significant increase of PCT in the early stage is correlated with the prognosis of patients with severe neurological conditions. Combined assessment of PCT and GCS score can significantly improve the prediction efficiency of patient prognosis.

To preliminarily investigate the safety and clinical effect of neuroendoscopic resection of tumors in the pineal region and superior cerebellar vermis via the infratentorial supracerebellar approach.

The clinical data of 8 patients who underwent neuroendoscopic resection of pineal region and superior cerebellar vermis tumors through the infratentorial supracerebellar approach in the Department of Neurosurgery of the First Affiliated Hospital of Anhui Medical University from August 2021 to March 2024 were retrospectively analyzed. Plain and enhanced MRI of the head were performed 3 months after surgery and annually to determine whether the tumor had recurred, the surgical efficacy was evaluated by the Karnofsky performance status (KPS) score.

Among the 8 patients, 6 cases underwent total tumor resection and 2 cases underwent near-total tumor resection. The clinical symptoms of the patients all improved after surgery, and no complications such as bleeding, infection and epileptic seizures occurred. Postoperative pathological examination results showed that among the pineal region tumors, there were 4 cases of meningioma, 1 case of pilocytic astrocytoma, and 1 case of moderately differentiated pineal parenchymal tumor. Among the cerebellar superior vermis tumors, there was 1 case of hemangioblastoma and 1 case of gastric metastatic carcinoma. The median follow-up time after surgery was 17.5 (3.0-48.0) months. At the last follow-up, among the 8 patients, 4 cases had a KPS score of 100, 3 cases had a KPS score of 90, and 1 case had a KPS score of 0. Among them, the patient with gastric metastasis gave up treatment due to systemic metastasis of the tumor 3 months after surgery and died; the other 7 patients lived a normal life without tumor recurrence.

Preliminary observations have found that the infratentorial supracerebellar approach combined with neuroendoscopic technology to remove tumors in the pineal region tumors and cerebellar superior vermis has the advantages of less trauma, fewer complications, safety and effectiveness, and is worthy of clinical promotion.

To compare the efficacy and prognosis of patients with supratentorial spontaneous intracerebral hemorrhage treated with neuroendoscopic and microscopic surgery.

The clinical data of patients with supratentorial spontaneous intracerebral hemorrhage who were admitted to the Department of Neurosurgery of the Third Affiliated Hospital of Nanjing Medical University (Changzhou Second People′s Hospital) from November 2017 to March 2024 were retrospectively analyzed. The patients underwent neuroendoscopic intracerebral hematoma evacuation (endoscopic group) and microscopic hematoma evacuation (microscopic group), respectively. The baseline data, surgical-related indicators, postoperative recovery, complications and prognosis of the two groups were compared. The Clavien-Dindo classification (CDC) was used to evaluate the severity of postoperative complications, and the Glasgow Outcome Scale (GOS) score and Barthel Index (BI) grading were used to evaluate the prognosis of the patients 3 and 6 months after discharge. Based on preoperative blood loss, patients were divided into two subgroups: those with blood loss >40 ml and those with blood loss ≤40 ml. Subsequently, we compared surgical outcomes, complications, and prognosis between patients treated with the two different surgical methods.

A total of 104 patients were included, with 63 in the microscopic group and 41 in the endoscopic group. No significant differences were observed in age, sex, disease duration, history of hypertension/diabetes, or preoperative Glasgow Coma Scale (GCS) scores between the two groups (all P>0.05). The preoperative hematoma volume [M(Q₁, Q₃)] was larger in the microscopic group than in the endoscopic group [52.2 (37.6, 68.7) ml vs. 34.2 (31.5, 60.1) ml, Z=-2.87, P=0.004], while there were no statistically significant differences in the hematoma volume and hematoma evacuation rate at 3 days after operation (both P>0.05). The endoscopic group had shorter surgical duration [M(Q₁, Q₃): 115.0 (90.0, 140.0) min vs. 170.0 (150.0, 206.3) min], less intraoperative blood loss [M(Q₁, Q₃): 50 (20, 100) ml vs. 280 (200, 500) ml], and a lower incidence of hypoproteinemia [73.2% (30/41) vs. 98.4% (62/63)] compared to the microscopic group (all P<0.001). There were no significant differences in the incidence of intracranial or pulmonary infection, postoperative rebleeding, hydrocephalus, secondary epilepsy, gastrointestinal bleeding, deep vein thrombosis, postoperative hypokalemia or hypernatremia, CDC of complications, length of hospital stay, length of stay in the intensive care unit, GOS score and BI at 3 or 6 months after surgery between the two groups (all P>0.05). After dividing all patients into subgroups based on preoperative bleeding volume (>40 ml and ≤40 ml), the endoscopic group had shorter surgical duration and less intraoperative blood loss than the microscopic group (both P<0.05), while there were no statistically significant differences in the CDC of postoperative complications and GOS scores at 3 or 6 months postoperatively (all P>0.05).

There is no significant difference in prognosis between patients with supratentorial SICH treated with microscopic surgery and those treated with neuroendoscopic surgery. However, the latter has a lower incidence of postoperative hypoproteinemia, shorter surgical duration, and less intraoperative blood loss.

To explore the efficacy of middle meningeal artery (MMA) embolization in the treatment of chronic subdural hematoma (CSDH).

The clinical data of 40 patients with CSDH who were treated by embolization of MMA in the Department of Neurosurgery, Jining No.1 People′s Hospital from April 2022 to December 2024 were retrospectively analyzed. The clinical symptoms and complications of the patients were observed after the operation, and the hematoma absorption was determined through CT and/or MRI examination.

The surgeries of 40 patients (48 on the side) were all successfully completed. Conservative treatment was adopted for 2 cases of side hematoma due to the small amount of bleeding. The imaging reexamination of 35 patients after the operation showed that the hematoma gradually absorbed, and the clinical manifestations of the patients returned to normal. The time[M(Q₁, Q₃)] for significant improvement of the main symptoms was 22.5 (7.0, 30.0) days. Imaging follow-up was obtained for 23 patients after the operation. The follow-up time[M(Q₁, Q₃)] was 90 (64, 130) days and it could be seen that the hematoma of all patients was completely absorbed. After the operation, 5 patients underwent drilling and drainage surgery due to aggravated clinical symptoms. In terms of complications, one patient suffered permanent blindness on the affected side after the operation. One patient presented with abducens nerve dysfunction after the operation, but returned to normal 40 days after the operation. The other patients had no serious perioperative complications.

MMA embolization is an effective treatment measure for CSDH and is worthy of clinical promotion and application.

To analyze the cellular composition, immune microenvironment, and genomic characteristics of lung adenocarcinoma (LUAD) and its brain metastases (BM) based on single-cell RNA sequencing (scRNA-seq) data, and to identify prognostic genes associated with LUAD-BM.

scRNA-seq data were collected from 10 LUAD (LUAD group) and 11 LUAD-BM (BM group) samples based on the GSE131907 dataset, and the gene with the highest expression variability was selected for subsequent principal component analysis. The "score_genes" function in the Scanpy package was used to evaluate gene signature scores and compare the differences in microenvironment between two groups. Differentially expressed genes (DEGs) between two groups were identified using the "FindMarkers" function in the Seurat package. Single-cell copy number variations (CNVs) and identifying tumorous epithelial cells were inferred using the Python package "infercnvpy". Based on the Cancer Genome Atlas (TCGA) -LUAD dataset (n=362) and the selected DEGs, prognostic related genes were preliminarily screened through univariate Cox regression analysis. Least absolute shrinkage and selection operator(LASSO) regression was applied to further optimize the gene feature set, and multivariate Cox regression analysis was used to determine independent prognostic genes and construct a prognostic model. The patients were stratified into high-risk and low-risk groups according to the median risk score. Kaplan-Meier survival curves were plotted, and differences in overall survival between different risk groups were compared using the Log-rank test.

Based on the expression of cell characteristic genes, 9 major cellular subpopulations were screened. Cell composition analysis between LUAD group and BM group revealed a significantly "tumor cell-dominant" microenvironment in the BM group, characterized by a higher proportion of epithelial cells [50.1%(12 542/25 050) vs. 15.3%(6 288/41 140)] and reduced immune cell infiltration. In contrast, the LUAD group exhibited an "immune cell-enriched" microenvironment, with natural killer CNK lymphocytes as the predominant immune population[44.0%(18 082/41 140)vs.15.7%(3 931/25 050)]. Immune cell profiling identified 6 functionally distinct macrophage subsets. Compared to the LUAD group, the BM group demonstrated a unique myeloid immune landscape with increased proportions of chemokine-secreting macrophages [(28.7%(1 498/5 225) vs.21.5%(1 697/7 889)] and hypoxia-responsive macrophages [17.2%(899/5 225) vs.8.4%(666/7 889)], and a significantly decreased proportion of immunoactivating dendritic cells[(7.1%(371/5 225) vs.14.7%(1 160/7 889)]. Twelve functionally distinct T or NKT cell subsets were identified, among which the BM group exhibited significant immune suppressive features, including elevated proportions of regulatory T cells [12.7%(499/3 929) vs.9.4%(1 704/18 082) and stress-responsive T cells [18.6%(729/3 929) vs.7.1%(1 291/18 082)]. CNV analysis showed greater genomic instability in the BM group. Integration of single-cell data identified normal epithelial and malignant epithelial cell populations. Tumor evolution analysis revealed that the LUAD group exhibited a typical epithelial-mesenchymal transition type Ⅲ (EMT-Ⅲ) phenotype, whereas the BM group showed lower EMT levels but enhanced hypoxic features (all P<0.05). In the TCGA-LUAD cohort, 1 659 significantly upregulated DEGs from the BM group were identified. Univariate Cox regression analysis identified 93 prognostically relevant genes, of which 25 were selected via LASSO regression. Multivariate Cox regression analysis further identified KRT6A, TMPRSS11E, and PDK4 as core genes for the prognostic model. Log-rank analysis showed a significant difference in survival rate between high-risk and low-risk groups (P<0.001).

The tumor microenvironment of LUAD-BM is characterized by a dominant malignant epithelial cell population and immunosuppressive features compared to LUAD lesion. A prognostic model based on its unique genomic variations and hypoxic adaptation features may have important clinical value.

Adenosine-induced temporary cardiac arrest is a novel systemic blood flow control technique, which significantly improves the safety of intracranial interventional surgery for arteriovenous malformations by minimizing the pressure gradient at the arteriovenous end of the malformed mass. At present, many medical centers abroad have widely applied this technology, and achieved a high cure rate of arteriovenous malformations, but no relevant literature has been reported in China. In November 2023, a patient with intracranial arteriovenous malformation was admitted to the Department of Neurosurgery of Huai' an 82nd Hospital. Adenosine-induced temporary cardiac arrest technique was used to assist transvenous approach embolization. Immediate postoperative digital subtraction angiography (DSA) showed that the malformed vascular mass was not developed. After 23 seconds of cardiac arrest, he was resuscitated without other complications. The modified Rankin scale score was 0. DSA follow-up at 7 months postoperatively showed curative embolization of arteriovenous malformations.

Meningioma is the most common primary intracranial tumor in adults, accounting for more than 1/3 of all intracranial tumors. The fifth edition of World Health Organization (WHO) CNS tumor grading emphasizes the role of molecular pathology diagnosis in meningioma grading, especially DNA methylation, which has become an important basis for predicting recurrence and prognosis of tumor patients. Meningiomas with different methylation types have obvious heterogeneity in biological behavior, clinical treatment and prognosis. In order to provide a new perspective on the molecular typing and treatment of meningioma, this paper reviews the DNA methylation studies related to meningioma recurrence in recent years.

The emergence of blood flow directing devices (FD) has brought a completely new direction to the endovascular treatment of intracranial aneurysms. FD mainly promotes the reconstruction of tumor-bearing artery by forming continuous and dense vascular endothelium on the stent mesh, and then promotes aneurysm occlusion. Endothelialization is the key to FD in the treatment of aneurysm occlusion after intracranial aneurysm. The material design of FD, the origin of new endothelial cells, adherence and hemodynamics are all important factors affecting the endothelialization after FD treatment of intracranial aneurysms. This paper focuses on the research on endothelialization after FD treatment of intracranial aneurysm, in order to provide theoretical basis for the effective treatment of intracranial aneurysm by FD and the research and development of related products.

The causes of vascular pulsatile tinnitus are related to the abnormalities of hemorheology and anatomy of head and neck. Persistent pulsatile tinnitus seriously affects the quality of life of patients and even causes psychological diseases such as anxiety. Studies have shown that endovascular therapy has a definite curative effect on improving pulsatile tinnitus and can effectively improve the quality of life of patients. Because of its safety and convenience advantages, it has gradually replaced traditional surgery and become the first-line treatment plan for vascular pulsatile tinnitus. This article systematically reviews the etiological mechanism and therapeutic progress of vascular pulsatile tinnitus, with emphasis on the clinical application value of endovascular therapy.

Traumatic brain injury (TBI) refers to a neurological disease that causes structural damage or dysfunction of brain tissue after the head is hit or bumped by external force. TBI is a major medical problem worldwide and is a common cause of death and severe disability in patients. With the development of science, the understanding of TBI is deepening. CT scan of the head is the first imaging method for diagnosing TBI, which can quickly identify acute injuries such as intracranial hemorrhage and skull fracture, and is of great significance for assessing the severity of TBI and formulating treatment plans. With the continuous progress of imaging technology, CT plays an increasingly important role in the diagnosis and treatment of TBI, which provides a more accurate basis for clinical treatment and prognosis assessment. This article reviews the predictive value of four common CT score or grading systems for the prognosis of TBI patients, in order to provide reference for the clinical diagnosis and treatment of TBI.