Volume 41 · Issue 07 · 2025

Critical care medicine is an important breakthrough and development achievement of modern medicine. From the failure of vital organs to the treatment of complications related to surgery, everything runs through the management concept of critical care medicine. Neurosurgery is a discipline with extremely high requirements for fine manipulation and fine management. Neurocritical medicine, as a subspecialty derived from the combination of the two, involves not only the management of respiratory and circulatory systems, but also the management of increased intracranial pressure, the regulation of cerebral perfusion, and the prevention and treatment of surgery-related complications. In order to improve the overall level of neurocritical care medicine in China, the deep integration of critical care medicine concept and neurosurgical patient management should be vigorously promoted. First of all, the popularization and training of critical care medicine in neurosurgery should be strengthened. Secondly, we should devote ourselves to the improvement of the management quality of neurosurgery critical care specialty. Finally, it is necessary to strengthen academic exchange and integration between multiple disciplines and regions. In short, on the basis of a deep understanding of the management concept of critical care medicine, the refined management of neurosurgery should be deepened, and the two should be deeply integrated, so as to improve the comprehensive diagnosis and treatment level of critical neurosurgery.

Facial nerve palsy seriously affects the quality of life and physical and mental health of patients, among which the treatment of severe facial nerve palsy with House-Brackmann (HB) grade V ~ VI requires surgical intervention^[1,2]。 According to the etiology, course of disease, severity and the patient's own requirements, there are many ways of surgical treatment. Among them, facial nerve replacement transplantation is widely used, which is suitable for patients with injured proximal central end of facial nerve, but injured distal facial nerve is still intact and facial muscle motor endplate function is normal^[3,4,5]。 Common donor nerves include hypoglossal nerve, accessory nerve and masseter nerve, among which hypoglossal-facial anastomosis (HFA) is the most widely used^[6,7,8,9,10]。 The distal end of the hypoglossal nerve was completely severed by traditional HFA and then anastomosed with the extracranial main trunk of the facial nerve^[8]。 This procedure takes the main trunk of hypoglossal nerve as the donor nerve reinnervated by facial muscle, and has the advantages of sufficient amount of donor nerve fibers, close cross-sectional area of donor and recipient nerves, adjacent anatomical sites, etc., and has a definite efficacy in recovering facial nerve function. However, the disconnection of hypoglossal nerve will inevitably lead to the dysfunction of ipsilateral tongue muscle, and even cause hemilateral tongue muscle atrophy, which will seriously affect the chewing, swallowing and speech functions of patients^[11,12]。 In order to avoid this defect of traditional HFA, a variety of improved surgical procedures have been proposed successively, including, (1) Bridging method: that is, using free nerves (such as sural nerve or great auricular nerve) to bridge between hypoglossal nerve and facial nerve, and perform end-to-side anastomosis with hypoglossal nerve to avoid its complete dissection. However, this procedure has two anastomosis and the number of donor fibers is reduced, which is not only not conducive to the reconstruction of facial nerve function, but also requires the sacrifice of another nerve for bridging, and the surgical trauma is greater^[6]。 (2) Partial hypoglossal nerve method: that is, part of the fibers are used for facial nerve anastomosis after longitudinal incision of the hypoglossal nerve, which causes great damage to the hypoglossal nerve fibers^[12]。 (3) Facial nerve transposition method: that is, the vertical segment of the facial nerve in the temporal bone is revealed by grinding off the mastoid process, and then it is transposed downward, so that it can directly anastomose with the hypoglossal nerve end-to-side. This procedure avoids some of the defects of bridging method, but end-to-side anastomosis also has the disadvantage of insufficient number of hypoglossal nerve donor fibers, and the abrasion of mastoid also increases the difficulty of surgery and the risk of related complications^[13,14,15]。 Therefore, how to improve the traditional HFA procedure to ensure the efficacy of facial nerve paralysis repair and avoid the damage of tongue muscle function has become a research hotspot in this field.

To evaluate the efficacy of endonasal endoscopic optic nerve decompression (EOND) for traumatic optic neuropathy (TON) with no light perception (NLP), and to identify the factors that affect the prognosis.

A retrospective study was conducted on 52 TON patients with NLP who underwent EOND at the Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University from June 2024 to January 2025. The interval between injury and surgery is less than 30 days. Postoperative visual recovery was assessed based on the WHO visual impairment classification. An increase of ≥1 point in postoperative visual acuity (VA) compared with preoperative conditions was considered as improvement. Multivariate logistic regression analysis was used to identify factors related to postoperative visual improvement.

All 52 patients with TON underwent EOND successfully. Surgical complications occurred in 14 patients (26.9%), including 8 cases of intraoperative cerebrospinal fluid leakage, 2 cases of massive intraoperative bleeding, and 4 cases of postoperative nasal mucosa bleeding. All the complications were resolved. The median(Q₁, Q₃) postoperative follow-up time was 5.0 months (4.5, 7.5 months). At the last follow-up, 20 patients (38.5%) achieved visual improvement, and other 32 patients (61.5%) showed no improvement in VA. Among these patients with visual improvement, 7 patients had light perception, 6 patients had the VA of the hand motion, 3 patients had the VA of counting fingers, and 4 patients had the VA of at least 0.05 but with visual field defects. In the visual improvement group, 55.0% (11/20) had a time interval from injury to surgery of ≤7 days, which was higher than 21.9% (7/32) in the non-improvement group. In the interval of 8–30 days, 45.0% (9/20) were in the visual improvement group and 78.1% (25/32) in the non-improvement group, with a statistically significant difference (χ²=5.967, P=0.015). Between the visual improvement group and non-improvement group, no significant differences existed in terms of age, pre-operative orbital canal fractures, orbital wall fractures, cerebral contusion and/or hemorrhage, sphenoid and/or ethmoid sinus hemorrhage, intra-operative optic nerve sheath incision, or steroids therapy (all P>0.05). Multivariate logistic regression analysis also showed that the time interval from injury to surgery of ≤7 days was an independent factor for postoperative visual improvement in TON patients with NLP (OR=0.157, 95%CI: 0.031–0.786, P=0.024).

EOND can effectively improve the VA of TON patients with NLP within 30 days post injury, and the time interval from injury to surgery may be a potential prognostic factor for postoperative visual recovery.

To investigate the efficacy and identify the prognostic factors associated with frameless neuronavigation-guided puncture and aspiration of cerebellar hematomas in patients with spontaneous cerebellar hemorrhage (SCH).

A retrospective analysis was performed on the clinical data of 63 patients with SCH [Glasgow Coma Scale (GCS) score≥9 points] who underwent frameless neuronavigation-guided aspiration of cerebellar hematomas at the Department of Neurosurgery, Qilu Hospital of Shandong University(Qingdao) between October 2017 and June 2024. Based on the Glasgow Outcome Scale (GOS) scores at discharge and at 6-month follow-up, patients were categorized into favorable (GOS Ⅴ) and unfavorable (GOS Ⅰ-Ⅳ) outcome groups. Preoperative baseline characteristics and treatment details were compared between groups. Variables with P<0.1 in univariate analysis, along with those of significant clinical relevance, were included in a multivariate logistic regression analysis to determine independent predictors of outcome at discharge and at 6-month follow-up.

All 63 procedures were successfully completed without postoperative rebleeding. The median (IQR) GCS score on postoperative day 1 was 13(2) scores. There were no perioperative mortalities. At discharge, GOS scores were Ⅲ in 1 patient, Ⅳ in 28 patients, and Ⅴ in 34 patients. At 6-month follow-up, GOS scores were Ⅲ in 1 patient, Ⅳ in 20 patients, and Ⅴ in 42 patients. There were no statistically significant differences in sex, age, medical history, history of anticoagulant use, admission muscle strength, preoperative hematoma volume, presence of ventricular rupture, or hematoma characteristics between the favorable (34 cases) and unfavorable (29 cases) outcome groups at discharge (all P>0.05). However, the favorable outcome group had significantly higher admission GCS scores [median (IQR): 12 (3) scores vs. 11 (3) scores] and a lower proportion of hematomas involving both cerebellar hemispheres [8.8% (3/34) vs. 37.9% (11/29)] (both P<0.05). At 6-month follow-up, there were no statistically significant differences in sex, age, medical history, history of anticoagulant use, admission GCS scores, bilateral cerebellar hematoma involvement, immediate postoperative hematoma evacuation rate, or other factors between the favorable (42 cases) and unfavorable (21 cases) outcome groups (all P>0.05). Multivariate logistic regression analysis showed that bilateral cerebellar hematoma involvement was an independent risk factor for unfavorable outcome at discharge (OR=6.01, 95%CI: 1.35-26.78, P=0.019) and 6-months follow-up (OR=3.74, 95%CI: 1.03-13.64, P=0.046).

Frameless neuronavigation-guided puncture and aspiration of cerebellar hematomas is an effective and safe treatment for SCH, resulting in a favorable overall patient prognosis. Bilateral cerebellar hematoma involvement is an independent risk factor for unfavorable outcome at both discharge and 6-month follow-up.

To construct a predictive model for the factors influencing the length of stay (LOS) in elderly patients with traumatic subdural hematoma (SDH) based on the National Inpatient Sample (NIS) database of the United States of America and to validate its effectiveness.

A retrospective analysis was conducted on data from 63 476 elderly traumatic SDH patients in the NIS database from 2016 to 2020. Data on 46 variables across four categories—demographic and medical services, hospital, clinical, and treatment characteristics—were collected. Patients were divided into a development set (50 780 cases) and a test set (12 696 cases) using stratified random sampling with an 8 ∶2 split. The development set was further divided into a training set (35 546 cases) and a validation set (15 234 cases) in a 7 ∶3 ratio. The 75th percentile of LOS (9 days) was used as a cutoff to classify patients into a normal LOS group (37 290 cases) and an extended LOS group (13 490 cases). Differences between these two groups across the 46 variables were compared. Variables with statistical significance were ranked based on the least absolute selection and shrinkage operator (LASSO) regression analysis, and the predictive variables were selected through a stepwise method. A logistic regression model was constructed using these predictors, and a nomogram was created. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC) and the precision-recall (P-R) curve. Calibration was evaluated using the calibration curve combined with the Hosmer-Lemeshow test. Clinical benefit of the predictive model was assessed using decision curve analysis (DCA).

Comparisons between the normal LOS group and the extended LOS group revealed no statistically significant differences in six variables: patient source, season of admission, hospital region, hospital location, comorbidity of hypertension, and depression (all P>0.05). However, 40 variables, including age, hospital ownership, comorbidity of type 2 diabetes, and craniotomy for hematoma removal and so on, showed significant differences (all P<0.05). Except for the LOS group variable, these 39 variables were analyzed using LASSO regression, resulting in the identification of 10 key predictive factors: emergency admission, mechanical ventilation >96 hours, craniotomy for hematoma removal, central venous catheter placement, urinary tract infection, number of abnormal diagnotic items during hospitalization, postoperative drainage placement, percutaneous burr hole drainage, long-term (current) aspirin use, and electrolyte, fluid, and acid-base imbalances. The model based on these 10 variables showed AUC values of 0.801, 0.799 and 0.803 for the training, validation, and test sets, respectively. The P-R curve demonstrated AUC values of 0.623, 0.611 and 0.619 for the training, validation and test sets, respectively, indicating good predictive value. Calibration curves and the Hosmer-Lemeshow test showed good consistency between the model predictions and the actual risk of extended LOS in the training, validation, and test sets. DCA results for the training, validation, and test sets indicated substantial standardized net benefit for the model in predicting prolonged LOS in elderly traumatic SDH patients.

The predictive model for LOS in elderly traumatic SDH patients, based on factors such as emergency admission, mechanical ventilation >96 hours, craniotomy for hematoma removal, central venous catheter placement, urinary tract infection, number of abnormal diagnotic items during hospitalization, postoperative drainage placement, percutaneous burr hole drainage, long-term (current) aspirin use, and electrolyte, fluid, and acid-base imbalances, demonstrates good predictive value and clinical utility.

To preliminarily explore the feasibility and effectiveness of designing surgical approaches based on the classification of basal ganglia hematoma location.

The clinical data of 107 patients with hypertensive basal ganglia hematoma admitted to the Department of Neurosurgery of Fuzhou University Affiliated Provincial Hospital from January 2019 to December 2023 were retrospectively analyzed. The patients were divided into the classification group (n=17) and the non-classification group (n=90) according to whether the surgical approach was designed based on the classification of basal ganglia hematoma location. The classification group was further divided into the suprasylvian type (anterior and posterior), sylvian junctional type, and subsylvian type based on the relationship between the hematoma and the sylvian fissure as shown in the CT three-dimensional reconstruction images. For the suprasylvian type, we selected the surgical approach from the superior segment of sylvian fissure to insular cortex; for the sylvian junctional type, we selected the surgical approach from the superior segment of sylvian fissure to insular cortex or anterior part of the superior temporal gyrus; for the subsylvian type, we selected anterior part of the superior temporal gyrus. In the non-classification group, the haematoma was removed at the most superficial point of the haematoma via a corticocutaneous fistula. The residual hematoma volume on the first day after surgery was evaluated based on the head CT scans, and the hematoma clearance rate was calculated. The 6-month follow-up was conducted by telephone interview, and the modified Rankin Scale (mRS) score was evaluated, with scores of 0-3 indicating good prognosis and scores of 4-6 indicating poor prognosis. The baseline data, proportion of small bone window, operation duration, hematoma clearance rate, proportion of patients with postoperative complications of cerebral infarction, and proportion of patients with good prognosis at 6 months postoperatively were compared between the two groups.

All 107 patients successfully underwent the surgery. Among the 17 patients in the classification group, the suprasylvian type was identified in 6, sylvian junctional type in 7, and subsylvian type in 4. The non-classification group had 5 cases of cerebral infarction. There were no deaths in either group. There were no statistically significant differences in age, gender, haematoma side, preoperative haematoma volume or Glasgow Coma Score between the non-classification group and the classification group (all P>0.05). Compared with the non-classification group, the proportion of small bone window in surgery in the classification group was higher (17/17 vs. 15/90), operation duration was shorter (2.34±0.65 h vs. 3.30±1.11 h), postoperative hematoma clearance rate was higher [(93.66±3.31)% vs. (79.56±21.71)%], proportion of patients with postoperative complications of cerebral infarction was lower (0 vs. 5/90), and proportion of patients with good prognosis at 6 months after surgery was higher (10/17 vs. 29/90), and the differences were statistically significant (all P<0.05).

Preliminary research has indicated that designing surgical approaches based on the classification of basal ganglia hematoma location is feasible and may improve the hematoma clearance rate and improve the outcomes of patients.

To explore the efficacy of anticoagulant therapy for pulmonary embolism (PE) in patients with intracranial hemorrhage and the influencing factors of intracranial rebleeding.

A retrospective analysis was performed on the clinical data of 38 patients with intracranial hemorrhage complicated by PE admitted to the Neurosurgical Intensive Care Unit, Northern Jiangsu People′s Hospital from January 2022 to July 2023. Among them, 33 patients underwent emergency craniotomy for intracranial hemorrhage, and 5 received conservative treatment. All 38 patients received anticoagulant therapy during hospitalization. According to the occurrence of intracranial rebleeding after anticoagulation, the patients were divided into a rebleeding group (12 cases) and a non-rebleeding group (26 cases), and the influencing factors of intracranial rebleeding were analyzed.

Emergency craniotomy was successfully completed in all 33 patients. For the 38 patients, the time interval from admission to PE diagnosis [M(Q₁, Q₃)] was 13 (8, 16) days, and the time interval from onset to the first use of low molecular weight heparin (LMWH) for anticoagulation [M(Q₁, Q₃)] was 11 (8, 16) days. After anticoagulant therapy, 12 patients (31.6%) experienced intracranial rebleeding during hospitalization, while 26 (68.4%) did not. After comprehensive treatment, 27 patients (71.1%) were discharged in improved conditions, and 11 (28.9%) were discharged at their own requests. Analysis of influencing factors for intracranial rebleeding after anticoagulation showed that the time from onset to the first use of LMWH was shorter in the rebleeding group compared with the non-rebleeding group [10(8, 16) days vs. 11(8, 15) days, P=0.020]. There were no statistically significant differences between the two groups in terms of gender, age, admission Glasgow Coma Scale score, medical history, smoking history, type of primary disease, or whether emergency surgery was performed after admission (all P>0.05).

Anticoagulant therapy for PE in patients with intracranial hemorrhage has certain efficacy. Early initiation of anticoagulation may increase the risk of intracranial rebleeding.

To explore the efficacy and safety of minimally invasive subarachnoid-subarachnoid (S-S) bypass surgery in the treatment of post-traumatic syringomyelia (PTS).

A retrospective analysis was conducted on the clinical data of 66 patients with PTS who were treated by minimally invasive S-S bypass surgery (20 cases) or subarachnoid reconstruction (46 cases) in the Department of Neurosurgery of Xuanwu Hospital, Capital Medical University from January 2003 to January 2023. According to the different surgical methods, the patients were divided into the minimally invasive S-S bypass surgery group and the subarachnoid reconstruction group, and the surgical efficacy and complications of the two groups were compared. The severity of spinal cord injury in patients was evaluated through the Motor and Sensory Scoring System of the American Spinal Injury Association, and the changes in cavity size were evaluated based on MRI.

The improvement rates of clinical outcomes in the minimally invasive S-S bypass surgery group and the subarachnoid reconstruction group were 85.0% (17/20) and 45.7% (21/46), respectively, and the improvement rates of cavity outcome were 75.0% (15/20) and 41.3% (19/46), respectively. The improvement rates of clinical outcomes and cavity outcome in the minimally invasive S-S bypass group were both higher than those in the subarachnoid reconstruction group (both P<0.05). In terms of complications, compared with the subarachnoid reconstruction group, the incidence of complications in the minimally invasive S-S bypass group was lower, and the difference was statistically significant (P=0.036). Among them, the incidences of postoperative neurological dysfunction in the minimally invasive S-S bypass group and the subarachnoid reconstruction group were 0(0/20) and 21.7% (10/46), respectively. The median follow-up time of the minimally invasive S-S bypass group and the subarachnoid reconstruction group post operation was 14.9 (12.0-18.0) months and 15.0(3.0-23.9) months, respectively. The analysis of the follow-up results showed that the rate of no symptom deterioration in the minimally invasive S-S bypass group was higher than that in the subarachnoid reconstruction group, and the difference was statistically significant (P=0.022).

Minimally invasive S-S bypass surgery for the treatment of PTS is safe and effective. It is worthy of clinical promotion and application.

To investigate the clinical efficacy of neuroendoscopic transnasal surgery in the treatment of patients with cavernous malformation in the orbital apex region accompanied with vision dysfunction.

A retrospective analysis was conducted on the clinical data of 20 patients with cavernous malformations in the orbital apex region who were admitted to the Neurosurgery Department of Beijing Tongren Hospital, Capital Medical University between June 2020 and October 2023. All patients exhibited decreased visual acuity accompanied by visual field defects. Among them, 2 patients also experienced headaches and retrobulbar pain, and 1 patient presented with exophthalmos. All 20 patients underwent neuroendoscopic transnasal surgery, during which bony decompression of the medial orbital wall and orbital apex-optic canal was performed to achieve complete removal of the lesion. Postoperative imaging follow-up was conducted to assess the degree of lesion resection, while outpatient or telephone follow-up was performed to monitor symptom changes, thereby evaluating surgical outcomes and complications.

All 20 patients achieved complete resection of their lesions. All patients were followed up, with a median follow-up duration of 39 months (range: 18-58 months). Compared with their preoperative condition, 6 patients experienced improved visual acuity postoperatively, 12 patients maintained their preoperative visual acuity, and visual acuity decreased in 2 patients, both of whom originally had no effective vision in the affected eye. The pain symptoms resolved within 3 months after surgery for the 2 patients who had preoperative pain, and the patients with exophthalmos returned to normal following surgery. One patient developed oculomotor nerve palsy postoperatively but recovered within 3 months, the remaining patients exhibited no abnormal eye movements. None of the patients experienced infection or cerebrospinal fluid leakage.

This preliminary study has shown that neuroendoscopic transnasal surgery can effectively improve or stabilize the visual function of patients with cavernous vascular malformation in the orbital apex region with vision loss.

To investigate the efficacy of posterior fossa decompression with dural splitting surgery (PFDDS) for the treatment of Chiari malformation type Ⅰ (CM-Ⅰ) and syringomyelia, and to identify factors influencing the prognosis.

A retrospective analysis was performed on the clinical data of 102 patients with CM-Ⅰand syringomyelia who underwent PFDDS at the Department of Neurosurgery, People′s Hospital of Xinjiang Uygur Autonomous Region between August 2012 and August 2022. The mean preoperative symptom duration was 31.94±7.05 days. Clinical and imaging parameters were compared between preoperative and 6-month postoperative evaluations. Postoperative outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) at 6 months after surgery, with scores of 12-16 categorized as favorable outcomes and 4-11 as poor outcomes. Perform univariate analysis on the clinical and imaging characteristics of patients with different prognoses, and include factors with statistical significance (P<0.05) in the multivariate logistic regression analysis to evaluate the factors affecting patient prognosis.

The surgeries of 102 patients were successfully completed, with 4 patients (3.92%) experiencing postoperative subcutaneous effusion and 4 patients (3.92%) encountering wound healing issues, all of which were cured through symptomatic treatment, with no deaths reported. Among the patients, 73 (71.57%) had favorable outcomes, while 29 (28.43%) had poor outcomes. Compared with preoperative conditions, the proportion of patients experiencing symptoms such as neck pain, cough-related headaches, sensory disturbances, abnormal sensations, and gait instability, as well as the imaging parameters of the degree of cerebellar tonsillar herniation, maximum diameter of spinal cord cavity, length of spinal cord cavity, spinal cord cavity to spinal cord ratiomaximum all decreased significantly at six months postoperative (all P<0.05). There was no statistically significant difference in the proportion of patients exhibiting cerebellar signs or motor dysfunction symptoms (both P>0.05). Single factor analysis shows that the duration of preoperative symptoms and the presence of motor dysfunction symptoms were factors affecting patient prognosis (both P<0.05), while preoperative neck pain, cough-related headaches, and imaging parameters like the degree of cerebellar tonsillar herniation or maximum anteroposterior diameter of the cavity had no impact on prognosis (all P>0.05). Multivariate logistic regression analysis demonstrated that a shorter duration of preoperative symptoms (OR=0.92, 95%CI: 0.86-0.99, P=0.022) was an independent protective factor, while the presence of motor dysfunction symptoms (OR=2.99, 95%CI: 1.06-8.41, P=0.039) was an independent risk factors influencing patient prognosis.

PFDDS treatment for CM-Ⅰwith syringomyelia is safe and effective. Early surgical intervention can significantly improve clinical prognosis for patients.

To investigate the value of intraoperative neurophysiological monitoring in contralateral cervical 7 (C₇)nerve transfer surgery for treatment of upper limb spastic hemiplegia.

This retrospective dual-center study included consecutive patients with spastic hemiparesis of one upper limb who underwent contralateral C₇ nerve transfer surgery at the Department of Neurosurgery the First Affiliated Hospital of Soochow University (6 cases) and the Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School(4 cases) between July 2022 and November 2023. During the procedure, real-time free muscle electromyography (f-EMG), trigger stimulation, somatosensory evoked potentials (SSEP), and transcranial electric motor-evoked potentials (Tce-MEP) were used to monitor and identify C₅-C₈ nerves, while monitoring the amplitude and latency changes of bilateral evoked potentials. Postoperatively, the changes in somatosensation, motor function, and muscle tone in both upper limbs were recorded.

During the procedure, f-EMG of 10 patients showed different degrees of traction response, and the C₅-C₈ nerves were initially identified. During the trigger stimulation, electrical stimulation of C₅-C₈ nerves induced compound muscle action potentials (CMAPs) in all 10 patients for their respective target muscles. The CMAP of 10 patients for each amplitude for all muscles showed the positivity of 10/10, the latency as follows, C₅ nerve(deltoid): 52.5±6.4 ms; C₆ nerve(biceps brachii): 55.0±3.3 ms; C₇ nerve(triceps brachii, musculus extensor carpi radialis and flexor carpi ulnaris): 65.5±4.4 ms, 83.0±4.8 ms and 84.5±5.0 ms; C₈ nerve (thenar and hypothenar muscle): 127.0±8.2 ms, respectively. The proportion of CMAP positivity induced by stimulating C₅-C₈ nerves in corresponding muscle groups and the CMAP latency of 10 patients who had positive CMAP were statistically significant (all P<0.05). SSEP recordings revealed no responses in the 10 patients on either side of C₇ nerve roots during the pre-resection phase. After C₇ nerve root resection, SSEP amplitude reductions were observed in all 10 patients on the healthy side, with amplitude decreases exceeding 50%, and 2 patients showing significant changes in latent period >10%. The results of Tce-MEP measurements showed no responses on the affected side for C₇ nerve root resection in 10 patients both before and after surgery. Postoperatively, Tce-MEP amplitude reductions exceeding 50% were observed in 2 patients on the healthy side, with concomitant increases in stimulation thresholds. The surgical procedure was successfully performed in all 10 patients, with a total surgery duration of 344.0(308.8, 545.0) minutes and an average hospital stay of 14.3±0.9 days. Postoperatively, no significant changes were observed in sensory or motor function on the affected side compared to preoperative conditions, with muscle relaxation improving as well. On the healthy side, 10 patients exhibited posterior arm and finger-to-hand sensation deficits (with SSEP amplitude reductions exceeding 50% during surgery), while 2 patients demonstrated upper limb strength reduction (observed as Tce-MEP monitoring showing latency changes >10%, along with increased stimulation thresholds). A total of 3 patients experienced postoperative neuropathic pain.

The f-EMG and trigger stimulation can be employed for accurate localization of the C₅-C₈ nerves during contralateral C₇ nerve transfer in cases of upper limb spastic hemiplegia. The SSEP and Tce-MEP examinations may provide valuable insights into prediction of postoperative sensory and motor functional status of the contralateral upper limb, thereby aiding in symptom management and improving patient outcomes.

To study the location landmarks of important anatomical structures in the infratemporal anterior petrosal approach by microanatomy.

Nine adult cadaveric head specimens (18 sides) fixed with 10% paraformaldehyde were used to simulate the infratemporal anterior petrosal approach surgical procedure under a microscope. The horizontal segment of the petrous internal carotid artery, cochlea, petrosal vein and Dorello canal were located through the lateral end point of the trigeminal notch, and the distances from the lateral end point of the trigeminal notch to these important anatomical structures were measured.

The anterior segment of the petrous internal carotid artery was within the angle between the greater superficial petrosal nerve and the lateral edge of the trigeminal notch. The distance from the lateral end of the trigeminal notch to the posterior edge of the petrous internal carotid artery was 10.00±0.28 mm on the left and 9.99±0.27 mm on the right. The cochlea was within the angle between the greater superficial petrosal nerve and the anterior wall of the internal auditory canal. The distance from the lateral end of the trigeminal notch to the basal turn of the cochlea was 10.10±0.18 mm on the left and 10.08±0.19 mm on the right. The distance from the lateral end of the trigeminal notch to the anterior end of the petrosal vein confluence with the superior petrosal sinus [M(Q₁, Q₃)] was 9.1 (6.6, 9.9) mm on the left and 9.0 (6.4, 10.0) mm on the right. The Dorello canal was located at the junction of the dorsum sella and the petrous tubercle. The distance from the lateral end of the trigeminal notch to the Dorello canal was 9.79±0.50 mm on the left and 9.86±0.51 mm on the right.

The lateral endpoint of the trigeminal notch is an important anatomical landmark for the infratemporal anterior petrosal approach. It can be used to locate important anatomical structures in the petrous bone and improve the safety of the operation.

To explore the potential driving factors of endothelial-mesenchymal transition (EndMT) in cerebral vascular endothelial cells following severe traumatic brain injury (sTBI).

Single-cell RNA sequencing data of brain tissues from sTBI model mice (n=16) were obtained from the Gene Expression Omnibus database. Functional enrichment analysis of differentially expressed genes and gene set activity scoring (AUCell scoring) were applied to identify endothelial cell clusters undergoing sustained EndMT post-sTBI and to determine the key transcription factors regulating this process. Additionally, transcriptomic data from an in vitro EndMT model of endothelial cells were integrated to identify potential driving genes regulating EndMT in the acute(1 d post injury), subacute(7 d post injury), and chronic(28 d post injury) phases of sTBI.

Analysis of the single-cell RNA-seq data from the brain tissues of the sTBI mouse models identified 47 distinct cell clusters with significantly differential transcriptional features, which were classified into 11 major cell types, including endothelial cells. Functional enrichment of differentially expressed genes revealed that endothelial subpopulations were significantly enriched in EndMT-related regulatory processes and signaling pathways. Subgroup analysis showed that endothelial cells exhibited prominent EndMT phenotypes at day 1, 7, and 28 post injury, with the most significant changes observed at day 7 (subacute phase). Key transcription factors Snai1 and Zeb1 were significantly upregulated in endothelial cells after sTBI (both P<0.001). Transcriptomic analysis of the in vitro EndMT model, validated by quantitative real-time PCR, revealed that Igfbp7 expression was increased (P<0.001) and S1pr1 expression decreased (P=0.042) at day 1 post-sTBI. At day 7, Sele was significantly upregulated (P<0.001), while at day 28, Junb was upregulated (P<0.001) and Cd200 was downregulated (P=0.001).

Experimental results demonstrate that Snai1 and Zeb1 are key transcriptional drivers of EndMT in cerebral vascular endothelial cells following sTBI. Igfbp7 and S1pr1 may act as potential regulators during the acute phase, Sele during the subacute phase, and Junb and Cd200 during the chronic phase of sTBI. These genes may represent critical targets for modulating EndMT.

To explore the influence of c-MYC expression level in gliomas on the sensitivity to temozolomide, and to uncover the potential mechanism of resistance of gliomas with high c-MYC expression to short-term temozolomide treatment.

By transfecting lentivirus, a glioma model with c-MYC overexpression was constructed in glioma stem cells. T22-1 cells were infected with empty vector virus and c-MYC overexpression virus respectively, which were set as the empty vector group and the c-MYC overexpression group. For the empty vector group and the c-MYC overexpression group, the CCK8 kit was used to detect the cell viability of glioma cells after treatment with temozolomide at concentrations of 0, 25, 50, 100, 200, 400, 800, and 1 200 μmol/L, and the half-inhibitory curve was fitted by GraphPad Prism 8.0. After treating the cells of the two groups with 75 μmol/L temozolomide for 3 days, the cell viability was detected by the same method, and the half-inhibitory curve was fitted. After treating the cells of the two groups with 75 μmol/L temozolomide, the Annexin V, FITC Apoptosis Detection Kit was used to detect the proportion of apoptosis and necrosis. After treating c-MYC overexpressed cells with 75 μmol/L temozolomide for 0, 12, 24, 36, and 48 hours, proteins were extracted, and western blot was used to detect the protein expression levels of key mismatch repair genes MSH2, MSH6, MLH1, PMS2 and H3 at each time point.

(1)Compared with the control group, the c-MYC high expression group showed a significant increase in c-MYC protein expression. (2) The results of cell viability detection showed that the half-inhibitory concentration (IC₅₀) of c-MYC overexpressed glioma cells was 350 μmol/L, which was significantly lower than that of the empty vector glioma cells (IC₅₀=1 124 μmol/L). The apoptosis rates of the untreated control group and the c-MYC high-expression group were (6.87±0.63)% and (6.53±0.16)%, respectively, with no statistically significant difference (P>0.05). In contrast, the apoptosis rates of the control group and the c-MYC high-expression group treated with 75 μmol/L TMZ were (15.01±0.81)% and (19.17±1.39)%, respectively, showing a statistically significant difference (P=0.002). The western blot results showed that the protein expression levels of key mismatch repair genes MSH2, MSH6, MLH1, and PMS2 were upregulated in c-MYC overexpressed glioma cells. (3) The number of surviving tumor cells in the c-MYC overexpression group was higher after treatment with the same concentration of temozolomide. (4) After treating with 75 μmol/L temozolomide for 3 days, the IC₅₀ values of the surviving cells of the two groups to temozolomide were detected again through the cell viability experiment. The results showed that the IC₅₀ of the surviving cells in the c-MYC overexpression group was 3 984 μmol/L, which was significantly higher than that of the surviving cells in the empty vector group (IC₅₀=1 592 μmol/L). The Western blot results showed that after c-MYC overexpressed glioma cells were treated with 75 μmol/L temozolomide, the mismatch repair protein PMS2 gradually decreased.

Temozolomide has more obvious inhibitory effect on the proliferation of c-MYC overexpressed glioma cells. However, the surviving cells after short-term temozolomide treatment will resist the killing effect of temozolomide by down-regulating the expression of the mismatch repair protein PMS2.

Loidiz syndrome (LDS) is an autosomal dominant connective tissue disease. The special clinical manifestations of LDS patients include aortic aneurysm, foot deformity, dysplasia, palatal arch height and uvula lobation, etc. At the same time, there may be dura mater dilation and congenital heart disease (left heart dysplasia syndrome). The Department of Neurosurgery, Women's and Children's Medical Center affiliated to Guangzhou Medical University, treated a child with LDS in July 2023, who presented with multiple lateral meningocele caused by dural dilatation, and underwent dural repair. No recurrence was seen after 18 months of postoperative follow-up.

Clinically, pituitary metastases are rare, and the differential diagnosis from pituitary neuroendocrine tumors is difficult. Patients with pituitary metastases had a poor overall prognosis, with a median survival of only 12.9 months. In April 2023, the Department of Neurosurgery of the Third Affiliated Hospital of the Army Medical University admitted a patient with lung adenocarcinoma with elevated peripheral blood prolactin level and pituitary space-occupying lesions revealed by sellar MRI as the first manifestation. Neuroendoscopic tumor resection was performed through nasosphenoidal approach, and partial tumor resection was performed due to severe adhesion between the tumor and surrounding blood vessels during the operation. No lung adenocarcinoma resection, radiotherapy and chemotherapy were performed after operation, and the Karnofsky functional status score was 40 points after 18 months follow-up.

Synovial sarcoma (SS) is a highly aggressive malignant tumor of soft tissue, which occurs near the large joints of the limbs. It is common to metastasize to lung and distant lymph nodes, and metastases to spinal cord and spine are rare in clinic. Spinal SS usually occurs epidurally, whereas metastases to subdural SS are more rare. This paper reports a patient with cervical subdural space occupying lesion, who was diagnosed as SS by pathology after surgical resection. Combined with the history of left scapular SS 1 year after surgery, it was comprehensively considered as cervical subdural metastasis of SS. Six months after operation, the patients recovered well by telephone follow-up and had the ability to complete daily living activities independently.

Intracranial infection after ventriculo-peritoneal shunt is a common and intractable complication in neurosurgery. In March 2025, a 71-year-old female patient was admitted to the Department of Neurosurgery, Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences. A patient underwent ventriculoperitoneal shunt due to secondary hydrocephalus, and developed intracranial infection after operation. Bacterial culture of cerebrospinal fluid showed that carbapenem-resistant Pseudomonas aeruginosa was positive, which was consistent with the pathogen detected by sputum culture. According to the results of drug sensitivity test, intravenous infusion of ceftazidime/avibactam, combined with intraventricular injection of amikacin and external ventricular drainage were given. The results of cerebrospinal fluid bacterial culture were negative on the 4th day of treatment. After 2 weeks, the white blood cell count of cerebrospinal fluid was normal. After the infection was clearly controlled, re-shunt was performed. No recurrence of infection was observed after 7 weeks of follow-up. Patients had no obvious adverse reactions during the treatment. This case suggests that there is a risk of dissemination of cross-infection in neurocritical patients, and early etiological diagnosis, targeted anti-infective therapy and active surgical intervention may be effective strategies to control such complex infections.

Glioma is the most common primary malignancy of the central nervous system, and patients receiving standard therapy still have a poor prognosis, eventually almost all recurring. Currently, no standard chemotherapy regimen for recurrent glioma after standard treatment has been retrieved. Therefore, a variety of anti-tumor drugs have been attempted to be applied to recurrent gliomas. The presence of blood-brain barrier limits the transport of drugs from peripheral blood to brain tissue, which is one of the main reasons for the poor efficacy of antitumor drugs in the treatment of patients with recurrent glioma. This article intends to review the progress of blood-brain barrier and glioma drug treatment, and to sort out the blood-brain barrier permeability of drugs that have been approved for glioma, drugs recommended in guidelines but not yet approved for indications, and other potential glioma treatment drugs, so as to expand new ideas for the drug treatment of recurrent glioma.

Neurofibromatosis type I (NF1) is a tumor susceptibility syndrome caused by autosomal gene mutations, which often involves multiple organ systems such as skin, nerves and bones. Plexiform neurofibroma (PN), as one of its main manifestations, often causes various clinical symptoms such as pain, dysfunction, skeletal deformity, disfigurement, etc., and even turns into malignant peripheral schwannoma. However, the traditional treatment of NF1-related PN (NF1-PN) is relatively limited. Surgery often fails to totally resect the tumor, radiotherapy and chemotherapy have no obvious curative effect, and the overall prognosis is poor. With the in-depth study of the pathogenesis of NF1-PN, novel targeted drugs provide effective therapeutic options for NF1-PN. This article will review the progress of drug research on NF1-PN, in order to deepen clinicians' understanding and emphasis on NF1-PN and its drug treatment.

Subarachnoid hemorrhage (SAH) has high incidence, complex pathogenesis and difficult treatment. The exploration of its treatment has become the focus and difficulty of current research. Recent studies have found that there is a lymphatic system in the brain, whose main function is to remove metabolites and toxins, and it has been confirmed that this system can play a variety of key roles in neurophysiology. At present, the role of lymphoid system in SAH has been revealed continuously, but there are few studies on lymphoid system and brain injury secondary to SAH. This paper briefly introduces the anatomical and physiological functions of lymphoid system, and reviews its role in brain injury of SAH patients, aiming to suggest the importance of lymphoid system in secondary brain injury of SAH, and provide reference for the diagnosis, treatment and prognosis of related neurological diseases.