Volume 41 · Issue 08 · 2025

Facial nerve palsy (FNP) is a common and frequently occurring disease in clinic. Because FNP cannot be completely cured, most patients have different degrees of sequelae, which seriously affects the physical and mental health of patients. In recent years, with the advancement of treatment concepts and technologies such as comprehensive evaluation of facial nerve function, surgery and neuroelectrophysiological monitoring, the level and efficacy of functional reconstruction after FNP have been rapidly improved. However, there are still many problems that need to be solved urgently. This paper discusses the existing problems and related technologies of functional reconstruction after FNP, and hopes to pay further attention to functional reconstruction after FNP, and comprehensively improve the diagnosis and treatment level after FNP in China.

spinal dural arteriovenous fistulas (SDAVF) are the most common spinal vascular malformations^[1]。 At present, there is still a lack of SDAVF-related diagnosis and treatment standards at home and abroad, and some clinicians have insufficient understanding of the disease, which leads to the disease being easily misdiagnosed and mistreated. Therefore, the Neurosurgery Branch of Chinese Medical Association organized and formulated the Expert Consensus on the Diagnosis and Treatment of Dural Arteriovenous Fistula (2025 Edition) to provide a standardized reference for the diagnosis and treatment of SDAVF. This article will focus on the epidemiology, etiology, pathophysiology, clinical and imaging manifestations, diagnostic methods, treatment and prognosis of SDAVF.

To explore the efficacy of layered reconstruction of skull base anatomical structures in repairing high-flow cerebrospinal fluid (CSF) leaks during endoscopic endonasal skull base tumor resection.

A retrospective analysis was conducted on the clinical data from 117 patients who experienced high-flow CSF leaks during endoscopic endonasal skull base tumor resection in the Department of Neurosurgery at the First Affiliated Hospital of Zhengzhou University between February 2020 and March 2024. After tumor resection, 65 patients received a traditional three-layer reconstruction method without watertight suturing of fascia lata or rigid support (embedding absorbable artificial dura + packing with fat or fascia lata + coverage with a vascularized nasoseptal flap). All patients in this group underwent postoperative lumbar drainage (traditional reconstruction group). The other 52 patients received a modified three-layer reconstruction technique based on restoring skull base anatomy (watertight suturing of fascia lata+ rigid support with L-lactide-glycolide copolymer bioabsorbable plate + coverage with a vascularized nasoseptal flap). Patients in this group did not undergo postoperative lumbar drainage (modified reconstruction group). The incidence of postoperative CSF leak and other related complications, as well as the time to first ambulation and length of hospital stay, were compared between the two groups.

Among the 117 patients, 11 (16.9%) in the traditional reconstruction group (65 cases) developed postoperative CSF leaks, compared with 2 (3.8%) in the modified reconstruction group (52 cases). This difference was statistically significant (χ²=5.00, P=0.025). There were no statistically significant differences in the incidence rates of intracranial infection, pulmonary infection, nasal mucosal bleeding, or deep vein thrombosis between the two groups (all P>0.05). The time to first ambulation and length of hospital stay were significantly shorter in the modified reconstruction group compared with the traditional reconstruction group, and these differences were statistically significant (both P<0.001). All 117 patients were followed up for 6-24 months postoperatively. The 13 patients who developed CSF leaks after reconstruction were cured after a second repair surgery with favorable outcomes.

The application of layered reconstruction of skull base anatomical structures for repairing high-flow cerebrospinal fluid leaks during endoscopic endonasal skull base tumor resection contributes to reducing the incidence rate of postoperative CSF leakage and enhances the patients′ quality of life.

To investigate the safety and efficacy of surgical treatment of lateral skull base tumors via modified endoscopic prelacrimal recess approach.

A retrospective analysis was conducted on 18 patients diagnosed with lateral skull base tumors and surgically treated via modified endoscopic prelacrimal recess approach at the Department of Neurosurgery, Peking University First Hospital from May 2016 to March 2024. The surgical resection of the tumor was evaluated based on cranial MRI after the operation. The patients were followed up at 3, 6, 12 months after the operation and every year. The general conditions of the patients, the recovery of neurological function, Karnofsky performance status (KPS) score, etc. were recorded.

Among the 18 patients, 13 cases were treated with a single modified prelacrimal recess approach, and 5 cases with a combined endoscopic trans-alar process approach or Caldwell-Luc approach. Postoperative MRI showed that total tumor resection was achieved in 16 cases and subtotal tumor resection in 2 cases. Postoperative pathological analysis showed that, there were 13 cases of schwannoma, 1 case of temporal lobe ganglion glioma, 1 case of adenoid cystic carcinoma, 1 case of maxillary ameloblastoma, 1 case of meningioma, and 1 case of parotid follicular cell tumor. Postoperative patients had 12 cases of aggravated or newly developed numbness on the surgical side, 2 cases of dry eyes on the surgical side, 3 cases of limited mouth opening, 3 cases of weak chewing on the surgical side, 1 case of misaligned teeth, and 1 case of diplopia. There were 3 cases of transient facial swelling, and all recovered within about one week. There were no serious complications such as cerebrospinal fluid leakage or intracranial infection during the perioperative period, and no symptoms of nasolacrimal duct obstruction such as epiphora. All 18 patients were followed up after the operation, with a median follow-up time of 14 (3-46) months. At the last follow-up, there were 5 cases with a KPS score of 90 and 13 cases with a score of 100. Enhanced MRI of the head and neck showed no recurrence of the tumors.

The modified prelacrimal recess approach of neuroendoscopy for the treatment of lateral skull base tumors has good surgical efficacy and high safety. It is particularly used for the resection of intracranial and extracranial communicating tumors mainly invading the inferior temporal fossa.

To investigate the efficacy and safety of neuroendoscopic small bone window channel technology in the surgical treatment of deep brain tumors.

A retrospective analysis was conducted on the clinical data of 42 patients with deep brain tumors who underwent neuroendoscopic surgery via the small bone window approach at the Craniocerebral Trauma Center of the Department of Neurosurgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2022 to December 2023. We analyzed the tumor resection rate, postoperative complications and other conditions of postoperative patients. Postoperative follow-up was mainly conducted in outpatient clinics, supplemented by follow-up through phone calls, the Wechat APP and the hospital′s internet platform. Plain and enhanced cranial MRI scans were reexamined at 1, 3 and 6 months post operation to determine the recurrence of tumor. The Karnofsky performance status (KPS) scores of the patients were documented to evaluate their recovery.

The operations of all 42 patients were successfully completed. The intraoperative blood loss was 113.0±74.6 ml (20-300 ml); the duration of the operation was 3.6±1.7 h (2.0-10.1 h). Among them, total tumor resection was achieved in 35 cases (83.3%), subtotal resection and near-total resection in 7 cases (16.7%). The KPS score of the patients at discharge was 81.9±13.7 points (50-100 points). During the perioperative period, the patient had no serious surgery-related complications such as secondary hemorrhage in the surgical area or large-area cerebral infarction. At 2 weeks post operation, late-onset complications occurred in 4 patients, and all were relieved after treatment. All patients were followed up after operation. At 6 months post operation, the patient′s KPS score was 89.5±9.3 points (50-100 points), and no tumor recurrence was revealed by MRI examinations.

The neuroendoscopic small bone window channel technique has good therapeutic effect and few complications in the treatment of deep brain tumors and is worthy of clinical promotion.

To identify the risk factors of cerebrospinal fluid (CSF) leakage after transnasal endoscopic resection of pituitary neuroendocrine tumor(PitNET).

A retrospective analysis was conducted on the clinical data of 254 patients with PitNET who underwent surgical treatment in the Department of Neurosurgery of the First Hospital of Shanxi Medical University from January 2021 to September 2024. The patients were divided into the postoperative CSF leakage group (19 cases) and the postoperative CSF non-leakage group (235 cases) based on whether they had CSF leakage after the operation. Further, through univariate and binary logistic regression analyses, independent risk factors influencing postoperative CSF leakage were screened.

The surgeries of all 254 patients were successfully completed, and the skull base reconstruction was also accomplished. Postoperative cranial MRI showed total tumor resection in 228 cases (89.8%) and near-total resection in 26 cases (10.2%). There were 19 cases (7.48%) of CSF leakage within 48 hours after operation. No serious complications such as intracranial infection and tension pneumocephalus occurred during the perioperative period. None of the patients had CSF leakage or intracranial infection at discharge. Compared with the postoperative non-leakage group, the maximum diameter of tumor, vertical diameter line of tumor, transverse diameter line of tumor, anterior-posterior diameter line of tumor, and the size of the sellar floor bone window in the postoperative CSF leakage group were all larger. The proportions of patients with intraoperative Kelly grade≥2, suprasellar extension grade ≥B, and postoperative pneumocephalus grade≥3 were all higher (all P<0.05). Multivariate logistic regression analysis showed that the enlarged sellar fundus window (OR=1.20, 95%CI: 1.06-1.35, P=0.004), and the intraoperative Kelly grade ≥grade 2 (OR=4.71, 95%CI: 1.14-19.43, P=0.032), suprasellar expansion grade≥B (OR=5.87, 95%CI: 1.00-34.26, P=0.049) and postoperative pneumocephalus grade≥3 (OR=12.92, 95%CI: 3.08-54.18, P<0.001) were all independent risk factors for CSF leakage after transnasal endoscopic resection of PitNET.

Enlarged sellar floor bone window, increased intraoperative Kelly grade, increased suprasellar extension grade and increased postoperative CT cranial airway grade seem to increase the risk of CSF leakage after transnasal endoscopic resection of PitNET.

This paper discusses the feasibility and effect of neuroendoscopic surgery in the treatment of acute subdural hematoma (ASDH) in the elderly. The clinical data of 11 elderly patients with ASDH admitted to the Department of Neurosurgery of Yichun People's Hospital from September 2023 to September 2024 were retrospectively analyzed. All patients underwent neuroendoscopic surgery to remove subdural hematoma. The hematoma clearance was satisfactory in 11 patients, and the intraoperative bleeding volume was equal<50 ml. All patients showed that the midline displacement was significantly better than that before operation, and the hematoma clearance rate reached 80% or more. There were no postoperative complications and rebleeding. The Glasgow Coma Scale score of 11 patients was 15 at discharge, and the Glasgow prognosis grade was IV to V after 3 months. The results of this study show that neuroendoscopic surgery can safely and effectively remove hematoma in elderly patients with ASDH, which may be a potential alternative treatment option for such patients.

To construct the MRI radiomics model using machine learning algorithms and to explore its role in predicting postoperative overall survival (OS) in patients with isocitrate dehydrogenase (IDH) mutant gliomas.

A total of 586 patients with IDH-mutant gliomas who underwent surgical resection at the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2021 were retrospectively selected, which was randomly divided into a training set (286 patients) and a test set (300 patients) by using a random number generator, and 53 patients with IDH-mutant gliomas were selected from The Cancer Genome Atlas (TCGA) database as the external validation set. In the training set, the machine learning algorithm was used to filter the MRI radiomics features related to patients′ OS and construct a prediction model to calculate the radiomics risk score (rad-score). Patients in the three datasets were categorized into low-risk and high-risk groups based on the rad-score optimal cutoff value respectively; survival curves were plotted using the Kaplan-Meier method, and the Log-rank test was used to assess the difference in OS between the rad-score low-risk group and the high-risk group. The correlation between clinical factors (gender, age, preoperative Karnofsky functional status score, pathological staging, degree of tumor resection, and whether or not radiotherapy and chemotherapy were administered postoperatively) and rad-score and OS of patients in the training set were analyzed by using univariate and multivariate Cox regression methods; a columnar graphical model was constructed by using the above mentioned parameters, and calibration curves were plotted to assess the accuracy of columnar graphical model in predicting OS. Comparative analysis of the efficacy of the clinical model and the radiomics-clinical model in predicting OS. The reliability of the model was assessed using the C-index, the model was tested for overfitting using the AIC (Akaike Information Criterion), and the benefit of the model was assessed using the decision curve.

A total of 15 (11 texture features and 4 intensity features) radiomics features associated with OS were screened for patients in the training set to construct the model. The Log-rank test showed that the difference in OS between the rad-score low-risk group and the high-risk group was statistically significant in all 3 datasets (all P<0.05). Multifactor Cox risk regression analysis showed that rad-score ≥0.078 was an independent influence factor for the patients′ postoperative OS (HR=4.772, 95%CI: 3.282-6.938, P<0.001). The C-indexes of the clinical factor prognostic model in the training set, test set, and external validation set were 0.675, 0.672, and 0.863, respectively, and the C-indexes of the radiomics-clinical model for predicting OS were 0.750, 0.698, and 0.963, respectively. The column-line graph of the radiomics-clinical model built based on the data of the test set showed that rad-score had a better effect than the clinical factor on the patients′ postoperative OS, and calibration curve analysis showed that the actual survival rates of patients at 3, 5, and 10 years after surgery were more consistent with those predicted based on the radiomics-clinical model. Analysis of the data from the training set and the test set showed that the AIC values of the radiomics-clinical model were lower than those of the clinical model, and the decision curves showed that the radiomics-clinical model predicted a higher postoperative OS benefit for patients than the clinical factors model.

A model constructed based on MRI radiomics could significantly improve predictive efficacy in predicting postoperative OS in patients with IDH-mutant gliomas.

To investigate the risk factors associated with severe bone flap resorption (BFR) in patients with cranial defects undergoing autologous cranioplasty.

A retrospective analysis was conducted on 73 patients with cranial defects who underwent autologous cranioplasty in the Department of Neurosurgery, China-Japan Union Hospital of Jilin University between May 2019 and July 2024. Thin-slice cranial CT scans were obtained, and bone flap area and volume were measured using ITK-SNAP software. An experienced neurosurgeon assessed BFR severity using the Oulu resorption scoring system. Grades 0 and Ⅰ were classified as non-severe BFR, while Grades Ⅱ and Ⅲ were classified as severe BFR. Clinical characteristics were compared between the two groups. Variables with P<0.05 in univariate analysis were included in a multivariate logistic regression model to identify independent risk factors associated with severe BFR.

All 73 procedures were completed successfully. The median (Q₁, Q₃) follow-up duration was 213.0 (159.5, 324.5) days. Up to the last follow-up, a total of 65 patients (89.0%) experienced varying degrees of BFR. The Oulu grade was 0 in 40 cases (54.8%), Ⅰ in 19 (26.0%), Ⅱ in 11 (15.1%), and Ⅲ in 3 (4.1%). Fourteen patients (19.2%) developed severe BFR. Compared with the non-severe BFR group (59 cases), the severe BFR group (14 cases) was significantly younger (40.21±12.38 years vs. 52.32±8.08 years, P=0.001), had a higher number of bone flaps [1.5 (1.0, 2.0) vs. 1.0 (1.0, 1.0), P=0.001] and a greater proportion with bone flap area >120 cm² (11/14 vs. 19/59, P=0.002). Multivariate logistic regression analysis demonstrated that increasing age was a protective factor against severe BFR (OR=0.91, 95%CI: 0.84-0.98, P=0.009), whereas a higher number of bone flaps (OR=4.45, 95%CI: 1.17-16.98, P=0.029) and bone flap area >120 cm² (OR=5.38, 95%CI: 1.05-27.48, P=0.043) were independent risk factors.

Younger age, increased number of bone flaps and bone flap area >120 cm² are associated with a higher risk of severe BFR following autologous cranioplasty in patients with cranial defects.

To investigate the geometric and hemodynamic changes after Enterprise stent implantation in patients with middle cerebral artery (MCA) stenosis accompanied by angulated lesions.

A retrospective analysis was conducted on 32 patients with symptomatic severe MCA stenosis and angulated lesions (angle>45°) treated at the Intervention Center of Cerebrovascular Disease, People′s Hospital of Zhengzhou University between June 2022 and October 2023. All patients underwent the Enterprise stent implantation. Three-dimensional digital subtraction angiography (DSA) data were collected preoperatively, immediately postoperatively, and during follow-up. Geometric and hemodynamic parameters of the affected vessels were obtained through three-dimensional reconstruction and computational fluid dynamics (CFD) simulations. Hemodynamic parameters included pressure ratio (PR) and wall shear stress ratio (WSSR) across the lesion. Geometric parameters included vessel angulation and curvature. The impact of Enterprise stent implantation on these parameters was analyzed.

All 32 patients successfully underwent stent implantation, with a residual stenosis rate of (15.6±3.4)% immediately postoperatively. DSA follow-up was performed at 6 to 7 months post-procedure. The PR values before stenting, immediately after stenting, and at follow-up were 0.12±0.06, 0.63±0.21, and 0.58±0.15, respectively. The corresponding WSSR median (Q₁, Q₃) values were 16.2 (14.5, 18.6), 3.9 (2.8, 4.6), and 3.7 (3.2, 4.5). The vessel angulation at these time points was (82.47±7.62)°, (53.48±5.09)° and (54.47±5.26)°, while the vessel curvature median (Q₁, Q₃) values was 0.09 (0.07, 0.11), 0.05 (0.03, 0.08), and 0.05 (0.04, 0.08), respectively. The changes in all parameters before and after stenting, as well as during follow-up, were statistically significant (all P<0.001). There were no significant differences between the immediate postoperative and follow-up measurements (all P>0.05).

Enterprise stent implantation in MCA stenosis with angulated lesions could significantly improve both the hemodynamic and geometric characteristics of the affected vessels.

Traumatic middle meningeal vein dural arteriovenous fistula (MMV-DAVF) has a low incidence and a variety of clinical manifestations and therapeutic methods. June 2016 to March 2024 Fujian Medical University Fuzong Clinical Medical College (Ninth Joint Logistics Support Force of the People's Liberation Army) ○ ○ Five patients with traumatic MMV-DAVF were admitted to the Department of Neurosurgery, all with a clear history of head trauma and fracture of the middle cranial fossa, and 3 patients with epidural hematoma of the same site. There were no clinical manifestations and symptoms related to MMV-DAVF in all 5 patients. Whole brain digital subtraction angiography (DSA) examination of one patient showed MMV-DAVF drainage to the pterygoid plexus, and was given conservative treatment for 2 weeks. Re-examination of DSA showed that the blood flow was significantly slower than before, and there was no special discomfort after discharge, so no re-examination was done. In the other 4 patients, MMV-DAVF was drained through the middle meningeal vein to the superior sagittal sinus, and all of them were treated endovascularly through the middle meningeal artery approach. Two cases were embolized with Onyx-18 glue, one case was embolized with spring coil, and one case was embolized with spring coil + Onyx-18 glue. Immediately after operation, DSA showed that the fistulas were completely embolized. DSA was re-examined 6 months after surgery, and the results showed that there was no recurrence of MMV-DAVF in all 4 patients.

To investigate the key factors that affect the accuracy of digital subtraction angiography (DSA) measurement under different conditions and its optimization strategy.

In this study, one 6F guiding catheter (with a measured outer diameter of 2.0 mm) was selected as the calibration tool, and five balloons of different diameters (with measured diameters of 11.1, 6.7, 4.3, 3.4, and 1.9 mm respectively after being filled with contrast agents) were used as the measurement targets. On three contrast machine devices, namely UNIQ FD 20/20, Innova IGS 630 and Artis zee biplane, the balloon diameters (i.e., DSA measurement values) at different projection angles (upright position, left/right oblique 30°, left/right oblique 60°) were measured respectively by using the 2D correction measurement method and the 3D direct measurement method. Each balloon, each projection angle and each measurement method were repeatedly measured three times on three contrast machine devices respectively. The actual diameter of the balloon measured by the vernier caliper was taken as the gold standard to calculate the measurement accuracy of DSA under multiple variables. The variance analysis of factorial design was used to analyze the influence of four factors on the measurement accuracy of DSA, and multiple linear regression analysis was adopted to determine the influence degree of different factors on the measurement accuracy of DSA.

The results of factorial design analysis of variance showed that the DSA measurement accuracy model of the four factors was statistically significant as a whole (F=9.20, P<0.001). Further analysis of the influence of each independent factor showed that the measurement accuracy of the 6.7 mm balloon was the highest(92.5%±0.8%) and that of the 3.4 mm balloon was the lowest(86.7%±0.8%). The measurement accuracy of upright transmission was the highest(91.5%±0.8%), while that of right-oblique transmission at 60° was the lowest(85.8%±0.8%). The measurement accuracy of both UNIQ FD 20/20(92.0%±0.6%)and Innova IGS 630 (91.0%±0.6%) devices was higher than that of Artis zee biplane(86.4%±0.6%). The measurement accuracy of DSA by the 2D correction measurement method (93.4%±5.5%) was higher than that by the 3D direct measurement method (86.2%±11.3%). All the above were statistically significant (all P<0.001). The comparison results of the standardized regression coefficients of multiple linear regression analysis showed that the ranking of the influence intensities of the four factors on the measurement accuracy of DSA was as follows: measurement method (B=0.373), equipment type (B=-0.218), balloon diameter (B=-0.196), and projection type angle (B=-0.164).

The measurement accuracy of DSA is most significantly affected by the measurement method, followed by the type of equipment, the diameter of the balloon and the projection angle. In clinical practice, it is recommended to give priority to using the 2D correction measurement method and calibrating the equipment. Special caution is needed when measuring small blood vessels.

To investigate the expression characteristics and underlying regulatory mechanisms of ferroptosis markers aldo-keto reductase family 1 member C1 (AKR1C1) and ferritin heavy chain (FTH1) in malignant peripheral nerve sheath tumor (MPNST).

Tumor tissue specimens were retrospectively collected from patients with neurofibromatosis type Ⅰ (NF1, 5 cases) and MPNST (8 cases) at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between January 2019 to December 2023. For three of the MPNST patients, non-tumor tissue specimens (referred to as peritumoral tissue) taken from 5 cm away from the tumor were also obtained as controls. In vitro experiments were conducted using the human plexiform neurofibroma cell line ipNF05.5 and the MPNST cell line sNF96.2. The mRNA levels of AKR1C1 and FTH1 in different tissues and cells were detected using real-time quantitative polymerase chain reaction (RT-qPCR). The protein expression of AKR1C1 and FTH1 in tumor tissues and peritumoral tissues was examined by immunohistochemistry (IHC). Western blotting (WB) was employed to assess the expression of AKR1C1 and FTH1 in ipNF05.5 cells and sNF96.2 cells. Additionally, transcriptome sequencing (RNA-seq) was performed on three NF1 and three MPNST tumor tissue samples, followed by an intersection analysis between the differentially expressed genes and the ferroptosis-related gene sets from the FerrDb database.

At the tissue level, RT-qPCR results revealed that the RNA expression levels of both AKR1C1 and FTH1 were significantly reduced in MPNST tumor tissues compared to peritumoral tissues (0.65±0.45 vs. 1.99±0.69; 0.95±0.10 vs. 1.32±0.17; both P<0.05). And the RNA expression levels of AKR1C1 and FTH1 were also significantly lower in MPNST tumor tissues compared to NF1 tumor tissues [M(range): 0.23(0.05-1.08) vs. 1.00(0.46-1.38); 0.69(0.24-1.12) vs. 1.66(0.67-2.13)], with both differences being statistically significant (both P<0.05). IHC results indicated a marked decrease in the protein expression of AKR1C1 and FTH1 in MPNST tumor tissues compared to peritumoral tissues and NF1 tumor tissues. At the cellular level, RT-qPCR results demonstrated that the relative RNA expression levels of AKR1C1 and FTH1 were significantly decreased in sNF96.2 cells compared to ipNF05.5 cells (0.02±0.00 vs. 0.72±0.24; 0.07±0.02 vs. 0.75±0.22; both P<0.05). WB results revealed a significant reduction in the protein expression levels of AKR1C1 and FTH1 in sNF96.2 cells compared to ipNF05.5 cells (0.04±0.00 vs. 0.33±0.02; 0.36±0.02 vs. 0.82±0.01; both P<0.05). RNA-seq differential gene expression analysis showed that there were 1 106 differentially expressed genes between NF1 tumor tissues and MPNST tumor tissues, of which 30 were related to ferroptosis. Among these, 26(86.7%) of the ferroptosis-related genes were pro-ferroptotic genes, with 22 genes being downregulated and only 4 genes being upregulated in MPNST tumor tissues.

The downregulation of ferroptosis markers AKR1C1 and FTH1 in MPNST may be associated with the widespread suppression of pro-ferroptotic genes, suggesting that ferroptosis resistance might play a crucial role in the malignant progression of MPNST.

To quantify the incidence of delirium in the patients after stroke using a meta-analysis.

We conducted a computerized search of clinical studies on the occurrence rate of post-stroke delirium in PubMed, Embase, and Medline databases, from their inception to May 2024. Two researchers independently screened the retrieved literature and extracted data, and evaluated the quality of the studies using the Newcastle-Ottawa Scale. The incidence of post-stroke delirium was analyzed using R 4.3.2 software. Heterogeneity among studies was assessed using the Q-test and I² value. If P<0.1 in the Q-test or I²>50%, significant heterogeneity was considered to be present, and a random-effects model was chosen for analysis. If P>0.1 in the Q-test or I²≤50%, no significant heterogeneity was considered to be present, and a fixed-effects model was used. Subgroup analysis and meta-regression were employed to explore the impact of study duration, clinical factors, and methodological factors on heterogeneity.

A total of 53 prospective observational cohort studies with 13 577 eligible patients were included. The overall occurrence of delirium after stroke was 23% (95%CI: 20%-28%, P<0.05), with high heterogeneity (I²=96%). The method of delirium assessment (R²=50%, P=0.003) and the type of cerebral infarction (R²=58%, P=0.060) affected the heterogeneity of the comprehensive assessment of delirium.

The incidence of post-stroke delirium is relatively high (23%), and the high heterogeneity among studies may be due to differences in delirium assessment methods and stroke types.

Primary cavernous sinus Ewing sarcoma/primitive neuroectodermal tumor is extremely rare. In September 2022, the Department of Neurosurgery of Guizhou-Guizhou International Hospital treated a child with cavernous sinus tumor with transpterional approach tumor resection, and was diagnosed as cavernous sinus Ewing sarcoma/primitive neuroectodermal tumor by pathological and genetic testing. Some tumors of the lateral wall of the cavernous sinus remained after operation, and the residual tumors of the children were followed up for 2 years without progression after radiation and chemotherapy.

Mucopapillary ependymoma (MPE) is a special subtype of ependymoma, which occurs rarely in the sellar region. A patient with MPE in the sellar area was admitted to the Department of Neurosurgery of the Second Hospital of Lanzhou University in November 2024. The patient was a 30-year-old male who developed blurred vision and unstable walking in both eyes 8 days before admission. After MRI of the head before operation, he was diagnosed as craniopharyngioma. He underwent neuroendoscopic nasal surgery to remove the space and was confirmed as MPE by pathological examination after operation. After 3 months of follow-up, the symptoms of the patients disappeared and they could live normally.

Macroglossia is a rare complication of posterior cranial fossa surgery in neurosurgery. It often occurs within hours or days after surgery. Patients can suffer from cerebral ischemia, hypoxia and even life-threatening due to severe upper respiratory tract obstruction. Its potential pathogenesis includes improper placement of surgical position, obstruction of lingual vein and lymphatic return, and neurogenic edema. In recent years, with the increase of posterior cranial fossa surgery, the progress of medical imaging technology and the popularization of postoperative intensive care, relevant cases have been reported internationally from time to time, but there is no diagnosis and treatment guideline based on evidence-based medical evidence at present, so it has not attracted enough attention from relevant disciplines in China. Based on this, this article reviews the research progress of epidemiology, etiology and risk factors, prevention and treatment of postoperative macroglossia in posterior cranial fossa, in order to improve the attention of related practitioners in neurosurgery, anesthesia and critical care medicine to this complication, strengthen the clinical ability to recognize it early and take timely standardized treatment.

The alpha thalassemia with mental retardation syndrome X-linked (ATRX) gene plays an important role in chromatin remodeling, maintenance of genomic and telomere stability. ATRX deletion is one of the main molecular changes in most astrogliomas. Analyzing the growth characteristics of this type of glioma and finding possible targets with clinical transformation potential is one of the important research directions of targeted therapy based on glioma molecular pathology. The purpose of this paper is to explain the high telomere replication pressure unique to ATRX-deleted glioma and its resolving mechanism, summarize the key molecules and regulatory nodes involved in this mechanism pathway, and analyze the potential specific therapeutic targets of ATRX-deleted glioma.

The latest study published in the New England Journal of Medicine in 2015 confirmed that patients with ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score ≥6 due to large vessel occlusion can benefit from mechanical thrombectomy (MT), opening a new era of stroke treatment. At present, authoritative guidelines at home and abroad have regarded acute macrovascular occlusive ischemic stroke with NIHSS score ≥6 as a clear indication for MT treatment. However, since the NIHSS score was excluded from the inclusion criteria for the major MT-related randomized controlled trials<There is a lack of high-quality evidence-based evidence for endovascular treatment decisions leading to acute large vessel occlusive minor stroke in patients with 6 scores. Clinical practice findings, NIHSS score<6 points, but patients with acute ischemic stroke with imaging confirmed large vessel occlusion are prone to early neurological deterioration, resulting in poor prognosis. The treatment of such patients is still controversial, and there are differences in existing observational studies and related clinical trial data. This article systematically reviewed the latest evidence-based evidence for MT treatment of mild stroke with acute anterior circulation occlusion of large vessels, aiming to provide theoretical basis for the formulation of individualized treatment strategies in clinical practice.

Craniocerebral trauma (TBI) is the leading cause of death and disability worldwide, placing a heavy burden on the healthcare system. At present, the diagnosis and prognosis of TBI are mainly based on clinical and imaging manifestations, which have certain limitations. In recent years, more and more biomarkers have been found to have potential clinical value in diagnosing TBI and predicting patient outcomes, but their clinical application in TBI is limited to a few patients who need to be exempted from CT examination. The pathophysiology and disease outcome mechanisms after TBI are complex and heterogeneous, and the multi-omics approach based on biomarkers is an ideal method to explore the complex pathological mechanisms of TBI. This paper summarizes the application progress of existing biomarkers in TBI research, and explores the potential of multi-omics research in constructing complex pathophysiological network of TBI, exploring candidate biomarkers and clinical diagnosis and treatment targets.