Volume 41 · Issue 09 · 2025

In 2023, the World Society of Emergency Surgery (WSES) issued the "Guidelines for the Management of Elderly and Frailed Trauma Patients". Based on the latest evidence-based medical evidence, the guidelines put forward comprehensive and comprehensive recommendations on the main treatment options for elderly and frailed trauma patients, especially emphasizing the inclusion of "frailty" in the risk assessment and clinical decision-making of elderly trauma patients, and reinforcing the importance of elderly craniocerebral trauma management. Combined with the research progress at home and abroad, this paper gives a brief interpretation of the core content of the guide.

To explore the surgical strategies and prognosis of skull base meningiomas.

A retrospective analysis was conducted on the clinical data of 1 546 patients with pathologically confirmed skull base meningiomas who underwent surgical treatment at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between January 2007 and January 2017. All patients received tumor resection, and the surgical approach was selected according to the anatomical location of the lesion. The extent of tumor resection was assessed based on intraoperative records and contrast-enhanced MRI within 72 hours post operation. Gross total resection (GTR) was defined as complete disappearance of the tumor; near-total resection (NTR) as 90%-99% resection; and subtotal resection (STR) as less than 90%. Follow-up evaluations were conducted at 3, 6, 12, and 24-36 months postoperatively via outpatient visits or other forms. Follow-up data included Karnofsky performance status (KPS) score, subsequent treatment, and cause of death. Kaplan-Meier survival curves were plotted to analyze progression-free survival (PFS) and overall survival (OS) at 1, 3, 5, and 10 years after surgery. Variables with P<0.05 in univariate analysis were included in a multivariate Cox regression model to identify independent factors associated with tumor progression (recurrence or regrowth of residual tumor).

Among the 1 546 patients, GTR was achieved in 1 162 (75.2%) patients, NTR in 336 (21.7%) and STR in 48 (3.1%). Postoperative pathological classification based on the World Health Organization(WHO) criteria showed 1 432 cases (92.6%) of grade 1, 106 cases (6.9%) of grade 2, and 8 cases (0.5%) of grade 3. The incidence of surgery-related complications was 24.7% (382 cases). The surgery related mortality rates at 1 and 3 months postoperatively were 0.4% (6 cases) and 0.6% (9 cases), respectively. A total of 170 patients were lost to follow-up, with 1 376 patients effectively followed up for an average duration of 58.2±17.2 months. During follow-up, tumor progression occurred in 83 patients (6.0%), and 48 patients (3.5%) died. The mean KPS score at last follow-up was 81.4±20.1. The 1-, 3-, 5-, and 10-year PFS rates were 99.4%, 97.9%, 94.6%, and 90.0%, respectively; and OS rates were 99.8%, 99.4%, 97.0%, and 92.1%, respectively. Comparison between the progression group (83 cases) and non-progression group (1 284 cases) revealed that both extent of resection and WHO grade were significantly different (both P<0.001). Multivariate Cox regression analysis showed that WHO grade 2-3 tumors (HR=3.48, 95%CI: 1.20-10.16, P=0.002) and non-GTR (HR=4.24, 95%CI: 2.02-9.02, P=0.011) were independent risk factors for postoperative tumor progression.

Surgical treatment of skull base meningiomas generally yields favorable outcomes. Individualized surgical strategies should be developed based on tumor location and imaging characteristics to achieve maximal resection. Patients with WHO grade 2-3 tumors or those who undergo non-GTR are at higher risk of postoperative tumor progression.

To explore the prognostic value of task-based functional magnetic resonance imaging (fMRI) combined with diffusion tensor imaging (DTI) for postoperative motor function in patients with functional area gliomas.

One hundred patients with brain gliomas in motor functional areas who underwent surgical resection at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from January 2014 to January 2024 were included in the retrospective study. All of them underwent preoperative task-state fMRI and DTI, in which the task-state fMRI sequence index was the lateralization index (LI) of activation in the M1 region of primary motor cortex (M1-LI). The relevant indexes of DTI consisted of the morphologic classification of corticospinal tract (CST), the minimum distance between the CST boundary and the tumor boundary (LTD), the LI of the anisotropy fraction (FA) (FA-LI) and the mean diffusion coefficient (MD) of LI (MD-LI). The LTD of all included patients was <10 mm. Differences in the above parameters were compared between the healthy and affected sides and among different tumor characteristics. According to the CST involvement pattern, patients were divided into 3 groups: CST symmetry group, malformation group, and overlap group. The differences in LTD=0, tumor volume, tumor resection degree and tumor grade were compared among the different malformation groups. Patients were divided into hemiplegic group and non-hemiplegic group according to whether they were hemiplegic or not at 1 week after surgery. Comparing the differences in general condition, tumor volume, resection degree, pathological grade and the above-mentioned imaging parameters between the two groups; indicators with statistically significant differences were included in the multifactorial logistic regression model for analysis, and tumor grade and resection degree were taken as covariates to analyze the risk factors that affected hemiplegia after surgery. The working characteristic(ROC) curves of the subjects were plotted, and the area under the curve (AUC) was calculated to assess the efficacy of the relevant imaging parameters in predicting postoperative hemiparesis.

In 100 patients, the tumor was completely resected in 43 cases; 38 cases (38.0%) were hemiplegic and 62 cases (62.0%) were not hemiplegic at 1 week after surgery. The M1-LI values of the patients were significantly higher than 0, and the FA of the affected CST was lower than that of the healthy side (all P<0.05). There were 15 patients in the CST symmetric group, 44 patients in the metaplastic group, 41 patients in the overlap group, and 72 patients (72.0%) had LTD=0. Comparing the CST symmetry group, malformations group and overlaps group, the percentage of patients with LTD=0, near total or partial resection, high-grade glioma, postoperative hemiparesis, and tumor volume all showed a gradual increase, with statistically significant differences (all P<0.05). At 1 week after surgery, the differences in gender, age, tumor volume, degree of resection, and pathological grading were not statistically significant when comparing the non-hemiplegic group with the hemiplegic group (all P>0.05). Compared with the hemiplegic group, the hemiplegic group had a higher percentage of patients with LTD=0, CST malformation of overlapping type, and higher values of M1-LI and FA-LI, and the difference was statistically significant (all P<0.01), while the difference in the MD-LI values was not statistically significant (P=0.251). Multivariate logistic regression analysis showed that high values of M1-LI (OR=22.60, 95%CI: 3.79-134.90, P=0.001) and FA-LI (OR=20.46, 95%CI: 3.97-105.42, P=0.038) were independent risk factors for hemiparesis in the postoperative period. The ROC curves showed that M1-LI, FA-LI, and M1-LI combined with FA-LI predicted postoperative hemiparesis with AUCs of 0.827, 0.700, and 0.865, respectively.

Task-state fMRI in combination with DTI is a good predictor of postoperative hemiparesis risk in patients with functional area gliomas. Categorization based on preoperative CST involvement can facilitate accurate preoperative surgical planning.

To explore the protective effect of intraoperative neuroelectrophysiological monitoring on the functions of the facial and vestibulocochlear nerves during vestibular schwannoma surgery and to investigate its prognostic predictive value.

A retrospective analysis was conducted on 228 patients with vestibular schwannoma who underwent microsurgical resection in the Department of Neurosurgery, Huashan Hospital, Fudan University from November 2020 to June 2023. Preoperatively, the facial nerve function of all patients was classified as House-Brackmann (HB) grade Ⅰ. According to the hearing grading criteria of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), 171 patients had residual hearing before surgery. Intraoperative neuroelectrophysiological monitoring was performed in all patients. Facial nerve function was monitored by facial nerve electromyography and facial nerve motor evoked potentials (FNMEP) with transcranial electrical stimulation. For patients with residual hearing, brainstem auditory evoked potential (BAEP) and cochlear nerve action potential (CNAP) were used to monitor hearing. The functions of the facial nerve and auditory nerve were evaluated at 3 days and 15 months after surgery. Patients with HB grades Ⅰ-Ⅱ were assigned to the good-outcome group, while those with grades Ⅲ-Ⅵ were classified into the poor-outcome group. Patients with AAO-HNS grades A-C were designated as the hearing-preserved group, and those with grade D were regarded as the non-hearing group. The differences in general clinical data (age, gender), tumor features (maximum diameter, side, Sammi grade, texture), and intraoperative neuroelectrophysiological monitoring parameters between the two groups were comparatively analyzed. The parameters that showed statistically significant differences between the hearing-preserved group and non-hearing group were incorporated into the multivariate logistics regression model for further analysis.

Total tumor resection was achieved in all 228 patients, and the anatomical preservation rate of the facial nerve reached 100.00%. At 3 days post operation, 205 (89.91%) patients were in the good-outcome group, while 23 (10.09%) were in the poor-outcome group. At 15 months post surgery, 213 (93.42%) patients were in the good-outcome group, and 15 (6.58%) in the poor-outcome group. When compared with the poor-outcome group, at both 3 days and 15 months post-operation, the proportion of patients with FNMEP decline≤50% and minimum current ≤0.05 mA was higher in the good-outcome group. The differences were all statistically significant (all P<0.001). There were no statistically significant differences in general clinical data or tumor-related characteristics between the two groups (all P>0.05). Among the 171 patients with pre-operative residual hearing, the evaluation results at 3 days and 15 months after surgery were consistent. Among them, 67 patients retained their hearing, with an overall hearing preservation rate of 39.18%. When compared with the hearing-preserved group, among the 104 patients in the non-hearing group, the patient is old, and the proportion of those with a maximum tumor diameter≥2 cm, cystic tumors, and Sammi grade 4 was higher. During intraoperative monitoring, the proportion of patients with a BAEP Ⅴ wave decline >50%, BAEP latency prolongation >0.8 ms, and the absence of the CNAP N1 wave was also higher. The differences in the above-mentioned indicators between the two groups were all statistically significant (all P<0.05). Multivariate logistics regression analysis revealed that BAEP wave Ⅴ decline >50% (OR=13.46, 95%CI: 2.25-80.51, P=0.003)and BAEP latency prolongation >0.8 ms(OR=15.68, 95%CI: 2.49-98.86, P=0.004) served as independent risk factors for postoperative hearing loss.

Intraoperative neuroelectrophysiological monitoring facilitates the preservation of the facial and vestibulocochlear nerves. Relevant monitoring parameters can help predict the short-term and long-term prognosis of the facial and vestibulocochlear nerve functions following surgery.

To explore the clinical diagnostic value of transmission electron microscopy technology in gonadotropin-containing cell tumors.

This study retrospectively collected tumor tissue samples from 40 patients with gonadotropin-containing cell tumors diagnosed at the Neuropathology Center of Beijing Neurosurgical Institute from July to November 2024. The expression of pituitary hormones, including growth hormone, prolactin (PRL), thyroid stimulating hormone, adrenocorticotropic hormone (ACTH) and follicle stimulating hormone/luteinizing hormone (FSH/LH) in gonadotropins, was detected by immunohistochemistry (IHC) staining. We used electron microscopy to observe the size, morphology, and mitochondrial changes of secretory granules in the cytoplasm of tumor cells. At the same time, ultrastructural diagnosis was made.

All 40 tumor tissue samples were diagnosed as gonadotropin-containing cell tumors. IHC staining results showed that gonadotropins (FSH/LH) were positively expressed, while other pituitary hormones were immunologically negative. The results of transmission electron microscopy observation showed that a large number of small circular FSH/LH secreting particles (diameter 100-250 nm, some particles with shell membrane structure) were observed in the cytoplasm of tumor cells in 40 tumor tissue samples, which were diagnosed as gonadotropin cell tumors. Twenty-one cases (52.5%) of tumor tissue samples showed other types of secretory granules in the cytoplasm of tumor cells, indicating the presence of other subtypes of pituitary neuroendocrine tumor cells. Among them, 5 cases (12.5%) had a small amount of droplet shaped or comma shaped ACTH particles (diameter of 350 nm), 2 cases (5.0%) had a small amount of large and irregular PRL particles (diameter of 600 nm), 2 cases (5.0%) had a small amount of PRL+ ACTH particles, 2 cases (5.0%) had a small amount of thyroid stimulating hormone (diameter of 200 nm)+ PRL particles distributed along the cell membrane, and 10 cases (25.0%) had eosinophilia. Abnormal mitochondrial morphology could be observed in the cytoplasm of some tumor cells.

Transmission electron microscopy could help accurately identify characteristic secretory granules of gonadotropin-containing cell tumors and detect mixed secretory granules and mitochondrial abnormalities missed by IHC, significantly improving diagnostic accuracy.

To analyze the risk factors of intracranial infection after ventricular tumor resection and to explore the validity of the relevant nomogram prediction model constructed.

A retrospective analysis was conducted on the clinical data of 101 patients with lateral ventricular tumors who underwent surgical treatment in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University and the Department of Neurosurgery of Zhongnan Hospital of Wuhan University from January 2020 to December 2023. Univariate analysis was applied to preliminarily screen the risk factors of postoperative intracranial infection. Further, least absolute shrinkage and selection operator regression analysis and multivariate logistic regression analysis were used to analyze the independent risk factors of postoperative intracranial infection, and a nomogram prediction model was constructed based on the above factors. The predictive efficacy of the model was evaluated by the area under curve (AUC) of the receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) and clinical impact curve (CIC) were adopted to evaluate the clinical benefits of the prediction model.

The surgeries of all 101 patients were successfully completed, and the operation time duration was 3.49±1.33 hours. Postoperative MRI showed that among them, 98 cases (97.0%) had total tumor resection and 3 cases (3.0%) had near total tumor resection. After the operation, 27 cases (26.7%) of patients developed intracranial infections. Among them, 3 cases died due to intracranial infections, and the rest were cured after treatment. Compared with the uninfected group, the proportion of diabetic patients in the infection group was higher, the proportion of those with high American Society of Anesthesiologists (ASA) scores was higher, the proportion of those with high National Hospital Infection Surveillance (NNIS) scores was higher, the postoperative operation duration was longer, the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were all higher, and the peripheral blood lymphocyte-to-monocyte ratio (LMR) was lower, the proportion of those with postoperative complications was higher, and the proportion of those treated in the ICU after surgery was higher (all P<0. 05). Multivariate logistic regression analysis showed that elevated NLR in postoperative peripheral blood (OR=1.82, 95%CI: 1.089-3.031) and decreased LMR (OR=0.16, 95%CI: 0.032-0.799) were both independent risk factors for intracranial infection after ventricular tumor surgery (both P<0.05). The ROC analysis results of the nomogram prediction model established based on the above factors showed that the AUC of the test set and the validation set were 0.996 and 0.843, respectively. The DCA results showed that this model had good clinical net benefits over a wide range of threshold probabilities. The CIC results showed that this model could accurately screen out the majority of target patients within an acceptable risk range.

Higher NLR and lower LMR values in peripheral blood in the early postoperative period are closely related to intracranial infection after ventricular tumor resection. Based on this, the constructed nomogram model has good predictive ability and clinical application value.

To investigate the clinical and pathological features, treatment and prognosis of HIV (human immunodeficiency virus)-infected patients with gliomas.

We retrospectively analyzed the clinical data of 13 patients diagnosed with HIV infection and glioma who were admitted to the Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University from January 2019 to August 2024. The collected data included demographic and epidemiological information, clinical symptoms, imaging findings, and pathological results from postoperative tissue and molecular studies. All patients underwent surgical resection or biopsy. Follow-up assessments were conducted through outpatient visits and telephone consultations, documenting postoperative adjuvant treatments, symptom improvement, tumor recurrence and metastasis and patient survival status.

The median age of the 13 patients was 37 (range: 21-57) years old. The ratio of male to female patients was 3.3 ∶1. The first symptoms were intermittent headache in 4 cases, seizures in 4 cases, poor limb movement in 4 cases, and poor speech in 1 case. All patients underwent regular highly active antiretroviral therapy (HAART). The surgical procedures included gross total resection in 8 cases, subtotal resection in 2 cases, partial resection in 1 case, and biopsy in 2 cases. All 13 patients were diagnosed with high-grade glioma, including 7 patients with glioblastoma, isocitrate dehydrogenase (IDH) wild-type; 3 patients with diffuse astrocytoma, IDH mutant; 2 patients with oligodendroglioma, IDH mutant and 1p/19q co-deletion, and 1 patient with diffuse midline glioma. Telomerase reverse transcriptase (TERT) promoter mutation was present in 3 cases, epidermal growth factor receptor (EGFR) amplification in 4 cases, and O⁶-methylguanine-DNA methyltransferase promoter hypermethylation in 6 cases, with Ki67 proliferation indexes of 10%-80%. The follow-up time duration of 13 patients was from 2 months to 25 months. There were 7 cases of concurrent chemoradiotherapy, 4 cases of no adjuvant therapy and 2 cases of radiotherapy alone. By the last follow-up, 9 patients had died (all from complications related to tumor recurrence) and 4 had survived. The median survival of the nine patients was 14 months.

This preliminary study indicates that patients with HIV-infected patients with glioma tend to have a younger age of onset and a higher prevalence in males. The main clinical symptoms include seizures, limb movement disorders, and intermittent headaches. Pathological types are mostly high-grade gliomas, primarily glioblastoma. Conventional treatments include surgical intervention, adjuvant radiotherapy and chemotherapy, as well as HAART. However, the overall survival remains poor.

To investigate the morphological and hemodynamic risk factors associated with rupture of single small and medium-sized intracranial aneurysms (IAs)(maximum diameter<15 mm).

Clinical and imaging data from 214 patients with single small and medium-sized IAs treated at the Department of Neurosurgery of Tianjin Fifth Central Hospital (128 cases) and Tianjin Medical University General Hospital (86 cases) between January 2016 and May 2022 were retrospectively analyzed, including 127 ruptured IAs (RIAs) and 87 unruptured IAs (UIAs). Computational fluid dynamics models were constructed using ANSYS Fluent 2021 R2 software to compare hemodynamic parameters across three IA regions: the neck, body, and dome. Univariate analysis identified significant variables (P≤0.001), and multivariate logistic regression analysis determined independent risk factors for IA rupture. Receiver operating characteristic (ROC) curves were constructed, and optimal cutoff values for geometric and hemodynamic parameters were identified using the maximum Youden index.

Analysis of clinical and morphological characteristics in 214 patients indicated that bifurcation type (OR=5.627, 95%CI: 2.548-12.427), irregular shape (OR=2.380, 95%CI: 1.096-5.172), high size ratio[SR, aneurysm length (L)/parent artery diameter (Dv)] (OR=2.612, 95%CI: 0.997-6.845), and high inflow angle (α) (OR=1.195, 95%CI: 0.558-2.563) were independent risk factors for IA rupture(all P<0.05). Hemodynamic analysis was completed in 167 patients (RIA: 86, UIA: 81). The comparison results of the two groups showed that there were statistically significant differences in pressure, oscillatory shear index (OSI), and relative residence time(RRT) among the three regional hemodynamic parameters(all P<0.05). Meanwhile, the normalized pressure at the aneurysm neck(NPA_neck), gradient oscillatory number at the aneurysm neck (GON_neck), velocity at the aneurysm neck (VE_neck) and vorticity at the dome (VOR_dome) also had statistical significance (all P<0.05). Further univariate analysis based on hemodynamic data showed that, compared to the UIA group, the RIA group had younger patients with a lower prevalence of diabetes mellitus, coronary artery disease, and hyperlipidemia, a higher proportion of bifurcation type aneurysms, higher geometric parameters [length, height, SR, bottleneck factor, height-to-width ratio (HWR), α, aneurysm angle], lower Dv and internal carotid artery angles, as well as lower hemodynamic parameters (NPA_neck, OSI_neck, RRT_neck, GON_neck, OSI_dome, RRT_dome) (all P<0.05). Multivariate logistic regression analysis revealed that high SR (OR=1.572, 95%CI: 0.426-5.798), high HWR(OR=2.099, 95%CI: 0.818-5.388), bifurcation type (OR=12.713, 95%CI: 4.542-35.579), low OSI_neck (OR=3.561, 95%CI: 0.843-15.051), low RRT_neck (OR=1.843, 95%CI: 1.409-8.306), and low RRT_dome (OR=17.565, 95%CI: 0.477-646.527) were independent risk factors for IA rupture(all P<0.05). ROC curve analysis determined optimal cutoff values as follows: SR, 0.862; α, 115.47; OSI_neck, 0.466; OSI_dome, 0.404; RRT_neck, 0.018; RRT_dome, 0.016.

The combination of morphological features including bifurcation type, high SR, high HWR, irregular shape, high inflow angle, and hemodynamic parameters including low OSI_neck, low RRT_neck, and low RRT_dome can serve as important indicators for evaluating rupture risk of single small and medium-sized IAs, providing quantitative evidence for clinical decision-making.

To explore the effect of aspirin on the morphology and wall stability of unruptured intracranial aneurysms (UIAs).

This study was a randomized controlled trial. Twenty-one patients (21 aneurysms) diagnosed with UIAs in the Department of Neurosurgery of the First Affiliated Hospital of Air Force Medical University from August 2022 to August 2023 were included and randomly divided into the experimental group (oral administration of enteric-coated aspirin tablets, 100 mg/d, for 6 consecutive months) and the control group (no medication). The differences in aneurysm stability before and after medication and between the two groups 6 months after medication were analyzed based on MRI morphological parameters of aneurysms, aneurysm-to-pituitary stalk contrast ratio (CR_stalk) value and volume transfer constant K^trans value.

None of the 21 patients experienced adverse drug reactions such as allergies, bleeding, or liver and kidney function damage during the medication or observation period, and none of the aneurysms ruptured. Compared with the parameters before taking aspirin, the width of aneurysms in the experimental group decreased after 6 months of medication (3.85±1.57 mm vs. 4.21±1.70 mm, paired t=2.35, P=0.047). The aneurysm K^trans value decreased (0.025±0.008 vs. 0.030±0.008, paired t=2.73, P=0.027). On the other hand, compared with the parameters before taking aspirin, the height of aneurysms in the control group [M(Q₁, Q₃)] increased after 6 months of medication[2.55 (2.17, 3.55) mm vs. 2.27 (1.76, 3.35) mm, Z=2.37, P=0.008]. The aneurysm K^trans value increased (0.031±0.005 vs. 0.028±0.006, paired t=3.24, P=0.008). After taking aspirin for 6 months, compared with the control group, the CR_stalk value of the longest diameter of the aneurysm wall in the experimental group decreased (0.64±0.19 vs. 0.85±0.20, t=2.41, P=0.026), and the aneurysm K^trans value decreased in the experimental group (0.025±0.008 vs. 0.031±0.005, t=2.28, P=0.034).

Aspirin could improve the morphology of UIAs, reduce the permeability of the aneurysm wall and increase the stability of the aneurysm wall.

To investigate the efficacy of hypoglossal nerve-ansa cervicalis combined transplantation for treating severe facial paralysis and factors potentially influencing the outcomes.

Clinical data of 67 patients with severe facial paralysis treated at the Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to December 2023 were retrospectively analyzed. Preoperatively, 42 patients were House-Brackmann (HB) grade Ⅴ and 25 were grade Ⅵ; the Sunnybrook Facial Grading System score [M(Q₁, Q₃)] was 9 (4, 13) points. All patients underwent combined transplantation surgery involving anastomosis of the proximal hypoglossal nerve to the distal facial nerve and anastomosis of the superior root of the ansa cervicalis to the distal hypoglossal nerve. Postoperative facial nerve functional recovery was assessed using the HB grade and Sunnybrook Facial Grading system score. Patients with HB grades Ⅰ-Ⅲ were defined as the favorable outcome group, while those with grades Ⅳ-Ⅵ as the unfavorable outcome group. Factors influencing prognosis were analyzed. The impact on tongue function was evaluated using the Tongue Disability Index (TDI).

All 67 surgeries were successfully completed. Postoperatively, 46 patients (68.7%) experienced mild perioral pain, and 11 (16.4%) had perioral skin numbness. The median follow-up time duration was 24 (16, 32) months. By 12 months postoperatively, all pain and numbness symptoms had resolved. At the last follow-up, 55 patients (82.1%) had favorable outcomes (HB grade Ⅱ in 19; grade Ⅲ in 36), while 12 (17.9%) had unfavorable outcomes (HB grade Ⅳ in 7; grade Ⅴ in 5). The Sunnybrook Facial Groding System score improved significantly to [M(Q₁, Q₃)] 61(54, 67) points, representing a mean increase of 49.7±14.8 points compared with preoperative [M(Q₁, Q₃)] 9 (4, 13) points (U=9.00, P<0.001). Tongue dysfunction occurred in 10 patients (14.9%) during follow-up, including masticatory difficulty (6 patients, 9.0%), dysphagia (6 patients, 9.0%), and dysarthria (7 patients, 10.4%), all of which improved with ongoing rehabilitation. The TDI at last follow-up [M(Q₁, Q₃)] was 1.5 (1.0, 2.0) points. Compared with the unfavorable prognosis group, the favorable outcome group had a significantly higher proportion of patients with a disease duration ≤6 months (P=0.020). There were no significant differences in age, sex, BMI (body mass index), etiology, or preoperative HB grade between the two groups (all P>0.05).

Hypoglossal nerve-ansa cervicalis combined transplantation effectively could restore facial nerve function in patients with severe facial paralysis, with a relatively low incidence of tongue dysfunction. Patients with a disease duration ≤6 months seem to have better outcomes, suggesting the benefit of early surgical intervention.

To investigate the clinical changes in patients with developmental venous anomalies (DVAs) during five years post initial diagnosis, and to provide evidence for the formulation of early treatment strategies following diagnosis.

A comprehensive retrieval of medical records from January 2013 to May 2024 was conducted through the Information Department of Fuzong Clinical Medical College of Fujian Medical University (900^th Hospital of PLA Joint Logistic Support Force) utilizing keywords such as "developmental venous anomalies", "cerebral venous malformation", "cerebral venous angioma" and "cerebrovascular malformation". All patients diagnosed with DVAs were screened, with alterations in clinical symptoms and treatment strategies within the first five-year period, and completion of five years post-consultation serving as the endpoint for observation. Patients possessing follow-up records within this timeframe were selected for retrospective analysis regarding changes in clinical symptoms and treatment methods after initial diagnosis.

A total of 26 DVAs patients were included in this cohort, comprising 19 males and 7 females aged between 5 and 85 years (mean: 49.6±18.2 months). Supratentorial and subtentorial lesions were identified in 13 cases, of which 11 were asymptomatic. In 5 cases (19.2%), significant symptom deterioration or emergence of new symptoms occurred within five years; these events transpired between one to four years post diagnosis, with four cases located in the subtentorium and 1 case in supratentorium. None of the asymptomatic patients developed new symptoms during this period. No statistically significant differences were observed in age, gender, lesion location, presence of symptoms at diagnosis, or proportion of associated vascular malformations between the group with disease progression and the group without disease progression (all P>0.05).

This preliminary study indicates that during the initial five years following diagnosis, if DVAs are incidentally discovered without accompanying symptoms, they tend to remain stable without necessitating frequent reviews. Conversely, those presenting with symptoms at first diagnosis may experience progression requiring regular monitoring.

To quantitatively analyze the exposure area and working space of the thalamus pulvinar achieved via the contralateral supracerebellar infratentorial (cSCIT) approach and the ipsilateral supracerebellar infratentorial (iSCIT) approach under both neuroendoscopy and microscopy through anatomical study.

Five adult cadaveric head specimens (10 sides in total) were used. The exposure areas via the cSCIT and iSCIT approaches under both neuroendoscopy and microscopy were observed and measured, with relevant data documented. The exposure effects of both approaches were compared under conditions of normal anatomy and extended dissection.

(1) Neuroendoscopy: the total pulvinar exposure area [M(Q₁, Q₃)] via the cSCIT and iSCIT approaches was 86.00 (85.00, 87.00) mm² and 78.50 (78.00, 79.00) mm^2, respectively. The superior exposure [M(Q₁, Q₃)] was 35.00 (33.00, 35.00) mm²vs. 31.50 (30.25, 32.75) mm^2, medial exposure [M(Q₁, Q₃)] was 41.50 (41.00, 42.00) mm²vs. 40.00 (40.00, 40.75) mm^2, and lateral exposure [M(Q₁, Q₃)] was 48.00 (47.00, 48.00) mm²vs. 40.00 (39.00, 41.00) mm² (all P<0.05). The maximum achievable depth [M(Q₁, Q₃)] via cSCIT was 75.00 (74.25, 75.00) mm, significantly greater than via iSCIT [70.00 (69.25, 71.00) mm] (P<0.001). Differences in inferior exposure area and working depth between the two approaches were not statistically significant (both P>0.05). (2) Microscopy: the total pulvinar exposure area [M(Q₁, Q₃)] via the cSCIT and iSCIT approaches was 85.00 (84.25, 85.75) mm² and 78.50 (77.25, 79.00) mm^2, respectively. The superior exposure [M(Q₁, Q₃)] was 33.00 (32.25, 34.50) mm²vs. 30.50 (30.00, 33.00) mm^2, and lateral exposure [M(Q₁, Q₃)] was 41.00 (40.00, 41.75) mm²vs. 39.00 (38.00, 40.00) mm² (all P<0.05). Differences in inferior exposure, medial exposure, working depth and maximum achievable depth between the two microscopic approaches were not statistically significant (all P>0.05). (3) cSCIT Endoscopy vs. microscopy: neuroendoscopic cSCIT provided significantly larger medial exposure [M(Q₁, Q₃): 41.50 (41.00, 42.00) mm²vs. 40.50 (40.00, 41.00) mm²], lateral exposure [M(Q₁, Q₃): 48.00 (47.00, 48.00) mm²vs. 41.00 (40.00, 41.75) mm²], and maximum achievable depth [75.00 (74.25, 75.00) mm vs. 69.50 (69.00, 71.00) mm] compared with microscopic cSCIT (all P<0.05). Differences in total exposure area, superior exposure, inferior exposure and working depth were not statistically significant (all P>0.05). (4)iSCIT endoscopy vs. microscopy: no statistically significant differences were found in any of the measured parameters between neuroendoscopic and microscopic iSCIT approaches (all P>0.05). (5)Regardless of using microscopy or neuroendoscopy, the cSCIT approach provided superior pulvinar exposure compared with iSCIT under extended dissection conditions.

The neuroendoscopic cSCIT approach could offer more adequate exposure of the pulvinar. Extending the dissection via the cSCIT approach could significantly increase the exposure area of the lateral region of the pulvinar.

To preliminarily investigate the molecular pathological mechanisms that hypoxia-inducible factor (HIF) 2α promotes the proliferation, invasion and chemotherapy resistance of glioblastoma cells through the methylation of miR-652-5p promoter.

Three primary glioma tissue specimens with histopathological grades corresponding to World Health Organization (WHO) grades 2, 3, and 4 were selected. DNA methyltransferase 1 (DNMT1) and miR-652-5p expression levels were assessed using Western blotting (WB) and reverse transcription quantitative real-time polymerase chain reaction(RT-qPCR) analyses. U87 and A172 cells were cultured under normoxic (21%O₂) or hypoxic (1%O₂) conditions for 12 or 24 hours, after which HIF2α, DNMT1, and miR-652-5p expression levels were evaluated by RT-qPCR. Methylation-specific PCR (MSP) was employed to determine the methylation status of the miR-652-5p promoter. Following 48-hour culture with miR-652-5p inhibition or overexpression, cell invasion was analyzed; additionally, cell proliferation and apoptosis were assessed after 48-hour treatment with temozolomide (100 μmol/L). The effects of DNMT1 inhibition via 5-aza-CdR on miR-652-5p expression and promoter methylation were also examined. In a separate set of experiments, HIF2α-knockdown cells were cultured under hypoxic conditions for 48 hours, followed by WB analysis of DNMT1 expression and RT-qPCR measurement of miR-652-5p levels. Cell invasion was evaluated using Transwell assays. After temozolomide treatment (100 μmol/L), cell proliferation was measured using the Cell Counting Kit-8 (CCK-8), and apoptosis was quantified by flow cytometry.

The expression of miR-652-5p was significantly lower in glioblastoma cells (WHO grade 4) compared with that in lower-grade gliomas (F=135.74, P<0.001). Under hypoxic conditions, RT-qPCR results showed that HIF2α and DNMT1 expression increased progressively over time (12 and 24 hours), while miR-652-5p expression decreased accordingly (all P<0.05). MSP analysis revealed an increase in miR-652-5p promoter methylation levels. HIF2α knockdown in A172 and U87 cells led to reduced proliferation following 48-hour temozolomide treatment as determined by CCK-8 assay (all P<0.001), and flow cytometric analysis demonstrated increased early, late, and total apoptosis compared with control groups (all P<0.05). Transwell invasion assays confirmed that HIF2α-depleted U87 cells exhibited significantly reduced invasiveness after 48-hour culture compared with controls (F=73.45, P<0.001). Inhibition of miR-652-5p enhanced cell invasion and proliferation while reducing apoptosis (all P<0.05), whereas miR-652-5p overexpression suppressed invasion and proliferation and increased apoptosis (all P<0.05). MSP analysis further indicated that hypoxia increased methylation levels of the miR-652-5p promoter and decreased non-methylated forms, whereas normoxia had the opposite effect. DNMT1 expression was higher in glioblastoma cells than in lower-grade gliomas (WHO grade 2, 3)(F=64.53, P<0.001). Treatment of A172 and U87 cells with 5-aza-CdR significantly reduced DNMT1 expression and promoter methylation levels compared with dimethyl sulfoxide control groups, while miR-652-5p expression was markedly upregulated (all P<0.001). Finally, hypoxic culture of HIF2α-knockdown cells for 48 hours resulted in decreased DNMT1 expression and increased miR-652-5p levels compared with controls (both P<0.05).

HIF2α promotes the proliferation, invasion and chemotherapy resistance of glioblastoma cells through the methylation of miR-652-5p promoter in hypoxia environment.

Both intracranial arteriovenous malformations and moyamoya syndrome are common cerebrovascular diseases in children, which often lead to neurological dysfunction in children. However, intracranial arteriovenous malformation combined with moyamoya syndrome in children is relatively rare. The Department of Neurosurgery of the Children's Hospital affiliated to Xi'an Jiaotong University treated a child with intracranial arteriovenous malformation combined with moyamoya syndrome in March 2024. The malformed vascular embolization was performed in the compound operating room. The malformed vascular mass was completely embolized after the operation, and there were no surgery-related complications. Whole brain digital subtraction angiography 6 months after surgery showed no recurrence of malformed vascular mass and no change of bilateral internal carotid artery stenosis. Long-term follow-up observation of moyamoya syndrome.

Brain glioma is the most common primary malignancy. Chimeric antigen receptor (CAR) -T cell therapy has been effective in hematological tumors, but it faces many challenges in the treatment of glioma. In recent years, researchers at home and abroad have carried out a large number of clinical studies, which have provided important clinical evidence and new ideas for CAR-T cell treatment of glioma. In this paper, the status quo of clinical trials of CAR-T cells in the field of glioma, the technical improvement path and the key points of clinical trial design are comprehensively analyzed.

Surgical robots have been used in minimally invasive neurosurgery of the brain for decades. Driven by the development of neural navigation technology, robots have been able to assist or independently complete accurate linear operations, such as target positioning and puncture under the guidance of multi-modal images. With the development of various nonlinear and flexible mechanical equipment, robots can also assist neurosurgeons in many minimally invasive operations such as targeted electrode implantation, drug delivery, lesion ablation, hematoma aspiration, and endovascular treatment. This article summarizes the current mainstream application scenarios of surgical robots and explores their future development trends, including smaller device size and cost, integrating multimodal data to assist clinical decision-making, and executing more treatment options via cerebrovascular under the design of new flexible devices.

Trigeminal neuralgia is a chronic neuropathic pain disorder characterized by recurrent episodes of severe pain in the innervated region of the trigeminal nerve. At present, the most effective treatment is microvascular decompression. The key to its operation lies in accurately locating the responsible blood vessel, clearly identifying the compression relationship between nerves and blood vessels, and achieving adequate decompression. However, traditional imaging methods have technical bottlenecks such as insufficient resolution of anatomical structure and difficulty in differentiating vascular properties. In recent years, with the development of multimodal imaging technology, especially the innovative application of artificial intelligence technologies such as machine learning and deep learning, breakthroughs have been brought to this field. This paper systematically reviews the research progress of MRI-based machine learning and deep learning techniques in the diagnosis and treatment of trigeminal neuralgia.

Traumatic craniocerebral injury (TBI) is a severe type of trauma that often results in disability and death in patients, and deep vein thrombosis (DVT) is one of the common complications in patients with TBI. Relevant studies at home and abroad have shown that the main risk factors of DVT after TBI are old age, coagulation dysfunction, combined with severe trauma, longer immobilization time and higher severity of injury. In addition, risk prediction models and prevention and treatment modalities for DVT after TBI are the focus of current research. DVT risk assessment should be included in the routine management of patients with TBI, and targeted preventive measures should be taken. More high-quality prospective cohort studies are needed in the future to further explore the risk factors of DVT after TBI and provide evidence-based medical evidence for formulating individualized prevention strategies.