Volume 41 · Issue 10 · 2025

Neuroendoscopic technology is an important part of minimally invasive neurosurgery, which constantly expands the surgical boundaries of traditional neurosurgery, and gradually forms many sub-specialties such as endoscopic transventral skull base surgery, endoscopic ventricular surgery, endoscopic transcranial neurosurgery and endoscopic spine surgery. Looking back on the development of endoscopic neurosurgery for more than a hundred years, it is not difficult to find that innovation is the core force driving its continuous development. This paper summarizes the technological breakthroughs of endoscopic neurosurgery in recent years, focusing on three dimensions: concept innovation, equipment progress and multi-technology integration, and explains how key innovations such as minimally invasive concept, high-definition imaging, special surgical instruments, neuronavigation, augmented reality, virtual reality and robotics can reshape surgical strategies and improve surgical safety and effectiveness.

Sellar lesions mainly include pituitary neuroendocrine tumors, craniopharyngiomas, meningiomas and Rathke cleft cyst, etc., which can involve a wide area extending to the optic path, cavernous sinus and brainstem with hypothalamus-pituitary as the core. In recent years, with the rapid development of neuroendoscopic transnasal skull base surgery, the vast majority of sellar region lesions can be treated by neuroendoscopic transnasal approach. The transnasal approach, with the sella turcica as the center, can be extended in multiple directions, and the sellar lesions can be removed under direct vision, which promotes the improvement of surgical treatment effect of sellar lesions^{[1,2,3,4,5,6,7]}。 However, due to the deep location of the lesions in the sellar region and the many important structures around it, even if the important structures such as hypothalamus and pituitary gland are reasonably protected during the operation, the incidence of surgical complications is still high, which restricts the improvement of surgical efficacy of the lesions in the sellar region^[8]。

To explore the efficacy of neuroendoscopic transnasal surgery for the treatment of sellar region germ cell tumors.

A retrospective study was conducted on the clinical data of 37 patients with sellar region germ cell tumors who underwent neuroendoscopic transnasal surgery at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from April 2019 to April 2025. The cohort included 31 cases of germinoma (germinoma group) and 6 cases of nongerminomatous germ cell tumors (NGGCTs)(NGGCTs group). Within 3 days postoperatively, tumor resection extent was assessed via brain MRI. Follow-up evaluations, including clinical symptoms, physical examinations, imaging studies and endocrine laboratory tests were performed at 3, 6 and 12 months post-surgery and annually thereafter.

Neuroendoscopic surgery was successfully completed in all 37 patients. In the germinoma group, complete resection was achieved in 10 cases, subtotal resection in 8, major resection in 5, and partial resection in 8. In the NGGCTs group, complete resection was achieved in 3 cases, subtotal resection in 2, and major resection in 1. Postoperative symptom relief was observed within 7 days in 5/8 of patients with headaches and 76.7% (23/30) of patients with visual disturbances. During a median (Q₁, Q₃) follow-up of 41.0(29.0, 50.0)months, tumor recurrence occurred in 1 case (2.7%), olfactory loss in 1 case (2.7%), and long-term pituitary dysfunction requiring hormone replacement therapy in 20 cases (54.1%).

Neuroendoscopic transnasal surgery effectively alleviates clinical symptoms in sellar region germ cell tumor patients, is associated with high resection rates of complete and subtotal resection, and demonstrates good safety and efficacy.

To explore the neuroendoscopic transnasal surgical strategies based on the imaging anatomical relationship between Knosp grade 4 invasive pituitary neuroendocrine tumors and the cavernous segment of the internal carotid artery (ICA), and to study the clinical outcomes of patients.

A retrospective analysis was conducted on 58 cases of Knosp grade 4 invasive pituitary neuroendocrine tumors treated with endoscopic transnasal surgery in the Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University from January 2020 to December 2024. Based on imaging findings of the relationship between the tumor and the cavernous segment of the ICA, patients were divided into three groups: ventral ICA invasion group (10 cases), dorsal ICA invasion group (28 cases), and complete ICA encirclement group (20 cases). Selection of individualized endoscopic endonasal surgical strategies (ventral, dorsal, or lateral to the internal carotid artery) was based on the direction of tumor invasion. Surgical resection rates, symptom improvement rates, and complications were analyzed among these groups. Follow-up evaluations including endocrine hormone tests and pituitary MRI were performed at 1, 3, 12, and 24 months post discharge.

Among the 58 patients, gross total resection (GTR) was achieved in 36 cases (62.1%), subtotal resection (STR) in 17 cases (29.3%), and partial resection in 5 cases (8.6%). Among them, the complete resection ratio were 7/10 for ICA ventral invasion group, 20/28 for dorsal invasion group, and 9/20 for complete encirclement group. Among 36 patients with preoperative visual impairment, 21 cases (58.3%) showed postoperative visual improvement. There were no surgery-related deaths. Complications included intraoperative ICA injury (1 case), cerebrospinal fluid leakage (1 case), intracranial infection (1 case), nasal bleeding (1 case), postoperative oculomotor nerve palsy (7 cases), postoperative tumor cavity hemorrhage (2 cases), and subarachnoid hemorrhage (1 case). During follow-up (range: 4-62 months; median: 33 months), 2 patients (3.4%) developed permanent central diabetes insipidus, 3 patients (5.2%) developed permanent hypopituitarism. Two cases (5.5%) with GTR experienced tumor recurrence.

For Knosp grade 4 invasive pituitary neuroendocrine tumors, the appropriate surgical approach is selected based on imaging anatomical relationships between the tumor and the cavernous segment of the ICA, achieving both a high GTR rate and favorable surgical safety.

To compare the clinical efficacy and safety of fully neuroendoscopic versus microscopic resection for cerebellopontine angle (CPA) tumors.

A total of 156 patients with CPA tumors who underwent surgical treatment in the Department of Neurosurgery, Affiliated Hospital of Nantong University between January 2021 and December 2024 were consecutively enrolled. Among the patients, there were 73 cases of vestibular schwannoma (acoustic neuroma), including 33 in the endoscopy group and 40 in the microscopy group; there were 33 cases of epidermoid cyst, including 19 in the endoscopy group and 14 in the microscopy group; there were 50 cases of meningioma, including 23 in the endoscopy group and 27 in the microscopy group. A retrospective comparative analysis was performed to evaluate the extent of tumor resection, operation duration, postoperative complications, and facial nerve function between the two groups.

Among patients with vestibular schwannoma and meningioma, there was no statistically significant difference in the gross total resection (GTR) rate between the two groups (both P>0.05). The operation duration was significantly longer in the endoscopy group than in the microscopy group (both P<0.001). For epidermoid cysts, the GTR ratio was 18/19 in the endoscopy group and 8/14 in the microscopy group, showing a statistically significant difference (P=0.014), whereas there was no significant difference in operation duration between the two groups (P=0.652). For the three tumor types, there were no statistically significant differences between the endoscopic and microscopic groups in the incidence of cerebrospinal fluid leakage, intracranial infection, intracranial hemorrhage, or hospital stay duration (all P>0.05). At the 6-month postoperative follow-up, there were no statistically significant differences in facial nerve function as assessed by the House-Brackmann grade between the endoscopy and microscopy groups for patients with vestibular schwannoma, epidermoid cyst, or meningioma (all P>0.05).

Neuroendoscopy provides superior visualization and exposure compared with microscopy for resection of CPA tumors. It offers distinct advantages in visualizing and managing deep-seated or obscured neurovascular structures. Particularly in the resection of complex epidermoid cysts, neuroendoscopy demonstrates a higher rate of gross total removal. These findings support the broader clinical adoption of this technique.

To explore the safety and efficacy of neuroendoscopic lateral transorbital approach (LTOA) in the resection of cranio-orbital lesions.

A retrospective analysis was conducted on the clinical data of 15 patients with cranio-orbital lesions who underwent neuroendoscopic LTOA resection in the Department of Neurosurgery of the Affiliated Hospital of Qingdao University from September 2022 to January 2025. Among the 15 cases of cranio-orbital lesions, there was 1 case of cranio-orbital abscess, 1 case of intraorbital hematoma, and the remaining 13 cases were all neoplastic lesions. Patients were followed up at 3, 6, 12 months after the operation and annually thereafter. The main method was outpatient follow-up, supplemented by telephone and Wechat follow-up. The content included the patient′s clinical symptoms, physical examination and cranial MRI.

All 15 surgeries were successfully completed. The operation time was (194.0±39.5) min, and the intraoperative blood loss was (100.0±12.7) ml. After the operation, 1 patient with abscess and 1 patient with hematoma both recovered. Among the 13 tumor-related patients, total tumor resection was achieved in 12 cases and subtotal resection in 1 case. Postoperative pathological analysis showed that there were 2 cases of cavernous hemangioma, 3 cases of schwannoma, 2 cases of low-grade glioma in the temporal lobe, and 6 cases of meningioma. One case of cerebrospinal fluid fistula and one case of cranial nerve palsy occurred in the postoperative patients, and both recovered after treatment. All patients were followed up after the operation, and the median follow-up time was 11 (3-30) months. Cranial MRI showed that no recurrence was observed in 1 case of abscess, 1 case of hematoma and 12 patients with total tumor resection, and no significant progression was observed in 1 patient with subtotal tumor resection. The lateral orbital incisions of the 15 patients all healed well.

Neuroendoscopic LTOA surgery is highly effective and safe in the treatment of cranio-orbital lesions. It is particularly suitable for the resection of lesions located on the lateral side of the optic nerve.

To explore the safety and efficacy individualized treatment of complex optic nerve injury by neurosurgical robot-assisted endoscopic transnasal surgery.

We retrospectively collected clinical data of 89 patients with complex optic nerve injuries in the Department of Brain Hospital, Xi′an People′s Hospital (Xi′an Fourth Hospital) from March 2021 to December 2024. According to the characteristics of the injury, complex optic nerve injuries were divided into 3 types: Type Ⅰ (skull base fracture displacement type, 47 cases), Type Ⅱ (cranio-orbital combined injury type, 25 cases), and Type Ⅲ (vascular injury type, 17 cases). All patients underwent neurosurgical robot-assisted endoscopic transnasal optic nerve decompression surgery. And we implemented individualized surgical treatment plans for each type, documented intraoperative conditions and postoperative complications, and followed up with patients through outpatient visits or telephone calls at 1, 3, and 6 months after surgery to evaluate their visual effective recovery (postoperative visual acuity improved by more than 1 level compared to preoperative or by 2 lines or more compared to preoperative logMAR visual acuity chart).

All 89 surgeries were successfully completed, with the orbital wall repair rate of 100%. One patient underwent endovascular embolization due to intraoperative bleeding caused by pseudoaneurysm rupture, while other patients did not develop surgery-related complications, and there were no deaths. At the 6-month postoperative follow-up, 42 patients (47.2%) achieved effective visual recovery. Among them, the number of patients with effective recovery in terms of no light perception, light perception, hand motion, finger counting, and logMAR ≥ 0.02 was 21, 7, 3, 5, and 6 cases, respectively. The effective recovery rate was 65.7% (23/35) in patients with an optic nerve injury course of ≤7 days, and 35.2% (19/54) in those with a course of >7 days, with a statistically significant difference (χ²=7.94, P=0.004).

Individualized surgical treatment of complex optic nerve injuries using neurosurgical robot-assisted neuroendoscopy and nasal optic nerve tube decompression is safe and effective. Patients who undergo surgery in the early stage (disease duration ≤ 7 days) have better visual recovery.

To investigate the factors influencing biochemical remission after endoscopic transnasal resection of growth hormone (GH)-secreting pituitary adenomas.

We retrospectively collected clinical data of 205 patients with GH-secreting pituitary adenomas who underwent endoscopic transnasal surgery at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between January 2020 and December 2023. Patients were classified into a biochemical remission group and a non-remission group based on hormone levels at postoperative week 12. Clinical characteristics, imaging parameters, and endocrine profiles were compared between groups. Univariate analysis and multivariate logistic regression were used to identify independent risk factors for failure to achieve biochemical remission at postoperative week 12. A subgroup analysis was further performed in patients with postoperative day 1 GH levels≥1.0 ng/ml to assess the impact of various factors on week 12 biochemical remission.

All 205 surgeries were completed successfully, with gross total resection achieved in 145 cases (70.7%) and subtotal resection in 60 cases (29.3%). Postoperative histopathology showed a Ki67 proliferation index of 3.0%(2.0%, 4.5%). Ultrastructural examination by transmission electron microscopy was performed in 172 cases, revealing secretory granules in all tumors: 70 (40.7%) were densely granulated and 102 (59.3%) sparsely granulated. At week 12 postoperatively, 131 patients (63.9%) achieved biochemical remission, while 74 (36.1%) did not. Compared with the non-remission group, the remission group was older, had fewer recurrent tumors, less cavernous sinus invasion, smaller maximal tumor diameter, a higher rate of gross total resection, and lower preoperative GH and insulin-like growth factor-1 (IGF1) levels, as well as lower GH, IGF1 levels, and IGF1 index on postoperative day 1 and week 12 (all P<0.05). Multivariate logistic regression identified recurrent tumors (OR=2.891, 95%CI: 1.288-6.491, P=0.010), higher preoperative GH levels (OR=6.255, 95%CI: 2.774-14.108, P<0.001), and subtotal resection (OR=4.973, 95%CI: 2.309-10.709, P<0.001) as independent risk factors for failure to achieve biochemical remission at postoperative week 12. In the subgroup of 130 patients with postoperative day 1 GH≥1.0 ng/ml, 62(45.4%) achieved biochemical remission. Compared with the non-remission group, the remission group had fewer recurrent tumors, less cavernous sinus invasion, smaller maximal tumor diameter, a higher rate of gross total resection, and lower preoperative GH and IGF1 levels, as well as lower postoperative day 1 GH, IGF1 levels, and IGF1 index (all P<0.05). Multivariate logistic regression revealed that higher postoperative GH levels (OR=1.150, 95%CI: 1.054-1.255, P=0.002), higher postoperative IGF1 index (OR=3.189, 95%CI: 1.604-6.339, P=0.001), and cavernous sinus invasion (OR=2.682, 95%CI: 1.054-6.826, P=0.038) were independent risk factors for failure to achieve biochemical remission at postoperative week 12 in this subgroup.

Recurrent tumors, higher preoperative GH levels, and subtotal resection are independent risk factors for failure to achieve biochemical remission after surgery for GH-secreting pituitary adenomas. In patients with postoperative day 1 GH≥1.0 ng/ml, postoperative high GH levels, IGF1 index, and cavernous sinus invasion may serve as early risk stratification indicators to guide individualized postoperative management.

To investigate the clinical outcomes of using a temporalis muscle-fascia flap for skull base reconstruction after endoscopic skull base ventral resection for complex skull base chordomas.

A retrospective analysis was conducted on the clinical data of 16 patients with complex skull base chordomas who underwent endoscopic skull base ventral resection at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between July 2020 and March 2025. Among them, 3 cases were primary and 13 were recurrent; 10 patients had a history of preoperative radiotherapy, and 1 patient had postoperative radiotherapy. In 4 patients with a history of radiotherapy, a planned immediate reconstruction with a temporalis muscle-fascia flap was performed after tumor resection, while 12 patients underwent flap reconstruction due to postoperative cerebrospinal fluid (CSF) leakage. Postoperative CSF leakage and related complications were assessed.

All 16 patients underwent successful skull base reconstruction. The follow-up duration ranged from 1 to 52 months, and no CSF leakage occurred again. During the perioperative period, 2 patients died from uncontrolled multidrug-resistant infections, and 2 patients developed hydrocephalus, which was alleviated after ventriculoperitoneal shunt placement. Among the 14 surviving patients, no temporalis muscle-fascia flap necrosis occurred, although all exhibited varying degrees of temporal hollowing. One patient developed choanal adhesion, resulting in nasal breathing difficulty. Two patients developed postoperative trismus, which had little effect on the quality of life after rehabilitation training.

Temporalis muscle-fascia flap reconstruction after endoscopic resection of complex skull base chordomas provides reliable therapeutic efficacy. However, given the risk of associated complications, surgical indications should be carefully evaluated.

To investigate the outcome of neuroendoscopic transnasal surgery and its influencing factors of pituitary neuroendocrine tumors (PitNETs) invading the cavernous sinus.

A retrospective analysis was conducted on the clinical data of 150 patients with PitNETs invading the cavernous sinus who were admitted to the Neurosurgery Department of the Third Affiliated Hospital of Sun Yat-sen University from January 2018 to April 2024. All patients were treated with neuroendoscopic endonasal approach (EEA). Postoperative regular follow-up was conducted to evaluate the degree of tumor resection in PitNETs patients based on imaging results, biochemical remission of functional tumors by endocrine criteria, and complications were documented. Univariate analysis and multivariate logistic regression analyses were performed to identify factors influencing surgical outcomes in patients.

The total resection rate was 78.0%(117/150), and the subtotal resection rate was 22.0% (33/150). The incidence of surgical complications was 12.0% (18/150), and the incidence of complications in patients undergoing subtotal tumor resection (24.2%, 8/33) was higher than that in patients undergoing total tumor resection (8.5%, 10/117) (χ²=4.61, P=0.032). The incidence of surgical complications in Knosp grade 4 patients (25.0%, 11/44) was higher than that in Knosp grade 3A (9.2%, 7/76) and 3B (0%, 0/30) patients (χ²=11.69, P=0.003). The results of univariate analysis showed that PitNETs patients with younger age, Knosp grade 4 tumors, reoperation, tumor toughness, complications, functional tumors, and higher adjusted scores had a lower total resection rate (all P<0.05). However, gender and age stratification were not factors affecting the degree of tumor resection in PitNETs patients (both P>0.05). The results of multivariate logistic regression analysis showed that only young age, Knosp grade 4 tumor, and higher adjusted scores were independent risk factors for subtotal tumor resection in PitNETs patients (all P<0.05). The results of univariate analysis showed that patients with functional PitNETs with Knosp grade 4 tumors, subtotal resection, and tumor toughness had lower biochemical remission rates (all P<0.05).

The EEA is an effective method for treating PitNETs patients with invasion of the cavernous sinus. Patients with Knosp grade 4 tumors and subtotal resection have a higher risk of developing complications. Younger age patients with Knosp grade 4 tumors and higher adjusted scores are more difficult to achieve complete tumor resection. Patients with functional PitNETs of Knosp grade 4, residual tumors, and tough texture have lower biochemical remission rates.

To explore the identification and preservation strategies for dangerous cortical veins during epilepsy resection surgery.

A retrospective analysis was conducted on the clinical data of 22 patients with refractory epilepsy admitted to the Department of Neurosurgery of the First Affiliated Hospital of Sun Yat-sen University from July 2022 to June 2024. All patients underwent craniotomy to remove the epileptogenic zone. Before the operation, the cerebral cortex and cortical veins were three-dimensionally reconstructed by MRI to identify the dangerous cortical veins, including the bypass veins flowing back to the dural sinus, the superficial veins of the lateral fissures, the anastomotic veins, and the cortical veins in important eloquent areas. During the operation, the above-mentioned veins were separated and protected through microscopic techniques. The patients were followed up via outpatient visits and phone calls at 1, 3, and 6 months postoperatively, and then annually thereafter. Cranial MRI scans were conducted to assess the patency of blood flow in the dangerous cortical veins, while the epilepsy control of the patients was evaluated using the modified Engel classification system.

All 22 patients obtained satisfactory three-dimensional reconstruction images before operation, including the morphology of the cerebral cortex, epileptogenic zones and cortical veins, etc., which were consistent with the intraoperative observation results. A total of 28 cortical dangerous veins were identified and protected during the operation, including 6 bridge veins (21.4%), 2 superficial Sylvian veins (7.2%), 6 anastomotic veins (21.4%), and 14 veins involving the central cortex (50.0%). Among the 28 veins, 24 (85.7%) were well protected. Four cases (14.3%) were accidentally injured during the operation, including 2 cases of central sulfamic veins, 1 case of superficial Sylvian veins and 1 case of bridge veins. After suture or compression hemostasis treatment, the venous blood flow was smooth. Postoperative head CT scans showed that none of the patients presented with symptoms such as cerebral hemorrhage, cerebral infarction or significant brain swelling. Among the 22 patients, the epileptogenic zone was completely resected in 17 cases (77.3%). Five cases (22.7%) had residual local epileptogenic zones. Muscle strength of the contralateral limb decreased in 7 cases (31.8%) within 2 weeks after the operation, which gradually recovered within 2 months after the operation. All 22 patients were followed up after the operation, with a median follow-up time duration of 12 (6-28) months. By the last follow-up, all the 28 cortical dangerous veins identified and protected during operation had unobstructed blood flow, and no venous infarction or blood flow obstruction was observed. Only 1 case had residual local sensory impairment, while the rest had no obvious neurological dysfunction. Among the patients, there were 17 cases (77.3%) of Engel grade Ⅰ, 1 case (4.5%) of grade Ⅱ and 4 cases (18.2%) of grade Ⅲ.

In epilepsy resection surgery, through the preoperative three-dimensional reconstruction technology of cortical MRI and strategic separation and protection during the operation, the dangerous cortical veins can be effectively identified and protected, reducing the risk of neurological deficits related to cerebral vein infarction post operation.

To analyze the adhesion characteristics of craniopharyngiomas and their surrounding structures, and to explore the relationship between adhesion status and treatment outcome.

Clinical data of 28 consecutive patients who underwent primary surgical resection for craniopharyngioma at the Department of Neurosurgery, West China Hospital, Sichuan University between May 2018 and June 2021 and were followed up for ≥4 years were retrospectively analyzed. Intra-operative findings and imaging features were reviewed to characterize tumor adhesion to adjacent tissues. The associations between adhesion and pituitary stalk preservation, tumor residue, and recurrence were investigated.

Adhesions were observed intraoperatively in 27 of 28 patients (96.4%). The most common adhesion sites were the pituitary stalk (96.3%, 26/27), followed by the hypothalamus (59.3%, 16/27), ventral surface of the optic chiasm (48.1%, 13/27), and Willis circle and its branches (11.1%, 3/27). In this series, 6 patients (21.4%) had only 1 adhesion site, all of which were tumor-to-pituitary stalk adhesions; 12 patients (42.9%) had 2 adhesion sites, primarily involving the pituitary stalk and hypothalamus (7 patients); 6 patients (21.4%) had 3 adhesion sites, primarily involving the pituitary stalk, ventral surface of the optic chiasm and hypothalamus (5 patients); 3 patients (10.7%) had 4 adhesion sites. Computed tomography results revealed calcifications in 7 patients (25.0%), and calcifications were detected intraoperatively in 12 patients (42.9%). Intraoperative optic chiasm injury occurred in 6 patients (21.4%), hypothalamic injury in 10 patients (35.7%), and postoperative visual acuity decreased or remained unchanged in 13 patients (46.4%). Adhesion to blood vessels caused bleeding in 2 patients (7.1%). Of the 28 patients, complete or partial preservation of the pituitary stalk was achieved in 12 patients (42.9%). Spearman rank correlation analysis between the degree of adhesion and preservation revealed a negative correlation (r=-0.43, P=0.022). Postoperative endocrine dysfunction was more common in the non-stalk preservation group (10/16) than in the partial or complete preservation group (4/12), but the difference was not statistically significant (P=0.127). The median follow-up period was 4.9 years(range: 4.1-6.2 years). At the last follow-up, residual tumor was observed in 9 patients (32.1%) and recurrence in 7 patients (25.0%). The number of intraoperative adhesion sites was associated with tumor residual (r=0.63, P<0.001) and recurrence (r=0.39, P=0.040).

This preliminary study has shown that tumor adhesions in patients with craniopharyngioma are commonly found in the pituitary stalk, hypothalamus and ventral surface of the optic chiasm. The location and degree of adhesions have a significant impact on surgical resection strategies and are associated with pituitary stalk preservation, tumor residue and recurrence.

To explore the factors influencing survival in patients with Klebsiella pneumoniae (KP) intracranial infection and to analyze the differences in survival rates among different treatment regimens.

A retrospective analysis was conducted on the clinical data of 176 patients with KP intracranial infection admitted to the Departments of Neurosurgery, Neurosurgical Intensive Care Unit and Neurology, the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2023. Based on the sensitivity of KP to carbapenem antibiotics, the patients were divided into the carbapenem-resistant KP(CRKP, 103 cases) group and the carbapenem-sensitive KP (CSKP, 73 cases) group. The clinical characteristics of the two groups were compared, and differential analysis of mortality rates was performed at 7 days, 30 days, 3 months, and 6 months after the first positive cerebrospinal fluid culture, which confirmed the etiological diagnosis. Using 30 days as the observation period for outcome, we divided the patients′ survival outcomes into the survival group (94 cases) and the death group (82 cases). Univariate Cox proportional hazards regression model analysis was conducted, and variables with P<0.01 were included in the multivariate Cox regression analysis to analyze the risk factors affecting patient death. During the 30-day observation period, based on different treatment regimens, 66 patients were divided into the intrathecal injection group (38 cases) and the intravenous group (28 cases) according to the administration route of polymyxin. Additionally, 110 patients were divided into the β-lactamase inhibitor group (89 cases) and the β-lactam group (21 cases) based on the choice of antimicrobial agents. Survival curves were drawn using the Kaplan-Meier method, and the log-rank test was used to compare survival rates between different treatment groups.

Compared with the CSKP group, the CRKP group had a younger age, lower Glasgow Coma Scale (GCS) score on admission, higher sequential organ failure assessment (SOFA) score on admission, and a higher proportion of patients with cerebral hemorrhage, neck rigidity, diabetes, bloodstream infection mechanical ventilation, used and history of intensive care unit admission. The proportion of patients with intracranial tumors was lower, cerebrospinal fluid lactate dehydrogenase levels were higher, peripheral blood leukocyte counts were higher, and the mortality rates at 7 days, 30 days, 3 months, and 6 months after diagnosis of intracranial infection were all higher; the differences were statistically significant (all P<0.05). The results of multivariate Cox regression model analysis showed that within the 30-day observation period, heart failure (HR=2.99, 95%CI: 1.36-6.59), mechanical ventilation used ≥24 h(HR=1.96, 95%CI: 1.03-3.75), CRKP (HR=2.11, 95%CI: 1.19-3.74), and high cerebrospinal fluid leukocyte count (HR=1.34, 95%CI: 1.11-1.63) were risk factors for death in patients with KP intracranial infection (all P<0.05). The Kaplan-Meier survival analysis results showed that the 30-day survival rate of patients in the polymyxin intrathecal injection group was higher than that in the intravenous group, and the β-lactamase inhibitor group was higher than the β-lactam group, with statistically significant differences (both P<0.05).

Patients with CRKP intracranial infection have higher mortality rate. Patients with heart failure, mechanical ventilation used, CRKP infection, and elevated cerebrospinal fluid leukocytes are risk factors for 30-day mortality. Both intrathecal injection of polymyxin and treatment with β-lactamase inhibitor combinations could significantly improve the survival rate of patients with KP intracranial infection.

To evaluate the efficacy of robot-assisted aspiration for brain abscess treatment.

A retrospective analysis was conducted on 32 patients with brain abscesses who underwent aspiration therapy in the Department of Neurosurgery at the First Affiliated Hospital of Zhengzhou University between January 2020 and January 2025. Among these, 21 patients received conventional image-guided aspiration (conventional group), and 11 underwent neurosurgical robotic navigation-assisted aspiration (robotic group). Comparative parameters included operative duration, incision length, postoperative hospital stay, abscess volume reduction rate, complication incidence, reoperation rate, and Glasgow Outcome Scale (GOS) score.

The median (Q₁, Q₃) incision lengths of the robotic group and the conventional group were 3.2 (3.0, 5.0) mm and 30.0 (30.0, 40.0) mm, respectively. The operation durations were 38 (32, 42) min and 49 (44, 64) min, respectively. The postoperative hospital stays were 9 (5, 20) d and 15 (13, 24) d, respectively. The reduction rates of abscess volume were (76.3±15.5)% and (59.8±26.1)%, respectively. There were statistically significant differences between the two groups (all P<0.05). There were no statistically significant differences in gender, age, preoperative abscess volume, postoperative complications, or postoperative GOS score (all P>0.05). In the conventional group, 5 patients underwent a secondary operation due to incomplete abscess clearance or poor infection control during the first operation, while there were no such cases in the robotic group. However, the difference was not statistically significant (P=0.138).

Compared to conventional image-guided localization methods, robotic-navigated aspiration of brain abscesses demonstrates superior efficacy in achieving higher volume reduction rates, minimizing tissue trauma, and shortening operative time without increasing procedure-related complications.

To characterize the molecular profiles of primary and metastatic lesions in patients with brain metastases from lung adenocarcinoma using single-cell RNA sequencing (scRNA-seq), and to investigate the potential role of downregulated surfactant protein (SFTP) expression in promoting tumor cell malignancy.

Fresh brain metastatic specimens from 7 patients with lung adenocarcinoma, including paired primary tumor samples from 3 patients, were collected at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between January 2021 and January 2022. Paired primary tumor samples were also collected from 3 of these patients. Single-cell suspensions were prepared for scRNA-seq. Public scRNA-seq data from 11 patients in the GSE131907 cohort, comprising brain metastases, primary lung adenocarcinomas and adjacent normal lung tissue, were integrated for dimensionality reduction, clustering, and differential expression analysis. Bulk RNA-seq data from 530 lung adenocarcinoma cases in The Cancer Genome Atlas (TCGA) were stratified into high- and low-expression groups according to the median mRNA levels of target genes, and univariate Cox regression was performed to assess prognostic relevance. For the 3 paired cases, differential expression and pseudotime trajectory analyses were conducted, followed by functional enrichment of identified genes.

Tumor cells from both primary and brain metastatic sites clustered primarily by patient origin, revealing significant expression heterogeneity both between tumors from different patients and within tumors from the same patient. Compared to normal lung epithelium, primary lung adenocarcinoma and brain metastases, the expression levels [median (Q₁, Q₃)] of surfactant proteins SFTPB [12.2 (11.1, 13.3), 10.1 (7.9, 11.2), 1.5 (0, 3.1)], SFTPC [12.3 (10.8, 13.2), 7.0 (5.0, 8.0), 0.5 (0, 1.0)], and SFTPD [9.5 (8.9, 10.3), 5.1 (1.9, 7.3), 0.5 (0, 1.3)] exhibited a stepwise downregulation from normal lung epithelium to primary tumor to brain metastasis (all P<0.001). Low expression of these proteins correlated with significantly worse overall survival, with shorter median survival times observed in the low-expression groups for all three genes (all P<0.05). In the paired single-cell analysis, N-myc downstream regulated genel(NDRG1) was consistently upregulated in brain metastatic tumor cells. Pseudotime analysis suggested that decreased SFTP expression coincided with NDRG1 upregulation, alongside enrichment of tumor-promoting pathways including HIF1 signaling and NF-κB signaling activation.

SFTP may inhibit tumor progression by restraining NDRG1-mediated microenvironmental remodeling. Their downregulation may facilitate the malignant transformation and progression of lung adenocarcinoma cells during brain metastasis.

The clinical data of 3 children with high-flow pial meningeal arteriovenous fistula undergoing endovascular treatment were retrospectively analyzed. All three children were diagnosed by whole brain digital subtraction angiography. The fistulas were located in the convex surface of the brain, suprasellar area and posterior cranial fossa, respectively. The venous ends of the fistulas were all aneurysms with a diameter of 2~4 cm. Two children underwent balloon-assisted coil + Onyx glue embolization, and one received simple coil embolization. All three children achieved imaging cure (fistula disappeared) and recovered well after operation. One case developed local cerebral edema around the lesion, which was relieved after anticoagulation treatment and blood pressure control. Three children were followed up by imaging at 19, 12 and 24 months postoperatively, and there was no recurrence of the lesions.

Intracranial teratoma is a rare central nervous system tumor in the histological classification of intracranial germ cell tumors. Its most common site of onset is the pineal region, followed by the sellar, parasellar or ventricular system. In August 2024, the Department of Neurosurgery of the Second Hospital of Lanzhou University treated a patient with irregular mass occupying space in the right cerebellar hemisphere. After surgical resection, he was pathologically diagnosed as mature cystic teratoma. After 3 months follow-up, the patient was in good health and no tumor recurrence was observed.

Glioblastoma is the most common primary malignant tumor in the cranium, with high malignancy and poor prognosis. Multimodal treatment strategies for glioblastoma are still being continuously explored. Laser interstitial hyperthermia, as an emerging minimally invasive treatment technology, has gradually attracted attention in the treatment of neurosurgical diseases such as intracranial tumors in recent years. This paper reviews the research progress of the mechanism, safety and effectiveness of laser interstitial hyperthermia in the treatment of glioblastoma, and prospects for future research directions, aiming at providing new ideas and basis for the treatment of this disease.

Macrophages play an important role in a variety of physiological and pathological processes, with prominent features of plasticity and functional polarization. Cellular senescence is a ubiquitous and dynamic complex phenomenon in the body. Its main characteristics include persistent cell cycle arrest and chronic inflammatory response. In recent years, the role of macrophage senescence in glioma microenvironment has become a hot research topic. As the key immune cells in the microenvironment of glioma, macrophages have a great influence on the progression of glioma malignancy through the secretion of senescence-related secretory phenotype molecules. In this paper, the role of macrophage senescence in glioma and its research progress are reviewed.