Volume 41 · Issue 11 · 2025

As an important branch of neurosurgery, skull base surgery is based on fine anatomy and superb surgical skills, and its core lies in the inheritance and continuous improvement of surgical techniques. Among them, the strategies of "first and later", "take and give up" and "advance and retreat" are the decision-making ideas that condense the long-term clinical practice of neurosurgery, and are still the fundamental principles that guide complex surgical operations. In recent years, new technologies such as neuroendoscopy, intraoperative imaging, neuronavigation, artificial intelligence, robotics and three-dimensional modeling have emerged continuously, driving the rapid development of skull base surgery. The integration of traditional strategies and technological innovation has promoted continuous breakthroughs in this field in multiple dimensions such as surgical safety, efficacy and innovation. It is foreseeable that under the joint drive of inheritance and innovation, skull base surgery will surely move towards a broader future.

To investigate the therapeutic efficacy of encephalo-duro-arterio-synangiosis (EDAS) and encephalo-duro-muscular-synangiosis (EDMS) in the treatment of pediatric moyamoya disease.

A prospective study was conducted on pediatric patients with moyamoya disease who underwent surgical treatment in the Department of Neurosurgery at Children′s Hospital of Fudan University from January 2020 to December 2022. The patients were divided into EDAS group and the EDMS group based on the type of surgery. Preoperative, intraoperative, and postoperative clinical indicators were compared between the two groups. Transient ischemic attacks (TIA) within one week postoperatively and subdural hemorrhage were used as short-term efficacy indicators, while clinical symptom improvement and changes in the modified Rankin Scale (mRS) score were used as long-term (>2 years) efficacy indicators.

A total of 75 patients (128 hemispheres) were enrolled into the study. The EDAS group consisted of 23 patients (42 hemispheres), while the EDMS group had 52 patients (86 hemispheres). Compared with the EDAS group, the EDMS group had shorter operative time duration, larger cranial window area, higher daily drainage volume, longer duration of fever, longer longer hospital stay, and higher incidence of TIA within one week postoperatively [23.08% (12/52) vs. 4.35% (1/23)], and all the differences were significant (all P<0.05). There were no statistically significant differences between the two groups in intraoperative or postoperative blood transfusion, postoperative negative pressure drainage duration, peak body temperature, or incidence of subdural hemorrhage (all P>0.05). The follow-up duration was 40.81±10.83 months for the EDAS group and 42.56±8.60 months for the EDMS group (P=0.464). At the last follow-up, there were no statistically significant differences between the two groups in changes in moyamoya vessels, the mRS scores, or clinical symptoms compared to preoperative conditions (all P>0.05). Among the 128 hemispheres, 115 did not experience TIA within one week postoperatively, while 13 did. Compared with the non-TIA group, the TIA group had a longer duration of negative pressure subcutaneous drainage, higher peak body temperature, longer duration of fever, larger cranial window area, and a higher proportion of postoperative subdural hemorrhage, and all the differences were significant (all P<0.01). Multivariate logistic regression analysis revealed that the cranial window area (OR=1.067, 95%CI: 1.016-1.121, P=0.010) and subdural hemorrhage (OR=28.999, 95%CI: 2.881-291.898, P=0.004) were risk factors associated with the occurrence of TIA postoperatively.

Both EDAS and EDMS indirect revascularization procedures are effective in the long-term treatment of pediatric moyamoya disease. The higher incidence of TIA within one week postoperatively in the EDMS group may be related to the larger cranial window area and the occurrence of subdural hemorrhage.

To investigate the safety and efficacy of the superior ophthalmic vein (SOV) approach in treating cavernous sinus dural arteriovenous fistulas (CS-DAVFs) with inferior petrosal sinus (IPS) occlusion.

Clinical data of 47 patients with IPS-occluded CS-DAVFs treated via the transfemoral vein-SOV approach in the Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to September 2024 were retrospectively analyzed. All patients underwent clinical and angiographic follow-up. The primary outcome measures were the immediate postoperative and follow-up embolization rates. Secondary outcome measures included perioperative complications, procedure duration, amount of embolization material used, recurrence rate, mortality, and disability rate.

All procedures were technically successful, achieving an immediate complete embolization rate of 93.6% (44/47). Perioperative complications occurred in 6.4% (3/47) of cases. The mean operative duration was 130.2±57.5 mins (range: 45-325 mins), with an average consumption of 1.3±1.1 coils (range: 0-5 coils) and 2.0±1.3 ml (range: 0.3-5.5 ml) Onyx per patient. All patients completed clinical follow-up, with a median follow-up time duration of 18 months (range: 6-84 months). At the last follow-up, ocular symptoms were significantly alleviated in all 47 patients. There were no cases of procedure-related mortality, permanent disability, or major neurological complications. Among them, 46 patients underwent imaging follow-up. Digital subtraction angiography at the final follow-up showed a complete embolization rate of 100%(46/46).

For patients with CS-DAVF with IPS occlusion, endovascular embolization via the femoral vein-superior ophthalmic vein approach has a high complete embolization rate and favorable outcomes, and can be used as an effective key alternative.

To investigate the factors influencing vascular luminal dilatational remodeling (VLDR) after drug-coated balloon angioplasty (DCBA) for intracranial atherosclerotic stenosis (ICAS).

A total of 92 patients with ICAS who underwent DCBA at the Cerebrovascular Department of Interventional Center, Zhengzhou University People′s Hospital between January 2019 and February 2024 were retrospectively enrolled. Digital subtraction angiography was performed preoperatively, immediately post operation, and at the 6-month follow-up to assess reference vessel diameter, minimal lumen diameter at the lesion site, stenosis degree, and the presence of VLDR. Based on VLDR status at the 6-month follow-up, all patients were divided into a VLDR group and a non-VLDR group. Baseline characteristics, intraoperative balloon usage, and postoperative lesion-related features were compared between the two groups. Multivariate logistic regression analysis was performed to identify factors associated with the occurrence of VLDR after DCBA treatment ICAS.

Twenty-seven patients were classified into the VLDR group and 65 patients into the non-VLDR group. There were no statistically significant differences between the two groups in baseline characteristics, including gender, age, lesion location before treatment, preoperative stenosis degree, or intraoperative balloon parameters such as the diameter of the predilation balloon or the drug-coated balloon (all P>0.05). Compared with the non-VLDR group, the VLDR group exhibited a higher immediate postoperative stenosis degree, a larger minimal lumen diameter of the target vessel at follow-up, a lower stenosis degree at follow-up, and a higher degree of stenosis reduction, all of which were statistically significant (all P<0.05). No significant differences were observed in the immediate postoperative minimal lumen diameter at the lesion site, follow-up duration, or reference vessel diameter at follow-up (all P>0.05). Multivariate logistic regression revealed that a higher immediate postoperative stenosis degree (OR=1.06, 95%CI: 1.01-1.11, P=0.009) could promote the occurrence of VLDR after DCBA treatment ICAS, while the history of diabetes(OR=0.27, 95%CI: 0.08-0.93, P=0.038)was not conducive to VLDR.

The high rate of vascular stenosis immediately after operation can promote the occurrence of VLDR after DCBA treatment of ICAS, while diabetes seems unfavorable to VLDR.

To compare the efficacy and safety of different flow diverter devices (FD) in the treatment of unruptured intracranial aneurysms(UIAs) , and to explore the risk factors of in-stent stenosis (ISS).

A retrospective analysis was conducted on the clinical data of patients with UIAs treated with FD implantation at the Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from August 2022 to August 2024. The immediate stent apposition status after FD implantation was evaluated based on intraoperative high-resolution flat-detector computed tomography(HR-FDCT) reconstructed images. The degree of aneurysm occlusion was assessed using the O′Kelly-Marotta (OKM) grading system. The perioperative complications associated with different brands of FD were observed and recorded, and the improvement in neurological function symptoms was assessed postoperatively and during follow-up using the modified Rankin scale (mRS) score. Clinical and imaging follow-up was conducted after the operation. The degree of complete occlusion of the aneurysm and the patency rate of the stent were evaluated based on the last digital subtraction angiography(DSA) follow-up. Univariate analysis and multivariate logistic regression analysis were employed to explore the possible factors influencing ISS.

A total of 117 patients (148 aneurysms) were included in this study, with 117 FD implants performed. Among them, 67 cases were treated with Tubridge FD (referred to as the TB group), 33 cases with Fred FD(referred to as the Fred group), and 17 cases with Nuva FD (referred to as the Nuva group). The HR-FDCT results showed that 11 cases had mild to moderate stent malapposition, including 7 cases of Type Ⅰ and 4 cases of Type Ⅱ. There were no statistically significant differences among the three groups of patients in terms of general data such as age and gender, preoperative comorbidities, aneurysm characteristics, parent artery characteristics, FD characteristics, preoperative mRS scores, and the proportion of incomplete FD apposition (all P>0.05). The mRS scores of the three groups before discharge were 1.06±0.43, 1.12±0.42, and 1.03±0.35, respectively, with no statistically significant differences among the groups (P=0.528). Acute in-stent thrombosis occurred perioperatively in 8 patients (including 4 cases in the TB group, 2 in the Fred group, and 2 in the Nuva group). After symptomatic treatment, such as microcatheter-directed thrombolysis or balloon dilation, the in-stent blood flow was restored. No statistically significant differences were found among the three groups (P=0.690). All 117 patients were followed up either through outpatient visits or by phone. The follow-up period was 7.28±1.43 months (range: 3-12 months). The mRS scores of TB, Fred and Nuva group at the last follow-up were 1.06±0.43, 1.03±0.39 and 1.07±0.36 respectively, and there was no statistically significant difference (P=0.861). All patients underwent DSA follow-up, with a follow-up period ranging from 6 months to 24 months, with an average of 9.27±2.28 months. The last imaging follow-up showed complete occlusion of 117 (79.1%)aneurysms (OKM grade D), and minimal contrast agent remnants at the aneurysm neck in 31 (20.9%) aneurysms (OKM grade C). No statistically significant differences were observed among the three groups (P=0.670). In 13 patients, in-stent stenosis was observed with an average stenosis rate of (59.15±9.30)% (range: 50%-85%), including 7 cases in the TB group, 4 in the Fred group, and 2 in the Nuva group. However, no statistically significant difference was identified among the three groups (P=0.966). The results of univariate analysis and multivariate logistic regression analysis showed that poor stent apposition, a parent artery diameter ratio>1.2, smoking, and diabetes were independent risk factors for in-stent stenosis (all P<0.05).

Treatment of UIAs with different brands of FD demonstrates high efficacy and safety with no significant differences. Diabetes, poor stent apposition during the procedure, artery diameter ratio>1.2, and smoking are independent risk factors for in-stent stenosis after FD implantation.

To investigate the risk factors associated with poor prognosis after decompressive craniectomy (DC) in patients with malignant brain edema (MBE) secondary to endovascular thrombectomy for acute ischemic stroke (AIS).

A total of 69 patients with acute ischemic stroke (AIS) who underwent decompressive craniectomy (DC) following malignant brain edema (MBE) after endovascular thrombectomy at Department Intensive care Medicine, Lishui Central Hospital between February 2018 and March 2023 were included. All patients had large vessel occlusion in the anterior circulation. Based on the modified Rankin Scale (mRS) scores at discharge, patients were divided into the favored outcome group (mRS: 0-3) and unfavored outcome group (mRS: 4-6). Baseline characteristics, clinical, laboratory test and imaging data before thrombectomy, after thrombectomy and after DC were retrospectively compared between the two groups. Variables with statistically significant differences (P<0.05) were included in a multivariate logistic regression model to identify independent risk factors for poor prognosis.

Among the 69 patients, 37 were in the unfavored group and 32 in the favored outcome group at discharge. Compared with the favored outcome group, the unfavored outcome group had older age, lower pre-thrombectomy body temperature, higher prevalence of atherosclerosis, larger volumes of brain tissue with time-to-peak > 6 s on CT angiography (CTA), and larger ischemic penumbra volume. Post-thrombectomy CT showed a higher proportion of patients with grade 1 cisternal compression, greater midline shift, and shorter time from thrombectomy to cerebral herniation. After DC, the poor prognosis group had higher levels of serum high-sensitivity C-reactive protein, neuron-specific enolase, D-dimer, and sodium, as well as higher incidences of coma, severe disability. All these differences were statistically significant (all P<0.05). Multivariate logistic regression analysis revealed that advanced age (OR=1.140, 95%CI: 1.036-1.255, P=0.007), larger ischemic penumbra volume before thrombectomy (OR=1.031, 95%CI: 1.012-1.051, P=0.002), grade Ⅰ cisternal compression after thrombectomy (OR=16.392, 95%CI: 2.222-120.956, P=0.006), and elevated serum C-reactive protein after DC (OR=1.031, 95%CI: 1.010-1.053, P=0.003) were independent risk factors for poor prognosis after DC in AIS patients with MBE secondary to thrombectomy.

Poor prognosis after DC in AIS patients with MBE secondary to thrombectomy is closely associated with advanced age, large ischemic penumbra, severe cisternal compression, and postoperative inflammatory response.

To evaluate the efficacy and safety of endovascular treatment for chronic intracranial internal carotid artery occlusion.

A retrospective analysis was conducted on the clinical data of 8 patients with chronic intracranial internal carotid artery occlusion who underwent endovascular treatment in the Department of Neurosurgery of General Hospital of Northern Theater Command from January 2022 to July 2025. All patients underwent digital subtraction angiography (DSA) before the operation. According to the DSA results, the patients were divided into residual stump type and non-residual stump type, and the surgical efficacy of patients of different types was analyzed. Patients were followed up through outpatient or inpatient visits at 3 and 6 months after the operation. The results of DSA or CT angiography of the patients were documented to evaluate vascular patency and their clinical outcomes at the same time.

All 6 patients with residual stump type were successfully recanalized after the surgery, while none of the 2 patients without residual stump type was successfully recanalized after the surgery. No serious complications such as ischemic or hemorrhagic stroke occurred during the perioperative period. Among them, one patient with non-residual stump type experienced ophthalmic artery spasm during the operation, while the postoperative vision was not affected. All 8 patients were followed up, and the follow-up period was 4.5±1.1 months (range: 3-6 months). By the last follow-up, the internal carotid arteries of all 6 patients with residual stump type were unobstructed, with no stenosis or re-occlusion. All clinical symptoms disappeared, achieving a curative effect. The intravascular occlusion conditions of the two non-stump type patients remained unchanged. One case showed improvement in symptoms after taking the medicine, while the other case was ineffective.

For patients with residual stump type chronic intracranial internal carotid artery occlusion, endovascular treatment is a safe and effective treatment method. For patients with non-residual stump type, endovascular treatment is more difficult and has a lower success rate.

To investigate the correlation between neuronal injury markers and prognosis of aneurysmal subarachnoid hemorrhage (aSAH), and to explore the predictive value for clinical outcomes.

A retrospective study was conducted on 215 patients with aSAH admitted to the Department of Neurosurgery, Henan Provincial People′s Hospital between May 2023 and December 2024. Serum and cerebrospinal fluid levels of glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), S100 calcium binding protein B (S100B), neuron-specific enolase (NSE), and myelin basic protein (MBP) were measured at 1, 2, 3 and 7 days post onset. All patients underwent 6-month follow-up. Based on Glasgow Outcome Scale-Extended scores, patients were categorized into favorable prognosis (score Ⅴ-Ⅷ) and unfavorable prognosis (score Ⅰ-Ⅳ) groups. Differences in relevant clinical data and serum/cerebrospinal fluid neuronal injury markers between groups were compared. Indicators with P<0.1 were incorporated into a multivariate logistic regression model to analyze the correlation between neuronal injury markers and prognosis in aSAH patients. Receiver operating characteristic curves were plotted and area under the curve (AUC) calculated to evaluate the predictive efficacy of neuronal injury markers for prognosis in aSAH patients.

Among 215 patients, 134 (62.3%) were assigned to the favorable prognosis group and 81 (37.7%) to the unfavorable prognosis group. Levels of all five neuronal injury markers were consistently higher in the unfavorable prognosis group at each time point compared with the favorable prognosis group (all P<0.05). Multivariate logistic regression analysis revealed that elevated levels of all five neuronal injury markers were associated with poor patient prognosis (all P<0.05). The AUC for predicting patient prognosis based on elevated serum GFAP, UCH-L1, S100B, NSE, and MBP levels on day 1 post-onset was 0.57, 0.65, 0.73, 0.74, and 0.74, respectively. The combined AUC for predicting prognosis using all five neuronal injury markers was 0.90.

Elevated levels of neuronal injury markers in serum and cerebrospinal fluid following onset are correlated with poor prognosis in patients with aSAH. Combined assessment of five neuronal injury markers significantly enhances predictive efficacy for patient outcomes.

To investigate the efficacy of robot-assisted stereotactic puncture in the treatment of basal ganglia hemorrhage.

The clinical data of 65 patients with basal ganglia hemorrhage (hematoma volume of 10-30 ml) admitted to the Department of Neurosurgery of Guiqian International General Hospital from January 2022 to December 2024 were retrospectively analyzed. According to the treatment method, patients treated with robot-assisted stereotactic puncture were categorized into the surgical group (30 cases), and those treated with conservative medication into the control group (35 cases). Head CT examination was performed before, 3 days and 7 days after treatment, and the amount of hematoma in the basal ganglia area was accurately calculated by artificial intelligence software. The National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the neurological functions of the patients. The baseline data, hematoma amount, neurological function, modified Rankin scale (mRS) score at 7 days after treatment, complications and length of hospitalization were compared between the two groups.

There were no significant differences in age, gender, or Glasgow Coma Scale score at admission between the two groups (all P>0.05). Repeated analysis of variance showed that the overall hematoma volume in the surgical group was lower than that in the control group, and surgical intervention accelerated hematoma clearance (both P<0.001). There was no significant difference in hematoma volume between the surgical group and the control group at admission (21.8±2.1 ml vs. 21.3±3.6 ml, P=0.554). The amount of hematoma decreased to 1.2±1.0 ml in the surgical group and 18.0±4.0 ml in the control group at 7 days after treatment. In terms of neurological function, the overall NIHSS score of the surgical group was higher than that of the control group, and the neurological function recovery of the surgical group was faster (all P<0.05). The NIHSS score of the patients in the surgical group at admission was higher than that of the control group (18.3±4.8 points vs.12.2±3.8 points, P<0.001). The NIHSS score of the surgical group was lower than that of the control group at 7 days after treatment (5.9±2.5 points vs. 7.6±3.4 points, P=0.026). There was no significant difference in the mRS score at 7 days after treatment, or the incidences of postoperative pneumonia and deep vein thrombosis between the two groups (all P>0.05). The hospitalization time of the patients in the surgery group was shorter than that in the control group (12.1±2.7 d vs. 14.1±2.5 d, P=0.003).

For patients with moderate basal ganglia bleeding with neurological dysfunction, robot-assisted stereotactic puncture can relieve the hematoma compression of functional areas in time, promote early recovery of neurological function, and shorten the length of hospital stay.

To investigate the application effect of privacy-preserving transfer learning technology in building an intracranial electroencephalogram (EEG) spike signal recognition model for patients with temporal lobe epilepsy.

Public intracranial EEG data from 39 patients with drug-resistant epilepsy were collected from two source domain hospitals: St. Anne′s University Hospital (FNUSA, 14 cases) and Mayo Clinic (MAYO, 25 cases). These data were used as the source domain to train a spike signal recognition model based on a dual-branch time-frequency fusion network (DTSF model) constructed using convolutional and recurrent neural networks. Additionally, 10 patients with drug-resistant temporal lobe epilepsy treated at the Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China (USTC) between September and October 2022 were included. Their stereoelectroencephalography (SEEG) data (referred to as the USTC dataset) were used as the target domain. Interictal intracranial EEG recordings from all patients were annotated by experienced EEG specialists to identify spikes and normal EEG signals, serving as the gold standard for evaluation. Two source-free domain adaptation techniques for privacy-preserving transfer learning— Privacy-Preserving Domain Adaptation (PPDA) and Neighborhood Uncertainty and Diversity (NUD)— were applied to optimize the model, resulting in the DTSF-PPDA and DTSF-NUD models. The performance of the DTSF, DTSF-PPDA, and DTSF-NUD models in spike detection was evaluated using the USTC dataset. Recall, precision, and F1-score were used as evaluation metrics, and repeated-measures ANOVA was employed to compare the performance of the three models.

Repeated-measures ANOVA showed that compared to the DTSF and DTSF-PPDA models, the DTSF-NUD model achieved higher recall [(86.11±6.04)% vs. (66.49±16.79)% and (74.20±10.62)%], precision [(92.63±4.09)% vs. (86.55±8.17)% and (81.92±14.81)%], and F1-score [(89.14±4.25)% vs. (74.21±12.88)% and (77.58±11.90)%], with all differences being statistically significant (all P<0.05). Compared to the DTSF model, the DTSF-PPDA model showed higher recall and F1-score but lower precision, with all differences being statistically significant (all P<0.05).

Privacy-preserving transfer learning based on source-free domain adaptation can improve the performance of deep learning models in SEEG spike signal recognition at target domain hospitals while effectively protecting the privacy of medical data from source domain hospitals.

To compare and analyze the efficacy of fludrocortisone in the treatment of cerebral salt wasting syndrome (CSWS).

A retrospective study was conducted on 107 patients with acute brain injury (ABI) who developed hyponatremia due to CSWS in the Department of Neurosurgery at Shanghai Tenth People′s Hospital between December 2014 and February 2025. Among them, 31 patients were treated with hypertonic saline alone (hypertonic saline group), 32 were treated with hypertonic saline plus cortisone acetate (cortisone acetate group), and 28 were treated with hypertonic saline plus fludrocortisone (fludrocortisone group). Additionally, 16 patients whose conditions responded poorly to cortisone acetate were switched to fludrocortisone treatment. The target for serum sodium correction was set at >140 mmol/L. Serial measurements of serum sodium levels were obtained daily (from day 1 to day 7) to evaluate the dynamics of its increase under different treatment regimens. A further comparison was made between the fludrocortisone and cortisone acetate groups regarding clinical and laboratory parameters, complications, and the serum sodium achievement rate before and after treatment. Kaplan-Meier curves were plotted to assess the time taken for the two groups to reach the target sodium level. A P-value of <0.05 was considered statistically significant.

After 7 days of treatment, the serum sodium levels in the fludrocortisone, cortisone acetate, and hypertonic saline groups were 142.1±1.2 mmol/L, 138.8±2.3 mmol/L, and 135.4±1.7 mmol/L, respectively. The difference in the increase of serum sodium levels among the three groups was statistically significant (F=27.11, P<0.001). In the 16 patients who switched from cortisone acetate, the serum sodium level was 137.4±1.1 mmol/L after 7 days of initial treatment and increased to 143.5±0.7 mmol/L after 7 days of fludrocortisone treatment. Before treatment, there were no statistically significant differences between the two groups (fludrocortisone vs. cortisone acetate) in serum sodium, serum potassium, 24-hour urine volume, or urinary sodium concentration (all P>0.05). After 7 days of treatment, compared with the cortisone acetate group, the fludrocortisone group had higher serum sodium levels and cumulative potassium supplementation, but lower 24-hour urine volume, urinary sodium, and cumulative sodium supplementation (all P<0.05). The serum sodium achievement rate on day 7 was 92.8% (26/28) in the fludrocortisone group, compared to 53.1% (17/32) in the cortisone acetate group. Kaplan-Meier analysis showed that the fludrocortisone group reached the target sodium level earlier than the cortisone acetate group, with median achievement times of 5 days and 7 days, respectively (log-rank: χ²=26.52, P<0.001). The incidence of hypokalemia was 28.6% (8/28) in the fludrocortisone group, compared to 12.5% (4/32) in the cortisone acetate group (P=0.047). After reaching the target sodium level, the rate of recurrent hyponatremia was 34.4% (11/32) in the cortisone acetate group, significantly higher than the 14.3% (4/28) in the fludrocortisone group (P=0.045).

Fludrocortisone can rapidly and effectively correct and help maintain stable serum sodium levels in ABI patients with CSWS-induced hyponatremia. However, hypokalemia is a common adverse reaction associated with its use.

To investigate the anatomical landmarks of the positional sign of the suboccipital segment of the occipital artery and its significance in surgery.

The suboccipital muscles were dissected layer by layer from superficial to deep on 10 cadaveric heads (20 sides) fixed with 10% formalin to observe the levels of the occipital artery and its anatomical relationship with the muscles and sutures. The imaging of patients (60 cases, 120 sides) who visited the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023 and underwent enhanced MRI scans were retrospectively analyzed. The length of the suboccipital segment of the occipital artery was measured on the cadaveric heads, and the diameter of artery at the starting and ending points of this segment was measured on the specimens and on the MRI of the skull.

The dissection of 10 cadaveric showed that the suboccipital segment of the occipital artery ran through the three layers of muscles in the suboccipital region from deep to shallow. Deep layer: the posterior belly of the digastric muscle, the lateral rectus muscle of the head and the superior oblique muscle were used as landmarks. The suboccipital segment of the occipital artery on the 20 sides of the specimens ran medially to medial side of the posterior belly of the digastric muscle, laterally to the lateral side of the superior oblique muscle, laterally to the lateral side of the lateralus muscle of the head, and medially to the medial side of the digastric groove; 9 specimens of the suboccipital segment of the occipital ran medially to the medial side of the occipitomastoid suture, and 11 ran laterally. Middle layer: the longest muscle of the head was used as an anical landmark, and the occipital artery was mostly located deep to the longest muscle of the head (19/20), where the occipital artery was surrounded the petrosal partition and was often adjacent to the sigmoid sinus. Superficial layer: the tendon sheath of the sternocleidomastoid muscle was used as a landmark. The length of the suboccipital segment the occipital artery was 66.88±5.46 mm, the diameter at the starting point was 2.99±0.63 mm, and the diameter at the ending point was 1.94±0.48 mm. The results of the imaging anatomy measurement showed that the diameter at the point of the suboccipital segment of the occipital artery was 2.61±0.37 mm and the diameter at the ending point was 1.96±0.37 mm in 60 cases (120 sides) of the subjects.

Familiarizing the local anatomy of the occipital segment of the occipital artery and establishing a method of spatial stratified anatomical positioning of the occipital artery with muscles and bony anatomical such as the longest muscle of the head, the superior oblique muscle, and the occipitomastoid suture could facilitate quick and effective separation and obtaining of the occipital artery in the suboccipital lateral approach.

To explore the enhanced effect of atorvastatin on the killing effect of natural killer (NK) cells on glioma cells and the related molecular mechanisms.

NK cells derived from human peripheral blood were obtained by Ficoll density gradient centrifugation and co-cultured with U87 glioma cells. They were divided into the U87+ NK group and the U87+ NK+ atorvastatin group based on whether atorvastatin intervention was used. The changes in the morphology and cell characteristics of NK cells before and after atorvastatin intervention were observed by electron microscopy and fluorescence microscopy. The cytotoxic activity of NK cells against glioma cells before and after intervention was determined by the CCK8 assay. The secretion levels of tumor necrosis factor-α (TNFα), interferon-γ (IFNγ), granzyme B (GzmB) and the changes of NK cell activation markers before and after the intervention were detected by flow cytometry, enzyme-linked immunosorbent assay (ELISA) and quantitative PCR (qPCR).

Primary cultured NK cells were successfully obtained from peripheral blood. After co-culturing NK cells with glioma cells for 3 days, the proportion of CD56⁺ CD16⁺ NK cells decreased significantly from 89.97% to 25.33%. Moreover, the immunological synapses of NK cells are significantly reduced. All different concentrations of atorvastatin (1.25-40.00 μmol/L) could promote the proliferation of NK cells (all P<0.05), among which the 10.00 μmol/L concentration had the most obvious effect on NK cells (P<0.001). Compared with the U87+ NK group, the secretion levels of TNFα, IFNγ and GzmB of NK cells in the U87+ NK+ atorvastatin group were all higher (all P<0.05). Flow cytometry detection showed that the proportion of CD56⁺ CD16⁺ NK cells in the U87+ NK+ atorvastatin group was higher than that in the U87+ NK group (P<0.05). The qPCR results showed that the expression level of natural killer rroup 2, member D in NK cells in the U87+ NK+ atorvastatin group was higher than that in the U87+ NK group, while the expression level of T-cell immunoglobulin and mucin-domain containing protein 3 was lower (both P<0.05). Moreover, the number of NK cell immune synapses in the U87+ NK+ atorvastatin group was higher than that in the U87+ NK group (P<0.05). ELISA experiments showed that at 3 days of co-culture, compared with the U87+ NK group, the U87+ NK+ atorvastatin group secreted higher levels of TNFα, IFNγ and GzmB (all P<0.05).

Atorvastatin can effectively enhance the killing effect of NK cells on glioma cells, which may be related to the fact that atorvastatin can promote the generation of immune synapses of NK cells and the secretion of various cytokines.

Intracranial cavernous malformation is one of the common intracranial vascular malformations, but extracerebral cavernous malformation occurring in the posterior cranial fossa is very rare. The Department of Neurosurgery of Beijing Tsinghua Chang Gung Memorial Hospital affiliated to Tsinghua University performed surgery in March 2024 to treat a patient with extracerebral cavernous malformation of the posterior cranial fossa. Postoperatively, the vascular malformation was totally resected without related complications. Five months after surgery, the patient recovered well without recurrence.

Hemangioblastoma (HB) is relatively rare clinically, and HB in the supratentorial, especially in the sellar region, is even rarer, and its surgical difficulty and risk are high. In December 2023, the Neurotumor Disease Diagnosis and Treatment Center of Shiyan Taihe Hospital affiliated to Hubei Medical College treated a patient with parenchymal HB in the right sellar area. Right pterional craniotomy was performed to remove the tumor through Dolenc approach. Postoperative reexamination of the skull MRI showed that the tumor was completely resected without new neurological dysfunction. HB was confirmed by pathological examination after surgery. The Karnofsky functional status score was 100 at 3 months postoperative follow-up.

Pleomorphic rhabdomyosarcoma is a special subtype of soft tissue malignant tumor rhabdomyosarcoma, which is highly aggressive and has poor prognosis, and is more common in adults. In March 2023, a patient with right temporal pleomorphic rhabdomyosarcoma with TP53 mutation was admitted to the Department of Neurosurgery, Zhuji Hospital affiliated to Wenzhou Medical University, with a previous history of mediastinal immature teratoma for 3 years. The tumor showed invasive growth during the operation, involving the right temporal muscle, skull and intracranial. After most of the tumor was resected, the patient recovered well with temozolomide + doxorubicin + ifosfamide chemotherapy and whole brain radiotherapy. The enhanced MRI of the head was reexamined 15 months after operation, and no tumor recurrence was found.

Brainstem glioma (BSG) has high surgical risks and poor prognosis for patients, and it is urgent to develop new therapeutic methods. Convection-enhanced drug delivery (CED) refers to the technique of delivering drugs directly to the interior of a tumor through sustained pressure, effectively increasing the concentration of drugs within the tumor while reducing their systemic distribution. For BSG that cannot be surgically resected, clinical studies on the delivery of traditional chemotherapy drugs, radionuclide drugs, oncolytic viruses, etc. through CED have been carried out internationally, and its safety and effectiveness have been preliminarily demonstrated. However, the drug selection, coverage and dynamic monitoring of CED in the treatment of BSG still need further improvement. This article introduces the current status of clinical diagnosis and treatment of BSG and the basic principles of CED, reviews and summarizes the previous clinical trials, and discusses the current challenges related to CED treatment, in order to provide reference for the design of follow-up clinical research.

Pituitary neuroendocrine tumors (PitNETs) are common benign tumors in the central nervous system, accounting for 15% of all CNS tumors. PitNETs can cause a variety of clinical symptoms by compressing adjacent brain tissue and excessive hormone secretion. PitNETs can be divided into two categories, namely non-functional PitNETs (NF-PitNETs) and functional PitNETs (F-PitNETs). This article will review the pathogenesis of NF-PitNETs and F-PitNETs, respectively, in order to provide new directions and strategies for early clinical detection, molecular typing and individualized targeted therapy of PitNETs.

Macula coerulea is a nucleus dominated by noradrenergic neurons in the brainstem, which is involved in the regulation of arousal, attention, and stress response through its extensive central projection. Its released norepinephrine can lead to different functional states of the body through different receptor-mediated effects, among which autonomic dysfunction is mainly manifested by sympathetic-parasympathetic imbalance. In recent years, neuromodulation technology has become a new strategy for treating autonomic dysfunction by changing the synaptic plasticity of neurons and regulating the release of transmitters. However, there is still a lack of research on the mechanism of coerulea in autonomic function homeostasis, especially in terms of its internal structure and external projection. This review will explore the role of coerulea in the maintenance of autonomic nerve function homeostasis from the anatomical position, internal composition and external connection of coerulea, analyze the influence of coerulea dysfunction on autonomic nerve under disease state, and review the potential mechanism and clinical application prospect of neuromodulation technology in the treatment of autonomic nerve dysfunction by targeting coerulea.

Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy, carotid stenting and intracranial and extracranial vascular bypass grafting. Early recognition and perioperative multimodal monitoring are the key to prevent CHS. In this paper, the research progress of existing CHS prediction methods is described in detail from the aspects of imaging technology, ultrasound technology and biomarkers.