Volume 41 · Issue 12 · 2025

Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke, but its endovascular treatment still faces many challenges. This article analyzes the successful experience of drug-eluting stents in the treatment of coronary artery stenosis, and explores its potential translational value in the treatment of ICAS. Drawing on the collaborative development model of "device innovation-surgical optimization-evidence accumulation" in coronary artery stenosis and overcoming the technical challenges brought by the particularity of intracranial vascular anatomy, the drug-device combination strategy is expected to bring important development opportunities for ICAS treatment, and its value will be continuously reflected in the field of prevention and treatment of cerebrovascular diseases.

Glioma is the most common primary intracranial tumor originating from glial cells. Current treatment methods mainly include surgery and postoperative adjuvant radiotherapy and chemotherapy, but most patients are insensitive to traditional treatment, and the overall prognosis is poor^[1,2]。 As a new therapeutic approach, targeted and immunotherapy have gradually been proved to be beneficial to delay tumor recurrence and improve curative effect. Second Edition Expert Consensus on Immune and Targeted Therapies for Central Nervous System Gliomas^[3](hereinafter referred to as the second edition consensus) has caused great repercussions in China. Given that substantial progress has been made in this area in recent years^{[4,5,6,7,8,9,10,11,12]}The leader of this consensus relies on the National Medical Center for Neurological Diseases and the Glioma Professional Committee of China Anti-Cancer Association, and organizes domestic experts to update the second edition of the consensus based on evidence-based medical evidence at different levels, so as to form the Expert Consensus on Targeting and Immunotherapy of Central Nervous System Glioma (2025 Edition), to evaluate and recommend the application scope of different treatment strategies (refer to the second edition of the consensus for specific recommendation level standards^[3]) for the reference of the majority of clinical medical workers.

To explore the efficacy and safety of NeuroStellar^® intracranial stents in the treatment of severe symptomatic intracranial atherosclerotic stenosis (ICAS).

Patients with severe symptomatic ICAS who underwent NeuroStellar^® intracranial stent implantation in the 12 domestic hospitals from June 2022 to April 2023 were prospectively included. The general information, laboratory tests, imaging examinations and follow-up data of the patients were collected. The primary outcome was the in-stent restenosis rate (ISR) at 6 months after surgery. The serious adverse events during the perioperative period and follow-up period, as well as the good prognosis rate, were collected as the secondary outcome. All patients who were enrolled and completed at least one effect evaluation were included in the full analysis set (FAS, 180 cases). All patients who completed the trial and had no missing primary efficacy indicators were included in the per-protocol set (PPS, 154 cases).

All the stent implantation surgery of the 180 patients were successfully completed, with a technical success rate of 95.56% (172/180), and the residual stenosis rate[M(Q₁, Q₃)] of the target vessels immediately after the operation was 27.97% (20.34%, 35.73%). Among the FAS, 13 cases (7.22%) had stroke during the perioperative period, 1 case (0.56%) died, and no other serious complications occurred. Six months after the operation, 158 patients completed the imaging follow-up. A total of 39 patients (including 22 who did not complete the follow-up) in FAS developed ISR, and the restenosis rate of the target vessels was 21.67% (95%CI: 15.65%-27.69%). Among PPS, 17 cases developed ISR, with a restenosis rate of 11.04% (95%CI: 6.09%-15.99%), among which 6 patients (3.80%) presented with symptomatic restenosis. At 6 and 12 months after the operation, the good prognosis rates of the patients were 97.13% (157/160) and 96.63% (172/178), respectively. Among PPS, six months after the operation, one patient (0.56%) died, two patients (1.12%) had ischemic stroke or transient ischemic attack (TIA) in the treatment area, and one patient (0.56%) had TIA in the non-treatment area.

NeuroStellar^® intracranial stents demonstrates good efficacy and safety in the treatment of severe symptomatic ICAS.

To evaluate the efficacy and safety of balloon angioplasty with the distal protection of stent retriever (BASIS) in the endovascular recanalization of symptomatic subacute intracranial large vessel occlusion (ILAO).

A total of 24 patients with symptomatic subacute ILAO who underwent endovascular recanalization with BASIS technology at the Department of Cerebral Vascular Disease Intervention, Zhangzhou Municipal Hospital Affiliated to Fujian Medical University from November 2023 to November 2024 were consecutively enrolled, and their clinical data were retrospectively analyzed. The recanalization of occluded vessels was evaluated by thrombolysis in cerebral infarction (TICI) score immediately post operation. The perioperative complications were observed and documented. Vascular reocclusion or stenosis was evaluated by imaging follow-up. Regular clinical follow-up was performed. The modified Rankin scale (mRS) at 90 days was used to evaluate the outcomes of the patients.

Successful recanalization was achieved in 24 patients (100%). Perforating branch occlusion occurred in 1 case (4.2%). No symptomatic intracranial hemorrhage, procedural complications (vascular dissection, perforation, vasospasm), or postoperative hyperperfusion syndrome occurred. Eighteen patients were followed up for 3 to 12 months, only 1 patient had in-stent reocclusion at 5 months after operation, and the remaining 17 patients had no restenosis or occlusion. All patients received clinical follow-up, and 95.8% (23/24) of the patients had mRS≤2 at 90 days at the last follow-up. None of the patients had recurrent stroke or transient ischemic attack.

The BASIS technique is safe and effective in the treatment of symptomatic subacute ILAO patients in the short term, while further studies are needed to determine its long-term treatment results.

To evaluate the safety and effectiveness of extracranial (EC)-intracranial (IC) bypass combined with endovascular treatment for complex intracranial aneurysms.

We retrospectively analyzed the clinical data of 11 patients with 12 complex intracranial aneurysms who underwent a staged combined approach at the Neurovascular Center of Changhai Hospital (the Frist Affiliated Hospital of Navy Military Medical University) from January 2010 to December 2024. All patients first received EC-IC bypass, followed by second-stage endovascular treatment. We collected and analyzed baseline clinical data, aneurysm characteristics, operative strategies, perioperative complications, angiographic outcomes (aneurysm occlusion rate and bypass patency) and clinical outcomes.

All patients underwent the staged procedures successfully, and no procedure-related ischemic or hemorrhagic complications occurred. At discharge, the modified Rankin Scale (mRS) scores were 0-1. During angiographic follow-up (6-60 months), 11 aneurysms achieved complete occlusion and 1 had a residual neck. Seven bypasses remained patent, 3 demonstrated regression in caliber, and 2 showed proximal stenosis. At the last follow-up, all patients had favorable outcomes (mRS: 0 in 7 patients and 1 in 4).

For complex intracranial aneurysms that are difficult to treat with conventional single methods, the strategy of combining EC-IC bypass with endovascular staged treatment is a safe and effective treatment option.

To investigate the possible influencing factors of unfavorable outcomes in patients with acute ischemic stroke caused by anterior circulation tandem lesions after endovascular treatment.

We retrospectively collected 76 patients with acute ischemic stroke who underwent endovascular treatment in Department of Neurology, the First Affiliated Hospital of Xi′an Jiaotong University from January 2019 to June 2023. The patients were divided into the favorable outcome group (modified Rankin Scale, mRS score ≤2) and the unfavorable outcome group (mRS score >2) according to the mRS score at 90 days after onset. The clinical data were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors related to the outcomes of patients.

Univariate analysis of the two groups showed that compared with the favorable outcome group(32 cases), patients in the unfavorable outcome group(44 cases) had older age at onset (66.4±9.3 years vs. 61.7±11.2 years, P=0.045), higher NIHSS (National Institutes of Health Stroke Scale) score at admission [median (IQR): 15 (7) vs.10 (8), P<0.001], lower GCS (Glasgow Coma Salce) score [10 (6) vs. 14 (3), P<0.001], higher random blood glucose [6.9 (3.8) mmol/L vs.5.9 (1.9) mmol/L, P=0.009], higher incidence of SAP (stroke associated pneumonia) [63.6% (28/44) vs. 31.3% (10/32), P=0.004], and lower proportion of thrombectomy attempts ≤2 times [59.1% (26/44) vs. 90.6% (29/32), P=0.002]. Multivariate logistic regression analysis showed that SAP (OR=4.128, 95%CI: 1.067-15.970, P=0.040) and random blood glucose at admission (OR=1.320, 95%CI: 1.066-1.635, P=0.011) were risk factors for unfavorable outcome in acute anterior circulation tandem lesion patients undergoing endovascular therapy, whereas GCS score at admission (OR=0.702, 95%CI: 0.503-0.981, P=0.038) and thrombectomy attempts≤2 times (OR=0.145, 95%CI: 0.027-0.784, P=0.025) served as protective factors.

Patients with acute ischemic stroke caused by anterior circulation tandem lesions undergoing endovascular treatment who present with higher random blood glucose levels at admission, lower GCS scores, concomitant SAP, and thrombectomy attempts >2 times are at increased risk for unfavorable outcomes.

To assess the efficacy and safety of acute endovascular treatment in the acute phase of cerebral infarction caused by severe anterior intracranial atherosclerotic stenosis.

A retrospective analysis was conducted on the clinical data of 18 patients with acute cerebral infarction due to severe stenosis of anterior circulation intracranial arteries who underwent endovascular treatment in the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University from January 2020 to September 2024. Patients were treated with balloon angioplasty and/or stent implantation. The intracranial arterial blood flow of the patients was evaluated by whole-brain digital subtraction angiography (DSA), and the effectiveness of the surgery was evaluated by the modified Rankin scale (mRS) score at 90 days after the operation. Among them, mRS score ≤2 was considered favorable outcome. The surgical safety was evaluated by the incidence of symptomatic cerebral hemorrhage, acute occlusion of target vessels, stroke progression or new stroke within 48 hours after surgery.

The surgeries of all 18 patients were successful. The proportion of successful vascular recanalization was 18/18, and the postoperative residual stenosis rate [M(Q₁, Q₃)] was 10.0% (5.0%, 13.8%), which was improved compared with that before the operation[86.5% (85.0%, 90.0%)]. The proportion of intracranial hemorrhage within 48 hours after the operation was 2/18, and all of them were asymptomatic hemorrhage. At the 90-day follow-up after the operation, the proportion of patients with favorable outcomes was 13/18, and there was no recurrence of stroke.

Endovascular treatment for patients with severe stenosis of anterior circulation intracranial arteries during the acute phase has certain clinical efficacy and high safety.

To preliminarily evaluate the feasibility and safety of a transradial combined catheter technique for whole-brain digital subtraction angiography (DSA) in patients with intracranial atherosclerotic stenosis (ICAS).

This retrospective study included 59 ICAS patients treated at the Neurovascular Center of the First Affiliated Hospital of Naval Medical University from January to June 2025. All patients underwent selective cerebral angiography via transradial access using a combined catheter approach. Assemble the Simmons 2 catheter with the distal access catheter or intermediate catheter. Post-procedural radial artery patency was assessed. Complications were documented to evaluate safety. Image quality for the arterial, capillary-bed, and venous phases was scored.

All 59 patients successfully completed whole-brain angiography. The image-quality score was 15 points in all cases. The per-vessel selection time was 242.9±82.9 s (range: 132-512 s). No access-site-related or systemic complications occurred.

Preliminary research shows that the transradial combined catheter technique appears safe and efficient for cerebral angiography in ICAS patients, providing high-quality vascular images.

To explore the feasibility of using flexible high-density cortical electrodes (flexible electrodes) to assist localization of the epileptogenic zone during the resection of epileptic foci in patients with drug-resistant epilepsy.

We retrospectively enrolled 3 patients with drug-resistant epilepsy who underwent EZ resection at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from August to December 2024. Intraoperatively, 256-channel flexible electrodes (with two contact diameters: 200 μm and 500 μm) were used for electroencephalogram (ECoG) monitoring, and one case also used a conventional electrode for ECoG. We analyzed the impact of different anesthesia maintenance regimens on ECoG signal quality. Epileptiform discharges including spikes and high-frequency oscillations (HFOs; ripples and fast ripples) were recorded before and after swapping the positions of the two contact types at the same spot in the cortex. We compared epileptiform activity recorded by conventional electrodes versus the 200 μm-contact flexible electrodes. Spatial co-registration and comparative analysis were performed between the distribution of intraoperative epileptiform discharges and preoperative fluorodeoxyglucose-PET (FDG-PET) hypometabolic regions.

Propofol anesthesia induced burst-suppression of ECoG monitoring by using flexible electrodes, which interfered with spike identification, whereas a dexmedetomidine-based intravenous regimen yielded better signal quality. Compared with conventional electrodes, flexible electrodes showed higher detection sensitivity: within 1 min they detected more spikes (10 times vs. 7 times), and spike mean amplitude (303 μV vs. 112 μV) and peak amplitude (702 μV vs. 149 μV) were both higher. Flexible electrodes also detected HFOs that conventional electrodes missed, including 4 ripples (maximum amplitude: 130 μV, mean amplitude: 100 μV) and 1 fast ripple (amplitude: 32 μV). A total of 6 epileptiform discharge spatial distributions were recorded in 3 patients before and after the exchange of positions of the flexible electrodes at the two contact diameters. Among all the discharge contact points, 81.3% (60.4%-100.0%) [M (range)] of the spike contacts, 98.1% (61.3%-100.0%) [M (range)] of the ripple contacts, 100.0%(before switching electrode spots) and 73.8%(after switching electrode spots) of the fast ripple contacts were distributed within the resection range. Moreover, all regions with epileptiform activity were highly concordant with the FDG-PET hypometabolic areas.

This preliminary study shows that compared with conventional electrodes, flexible electrodes with an optimized anesthesia regimen can provide higher-quality intraoperative ECoG signals. HFOs (ripples and fast ripples) may have higher localizing specificity, supporting their valuable application in surgical localization for drug-resistant epilepsy.

To investigate the role in V wave in brainstem auditory evoked potential (BAEP) monitoring in hearing preservation during vestibular schwannoma surgery and its predictive value for postoperative hearing outcomes.

A retrospective analysis was conducted on the clinical data of 66 patients with vestibular schwannomas who underwent surgery at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from January to December 2020. All patients underwent intraoperative BAEP monitoring, recording the amplitude reduction rate and latency prolongation of the V wave. Postoperative hearing function was assessed at 6 months using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) grading system, categorizing patients into two groups: the group with no significant hearing decline (grades A and B) and the group with significant hearing decline (grades C and D). Clinical characteristics were compared between the two groups. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to determine the critical value and predictive efficacy of BAEP V wave.

In all 66 patients, valid V wave waveforms were recorded during surgery. The amplitude reduction rate was (51.4±16.4)%, and the latency prolongation was 0.76±0.29 ms. Surgery was successfully completed in all cases, and postoperative pathological examination confirmed vestibular schwannomas. At 6 months post surgery, 36 patients (54.5%) maintained stable hearing, while 30 patients (45.5%) showed significant hearing decline. Of those with hearing decline, 19 (63.3%) had a >50% reduction in V wave amplitude, and 28 (93.3%) had a latency prolongation >0.50 ms. Compared with the stable hearing group, patients with significant hearing decline had larger tumor size, higher amplitude reduction rate of BAEP V wave, and longer latency prolongation, with all differences being statistically significant (all P<0.05). No significant differences in age, gender, or degree of tumor resection were observed between the two groups (all P>0.05). ROC analysis revealed that the AUC for BAEP V wave amplitude reduction in predicting postoperative hearing dysfunction was 0.819 (95%CI: 0.720-0.917, P<0.001) with a critical value of 61.9%, sensitivity of 56.7%, and specificity of 91.7%. For BAEP V wave latency prolongation, the AUC was 0.830 (95%CI: 0.725-0.934, P<0.001) with a critical value of 0.67 ms, sensitivity of 90.0%, and specificity of 69.4%. The combined model had an AUC of 0.900 (95%CI: 0.820-0.980, P<0.001), sensitivity of 92.0%, and specificity of 83.3% outperforming the individual models.

Intraoperative BAEP monitoring is helpful in predicting short-term postoperative hearing outcomes in patients with vestibular schwannomas. An amplitude reduction of the BAEP V wave >60% and a latency prolongation >0.67 ms can serve as intraoperative warning criteria for predicting poor hearing function in short-term follow-up.

To evaluate the predictive value of a clinicopathological fusion model based on clinical factors and features from hematoxylin-eosin (HE) stained whole-slide images (WSI) for molecular subtyping of adult-type diffuse gliomas: IDH-mutant with 1p/19q non-codeletion, IDH-wildtype, and IDH-mutant with 1p/19q codeletion.

Clinical and HE stained WSI data were retrospectively collected from adult patients with pathologically diagnosed adult-type diffuse glioma who underwent tumor resection. The data were sourced from the Department of Neurosurgery at the First Affiliated Hospital of Zhengzhou University (Dataset 1: 780 cases) between January 2018 and January 2021 and from the Department of Neurosurgery at Henan Provincial People′s Hospital (Dataset 2: 360 cases) between January 2015 and January 2020. Key features were extracted and selected from the WSI. A clinicopathological fusion model was developed using algorithms such as Boruta and random forest in R software (version 4.4.1). Dataset 1 was randomly split into training and internal validation sets in an approximately 1 ∶1 ratio for machine learning, while Dataset 2 was used as an independent external validation set. Receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the model. DeLong test was employed to compare the performance differences in predicting the three molecular subtypes between the clinicopathological fusion model and the individual clinical or pathological models across different validation sets.

In Dataset 1, the training set consisted of 411 cases and the internal validation set of 369 cases. There were no statistically significant differences in gender, age, or molecular subtypes of glioma between the two sets (all P>0.05). Similarly, no statistically significant differences were observed in the aforementioned clinical data between Dataset 1 and Dataset 2 (all P>0.05). Sixteen key features extracted from HE-stained WSI showed significant correlations with the molecular subtypes of adult-type diffuse gliomas. These features were ranked by importance based on the mean decrease in Gini index (value range: 7.99-17.91). Among them, cytoplasmic texture features (mean decrease in Gini index: 17.91) and nuclear morphological features (mean decrease in Gini index: 15.86) contributed most significantly to the model. The ROC curve results showed that in the internal validation set, the AUC (95%CI) for predicting IDH-mutant with 1p/19q non-codeletion, IDH-wildtype, and IDH-mutant with 1p/19q codeletion type was 0.800 (0.746-0.855), 0.847 (0.805-0.890) and 0.795 (0.727-0.862) respectively. In the external validation set, the AUC (95%CI) was 0.839 (0.782-0.895), 0.866 (0.825-0.907) and 0.822 (0.757-0.886) respectively. DeLong test results demonstrated that the predictive performance of the clinicopathological fusion model for the three molecular subtypes was significantly superior to that of either the clinical-only model or the pathological-only model in both the internal and external validation sets (all P<0.05).

The fusion model based on clinical factors and HE-stained WSI features demonstrates high predictive value for molecular subtyping of adult-type diffuse gliomas.

To explore the risk factors affecting the prognosis of patients with severe diffuse axonal injury (DAI).

A retrospective analysis was conducted on 47 patients with severe DAI admitted to the Department of Neurosurgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2020 to February 2024. None of the patients had surgical indications during their course of disease. Based on the Glasgow Outcome Scale at 3 months after discharge, the patients were divided into a poor prognosis group (grades Ⅰ-Ⅲ) and a good prognosis group (grades Ⅳ-Ⅴ). The differences in clinical and imaging data between the two groups were compared, and variables with P<0.01 in the comparison between the two groups were included in the multivariate logistic regression model to analyze the factors influencing the prognosis of DAI.

Among the 47 patients, 19 (40.4%) were in the good prognosis group and 28 (59.6%) were in the poor prognosis group. Compared with the poor prognosis group, the good prognosis group had a younger age, higher Glasgow Coma Scale (GCS) score at admission, lower proportions of patients with pupil changes, involvement of midbrain structures, paroxysmal sympathetic hyperactivity, and severe pulmonary infection, and shorter hospital stays. All these differences were statistically significant (all P<0.05). There were no statistically significant differences in gender, history of primary hypertension, diabetes, subarachnoid hemorrhage, epidural hemorrhage, subdural hemorrhage or contusion, or intraventricular hemorrhage between the two groups (all P>0.05). Multivariate logistic regression analysis showed that increased age (OR=1.422, 95%CI: 1.033-1.958, P=0.031) and decreased GCS score at admission (OR=22.966, 95%CI: 1.301-405.495, P=0.032) were independent risk factors for poor prognosis in patients with severe DAI.

Age and low GCS score at admission are important risk factors for poor prognosis in patients with severe DAI.

To characterize the metabolic characteristics of patients with traumatic chronic subdural hematoma (cSDH) by metabonomics and to analyze the abnormal metabolic pathways and explore their potential biomarkers.

A total of 25 patients with cSDH (cSDH group) and 20 patients after mild traumatic craniocerebral injury (no secondary cSDH after 6 months, mild trauma group) who were diagnosed and treated at the Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University from February 2023 to March 2024 were included. Twenty healthy volunteers matched by age and gender (healthy control group) were selected, and the clinical data of the patients were analyzed. The plasma metabolites of the research subjects were detected by ultra-performance liquid chromatography-tandem mass spectrometry. The differential metabolites with significant differences between the chronic subdural hematoma group and the mild trauma group were screened out, and the pathway enrichment analysis of the differential metabolites was conducted.

Univariate analysis showed that there were no statistically significant differences in age, gender, platelet count, history of anticoagulant drug use, or history of essential hypertension among the three groups (all P>0.05). A total of 1 642 metabolites were detected among the three groups. After further analysis, 91 differential metabolites were screened out between the cSDH group and the mild trauma group. Among them, 33 were up-regulated and 58 were down-regulated in the cSDH group. Pathway enrichment analysis revealed that the main enrichment pathways of differential metabolites included the sphingomyelin signaling pathway, γ-aminobutyric acid synaptic metabolism, glycine, serine and threonine metabolism, taurine and hypotaurine metabolism pathways, et al.

cSDH has specific plasma metabolomics characteristics. Fatty acids such as octanoic acid are important metabolites of cSDH and their related metabolic pathways may play a role in the early diagnosis and treatment of cSDH.

To determine the predictive value of serum Tau protein combined with glial fibrillary acidic protein (GFAP) levels for early cognitive impairment in patients with acute traumatic brain injury (TBI).

A retrospective analysis was conducted on the clinical data of 115 patients with TBI who were treated in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from February 2023 to August 2024. Serum Tau protein and GFAP levels were measured at 1, 3, 5 and 7 days post injury. At 6 months after injury, cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). According to the 6-month cognitive assessment results, patients were divided into a cognitive impairment group (46 cases) and a non-cognitive impairment group (69 cases). We then compared the differences in baseline characteristics between the two groups, analyzed the differences in Tau protein and GFAP levels between the two groups, and investigated the correlations between Tau protein and GFAP and MMSE and MoCA scores respectively. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of Tau protein and GFAP in predicting cognitive dysfunction.

There were no statistically significant differences in age, sex, or educational level between the two groups (all P>0.05). At different time points after TBI, the levels of serum Tau protein and GFAP in the group with cognitive dysfunction were significantly higher than those in the group without cognitive dysfunction (all P<0.05). Moreover, the levels of serum Tau protein and GFAP were significantly negatively correlated with MMSE and MoCA scores (all P<0.05). ROC curve analysis showed that the combination of Tau protein and GFAP 1 day after TBI had the best effect in predicting cognitive dysfunction in patients, with an area under the curve(AUC) value of 0.805 (95%CI: 0.720-0.891), which was superior to the prediction of a single marker in the same period (AUC_Tau=0.779, AUC_GFAP=0.689).

The combined detection of serum Tau protein and GFAP levels at 1 day after TBI can effectively predict cognitive impairment at 6 months post injury.

To investigate the process and potential mechanism through which THBD⁺ tumor-associated macrophages (TAMs) induce the microvascular and the formation of hypoxic microenvironment occlusion via regulation of coagulation and fibrinolysis in glioblastoma (GBM).

Tumor tissue samples were collected from primary GBM patients who underwent tumor resection at the Department of Neurosurgery, Chongqing General Hospital between October 2021 and June 2024. Multi-point sampling and pathological examination were performed to characterize the perinecrotic hypoxic regions. The mRNA expression levels of inflammatory factors in different regions of GBM were detected using quantitative real-time polymerase chain reaction (qPCR). Based on single-cell transcriptomic data from 17 GBM patients in an integrated gene expression database, myeloid cells were annotated as THBD⁺ or THBD^- according to THBD expression. Differential gene expression between these subsets was analyzed, followed by gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analyses. Using transcriptomic data from GBM patients from the Ivy Glioblastoma Atlas Project (Ivy GAP) database (n=270), expression differences in fibrinolysis-related genes were assessed. THBD mRNA and protein expression levels and their impact on patient prognosis were analyzed using data from the Cancer Genome Atlas (TCGA) GBM cohort (n=162) and the Clinical Proteomic Tumor Analysis Consortium (CPTAC) GBM dataset (n=62). The distribution features of THBD⁺ TAMs in clinical samples were analyzed, and a THBD-overexpressing TAM model was constructed using THP1 cells to validate the regulatory effects of THBD⁺ TAM-conditioned medium on coagulation and fibrinolysis.

HE staining of GBM specimens revealed vascular occlusion and microthrombus formation in necrotic core regions. The qPCR results showed that expression levels of inflammatory factors IL6 and CCL2 were upregulated in the perinecrotic region compared with the tumor leading edge, cellular tumor region, and microvascular proliferation area (all P<0.05). Analysis of the Ivy GAP database indicated increased expression of antifibrinolytic genes in perinecrotic regions. Single-cell sequencing data demonstrated that THBD was expressed in specific myeloid-derived cell subclusters. In the CPTAC database, THBD expression was higher in GBM than in normal brain tissue (P=0.003), while no significant difference was observed in the TCGA database (P=0.059). In TCGA, patients with high THBD expression (n=81) had shorter overall survival than those with low expression (n=81) (P=0.028), but no significant difference was found in disease-free survival (P=0.053). Immunofluorescence staining confirmed THBD enrichment in macrophages, with THBD⁺ TAMs predominantly localized to perinecrotic regions.Conditioned medium from THBD⁺ TAMs shortened clot formation time (6.0 min vs. 7.3 min, P<0.001) and prolonged clot lysis time (102.4 min vs. 62.9 min).

THBD⁺ TAMs induce the formation of hypoxic microenvironment in GBM by promoting coagulation and inhibiting fibrinolytic function to maintain the stability of intratumoral microthrombus.

Hunter's arch syndrome (BHS), also known as rotating vertebral artery syndrome, is relatively rare in onset, and the exact prevalence and incidence are still unclear. Rotational atlantoaxial dislocation or subluxation is a rare cause of BHS. An adult female patient with BHS secondary to Fielding type I atlantoaxial subluxation treated with atlantoaxial fusion fixation was reported. After 3 months postoperative outpatient review, the symptoms of posterior circulatory ischemia disappeared, and there was no other discomfort except limitation of neck movement. The SF-36 quality of life scale score was 124.8 at 6 months postoperatively.

Poststroke limb dysfunction brings a huge burden to patients and society, while dual-target spinal cord electrical stimulation with neck enlargement and lumbar enlargement can simultaneously improve the motor function of upper and lower limbs in patients with hemiplegia after stroke. In July 2024, the Department of Neurosurgery of Beijing Chaoyang Hospital affiliated to Capital Medical University treated a patient with left limb movement disorder after stroke caused by right middle cerebral artery ischemia. After admission, he was treated with dual-target spinal cord electrical stimulation for cervical enlargement and lumbar enlargement. After 3 months of treatment, the patient's left limb Fugl-Meyer score was increased from 9 to 29, the modified Ashworth spasticity scale was increased from 3 to 1, the visual analogue scale of pain was decreased from 10 to 2, the limb movement disorder was significantly improved, the pain and spasticity were significantly relieved, and no adverse reactions were observed.

Intracranial venous sinus thrombosis is a cerebrovascular disease characterized by intracranial venous return obstruction and cerebrospinal fluid absorption disorder. It is relatively rare in clinic. The common involvement sites are transverse sinus and superior sagittal sinus. In October 2020, a patient with spontaneous cerebral hemorrhage was admitted to the Department of Neurosurgery of Hebei University Affiliated Hospital. After 4 days of conservative treatment, he suffered from a sudden grand mal seizure. Thrombosis of left transverse sinus, sigmoid sinus, sinus sinus, straight sinus and superior sagittal sinus with intracranial hemorrhage was diagnosed by cranial digital subtraction angiography and magnetic resonance venography. After 3 months of anticoagulation therapy, reexamination of cranial magnetic resonance venography showed that the right transverse sinus was not developed, and the rest of the veins were well developed. The muscle strength of the limbs of the patient was grade V, muscle tone was normal, and the modified Rankin scale score was 0.

Craniocerebral trauma (TBI) is one of the main causes of death and disability. Its harm not only originates from the primary injury, but more importantly, the subsequent triggered secondary injury, and neuroinflammation is the core link in this process. Neuroinflammation can both exacerbate damage and participate in damage repair under specific conditions. Extracellular vesicles, as important intercellular communication mediators, play a key role in the progression of CNS diseases and injuries. After TBI, the number of extracellular vesicles in the central and peripheral circulation and their contents change significantly, precisely influencing the progression of neuroinflammation by activating target cell receptors or delivering inflammatory regulators. The purpose of this review is to systematically explain the mechanism of inflammatory response after TBI, and focus on the regulatory role of extracellular vesicles in it, so as to provide theoretical basis for deeply understanding the pathophysiological mechanism of TBI and finding new therapeutic strategies.