Volume 42 · Issue 01 · 2026

This article reviews the development and major contributions of Chinese Journal of Neurosurgery since its 40th anniversary. Since its inception, this journal has always grown together with the cause of neurosurgery in China. Since the initial introduction of the diagnosis, treatment and basic surgical methods of common neurosurgery diseases, it has gradually developed into an authoritative academic journal that comprehensively reflects the highest level of neurosurgery in China and leads the technological trend. The journal not only promotes the innovation and standardization of clinical technology, but also significantly improves the scientific research level and domestic and foreign influence of the discipline by issuing industry standards and strict review system. Looking ahead, the journal will continue to uphold the purpose of running a journal to promote the development of neurosurgery in China towards precision, minimally invasive and intelligent.

Combined neurosurgery is a surgical mode that integrates microsurgery with endovascular treatment, aiming to improve the surgical effect of complex and refractory neurosurgical diseases. Previously, the development of new composite surgical technologies such as "preoperative embolization downgrade, combined with microresection" and "temporary balloon occlusion-assisted aneurysm clipping" significantly reduced the surgical disability and mortality rate of complex and refractory cerebrovascular diseases. At present, the treatment scope of neurosurgery combined surgery gradually extends to intracranial tumors, emergency treatment, functional nervous system diseases, etc. In addition, through intravascular insertion devices, such as E-shunt system, intracranial sinus recording and stimulation electrodes, intravascular radio frequency devices, with the help of current, radio frequency, ultrasound, etc., neurosurgical techniques for transvascular treatment of paravascular and extravascular nervous system diseases are beginning to take shape. In the future, the expanded neurosurgical composite surgery will be involved in a broader field of clinical neuroscience with the strong support of materials science and bioengineering science.

In recent years, with the gradual development of neurosurgical compound surgery and the accumulation of clinical practice experience, its application is no longer limited to neurovascular diseases, but has expanded to neurotumors, trauma treatment and other fields, and neurovascular compound surgery has gradually evolved into neurosurgical compound surgery. Expert Consensus on Compound Surgery in Neurosurgery (2026 Edition) is the 2017 Expert Consensus on Compound Surgery Specifications for Neurovascular Diseases^[1]The revision and supplement will incorporate the latest clinical evidence of composite neurosurgery at home and abroad to guide clinical practice and lead the development of composite neurosurgery in the future.

To evaluate the efficacy of hybrid surgery for hypervascular meningiomas and to identify factors associated with arterial embolization degree.

A retrospective analysis was conducted on 39 patients with hypervascular meningiomas treated at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University between January 2020 and June 2025. All surgeries were completed in a hybrid operating room. Patients were divided into major (≥80%) and partial (<80%) embolization groups. Clinical and imaging characteristics were compared. Based on the extent of embolization of the feeding arteries and the patient′s individual condition, a one-stage or staged tumor resection may be selected, or embolization of the feeding arteries alone may be performed. The extent of tumor resection and intraoperative blood loss need evaluating. Tumor recurrence and growth were assessed with MRI follow-up.

Of 39 patients, 13 were in the major embolization group and 26 in the partial embolization group. Thirty patients underwent one-stage resection, six had staged resection, and three did not undergo resection. In the resected cases, the major embolization group had a median blood loss of 400 (Q₁, Q₃ : 325, 500) ml, while the partial embolization group had 1 200(Q₁, Q₃: 600, 3 000) ml, showing significant difference (U=44.01, P=0.001). Postoperative MRI showed residual tumor in 5 cases, and 4 had recurrence after median follow-up of 6 (Q₁, Q₃ : 3, 8) months. In the embolization-only group, 2 tumors shrank and 1 showed no change. The partial embolization group had significantly larger tumors and feeding arteries from multiple systems, more involvement of the ophthalmic artery and tortuous supply routes, with a higher proportion of dangerous anastomoses (all P<0.05).

Tumor size, arterial supply patterns, involvement of the ophthalmic artery and dangerous anastomoses influence embolization degree. Higher embolization degree could help reduce intraoperative blood loss.

To explore the strategies and efficacy of hybrid surgery regarding the diagnostic and therapeutic challenges of spinal vascular malformations (SCVM).

This retrospective study included 38 patients with SCVM treated at the Department of Neurosurgery, Huashan Hospital, Fudan University from January 2017 to December 2024. Among them, there were 25 cases of spinal dural arteriovenous fistula (sDAVF), 7 cases of spinal arteriovenous malformation (sAVM), and 6 cases of perimedullary arteriovenous fistula (PMAVF). The misdiagnosis rate was 71.1% (27 cases), the mismanagement rate was 55.3% (21 cases), and the median time to diagnosis was 9.5 months. After multimodal imaging fusion (MIF), all patients underwent hybrid surgery. The surgical strategies were chosen based on comprehensive evaluation of imaging data and the patients′ clinical conditions and included surgical resection plus digital subtraction angiography (DSA) and endovascular treatment (EVT) plus surgical resection. The outcomes (cure, improvement, no change or deterioration) were comprehensively assessed based on imaging (lesion occlusion rate) and clinical spinal cord function (modified Ashworth scale score).

Among 25 patients with sDVAF, 20 patients underwent surgical resection plus DSA. Due to incomplete embolization of EVT, 5 patients underwent surgical resection later. In 7 patients with sAVM, 2 patients underwent surgical resection plus DSA, and 5 patients with multiple feeding arteries and high flow were treated by EVT plus surgical resection. In 6 patients with PMAVF, 3 patients underwent surgical resection plus DSA, and 3 patients underwent EVT plus surgical resection. A total of 30 cases (78.9%) were followed up, with mean 11.8±4.8 months (range: 6-24 months). The overall cure and improvement rate was 73.3% (22 cases), stabilization rate was 20.0% (6 cases) and deterioration rate was 6.7% (2 cases).

MIF combined with individualized combined surgical treatment strategies can improve the overall efficacy of SCVM treatment.

To explore the learning curve for hybrid surgery in treating adult intracranial arteriovenous malformations (AVMs).

This study was a retrospective cohort study. Data were obtained from the registry of multimodality treatment for brain AVMs in Mainland China (MATCH), involving AVM patients registered at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University between August 2011 and December 2023. The cumulative sum (CUSUM) control chart method was used to plot the overall learning curves for poor outcomes and complications. Poor outcomes were defined as an increase in the modified Rankin scale (mRS) score by ≥2 points at discharge compared to preoperatively (worsening) or an mRS score of 5-6. Complication indicators included four major complications (intracranial hemorrhage, ischemia, infection and seizures) and intraoperative blood loss. Intraoperative blood loss >549 ml was defined as a failure. The correlation between the number of surgical cases and poor outcomes and major complications was assessed using curve fitting. Patients were divided into a learning phase group (before reaching the peak, including the boundary point) and a mastery phase group (after the peak) based on the highest peak of CUSUM value of the overall learning curve. Baseline characteristics, treatment and outcomes were compared between the two groups. Further stratified analysis was performed: based on the number of patients at the peak, an equally sized population from the tail end of the learning curve was selected as the proficient mastery group and compared with the learning phase group regarding embolization strategies; based on the key threshold where CUSUM=0, patients were divided into a non-achievement group (before reaching the threshold, including the boundary point) and an achievement group (after the threshold) for comparison of embolization strategies.

A total of 176 patients were included, comprising 43 cases of curative embolization, 111 cases of palliative embolization and 22 cases of targeted embolization. All patients underwent one-stage embolization and surgical resection of AUM. Among them, 116 patients (65.9%) completed follow-up, with a mean follow-up time of 49.67±20.45 months (range: 6.0-77.4 months). CUSUM learning curve analysis showed that the overall learning curve exhibited a linear downward trend with a high correlation (R²=0.94). The peak of the overall CUSUM learning curve corresponded to the 19th surgical case, and the point where CUSUM returned to zero corresponded to the 31st surgical case. There were no statistically significant differences in baseline characteristics between the learning phase group (cases 1-19) and the mastery phase group (cases 20-176) (all P>0.05). The difference in embolization strategies between the two groups was statistically significant (P<0.001). The learning phase group had a higher proportion of curative embolization (14/19), while the mastery phase group had a higher proportion of palliative embolization (68.2%, 107/157). Compared to the learning phase group, the mastery phase group had a shorter follow-up time (45.84 ±19.64 months vs. 72.20±3.72 months), lower proportions of patients with poor outcomes (29/157 vs. 8/19) and mRS score worsening (27/157 vs. 7/19), and higher proportions of patients with mRS scores of 0-2 at both discharge (128/157 vs. 11/19) and last follow-up (91/99 vs. 12/17) (all P<0.05). Stratified analysis results showed that compared to the learning phase group (cases 1-19), the proficient mastery group (cases 158-176) had a larger proportion of palliative and targeted embolization (P<0.001). Compared to the non-achievement group (cases 1-31), the achievement group (cases 32-176) had a larger proportion of palliative and targeted embolization (P<0.001).

Approximately 19 cumulative surgical cases are required to master hybrid surgery for adult AVMs. After 31 surgeries, the incidence of poor outcomes and complications significantly decrease. With accumulated experience, there is a greater tendency towards adopting palliative and targeted embolization strategies.

To preliminarily evaluate and explore the technical feasibility and clinical benefits of hybrid surgery combined with balloon-guided catheterization for the recanalization of chronic internal carotid artery occlusion (CICAO).

From January to November 2024, 10 patients with symptomatic CICAO were treated with hybrid surgery (carotid endarterectomy and stent implantation) at the Cerebrovascular Disease Center of the First Affiliated Hospital of Naval Medical University. During operation, a balloon guide catheter was placed in the ipsilateral common carotid artery of all patients to establish proximal intravascular access. The vascular recanalization status and perioperative complications were retrospectively evaluated. At 90 days postoperatively, the modified Rankin scale (mRS) was used to assess clinical outcome, and computed tomography angiography (CTA) was used to evaluate vascular recanalization.

All occluded vessels in the 10 patients were successfully recanalized. The residual stenosis rate after intraoperative plaque removal ranged from 10% to 40%. Intraoperative distal dissection occurred in 6 patients; 1 to 3 stents were implanted for intraoperative distal dissection and residual stenosis in all affected cases. Postoperative MRI examination showed no new cerebral infarction in any patient, and no patient developed new neurofunctional deficit symptoms. CTA examination at 90 days postoperatively showed that the blood flow at the carotid stent implantation site on the affected side was unobstructed, with no in-stent restenosis in the 10 patients. All 10 patients had favorable outcomes, with mRS scores of 0 to 1, and no new neurofunctional deficit symptoms occurred during the 90-day postoperative follow-up period.

Preliminary observational results indicate that hybrid surgery combined with balloon-guided catheterization in the treatment of CICAO has a good success rate and safety.

To investigate the outcomes of hybrid surgery for intracranial arteriovenous malformations (AVMs) and their influencing factors.

Clinical data of AVM patients who underwent hybrid surgery at the Department of Neurosurgery, Huashan Hospital, Fudan University between January 2019 and March 2025 were retrospectively analyzed. All patients underwent craniotomy for lesion resection, with intraoperative or immediate postoperative digital subtraction angiography evaluation. Postoperative clinical and imaging follow-up was performed. Neurological outcomes were assessed using the modified Rankin Scale (mRS). Univariate and multivariate logistic regression analyses were performed to identify factors influencing the outcomes.

A total of 135 patients were enrolled into this study. Intraoperative digital subtraction angiography identified residual lesions in 8 cases (5.9%), which were all successfully resected during the same operation, resulting in complete resection in all 135 patients (100%). At 6 months postoperatively, 126 patients (93.3%) had favorable outcomes (mRS score: 0-2) and 9 patients (6.7%) had unfavorable outcomes (mRS score: 3-5). Univariate analysis showed that history of radiotherapy, Spetzler-Martin grade Ⅳ-Ⅴ, and diffuse nidus were associated with increased risk of unfavorable outcomes (all P<0.05). Multivariate logistic regression analysis identified history of radiotherapy as an independent risk factor for unfavorable prognosis (OR=10.680, 95%CI: 1.671-68.283, P=0.018), while lesion size, deep venous drainage, Spetzler-Martin grade or diffuse nidus was not independent influencing factor (all P>0.05).

Hybrid surgery for intracranial AVMs is safe and effective with high total resection rate and low complication rate. History of radiotherapy is an independent risk factor for unfavorable outcome.

To preliminarily evaluate the clinical efficacy of hybrid surgery in the treatment of emergency severe hemorrhagic cerebrovascular disease.

A retrospective analysis was conducted on 24 patients with emergency severe hemorrhagic cerebrovascular diseases who were treated with hybrid surgery between January 2023 and January 2025 at the Department of Neurosurgery, Gaozhou People′s Hospital. The causes of hemorrhage included cerebral aneurysms (17 cases), intracranial arteriovenous malformations (AVMs, 5 cases), dural arteriovenous fistula (1 case), and intracranial AVM combined with an aneurysm (1 case). All procedures were completed in a hybrid operating room. For patients without brain herniation, a stereotactic intracranial hematoma puncture and catheter placement (without hematoma aspiration) was performed first, followed by endovascular treatment for the responsible lesion of hemorrhage. Dyna-CT was used to check for any increase in hemorrhage; based on the findings, either craniotomy for hematoma removal or continued drainage was chosen. For patients with brain herniation, endovascular treatment for the responsible lesion of hemorrhage was performed first, followed immediately by craniotomy for hematoma evacuation. In AVM or dural arteriovenous fistula cases, Onyx or Glubran glue embolization was performed. In aneurysm cases, coil embolization was used (with stent-assisted coiling if necessary). Intraoperative findings were used to decide whether additional open surgery was needed for resection of the malformation nidus or surgical clipping of the aneurysm. Surgical complications, Glasgow coma scale (GCS) at discharge and the modified Rankin scale (mRS) score were documented. Clinical follow-up at 6 months postoperatively included repeat digital subtraction angiography (DSA). The outcomes were evaluated based on the mRS (good outcome defined as 0-3, poor outcome as 4-6).

All 24 patients successfully underwent one-stage hybrid surgery. No patient experienced re-bleeding of an aneurysm or malformation, and there were no intracranial infections or other surgical complications. The GCS score for all patients improved from 8.42±4.22 on admission to 10.33±5.47 at discharge, although the difference was not statistically significant (paired t=1.63, P=0.116). Among 14 patients who were in a coma at admission, the GCS score improved from 5.14±1.03 to 9.71±5.41 at discharge (t=3.58, P=0.034), and 5 of these patients regained full consciousness from coma. At discharge, the mRS scores were: 0 in 1 patient, 1 in 2 patients, 3 in 8 patients, 4 in 4 patients, 5 in 7 patients and 6 in 2 patients. Two patients died postoperatively and five discontinued treatment. By the 6-month follow-up, the mRS scores were 0 in 3 patients, 3 in 8 patients, 4 in 4 patients, 5 in 1 patient and 6 in 8 patients. The overall proportion of good outcomes was 45.8% (11/24). Specifically, 4 out of 5 of AVM patients achieved a good outcome, compared to 6 out of 17 of aneurysm patients. Fifteen patients underwent follow-up DSA. Of the 5 AVM patients, only 1 had a small residual malformation in the left basal ganglia region. None of the 9 aneurysm patients (including the 1 patient with an AVM and multiple aneurysms) showed aneurysm recurrence. The dural arteriovenous fistula patient showed no recanalization of the fistulous connection.

A Preliminary study shows that hybrid surgery for emergency severe hemorrhagic cerebrovascular disease patients (particularly those presenting in coma) tends to improve the GCS score at discharge. Moreover, this hybrid surgical approach is feasible for the definitive treatment of complex intracranial AVMs and multiple intracranial aneurysms.

To evaluate the safety and clinical efficacy of hybrid surgery for symptomatic chronic vertebral artery origin occlusion.

A retrospective analysis was conducted on the clinical data of 34 patients with chronic vertebral artery origin occlusion who underwent vertebral endarterectomy (VEA) or combined with endovascular treatment surgery at the Department of Neurosurgery, Qilu Hospital of Shandong University from October 2016 to April 2024. The efficacy and safety of the surgery were evaluated through the vascular recanalization rate, the incidence of vascular restenosis and surgical complications et al. At 3, 6 and 12 months after the operation, follow-up was conducted through outpatient follow-up visits combined with phone calls. We documented the improvement of patients′ symptoms, the occurrence of restenosis/reocclusion of blood vessels et al. The neurological function of the patients was evaluated by using the modified Rankin Scale (mRS) score. The patency of blood vessels is determined through CT angiography or digital subtraction angiography.

The total vascular recanalization rate of recanalization surgery in 34 patients was 88.24% (30/34). The proportion of vascular recanalization evaluated by VEA combined with intraoperative angiography in the treatment of pan-combined surgery was 15/15, that by VEA combined with endovascular treatment in the combined surgery was 15/19. The postoperative hospital stay [M(Q₁, Q₃)] was 13.00 (10.00, 17.25) days. There were no serious complications such as new posterior circulation ischemia symptoms, cerebral hyperperfusion syndrome, or cerebral hemorrhage. Among them, the incidence of patient-level complications was 23.53% (8/34) and that of event-level complications was 26.47% (9/34). All 30 patients with vascular recanalization were followed up, with a median follow-up time of 21 (20-30) months. At the last follow-up, the incidence of vascular restenosis was 20.00% (6/30). The mRS score of the patients [M(Q₁, Q₃)] improved compared with that before the operation [1 (0, 2) points vs. 2 (1, 3) points; U=251.50, P<0.001]. There were no new posterior circulation strokes or deaths during the follow-up period.

VEA combined with endovascular treatment in the treatment of symptomatic chronic vertebral artery initiation occlusion has high surgical safety and good clinical efficacy.

To evaluate the feasibility, safety and early clinical efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with acute large-core cerebral infarction beyond the standard therapeutic time window who failed or were ineligible for endovascular recanalization or intravenous thrombolysis.

A prospective analysis was conducted on 6 patients with acute large-vessel occlusion-related large-core cerebral infarction who underwent emergency STA-MCA bypass in the Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University between December 2022 and November 2024. Preoperative CT angiography (CTA) and CT perfusion (CTP) confirmed a core infarction volume >70 ml or the presence of perfusion-core mismatch, and all patients were deemed unsuitable for standard recanalization therapy. Two bypass configurations, 1 donor-1 recipient (1D1R) and 2 donor-2 recipient (2D2R), were applied. Postoperative complications were recorded. CTA/CTP was performed one week after surgery to compare pre- and postoperative volumes of infarct core (relative cerebral blood flow <30%), hypoperfused tissue (time to maximum >6 s), ischemic penumbra and mismatch ratio. Neurological outcomes were assessed using the modified Rankin Scale(mRS) score at 3 months.

All 6 patients underwent STA-MCA bypass within 24 hours of onset, with a median surgical time window [M(Q₁, Q₃)] of 7.5 (5.8, 12.0) hours and a median operative duration [M(Q₁, Q₃)] of 4.4 (4.0, 4.9) hours. Three patients received concurrent decompressive craniectomy and three patients receired bone flap reduction. No postoperative complications occurred, including cerebral hyperperfusion syndrome, intracranial hemorrhage, new infarction, or seizures. Median hospital stay [M(Q₁, Q₃)] was 11.5 (9.0, 14.0) days. At one week postoperatively, quantitative CTP analysis showed significant reductions in infarct core, hypoperfused area, and penumbra compared with preoperative values (all P<0.05), with reduction rates [M(Q₁, Q₃)] of 83.4% (37.8%, 94.5%), 81.1% (47.8%, 89.4%), and 75.9% (22.9%, 88.5%), respectively. The mismatch ratio showed no significant change (T=-0.11, P=0.917). At 3-month follow-up, all patients survived and demonstrated neurological improvement. The median mRS scores [M(Q₁, Q₃)] decreased from 5.0 (4.0, 5.0) preoperatively to 3.5 (3.0, 4.0) postoperatively (T=-2.21, P=0.027).

Preliminary observations show that emergency STA-MCA bypass appears to be a feasible and safe rescue strategy for strictly selected patients with large-core acute cerebral infarction beyond the time window who cannot benefit from conventional recanalization therapy. This technique significantly improves cerebral perfusion and may promote early neurological recovery.

To evaluate the safety and efficacy of deliberately staged endovascular embolization combined with microsurgical resection in the treatment of cerebral arteriovenous malformations (AVMs), and to analyze the related factors of poor outcomes in patients.

A retrospective analysis was conducted on the clinical data of 46 patients with intracranial AVM who underwent deliberate staged combined surgery in the Department of Neurosurgery of the First Affiliated Hospital of Harbin Medical University from April 2015 to December 2024. We evaluated the cure rate of AVM and the occurrence of complications after surgery. Follow-up was conducted through the outpatient visits at 3, 6, and 12 months after the operation and annually thereafter. The good prognosis rate of AVM was evaluated by digital subtraction angiography (DSA) or MRI, and the recovery of neurological function of patients was evaluated by the modified Rankin Scale (mRS) score. The related risk factors for poor outcomes in patients with AVM were predicted through univariate logistic regression analysis.

All patients successfully completed the deliberate staged combined surgery, and all AVMs were cured after the operation. The interval time between the total surgical scores [median (Q₁, Q₃)] was 5.5 (2, 8) days. The total incidence of postoperative complications was 28.26% (13/46). The incidence of postoperative normal perfusion pressure breakthrough syndrome was 0, and the incidence of permanent neurological deficit was 21.74% (10/46). All patients completed the long-term follow-up, and the follow-up period was 30.80±27.96 months (4.70-95.07 months). Up to the last follow-up, no recurrence or recanalization of AVM was observed in imaging examinations. The mRS score [median (Q₁, Q₃)] of the patients [1(0, 1) points] was lower than that before the operation [1(1, 2) points, Z=-3.71, P<0.001]. The good outcome (mRS score≤2 points) rate of the patients after the operation was 86.67% (40/46). Univariate Logistic analysis showed that higher Lawton-Young supplementary grade (OR=2.54, 95%CI: 1.07-6.02, P=0.030) and poorer preoperative neurological function status (OR=7.00, 95%CI: 1.10-44.72, P=0.040) were both related risk factors affecting the outcomes of patients with AVM treated by deliberately staged combined surgery.

A deliberately staged combined surgery for AVM has a relatively high cure rate and good safety. Higher suplementary Lawton-Young grade and poorer preoperative neurological function status are the relevant risk factors affecting the therapeutic effect.

To investigate the safety and efficacy of the treatment strategy combining maximal flow reduction by staged endovascular embolization under safe conditions with microsurgical resection in the management of intracranial arteriovenous malformations (AVM).

A retrospective analysis was performed on 17 patients who underwent staged endovascular embolization for maximal flow reduction under safe conditions, followed by microsurgical resection at Department of Neurosurgery, South China Hospital, Medical School of Shenzhen University between January 2022 and December 2024. According to the Spetzler-Martin grading system, there were 4 cases of grade Ⅲ, 10 cases of grade Ⅳ, and 3 cases of grade Ⅴ. Clinical follow-up was conducted at 6 and 12 months post operation. Neurological outcomes were assessed using the modified Rankin Scale (mRS). Radiological follow-up was used to evaluate AVM cure, defined as complete obliteration of the nidus with no early venous drainage on postoperative imaging.

All 17 patients successfully completed staged endovascular embolization and microsurgical resection. The number of embolization sessions ranged from 2 to 4 (median: 2). Intraprocedural hemorrhage during embolization occurred in 1 patient. Immediate postoperative angiography after microsurgical resection showed complete obliteration in 16 patients and residual nidus in 1 patient. Worsening of pre-existing neurological deficits occurred in 2 patients after microsurgery, with complete resolution in both at 2 weeks. New neurological deficits developed in 2 patients after microsurgery, 1 resolved at 2 weeks, and 1 persisted. Postoperative hematoma occurred in 1 patient. No perioperative deaths were observed. At 12-month follow-up, the overall cure ratio was 16/17, and 1 patient had persistent neurological deficits. The mRS score was 0 in 16 patients and 1 in 1 patient.

For intracranial AVM, staged endovascular embolization aimed at achieving maximal flow reduction within a safe range, followed by elective microsurgical resection, represents a safe and effective curative strategy. This approach is associated with a high obliteration rate and a low incidence of procedure-related complications.

To explore the application value of low-concentration contrast agent Dyna-CT angiography in the surgery of craniocervical junction arteriovenous fistula (CCJAVF). The clinical data of 7 patients with CCJAVF who underwent microsurgical treatment in the Department of Neurosurgery, Changzhou First People's Hospital from May 2022 to August 2024 were retrospectively collected. All patients underwent three-dimensional whole brain digital subtraction angiography (3D-DSA) before surgery, and the vascular architecture and anatomical location of CCJAVF were determined by low-concentration contrast agent Dyna-CT angiography. The results of 3D-DSA showed that in terms of blood supply arteries, 5 cases were supplied by ipsilateral vertebral artery V4 dural branch, 2 cases were supplied by ipsilateral vertebral artery V3 dural branch, and 7 cases were complicated with pipial vascular blood supply; The drainage direction was mainly upward, in which 5 cases were drained upward through the perimedullary vein, 1 case was drained upward through the anterior medullary vein, and 1 case was drained downward through the anterior medullary vein and the posterior medullary vein. Low-concentration contrast agent Dyna-CT angiography showed that the fistula locations were located in the vertebral artery perforating the dura in 1 case, the ventral area of the medulla oblongata in 3 cases, the ventrolateral area of the medulla oblongata in 1 case, and the ventral area of the cervical spinal cord and the ventrolateral area of the cervical spinal cord in 1 segment in 1 case. The results of Dyna-CT angiography in 7 patients were consistent with the intraoperative findings, and the fistula was accurately cut under the microscope, and the operation was successfully completed. Postoperative follow-up showed that 5 patients were cured by DSA 1 year after operation; In one patient, the fistula disappeared by MRA at 3 months postoperatively; The other case was not evaluated by imaging. In terms of functional outcomes, the median modified Rankin scale (mRS) score was 1 (0-1) in 6 patients at 36 months postoperatively; Another patient with Hunt-Hess grade V before surgery had a mRS score of 4 at 6 months and 1 year after surgery.

To identify and validate biomarkers and key genes associated with immunogenic cell death (ICD) in smooth muscle cells (SMCs) of carotid atherosclerotic plaques at the single-cell level.

Single-cell RNA sequencing data from 3 patients with carotid stenosis who underwent carotid endarterectomy were included from the Gene Expression Omnibus database. Biomarkers and key genes related to ICD in the SMC of carotid atherosclerotic plaques were determined by performing AUCell assessment, differential expression and enrichment analysis, pseudotime trajectory, intercellular communication and protein interaction analysis of ICD gene sets for SMC and its various subgroups. Further validation was performed by immunofluorescence experiment, using samples from 3 patients with carotid stenosis who underwent carotid endarterectomy at Department of Cerebrovascular Disease, Henan Provincial People′s Hospital—early plaques (yellow membranes with low calcification at both ends and regular morphology) and late plaques (highly calcified core regions in the middle of specimens).

The dataset had 52 293 cells, 41 890 from the calcified core of the plaques (experimental group) and 10 403 from proximal periplaque carotid tissues (control group). Cell clustering identified 41 clusters as 8 cell types, and SMCs into 11 subpopulations. AUCell scoring results showed higher ICD gene set expression in experimental SMCs (P<0.05), and higher activity in the experimental group of ICD-related Fib SMC subpopulation (P<0.05). ICD marker genes were more highly expressed in experimental SMCs than controls (all P<0.05). CellChat and Monocle2 analyses defined SMC subpopulation communication and evolutionary trajectories. Analyses of SMC differentially expressed genes and ICD-related genes identified multiple hub genes and the shared gene LRP1 (involved in key enriched pathways). Immunofluorescence showed upregulated ICD core genes (CALR, HSP90, HMGB1) and downregulated LRP1 in late-stage plaque SMCs (all P<0.05).

Enhanced expression of ICD-related biomarker genes exists in SMCs of carotid atherosclerotic plaques, with subpopulations closely linked to ICD. In late-stage plaque SMCs, ICD biomarkers are upregulated, while ICD-related LRP1 is downregulated.

The incidence of cervical neurogenic tumors is low, and collision tumors are more rare. Due to the lack of typical clinical manifestations and imaging features, diagnosis and treatment are often delayed. In May 2024, a patient with cervical neurogenic collision tumor was diagnosed and treated in the Department of Neurosurgery of the First Affiliated Hospital of Chongqing Medical University. The tumor was completely removed by microsurgery, and the patient recovered well. Postoperative pathological diagnosis of schwannoma and ganglioneuroma.

Intracranial chondroma is a benign tumor that mostly originates from the base of the skull, while chondroma originating from the parafalx of the brain is extremely rare. In April 2024, the Department of Neuromedicine of the 946th Hospital of the Xinjiang Military Region General Hospital of the People's Liberation Army treated a child with giant parafalx chondroma of the brain. The first symptom was headache with limb weakness. Preoperative CT and MRI of the head showed that the left frontotemporal parietal lobe occupied space (12.1 cm ×4.3 cm ×8.5 cm in size). After total resection, it was pathologically confirmed as intracranial chondroma. The child did not show any symptoms related to neurological deficit after operation. Twelve months after surgery, no tumor recurrence was observed by MRI.

Glioma is a high-incidence tumor of the central nervous system, and there are bottlenecks in conventional clinical intervention. Photodynamic therapy (PDT) is a photosensitizer-mediated photochemical reaction that produces reactive oxygen species and targets the killing of glioma cells. Based on the characteristics of glioma microenvironment and metabolic reprogramming, the relationship between PDT and glioma microenvironment was discussed, and the molecular mechanism of PDT influencing glioma progression by regulating metabolic pathways was discussed in depth.