Volume 42 · Issue 03 · 2026

December 2025 is the centenary of the birthday of Academician Wang Zhongcheng, the pioneer and founder of neurosurgery in China and the winner of the State Preeminent Science and Technology Award. As one of the inheritors of neurosurgery founded by Academician Wang, it is a great honor and a heavy responsibility for me to discuss and share the understanding and practice of "loyalty spirit" here. "A century of loyalty, passing on the fire, carrying forward the spirit of loyalty and creating new brilliance" is the unswerving pursuit and commitment of generations of Chinese neurosurgeons.

Endovascular treatment of cerebrovascular diseases is experiencing a period of rapid development driven by technological innovation and concept breakthrough. In the field of ischemic stroke, thrombectomy technology continues to be optimized, and the application of large-diameter aspiration catheter and new thrombectomy stent further improves the efficiency of vascular recanalization; Artificial intelligence-based imaging screening and prognosis prediction models are gradually integrated into clinical decision-making processes. In the field of hemorrhagic cerebrovascular diseases, the application concept of blood flow guidance devices is continuously deepened, the indications are gradually broadened, and the clinical evidence for its treatment of intracranial ruptured aneurysms is more sufficient; Intratumoral spoiler devices provide a new solution for bifurcated wide-neck aneurysms; The research and development of new coated coils and bioactive materials aims to improve the long-term occlusion rate of aneurysms. In addition, the exploration of new treatment pathways such as intravascular opening of venous sinus stenosis or occlusion, transvenous embolization of intracranial arteriovenous malformations, and the refinement of perioperative antithrombotic management and complication prevention and treatment together constitute the all-round progress of endovascular treatment. In the future, the endovascular treatment of cerebrovascular diseases will continue to develop in a more efficient, safer, more accurate and individualized direction.

Ependymal tumors are neuroepithelial tumors that may originate from ependymal cells of the ventricular system, the central canal of the spinal cord, or ectopic residual cells in the cortex^[1]。 According to the anatomical site of occurrence, ependymal tumors can be divided into three categories: supratentorial, posterior fossa and spinal cord ependymal tumors^[1]。 According to the fifth edition of the World Health Organization (WHO) Central Nervous System (CNS) Tumor Classification, spinal ependymal tumors include 4 integrated pathology subtypes: spinal ependymoma; Spinal ependymoma, MYCN-amplified; Mucopapillary ependymoma; Subependymoma^[2,3]。 According to 2024 data from the Central Brain Tumor Registry of the United States (CBTRUS), the age-standardized annual incidence of ependymal tumors is 0.41 per 100,000, with a slightly higher incidence of 0.47 per 100,000 for men and 0.35 per 100,000 for women. This type of tumor can occur in all age groups, but the distribution characteristics are different: in the 0-19 year old group, it accounts for 18.3% of primary spinal cord tumors; Among those aged ≥20 years, the proportion was 15.5%^[4]。 Spinal ependymoma is the most common type of adult intramedullary tumor, accounting for about 60%^[5,6,7]。

To evaluate the clinical efficacy of stent-assisted treatment for the treatment of ruptured intracranial blood blister-like aneurysm (BBA).

A retrospective analysis was conducted on the clinical data of 15 patients with ruptured BBA who received stent-assisted embolization treatment at the Neurosurgery Center of Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2019 to December 2021. The patients were grouped based on their Hunt-Hess classification at admission and the type of stent implanted, and their clinical outcomes were compared. Follow-up visits were conducted for the patients at 6, 12, 24, and 48 months after the operation through outpatient visits, hospitalizations, or phone calls. The recurrence of aneurysms was evaluated through magnetic resonance angiography, CT angiography, or digital subtraction angiography, and the healing status of the aneurysms was assessed according to the O′Kelly-Marotta classification. The recovery of the patients′ neurological function was evaluated using the modified Rankin Scale (mRS) score.

All 15 patients successfully underwent endovascular treatment, with a total of 15 stents implanted. Among them, 7 cases received Pipeline flow diverters, 7 cases received Willis stents, and 1 case received LVIS stents. Immediate postoperative angiography showed that the aneurysms were completely occluded in 12 cases, with only the neck of the aneurysm remaining visible in 1 case, and the entire body of the aneurysm being partially visible in 2 cases. Four patients in the postoperative group developed ischemic complications, without any bleeding-related symptoms. The proportion of patients with favorable outcome (mRS score≤2) at discharge was 11/15. Among them, the proportion of patients with favorable outcome in the Hunt-Hess grade Ⅰ-Ⅱ group was 10/10, the proportion in the grade Ⅲ group was 1/5, and the difference was statistically significant (P=0.004). There were no statistically significant differences in the proportions of complete aneurysm occlusion (5/7 vs. 6/7), complication occurrence (2/7 vs. 2/7), and unfavorable outcome (mRS score≥3, 2/7 vs. 2/7) between the covered stent treatment group and the flow diverter treatment group (all P>0.05). Thirteen patients completed follow-up after the operation. The median imaging follow-up time was 12 (5-47) months. At the last follow-up, 11 aneurysms were completely occluded, and only the neck of the aneurysm remained visible in 2 cases. The median follow-up time for neurological functional outcome was 42(6-48)months. At the last follow-up, the proportion of patients with favorable outcome was 13/13.

Preliminary research indicates that, stent-assisted embolization is an effective treatment for ruptured intracranial aneurysms, achieving high occlusion rates and favorable functional outcomes. Both covered stents and flow diverters are feasible and effective options for the treatment of intracranial BBA.

To preliminarily explore the clinical efficacy of the Woven EndoBridge (WEB) intrasaccular flow disrupter in the treatment of intracranial wide-neck bifurcation aneurysms.

We retrospectively and consecutively enrolled 14 patients with intracranial unruptured wide-neck bifurcation aneurysms. All patients were treated solely with WEB intrasaccular flow disruption device in the Interventional Department of Civil Aviation General Hospital between March 2024 and March 2025. The aneurysm locations were as follows: middle cerebral artery in 5 cases, anterior communicating artery in 6 cases, internal carotid artery terminus in 2 cases, and basilar artery in 1 case. The aneurysm occlusion status was graded using the WEB Occlusion Scale (WOS), in which grade A indicated complete aneurysm occlusion, grade B represented complete occlusion with a minor neck remnant, grade C indicated a neck remnant, and grade D indicated a body remnant. Clinical outcomes were assessed using the modified Rankin Scale (mRS) score.

All 14 patients had the WEB device successfully implanted. Immediate postoperative WOS grading indicated that there were 4 cases of grade A, 2 cases of grade B, and 8 cases of grade C. The median follow-up time duration for the 14 patients was 13 months (range: 6-18 months). The assessment at 6 months post-procedure revealed WOS grades of A in 5 cases, B in 3 cases, C in 4 cases, and D in 2 cases. At the last follow-up, WOS grading was A in 6 cases, B in 5 cases, C in 1 case, and D in 2 cases; the mRS scores were 0 points in 8 cases, 1 point in 4 cases, and 2 points in 2 cases. No complications such as aneurysm rupture and hemorrhage, vasospasm, cerebral ischemia, or cerebral infarction occurred in any of the patients.

The treatment of intracranial wide-neck bifurcation aneurysms with the WEB intrasaccular flow disruptor is safe and effective, and patients can achieve favorable outcomes.

To evaluate prognostic differences and complication factors of LVIS stents and flow diverters in the treatment of intracranial aneurysm.

This retrospective study included 295 patients with intracranial aneurysms who underwent endovascular treatment at the Department of Neurosurgery, Linyi People′s Hospital Affiliated to Shandong Second Medical University from January 2022 to December 2023. Patients were divided into two groups based on the treatment method: the flow diverter (FD) group and the LVIS group. The degree of aneurysm occlusion and the incidence of complications were compared between the two groups immediately after surgery and during follow-up. Surgical costs were also compared, and multivariate logistic regression analysis was used to identify factors associated with incomplete aneurysm occlusion.

The surgeries for 295 patients (with 335 aneurysms) were all successfully completed, and the success rate of stent implantation was 100%(295/295). Among them, 189 cases (210 aneurysms) were in the LVIS group and 106 cases (125 aneurysms) were in the FD group. There were no statistically significant differences in the baseline admission data, peripheral blood laboratory test results, aneurysm characteristics, follow-up time between the two groups (all P>0.05). The usage rate of combined coils in the LVIS group was significantly higher than that in the FD group [99.0%(208/210) vs. 6.6%(8/125), P<0.001]; the surgical-related costs in the LVIS group [M(Q₁, Q₃): 10.59 (9.37, 20.91) ten thousand yuan] were significantly lower than those in the FD group [19.65 (16.72, 20.81) ten thousand yuan, P<0.001)]. Immediate postoperative angiography showed that the complete occlusion rate of aneurysms in the LVIS group was significantly higher than that in the FD group [93.8%(197/210) vs. 4.8%(6/125), P<0.001]. At 6 months post operation, the imaging follow-up showed that the complete occlusion rate of aneurysms in the LVIS group was higher than that in the FD group [95.5%(147/154) vs. 66.1%(72/109), P<0.001], while the complete occlusion rate of aneurysms in the FD group significantly increased with the extension of the postoperative time (P<0.001). There were no statistically significant differences in the incidence of complications during the intraoperative and postoperative follow-up periods between the two groups (all P>0.05). Multivariate logistic regression analysis revealed that a wider aneurysm neck (OR=1.254, 95%CI: 1.017-1.546, P=0.034) was an independent risk factor for incomplete aneurysm occlusion during postoperative follow-up, while combined coils (OR=0.004, 95%CI: 0-0.075, P<0.001) and higher total cholesterol levels (OR=0.590, 95%CI: 0.387-0.900, P=0.014) were independent protective factors for incomplete aneurysm occlusion.

The LVIS stent and FD have similar safety in endovascular treatment of intracranial aneurysms. The short-term efficacy of LVIS stent after surgery is superior to that of FD, and the cost of LVIS stent surgery seems lower. A wide aneurysm neck, combined coil embolization, and high total cholesterol levels are independent influencing factors for post-operative aneurysm occlusion.

To investigate the factors influencing the rupture of intracranial microaneurysms (≤3 mm in maximum diameter).

A retrospective comparative analysis was conducted on the clinical and imaging characteristics of patients with ruptured (n=48) and unruptured (n=57) intracranial microaneurysms admitted to the Department of Neurosurgery, Xingtai People′s Hospital from January 2022 to December 2024. Data collected included general information, medical history, personal history and imaging data (presence of multiple aneurysms, location of target aneurysms, maximum diameter, size ratio, and aspect ratio). For patients with multiple aneurysms, the target aneurysms in the rupture group were those causing subarachnoid hemorrhage, while those in the non-rupture group were the largest aneurysms. Statistical analysis was performed using SPSS 26.0, with comparisons between groups conducted via independent samples t-test or χ² test. Variables with statistically significant differences (P<0.05) from univariate analysis were included in multivariate logistic regression analysis to identify the influencing factors for the rupture of intracranial microaneurysms.

Compared with the unruptured group, the ruptured group exhibited a higher age (58.3±7.7 years vs. 55.1±6.9 years, P=0.044), a higher proportion of patients with primary hypertension [70.8% (34/48) vs. 43.9% (25/57), P=0.008], and a higher prevalence of smoking history [45.8% (22/48) vs. 28.1% (16/57), P=0.045]. The ruptured group also showed a higher incidence of multiple aneurysms [29.2% (14/48) vs. 14.0% (8/57), P=0.044] and posterior circulation aneurysms [33.3% (16/48) vs. 14.0% (8/57), P=0.003]. Additionally, the ruptured group had larger maximum aneurysm diameter (2.52±0.41 mm vs. 2.41±0.53 mm, P=0.025), a higher size ratio (1.92±0.38 vs. 1.45±0.32, P=0.005), and a greater aspect ratio (0.82±0.15 vs. 0.63±0.12, P=0.002) compared to the unruptured group. Multifactorial analysis showed that age (OR=1.120, 95%CI: 1.028-1.218, P=0.009), hypertension (OR=3.150, 95%CI: 1.318-7.514, P=0.009), smoking history (OR=2.317, 95%CI: 1.060-5.060, P=0.034), posterior circulation location (OR=3.001, 95%CI: 1.167-7.712, P=0.023), multiple aneurysms (OR=2.231, 95%CI: 1.018-4.888, P=0.044), size ratio (OR=4.867, 95%CI: 2.336-10.133, P=0.002) and aspect ratio (OR=6.210, 95%CI: 3.150-12.242, P=0.001) were independent risk factors for rupture.

Patients who are older, have primary hypertension, have a history of smoking, have an aneurysm located in the posterior circulation, have multiple aneurysms, and have a large size ratio and aspect ratio of the aneurysm are at higher risk of intracranial microaneurysm rupture.

To explore the influencing factors of successful endovascular recanalization in stroke patients with symptomatic non-acute middle cerebral artery occlusion (SNA-MCAO) and to construct a prediction model.

A retrospective analysis was conducted on the clinical data of 204 SNA-MCAO stroke patients who received endovascular treatment at the Department of Cerebrovascular Intervention, Henan Provincial People′s Hospital from January 2019 to June 2024. Simple balloon dilation or balloon dilation combined with stent implantation was adopted. The patients were divided into successful group and failed group. LASSO regression analysis and logistic regression analysis were used to screen the factors influencing the success of endovascular recanalization and construct a nomogram prediction model. The area under the curve (AUC) was drawn through the receiver operating characteristic curve to evaluate the discrimination of the model. The accuracy of the model was evaluated by the Bootstrap method and the Hosmer-Lemeshow Goodness-of-fit test. The decision curve was used to evaluate the prediction performance of the model.

The success rate of surgical recanalization was 83.3% (170/204). All patients in the successful recanalization group received imaging follow-up. The follow-up time [M(Q₁, Q₃)] was 183 (116, 213) days. By the last follow-up, the stent restenosis rate in patients receiving stent implantation was 18.1% (28/155). LASSO analysis and further binary logistic regression analysis showed that the presence of a conical occlusion stump (OR=6.013, 95%CI: 2.316-17.583), occlusion involving the M1 segment bifurcation of the middle cerebral artery at the distal end (OR=0.151, 95%CI: 0.033-0.303), and a longer time from imaging diagnosis of occlusion to recanalization (OR=0.966, 95%CI: 0.943-0.984) were independent influencing factors for successful recanalization surgery (all P<0.001). Based on these factors, a nomogram prediction model was constructed, and its AUC was 0.820 (95%CI: 0.618-0.882). After 1 000 internal validation and calibration using the Bootstrap method, the AUC was 0.804. The Hosmer-Lemeshow goodness-of-fit test revealed that the model had a high prediction accuracy (χ²= 3.255, P=0.617). The clinical decision curve indicated that when the threshold probability was between 0.16 and 0.98, the net benefit of this model in prediction of the success probability of endovascular recanalization surgery was relatively high.

The tapered occluded stump, the involvement of the distal occlusion in the bifurcation of the M1 segment of the middle cerebral artery, and the time from imaging confirmation to recanalization are independent influencing factors for endovascular recanalization in SNA-MCAO stroke patients. The nomogram prediction model constructed based on this data demonstrates good predictive value for the success of endovascular recanalization procedures.

To investigate the efficacy and safety of endovascular embolization as therapy in high-grade (Spetzler-Martin grade Ⅲ-Ⅴ) intracranial arteriovenous malformation (AVM).

A retrospective analysis was conducted on the clinical data of 139 patients with high-grade intracranial AVM from January 2015 to October 2024 in the Department of Neurosurgery, the Affiliated Jinling Hospital of Nanjing University Medical School. According to the treatment strategy or treatment period, patients were divided into the combined treatment group (receiving embolization combined with microsurgical treatment, 35 cases), the early embolization group (receiving embolization treatment alone from 2015 to 2020, 37 cases), and the recent embolization group (receiving embolization treatment from 2021 to 2024, 67cases). To reduce confound bias, the propensity score matching (PSM) method was adopted to conduct inter-group comparative analyses of the early embolization and the recent embolization, as well as between the combined treatment and the recent embolization, in order to respectively evaluate the influence on efficacy and safety of the "technological progress" and "treatment strategy". Meanwhile, a comparative analysis was conducted on the patients who received single embolization and staged embolization treatment. The main observation indicators included the cure rate, the incidence of permanent dysfunction, postoperative complications and modified Rankin Scale (mRS) score (an increase in score of mRS indicating deterioration, and a score of 0 to 2 indicating good prognosis).

After PSM, the patients in the recent embolization group had a higher cure rate [80.8%(21/26) vs. 42.3%(11/26)], a lower rate of permanent dysfunction [15.4%(4/26) vs. 42.3%(11/26)], and more embolization times [M(Q₁, Q₃): 1 (1, 2) times vs. 1 (1, 1) times] than the early embolization group, and the differences were all statistically significant (all P<0.05). There were no statistically significant differences in the incidence of postoperative complications or the deterioration rate of mRS score before discharge between the two groups of patients (both P>0.05). After PSM, compared with the combined treatment group, the proportion of patients with deep intracranial AVM in the recent embolization group was higher [32.1%(9/28) vs. 3.6%(1/28)], and the incidence of postoperative complications was lower [25.0%(7/28) vs. 57.1%(16/28)], and the differences were statistically significant (both P<0.05). However, there were no statistically significant differences in the cure rate, the rate of permanent dysfunction, or the deterioration rate of mRS score before discharge (all P>0.05). There were no statistically significant differences in the cure rate, the incidence of postoperative complications, or the proportion of patients with good prognosis between the staged embolization group and the single embolization group in the recent embolization group (all P>0.05). A total of 122 patients were followed up clinically and radiologically, and the median follow-up time was 5 months (ranged from 3 to 48 months). At the last follow-up, 119 cases (97.5%) had stable or improved mRS scores. The proportions of patients with good prognosis in the combined treatment group, the early embolization group, and the recent embolization group were 60.0% (21/35), 56.8% (21/37) and 77.6% (52/67), respectively.

With the advancement of technology, the cure rate and safety of endovascular embolization alone for high-grade intracranial AVM have significantly improved. The short-term efficacy seems superior to that of the early stage and comparable to that of combined surgical treatment, with fewer complications. For some patients, the staged embolization strategy is safe and feasible, providing a new and effective option for the treatment of high-grade intracranial AVM.

To assess the surgical technique and clinical efficacy of percutaneous minimally invasive ligamentum flavum resection combined with partial isthmic laminectomy for central lumbar spinal stenosis with grade Ⅰ spondylolisthesis.

A retrospective analysis was conducted on clinical data from 22 patients with single-level central lumbar spinal stenosis and Grade Ⅰ spondylolisthesis, who were admitted to the Department of Neurosurgery of the No.904 Hospital of PLA Joint Logistics Support Force between June 2022 and September 2024. Preoperative measurements were performed on lumbar MRI T2-weighted sagittal images to determine the distances from the superior edge of the starting level of posterior dural sac compression to the upper and lower borders of the ligamentum flavum. On axial images, the transverse diameter, sagittal diameter and cross-sectional area of the dural sac at the most stenotic level were measured. Operative time, intraoperative blood loss and complications were documented. Visual Analog Scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) were assessed preoperatively and at 1 day, 7 days, 1 month, and 6 months postoperatively to evaluate pain improvement and clinical outcomes. Follow-up imaging was performed 3 to 6 months postoperatively. Postoperative lumbar MRI was used to assess the length of decompression in the sagittal plane, as well as changes in the transverse diameter, sagittal diameter and area of the dural sac at the most stenotic level on axial images. Postoperative CT and X-rays were utilized to evaluate lumbar stability.

The mean operative time for all 22 patients was 62.7±8.6 minutes (range: 40-75 minutes), with a mean intraoperative blood loss of 35.3±10.6 ml (range: 20-65 ml). No cases of nerve injury or cerebrospinal fluid leakage occurred; only one patient developed superficial skin infection 5 days postoperatively. Postoperative lumbar MRI confirmed adequate decompression of the spinal canal in all patients. The sagittal decompression length was 22.4±1.7 mm, which was significantly greater than the preoperative distance from the superior edge of the stenotic level to the lower border of the ligamentum flavum (20.2±1.4 mm, P<0.001). Compared with preoperative values, significant increases were observed at the most stenotic level in the dural sac transverse diameter (13.0±2.0 mm vs. 9.9±1.4 mm), sagittal diameter (9.8±1.4 mm vs. 6.4±1.0 mm) and cross-sectional area (102.5±15.6 mm²vs. 45.0±9.7 mm²)(all P<0.001). All 22 patients were followed up for a mean duration of 8.3±2.7 months (range: 6-12 months). Repeated-measures analysis of variance revealed statistically significant improvements over time (all P<0.05): the VAS scores decreased from 6.9±1.1 preoperatively to 0.5±0.3 at the final assessment, the ODI decreased from (70.2±3.5)% to (13.3±2.4)%, and the JOA scores increased from 15.1±2.0 to 27.2±1.4. Postoperative X-ray or CT scans in the patients showed no evidence of increased spondylolisthesis, laminar fracture, or scoliosis deformity.

The percutaneous minimally invasive ligamentum flavum resection combined with partial isthmic laminectomy shows adequate decompression of the spinal canal for patients with central lumbar spinal stenosis and Grade Ⅰ spondylolisthesis. Short-term follow-up demonstrated significant improvements in pain, neurological function and quality of life with a favorable surgical safety profile.

To explore the clinical efficacy and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) guided by intraoperative O-Arm three-dimensional scanning combined with intraoperative neuronavigation for the treatment of lumbar degenerative diseases.

A retrospective analysis was conducted on the clinical data of 43 patients with lumbar degenerative diseases (navigation group) who underwent MIS-TLIF assisted with intraoperative O-Arm three-dimensional scanning and neuronavigation at the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2020 to June 2023. Meanwhile, 38 patients with lumbar degenerative diseases who underwent MIS-TLIF under C-arm fluoroscopy guidance during the same time period were included as the C-arm group. Postoperative three-dimensional computed tomography reconstruction was performed to assess the accuracy of pedicle screw placement. Postoperative follow-up was performed through outpatient visit and telephone interview. The Oswestry Disability Index (ODI) was used to assess patients′ quality of life, and the modified MacNab criteria were applied to evaluate the surgical efficacy. Patients′ sex, age, intraoperative blood loss, operation duration, screw placement time, preoperative and postoperative ODI scores, excellent and good rate of surgical efficacy, and complications were compared between the two groups.

There were no statistically significant differences in patients′ sex, age, intraoperative blood loss, operation duration, pre-and postoperative ODI scores, or surgical efficacy between the two groups (all P>0.05). The screw placement time in the C-arm group was significantly longer than that in the navigation group(7.7±2.3 min vs. 3.3±0.9 min, P<0.001). All pedicle screws in the navigation group were accurately positioned, while 3 cases in the C-arm group had suboptimal screw positions. In the C-arm group, there were 2 cases of surgery-related complications, including 1 case of intraoperative dural tear and 1 case of transient lower limb weakness caused by cauda equina injury. No intraoperative dural tear, cauda equina injury, or nerve root injury occurred in the navigation group.

For the treatment of lumbar degenerative diseases with MIS-TLIF surgery, intraoperative O-arm 3D scanning combined with neuronavigation achieves comparable surgical efficacy to traditional C-arm fluoroscopy localization. It can improve the accuracy of percutaneous pedicle screw placement, shorten the screw placement time and reduce the incidence of intraoperative complications, thereby enhancing surgical safety.

To investigate the role of absorbable collagen-based barrier membranes in lower limb nerve decompression surgery for diabetic peripheral neuropathy (DPN).

The DPN patients diagnosed and treated in the Department of Neurosurgery at Shanghai Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2019 to March 2022 were prospectively enrolled. Patients were randomly assigned to three groups using a random number table: the barrier membrane group, conventional surgery group and drug therapy group. The conventional surgery group underwent classic Dellon decompression of three lower limb nerves (common peroneal nerve, distal peroneal nerve, tibial nerve and its branches) bilaterally. The barrier membrane group used an absorbable collagen-based barrier membrane to wrap the decompressed nerves postoperatively. Lower limb pain and numbness were assessed using the Visual Analogue Scale (VAS) at baseline and 6 months post-treatment, with VAS improvement defined as effective. The Toronto Clinical Score System (TCSS) evaluated neurological symptoms, reflexes and sensory function. Neurophysiological testing measured conduction velocities of the tibial and common peroneal nerves, while the two-point discrimination test (2-PD) assessed skin sensitivity in the toes.

Sixty-nine patients were enrolled (23 per group). One patient was lost to follow-up in the barrier membrane group. Pre-treatment differences in diabetes duration, pain duration, TCSS and VAS scores, tibial and peroneal nerve conduction velocities, or 2-PD values were not statistically significant among the three groups (all P>0.05). At 6 months post-treatment, the efficacy rates were 90.9% (20/22) for the barrier membrane group, 82.6% (19/23) for the conventional surgery group, and 26.1% (6/23) for the medication group, with statistically significant differences (P<0.001). At 6 months post-treatment, TCSS and VAS scores, tibial nerve and common peroneal nerve conduction velocities, and 2-PD values improved in both the barrier membrane group and the conventional surgery group compared to preoperative levels. These improvements were superior to those in the drug therapy group, the barrier membrane group were superior to the conventional surgery group, and the differences were statistically significant (all P<0.05).

Lower extremity nerve decompression surgery is effective for treating DPN. Absorbable collagen-based barrier membranes can further enhance its therapeutic efficacy.

To summarize the types of vascular injuries in patients with traumatic optic neuropathy (TON) combined with injury of the internal carotid artery or its branches, and to explore the optimal treatment strategies and therapeutic effects.

A retrospective analysis was conducted on the clinical data of 17 patients with TON combined with injuries of the internal carotid artery or its branches who were admitted to the Department of Brain Hospital, Xi′an People′s Hospital (Xi′an Fourth Hospital) from January 2022 to December 2024. All patients underwent head CT, high-resolution CT of the optic canal, CT angiography, and digital subtraction angiography (DSA) preoperatively. Individualized endovascular treatment strategies were formulated according to the different type of vascular injuries. Transnasal endoscopic optic canal decompression was performed for all patients after the assessment or treatment of vascular injury was completed. For patients with concurrent basilar skull fractures or cerebrospinal fluid rhinorrhea, orbital medial wall restoration or cerebrospinal fluid rhinorrhea repair was carried out simultaneously. At 6 months postoperatively, all patients were followed up clinically and radiologically to evaluate the improvement of vision and whether there was any progression or recurrence of the vascular injury.

Among the 17 patients, 4 cases presented clinical manifestations of vascular injury such as epistaxis and exophthalmos before the operation, and 17 cases (18 sides) had decreased vision or blindness. CT scans of the optic nerve canal revealed 18 sides with optic nerve canal fractures occurring in 17 patients, with the medial and inferior walls of the optic nerve canal being the most common. Among them, 12 cases were accompanied by fractures of the lateral wall of the sphenoid sinus, and 15 cases were accompanied by other craniofacial fractures on the head CT scans. DSA showed that the types of vascular injuries included internal carotid artery dissection (7 cases), internal carotid artery pseudoaneurysm (2 cases), carotid-cavernous fistula (2 cases), ophthalmic artery pseudoaneurysm (2 cases), and other combined vascular injuries (4 cases, among which 3 cases were combined with internal carotid artery dissection). In terms of treatment, among the patients with internal carotid artery dissection, 9 cases did not undergo endovascular treatment due to good blood flow compensation on the affected side. One patient had slightly poor compensation but refused endovascular treatment, and developed cerebral infarction 1 month later. A total of 9 patients (including 2 cases of combined injury with internal carotid artery dissection but untreated dissection) received endovascular treatment. All lesions were treated successfully and no complications related to endovascular treatment occurred. Transnasal endoscopic optic nerve canal decompression was completed for all patients, and good pulsation of the optic nerve sheath was observed during the operation. The decompression in all 17 patients was adequate. Nine cases underwent medial orbital wall reconstruction and 2 cases underwent repair of cerebrospinal fluid rhinorrhea at the same time, and no complications such as epistaxis, cerebrospinal fluid leakage, intracranial or intraorbital infection occurred after the operation. There were 2 patients who had improved vision acuity at discharge. All 17 patients completed the 6-month clinical follow-up. Among them, the visual acuity of 4 cases (4 sides) had improved vision acuity compared with preoperative conditions. Nine patients who received endovascular treatment underwent DSA follow-up, and no progression or recurrence of vascular injuries was observed. Patients with preoperative symptoms such as nasal bleeding and exophthalmos experienced relief or disappearance of symptoms after treatment.

For patients with TON combined with injury of the internal carotid artery or its branches, individualized endovascular treatment combined with optic canal decompression based on the type of vascular injury can help improve the vision acuity of some patients and effectively handle the vascular injuries and prevent serious complications. Meanwhile, comprehensive imaging assessment and concurrent combined surgical procedure are of great significance for improving the prognosis of these patients.

By analyzing early MRI imaging, we investigated the imaging factors affecting the prognosis of children with spinal cord injury without fracture and dislocation (SCIWORA). The clinical data of 46 children with SCIWORA diagnosed and treated in neurosurgery departments of 4 hospitals led by the Children's Hospital affiliated to Suzhou University from January 2017 to August 2024 were retrospectively analyzed. Neurological outcomes at 6 months after injury were assessed by the American Spinal Cord Injury Association Injury Scale (AIS) grading, and the degree of spinal cord injury at 48 hours after injury was assessed by the Brain and Spinal Cord Injury Center (BASIC) score. The results showed that there were intramedullary abnormal signals in 22 cases (47.8%), and the injuries were mainly in thoracic segment (47.8%, 22/46) and conus (21.7%, 1/46); Among them, those with a BASIC score of 2 points accounted for the highest proportion (16/22), followed by those with a BASIC score of 1 point (3/22), 3 point (2/22) and 4 point (1/22). AIS was classified as A in 9 cases (19.1%) and B-E in 37 cases (80.9%). Compared with children with tethered spinal cord, children without tethered spinal cord had higher BASIC scores and more injured segments (allP<0.05)。 Spearman rank correlation analysis showed that BASIC scores were positively correlated with AIS grades in 46 children (r＝0.655，P<0.001)。 Preliminary studies have shown that early trauma MRI is valuable in evaluating the neurological prognosis of children with SCIWORA.

To preliminarily investigate the gene expression profiles in the blood vessels of patients with adult moyamoya disease (MMD) and their role in the pathophysiology of chronic vascular occlusion.

A retrospective analysis was conducted on 20 adult MMD patients who underwent combined intracranial and extracranial revascularization at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University between January 2020 and December 2023. A total of 10 specimens each of the superficial temporal artery (STA) and middle cerebral artery (MCA) were collected. Four non-MMD patients who underwent craniotomy via the frontotemporal approach were included as controls, from whom 3 STA specimens and 1 MCA specimen were obtained. RNA was extracted from the specimens for sequencing. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using R language. Gene Set Enrichment Analysis (GSEA) was conducted based on gene function, and single nucleotide polymorphism analysis was used to identify genetic mutation sites.

The transcriptomic analysis results revealed 3 426 differentially expressed genes between the STA of the MMD group and the control group, with 2 259 upregulated and 1 167 downregulated in the MMD group. Additionally, 501 differentially expressed genes were identified between the MCA of the MMD group and the control group, including 428 upregulated and 73 downregulated genes. Compared with the control group, the FABP1 gene was upregulated in both the STA and MCA of MMD patients (both P<0.05). Further GO enrichment analysis indicated that the differentially expressed genes between the two groups of STA samples were primarily enriched in protein functions related to cell-cell adhesion molecule activity and membrane-targeted localization. KEGG pathway analysis results demonstrated that the differentially expressed genes were mainly enriched in oxidative phosphorylation, the PPAR signaling pathway, and the signal recognition particle dependent cotranslational protein targeting to membrane pathway. GSEA results suggested that upregulation of the oxidative phosphorylation pathway was positively correlated with differentially expressed genes in the STA (P=0.031). GO enrichment analysis revealed that the differentially expressed genes in the MCA of MMD patients compared to the control group were primarily enriched in angiogenesis and focal adhesion protein functions. KEGG pathway analysis results showed that the differentially expressed genes in the MCA of MMD patients and the control group were mainly enriched in focal adhesion and vascular smooth muscle contraction pathways. Single nucleotide polymorphism analysis indicated that 18 MMD vascular specimens exhibited variations in the FABP1 gene at the rs2241883 locus.

Genes such as FABP1 are upregulated in the blood vessels of MMD patients, which may be associated with abnormal angiogenesis and chronic occlusion in the pathogenesis of MMD.

To evaluate the operability, safety, and efficacy of rapamycin self-expanding drug-eluting stents (SDES) in canine vertebrobasilar artery system placement.

A total of 16 adult beagles were used. Among them, 15 dogs were randomly divided (using a random number table) into five evaluation groups at 7, 14, 21, 28, and 90 days post stent implantation, with 3 dogs in each group. One dog served as a blank control for assessing rapamycin metabolism without stent implantation. In the 90-day group, only one SDES (3.0 mm × 20.0 mm) was implanted into the anterior spinal artery. In the remaining four groups, one SDES was implanted into the basilar artery and one self-expanding bare metal stent (SBMS) (both 2.0 mm×13.0 mm) was implanted into the anterior spinal artery in each dog to evaluate the operational performance of stent placement. At the experimental endpoint, digital subtraction angiography (DSA) was used to assess the occurrence of in-stent stenosis (stenosis rate >50% defined as in-stent stenosis). Liquid chromatography-mass spectrometry was employed to detect the metabolism of rapamycin in the stents, the stented vessel segments and surrounding brain tissue, peripheral blood and cerebrospinal fluid, as well as in vital organ tissues.

All stents were successfully implanted, and all animals survived until the experimental endpoint. The operational performance during implantation was rated as excellent or good for all stents. DSA evaluation showed that in vessels implanted with SBMS, two vessels in the 28-day group developed in-stent stenosis (50.0% and 53.8%, respectively); whereas no in-stent stenosis occurred in any vessel implanted with SDES. Blood flow was patent in all stented vessels, with no evidence of vascular dissection, aneurysm, or in-stent thrombosis. The rapamycin metabolism results in the SDES-implanted groups showed rapid drug release in the 21- and 28-day groups, and complete release in the 90-day group, with a statistically significant difference in drug release rates among the groups (P=0.01). The drug concentration in the SDES-stented vessel segments was highest in the 14-day group, gradually decreased at 21 and 28 days, and dropped to 0 μg/g by 90 days, with a statistically significant difference among the groups (P=0.04). The median concentration of detected in the brain tissue surrounding the stented vessel segments was 0.010 (0-0.073) μg/g, with no statistically significant difference among the groups (P=0.30). Throughout the experimental period, rapamycin was not detected in the blood or cerebrospinal fluid. The median concentration detected in vital organs was 0 (0-0.022) μg/g.

The self-expanding rapamycin-eluting stent demonstrated good operability and safety profile for implantation in the canine vertebrobasilar artery system and may reduce the incidence of in-stent stenosis.

Solitary fibrous tumors of the central nervous system are rare and have a high rate of local recurrence and distant metastasis. As of December 31, 2025, no cases of multiple intracranial recurrences with metastasis to the spinal canal have been reported. A patient with solitary fibrous tumor of the central nervous system was admitted to the Department of Neurosurgery of the People's Hospital of Inner Mongolia Autonomous Region. After surgical resection, the tumor recurred multiple times in the cranium and metastasized in the spinal canal. Four surgical resections were performed within 5 years, and the interval between operations was gradually shortened, and the Ki67 proliferation index showed an increasing trend, suggesting that the malignancy degree of the tumor was increasingly higher and the prognosis of the patient was poor. Up to the last follow-up, the muscle strength of both lower limbs of the patient was grade Ⅰ ~ Ⅱ, and he continued to undergo rehabilitation treatment, which is still under close follow-up.

Hunter's Arch Syndrome is a rare syndrome characterized by vertebrobasilar insufficiency caused by mechanical compression of the vertebral artery during head and neck rotation or hyperextension. At present, there are few cases of cerebellar infarction caused by Hunter's arch syndrome secondary to atlanto-occipital deformity. A male patient was admitted to the Department of Neurosurgery of the First Hospital of Hebei Medical University. The clinical manifestations were dizziness, nausea and double vision when turning the head. Skull MRI showed bilateral cerebellar infarction, and digital subtraction angiography of the head showed distal occlusion of the left vertebral artery V3 segment, and interruption of the right vertebral artery V2 segment with distal blood flow when turning the head. Cervical CT showed skull base depression combined with atlantoaxial dislocation, and was diagnosed as Hunter's Arch Syndrome. The patient's symptoms disappeared completely after treatment with atlanto-occipital fusion by posterior approach. Five months after surgery, cranial DSA showed that the right vertebral artery was patent when the head was rotated, and the clinical symptoms of the patient did not recur.

Autoimmune glial fibroacidic protein astrocytopathy (GFAP-A) is a rare form of meningoencephalomyelitis with early clinical symptoms often similar to intracranial infection. This paper reports a patient with GFAP-A misdiagnosed as intracranial infection after right acoustic neuroma operation. After tumor resection, he repeatedly experienced fever and headache, but the replacement of various antibiotics was ineffective. After perfecting cerebrospinal fluid autoantibody detection, he was finally diagnosed as GFAP-A, and improved after hormone therapy.

Craniopharyngioma is a rare benign tumor. The common complication is hypothalamic obesity, which is mostly caused by the tumor itself or the damage of hypothalamus caused by surgery, radiotherapy and other treatments. Hypothalamic obesity is mainly manifested by rapid increase in body mass, and it is difficult to control through diet and exercise, which seriously damages the physical and mental health of patients. Its pathogenesis is related to abnormal appetite and energy expenditure caused by hypothalamic injury, involving leptin resistance, inflammatory reaction and abnormal neuropeptide secretion. Current treatments include glucagon-like peptide 1 (GLP1) receptor agonists, oxytocin, bariatric surgery, and diet and exercise interventions. Among them, GLP1 receptor agonist can improve the body mass and metabolic index of patients, while bariatric surgery can effectively improve the body mass and metabolic function. This article mainly expounds the mechanism of craniopharyngioma complicated with hypothalamic obesity and the latest therapeutic progress, in order to provide a basis for follow-up research.