Volume 42 · Issue 06 · 2026

Although the diagnosis and treatment of moyamoya disease in China is progressing rapidly, it still faces challenges in the study of etiology and pathogenesis, accurate evaluation of cerebral revascularization surgery and long-term health management. This paper discusses the above contents from three aspects: firstly, the study of etiology and pathogenesis should go beyond single genetic factor, and comprehensively explore from the synergistic effects of polygenic susceptibility, environmental exposure and spatiotemporal factors; Secondly, during cerebral revascularization, attention should be paid to the accurate assessment of the bearing capacity of the recipient's cerebral vascular network and the cerebral ischemic state of the patient; Finally, surgery did not change the natural course of the disease, and moyamoya disease required long-term follow-up and comprehensive intervention.

Craniocerebral trauma is a serious public health event on a global scale. In China, the annual incidence rate of craniocerebral trauma is about 55.4/100,000~64.1/100,000. The disability rate of craniocerebral trauma is high, which seriously affects the quality of life of patients, and brings heavy economic and psychological burden to individuals, families and society.

Epilepsy is a common chronic neurological disease, in which approximately 1/3 of patients have poor drug therapy and is defined as drug-refractory epilepsy (DRE), which seriously affects the quality of life and social function of patients. Surgical treatment has become an important means for some DRE patients to achieve long-term seizure-free. Traditional craniotomy can significantly control seizures, but its application in some patients is limited because of its high trauma, long recovery cycle, and high risk of complications^[1]。 laser interstitial thermal therapy (LITT) was first proposed by Bown in 1983. In 1990, Sugiyama first used it for the treatment of brain lesions. In 2007, the U.S. Food and Drug Administration approved magnetic resonance guided LITT (MRgLITT) for the treatment of intracranial diseases^[2]And rapidly promoted in the field of epilepsy surgery. Since 2020, many epilepsy centers in my country have successively carried out clinical practice of using MRgLITT to treat DRE, accumulating relatively rich experience, laying the foundation for the localized application and promotion of this technology. At present, there are few relevant guidelines or consensus at home and abroad. Most of the existing literatures are single-center retrospective studies, and there is a lack of unified standards in patient selection, surgical indications, technical operating specifications and perioperative management. Under this background, Tan Qifu Professional Committee of Preoperative Evaluation and Surgical Technology of Epilepsy Surgery of China Anti-Epilepsy Association organized domestic experts in relevant fields to formulate the Expert Consensus on the Application of Laser Interstitial Hyperthermia in Epilepsy Surgery Guided by Magnetic Resonance (2026 Edition), which is in line with China's national conditions, which has important clinical and academic value for standardizing surgical indications and contraindications, guiding preoperative evaluation and surgical operation, improving surgical efficacy and safety, and promoting multi-center collaboration and clinical promotion.

To investigate the association between long-term exposure to ambient fine particulate matter (PM2.5) and the incidence of moyamoya disease.

A retrospective study was conducted on patients with moyamoya disease residing in Henan Province and Hebei Province, who were admitted to the Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital between January 2003 and December 2022. Data on municipal PM2.5 concentrations, meteorological factors (mean temperature, precipitation), and socioeconomic indicators were collected for the same period. A generalized additive model combined with negative binomial regression was applied to analyze the exposure-response relationship between long-term PM2.5 exposure and the incidence of moyamoya disease, with confounding factors adjusted in a stepwise manner.

A total of 2 310 patients with moyamoya disease from the two provinces were included. After controlling for the random effects of the control cities and other confounding factors, there was a significant nonlinear association between the increase in PM2.5 concentration and the increase in the incidence of moyamoya disease (P=0.023). The model bias interpretability metric was 65.9% (corrected R²=0.731). The exposure-response curve of PM2.5 indicated that at PM2.5 concentrations of 57.38, 69.63 and 79.20 μg/m³ (corresponding to the 25th, 50th and 75th percentiles, respectively), the relative risks for moyamoya disease onset were 1.90 (95%CI: 0.63-5.68), 2.26 (95%CI: 0.77-6.62) and 2.41 (95%CI: 0.83-7.01), showing an overall non-linear increasing trend.

Long-term exposure to high levels ambient PM2.5 may be an important environmental risk factor for moyamoya disease, and its pathogenic effect seems to show a non-linear growth trend.

To investigate the short-term effects of revascularization surgery on cognitive function in patients with moyamoya disease.

Patients with moyamoya disease admitted to the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University (181 cases) and Peking University International Hospital (43 cases) between July 2022 and July 2025 were prospectively enrolled. Patients receiving healthy lifestyle intervention alone were included in the healthy lifestyle intervention group, while those receiving healthy lifestyle intervention combined with revascularization surgery were included in the surgery group. Patients in the surgery group underwent computed tomography angiography (CTA) within one week postoperatively to assess graft patency. Follow-up assessments were conducted at the 6-month outpatient revisit after treatment. Cognitive evaluations covering 11 domains, including choice reaction time, Raven′s graphic reasoning, three-dimensional mental rotation, spatial working memory, forward and backward verbal memory span, simple and complex subtraction, verbal memory, and forward and backward executive function, were performed before treatment and at follow-up. Paired t-tests (with Bonferroni correction) were used to compare pre-treatment and last follow-up cognitive assessment results in both groups. Subgroup analysis was performed in the surgery group based on the surgical side (left or right).

A total of 224 patients with moyamoya disease were enrolled, including 184 in the surgery group and 40 in the healthy lifestyle intervention group. Postoperative cranial CTA in the 184 surgery group patients confirmed patent anastomotic vessels. The follow-up duration [M(Q₁, Q₃)] for the surgery group was 6(4, 7) months. Compared with pre-treatment values, the surgery group showed significant improvements at last follow-up in verbal memory (0.108±0.944 points vs.-0.174±1.091 points), three-dimensional mental rotation (0.158±1.047 points vs.-0.111±1.005 points), and Raven′s graphic reasoning (0.142±1.076 points vs.-0.130±0.972 points) (all adjusted P<0.05). No significant differences were observed in other cognitive domains (all adjusted P>0.05). In the healthy lifestyle intervention group, the follow-up duration [M(Q₁, Q₃)] was 11 (7, 13) months, and no significant differences were found in any of the 11 cognitive domain scores between pre-treatment and last follow-up (all adjusted P>0.05). Before treatment, there were no significant differences in the 11 cognitive domain scores between the left-sided surgery subgroup (91 cases) and right-sided surgery subgroup (93 cases) (all adjusted P>0.05). At last follow-up, the right-sided surgery subgroup had significantly higher forward verbal memory span scores than the left-sided surgery subgroup (adjusted P=0.049); no significant differences were observed in other cognitive domains (all adjusted P>0.05).

Revascularization surgery can improve certain cognitive functions in patients with moyamoya disease, particularly in verbal memory, spatial processing, and logical reasoning. The improvement in forward verbal working memory is more pronounced in patients undergoing right-sided surgery than in those undergoing left-sided surgery.

To investigate the efficacy of Dujiangyan-style side-to-side anastomotic bypass surgery for adult moyamoya disease.

A retrospective analysis was conducted on the clinical data of 240 adult patients with moyamoya disease who underwent unilateral superficial temporal artery(STA)-middle cerebral artery (MCA) bypass surgery at the Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2022 to December 2024. Patients were divided into two groups based on the surgical technique: the Dujiangyan-style side-to-side anastomosis group (n=197, Dujiangyan group) and the end-to-side anastomosis group (n=43). Baseline characteristics, postoperative outcomes, complications and postoperative-to-preoperative regional cerebral blood flow (rCBF) ratios were compared between the two groups. Multivariable logistic regression analysis (stepwise method) was used to identify independent factors influencing cerebral hyperperfusion syndrome (CHS).

There were no statistically significant differences in baseline characteristics such as age, sex, and Suzuki stage between the two groups of patients (all P>0.05). The incidence of CHS was significantly lower in the Dujiangyan group than in the end-to-side anastomosis group [3.6% (7/197) vs. 18.6% (8/43), P=0.001]. However, no significant differences were found between the two groups in postoperative-to-preoperative rCBF ratio, incidence of postoperative cerebral infarction or cerebral hemorrhage, postoperative modified Rankin scale score, Matsushima grade at 3 months postoperatively, or graft occlusion rate (all P>0.05). Multivariable logistic regression analysis showed that an increased postoperative-to-preoperative rCBF ratio was an independent risk factor for CHS after STA-MCA bypass surgery (OR=619 062.37, 95%CI: 1 125.23-340 585 878.10, P<0.001), whereas the Dujiangyan-style side-to-side anastomosis was an independent protective factor (OR=0.14, 95%CI: 0.03-0.53, P=0.004). Age, Suzuki stage, or Matsushima grade was not significant influencing factor for CHS after STA-MCA bypass surgery(all P>0.05).

Compared with conventional end-to-side anastomosis, the Dujiangyan-style side-to-side anastomotic bypass procedure provides comparable neurological functional outcomes in adult patients with moyamoya disease while reducing the risk of postoperative cerebral hyperperfusion syndrome.

To investigate the risk factors for postoperative complications in adult patients with moyamoya disease (MMD) undergoing combined cerebral revascularization.

The clinical data of 2 007 adult MMD patients who underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) in the Department of Neurosurgery, Henan Provincial People′s Hospital from January 2018 to June 2023 were retrospectively analyzed. The occurrence of cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage, reversible ischemic neurological deficit (RIND), epileptic seizure within 3 weeks after surgery, and transient ischemic attack (TIA) within 14 days after surgery was documented. Patients were divided into complication group and non-complication group. The differences in preoperative clinical data between the two groups were compared, and indicators with statistically significant differences were included in the multivariate logistic regression model for analysis.

Among the 2 007 patients, 376 cases (18.7%) developed postoperative complications, including 72 cases (3.6%) of cerebral infarction, 35 cases (1.7%) of cerebral hemorrhage, 12 cases (0.6%) of subarachnoid hemorrhage, 149 cases (7.4%) of RIND, 44 cases (2.2%) of TIA, and 64 cases (3.2%) of epileptic seizure. There were 1 631 cases (81.3%) in the non-complication group. Compared with the non-complication group, the complication group had a higher proportion of preoperative frequent TIA [51.1% (192/376) vs.27.2% (444/1 631)], bilateral cerebral hemispheric asymmetrical vascular progression [20.7% (78/376) vs.3.1% (50/1 631)], and higher preoperative systolic blood pressure (147.5±13.0 mmHg vs.134.0±14.5 mmHg, 1 mmHg=0.133 kPa), with statistically significant differences (all P<0.001). There were no significant differences in age, gender, coronary atherosclerotic heart disease, diabetes mellitus, smoking history, drinking history, preoperative diastolic blood pressure, or Suzuki stage between the two groups (all P>0.05). Multivariate logistic regression analysis showed that preoperative frequent TIA (OR=2.985, 95%CI: 1.771-5.032), bilateral cerebral hemispheric asymmetrical vascular progression (OR=9.854, 95%CI: 4.128-23.522), and elevated preoperative systolic blood pressure (OR=1.081, 95%CI: 1.058-1.104) were independent risk factors for postoperative complications (all P<0.001).

Preoperative frequent TIA, bilateral cerebral hemispheric asymmetrical vascular progression, and elevated systolic blood pressure are independent risk factors for postoperative complications after combined cerebral revascularization in adult patients with MMD.

To explore the risk factors for perioperative sleep disturbances in adult patients with moyamoya disease, to construct a nomogram model to predict the risk of sleep disturbance occurrence, and to validate its efficacy.

A retrospective analysis was conducted on the clinical data of 300 consecutive adult moyamoya disease patients who underwent encephaloduroarteriosynangiosis (EDAS) at the Department of Neurosurgery, the Fifth Medical Center of the Chinese PLA General Hospital from December 2022 to May 2023. Patients were divided into a sleep disturbance group and a non-sleep disturbance group based on whether perioperative sleep disturbances occurred. Multivariate logistic regression analysis was employed to screen for risk factors associated with perioperative sleep disturbances, and a nomogram model for predicting the risk of sleep disturbance occurrence was constructed. External validation was performed using data from 91 adult patients with moyamoya disease who underwent EDAS and were admitted to the same center between June and July 2023. The discriminative ability of the model was evaluated using the receiver operating characteristic (ROC) curve. Decision curve analysis was used to assess the clinical net benefit of the model.

Multivariate logistic regression analysis revealed that advanced age (OR=1.062, 95%CI: 1.035-1.090, P<0.001), preoperative fear (OR=0.468, 95%CI: 0.272-0.804, P=0.006), high Self-Rating Anxiety Scale (SAS) score (OR=0.560, 95%CI: 0.324-0.970, P=0.011) and high Self-Rating Depression Scale (SDS) score (OR=0.376, 95%CI: 0.178-0.796, P=0.017) were all independent risk factors for perioperative sleep disturbances in adult moyamoya disease patients. A predictive model for sleep disturbance occurrence in moyamoya disease patients was constructed based on the above four risk factors. The results demonstrated that the area under the receiver operating characteristic curve (AUC) of the multivariable combined model was 0.719 (95%CI: 0.660-0.777), which was superior to the models corresponding to any single factor (all P<0.05). The AUC of the model in the validation set was 0.789 (95%CI: 0.669-0.868), with a Bootstrap-corrected concordance index of 0.768, sensitivity of 0.722, specificity of 0.741, and Youden index of 0.463, and a Brier score of 0.083. Decision curve analysis demonstrated that the nomogram model provided actual clinical benefit for patients.

Older age, preoperative fear, and higher SAS and SDS scores are all identified as risk factors for perioperative sleep disturbances in adult patients with moyamoya disease. The nomogram model constructed based on these factors demonstrates favorable predictive performance for perioperative sleep disturbance risk in moyamoya disease patients and holds certain clinical application value.

To explore the biological effects of ischemic type pediatric moyamoya disease plasma exosomes on human cerebral artery vascular smooth muscle cells (HBVSMC) and to analyze the potential proteomic mechanisms.

Ten children with ischemic moyamoya disease diagnosed in the Department of Neurosurgery of Henan Provincial People′s Hospital and five healthy children undergoing physical examination during the same period were selected for plasma sample collection. Exosomes were extracted and identified by ultracentrifugation. The samples were classified into the moyamoya disease group and the control group based on the source of the exosomes. The differences between the negative control (NC) group and the experimental group were detected by CCK8 assay, EdU cell proliferation assay and Transwell cell migration assay, to clarify the effects of moyamoya disease-related exosomes on the proliferation, migration and phenotypic transformation of HBVSMC. The expression of related proteins was detected by western blotting (WB). Data-independent acquisition (DIA) proteomics technology was used to screen the differentially expressed proteins (DEPs) between the two groups of exosomes. Functional enrichment and protein-protein interaction (PPI) network analysis were performed using bioinformatics methods.

Exosomes from the plasma of children with ischemic moyamoya disease were successfully extracted and identified. Under the electron microscope, the exosomes appeared as typical cup-shaped or saucer-like morphology with a double-layer membrane structure. The average particle size of the vesicles was 151.3 nm, with a peak particle size of 146.4 nm. Compared with the NC group, the proliferation rate and the number of migrating cells of HBVSMC in the experimental group were significantly increased (both P<0.01). WB results showed that compared with the NC group, the expression levels of contractile markers α-smooth muscle actin and smooth muscle 22α in HBVSMC of the experimental group were significantly decreased, while the expression levels of synthetic markers osteopontin and matrix metalloproteinase 2 were significantly increased (all P<0.01). A total of 279 DEPs were screened out by proteomics analysis, including 82 up-regulated and 197 down-regulated ones, showing a unique expression pattern. Bioinformatics analysis revealed that the DEPs were mainly involved in biological processes such as complement and coagulation cascade reactions, inflammation and immune response, and extracellular matrix remodeling. PPI network analysis revealed the complex interactions among the DEPs, and the top 10 core molecules were visualized as ALB, DECR1, F2, HSPA9, HSPD1, TF, ACTA1, FN1, TFRC and PRDX3.

The plasma exosomes from ischemic-type pediatric moyamoya disease could induce pathological behavioral changes in HBVSMC related to vascular remodeling and lumen narrowing. The underlying mechanism may be related to the key DEPs carried by the exosomes, which are involved in complement activation, inflammatory immune response, and extracellular matrix remodeling.

The clinical data of 5 adult patients with hemorrhagic moyamoya disease admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital from September 2019 to February 2023 were retrospectively analyzed. All 5 patients had intraventricular hemorrhage and hydrocephalus. All patients underwent first-stage ventriculoperitoneal shunt and second-stage cerebral revascularization. CT reexamination within 1 d after cerebral revascularization in 5 patients showed subdural effusion (SDF) on the operative side, accompanied by different degrees of consciousness disturbance. Two cases were treated with up-adjustment of pressure divider valve pressure and drilling drainage, one case was only up-adjustment of pressure divider valve pressure, and two cases were not treated. At the time of discharge, the state of consciousness recovered to the level before cerebral revascularization, and the modified Rankin scale (mRS) score was 3 in 2 cases, 2 cases, and 1 case. At 6 months of follow-up, mRS scores were 2 in 4 cases and 4 in 1 case; Recurrence of hemorrhagic stroke occurred in 1 case and seizure occurred in 1 case. The results of CT reexamination showed that SDF disappeared in 2 cases and a small amount of SDF remained in 3 cases. Adults with hemorrhagic moyamoya disease combined with hydrocephalus treated by ventriculo-peritoneal shunt and cerebral revascularization surgery with SDF after surgery are rare. This study suggests that severe enlargement of the subdural space and arachnoid valve formation may be involved in its formation, and the use of regulating pressure divider valve pressure and/or drilling drainage can effectively treat SDF.

To investigate the imaging characteristics and genetic etiology of familial hemifacial spasm (FHFS).

Clinical data of 5 FHFS patients from two pedigrees admitted to the Department of Neurosurgery, Qilu Hospital of Shandong University between July 2024 and January 2025 were retrospectively analyzed. Pedigree members underwent imaging examinations and whole-exome sequencing (WES) to explore the imaging features of FHFS patients and the types of gene variants associated with the phenotype.

All 5 FHFS patients exhibited vertebrobasilar artery developmental anomalies. The posterior fossa crowdedness index [M(Q₁, Q₃)] was 87.5% (84.9%, 89.8%). The facial-pontine angle (FPA) [M(Q₁, Q₃)] on the affected side was significantly smaller than that on the healthy side [92.3° (88.9°, 104.2°) vs. 117.2° (105.4°, 118.3°), W=0, P=0.031]. WES results revealed that the proband, father, and cousin in pedigree 1 all carried variants in the PCDHGB3, CLK4, FRMPD1, and OXA1L genes. Among these, the heterozygous frameshift deletion variant PCDHGB3 c. 2343_2344delAT was a novel mutation which had not been previously reported.

Preliminary findings indicate that FHFS patients are characterized by a high incidence of vertebrobasilar artery developmental anomalies, a crowded posterior fossa structure, and a smaller FPA on the affected side. Variants in the PCDHGB3, CLK4, FRMPD1, and OXA1L genes may represent potential genetic underpinnings of FHFS.

To investigate the correlation between the anatomical characteristics of offending vessels and the severity of clinical symptoms in hemifacial spasm (HFS).

A retrospective study was conducted on 142 HFS patients who underwent microvascular decompression (MVD) at the Department of Neurosurgery, Peking University People′s Hospital between June and November 2024. The severity of HFS symptoms was assessed using the preoperative Hemifacial Spasm Grading Scale (HSGS). Patients with a total score ≤7 were classified into the mild-to-moderate group, while those with scores >7 were classified into the severe group. Intraoperative video recordings were reviewed to evaluate the types and morphological characteristics of offending vessels, including the morphology of the anterior inferior cerebellar artery (AICA) (type α vs. non-α), bifurcation location (proximal vs. distal), vertebral artery (VA) course (bypass type vs. compressive type), vertebral artery-posterior inferior cerebellar artery (VA-PICA) morphology (type η vs.non-η), and perforating artery type (short perforating artery vs. non-short perforating artery). Differences in anatomical characteristics of offending vessels between the mild-to-moderate and severe groups were compared. Variables with statistically significant differences were incorporated into a multivariate logistic regression model to analyze their correlation with HFS symptom severity.

Compared with the mild-to-moderate group, the severe group exhibited significantly higher proportions of type α AICA [26.8% (11/41) vs.12.9% (13/101)], compressive VA course [53.7% (22/41) vs. 22.8% (23/101)], and type η VA-PICA configuration[61.0% (25/41) vs. 11.9% (12/101)] (all P<0.05). No statistically significant differences were observed between the two groups in the age, sex, disease duration, affected side, AICA bifurcation location, or perforating artery type (all P>0.05). Multivariate logistic regression analysis revealed that type η VA-PICA configuration (OR=12.705, 95%CI: 4.070–39.658, P<0.001) and type α AICA (OR=3.198, 95%CI: 1.033-9.905, P=0.044) were independently associated with severe HFS.

HFS symptoms are correlated with the anatomical characteristics of offending vessels. Specifically, the loop structure of the AICA and the collaborative type η compressive configuration of the VA-PICA complex are independently associated with severe HFS.

To investigate the feasibility and clinical efficacy of neuroendoscopic surgery for patients with medial thalamic hemorrhage combined with intraventricular cast.

A retrospective comparative analysis was conducted on clinical data from patients with medial thalamic hemorrhage and severe intraventricular cast treated in the Department of Neurosurgery, the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, from January 2020 to December 2024. Patients were divided into two groups: the endoscopic group (57 cases) treated with neuroendoscopic intraventricular hematoma evacuation, and the catheterization group (32 cases) treated with simple ventricular puncture for hematoma external drainage combined with fibrinolytic drug thrombolysis. Baseline data, operative time, immediate postoperative hematoma clearance rate, frequency of fibrinolytic drug use, Glasgow coma scale (GCS) score on postoperative day 1, hematoma clearance rate at catheter removal, complications, and Glasgow outcome scale (GOS) at 3 months postoperatively were compared between the two groups.

No significant differences were observed in baseline data such as gender, age, or preoperative GCS scores between the two groups (all P>0.05). All surgeries were successfully completed without intraoperative deaths or adverse events. In the endoscopic group, 3.5% (2/57) of patients experienced oozing from the original bleeding site during surgery, which was inadequately controlled with gelatin sponge compression, leading to postoperative rebleeding and subsequent conversion to large bone flap microscopic hematoma evacuation. In the catheterization group, 6.3% (2/32) of patients had unilateral catheter misplacement outside the lateral ventricle. Compared to the catheterization group, the endoscopic group had a longer operative time (114.37±25.47 min vs. 32.53±5.30 min), higher hematoma clearance rates immediately postoperatively (76.44±12.65% vs. 17.72±7.44%) and at catheter removal (92.00±8.23% vs. 77.25±10.26%), fewer uses of fibrinolytic drugs [M(Q₁, Q₃): 2.0 (1.0, 4.5) times vs. 10.0 (8.0, 12.0) times], higher GCS scores on postoperative day 1 (9.65±1.62 points vs. 8.88±1.36 points), and lower incidences of postoperative intracranial infection [10.6% (6/57) vs. 28.1% (9/32)] and hydrocephalus [12.3% (7/57) vs. 34.4% (11/32)] (all P<0.05). No significant differences were observed in the incidences of infectious pneumonia, gastrointestinal bleeding, hepatic or renal failure, or venous thrombotic events between the two groups (all P>0.05). There was no significant difference in GOS grades at 3 months postoperatively between the two groups (P=0.135). However, compared to the catheterization group, the endoscopic group had a lower mortality rate within 3 months postoperatively [8.8% (5/57) vs. 25.0% (8/32), P=0.037].

Neuroendoscopic surgery for medial thalamic hemorrhage with ventricular cast offers certain advantages over simple catheter drainage combined with fibrinolytic therapy. It improves immediate postoperative hematoma clearance, reduces the frequency of fibrinolytic drug use, and lowers the risks of intracranial infection and hydrocephalus.

To investigate the preliminary application of three-dimensional (3D) neuroendoscopy in neurosurgical operations.

A retrospective study was performed on 58 patients who underwent 3D neuroendoscopic surgery in the Department of Neurosurgery, Affiliated Hospital of Nantong University from December 2023 to April 2025. The cohort included 19 cases of intracranial mass lesions, 21 cases of primary hemifacial spasm (HFS), and 18 cases of primary trigeminal neuralgia (TN). No less than 80% of the core surgical steps were completed under 3D neuroendoscopy during the whole operation. Intraoperative paired comparison was conducted by switching between 3D and 4K-resolution two-dimensional (2D-4K) neuroendoscopy in the same surgical field. The subjective experience of the two endoscopes among neurosurgeons was evaluated via intraoperative operator assessment and anonymous questionnaire survey. Meanwhile, the surgical efficacy and safety were evaluated.

The surgeon assessment showed that compared with 2D-4K neuroendoscopy, 3D neuroendoscopy could truly restore the 3D structure of the surgical field, with higher accuracy and fluency of surgical manipulation. A total of 220 valid questionnaires were collected, and the results indicated that the proportion of respondents who considered 3D neuroendoscopy superior was higher than that of 2D-4K neuroendoscopy in terms of sense of reality, stereoscopic vision, depth perception, and anatomical structure understanding, while the proportion of respondents who considered 2D-4K neuroendoscopy superior was higher in terms of image clarity and operation-related vertigo. The median follow-up duration of the 58 patients was 6.9 (Q₁, Q₃: 3.0, 14.5) months. Postoperative cranial MRI confirmed total tumor resection in all 19 patients with intracranial mass lesions, and no tumor recurrence was found at the last follow-up. At the last follow-up, the overall symptom relief rate was 100.0% in the 21 patients with primary HFS, with a complete relief rate of 95.2% (20/21); the facial pain relief rate reached 100.0% in the 18 patients with primary TN. No severe surgery-related complications occurred in this cohort.

Preliminary study indicates that 3D and 2D-4K neuroendoscopy have their respective advantages in subjective evaluation, and the overall advantages of 3D neuroendoscopy are more prominent than those of 2D-4K neuroendoscopy. Neurosurgical operations performed under 3D neuroendoscopy have satisfactory overall efficacy and favorable safety.

To investigate the expression of progranulin (GRN) in glioblastoma (GBM) and its correlation with patient prognosis, molecular subtypes and the tumor immune microenvironment.

Transcriptomic data and corresponding clinical information of GBM patients were obtained from The Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas public databases (n=139、n=105), patients were divided into high GRN expression and low GRN expression groups according to the median expression value of GRN. Kaplan-Meier survival analysis and multivariate Cox regression were used to evaluate the association between GRN expression and patient prognosis. The differences in GRN expression levels among different molecular subtypes (Verhaak classification, Wu classification, Garofano classification) were compared. IVYGAP enrichment analysis, 'ESTIMATE’ algorithm, and 'CIBERSORT’ deconvolution method were employed to systematically assess the correlation between GRN expression and tumor anatomical features, immune microenvironment and immune checkpoint molecules. Single-cell transcriptomic datasets published by Yu et al. and Neftel et al. were utilized to characterize the expression distribution of GRN across distinct cellular subpopulations.

In the TCGA cohort, patients with high GRN expression exhibited significantly shorter overall survival compared to those with low GRN expression (P=0.024). In the TCGA cohort, Cox multivariate regression analysis confirmed that high GRN expression was an independent risk factor for poor prognosis in GBM patients (HR=2.01, 95%CI: 1.21~3.40, P=0.007). GRN expression levels were significantly elevated in the Verhaak mesenchymal subtype, the Wu M3 subtype, and the Garofano GPM subtype (all P<0.01). IVYGAP enrichment analysis revealed that the high GRN expression group had significantly higher scores for pseudopalisading cells around necrosis and microvascular proliferation regions, but lower scores for cellular tumor region compared to the low GRN expression group (all P<0.01). 'ESTIMATE’ analysis indicated that patients with high GRN expression had lower tumor purity, but significantly higher stromal and immune scores compared to the low GRN expression group (all P<0.01). 'CIBERSORT’ immune infiltration analysis suggested that the high GRN expression group exhibited a lower proportion of lymphocytes, higher proportions of macrophages and M2-type macrophages, and a lower proportion of activated dendritic cells compared to the low GRN expression group (all P<0.05). Concurrently, multiple immunosuppressive checkpoint molecules such as TIGIT and HAVCR2 were significantly upregulated in the high GRN expression group compared to the low GRN expression group (all P<0.05). Single-cell transcriptomic data analysis demonstrated that GRN was predominantly expressed in myeloid cells, with relatively low expression levels in malignant cells, oligodendrocytes and other immune cells.

High expression of GRN is significantly associated with poor prognosis in patients with glioblastoma, and is closely related to the immunosuppressive tumor microenvironment. GRN may regulate the functional remodeling of myeloid cells to reshape the immune microenvironment of GBM.

To systematically analyze the effectiveness and safety of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH).

The system searched the CNKI, VIP, Wanfang, China Biomedical Literature Database, PubMed, the Cochrane Library, and ScienceDirect databases. The search time range was from the establishment of the databases to June 27, 2025. Randomized controlled trials (RCTs) on patients with chronic subdural hematoma (CSDH) treated with surgery were screened. The control group received the optimal treatment regimen, including medication, burr hole drainage, or craniotomy for hematoma evacuation (referred to as "conventional treatment" ), while the experimental group received conventional treatment combined with MMAE. The revised risk-of-bias assessment tool was used to evaluate the methodological quality of the included RCT studies. The outcome indicators extracted from the RCT studies included recurrence, reoperation, surgery-related complications, and death. Review Manager 5.4.1 software was used to analyze the data. The Q-test and I² value was used to evaluate the heterogeneity of the studies. When I² < 50%, a fixed-effect model was used; when I² ≥ 50%, a random-effect model was adopted. Sensitivity analysis was conducted by the method of excluding studies one by one to evaluate the source of heterogeneity and its impact on the conclusion. When the number of included studies was ≥ 5, the Egger′s and Begg′s tests was used to comprehensively assess the existence of publication bias.

A total of 6 studies involving 1 850 patients were included, with 912 patients in the experimental group and 938 in the control group. Four studies reported the 90-day follow-up results, and 2 studies reported the 180-day follow-up results. The results of the risk assessment of literature bias showed that all 6 included studies had some risks of bias. The results of the meta-analysis showed that compared with the control group, the recurrence rate of chronic subdural hematoma (CSDH) in the experimental group (RR=0.55, 95%CI: 0.41-0.73, P<0.001) and the re-operation rate (RR=0.37, 95%CI: 0.25-0.56, P<0.001) were both lower. However, there were no statistically significant differences in the incidence of surgery-related complications (RR=0.89, 95%CI: 0.71-1.11, P=0.290), or the mortality rate (RR=0.92, 95%CI: 0.49-1.71, P=0.790) between the two groups (both P>0.05). There were no statistically significant differences in the 4 outcome indicators between the 90-day and 180-day follow-up results (all P>0.05). The results of Begg′s and Egger′s tests showed that no publication bias was detected among the literatures (all P>0.05). In the sensitivity analysis, excluding the literature only affected the RR value of the mortality rate between the two groups (maximum RR=1.11, 95%CI: 0.68-1.83), but the difference in the mortality rate between the two groups was still not statistically significant (P=0.674).

MMAE can effectively reduce the risks of hematoma recurrence and reoperation at 90 days and 180 days after surgery in the treatment of CSDH, without increasing the risks of surgery-related complications and death.

Acute middle cerebral artery occlusion is a clinically critical severe cerebrovascular disease, and timely and effective vascular recanalization therapy is crucial to improve the prognosis of patients. At present, its main treatment methods include intravenous thrombolysis, mechanical thrombectomy and bridging therapy. Arteriotomy and thrombectomy have not been popularized in clinical practice because of its high requirements for the operator's operation experience and the risks of postoperative intracranial infection and epileptic seizures. In July 2021, a patient with acute middle cerebral artery occlusion was admitted to the Department of Neurosurgery of Tianjin First Central Hospital. Due to individual factors of the patient, middle cerebral artery incision and thrombectomy through left pterional approach was finally selected, and the blood vessels were successfully recanalized after operation. Two years after surgery, the patient had poor speech fluency and normal muscle strength in his limbs, with a modified Rankin scale score of 1.

Calcified pseudotumor of nerve axis is a rare benign fibroskeletal lesion of nerve axis, which is easy to be misdiagnosed and misdiagnosed because of its non-specific clinical manifestations and imaging features. In February 2025, a 48-year-old female patient with calcified pseudotumor of the nerve axis was admitted to the Department of Neurosurgery of Nanyang Nanshi Hospital. She came to the doctor for 6 months of progressive headache. Imaging examination showed cystic-solid mass occupation in the left frontal insula with local calcification. Craniotomy was performed to remove the lesion, and the tumor was nearly totally resected. HE staining showed a nodular distribution of chondroid tissue with calcification, proliferation of peripheral small blood vessels, and lymphocyte infiltration. The results of immunohistochemical staining showed that acid calcium binding protein (+) and epithelial membrane antigen (+). The patient's headache was completely relieved after operation, and no tumor recurrence was seen after 12 months of follow-up. There was no new neurological deficit in the patient. By combining the clinical data of this patient and systematically reviewing relevant literatures, the etiology, clinical and imaging manifestations, pathological characteristics, key points of differential diagnosis and treatment strategies of this disease were summarized. The diagnosis of this disease should be combined with imaging and pathological features, and its treatment should follow the principle of individualization.

Glioma is the most common primary malignant tumor of the central nervous system, which has clinical features such as strong aggressiveness, high recurrence rate and poor prognosis. At present, the standard treatment plan for glioma is surgical resection combined with radiotherapy and chemotherapy. The presence of the blood-brain barrier significantly limits the therapeutic effect of chemotherapeutic drugs. In recent years, focused ultrasound combined with microbubble technology has shown significant advantages in the field of glioma treatment because it can reversibly, safely and non-invasively open the blood-brain barrier. A large number of basic experimental studies have shown that this technique can effectively increase the drug concentration in tumor tissue, enhance the therapeutic effect, and reduce systemic toxic reactions. In this paper, the research progress of focused ultrasound combined with microbubble technology in glioma drug delivery was systematically reviewed, in order to provide reference for follow-up research and clinical translation.

Autologous skull is an ideal cranial repair material, but the existence of related complications limits its clinical application. The premise to ensure the success of autologous skull repair is to preserve the bone flap reliably. If bone resorption can be effectively avoided and the risk of infection can be strictly controlled, autologous skull is still the most effective clinical repair material. By adopting strict preservation and treatment process, the activity of autologous skull can be maintained, and the clinical application effect of autologous skull can be improved. This article focuses on the research progress of autologous skull preservation technology.