Volume 42 · Issue 09 · 2026

To compare the efficacy and safety of deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) (referred to as GPi-DBS) versus subthalamic nucleus (STN) DBS (referred to as STN-DBS) for the treatment of cervical dystonia (CD).

A retrospective analysis was conducted on clinical data from CD patients who underwent bilateral GPi-DBS (n=20) or STN-DBS (n=17) at Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between January 2005 and December 2021. All patients were followed up for 36 months postoperatively. DBS efficacy was assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), and safety was evaluated based on the occurrence of stimulation-related adverse events. The TWSTRS improvement rates, stimulation-related complications, and programming parameters were compared between the two groups at 1, 3, 6, 12, 24, and 36 months postoperatively.

At 36 months postoperatively, there were no statistically significant differences between the GPi-DBS and STN-DBS groups in terms of improvement rates for total TWSTRS score (60.52%±27.87% vs. 62.60%±27.26%), severity subscore (54.06%±27.26% vs. 59.11%±25.37%), disability subscore (60.33%±30.32% vs. 59.12%±32.24%), or pain subscore [M(Q₁, Q₃): 94.45% (80.50%, 100.00%) vs. 100.00% (93.80%, 100.00%)] (all P>0.05). The STN-DBS group showed significantly greater improvement than the GPi-DBS group in total TWSTRS improvement rate (47.59%±18.87% vs. 33.31%±15.25%, P=0.015) and severity subscore improvement rate (41.89%±16.56% vs. 22.57%±18.39%, P=0.002) at 1 month postoperatively; however, this advantage disappeared from 3 months post-surgery and thereafter. Regarding programming parameters, the GPi-DBS group required higher stimulation voltage [M(Q₁, Q₃)] than the STN-DBS group [3.0 (2.7, 3.2) V vs. 2.1 (2.0, 2.5) V, P<0.001]. The proportion of patients experiencing stimulation-related complications was higher in the STN-DBS group than in the GPi-DBS group (14/17 vs. 6/20, P<0.001) at 36 months post operation, with dyskinesia being the most prominent (12/17 vs. 3/20). Most stimulation-related complications were effectively alleviated by adjusting stimulation parameters. In terms of durability of efficacy, TWSTRS improvement rates in both groups stabilized at 12 months postoperatively and were maintained through the final follow-up.

GPi-DBS and STN-DBS provide comparable long-term efficacy for the treatment of CD. STN-DBS exhibits a faster onset of action but is associated with a higher rate of stimulation-related complications, whereas GPi-DBS requires higher stimulation voltages.

To analyze the distribution characteristics of brain regions associated with different seizure types induced by high-frequency electrical stimulation, explore the correlation between stimulation-induced seizures and the seizure onset zone (SOZ), and investigate the application value of electrically induced seizures in the localization of SOZ.

A retrospective analysis was conducted on the clinical data of 82 patients with drug-resistant epilepsy who underwent stereotactic electroencephalogram (SEEG) electrode implantation and cortical electrical stimulation at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from December 2020 to November 2021. The electrical stimulation results were classified into four types: habitual seizure (SZ-H), habitual subclinical discharge (SCD-H), non-habitual seizure (SZ-NH), and non-habitual subclinical discharge (SCD-NH). The seizure characteristics of different brain regions under electrical stimulation were analyzed, the differences in seizure induction between SOZ and non-SOZ areas were compared, and their correlations with surgical prognosis were investigated. The diagnostic role of electrical stimulation-induced seizures in SOZ was summarized.

Among the 82 patients, 72 cases (87.8%) could experience at least one type of epileptic seizure induced by electrical stimulation, with a total of 261 seizure occurrences. Among them, 42 cases (58.3%) experienced SZ-H, 19 cases (26.4%) developed SZ-NH, 7 cases (9.7%) developed SCD-H, and 4 cases (5.6%) showed SCD-NH. Ten cases did not experience any seizures through electrical stimulation. The characteristics of seizure induction by electrical stimulation in different brain regions were as follows: the frontal lobe induced seizures 59 times, including 42 times (71.2%) of habitual seizures; the lateral temporal lobe induced seizures for 44 times, including 28 times (63.6%) of non-habitual seizures; the medial temporal lobe induced seizures for 108 times, including 70 times (64.8%) of non-habitual seizures; the parietal lobe induced seizures for 20 times, including 12 times (60.0%) of habitual seizures; the occipital lobe induced seizures for 6 times, with 3 times of habitual seizures and 3 times of non-habitual seizures each; the insular lobe induced seizures for 24 times, including 18 times (75.0%) of habitual seizures. There was statistically significant difference in the distribution of epileptic seizure types induced by electrical stimulation in different brain regions (χ²=23.47, P<0.001). The habitual seizures induced by electrical stimulation only occurred at the stimulation sites of the SOZ area. SOZ was an independent related factor for habitual seizures (complete separation, 95%CI: 15.3-∞, P<0.001). The prognosis analysis showed that patients whose surgical resection range included the seizure inducing electrode sites of SZ-H or SCD-H had a good prognosis rate of 93.75% (45/48), significantly higher than that (69.70%, 23/33) observed in patients without habitual seizure induction (χ²=8.40, P=0.004).

The patterns of epileptic seizure induction by high-frequency electrical stimulation in different brain regions vary. Typical seizures are more likely to be induced in the frontal lobe and insular cortex, while atypical seizures are more prone to be induced by the stimulation of medial temporal lobe. The typical seizures induced by electrical stimulation are the specific markers of SOZ, and intraoperative resection of the site that triggers habitual seizures can significantly improve surgical outcomes for patients with epilepsy.

To investigate the efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) in the treatment of MRI-negative focal drug-resistant epilepsy (DRE) and to explore the factors influencing its prognosis.

The clinical data of 20 patients with MRI negative focal DRE who underwent SEEG-guided RF-TC at the Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University between January 2021 and June 2024 were retrospectively analyzed. Postoperative seizure outcomes were assessed at 3, 6, 12, 24, and 36 months using the Engel classification system. The incidence of permanent neurological deficits at the last follow-up was also documented. Based on the seizure outcomes at the final follow-up, patients were divided into a favorable prognosis group (Engel class Ⅰ) and an unfavorable prognosis group (Engel classes Ⅱ–Ⅳ), and factors influencing the outcomes were analyzed.

Twenty patients underwent implantation of 12.90±3.14 electrodes (range: 7-20 electrodes). Habitual seizures were induced by electrical stimulation in 18 patients, and electrographic seizures were recorded in 12 patients, which were consistent with the seizure onset zone (SOZ) in 5 cases and inconsistent in 7 cases. All 20 patients successfully underwent RF-TC. Six patients still had seizures after surgery. One patient developed permanent neurological deficits. The follow-up duration after RF-TC was 24.05±11.96 months (range: 6-45 months). At 3 months postoperatively, 70% (14/20) of patients were seizure-free; the seizure-free rates at 12, 24, and 36 months were 9/16, 6/10, and 1/4, respectively. At the last follow-up, among the 20 patients, 12 were classified as Engel class Ⅰ, 1 as Engel class Ⅱ, 6 as Engel class Ⅲ, and 1 as Engel class Ⅳ. Among the 8 patients with persistent seizures, 4 had never achieved seizure freedom after surgery, 2 had recurrence within 3 months postoperatively, while 2 experienced recurrence more than 6 months after surgery. Compared with the unfavorable prognosis group(8 cases), the favorable prognosis group (12 cases) had a higher proportion of patients with overlap between hypometabolic regions on positron emission tomography-computed tomography (PET-CT) and the SOZ, and a higher proportion of patients with no electrographic seizures or electrographic seizures consistent with the SOZ during SEEG monitoring; the proportion of patients with seizures inconsistent with the SOZ before electrode removal after RF-TC was lower in the favorable prognosis group (all P<0.05).

SEEG-guided RF-TC is an effective and safe treatment option for achieving short-term seizure control in some patients with MRI-negative focal DRE. Favorable prognosis is associated with concordance between the SOZ and hypometabolic regions identified on PET-CT. Conversely, patients have a poorer prognosis when electrical seizures occur that do not fully correspond to the SOZ, or when seizures inconsistent with the SOZ arise after RF-TC but prior to electrode removal.

To explore the influencing factors of surgical efficacy in patients with drug-resistant epilepsy (DRE).

A retrospective analysis was performed on the clinical data of 99 patients with DRE who underwent epilepsy surgery at the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2023. The last follow-up was conducted in August 2025. Surgical outcomes were evaluated using the Engel classification at the final follow-up, with Class Ⅰ defined as a favorable prognosis and Classes Ⅱ-Ⅳ as an unfavorable prognosis. Differences in clinical characteristics between the favorable and unfavorable prognosis groups were compared, and factors with P<0.1 were included in a multivariate logistic regression model. Patients were stratified into a temporal lobe epilepsy (TLE) group and an extra-temporal lobe epilepsy (exTLE) group according to the primary lesion location, and the prognosis of the two groups was analyzed separately.

The median follow-up duration for the 99 patients was 40 (Q₁, Q₃: 30, 48) months. At the final follow-up, 68 patients (68.7%) were classified as Engel Class Ⅰ, 25 (25.2%) as Class Ⅱ, and 6 (6.1%) as Class Ⅲ. The median time to the first postoperative seizure for the 31 patients in Classes Ⅱ and Ⅲ was 9 months (range: 1-20). Compared with the favorable prognosis group (68 cases), the unfavorable prognosis group (31 cases) had a younger age at onset, a higher proportion of male patients and exTLE cases, and a lower proportion of patients with hippocampal sclerosis (HS)-related pathological changes (HS-positive), with all differences being statistically significant (all P<0.05). No statistically significant differences were observed between the two groups in surgical age, ethnicity, disease duration, or lesion laterality (all P>0.05). Multivariate logistic regression analysis showed that TLE (OR=9.90, 95%CI: 2.91-33.69, P<0.001), female sex (OR=4.65, 95%CI: 1.20-18.05, P=0.026), and HS positivity (OR=5.59, 95%CI: 1.02-30.57, P=0.047) were independently associated with an Engel Class Ⅰ prognosis. At the end of follow-up, the rates of Engel Class Ⅰ prognosis were 88.2% (60/68) in the TLE group and 25.8% (8/31) in the exTLE group, with a statistically significant difference (χ²=35.74, P<0.001). Subgroup stratification analyses by surgical age, age at onset, disease duration, sex, and HS-related pathological positivity showed that, except for the female sex and HS-positive subgroups where the differences did not reach statistical significance (P>0.05), TLE were a protective factor for an Engel Class Ⅰ prognosis across all other subgroups (all P<0.01).

TLE, HS positivity, and female sex are independent factors associated with a favorable Engel Class I prognosis following surgery.

To evaluate the surgical efficacy of stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) in the treatment of periventricular nodular heterotopia (PNH)-related drug-resistant epilepsy and its impact on brain network topological structure.

A retrospective analysis was performed on 7 consecutively enrolled PNH patients who underwent radiofrequency thermocoagulation at the Department of Neurosurgery, the Second Affiliated Hospital of Army Medical University from January 2020 to January 2024. All patients underwent preoperative high-resolution MRI, positron emission tomography-CT, video electroencephalography monitoring and genetic testing, with imaging, symptomatic and electrophysiological characteristics collected. Postoperative follow-up lasted at least 12 months, and the Engel classification was used to assess efficacy. Further exploration was conducted on changes in brain network connectivity before and after RFTC in 4 patients with complete SEEG data. Mutual information algorithm was adopted to extract connectivity, and clustering coefficient, local efficiency and betweenness centrality were used as network characteristic indicators to compare differences between thermocoagulation and non-thermocoagulation channels across different frequency bands.

On average, 11.9 depth electrodes (range: 7-14), each with 8-16 contacts, were implanted in the 7 patients. One patient experienced transient postoperative agraphia, but no patients suffered long-term postoperative complications. At the 12-month postoperative follow-up, all 7 patients achieved an Engel Class Ⅰa outcome. A total of 475 channels from 4 patients were included in the analysis: 107 thermocoagulation channels and 368 non-thermocoagulation channels. Analysis of brain connectivity changes revealed that, following thermocoagulation, the clustering coefficient, local efficiency, and betweenness centrality increased across all frequency bands (δ, θ, α, β, γ, and the full frequency range) for the thermocoagulation channels, whereas these three metrics decreased across all frequency bands for the non-thermocoagulation channels. After Bonferroni correction, betweenness centrality was higher in thermocoagulation channels than in non-thermocoagulation channels across all frequency bands; additionally, clustering coefficients and local efficiency values in the θ, α, β, and γ bands were higher in thermocoagulation channels than in non-thermocoagulation channels (all P<0.05).

SEEG-RFTC treatment effectively controls seizures in patients with drug-resistant epilepsy associated with PNH. By disrupting the connections within epileptic networks and their nodes, SEEG-RFTC can effectively remodel the network topology.

To investigate the clinical efficacy of high-frequency spinal cord stimulation in the treatment of painful diabetic peripheral neuropathy.

A retrospective analysis was conducted on the clinical data of 16 patients with painful diabetic peripheral neuropathy who underwent high-frequency(10 kHz) spinal cord stimulation at the Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University from August 2023 to April 2025. All patients underwent electrode implantation during Phase Ⅰ, with the electrodes connected to an external stimulator that was turned on to deliver electrical stimulation. After a one-week trial of low-frequency electrical stimulation, if the pain visual analog scale (VAS) decreased by ≥50%, Phase Ⅱ surgery was performed to implant a permanent pulse generator. Following two weeks of low-frequency stimulation, patients received two weeks of high-frequency stimulation; thereafter, patients could choose to resume low-frequency stimulation or continue with high-frequency stimulation based on their preference. Pain intensity was assessed using VAS scores at preoperative, one week post-Phase Ⅰ surgery, and two weeks, four weeks, and three months post Phase Ⅱ surgery. The EQ-5D-5L questionnaire was administered at preoperative and three months post Phase Ⅱ surgery to evaluate improvements in health related quality of life. Lower limb skin temperature was measured using an infrared thermography at preoperative and one week post-Phase Ⅰ surgery.

All 16 patients successfully underwent Phase Ⅰ and Phase Ⅱ surgeries. None of the patients experienced surgery related complications such as infection, electrode displacement, or hematoma. The pain VAS scores of the 16 patients were 9.00±1.15 points, 3.93±0.68 points, 4.06±0.77 points, 3.25±1.18 points, and 2.93±1.12 points at preoperative, one week post Phase Ⅰ surgery, two weeks post Phase Ⅱ surgery, four weeks post Phase Ⅱ surgery, and three months post Phase Ⅱ surgery respectively, with pain VAS scores showing a decreasing trend over time (F=536.682, P<0.001). Four weeks after the Phase Ⅱ surgery, 14 patients experienced further pain relief and requested to remain on the high-frequency mode, while the other 2 patients chose to switch to the low-frequency stimulation mode. At the three month follow up after the Phase Ⅱ surgery, all 16 patients reported good pain relief, with VAS scores decreasing by ≥2 points. Three months after the Phase Ⅱ surgery, the patients′ EQ-5D-5L scores were higher than preoperative levels (0.723±0.134 points vs. 0.546±0.162 points, paired t=-9.983, P<0.001). Infrared thermography of the lower extremities showed that, one week after Phase Ⅰ surgery, the surface temperature of both legs and the soles of the feet in all 16 patients was higher than at the same sites preoperatively, indicating improved local microcirculation.

Preliminary studies indicate that high-frequency spinal cord stimulation is safe and effective for alleviating pain associated with painful diabetic peripheral neuropathy, and that the majority of patients prefer the high-frequency mode.

To investigate the clinical prognosis of pediatric medulloblastoma (MB) based on molecular subtypes and its influencing factors.

The clinical data of 235 children with MB who underwent surgical treatment at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from January 2011 to December 2021 were retrospectively included. The data included the 5-year survival information of the children, the histopathological type, molecular type, extent of resection and M stage of the tumors. The survival curves were plotted using the Kaplan-Meier method. The 5-year progression-free survival (PFS) rate and 5-year overall survival (OS) rate of the children were calculated. The survival differences between different groups were compared using the Log-rank test. The univariate and multivariate Cox regression analyses were used to screen the factors affecting the survival of the patients.

Among the 235 children, 158 were male and 77 were female. The age [M(Q₁, Q₃)] was 7.0 (4.5, 9.0) years. A total of 206 children (87.7%) underwent complete or near-complete tumor resection, compared with 29 children (12.3%) who had tumor remnants. The histopathological results showed that 130 cases were diagnosed as classic MB, 90 cases as desmoplastic/nodular and extensive nodularity type MB, and 15 cases as large cell/anaplastic type MB. The molecular pathological results showed that there were 20 cases of WNT subtype, 35 cases of SHH subtype, 58 cases of Group3 subtype, and 122 cases of Group4 subtype. Six children (3 cases each for SHH and WNT subtypes) had TP53 mutations. The median follow-up time for the 235 children was 71.0 months. The last follow-up showed that 72 children had tumor recurrence and 58 died (including 3 children with TP53 mutation, 2 with SHH subtype, and 1 with WNT subtype). The Kaplan-Meier analysis results indicated that the 5-year PFS rate of the 235 children was 70.6%, and the 5-year OS rate was 81.2%. The 5-year PFS rates for children with WNT, SHH, Group3, and Group4 subtypes were 90.0%, 72.5%, 61.5%, and 71.2% respectively, and the 5-year OS rates were 88.2%, 85.7%, 68.6%, and 84.6% respectively. Univariate Log-rank test showed that patients with residual tumor, those classified as WNT, SHH, or Group4 molecular subtypes, and those receiving combined adjuvant chemoradiotherapy had higher 5-year PFS and OS rates, compared with patients who underwent complete resection, those with Group3 subtype, or those treated with radiotherapy or chemotherapy alone (all P<0.05). Univariate Cox regression analysis showed that tumor molecular classification and postoperative adjuvant therapy were the influencing factors for the survival of children with MB (both P<0.05). Multivariate Cox regression analysis revealed that patients who received chemotherapy alone had a significantly higher risk of death compared with those receiving radiotherapy alone (HR=132.55, 95%CI: 31.97-549.59, P<0.001). In contrast, patients with residual tumor exhibited a lower risk of death than those who underwent gross-total or near-total resection (HR=0.10, 95%CI: 0.02-0.44, P=0.002).

The molecular classification of MB is closely related to prognosis. The Group3 subtype has the worst prognosis. The extent of tumor resection and postoperative adjuvant therapy are important factors affecting the survival of children. Standardized postoperative comprehensive treatment can significantly improve the prognosis of children.

To explore the efficacy and safety of rescue stenting for patients with acute vertebrobasilar artery occlusion (AVBAO) at different time windows.

A retrospective analysis was conducted on consecutive patients who underwent rescue stenting for AVBAO at the Department of Cerebrovascular Intervention, Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to December 2024. Based on the treatment time window, patients were categorized into a late window group (6-24 hours) and an ultra-late window group (>24 hours). To balance baseline differences between the groups, Overlap Weighting was applied for adjustment. The primary efficacy endpoint was the proportion of patients with a favorable outcome (defined as modified Rankin Scale score≤2) at 90 days. Safety outcomes included the incidence of symptomatic intracranial hemorrhage within the perioperative period, all-cause mortality within 90 days, and the occurrence of other complications.

A total of 78 patients were enrolled, including 33 in the late time-window group and 45 in the ultra-late time-window group. In terms of baseline characteristics, compared with the late time window group, the ultra-late time window group was characterized by a higher proportion of patients with both preoperative symptom progression and a history of cerebral infarction or transient ischemic attack, along with a lower rate of intravenous thrombolysis, fewer thrombectomy passes and a lower median preoperative posterior circulation Alberta Stroke Program Early CT Score (all P<0.05). After adjustment with the overlap weighting, no statistically significant differences in baseline characteristics were observed between the two groups(all P>0.05). There were no significant differences between the ultra-late and late time-window groups in the 90-day favorable outcome rate [60.0% (27/45)] vs. 57.6% (19/33)], symptomatic intracranial hemorrhage rate[4.4% (2/45) vs. 6.1% (2/33)], or perioperative mortality [11.1% (5/45) vs. 15.2% (5/33)] (all P>0.05). However, the incidences of any intracranial hemorrhage [4.4% (2/45) vs. 24.2% (8/33) ] and other perioperative complications [2.2% (1/45) vs. 18.2% (6/33)] were significantly lower in the ultra-late time-window group than in the late time-window group (all P<0.05).

For rigorously selected patients with AVBAO, rescue stenting in the ultra-late time window may be non-inferior to that in the late time window in terms of efficacy and safety.

To investigate the clinical efficacy and safety of hybrid surgery in the treatment of symptomatic chronic carotid artery occlusion (SCCAO).

The clinical data of 21 patients with SCCAO who were admitted to the Neurovascular Department of Inner Mongolia Autonomous Region People′s Hospital and received hybrid surgery from March 2023 to December 2025 were retrospectively analyzed. The efficacy and safety of the surgery were evaluated by vascular recanalization rate and perioperative complications. Follow-up was conducted 6 months after the surgery through outpatient visits or phone calls. The vascular occlusion status of the patients was evaluated by computed tomography angiography (CTA), and the neurological function recovery of the patients was assessed using the modified Rankin Scale (mRS).

The hybrid surgeries of all 21 patients were successfully completed. Among them, 4 cases underwent carotid endarterectomy (CEA) combined with digital subtraction angiography, 9 cases underwent CEA combined with carotic balloon angioplasty (CBA), and 8 cases underwent CEA combined with CBA plus carotid stent implantation. The overall vascular recanalization rate was 100% (21/21). One week after the surgery, 1 patient (4.8%) developed new hoarseness, which was completely relieved after nutritional nerve symptomatic treatment; 3 days after the surgery, 1 patient (4.8%) suffered from ventricular fibrillation, and despite active rescue, the circulatory function could not be maintained, and the patient died. The remaining patients did not have any surgical-related complications such as cervical hematoma, hemorrhagic stroke, ischemic stroke, or transient ischemic attack during the perioperative period. Excluding the cases of perioperative death, the remaining 20 patients completed imaging and clinical follow-up. Six months after the surgery, 1 patient (5.0%) showed target vessel reocclusion on head and neck CTA examination, while the mRS score was not worsened compared to before the surgery. The target vessels of the remaining 19 patients (95.0%) remained unobstructed. During the follow-up period, no new ischemic stroke, transient ischemic attack, or death adverse events occurred.

The Hybrid surgery treatment for SCCAO has a high technical success rate, and the incidence of perioperative complications is relatively low. It has initially demonstrated good safety and effectiveness.

To investigate the clinical value of an optimized contrast agent dilution protocol for evaluating flow diverter (FD) apposition using high-resolution C-arm computed tomography (HR-CBCT) in patients with intracranial aneurysms.

We retrospectively analyzed the clinical and imaging data of consecutive patients with intracranial aneurysms who underwent FD implantation at the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University between June 2022 and May 2025. Patients treated between June 2022 and June 2024 who underwent HR-CBCT using a conventional contrast dilution protocol for the assessment of FD apposition were assigned to the control group. Patients treated between July 2024 and May 2025 who underwent HR-CBCT using an optimized contrast dilution protocol for FD apposition assessment were assigned to the experimental group. The primary outcomes included the intraoperative detection rate of incomplete stent apposition (ISA), subjective image quality scores of HR-CBCT postprocessing images, perioperative and follow-up complications, complete aneurysm occlusion rates, and in-stent stenosis rates.

A total of 289 patients with 342 aneurysms were included, and 342 FDs were implanted. Among them, 152 patients (with 180 aneurysms) in the control group received 180 FDs, and 137 patients (with 162 aneurysms) in the experimental group received 162 FDs. Compared with the control group, the experimental group demonstrated a significantly higher intraoperative ISA detection rate [15.4% (25/162) vs. 6.7%(12/180), P=0.009] and higher subjective HR-CBCT postprocessing image quality scores (8.05±1.03 vs. 6.93±2.00, P<0.001). The perioperative complication rate was lower in the experimental group than in the control group [1.5% (2/137) vs. 6.6% (10/152), P=0.029], as was the long-term ischemic stroke rate [1.5% (2/137) vs. 5.9% (9/152), P=0.048]. The mean clinical follow-up duration was 13.72±2.67 months (range: 6-21 months), and the mean imaging follow-up duration was 11.14±2.50 months (range: 6-15 months). At the final digital subtraction angiography follow-up, the experimental group showed lower rates of incomplete aneurysm occlusion [13.6% (22/162) vs. 22.2% (40/180), P=0.038] and in-stent stenosis [1.2% (2/162) vs. 6.7% (12/180), P=0.011] compared with the control group.

Compared with the conventional protocol, the optimized contrast dilution protocol could significantly improve HR-CBCT post-processing image quality and enhance the intraoperative detection of ISA during FD implantation, suggesting its potential clinical utility in FD apposition assessment.

To comparatively analyze the clinical efficacy and safety of polyetheretherketone (PEEK), autologous bone and titanium mesh for cranioplasty in pediatric patients.

A retrospective analysis was conducted on the clinical data of 61 pediatric patients who received cranioplasty at the Department of Neurosurgery, Beijing Children′s Hospital, Capital Medical University between July 2016 and January 2025. Enrolled patients were stratified into three groups based on cranioplasty materials applied: the PEEK group (n=22), autologous bone group (n=24), and titanium mesh group (n=15). Baseline demographics, surgical parameters and postoperative complications (including surgical site infection and implant displacement) were compared across the three groups. Furthermore, independent factors associated with autologous bone resorption were explored in the autologous bone subgroup.

Statistically significant differences in skull defect etiology, defect count, cranioplasty timing and medical costs were observed among the three groups (all P<0.05). Post-hoc pairwise comparisons showed that the titanium mesh group had a higher proportion of trauma-induced skull defects than the autologous bone group (11/15 vs.13/24, P=0.029). The autologous bone group yielded the shortest median cranioplasty interval (2.5 months), followed by the titanium mesh group (6.0 months) and the PEEK group (8.0 months) (all P<0.001). The PEEK group had a significantly higher median total medical cost (180 000 RMB) than the titanium mesh group (61 000 RMB) and the autologous bone group (67 000 RMB) (all P<0.001). Univariate logistic regression analysis revealed no significant intergroup differences in the incidence rates of postoperative surgical site infection (1/22, 2/24, 0/15), implant displacement (1/22, 0/24, 0/15) and overall complications (2/22, 2/24, 0/15) across the three groups (all P>0.05). After adjustment for baseline confounders via multivariate logistic regression, cranioplasty material type was not independently associated with the risks of postoperative infection, implant displacement or overall complications (all P>0.05). The postoperative follow-up duration of the 24 pediatric patients in the autologous bone group was presented as median (Q₁, Q₃): 2.0 (2.0, 3.0) months. Among them, 13 (54.2%) pediatric patients developed postoperative autologous bone resorption. Bone resorption progressed persistently during follow-up, with its severity gradually aggravated over time. Univariate analysis confirmed that larger bone flap area was an independent risk factor for autologous bone resorption (P=0.017). By comparison, sex, age, skull defect etiology and quantity, operative time, bone flap cryopreservation duration, cranioplasty timing and intraoperative blood loss were not influencing factors for autologous bone resorption (all P>0.05).

PEEK, autologous bone and titanium mesh all achieve favorable safety for pediatric cranioplasty, with low postoperative complication rates. Autologous bone provides economic benefits but bears a risk of bone resorption, and larger bone flap size independently elevates such resorption risk. PEEK implantation incurs significantly higher medical expenses, while titanium mesh yields stable clinical efficacy with moderate cost-effectiveness.

To evaluate the preliminary efficacy of endovascular therapy for corpus callosum arteriovenous malformations(CC-AVM) in children and adolescents(aged≤18 years).

Clinical data of 10 pediatric patients with CC-AVM who underwent endovascular treatment at the Department of Neurosurgery, the Affiliated Children′s Hospital of Xi′an Jiaotong University from January 2019 to December 2024 were retrospectively analyzed. Outpatient and inpatient follow-up visits were scheduled at 1, 3 and 6 months postoperatively. Treatment outcomes were assessed via neurological examination, cranial magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Neurological functional recovery was evaluated using the modified Rankin Scale (mRS).

A total of 9 children underwent endovascular treatment. Immediate postoperative DSA showed complete embolization in 7 cases and subtotal embolization in 2 cases. One case experienced an emergency embolization of the blood supply artery after micro-guide wire perforation during the operation, and postoperatively, intraventricular hemorrhage occurred, which was treated conservatively and improved. There were no deaths during the perioperative period, and no severe surgical complications such as cerebral infarction, epilepsy, or permanent neurological deficits were observed. All children completed postoperative clinical and imaging follow-up, with a median follow-up time of 3.8 (0.5-6.0) months. At the last follow-up, no recurrence of malformations or intracranial rebleeding was observed in the head imaging or whole brain angiography; the mRS score of the children was: 0 points in 9 cases and 1 point in 1 case. No long-term neurological dysfunction or hydrocephalus occurred in the long term follow-up.

Preliminary studies have shown that endovascular treatment for CC-AVM has good efficacy and safety. The rate of malformation occlusion is high and the neurological prognosis seems good.

To conduct comparative analysis of the safety and efficacy of sealing the fistula with intrasacral fat and subcutaneous fat in fistula occlusion surgery for sacral canal cysts.

A retrospective analysis was conducted on the clinical data of 24 patients with sacral cysts who were treated at the Neurosurgery Department of the First Affiliated Hospital of Soochow University (13 cases) and the Second Affiliated Hospital of Soochow University (11 cases) from June 2014 to November 2024. According to the different sources of the fat used to seal the fistula, the patients were divided into the sacral intrasacral fat group (13 cases) and the subcutaneous fat group (11 cases). In the sacral intradural fat group, free epidural fat from the sacral canal was used to seal the fistula, and at the same time, subcutaneous fat was used to fill the residual cavity of the cyst; in the subcutaneous fat group, subcutaneous fat was used to seal the fistula and fill the residual cavity of the cyst. The Japanese Orthopaedic Association (JOA) score, pain visual analogue scale (VAS) score before surgery, at discharge, and 6 months after surgery were recorded to evaluate the surgical efficacy. Sacral MRI was used to examine the recurrence of the cyst.

There were no statistically significant differences in age, gender distribution, disease duration, or cyst size between the two groups before the operation (all P>0.05). Both operations were successfully completed in both groups. No secondary nerve injury occurred during the operation. All patients recovered and were discharged. During the 6-month follow-up period after discharge, patients in the subarachnoid fat group did not experience cerebrospinal fluid leakage, recurrence of pain, or aggravation of lower limb neurological dysfunction; one patient in the subcutaneous fat group experienced increased lumbar-sacral pain and walking weakness more than one month after the operation; one patient experienced cerebrospinal fluid leakage from the incision one month after the operation. There were no statistically significant differences in JOA or VAS scores between the two groups before the operation (all P>0.05). At the time of discharge after the operation and 6 months later, the JOA scores of the subarachnoid fat group (24.38±2.99 points and 27.15±2.41 points, respectively) were improved compared with the subcutaneous fat group (21.82±2.32 points and 23.18±4.26 points, respectively), and the VAS scores of the subarachnoid fat group (1.54±0.71 points and 0.23±0.26 points, respectively) were lower than those of the subcutaneous fat group (4.09±0.83 points and 3.82±1.00 points, respectively), and the differences were statistically significant (all P<0.05). At 6 months after the operation, the proportion of excellent improvement in JOA scores in the subarachnoid fat group (10/13) was higher than that in the subcutaneous fat group (4/11) (P=0.028); the recurrence rate of cysts in the subarachnoid fat group (0/13) was lower than that in the subcutaneous fat group (3/11) (P=0.039).

During the surgery for sacral canal cysts, using intrasacral canal fat to seal the fistula has higher safety and efficacy compared with using subcutaneous fat tissue.

To evaluate the relevant anatomical parameters for percutaneous full-endoscopic C₂ ganglionectomy (PEC2G), and to define the skin puncture target, the endoscopic guidance trajectory to the C₂ ganglion and the resection strategy for the C₂ ganglion under spinal endoscopy.

Twelve fresh adult cadaveric specimens were used in this study. Of these, four cadavers were employed to perform simulated bilateral percutaneous full-endoscopic C₂ ganglionectomy (PEC2G). All procedures were meticulously documented and evaluated according to a strict standardized protocol, which ultimately defined the puncture target, the optimal endoscopic exploration pathway to the C₂ ganglion, and the standardized resection technique. The remaining eight specimens underwent bilateral C₂ ganglion exposure under spinal endoscopy, and 10 sets of surgically relevant anatomical parameters were precisely measured.

Bilateral PEC2G was successfully completed in all four cadavers, with eight C₂ ganglia resected and no complications such as dural tear or vertebral artery injury. The inferior articular process of C₂ was confirmed as an ideal bony puncture landmark, and the C₂ pedicle as a reliable anatomical guide for ganglion localization, enabling optimization of the resection strategy. Anatomical measurements from 12 specimens (24 sides) yielded the following values: vertical distance between C₁ and C₂ laminae(9.12±1.60 mm); shortest distance from the C₂ transverse foramen to the medial pedicle border (9.25±1.10 mm); vertical distance from the center of the C₂ inferior articular process to the midline (26.90±2.35 mm); radius of the target zone on the inferior articular process (5.95±0.75 mm); distance from entry point to spinal canal (9.18±1.15 mm); distance from the upper pedicle border to the lateral atlantoaxial joint (9.20±1.45 mm); proximal ganglion-dural sac distance (3.61±0.85 mm); distal ganglion-vertebral artery distance(8.38±1.80 mm); ganglion length (5.44±0.50 mm); and ganglion width(4.51±0.55 mm).

Using the C₂ inferior articular process as the bony puncture landmark and the C₂ pedicle as a guide to the C₂ ganglion, PEC2G can be successfully performed. The relevant anatomical data may provide a foundation for the safety and reproducibility of this technique.

To explore the neuroprotective effects and underlying mechanisms of melatonin against early brain injury (EBI) following subarachnoid hemorrhage (SAH), with a focus on its modulation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) and nuclear factor E2-related factor 2 (Nrf2) signaling pathways.

A total of 108 healthy male Sprague-Dawley rats were divided into six groups using a random number table: the sham surgery group, the SAH group, the SAH+ solvent (V) group, the SAH+ melatonin (M) group, and two reverse validation groups—the SAH+ M+ LY group (treated with the PI3K inhibitor LY294002) and the SAH+ LY group—with 18 rats in each group. A SAH model was established using the anterior chiasmatic cistern hemorrhage method. Two hours after hemorrhage, the SAH+ M group received an intraperitoneal injection of 150 mg/kg melatonin, while the SAH+ V group received an equal volume of 1% ethanol in saline as the solvent control. Both the SAH+ M+ LY group and the SAH+ LY group received a 5 μl injection of the PI3K inhibitor LY294002 (at a concentration of 500 nmol/L) into the lateral ventricle 30 minutes prior to modeling. Twenty-four hours after SAH, rats in each group underwent neurological function scoring; blood-brain barrier permeability was assessed using the Evans Blue extravasation assay; brain tissue water content, malondialdehyde levels, and superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were measured. TUNEL staining was used to assess apoptosis. Nissl staining was used to evaluate neuronal changes. Western blotting (WB) was used to detect the expression of Bcl2, Bax and cleaved caspase-3 proteins in brain tissue. An enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of interleukin (IL)1β and tumor necrosis factor (TNF) α in brain tissue. Real-time quantitative fluorescent polymerase chain reaction (qPCR), Western blotting (WB), and immunofluorescence staining were used to detect the expression of Nrf2 and its downstream targets heme oxygenase 1 (HO1) and quinone oxidoreductase 1 (NQO1) in brain tissue, cell nuclei and cytoplasm.

Compared with the SAH and SAH + V groups, the SAH+ M group exhibited improved neurological scores, reduced brain edema and Evans blue extravasation, decreased malondialdehyde, IL1β, and TNFα levels, increased SOD and GPx activities, reduced apoptosis (upregulated Bcl2, downregulated Bax and cleaved caspase3), and elevated Nrf2/HO1/NQO1 expression in total tissue and nuclei with decreased cytoplasmic expression (all P<0.05). These effects were partially reversed by co-administration of LY294002 (all P<0.05).

Melatonin ameliorates neurological deficits in rats after SAH by mitigating EBI-related brain edema, oxidative stress, inflammation and apoptosis, possibly through PI3K/AKT-mediated Nrf2 nuclear translocation and subsequent activation of the Nrf2-ARE pathway, leading to upregulated HO1 and NQO1 expression.

Clinical reports of spontaneous ossification of the skull are extremely limited. In October 2024, the Department of Neurosurgery at Children's Hospital Affiliated to Soochow University treated a 12-year-old child with brainstem glioma using a transuboccipital posterior median approach. After discharge, the child underwent radiotherapy. One month after surgery, occipital "bone bridge"-like ossification occurred, and the main clinical manifestations were occipital tenderness and subcutaneous effusion. After surgical resection of the abnormal "bone bridge" for 2 months, the pain symptoms and subcutaneous effusion completely disappeared, and no ossification recurrence was observed.

Parkinson's disease (PD) is a common neurodegenerative disease characterized by progressive apoptosis of dopaminergic neurons in the A9 region of the dense substantia nigra of the midbrain and decreased dopamine levels in the striatum as its core pathological features. The main clinical manifestations are resting tremor, bradykinesia, muscle stiffness and other motor symptoms, often accompanied by refractory non-motor symptoms such as cognitive impairment and mood abnormalities. Currently, mainstream clinical interventions such as levodopa drug replacement therapy and deep brain electrical stimulation can only symptomatically relieve symptoms and cannot stop the progressive degeneration of neurons or achieve etiological treatment. Stem cell technology, with its self-renewal ability and multi-directional differentiation potential, provides new ideas for cell replacement therapy of PD. This paper systematically reviews the application progress of embryonic stem cells, induced pluripotent stem cells, mesenchymal stem cells and neural stem cells in the treatment of PD. It focuses on analyzing the differentiation strategies, clinical expected efficacy, clinical translation status and key technical challenges of different stem cell types, and explores the application prospects of optimization strategies such as gene editing, cell preconditioning and combination therapy, aiming to provide theoretical reference for the clinical translation of stem cell therapy for PD.