Volume 42 · Issue 10 · 2026

Chronic disorder of consciousness (DoC) has gradually developed from a "gray area" with vague diagnosis and unclear discipline attribution into an emerging subspecialty with independent disease codes, clear classification and systematic management pathways. In recent years, the widespread recognition of hidden consciousness and the establishment of a multimodal assessment system have promoted a fundamental shift in treatment concepts from "passive maintenance" to "active repair". This article systematically reviews the comprehensive treatment strategies of DoC, including discipline orientation, updating of treatment concepts, neuromodulation and awakening techniques, cranial cavity environment reconstruction and non-invasive regulation, drugs, and brain-computer interfaces. It also looks forward to intelligent diagnosis, precise treatment, and closed-loop rehabilitation.

To explore the therapeutic effect of percutaneous spinal cord stimulation (SCS) in patients with disorders of consciousness (DoC), and to analyze the association between electrode migration and clinical outcomes.

The clinical data of 71 DoC patients who received percutaneous SCS at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University from December 2024 to November 2025 were retrospectively analyzed. Variables included gender, age, disease duration, etiology, pre- and post-operative consciousness level, coma recovery scale revised (CRS-R) score, operative duration, downward electrode migration distance and cervical spine curvature were collected. Clinical follow-up was performed at 3 months after surgery. Improved CRS-R score and elevation of consciousness level were set as outcome indicators. Univariate analysis was used to identify factors influencing clinical prognosis. Mean bias corrected Logistic regression was performed to clarify the relationship between postoperative electrode migration and clinical outcomes.

Among the 71 patients, increased postoperative CRS-R scores were observed in 32 cases (45.1%, 95%CI: 33.2%-57.3%), and elevation of consciousness level was achieved in 24 cases (33.8%, 95%CI: 23.0%-46.0%). Of patients with improved CRS-R scores, 24 (75.0%) obtained elevated consciousness level. The median pre- and post-operative CRS-R scores of the 71 patients were 7.0 (Q₁, Q₃: 6.0, 9.0) and 9.0 (Q₁, Q₃: 6.0, 11.5), respectively. The median postoperative downward electrode migration distance was 11.0 mm (range: 0-28 mm). For patients with versus without improved CRS-R scores, no significant inter-group differences were found in age, gender, disease duration, etiology, operative duration, cervical spine curvature, preoperative consciousness level, or postoperative downward electrode migration distance (all P>0.05), whereas preoperative CRS-R score showed a significant difference (P=0.030). There were no statistically significant differences in age, gender, disease duration, etiology, operative duration, cervical spine curvature, preoperative consciousness level, preoperative CRS-R score, or postoperative downward electrode migration distance between patients with and without elevated consciousness level (all P>0.05). After adjusting for preoperative CRS-R score, age and other potential factors, postoperative downward electrode migration was not independently associated with improved CRS-R score (adjusted OR=0.85, 95%CI: 0.61-1.18, P=0.323) or elevation of consciousness level (adjusted OR=0.84, 95%CI: 0.59-1.18, P=0.309). No permanent neurological deficits occurred during the follow up period in the patients.

This preliminary study indicates that percutaneous short term SCS can improve CRS-R scores and promote elevation of consciousness level in DoC patients. Within the observed migration range of 0-28 mm, no association could be detected between electrode migration and the above mentioned clinical outcomes.

To investigate the application value of digital subtraction angiography (DSA)-assisted visualization of the interlaminar space in percutaneous spinal cord stimulation (SCS) for disorders of consciousness (DoC).

Forty patients with DoC who underwent percutaneous SCS at the Department of Neurosurgery, Hebei General Hospital from May to October 2024 were prospectively enrolled and assigned to a study group or a control group using a random number table. The study group underwent DSA-assisted visualization of the interlaminar space for puncture, whereas the control group underwent conventional anteroposterior fluoroscopy-guided puncture. The number of puncture adjustments, radiation exposure during puncture, operative duration, perioperative complications, and other outcomes were compared between the two groups. All patients were followed up for 1-3 months after surgery. The coma recovery scale-revised (CRS-R) was used to assess consciousness scores and levels. An improvement in the level of consciousness by at least one grade compared with the preoperative level was defined as an effective treatment. Lead migration was assessed by imaging, and delayed complications were also evaluated.

Twenty-two patients were included in the study group and 18 in the control group, and all procedures were successfully completed. The numbers of puncture adjustments were 1.5 (1.0, 2.0) and 4.0 (2.3, 6.8) in the study and control groups, respectively, and the operative durations were 20.8±3.9 min and 28.5±5.2 min, respectively; the differences were statistically significant (both P<0.001). Radiation exposure during puncture was 13.5±3.8 mGy in the study group and 15.8±4.6 mGy in the control group, with no statistically significant difference (P=0.104). Inadvertent dural puncture occurred in 3 patients in the control group, requiring a change in the puncture site or intervertebral level, whereas no such event occurred in the study group; the difference was not statistically significant (P=0.083). The mean postoperative follow-up duration of the 40 patients was 2.1±0.6 months. At the final follow-up, the effective treatment rates were 40.9% (9/22) in the study group and 38.9% (7/18) in the control group, with no statistically significant difference (P=1.000). Lead migration occurred in 2 patients in each group, and none required reoperation. No delayed complications were observed in any patient.

Compared with conventional puncture, DSA-assisted visualization of the interlaminar space may help reduce the number of puncture adjustments and shorten the operative duration during percutaneous SCS, without increasing radiation exposure during puncture or procedure-related complications.

To investigate the efficacy of spinal cord stimulation (SCS) for consciousness recovery in patients with disorders of consciousness (DoC), and to explore the auxiliary evaluation value of scalp electroencephalography (EEG) based on the " ABCD" model.

A total of 35 patients with DoC who underwent SCS surgery in the Department of Functional Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University from October 2021 to June 2024 were retrospectively enrolled. The changes in the Coma Recovery Scale-Revised (CRS-R) scores, CRS-R index and scalp EEG power spectrum before and after surgery were recorded and compared. Treatment response was defined as an increase of ≥2 points in the total CRS-R score at 6 months after surgery, and the treatment response rate was calculated. Patients were divided into responder group and non-responder group accordingly. The CRS-R scores and EEG power values were compared between the two groups.

All patients successfully underwent electrode implantation without surgery-related complications, and all patients received standardized daily electrode stimulation therapy postoperatively. Postoperative CRS-R score follow-up was completed in all patients. The auditory, visual, motor, verbal and communication subscores, proportion of patients with communication subscore≥1, arousal score, total CRS-R score and CRS-R index increased with extended follow-up time (all P<0.05). At 3 months postoperatively, all assessment parameters except communication subscore were significantly higher than baseline (all P<0.05). At 6 months postoperatively, all parameters were elevated compared with baseline (all P<0.05). Compared with 3 months postoperatively, all parameters except communication subscore increased at 6 months postoperatively (all P<0.05). The treatment response rate at 6 months after surgery was 62.86% (22/35). A total of 21 patients completed EEG follow-up at 6 months postoperatively. In the responder group, for the 8-13 Hz frequency band associated with "D pattern", the EEG power value increased at 1 electrode at 3 months postoperatively and at 18 electrodes at 6 months postoperatively compared with baseline (all P<0.05). For the 20-35 Hz frequency band associated with "C pattern", the power value increased at 15 electrodes at 3 months postoperatively and at 12 electrodes at 6 months postoperatively (all P<0.05). For the 5-8 Hz frequency band associated with "B pattern", the power value increased at 3 electrodes at 6 months postoperatively (all P<0.05). No statistically significant changes in EEG power values across all frequency bands at different time points were observed in the non-responder group (all P>0.05).

SCS can improve behavioral and neuroelectrophysiological indicators in patients with DoC. The " ABCD" model of EEG power spectrum may facilitate evaluating postoperative outcomes.

To analyze differences in intra- and inter-network functional connectivity in patients with acute disorders of consciousness (aDoC) who exhibited divergent long-term consciousness outcomes, and to identify acute-phase neuroimaging biomarkers for predicting consciousness recovery.

Resting-state functional magnetic resonance imaging (fMRI) data from 37 aDoC patients (traumatic brain injury or spontaneous intracerebral hemorrhage) who were admitted to the Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from August 2022 to August 2024 were analyzed using graph theory. Intra- and inter-network functional connectivity strengths were quantified via Pearson correlation coefficients, and small-world network properties were subsequently derived. Consciousness outcomes were clinically assessed 6 months post-injury. Correlation analyses evaluated associations between brain network features and outcomes, while receiver operating characteristic (ROC) curves assessed the prognostic accuracy of significant connectivity measures.

During the aDoC phase, the eMCS (emergence from minimally conscious state) group (n=19) showed significantly greater intra- and inter-network connection strengths in the default mode network(DMN), action mode network(AMN), and somatomotor network (SMN) compared with the DoC (disorder of consciousness) group (n=18) (all P<0.05). In the DMN, the eMCS group exhibited a higher clustering coefficient (t=2.528, P=0.016), greater global efficiency (t=2.033, P=0.049), and shorter characteristic path length (t=-2.119, P=0.041) than the DoC group. No significant between-group differences in these small-world properties were found in the AMN or SMN (all P>0.05). Inter-network connection strengths were significantly higher in the eMCS group for AMN-DMN (t=5.344, P<0.001) and AMN-SMN (t=7.302, P<0.001), but not for DMN-SMN (t=0.182, P=0.857). AMN-DMN connection strength was moderately correlated with outcomes (r=0.549, P<0.001) and showed predictive capacity (AUC=0.763, 95%CI: 0.611-0.916, P=0.006), while AMN-SMN connection strength demonstrated a stronger correlation (r=0.798, P<0.001) and higher predictive value (AUC=0.950, 95%CI: 0.927-1.000, P=0.005).

Brain network features differ significantly between aDoC patients with different consciousness outcomes. External connections of the AMN exhibit certain predictive value for consciousness prognosis in aDoC.

To preliminarily explore the efficacy of short-term spinal cord stimulation (SCS) in patients with disorders of consciousness (DOC) and the application value of neuroelectrophysiological assessment.

A retrospective analysis was conducted on patients with DOC who underwent SCS at the Department of Neurosurgery, the Second Hospital of Hebei Medical University from May 2023 to May 2025 and had complete neuroelectrophysiological assessment data. Clinical outcome was assessed using the coma recovery scale-revised (CRS-R). In patients with consistent stimulation frequency and improved CRS-R scores, neuroelectrophysiological metrics were recorded and analyzed, including the absolute power and relative power of each frequency band [δ(1.5-3 Hz), θ(4-7 Hz), α(8-13 Hz), low-frequency β(14-20 Hz), high-frequency β(21-35 Hz), and γ(36-45 Hz)] across 19 channels, as well as the changes in connectivity between different brain regions in each frequency band.

A total of 10 patients were included in the efficacy analysis, and 5 patients were included in the neuroelectrophysiological analysis. Among the 10 patients followed up for 2 or 3 weeks postoperatively, 2 showed no significant changes in CRS-R scores, while 8 showed varying degrees of improvement in CRS-R scores. After 2 weeks of stimulation at 5 Hz, an upward trend in the relative power of the α band and a downward trend in the relative power of the δ band were observed across all channels in the 5 patients, while no consistent change pattern was observed in the absolute power across all frequency bands. Regarding functional connectivity, a trend toward increased occipital-occipital connectivity was observed in the low-frequency β band following stimulation.

This preliminary study shows that short-term SCS may help improve CRS-R scores in patients with chronic DOC. Neuroelectrophysiological indicators may serve as auxiliary observational evidence combined with the CRS-R scale for the comprehensive assessment of the efficacy of SCS and patient prognosis.

To investigate the clinical efficacy of central thalamic deep brain stimulation (DBS) in patients with disorders of consciousness (DoC) and its influencing factors, and to evaluate the value of intraoperative microelectrode recording (MER) of electrophysiological characteristics.

A retrospective analysis was conducted on 62 DoC patients who underwent DBS treatment at the Neurosurgery Center, Beijing Tiantan Hospital, Capital Medical University between January 2021 and December 2025. All patients received DBS electrode implantation targeting the centromedian-parafascicular complex (CM-Pf) of the thalamus. Intraoperative MER was performed, and 34 electrophysiological features were extracted to analyze their correlation with electrode depth. Consciousness was assessed using the Coma Recovery Scale-Revised (CRS-R). Clinical outcomes (classified as consciousness recovery, improvement, or no response) were evaluated at 1, 3, and 6 months post operation.

Among the 62 patients, 34(54.84%) showed improvement in consciousness, of whom 28(45.16%) achieved recovery of consciousness, while 28 patients (45.16%) showed no response to the treatment. Compared with the non-recovery group, patients in the recovery group were younger, had lower proportions of hypoxic-ischemic encephalopathy and vegetative state, and had higher preoperative CRS-R total scores, with statistically significant differences (all P<0.05). MER analysis from 23 patients revealed that 18 electrophysiological features were significantly correlated with electrode depth (all P<0.01). Among those, five features, including clustering ratio, clustering index, firing rate and multi-unit activity(MUA) power in the θ and α bands, were identified as key depth-related features, exhibiting stage-specific distribution patterns during electrode implantation.

Central thalamic DBS could effectively promote consciousness recovery in selected DoC patients. Electrophysiological features demonstrate clear correlations with electrode implantation depth, providing objective guidance for intraoperative target confirmation and facilitating individualized surgical strategies.

To investigate the clinical efficacy of deep brain stimulation (DBS) in the treatment of disorders of consciousness (DoC) after primary brainstem hemorrhage (PBSH).

This retrospective study included 26 patients with DoC following PBSH who were admitted to the Department of Neurosurgery, Huanhu Hospital Affiliated to Tianjin Medical University between January 2017 and December 2025. Based on the treatment received, patients were divided into a DBS group (12 cases) and a conventional arousal therapy group (14 cases). All patients completed preoperative multimodal assessments, including clinical behavioral, neuroimaging, and neuroelectrophysiological evaluations. The DBS group received DBS targeting the centromedian-parafascicular complex (CM-Pf) in addition to conventional arousal therapy. Follow-up was performed at 1, 3, and 6 months after treatment through outpatient, inpatient, or telephone visits. Efficacy was assessed using the coma recovery scale-revised (CRS-R) to determine the level of consciousness [unresponsive wakefulness syndrome (UWS), minimally conscious state minus (MCS-), or minimally conscious state plus (MCS+ )]. Improvement in consciousness was defined as an upgrade in the level of consciousness from baseline to the 6-month follow-up. Two-way repeated measures analysis of variance was used to compare CRS-R total scores before and after treatment between the two groups.

All 12 patients in the DBS group successfully underwent CM-Pf electrode implantation. Postoperative imaging verification and Lead DBS reconstruction confirmed satisfactory electrode placement in all patients. No surgical complications, including intracranial hemorrhage, severe infection and electrode displacement, occurred during the postoperative period or follow-up. At 6 months after treatment, the proportion of patients with consciousness improvement was significantly higher in the DBS group than in the conventional arousal therapy group (8/12 vs. 3/14, P=0.045). Two-way repeated measures ANOVA revealed significant main effects of time, group, and time × group interaction (all P<0.05). Simple effect analysis showed that the CRS-R total score increased significantly from baseline to 6 months after treatment in the DBS group (11.75±2.30 points vs. 9.67±1.37 points, P<0.001), whereas no significant change was observed in the conventional arousal therapy group (9.00±1.66 points vs. 9.29±1.73 points, P=0.435). Before treatment, there was no significant difference in CRS-R total scores between the two groups (P=0.279). However, at 6 months after treatment, the DBS group had a significantly higher CRS-R total score than the conventional arousal therapy group (P=0.005).

Conventional arousal therapy combined with DBS is safe for patients with DoC after PBSH and may achieve greater improvement in consciousness than conventional arousal therapy alone.

To investigate the therapeutic effect of anatomical repair surgery for patients with disorders of consciousness (DoC) and the prognostic influencing factors.

A retrospective analysis was conducted on the clinical data of 302 patients with chronic DoC who were admitted to the Department of Neurosurgery, the Seventh Medical Center of the PLA General Hospital from June 2020 to June 2024. After assessment, all patients were recommended for surgical treatment involving anatomical repair. The patients were divided into the surgical group (n=162) and the non-surgical group (n=140) based on whether they underwent anatomical repair surgery. The clinical data, prognostic indicators, and related complications of the two groups were compared. According to the prognosis after 6 months of treatment, the patients were divided into the good prognosis group (n=201) and the poor prognosis group (n=101). Univariate analysis and multivariate logistic regression analysis were used to investigate the prognostic factors of patients with chronic DoC.

There were no statistically significant differences in age, gender, etiology, disease duration, Glasgow coma scale (GCS) score at admission, coma recovery scale-revised (CRS-R) score at admission, primary hypertension, diabetes, seizure, or consciousness status between the surgical group and the non-surgical group (all P>0.05). The incidence of surgical site infection in the surgical group was higher than that in the non-surgical group (χ²=9.866, P=0.002). However, there were no statistically significant differences in the incidences of pulmonary infection, urinary tract infection, sepsis, deep vein thrombosis, pressure ulcers or malnutrition between the two groups (all P>0.05). The CRS-R scores at 6 and 12 months after surgery, the awareness recovery rate at 12 months after surgery, the GCS scores at 6 and 12 months after surgery, and the survival rate at 24 months after surgery in the surgical group were all higher than those in the non-surgical group (all P<0.05). Univariate analysis and further multivariate logistic regression analysis showed that older age (OR=1.770, 95%CI: 1.086-2.844), longer disease duration (OR=1.513, 95%CI: 1.198-1.910), lower GCS score at admission (OR=1.652, 95%CI: 1.099-2.484), lower CRS-R score (OR=1.868, 95%CI: 1.092-3.196), anatomical repair surgery (OR=0.532, 95%CI: 0.323-0.875), and more than 2 types of complications (OR=2.264, 95%CI: 1.248-4.108) were independent risk factors for poor prognosis in patients with chronic consciousness disorders (all P<0.05).

Anatomical repair surgery can effectively improve the level of patients′ consciousness disorders. Moreover, age, disease duration, GCS score at admission, CRS-R score at admission, anatomical repair surgery and types of complications are all influencing factors for the prognosis of patients.

To analyze the false-negative (FN) results of transcranial motor evoked potential (TcMEP) monitoring in predicting postoperative motor dysfunction during neurosurgical procedures and to explore the underlying causes.

A retrospective analysis was performed on the clinical data of 1 043 patients who underwent neurosurgery with TcMEP monitoring at the Department of Neurosurgery, West China Hospital, Sichuan University from July 2024 to December 2024. The cohort included 569 supratentorial lesions (including 302 cases of cerebrovascular disease), 292 infratentorial lesions and 182 intraspinal lesions (132 extramedullary and 50 intramedullary tumors). Motor function was assessed preoperatively, 1-3 days postoperatively, and at discharge (7-10 days postoperatively). Excluding deficits caused by postoperative hemorrhage confirmed by CT, an FN result was defined as the occurrence of new or worsened postoperative motor dysfunction despite no significant intraoperative TcMEP changes or only reversible changes. The diagnostic efficacy of TcMEP was evaluated.

The overall FN results was 2.01% (21/1 043). Among the FN cases, 13 were supratentorial lesions [including 8 adjacent to or involving the primary motor area (M1) and/or supplementary motor area (SMA), 3 deep-seated lesions, and 2 intracranial aneurysms], 3 were infratentorial lesions, and 5 were intraspinal lesions (all extramedullary). By discharge, 11 patients suffered persistent or worsened deficits while 10 recovered. TcMEP predicted early postoperative motor impairment (days 1-3) with sensitivity of 44.74% and negative predictive value of 97.94%. At discharge, these values improved to 60.71% and 98.92%, respectively.

TcMEP monitoring has technical limitations in evaluating SMA lesions, vascular injuries (such as venous infarction and perforating artery ischemia) and spinal nerve root injuries, which may lead to FN results.

To conduct a preliminary study on the application of Onyx liquid embolic agent for middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) based on its classification and efficacy.

A retrospective analysis was conducted on the clinical data of 100 patients (103 hematomas) with CSDH who were admitted to the Neurosurgery Department of Changzhou First People′s Hospital (the Third Affiliated Hospital of Soochow University) from April 2021 to April 2025 and received MMAE treatment. Based on the location of CSDH and the Onyx liquid embolic agent used for embolization, MMAE was divided into two subtypes: TypeⅠ(78 cases): embolization of the anterior branch and main trunk of the middle meningeal artery (MMA), with the Onyx liquid embolic agent completely filling the anterior branch and main trunk of the middle meningeal artery; TypeⅡ(22 cases): embolization of the anterior + posterior branches of the middle meningeal artery+ main trunk, with the Onyx liquid embolic agent completely filling the anterior, posterior branches and main trunk of the middle meningeal artery. According to this classification, the patients were divided into Type Ⅰ group and Type Ⅱ group, and subsequently received combined treatment with either simple drugs or drilling and drainage. Three months after the surgery, the volume changes of the hematomas were evaluated through imaging examinations to assess the treatment efficacy.

There were no statistically significant differences in age, gender, previous medical history, hematoma side, preoperative modified Rankin Scale score, or subsequent combined treatment between the two groups (all P>0.05). All patients successfully completed the MMAE surgery. There were 78 cases of MMAE type Ⅰ embolization, among which 66 cases received combined drilling and drainage treatment after surgery, and 12 cases received combined drug treatment; there were 22 cases of MMAE type Ⅱ embolization, among which 17 cases received combined drilling and drainage treatment after surgery, and 5 cases received combined drug treatment. No surgery-related complications, serious adverse events, or death cases occurred during the perioperative period in either group. Three months after surgery, 5 cases (5%) of hematoma recurrence occurred. There was no statistically significant difference in the hematoma recurrence rate between the type Ⅰ group (3 cases) and the type Ⅱ group (2 cases) (P=0.303). There was no statistically significant difference in the hematoma recurrence rate between the type Ⅰ and type Ⅱ patients in different treatment subgroups (all P>0.05).

Preliminary findings indicate that, the Onyx liquid embolic agent of type MMAE I and type Ⅱ have shown significant therapeutic effects in treating chronic CSDH, with good safety profiles.

To investigate the imaging characteristics of inner membrane enhancement of chronic subdural hematoma (CSDH) evaluated by flat-panel detector CT (FDCT) during middle meningeal artery embolization (MMAE) and its clinical significance.

The clinical data of CSDH patients who underwent MMAE in the Department of Neurosurgery of the Affiliated Hospital of Yangzhou University from January 2022 to February 2025 were retrospectively analyzed. All patients received FDCT and high-resolution FDCT (HR-FDCT) scans during the operation. The enhancement characteristics of the inner and outer membranes of hematoma and the distribution of dural vascular network were observed. The differences in the incidence of inner membrane enhancement among different types of CSDH and the correlation between hematoma formation time and the incidence of inner membrane enhancement were compared.

A total of 72 patients with 90 hematoma lesions were included. Forty-six patients received MMAE alone, and 26 patients received MMAE combined hard-channel puncture and drainage (10 of whom underwent " one-stop" surgery). Intraoperative FDCT showed that the enhancement rate of the outer membrane of hematoma was 100% (90/90), and the total enhancement rate of the inner membrane of hematoma was 28.9% (26/90). The enhanced inner membrane was mostly connected with the outer membrane and symmetrically thickened at both ends of the hematoma. When involving the skull base, the inner and outer membranes were intermittently separated, forming the " lotus root sign" or " cocktail glass sign". When involving the sphenoid ridge, the inner and outer membranes were connected at the ridge, forming the " butterfly wing sign". HR-FDCT clearly showed the middle meningeal artery branches and perforating vessels on the medial side of the skull plate connecting to the enhanced outer membrane. Comparison results among different CSDH types showed that the incidence of inner membrane enhancement in recurrent CSDH was higher than that in primary CSDH [39.5% (17/43) vs. 19.1% (9/47), χ²=4.542, P=0.033], the incidence in mixed-density CSDH was higher than that in homogeneous-density CSDH [37.3% (19/51) vs. 17.9% (7/39), χ²=4.010, P=0.045], and the incidence in CSDH involving the sphenoid ridge was higher than that in CSDH not involving the sphenoid ridge [76.2% (16/21) vs. 14.5% (10/69), χ²=29.833, P<0.001].Canonical correlation analysis showed that the hematoma formation time was positively linearly correlated with the incidence of inner membrane enhancement (R²=0.926).

Intraoperative FDCT during MMAE confirms that the blood supply of the inner and outer membranes of CSDH mainly originates from the middle meningeal artery, providing a theoretical basis for MMAE treatment. The inner membrane enhancement can be used as an imaging marker of dural tear. Inner membrane enhancement is significantly correlated with recurrence, mixed density and involvement of the sphenoid ridge, and its probability increases with the prolongation of hematoma duration, providing imaging evidence for optimizing MMAE strategies.

To investigate the clinical efficacy of stent retriever thrombectomy in treating acute ischemic stroke caused by branch artery occlusion.

A retrospective, consecutive analysis was conducted on 46 patients with acute ischemic stroke due to branch artery occlusion who underwent stent retriever thrombectomy at the Department of Intervention, Civil Aviation General Hospital (Civil Aviation Clinical Hospital of Peking University) from March 2017 to September 2024. Among them, there was 39 cases of occlusion in the M2/M3 segment of the middle cerebral artery, 4 cases of occlusion in the A2 segment of the anterior cerebral artery, and 3 cases of occlusion in the P2 segment of the posterior cerebral artery. Postoperative blood flow recanalization was assessed using the modified Thrombolysis in Cerebral Infarction (mTICI) grading scale. Successful recanalization was defined as achieving an mTICI grade of 2b or 3. The occurrence of postoperative complications was observed. The improvement of neurological function was assessed using the National Institutes of Health Stroke Scale (NIHSS) both at 24 hours and 14 days after surgery, and the prognosis was evaluated using the modified Rankin Scale (mRS) 90 days after surgery and an mRS score ≤2 indicated good prognosis.

All patients completed stent thrombectomy with a technical success rate of 100% (46/46). The postoperative successful recanalization rate was 89.1% (41/46). Among the 46 patients, 4 cases (8.7%) experienced postoperative intracerebral hemorrhage and 6 cases (13.0%) developed large-area cerebral infarction. The preoperative NIHSS score was 14.52±4.39 points, while the NIHSS scores at 24 hours and 14 days postoperatively were 6.73±2.57 points and 3.86±1.78 points, respectively, all of which were lower than the preoperative score (all P<0.001). Among the 46 patients, 35 (76.1%) had a favorable prognosis, including 15 with a score of 0, 14 with a score of 1, and 6 with a score of 2. Two patients (4.3%) died.

For patients with acute ischemic stroke caused by branch artery occlusion, stent retriever thrombectomy is generally safe and effective that can help achieve favorable outcomes.

To investigate the expression characteristics and clinicopathological associations of the myosin-ⅠF (MYO1F) gene in gliomas and its association with the immune microenvironment.

Clinicopathological data from 1 018 patients with glioma in the Chinese Glioma Genome Atlas (CGGA) database were retrospectively analyzed, including the CGGA-325 cohort (n=325) and the CGGA-693 cohort (n=693). Based on the WHO classification of central nervous system tumors, samples were characterized according to isocitrate dehydrogenase (IDH) mutation status, 1p/19q codeletion status, and O⁶-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. Differential MYO1F expression was analyzed across clinicopathological subgroups. Somatic mutation data from the CGGA whole-exome sequencing (WEseq_286) cohort were used to compare gene mutation patterns between the MYO1F-high-expression (115 cases) and MYO1F-low-expression (116 cases) groups. Gene Ontology (GO) enrichment analysis was performed to characterize the biological functions of MYO1F-related genes. Immune infiltration was analyzed using mRNA expression profiles from the CGGA-693 cohort. The relative abundances of 22 immune-cell types were inferred using non-negative least-squares deconvolution with the LM22 signature matrix and compared between the MYO1F-low-expression (326 cases) and MYO1F-high-expression (325 cases) groups. Univariate and multivariable Cox proportional hazards regression models were used to evaluate the association between MYO1F expression and overall survival (OS) in the combined cohort. Kaplan-Meier analysis and log-rank tests were used to compare OS between MYO1F expression groups in each cohort. A two-sided P<0.05 was considered statistically significant.

In both cohorts, MYO1F expression increased with WHO grade and was higher in glioblastoma (GBM), IDH-wildtype, and 1p/19q non-codeleted gliomas than in lower-grade, IDH-mutant, and 1p/19q-codeleted gliomas, respectively (all P<0.05). In the combined cohort, MYO1F expression was also associated with age, transcriptional subtype, MGMT promoter methylation status, and survival status (all P<0.05). Somatic mutation profiling showed higher mutation frequencies of IDH1 and CIC in the MYO1F-low-expression group, whereas ATRX and EGFR mutations were more frequent in the MYO1F-high-expression group. Genes positively correlated with MYO1F were mainly enriched in immune- and inflammation-related processes, including cytokine production, inflammatory response, immune-response regulation, and T-cell activation; negatively correlated genes were mainly involved in chemical synaptic transmission, synaptic signaling regulation, and nervous system development. Compared with the MYO1F-low-expression group, the MYO1F-high-expression group showed a higher proportion of M2 macrophages, and MYO1F expression was positively correlated with the immunosuppression score (all P<0.01). In both cohorts, patients with high MYO1F expression had shorter OS than those with low expression (both P<0.01). Multivariable Cox regression identified high MYO1F expression as an independent adverse prognostic factor for OS (HR=1.222, 95%CI: 1.057-1.414, P=0.007).

MYO1F expression in glioma is associated with malignant progression, distinct molecular genetic features, and an immunosuppressive microenvironment. MYO1F may serve as a potential biomarker for prognostic evaluation in patients with gliomas.

Chemotherapy is one of the important treatments for adult glioma patients. As a first-line chemotherapy drug, the efficacy of temozolomide in low-grade glioma is still controversial. This article, based on the 2021 edition of the World Health Organization's Central Nervous System Tumor Classification Guidelines, systematically reviews the recent research progress on the efficacy and drug resistance mechanisms of temozolomide in low-grade gliomas of different molecular pathological subtypes, in order to provide a reference for the precise treatment of gliomas.

Imaging outcome prediction after endovascular treatment of intracranial aneurysms is essential for the evaluation of clinical prognosis. However, traditional methods rely heavily on empirical judgments and conventional statistical models, making it difficult to effectively handle the multi-dimensional, nonlinear, and complex relationships involved in this process, thus limiting their predictive effectiveness. Artificial intelligence (AI), especially machine learning and deep learning, provides a new path for building high-precision predictive models by integrating multimodal information such as clinical features, morphological parameters, hemodynamic indicators, and imaging omics. This paper systematically reviews the model construction methods of AI in predicting the imaging outcome after endovascular treatment of intracranial aneurysms, summarizes its specific applications and predictive performance in the evaluation of the efficacy of traditional embolization therapy, blood flow guidance devices and intratumoral perturbation devices, and sorts out and looks forward to the challenges and development directions currently facing this field.

The Twist1 transcription factor and its signaling pathway play an important role in skull development and related diseases. Although several studies have explored the role of Twist1 in the skeletal system in recent years, its exact mechanism of action in cranial osteogenesis remains unclear. This review systematically reviewed the molecular structural basis of the Twist1 signaling pathway and its research progress in the field of cranial osteogenesis, analyzed and summarized its molecular mechanism in cranial osteogenesis and its connection with related diseases, thereby revealing its function and mechanism of action in the physiological and pathological states of the skull, and exploring the feasibility of the Twist1 signaling pathway as a therapeutic target for cranial-related diseases.