Chinese Neurosurgical Journal最新文献

Background: Secondary decompressive craniectomy (DC) is commonly integrated into tiered therapeutic protocols in the intensive care unit (ICU) to manage elevated intracranial pressure following traumatic brain injury (TBI). Identifying high-risk patients in advance could enable early intervention and help prevent further deterioration. This study aims to develop a machine learning-based predictive model using radiomics to assess the likelihood of secondary DC in TBI patients.

Methods: A total of 65 patients were enrolled and divided into training and test cohorts through stratified random sampling with a 7:3 ratio. Radiomic features were extracted from pre-evacuation CT data. The most relevant features were identified through importance score computation, and various predictive models were assessed using distinct machine learning algorithms and data sources. Model performance was benchmarked to construct an optimal predictive model.

Results: No statistically significant differences were observed in demographic and clinical characteristics between the DC and non-DC groups. The model based solely on demographic and clinical data did not achieve satisfactory performance, with an AUC below 0.5 in the test cohort. In radiomic modeling, the randomForest model demonstrated consistent performance, achieving an AUC of 0.83 in the test cohort. The multiomic model, which incorporated demographic, clinical, and radiomic features, showed improved predictive performance, with the cforest model achieving an AUC of 0.87 in the training cohort and 0.86 in the test cohort.

Conclusion: We developed radiomics-based predictive models to assess the likelihood of progressively refractory intracranial hypertension leading to secondary DC in a selected cohort of TBI patients who had undergone emergent craniotomy for hematoma evacuation with bone flap replacement. The model relying solely on radiomic features extracted from the lesion demonstrated satisfactory performance. When these features were integrated with demographic and clinical data to create a multiomic model, predictive performance further improved. These findings highlight the model's potential to identify high-risk patients, enabling early intervention to prevent further deterioration.

Background: Patients with pituitary neuroendocrine tumors (PitNETs) frequently experience cognitive impairment (CI), yet the underlying mechanisms remain poorly understood.

Method: In this study, we assessed cognitive function in 42 PitNETs patients and 42 healthy controls using the Montreal Cognitive Assessment (MoCA), evaluating the effects of tumor volume, invasiveness, pituitary hormone levels, lineage, and surgical intervention.Furthermore, 16S rRNA amplicon sequencing of fecal samples was performed to reveal alterations in gut microbiota composition.

Results: The results demonstrated significantly lower MoCA scores in PitNETs patients compared to controls. Patients with PIT1 lineage tumors exhibited more severe CI than those with SF-1 lineage tumors. Notably, surgical treatment led to improved cognitive performance. The sequencing revealed significant alterations in gut microbiota composition in PitNETs patients. Specifically, PIT1 lineage cases showed reduced levels of the butyrate-producing genus Agathobacter and increased abundance of UBA1819 and Alistipes indistinctus, taxa that have been implicated in pro-inflammatory states.

Discussion: These preliminary findings suggest that PIT1-lineage PitNETs may be associated with an increased susceptibility to cognitive impairment, potentially involving interactions between hormonal dysregulation and gut microbiota dysbiosis. This exploratory hypothesis provides a conceptual framework for future research to elucidate underlying mechanisms and explore potential interventions for cognitive impairment in PitNETs.

Background: Chordoma is a devastating rare tumor with a poor prognosis, limited therapeutic options and a high recurrence rate. The exploration of novel therapeutic targets has important clinical significance in chordoma diagnosis, treatment, and outcome prediction.

Methods: In this study, chordoma patients with histopathologically verified disease and KI67 proliferation index data were enrolled. The peripheral eosinophil counts of chordoma patients were summarized, the antitumor effects of eosinophils against chordoma cells were investigated using a coculture experiment, and the potential mechanisms were analyzed.

Results: The chordoma patients were classified into two groups according to KI67 proliferation index: 1) ≤ 5% (n = 62), and 2) > 5% (n = 80). The results showed that peripheral eosinophil and tumor-infiltrated eosinophil counts decreased with increased KI67 proliferation index, peripheral eosinophil counts deceased after tumor recurrence, and eosinophils could inhibit chordoma cells proliferation by inducing apoptosis and secreting inflammatory cytokines (TNF-α, IL-2 and IFN-γ); moreover, this apoptotic effect could be reversed by blocking TNF-α.

Conclusions: The current study suggests that eosinophils may be a new target for immunotherapy against chordoma.

Background: The aim of this study was to evaluate and compare complication rates and clinical outcomes associated with smooth and perforated polyetheretherketone (PEEK) implants used in cranioplasty.

Methods: A retrospective analysis of 94 patients who underwent cranioplasty with either smooth (n = 45) or perforated (n = 49) PEEK implants over a five-year period was conducted. Patient demographics, comorbidities, reasons for initial craniectomy, time interval between craniectomy and cranioplasty, postoperative complications, hospital stays, and rates of revision surgeries were analyzed. Multivariate logistic regression was used to control for confounding factors.

Results: No statistically significant differences were observed in demographic characteristics, reasons for initial craniectomy, or median time to cranioplasty between groups. Complication rates including wound complications, infections, ventriculoperitoneal (VP) shunt placements, significant fluid collections, return to surgery, and implant removals were comparable between groups, though trends suggested potential increases in wound complications (17.8% vs. 8.2%, p = 0.11) and infections (17.8% vs. 8.2%, p = 0.22) in the smooth implant group. Interaction analysis indicated a significant reduction in significant fluid collections with smooth implants in trauma patients (p = 0.045). Importantly, a rare and previously unreported case of malignant cerebral edema following smooth PEEK implant placement was documented.

Conclusions: Although no statistically significant differences were found, the identified trends toward increased complications with smooth implants and the novel finding of malignant cerebral edema highlight the importance of implant surface characteristics. Further prospective randomized studies are needed to clarify these preliminary observations and guide clinical decision-making in cranioplasty procedures.

Neurosurgical care remains inaccessible to over two-thirds of the global population, with the greatest burden falling on low- and middle-income countries (LMICs). Neurological disorders contribute to nearly 9 million deaths annually, while an estimated 22.6 million new cases require neurosurgical attention each year. Workforce shortages, particularly in Africa and Southeast Asia, exacerbate this crisis, with many countries falling below the minimum target of 0.5 neurosurgeons per 100,000 population. Beyond workforce deficits, systemic barriers, including limited access to training, mentorship, funding, and equitable career advancement, compound disparities and hinder long-term retention. The Boston Declaration 2025 and the World Health Organization (WHO) Intersectoral Global Action Plan emphasize the integration of neurosurgical services into national surgical, obstetric, and anesthesia plans, alongside investment in mentorship, inclusivity, and institutional support. Telemedicine has shown promise in expanding access through remote consultations, teaching, and follow-up care, yet infrastructure and policy challenges persist. This correspondence focuses on addressing global inequities in neurosurgery, which requires multipronged strategies: workforce expansion, digital health adoption, systemic reforms, and embedding neurosurgical care into broader health frameworks. Sustainable progress will depend on consistent investment, evidence-driven policies, and global collaboration to ensure equitable access to neurosurgical care worldwide.

Parkinson's disease remains a progressive and debilitating neurodegenerative disorder with limited therapeutic options that can modify disease progression. While conventional treatments like levodopa alleviate motor symptoms, they often fall short in addressing long-term neurodegeneration and may lead to significant side effects. Recent advances in regenerative medicine have highlighted the potential of combining stem cell therapy with Brain-Derived Neurotrophic Factor (BDNF) enhancement as a synergistic approach to restore dopaminergic function and promote neuronal survival. Stem cells not only offer the capacity to replace lost neurons but can also serve as delivery vectors for sustained BDNF expression, amplifying neuroprotective effects through Tropomyosin receptor kinase B-mediated signaling pathways. Preclinical studies in animal models demonstrate that this combined strategy enhances motor recovery, reduces neuroinflammation, and promotes neural circuit integration. As the field progresses, this dual therapy holds great promise for transforming the future management of Parkinson's disease by offering both symptomatic relief and disease modification.

Background: Ischemic strokes represent a significant public health concern, with a prevalence of 2.5% in the United States and over 250,000 new cases annually in Thailand, where strokes remain the leading cause of mortality. Chronic cerebral arterial occlusion and moyamoya disease are specific subtypes of ischemic stroke. In certain regions, advanced diagnostic tools are often inaccessible. Simple bypass protocols, which utilize mean transit time (MTT) in conjunction with surgical interventions such as the single-barrel bypass, are valuable for enhancing patient outcomes in these settings. The objective of this study is to elucidate the efficacy of MTT as a diagnostic tool and to evaluate the single-barrel bypass as a therapeutic intervention for chronic cerebral arterial occlusion.

Methods: This retrospective study assessed the utility of MTT as a selection criterion and evaluated the efficacy of the single-barrel bypass procedure for chronic cerebral arterial occlusion. Conducted at Rajavithi Hospital, the study included patients treated between 2010 and 2024 with complete medical records. Outcomes measured were changes in neurological function, alterations in MTT, and the incidence of surgical complications within one month postoperatively.

Results: Among the 30 patients who underwent the simple bypass protocol, 80% (24/30) demonstrated symptomatic improvement and better Modified Rankin Scale scores. Only one complication was reported-a brainstem infarction in a single patient.

Conclusions: The simple bypass protocol is an effective intervention for patients exhibiting prolonged MTT and is particularly useful in regions where stress tests such as acetazolamide or CO2 challenge testing are unavailable.

Background: The infiltration of the corticospinal tract (CST) in patients with gliomas may lead to more postoperative paralysis and worse survival than others. The aim of this study is to investigate the clinical outcomes and propose the surgical strategy for these patients.

Methods: We retrospectively identified 101 patients with CST infiltrated by cerebral gliomas on preoperative DTI tractography. Surgical, neurologic, and oncological outcomes were assessed on long-term follow-up.

Results: Forty-eight (47.5%) patients harbored grade II gliomas, 26 (25.7%) had grade III gliomas, and 27 (26.7%) had grade IV gliomas. Gross-total resection (GTR) or subtotal resection (STR) was achieved in 67.3% of patients, and partial resection (PR) was achieved in 32.7% of patients. Large tumors (≥ 24.5 ml) and low-grade gliomas (LGGs) were independent prognostic factors for partial resection. Patients with high-grade gliomas (HGGs) and pre-operative motor deficit had a higher risk for permanent paralysis. Thirty-three of 101 patients (32.7%) had long-term paralysis, and 7 patients (6.9%) suffered from severe paralysis. The median PFS and OS were 12 months and 24 months in grade IV gliomas. In multivariate analysis using the Cox model, low tumor grade and IDH1 mutation were independent factors for longer PFS, and low tumor grade was an independent factor for longer OS.

Conclusion: Preoperative DTI tractography is a valuable tool for determining the extent of CST involvement in patients with gliomas. The risk of postoperative paralysis is extremely high; therefore, careful and conservative resection should be performed to preserve motor function. Despite this challenge, patients can still achieve positive oncological outcomes with standard adjuvant therapy after surgery.

Disorders of consciousness (DoC) present significant challenges in clinical neurology, particularly when caused by brainstem injury. The brainstem's role, especially its ascending reticular activating system (ARAS), is crucial for maintaining arousal, a fundamental component of consciousness. However, the precise mechanisms by which brainstem injuries lead to DoC remain incompletely understood, and treatment options are limited. This gap in understanding hampers the development of effective therapies and impedes clinical management of these conditions. Here, we provide a comprehensive review of the latest research on the anatomical, neurochemical, and network-based mechanisms linking brainstem injury to DoC. We focus on the brainstem nuclei and neurotransmitter systems, such as serotonin from the dorsal raphe nucleus, norepinephrine from the locus coeruleus, and dopamine from the ventral tegmental area, highlighting their roles in arousal regulation and brainstem-cortical communication. Furthermore, we explore how disruptions in connectivity between the ARAS and cortical networks, as revealed by advanced neuroimaging techniques like diffusion tensor imaging and functional MRI, correlate with the severity of consciousness impairment. Additionally, we discuss therapeutic strategies, including pharmacological interventions and neuromodulation techniques, which aim to restore consciousness by targeting these disrupted networks. This review advances the field by synthesizing current knowledge on the brainstem's role in consciousness and highlighting the potential of targeted therapies to improve patient outcomes. By elucidating the mechanisms underlying DoC caused by brainstem injury, this review provides a foundation for future research to develop more effective treatments, ultimately contributing to better clinical management and recovery strategies for patients with DoC.