Chinese Neurosurgical Journal最新文献

Background: To validate the clinical safety and efficacy of a domestically produced robotic-assisted system (YDHB-NS01) for cerebral angiography and to review the current status, advantages, and challenges of robot-assisted technology in cerebrovascular interventions.

Methods: From May to October 2025, 25 consecutive patients who underwent robotic-assisted cerebral angiography and 25 consecutive patients who underwent manual cerebral angiography at our center were prospectively enrolled. The primary endpoints were technical success rate and clinical success rate. Secondary endpoints included procedure time, fluoroscopy time, radiation dose, contrast volume, total angiography room time, device performance evaluation, and complication rate. Additionally, a literature review was conducted to summarize the applications and developments of various robotic systems in neurointervention.

Results: All 50 (25 in the robotic-assisted group and 25 in the manual group) procedures were successfully completed with a 100% technical success rate. There were no differences between the two groups in patients' demographic data, fluoroscopy time, patient radiation dose, contrast agent dose, or total angiography room time (all p > 0.05). The robotic-assisted group had a shorter procedure time than the manual group (27 [15, 143] vs. 38 [21, 105], p = 0.005). A learning curve for the robotic-assisted system was observed. The robotic-assisted system operated stably without malfunctions. No procedure-related or device-related complications occurred.

Conclusion: The preliminary clinical application demonstrates that the YDHB-NS01 robot-assisted system is feasible for diagnostic cerebral angiography and shows early indications of safety and comparable procedural performance to those of conventional manual methods. Given the small, single-center cohort and the exploratory nature of this study, larger multicenter controlled trials are required to confirm these findings.

Background: Determining the location of paraclinoid aneurysms (PAs) is crucial. We aimed to evaluate the utility of paraclinoid high-resolution MRI (HRMRI) in determining PA locations.

Methods: We enrolled patients with suspected PAs who underwent our HRMRI sequence in 6 months. PAs were categorized into five types based on their origin from the internal carotid artery (ICA): Superior ophthalmic segment (Type S), Ventral ophthalmic segment (Type V), Medial clinoidal segment (Type M), Lateral clinoidal segment Type L, and Posterior clinoidal segment) (Type P). The paraclinoid HRMRI protocol included five main sequences: TOF-MRA, coronal and saggital high-resolution T2-weighted images, coronal and saggital enhanced high-resolution T1-weighted images. We utilized cerebrospinal fluid (CSF) notch and cavernous sinus enhanced signals to determine the location of PAs.

Results: Sixty-nine patients with 75 PAs were included. Based on our classification, there were 10 Type S, 2 Type V, 45 Type M, 11 Type L, and 7 Type P PAs. Among the Type S PAs, 9 were fully located within the subarachnoid space, and 1 was in the juncture area. Both Type V PAs were situated within the cavernous sinus. Among the Type M PAs, 34 were located in the cavernous sinus, and 1 was in the juncture. Of the Type L PAs, 5 were within the cavernous sinus, and 1 was in the juncture area. All 7 Type P PAs were located within the cavernous sinus.

Conclusions: HRMRI sequences may assist in determining the location of PAs and could provide useful information for clinical decision-making, especially when radiation-free or iodine-free evaluation is preferred.

Trial registration: The clinical trial of China Internal Aneurysm Project (NCT03115905).

Background: Woven EndoBridge (WEB™) has been shown to be safe and effective in the treatment of wide-necked bifurcation aneurysms (WNBAs). However, the use of this device has not been studied in China. This study assessed safety and effectiveness of WEB for the treatment of intracranial WNBAs in a Chinese population.

Methods: The WEB Intrasaccular Therapy China Study (WEB-IT China) was a prospective, single-arm study allowing enrollment of adult WNBA patients treated with the WEB device between June 2017 and August 2019 among 8 centers in China. The primary effectiveness endpoint was treatment success rate, defined as complete aneurysm occlusion without retreatment, recurrent subarachnoid hemorrhage (SAH), or >50% parent artery stenosis at 1 year. The primary safety endpoint was the proportion of patients with major adverse event (MAE) incidence at 1 year follow-up, including non-accidental death or any major stroke within 30 days, or major ipsilateral stroke, or neurological death from day 31 to 1 year after treatment.

Results: A total of 60 patients with 60 unruptured aneurysms were enrolled. Technical success rate was 98.3% (59/60). At 1 year, the treatment success rate was 54.2% (26/48), and two patients (3.9%) experienced an MAE, which was not device related. At 1 year, the complete occlusion rate was 56% and adequate occlusion rate was 82%. There were no retreatments, new bleeding events, or mortalities.

Conclusions: This study demonstrated that the WEB device is safe and effective in the treatment of WNBAs in the Chinese population.

Trial registration: Clinicaltrials.gov Unique Identifier NCT03207087.

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.