Chinese Neurosurgical Journal最新文献

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.

Background: Primary central nervous system lymphoma (PCNSL) is a rare intracranial tumor, and even rarer when the lesion involves the ventricles. This article aims to evaluate the clinical features of PCNSL lesions involving the ventricles.

Methods: Gathering data from a single institution, we conducted a retrospective analysis of all patients with pathologically proven PCNSL between August 2004 and August 2021 from Xiangya Hospital databases and searched for previously reported cases in PubMed. The MRI signal characteristics, location, size, and hydrocephalus presence were evaluated on the images.

Results: We identified 29 new cases and reviewed 22 previously reported cases. The study included 32 (62.75%) males and 19 (37.25%) females, with a median age of 53 years. Of the 22 cases with preoperative imaging available for review, all lesions appeared as isointense or hyperintense on T1WI. Twenty lesions presented as isointense or hypointense, and two cases presented as hyperintense on T2WI. The median Ki-67 of PCNSL involving the ventricle was 80%. BCL-2 was positive in 10/22 (45.45%) cases, and BCL-6 was positive in 18/28 (64.29%) cases.

Conclusions: We found that age ≥ 60 years old and female gender were significant risk factors for survival outcome (P < 0.05). In terms of imaging presentation and prognosis, PCNSL lesions invading the ventricles were similar to those that were non-invasive. Our findings further suggest that ventricular PCNSL may have more diverse signal types on T2WI. Therefore, we recommend that ventricular lymphoma be treated in the same way as non-ventricular PCNSL.

Background: The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (US) populations as do the plaque features on imaging.

Objectives: The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and US patients.

Methods: Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10-µm thickness) at 0.5-1 mm intervals. Hematoxylin and eosin staining and Mallory's trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups.

Results: A total of 1152 histological sections from 75 Chinese patients and 1843 sections from 111 US patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3 mm, p = 0.046) and a larger percent wall volume (median: 74% vs. 70%, p = 0.018) than the US group. After adjusting for confounding factors, carotid plaques in the Chinese population had larger lipid pools (β = 10.0%, 95% CI: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; β = 8.4%, 95% CI: 4.5 to 12.7%), less late IPH (β = - 8.2%, 95% CI: - 11.3 to - 5.4), and fewer fibrous cap disruptions (45% vs. 67%, p = 0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did US plaques (20% vs 2.7%, p < 0.001).

Conclusions: The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which indicates a need for a different management approach.

Background: Intracranial aneurysm(IA) are among the most common cerebrovascular diseases, and their rupture can lead to severe consequences. Aging plays a significant role in the onset and progression of many diseases, yet it remains understudied in the context of intracranial aneurysms. The aim of this study is to investigate the role of aging-related genes in the development of intracranial aneurysms using public databases, in order to understand the underlying biological mechanisms.  METHODS: Gene expression profiles for intracranial aneurysms were downloaded from the GEO database. Human aging-related genes were obtained from the HAGR website. Differentially expressed gene analysis and WGCNA were used to identify core hub genes. GO and KEGG enrichment analyses were conducted to determine the potential biological functions and pathways that these differentially expressed aging-related genes in intracranial aneurysms might be involved in. Based on the hub genes, co-expression gene networks and Gene-TF-miRNA regulatory networks were constructed. Further exploration of drug-gene interactions was conducted to screen potential target drugs.

Results: Through the intersection of aging-related genes and differentially expressed genes in IA, 32 common differentially expressed genes were identified, with 20 genes upregulated and 12 genes downregulated. GO enrichment analysis showed that these genes were mainly involved in epithelial cell proliferation and regulation, peptide enzyme activity modulation, and metabolic Homeostasis. KEGG enrichment analysis showed that these genes were primarily involved in the adipocytokine signaling pathway, growth Hormone synthesis,secretion and action, neurotrophin signaling pathway, and longevity regulating pathway. WGCNA was used to identify genes highly correlated with the IA phenotype, and an intersection with the 32 differentially expressed aging-related genes yielded 11 candidate Hub DEARGs. The expression of the candidate Hub DEARGs was validated using an external dataset, ultimately confirming 4 hub DEARGs related to intracranial aneurysms. Among them, NGFR and ADCY5 were downregulated, while BUB1B and SERPINE1 were upregulated.  CONCLUSIONS: This study identified four aging-related genes, NGFR, ADCY5, SERPINE1, and BUB1B, that are associated with intracranial aneurysms. This provides new insights into the molecular mechanisms underlying the development of intracranial aneurysms. The identified core genes provide promising leads for further experimental research to explore the pathogenesis of the disease.

Background: The postoperative space-occupying cyst (SOC) in the Tumor bed is rarely reported, and they are easily overlooked in the early stages. This oversight may result in serious consequences. This study aimed to systematically analyze the clinical characteristics and principles of managing SOC.

Method: We conducted a retrospective analysis of clinical data on postoperative Tumor bed SOC at our institute. Comprehensive searches of English literature were performed on PubMed and Web of Science databases, while Chinese literature searches were conducted on the China National Knowledge Infrastructure and Wanfang Database, with a cutoff date of August 2024. Results Among 1026 brain Tumor resections performed at our institute, 10 patients (0.97%) had tumors situated in the supratentorial area. Four (40%) patients were managed with external drainage using an Ommaya reservoir placed in the cystic cavity, while six (60%) underwent direct percutaneous puncture drainage. A favorable prognosis was observed in all treated cases. A total of 106 cases were documented in both Chinese and English literature, yielding an incidence rate ranging from 0.04% to 4%. Percutaneous puncture external drainage was the predominant intervention, performed in 47 cases, representing the highest percentage at 44.3%. A favorable prognosis was observed in 78.1% (82/105) of treated cases, with four reported deaths.

Conclusions: Supratentorial brain tumors situated within the cerebrospinal fluid circulation may give rise to SOC after resection. Following aggressive treatment, most patients experience a favorable prognosis.

Background: In recent years, robot-assisted stereotactic system has been widely used in stereo-electroencephalogram (SEEG) surgery. However, current registration mainly based on bone-fiducial registration (CBR) is limited by the inconvenient of repeated contact during the process. Here, a novel contactless optical-tracking registration (OTR) were applied for SEEG using robot-assisted stereotactic system. To demonstrate the accuracy and convenience of the novel OTR method compared with contact CBR method during the robot-assisted SEEG in phantom and animal model study.

Methods: A head phantom and 12 Bama pigs (Sus scrofa domestica) with six under CBR and six under OTR were selected for the SEEG. Procedures were performed using the robot-assisted stereotactic system in different registration methods. The positioning error and time consumption during the registration process were assessed to compare the accuracy and convenience of OTR and CBR. Besides, two new users for the robot-assisted stereotactic system were selected for the learning curve analysis.

Results: The mean positioning errors in OTR group of the target and entry points were 1.68 ± 0.80 mm and 0.76 ± 0.39 mm. And in CBR group, mean positioning errors of the target and entry points were 1.49 ± 0.79 mm and 0.70 ± 0.33 mm. The registration time of OTR method (99.71 ± 1.08 s) was significantly shorter than that using CBR method (241.29 ± 28.95 s) (p value < 0.001). During the learning curve analysis, it is earlier for the users to go under OTR than CBR to reach a preferable entry error of 0.5 mm.

Conclusion: The contactless OTR method can effectively reduce the time consumption during the registration process while maintaining the accuracy with CBR method. The novel method not only simplify the procedure by optical-tracking but also shorten the new user's learning curve compared with current method.

Background: Deep learning (DL) based on MRI of medulloblastoma enables risk stratification, potentially aiding in therapeutic decisions. This study aims to develop DL models that identify four medulloblastoma molecular subgroups and prognostic-related genetic signatures.

Methods: This retrospective study enrolled 325 patients for model development and an independent external validation cohort of 124 patients, totaling 449 MB patients from 2 medical institutes. Consecutive patients with newly diagnosed MB at MRI (T1-weighted, T2-weighted, and contrast-enhanced T1-weighted) at two medical institutes between January 2015 and June 2023 were identified. Two-stage sequential DL models were designed-MB-CNN that first identifies wingless (WNT), sonic hedgehog (SHH), Group 3, and Group 4. Further, prognostic-related genetic signatures using DL models (MB-CNN_TP53/MYC/Chr11) were developed to predict TP53 mutation, MYC amplification, and chromosome 11 loss status. A hybrid model combining MB-CNN and conventional data (clinical information and MRI features) was compared to a logistic regression model constructed only with conventional data. Four-classification tasks were evaluated with confusion matrices (accuracy) and two-classification tasks with ROC curves (area under the curve (AUC)).

Results: The datasets comprised 449 patients (mean age ± SD at diagnosis, 13.55 years ± 2.33, 249 males). MB-CNN accurately classified MB subgroups in the external test dataset, achieving a median accuracy of 77.50% (range in 76.29% to 78.71%). MB-CNN_TP53/MYC/Chr11 models effectively predicted signatures (AUC of TP53 in SHH: 0.91, MYC amplification in Group 3: 0.87, chromosome 11 loss in Group 4: 0.89). The accuracy of the hybrid model outperformed the logistic regression model (82.20% vs. 59.14%, P = .009) and showed comparable performance to MB-CNN (82.20% vs. 77.50%, P = 0.105).

Conclusion: MRI-based DL models allowed identification of the molecular medulloblastoma subgroups and prognostic-related genetic signatures.

Background: Absorbable cranial flap fixation products, represented by Aesculap^® CranioFix absorbable clamp, are widely used in neurosurgery. However, the product has some shortcomings, as it is not entirely biodegradable, the lower disc's angle cannot be adjusted, and there is a failure to readjust after fixation. To address these issues, MedArt Technology Co., Ltd. from China has come up with a high-purity PLLA combined with an innovative structural design to develop a novel cranial flap fixation system that is more convenient to operate, has a better resetting effect, and can be fully absorbed. This study aims to verify its safety and effectiveness through in vitro experiments and clinical trials.

Methods: In this study, the absorbable cranial flap fixation system of MedArt was used as the experimental group, and the CranioFix absorbable clamp constituted the control group. The material properties and the changing trend of mechanical properties of the two groups were compared by accelerated degradation experiments in vitro. A multicenter, randomized, parallel, positive-controlled, non-inferiority clinical study was conducted with a 48-week follow-up. The shortening degree of the bone flap gap, qualified rate of bone flap displacement, changing trend of implant volume, and occurrence of postoperative adverse events were compared between the two groups.

Results: The results of the in vitro accelerated degradation showed that in terms of the decrease in intrinsic viscosity, the control and experimental groups took 7 days and 14 days, respectively, to reach the test endpoint. For mechanical properties, the control group and experimental groups lost clinical safety fixation significance on the 3rd and 4th day after the degradation began, respectively. Regarding the release of degradation products, the control group showed a burst of lactic acid release during the first 3-7 days, while the experimental group released lactic acid slowly and constantly. In the clinical study, 90 patients were randomly enrolled, 87 of whom completed the operation, with an average age of 50. The 3D reconstruction of CT images showed that the bone flap gaps in both groups were less than 2 mm after surgery. The qualified rate of bone flap displacement in the experimental group was 100% after surgery. In contrast, in the control group, there was one unqualified case at 1 week after surgery and two unqualified cases at 6 weeks, 12 weeks, 24 weeks, and 48 weeks. The residual volume of the implant in the experimental group was closer to 50% (about 48.8%) 48 weeks after surgery, than in the control group (about 43.9%) 12 weeks after surgery. Regarding safety, only one possible device-related adverse event occurred in the control group, with an incidence rate of 2.22%, manifested as poor healing at the incision site.

Conclusions: The study has verified that the experimental group