Chinese Neurosurgical Journal最新文献

Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the central nervous system, typically resulting from an imbalance between CSF production and absorption. Traditional classifications of hydrocephalus do not incorporate management strategies (not classified according to the degree of difficulty of treatment). Clinically, hydrocephalus that is challenging to treat is often categorized as refractory hydrocephalus (RH). However, the absence of a unified definition of RH impedes the standardization of treatment approaches, raising clinical dilemmas. This article explores the definition, etiologies, classification, and management strategies for RH. Based on the literature and the Diagnosis-Related Group payment system principles, RH is clinically defined as progressive hydrocephalus meeting one or more of the following criteria: (1) the absence of significant clinical or radiological improvement within 60 days despite standard interventions, usually due to pathological factors, such as abnormal CSF characteristics, (2) inability to achieve curative surgical treatments attributable to complex anatomy such as abnormal dynamic changes or multiloculated compartments, and (3) failure to respond after two consecutive therapeutic procedures. RH consists of six distinct subtypes, with infectious hydrocephalus being the most common, followed by low-pressure hydrocephalus. Temporary management strategies for RH must be carefully tailored to patient-specific characteristics, considering the risk-benefit analysis of available measures. In cases of infectious RH, achieving CSF sterilization and evaluating the results are crucial. Curative surgery for infectious RH should be performed only after CSF has been completely sterilized to normal levels. In low-pressure RH, a critical focus is identifying and addressing the sites receiving CSF.

Background: Brain abscess (BA) is a serious condition that causes significant mortality and morbidity. While various prognostic factors have been studied, there is limited research on long-term survival predictions. The present study aimed to identify predictors of long-term survival in BA patients and develop a dynamic nomogram for individualized prognostication. Additionally, the secondary objective was to develop and validate a dynamic nomogram for predicting long-term survival in BA patients.

Methods: A retrospective cohort study was conducted on BA patients diagnosed at a tertiary care hospital in Southern Thailand. Demographic, clinical, laboratory, and imaging finding were analyzed. Cox regression was used to identify independent prognostic factors. A dynamic nomogram was developed and validated using Harrell's concordance index (C-index), calibration plots, and cumulative case/dynamic control survival receiver operating characteristic (ROC) curves.

Results: A total of 205 patients were included, with a mean follow-up of 41.66 months. The 1-year, 2-year, and 5-year survival probabilities were 0.77, 0.73, and 0.69, respectively. Independent predictors of long-term survival included age, Karnofsky performance status, hemoculture results, preoperative coagulopathy, neutrophil-to-lymphocyte ratio, bandemia, and occipital BA. The dynamic nomogram revealed strong predictive performance, with a C-index of 0.855 for apparent validation and 0.701 for validation with testing data. Calibration plots and ROC analysis further supported its reliability.

Conclusions: This study presents a validated dynamic nomogram for predicting long-term survival in BA patients. The model provides an interactive tool for individualized risk assessment and facilitating clinical decision-making. Future research should focus on external validation and refinement of the model for broader applicability.

Background: Surgical resection for hypervascular central nervous system tumors poses a significant challenge for neurosurgeons. Controversy remains about the effect and safety of the traditional therapeutic mode, which combines preoperative embolization and delayed tumor resection, remain controversial. Whether a one-stage hybrid operation modality offers a novel approach to address treatment challenges in a safer and more effective way remains unknown.

Methods: From the neurosurgical operation database, we retrospectively reviewed patients with hypervascular central nervous system tumor patients who underwent one-stage hybrid operation between January 1, 2014, and September 30, 2024. Intraoperative blood loss, the percentage of tumor devascularization, and complications associated with embolization were recorded. Novel embolization strategies used to facilitate the resection of tumors in one-stage hybrid operations were analyzed.

Results: In total, 31 hypervascular central nervous system tumor patients were recruited. The main pathological types included various types of meningiomas (45.2%), hemangioblastomas (16.1%), paragangliomas (9.7%), and solitary fibrous tumors (9.7%). Embolization of tumor-feeding arterial pedicles alone was achieved in 25 patients, and various materials, such as ethylene-vinyl alcohol copolymer, Guglielmi detachable coil, and silk suture segments, were used, in which the tumor blood supply was blocked satisfactorily and the texture became softer postembolization. Intratumoral vascular beds were embolized in six patients. The mean occlusion rate of the target pedicle was 83.3%. Gross-total resection was achieved in 22 patients (71.0%), with a mean blood loss volume of 1127 ± 1114.4 mL (ranging from 150 - 4500 ml). No embolization-related complications occurred. Deterioration of neurological deficits was observed in three patients (9.7%) at discharge.

Conclusion: A one-stage hybrid operation is safe for the treatment of hypervascular central nervous system tumors. A prospective study to evaluating its safety and efficacy compared with separate-stage treatment is needed.

BACKGROUND : Chondrosarcoma is a rare and malignant tumor in the sellar region. Due to the limited understanding of its oncological behavior, it is often misdiagnosed as other lesions, such as chordoma or invasive pituitary adenoma. In the past, craniotomy was considered the primary treatment option. However, with the advancement of neuroendoscopic techniques, many centers have begun adopting endoscopic approaches for this disease. In this article, we summarized our case series and reviewed the previous papers to evaluate the clinical outcomes of neuroendoscopic resection for sellar chondrosarcomas.

Methods: Four patients with sellar chondrosarcomas who underwent tumor resection by endonasal endoscopic approach (EEA) in our institute from 2017 to 2021 were reviewed. In addition, we reviewed the current literatures on sellar chondrosarcomas.

Results: Our series included 4 patients, and 8 cases of sellar chondrosarcomas were reported in previous literatures. In the pooled cohort, there were 6 males and 6 females. The median age at diagnosis was 28.5 years (interquartile range, 22.8-39.3). The most common clinical presentation was blurring of vision (66.7%) and headache (50%). The incidence of preoperative endocrine disorder in such patients was 33.3%; these abnormalities could return to normal after surgery. Complete resection and incomplete resection were achieved in 7 (58.3%) and 5 (41.7%) cases, respectively. Among the 12 patients, only one patient was diagnosed with chondrosarcoma preoperatively; other patients were misdiagnosed with chordoma (n = 5; 41.7%), invasive non-functioning pituitary adenoma (INPA) (n = 4; 33.3%), or craniopharyngioma (n = 2; 16.7%).

Conclusions: The preoperative diagnosis of sellar chondrosarcoma remains challenging and often requires differentiation from chordoma, INPA, or craniopharyngioma. When a calcified mass in the sellar region presents with intact or slightly disturbed anterior pituitary function, heterogeneous enhancement and no diffusion restriction on Magnetic Resonance Imaging(MRI) sequences, and surrounding bony destruction and bony attachment on Computed Tomography(CT) scans, a chondrosarcoma should be suspected preferentially. Complete resection is the optimal goal for the management of sellar chondrosarcoma, but adjuvant radiotherapy and periodic follow-up should be highlighted.

Background: The increased permeability of the blood-brain barrier (BBB) is related to the occurrence and development of diseases such as acute ischemic stroke, chronic ischemia, or small vessel disease. Patients with carotid artery stenosis have chronic ischemia. The exact effect of carotid endarterectomy on the blood-brain barrier is still unclear. The aim of the study was to assess the effect of carotid endarterectomy on basic perfusion parameters and permeability surface area-product (PS).

Methods: The study included a total of 17 subjects (13 men), of which bilateral carotid artery stenosis was greater than 70%. All patients underwent unilateral carotid endarterectomy. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after operation: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material.

Results: Before surgery, the operative side exhibited significantly lower CBF (p = 0.001) and prolonged MTT (p = 0.002) and TTP (p = 0.001) compared to the nonoperative side, while PS and CBV showed no significant differences. After carotid endarterectomy, only the operative side demonstrated improvements, with CBV increasing by 9.4%, MTT decreasing by 20.3%, TTP decreasing by 14.1%, and PS decreasing by 27.5% (all p < 0.01). No significant changes were observed on the nonoperative side.

Conclusions: Carotid endarterectomy augmented BBB permeability can be controlled by carotid endarterectomy in patients with carotid artery stenosis.

Background: Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium (ASPP) mainly used European and American national healthcare databases, lacking detailed patient-level data and precise event timing.

Aim: (1) To identify the risk factors and prognostic factors for ASPP, (2) to assess the risk of recurrent stroke, particularly during subsequent pregnancies, and (3) to evaluate offspring prognosis.

Design: This study is a retrospective, observational, nationwide, multicenter research project planned to include 400 ASPP patients from 36 centers across 22 provinces in China, from 2015 to 2024. ASPP is defined as acute ischemic or hemorrhagic stroke during pregnancy or within 6 weeks postpartum, confirmed by neuroimaging. Two matched groups will be included for comparison: 400 pregnant/puerperal participants without a stroke history and 400 nonpregnant/puerperal participants with a recent stroke, matched by age and/or stroke etiology.

Methods: All participants will be followed up through telephone interviews. The initial follow-up is scheduled to take place between December 2024 and February 2025. The follow-up phase will consist of three rounds, each lasting 3 months and conducted every 3 years. Primary outcomes include unfavorable functional outcomes (mRS > 2 or EQ-5D index score < 0.7) at follow-up for Aim 1, recurrent strokes (neuroimaging-confirmed) for Aim 2, and neonatal asphyxia (Apgar scoring) and future development (ASQ-3) of offspring for Aim 3.

Discussion: The ASPP study is the first nationwide multicenter study to systematically evaluate the risk factors, prognosis, and risk of recurrent stroke in ASPP patients, particularly during subsequent pregnancies. This research may offer new insights into the long-term impacts of pregnancy-related stroke.

Trial registration: ClinicalTrials.gov (NCT06527807).

Glioblastoma (GBM) is the most aggressive and common primary brain malignancy in adults, characterized by poor prognosis and treatment resistance. Despite advancements in treatment options, the median survival is roughly 15 months, underlining the need for novel and effective treatments. Artificial intelligence (AI) has emerged as a transformative technology in healthcare, offering outstanding capabilities in data analysis, pattern recognition, and helping in decision-making. This review explores the current and potential role of AI in GBM care, focusing on its applications in diagnosis, treatment planning, prognostication, and drug discovery. AI-based algorithms have demonstrated promising potential in enhancing diagnostics through imaging analysis, radiomics, and tumor segmentation. These technologies could enable non-invasive molecular profiling and early detection of GBM. In treatment planning, AI could improve approaches by optimizing surgical resection, radiotherapy regimen, and chemotherapy protocols. Furthermore, machine learning models can integrate multimodal data to develop personalized treatments. They can also enhance prognostication by predicting survival, recurrence, and treatment responses, helping clinicians to make more informed decisions. AI is also revolutionizing pharmacotherapy by identifying novel molecular targets and optimizing combination therapies. Despite notable progress, challenges persist. Limited data quality and quantity, algorithm interpretability, integration problems, and ethical considerations, remain significant challenges to clinical implementation. This review emphasizes the need for continued research and interdisciplinary collaboration to overcome many barriers and realize the transformative potential of AI in GBM care.

Background: Gliomas represent the most prevalent primary neoplasm in the adult central nervous system. Despite advancements in therapeutic modalities, such as surgical intervention, radiotherapy, chemotherapy, and tumor treatment, the 5-year survival rate of glioma patients remains low. Therefore, there is an urgent need to develop additional treatment methods. Recent studies have suggested that FAM111B is involved in DNA repair, cell cycle regulation, and apoptosis. FAM111B mutations and overexpression are related to cancer.

Methods: We found that FAM111B was significantly overexpressed in glioma tissues compared to the adjacent tissues by analyzing data from the TCGA_GBM&LGG and CGGA databases. Moreover, overexpression of FAM111B was associated with shorter overall survival, and disease-specific survival and tended to increase with disease stage progression. Cellular experiments confirmed these results. These results suggest that overexpression of FAM111B promotes the proliferation, migration, and invasion of glioma cells, whereas the knockdown of FAM111B inhibits these activities. We also found that FAM111B regulated glioma cell proliferation, migration, and invasion via the PI3K/AKT pathway.

Results: FAM111B is capable of enhancing the proliferation, invasion, and migration capabilities of glioma cells and promotes the malignant progression of glioma via the PI3K/Akt signaling pathway.

Conclusions: This is the first study to demonstrate that FAM111B plays a crucial role in the proliferation, migration, and invasion of glioma cells. The malignant phenotype of FAM111B has also been shown to be closely associated with the PI3K/AKT pathway. FAM111B may be a predictive biomarker and a potential therapeutic target for gliomas.

Background: Intracranial aneurysm is a leading cause of subarachnoid hemorrhage and affects approximately 7% of the Chinese population, posing a significant public health concern. Due to the lack of a national cohort of unruptured intracranial aneurysms (UIAs) in China, optimal surgical management for UIAs remain insufficiently explored.

Methods: The China Treatment Trial for Unruptured Intracranial Aneurysm (ChTUIA) is a national, prospective, observational, multi-center registry study designed to identify optimal surgical management for UIAs in the Chinese population. Eligible patients were recruited from 83 regional neurological centers in China between December 2021 and December 2022. All patients will be followed up routinely for at least two years.

Results: A total of 25,438 patients with UIAs have been enrolled in the study, of whom 9794 (38.5%) were male, with a median age of 59 years (interquartile range: 52-67 years). The mean follow-up period was 4.28 years (interquartile range: 2.86-6.37 years). Among the patients, 6,712 (26.4%) patients underwent microsurgical clipping, and 18,726 (73.6%) patients underwent endovascular treatment, including 3,017 (16.1%) receiving coil alone or balloon-assisted coiling, 11,431 (61.1%) underwent stent-assisted coiling, and 4,278 (22.8%) treated with flow diverters. Comprehensive data collection encompassed 874,890 demographic and clinical records, 42,109 radiological records, 13,528 hemodynamic records, and 12,727 biological records, with a lost-to-follow-up rate of 5.4% and a data-missing rate of 8.3%.

Conclusions: The ChTUIA study represents the first national prospective investigation into surgical management protocols and treatment trends toward UIAs in the Chinese population. This study will provide critical evidence to guide the clinical management of UIA patients.

Trial registration: NCT05844163 ( https://clinicaltrials.gov/study/NCT05844163 ).