Abstract:Stroke has become the leading cause of death and disability among adults in China.The recovery of motor function is crucial for the daily activities of stroke patients.Although traditional rehabilitation methods(e.g.,physical therapy,functional electrical stimulation)show certain effectiveness,their potential for restoring motor function in patients with severe hemiplegia remains limited.In recent years,brain-computer interface(BCI)technology,by establishing a direct communication pathway between the brain and external devices,offers patients the possibility of active participation in rehabilitation training and demonstrates significant potential for clinical application.This article discusses the application value and technical challeng-es of BCI in the treatment of hemiplegia following stroke.

Abstract:Epithelial-myoepithelial carcinoma(EMC)is a rare low-grade malignant epithelial neoplasm,and EMC in the sellar region is particularly uncommon.Due to the lack of specific clinical and radiological manifestations,preoperative diagnosis of EMC is challenging and misdiagnosis is prone to occur.This article reports a case of primary EMC in the sellar region in a 28-year-old male who presented with blurred vision in both eyes for over 5 months.MRI revealed a lobulated mass in the sellar region,ap-proximately 3.5 cm×3.4 cm×3.0 cm in size,showing T1-weighted contrast enhancement,with compression and displacement of the optic chiasm.A sellar tumor was suspected.After completing preoperative preparations,the sellar lesion was totally resected via a pterional approach.Postoperative pathological diagnosis confirmed EMC.Six months postoperatively,recurrence of the sellar tumor occurred.PET/CT scan showed no systemic metastases,and the patient subsequently underwent Gamma Knife radiosurgery.Follow-up contrast-enhanced MRI of the brain six months after Gamma Knife treatment showed no abnormal signal in the sellar region.This case suggests that EMC should be considered in the differential diagnosis of sellar lesions,and early detection and timely surgery are crucial.

Abstract:Objective To explore the application effect of the Feynman technique in the practical teaching of lum-bar puncture in neurosurgery.Methods From March to May 2023,51 fifth-year undergraduate students from Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were enrolled and randomly divided into groups A,B,and C using a random number table,with 17 students in each group.Group A served as the Feynman teaching group and under-went a dynamic teaching model consisting of"clear objectives,simulated teaching,feedback and correction,simplification and summarization."They first received conventional instruction from teachers and then taught students in groups B and C.After the teaching sessions,they conducted summaries and reflections.Groups B and C received instruction from group A before undergo-ing another session of conventional teacher-led teaching.After the training,all three groups underwent theoretical and practical assessments on lumbar puncture.A questionnaire survey was used to evaluate teaching satisfaction.Results The theoretical and practical scores of group A were significantly higher than those of groups B and C(P<0.05),while there was no statistically significant difference between groups B and C in either theoretical or practical scores(P>0.05).The questionnaire results showed that group A scored significantly higher than groups B and C in terms of practical skill improvement,anatomical understanding,and method acceptance(P<0.05).Conclusion The Feynman technique significantly improved the effectiveness of lumbar puncture teaching through multi-stage feedback and knowledge internalization.

Abstract:Stroke,as one of the diseases with the highest global disability rate,has long faced efficacy bottlenecks in its rehabilitation.In recent years,brain-computer interface(BCI)technology,by directly decoding motor intentions of the brain and combining neuromuscular stimulation via functional electrical stimulation(FES),has established a"brain-limb-brain"closed-loop feedback system,offering novel perspectives for precision rehabilitation.The combined application of BCI and FES provides a new paradigm for overcoming the limitations of traditional rehabilitation approaches.This article systematically re-views the technological principles,mechanisms of action,and clinical applications of BCI and FES,with a focus on analyzing their innovative role in modulating post-stroke neuroplasticity and their application in upper limb functional recovery as well as lower limb and gait rehabilitation.

Abstract:Objective To investigate the effectiveness of the stent tail-flipping technique in the interventional treat-ment of posterior communicating artery(PComA)aneurysms with fetal-type posterior cerebral artery(fPCA).Methods The clinical data of 16 patients with fPCA-associated PComA aneurysms treated with stent tail-flipping-assisted coil embolization at the Department of Neurosurgery,Guizhou Provincial People's Hospital from January 2019 to June 2024 were retrospectively analyzed.The Raymond scale was used to evaluate the degree of aneurysm occlusion,and the modified Rankin Scale(mRS)was applied to assess patient prognosis.Results All 16 aneurysms successfully underwent stent-assisted embolization.Imme-diate post-procedural angiography showed Raymond grade Ⅰ occlusion in 13 cases(81.25%)and grade Ⅱ in 3 cases(18.75%).All posterior communicating arteries remained patent.Perioperative complications occurred in 3 cases(18.75),including 1 intraoperative aneurysm rupture and 2 postoperative pulmonary infections.No ischemic events occurred after the procedure.At discharge,mRS scores were 0-2 in 14 patients(87.5%)and 3 in 2 patients.During a follow-up of 3-15 months(median 9 months),15 patients survived.Among them,13(86.67%)achieved complete aneurysm occlusion,1 showed improvement,and 1 remained stable.All posterior communicating arteries remained patent.Follow-up mRS scores were 0 in 12 patients,1 in 2 pa-tients,and 2 in 1 patient.One patient died due to rupture of an untreated contralateral posterior communicating artery aneurysm.Conclusion Endovascular interventional treatment using the stent tail-flipping technique is feasible and effective for posterior communicating artery aneurysms associated with fetal-type posterior cerebral artery.

Abstract:Objective To explore the diagnosis and treatment of traumatic posterior cerebral artery(PCA)pseudoaneu-rysm complicated by delayed subdural hematoma(SDH).Methods The clinical data of 2 patients with traumatic PCA pseudoan-eurysm presenting with delayed SDH,admitted to the Department of Neurosurgery of The First Affiliated Hospital of Hainan Med-ical University,were retrospectively analyzed and summarized in conjunction with relevant literature.Results Both patients had a clear history of trauma.CT on the day of injury revealed parafalcine and tentorial SDH.Their condition deteriorated after conserva-tive treatment.Follow-up head CT showed increased hematoma.Post-evacuation,digital subtraction angiography(DSA)confirmed PCA aneurysms,suspected as pseudoaneurysms.One patient was treated with dual-stent telescoping angioplasty,and the other with coil occlusion of the responsible vessel.Post-procedural angiography showed aneurysm disappearance.At the 3-month follow-up,both patients had a favorable prognosis with no aneurysm recurrence.Conclusion For patients with a clear history of head trau-ma presenting with parafalcine and tentorial SDH,the possibility of intracranial arterial injury should be vigilant.Particularly for patients developing delayed tentorial SDH after trauma,injury to the posterior cerebral artery leading to traumatic pseudoaneurysm should be suspected.Early vascular examination aids in the early detection of pseudoaneurysms.Once a traumatic pseudoaneurysm is confirmed,endovascular treatment is the preferred option,offering relatively high safety and effectiveness.

Abstract:Endoscopic endonasal surgery is a common approach for sinonasal tumors.However,intraoperative injury to the internal carotid artery(ICA)represents an extremely dangerous complication of such procedures.Although the conse-quences of intraoperative ICA rupture are severe,its incidence is relatively low,ranging from 0%to 0.1%.This article reports a case of a 38-year-old female patient who underwent endoscopic endonasal resection for a sphenoid sinus tumor.After gross total resection of the tumor,bleeding from the ICA progressed from oozing to massive hemorrhage,with an estimated blood loss of approximately 2000 mL.Following successful hemostasis by packing with iodoform gauze,emergency digital subtraction angi-ography(DSA)was performed,confirming rupture of the cavernous segment of the left ICA.The defect was then sealed using a Willis covered stent,followed by skull base reconstruction.At the 9-month follow-up,the patient recovered well.Follow-up magnetic resonance angiography(MRA)showed patency of the cavernous segment of the left ICA,and follow-up MRI revealed no tumor recurrence.This case suggests that for intraoperative ICA rupture,the defect must be managed urgently,followed by reconstruction of the blood flow pathway using a covered stent or a high-flow bypass to avoid complications from distal ischemic infarction.

Abstract:Objective To investigate the expression levels of long non-coding RNA(lncRNA)small nucleolar RNA host gene 5(SNHG5)and microRNA-212-3p(miR-212-3p)in malignant meningioma tissues and their correlation with clinicopathological features and prognosis of patients.Methods Ninety-eight cases of malignant meningioma were pro-spectively collected at Handan Central Hospital from January 2018 to March 2021.Real-time quantitative PCR was used to detect the expression levels of lncRNA SNHG5 and miR-212-3p in tumor tissues and adjacent tissues.All patients were fol-lowed up for 36 months postoperatively.Results Compared with adjacent tissues,malignant meningioma tissues showed significantly increased expression levels of lncRNA SNHG5(P<0.001)and significantly decreased expression levels of miR-212-3p(P<0.001).The bioinformatics software Starbase predicted binding sites between lncRNA SNHG5 and miR-212-3p.Pearson correlation analysis revealed a significant negative correlation between the expression levels of lncRNA SNHG5 and miR-212-3p in malignant meningioma tissues(r=-0.557,P<0.001).The expression levels of lncRNA SNHG5 and miR-212-3p were closely associated with tumor invasion type and extracranial metastasis(P<0.001),but showed no significant correlation with patient gender,age,tumor location,tumor size,pathological tumor type,or degree of peritumoral edema(P>0.05).During the 36-month postoperative follow-up,41 patients died,with a mortality rate of 41.8%.Multivariate Cox proportional hazards regres-sion analysis indicated that high expression of lncRNA SNHG5 and low expression of miR-212-3p were independent risk factors for death in patients with malignant meningioma(P<0.05).Kaplan-Meier survival curve analysis demonstrated that the median survival time was significantly longer in patients with low lncRNA SNHG5 expression compared to those with high expression(P<0.001),and significantly shorter in patients with low miR-212-3p expression compared to those with high expression(P<0.001).Conclusion The expression of lncRNA SNHG5 is upregulated while that of miR-212-3p is downregulated in malignant menin-gioma tissues.Both are closely associated with tumor invasion,extracranial metastasis,and patient survival prognosis.

Abstract:Meningioma is the most common benign intracranial tumor.The vast majority of meningiomas are solid,highly cellular and vascularized tumors.Complete cystic degeneration is rare;therefore,pure cystic meningioma is a very un-common central nervous system tumor.This paper reports a case of pure cystic meningioma in a 44-year-old female who was admitted due to intermittent headache and dizziness for 2 years,accompanied by sudden slurred speech for 1 day.Non-contrast cranial CT revealed a hypodense shadow in the left temporal region.Cranial MRI showed long T1 and long T2 signals without enhancement after contrast administration.Surgery was performed after completing preoperative preparations.The pure cystic lesion was completely resected under the microscope during the operation.Postoperative histopathological examination con-firmed it was a meningioma(meningothelial type)with a microcystic pattern(WHO gradeⅠ).Follow-up non-contrast cranial CT and MRI scans at 3 months postoperatively showed no tumor recurrence.

Abstract:The cervical and occipital regions persistently endure complex mechanical stress,which can lead to re-peated stretching and compression,resulting in injury to the myofascial tissues surrounding the occipital nerves.Occipital nerve-myofascial injury is characterized by pathological features such as occipital nerve entrapment,myofascial adhesion,and chronic pain,thereby reducing patients'functional status and quality of life.Biomechanics focuses on the internal mechanical laws of biological systems and the interaction mechanisms between external forces and biological tissues or organs,which aids in exploring the physiological and pathological changes in the body under various mechanical stimuli,as well as the mechanical phenomena such as stress involved in occipital nerve-myofascial injury and their impact on the body.From a biomechanical per-spective,this article analyzes the pathogenesis of occipital nerve-myofascial injury,extracorporeal shock wave therapy,and its therapeutic efficacy.

Abstract:Craniocerebral penetrating injury refers to an open injury that penetrates the skull and brain,involving scalp and facial lacerations,skull fractures,and cerebral contusions.Gunshot wounds are a common cause,while sharp objects such as nails or screwdrivers can also result in rare penetrating injuries.This article reports a rare case of a steel rod penetrating the head.The patient fell from a height while holding a steel rod approximately 1 meter long,which entered from below the right mandible,passed upward and to the left through the oral cavity into the cranial cavity,traversed the oropharynx,and exited at the left frontopa-rietal region.This resulted in blindness in the left eye and significant bleeding from the mouth and nose.Emergency tracheostomy was performed along with fluid resuscitation and other symptomatic treatments.Following multidisciplinary consultation and com-pletion of cranial CT and DSA examinations,the diagnosis was established as cranio-orofacial penetrating injury,left optic nerve in-jury,contusion of the left frontal lobe,and skull fracture.After preoperative preparation,a craniotomy was performed to remove the steel rod,followed by repair of the skull base fistula and cranial reconstruction.Postoperative management included antibiotics and lumbar cisternal drainage for infection prevention/control.Over one month after surgery,the patient recovered well and resumed normal life.A six-month telephone follow-up indicated persistent blindness in the left eye,with no symptoms such as headache,dizziness,or limb weakness.In summary,for patients with complex craniocerebral injuries,formulating a comprehensive treatment plan through multidisciplinary consultation is crucial to reduce improper maneuvers and iatrogenic injuries.

Abstract:Objective To construct a prediction model for facial nerve function outcomes after resection of Koos grade 3～4 vestibular schwannomas using machine learning,and to evaluate its efficacy.Methods The clinical data from 55 patients with Koos grade 3～4 vestibular schwannomas who underwent surgical treatment in the Department of Neurosurgery at our institution between August 2020 and May 2022 were retrospectively analyzed.Facial nerve function was assessed 6 months postoperatively using the House-Brackmann(H-B)grading system,with H-B gradesⅠ～Ⅱ defined as favorable prognosis and grades Ⅲ～Ⅵ as unfavorable prognosis.Feature variables were initially screened using the Random Forest(RF)algorithm.Combined with results from multivariate logistic regression analysis,the final variables were incorporated into the prediction model.The subjects were randomly divided into a training set and a testing set in a 7:3 ratio.Five machine learning methods were employed for modeling:Support Vector Machine(SVM),Naive Bayes(NB),XGBoost,Gradient Boosting Decision Tree(GBDT),and LightGBM.Results Among the 55 patients,38 had a favorable facial nerve functional prognosis and 17 had an unfavorable prognosis.The prognostic factors screened by the RF algorithm,ranked by feature importance score,were:degree of tumor adhesion to the facial nerve(32.3%),tumor consistency(26.1%),tumor diameter(22.6%),age(11.4%),and preopera-tive facial nerve function grade(7.7%).Multivariate logistic regression analysis identified cystic tumor consistency,larger tumor diameter,and severe tumor adhesion to the facial nerve as independent risk factors for unfavorable facial nerve functional out-comes in Koos grade 3～4 vestibular schwannomas(P<0.05).Integrating results from the RF algorithm and multivariate logistic regression,the top four prognostic factors(degree of tumor adhesion to the facial nerve,tumor diameter,tumor consistency,and age)were selected for machine learning model development.In the training set,the XGBoost and GBDT models performed best,both with an area under the ROC curve(AUC)of 1.000.However,in the testing set,their AUCs were 0.764 and 0.786,respec-tively,indicating suboptimal performance and a tendency towards overfitting.In the testing set,the SVM model demonstrated the best predictive performance.To ensure model stability and generalizability,the SVM model was ultimately selected as the final prediction model,as it showed good performance in both the training set(AUC=0.989)and the testing set(AUC=0.971).Conclusion This study demonstrates the value of machine learning in developing predictive models for facial nerve functional outcomes following resection of Koos grade 3～4 vestibular schwannomas,with the SVM model showing the best predictive effi-cacy in this cohort.

Abstract:Objective To investigate the clinical characteristics and surgical efficacy of anterior clinoid process mu-coceles accompanied by visual impairment.Methods The clinical data of 8 patients with anterior clinoid process mucoceles accompanied by visual impairment,who underwent surgical treatment at the Department of Neurosurgery of Beijing Tongren Hospital from June 2016 to September 2024,were retrospectively analyzed.Results Among the 8 patients,6 had residual vision preoperatively,while 2 had no residual vision.Two cases were accompanied by headache and retro-orbital pain,and one case presented with exophthalmos.Five patients underwent endoscopic transnasal-transethmoidal resection of the anterior clinoid process mucocele,and three underwent resection via a frontotemporal craniotomy.Postoperatively,the 6 patients with preoperative residual vision showed varying degrees of visual improvement,while the 2 patients without preoperative residual vision showed no improvement.No postoperative complications such as infection or cerebrospinal fluid leakage occurred.Fol-low-up revealed no cyst recurrence.Conclusion Surgery is an effective method for treating anterior clinoid process mucoceles accompanied by visual impairment.Early diagnosis and timely surgery can effectively improve patients'vision.

Abstract:Objective To explore the surgical techniques and outcomes of resecting pineal region tumors via the poste-rior interhemispheric transtentorial approach.Methods A retrospective analysis was conducted on the clinical data of 21 patients with pineal region tumors who underwent microsurgery via the posterior interhemispheric transtentorial approach in the Department of Neurosurgery,Renmin Hospital of Wuhan University,between January 2014 and January 2022.Results Postoperative cranial MRI examinations at 1～3 months showed total resection in 19 cases and subtotal resection in 2 cases.Postoperative pathological results indicated 10 cases of germ cell tumors,5 cases of pineocytoma,4 cases of astrocytoma,1 case of glioblastoma,and 1 case of small cell neuroendocrine carcinoma(of pulmonary origin).Postoperatively,1 patient developed contralateral parietal epidural hematoma,which was surgically evacuated with good recovery.New-onset upward gaze palsy occurred in 2 cases and diplopia in 3 cases,both resolving within 3 months postoperatively.Eight patients underwent external ventricular drainage before tumor re-section,and 4 patients underwent third ventriculostomy after tumor resection during the same surgery.No visual field deficits were observed postoperatively,and follow-up cranial CT scans showed no occipital lobe edema or contusion.Postoperative follow-up ranged from 6 to 36 months,with all 21 patients surviving.Three patients required ventriculoperitoneal shunting after tumor resec-tion,and tumor recurrence occurred in 6 cases.Conclusion Microsurgery is an important treatment modality for pineal region tumors.Patients with benign or low-grade malignant lesions can achieve long-term survival after surgical resection.For highly ma-lignant tumors,maximal safe resection followed by adjuvant radiotherapy and chemotherapy can prolong patient survival.

Abstract:Objective To investigate the safety and efficacy of stand-alone balloon angioplasty in patients with intracra-nial atherosclerotic stenosis(ICAS).Methods The clinical data of 77 ICAS patients admitted to Kuitun Hospital of Ili Prefecture,Xinjiang,from June 2022 to September 2023 were retrospectively analyzed.All patients underwent stand-alone balloon angioplasty and were followed up for 3 months postoperatively.Results All patients successfully completed stand-alone balloon angioplasty.Among them,7 cases(9.09%)received stent placement due to elastic recoil after balloon dilation,and 6 cases(7.79%)received stent placement due to target vessel dissection.Target vessel dissection occurred in 22 cases(28.57%)after balloon dilation,of which 16 cases did not receive further intervention due to good antegrade blood flow.Within 72 hours postoperatively,there was 1 case of symptomatic intracranial hemorrhage and 1 case of non-fatal symptomatic cerebral infarction.Among the 77 cases treated with stand-alone balloon angioplasty,the procedural success rate was 83.70%;16 cases had recurrence,with a recurrence rate of 20.78%.After 3 months of postoperative follow-up,76 patients survived and 1 patient died,resulting in a case fatality rate of 1.30%.At 3 months postoperatively,the NIHSS and mRS scores of the surviving patients were significantly lower than those before surgery(P<0.05),and the proportion of patients with mTICI grade 2b-3 was significantly higher than before surgery(P<0.05).One case ex-perienced recurrent acute cerebral infarction,while the other 75 cases showed no restenosis or re-occlusion of the intracranial large vessels.Conclusion Stand-alone balloon angioplasty for ICAS patients can effectively promote vascular recanalization,improve neurological function and prognosis,and demonstrates favorable efficacy and safety.In the treatment of ICAS,stand-alone balloon angioplasty has a relatively high success rate,but there remains a certain risk of recurrence and mortality.Clinically,the treatment plan should be selected based on the characteristics of the patient's lesion and vascular access.

Abstract:Objective To investigate the clinical efficacy of surgical treatment for pituitary prolactinomas.Methods A retrospective analysis was conducted on the clinical data of 41 patients with pituitary prolactinomas who under-went transsphenoidal surgery in the Department of Neurosurgery,Central Theater General Hospital,from January 2014 to March 2024.Initial efficacy at 1 week postoperatively and long-term efficacy at 1 year postoperatively were assessed based on serum prolactin levels,MRI findings,and clinical symptom improvement.Results Among the patients,32 underwent microscopic transsphenoidal surgery,7 underwent endoscopic transsphenoidal surgery,and 2 with Knosp grade Ⅳ tumors underwent mi-croscopic pterional approach surgery.Gross total resection was achieved in 30 cases(73.2%),and subtotal resection in 11 cases(26.8%).For initial efficacy:complete remission was observed in 15 cases(36.6%),including 3 microadenomas(100%)and 12 non-invasive macroadenomas(63.2%);partial remission in 8 cases(19.5%);and no response in 18 cases(43.9%).For long-term efficacy:complete remission was achieved in 24 cases(58.5%),and recurrence occurred in 5 cases(12.2%).Postoperative com-plications included transient diabetes insipidus in 9 cases(21.9%),pituitary insufficiency in 8 cases(19.5%),and cerebrospinal fluid rhinorrhea in 1 case(2.4%).There were no surgical mortalities.Conclusion Transsphenoidal surgery(microscopic or endoscopic)yields high clinical symptom and endocrine remission rates for microadenomas and non-invasive macroadenomas of pituitary prolactinomas.It is particularly suitable for patients who are unresponsive to medication,intolerant to drugs,or have visual impairment.When surgical indications are strictly followed and the procedure is selectively performed in experienced medical centers,surgery serves as an important supplement to pharmacological therapy.

Abstract:Objective To explore adverse events(AEs)associated with the use of mannitol,assess the safety of its clinical application,and provide evidence for safe drug use.Methods Data from the FAERS database from the first quarter of 2004 to the third quarter of 2023 were searched for AEs where mannitol was the primary suspect.Positive signal AEs were screened using the reporting odds ratio(ROR),proportional reporting ratio(PRR),and empirical Bayesian geometric mean(EBGM)methods.The screening criteria were an ROR 95%lower confidence interval(CI)limit>1 and ROR≥3;PRR>2 and χ²>4;and EBGM05>2.Results A total of 1 101 patients were identified,with the majority aged 51～60 years and a slightly higher propor-tion of males.The primary AEs related to mannitol affected the following System Organ Classes:skin and subcutaneous tissue disorders(23.05%),renal and urinary disorders(21.32%),and general disorders and administration site conditions(14.81%).Fre-quent mannitol-associated AEs included renal impairment(9.18%),pruritus(7.08%),and acute kidney injury(7.01%).Co-medica-tion analysis identified 2,078 cases.The top ten concomitant drugs were sodium chloride(6.69%),dexamethasone(4.76%),cispla-tin(2.94%),furosemide(1.88%),ondansetron(1.20%),epoprostenol(1.06%),propofol(0.91%),nitrous oxide(0.87%),fentanyl(0.82%),and lidocaine(0.77%).Common combinations for synergistic reduction of intracranial pressure included mannitol with dexamethasone or furosemide.84 death-related events were retrieved.Through matching preferred terms and full information,complete death details were obtained for 6 cases,including 4 deaths related to renal impairment.Analysis of death-related causes indicated the need to pay attention to drug incompatibilities,renal impairment,and electrolyte metabolism disorders in patients.Monitoring is also advised when using mannitol in patients with multiple chronic diseases.Most mannitol AEs occurred within 1 month of administration(98.18%).Conclusion Mannitol AEs frequently involve the skin and renal systems.Some adverse reactions are not listed in pharmacopeias.Therefore,close monitoring of liver and kidney function is still necessary during man-nitol use.For patients with worsening renal function,reducing mannitol use is recommended.Additionally,mannitol can be used sequentially with dexamethasone/furosemide to synergistically reduce intracranial pressure and improve patient prognosis.

Abstract:Objective To explore the clinical characteristics and prognosis of children with traumatic intracranial hemorrhage complicated by secondary brain swelling.Methods The clinical data of 41 children with intracranial hemorrhage complicated by secondary brain swelling,admitted to the Department of Neurosurgery,Children's Hospital Affiliated to Xi'an Ji-aotong University between January 2019 and December 2023,were retrospectively analyzed.Results Brain swelling predom-inantly occurred in infants aged 1-6 years(61.0%).Traffic accidents were the most common cause(48.8%),followed by falls(34.1%).Traumatic subarachnoid hemorrhage was the most frequent presentation(53.7%),and pupillary changes were common(46.3%).Hemispheric brain swelling was observed in 20 cases,and diffuse brain swelling in another 20 cases.The time to onset of brain swelling ranged from 2 to 96 hours post-injury,with a median time of 8 hours.The median times for brain swelling on-set were 5 hours in the early-onset group(<24 hours)and 24 hours in the delayed-onset group(>24 hours).There were 29 cases(70.7%)in the early-onset group and 12 cases(29.3%)in the delayed-onset group.Children in the early-onset group exhibited early pupillary changes,elevated white blood cell count,and decreased fibrinogen levels,had higher Rotterdam CT scores,and despite surgical intervention,had poorer prognoses.Children in the delayed-onset group showed a trend of decreased mean ar-terial pressure and prolonged activated partial thromboplastin time upon admission;most were managed non-surgically and had better prognoses.At 1 year post-injury,the Glasgow Outcome Scale(GOS)scores in the early-onset group were:5 points in 11 cases,4 points in 2 cases,3 points in 5 cases,2 points in 4 cases,and 1 point in 7 cases.In the delayed-onset group,GOS scores were:5 points in 7 cases,4 points in 1 case,2 points in 2 cases,and 1 point in 2 cases.Conclusion Early post-injury brain swelling and bilateral hemispheric swelling are associated with poor prognosis.Timely fibrinogen supplementation and main-taining adequate fluid resuscitation to improve cerebral perfusion are necessary.Close monitoring of coagulation abnormalities is essential to be vigilant for delayed brain swelling.

Abstract:Paradoxical herniation is a relatively rare clinical condition.This article reports a case of acute paradoxical herniation caused by epidural overdrainage following unilateral decompressive craniectomy.The patient was a 75-year-old male admitted due to drowsiness for 3 hours after a traffic accident.On admission,his Glasgow Coma Scale(GCS)score was 14,and a cranial CT scan showed left frontotemporal contusion and laceration accompanied by subdural and epidural hematomas,with the ambient cistern preserved.Two hours post-admission,his consciousness deteriorated,with a GCS score of 11.An immediate repeat CT scan revealed hematoma expansion,compression of the ambient cistern,and a midline shift of 7 mm.An emergency left decompressive craniectomy and intracranial hematoma evacuation were performed.Postoperatively,intravenous infusion of 20%mannitol and cerebrospinal fluid(CSF)drainage were initiated.At 37 hours post-surgery,the patient gradually progressed to coma with a GCS score of 7.A repeat CT scan showed left subdural accumulation of blood and air,significant scalp sinking,a midline shift to the left of approximately 13 mm,and marked compression of the ambient cistern.A diagnosis of acute paradoxi-cal herniation following decompressive craniectomy was made.The drainage tube was promptly removed,mannitol administra-tion was stopped,and rapid fluid resuscitation was initiated.Following treatment,the patient's consciousness gradually improved.Three months after discharge,the patient underwent cranioplasty at another hospital.At the 9-month follow-up,the outcome was favorable with a Glasgow Outcome Scale(GOS)score of 5.This case suggests that after decompressive craniectomy,a history of substantial CSF drainage combined with unexplained impaired consciousness,sunken bone flap,and signs of increased intra-cranial pressure should raise suspicion for paradoxical herniation.The therapeutic goal is to increase intracranial pressure.

Abstract:Intracranial aneurysms carry a risk of rupture and pose a serious threat to human life and health.Clinical treatment options include interventional therapy and surgical clipping.Interventional therapy comprises aneurysm coiling and flow diverter implantation.Wide-neck intracranial aneurysms are difficult to treat with coiling alone and are often managed with stent-assisted coiling,which improves the aneurysm occlusion rate and reduces the risk of recurrence.Commonly used clinical stents for aneurysm-assisted coiling include laser-cut stents(LCS)and braided stents.Due to their unique advantages,such as stable support,accurate positioning,and low thrombogenicity,LCS are widely used.Common intracranial LCS include the Sol-itaire,Neuroform,and Enterprise stents,among which the Neuroform Atlas and Enterprise2 stents are two recently introduced LCS frequently used in clinical practice.This article reviews the characteristics,clinical applications,and complications of LCS.