Abstract:Objective To investigate the effects of electrical stimulation of the centromedian nucleus of the thalamus(CM)on epileptic seizures in Sprague-Dawley(SD)rats.Methods Ten male SD rats were selected and divided into a sham stimulation group and a CM electrical stimulation group,with 5 rats in each group.After weighing the rats in the CM electrical stimulation group,a stimulating electrode was implanted into the CM nucleus according to the following coordinates(x-axis:3 mm,y-axis:-5.2 mm,z-axis:-3.5 mm).Epileptic seizures were induced in all the rats by intraperitoneal injection of pentetrazol at a dose of 70 mg/kg body weight.Immediately after injection,the CM electrical stimulation group received low-parameter CM electrical stimulation continuously until the seizure ended,while the sham stimulation group did not receive CM electrical stimulation.The changes in the number of electroencephalogram(EEG)spike waves,seizure severity(Racine scale),seizure duration,and seizure latency were observed in both groups.Results Compared with the sham stimulation group,rats in the CM stimulation group exhibited reduced seizure severity as assessed by the Racine scale.In addition,the number of electroencephalographic spikes within the first 5 min of seizure onset was significantly decreased(9.4±2.7 vs.95.6±40.1),and the total seizure duration was significantly shortened[204(129,728)s vs.1254(546,1619.5)s].Conclusions Electrical stimulation of the CM may inhibit epileptic seizures in rats by interrupting the propagation pathways in seizure propagation.

Abstract:Approximately 1%of the global population suffers from epilepsy,and about 30%of these patients have drug-resistant epilepsy.Without surgical intervention,such patients are at increased risk of developing various complications,which can be life-threatening in severe cases.Although surgical resection is currently the optimal surgical intervention,it is not suitable for patients with multifocal onset,no clearly identifiable epileptogenic focus,or foci located within eloquent cortical regions.These limitations have driven the development of neuromodulation therapies.Among them,responsive neurostimulation(RNS)is the only closed-loop stimulation therapy approved by the Food and Drug Administration(FDA)for the treatment of drug-resistant focal epilepsy.RNS not only provides long-term intracranial electroencephalographic monitoring but also exhibits significant clinical value.This article comprehensively reviews the current literature on RNS,focusing on five aspects:the mechanisms of RNS,its advantages,patient selection,electrode placement,and stimulation parameter settings,and discusses its current clinical applications in patients with drug-resistant epilepsy.

Abstract:Objective To investigate the efficacy and safety of retroauricular external ventricular drainage(RaEVD)in the treatment of pyogenic ventriculitis(PV).Methods The clinical data of 7 patients with PV who underwent a total of 9 RaEVD procedures were analyzed retrospectively.On the basis of conventional external ventricular drainage(EVD),an FR10 diameter drainage tube was placed in the hairless area behind the ear via a subcutaneous tunnel,with a tunneling distance of 15-20 cm from the frontal region and 12-15 cm from the occipital region.The catheter indwelling duration,the incidence of new infections,complications,whether ventriculoperitoneal shunt(VPS)was performed,and the modified Rankin scale(mRS)scores before and after surgery were statistically analyzed.Results The median RaEVD drainage duration was 23 days(range:12-39 days).One case(1/7)developed intraventricular hemorrhage.There were no cases of catheter obstruction,drainage-related infections,or cerebrospinal fluid leakage.Six patients underwent VPS after surgery.The median follow-up time was 10 months(range:1-19 months).The median mRS score decreased from 4 preoperatively to 1 postoperatively.Four patients(4/7)had a favorable outcomes(mRS 0-1),and one(1/7)had poor outcomes(mRS 4),while 2 patients(2/7)died due to disease deterioration.Conclusions RaEVD offers a long catheter indwelling duration,,a low risk of catheter obstruction,and a high effecacy rate in the treatment of PV.It is a simple procedure and can serve as an adjuvant or alternative approach.Subsequent studies with larger sample sizes and longer follow-up periods are needed to validate its safety and efficacy.

Abstract:Objective To explore the feasibility and operational workflow experience of non-intraoperative magnetic resonance-guided laser interstitial thermal therapy(nMRgLITT)in the treatment of drug-resistant epilepsy(DRE).Methods Clinical data of 28 patients who underwent nMRgLITT were analyzed retrospectively.In the absence of intraoperative MRI,the surgical workflow was systematically summarized,including target planning,optical fiber implantation,patient transfer arrangements,ablation strategies,troubleshooting,and postoperative management,and corresponding optimization strategies were proposed.Results All 28 procedures were successfully completed.Perioperative safety was favorable,with only 3 cases(3/28,10.7%)experiencing transient neurological symptoms that resolved completely,and no severe complications occurred.Postoperative follow-up was obtained in 27 patients,while 1 patient was lost to follow-up.Postoperative follow-up evaluation of 27 evaluable patients showed that 22(22/27,81.5%)achieved International League Against Epilepsy(ILAE)class 1(seizure-free),and 1(1/27,3.7%)achieved ILAE class 2(only aura)and 4(4/27,14.8%)achieved ILAE≥class 3(still experiencing seizures).Conclusions In the context of limited access to intraoperative MRI,nMRgLITT offers a viable alternative.By optimizing the procedural workflow,the safety and precision of the operation can be enhanced,providing a reliable minimally invasive treatment option for patients with DRE.

Abstract:Objective To investigate the influence of different relative positions between the electrode and the bone hole during deep brain stimulation(DBS)surgery on pneumocephalus in patients with Parkinson disease(PD).Methods Clinical data of PD patients who underwent bilateral subthalamic nucleus(STN)-DBS or globus pallidus interna(GPi)-DBS were collected.According to the relative position of the electrode to the bone hole during DBS surgery,patients were divided into an electrode-near-upper edge of the bone hole group(upper-edge group,n=150)and an electrode-near-lower edge of the bone hole group(lower-edge group,n=234).The differences in pneumocephalus volume,electrode accuracy,electrode tip displacement,Tao's DBS scale and programming parameters between the two groups were compared.Results The lower-edge group showed a smaller postoperative intracranial pneumocephalus volume[0.26(0,2.02)mL vs.5.68(1.08,7.14)mL,P<0.001],higher electrode accuracy[(1.10±0.51)mm vs.(1.41±0.44)mm,P<0.001],and less displacement of the electrode tip along the y-axis[(0.76±0.33)mm vs.(1.22±0.38)mm,P<0.001].There were no statistically significant differences between the two groups in initial stimulation voltage or programming voltage.Conclusions Implanting the electrode near the lower edge of the bone hole can reduce the volume of pneumocephalus,improve electrode accuracy in PD patients,as well as decrease y-axis displacement of the electrode tip.This approach shows a trend toward reducing initial and programming voltages,which may help decrease battery consumption of the DBS pulse generator.

Abstract:Precise localization of the epileptogenic zone is crucial for successful epilepsy surgery and improved patient outcomes.In recent years,high-frequency oscillations(HFOs)have garnered significant attention as potential biomarkers for the epileptogenic zone,with their underlying pathophysiological mechanisms being increasingly elucidated.Studies indicate that the generation of HFOs is closely associated with the synchronous firing of pathological neuronal clusters.This process involves mechanisms such as neural circuit reorganization and excitatory/inhibitory imbalance,thereby conferring high spatial and pathological specificity.Currently,the detection of HFOs primarily relies on intracranial electroencephalography(iEEG),especially stereo-electroencephalography(SEEG),which has demonstrated considerable advantages in localizing the epileptogenic zone.Regarding analytical methods,the introduction of novel techniques like automated detection and machine learning has further enhanced the efficacy and reliability of HFO identification.Although HFOs hold significant potential in the presurgical evaluation for epilepsy,their clinical application still faces numerous challenges,including the differentiation between physiological and pathological HFOs and the limitations of non-invasive detection techniques.This review systematically summarizes the current understanding of the generation mechanisms,detection methodologies,and clinical applications of HFOs,aiming to provide new theoretical foundation and strategic direction for the precise diagnosis,treatment,and prognostic assessment of epilepsy.

Abstract:Objective To analyze the risk factors for intraoperative brain bulge(IOBB)in patients with traumatic brain injury(TBI)and construct a nomogram predictive model.Methods Clinical data of 360 TBI patients were analyzed retrospectively.The patients were divided into a modeling group(n=288)and a validation group(n=72)in a 4:1 ratio.Based on the clinical data of the modeling group,patients were divided into an IOBB group and a non-IOBB group according to whether IOBB occurred.Univariate and multivariate analyses were performed.A nomogram predictive model was constructed based on the results of the multivariate analysis,and the model's discrimination and clinical utility were validated.Results There were no statistically significant differences in the clinical data between the modeling group and the validation group(all P>0.05).The univariate analysis results showed that there were statistically significant differences between the IOBB group and the non-IOBB group in terms of pupil dilation,contralateral skull fracture,epidural hemorrhage,subdural hemorrhage,age,blood glucose,preoperative intracranial pressure,preoperative GCS score,midline displacement of brain CT,CT value of the lesion side transverse sinus,CT value of the healthy side transverse sinus,and CT value of the superior sagittal sinus(all P<0.05).The multivariate analysis results showed that pupil dilation(OR=7.907,95%CI:1.790-34.934,P=0.006),contralateral skull fractures(OR=7.094,95%CI:2.053-24.511,P=0.002),subdural hemorrhage(OR=6.534,95%CI:1.594-26.787,P=0.009),age(OR=0.888,95%CI:0.817-0.965,P=0.005),and CT values of the affected transverse sinus(OR=1.328,95%CI:1.169-1.510,P<0.001)were all risk factors for IOBB in TBI patients.The area under the curve(AUC)values for the modeling group and the validation group were 0.929(95%CI:0.880-0.978)and 0.964(95%CI:0.914-1.000),respectively.Decision curve analysis(DCA)showed that within the threshold probability range of 0-1.0,patients could potentially obtain a relatively high positive net benefit when interventions were carried out based on this model.Clinical impact curve(CIC)analysis indicated that within the threshold probability range of 0-1.0,this model could accurately predict the risk of IOBB in TBI patients.Conclusions Multiple factors can lead to IOBB in TBI patients.Constructing a nomogram predictive model and conducting a preoperative risk assessment of IOBB are of great significance for preventing IOBB.

Abstract:Objective To observe the changes in the levels of differentiation antagonizes non-protein coding RNA(DANCR)and micro RNA-214-5p(miR-214-5p)in patients with acute cerebral infarct(ACI)and to explore the correlation between their expression and both the size of cerebral infarct foci and clinical prognosis.Methods Clinical data of 123 ACI patients were analyzed retrospectively.Based on the size of the cerebral infarction,the patients were divided into three groups:small infarct group(<5 cm³,39 cases),medium infarct group(5-10 cm³,61 cases),and large infarct group(>10 cm³,23 cases).The prognosis was evaluated using the National Institute of Health Stroke Scale(NIHSS)score,with ACI patients having an NIHSS score<6 classified into the good prognosis group(84 cases)and those with an NIHSS score≥6 into the poor prognosis group(39 cases).Additionally,117 healthy individuals who underwent physical examinations during the same period were selected as the control group.Real-time quantitative PCR(RT-qPCR)was used to analyze DANCR and miR-214-5p.Logistic regression was applied to explore the factors associated with poor prognosis in ACI patients.The correlation between DANCR and miR-214-5p was assessed using Pearson's test.The receiver operating characteristic(ROC)curve were constructed to investigate the expression and clinical significance of DANCR and miR-214-5p in ACI patients.Results Compared with the control group,the expression of DANCR in ACI patients was significantly increased(P<0.001),while miR-214-5p was significantly downregulated(P<0.001).There was a significant negative correlation between DANCR and miR-214-5p in ACI patients(r=-0.486,P<0.001).Compared with the small infarct group,the serum levels of DANCR were significantly higher and miR-214-5p levels were significantly lower in the medium and large infarct groups(all P<0.05);compared with the medium infarct group,the serum levels of DANCR were significantly higher and miR-214-5p levels were significantly lower in the large infarct group(all P<0.05).Compared with the good prognosis group,the poor prognosis group had higher serum DANCR levels,a longer time from onset to admission,and significantly lower miR-214-5p levels(all P<0.001).DANCR was a risk factor for poor prognosis in ACI patients(OR=2.013,95%CI:1.079-3.754,P=0.028),while miR-214-5p was a protective factor(OR=0.806,95%CI:0.657-0.988,P=0.038).The areas under the ROC curves(AUC)for DANCR,miR-214-5p,and their combined diagnosis of poor prognosis in ACI patients were 0.727,0.739,and 0.857,respectively.The combined diagnostic performance was higher than that of individual tests(Z=2.070,P=0.038;Z=2.097,P=0.036).Conclusions High expression of serum DANCR and low expression of miR-214-5p in ACI patients may be significantly associated with the size of cerebral infarct foci and prognosis.The combination of the two has certain value in diagnosing poor prognosis in the patients.

Abstract:Objective To investigate the classification of the cavernous segment of the internal carotid artery(ICA)curvature in patients with Knosp grade 4 pituitary adenomas and to evaluate its clinical significance in guiding endoscopic endonasal surgery.Methods Clinical data of 119 patients with pituitary adenomas treated via endoscopic endonasal approach,,including 74 with Knosp grade 4(grade 4 group)and 45 with Knosp grade 0(grade 0 group)as controls.The posterior bend angle of ICA was measured on preoperative sagittal MRI and classified as type A(<80°),type B(≥80°to 100°),or type C(≥100°).The posterior bend angles and ICA curvature types were compared between the patients with different Knosp grades.A generalized estimating equation(GEE)was applied to assess the association between ICA classification and the risk of incomplete tumor resection.Results All the 119 surgeries were completed successfully.The total tumor resection rate in the Knosp grade 4 group was 36.5%(27/74),significantly lower than that in the Knosp grade 0 group(86.7%,39/45)(P<0.05).Compared with the Knosp grade 0 group,the posterior bend angle of the ICA in the Knosp grade 4 group was significantly larger,and the proportion of Type C was significantly higher(both P<0.05).Among patients with unilateral Knosp grade 4,the posterior bend angle of the ICA on the grade 4 side was significantly larger than that on the contralateral(non-grade 4)side,and the ICA classification showed a significantly asymmetric distribution(both P<0.05).GEE analysis revealed that in patients with Knosp grade 4,the risk of incomplete resection was significantly higher for type A ICA compared to type C(OR=2.684,95%CI:1.190-6.055,P=0.017);the results remained consistent after adjusting for tumor size(OR=2.497,95%CI:1.085-5.750,P=0.032).Conclusions Compared with patients with Knosp grade 0,patients with Knosp grade 4 pituitary adenomas tend to have a larger posterior bend angle of the ICA.A smaller posterior bend angle with greater curvature of the cavernous segment may increase the difficulty of surgical resection,suggesting that ICA curvature classification could serve as a valuable reference for preoperative assessment and surgical planning.

Abstract:Objective To evaluate the clinical value of ultrasound-assisted novel portable contact endoscope-guided direct visualization technology in the treatment of supratentorial hypertensive intracerebral hemorrhage(HICH).Methods Clinical data of 271 patients with supratentorial HICH were analyzed retrospectively.According to the surgical method,patients were divided into an observation group(152 cases,treated with ultrasound-assisted novel portable contact endoscope-guided direct visualization technology)and a control group(119 cases,treated with traditional neuroendoscopic intracerebral hematoma evacuation).Baseline data,core surgical indicators(hematoma evacuation rate,operation time,success rate of single hematoma puncture,intraoperative blood loss),the incidence of surgery-related complications,and functional prognosis at 6 months after surgery[modified Rankin scale(mRS),Barthel index(BI),and National Institute of Health Stroke Scale(NIHSS)]were compared between the two groups.Results There were no statistically significant differences in age,gender,hematoma location,and initial hematoma volume between the two groups(all P>0.05).The observation group showed significantly better results than the control group in terms of hematoma evacuation rate[(95.2±3.2)%vs.(86.4±12.1)%],operation time[(1.8±0.7)h vs.(2.4±0.6)h],intraoperative blood loss[(46.4±12.2)mL vs.(66.4±14.3)mL],success rate of single puncture for hematoma(96.7%vs.76.5%),and drainage tube indwelling rate(41.4%vs.47.1%)(all P<0.05).The overall incidence of surgery-related complications in the observation group was lower than that in the control group(18.4%vs.24.4%),with significantly reduced rates of rebleeding(5.9%vs.10.9%)and severe pulmonary infection(0 vs.1.68%)(all P<0.05).The surgery-related mortality rate within 30 days was 3.4%(4/119)in the control group,while there were no surgery-related deaths in the observation group,with a statistically significant difference between the two groups(P=0.031).In terms of functional prognosis at 6 months after surgery,the proportion of patients with favorable functional outcome in the observation group was significantly higher than that in the control group(74.7%vs.67.2%),and the BI score was slightly higher in the observation group[(58.5±7.2)points vs.(55.7±6.8)points],with statistically significant differences(all P<0.05);there was no statistically significant difference in NIHSS scores between the two groups[(11.2±4.2)points vs.(13.2±3.1)points,P=0.154].Conclusions Ultrasound-assisted novel portable contact endoscope-guided direct visualization technology in the treatment of supratentorial HICH offers advantages such as a high hematoma evacuation rate,short operation time,minimal intraoperative trauma,high puncture accuracy,and a low incidence of complications.It can significantly improve patients'functional prognosis and is a safe and effective minimally invasive treatment option,thus being worthy of clinical promotion and application.

Abstract:Objective To enhance the clinicopathological understanding of central nervous system lymphomatoid granulomatosis(CNS-LyG).Methods Clinical data of 4 patients with CNS-LyG were analyzed retrospectively,including clinical manifestations,pathological morphology,immunohistochemistry,and in situ hybridization,supplemented by a literature review.Results The clinical manifestations of CNS-LyG varied depending on the lesion location and extent of damage,with no characteristic serological findings.CT or MRI revealed non-characteristic patchy or strip-like enhancement at the lesion site.Pathologically,it was characterized by the presence of varying numbers of mildly immature lymphocyte-like cells proliferating around capillaries in brain tissue,forming sheet-like distributions.Immunohistochemical markers were often polyclonal.The Epstein-Barr virus-encoded RNA(EBER)test results were negative.Treatment primarily involved surgery,supplemented by immunotherapy and/or radiotherapy/chemotherapy.Prognosis was associated with the location,size,and grade of the lesion.Conclusions CNS-LyG is rare,and its diagnosis requires a comprehensive analysis combining clinical manifestations,pathological morphology,immunohistochemistry,and in-situ hybridization.When atypical cells show single immunohistochemical marker expression,it suggests the possibility of malignant lesions,necessitating further immunohistochemical and molecular testing.The prognosis of CNS-LyG is related to its pathological grading.

Abstract:Objective To analyze the clinical efficacy of neuroendoscopic hematoma evacuation via transfrontal and transtemporal approaches for basal ganglia cerebral hemorrhage.Methods Clinical data of 80 patients with basal ganglia cerebral hemorrhage were analyzed retrospectively.According to the primary anatomical location of the hematoma,patients were assigned to different surgical approaches and divided into a transfrontal approach group(40 cases)and a transtemporal approach group(40 cases).The operative time,intraoperative blood loss,postoperative residual hematoma volume,hematoma evacuation rate,postoperative cerebral edema,postoperative Glasgow Coma Scale(GCS)scores,National Institutes of Health Stroke Scale(NIHSS)scores,Activities of daily living(ADL)scores at 1 month postoperatively,modified Rankin Scale(mRS)scores at 3 months postoperatively,and incidence of complications were compared between the two groups.Results The operative time and postoperative cerebral edema volume in the transfrontal approach group were significantly lower than those in the transtemporal approach group,with statistically significant differences(both P<0.05).There were no statistically significant differences between the two groups in terms of intraoperative blood loss,hematoma evacuation rate,complications,or postoperative rebleeding(all P>0.05).The protection of white matter fiber tracts,improvement in postoperative GCS scores,and NIHSS scores in the transfrontal approach group were significantly better than those in the transtemporal approach group.The ADL scores at 1 month postoperatively and mRS scores at 3 months postoperatively in the transfrontal approach group were also superior to those in the transtemporal approach group,with statistically significant differences(all P<0.05).Conclusions In the treatment of basal ganglia cerebral hemorrhage with neuroendoscopic hematoma evacuation,compared with the transtemporal approach,the transfrontal approach offers advantages such as shorter operative time,relatively milder postoperative cerebral edema,and more significant improvement in prognosis,making it worthy of clinical promotion.

Abstract:Objective To explore the clinical efficacy of minimally invasive surgery using the parafascicular approach guided by Diffusion Tensor Imaging(DTI)in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 75 patients with HICH were analyzed retrospectively.Among them,45 patients underwent hematoma evacuation via a parafascicular approach beside the white matter fiber tracts using a visualized neuroendoscope,with surgical pathways planned under navigation using DTI image fusion technology(the visualized endoscopic parafascicular approach hematoma evacuation group,referred to as the parafascicular group).The other 30 patients underwent conventional craniotomy for hematoma evacuation under a microscope(the conventional craniotomy hematoma evacuation group,referred to as the conventional group).The surgical time,intraoperative blood loss,hematoma evacuation rate,postoperative recovery time of consciousness,Activity of Daily Living(ADL)score at 6 months postoperatively,and the incidence of postoperative complications were compared between the two groups.Results The surgical time[(2.16±0.73)h vs.(2.98±0.82)h]and intraoperative blood loss[(67.42±35.34)mL vs.(143.33±72.51)mL]in the parafascicular group were both significantly less than those in the conventional group(both P<0.001).The hematoma evacuation rate in the parafascicular group was lower than that in the conventional group,but the difference was not statistically significant(P>0.05).The postoperative recovery time of consciousness in the parafascicular group[(5.69±2.90)d]was shorter than that in the conventional group[(12.10±6.25)d],and the ADL score at 6 months postoperatively[(57.22±21.17)]was higher than that in the conventional group[(48.83±16.27)],with both differences being statistically significant(both P<0.05).The incidence of complications in the parafascicular group was lower than that in the conventional group,but the difference was not statistically significant(P>0.05).Conclusions By utilizing DTI image fusion technology to display the three-dimensional anatomical relationship between the hematoma and white matter fiber tracts,and performing minimally invasive surgery via a fiber tract-parafascicular approach under neuro-navigation guidance with a visualized neuroendoscope,the postoperative recovery time of consciousness in patients with HICH can be shortened,and their postoperative activities of daily living can be improved.

Abstract:Objective To investigate the clinical efficacy of neuronavigation combined with endoscope-assisted microsurgery via the retrosigmoid approach for primary pontine hemorrhage.Methods The clinical data of 60 patients with primary pontine hemorrhage were analyzed retrospectively.Among them,30 patients underwent microsurgical treatment via the retrosigmoid approach with neuronavigation and endoscopic assistance(surgical group),while 30 patients received conservative treatment(control group).The hematoma evacuation rate or spontaneous hematoma absorption rate,complications,modified Rankin Scale(mRS)scores,and changes in serum inflammatory markers,including interleukin(IL)-6 and S100 calcium-binding protein β(S100β),were compared between the two groups.Results The hematoma evacuation rate at 72 hours postoperatively in the surgical group was(92.3±6.5)%,whereas the spontaneous absorption rate in the conservative group was(45.6±12.3)%.The incidence of stress ulcers was 3.33%(1/30)in the surgical group versus 26.67%(8/30)in the conservative group,and the incidence of severe pneumonia was 10.00%(3/30)in the surgical group versus 33.33%(10/30)in the conservative group,with statistically significant differences(both P<0.05).A favorable prognosis(mRS 0-2)was observed in 15 patients(50.00%)in the surgical group and 5 patients(16.67%)in the conservative group,with a statistically significant difference(P<0.05).Serum IL-6 and S100β levels at 72 hours post-treatment were significantly lower in the surgical group than in the conservative group(both P<0.05).Logistic regression analysis revealed that conservative treatment significantly increased the risk of poor prognosis compared with surgical treatment(OR=11.034,95%CI:1.610-75.639,P=0.015).Additionally,an elevated intracerebral hemorrhage score was associated with an increased risk of poor prognosis(OR=5.279,95%CI:1.412-19.737,P=0.013).Conclusions Neuronavigation combined with endoscope-assisted microsurgery via the retrosigmoid approach for primary pontine hemorrhage effectively suppresses inflammatory responses,improves neurological function,and significantly reduces the risk of systemic complications,demonstrating favorable therapeutic efficacy.

Abstract:Glioblastoma(GBM)is a highly malignant tumor with a high recurrence rate,leading to poor prognosis in affected patients.As the first-line chemotherapeutic agent for GBM,temozolomide(TMZ)induces tumor cell apoptosis by causing DNA damage.However,drug resistance to TMZ has emerged as a critical factor affecting chemotherapy efficacy.Investigating and analyzing TMZ resistance mechanisms,with the aim of reversing resistance,represents a crucial strategy for enhancing chemotherapy outcomes.O6-methylguanine-DNA methyltransferase(MGMT),cancer stem cells,DNA damage repair systems,autophagy,the tumor immune microenvironment,and abnormalities in related gene expression and signaling pathways are all closely associated with TMZ resistance.With advancing clinical research,the role of long non-coding RNA(lncRNA)in tumor cell drug resistance has also garnered significant attention.This review summarizes the mechanisms of TMZ resistance in GBM and the progress in lncRNA research related to GBM and TMZ resistance,aiming to provide countermeasures based on lncRNA for overcoming TMZ resistance in GBM and to identify novel targets and strategies.

Abstract:Objective To explore the factors influencing transient ischemic attack(TIA)after endovascular interventional therapy for ruptured intracranial aneurysms.Methods The clinical data of 224 patients with ruptured intracranial aneurysms,all of whom received endovascular interventional therapy,were analyzed retrospectively.They were divided into a TIA group(n=71)and a non-TIA group(n=153)based on whether TIA occurred within 14 days after treatment.Clinical data of the patients,as well as their serum levels of tumour necrosis factor-alpha(TNF-α),interleukin(IL)-6,and IL-8,were collected.Multivariate logistic regression analysis was used to investigate the influencing factors for TIA after endovascular interventional therapy for ruptured intracranial aneurysms.Results TIA occurred in 71 patients after treatment,with an incidence rate of 31.70%(71/224).There were statistically significant differences between the TIA group and the non-TIA group in terms of age,hypertension,smoking,alcohol abuse,and Hunt-Hess grade(all P<0.05).The levels of TNF-α,IL-6,and IL-8 before treatment in the TIA group were significantly higher than those in the non-TIA group(all P<0.05).Multivariate logistic regression analysis showed that age(OR=1.731,95%CI:1.149-2.607),hypertension(OR=1.556,95%CI:1.049-2.307),smoking(OR=1.982,95%CI:1.069-3.675),alcohol abuse(OR=2.352,95%CI:1.175-4.707),Hunt-Hess gradeⅢ-Ⅳ(OR=2.327,95%CI:1.120-4.834),and TNF-α(OR=3.154,95%CI:1.188-8.371)were risk factors for TIA after endovascular interventional therapy for ruptured intracranial aneurysms(all P<0.05).Conclusions Age,hypertension,smoking,alcohol abuse,Hunt-Hess grade,and TNF-α level can all influence the occurrence of TIA after endovascular interventional therapy for ruptured intracranial aneurysms.Reasonable clinical interventions should be implemented,and individuals should quit smoking and drinking to reduce the occurrence of TIA.

Abstract:Objective To analyze the risk factors for surgical site infection(SSI)after microvascular decompression(MVD)and construct a predictive model.Methods The clinical data of 645 patients who underwent MVD,were analyzed retrospectively.Based on the occurrence of SSI,they were divided into the infected group(n=55)and the non-infected group(n=590).Univariate analysis was used to compare the differences in clinical data between the two groups.Multivariate logistic regression analysis was employed to screen for the risk factors of SSI after MVD,and a regression equation for the incidence rate was constructed.Predictive ability analysis and internal validation were performed using goodness-of-fit tests,receiver operating characteristic(ROC)curves,and calibration curves.Results The incidence rate of SSI after MVD was 8.53%(55/645).Nine strains of pathogens were isolated,all of which were Gram-negative bacteria,with Klebsiella pneumoniae accounting for 66.67%(6/9).Logistic regression analysis revealed that the risk factors for SSI after MVD were hypoproteinemia,mastoid air cell opening,operation time≥3 h,cerebrospinal fluid leakage,and indwelling drainage tube(all P<0.05).The regression equation for the incidence rate of SSI was:Logit(P)=-9.218+1.187×hypoproteinemia+0.986×mastoid air cell opening+0.963×operation time(≥3 h)+2.436×cerebrospinal fluid leakage+3.412×indwelling drainage tube.The Hosmer-Lemeshow test indicated good model fit(P=0.696).The area under the curve(AUC)of this predictive model was 0.809(95%CI:0.743-0.869),with a sensitivity of 80.20%and a specificity of 73.10%,demonstrating good discrimination.The calibration curve showed good consistency of the model.Conclusions There is a certain incidence rate of SSI after MVD.The predictive model constructed based on the risk factors has high value in predicting SSI after MVD.Timely intervention targeting the risk factors can reduce the incidence rate of SSI.

Abstract:Objective To explore the risk factors for early neurological deterioration(END)during hospitalization in elderly patients with moderate traumatic brain injury(TBI)and to construct a nomogram prediction model.Methods The clinical data of 219 elderly patients with moderate TBI were analyzed retrospectively,and the occurrence of END during hospitalization was recorded.Multivariate logistic regression analysis was applied to identify the factors associated with END in elderly patients with moderate TBI during hospitalization.A nomogram prediction model was then established,and its discriminative ability,calibration performance,and clinical utility were evaluated.Results END occurred in 67 elderly patients with moderate TBI during hospitalization.The END group had lower Glasgow Coma Scale(GCS)scores upon admission(P<0.05)and greater hemorrhage volumes(P<0.05)compared to the non-END group.The proportions of patients with Marshall CT gradeⅢ,sluggish pupillary response,seizures,vasospasm,and cerebral edema were higher in the END group(all P<0.05).Additionally,levels of prothrombin time(PT),D-dimer,and neuronspecific enolase(NSE)were higher in the END group(all P<0.05).Multivariate logistic regression analysis revealed that Marshall CT gradeⅢ,vasospasm,cerebral edema,and elevated D-dimer levels were risk factors for END in elderly patients with moderate TBI(all P<0.05).Based on these risk factors,a nomogram prediction model was constructed.Validation showed that the model had high calibration accuracy,with a mean absolute error of 0.002,a C-index of 0.897,and a Hosmer-Lemeshow P-value of 0.73.The area under the curve(AUC)for predicting END during hospitalization was 0.896(95%CI:0.848-0.933),with a sensitivity of 91.04%and a specificity of 86.84%,indicating excellent predictive performance.Conclusions The nomogram prediction model,based on Marshall CT grade,vasospasm,cerebral edema,and elevated D-dimer levels,can visually and accurately predict the risk of END in elderly patients with moderate TBI.

Abstract:Objective To investigate whether mild intraoperative hypothermia(35.5℃to<36℃)affects the perioperative outcomes of patients with traumatic brain injury(TBI).Methods The perioperative data of 340 TBI patients who underwent surgical treatment,were analyzed retrospectively.Patients were divided into a hypothermia group(n=113,with an average intraoperative body temperature of 35.5℃to<36℃)and a normal body temperature group(n=227,with an average intraoperative body temperature of≥36℃to 37℃)based on their average intraoperative body temperature.The propensity score matching(PSM)method was applied to balance the clinical data between the two groups,resulting in 113 cases in each group.The perioperative outcomes of the two groups were then compared and analyzed.Results After PSM,in the hypothermia group,the anesthesia recovery time was(32.18±13.04)min,with a postoperative pulmonary infection rate of 11.50%,urinary system infection rate of 0.88%,surgical site infection rate of 0.88%,acute kidney injury rate of 1.77%,thromboembolism rate of 0.88%,no intracranial infection,hospital stay of 12(8,22)days,ICU stay of 6(3,17)days,and in-hospital mortality rate of 8.85%.In the normal body temperature group,the anesthesia recovery time was(32.03±12.95)min,with a postoperative intracranial infection rate of 0.88%,pulmonary infection rate of 10.62%,surgical site infection rate of 1.77%,acute kidney injury rate of 0.88%,thromboembolism rate of 0.88%,no urinary system infection,hospital stay of[11(9,20)]days,ICU stay of[6(3,15)]days,and in-hospital mortality rate of 7.96%.There were no statistically significant differences in the aforementioned indicators between the two groups(all P>0.05).Conclusions Mild intraoperative hypothermia does not affect the perioperative outcomes of TBI patients.Routine thermal insulation measures during surgery for TBI patients can meet clinical medical requirements and can save medical expenses for maintaining intraoperative body temperature.

Abstract:Objective To evaluate the incidence rate,prognosis,and related risk factors of rebleeding after endovascular interventional therapy for intracranial ruptured aneurysms.Methods The clinical data of 237 patients with aneurysmal subarachnoid hemorrhage were analyzed retrospectively,all of whom underwent endovascular interventional therapy.Information on demographic characteristics,treatment strategies for intracranial aneurysms,and prognosis was recorded.Univariate analysis and multivariate logistic regression analysis were used to explore the related risk factors affecting rebleeding.Results Among the patients,171 underwent simple coil embolization,and 66 underwent stent-assisted coil embolization.Rebleeding after treatment occurred in 7 patients(2.9%,7/237).Univariate analysis showed that the World Federation of Neurological Surgeons(WFNS)grade,modified Fisher(mFisher)grade,hypertension,stent use,and incomplete embolization were associated with rebleeding after treatment.Multivariate logistic regression analysis revealed that WFNS gradeⅣ-Ⅴ(OR=13.30,95%CI:1.08-16.31,P=0.043),stent use(OR=23.73,95%CI:1.86-303.04,P=0.015),and incomplete embolization(OR=19.75,95%CI:2.23-174.69,P=0.007)were risk factors for rebleeding.Secondary treatment was administered to all 7 patients with rebleeding,including 1 case of surgical clipping and 6 cases of secondary endovascular interventional therapy.At discharge,3 patients were in good condition,2 were disabled,and 2 died.Conclusions The rebleeding rate after endovascular therapy for intracranial ruptured aneurysms is 2.9%,but there is a relatively high disability and mortality rate postoperatively.Poor WFNS grade,stent use,and incomplete embolization are associated with rebleeding after endovascular interventional therapy for intracranial ruptured aneurysms.