Abstract:Objective To investigate the relationship between serum angiopoietin-like 4(ANGPTL4),galectin-3(Gal-3)and delayed cerebral ischemia(DCI)after aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 130 aSAH patients were prospectively collected from April 2019 to April 2024.Serum levels of ANGPTL4 and Gal-3 were measured using enzyme-linked immunosorbent assay.DCI was diagnosed based on clinical manifestations and CT findings between 4 and 14 days post-hemorrhage.Results Among the 130 patients,50 developed DCI,with an incidence rate of 38.46%.Compared to patients without DCI,serum levels of ANGPTL4 and Gal-3 were significantly increased in DCI patients(P<0.05).Multivariate logistic regression analysis showed that increased serum ANGPTL4 level(OR=2.171,95%CI 1.317～3.579,P=0.002)and increased serum Gal-3 level(OR=1.928,95%CI 1.352～2.749,P<0.001)were independent risk factors for DCI in aSAH patients.ROC curve anal-ysis showed that serum ANGPTL4 and Gal-3 had certain application value in predicting DCI in aSAH patients,with areas under the curve of 0.884 and 0.871,respectively.The combined use of both markers had higher predictive value,with an area under the curve of 0.941.Conclusion Serum levels of both ANGPTL4 and Gal-3 are significantly upregulated in aSAH patients who de-velop DCI.The combination of ANGPTL4 and Gal-3 can serve as a good indicator for predicting DCI in aSAH patients.

Abstract:Intracranial abscess secondary to endovascular embolization of intracranial aneurysms is clinically rare.This article reports a case of a 68-year-old male admitted to the hospital due to severe headache for one day.Head CT revealed subarachnoid hemorrhage,and DSA identified an anterior communicating artery aneurysm.Emergency coil embolization was performed,but the aneurysm was not completely occluded,with residual neck remaining.On the 4th day post-surgery,the pa-tient developed a fever,with a maximum temperature of 38.9℃.Blood tests and cerebrospinal fluid analysis diagnosed intracra-nial infection,and anti-infective treatment with vancomycin+meropenem was initiated.On the 21st day post-surgery,a follow-up head MRI revealed bilateral frontal lobe abscesses.The patient continued anti-infective treatment with vancomycin+meropenem and underwent lumbar cisternal drainage for cerebrospinal fluid for 6 weeks,eventually recovering and being discharged.This case suggests that close monitoring is essential after partial embolization of a ruptured intracranial aneurysm.Once signs of in-tracranial infection are detected,prompt diagnosis and treatment should be implemented to improve patient outcomes.

Abstract:Objective To investigate the clinical manifestations,diagnosis,and treatment strategies of Von Hip-pel-Lindau(VHL)syndrome.Methods The clinical data of two VHL patients admitted to General Hospital of Central Theater Command were retrospectively analyzed,and diagnostic and therapeutic experiences were summarized with a literature review.Results One patient was a sporadic case who presented to the ophthalmology department with decreased vision.Examination revealed tortuous and dilated retinal vessels with exudation.Fundus fluorescein angiography showed early arterial filling of the tumor,consistent with typical retinal hemangioblastoma.MRI revealed multiple lesions in the bilateral cerebellum and spinal cord,highly suggestive of hemangioblastoma,with mass effects leading to compression of the fourth ventricle and hydroceph-alus.Consequently,a midline posterior approach was performed to resect the left cerebellar lesion,alleviating the risk of severe cerebral herniation.Postoperative pathological diagnosis confirmed hemangioblastoma,and genetic testing detected a VHL gene mutation.The other patient had a clear family history and presented with headache and dizziness as initial symptoms.Although the diagnosis was straightforward,the disease course was characterized by repeated surgeries.Therefore,surgical intervention was performed to address obstructive or symptomatic recurrent fourth ventricular hemangioblastoma.Conclusions Early di-agnosis is crucial for VHL syndrome.A clear family history and corresponding genetic testing are key to definitive diagnosis.Multidisciplinary intervention and individualized management can significantly improve patient outcomes.

Abstract:Objective To investigate the neuroprotective effect of Ginkgo biloba extract EGb761 on rats with dia-betic peripheral neuropathic pain(DPNP)and its mechanism.Methods Fifty adult male SD rats were randomly divided into a control group,a DPNP group,a low-dose EGb761 group,a high-dose EGb761 group,and a PI3K activator group,with 10 rats in each group.The DPNP rat model was established using a high-sugar diet combined with intraperitoneal injection of streptozo-tocin.The low-dose and high-dose EGb761 groups were administered EGb761 by gavage(50,100 mg/kg).The PI3K activator group received intraperitoneal injection of the PI3K activator 740Y-P(0.02 mg/kg)based on high-dose EGb761 gavage.The control and DPNP groups were given an equal volume of saline by gavage,once daily for 14 consecutive days.Mechanical pain stimulation tests and thermal sensitivity tests were used to assess pain symptoms.Laser Doppler flowmetry was used to measure blood flow in the lower limbs.A biological signal acquisition system was used to determine nerve conduction velocity.TUNEL staining was used to detect neuronal apoptosis in the spinal cord dorsal horn.Western blotting was used to measure the protein expression levels of PI3K,p-PI3K,AKT,p-AKT,mTOR,and p-mTOR in the spinal cord dorsal horn tissue.Results Compared with the control group,the DPNP group showed significantly decreased paw withdrawal threshold,nerve blood flow velocity,and nerve conduction velocity(P<0.05),and significantly increased neuronal apoptosis rate in the spinal cord dorsal horn,as well as the protein expression ratios of p-PI3K/PI3K,p-AKT/AKT,and p-mTOR/mTOR in the spinal cord dorsal horn tissue(P<0.05).Compared with the DPNP group,the EGb761 groups showed significantly increased paw withdrawal threshold,ther-mal withdrawal latency,nerve blood flow velocity,and nerve conduction velocity(P<0.05),and significantly decreased neuronal apoptosis rate in the spinal cord dorsal horn and the protein expression ratios of p-PI3K/PI3K,p-AKT/AKT,and p-mTOR/mTOR(P<0.05).Activation of PI3K significantly reversed the neuroprotective effects of EGb761(P<0.05).Conclusion EGb761 has a neuroprotective effect in DPNP rats,and its mechanism may be achieved by inhibiting the PI3K/Akt/mTOR signaling pathway.

Abstract:Objective To explore the clinical application value of 4D-DSA in the diagnosis and treatment of spinal vascular diseases.Methods The clinical and imaging data of 13 patients with spinal vascular diseases admitted from March 2018 to March 2023 were retrospectively analyzed.Results 4D-DSA diagnosed 8 cases of spinal dural arteriovenous fistula,2 cases of perimedullary arteriovenous fistula,2 cases of spinal arteriovenous malformation,and 1 case of spinal epidural ar-teriovenous fistula.The 4D-DSA images clearly displayed the number of fistulas,feeding arteries,and draining veins,as well as the venous drainage direction.The structures of the feeding arteries,draining veins,and nidus within the malformation were also clearly demonstrated in the 2 patients with arteriovenous malformation.Eleven patients with arteriovenous fistula under-went endovascular embolization or surgical treatment guided by 4D-DSA,and their spinal cord function improved to varying degrees postoperatively.Two patients with arteriovenous malformation received conservative treatment with poor outcomes.Conclusion 4D-DSA can help clinicians more intuitively and accurately understand the intravascular architecture and hemody-namics of spinal vascular diseases,optimize treatment plans,and reduce complications.

Abstract:Objective To investigate the clinical characteristics and surgical outcomes of pituitary prolactino-mas.Methods A retrospective analysis was conducted on the clinical data of 103 patients with pituitary prolactinomas who underwent surgical treatment at The First Affiliated Hospital of Xinjiang Medical University between January 2020 and De-cember 2024.Results Macroadenomas were the most common type in both male and female patients.However,the propor-tion of microadenomas was significantly higher in females(P<0.05),while the proportion of giant adenomas was significantly lower in females(P<0.05).The Knosp grade of tumors was mainly distributed in grades 3-4 in males and grades 0-2 in females.Preoperative gonadal hormone(estradiol,testosterone)abnormalities were the most common(77.67%),followed by thyroid dysfunction(16.50%),with cortisol abnormalities being the least frequent(5.83%).Preoperative hormone deterioration rates were lowest in microadenomas,followed by giant adenomas,and highest in macroadenomas.Among the 103 cases,gross total resection was achieved in 33,subtotal resection in 38,and partial resection in 32.Postoperative normalization rates for cortisol and gonadal hormones were highest in microadenomas,followed by macroadenomas,and lowest in giant adenomas.Preopera-tively,there was no thyroid dysfunction in microadenomas.The postoperative normalization rate of thyroid function was higher in macroadenomas than in giant adenomas.Intraoperative cerebrospinal fluid(CSF)rhinorrhea occurred in 21 cases,which improved with conservative treatment or lumbar cistern drainage.No new cases of CSF leakage occurred postoperatively.Post-operative complications included epistaxis(5 cases),intracranial infection(21 cases),and central diabetes insipidus(4 cases).Multivariate logistic regression analysis showed that the extent of tumor resection and gender were independent influencing factors for postoperative biochemical remission in patients with pituitary prolactinomas(P<0.05);while Knosp grade and tumor size were independent influencing factors for the gross total resection rate of pituitary prolactinomas(P<0.05).Conclusion For pituitary prolactinomas,timely surgery for microadenomas and macroadenomas can alleviate hormone levels,reduce depen-dence on medication,shorten the overall disease course,and can be considered as a first-line treatment.Giant adenomas have a low rate of biochemical remission after surgery.Asymptomatic giant adenomas should be actively managed with medication within the patient's tolerance.However,for patients with significant mass effects due to large tumor size,tumor apoplexy,or drug intolerance,active surgery is required to relieve symptoms.

Abstract:Cavernous sinus cavernous hemangiomas(CSHs)are clinically rare,representing a type of extra-axial cav-ernous hemangioma.Their primary manifestations are mass effects,such as headache,dizziness,epilepsy,endocrine disorders,visual acuity and field impairments,ptosis,restricted eye movement,and facial paresthesia.Because their clinical symptoms re-semble those of other lesions in the cavernous sinus region,clinical diagnosis is challenging,leading to a high rate of misdiagno-sis.This article reports a case of CSH initially misdiagnosed as a pituitary adenoma,with the diagnosis later confirmed as CSH through surgery and postoperative pathology.By reviewing the literature and analyzing the clinical data and diagnostic-thera-peutic process of this case,this paper summarizes the reasons for the misdiagnosis and proposes preventive measures,aiming to reduce misdiagnosis and mismanagement and provide a reference for clinical practice.

Abstract:Objective To investigate the characteristics of pathogenic bacteria causing postoperative intracranial in-fection(ICI)in patients with spontaneous intracerebral hemorrhage(SICH)and their correlation with cerebrospinal fluid(CSF)indicators,providing a reference for clinical anti-infective treatment.Methods The clinical data of 81 SICH patients with postoperative ICI admitted between January 2018 and December 2022 were retrospectively analyzed.The etiological character-istics of CSF culture-positive bacteria were analyzed,and differences in CSF indicators were compared between patients with Gram-negative bacilli(GNB)and Gram-positive cocci(GPC)infections.Results Among the 81 ICI cases,pathogens were de-tected in the CSF of 49 patients,of whom,15(30.60%)were GPC and 34(69.40%)were GNB.There were no statistically sig-nificant differences in age,gender,hemorrhage volume,or admission GCS score between patients with GNB and GPC infections(P>0.05).Compared to patients with GPC infection,those with GNB infection had significantly increased CSF white blood cell(WBC)count,protein level,and lactate dehydrogenase(LDH)level(P<0.05),while the CSF glucose level was significantly de-creased(P<0.05).ROC curve analysis showed that CSF WBC count,protein level,LDH level,and glucose level had certain pre-dictive value for postoperative GNB ICI in SICH patients,with areas under the curve of 0.912,0.831,0.920,and 0.794,respec-tively(P<0.05).Conclusion In our hospital,GNB are the predominant pathogens causing secondary ICI after SICH surgery,exhibiting high drug resistance rates.This suggests that clinicians need to highly prioritize submitting samples for culture before antibiotic administration,reduce the use of broad-spectrum antimicrobials,and decrease iatrogenic drug resistance.Furthermore,for patients suspected of ICI,when etiological evidence is unavailable,CSF WBC count,protein level,LDH level,and glucose content can serve as references for differentiating between GNB and GPC infections.

Abstract:Chronic subdural hematoma,one of the most common neurosurgical conditions,is characterized by insid-ious onset and slow progression,predominantly affecting the elderly.With the accelerating aging population and the increasing use of anticoagulant and antiplatelet medications,its incidence continues to rise.Although burr hole drainage remains the pri-mary treatment,the high postoperative recurrence rate persists as a clinical challenge,underscoring the significance of exploring safe and effective nonsurgical strategies.Recent research has focused on the pathophysiological mechanisms of chronic subdural hematoma,proposing core hypotheses such as local inflammatory response,abnormal angiogenesis,and hyperfibrinolysis,which have informed the development of pharmacological therapies including corticosteroids,atorvastatin,and tranexamic acid.This article systematically reviews advances in pathogenesis of chronic subdural hematoma,outlines key pathological pathways,and evaluates the efficacy and challenges of current drug therapies,aiming to provide direction for future research.

Abstract:Objective To investigate the safety and efficacy of endovascular interventional therapy for Moyamoya disease combined with symptomatic vertebrobasilar artery stenosis.Methods A retrospective analysis was conducted on the clinical data of 10 patients with Moyamoya disease and symptomatic vertebrobasilar artery stenosis who underwent interven-tional treatment between March 2020 and January 2023.Results Among the cases,7 involved stenosis of the dominant ver-tebral artery,with a stenosis rate exceeding 70%;1 case had severe localized stenosis of the basilar artery,with a stenosis rate over 80%;and 2 cases exhibited severe stenosis at the junction of the vertebral and basilar arteries,with stenosis rates above 70%.All 10 patients successfully underwent endovascular interventional therapy,including vertebral artery orifice stenting in 7 cases,mid-basilar artery stenting in 1 case,and stenting at the vertebral-basilar artery junction in 2 cases.Immediate post-op-erative angiography revealed a residual stenosis rate of less than 10%.During the one-year follow-up,one patient with stenosis at the vertebral-basilar artery junction developed in-stent restenosis and underwent drug-coated balloon angioplasty as salvage therapy;one patient with vertebral artery orifice stenting developed restenosis but remained asymptomatic and continued under observation.All patients showed improvement in posterior circulation ischemia symptoms.Conclusion Endovascular inter-ventional therapy is safe and effective for patients with Moyamoya disease combined with symptomatic vertebrobasilar artery stenosis,with favorable outcomes observed at the one-year follow-up.Long-term efficacy requires continued monitoring.

Abstract:Objective To investigate the application effect of hematoma surface projection technology combined with neuroendoscopy in the surgical treatment of hypertensive basal ganglia hemorrhage.Methods The clinical data of 70 patients with hypertensive basal ganglia hemorrhage who underwent surgical treatment between January 2018 and December 2021 were retrospectively analyzed.Among them,35 patients underwent hematoma evacuation using hematoma surface projection technology combined with neuroendoscopy(endoscopy group),while the other 35 patients underwent traditional microscopic hematoma evacuation(microscopy group).Results Compared to the microscopy group,the endoscopy group showed significantly higher hematoma evacuation rates(P<0.05),significantly shorter operative times(P<0.05),significantly reduced intraoperative blood loss(P<0.05),and significantly lower incidences of postoperative complications and modified Rankin Scale(mRS)scores at 6 months postoperatively(P<0.05).Conclusion For hypertensive basal ganglia hemorrhage,the application of hematoma surface projection technology combined with neuroendoscopic surgery can effectively leverage the advantages of minimally invasive and precise localization,improve surgical outcomes,and lead to better patient prognosis.

Abstract:Objective To investigate the surgical outcomes and influencing factors for drug-resistant temporal lobe epilepsy(TLE)caused by focal cortical dysplasia(FCD)in children.Methods A retrospective analysis was conducted on the clinical data of 60 children with drug-resistant TLE who underwent surgical treatment between January 2017 and June 2019.At the last postoperative follow-up,seizure control outcomes were assessed using the Engel classification,with Engel Class Ⅰ indicating favorable seizure control.Results Postoperative pathological findings diagnosed all cases as FCD type Ⅲ.Preoperative MRI:36 cases exhibited typical features of hippocampal sclerosis,while 24 cases were MRI-negative.Among the MRI-negative patients,17(70.83％)were identified as FCD type Ⅲa.The complete resection rate of the epileptogenic zone was significantly lower in MRI-negative patients(70.83％)compared to MRI-positive patients(97.22％;P=0.005).At the 2-year postoperative follow-up,35 cases(58.33％)achieved favorable seizure control;at the 5-year postoperative follow-up,42 cases(70.0％)exhibited favorable seizure control.Multivariate logistic regression analysis revealed that longer disease duration and MRI-negative status were independent risk factors for poor postoperative seizure control(P<0.05),while complete resection of the epileptogenic zone was a protective factor for favorable postoperative seizure control(P<0.05).Conclusion The majority of children with FCD type Ⅲ drug-resistant TLE achieved favorable seizure control following surgical treatment.MRI-negative status affects the complete resection rate of the epileptogenic zone in children,leading to suboptimal postoperative seizure control outcomes.

Abstract:The primitive trigeminal artery is a transient precursor vessel present during early embryonic development,which typically regresses and disappears as the posterior communicating artery forms.Its persistence results in these anastomotic vessels becoming permanent conduits between the carotid and basilar arteries.This article reports a rare case of an aneurysm on the main trunk of a persistent trigeminal artery accompanied by an aneurysm on the clinoid segment of the internal carotid artery.The patient,a 66-year-old female,underwent MRA for dizziness,which revealed the intracranial aneurysms.Under general anesthesia,coil embolization was performed to treat the aneurysm on the main trunk of the persistent trigeminal artery.Immediate post-operative angiography showed satisfactory aneurysm embolization,reduced blood flow within the persistent trigeminal artery,and good opacification of the basilar artery,bilateral posterior cerebral arteries,and their distal vessels.The patient experienced no post-operative cerebral ischemia or neurological deficits.A 3-month follow-up cranial MRA showed occlusion of the left persistent trigeminal artery.A 6-month follow-up cerebral angiogram revealed no filling of the left persistent trigeminal artery aneurysm,and the original left internal carotid artery clinoid segment aneurysm showed no significant change.

Abstract:Objective To evaluate the efficacy of posterior median approach via microchannel for microscopic resection of spinal intramedullary cavernous hemangiomas.Methods The clinical data of 26 patients with spinal intramedullary cavernous hemangiomas surgically treated between January 2020 and June 2024 were retrospectively analyzed.All patients underwent microscopic resection via posterior median approach with microchannel technique.Results Hemilaminectomy was performed in 18 cases and total laminectomy in 8 cases.Incision length was(3.5±0.5)cm,and hospital stay was(5.0±2.0)days.Gross total resection under microscopy was achieved in all 26 cases(100.0%)without intraoperative complications.Postoperative complications occurred in 5 cases(19.23%).Modified McCormick Scale scores at 3 months postoperatively[(2.7±1.0)points]were significantly lower than preoperative scores[(3.4±1.1)points;P=0.026].At 6-month follow-up,neurological function improved in 17 cases(65.4%)and remained stable in 9(34.6%).No signs of kyphosis or recurrence were observed.Conclusion Microscopic resection of spinal intramedullary cavernous hemangiomas via posterior median approach with microchannel technique is feasible,demonstrating safe and reliable therapeutic outcomes.

Abstract:Intracranial germinomas are highly radiosensitive and can be cured by radiotherapy alone.Radiation-induced glioma is a rare long-term complication of radiotherapy.This article reports a case of glioblastoma concurrent with radiotherapy following total resection of a germinoma.A pineal region mass was detected and surgically removed in a 4-year-old child,with postoperative pathological diagnosis of mixed germinoma.Standard radiotherapy,chemotherapy,and regular follow-up were conducted after surgery.Five years post-surgery,multiple intracranial masses were found during follow-up,and a second surgery was performed.Postoperative pathological diagnosis indicated high-grade glioma,considered radiation-induced glioma.The patient was discharged one week after surgery with clear consciousness and left limb muscle strength of grade 4.After discharge,radiotherapy concurrent with temozolomide chemotherapy was continued.At the 3-month follow-up,the patient developed impaired consciousness,reduced mobility of the left limb,increased intracranial pressure,and brain herniation.No further surgical intervention was performed,and the patient died six months later.This case suggests that although the incidence of secondary glioma after radiotherapy for intracranial germinoma is low,the prognosis is poor,highlighting the need to be vigilant about the risk of radiation-induced secondary tumors.

Abstract:Objective To investigate the clinical efficacy of revascularization therapy for chronic internal carotid artery occlusion with intracranial hypoperfusion.Methods The clinical data of 72 patients with chronic internal carotid artery occlusion with intracranial hypoperfusion who underwent vascular recanalization therapy between June 2020 and June 2024 were retrospectively analyzed.Results According to the Hasan classification,there were 37 cases of type A,22 of type B,11 of type C,and 2 of type D.Among them,13 patients were treated with carotid endarterectomy(CEA group),19 with carotid artery stenting(CAS group),and 40 with hybrid surgery(hybrid group).Immediate postoperative angiography showed successful vascular recanalization in 53 cases,yielding an overall recanalization rate of 73.61%.The recanalization rates were 76.92%(10/13)in the CEA group,68.42%(13/19)in the CAS group,and 75.00%(30/40)in the hybrid group,with no statistically significant difference among the three groups(P=0.828).The recanalization rates for Hasan type A,B,C,and D were 83.78%(31/37),72.72%(16/22),54.55%(6/11),and 0%,respectively.The recanalization rate in patients with Hasan types A and B(79.66%)was significantly higher than that in those with types C and D(46.15%;P=0.033).The incidence of postoperative complications in the CEA group[7.69%(1/13)]was lower than that in the CAS group[31.58%(6/19)]and the hybrid group[22.50%(9/40)],but no statistically significant difference was observed among the three groups(P=0.320).A 6-month postoperative follow-up was conducted for the 53 patients with successful recanalization,including 10 in the CEA group,13 in the CAS group,and 30 in the hybrid group.The incidence of postoperative restenosis was 0%in the CEA group,7.69%(1/13)in the CAS group,and 6.67%(2/30)in the hybrid group,with no statistically significant difference among the groups(P>0.999).The rates of favorable prognosis(mRS score≤2)were 90.00%(9/10)in the CEA group,92.31%(12/13)in the CAS group,and 86.67%(26/30)in the hybrid group,with no statistically significant difference(P>0.999).Conclusion Vascular recanalization therapy is a safe and effective treatment for patients with chronic internal carotid artery occlusion with intracranial hypoperfusion,with satisfactory short-term follow-up outcomes,particularly in patients with Hasan types A and B.CEA,CAS,and hybrid surgery can all achieve good outcomes,and the recanalization method should be chosen according to the specific condition of the patient.

Abstract:The persistent hypoglossal artery(PHA)is the second most common anomalous anastomosis between the carotid and vertebrobasilar systems.It is often associated with ipsilateral,contralateral,or bilateral vertebral artery hypoplasia,accompanied by hypoplasia or absence of the posterior communicating artery.Due to the coexistence of this anatomical anomaly and hemodynamic disturbances,it frequently leads to vascular diseases such as intracranial aneurysms and cerebrovascular malformations.This paper reports a case of a 69-year-old female with PHA combined with ruptured cerebellar arteriovenous malformation(AVM).She was admitted due to sudden onset of dizziness accompanied by nausea and vomiting for 10 hours.Her Glasgow Coma Scale(GCS)score was 15,with muscle strength grade Ⅳ in the left limbs and positive left-sided limb ataxia.Cerebral angiography revealed a PHA,an AVM supplied by the left superior cerebellar artery and anterior inferior cerebellar artery,and bilateral vertebral artery hypoplasia.After completing preoperative preparations,the AVM was surgically resected via a left retrosigmoid approach under neuroelectrophysiological monitoring.The lesion was completely excised under intraoperative microscopy.Immediate postoperative head CT showed no hemorrhage in the surgical area or intracranial cavity.At the 2-month follow-up,muscle strength in the left limbs was gradeⅣ+,and a follow-up head CT revealed a softened area at the site of the previous intracranial hemorrhage.This case suggests that identifying congenital variants can contribute to the early detection and treatment of related diseases.

Abstract:Objective To explore the nursing strategies for hematoma and thrombosis at the puncture site following removal of an internal jugular vein catheter.Methods The clinical data of one patient who developed hematoma and thrombosis at the puncture site after internal jugular vein catheter removal were retrospectively analyzed,and nursing experience was summarized with a literature review.Results Systematic interventions were implemented:① Pre-removal:enhanced risk assessment and standardized catheter flushing and sealing;② Post-removal:dynamic monitoring of neck circumference(measured every 6 hours)combined with Doppler ultrasound for early thrombosis identification;③Anticoagulation therapy with low-molecular-weight heparin calcium and rivaroxaban.The hematoma was completely absorbed within two weeks(neck circumference decreased from 34.5 cm to 32 cm).Although thrombus length increased from 2.3 cm to 3.5 cm,good collateral circulation was established.At discharge,the GCS score was 15,with no neurological deficits.Conclusion Standardized risk assessment,dynamic monitoring,and multidisciplinary collaboration are crucial for preventing complications after internal jugular vein catheter removal.

Abstract:Objective To explore the feasibility and effectiveness of neuroendoscopic surgery for acute subdural hematoma.Methods The clinical data of 8 patients with acute subdural hematoma treated by neuroendoscopic surgery between October 2021 and October 2022 were retrospectively analyzed.Results A frontoparietal curved incision,approximately 12 cm in length,was made,and a bone window of about 3 cm×6 cm was created.The acute subdural hematoma was evacuated under neuroendoscopy.Hematoma evacuation was satisfactory in all patients,with a hematoma evacuation rate exceeding 96%.The operation time ranged from 105 to 170(123.8±20.7)min.Intraoperative findings revealed the bleeding source was rupture of the angular artery in 2 cases,hemorrhagic contusion in 2 cases,dural tear due to skull fracture in 1 case,and bridging vein hemorrhage in 1 case;no definite bleeding site was identified in 2 cases.Hemostasis was satisfactory during surgery,and no postoperative intracranial rebleeding occurred.At one month postoperatively,assessment using the modified Rankin Scale showed a score of 0 in 5 cases,2 in 1 case,5 in 1 case,and 6 in 1 case.Conclusion For appropriate cases of acute subdural hematoma,neuroendoscopic surgery can effectively evacuate the hematoma,achieve reliable hemostasis,shorten operation time,reduce collateral damage,and improve patient prognosis.

Abstract:Objective To explore the clinical features,treatment,and prognosis of patients with recanalization and rupture of intracranial thrombotic aneurysms.Methods The clinical data of 2 patients with intracranial thrombotic aneurysms were retrospectively analyzed,along with a literature review.Results One case involved a thrombotic aneurysm of the right posterior inferior cerebellar artery,and the other involved a thrombotic aneurysm of the anterior communicating artery.Both cases had multiple intracranial aneurysms,and the tnrombotic aneurysms were not visible on the initial DSA.After endovascular treatment for the other intracranial aneurysms,the tnrombotic aneurysms ruptured and bled.Subsequent angiography revealed the tnrombotic aneurysms,which were then treated with endovascular intervention.Immediate post-procedural angiography showed complete embolization of the aneurysms.After surgery,one patient developed hydrocephalus and died one month after being transferred back to the local hospital;the other patient recovered well.Conclusion Intracranial tnrombotic aneurysms are extremely rare and difficult to diagnose,especially when combined with multiple intracranial aneurysms.For patients prone to thrombosis or those with a mismatch between the location of subarachnoid hemorrhage and the corresponding aneurysm,the possibility of an intracranial tnrombotic aneurysm should be considered.Multimodal imaging is necessary for accurate diagnosis and developing a personalized treatment plan.