Abstract:Supratentorial hypertensive intracerebral hemorrhage is a common and critical neurological disorder.Currently,there are various treatment options for hypertensive intracerebral hemorrhage,with surgery remaining the primary approach.This article first outlines the hazards of hypertensive intracerebral hemorrhage,then explores its treatment strategies,focusing on the timing of surgical intervention and various surgical methods,including their indications,key procedural points,and clinical outcomes.It also briefly describes other treatment options,such as traditional Chinese medicine,stem cell therapy,and gene therapy,and looks ahead to future research directions,including robot-assisted minimally invasive surgery and personalized treatment plans.This article aims to analyze the treatment strategies for supratentorial hypertensive intracerebral hemorrhage,providing theoretical support for clinical decision-making to optimize treatment plans and improve patient outcomes.

Abstract:Spontaneous intracerebral hemorrhage is often accompanied by varying degrees of cognitive impairment,which tends to respond poorly to treatment,adversely affecting patients'quality of life and placing a heavy burden on both society and patients'families.In clinical practice,it is of great significance to conduct in-depth research on the screening,treatment,and prognostic evaluation of such cognitive impairment.By reviewing literature related to cognitive impairment following spontaneous intracerebral hemorrhage,this article provides a comprehensive overview of recent advances in the study of cognitive impairment after spontaneous intracerebral hemorrhage.

Abstract:Objective To investigate the risk factors for recurrence of trigeminal neuralgia after fully endoscopic microvascular decompression.Methods The clinical data of 104 patients with trigeminal neuralgia treated with fully endoscopic microvascular decompression from February 2020 to January 2024 were retrospectively analyzed.Postoperative follow-up was conducted for 1 year,recurrence were assessed according to the Barrow Neurological Institute(BNI)Pain Intensity Scale.Results Immediate postoperative pain was completely relieved in 103 cases(99.04%);complications occurred in 4 cases(2.70%).During the 1-year postoperative follow-up,recurrence was observed in 11 cases(10.58%).Multivariate logistic regression analysis showed that poor response to analgesic drugs,atypical clinical symptoms,non-arterial compression,and a cerebellopontine angle area ratio(healthy/affected side)>1 were independent risk factors for recurrence of trigeminal neuralgia after fully endoscopic microvascular decompression(P<0.05).Conclusion Fully endoscopic microvascular decompression is an effective method for treating trigeminal neuralgia.Patients with poor response to analgesic drugs,atypical clinical symptoms,non-arterial compression,and a cerebellopontine angle area ratio(healthy/affected side)>1 have an increased risk of postoperative recurrence.

Abstract:Objective To investigate the risk factors for hydrocephalus following craniotomy in patients with moderate to severe traumatic brain injury.Methods The clinical data of 62 patients with moderate to severe traumatic brain injury who underwent craniotomy from July 2019 to April 2021 were retrospectively analyzed.Hydrocephalus was diagnosed based on head CT or MRI scans conducted within three months after surgery.Results Among the 62 patients,24 developed hydrocephalus postoperatively,with an incidence rate of 38.7%.Three of these patients underwent ventriculoperitoneal shunt surgery.Univariate analysis revealed that admission GCS score,preoperative brain herniation,subarachnoid hemorrhage,preoperative compression of the circummesencephalic cistern,decompressive craniectomy,and postoperative subdural effusion were associated with postoperative hydrocephalus(P<0.05).Multivariate logistic regression analysis indicated that subarachnoid hemorrhage(OR=16.15,95%CI 2.60～100.21,P=0.003)and postoperative subdural effusion(OR=23.16,95%CI 2.67～200.89,P=0.004)were independent risk factors for hydrocephalus following craniotomy in patients with moderate to severe traumatic brain injury.Conclusion For patients with moderate to severe traumatic brain injury treated with craniotomy,the presence of subarachnoid hemorrhage or postoperative subdural effusion significantly increases the risk of hydrocephalus.Timely diagnosis and appropriate interventions should be implemented to reduce the incidence of hydrocephalus and improve patient outcomes.

Abstract:Objective To investigate the efficacy of robot-assisted drainage in the treatment of moderate-volume(15～40 mL)basal ganglia hemorrhage.Methods A retrospective analysis was conducted on the clinical data of 90 patients with moderate-volume basal ganglia hemorrhage admitted between January 2022 and October 2024.Among them,41 patients received conservative treatment(conservative group),while 49 underwent puncture and drainage assisted by the Remebot robotic system(drainage group).Results The operative time in the drainage group was(25.67±4.32)minutes,with a robotic positioning accuracy of 0.30～1.45 mm.Postoperative CT scans confirmed accurate placement of the drainage tubes in all cases.In patients with a hematoma volume≥25 mL,the hematoma clearance rate at 2 weeks postoperatively was significantly higher in the drainage group[(92.77±9.53)%]compared to the conservative group[(70.68±27.21)%,P=0.002].The total incidence of postoperative complications was significantly lower in the drainage group(10.20%)than in the conservative group(29.27%,P=0.030).At the 3-month follow-up,the modified Rankin Scale score was significantly lower in the drainage group[(1.96±1.22)points]compared to the conservative group[(3.34±1.85)points,P=0.038].Conclusion For moderate-volume basal ganglia hemorrhage,robot-assisted drainage is an effective treatment strategy,particularly in patients with a hematoma volume of 25～40 mL.It facilitates rapid hematoma clearance,promotes neurological recovery,and improves patient prognosis.

Abstract:Objective To investigate the clinical efficacy of a novel laser positioning-assisted puncture drainage technique in the treatment of brain abscesses.Methods A retrospective analysis was conducted on the clinical data of 12 patients with brain abscesses treated with the novel laser positioning-assisted puncture drainage technique between January 2020 and January 2024.Results With the assistance of the novel laser positioning technology,all 12 patients achieved successful puncture on the first attempt,resulting in a success rate of 100%.Postoperative CT scans confirmed that the drainage catheter placement was consistent with the preoperative plan,with no complications such as intracranial hemorrhage or abscess rupture and dissemination observed.The drainage catheters were removed 1～3 days after surgery,and antibiotic therapy was administered for 4～6 weeks postoperatively.During the follow-up period of 3～9 months,no recurrence of brain abscess was observed in any patient.At 3 months postoperatively,the GOS score was 5 in 10 cases and 4 in 2 cases.Conclusion The novel laser positioning-assisted puncture drainage technique demonstrates favorable clinical outcomes in the treatment of brain abscesses,providing a more precise,safe,and minimally invasive approach for the surgical management of this condition.

Abstract:Objective To investigate the efficacy of neuroendoscopic surgery in the treatment of thalamic hemorrhage with intraventricular extension.Methods A retrospective analysis was conducted on the clinical data of 18 patients with thalamic hemorrhage and intraventricular extension who underwent neuroendoscopic surgery between November 2022 and May 2023.Results The preoperative hematoma volume was(36.9±17.4)ml.The hematoma clearance rate was 85.5%on postoperative day 1 and 100.0%on postoperative day 3.The preoperative GCS score was(9.5±2.8)points,and the time to consciousness recovery was(2.6±2.2)days postoperatively.Postoperative complications included stress ulcer in 2 cases,electrolyte disturbances in 3 cases,and hydrocephalus in 2 cases.During the 6～12 months of postoperative follow-up,the GOS scores were as follows:5 points in 5 cases,4 points in 6 cases,3 points in 3 cases,and 2 points in 4 cases.Conclusion Neuroendoscopic surgery for thalamic hemorrhage with intraventricular extension achieves a high hematoma clearance rate and a low incidence of postoperative complications,and effectively improves patient prognosis.

Abstract:Objective To investigate the feasibility and effectiveness of endovascular recanalization for chronic vertebrobasilar artery occlusion under the guidance of a"virtual road map"based on high-resolution magnetic resonance vessel wall imaging(HRMR-VWI).Methods The clinical data of 5 patients with chronic vertebrobasilar artery occlusion who underwent endovascular recanalization between May 2023 and May 2024 were retrospectively analyzed.The entire vertebrobasilar artery was identified using HRMR-VWI,and the occluded arterial segment was reconstructed.Magnetic resonance angiography(MRA),computed tomography angiography(CTA),and digital subtraction angiography(DSA)images were anatomically aligned and fused.The fused images served as a"virtual road map"for intraoperative guidance,visualizing the occluded arterial segment to direct interventional procedures.Results HR-MRI vessel wall imaging clearly displayed the vessel wall and lumen of the occluded arterial segment.The fused images accurately represented anatomical locations,fully visualized the target occluded arterial segment,and effectively guided the interventional operations.Successful recanalization was achieved in all cases,with immediate post-procedural angiography showing TICI grade of 2b was achieved 3 cases and grade 3 in 2 cases.None of the patients experienced new stroke-related complications after the procedure.During the follow-up period of 3 to 12 months,no new neurological deficits were observed.Angiographic follow-up in 3 cases confirmed maintained patency of the recanalized vessels.Modified Rankin Scale(mRS)scores at three months post-operation were 0 in two cases and 1 in three cases.Conclusion HRMR-VWI combined with multimodal image fusion enables accurate three-dimensional visualization during surgery and guides interventional procedures,thereby improving the success rate of recanalization for chronic vertebrobasilar artery occlusion,reducing complications,and enhancing patient outcomes.

Abstract:Objective To investigate the value of serum levels of Forkhead box transcription factor O subfamily protein 1(FOXO1)and SMAD family member 2(SMAD2)in the prognostic assessment of patients with hypertensive intracerebral hemorrhage(HICH).Methods From January 2022 to December 2022,204 patients with HICH(HICH group)were prospectively recruited,and another 204 hypertensive patients without intracerebral hemorrhage during the same period were recruited as the control group.Serum levels of FOXO1 and SMAD2 were detected using enzyme-linked immunosorbent assay(ELISA).Three months after onset,prognosis was assessed according to the Glasgow Outcome Scale(GOS)score,where a score of 1～3 indicated poor prognosis and a score of 4～5 indicated good prognosis.Results Compared with the control group,the HICH group had significantly lower serum FOXO1 levels(P<0.05)and significantly higher SMAD2 levels(P<0.05).Among the 204 HICH patients,133 had a good prognosis and 71 had a poor prognosis at three months post-onset.Multivariate logistic regression analysis showed that elevated serum SMAD2 level was an independent risk factor for poor prognosis in HICH patients(OR=5.209,95%CI 1.891～14.349,P=0.001),while an elevated serum FOXO1 level was a protective factor against poor prognosis(OR=0.216,95%CI 0.087～0.535,P=0.001).ROC curve analysis revealed that FOXO1≤11.287 ng/mL and SMAD2≥37.172 μg/L had certain predictive value for the prognosis of HICH patients at three months post-onset,and their combined prediction yielded better results[area under the curve(AUC)=0.866(95%CI 0.815～0.917),sensitivity 78.90%,specificity 80.50%].Conclusion Serum FOXO1 levels are significantly decreased and SMAD2 levels are significantly increased in HICH patients.The combined detection of both markers holds high clinical value for the prognostic assessment of HICH.

Abstract:Temporal lobe epilepsy(TLE)stands out as one of the most responsive forms of epilepsy to surgical intervention,yet a significant number of patients still face a poor prognosis.The key to a favorable patient outcome lies in rigorous preoperative evaluation and the judicious selection of surgical strategies.Over recent years,the field has witnessed remarkable advancements in symptomatology,neuroimaging,neuropsychology,and electrophysiology,which have been complemented by a deeper understanding of TLE's etiology and network dynamics among epilepsy specialists.These developments have significantly enhanced the standards of preoperative assessment and surgical management for TLE.This review reviews the latest advancements in the preoperative evaluation and surgical treatment of TLE,serving as a reference for clinical practice.

Abstract:Between 20%and 30%of depression patients show little to no improvement after receiving two or more adequate courses of antidepressant medication at sufficient doses.This form of depression is termed treatment-resistant depression(TRD),for which effective treatment options remain limited.In 2005,the U.S.Food and Drug Administration approved vagus nerve stimulation(VNS)for the clinical treatment of TRD.This article reports the case of a 55-year-old female with TRD who was admitted to the hospital due to low mood,sleep disturbances,and anxiety lasting for seven years.Previous treatments at other hospitals,including various medications and transcranial magnetic stimulation,had yielded no significant improvement.Following multidisciplinary consultation and informed consent from the patient,VNS was administered.During the one-year postoperative follow-up,her Hamilton Depression Rating Scale-17(HAMD-17)score decreased from 28 to 4;her Montgomery-Asberg Depression Rating Scale(MADRS)score decreased from 36 to 8;her Self-Rating Depression Scale(SDS)score decreased from 30 to 5;her Pittsburgh Sleep Quality Index(PSQI)score decreased from 21 to 6;and her Montreal Cognitive Assessment(MoCA)score increased from 16 to 24.The patient reported satisfaction with the outcomes and voluntarily discontinued medication.At the two-year follow-up,she reported continued symptom improvement,with significant enhancements in sleep and memory.This case suggests that VNS is a feasible and effective treatment for TRD,though preoperative multidisciplinary discussion and strict patient selection are essential.

Abstract:Objective To evaluate the safety and efficacy of the Remebot robotic-assisted contact endoscopic technique for biopsy of intracranial lesions.Methods A retrospective analysis was conducted on the clinical data of 16 patients who underwent intracranial lesion biopsy between November 2023 and January 2024.Preoperative head CT and MRI T1-weighted 3D magnetization-prepared rapid gradient-echo sequences were performed.The CT and MRI data were imported into the Remebot robotic workstation to plan the puncture path.During surgery,the puncture procedure was visually observed under a contact endoscope to avoid blood vessels along the puncture path,distinguish target lesion tissue from normal brain tissue,and collect lesion samples for pathological examination to confirm the diagnosis.Results All 16 biopsies were successfully completed.Postoperative pathological diagnoses included 7 cases of diffuse astrocytoma and oligodendroglial tumor,6 cases of primary central nervous system diffuse large B-cell lymphoma,1 case of craniopharyngioma,1 case of cerebral tuberculoma,and 1 case of diffuse meningeal melanocytosis.The biopsy positive rate was 100%(16/16).No postoperative hemorrhage at the lesion site or along the puncture path was observed.Conclusion The Remebot robotic-assisted contact endoscopic technique can significantly improve the safety and efficacy of intracranial lesion biopsy and reduce postoperative complications.

Abstract:Dyke-Davidoff-Masson syndrome(DDMS)is a rare central nervous system disorder characterized by varying degrees of hypoplasia or atrophy of one cerebral hemisphere,midline shift of the brain,and compensatory changes in the skull.This article reports a case of a 14-year-old female patient with DDMS who was admitted due to recurrent episodes of loss of consciousness and limb convulsions for 13 years following a craniocerebral injury.The patient exhibited normal muscle strength and tone in the right limbs,while the left upper limb showed proximal muscle strength of grade 3 and distal muscle strength of grade 2,and the left lower limb showed proximal muscle strength of grade 4 and distal muscle strength of grade 2,with normal muscle tone in the left limbs and a left hemiplegic gait.After non-invasive initial evaluations including MRI,PET,and VEEG,the patient underwent peri-insular hemispherotomy.Postoperatively,the wound healed well,the patient remained conscious,and muscle strength in the left limbs decreased.During the one-year follow-up after discharge,no epileptic seizures occurred,functional compensation was satisfactory,and no relatively severe complications were observed,achieving Engel ClassⅠoutcome.

Abstract:Objective To investigate the effect of early application of anticoagulant drugs on lower extremity deep vein thrombosis(DVT)after surgery for severe hypertensive intracerebral hemorrhage.Methods A retrospective analysis was conducted on the clinical data of 93 patients with severe hypertensive intracerebral hemorrhage who underwent surgical treatment between August 2021 and June 2023.All patients underwent craniotomy for hematoma evacuation.Among them,48 patients received anticoagulation therapy with low-molecular-weight heparin calcium within 48 hours of admission(early group),while 45 patients received anticoagulation therapy 48 hours or later after admission(late group).Lower extremity DVT was assessed using color Doppler ultrasound one week after surgery.Results Compared with the late group,the incidence of lower extremity DVT was significantly lower in the early group(14.6%vs.33.3%;P=0.033).There were no statistically significant differences in the incidence of intracranial rebleeding or gastrointestinal bleeding between the two groups(P>0.05).Conclusion Early application of anticoagulant drugs in patients with severe hypertensive intracerebral hemorrhage can significantly reduce the risk of DVT with a high safety profile.

Abstract:Objective To investigate the factors influencing short-term poor prognosis after craniopharyngioma resection.Methods The clinical data of 94 patients with craniopharyngioma who underwent surgical treatment between May 2017 and May 2022 were retrospectively analyzed.Postoperative follow-up was conducted for 12 months,and the outcomes were assessed using the postoperative efficacy evaluation scale for craniopharyngioma.Grades 0～2 were defined as good prognosis,while grades 3～4 were defined as poor prognosis.Results At 12 months post-surgery,the incidence of poor prognosis was 43.62%(41/94).Univariate analysis showed that tumor diameter,QST classification,tumor adhesion strength classification,extent of tumor resection,and surgical approach were associated with short-term poor prognosis(P<0.05).Multivariate logistic regression analysis revealed that large tumor diameter,T-type QST classification,and non-fused adhesion strength classification were independent influencing factors for short-term poor prognosis after craniopharyngioma resection(P<0.05).ROC curve analysis demonstrated that the combination of tumor diameter≥4.31 cm,T-type QST classification,and non-fused adhesion strength classification yielded an area under the curve of 0.900(95%CI 0.840～0.960)for predicting short-term poor prognosis after craniopharyngioma resection.Conclusion Tumor size,QST classification,and adhesion strength classification are influencing factors for short-term poor prognosis after craniopharyngioma resection.The prediction model established based on these factors holds significant value for the early prediction of poor prognosis in craniopharyngioma.

Abstract:Objective To investigate the changes in serum levels of soluble vascular cell adhesion molecule-1(sVCAM-1)and calcitonin gene-related peptide(CGRP)in patients with aneurysmal subarachnoid hemorrhage(aSAH)and their predictive value for cerebral vasospasm(CVS).Methods From April 2022 to April 2024,145 aSAH patients were prospectively enrolled,and 105 healthy individuals undergoing physical examination during the same period were selected as the control group.Serum levels of sVCAM-1 and CGRP were measured using ELISA.CVS was diagnosed if transcranial Doppler ultrasound showed a mean blood flow velocity in the middle cerebral artery>140 cm/s.Results Compared with the control group,aSAH patients had significantly higher serum sVCAM-1 levels(P<0.001)and significantly lower serum CGRP levels(P<0.001).Among the 145 aSAH patients,51 developed CVS,with an incidence rate of 35.17%.Multivariate logistic regression analysis showed that elevated serum sVCAM-1 levels were an independent risk factor for CVS in aSAH patients(OR=2.798,95%CI 1.406～5.567,P=0.003),while elevated serum CGRP levels were a protective factor against CVS in aSAH patients(OR=0.745,95%CI 0.620～0.896,P=0.002).ROC curve analysis revealed that the combination of serum sVCAM-1≥204.81 ng/mL and serum CGRP≤20.83 pg/mL predicted CVS in aSAH with an area under the curve of 0.947(95%CI 0.886～0.981),a sensitivity of 89.47%,and a specificity of 91.55%.Conclusion aSAH patients exhibit increased serum sVCAM-1 levels and decreased serum CGRP levels,which are closely associated with CVS.Combined detection of serum sVCAM-1 and CGRP has high predictive value for CVS following aSAH.

Abstract:Objective To investigate the efficacy and safety of the dual-scope technique in microvascular decompression(MVD)for hemifacial spasm(HFS).Methods A retrospective analysis was conducted on the clinical data of 98 HFS patients who underwent MVD between January 2021 and December 2023.Results Of 98 HFS patients,51 patients underwent surgery under microscopy alone(conventional microscopy group),while 47 underwent surgery using a combination of neuroendoscopy and microscopy(dual-scope group).The postoperative hospital stay was significantly shorter in the dual-scope group[(8.61±2.05)days]compared to the conventional microscopy group[(10.60±2.90)days;P=0.048].The total effective rate of surgery was significantly higher in the dual-scope group(95.75%)than in the conventional microscopy group(82.35%;P=0.036).The incidence of postoperative complications was significantly lower in the dual-scope group(4.26%)compared to the conventional microscopy group(21.56%;P=0.012).Conclusion Neuroendoscopy provides a clearer and more panoramic surgical view,significantly reducing the extensive dissection required for microscope exposure and minimizing tissue damage caused by surgical manipulation.Furthermore,neuroendoscopy offers greater safety than microscopy in terms of structural visualization and neurovascular discrimination.In MVD for HFS patients,fully utilizing the technical advantages of both neuroendoscopy and microscopy can significantly reduce complications and improve surgical efficacy.

Abstract:Skull metastasis is relatively rare in patients with renal cell carcinoma,and the occurrence of skull metastasis accompanied by scalp mass formation is even more uncommon.Such cases are often misdiagnosed as tumors of other origins,which can impact subsequent treatment.This paper reports a case of a 76-year-old female patient who developed skull metastasis after renal cell carcinoma surgery.She was admitted to the hospital due to a left frontal scalp mass that had been present for over one month.The patient underwent a left frontal bone mass resection under general anesthesia.Postoperative pathology confirmed metastatic renal cell carcinoma.Following consultation with an oncologist,she was transferred to the oncology department for radiotherapy and targeted therapy.This case highlights that for patients with a history of renal cell carcinoma presenting with a scalp mass,the possibility of skull metastasis should be considered.Early diagnosis and treatment are crucial to avoid misdiagnosis and delays in management.

Abstract:Early microcirculatory disturbances after subarachnoid hemorrhage(SAH)are intricately associated with delayed brain injury and patients'outcomes.Thus,the early detection and management of intracranial ischemia and hypoxia resulting from microcirculatory impairments hold great significance in enhancing the prognosis of SAH patients.Near infrared spectroscopy(NIRS)currently has a certain potential in the monitoring of intracranial microcirculation disorders in SAH patients.This paper aims to comprehensively review the principles,mechanisms,and clinical values of the current applications of NIRS in SAH patients.The intention is to provide valuable insights for establishing a non-invasive,continuous,and bedside multimodal monitoring protocol targeting secondary brain injury in SAH patients,thus offering a reference for improving patient prognoses.

Abstract:Objective To investigate the value of brain volume and cisternal blood volume in the prognostic assessment of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods The clinical data of 160 aSAH patients admitted between January 2019 and January 2021 were retrospectively analyzed.Brain volume and cisternal blood volume were measured using 3D Slicer software based on dynamic CT imaging within one week post-admission.The brain volume change rate was calculated as(maximum brain volume-minimum brain volume)/cranial cavity volume×100%.At the last follow-up,prognosis was assessed using the Glasgow Outcome Scale(GOS)score:good prognosis(GOS 4～5)and poor prognosis(GOS 1～3).Multivariate logistic regression analyzed prognostic factors,while ROC curves evaluated the predictive value of brain volume and cisternal blood volume.Results The patients were followed for 9～24 months(median:14.6 months).Among 160 cases,98 had good prognoses and 62 had poor prognoses.Multivariate analysis identified a higher brain volume change rate(OR=3.456;95%CI 1.359～8.784;P=0.009)and interpeduncular cistern blood volume(OR=2.622;95%CI 1.240～5.544;P=0.012)as independent risk factors for poor prognosis.ROC analysis showed AUCs for predicting poor prognosis were 0.784(95%CI 0.711～0.857)for brain volume change rate and 0.712(95%CI 0.631～0.792)for interpeduncular cistern blood volume,with sensitivities of 77.42%and 66.13%,and specificities of 71.43%and 60.20%,respectively.Conclusion Brain volume change rate and interpeduncular cistern blood volume measured within one week post-admission hold prognostic value for aSAH patients.