Abstract:The efficacy evaluation criteria for brain gliomas have undergone continuous iteration,evolving from the Macdonald criteria and Response Evaluation Criteria in Solid Tumors(RECIST)to the Response Assessment in Neuro-Oncology(RANO)and its related criteria(RANO-HGG,RANO-LGG,iRANO,mRANO),and most recently to RANO 2.0.Early criteria focused on two-dimensional measurements and radiographic changes,which improved the standardization of clinical trials but struggled to address the complex radiographic manifestations of gliomas,such as infiltrative growth and"pseudoprogression/pseudoresponse".Building on this foundation,the RANO series introduced elements such as non-enhancing lesions,cognitive function,seizure control,and adaptability to immunotherapy,enabling a more comprehensive assessment.However,the current system still faces challenges,including rigid thresholds,high subjectivity in interpretation,and insufficient integration with molecular classification.RANO 2.0 proposes a framework emphasizing uniformity rather than mechanism dependency,attempting to accommodate both high-grade and low-grade gliomas as well as diverse treatment modalities.This article provides a comprehensive review of the progress in glioma efficacy evaluation,aiming to summarize its development and existing shortcomings and to offer insights for constructing a more precise and individualized efficacy evaluation system in the future.

Abstract:Objective To investigate the relationship between transcranial Doppler ultrasound(TCD)parameters and neurological injury in patients with severe traumatic brain injury(sTBI)and to construct a nomogram model for predicting poor prognosis.Methods The clinical data of 94 patients with sTBI were analyzed retrospectively.According to the survival status of the patients after a 28-day follow-up,they were divided into a good prognosis group(survival,68 cases)and a poor prognosis group(fatality,26 cases).The survival time of patients with poor prognosis was recorded.TCD parameters[systolic peak flow velocity(Vs),mean peak flow velocity(Vm),resistance index(RI),and pulsatility index(PI)]and neurological injury indicators[neuron-specific enolase(NSE),S100 calcium binding protein β(S100β),N-terminal pro-brain natriuretic peptide(NT-proBNP),and Glasgow Coma Scale(GCS)score]were statistically analyzed and compared between the two groups.Survival curves were plotted to analyze the survival status of sTBI patients.Bivariate Pearson correlation analysis was used to analyze the relationship between TCD parameters and neurological injury in sTBI patients.Cox regression analysis was used to analyze the relationship between TCD parameters and prognosis in sTBI patients and to construct a nomogram prediction model.Results After a 28-day follow-up,the prognosis of the patients during this period was recorded.Among them,26 patients had a poor prognosis,with a poor prognosis rate of 27.66%(26/94),and the average survival time was 14.00(10.00,18.00)days.At admission,the RI and PI levels in the poor prognosis group were higher than those in the good prognosis group,while the Vs and Vm were lower than those in the good prognosis group,with statistically significant differences(all P<0.05).At admission,the levels of NSE and S100β in the poor prognosis group were higher than those in the good prognosis group,while the NT-proBNP level and GCS score were lower than those in the good prognosis group(all P<0.05).In sTBI patients,the RI and PI levels were positively correlated with NSE and S100β(RI:r=0.256,0.229;PI:r=0.255,0.280;all P<0.05)and negatively correlated with NT-proBNP and GCS(RI:r=-0.210,-0.237;PI:r=-0.219,-0.271;all P<0.05).The Vs and Vm levels were negatively correlated with NSE and S100β(Vs:r=-0.316,-0.314;Vm:r=-0.314,-0.282;all P<0.05)and positively correlated with NT-proBNP and GCS(Vs:r=0.218,0.511;Vm:r=0.274,0.287;all P<0.05).Cox regression analysis showed that high levels of RI and PI were risk factors for poor prognosis in sTBI patients(HR=25.487,1.985;both P<0.05),while Vs and Vm were protective factors(HR=0.964,0.950;both P<0.05).The concordance index(C-index)of the nomogram model was 0.971.The area under the curve(AUC)for the model's prediction of poor prognosis in sTBI patients was 0.943,with a sensitivity of 0.846,a specificity of 0.941,and a Youden index of 0.787.Conclusions TCD parameters in sTBI patients are closely related to neurological injury.Meanwhile,a nomogram model constructed based on TCD parameters can effectively predict the risk of poor prognosis in patients.

Abstract:Objective To investigate the relationship between the hemoglobin-albumin-lymphocyte-platelet(HALP)score,pan-immune inflammatory value(PIV),and postoperative cognitive dysfunction(POCD)in patients with aneurysmal subarachnoid hemorrhage(aSAH),and to construct a predictive model.Methods The data of 235 aSAH patients who underwent interventional embolization were retrospectively analyzed.The patients were randomly divided into a training set(165 patients)and a validation set(70 patients)at a 7:3 ratio.Based on the occurrence of POCD at 6 months postoperatively,aSAH patients were divided into a POCD group and a non-POCD group.The HALP score and PIV were calculated.Multivariate logistic regression was applied to identify risk factors of POCD in aSAH patients and construct a nomogram prediction model.The Hosmer-Lemeshow(H-L)test assessed goodness-of-fit,the receiver operating characteristic(ROC)curve evaluated the predictive performance,the concordance index(C-index)evaluated discriminatory ability,the calibration curve evaluated accuracy,and decision curve analysis(DCA)assessed clinical benefit.Results The incidence of POCD was 43.03%(71/165)in the training set and 40.00%(28/70)in the validation set.Hypertension(OR=4.491,95%CI:1.605-12.564,P=0.004),Hunt-Hess grade Ⅲ～Ⅳ(OR=3.274,95%CI:1.252-8.559,P=0.016),modified Fisher grade Ⅲ～Ⅳ(OR=3.140,95%CI:1.239-7.962,P=0.016),and an increased PIV(OR=1.011,95%CI:1.006-1.015,P<0.001)increased the risk of POCD in aSAH patients,while a higher HALP score(OR=0.923,95%CI:0.888-0.960,P<0.001)reduced this risk.A nomogram predictive model for POCD in aSAH patients was established based on the HALP score and PIV[Logit(P)=-0.912+1.502×hypertension+1.186×Hunt-Hess grade+1.144×modified Fisher grade-0.080×HALP+0.011×PIV].The H-L testχ²=5.819,P=0.668.Internal and external validations were performed on the training and validation sets,respectively.The area under the curve(AUC)for predicting POCD in aSAH patients by the nomogram predictive model in the training set and the validation set was 0.912 and 0.888,respectively,both of which were greater than those predicted by hypertension,Hunt-Hess grade,modified Fisher grade,HALP score,and PIV alone(all P<0.05).After 1,000 bootstrap resampling validations,the C-indices were 0.912 and 0.872,respectively.The calibration curve of the nomogram predictive model closely matched the actual curve.The nomogram predictive model provided a positive net benefit within the threshold probability range of 0.05-1.0 in the training set and 0.15-1.0 in the validation set.Conclusions A decreased HALP score and an increased PIV are significant risk factors for the occurrence of POCD in aSAH patients.The nomogram predictive model constructed based on these factors has high predictive performance for the occurrence of POCD in aSAH patients.

Abstract:Objective To establish a clinical prediction model for delayed cerebral ischemia(DCI)after aneurysmal subarachnoid hemorrhage(aSAH)and to investigate its risk factors.Methods Clinical data of 651 patients with aSAH were analyzed retrospectively.Based on the occurrence of DCI,these patients were categorized into non-DCI group(494 cases)and DCI group(157 cases).Potential risk factors were screened through univariate analysis.A predictive model was then constructed using multivariate logistic regression analysis.The predictive performance and accuracy of the model were evaluated using the receiver operating characteristic(ROC)curve and the calibration curve.Results Univariate analysis revealed that surgical method,hydrocephalus,World Federation of Neurological Surgeons(WFNS)grade,Glasgow Coma Scale(GCS)score,Hunt-Hess grade,modified Fisher(mFisher)score,prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),D-dimer,and fibrin degradation products(FDP)were significantly associated with the occurrence of DCI(all P<0.05).Variables that were statistically significant in the univariate analysis were included in the multivariate logistic regression analysis,which showed that craniotomy,GCS score of 3-7,mFisher score≥3,PT>13 s,INR>1.2,and D-dimer>0.55 mg/L were independent risk factors for DCI.Based on the results of the multivariate logistic regression analysis,variables with statistical significance were incorporated into the prediction model.The equation for constructing the prediction model was:Log[P(Y=1)/1-P(Y=1)]=β0+β1X1+β2X2+...+βkXk.The 651 patients were randomly divided into a model training set(456 patients)and a model validation set(195 patients)at a 7:3 ratio.The area under the ROC curve in the validation set was 0.861,and the calibration curve indicated good predictive performance of the model.Conclusion Craniotomy,GCS score,mFisher score,PT,INR,and D-dimer are independent risk factors for DCI following aSAH.The constructed prediction model has high predictive efficacy and can provide a reference for early clinical intervention.

Abstract:Objective To investigate the predictive value of serum biomarkers for cerebral edema and prognosis after endovascular thrombectomy(EVT)in patients with acute ischemic stroke and large vessel occlusion(AIS-LVO)in the anterior circulation.Methods A total of 108 patients with anterior circulation AIS-LVO were selected and divided into a mild group(n=42),a moderate group(n=31),and a severe group(n=35)according to the severity of cerebral edema.An ordinal multinomial logistic regression model was used to analyze the influencing factors of the severity of cerebral edema in patients with anterior circulation AIS-LVO.The severity of cerebral edema and prognosis were compared among patients with different levels of nuclear factor erythroid 2-related factor 2(Nrf2)and heme oxygenase-1(HO-1).Results There were significant differences in the serum levels of Nrf2 and HO-1 among the three groups(all P<0.05).As the severity of cerebral edema increased,the serum levels of Nrf2 and HO-1 decreased.Hypertension and a high National Institutes of Health Stroke Scale(NIHSS)score at admission were independent risk factors for the severity of cerebral edema after EVT in patients with anterior circulation AIS-LVO.Vascular recanalization,Nrf2,and HO-1 were associated with reduced severity of cerebral edema after EVT in AIS-LVO patients(all P<0.05).The likelihood ratio test results indicated that the model fit was statistically significant(χ2=81.629,P<0.01).There were significant differences in the severity of cerebral edema and prognosis among patients with different levels of Nrf2 and HO-1(all P<0.05).In patients with anterior circulation AIS-LVO,lower levels of Nrf2 and HO-1 were associated with more severe cerebral edema and a higher risk of poor prognosis.The combined predictive ability of serum Nrf2 and HO-1 levels for the prognosis of AIS-LVO patients was reflected by an area under the curve(AUC)value of 0.854,which was greater than the prediction made by either serum Nrf2(Z=2.146,P=0.032)or HO-1(Z=2.323,P=0.020)levels alone.Conclusions Decreased serum levels of Nrf2 and HO-1 are associated with increased severity of cerebral edema and poor prognosis in patients with anterior circulation AIS-LVO.They are protective factors for cerebral edema,and combined detection has a higher predictive value for prognosis.

Abstract:Objective To explore the impact of epidermal growth factor receptor variant Ⅲ(EGFRv Ⅲ)on transmembrane calcium ion(Ca²⁺)flow in glioma cells and its association with temozolomide(TMZ)resistance.Methods Stably transfected U87 and LN229 glioma cell lines expressing EGFRv Ⅲ were established.EGFRv Ⅲ protein and mRNA expression levels were validated using immunofluorescence staining,quantitative real-time PCR(qRT-PCR),and Western blotting.Non-invasive micro-test technique(NMT)was employed to measure transmembrane Ca²⁺flux characteristics.Results Compared with non-transfected controls,EGFRv Ⅲ-transfected U87 and LN229 cells exhibited strong positive immunofluorescence signals for EGFRvⅢ,with significantly elevated mRNA and protein levels confirmed by qRT-PCR and Western blotting(all P<0.001),indicating successful transfection.NMT measurements revealed that non-transfected cells predominantly demonstrated Ca²⁺influx,whereas EGFRv Ⅲ-transfected cells showed a reversal of transmembrane Ca²⁺ flux direction from influx to efflux.Conclusions EGFRv Ⅲ expression significantly alters transmembrane Ca²⁺ flux patterns in glioma cells(from influx to efflux),suggesting that EGFRv Ⅲ may contribute to TMZ resistance in glioma by promoting cellular Ca²⁺efflux.

Abstract:Objective To construct and validate a robust prognostic model based solely on the integration of conventional hematoxylin-eosin-stained whole slide imaging(WSI)and clinical features,with the goal of enhancing its clinical applicability.Methods A total of 1,136 WSIs and clinical data from 300 patients in The Cancer Genome Atlas Glioblastoma Multiforme(TCGA-GBM)dataset were retrospectively analyzed.The data were randomly divided into a training set(210 patients)and a test set(90 patients)at a 7:3 ratio.Using a weakly-supervised deep learning framework,prognostic-related features were extracted from over 3.4 million image patches based on the median survival time(15 months).The patch likelihood histogram(PLH)was systematically compared and selected as the patient-level feature aggregation strategy.After integrating clinical variables,13 core features were selected through LASSO regression.Eight machine learning survival models,including random survival forest(RSF)and the LASSO-Cox model,were used for ensemble modeling and evaluation.Results The RSF model demonstrated the best performance in the test set,with time-dependent area under the curve(AUC)values of 0.829,0.887,0.968,0.911,0.841,and 0.848 at 6,12,15,18,24,and 36 months,respectively,showing stable discriminatory performance from the early to medium-long term,with a concordance index(C-index)consistently above 0.782.The model demonstrated good calibration performance,and decision curve analysis revealed significant clinical net benefits across a wide range of threshold probabilities.The survival difference between the high-risk and low-risk groups,divided based on the model's risk score,was highly significant hazard ratio(HR)=5.184,95%confidence interval(CI):4.003-6.712,P<0.0001).Visual analysis indicated that the morphological features identified by the model were qualitatively consistent with typical regions of poor prognosis,such as necrosis and microvascular proliferation.Conclusions The"pathomics-clinical feature"prognostic model for glioblastoma(GBM)patients demonstrates excellent predictive accuracy,robustness,and clinical practicality.It is particularly adept at identifying early high-risk patients,providing an artificial intelligence tool based on conventional data with the potential for visual interpretation and easy dissemination for individualized postoperative prognostic assessment in GBM patients.

Abstract:Objective Based on the WHO Classification of Tumors of the Central Nervous System(5th Edition),this study aimed to explores the predictive value of peripheral blood cell counts and related inflammatory markers for glioma grading,providing a new evidence for preoperative glioma staging.Methods Clinical data of 302 glioma patients were analyzed retrospectively.Clinical information,including complete blood cell counts and serum biochemical test results,was collected to calculate related inflammatory markers.Immunohistochemistry and molecular testing results were also collected.Integrated diagnosis of gliomas was performed according to the WHO Classification of Tumors of the Central Nervous System(5th Edition),and the patients were divided into high-grade glioma(HGG)and low-grade glioma(LGG)groups.Univariate and multivariate logistic regression analyses were used to identify independent predictors of glioma grade.A predictive model was established,and its performance was evaluated using receiver operating characteristic(ROC)curve analysis.Results Univariate analysis revealed that age,absolute neutrophil count,absolute monocyte count,neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),systemic immune-inflammation index(SII),and systemic inflammation response index(SIRI)were significantly higher in HGG patients than in LGG patients.Multivariate analysis identified age,absolute neutrophil count,NLR,SII,and SIRI as independent predictors of glioma grade(all P<0.05).Among the predictive models,the combination of age and absolute neutrophil count demonstrated the highest predictive efficacy(AUC=0.777).Conclusions Under the WHO Classification of Tumors of the Central Nervous System(5th Edition)grading criteria,preoperative absolute neutrophil count and related inflammatory markers are significantly associated with glioma grade.HGG patients exhibit a stronger systemic inflammatory state.Absolute neutrophil count and related inflammatory markers can serve as auxiliary tools for preoperative evaluation of glioma grading in the new classification system.

Abstract:Glioblastoma(GBM)is the most common and highly malignant primary tumor of the central nervous system,characterized by high invasiveness,heterogeneity,and significant treatment resistance,leading to a dismal overall prognosis for patients.Conventional treatment modalities include surgical resection,radiotherapy,and temozolomide chemotherapy;however,their efficacy is severely compromised by factors such as the blood-brain barrier(BBB),abnormalities in the tumor microenvironment(TME),and enhanced antioxidant defenses in tumor cells.In recent years,nanozymes,nanomaterials with enzyme-like catalytic activity,have emerged as a research hotspot in GBM therapy due to their excellent stability,tunable catalytic properties,and multifunctional integration capabilities.Nanozymes can mimic the activities of peroxidase,oxidase,and catalase,generating reactive oxygen species(ROS)and disrupting intracellular homeostasis by depleting glutathione(GSH),alleviating hypoxia,and accelerating redox reaction rates,thereby inducing oxidative stress-related cell death.Some nanozymes exhibit significantly enhanced catalytic efficiency under exogenous stimuli such as ultrasound,light,or magnetic fields,synergizing with radiotherapy and chemotherapy.In the TME,nanozymes can also improve tumor permeability and sensitivity by denaturing collagen,remodeling the extracellular matrix,and modulating immune-related signaling pathways,while activating antitumor immune responses.Through surface functionalization and coupling with targeting molecules,nanozymes achieve trans-BBB delivery and tumor-selective localization.However,the clinical translation of nanozymes for GBM therapy still faces challenges such as long-term biosafety,insufficient delivery efficiency,individual variability,and standardization of synthesis processes.Overall,nanozymes offer novel and multidimensional therapeutic strategies for GBM treatment by catalytically modulating the TME and inducing multi-pathway cell death,holding promise for overcoming current therapeutic bottlenecks and improving patient outcomes.

Abstract:Glioblastoma(GBM)is one of the most aggressive malignant brain tumors.Although temozolomide(TMZ)is the most widely used chemotherapeutic agent,treatment failure often occurs due to drug resistance.This review summarizes the role and mechanisms of epigenetic regulation in TMZ resistance,including DNA methylation,histone modifications(mainly including acetylation,methylation,and lactylation)that promote resistance by regulating MGMT expression,DNA damage repair,mismatch repair function,and cancer stem cell properties;and non-coding RNAs(including long non-coding RNAs,microRNAs,and circular RNAs)that mediate resistance through various mechanisms such as influencing MGMT transport,DNA repair,signaling pathways,and cellular metabolism.Current targeted epigenetic therapeutic strategies show promise in reversing TMZ resistance.Future research should focus on elucidating the collaborative epigenetic regulatory networks and advance individualized precision treatment strategies to improve the prognosis of GBM patients.

Abstract:Objective To characterize secondary spinal cord metastasis(SCM)from intracranial gliomas and to evaluate the association between different treatment combinations and post-SCM survival.Methods The clinical course and management of 2 patients with glioblastoma(GBM)who developed SCM after surgery were analyzed retrospectively.A systematic review of SCM cases was performed following preferred reporting items for systematic reviews and meta-analyses(PRISMA)guidelines(searches conducted up to October 2024).Demographic data,primary tumor characteristics,treatment modalities,and survival outcomes were extracted from included cases.Kaplan-Meier analysis and Log-rank tests were used to compare post-SCM overall survival(post-SCM OS)across different treatment combinations.Results Two SCM patients were female with isocitrate dehydrogenase(IDH)wildtype GBM and developed SCM after standard multimodal therapy.One patient presented with multiple intramedullary segmental lesions and an intraspinal mass at T5-T6 six months post-surgery,experienced short-term remission after concurrent chemoradiotherapy and bevacizumab,but subsequently died from intracranial dissemination.The other patient developed a T7-T8 extramedullary subdural lesion on the background of intracranial recurrence with residual disease;gross total resection was achieved without perioperative complications,and histopathology and molecular profiling were concordant with the primary GBM,confirming secondary SCM.The systematic review included 79 SCM patients with a median age of 43 years;63.3%were male.The primary tumors were predominantly located in the temporal lobe(50.6%),with GBM being the most common pathological type(75.9%).The median interval from initial diagnosis to SCM was 8 months,and the median overall survival after SCM diagnosis was only 3 months.Survival analysis revealed that treatment modality significantly influenced prognosis(χ2=20.02,P=0.005 5),with the surgery-plus-radiotherapy group(without concurrent chemotherapy)demonstrating the longest median survival(9 months).Notably,the addition of chemotherapy to surgery and radiotherapy did not further prolong survival(median survival:3 months;χ2=6.812,P=0.0091).Conclusions SCM carries a dismal prognosis.For patients with high-grade glioma and high-risk features such as ventricular/subventricular zone(SVZ)involvement or intraoperative ventricular entry(VE),spinal MRI should be performed promptly when spinal cord-related symptoms arise during follow-up that cannot be explained by the primary lesion;whole neuraxis imaging may be warranted when indicated.After SCM is confirmed,surgery combined with radiotherapy may be associated with longer post-metastasis survival,whereas the decision to add chemotherapy should be individualized based on disease status and treatment tolerance.

Abstract:Objective To explore the application of the Response Assessment in Neuro-Oncology(RANO)resection classification in insular glioblastoma(GBM)and the factors influencing prognosis.Methods Clinical data of 86 patients with insular GBM from the Chinese Glioma Genome Atlas(CGGA)database were analyzed retrospectively.All the patients underwent craniotomy for tumor resection,with 73 receiving postoperative radiotherapy,6 without radiotherapy,7 missing data and 69 receiving chemotherapy,9 without chemotherapy,8 missing data.The clinical characteristics of all the patients were summarized,including the presence of a history of epilepsy,O6-methylguanine-DNA methyltransferase(MGMT)methylation status,preoperative/postoperative enhanced tumor volume,and RANO resection classification.The Kaplan-Meier method was used to analyze the progression-free survival(PFS)and overall survival(OS)of all the patients.Univariate Cox regression analysis for OS and PFS was performed to screen factors associated with OS and PFS,and further multivariate Cox regression analysis was used to identify the clinical factors influencing PFS and OS.Results Among the 86 patients,24 underwent RANO class 1 resection,58 underwent RANO class 2 resection,and 4 underwent RANO class 3 resection.MGMT promoter methylation was detected in 29 patients(33.7%),unmethylated in 53(61.6%),and missing in 4(4.7%).Kaplan-Meier analysis showed that the median OS and median PFS in the RANO class 1 resection group were 544 days and 527 days,respectively;the median OS and median PFS in the RANO class 2 resection group were 694 days and 502 days,respectively;the median OS and median PFS in the RANO class 3 resection group were 428 days and 210 days,respectively.No significant differences in OS or PFS were observed between the RANO class 1 and class 2 resection groups(both P>0.05).Compared with RANO class 1 and class 2,RANO class 3 resections showed significantly shorter OS(Class 3 vs.Class 1:P=0.05;Class 3 vs.Class 2:P=0.004)and PFS(Class 3 vs.Class 1:P=0.006;Class 3 vs.Class 2:P<0.001).Univariate Cox regression identified MGMT promoter methylation status,age,RANO resection classification,telomerase reverse transcriptase(TERT)promoter mutation status,and histopathology as factors influencing OS(all P<0.05).Multivariate Cox regression revealed MGMT promoter methylation,age,and RANO class 2 resection as independent protective factors for OS(all P<0.05),while MGMT promoter methylation,age and RANO class 2 and RANO class 1 resections were independent protective factors for PFS(all P<0.05).Conclusions With advances in microsurgical techniques and the development of molecular therapies,the prognosis of insular GBM has improved to a certain extent.The analysis showed that compared with RANO class 3 resection,RANO class 1 and class 2 resections significantly improve patient prognosis,indicating the importance of complete resection of MRI T1-enhancing lesions in insular GBM.However,excessive pursuit of resection of the preoperative edematous area(MRI T2 hyperintense area)should be avoided to prevent neglect of neurological function protection.

Abstract:The tumor microenvironment(TME)is a key factor in tumor progression,and various components within it play specific roles.As one of the main components,cancer-associated fibroblast(CAF)have gradually become one of the focuses of tumor-related research in recent years.This article summarizes the current research status of CAF in glioma and other tumors,including the origin and heterogeneity of CAF,their interaction with tumor cells(with a particular focus on their inhibitory effect on the immune microenvironment),as well as the research progress of CAF-targeted therapy.Although research on CAF in glioma is relatively limited,it can be inferred from the current research that CAF-targeted therapy has potential research and application value in glioma,and it is worthwhile to explore more CAF targets in the future.

Abstract:Objective To explore a precise localization technique based on the recognition of brain surface topological features,aiming to enhance the extent of tumor resection and reduce postoperative dysfunction.Methods Three-dimensional reconstruction was performed using 1 mm-thick MRI data to construct projection models of the lesion on the brain surface and the lateral fissure.Topological features such as sulci,gyri,and blood vessels were identified to plan individualized cerebral cortical incisions.DTI neural tract imaging was integrated to simultaneously display the spatial relationship between the tumor and critical functional tracts.Results Preoperative localization and intraoperative anatomy were highly consistent in three cases of gliomas located in different regions(frontal lobe,temporal lobe,and insular subcortex).The length of cortical incisions was shortened,the protection of vascular and neural structures was remarkable,tumor resection was satisfactory,and no severe postoperative complications occurred.Conclusions The topological localization technique provides a more intuitive intraoperative lesion localization method through a brain surface topological feature matching mechanism,overcoming brain shift errors associated with traditional neuronavigation.It offers a novel strategy for high-precision glioma surgery,achieving a balance between"anatomical resection"and"functional preservation".

Abstract:Glioblastoma(GBM)is the most common and aggressive primary malignancy of the central nervous system,and current multimodal treatments still fail to substantially improve patient prognosis.Although immune checkpoint blockade(ICB)has shown substantial efficacy in several extracranial malignancies,its overall clinical benefit in GBM remains limited,with responses observed in only a subset of patients.The restrictive blood-brain barrier(BBB)and the profoundly immunosuppressive tumor microenvironment(TME)represent major obstacles to systemic ICB delivery,resulting in limited overall clinical benefit and therapeutic responses confined to a subset of patients with GBM.Neurosurgical intervention provides a unique therapeutic window to overcome these barriers.Local administration of ICBs during the perioperative period enables direct,high-concentration exposure at the tumor site,bypasses the BBB,and promotes more effective modulation of the local immune milieu.Recent advances in neurosurgically enabled local delivery systems,such as sustained-release formulations within the resection cavity,have further expanded the potential of this strategy.Integration of local ICB delivery with surgery,radiotherapy,and chemotherapy is increasingly recognized as a promising approach,highlighting the emerging paradigm of surgical window-guided personalized immunotherapy for GBM.

Abstract:Stroke often leads to severe loss of motor function in patients,and traditional rehabilitation methods show limited efficacy for those in the chronic stage.Breaking through the current therapeutic bottlenecks to achieve effective motor function recovery has become an urgent clinical challenge.Spinal cord stimulation(SCS),by precisely modulating spinal neural networks and activating residual neural pathways,promotes neural plasticity and demonstrates remarkable efficacy in improving muscle tone and enhancing motor control.This article summarizes the potential mechanisms,therapeutic effects,and innovative developments of SCS in treating post-stroke motor disorders,providing a reference for the application of SCS in managing motor impairments after stroke.

Abstract:Refractory epilepsy(RE)refers to epilepsy in which patients continue to experience seizures despite receiving two or more appropriately chosen and tolerated antiseizure medications(ASMs).Vagus nerve stimulation(VNS)is a therapeutic method that delivers intermittent electrical stimulation to the vagus nerve trunk via an implanted stimulator,thereby transmitting impulses to the intracranial regions and inducing widespread functional changes in the nervous system to alleviate RE.Studies have suggested that VNS may improve RE by modulating inflammatory pathways,with its mechanism potentially involving the regulation of the NOD-like receptor family pyrin domain containing 3(NLRP3)/cysteine-dependent aspartate-directed protease 1(Caspase-1)/interleukin(IL)-1β inflammasome signaling pathway.This review provides a comprehensive overview of research on VNS regulation of the NLRP3/Caspase-1/IL-1β pathway in improving RE,aiming to enhance the understanding of the mechanisms of VNS therapy and to provide theoretical support for clinical treatment.

Abstract:Objective To analyze the clinical features and risk factors of invasiveness in non-functioning pituitary adenomas(NFPA).Methods Clinical data of 111 patients with NFPA were analyzed retrospectively.According to pituitary hormone testing,imaging examination,and postoperative pathological results,patients were divided into an invasive group(n=47)and a non-invasive group(n=64).The clinical data as demographic indicators,endocrine indicators,features of the tumor,and surgery-related indicators were collected.Univariate analysis was used to identify clinical features of invasiveness of NFPA,and multivariate analysis was employed to determine the influencing factors.Receiver operating characteristic(ROC)curves were plotted to analyze the influencing factors and their predictive efficacy for invasiveness.Cox regression analysis was utilized to identify factors influencing recurrence.Results Among the 111 NFPA patients,47(42.34%)were classified into the invasive group,and the remaining 64(57.66%)into the non-invasive group.The invasive group exhibited larger maximum tumor diameters,higher proportions of unilateral/bilateral hemianopsia,irregular tumor shapes,optic nerve compression,and cavernous sinus invasion,but a lower proportion of tumor apoplexy compared to the non-invasive group(all P<0.05).The invasive group also had higher proportions of near-total/subtotal tumor resection and postoperative complications than the non-invasive group(both P<0.05).Multivariate logistic regression analysis revealed that total tumor resection and cavernous sinus invasion were influencing factors for invasiveness in NFPA patients,with total tumor resection serving as a protective factor(P<0.05).ROC analysis showed that the area under the curve(AUC)values for predicting NFPA invasiveness were 0.894 for the extent of tumor resection and 0.911 for cavernous sinus invasion;the combined assessment yielded the highest AUC value(0.969),significantly greater than those for individual predictions(Z=2.944,3.041,P<0.05).The recurrence rate was higher in the invasive group than in the non-invasive group(P<0.05).Multivariate Cox regression analysis indicated that cavernous sinus invasion and near-total/subtotal resection were risk factors for recurrence(P<0.05).Conclusions Cavernous sinus invasion is a risk factor for invasiveness in NFPA,while achieving total tumor resection is an important protective factor.The combination of these two indicators demonstrates good predictive value for invasiveness.Invasive NFPA has a higher recurrence rate,with cavernous sinus invasion and near-total/subtotal resection being risk factors for recurrence.Preoperative imaging assessment of cavernous sinus invasion holds core guiding value for predicting NFPA invasiveness and formulating surgical strategies.