The implantable brain-computer interfaces (iBCIs) are cutting-edge technologies that integrate neural signal transducers like micro-electrodes into the cerebral cortex or deep brain tissue through neurosurgical procedures, establishing direct communication pathways between the brain and external devices. As a revolutionary medical advancement, iBCIs technology has been offering hope for refractory motor disorders and neurological conditions. Currently, iBCIs therapeutic strategies, such as deep brain stimulation and responsive neurostimulation, have been widely adopted in clinical practice for major brain diseases including Parkinson disease, consciousness disorders, drug-resistant epilepsy and torsion spasm, achieving significant therapeutic outcomes. However, the rapid clinical adoption of iBCIs technology has prompted urgent consideration of critical ethical issues, including patient eligibility screening, treatment goal determination, optimal intervention windows, and therapeutic targets. This review examines the current status of iBCIs applications in nationally approved clinical treatments and addresses essential ethical considerations during implementation, aiming to provide guidance for both the accelerated development and research of iBCIs technologies.

To investigate the effects and mechanisms of human umbilical cord mesenchymal stem cell-derived exosomes (hUC-MSCs EXOs) on inflammatory response and nerve damage after intracerebral hemorrhage (ICH).

(1) A total of 108 healthy male C57BL/6J mice were randomly divided into three groups: Sham group, Model group, and EXO group, with 36 mice in each group. The ICH model was established by stereotactic injection. The EXO group received a tail vein injection of 100 μg hUC-MSCs-EXOs in PBS solution 4 h after ICH surgery. Neurological function was evaluated using the modified neurological severity score (mNSS) on post-operative days 3, 7, and 14. On day 7 post-surgery, pathological morphological changes were observed via HE staining, and brain edema and oxidative stress indicators [malondialdehyde (MDA) content, total superoxide dismutase (SOD) activity] were detected. (2) An in vitro ICH model using BV2 cells was established and divided into three groups: Control group, PBS group, and EXO group. The EXO group was pre-treated with 10 μg/mL hUC-MSCs-EXOs for 2 h, followed by stimulation with 160 μmol/L hemin for 12 h. Subsequently, the relative mRNA expression level of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6], cell viability, apoptosis rate, and relative protein expression level of high mobility group protein B1 (HMGB1), nuclear factor kappa B inhibitory protein alpha (IκBα), nuclear factor kappa B (NF-κB) were detected in each group.

(1) The effect of hUC-MSCs-EXOs on ICH mice: hUC-MSCs-EXOs significantly alleviated the pathological damage and inflammatory cell infiltration in the brain tissue of mice after ICH. Compared with the Model group, the mNSS scores of mice in the EXO group at 3, 7, and 14 d after surgery, as well as the brain tissue water content and MDA content at 7 d after surgery, were significantly reduced, while SOD activity was significantly increased, and the differences were statistically significant (P<0.05). (2) The effect of hUC-MSCs-EXOs on BV2 cells after ICH: Compared with the PBS group, the mRNA relative expression levels of TNF-α, IL-1β, and IL-6, early cell apoptosis levels, and protein levels of HMGB1 and NF-κB in the EXO group were significantly reduced. Cell viability and protein levels of IκBα were significantly increased, and the differences were statistically significant (P<0.05).

hUC-MSCs-EXOs alleviate inflammatory responses and neuronal damage after ICH by inhibiting the HMGB1-NF-κB signaling pathway, providing a new potential strategy for the treatment of ICH.

To explore the role and mechanism of glycyrrhizic acid, a high-migration group protein B1 (HMGB1) inhibitor, in cognitive disorders in rats with traumatic brain injury (TBI).

Thirty healthy and clean male rats were screened and divided into sham surgery group, model group and inhibitor group by random number table method, with 10 rats in each group. The model group and inhibitor group constructed a TBI cognitive disorder model through the strike method. After modeling, the inhibitor group was injected with glycyrrhizic acid (10 mg/kg) in the peritoneal cavity, once every 6 h for 4 times; the model group was injected with the same dose of physiological saline in the peritoneal cavity. The pseudo-operation group only routinely opened the skull, did not strike, and injected the abdominal cavity and other doses of physiological saline. Morris water maze experiment was used to screen rats with cognitive dysfunction; ELISA was used to detect the activity of total superoxide dismutase (SOD), malondialdehyde (MDA), and the expression levels of high mobility group protein B1 (HMGB1), Toll like receptor 4 (TLR4), and matrix metalloproteinase-9 (MMP9) in serum; Western blot was used to detect the expression of related proteins in brain tissue and hippocampus; RT-qPCR was used to detect the mRNA expression levels of MMP9, HMGB1, and TLR4.

(1) Water maze laboratory test. Positioning navigation experiment: The latency period of the model group was longer than that of the sham surgery group and the inhibitor group, and the difference was statistically significant (P<0.05). Space exploration experiment: Compared with the sham surgery group and the inhibitor group, the number of times they passed through the target quadrant, the distance from the target quadrant, and target quadrant time were all reduced, and the difference was statistically significant (P<0.05). (2) ELISA detection: Compared with the sham surgery group, the SOD activity of the model group rats decreased, while the MDA content and the expression levels of HMGB1, MMP9, and TLR4 increased; Compared with the model group, the inhibitor group showed SOD activity increased, MDA content and expression levels of HMGB1, MMP9, TLR4 decreased, and the differences were statistically significant (P<0.05). (3) RT-qPCR detection: The mRNA expression of MMP9, HMGB1, and TLR4 in the model group rats was higher than that in the sham operation group and inhibitor group, and the differences were statistically significant (P<0.05). (4) Western blot experiment: The expression levels of HMGB1, MMP9, and TLR4 proteins in the model group rats were higher than those in the sham operation group and inhibitor group, and the differences were statistically significant (P<0.05).

HMGB1 inhibitors can improve cognitive impairment in TBI rats, reduce the expression levels of MDA, MMP9, TLR4, and HMGB1, and enhance SOD activity.

To evaluate the efficacy of peripheral nerve decompression surgery in the treatment of moderate-severe uremic peripheral neuropathy (UPN) and to explore the possible mechanisms of action.

Fifty-three patients with moderate-severe UPN treated at Neurosurgery Department and Hemodialysis Center of Jinjiang Hospital from January 2022 to August 2024 were selected and randomly divided into a treatment group (27 cases) and a control group (26 cases) using a random number table method. The control group received conservative treatment, while the treatment group underwent peripheral nerve decompression surgery. The clinical effects of the two groups were evaluated using visual analog scale (VAS), Toronto clinical scoring system (TCSS), quantitative sensory testing (QST), nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV). Musculoskeletal ultrasound was used to measure the changes in nerve diameter and thickness in both groups before and after treatment. The concentrations of C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in the two groups were compared before and after treatment.

In the treatment group, 23 cases were included and 4 cases were shed, and in the control group, 24 cases were included and 2 cases were shed. There was no statistically significant difference in gender, age, average disease duration, average dialysis time, and primary disease between the two groups (P>0.05). The VAS and TCSS scores, VPT, and WPT of the treatment group were lower than those of the control group after treatment, and lower than those before treatment in the same group; the CPT, MNCV, and SNCV scores in the treatment group were higher than those in the control group after treatment, and were also higher than those before treatment in the same group, with statistically significant differences (P<0.05). The diameter of the muscle bone ultrasound nerve in the treatment group after treatment was smaller than that in the control group, and also smaller than that before treatment in the same group, with statistical significance (P<0.05). After treatment, the serum levels of CRP, TNF, IL-6, and IL-8 in both groups of patients were significantly reduced compared to before treatment, and the treatment group was lower than the control group, with statistically significant differences (P<0.05).

Peripheral neurolysis has significant clinical effects in the treatment of moderate-severe UPN. This surgical approach can effectively alleviate symptoms such as pain, cause swelling and compression of nerves, increase nerve conduction velocity, and reduce inflammatory reactions. The surgical safety is high and there are few adverse reactions.

To construct a nomogram model for predicting the risk of new bleeding for traumatic brain injury (TBI) after decompressive craniectomy.

A total of 187 TBI patients who underwent decompressive craniotomy at Second Department of Surgery of Chongqing Kaizhou Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were selected, the occurrence of postoperative new blood emission was recorded. Patients were divided into newly generated blood group and non-newly generated blood group based on whether they experienced new bleeding after surgery, and binary Logistic regression analysis was used to screen for risk factors for new blood emission. The risk prediction model of new blood flow after TBI was constructed by risk factors. Internal validation was performed using bootstrap resampled 1000 times (validation set of 63 cases). Hosmer-Lemeshow was used to evaluate the fit degree of the model, receiver operating characteristic (ROC) curve was used to analyze the value of the model, calibration curve was used to verify the accuracy of the model, and decision curve was used to evaluate the clinical benefits of the model.

Among the 187 patients, there were 23 cases (12.3%) in the newly generated blood group and 164 cases (87.7%) in the non- newly generated blood group. There were differences in the combined skull fracture, preoperative hematoma volume, preoperative Rotterdam CT score, preoperative subdural hematoma, cerebral hernia, postoperative hypotension, surgery time, injury to surgery time, and thrombin time between the two groups of patients (P<0.05). Binary Logistic regression analysis confirmed that combined skull fractures, preoperative hematoma volume≥20 cm³, Rotterdam CT score (4-6 points), postoperative hypotension, and surgery time were independent risk factors for new postoperative bleeding. Constructing a predictive model for risk factors using R language, Hosmer Lemeshow test showed good calibration of the training set (χ²=1.944, P=0.963). ROC analysis showed that the AUC of the training set and validation set were 0.905 (95%CI: 0.849-0.960) and 0.925 (95%CI: 0.839-1.000), respectively. The calibration curve fits well with the ideal curve, indicating high accuracy of the prediction model; The decision curve analysis shows that the model predicts a relatively large net benefit range for new bleeding after decompressive craniectomy.

Combined with skull fracture, preoperative hematoma ≥20 cm³, Rotterdam CT score (4-6 points), postoperative hypotension, and long operation time are the influencing factors for postoperative new blood emission. The risk prediction model based on this construction can provide an auxiliary reference for clinical assessment of the risk of postoperative new blood emission.

To investigate the correlation between postoperative pathological immunohistochemical classification of pituitary adenomas (PAs) and preoperative serum hormone levels.

Patients with PAs who underwent surgical treatment in Neurosurgery Department of General Hospital of Ningxia Medical University from July 2015 to November 2020 were selected as the study subjects. According to the preoperative pathological immunohistochemical staining classification guidelines, PAs were classified into adrenocorticotropic hormone (ACTH) tumors, prolactin (PRL) tumors, gonadotropin (GnH) tumors [luteinizing hormone (LH) tumors and follicle stimulating hormone (FSH) tumors], growth hormone (GH) tumors, thyroid stimulating hormone (TSH) tumors, and zero cell adenomas. General patient data, preoperative serum hormone levels, preoperative imaging reports, and postoperative pathological immunohistochemical staining results were collected. Spearman correlation analysis was used to assess the relationship between preoperative hormone levels and continuous variables such as age, gender, and tumor size. The Kappa consistency test was used to evaluate the diagnostic agreement between preoperative hormone levels and postoperative immunohistochemical classification.

Among the 213 patients with PAs, the 40-60 years age group had the highest number of cases (P<0.05); The proportion of macroadenomas was significantly higher than that of microadenomas and giant adenomas (P<0.05). In GH-secreting adenomas, preoperative GH levels showed a moderate negative correlation with age (r=-0.703, P<0.05). In multihormonal adenomas, preoperative PRL levels were correlated with gender (r=0.400, P<0.05), preoperative FSH levels were correlated with age (r=0.427, P<0.05), and there is no correlation between preoperative hormone levels and tumor size (P>0.05). Among different preoperative serum PRL level stratifications, using PRL>100 ng/mL as the diagnostic reference index yielded the highest agreement rate and Kappa coefficient (94.05%, 0.589). However, the consistency between postoperative pathological immunohistochemical staining diagnosis and preoperative hormone levels was poor in multi hormone adenomas, zero cell adenomas, ACTH tumors, GH tumors, TSH tumors, and GnH tumors.

The correlation between preoperative serum hormone levels and postoperative immunohistochemical classification has significant tumor type specificity. The clinical serological diagnosis of PRL-secreting adenomas was consistent with pathological immunohistochemical diagnosis, and PRL>100 ng/mL could serve as a serological reference value for diagnosing PRL-secreting adenomas. However, the postoperative pathological immunohistochemical staining diagnosis is inconsistent with preoperative hormone levels in multi hormone adenomas, zero cell adenomas, ACTH tumors, GH tumors, TSH tumors, and GnH tumors.

To analyze the epidemiology of traumatic brain injury (TBI) inpatients in the Xinjiang Uyghur Autonomous Region, with the aim of providing feasible recommendations for enhancing the treatment of TBI patients in this region.

Clinical data of TBI inpatients from 29 hospitals of different levels in Xinjiang in 2021 were retrospectively collected. Epidemiological data included demographic distribution, time of injury, cause and location of injury, severity and type of injury, extracranial concomitant injuries, treatment modalities, and prognosis.

A total of 3174 TBI patients were included, with 2281 males (71.87%) and 893 females (28.13%). Middle-aged adults (31-60 years, 1690) constituted the majority, and farmers were the largest occupational group [1215 (38.28%)]. TBI incidence showed clear seasonal variation, peaking in January with a secondary increase from May to July. Ground-level falls (37.52%) and road-traffic injuries (36.11%) were the leading causes; fall-related TBIs were predominantly mild (75.24%), whereas road-traffic injuries and high-level falls more frequently resulted in moderate-to-severe TBI. The most common CT findings were brain contusion/laceration (44.11%), traumatic subarachnoid hemorrhage (42.66%), and skull fractures (41.08%). Extracranial injuries occurred in 53.88% of patients, mainly involving the head and face. Surgical intervention was performed on 19.34% of patients, with intracranial hematoma evacuation combined with decompressive craniectomy being the most common procedure (38.93%). The overall in-hospital mortality rate was 4.44%, with severe TBI showing a markedly higher mortality rate of 82.27%, representing the main source of deaths.

TBI in Xinjiang is mainly affected by male, middle-aged and young people, and farmers, with a high incidence in January. It is necessary to raise public awareness of fall prevention. The proportion of injuries at admission and overall prognosis reflect that the autonomous region's ability to treat severe TBI needs to be improved, and the standardization of diagnosis and treatment processes should be strengthened.

3D-Slicer is a medical imaging analysis and visualization tool that has the advantages of being free and open-source, easy to operate, and widely used in multidisciplinary diagnosis, treatment, and surgery. In the field of neurosurgery in China, 3D-Slicer can integrate DICOM information from CT and MRI to generate multi view 3D models of cranial lesions, assisting physicians in accurately locating preoperative lesions and achieving precise treatment, can be used for diagnosis and surgical treatment of hemorrhagic cerebrovascular disease, intracranial tumors, and functional neurosurgical fields. In addition, 3D-Slicer is also used for surgical teaching of neurosurgery students, which can effectively enhance their learning interest and spatial thinking ability. This article provides a comprehensive review of the core advantages of 3D-Slicer in medical applications, as well as the current status of its clinical and educational use in Neurosurgery, and proposes potential future directions for technological innovation.