Cardiovascular system dysfunction is a common and serious complication in spinal cord injury （SCI） patients throughout the course of SCI， including autonomic dysreflexia and chronic coronary artery disease. At present， clinical and basic research mainly focuse on the reconstruction of motor function in SCI patients and pays insufficient attention to the dysfunction of cardiovascular system. This article mainly reviews the pathophysiological mechanisms，comprehensive assessment methods，and whole-process management strategies of cardiovascular system dysfunction after SCI.
To analyze the clinical effect of cervical spine fixation and posterior fossa decompression combined with syringomyelo-subarachnoid drainage in the treatment of atlantooccipital malformation with syringomyelia （SY）.
Methods
A retrospective collection was conducted on 93 patients with atlantoaxial malformation combined with SY syndrome who underwent cervical spine fixation and posterior fossa decompression combined with syringomyelo - subarachnoid drainage in Neurosurgery Department of the 920th Hospital of PLA Joint Logistics Support Force from January 2017 to May 2024.The clinical symptoms，changes in SY diameter and volume，and imaging data before and after surgery were compared and analyzed.
Results
After the Combined surgical treatment， the patient's symptoms such as headache， dizziness， neck and shoulder pain， numbness， limb immobility， difficulty in moving limbs or unsteady walking， posterior cranial nerve disorders， decreased muscle strength in the limbs， and sensory impairment were significantly relieved， while muscle atrophy improved less. The maximum anterior posterior diameter of the SY， the anterior posterior diameter of the spinal cord in the same plane，the ratio of the cavity to the spinal cord，the length of the cavity，and the volume of the cavity in postoperative patients were significantly reduced compared with preoperative values， and the differences were statistically significant （P＜0.05）. Postoperative MRI showed significant improvement in cavity volume in 82 cases （88.2%）， improvement in 10 cases （10.8%）， and no improvement in 1 case（1.1%）.
Conclusion
Cervical spine fixation and posterior fossa decompression combined with syringomyelo-subarachnoid drainage is effective and safe in treating atlantoaxial malformation with SY.
To explore the relationship between the inflammatory response and the severity and neurological improvement of traumatic spinal cord injury （tSCI）.
Methods
The clinical data of patients with traumatic spinal fractures and spinal cord injuries admitted to Neurosurgery Department of the First Naval Hospital of Southern Theater Command from January 2020 to December 2023 were analyzed. The AIS grading of patients at admission and 6 months after surgery was evaluated， and blood related indicators were collected at admission， including white blood cells （WBC）， neutrophils （NEUT），neutrophil to lymphocyte ratio （NLR）， and C-reactive protein （CRP）. Patients were classified into AIS grades A， B， C， and D according to the AIS grading at admission. The inflammatory indicators of patients with different grades of tSCI were compared， and the correlation between inflammatory indicators and neurological function improvement at 6 months after surgery was analyzed. At the same time， to further demonstrate the important role of inflammation response in tSCI， tSCI related datasets （GSE226238 and GSE151371） were downloaded from GEO database， differentially expressed genes （DEGs） were screened using GEO2R， and GO function and KEGG pathway enrichment analysis were performed on DEGs using Metascape and KOBAS online analysis databases.
Results
The serum levels of WBC，NEUT，NLR，and CRP in AIS grade A patients were significantly higher than those in grade B， C， and D， the CRP level in grade B patients was significantly higher than that in grade C and D patients， and the differences were statistically significant （P＜0.05）. Correlation analysis showed a strong correlation between WBC， NEUT，and CRP and improvement in neurological function at 6 months postoperatively（Eta2=0.975，0.986，0.968，P＜0.05）.A total of 156 differentially expressed genes were screened from the GSE226238 and GSE151371 datasets， including 14 upregulated genes and 142 downregulated genes. Gene function enrichment and pathway enrichment analysis showed that these genes were mainly enriched in immune/inflammation related processes， including cell response to cytokine stimulation， NEUT degranulation， acute/chronic inflammation response， regulation of WBC proliferation， regulation of immune cells， PI3K-AKT signaling pathway， cytokine - cytokine receptor interactions， and Th17 cell differentiation， etc..
Conclusion
Inflammatory response is closely related to tSCI severity and neurologic improvement， and may be one of the key factors determining functional improvement after tSCI.
To investigate the feasibility and safety of one-stage surgical resection of thoracic dumbbell shaped schwannoma under percutaneous tubular retractor system and microscopy.
Methods
A retrospective analysis was conducted on 43 cases of thoracic dumbbell shaped schwannoma treated by a combination of percutaneous tubular retractor system and microscopy in Neurosurgery Department of Fuzong Clinical Medical College of Fujian Medical University from June 2017 to December 2022. The patient's intraoperative bleeding volume， surgical time， hospital stay， and postoperative complications were recorded. The McCormick grading system was used to evaluate the improvement of spinal cord function in patients. The visual analog scale （VAS） was used to assess the level of pain in patients and the changes in scores before and after surgery were compared.
Results
All 43 cases of tumors were completely removed， and postoperative pathology confirmed that they were all schwannomas.Intraoperative bleeding was （85.2±16.7） mL， and the surgical time was 80.0 （68.0， 90.0） min. The length of hospital stay was 6.0 （5.0， 7.0） d. Two cases of pleural tear occurred during surgery and were immediately occluded，and no pneumothorax or pneumonia occurred after surgery.The last follow-up after surgery showed no thoracic vertebral deformities or tumor recurrence on CT and MRI. Forty-two cases（97.7%）showed improvement in spinal cord function，while 1 case （2.3%）showed no improvement.There was a statistically significant difference in the VAS scores of patients before surgery， at discharge， and at the last follow-up （P＜0.05）.
Conclusion
Combination of percutaneous tubular retractor system and microscope can safely remove thoracic dumbbell shaped schwannoma in one stage， reducing intraoperative bleeding and postoperative complications， shortening hospital stay， and reducing the incidence of spinal instability.
To evaluate the effects of contact lasers in the lipomyoma type of tethered cord syndrome （TCS）.
Methods
A retrospective analysis was conducted on the clinical data of 28 patients with lipomyoma type of TCS who were operated solely by one surgeon from April 2021 to June 2023. All patients received contact lasers assisted by electrophysiological monitoring， microscope and three-dimensional external view mirror. Kirollos and Van Hille grading were used to evaluate the degree of loosening of the thrombus during surgery； JOA score was used to assess the neurological function of patients before and after surgery.
Results
During the use of the contact laser，the amount of bleeding in the surgical field was minimal， with an average of 65 mL. There were no cases of infection or death after surgery， and there were no irreversible electrophysiological monitoring alarms at the end of the operation.Among 28 patients， 25 （89.29%） had complete release of the spinal cord， 2 （7.14%） had partial release，and 1 （3.57%） had no release. Twenty - eight patients showed varying degrees of improvement in postoperative JOA scores compared to preoperative levels， with particularly significant changes observed in the number of patients scoring 10-15 and 16-24. Follow up for 3-24 months showed no new cases of severe neurological dysfunction.
Conclusion
Contact lasers could accurately remove lipomatoid tissue especially mixed tough fibre for the lipomyoma type of TCS， little bleeding and low thermal damage， in favour of increasing the proportion of releasing degree， increasing the curative effect for the lipomyoma type of TCS.
Cervical intra- and extra-vertebral dumbbell-type nerve sheath tumor is a special type of cervical spinal canal tumor， which is located in the anatomically complex cervical region， and the tumors are often closely related to the surrounding important tissues and structures， such as cervical marrow， nerve roots， vertebral arteries， etc.， which make surgical resection very risky and challenging.This article reviews the research progress on surgical treatment of cervical intra- and extra-vertebral dumbbell-type nerve sheath tumors in the relevant literature in recent years.
To analyze the risk factors of postoperative encephalocele in patients with severe traumatic brain injury （sTBI）， and to construct a risk prediction model for postoperative encephalocele using random forest algorithm.
Methods
One hundred and eighty patients with sTBI who underwent surgical treatment from March 2020 to June 2023 in Rehabilitation Department of the 901st Hospital of the PLA Joint Logistic Support Force were retrospectively collected as the research objects and used as the modeling group. The patients were divided into the encephalocele group and the nonencephalocele group according to whether they developed encephalocele after surgery. Multivariate Logistic regression was used to analyze the risk factors of postoperative encephalocele in patients with sTBI， and R software was used to establish a random forest model to predict the occurrence of postoperative encephalocele in patients with sTBI. At the same time， 78 patients with sTBI admitted to our hospital from July 2023 to April 2024 were collected as the verification group to verify the accuracy of the random forest model.
Results
Among 180 patients with sTBI， 104 patients with sTBI had postoperative encephalocele （encephalocele group）， and 76 patients with sTBI did not have postoperative encephalocele （non-encephalocele group）， and the incidence of postoperative encephalocele was 57.78%（104/180）. There were significant differences in preoperative intracranial pressure， preoperative GCS score， time from injury to operation， no artificial dural relaxation suture， use of elastic swimming cap and delayed hemorrhage between the encephalocele group and the non - encephalocele group （P＜0.05）.Multivariate Logistic regression analysis showed that preoperative intracranial pressure ＞60 mmHg，preoperative GCS score 3-5 points，time from injury to operation ＞6 h，no artificial dural relaxation suture，no use of elastic swimming cap， and delayed hemorrhage were all independent risk factors for postoperative encephalocele in sTBI patients （P＜0.05）. The results of random forest analysis showed that the relative important predictors of postoperative encephalocele in sTBI patients were， in order，preoperative GCS score， time from injury to operation， no artificial dural relaxation suture， preoperative intracranial pressure， delayed hemorrhage， and use of elastic swimming cap. Based on the above factors，the AUC value of the random forest model for postoperative encephalocele in sTBI patients was 0.850（sensitivity 78.85%，specificity 78.95%），which was higher than that of the multivariate Logistic regression model （AUC=0.811）， and the difference was statistically significant （Z=2.296， P=0.022）. Further external verification of the model found that， The AUC value， specificity and sensitivity of the verification group were 0.838， 81.40% and 74.36%， respectively， which were close to the AUC of the modeling group， with medium prediction efficiency （Z=0.740，P=0.460）.
Conclusion
The influencing factors of postoperative encephalocele in sTBI patients were in order of preoperative GCS score， time from injury to operation， no artificial dural relaxation suture，preoperative intracranial pressure，delayed hemorrhage，and use of elastic swimming cap.The random forest model constructed in this study has a good risk prediction efficiency.
To investigate the diagnostic value of diffusion tensor imaging combined with homocysteine （Hcy） in patients with ischemic stroke complicated with carotid plaque.
Methods
A total of 142 patients with ischemic stroke admitted to Imaging Center of Hefei First People's Hospital from January 2021 to June 2022 were retrospectively selected as the study objects， and were divided into carotid plaque group and no carotid plaque group according to whether they had carotid plaque. The patients were examined by diffusion tensor imaging （DTI） using MRI scanner， the homocysteine level was detected by enzyme circulation method，and the diagnostic efficacy of diffusion tensor imaging parameters［fractional anisotropy （FA） and mean diffusivity （MD）］ and Hcy levels for ischemic stroke complicated with carotid plaques was analyzed by receiver operating characteristic （ROC） curve.
Results
Among 142 patients with ischemic stroke， there were 75 cases in no carotid plaque group and 67 cases carotid plaque group.Compared with no carotid plaque group，the DTI parameters of FA and MD in patients with carotid plaques were reduced， and the serum Hcy level was increased， with statistical significance （P＜0.05）. Logistic regression analysis showed that FA， MD， and Hcy were all risk factors for ischemic stroke complicated with carotid plaques （P＜0.05）. ROC curve analysis showed that the area under the curve（AUC） of FA， MD， and Hcy for the diagnosis of stroke complicated with carotid plaques were 0.830，0.820，and 0.841，respectively.The AUC of the combined detection of FA，MD，and Hcy was 0.909，which was higher than the single detection of FA， MD， and Hcy.
Conclusion
Magnetic resonance diffusion imaging DTI parameters combined with Hcy testing can improve the diagnostic efficiency of patients with ischemic stroke complicated with carotid plaque.
Metaverse is the latest form of Internet in recent years，which has the characteristics of immersion，simulation，real-time synchronization and so on.The application of metaverse in the training of Neurosurgery professionals is of great significance for safeguarding people 's lives and health. The metaverse builds a good learning platform for surgery and patient simulation， remote collaboration and communication， and personalized teaching guidance， which is conducive to integrating educational resources， closely integrating neurosurgical theory and practice， and improving learning efficiency； To break down educational barriers and give the regions with relatively backward educational resources and economic conditions the opportunity to develop neurosurgery；To improve personalized education guidance and develop exclusive learning programs for neurosurgery students to improve learning efficiency. This article elaborates on the application of metaverse technology in neurosurgery and clinical teaching.
Glioma is the primary malignant tumor with the highest incidence rate in the adult central nervous system， and the incidence rate is about 50.1%. Non coding RNA （ncRNA） is a type of RNA molecule that can transcribe but does not encode proteins. It is widely present in eukaryotic genomes and has been shown to participate in various disease biological processes， such as cell proliferation， apoptosis， migration， and invasion. Research has shown that ncRNA such as microRNA，long nRNA， and circular RNA can participate in regulating the biological behavior and progression of gliomas through multiple signaling pathways， and ncRNAs related to the MAPK signaling pathway are potential biomarkers for glioma diagnosis， prognosis evaluation， and treatment. Therefore， this article reviews the role and clinical application of ncRNA related to the MAPK signaling pathway in the occurrence and development of gliomas， aiming to explore new potential biomarkers for the treatment of gliomas.
