Acute brain bulge is a critical phenomenon in open surgery for traumatic brain injury（TBI）， with common causes including delayed hematoma， massive cerebral infarction and diffuse cerebral swelling， the prognosis is usually very poor. In recent years， with the promotion and application of the concept of controlled intracranial decompression （CID） and related technologies， the incidence of intraoperative brain bulge has decreased significantly. However， some patients still suffer from brain bulge， especially those with severe diffuse cerebral swelling. Traumatic brain swelling （TBS） is an important basis for primary brain bulge， and the pathological mechanisms of both are complex. Therefore，the clinical efficacy of CID technology should be viewed rationally， and new theories and mechanisms of TBS should be explored. This article mainly reviews the mechanisms of TBS and primary brain bulge， the operational principles of CID technology， and its preventive mechanism and effect， with the aim of providing reference for improving the success rate of surgery for TBI patients.
To explore the targeted regulatory mechanism of circ-SESN2 silencing on miR-23a-5p and ULK1 pathway in a neuronal oxidative stress model.
Methods
（1） B35 cells were treated with different concentrations （0，100，200，400，600，800 μmol/L）of H2O2 for 24 h.The cell status was detected using CCK-8 method and flow cytometry to determine the optimal conditions for H2O2 induced oxidative stress damage in B35 cells. （2） B35 cells were transfected with wild-type （WT） and mutant（MT）plasmids containing circ-SESN2 and divided into four groups：circ-SESN2-3’UTR WT+miRNC group，circ-SESN2-3’UTR WT+miR-23a-5p group，circ-SESN2-3’UTR MT+miR-NC group，and circ-SESN2-3’UTR MT+miR-23a-5p group. Dual luciferase activity was used to detect the expression of circ-SESN2 gene and verify the targeted binding relationship between circ-SESN2 and miRNA-23a-5p. （3）The transfection effects of siRNA at different concentrations （0.1，0.01 μmol/L）and transfection durations（24，48 h），as well as the silencing effects of 3 different targets（siRNA-ccirc-SESN2-1156，1227，1692）on circ-SESN2 were compared， in order to determine the optimal transfection conditions and most effective circ-SESN2 siRNA targets for siRNA. （4） B35 cells were divided into blank group， model group， H/R model+siRNA negative control group， and H/R model+circ-SESN2-siRNA group. Except for the blank group， all three groups were treated with 400 μmol/L f H2O2 for 24 h. After intervention， the cell status was detected using CCK-8 and flow cytometry， and oxidative stress indicators such as manganese superoxide dismutase （Mn-SOD）， total superoxide dismutase （T-SOD）， NO， and 3-nitrotyrosine （3-NT）were detected using a biochemical kit. miRNA-23a-5p and ULK1 gene expression were detected using qRT-PCR， and ULK1 protein content was detected using Western blot.
Results
（1） The CCK-8 detection and SOD activity detection results showed that the survival rate and SOD activity of B35 cells gradually decreased with the increase of H2O2 concentration. Among them， the survival rate of the 400 μmol/L group decreased significantly compared to the 0， 100， and 200 μmol/L groups， and the SOD activity of the 400 μmol/L group decreased significantly compared to the 0 and 100 μmol/L groups， with statistical significance （P＜0.05）. Therefore， 400 μmol/L H2O2 was used as the oxidative stress damage condition for subsequent experiments.（2）The luciferase activity of the circ-SESN2-3’UTR WT+miR-23a-5p group was significantly lower than that of the circ-SESN2-3’UTR WT+miR-NC group，circ-SESN2-3’UTR MT+miR-NC group， and circ-SESN2-3’UTR MT+miR-23a-5p group， with statistical significance （P＜0.05）. （3） The transfection efficiency of 0.1 μmol/L siRNA transfection for 48 h was significantly better than other transfection conditions （0.01 μmol/L siRNA transfection for 24 h， 0.01 μmol/L siRNA transfection for 48 h， 0.1 μmol/L siRNA transfection for 24 h）. In target screening， the gene levels of the siRNA-ccirc-SESN2-1156 group，siRNA-ccirc-SESN2-1227 group，and siRNA-ccirc-SESN2-1692 group were significantly lower than those of the blank group and siRNA-NC group， with siRNA-ccirc-SESN2-1692 showing the best silencing effect. （4） The cell survival rate of the H/R model+circ-SESN2-siRNA group was lower than that of the blank group， but higher than that of the H/R model+siRNA negative control group and the model group； The apoptosis rate of cells in the H/R model+circ-SESN2-siRNA group was higher than that in the blank group， but lower than that in the H/R model+siRNA negative control group and model group， and the differences were statistically significant （P＜0.05）. The Mn-SOD and T-SOD contents in the H/R model+circ-SESN2-siRNA group were lower than those in the blank group， but higher than those in the model group and the H/R model+siRNA negative control group； The levels of NO and 3-NT increased compared to the blank group， and decreased compared to the model group and the H/R model+siRNA negative control group， with statistically significant differences （P＜0.05）. Fluorescence quantitative detection showed that miRNA-23a-5p in the H/R model+circ-SESN2-siRNA group was higher than that in the model group and H/R model+siRNA negative control group，while ULK1 was lower than that in the model group and H/R model+siRNA negative control group， with statistical significance （P＜0.05）.
Conclusion
Silencing circRNA-SESN2 may reduce the expression of ULK1 through the SESN2/miRNA-23a-5p/ULK1 pathway and play a protective role in B35 neurons under oxidative stress.
To investigate the effect of intravascular embolization combined with surgical resection in the treatment of scalp arteriovenous malformations （SAVMs）.
Methods
The clinical data of 53 patients with SAVMs admitted to Neurosurgery Department of the 970th Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China from January 2011 to February 2021 were retrospectively analyzed， and the patients were divided into surgical resection group （n=21）and joint therapy group （n=32） according to the different surgical approaches. The surgical resection group applied surgical resection treatment， and the joint therapy group applied intravascular embolization combined with surgical resection treatment. The clinical symptom improvement， imaging findings，postoperative complications and recurrence rate were observed and compared between two groups.
Results
There was no statistically significant difference in the total resection rate between the two groups （P＞0.05）. The blood loss and operation time in joint therapy group were both less than those in surgical resection group，and the differences were statistically significant （P＜0.05）.The clinical symptoms（scalp swelling， localized pressure sensation and dizziness） and imaging evaluation results （maximum diameter of SAVMs， vascular diameter and blood flow resistance index） showed improvement in both groups after treatment， and the improvement was more significant in joint therapy group compared to surgical resection group （P＜0.05）. The incidence rate of neurological damage and postoperative bleeding in joint therapy group was lower than that in surgical resection group （P＜0.05）. Within 2 years of postoperative follow - up， the recurrence rate in surgical resection group was 19.05%， whereas no recurrence occurred in joint therapy group， the difference was statistically significant （P＜0.05）.
Conclusion
Application of intravascular embolization combined with surgical resection in the treatment of SAVMs can effectively ameliorate the clinical symptoms， reduce the size of lesion， improve the peripheral vascular status，and lower the recurrence rate.
To investigate the application value of neurofilament light chain （NF-L），nucleotides binding oligomer domain like receptor protein 3（NLRP3）and S100B protein in the evaluation of the severity and prognosis of traumatic brain injury （TBI）.
Methods
One hundred TBI patients admitted to Neurosurgery Department of General Hospital of Northern Theater Command of PLA from January 2016 to December 2023 were selected as the study group. The patients were divided into mild group （n=32，GCS＞12 score） and moderate to severe group （n=68，GCS≤12 score） according to GCS score at admission. Thirty days after routine treatment， the patients were further divided into good prognosis group （n=72， GOS＞3 score） and poor prognosis group （n=28， GOS≤3 score） according to GOS score. One hundred healthy subjects were selected as the control group during the same period. NF-L， NLRP3 and S100B were detected by enzyme-linked immunosorbent assay， and the general data and levels of NF-L，NLRP3 and S100B in the two groups were compared between groups， and receiver operating characteristic （ROC）curve was drawn to analyze the application value of NF-L，NLRP3 and S100B in the evaluation of severity and prognosis of TBI.
Results
The levels of NF-L， NLRP3， and S100B in the study group were higher than those in the control group， and the differences were statistically significant（P＜0.05）. In the study group， the levels of NF-L， NLRP3， and S100B were higher in the moderate to severe group than in the mild group， the levels of NF-L， NLRP3， and S100B were higher in the poor prognosis group than in the good prognosis group， and the differences were statistically significant （P＜0.05）.ROC curve analysis showed that the area under the curve （AUC）of NF-L，NLRP3，S100B，and their combined assessment of moderate to severe TBI were 0.682 （0.649-0.715）， 0.706 （0.682-0.730）， 0.711（0.685-0.737）， and 0.824 （0.733-0.915）， respectively. The application efficiency of the combined assessment of TBI severity was higher than that of a single indicator； The AUC of NF-L， NLRP3， S100B， and their combined prediction of poor prognosis in TBI were 0.615（0.584-0.646），0.735（0.685-0.785），0.692（0.616-0.768）， and 0.816 （0.728-0.904）， respectively. The application efficiency of the combined prediction of TBI by the three indicators was higher than that of a single indicator.
Conclusion
NF-L， NLRP3 and S100B are highly expressed in moderate and severe TBI and poor prognosis，which can reflect the severity of TBI and provide a certain reference for predicting poor prognosis.
To compare the efficacy of minimally invasive drilling drainage and neuroendoscopic hematoma removal for treatment of critical basal ganglia hemorrhage.
Methods
A prospective study was conducted on 60 patients with critical basal ganglia hemorrhage admitted to Neurosurgery Department of Xuzhou Central Hospital from January 2020 to January 2023. The patients were randomly divided into neuroendoscopic group （30 cases） and puncture drainage group （30 cases）.Neuroendoscopic surgery and puncture drainage were performed respectively. The perioperative indicators， as well as the levels of interleukin-6 （IL-6） and neuron specific enolase （NSE） before and 1， 2，and 4 weeks after surgery， were compared between the two groups. The changes in the National Institutes of Health stroke scale （NIHSS） score， GCS score， and Montreal cognitive assessment （MoCA） score of the two groups were observed after surgery.
Results
The hematoma clearance rate of the puncture drainage group was slightly lower than that of the neuroendoscopic group， but the surgical time，hospitalization time， and hospitalization costs were all less than those of the neuroendoscopic group， and the differences were statistically significant （P＜0.05）. As the course of the disease prolonged， the levels of IL-6 and NSE in both groups decreased significantly at 1， 2， and 4 weeks after surgery compared to preoperative levels， with the puncture drainage group showing a more significant decrease， and the differences were statistically significant （P＜0.05）； The GCS scores of the two groups gradually increased at 1， 2， and 4 weeks after surgery compared to preoperative levels， while the NIHSS scores gradually decreased， and the improvement was more significant in the puncture drainage group， the differences were statistically significant （P＜0.05）. The MoCA scores of both groups at 4 weeks after surgery were higher than those before surgery， and the MoCA score was higher in the puncture drainage group than in the neuroendoscopic group， with statistical significance （P＜0.05）.
Conclusion
Compared with neuroendoscopic hematoma removal， minimally invasive drilling drainage can more effectively improve cognitive dysfunction in patients with critical basal ganglia hemorrhage， reduce IL-6 and NSE levels，decrease the degree of postoperative cranial brain injury， shorten hospitalization time and overall hospitalization costs，and improve patient prognosis.
To explore the application value of neuronavigation combined with intraoperative neurophysiological monitoring （IONM） in the surgical resection of brainstem glioma.
Methods
The case data of 107 patients with brainstem glioma treated in Neurosurgery Department of the 910th Hospital of Quanzhou Joint Logistics Support Force from August 2018 to April 2020 were retrospectively analyzed， and the patients were divided into observation group （neuronavigation combined with IONM for tumor resection， n=55） and control group （traditional craniocerebral microsurgery-assisted tumor resection， n=52） according to different surgical methods. The clinical efficacy， perioperative indicators， neurological function， activity of daily living， survival quality and surgical complications were compared between two groups.
Results
The tumor resection degree and surgical treatment effect of the observation group were better than those of the control group， and the surgical duration and postoperative hospital stay were shorter than those of the control group，with statistical significance（P＜0.05）.The scores of Karnofsky functional status and functional independence measure of the observation group at 6 months after surgery were higher than those of the control group，and the difference was statistically significant（P＜0.05）. After a 2-year follow-up， the average survival period of the observation group was （26.77±7.69）months， and the progression free survival period was （23.21±6.45） months. The average survival period of the control group was （21.00±7.15） months， and the progression free survival period was （18.75±5.58）months.The survival of the observation group was better than that of the control group，and the difference was statistically significant （P＜0.05）. The total incidence of surgical complications in the observation group was lower than that in the control group， and the difference was statistically significant （P＜0.05）.
Conclusion
The application of neuronavigation combined with IONM can enhance the degree of tumor resection， increase the surgical efficacy and postoperative survival quality， significantly improve the neurological function and activity of daily living， and reduce the incidence rates of surgical complications in the surgical resection of brainstem glioma.
To compare and analyze the clinical efficacy of stereotactic puncture and drainage of hematoma through frontal parallel white matter fiber and hematoma evacuation under neuroendoscopy in the treatment of basal ganglia intracerebral hemorrhage.
Methods
A total of 45 patients with basal ganglia intracerebral hemorrhage admitted to Neurosurgery Department of Ma’anshan People’s Hospital from June 2020 to April 2024 were collected. According to the treatment method，patients were divided into the stereotactic group （31 patients underwent stereotactic hematoma puncture and drainage via frontal parallel white matter fiber bundle） and the neuroendoscopic group （14 patients underwent endoscopic hematoma removal）. The operation time， intraoperative blood loss， postoperative residual hematoma volume，postoperative brain edema，postoperative activities of daily living （ADL）score and modified Rankin scale （mRS） score，and complications were compared between two groups.
Results
The intraoperative bleeding and postoperative brain edema volume in the stereotactic group were significantly less than those in the neuroendoscopy group， and the hematoma volume at 6 h after surgery was greater than that in the neuroendoscopy group， with statistical significance （P＜0.05）. There was no statistically significant difference in the surgical time， postoperative 3-day hematoma volume，complications， and postoperative rebleeding between two groups （P＞0.05）. The white matter tract protection， ADL score at 1 month after surgery， and mRS score at 3 months after surgery in the stereotactic group were all better than those in the neuroendoscopy group， and the differences were statistically significant （P＜0.05）.
Conclusion
Transfrontal parallel white matter fiber tract stereotactic hematoma puncture and drainage is superior to neuroendoscopic hematoma removal in terms of intraoperative blood loss， postoperative brain edema and prognosis， and can reduce the damage of cerebral white matter fiber tracts.
Chronic subdural hematoma （CSDH） is a common condition in neurosurgery， with its incidence rising steadily due to population aging.Surgery remains the first-line treatment for symptomatic CSDH. With the growing trend toward minimally invasive approaches， minimally invasive surgery and non-surgical treatments are gradually replacing traditional craniotomy for hematoma evacuation as the preferred therapeutic options for neurosurgeons. This article provides a comprehensive review of recent advances in minimally invasive surgical and non-surgical treatments for CSDH， and explores various new non-surgical treatment methods and multimodal treatment strategies， in order to provide new theoretical basis and practical direction for the optimization and personalized treatment of clinical CSDH treatment plans.
Alginate gel has good histocompatibility and biodegradability， and has been widely studied and applied in bone tissue repair as a three-dimensional culture scaffold，and remarkable progress has been made. Because of its superior mechanical properties and biological activities， alginate gel can play a continuous role in the skull defect area， so as to promote the regeneration， proliferation and differentiation of bone cells， accelerate the process of bone tissue repair， and improve its therapeutic effect in bone tissue repair.This review focuses on the application of alginate saline gel combined with 3D stent in the repair of skull defects in recent years， in order to provide a reference for its clinical application.
