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  • 1.
    Expert consensus of cranioplasty for skull defect (2025 version)
    Professional Committee of Traumatic Brain Injury, World Association of Chinese Neurosurgeon, Collaborative Group for Expert Consensus of Cranioplasty for Skull Defect
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (04): 210-219. DOI: 10.3877/cma.j.issn.2095-9141.2025.04.002
    Abstract (1084) HTML (224) PDF (3766 KB) (1182)

    Skull defects remaining after decompressive craniectomy can lead to a lack of protection for brain tissue, disruption of cranial cavity integrity, resulting in limited recovery of neurological function, as well as affecting patients' appearance and psychological health. However, skull defect repair involves multiple factors such as scalp healing, bone resorption, postoperative cerebrospinal fluid dynamics changes, and the need for neurological functional compensation. The timing of repair, material selection, and surgical strategies remain controversial. Based on evidence-based medical evidence and the experience of multidisciplinary experts, the China Expert Consensus Collaboration Group on Cranioplasty organized domestic experts. Through literature analysis and expert experience integration, and using the Delphi method, this consensus was developed to provide standardized guidance for cranioplasty.

  • 2.
    Mechanism of GRP75 in neuroinflammation caused by traumatic brain injury
    Xingyuan Ma, Hongtao Sun, Jingjing Wang, Dangli Ren, Zemeng Li, Xiao Ding, Yuhang Zhang, Tingzhen Deng, Yueyang Chen, Shuying Wang, Yitai Yang, Hekong Wang, Maohua Zheng
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 75-85. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.002
    Abstract (193) HTML (5) PDF (6083 KB) (20)

    Objective

    To investigate the effects of lipopolysaccharide (LPS) on gene expression levels in the BV2 microglial cell line using transcriptome sequencing and bioinformatics analysis, and to explore the function and mechanism of glucose-regulated protein 75 (GRP75) in neuroinflammation induced by traumatic brain injury (TBI).

    Methods

    BV2 cells were selected for the experiment and randomly divided into the control group and an LPS group. The control group did not receive any treatment, while the LPS group was treated with 1 μg/mL LPS for 6 h. Three biological replicates were set up for each experimental group. Transcriptome sequencing was performed on the two groups of cells.Bioinformatics analysis was used to screen for significantly differentially expressed genes (DEGs), and cluster analysis was performed on the significant DEGs to analyze the changes in the expression level of GRP75 in an in vitro cellular neuroinflammation model. The expression level of GRP75 was validated using qPCR and Western blotting. Fifteen healthy male SD rats were selected to construct TBI and Sham rat models. They were divided into sham operation group (Sham group), TBI 3 d group, TBI 7 d group, TBI 14 d group, and TBI 28 d group according to the double random number table method, with three rats in each group. Western blotting was used to detect the expression of GRP75 at different time periods. To investigate the mechanism of action of GRP75 in neuroinflammation, GRP75 overexpression experiments and GRP75 inhibition experiments were designed separately. In the GRP75 overexpression experiment,BV2 cells were transfected with empty vector plasmid (Vector) and GRP75 overexpression plasmid(GRP75-OE), and divided into Vector group, GRP75-OE group, Vector+LPS group, and GRP75-OE+LPS group; In the GRP75 inhibitor treatment experiment, BV2 cells were treated with 5 μg/mL GRP75 inhibitor MKT-077 for 18 h, and the cells were divided into CON group, MKT-077 group, LPS group, and LPS-MKT-077 group. Western blotting was used to detect the protein levels of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and phosphorylated nuclear factor kappa B P65 subunit(NF-κB P65) in each group of cells, and the effects of GRP75 overexpression and inhibition on the NF-κB pathway were analyzed.

    Results

    Transcriptomic analysis indicated that GRP75 protein expression levels in the LPS group were significantly lower than those in the control group (P<0.05). Validation experiments showed that GRP75 expression in the the LPS group was significantly lower than that in the control group (P<0.05). In TBI rat brain tissues, compared with the Sham group, the relative expression levels of GRP75 protein decreased in the TBI 3 d group, TBI 7 d group, TBI 14 d group, and TBI 28 d group (P<0.05). In experiments exploring the anti-inflammatory mechanism of GRP75, overexpression experiments of GRP75 showed that iNOS, COX-2, and phosphorylated NF-κB P65 levels were significantly reduced in the GRP75-OE+LPS group compared to the Vector+LPS group (P<0.05). The GRP75 inhibitor treatment experiment showed that iNOS, COX-2, and phosphorylated NF-κB P65 levels were significantly increased in the MKT-077+LPS group compared to the LPS group (P<0.05).

    Conclusions

    GRP75 expression is downregulated in TBI rat brain tissues and in vitro neuroinflammation models. Overexpression of GRP75 significantly reduces neuroinflammation, potentially by modulating the NF-κB pathway, thereby alleviating neuroinflammation following TBI and reducing secondary damage. GRP75 may therefore play a protective role in TBI and serve as a potential therapeutic target for mitigating TBI-induced neuroinflammation.

  • 3.
    Intermittent fasting improves cerebral ischemia/reperfusion injury by promoting the Nrf2 pathway to inhibit oxidative stress
    Lijun Ma, Zhibiao Wang, Xiaowei Fei, Zheming Yue, Jia Yong, Hongjie Wang, Yanghong Bai, Lu Che, Hongchen Zhang, Xia Li
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (04): 220-229. DOI: 10.3877/cma.j.issn.2095-9141.2025.04.003
    Abstract (193) HTML (3) PDF (4013 KB) (12)
    Objective

    To explore the neuroprotective effects and mechanisms of intermittent fasting (IF) on ischemia/reperfusion (I/R) injury in mice.

    Methods

    A total of 150 healthy male C57BL/6J mice were randomly divided into three groups using a random number table: sham surgery group (Sham group), ischemia/reperfusion group (I/R group), and intermittent fasting group (IF group), with 50 mice in each group. The I/R group underwent right middle cerebral artery occlusion (MCAO) to establish a focal cerebral I/R model; the IF group implemented a 16/8 intermittent fasting regimen based on the I/R group; the Sham group only isolated the blood vessels without inserting the filament. All mice were fasted for 12 h prior to surgery with free access to water. After 30 d, the neurological function of the mice was assessed using the modified neurological severity score (mNSS), motor function was evaluated using the rotarod test, learning and memory function was assessed using the novel object recognition test, brain edema was measured using the dry/wet weight method, brain infarct volume was calculated using Image-J software, neuronal injury was detected using Nissl staining, and levels of reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH), and total antioxidant capacity (T-AOC) in brain tissue were measured using commercial kits. Gene expression levels of NADPH quinine oxidoreductase-1 (NQO-1), heme oxidase-1 (HO-1), and glutathione peroxidase 4 (GPX4) in brain tissue were detected by qPCR and Western blot, and the levels of nuclear factor-E2-related factor 2 (Nrf2) protein in the nucleus and cytoplasm of brain tissue were measured by Western blot.

    Results

    The mNSS scores, drop time of the rotating rod test, new object recognition index, degree of brain edema, brain infarct volume, degree of neuronal damage, oxidative stress intensity (ROS, MDA, GSH, and T-AOC levels), nuclear translocation level of Nrf2, and mRNA and protein expression of antioxidant genes NQO-1, HO-1, and GPX4 in Sham group, I/R group, and IF group mice 30 d after I/R were compared, and the differences were statistically significant (P<0.05). The mNSS scores and rotarod drop times of the IF group were significantly lower than those of the I/R group, while the recognition index for new objects was significantly higher in the IF group compared to the I/R group, with statistical significance (P<0.05). The degree of brain edema and brain infarct volume in the IF group were significantly lower than those in the I/R group, and the number of surviving neurons was significantly higher in the IF group compared to the I/R group, with statistical significance (P<0.05). The levels of ROS and MDA in the IF group were significantly lower than those in the I/R group, while the levels of GSH and T-AOC were significantly higher in the IF group compared to the I/R group, with statistical significance (P<0.05). Compared with the I/R group mice, the mRNA levels of NQO-1, HO-1, and GPX4 in the brain tissue, nuclear translocation water of Nrf2, and protein levels of NQO-1, HO-1, and GPX4 in the IF group mice were significantly increased, while the cytoplasmic Nrf2 level was significantly decreased, with statistical significance (P<0.05).

    Conclusions

    IF significantly improves neurological function damage in I/R mice, and its mechanism may promote Nrf2 pathway to inhibit oxidative stress following I/R injury.

  • 4.
    Ameliorative effect and mechanism of Wuling powder on high altitude cerebral edema in hypoxic rats
    Yueyang Chen, Jingjing Wang, Shuying Wang, Yitai Yang, Zemeng Li, Di Hu, Pengbo Zhou, Wei Li, Dangli Ren, Hongtao Sun
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 86-93. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.003
    Abstract (163) HTML (4) PDF (1730 KB) (27)

    Objective

    To explore the effect and mechanism of Wuling powder on hypoxia induced high altitude cerebral edema (HACE).

    Methods

    Forty healthy male SD rats were randomly divided into four groups using a random number table: normobaric normoxic group (NC group), high-altitude cerebral edema group (HACE group), low-dose Wuling powder intervention group (WP-L group), and high-dose Wuling powder intervention group (WP-H group), with 10 rats in each group. The NC group was normally housed under normal pressure and oxygen conditions, while the remaining three groups were housed in a low-pressure, low-oxygen animal chamber which simulated the low-temperature and hypoxic environment of the plateau at an altitude of 6000 m to establish a plateau cerebral edema model. The rats in WP-L and WP-H groups were given 260 and 780 mg/kg of Wuling powder by gavage continuously 4 d before and 3 d after entering the cabin, respectively. HACE group was given the same amount of physiological saline.After 7 d, the brain water content was measured using the dry wet mass method, and the degree of brain function damage in rats was evaluated using the modified neurological severity score (mNSS) and corner test. The level of superoxide dismutase (SOD) in the cortical brain tissue of rats was detected using the microcalorimetry method, and the level of malondialdehyde (MDA) was detected using the colorimetric method. The mRNA relative expression levels of inflammatory factors interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) in the cortical brain tissue of rats were detected using qPCR experiment. The expression of aquaporin-4 (AQP4), protein kinase D1 (PKD1), and hypoxia inducible factor-1α (HIF-1α)in the cortical brain tissue of rats was determined using Western blot experiment.

    Results

    After 72 h of low-temperature and low oxygen environment feeding, the brain water content of rats in the WP-L group and WP-H group was significantly lower than that in the HACE group, and the difference was statistically significant (P<0.05). The mNSS score of HACE group rats was significantly higher than that of NC group,and the proportion of left turn was significantly increased; the mNSS scores of rats in the WP-L and WP-H groups were significantly lower than those in the HACE group, and the proportion of left turn was significantly reduced, with statistically significant differences (P<0.05). The MDA level in the brain tissue of HACE group rats was significantly higher than that of NC group, and the SOD activity was significantly decreased; the MDA level in the brain tissue of rats in both WP-L and WP-H groups decreased significantly, while the SOD activity increased significantly, and the differences were statistically significant (P<0.05). The levels of IL-1β, IL-6, and TNF-α in the HACE group were higher than those in the NC group, while the mRNA levels of various inflammatory factors in the WP-L and WP-H groups were significantly lower than those in the HACE group, and the differences were statistically significant (P<0.05). The expression of AQP4, HIF-1α, and PKD1 proteins in the HACE group was significantly increased compared to the NC group; the expression of AQP4, HIF-1α, and PKD1 proteins in the WP-L and WP-H groups gradually decreased compared to the HACE group, and the differences were statistically significant (P<0.05).

    Conclusions

    Wuling powder can significantly reduce cerebral edema and neurological impairment in HACE rats, and its mechanism of action may be related to the modulation of the HIF-1α/PKD1 pathway to play a role in alleviating oxidative stress injury, reduce inflammatory response, and ultimately play a role in improving hypoxia-induced plateau cerebral edema.

  • 5.
    Microvascular decompression for rare brain and nerve disorders
    Hongtao Sun
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 69-74. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.001
    Abstract (140) HTML (1) PDF (3120 KB) (28)

    Microvascular decompression (MVD) is the first-line surgery for common cranial nerve disorders like facial spasms and trigeminal neuralgia. As microsurgical tech advances, MVD is now used for rare brain and nerve disorders such as masseter spasms, oculomotor paralysis, neurogenic hypertension, pulsatile tinnitus, intermediate nerve pain, and laryngospasm, which often stem from nervevessel compression causing abnormal nerve conduction and damage. MVD restores normal nerve function by removing the offending vessels. This article mainly reviews the pathogenesis, diagnostic criteria, and treatment strategies of related rare diseases, and systematically explores the application of MVD in rare brain and nerve disorders, aiming to provide scientific basis for the selection of clinical treatment plans.

  • 6.
    Research progress on the neurotoxic effects of soman and countermeasures
    Ruoyan Gao, Hao Fu, Hongtao Sun, Kangni Feng
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 123-126. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.008
    Abstract (132) HTML (3) PDF (884 KB) (20)

    As an organophosphorus nerve agent, soman exerts its neurotoxic effects by irreversibly inhibiting acetylcholinesterase activity. This inhibition leads to the accumulation of acetylcholine at neural synapses and neuromuscular junctions, triggering persistent epileptic states and potentially fatal symptoms such as respiratory failure. Despite the existence of standard treatment protocols, their efficacy heavily relies on early intervention, as delayed treatment often fails to prevent neurological damage and death. Even with timely administration of medication, uncontrolled epileptic activity within 20 min can cause widespread neuropathological damage across multiple brain regions, significantly increasing the mortality rate. Further exploration of novel combination therapy strategies, expansion of the therapeutic time window, and improvement of outcomes for delayed treatment are crucial for emergency response to soman poisoning. This article provides a comprehensive review of the neurotoxic mechanisms of soman and recent advancements in therapeutic drugs, aiming to offer a reference for the further development of new treatment strategies for soman poisoning.

  • 7.
    GP-17 improves PTSD-like behaviour in rats by affecting AKT/NF-κB-mediated neuroinflammation
    Shuying Wang, Yitai Yang, Zemeng Li, Dangli Ren, Jingjing Wang, Yueyang Chen, Huimin Zhang, Hongtao Sun
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 94-102. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.004
    Abstract (131) HTML (3) PDF (6847 KB) (15)

    Objective

    To investigate the effect of gypenoside ⅩⅦ (GP-17) on neuroinflammation after post-traumatic stress disorder (PTSD) and explore its mechanism of action.

    Methods

    Twenty-four 8-week-old male SD rats were randomly divided into Control group, SPS group, GP-17 low-dose group(1 mg/kg), and GP-17 high-dose group (4 mg/kg), with 6 rats in each group. A single prolonged stress(SPS) modelling was carried out in all groups except Control group, followed by intraperitoneal injection of 1, 4 mg/kg in GP-17 treatment group, and equal amount of saline was given intraperitoneally in Control group as well as in SPS group. After 7 d of SPS modeling, the fear status of PTSD rats was assessed using a capture refusal score and a fear condition test. Enzyme linked immunosorbent assay (ELISA) kit was used to detect the protein expression of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α),RT-qPCR was used to detect the mRNA expression of the above inflammatory factors. Immunofluorescence staining was used to detect the expression of microglial polarization marker INOS. Western blot was used to detect the relative expression levels of pathway related proteins phospho-protein kinase B (p-AKT),phospho-nuclear factor kappa B (p-P65), and phospho-inhibitor of nuclear factor-κB kinase α/β (p-IKKα/β).

    Results

    After 7 d of SPS modeling, the refusal score and freezing time of SPS group, GP-17 low-dose group, and high-dose group were significantly higher than those of the control group. The refusal score and freezing time of the GP-17 low-dose group and high-dose group were significantly lower than those of the SPS group, and the differences were statistically significant (P<0.05). ELISA and RT-qPCR results showed that the expression of IL-1β, IL-6, and TNF-α in the brain tissue of GP-17 low-dose and highdose groups after modeling was lower than that of SPS group at the RNA and protein levels (P<0.05), with the exception of IL-1β expression in the low-dose GP-17 group (P>0.05). Immunofluorescence results showed that the expression of the M1 polarization marker INOS in microglia in GP-17 low-dose and highdose groups was significantly lower than that in SPS group (P<0.05). Western blot results showed that compared with the SPS group, the expression levels of p-IKKα/β, p-AKT, and p-P65 were significantly decreased in both GP-17 high-dose group and low-dose groups (P<0.05), with the exception of the expression level of p-IKKα/β in the GP-17 low-dose group (P>0.05).

    Conclusions

    GP-17 attenuates panic behaviour and inhibits the expression of IL-1β, IL-6 and TNF-α in prefrontal cortex of PTSD rats,and also inhibits the expression of M1-type marker INOS in BV2 cells, which exerts neuroprotective effects, and the mechanism of its action may be related to the inhibition of neuroinflammation mediated by the AKT/NF-κB inflammatory pathway.

  • 8.
    Research progress in drug therapy targeting neuroinflammation in traumatic brain injury
    Yuyang Liu, Yaping Feng
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (03): 137-143. DOI: 10.3877/cma.j.issn.2095-9141.2025.03.001
    Abstract (121) HTML (3) PDF (3020 KB) (35)

    Traumatic brain injury (TBI) is one of the leading causes of disability and death among young people, resulting in acute or permanent damage to physical, psychological, and cognitive functions. Currently, the treatment for TBI primarily involves surgical decompression and symptomatic supportive care, with a lack of effective interventions targeting the underlying pathological mechanisms. Recent studies have confirmed that neuroinflammation plays a crucial role in the pathophysiological process of TBI, and strategies targeting neuroinflammation hold promise for providing new pathways for TBI. This review aims to discuss the progress in drug therapies targeting neuroinflammation in TBI, with the goal of providing reference for future research.

  • 9.
    Clinical and imaging characteristics of cerebral herniation caused by critical cerebrospinal fluid hypovolemia after craniotomy in patients with acute traumatic brain injury
    Shanwen Chen, Lu Wang, Quanli Kang
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (04): 256-263. DOI: 10.3877/cma.j.issn.2095-9141.2025.04.008
    Abstract (103) HTML (4) PDF (3275 KB) (8)
    Objective

    To investigate the clinical and imaging characteristics of patients with herniation secondary to critical cerebrospinal fluid hypovolemia (CCSFH) after craniotomy.

    Methods

    From January 2019 to November 2023, fourteen patients with acute brain injury were admitted to Neurosurgery Department of Beijing Shunyi District Hospital, and experienced cerebral herniation due to CCSFH after craniotomy. Their clinical and imaging characteristics, treatment course, and outcomes were analyzed. Prognosis at six months post-discharge was assessed with the modified Rankin scale (mRS).

    Results

    CCSFH occurred within 1 to 13 d post-surgery. Seven patients exhibited a decline in consciousness or mental state, with three showing anisocoria. The remaining seven patients had regular pupil sizes, complicating consciousness assessment due to postoperative sedation and analgesia. The midline shift was (10.95±2.90) mm during the CCSFH presentation, ranging from 6.69 to 16.00 mm. Intracranial pressure ranged from 1-11 mmHg (1 mmHg=0.133 kPa) in 5 cases with CCSFH. Four cases underwent decompressive craniectomies owing to delayed CCSFH identification, while 10 cases received conservative treatment. The CCSFH condition was successfully reversed in all patients. Six months post-discharge, 6 cases had mRS scores≤2, and 8 had scores>2.

    Conclusions

    Post-craniotomy CCSFH often presents with deteriorating consciousness or mental status, and in severe cases, it may lead to transtentorial herniation. CT scans show significant midline shift, but the intracranial pressure remains relatively low. The primary treatment is positioning the patient supine, along with stopping cerebrospinal fluid drainage, halting use of hypertonic diuretics, and administering intravenous hydration, which often leads to good outcomes.

  • 10.
    Curcumol inhibits post-traumatic stress disorder by modulating apoptosis mediated by the eif2aCHOP signalling pathway
    Yitai Yang, Shuying Wang, Yueyang Chen, Jingjing Wang, Zemeng Li, Dangli Ren, Hongtao Sun
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 103-110. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.005
    Abstract (99) HTML (4) PDF (10376 KB) (17)

    Objective

    To investigate the protective effect of curcumol against apoptosis and its mechanism of action on cortical cells after post-traumatic stress disorder (PTSD) in rats.

    Methods

    Twelve healthy male SD rats were divided into blank control group, SPS group and curcumin group according to the randomized numerical table method, and the curcumin group was divided into a low concentration group (2.0 mg/kg) and a high concentration group (4.0 mg/kg) according to different concentrations, with three rats in each group. The SPS group and the curcumol group were subjected to single prolonged stress to establish the SPS model, and the conditioned fear test for the fearfulness of the rats was performed on the 7th day. The curcumol group was injected continuously intraperitoneally[2.0 and 4.0 mg/(kg·d)] 7 d after SPS modeling, while the SPS group was only intraperitoneally injected with physiological saline, the control group did not receive any treatment. Cerebral cortex tissue specimens were collected from rats after execution. Western blotting was used to detect the effects of drug intervention on the protein expression levels of phosphorylation of the eukaryotic initiation factor 2 (p-eif2a), the eukaryotic initiation factor 2 (eif2a), C/EBP-homologous protein (CHOP), and β-actin; Use an enzyme-linked immunosorbent assay kit to detect changes in the expression levels of inflammatory factors interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α); TUNEL cell apoptosis staining was used to detect the apoptosis of cells in the medial prefrontal cortex of rats;Pharmacotoxicity of curcumol on neuroglia was detected by live-dead cell staining and flow cytometry.

    Results

    After 7 d of SPS modelling, the results of the conditional fear box test showed that the freezing time percentage of the SPS group rats was significantly higher than that of the control group, and the freezing time percentage of curcumin group was significantly lower than that of the SPS group, with statistical significance (P<0.05). The Western blotting results showed that the levels of p-eif2a and CHOP proteins in the SPS group were significantly higher than those in the control group, while the levels of p-eif2a and CHOP proteins in the low concentration and high concentration groups of curcumin were significantly lower than those in the SPS group, with statistical significance (P<0.05). The ELISA detection results showed that the levels of IL-1β, IL-6, and TNF-α in the SPS group were significantly increased compared to the control group, while the levels of IL-1β, IL-6, and TNF-α in the high concentration group of curcumin were significantly decreased compared to the SPS group, with statistical significance (P<0.05). The apoptosis rate of cells in the SPS group was significantly higher than that in the control group, while the apoptosis rate of cells in the high concentration group of curcumin was significantly lower than that in the SPS group, and the differences were statistically significant (P<0.05).CCK-8 detection showed that after co culturing with 2 μg/mL curcumin solution for 0, 3, 6, 12, and 24 h,there was no significant change in the activity of microglia at each time point, and no obvious dead cells were observed.

    Conclusions

    Curcumol was able to inhibit the fear freezing state in rats after PTSD,exerting neuroprotective effects and inhibiting neuroinflammation, and its mechanism of action may be related to the inhibition of the expression of the eif2a-CHOP endoplasmic reticulum stress pathway and the inhibition of apoptosis by curcumol.

  • 11.
    Neurosurgical therapeutic strategies for diabetic foot
    Li Zhang
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (04): 205-209. DOI: 10.3877/cma.j.issn.2095-9141.2025.04.001
    Abstract (94) HTML (8) PDF (2389 KB) (24)

    Diabetic foot ulceration and deep tissue destruction result from concurrent lower-limb neurological and vascular damage in patients with diabetes mellitus, imposing a substantial burden on health and quality of life. Conventional medical strategies that focus on metabolic control and hemodynamic improvement offer limited benefit for refractory ulcers dominated by diabetic peripheral neuropathy, making surgical intervention essential. Neurosurgical techniques provide an individualized approach for different pathogenic subtypes through decompression of entrapped nerves, spinal cord stimulation for analgesia and microcirculatory enhancement, and comprehensive wound care. This review summarizes current clinical classification, differential diagnostic considerations, and neurosurgical treatment principles, emphasizing the value of multidisciplinary collaboration and neuromodulation technology in optimizing integrated management of diabetic foot.

  • 12.
    Analysis of the therapeutic effect of transsphenoidal neuroendoscopic resection of functional pituitary adenoma
    Han Wang, Yong Yi, Shijun Zhou, Xuefang Yang, Jingcheng Jiang, Qingshan Deng
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (03): 154-159. DOI: 10.3877/cma.j.issn.2095-9141.2025.03.003
    Abstract (84) HTML (9) PDF (2553 KB) (19)
    Objective

    To investigate the efficacy of transsphenoidal endoscopic functional pituitary tumor resection, and to analyze the postoperative changes in pituitary hormone levels and their impact on visual function.

    Methods

    A total of 58 patients with functional pituitary tumors who underwent surgical treatment at Neurosurgery Dpartment of Yibin Second People's Hospital from April 2018 to April 2022 were retrospectively analyzed. According to different surgical methods, the control group (n=28) underwent transsphenoidal microscopic pituitary tumor resection, while the study group (n=30) underwent transsphenoidal neuroendoscopic pituitary tumor resection. Pituitary hormone levels, visual function, surgical time, intraoperative blood loss, postoperative hospital stay, recurrence rate, and resection rate were compared between the two groups.

    Results

    The postoperative levels of human growth hormone (HGH) in patients with HGH tumors, pattern standard deviation of visual field, and mean deviation of visual field in the study group were significantly lower than those in the control group, while the visual field indexwas significantly higher than that in the control group (P<0.05). The study group also demonstrated shorter surgical duration, reduced postoperative hospital stay, and lower tumor recurrence rates compared to the control group, with a higher total tumor resection rate compared to the control group (P<0.05). However, no statistically significant differences were observed between the two groups in postoperative prolactin levels among prolactinoma patients, postoperative adrenocorticotropic hormone levels among adrenocorticotropic hormone patients, or intraoperative blood loss (P>0.05).

    Conclusions

    Transsphenoidal neuroendoscopic resection is effective for functional pituitary adenomas, offering significant advantages in reducing serum growth hormone levels, improving visual function, and increasing the gross-total resection rate.

  • 13.
    Correlation study between temporal muscle thickness and recurrence in patients with chronic subdural hematoma after burr hole drainage
    Yonghui Huang, Baohua Fan, Tian Huai, Jianqiang Ma, Rujiang Bai
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (03): 174-179. DOI: 10.3877/cma.j.issn.2095-9141.2025.03.006
    Abstract (83) HTML (2) PDF (2551 KB) (22)
    Objective

    To analyze the correlation between temporal muscle thickness (TMT) and postoperative recurrence in patients with chronic subdural hematoma (CSDH) who underwent burr hole drainage.

    Methods

    A retrospective analysis was conducted on the clinical data of 108 CSDH patients who received burr hole drainage in the Neurosurgery Department of Taihe County People's Hospital from January 2021 to December 2023. TMT was measured by preoperative head CT scan. Patients were stratified by gender, and their TMT was compared between males and females. The receiver operating characteristic (ROC) curve and maximum Jordan index were used to determine the gender specific threshold for TMT. Based on this threshold, patients were divided into a low temporal muscle thickness (LTMT) group and a high temporal muscle thickness (HTMT) group, and their clinical data were compared between the two groups. According to whether the patient has a recurrence 6 months after surgery, they were divided into a recurrence group and a non-recurrence group. Adopting multiple Logistic regression analysis to identify independent risk factors for postoperative recurrence in CSDH patients.

    Results

    Among the 108 patients, there were 19 patients in the recurrence group and 89 patients in the non-recurrence group. The TMT of male patients was significantly higher than that of females, and the difference was statistically significant (P<0.05). ROC curve analysis showed that the optimal TMT threshold for predicting recurrence was 4.175 mm for males and 3.300 mm for females. There were 56 cases in the HTMT group and 52 cases in the LTMT group. The recurrence rate of patients in the LTMT group was higher than that in the HTMT group, and the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that age ≥70 years, TMT≤critical value (4.175 mm for males and 3.300 mm for females), and hematoma volume were independent risk factors for postoperative recurrence in CSDH patients.

    Conclusions

    Preoperative TMT below the gender specific threshold is an independent risk factor for postoperative recurrence in CSDH patients, and its predictive value is not affected by age and hematoma volume, which helps identify patients at high risk of recurrence.

  • 14.
    Efficacy analysis of intracranial hematoma evacuation combined with decompressive craniectomy for traumatic brain injury patients
    Jiuqiang Fang, Yu Zhai, Junfeng Yang, Bin Shen
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (03): 160-166. DOI: 10.3877/cma.j.issn.2095-9141.2025.03.004
    Abstract (79) HTML (1) PDF (2836 KB) (20)
    Objective

    To explore the effect of intracranial hematoma evacuation combined with decompressive craniectomy in the treatment of traumatic brain injury (TBI) patients.

    Methods

    The clinical data of 94 patients with TBI in Neurosurgery Department of Nanjing Luhe People's Hospital were retrospectively analyzed from January 2020 to January 2024. The patients who underwent intracranial hematoma evacuation and decompressive craniectomy were included in experimental group (49 cases), while those who underwent intracranial hematoma evacuation and bone flap reduction were included in control group (45 cases). The postoperative hematoma clearance rate, intracranial rebleeding rate, and incidence of complications were compared between two groups of patients. The changes in preoperative and postoperative GCS scores, intracranial pressure levels, coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer], serum inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT)], and vasoactive factors [vascular endothelial growth factor (VEGF), angiogenin-1 (Ang-1)] were analyzed. The patients were followed up for 3 months, and the prognosis (GOS grading) of two groups of patients was compared.

    Results

    At 7 d after surgery, the GCS score in both groups was significantly enhanced than that before surgery; While PT and APTT were extended, intracranial pressure, D-dimer, CRP, TNF-α, IL-6, PCT, VEGF and Ang-1 were decreased than before surgery (P<0.05). The GCS score, the hematoma clearance rate, and the intracranial rebleeding rate in experimental group was higher than that in control group while the intracranial pressure, D-dimer, CRP, TNF-α, IL-6, PCT, VEGF and Ang-1 were lower than that in control group (P<0.05). There were no obvious differences in the incidence rates of complications between two groups (P>0.05). After 3 months of follow-up, there was no obvious difference in GOS grading between both groups (P>0.05).

    Conclusions

    For patients with TBI, intracranial hematoma evacuation combined with decompressive craniectomy can not only effectively removes the hematoma, but also optimize coagulation function, inhibit inflammatory factors, and regulate vascular active factors. Its therapeutic efficacy is superior to that of intracranial hematoma evacuation and bone flap reduction.

  • 15.
    Establishment of biomarkers for diabetic peripheral neuropathy based on plasma transcriptomics
    Heng Zhang, Ge Shi, Ze Zhang, Zhenxuan Gao, Wenqiang Yang, Qi Wang, Li Zhang
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 127-134. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.009
    Abstract (78) HTML (4) PDF (14187 KB) (22)

    Objective

    To establish biomarkers for diabetic peripheral neuropathy (DPN) by analyzing plasma transcriptomic profiles and elucidate its underlying mechanisms.

    Methods

    A prospective clinical cohort study was carried out. A total of 83 subjects were included, including 33 patients with DPN (DPN group) who visited the Neurosurgery Department of China-Japan Friendship Hospital from January to September 2023, 30 healthy subjects (NDM group) and 20 patients with type Ⅱdiabetes (DM group) who were recruited from community near China-Japan Friendship Hospital at the same time. Demographic and clinical information of all subjects were evaluated, and blood samples of 60 patients were sent for plasma transcriptomic sequencing by propensity matching. Feature screening was performed by differential analysis and multiple machine learning algorithms (Lasso regression, Logistic regression, SVM and XGBoost) to establish biomarkers that can predict the occurrence of DPN. Based on key gene features, the possible mechanism of DPN was studied.

    Results

    A total of 133 differentially expressed genes related to DPN were identified. Through feature screening using Lasso regression,Logistic regression, SVM, and XGBoost, 47 key gene features highly correlated with the occurrence of DPN were identified. GO enrichment and KEGG pathway enrichment analysis showed that 35 genes were associated with protein binding function (P=0.010). The correlation analysis results showed that these genes were significantly correlated with the severity of neuropathy and pain symptoms (P<0.05). GO enrichment and KEGG pathway enrichment analysis showed that the B cell receptor signaling pathway and insulin resistance pathway were significantly enriched, playing a core role in the pathogenesis of DPN.

    Conclusions

    Based on plasma transcriptomics and multidimensional clinical scales, 47 key gene markers of DPN were revealed, confirming that insulin resistance and abnormal B cell receptor signaling are the core mechanisms of DPN.

  • 16.
    Predictive value of early expression level of plasma PKM2 for the severity and prognosis of aneurysmal subarachnoid hemorrhage
    Junyan Xiong, Huaming Zhang
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (04): 243-249. DOI: 10.3877/cma.j.issn.2095-9141.2025.04.006
    Abstract (78) HTML (3) PDF (2815 KB) (16)
    Objective

    To investigate the predictive value of early expression levels of plasma pyruvate kinase M2 (PKM2) for the severity and prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH).

    Methods

    A total of 95 aSAH patients admitted to Neurosurgery Department of China Resources Wuhan Iron and Steel General Hospital from September 2021 to May 2023 were prospectively enrolled as aSAH group, while 100 healthy individuals who underwent physical examination in the hospital during the same period were selected as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to measure the PKM2 levels of patients in the aSAH group 12 h after admission, as well as the PKM2 levels of the control group on the day of admission physical examination, and general data and early plasma PKM2 levels were collected and compared between the two groups. The aSAH group was further stratified by disease severity (mild: Hunt-Hess grade Ⅰ-Ⅱ, moderate: Hunt-Hess grade Ⅲ, severe: Hunt-Hess grade Ⅳ) and surgical approach (craniotomy clipping subgroup and endovascular embolization subgroup), with their prognosis evaluated using the modified Rankin scale (mRs) at 90 d after discharge, patients with an mRs score>2 were assigned to the poor prognosis group, and those with an mRs score≤2 to the good prognosis group, and clinical data differences among these subgroups were compared. Additionally, the aSAH patients were divided into the high-expression group (plasma PKM2 level≥190.0 ng/L) and the low-expression group (plasma PKM2 level<190.0 ng/L), and the clinical data of aSAH patients with different plasma PKM2 levels were compared. Receiver operating characteristic (ROC) curve was plotted to assess the predictive value of early plasma PKM2 levels for poor prognosis in aSAH patients.

    Results

    Early plasma PKM2 levels were significantly higher in the aSAH group than in the control group (P<0.05). Furthermore, significant differences in maximum diameter of aneurysms, plasma PKM2 expression levels, modified Fisher grading, and GCS scores among patients with mild, moderate, and severe aSAH (P<0.05), and the more severe the condition, the higher the plasma PKM2 expression level. In contrast, no statistically significant differences in plasma PKM2 levels or clinical outcomes were found between the different surgical groups (P>0.05). The differences in hypertension history, Hunt-Hess grading, GCS score, modified Fisher grading, and plasma PKM2 expression levels between patients with favorable and unfavorable outcome were statistically significant (P<0.05). The differences in Hunt-Hess grading, GCS score, and modified Fisher grading between patients with high PKM2 expression and those with low PKM2 expression were statistically significant (P<0.05). ROC curve analysis demonstrated that early plasma PKM2 levels effectively predicted unfavorable outcomes in aSAH patients, with an area under the curve of 0.846 (95%CI: 0.764-0.928), a sensitivity of 80.60%, and a specificity of 81.40% at the optimal cut-off value of 190.0 ng/L.

    Conclusions

    The early expression level of plasma PKM2 is related to the severity and prognosis of aSAH patients, providing certain diagnostic value for predicting disease progression and potentially serving as a new marker for predicting the outcome of aSAH patients.

  • 17.
    Study of risk factors of hospital acquired pneumonia after emergency craniotomy for acute spontaneous cerebral hemorrhage in Neurosurgical ICU
    Liang Chen, Yi Zeng, Anliang Gao, Jie Feng, Chunling Li, Longyi Chen, Ruxiang Xu, Yongsheng He
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (04): 250-255. DOI: 10.3877/cma.j.issn.2095-9141.2025.04.007
    Abstract (74) HTML (2) PDF (2487 KB) (7)
    Objective

    To explore the independent influencing factors of hospital-acquired pneumonia (HAP) in Neurosurgical Intensive Care Unit (NICU) after emergency craniotomy for acute spontaneous cerebral hemotoma removal, as to provide important reference data for clinic.

    Methods

    The medical record data of 207 enrolled patients with emergency craniotomy for acute spontaneous cerebral hematoma removal in NICU of Sichuan Provincial People's Hospital from January 2016 to June 2021 were retrospectively analyzed. According to the patients with acute spontaneous intracerebral hemorrhage in NICU, whether they had hospital-acquired pneumonia after emergency craniotomy and hematoma removal, they were divided into infection group and non-infection group. Multiple Logistic regression analysis was used to screen for independent risk factors for HAP in NICU patients with spontaneous intracerebral hemorrhage after emergency craniotomy.

    Results

    Of the patients enrolled in this study, 127 cases were in the infection group and 80 cases in the non-infection group. There were significant differences between patients in infection and non-infection groups in age, GCS score≤8 on admission, preoperative blood glucose, preoperative albumin, hypertension, operation duration, and postoperative mechanical ventilation. The factors with P<0.1 were included in the multivariate Logstic regression analysis, and the results showed that those with GCS score≤8 on admission, operation duration ≥240 min (4 h), postoperative mechanical ventilation, preoperative blood glucose≥10.0 mmol/L, and preoperative albumin<42.5 g/L were the independent risk factors for HAP in patients with spontaneous intracerebral hemorrhage undergoing emergency craniotomy and hematoma evacuation in NICU.

    Conclusions

    The independent risk factors for HAP in patients with spontaneous intracerebral hemorrhage undergoing emergency craniotomy and hematoma evacuation in NICU include admission GCS score ≤8, operation duration ≥4 h, postoperative mechanical ventilation, preoperative blood glucose ≥10.0 mmol/L, and preoperative albumin <42.5 g/L. Early screening and corresponding prevention and treatment measures can help reduce the incidence of postoperative HAP and improve long-term prognosis.

  • 18.
    Application effect of the fast track surgery in patients undergoing microvascular decompression surgery for trigeminal neuralgia
    Yahong Hou, Ruoyan Gao, Hongtao Sun
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 117-122. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.007
    Abstract (71) HTML (2) PDF (894 KB) (17)

    Objective

    To investigate the application effects of the fast track surgery (FTS)concept in patients undergoing microvascular decompression (MVD) surgery for trigeminal neuralgia.

    Methods

    A retrospective study was conducted on 123 TN patients with MVD admitted to Institute of Neurotrauma Repair, Characteristic Medical Center of Chinese People&apos;s Armed Police Force from January 2022 to January 2024, 59 patients admitted from January 2022 to January 2023 were included in the control group, and 64 patients admitted from February 2023 to January 2024 were included in the observation group. The control group received conventional perioperative interventions, while the observation group was managed with the FTS concept in addition to conventional care. Postoperative complications, pain scores, anxiety and depression levels, sleep quality, and quality of life between the two groups of patients were compared.

    Results

    After 7 d of surgery, the incidence of postoperative complications in the observation group was lower than that in the control group, except for intracranial infection, there was a statistically significant difference in the incidence of other complications (high fever, headache, nausea and vomiting, urinary tract infection) (P<0.05). On postoperative days 1 and 7,the visual analog scale (VAS) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale(SDS) scores, and Pittsburgh sleep quality index (PSQI) scores of both groups of patients decreased compared to admission, and the observation group was lower than the control group, with statistical significance (P<0.05). After 7 d of surgery, the quality of life scores of both groups of patients increased compared to admission, and the observation group was higher than the control group, with statistical significance (P<0.05).

    Conclusions

    The application of FTS concept in TN patients undergoing MVD can reduce the incidence of postoperative complications, alleviate pain, anxiety, and depression, improve sleep quality and quality of life. This approach is safe and effective.

  • 19.
    Three case report of transsphenoidal resection for pituitary abscess
    Changdong Li, Yaqiang Nan, Zhihong Wang
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (03): 197-200. DOI: 10.3877/cma.j.issn.2095-9141.2025.03.010
  • 20.
    Endoscopic transfrontal keyhole approach via the lateral fiber tract for the treatment of basal ganglia hemorrhage
    Xiaodong Li
    Chinese Journal of Neurotraumatic Surgery(Electronic Edition) 2025, 11 (02): 135-136. DOI: 10.3877/cma.j.issn.2095-9141.2025.02.010
    Abstract (70) HTML (1) PDF (3001 KB) (4)

    基底节区脑出血是指尾状核、壳核、苍白球等结构受到高血压等因素的影响而破裂出血。传统的手术方式包括显微镜下经翼点/扩大翼点入路血肿清除术和钻孔引流术。随着神经外科微创技术的快速发展,神经内镜技术广泛应用于脑出血的治疗中。凭借最小的创伤、最大限度清除血肿及最理想的治疗效果,神经内镜技术逐渐成为神经外科手术的首选方式,并有望成为未来神经外科手术发展的主流技术。神经内镜下经额锁孔纤维束外侧入路治疗基底节区脑出血安全有效,可显著减少患者术中出血,明显缩短手术时长,促进患者的神经功能恢复。

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