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.

To establish a model of transient middle cerebral artery occlusion (MCAO) in mice by inserting monofilament through common carotid artery and external carotid artery embolization, and to compare and analyze the survival rate, behavior, infarct volume, brain edema degree and neuronal apoptosis of the two models. In order to select a more feasible and effective method for establishing cerebral infarction model.

Forty-two C57BL/6 male mice weighing 20-22 g were randomly divided into sham-operated group (6 mice, S-group), MCAO model external carotid artery catheterization group (18 mice, E-group) and MCAO model common carotid artery catheterization group (18 mice, C-group). E-group prepared a mice model of middle cerebral artery embolism from the beginning of middle cerebral artery embolization by inserting a monofilament embolism into the external carotid artery shear. C-group prepared a mice model of middle cerebral artery embolism from the beginning of middle cerebral artery embolization by inserting a monofilament embolism into the common carotid artery shear. The S- group was ligated with the ipsilateral common carotid artery of the model group, but no monofilament was inserted as the control group. After 1 h of ischemia in model group and 1 h of ligation in S-group, the ligation of common carotid artery was removed and the ligation was reperfused for 24 h. Later, Longa nerve function score was used and TTC staining was performed to calculate the infarction volume, measure the water content of brain tissue and observe the neuronal apoptosis, and then the comparative analysis was made.

In both E-group and C-group, apoplexy, elevated neurological function score, brain edema, obvious infarct volume and neuronal apoptosis were observed in all mice, while in S-group, there were no obvious manifestations. Compared with the E-group, the infarction volume and the degree of brain edema in both group was close, and the number of apoptotic neurons was basically the same. The difference has no statistical significance (P>0.05). Compared with the E-group, the C-group had a higher score of neurological function and a higher mortality rate, with statistical significance(P<0.05).

The results of cerebral infarction caused by two kinds of embolization are consistent, but considering that some experiments need long-term administration and observation, and the survival rate of experimental animals in E-group is higher, so it is recommended to use external carotid artery embolization method to make middle cerebral artery embolization model.

To valuate the clinical application of target directed therapy of monitoring regional cerebral oxygen saturation (rScO₂) in severe traumatic brain injury (sTBI).

A total of 60 patients with sTBI who were treated in the neurosurgical intensive care unit (NSICU) of Inner Mongolia People's Hospital from April 2018 to November 2020 were randomly divided into experimental group and control group, with 30 patients in each group. The control group was given traditional neurosurgical intensive care management, and the experimental group was given rScO₂ target monitoring and guidance treatment on the basis of conventional neurosurgical intensive care management. The hospital stay in NSICU, GCS score at discharge, complication rate, mortality after 6 months, modified Rankin scale (mRs) score and GOS score were compared between the two groups.

The GCS score of both groups at discharge were higher than the initial score at admission, and the GCS scores of the experimental group at discharge were higher than those of the control group, but the difference was not statistically significant (P>0.05). The length of stay in NSICU in experimental group was significantly decreased compared with control group (P<0.05). After 6 months of follow-up, both the mRs score and GOS score in the experimental group were significantly better than those in the control group, and the mortality was significantly lower than that in the control group (P<0.05). Kaplan-Meier survival curve analysis showed that the survival time of experimental group was significantly better than that of control group (P<0.05).

The target-directed therapy under the direction of monitoring rScO₂ can effectively shorten the length of stay in NSICU, reduce the fatality rate and improve the prognosis of patients with sTBI.

To analyze risk factors for short-term and long-term facial nerve function after acoustic neuroma surgery.

Sixty-two patients with acoustic neuroma admitted to Neurosurgery Department of the First Affiliated Hospital of Xiamen University from January 2015 to June 2018 were retrospectively analyzed. The facial nerve function of all patients was evaluated at 7 d and 6 months after surgery. The risk factors that may be related to the short-term and long-term facial nerve dysfunction were collected. The relationship between the related factors and the short-term and long-term facial nerve function was analyzed by Logistic regression.

Seven days after surgery, 21 patients (33.9%) had normal facial nerve function, 41 patients (66.1%) had facial nerve function impairment; 6 months after surgery, 49 patients (79.0%) had normal facial nerve function, and 13 patients (21.0%) had facial nerve function impairment. Logistic univariate regression analysis showed that the larger the maximum diameter of the tumor and the tighter adhesion between tumor and facial nerve, the greater the possibility of facial nerve function nerve injury occurred 7 d after surgery (P=0.002, 0.002); the duration of clinical symptoms before surgery was the risk factor of facial nerve dysfunction 6 months after surgery (P=0.035). Logistic multivariate regression analysis showed that the degree of adhesion between the tumor and the facial nerve and the maximum tumor diameter were the independent risk factors for facial nerve dysfunction 7 d after surgery (P=0.003, 0.014); the duration of clinical symptoms before surgery and the maximum diameter of tumor were the independent risk factors of facial nerve dysfunction 6 months after surgery (P=0.010, 0.030).

The tighter the adhesion between the tumor and the facial nerve and the larger the maximum diameter of the tumor, the greater the possibility of facial nerve function injury occurred 7 d after surgery. The longer the duration of clinical symptoms and the larger the maximum diameter of tumor, the greater the possibility of facial nerve injury 6 months after surgery.

To investigate the characteristics of traumatic intracranial pseudoaneurysms and the surgical treatment ethods and outcome.

The information of a total of 14 cases of traumatic intracranial pseudoaneurysms from October 2008 to December 2014 was analyzed retrospectively about the clinical manifestations, imaging characteristics and surgical method. One case with cavernous sinus segment carotid pseudoaneurysm underwent ECA-MCA bypass and aneurysm isolated after blood flow after blocking test (Matas test); ten patients underwent endovascular interventional embolization; three patients underwent pseudoaneurysm neck reinforcement or clipping.

Three cases underwent surgical removal of the aneuryms and had the pathological specimens. The pathological examination showed compound for a large number of thrombosis and machine, without inelastic fiber or smooth muscle cells and other normal blood vessels. It conforms to the characteristics of pseudoaneurysms. These patients’ GOS score when discharged from hospital including 5 in 6 cases, 4 in 4 cases and 3 in 4 cases. All the patients were followed up from 6 months to 6 years, 10 cases DSA and CTA examination showed aneurysms disappear and the parent artery patency. All patients were followed up without bleeding again.

Traumatic intracranial pseudoaneurysms is a special kind of aneurysm, with high operation risk and difficult. It is necessary to fully understand the characteristics of pseudoaneurysms and the status of compensatory intracranial vascular preoperative. If the characteristics of pseudoaneurysms can be fully understood and individualized surgical treatment can be undergone, the patients could have a good outcome.

To explore the preliminary application of three-dimensional (3D) printing technique in the operation of epidural hematoma.

Two cases of epidural hematoma in the Department of Neurosurgery, Yangxin County People’s Hospital of Binzhou City from January to September 2016 were selected to obtain the original data of brain CT scan. The three-dimensional model of epidural hematoma and the three-dimensional model of "armor" completely fitted to the head and facial tissues were made through Mimics 17.0 software. According to the projection of the epidural hematoma in the "armor" model, the scope of epidural hematoma is obtained, and the operative mold is obtained by 3D printing. The rational surgical incision was designed and the operation was performed. The effect of postoperative treatment was observed.

The operation has proved that the location of the epidural hematoma is accurate according to this method. After reexamination of CT hematoma, the removal of hematoma was more thorough and no delayed hemorrhage. The symptoms such as severe headache, disturbance of consciousness and hemiplegia before operation disappeared. After 6 months’ follow-up, the patients returned to normal life and social interaction, and the GOS score was 5 points.

For patients with epidural hematoma, the 3D printing technique was used before the operation, the accurate location of the epidural hematoma, the risk of operation, the rational surgical approach, the reduction of surgical trauma and the oppression of hematoma were selected. It is suitable for promotion in primary hospitals and junior doctors.

To investigate the risk factors of incontinent-associated dermatitis in the acute severe stroke patients.

Incontinent-associated dermatitis were assessed by application of Incontinence-associated Dermatitis and Its Severity Instrument(IADS) and Perineal Assessment scale(PAT) in the patients of acute severe stroke, and their risk factors were analyzed.

(1)128 cases of patients with acute cerebral stroke were 36 cases of pre-hospital IAD, the incidence of 28.13%. There were 20 cases were mild; 9 cases were of moderate; 7 cases were severe. (2)The risk factors of IAD for the pre-hospital IAD included age≥65 years, history of stroke, diabetes, coma, period≥12 h, the temperature≥38.0 ℃, fecal incontinence, urinary incontinence, NIHSS score≥12, poor nutritional status and immune function, that were relatively higher risk of pre-hospital IAD in the patients of acute cerebral stroke.

There was higher incidence rate of pre-hospital IAD in the acute severe stroke patients. The risk factors had characteristic. This study could provid individualized nursing care for patients admitted to hospital.

The incidence of acute ischemic stroke rises year by year, and has a high disability rate and mortality rate. Due to limitations of intravenous alteplase in the treatment of acute ischemic stroke, five randomized trials have demonstrated the benefit of new-generation endovascular recanalization therapies (primarily stent retrievers) over medical therapy alone among patients with acute ischemic stroke since 2015, and the guidelines with acute ischemic stroke guidelines have updated in many countries. This review focuses on five major clinical studies and the latest guidelines in Europe and the United States on the selection of suitable stroke patients for mechanical thrombectomy. The following is a review of the research progress.

To summarize the clinical treatment experience of civilian craniocerebral firearm wounds, for the benefit of improving the treatment level of craniocerebral firearm wounds.

A number of 235 patients with craniocerebral firearm wounds in Neurosurgery Department of 920^th Hospital of Joint Logistics Support Force from January 1979 to December 2019 were analyzed retrospectively. The therapeutic outcomes were evaluated by GOS at discharge.

Finally 203 cases (86.4%) survived and 32 cases (13.6%) died. On discharge, 108 cases (53.2%) recovered well, 51 cases (25.1%) with moderate disability, 30 cases (14.8%) with severe disability, and 14 cases (6.9%) had plant survival.

Quick and accurate judgment of the injury, timely and thorough emergency debridement surgery, and early rehabilitation are of great significance to improve the clinical treatment of patients with craniocerebral firearm wounds.