Expression and clinical significance of VISTA, B7-H3, and PD-L1 in glioma.

Immune checkpoint (IC) therapy has led to a breakthrough in cancer treatment. However, the interaction of ICs is controversial in glioma. We detected features of ICs using transcriptome data and a multicolor immunofluorescence assay. We discovered that B7-H3 increased with grade and age and predicted worse overall survival (OS) at the transcriptional and proteomic levels. VISTA and PD-L1 were associated with OS and grade at the RNA level. At the protein level, VISTA was primarily expressed in tumor cells and TAMs. B7-H3 and VISTA were positively correlated with PD-L1. There was a strong correlation between PD-L1 and CD3 and between VISTA and IBA-1. PD-L1 was coexpressed with T cells. VISTA was coexpressed with TAMs. In T cells, we found a strong correlation in ICs, which worsened in TAMs and tumor cells. In conclusion, B7-H3 is a vital prognostic target for immunotherapy. We provided a potential mechanism for the immunosuppressive microenvironment in glioma.

Effect of antiplatelet treatment on aneurysmal subarachnoid hemorrhage patients after endovascular treatment: a systematic review with meta-analysis.

Antiplatelet treatment (APT) has been reported to be used in some patients with aneurysmal subarachnoid hemorrhage (aSAH) after endovascular treatment, but there is controversy among different studies regarding its clinical effects. This study intends to conduct a meta-analysis to evaluate the impact of APT on aSAH patients after endovascular treatment. The PubMed, EMBASE, and Cochrane Library databases were systematically searched up to January 2022 for eligible English publications. Quality assessment was conducted for the included studies. Publication bias and heterogeneity were assessed by Egger's test and the I2 statistic, respectively. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by meta-analysis. Robustness was checked by subgroup and sensitivity analyses. In total, 597 and 522 patients with and without APT, respectively, in 5 retrospective studies were retained for the meta-analysis. Pooled analyses showed that the APT group had a lower mortality (41/499 [8%] versus 56/402 [14%]; OR = 0.533; 95% CI, 0.347-0.820; P = 0.004) and a higher proportion of favorable clinical outcomes (400/532 [75%] versus 266/421 [63%]; OR = 1.801; 95% CI, 1.359-2.414; P = 0.000) than the control group. There was no significant difference in the incidence of hemorrhagic complications (39/564 [7%] versus 26/503 [5%]; OR = 1.386; 95% CI, 0.825-2.329; P = 0.218) between groups. Although the incidence of delayed cerebral ischemia (DCI) was significantly lower in the APT group (65/512 [13%] versus 105/447 [23%]; OR = 0.325; 95% CI, 0.107-0.988; P = 0.048), it showed substantial heterogeneity (I2 = 64.7%). Subsequent sensitivity analysis suggested that the meta-analysis was robust. Subgroup analyses revealed that long-term (> 2 weeks) APT (60/479 [13%] versus 103/428 [24%]; OR = 0.212; 95% CI, 0.056-0.806; P = 0.023) significantly reduced the DCI rate and that different grouping methods in the included studies may be a source of heterogeneity. In the absence of randomized controlled trials, a meta-analysis of retrospective studies suggested that APT was associated with reduced mortality and better functional outcomes in aSAH patients after endovascular treatment without an increased incidence of hemorrhagic complications. Long-term APT was also associated with a decrease in the incidence of DCI. Well-designed randomized controlled trials are warranted and updated meta-analyses are needed to verify our findings.

[Advances in Intraoperative Neurophysiological Monitoring Techniques in Transnasal Endoscopic Skull Base Surgery].

Transnasal endoscopic skull base surgery has been increasing in volume in recent years and its indications are constantly expanding. The potential occurrence of intraoperative and postoperative neurovascular complications deserves special attention from neurosurgeons. Multimodal intraoperative neurophysiological monitoring technology allows neurosurgeons to monitor cerebral perfusion and the functional status of the associated cranial nerves in real time, thereby enabling surgeons to make prompt adjustments in surgical procedures and strategies and reduce the risks of postoperative neurological complications in patients. Based on available literature, we reviewed how appropriate monitoring strategies were optimized for different key components of transnasal endoscopic skull base procedures, intending to provide reference for clinicians.

Atypical teratoid/rhabdoid tumor in adult: case series and an integrated survival analysis.

BACKGROUND: Atypical teratoid/rhabdoid tumor (AT/RT) is well documented in children but less so in adults because of its rarity. METHOD: We report a series of five cases, a literature review and quantitative analysis of the survival outcome of adult AT/RT patients. RESULTS: Seventy-four patients including our five cases (male: female = 16: 58) were evaluated, whose median age was 32.5 years (18-80 years). The commonest location was the sellar region. Median overall survival (OS) was 12.5 months (0.5-204.00 months). Chemotherapy was associated with OS (HR: 0.349, 95%CI: 0.176-0.694, p = 0.003), while other factors did not influence OS. From Kaplan-Meier analysis, surgery combining postoperative chemotherapy and radiotherapy was associated with better prognosis (Log Rank: χ2 = 14.662, p = 0.001). CONCLUSIONS: Adult AT/RT is commoner in females and tends to recur rapidly after surgical resection. Chemotherapy may provide a survival benefit. Surgery combined with postoperative chemotherapy and radiotherapy was associated with better prognosis for adult AT/RT patients, though the overall prognosis was still poor.

[The application of nasopharyngeal airway in nurosurgery patients during anesthesia recovery].

OBJECTIVE: To evaluate safety and effectiveness of nasopharyngeal airway used for neurosurgery patients during the anesthesia recovery period. METHODS: A total of 60 patients (ASAI-II), aged between 25 to 67 years old, who were scheduled to undergo elective neurosurgery operation under general anesthesia, were randomly divided into the oropharyngeal airway group (group O) and the nasopharyngeal airway group (group N), with 30 cases in each group. After respiratory recovery was satisfactory at the end of operation, endotracheal tube was extubated under deep anesthesia. Afterwards, oropharyngeal airway was intubated in group O, and nasopharyngeal airway was intubated in group N. BP and HR before induction (T0), before airway intubation (T1), at 1 min (T2) and 5 min (T3) after airway intubation were recorded. Meanwhile, one-time success rate of airway intubation, the airway retention time, the times of airway regulation due to location change and the change of respiration and circulation in each groups during airway retention period were recorded. In addition, adverse reactions during airway retention period and tolerance scores of patients in both groups were recorded. RESULTS: BP and HR in group N at T1 and T2 increased significantly compared with T0 (P < 0.05), Compared with T1, BP and HR increased significantly at T2 in group N (P < 0.05). Compared with T1 and T2, the same index reduced significantly at T3 (P < 0.05). BP and HR in group N were significantly higher than those in group O at T2 (P < 0.05). Airway retention time in group N was significantly longer than that in group O [(137.4 +/- 18.32) min vs. (64.2 +/- 8.25) min, P < 0.053; the times of airway location regulation in group N was less than that in group O (0.34 +/- 0.21 vs. 2.80 +/- 0.54) (P < 0.05). During airway retention period the incidence of BP and HR exceeding the base value by 15% in group O was higher than that in group N (80.0% vs. 46.7%)(P < 0.01), and the incidence of SPO2 less than 95% in group O was higher than that in group N (26.7% vs. 6.7%) (P < 0.05). The incidence of nausea, upper airway obstruction and restlessness in group O was significantly higher than that in group N (P < 0.05). Moreover, airway tolerance score of patients in group N was significantly better than that in group O (P < 0.05). CONCLUSION: Nasopharyngeal airway could better maintain unobstructed upper airway in neurosurgery patients during the anesthesia recovery period with advantages such as small circulatory effect, good tolerance and fewer complications.

Advances in objective assessment of ergonomics in endoscopic surgery: a review.

Background: Minimally invasive surgery, in particular endoscopic surgery, has revolutionized the benefits for patients, but poses greater challenges for surgeons in terms of ergonomics. Integrating ergonomic assessments and interventions into the multi-stage endoscopic procedure contributes to the surgeon's musculoskeletal health and the patient's intraoperative safety and postoperative recovery. Objective: The purpose of this study was to overview the objective assessment techniques, tools and assessment settings involved in endoscopic procedures over the past decade and to identify the potential factors that induce differences in high workloads in endoscopic procedures and ultimately to design a framework for ergonomic assessment in endoscopic surgery. Methods: Literature searches were systematically conducted in the OVID, pubmed and web of science database before October 2022, and studies evaluating ergonomics during the process of endoscopic procedures or simulated procedures were both recognized. Results: Our systematic review of 56 studies underscores ergonomic variations in endoscopic surgery. While endoscopic procedures, predominantly laparoscopy, typically incur less physical load than open surgery, extended surgical durations notably elevate ergonomic risks. Surgeon characteristics, such as experience level and gender, significantly influence these risks, with less experienced and female surgeons facing greater challenges. Key assessment tools employed include electromyography for muscle fatigue and motion analysis for postural evaluation. Conclusion: This review aims to provide a comprehensive analysis and framework of objective ergonomic assessments in endoscopic surgery, and suggesting avenues for future research and intervention strategies. By improving the ergonomic conditions for surgeons, we can enhance their overall health, mitigate the risk of WMSDs, and ultimately improve patient outcomes.

TUG-891 inhibits neuronal endoplasmic reticulum stress and pyroptosis activation and protects neurons in a mouse model of intraventricular hemorrhage.

Pyroptosis plays an important role in hemorrhagic stroke. Excessive endoplasmic reticulum stress can cause endoplasmic reticulum dysfunction and cellular pyroptosis by regulating the nucleotide-binding oligomerization domain and leucine-rich repeat pyrin domain-containing protein 3 (NLRP3) pathway. However, the relationship between pyroptosis and endoplasmic reticulum stress after intraventricular hemorrhage is unclear. In this study, we established a mouse model of intraventricular hemorrhage and found pyroptosis and endoplasmic reticulum stress in brain tissue. Intraperitoneal injection of the selective GPR120 agonist TUG-891 inhibited endoplasmic reticulum stress, pyroptosis, and inflammation and protected neurons. The neuroprotective effect of TUG-891 appears related to inhibition of endoplasmic reticulum stress and pyroptosis activation.

Low-temperature 3D-printed collagen/chitosan scaffolds loaded with exosomes derived from neural stem cells pretreated with insulin growth factor-1 enhance neural regeneration after traumatic brain injury.

There are various clinical treatments for traumatic brain injury, including surgery, drug therapy, and rehabilitation therapy; however, the therapeutic effects are limited. Scaffolds combined with exosomes represent a promising but challenging method for improving the repair of traumatic brain injury. In this study, we determined the ability of a novel 3D-printed collagen/chitosan scaffold loaded with exosomes derived from neural stem cells pretreated with insulin-like growth factor-1 (3D-CC-INExos) to improve traumatic brain injury repair and functional recovery after traumatic brain injury in rats. Composite scaffolds comprising collagen, chitosan, and exosomes derived from neural stem cells pretreated with insulin-like growth factor-1 (INExos) continuously released exosomes for 2 weeks. Transplantation of 3D-CC-INExos scaffolds significantly improved motor and cognitive functions in a rat traumatic brain injury model, as assessed by the Morris water maze test and modified neurological severity scores. In addition, immunofluorescence staining and transmission electron microscopy showed that 3D-CC-INExos implantation significantly improved the recovery of damaged nerve tissue in the injured area. In conclusion, this study suggests that transplanted 3D-CC-INExos scaffolds might provide a potential strategy for the treatment of traumatic brain injury and lay a solid foundation for clinical translation.

Case Report: Successful Use of BRAF/MEK Inhibitors in Aggressive BRAF-mutant Craniopharyngioma.

BACKGROUND: Although a benign intracranial tumor, craniopharyngioma treatment has always been considered a challenging clinical problem. Recently, BRAF V600E mutation in the pathogenesis of papillary craniopharyngioma (PCP) has been further revealed. Thus, BRAF inhibitors (BRAFi) serve as an applicable treatment for patients with PCP. METHODS: Two patients with recurrent PCP were treated with combined BRAFi dabrafenib (150 mg, orally twice daily) and MEK inhibitors (MEKi) trametinib (2 mg, orally twice daily). A follow-up exceeding 2 years was conducted. We meticulously scrutinized the treatment's safety and efficacy profiles by delving into existing literature. RESULTS: One patient harboring a solid tumor achieved a complete tumor response devoid of any adverse events and encountered no recurrence over 2 years subsequent to discontinuation. Moreover, within a mere month of commencing targeted therapy, the tumor demonstrated observable shrinkage. This finding substantiates the considerable potential inherent in targeted therapy for PCP cases marked by the somatic BRAF V600E mutation. CONCLUSIONS: Under specific conditions, individuals diagnosed with PCP can attain a complete tumor response following combined treatment with BRAFi/MEKi.

Necrostatin-1 decreases necroptosis and inflammatory markers after intraventricular hemorrhage in mice.

Necrostatin-1, an inhibitor of necroptosis, can effectively inhibit necrotic apoptosis in neurological diseases, which results in the inhibition of inflammation, endoplasmic reticulum stress, and reactive oxygen species production and substantial improvement of neurological function. However, the effects of necrostatin-1 on intraventricular hemorrhage (IVH) remain unknown. In this study, we established a mouse model of IVH by injecting autologous blood into the lateral ventricle of the brain. We also injected necrostatin-1 into the lateral ventricle one hour prior to IVH induction. We found that necrostatin-1 effectively reduced the expression levels of the necroptosis markers receptor-interacting protein kinase (RIP)1, RIP3, mixed lineage kinase domain-like protein (MLKL), phosphorylated (p)-RIP3, and p-MLKL and the levels of interleukin-1ß , interleukin-6, and tumor necrosis factor-α in the surrounding areas of the lateral ventricle. However, necrostatin-1 did not reduce ependymal ciliary injury or brain water content. These findings suggest that necrostatin-1 can prevent local inflammation and microglial activation induced by IVH but does not greatly improve prognosis.

[The clinical features and perioperational managements of craniopharyngiomas in posterior fossa].

OBJECTIVE: To investigate the clinical features and perioperational managements of craniophayngiomas located in posterior fossa. METHODS: Nine patients with craniopharyngioma situated in posterior fossa were included in the study. The clinical manifestations, neuroimage features, operational treatment, and perioperational managments were retrospectively analyzed. RESULTS; All tumors associated with big or huge volume, arised from sellar/suprasellar region and extended into posterior fossa. Tumors showed cystic lesions in 2 cases and cystic-solid lesions in 7 cases. Headache was the most common symptoms (6/9), followed by cranial nerve deficit (4/9) and endocrine dysfunction(3/9). The supra- and infra-tentorial approaches were the optimal approaches for removal these tumors (7/9). Cranial nerves deficit was the most common complication in perioperative period. No perioperational death occured, most of the patients showed good recovery during the fellow-up period. CONCLUSION: Craniophayngiomas in posterior fossa shows different clinical manifestations, radiological features, surgical complications to the tumor in sellar/suprasellar region.

[The establishment of craniopharyngioma cell line].

OBJECTIVE: To establish the craniopharyngioma cell line with primary culture which might provide experiment background and evidence for future eternal tumor cell line establishment. METHODS: Thirty six surgical specimens were collected from patients with craniopharyngiomas definited by iconography and pathology examinations in West China Hospital, Sichuan University, including twenty one adamantine epitheliomas and fifteen squamous papillary tumors. The tumor cell was treated through primary cukture, purification, passage, freezing, resuscitation, and identified by keratin 7 staining through SP method. The growth curve and double time were detected through trypan blue dye cell count and MTT assay. The growth of the tumor cells treated with growth hormone (GH) and Tamoxifen was also observed. RESULTS: Thirty six primary cultures were done, 29 of which were successful and subculture was achieved in 80.6% of all primary cultures. These cell lines were from squamous epithelium by keratin 7 antibody identification, with three days of double time. Proloferative effect of GH was most prevalent at 100 ng/mL, while tamoxifen suppressed cell growth. CONCLUSION: The finite craniopharyngioma cell lines were obtained through primary culture.

Development and validation of an early predictive nomogram for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

BACKGROUND: Previous studies have shown that platelet is involved in the occurrence and progression of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), but the relationship between platelet and DCI is not completely clear. Here, we aimed to screen the early platelet parameters associated with DCI after aSAH and develop an early predictive nomogram for DCI after aSAH. METHODS: The study was carried out in the neurosurgery department of Affiliated Hospital of North Sichuan Medical College. A total of 285 consecutive aSAH patients admitted within 24 hours after onset were analyzed retrospectively. Univariate and multivariate analyses were used to identify risk factors for DCI. A predictive nomogram was developed and validated with R software. RESULTS: Sixty-six (23.16%) of the 285 patients with aSAH exhibited DCI during hospitalization. The DCI group and the non-DCI group showed statistically significant differences in red blood cell count (RBC), platelet count (PLT), mean platelet volume (MPV), modified Fisher grade and platelet distribution width (PDW). Multivariable logistic regression analysis showed that modified Fisher grade [odds ratio (OR) =1.354; 95% confidence interval (CI): 1.034-1.773; P=0.028] and mean MPV [OR =1.825; 95% CI: 1.429-2.331; P<0.001] were independent risk factors for DCI. Modified Fisher grade, RBC, PLT, MPV, and PDW were used to develop a predictive nomogram for DCI. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.799 (95% CI: 0.737-0.861) in the training set and 0.783 (95% CI: 0.616-0.949) in the validation set. The calibration curve showed that the predicted probability concurred with the actual probability. Decision curve analysis indicated that this nomogram had good clinical application value and could be used for clinical decision making. CONCLUSIONS: Our study found that MPV was an early predictor of DCI after aSAH. The nomogram incorporating early MPV had greater value in predicting DCI after aSAH.

[Expression of CXCR4 and VEGF in hemangioblastomas of the central nervous system and its relation to tumor angiogenesis].

OBJECTIVE: To evaluate the relationships of CXCR4 (chemokine stromal cell-drived factor-1 receptor) and VEGF (vaseular endothelial growth factor) expression to tumor angiogenesis in hemangioblastomas of the central nervous system. METHODS: The protein expressions of CXCR4 and VEGF were detected by SP immunohistochemical staining in 40 hemangioblastomas. The endothelial cells of blood vessels within the tumor were labeled by CD34, then the microvessel density (MVD) was calculated. RESULTS: Total positive expression rates of CXCR4 and VEGF were 95% (38/40) and 85% (34/40) respectively. The expression rates of CXCR4 and VEGF were found positive obviously in hemangioblastomas compared with the normal cerebellar tissues (P < 0.01). CXCR4 expression was located in the nucleus of tumor stromal cells. VEGF expression was located in the cytoplasm and membrane of tumor stromal cells and some endothelial cells. VEGF has significant positive correlation with the expression level of CXCR4 (r = 0.704, P <0.001). MVD also has significant positive correlation with the expression level of CXCR4 and VEGF (P < 0.001). But there is no significant difference between the cystic and solid tumors, VHL disease and sporadic disease on the expression level of CXCR4, VEGF and MVD (P > 0.05). CONCLUSION: CXCR4 and VEGF may collaborate to induce angiogenesis in hemangioblastomas.

Risk Factors for Recurrence of Chronic Subdural Hematoma: A Single Center Experience.

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We aimed to investigate the predictive factors for the postsurgical recurrence of CSDH. METHODS: We retrospectively reviewed the medical records of patients with CSDH who underwent surgery in West China Hospital between January 2012 and June 2018. Univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, sex, history of injury, Markwalder grading, computed tomography findings, surgical methods, and outcomes. RESULTS: A total of 328 patients (281 men and 47 women) aged 22-93 years (mean age, 65.14 ± 13.76 years) were included. Computed tomography findings at admission showed mixed density hematoma in 136 patients, isodensity hematoma in 140, high-density hematoma in 34, and low-density hematoma in 18. The mortality and recurrence rate were 0.30% (1 of 328) and 2.44% (8 of 328), respectively. Six months postoperatively, 327 patients had Markwalder grade 0. Hematoma recurred in 8 patients of which 7 were mixed density hematoma and 1 was isodensity hematoma. Six patients who underwent craniotomy had thickened inner neomembrane that was resected. Univariate and multivariate analyses found mixed density hematoma to be an independent risk factor for the recurrence of CSDH. CONCLUSIONS: Burr hole craniostomy with irrigation and closed-system drainage is effective for the surgical treatment of CSDH. Mixed density hematoma is an independent predictor for the recurrence of CSDH. Presence of thick inner neomembrane might be the primary cause of CSDH recurrence.

Application of the Willis Covered Stent in the Treatment of Ophthalmic Artery Segment Aneurysms: A Single-Center Experience.

OBJECTIVE: The purpose of this study is to introduce our initial experience with the evaluation of the feasibility of using Willis covered stents (WCSs) in the treatment of complicated ophthalmic artery (OA) segment aneurysms. METHODS: Of the 162 patients with OA segment aneurysms treated by endovascular techniques in West China Hospital from January 2015 to August 2017, a total of 26 patients treated with WCSs were included in the study. RESULTS: Twenty-six patients with 26 aneurysms were included (mean age, 57.0 years; range, 22-76 years). The cohort had 20 patients with large or giant aneurysms, 3 patients with blood blister aneurysms, and 3 patients with pseudoaneurysms. Ten aneurysms were OA type, and 16 were internal carotid artery (ICA) type. Twenty-four patients were treated with 1 stent, and 2 patients were treated with 2 stents. Among the 26 patients, 2 patients had minimal endoleak, and 24 patients had complete occlusion after immediate postoperative angiography. One patient who had complete occlusion experienced contrast agent extravasation, and this phenomenon disappeared by balloon compression during the procedure. The 3- to 15-month angiographic follow-up showed that all patients experienced complete occlusion, including 2 patients with minimal endoleak during immediate postprocedural angiography. Two patient showed signs of in-stent stenosis. Clinical follow-up demonstrated that no delayed thromboembolic or ischemic events were recorded in the stent-grafted vascular region and no bleeding occurred in any of the patients (except 1 patient who experienced subarachnoid hemorrhage, left frontal lobe hemorrhage, and hydrocephalus 10 days after the procedure). CONCLUSIONS: WCSs may provide an alternative solution for treating complex OA segment aneurysms by reconstruction and preservation of the ICA. Our study also confirms the safety, efficacy, and midterm durability of WCSs for complex OA segment aneurysms.

Application of the Willis Covered Stent in the Treatment of Carotid-Cavernous Fistula: A Single-Center Experience.

BACKGROUND: The purpose of the present study was to describe our single-institutional experience of treating direct carotid-cavernous fistulas (DCCFs) with Willis covered stents (WCSs). METHODS: Of a total of 31 DCCFs, 10 were treated with WCSs (Microport, Shanghai, China) at West China Hospital from January 2015 to December 2016. The indications for treatment, perioperative findings, and postoperative and follow-up results were collected and analyzed. RESULTS: All 10 patients had successful deployment of WCSs. Complete exclusion of the fistula was achieved in 6 patients immediately after deployment of 1 stent. Endoleak was observed in 4 patients (patients 2, 4, 5, and 9). Thus, repeat dilation of the stent with greater pressure was performed, which resolved the endoleak in 2 patients (patients 2 and 9). The endoleak of the other 2 patients persisted after repeat dilation of the balloon. Hence, a second stent was deployed in these 2 patients (patients 4 and 5), which eliminated the endoleak in patient 4. However, patient 5 continued to have a minimal endoleak. Nine patients had fistulas successfully occluded by WCSs during the follow-up period. One patient experienced recurrence of a DCCF at the 10-day follow-up point. We chose coil embolization to address this DCCF. No stenosis of the internal carotid artery or DCCF recurrence, except that in the abovementioned patient, was observed. CONCLUSIONS: WCS was proved to be an alternative treatment method for complex DCCFs through reconstruction and preservation of the internal carotid artery. Our study also confirmed the safety, efficacy, and midterm durability of WCSs for complex DCCFs without any serious delayed complications.

[Microsurgical treatment of gigantic dumbbell-shaped jugular foramen tumor].

OBJECTIVE: To discuss the method of microsurgical treatment for jugular foramen tumor (JFT). METHODS: Ten patients with dumbbell-shaped JFTs who were microsurgically treated by the same group were retrospectively studied, the surgical approaches includes infratemporal approach and modified far lateral approach according to tumors' size, blood feeding, hearing and growth manner. Cranial nerve function, pre- and postoperative complications, follow-up data were presented and discussed. RESULTS: Gross total tumor removal was achieved in 7 patients, subtotal removal in 2 cases, partial removal in 1 case, postoperative cerebrospinal fluid leaking in 1 cases, postoperative new cranial nerve defects in 1 cases, aggravation in 2 cases. Postoperative deficits of the cranial nerves improved in 80 percent of the patients. Favorable facial function in 6 months postoperatively (House-Brackmann grade system in Grade 1 and Grade 2) was noted in 7 of the 10 patients. The postoperative level of hearing was preserved in 3 of the 6 patients with residual hearing. Recurrence was noted in 1 case during the follow-up period. CONCLUSIONS: Surgical total removal of JFT is possible depends on microsurgical operation with the two approaches with lowly additional neurological deficits. The function of preoperative affected cranial nerves can be recovered.

Prognosis of Symptoms and Complications After Microvascular Decompression for Hemifacial Spasm: A Single-Center Experience.

OBJECTIVE: The aim of this study was to identify potential prognostic factors of hemifacial spasm (HFS) after microvascular decompression (MVD), to establish the appropriate way to tackle postprocedure symptoms and complications (PPSCs), and to find the incidence and duration of PPSCs. METHODS: Two hundred and forty-eight patients with HFS were monitored between December 2009 and December 2014. The mean follow-up duration was 24 months (range, 6-67 months). We divided patients based on their PPSC status and investigated the following factors: age, sex, spasm side, facial nerve block before MVD (botulinum toxin treatment), acupuncture before MVD, duration of HFS, hypertension, diabetes, hepatitis B virus (HBV) infection status, herpes simplex virus infection status, smoking status and alcohol use, offending vessels, Chiari malformation, electrophysiologic monitoring results, and postoperative HFS. Univariable analysis and multivariate logistic regression were used to find potential risk factors. Kaplan-Meier analysis was used to show the duration of postprocedure facial palsy. RESULTS: Age (odds ratio [OR], 1.037; 95% confidence interval [CI], 1.004-1.072; P = 0.03) and HBV status (OR, 18.256; 95% CI, 2.723-122.415; P = 0.03) were positive predictors of PPSCs. Postoperative HFS (OR, 0.249; 95% CI, 0.084-0.0739; P = 0.012) may be a protective factor for postprocedure facial palsy. Most PPSCs related to cranial nerves recovered spontaneously in 3 months. Infections and cerebrospinal fluid leakages were controlled by medical intervention in 1-2 weeks. The permanent complication rate was only 4.8%. CONCLUSIONS: Although the incidence of PPSCs after MVD is very high, most PPSCs related to cranial nerves recovered spontaneously in several days. Permanent complications after MVD for HFS are rare. Age may relate to the occurrence of PPSCs, and postoperative HFS may be a protective factor for patients with facial palsy after MVD.

Influencing factors for posttraumatic hydrocephalus in patients suffering from severe traumatic brain injuries.

OBJECTIVE: To detect the influencing factors for posttraumatic hydrocephalus in patients with severe traumatic brain injuries and provide theoretical reference for clinical treatment. METHODS: Retrospective study was made on 139 patients with severe traumatic brain injuries in our hospital. The patients were divided into two groups: hydrocephalus group and non-hydrocephalus group. Single factor analysis and multiple factor analysis were used to determine the related factors and hydrocephalus. Multiple factor analysis was conducted with logistic regression. RESULTS: Posttraumatic hydrocephalus was found in 19.42% of patients. Age(OR equal to 1.050, 95%CI: 1.012-1.090), decompressive craniectomy (OR equal to 4.312, 95%CI: 1.127-16.503), subarachnoid hemorrhage(OR equal to 43.421, 95%CI: 7.835-240.652) and continuous lumbar drainage of cerebrospinal fluid (OR equal to 0.045, 95%CI: 0.011-0.175) were screened out from nine factors as the influencing factors for posttraumatic hydrocephalus. CONCLUSIONS: Risk factors for PTH are as follows: age, decompressive craniectomy and subarachnoid hemorrhage (SAH). Continuous lumbar drainage of cerebrospinal fluid can greatly reduce posttraumatic hydrocephalus.