OBJECTIVE:Meige syndrome is a complex movement disorder characterized by blepharospasm and oromandibular dystonia that is often resistant to conventional pharmacological and botulinum toxin treatments. Deep brain stimulation (DBS) offers a promising alternative, but the relative efficacy of globus pallidus internus (GPi) versus subthalamic nucleus (STN) targeting remains underexplored. Therefore, the aim of this study was to evaluate and compare the short- and long-term efficacy of GPi-DBS and STN-DBS in managing Meige syndrome. METHODS:This retrospective study analyzed patients with primary Meige syndrome who underwent either GPi-DBS or STN-DBS at a single institution from October 2018 to October 2024. The main outcome measure was the change in the Burke-Fahn-Marsden Dystonia Rating Scale for movement (BFMDRS-M) scores, which were assessed preoperatively and at 3 months and a mean of 37.2 months postoperatively. RESULTS:Of 162 patients (110 female, mean age 57.8 years) included in the analysis, 83 underwent GPi-DBS and 79 underwent STN-DBS. The GPi-DBS group had an average improvement rate of 53.3% in the mean BFMDRS-M score at 3 months postoperatively and 63.0% at the final follow-up. Similarly, the STN-DBS group had average improvement rates of 53.6% at 3 months and 65.2% at the final follow-up. At the final follow-up, 71.1% of patients in the GPi-DBS group and 70.9% of patients in the STN-DBS group had ≥ 50% improvement, while 41.0% and 46.8%, respectively, had > 75% improvement. There was no significant difference in short-term (p = 0.602) or long-term (p = 0.419) efficacy between the two groups. CONCLUSIONS:GPi-DBS and STN-DBS are both effective for the management of Meige syndrome, with no significant difference in overall efficacy. However, further research is required to confirm these findings.

Background The association between pregnancy and the risk of symptomatic hemorrhage (SH) in brainstem cavernous malformations remains uncertain. We aimed to quantify the risk of pregnancy‐associated SH in women with brainstem cavernous malformations. Methods We analyzed women with brainstem cavernous malformations in a prospective registry (2016–2022) experiencing pregnancy after enrollment. Follow‐up was divided into pregnancy‐associated segments (pregnancy plus ≤6 weeks postpartum or postabortion) and nonpregnant segments. Primary analysis used case‐crossover models; propensity score‐matched analyses assessed robustness. Results Among 63 women (median age, 30.0 years), 53 (84.1%) had bled before enrollment, including 45 (71.4%) with SH in the preceding year. Prospectively, they contributed 72 pregnancies and 371.7 patient‐years, observing 34 SHs. The pregnancy annual SH rate was 20.4% versus 7.2% nonpregnant (adjusted incidence rate ratio: 2.56, 95% CI, 1.11–5.93; P=0.028). Trimester‐specific and postpartum annual SH rates were 5.9%, 16.8%, 34.6%, and 38.3%; risk significantly increased only during the third trimester (P=0.004) and postpartum (P=0.007). This pregnancy effect was confined to segments with SH in the preceding year (annual SH rates 46.7% versus 9.4%; P=0.007), which was an independent risk factor. Propensity score‐matched analyses yielded consistent results. Conclusions Pregnancy is associated with an elevated SH risk in women with brainstem cavernous malformations, specifically among those with SH in the preceding year. Because of selection bias, generalizability to asymptomatic or incidental lesions is limited, warranting cautious extrapolation. Registration URL: www.chictr.org.cn; Unique Identifier: ChiCTR‐POC‐17011575.

Disorders of consciousness (DoC) following severe brain injury represent a formidable clinical challenge, with limited therapeutic options for patients in prolonged unresponsive or minimally conscious states. Deep brain stimulation (DBS) of the central thalamus has re-emerged as a pivotal strategy to restore arousal and functional communication. In this review, we integrate systems neuroscience with clinical evidence to delineate the transition of DBS from an experimental intervention toward circuit-guided precision medicine. We first articulate the mesocircuit hypothesis, positing that DBS acts not by local excitation alone, but by reversing a circuit-level collapse driven by striatal deafferentation and excessive pallidal inhibition. Synthesizing recent clinical data, we highlight an emerging reinterpretation of targeting, in which efficacy may depend less on named anatomical nuclei than on the recruitment of preserved arousal conduits and fronto-striatal projections—a hypothesis supported by connectomic analyses but awaiting direct causal validation. Furthermore, we discuss the redefinition of patient selection through Cognitive Motor Dissociation (CMD) and the evolution of stimulation paradigms toward biomimetic, adaptive control policies (e.g., 40–60 Hz state-dependent modulation). Finally, we address the ethical framework of “consent under uncertainty” essential for responsible translation. We conclude that while heterogeneity remains a hurdle, combining connectome-based targeting with sensing-enabled technologies offers a viable roadmap to validate DBS as a standard of care for carefully selected patients.

BackgroundMaintaining mobility is central to healthy ageing. We tested whether named-site pain burden predicts future mobility limitation consistently across populations.MethodsWe analysed adults aged 45–69 years from the China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Survey of Health, Ageing and Retirement in Europe (SHARE), free of mobility limitation at baseline. Pain burden was harmonised as 0, 1, or ≥2 named sites. Repeated-interval modified Poisson models estimated adjusted risk ratios (RRs). Prediction compared a common clinical model with the same model plus pain burden, with bootstrap internal validation and six reciprocal external transfers.FindingsThe association analysis included 78,845 person-intervals and 11,659 events. For ≥2 versus 0 pain sites, adjusted RRs were 1·35 (95% CI 1·28–1·43) in CHARLS, 2·37 (2·15–2·62) in ELSA, and 1·98 (1·82–2·16) in SHARE. The prediction sample included 37,892 participants and 5790 events. Across six external transfers, the area under the receiver operating characteristic curve (AUROC) for the pain-enhanced model ranged from 0·646 to 0·713; the AUROC increment was positive in all six and its 95% CI excluded zero in five. Calibration intercept shifted in every transfer. Intercept-only updating improved Brier score and log loss in all six and increased decision-curve support.InterpretationNamed-site pain burden provided modest but reproducible prognostic ranking information across ageing populations. Absolute risks were less transportable, supporting local calibration before threshold-based use.

Objectives To investigate the surgical strategies, technical aspects, and clinical outcomes of microvascular decompression (MVD) in treating primary trigeminal neuralgia (PTN) associated with vertebrobasilar dolichoectasia (VBD). Methods A retrospective analysis was conducted on 34 consecutive VBD-related PTN patients treated by a single neurosurgeon at China-Japan Friendship Hospital from January 2020 to April 2025. VBD compression patterns were classified into two types: Type I: Imaging showing significant brainstem deformation and obliteration of the arachnoid space by VBD (n = 16, 47.1

BackgroundIntracerebral hemorrhage (ICH) is a severe neurological condition with high morbidity and mortality rates. Robot-Assisted Minimally Invasive Surgery (RA-MIS) has emerged as a novel technique that may offer advantages over traditional craniotomy. This study aims to evaluate the clinical efficacy of RA-MIS compared to conventional craniotomy in patients with ICH.MethodsA retrospective cohort study was conducted involving 44 patients with ICH admitted to two medical centers between December 1, 2022, and October 31, 2024. Patients were divided into two groups: 24 underwent RA-MIS, and 20 underwent traditional craniotomy. Baseline characteristics, functional outcomes [modified Rankin Scale (mRS)], neurological deficits [National Institutes of Health Stroke Scale (NIHSS)], postoperative complications, hospitalization costs, duration of respiratory support, and mortality rates were analyzed.ResultsThe RA-MIS group demonstrated significantly better functional outcomes at 90 days postoperative, with a mean mRS score of 2.58 ± 1.72 compared to 3.85 ± 1.63 in the craniotomy group (P = 0.017). NIHSS scores at 90 days were also significantly lower in the RA-MIS group (3.64 ± 3.32 vs. 7.71 ± 5.35; P = 0.006), indicating improved neurological recovery. RA-MIS patients experienced fewer postoperative complications, including lower incidences of pneumonia (16.7% vs. 70.0%; P < 0.001) and intracranial infections (0.0% vs. 20.0%; P = 0.036). The total hospitalization costs were significantly lower for the RA-MIS group (¥78,677 ± 38,904 vs. ¥136,399 ± 85,916; P = 0.006), and the duration of respiratory support was shorter (64.00 ± 161.79 h vs. 238.25 ± 197.04 h; P = 0.002). The mortality rate was significantly lower in the RA-MIS group (8.3% vs. 30.0%; P = 0.020).ConclusionsRA-MIS is associated with improved functional and neurological outcomes, fewer postoperative complications, reduced hospitalization costs, and lower mortality rates compared to traditional craniotomy in patients with ICH. These findings suggest that RA-MIS may be a more effective and economical surgical option for hematoma evacuation in ICH patients.

Spinal cord stimulation (SCS) is a non-pharmacological neuromodulation technique used to treat various neurological disorders. It functions by delivering electrical impulses to specific areas of the dorsal columns of the spinal cord, thereby modulating abnormal neural signal transduction to alleviate symptoms. In recent years, the clinical applications of SCS have significantly expanded beyond its primary indication for refractory chronic pain. It is now increasingly utilized in diverse areas, including functional recovery in central paralysis, improvement of lower limb blood perfusion, intervention for diabetic foot pain and dysfunction, and promotion of arousal in consciousness disorder patients. This review summarizes recent clinical advances and mechanistic explorations of SCS in these expanding indications. It emphasizes the critical importance of postoperative programming management for optimizing therapeutic outcomes. Finally, the review discusses current challenge and future direction.

To compare the long-term efficacy and safety of repeat microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with recurrent trigeminal neuralgia (TN) after initial MVD. Comprehensive clinical baseline characteristics, surgical details, and postoperative follow-up information were systematically collected. Propensity score matching was employed using sex, age, and follow-up time for 1:1 matching. The primary outcome was pain recurrence. Secondary outcomes included bothersome facial numbness, defined as a Barrow Neurological Institute (BNI) facial numbness score of III or higher, and poor overall outcome, defined as a composite BNI score (sum of the BNI pain intensity and facial numbness scores) of V or higher. Univariate and multivariate Cox proportional hazards and logistic regression models were employed to assess factors associated with pain recurrence and secondary outcomes, respectively. In this multi-center, retrospective, propensity-score-matched cohort study, the matched cohort comprised 286 patients (143 pairs) with recurrent TN after prior MVD. After excluding 30 patients lost to follow-up and 8 because of treatment failure, the final analysis included 127 patients who underwent repeat MVD and 121 treated with PBC. The two procedures demonstrated comparable long-term pain control. The pain recurrence rate was 16.5

Painful diabetic peripheral neuropathy is recognized as a common and highly disabling complication in diabetes. Its underlying mechanisms remain incompletely understood, and effective therapeutic options are lacking. A growing body of evidence indicates that long noncoding RNAs, microRNAs, and messenger RNAs form complex competing endogenous RNA networks that influence painful diabetic peripheral neuropathy development. Given the central role of the dorsal root ganglion in sensory processing, this study investigated transcriptomic alterations in dorsal root ganglion tissue from a streptozotocin-induced rat model of painful diabetic peripheral neuropathy. Behavioral, electrophysiological, and histopathological assessments confirmed the successful establishment of neuropathic pain phenotypes. Whole-transcriptome RNA sequencing identified 101 messenger RNAs and 184 long non-coding RNAs that were differentially expressed. Key dysregulated genes included the proinflammatory cytokine Ccl3, the neurotrophic factor Igf1, the transcription factor Fosb, and the metabolic enzyme Alox15. Enrichment analyses indicated that these genes were mainly involved in immune-inflammatory responses, regulation of neurotransmission, ion channel activity, and energy metabolism. Construction of a competing endogenous RNA network showed that 1892 positively correlated long non-coding RNA-messenger RNA pairs contributed to a competing endogenous RNA network in which XR_005494971.1 was the most prominent long non-coding RNA regulator. Integration of microRNA predictions further identified rno-miR-466b-3p as a central node linking messenger RNAs and long non-coding RNAs. Reverse transcription-quantitative polymerase chain reaction and western blotting validated the sequencing results. These findings provide an integrated overview of coding and non-coding RNA interactions in a rat model of painful diabetic peripheral neuropathy and highlight molecular targets that may support early diagnosis and precision therapeutic strategies.

Wireless microsystems for neural signal recording have emerged as a solution to overcome the limitations of tethered systems, which restrict the mobility of subjects and introduce noise interference. However, existing microsystems often face data throughput, signal processing, and long-distance wireless transmission challenges. This study presents a high-performance wireless microsystem capable of 32-channel, 30 kHz real-time recording, featuring Field Programmable Gate Array (FPGA)-based signal processing to reduce transmission load. The microsystem is integrated with platinum nanoparticles/poly (3,4-ethylenedioxythiophene) polystyrene sulfonate-enhanced microelectrode arrays for improved signal quality. A custom NeuroWireless platform was developed for seamless data reception and storage. Experimental validation in rats demonstrated the microsystem’s ability to detect spikes and local field potentials from the hippocampal CA1 and CA2 subregions. Comparative analysis of the neural signals revealed distinct activity patterns between these subregions. The wireless microsystem achieves high accuracy and throughput over distances up to 30 m, demonstrating its resilience and potential for neuroscience research. This work provides a compact, adaptable solution for multi-channel neural signal detection and offers a foundation for future applications in brain–computer interfaces.

Traumatic brain injury (TBI) involves diverse molecular pathological alterations and biological processes in a temporally dynamic manner. However, current knowledge on the various processes during the acute phase of TBI is still rather limited. RNA-seq analysis was performed on brain tissues from C57/BL6 mice at 10 time points(0 h, 1 h, 2 h, 3 h, 4 h, 6 h, 12 h, 1d, 3d, and 7d) following TBI modeling. Subsequently, a bioinformatics approach, Weighted Gene Co-expression Network Analysis (WGCNA), was employed to identify characteristic modules, which were then validated using the Mfuzz method. Pathway enrichment analysis was conducted on WGCNA module genes, and hub genes were screened using the STRING database. After exploring the various potential pathways and expression patterns (neuroinflammation, cognition, gliosis and myelin regeneration etc.), we focus on pyroptosis, a inflammatory cell death influencing immune response, for in-depth analysis. RT-qPCR, Western blot(WB) and Immunofluorescence(IF) were used to validate the hub genes and key pyroptosis-related genes(Casp1, Casp11, GSDMD). Additionally, single-cell RNA sequencing data at 7 day post injury(dpi) was also used to validate the expression of the identified hub genes. Our approach to intensive transcriptomic analysis comprehensively reveals the temporal molecular pathological alterations during TBI progression. Pyroptosis may be a key mechanism in the neuroinflammatory process. Intervention strategies targeting specific molecular pathways may offer novel approach for the treatment of TBI.

Diffuse glioma, the most prevalent and malignant intracranial tumor, presents a formidable challenge due to its immunosuppressive microenvironment, which complicates conventional therapeutic approaches. This study conducted a comprehensive prognostic meta-analysis involving 2,968 patients with diffuse glioma and established a comprehensive machine learning framework with nested resampling of 18 machine learning algorithms, and developed the Immune Glioma Survival Signature (IGLoS). This signature, comprising CCL19, ICOSLG, IL11, PTGES, TNFAIP3, and TRAF3IP3, has been demonstrated to predict survival outcomes across a range of cancers and to correlate with tumor progression at the level of multi-omics. It is noteworthy that the IGLoS score enables precise patient stratification for personalized cancer treatments and elucidates pivotal resistance mechanisms to immunotherapy. Furthermore, siRNA screening has underscored the critical role of TRAF3IP3 in modulating PDL1 expression and immune pathways, with implications on the ERK pathway and NFATC2 involvement. Through single-cell analysis of published and in-house datasets, TRAF3IP3 exhibited selective enrichment in NPC-like and MES-like tumor cells, and showed a dual functionality in mediating T-Cell Exhaustion. Targeting TRAF3IP3 emerges as a promising avenue to combat immunotherapy resistance, particularly in glioma, thus paving the way for precision medicine.

Recurrent Trigeminal Neuralgia (TN) poses significant challenges for treatment, often necessitating repeated Microvascular Decompression (MVD). This study aims to evaluate the safety, efficacy, and prognostic factors associated with repeated MVD for recurrent TN at our institution. A retrospective review was conducted on 147 patients who underwent repeated MVD between September 2010 and September 2023. Data on surgical procedures, postoperative outcomes, and recurrence rates were collected. The primary endpoint was recurrent pain. Univariate and multivariate Cox proportional hazards analyses were used to identify predictors of pain recurrence. In this cohort, 147 patients underwent revision surgery, comprising 97 females and 50 males. The primary reason for the nonresolution in 96 patients was adhesions of Teflon pledgets to the trigeminal nerve, while in 51 patients, previously missed vascular compression was identified. After a median follow-up of 53.3 months, 14 patients were lost to follow-up. Twelve patients (9.0

BACKGROUND:Although deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) or the subthalamic nucleus (STN) has shown efficacy for Meige syndrome (MS), there is limited comparative evidence available. METHODS:This retrospective cohort study consecutively enrolled patients with primary MS who underwent bilateral GPi-DBS or STN-DBS at our center between March 2015 and February 2025. Propensity score matching (PSM, 1.5:1) was employed to balance baseline covariates. The primary outcomes were improvements in the Burke-Fahn-Marsden Dystonia Rating Scale movement subscore (BFMDRS-M) at 3-month (short-term) and at the final follow-up (long-term). Additionally, stimulation parameters, programming adjustments, and adverse events (AEs) were analyzed. RESULTS:The study cohort comprised 254 eligible patients (GPi-DBS: 176; STN-DBS: 78), with 14 patients (4.8%) lost to follow-up. The overall cohort consisted of 178 women (70.1%) with a mean surgical age of 57.7 ± 8.6 years. After PSM, 157 patients were matched (89 GPi-DBS, 68 STN-DBS). At 3-month follow up, the mean improvement rate of BFMDRS-M total score was 51.0% [95% confidence interval (CI): 46.7-55.3%] for GPi-DBS and 54.6% (95% CI: 49.3-59.8%) for STN-DBS, with no significant intergroup difference (P = 0.235). After a mean follow-up of 42.4 ± 23.6 months, the mean improvement was 61.0% (95% CI: 56.4-65.5%) for GPi-DBS and 65.2% (95% CI: 59.2-71.1%) for STN-DBS, again indicating no significant difference ( P = 0.192). STN-DBS required lower stimulation parameters but significantly more programming adjustments than GPi-DBS (mean sessions: 5.49 vs 4.33; P < 0.001). AE incidence was similar between groups (GPi-DBS vs STN-DBS: 5.4% vs 3.6%; P = 0.731). CONCLUSIONS:Both GPi-DBS and STN-DBS provided significant and sustained motor symptom improvement in refractory MS, with no statistically significant difference between groups.

Microvascular decompression (MVD) plays a critical role in the treatment of neurovascular compression-related diseases, with its success heavily dependent on the precise preoperative identification of key anatomical structures, especially small-volume and densely distributed tissues like nerves and vessels. To address this challenge, we propose a multi-attention aggregation network (MAA-Net), for the segmentation of MVD-related structures in MRI images. The method is based on the U-Net architecture and incorporates two attention mechanisms. A spatial-channel parallel attention module at the bottleneck jointly models spatial and channel dependencies to better capture complex interwoven anatomical structures, particularly in regions where nerves and cerebral vessels are intertwined. In addition, a lightweight gated attention module is inserted between the encoder and decoder to improve the perception of small-volume nerve targets by promoting feature selectivity and suppressing background noise, especially when processing fine nerve structures. We evaluated the proposed method on a private clinical dataset covering the brainstem, nerves, cerebral vessels, and cerebellum. The results demonstrate that our method achieves superior performance in volume overlap metrics (e.g., Dice score), delivers precise boundary delineation in distance-based metrics (HD95 and ASD), and exhibits strong recognition ability for elongated structures as reflected in the clDice score, confirming its practical value for preoperative MVD localization.

Background This study investigates the predictive value of baseline quantitative susceptibility mapping (QSM) metrics for assessing the risk of future symptomatic haemorrhages in patients with brainstem cavernous malformations (CMs). Methods From July 2020 to September 2023, a prospective multicentre cohort of 155 patients with brainstem CMs was enrolled from 12 institutions. We analysed baseline QSM metrics, including lesional mean, median, IQR and maximum susceptibility. Propensity score matching was adjusted for baseline confounders, and Cox regression models assessed haemorrhage risk. Risk stratification was performed based on thresholds determined from planned receiver operating characteristic (ROC) analyses. Results Postmatching cohorts (56 haemorrhage-free vs 30 haemorrhage cases) showed balanced baseline characteristics. Over a mean follow-up of 22.6 months, the baseline QSM metrics, particularly the median susceptibility (QSMmedian) (HR 58.896, 95% CI 8.544 to 405.989, p<0.001; Bonferroni-adjusted p=0.0001, k=4) and IQR of susceptibility (QSMIQR) (HR 29.754, 95% CI 6.101 to 145.119, p<0.001; Bonferroni-adjusted p=0.0001, k=4) were associated with prospective haemorrhage after adjusting for age, gender, lesion volume and prior haemorrhage. QSMmedian (area under curve (AUC)=0.759) and QSMIQR (AUC=0.740) demonstrated modest predictive performance. Risk stratification based on QSMmedian and QSMIQR demonstrated 2-year haemorrhage-free survival rates of 83.3%, 62.8% and 35.7% for the low-risk, intermediate-risk and high-risk groups, respectively. High-risk patients showed a 7.7-fold greater risk of haemorrhage compared with the low-risk group. Conclusions This study explored the predictive value of QSM metrics for future symptomatic haemorrhage, suggesting that QSM may serve as a complementary imaging biomarker to existing prognostic models. Further validation in larger, independent cohorts is warranted.

To compare the efficacy and safety of microvascular decompression (MVD) and percutaneous balloon compression (PBC) in trigeminal neuralgia (TN) management, focusing on pain relief, recurrence, complications, and patient satisfaction.A retrospective cohort of 226 MVD and 127 PBC patients was analyzed after propensity score matching (PSM). Clinical baseline characteristics, surgical details, and postoperative follow-up information were collected. The primary outcome of this study was recurrent pain of TN, and the secondary outcome was facial numbness dissatisfaction. Univariate and multivariate Cox proportional hazards regression models were employed to assess potential predictors associated with pain recurrence.From May 2019 to May 2023, this study retrospectively collected 405 patients with TN: 265 underwent MVD and 140 received PBC. The overall cohort included 234 females (57.8

BACKGROUND:Neurovascular compression syndromes (NVCSs) are a series of vascular compression diseases wherein there is usually entrapment or distortion of cranial nerves due to redundant or aberrant culprit vessels. Microvascular decompression (MVD) is an effective treatment for NVCS. However, the global adoption of fully endoscopic MVD (E-MVD) remains limited. METHODS:This retrospective study reviewed 105 patients with NVCS (102 cases for initial operation and 3 cases of disease recurrence) who underwent E-MVD. The cohort comprised of 59 hemifacial spasm (HFS), 34 trigeminal neuralgia (TN), and 12 glossopharyngeal neuralgia cases. All patients were followed up by telephone one year postoperatively, focusing on the relief of symptoms and surgical complications such as hearing loss, tinnitus, or vertigo. RESULTS:In the de novo NVCS group, the pain completely resolved immediately after surgery (from Barrow Neurological Institute grade IV and V to grade 0) in 32 TN patients (32/34, 94.1%) and all 12 glossopharyngeal neuralgia patients (100%), and spasm symptoms disappeared (from Shorr grading III and IV to 0) in 57 HFS patients (96.6%). Three recurrent patients (2 with HFS and 1 with TN) experienced complete symptom relief without reappearance. Additionally, two left HFS patients with preoperative neurogenic hypertension had their blood pressure gradually return to normal levels postoperatively. Postoperative neurological complications included hearing loss, tinnitus, and dysphagia, each occurring in 1 case (2.9%). Other complications included meningitis (5/105, 4.8%), cerebrospinal fluid leakage (1/105, 1%), and incisional fat liquefaction (2/105, 1.9%). CONCLUSIONS:E-MVD represents a significant advancement in the treatment of NVCS, offering a promising alternative to traditional strategies.

Background:The mechanisms underlying stroke or cognitive impairment in patients with vertebrobasilar dolichoectasia (VBD) remain unclear. This study aimed to examine the hemodynamic abnormalities in patients with VBD through use of multidelay arterial spin labeling (ASL) magnetic resonance imaging. Methods:A retrospective case-control study was conducted and enrolled 30 patients with VBD and 30 healthy participants. Multidelay ASL was used to evaluate the cerebral blood flow (CBF) and arterial transit time (ATT), while carotid Doppler ultrasound was performed to measure extracranial artery flow velocity. The extracranial artery flow velocity and perfusion parameters in the study group and control group were compared. According to the magnetic resonance angiography, VBD in patients was classified as mild, moderate, or severe type. The correlation of the CBF and extracranial artery flow velocity with the severity of VBD was determined. Results:The mean cerebral blood flow (mCBF) in both the anterior and posterior circulations was lower in the study group than in the control group (P<0.05). The ATT in the study group was significantly longer than that of the control group (P<0.05). In the study group, end-diastolic velocity (EDV) of the right extracranial internal carotid artery was correlated with the mCBF of the right frontal and parietal lobe (P<0.05), whereas the CBF and blood velocity of the vertebral arteries were not correlated. In the control group, the mean peak systolic velocity and mean end-diastolic velocity (mEDV) of the bilateral vertebral arteries were correlated with CBF values of the region of interests in the posterior circulation (P<0.05). There were strong negative correlations between the ATT and mCBF in the control group (P<0.05). No meaningful associations between ATT and mCBF were found in the study group for any region, with the exception of the insula (r=-0.402; P=0.001). There were 7 (23%), 14 (47%), and 9 (30%) cases of mild, moderate, and severe VBD, respectively. Additionally, 10 patients with VBD showed ischemic or infarcted lesions, while 20 had no lesions. The severity of VBD was significantly associated with the mEDV of the bilateral vertebral arteries and the EDV of the right and left extracranial internal carotid artery (P<0.05). There was no association between VBD severity and the occurrence of ischemia (P>0.05). Conclusions:VBD may lead to brain hypoperfusion, and CBF is not associated with ATT. The hemodynamic disorders in VBD may indicate impaired cerebrovascular autoregulation, which is an underlying mechanism for cerebral small vessel disease.