The increasing need for rapid, decentralized assessment of nerve injury has driven the development of portable diagnostic technologies for monitoring biomarkers associated with neural damage and regeneration. Conventional analytical methods such as ELISA and PCR provide high sensitivity but are limited by laboratory dependence and delayed analysis, prompting a shift toward point-of-care biosensing platforms. This review summarizes recent advances in portable analytical techniques, including electrochemical, optical, and field-effect transistor-based sensors, which enable real-time, sensitive, and minimally invasive detection. Emphasis is placed on the role of advanced materials, e.g., such as gold nanoparticles, graphene, carbon nanotubes, and conductive polymers, in enhancing sensor performance through improved signal transduction and biocompatibility. Key biomarkers relevant to nerve injury and regeneration, including neurotrophic factors, inflammatory mediators, structural proteins, and nucleic acids, are discussed in the context of their detection in accessible biofluids such as blood, cerebrospinal fluid, and interstitial fluid. Finally, emerging integrations with microfluidics, wearable systems, and digital health technologies are highlighted as critical steps toward continuous monitoring and personalized care. Despite ongoing challenges in standardization and clinical validation, portable diagnostics hold significant promise for advancing neuroregenerative research and improving patient outcomes.

The abducens nerve’s long intracranial course makes it highly vulnerable to injury during traumatic brain injury. While traditionally attributed to skull base fractures, high-resolution MRI has identified avulsion in cistern as a significant, yet underrecognized, mechanism, which can occur even without adjacent fractures. The study retrospectively analyzed 31 patients with traumatic abducens nerve palsy and radiologically suspected or surgically confirmed cisternal segment avulsion. Injuries were classified via MRI as complete or partial/suspected avulsion. Patients received different treatments: neurosurgical intervention (n = 8, including exploration, microvascular decompression, end-to-end anastomosis, or trigeminal motor branch-abducens nerve anastomosis), strabismus surgery (n = 7), or medication alone (n = 16). Outcomes were assessed using a standardized symptom improvement score (0–4, higher scores represent better recovery). The cohort included 13 males (41.9

BACKGROUND:Hemimasticatory spasm (HMS) is an uncommon movement disorder of the trigeminal motor rootlet characterized by unilateral, involuntary, and paroxysmal contractions of the muscles of mastication. The mechanisms for HMS are still unclear, and an efficient treatment strategy still needs to be developed. This study aims to investigate the clinical features and surgical treatment of HMS. METHODS:Twelve patients with HMS were included in our study. The patient data regarding clinical characteristics, neuroimaging presentations, intraoperative findings, and treatment outcomes were analyzed retrospectively. Highly selective trigeminal motor root rhizotomy (HSTR) combined with microvascular compression was performed in nine cases with neurovascular conflict, whereas three patients without vascular compression underwent HSTR only. RESULTS:Intraoperative findings showed that there were two patients with six branches, two patients with five branches, and the remaining patients with three to four branches of the trigeminal motor roots. Seven patients had two motor branches severed, three patients had one motor branch severed, and two patients each had three motor branches severed. Nine patients recovered uneventfully and showed no signs of spasms, and the remaining two patients experienced complete disappearance of symptoms within 3 months after surgery. In one patient, the symptoms disappeared immediately after surgery but recurred 2 years later. CONCLUSION:The surgical procedures of HSTR can significantly alleviate the clinical symptoms of patients with HMS without serious complications.

INTRODUCTION:Trigeminal neuralgia (TN), characterized by severe facial pain triggered by mild stimuli, is challenging to treat effectively and non-invasively. Traditional treatments, including microvascular decompression and medications like carbamazepine, have limitations. This study investigates the potential of Bulleyaconitine A (BAA), an alkaloid that selectively inhibits specific sodium channels, for managing TN in a rat model via intranasal administration. METHOD:Adult male Sprague-Dawley rats were subjected to a Chronic Constriction Injury (CCI) of the distal infraorbital nerve to model trigeminal neuralgia (TN). BAA was administered intranasally, and pain thresholds were assessed using the von Frey filament stimulation technique. Comparative analyses involved transnasal carbamazepine administration, with a focus on optimizing BAA dosage and delivery methods, including nasal drops, gavage, and subcutaneous injection. RESULT:Intranasal BAA significantly increased pain thresholds in TN rats, demonstrating superior performance compared to the control group and achieving efficacy comparable to carbamazepine over a two-week period. Among various administration routes evaluated, nasal delivery was identified as the most effective. DISCUSSION:The study shows BAA's superior efficacy compared to carbamazepine, highlighting its potential as a TTX-selective sodium channel blocker for TN. Intranasal BAA administration offers a novel, non-invasive therapeutic option. Further research on dosage forms for clinical use, such as drug-encapsulating nanoparticles or vesicles for targeted delivery in neurological disorders, is warranted.

BACKGROUND:Non-flaccid facial palsy sequelae manifest as sequelae following Bell's palsy. Currently, there are no effective remedies for addressing this issue. In this study, the authors proposed a new surgical solution, epineurectomy of the extracranial facial nerve trunk, and assessed its safety and efficacy as a potential remedy. METHODS:In this single-arm trial, adult patients with non-flaccid facial palsy sequelae were enrolled and subjected to epineurectomy of the extracranial facial nerve trunk. The primary efficacy endpoint was the Sunnybrook scores at months 12 postoperatively. The secondary endpoints included non-flaccid facial palsy sequelae symptom scores, such as facial tightness or facial stiffness, facial synkinesis, eye fissures narrowing or difficulty in opening the eyes, House-Brackmann grade scale, and Facial Disability Index. RESULTS:A total of 22 patients were enrolled between July 2020 and January 2021. One patient was lost to follow-up. One year after surgery, the Sunnybrook score was 72.0 (63.0-75.0) at 12 months versus 68.0 (58.0-70.8) at baseline. The mean difference was -5.4 (-7.2 to -3.6). The scores of facial tightness or facial stiffness, synkinesis, eye fissures narrowing or difficulty in opening eyes were 0.0 (0.0-1.0), 1.0 (1.0-1.0), 1.0 (1.0-2.0) at 12 months versus 3.0 (1.3-3.0), 2.0 (1.0-2.8), 2.0 (2.0-3.0) at baseline, respectively. The median (IQR) values of the Facial Disability Index physical function were 92.0 (90.0-95.0) at months 12, and the mean difference (95% CI) was -32 (-38 to -26) compared to baseline. The mean difference (95% CI) in the Facial Disability Index social/well-being function between month 12 and baseline was -38 (-46 to -31). CONCLUSIONS:Epineurectomy of the extracranial facial nerve trunk can effectively and safely alleviate the sequelae of non-flaccid facial palsy.

High-flow cerebrospinal fluid (CSF) leakage is a major complication after surgery via the extended endoscopic endonasal approach (EEA). Thus, surgeons are still searching for techniques to avoid postoperative cerebrospinal fluid (poCSF) leakage. Recently, several surgeons have attempted dural suturing to prevent poCSF leakage. This study was performed to evaluate the efficacy of dural suturing for preventing poCSF leakage and presents a description of our operative technique. A total of 167 patients who underwent surgery via the extended EEA were enrolled in this study from January 2020 to May 2024. Among them, 75 patients underwent multilayered reconstruction only before May 2022. 92 patients underwent multilayered reconstruction combined with dural suturing after May 2022. The clinical data of the dural suturing group were compared with those of the no dural suturing group. All surgeries were performed by an experienced endoscopic neurosurgical team. Eighteen of 75 (24.0

Demyelination is widely acknowledged as the underlying pathological mechanism of trigeminal neuralgia (TN), while ferroptosis has been implicated in neurodegenerative disorders associated with demyelination. However, the precise contribution of ferroptosis to TN-related demyelination has yet to be elucidated. To investigate the putative pathway implicated in neuropathic pain, we conducted RNA-seq analysis in the IoN-CCI rat model that is deemed to simulate the pathology of TN. Subsequently, we explored iron metabolism and the ferroptosis-related pathway in this TN model. Finally, we utilized Ferrostatin-1 and Liproxstatin-1 to suppress ferroptosis and assessed alterations in iron metabolism and myelin sheath integrity through immunohistochemistry and transmission electron microscopy. Our experiments showed that IoN-CCI induced ferroptosis, characterized by increased iron accumulation and decreased expression of GPX4, FPN, and SLC7A11. This resulted in mitochondrial shrinkage in Schwann cells and loosened wrapping of the myelin sheath, as well as activation of neuroinflammation and oxidative stress. Inhibition of ferroptosis reversed these effects and alleviated demyelination and neuropathic pain. In conclusion, our study has clarified the impact of ferroptosis-induced demyelination in TN, providing a potential strategy for treating TN and offering new insights into the study of peripheral nerve demyelination diseases.

Oculomotor nerve palsy following head trauma can cause eye movement disorders and severe visual problems, but it was considered to have a poor prognosis with a wide range of interventions in the past. However, we performed neuroanastomosis in a patient with isolated oculomotor nerve injury and obtained a satisfactory long-term recovery, although the short-term effect was not obvious. The clinical presentation, surgical management, and functional rehabilitation of this patient are discussed.

IMPORTANCE:Postoperative neurocognitive disorders (PNCD) are a group of complications following surgery and anesthesia. Huperzine A, an acetylcholine esterase (AChE) inhibitor used to treat cognitive disorders, is promising in improving the postoperative cognitive function. OBJECTIVE:To assess the efficacy of huperzine A injection on improving early postoperative cognitive function in patients undergoing neurosurgical procedures under general anesthesia. DESIGN, SETTING, AND PARTICIPANTS:This parallel-group, randomized trial was conducted at a neurosurgical department of a tertiary hospital in China from May, 2021 to February, 2023. Adult patients scheduled for selective neurosurgical operations requiring general anesthesia were recruited. Participants were randomized 1:1 to postoperative huperzine A injections or standard care without additional pharmacological intervention. INTERVENTION:In the intervention group, 0.2 mg huperzine A was intramuscularly injected after tracheal extubation, and at 10:00 ± 2 h on the first, second and third postoperative days, respectively. Patients in the non-intervention group did not receive huperzine A injection after surgery. MAIN OUTCOMES AND MEASURES:The evaluation was performed at 6 h ± 2 h, 24 h ± 2 h, 48 h ± 2 h, 72 h ± 2 h, 96 h ± 2 h after the first administration. The primary outcome was the area under the curve in 0 to 96 hours postoperatively (AUC0-96h) of the mini-mental state examination (MMSE; score range: 0-30, with the higher score indicating better cognitive function) in total score and score changes from baseline, which represented total "cognitive burden" over the critical first 96 postoperative hours. RESULTS:The trial recruited 127 patients, of which 123 patients were included in the full analysis set (76 females [61.8%]; mean [SD] age, 59.6 [12.6] years). There were 58 patients in intervention group (40 females [69.0%]; mean [SD] age, 59.6 [11.9] years) and 65 in non-intervention group (36 females [55.4%]; mean [SD] age, 59.7 [13.2] years). Preoperative MMSE baseline were comparable between the two groups (intervention group: 28.5 [2.1]; non-intervention group: 28.0 [2.7], P = 0.608). Postoperatively, the intervention group demonstrated a significantly less decline in cognitive function, as measured by the mean (SD) AUC0-96h of the MMSE total scores (2770.67 [150.67]) compared with non-intervention group (2651.34 [257.41]) (P = 0.010). Accordingly, the mean MMSE change from baseline in the AUC0-96h was also significantly better in the intervention group (-2.67 [170.29]) than in the non-intervention group (-53.05 [164.04]) (P = 0.021). CONCLUSIONS AND RELEVANCE:In adults undergoing neurosurgery with general anesthesia, postoperative administration of Huperzine A associated with significantly improved MMSE scores over the 96-hour postoperative period.

OBJECTIVE:The hypoglossal-facial and cervical-hypoglossal nerve anastomoses (HFCHA) technique addresses severe facial palsy after cerebellopontine angle (CPA) tumor resection. However, postoperative facial function recovery and tongue dysfunction vary significantly among patients. This study identifies prognostic factors influencing these outcomes. METHODS:We retrospectively followed up on 43 patients with facial palsy who underwent HFCHA for CPA tumor resection (July 2019-December 2022). The patients were divided into two groups based on their recovery of facial function or tongue function: the good recovery group and the poor recovery group; or the tongue dysfunction group and the normal tongue function group. Potential prognostic factors were evaluated using univariate and multivariable analyses. RESULTS:Patients with a duration of facial palsy less than 10.75 months may exhibit an increased likelihood of achieving improved facial function recovery following surgical intervention. Compared to individuals who engaged in longer postoperative tongue rehabilitation exercises, patients whose exercise duration was shorter than 4.5 months demonstrated a tendency towards experiencing tongue dysfunction after surgery. CONCLUSIONS:A shorter time interval between facial nerve injury and surgery helps with the recovery of facial palsy. Longer postoperative tongue rehabilitation exercises may also potentially alleviate tongue dysfunction.

BACKGROUND Traumatic abducens nerve palsy can be caused by fractures around the Dorello's canal, direct injury at the dura entry point or within the Dorello's canal, or ischemia due to posterior meningeal artery damage. Recent imaging studies have also identified avulsion of the abducens nerve at its cisternal segment as a significant cause. CASE REPORT We present 2 cases of traumatic abducens nerve palsy due to avulsion at the cisternal segment. Preoperative thin-slice T2 magnetic resonance imaging indicated unclear visualization of the nerve at the cisternal segment in both cases. Surgical exploration revealed a partially avulsed nerve at the root exit zone in Case 1. In Case 2, only the distal stump was visible, compressed by an enlarged tortuous vertebral artery. No surgical intervention was performed in Case 1, while in Case 2, a partial anastomosis was performed between motor branches of the trigeminal nerve and the abducens nerve at the cisternal segment. CONCLUSIONS Avulsion of the abducens nerve at the cisternal segment should be considered an important cause of traumatic abducens nerve palsy. Additionally, vessels located in the cistern of the brain may also contribute to nerve disruption. End-to-end anastomosis, nerve grafting, and nerve transfer are the alternative procedures to treat the avulsion.

AIM: To investigate whether the latency of spread could reflect the complexity level of intraoperative offending vessels in patients with typical hemifacial spasm. MATERIAL and METHODS: A total of 96 patients with typical hemifacial spasm who underwent microvascular decompression (MVD) in our department between August 2018 and December 2019 were retrospectively analyzed. We introduced a new concept of three complexity levels of offending vessels based on six vascular classifications proposed by Kwan Park et al. and the difficulty of intraoperative management reviewed by surgical videos. One-way analysis of variance, Spearman correlation analysis, and multivariate linear regression analysis were performed. RESULTS: There were significant differences in latency of spread among the three complexity levels of offending vessels (p<0.01). Spearman correlation analysis showed a strong negative correlation between vascular complexity level and the latency of spread (r=-0.7997, p<0.0001). Multivariate linear regression analysis showed that the vascular complexity level was the main factor affecting the latency of spread (p<0.01). In contrast, other factors such as sex, side, age, hypertension, and diabetes had no significant effects. CONCLUSION: The latency of spread, as an important clinical indicator, can reflect the complexity level of offending vessels in patients with typical hemifacial spasm before MVD.

BackgroundMandibular first premolar has a complex and variable anatomy of the root canal system, which often leads to failure of endodontic treatment due to missing root canals. Identifying the complete structure of the root canal system to ensure that all root canals are perfectly cleared and filled becomes critical to the success of root canal therapy. This report introduced a unique case of endodontic treatment of a two-rooted mandibular first premolar in the buccolingual direction with a total of four canals.Case presentationAn adult male patient with a lower left first premolar was diagnosed with acute apical periodontitis and treated with open pulp drainage in a general hospital. One day later, due to the complexity of the root canal structure, the patient was referred to our clinic for subsequent treatment. The tooth #34 was diagnosed with abnormal central cusp, apical periodontitis, and incomplete fracture through clinical and x-ray examinations. Cone-beam Computed Tomography (CBCT) results showed that the tooth #34 processed two roots with a buccolingual bifurcation and a total of 4 root canals: 1 lingual canal, 2 mesiobuccal canals, and 1 distobuccal canal. Notably, the buccal root presented a C-shaped configuration, and the mesiobuccal canals were of 2-1 type. The tooth was treated with microendodontics and crown restoration. One year after the treatment, the follow-up results showed that the tooth #34 was functioning normally without any abnormalities.ConclusionThis report enhances our understanding of the anatomical variations in the root canal system of the mandibular first premolar and emphasizes the importance of CBCT in identifying anatomical variations within the root canal system. Clinicians must be aware of such changes in the mandibular first premolar during treatment to ensure a perfect treatment and better prognosis in clinical practice.