OBJECTIVE:The prevalence of ischemic stroke in young adults has increased dramatically. However, factors associated with prognosis in this cohort have not been well studied. This study primary aimed to construct and validate a nomogram for predicting stroke recurrence and to achieve risk stratification of young adults after acute ischemic stroke (AIS). METHODS:In this retrospective, multicenter study, we identified AIS patients aged 18-50 years in Tianjin Huanhu Hospital (training cohort) and The Affiliated Hospital of Chengde Medical College (validation cohort) from September 2019 to September 2021, respectively. Demographics and clinical characteristics data were systematically collected. A stepwise Cox proportional hazards regression analysis was used to identify the independent predictors of stroke recurrence in the training cohort and employed to construct the best-fit nomogram. Patients were stratified into low-, medium-, and high-risk groups based on the total points. Receiver operating characteristic (ROC) analysis and calibration curves were used to assess the discrimination and calibration of the nomogram. The discriminate value of risk stratification was verified using Kaplan-Meier curves, and external validation was performed with the validation cohort. RESULTS:A total of 467 young adult AIS patients were enrolled in this study. The overall prevalence of young adults in AIS patients was 13.3 % (95 % confidence interval, 12.2 %-14.5 %). Hyperlipidemia (Hazard ratio, 2.4 [1.2-4.9]), current smoking (5.9 [2.7-12.8]), stroke subtype (small-vessel occlusion, 3.7 [1.8-7.6]; stroke of undetermined cause/ others, 14.5 [3.0-70.2]), and stenosis (11.4 [4.5-28.9]) were significant independent predictors of stroke recurrence. A nomogram was constructed with the above predictors and achieved a satisfactory prediction in the validation cohort. Patients were classified into low-, medium-, and high-risk groups based on the total points with the cutoff value of 110.8 and 185.2. The log-rank test showed significant discrimination among the Kaplan-Meier curves of different risk groups (P < 0.001). CONCLUSION:The nomogram can satisfactory prediction of stroke recurrence-free rate in young adult patients and achieved risk stratification, may help to personalize management of patients.

2025年11月28-29日,由天津市精准医疗学会主办、天津市环湖医院承办的"2025环湖国际颅脑创伤与神经重症大会"在天津成功召开.大会邀请国内外众多颅脑创伤与神经重症领域顶尖专家、学科带头人及骨干医护人员,天津市卫生健康委员会、天津大学、河北工业大学、中国医学科学院生物医学工程研究所领导和专家以及涉及院前急救的天津市相关部门重要领导均莅临会场.

To explore the effect of brain cognitive compensation on the pathogenesis of postoperative delirium (POD) in the frontal glioma patients. Eighty-four adult patients with unilateral frontal glioma who underwent elective craniotomy and 37 healthy controls were recruited. Primary outcomes were POD during postoperative 1–7 days, as assessed by Confusion Assessment Method. Cognition before surgery was measured by the battery of neuropsychological tests. Then we evaluated gray matter volume (GMV) and white matter integrity (i.e. fractional anisotropy (Casey et al.)) by presurgical voxel-based morphometry and diffusion tensor imaging. We investigated the association between presurgical structural index of potential compensatory brain regions with POD incidence and severity. POD occurred in 13 of 67 subjects (19.4

Objective To analyze the influencing factors of acute kidney injury (AKI) after surgery in spontaneous intracranial hemorrhage (sICH). Methods A total of 151 patients with sICH who underwent surgery in Tianjin Huanhu Hospital from March 2023 to June 2024 were selected. According to whether AKI occurred after surgery, they were divided into AKI group (n = 100) and non-AKI group (n = 51). Logistic regression analyses were used to screen the influencing factors of AKI after surgery in patients with sICH. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of intracranial pressure (ICP) and serum neuron-specific enolase (NSE) 3 d after surgery and their combination for AKI. Results Logistic regression analysis showed that increased cardiac troponin (OR = 1.011, 95%CI: 1.005-1.017; P = 0.001), and increased ICP 3 d after surgery (OR = 1.289, 95%CI: 1.126-1.477; P = 0.000) were the risk factors for AKI after surgery in sICH patients. ROC curve showed that the area under the curve (AUC) of ICP and serum NSE 3 d after surgery and their combination in the prediction of AKI after surgery were 0.729 (95%CI: 0.649-0.810, P = 0.000), 0.720 (95%CI: 0.631-0.809, P = 0.000) and 0.751 (95%CI: 0.672-0.830, P = 0.000), the sensitivity were 45%, 73% and 51%, and the specificity were 88.24%, 66.67% and 90.20%. There was no significant difference in the AUC among the 3 indicators (P > 0.05, for all). Conclusions The increased cardiac troponin and ICP 3 d after surgery were risk factors for AKI after surgery in sICH. Moreover, the elevated ICP and serum NSE 3 d after surgery can predict the occurrence of AKI, but the combined monitoring does not improve the prediction efficiency.

PurposeAccurate differentiation between glioma recurrence and radiation necrosis is critical for the management of patients suspected of glioma recurrence following radiation therapy. This study aims to develop a deep learning-based methodology for automated discrimination between glioma recurrence and radiation necrosis using routine magnetic resonance imaging (MRI) scans.MethodWe retrospectively investigated 234 patients who underwent radiotherapy after glioma resection and presented with suspected recurrent lesions during follow-up MRI examinations. Routine 3D-MRI scans, including T1-weighted, T2-weighted, and contrast-enhanced T1 (T1ce) sequences, were acquired for each patient. Among the analyzed cases, 192 (82.1%) were pathologically confirmed as glioma recurrence, while 42 (17.9%) were diagnosed as radiation necrosis. Various Convolutional Neural Network (CNN) models were employed to learn radiological features indicative of glioma recurrence and radiation necrosis from the MRI scans. Performance evaluation metrics, such as sensitivity, specificity, accuracy, and area under the curve (AUC), were used to assess the models’ performance.ResultAmong the evaluated CNN models, ResNet10 demonstrated the highest sensitivity (0.78), specificity (0.94), accuracy (0.91), and an AUC value of 0.83. Additionally, the MresNet model achieved the highest specificity (0.980) but exhibited a relatively lower sensitivity (0.56). Another evaluated CNN model, Vgg16, showed a sensitivity of 0.56, specificity of 0.94, accuracy of 0.88, and an AUC value of 0.70.ConclusionThe proposed ResNet10 CNN model demonstrates promising performance on routine MRI scans, rendering it highly applicable in clinical settings. These findings contribute to enhancing the diagnostic accuracy for distinguishing between glioma recurrence and radiation necrosis using routine MRI.

OBJECTIVES:Delirium is a significant health concern in acute stroke patients. We aim to systematically summarize existing evidence to conduct a meta-analysis to quantify the occurrence and risk factors for delirium after acute stroke. METHOD:PubMed, EMBASE and MEDLINE were searched from inception to Feb. 2023 for prospective observational studies that reported the incidence or prevalence of post-stroke delirium and/or evaluated potential risk factors. The search strategy was created using controlled vocabulary terms and text words for stroke and delirium. We performed a meta-analysis of the estimates for occurrence and risk factors using random-effects models. Meta-regression and subgroup meta-analyses were conducted to explore the sources of heterogeneity. Study quality and quality of evidence were assessed using the customized Newcastle-Ottawa Scale and GRADE, respectively. RESULTS:Forty-nine studies that enrolled 12383 patients were included. The pooled occurrence rate of post-stroke delirium was 24.4 % (95 %CI, 20.4 %-28.9 %, I2=96.2 %). The pooled occurrence of hyperactive, hypoactive, and mixed delirium was 8.5 %, 5.7 % and 5.0 %, respectively. Study location, delirium assessment method and stroke type independently affected the heterogeneity of the pooled estimate of delirium. Statistically significant risk factors were older age, low education level, cigarette smoking, alcohol drinking, atrial fibrillation, lower ADL level, higher pre-stroke mRS score, premorbid cognitive impairment or dementia, aphasia, total anterior circulation impairment, higher National Institute of Health Stroke Scale score and infection. CONCLUSIONS:Delirium affected 1 in 4 acute stroke patients, although reported rates may depend on assessment method and stroke type. Timely prevention, recognition and intervention require prioritizing patients with dominant risk factors.

Although structural and functional damage to the brain is considered to be an important neurobiological mechanism of postoperative delirium (POD), alterations in the visual cortical network related to this vulnerability have not yet been determined. In this study, we investigated the impact of alterations in the visual network (VN), as measured by structural and functional magnetic resonance imaging (MRI), on the development of POD. Thirty-six adult patients with frontal glioma who underwent elective craniotomy were recruited. The primary outcome was POD 1–7 days after surgery, as assessed by the Confusion Assessment Method. Cognition before surgery was measured by a battery of neuropsychological tests. Then, we evaluated preoperative and postoperative gray matter volume (GMV) and functional connectivity (FC) alterations by voxel-based morphometry and resting-state functional MRI (rs-fMRI) between the POD and non-POD groups. Multiple logistic regression models were used to investigate the associations between neuroimaging biomarkers and the occurrence of POD. Compared to those in the non-POD group, a decreased GMV in the fusiform gyrus (0.181 [0.018] vs. 0.207 [0.022], FDRp = 0.001) and decreased FC between the fusiform gyrus and VN (0.351 [0.153] vs. 0.610 [0.197], GFRp < 0.001) were observed preoperatively in the POD group, and increased FC between the fusiform gyrus and ventral attentional network (0.538 [0.180] vs. 0.452 [0.184], GFRp = < 0.001) was observed postoperatively in the POD group. According to our multiple logistic regression analysis, age (Odds ratio [OR]: 1.141 [1.015 to 1.282], P = 0.03) and preoperative fusiform-VN FC (OR 0.001 [0.001 to 0.067], P = 0.01) were significantly related to risk of POD. Our findings suggested that preoperative functional disconnectivity between fusiform and VN might be highly involved in the development of POD. These findings may allow for the discovery of additional underlying mechanisms.

OBJECTIVES:The primary aim of this study is to explore the factors associated with delirium incidence in postoperative patients who have undergone endoscopic transsphenoidal approach surgery for pituitary adenoma. METHODS:The study population included patients admitted to Tianjin Huanhu Hospital's Skull Base Endoscopy Center from January to December 2022, selected through a retrospective cohort study design. The presence of perioperative delirium was evaluated using the 4 'A's Test (4AT) scale, and the final diagnosis of delirium was determined by clinicians. Statistical analysis included Propensity Score Matching (PSM), χ2 Test, and Binary Logistic Regression. RESULTS:A total of 213 patients were included in this study, and the incidence of delirium was found to be 29.58 % (63/213). Among them, 126 patients were selected using PSM (delirium:non-delirium = 1:1), ensuring age, gender, and pathology were matched. According to the results of univariate analysis conducted on multiple variables, The binary logistic regression indicated that a history of alcoholism (OR = 6.89, [1.60-29.68], P = 0.010), preoperative optic nerve compression symptoms (OR = 4.30, [1.46-12.65], P = 0.008), operation time ≥3 h (OR = 5.50, [2.01-15.06], P = 0.001), benzodiazepines for sedation (OR = 3.94, [1.40-11.13], P = 0.010), sleep disorder (OR = 3.86, [1.40-10.66], P = 0.009), and physical restraint (OR = 4.53, [1.64-12.53], P = 0.004) as independent risk factors for postoperative delirium following pituitary adenoma surgery. CONCLUSIONS:For pituitary adenoma patients with a history of alcoholism and presenting symptoms of optic nerve compression, as well as an operation time ≥3 h, enhancing communication between healthcare providers and patients, improving perioperative sleep quality, and reducing physical restraint may help decrease the incidence of postoperative delirium.

Published data on whether post-stroke delirium (PSD) is an independent predictor of outcomes in patients with acute stroke are inconsistent and have not yet been synthesized and quantified via meta-analyses. This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The study protocol involved a search of the PubMed, Embase, PsycINFO, and Medline databases from 1946 to November 1, 2023, of which prospective observational and case–control studies were included. The quality of the included studies was rated using the Newcastle Ottawa Scale. Pooled effect estimates calculated using a random-effects model were expressed as the odds ratios (ORs), hazard ratios (HRs), and standardized mean differences (SMDs) with 95

ObjectiveWe introduce the comprehensive inflammatory prognostic index (CIPI), a novel prognostic tool for critically ill cerebral infarction patients, designed to meet the urgent need for timely and convenient clinical decision-making in this high-risk patient group.MethodsUsing exploratory factor analysis on selected indices—neutrophil to lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and systemic immune inflammation index (SIII)—we derived CIPI, a latent variable capturing their combined predictive power. Data from 1,022 patients in the Medical Information Mart for Intensive Care (MIMIC)-IV database were used to develop CIPI-based survival models, with the robustness and area under the receiver operating characteristic curve (AUC) performance of CIPI validated against an independent dataset of 326 patients from the MIMIC-III CareVue subset. The CIPI’s predictive power for in-hospital and intensive care unit (ICU) mortality was assessed through Kaplan–Meier analysis, univariate and multivariate Cox regression models, and time-dependent AUC analysis. Linearity, subgroup sensitivity analyses and interaction effects with CIPI were also evaluated.ResultsCIPI was an independent prognostic factor, demonstrating a statistically significant association with in-hospital and ICU mortality, when assessed as a continuous and a categorical variable. It showed a linear relationship with mortality rates and demonstrated stability across most subgroups, with no significant interactions observed. Its predictive capabilities for in-hospital and ICU mortality among critically ill cerebral infarction patients matched those of established prognostic indices in the MIMIC database.ConclusionOur study indicates that CIPI is a reliable and effective prognostic tool for critically ill cerebral infarction patients in predicting in-hospital and ICU mortality. Its straightforward calculation, rooted in routine blood tests, enhances its practicality, promising significant utility in clinical settings.

OBJECTIVE Patients with frontal gliomas often experience executive dysfunction (EF-D) before surgery, and the changes in brain plasticity underlying this effect remain obscure. In this study, the authors aimed to assess whole-brain structural and functional alterations by using structural MRI and resting-state functional MRI (rs-fMRI) in frontal glioma patients with or without EF-D. METHODS Fifty-seven patients with frontal gliomas were admitted prospectively to the authors' institution and assigned to one of two groups: 1) the normal executive function (EF-N) group and 2) the EF-D group, based on patient results for the Trail Making Test, Part B and Stroop Color-Word Test, Part C. Twenty-nine baseline-matched healthy controls were also recruited. All participants underwent multimodal MRI examination. Cortical surface thickness, surface-based resting-state activity (fractional amplitude of low-frequency fluctuation [fALFF] and regional homogeneity [ReHo]), and edge-based network functional connectivity (FC) were measured with FreeSurfer and fMRIPrep. The correlation between altered MRI parameters and executive function (EF) was assessed using Pearson correlation and receiver operating characteristic (ROC) analysis. RESULTS Demographic characteristics (sex, age, and education level) and clinical characteristics (location, volume, grade of tumor, and preoperative epilepsy) were not significantly different between the groups, but the Karnofsky Performance Scale score was worse in the EF-D group. There was no significant difference in cortical surface thickness between the EF-D and EF-N groups. In both low-grade and high-grade glioma patients the fALFF value (permutation test + threshold-free cluster enhancement, p value after family-wise error correction < 0.05) and ReHo value (t-test, p < 0.001) of the left precuneus cortex in the EF-D group were greater than those in the EF-N group, which were negatively correlated with EF (p < 0.05) and enabled prediction of EF (area under the ROC curve 0.826 for fALFF and 0.855 for ReHo, p < 0.001). Compared with the EF-N group, the FCs between the default mode network (DMN) from DMN node to DMN node (DMN-DMN) and from the DMN to the central executive network (DMN-CEN) in the EF-D group were increased significantly (network-based statistics corrected p < 0.05) and negatively correlated with EF (Pearson correlation, p < 0.05). CONCLUSIONS Apart from local disruption, the abnormally activated DMN in the resting state is related to EF-D in frontal glioma patients. DMN activity should be considered during preoperative planning and postoperative neurorehabilitation for frontal glioma patients to preserve EF. Clinical trial registration no.: NCT03087838 (ClinicalTrials.gov).

Stroke is a cerebrovascular disease that can lead to severe sequelae such as hemiplegia and mental retardation with a mortality rate of up to 40%. In this paper, we proposed an automatic segmentation network (CHSNet) to segment the lesions in cranial CT images based on the characteristics of acute cerebral hemorrhage images, such as high density, multi-scale, and variable location, and realized the three-dimensional (3D) visualization and localization of the cranial lesions after the segmentation was completed. To enhance the feature representation of high-density regions, and capture multi-scale and up-down information on the target location, we constructed a convolutional neural network with encoding-decoding backbone, Res-RCL module, Atrous Spatial Pyramid Pooling, and Attention Gate. We collected images of 203 patients with acute cerebral hemorrhage, constructed a dataset containing 5998 cranial CT slices, and conducted comparative and ablation experiments on the dataset to verify the effectiveness of our model. Our model achieved the best results on both test sets with different segmentation difficulties, test1: Dice = 0.918, IoU = 0.853, ASD = 0.476, RVE = 0.113; test2: Dice = 0.716, IoU = 0.604, ASD = 5.402, RVE = 1.079. Based on the segmentation results, we achieved 3D visualization and localization of hemorrhage in CT images of stroke patients. The study has important implications for clinical adjuvant diagnosis.

OBJECTIVE:Despite the controversy surrounding brain invasion (BI) as the sole indicator used to diagnose atypical meningioma, this criterion was still incorporated in the 2021 WHO classification scheme. In this study, the authors investigated the reproducibility of this prognostic effect and the impact of BI on the prognosis in otherwise benign meningioma (benign meningioma with BI).METHODS:Patients (n = 1006) with a pathological diagnosis of benign or atypical meningioma according to the latest WHO classification criteria were enrolled in this study. In patients with atypical meningioma, the cases were further categorized as benign meningioma with BI and classical atypical meningioma. Clinical, pathological, and follow-up data were collected. Kaplan-Meier curves were compared with a log-rank test, and univariate and multivariate analyses were performed.RESULTS:The study patient cohort included 282 (28.0%) individuals who were pathologically confirmed as having BI among all 1006 patients with benign or atypical meningioma. A significant difference in recurrence-free survival was observed between patients who had benign meningioma with BI and those who had classical atypical meningioma (p < 0.001), as well as between patients with benign meningiomas and those without BI (p = 0.003). Multivariate Cox analysis indicated that BI was independently associated with increased risk of relapse in the entire population (HR 1.46, 95% CI 1.01-2.12, p = 0.049) and in the atypical meningioma subcohort (HR 2.21, 95% CI 1.32-3.71, p = 0.003), as well as the benign meningioma with and without BI subcohorts (HR 1.89, 95% CI 1.01-3.56, p = 0.049). Moreover, patients with classical atypical meningiomas had a risk of relapse four times higher than those who had benign meningioma with BI (p < 0.001).CONCLUSIONS:The findings demonstrate that benign meningioma with BI typically has an intermediate prognosis and can be differentiated from benign meningioma and classical atypical meningioma, which suggests that the importance of the diagnostic effect of BI is insufficiently accounted for in grading of atypical meningioma. Increased emphasis on the presence of BI in patients with atypical meningioma may be helpful in postsurgical decision-making and facilitating improvements in individual therapy.

目的 探讨术后谵妄(postoperative delirium,POD)与术后神经认知障碍(postoperative neurocognitive disorder,p-NCD)的相关性.方法 系统检索PubMed、Embase和the Cochrane Library,查找建库至2022年1月1日关于POD与p-NCD相关性的研究,应用CMA V3统计软件进行Meta分析,采用双侧检验,应用随机效应模型计算比值比(odds ratio,OR)及95％CI,使用漏斗图和Egger's检验评价发表偏倚.结果 纳入11项研究,共计5 326例患者,参与者年龄＞60岁.Meta分析显示POD与p-NCD显著相关(OR2.308,95％CI 1.555～3.426,P＜0.001).亚组分析发现,POD与术后注意力下降(OR 1.671,95％CI 1.044～2.674,P＜0.05)以及记忆力下降(OR 1.483,95％CI 1.115～1.974,P＜0.05)显著相关.风险轨迹研究显示,除术后第3个月外,POD与术后 1 个月(OR 2.841,95％CI 2.179～3.706,P＜0.001)、2个月(OR 2.095,95％CI 1.182～3.714,P＜0.05)、6个月(OR 1.516,95％CI 0.404～5.691,P＜0.001)、12个月(OR 3.319,95％CI 2.378～4.632,P＜0.001)p-NCD风险均显著相关.结论 POD与p-NCD密切相关.

Controversies persist regarding the benefits of surgery in elderly patients with meningiomas. The objective of this study was to develop decision-making scale to clarify the necessity for surgical intervention and provide clinical consultation for this special population. This retrospective cohort study was conducted at a single center and included 478 elderly patients (≥ 65 years) who underwent meningioma resection. Follow-up was recorded to determine recurrence and mortality rates. Univariate and multivariate analyses were performed to identify significantly preoperative factors, and prognostic prediction models were developed with determined cutoff values for the prognostic index (PI). Model discrimination was evaluated using Kaplan-Meier curves based on the PI stratification, which categorized patients into low- and high-risk groups. A decision-making tree was then established based on the risk stratification from both models. Among all patients analyzed (n = 478), 62 (13.0%) experience recurrence and 47 (10.0%) died during the follow-up period. Significantly preoperative parameters from both models included advanced age, aCCI, recurrent tumor, motor cortex involvement, male sex, peritumoral edema, and tumor located in skull base (all P < 0.05). According to the classification of PI from the two models, the decision-making tree provided four recommendations that can be used for clinical consultation. Surgery is not recommended for patients assigned to the high-risk group in both models. Patients who meet the low-risk criteria in any model may undergo surgical intervention, but the final decision should depend on the surgeon's expertise.

BACKGROUND:Extraventricular neurocytoma at the sellar region (EVNSR) is an exceedingly rare tumor. Given the paucity of specificity and its peculiar nature, our study aimed to characterize the clinical, imaging, and pathological features, including treatment and clinical outcomes of this tumor. METHOD:Eight patients with pathologically confirmed EVNSR at Beijing Tiantan Hospital from 2012 to 2020 were retrospectively analyzed. Additionally, 7 cases from the prior detailed literature were also retrieved. FINDINGS:Among the 8 patients from Beijing Tiantan Hospital, 2 males and 6 females with an average age of 45.3 (range, 8-61). Vision impairment and headache were the most common complaints at presentation. Preoperative diagnoses were pituitary adenoma (n = 6), meningioma (n = 1), and oligodendroglioma (n = 1). Treatment included subtotal tumor resection (n = 3), partial resection (n = 5), adjuvant therapy covered radiotherapy (n = 2), and gamma knife surgery (n = 3). The clinical outcomes of these 8 cases were stable (n = 5), survival after progression (n = 1), and death after recurrence (n = 2). CONCLUSIONS:EVNSRs are extremely rare tumors, and most have benign prognoses after appropriate treatment. Due to the unique location, total removal of the tumor is challenging; And adjuvant radiation therapy for eligible patients is recommended. Regular imaging review is also advised. Future studies with more patients are needed to elucidate the biological nature of EVNSRs.

Objective The brain compensation mechanism in postoperative delirium (POD) has not been reported. We uncovered the mechanism by exploring the association between POD and glioma grades, and the relationship between preoperative brain structural and functional compensation with POD in patients with frontal glioma. Methods A total of 335 adult patients with glioma were included. The multivariable analysis examined the association between tumor grade and POD. Then, 20 patients with left frontal lobe glioma who had presurgical structural and functional MRI data and Montreal Cognitive Assessment (MoCA) in this cohort were analyzed. We measured the gray matter volume (GMV) and functional connectivity (FC) in patients with (n = 8) and without (n = 12) POD and healthy controls (HCs, n = 29) to detect the correlation between the structural and functional alteration and POD. Results The incidence of POD was 37.3%. Multivariable regression revealed that high-grade glioma had approximately six times the odds of POD. Neuroimaging data showed that compared with HC, the patients with left frontal lobe glioma showed significantly increased GMV of the right dorsal lateral prefrontal cortex (DLPFC) in the non-POD group and decreased GMV of right DLPFC in the POD group, and the POD group exhibited significantly decreased FC of right DLPFC, and the non-POD group showed the increasing tendency. Partial correlation analysis showed that GMV in contralesional DLPFC were positively correlated with preoperative neurocognition, and the GMV and FC in contralesional DLPFC were negatively correlated with POD. Conclusions Our findings suggested that insufficient compensation for injured brain regions involving cognition might be more vulnerable to suffering from POD.

Although every glioma patient varies in tumor size, location, histological grade and molecular biomarkers, non-tumoral morphological abnormalities are commonly detected by a statistical comparison among patient groups, missing the information of individual morphological alterations. In this study, we introduced an individual-level structural abnormality detection method for glioma patients and proposed several abnormality indexes to depict individual atrophy patterns. Forty-five patients with a glioma in the frontal lobe and fifty-one age-matched healthy controls participated in the study. Individual structural abnormality maps (SAM) were generated using patients' preoperative T1 images, by calculating the degree of deviation of voxel volume in each patient with the normative model built from healthy controls. Based on SAM, a series of individual abnormality indexes were computed, and their relationship with glioma characteristics was explored. The results demonstrated that glioma patients showed unique non-tumoral atrophy patterns with overlapping atrophy regions mainly located at hippocampus, parahippocampus, amygdala, insula, middle temporal gyrus and inferior temporal gyrus, which are closely related to the human cognitive functions. The abnormality indexes were associated with several molecular biomarkers including isocitrate dehydrogenase (IDH) mutation, 1p/19q co-deletion and telomerase reverse transcriptase (TERT) promoter mutation. Our study provides an effective way to access the individual-level non-tumoral structural abnormalities in glioma patients, which has the potential to significantly improve individualized precision medicine.

Background: Evidence of brain cognitive compensation in the pathogenesis of postoperative delirium (POD) is currently lacking. The present study was conducted in frontal glioma patients to investigate the impact of premorbid cognition-related brain structural compensation on POD.Methods: Eighty-four adult patients with unilateral frontal glioma who underwent elective craniotomy were recruited. Primary outcomes were POD incidence and severity. Cognition before surgery was measured by the battery of neuropsychological tests. Then we evaluated gray matter volume (GMV) and white matter integrity (i.e. fractional anisotropy [FA]) by presurgical voxel-based morphometry and diffusion tensor imaging. We investigated the association between presurgical structural index of potential compensatory brain regions with POD incidence and severity.Findings: Whatever the tumor was located in left or right side, the GMV in the contralateral dorsal lateral prefrontal cortex (DLPFC) was significantly positive correlated with presurgical cognition, and negative correlated with incidence and severity of POD. Additionally, partial correlation analysis after controlling for the confounders revealed that the FA value in the genu of the corpus callosum (gCC) was significantly positively correlated with the GMV in the contralateral DLPFC and preoperative cognition, and negatively correlated with incidence and severity of POD.Interpretation: Compensation of contralateral DLPFC could decrease the risk of POD in frontal glioma patients. POD may depend upon whether an individual engenders the sufficient cognitive compensation response to the underlying neural injury.Trial Registration Details: The study was registered at ClinicalTrials.gov (NCT_05375409) Funding Information: This work was supported by the National Natural Science Foundation of China (81801042) and Beijing Hospital Authority Youth Programme (20190504).Declaration of Interests: No competing interests were declared by all authors.Ethics Approval Statement: This prospective cohort study was conducted in the neurosurgical department in Beijing Tiantan Hospital, Capital Medical University, Beijing, China from September 2018 to December 2020. The study was was approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University, Beijing, China (KY2017-018-02). We obtained written informed consent from each participant.

Meningioangiomatosis (MA) is a disease that is extremely rarely reported. Sporadic MA is occasionally combined with meningioma or other lesions (identified as non-pure MA). This retrospective study investigated the difference between pure MA and non-pure MA by exploring clinical manifestations, histopathology characteristics, and outcomes of MA after surgery. We reviewed the medical records of 36 histopathologically confirmed MA patients (18 pure MA and 18 non-pure MA) who received surgery at our institution between 2012 and 2021. We compared differences in demographic, clinical, imaging, pathological features, and surgical outcomes between pure MA and non-pure MA through descriptive statistics. Compared to non-pure MA, pure MA presented with a more prominent male predilection (5:1 vs. 1.57:1, P = 0.264), a higher seizure incidence (83.3% vs 50.0%, P = 0.038), a more seizure type of GTCS (14/15 vs 5/9, P = 0.047), a less prominent enhancement on MRI (27.8% vs 88.9%, P < 0.001) and a preference of temporal and frontal lobe (100% vs 44.4%, P < 0.001). The differences in clinical characteristics between pure MA and non-pure MA demonstrate their disparate biological natures. Pure MA seems to be a non-neoplastic lesion, while non-pure MA is commonly combined with meningioma, which is a neoplastic lesion. A correct differential diagnosis can be achieved via a triad of the type of seizure, the location of lesion and the radiological presentation. MA is curable and the prognosis is excellent as most patients are free of seizure and recurrence after surgical treatment.