Background: Carotid body tumors (CBTs) are rare neuroendocrine neoplasms whose hardness (soft vs. hard) correlates with surgical complexity and perioperative complications. This study aimed to identify predictive multimodal imaging biomarkers of CBTs' hardness. Methods: This single-center retrospective cohort study included 82 patients with CBTs who underwent surgical resection. Preoperative multimodal imaging and clinical data were analyzed; tumor hardness was assessed via Masson-stained fibrous proportion. Multivariate logistic regression was performed to identify independent predictors. Results: The mean age of the 82 patients was 46 ± 13 years, including 37 males, with no significant intergroup differences in age or gender. Hard CBTs were associated with longer operative durations and a higher incidence of perioperative complications including pre-, intra-, and postoperative nerve and vascular injury. Multimodal imaging analysis revealed differences in signal homogeneity on T1WI and T1WI-CE sequences of MRI between soft and hard CBTs. The CBT-to-sternocleidomastoid muscle (SCM) value on T2WI (OR 0.329; 95% CI 0.151-0.591, p < 0.001) and the erosion of perivascular fat space (PFS) (OR 19.2; 95% CI 4.390-115.884, p < 0.001) were associated with the hardness of CBTs. ROC curve analysis demonstrated that an optimal cutoff value of 2.44 for the CBT/SCM ratio on T2WI predicted hard CBTs with a specificity of 100% and a sensitivity of 67.7% (PPV 100%, NPV 83.6%, AUC = 0.892). Conclusions: Preliminary findings suggest that CBT/SCM value on T2WI and PFS erosion are promising imaging biomarkers for predicting hardness. These parameters may facilitate preoperative risk prediction, though further prospective validation is required.

Carotid body tumors (CBTs) exhibit pronounced clinical heterogeneity, particularly in fibrotic progression, yet the underlying cellular mechanisms remain poorly defined. Here, we performed single-cell RNA sequencing on 64,944 cells from three fibrotic CBT (FCBT) and three non-fibrotic CBT (nFCBT) specimens to construct a high-resolution cellular atlas of CBT fibrosis. Integrated analyses revealed that FCBTs are distinguished by a FOXP2+ chief cell subpopulation exhibiting a metabolic shift toward mitochondrial respiration and enhanced MIF signaling, which may facilitate macrophage recruitment. Endothelial cells expanded in FCBTs and acquired pro-angiogenic signatures driven by macrophage-derived CXCL signaling. Notably, CXCL14+ fibroblasts emerged as the principal effectors of extracellular matrix deposition, with lineage inference suggesting their origin from smooth muscle cells. Immune cells, including T/NK and mast cells, further modulated the fibrotic niche through cytokine interactions. This study provides the first comprehensive single-cell dissection of CBT fibrosis, identifies FOXP2+ chief cells as initiators of stromal remodeling, and highlights CXCL14+ fibroblasts as key matrix-producing effectors. These findings nominate FOXP2 and CXCL14 as potential therapeutic targets for mitigating fibrosis in CBT patients.

Background Complete common carotid artery (CCA) occlusion (CCAO) lacks standardised treatment guidelines and is frequently associated with severe complications. Subclavian artery-to-CCA bypass grafting (SCBG) provides a viable revascularisation strategy, yet its neurosurgical application remains underexplored. This study evaluated the clinical efficacy and technical nuances of SCBG from a neurosurgical perspective. Methods This retrospective study enrolled 20 symptomatic patients with CCAO demonstrating ipsilateral hypoperfusion on CT perfusion (CTP). Preoperative evaluations included CT angiography, CTP and high-resolution MRI. Surgical indications comprised recurrent ischaemic events and significant ipsilateral hypoperfusion. SCBG was performed using prosthetic grafts (PGs), with intraoperative patency verified via indocyanine green angiography. Postoperative protocols for anticoagulation, antiplatelet and statin therapies were standardised. Results The median operative duration was 255.5 min (IQR 202.25–319.75 min), with a median estimated blood loss of 50 mL (IQR 20–50 mL). The primary patency rate was 85%, with initial graft occlusion occurring in three cases. Two cases were managed conservatively, and one underwent successful emergency thrombectomy, restoring patency (final secondary patency 90%). Complications included asymptomatic acute ischaemic strokes (2/20), pleural effusion (1/20) and extended intensive care unit stay (1/20). During follow-up, the median postoperative modified Rankin Scale was 0. CTP volumetric analysis confirmed a significant reduction in the time to maximum>6 s hypoperfusion volume (p=0.004) in the patent cohort. Conclusions Our findings suggest that SCBG presents a high-flow revascularisation option for symptomatic CCAO, with initial evidence suggesting acceptable safety and an 85% primary and 90% final patency rate using PGs. It may address a therapeutic gap when endovascular techniques or superficial temporal artery-to-middle cerebral artery bypasses are unsuitable. However, these conclusions are limited by our small sample size and lack of a control group and should be considered preliminary until confirmed by larger studies with long-term follow-up.

To investigate the surgical procedure and clinical effectiveness of microsurgical reinforced radiculoplasty for postoperative recurrent sacral Tarlov cysts (TCs). A retrospective analysis was performed on 12 cases of postoperative recurrent symptomatic sacral Tarlov cysts (TCs) between 2019 and 2023, and the clinical features and causes of recurrence were summarized. Microsurgical reinforced radiculoplasty was performed on all patients, and the prognosis was summarized and analyzed. In addition, the experience of reinforced radiculoplasty was introduced. Microsurgical reinforced radiculoplasty was performed on 12 patients (6 females) with recurrent postoperative symptomatic sacral TCs. The ages of the patients ranged from 21 to 75 years. The mean follow-up period was over 1 year. Symptoms included severe pain in the lumbosacral and perineal regions, numbness, urinary dysfunction, and sexual dysfunction. There were 5 cases of solitary sacral cysts and 7 cases of multiple sacral cysts, with multiple cysts being more prevalent. After the second surgery, MRI imaging indicated that the postoperative recurrent sacral TCs had disappeared in all patients, and no adverse events such as new-onset neurological deficits, limb sensory/motor disorders, perineal sensory disorders, bowel/bladder dysfunction, sexual dysfunction, cerebrospinal fluid leakage, or wound infection occurred after the operation. Postoperative JOA scores were evaluated after the second surgery. There was a statistically significant difference between the preoperative and postoperative JOA scores (16.2 ± 1.1 versus 19.8 ± 0.9, p = 0.002). Microsurgical reinforced radiculoplasty demonstrates preliminary clinical efficacy in the treatment of postoperative recurrent sacral TCs and is both safe and effective.

BACKGROUND:Postoperative hypokalemia is a common electrolyte disturbance associated with adverse outcomes, particularly in older adults. This study aimed to identify risk factors and develop predictive models for hypokalemia within 24 hours after carotid endarterectomy (CEA) for severe carotid artery stenosis, a condition that primarily affects older patient populations. METHODS:A retrospective cohort of 1,076 CEA patients (October 2021 to May 2023) was analyzed. Risk factors were identified using univariate and multivariate logistic regression. A predictive nomogram was developed and internally validated via bootstrapping. Machine learning models (Random Forest and XGBoost) were developed and interpreted using SHAP (SHapley Additive exPlanations) analysis. Subgroup analyses were performed in patients aged ≥70 years and by comparing postoperative potassium levels &gt;4.0 mmol/L versus 3.5-4.0 mmol/L. RESULTS:The cohort had a median age of 65 years. Multivariate analysis identified preoperative potassium (odds ratio [OR]=0.60, 95% confidence interval [CI] 0.50-0.72), hemoglobin (OR=0.74, 95% CI 0.63-0.88), BMI (OR=0.74, 95% CI 0.63-0.88), and postoperative visual analogue scale score (OR=1.28, 95% CI 1.09-1.51) as independent predictors. Frailty showed borderline significance (OR=1.56, 95% CI 1.00-2.44, p=0.05). The nomogram achieved an area under the curve (AUC) of 0.710, demonstrating good discrimination and calibration. Machine learning models similarly performed well (AUC 0.707-0.709). CONCLUSION:We developed a validated tool to predict postoperative hypokalemia after CEA. The model highlights that in addition to biochemical and surgical factors, geriatric syndromes like frailty and nutritional status are pivotal risk determinants. This facilitates early, individualized management, including tailored potassium supplementation, nutritional support, and pain control, especially for vulnerable older adults, to mitigate complications and promote recovery.

OBJECTIVE:To precise classify sacral meningeal cysts, effective guide minimally invasive neurosurgery and postoperative personalized rehabilitation by multiple dimensions radiographic reconstruction MRI. METHODS:From March to December 2021, based on the original 3D-fast imaging employing steadystate acquisition (FIESTA) scanning sequence, 92 patients with sacral meningeal cysts were pre-operatively evaluated by multiple dimensional reconstruction MRI. The shape of nerve root and the leakage of cyst were reconstructed according to the direction of nerve root or leakage track showed on original MRI scans. Sacral canal cysts were accurately classified as including nerve root and without nerve root, so as to accurately design the incision of skin and formulate corresponding open range of the posterior wall of the sacral canal. Under the microscope intraoperation, the shape of the nerve roots inside cysts or leakage track of the cysts without nerve roots were verified and explored. After the reinforcement and shaping operation, several reexaminations of multiple dimensional reconstruction MRI were performed to understand the deformation of the nerve root and hydrops in the operation cavity, so as to formulate a persona-lized rehabilitation plan for the patients. RESULTS:Among the 92 patients with sacral mengingeal cyst, 58 (63.0%) cysts with nerve root cyst, 29 (31.5%) cysts without nerve root cyst, and 5 (5.4%) cysts with mixed sacral canal cyst. In 58 patients with nerve root cysts, the accuracy of preoperative clinical classification on MRI image reached 96.6% (56/58) through confirmation by operating microscope. Only 2 cases of large single cyst with nerve root on the head of cyst were mistaken for without nerve root type. In 29 patients with sacral cyst without nerve root, the accuracy of preoperative image reached 100% through confirmation by operating microscope. The accuracy of judging the internal nerve root and leakage of 12 cases with recurrent sacral cyst was also 100%. Two cases of delayed postoperative hydrops were found one month after operation. After rehabilitation treatment by moxibustion and bathing, the hydrops disappeared 4-6 months after operation. CONCLUSION:Multiple dimensional reconstruction MRI can precisely make clinical classification of sacral meningeal cysts before operation, guide minimally invasive neurosurgery effectively, and improve the rehabilitation effect.

Background: Carotid body tumors (CBTs) are rare neoplasms originating from the carotid body. A comprehensive synthesis of the available evidence is essential to enhance the understanding of this condition among clinicians and researchers. Purpose: This review aims to provide a comprehensive overview of CBTs, encompassing their epidemiology, pathophysiology, clinical manifestations, current treatment modalities, and associated complications. Research Design: A narrative literature review was conducted, synthesizing information from relevant studies identified through a systematic search of electronic databases. Study Sample: The review included studies focusing on human subjects with carotid body tumors, encompassing case reports, case series, cohort studies, and relevant review articles. Data Collection and Analysis: The literature search was primarily conducted in the PubMed database. The search strategy utilized a combination of keywords and Medical Subject Headings (MeSH) terms related to "carotid body tumors," "chemodectoma," and "paraganglioma." Retrieved articles were screened based on titles and abstracts, and full texts of relevant studies were reviewed for data extraction. Data on epidemiology, pathogenesis, clinical features, treatments, and complications were then thematically analyzed. Results: Epidemiological data indicate a slight increase in the global incidence of CBTs, although they remain relatively uncommon. The pathogenesis involves factors such as genetic predisposition, chronic hypoxia, and geographical influences. Clinical presentation is variable, commonly featuring neck masses, carotid sinus syndrome, and voice changes, depending on tumor size and location. Primary treatment options include surgical excision, radiotherapy, and embolization, with the choice of modality influenced by patient age, tumor size, and location. While surgery is often the preferred approach, it carries risks of complications such as cranial nerve injury, stroke, and hemorrhage. The review also identifies and discusses rare complications, including baroreceptor reflex failure. Conclusions: A thorough understanding of the multifaceted aspects of CBTs is crucial for refining diagnostic and therapeutic strategies. This integrated knowledge is expected to contribute to improved patient survival and quality of life.

Neutrophil to lymphocyte ratio (NLR) is a biomarker which is related with inflammation and atherosclerosis. Higher NLR is associated with vulnerability of carotid atherosclerotic plaques. Covert brain infarction (CBI) following carotid endarterectomy (CEA) indicates poor prognosis in cognization. In this study, we aimed to investigate the relationship between NLR and CBI in patients who accepted CEA. In this observational and retrospective cohort study, 333 patients who underwent CEA due to severe carotid artery stenosis were enrolled. NLR was acquired from routine blood tests upon admission. Postoperative CBI was detected on magnetic resonance imaging. Logistic regression analysis was used to examine the association between NLR and CBI. Patients with CBI had higher NLR (CBI patients: 2.45[1.76–3.58] vs. non-CBI patients: 2.31[1.82–2.88]; P = 0.05). NLR is a strong independent factor predicting the risk of CBI following CEA (odds ratio [OR], 1.740; 95

Covert brain infarction (CBI) is a common complication after carotid endarterectomy (CEA) and is associated with cognitive decline. Carotid artery perivascular fat density (PFD) reflects the severity of inflammation around the artery and is also related to plaque vulnerability. This study aimed to investigate the association between PFD and CBI in patients undergoing CEA. A total of 185 patients who underwent CEA were enrolled. PFD was measured using computed tomography angiography (CTA), and CBI was assessed on postoperative magnetic resonance imaging (MRI). Baseline characteristics, plaque features, and PFD were compared between patients with and without CBI. Logistic regression analysis was performed to evaluate the association between PFD and CBI, adjusting for confounding factors. Among 185 patients, 45 (24.3

Background and purpose The classic Shamblin system fails to provide valuable guidance in many Shamblin's III carotid body tumors (III-CBTs) due to the variable forms of carotid arteries and the complex anatomic relationships in parapharyngeal space. We proposed a modified classification to separately divide III-CBTs into different subgroups on the basis of arterial relevant features and anatomical relevant features.Materials and methods From 2020 to 2023, a total of 129 III-CBTs at a single institution were retrospectively analyzed. All cases were independently classified as arterial-relevant and anatomical-relevant subgroups. The pre-, peri- and postoperative data were summarized and compared accordingly.Results Among the 129 cases, 69 cases were identified as "Classical type", 23 cases as "Medial type", 27 cases as "Lateral type" and 10 cases as "Enveloped type" according to arterial morphologies. Besides, 76 cases were identified as "Common type", 15 cases as "Pharynx- invasion type", 18 cases as "Skull base-invasion type" and 20 cases as "Mixed type" according to anatomical relationships. "Enveloped type" of tumors in arterial-relevant classification and "Mixed type" of tumors in anatomical-relevant classification are the most challenging cases for surgeons with the lowest resection rate, highest incidence of carotid arteries injury and postoperative stroke.Conclusion The modified classifications provide comprehensive understanding of different III-CBTs which are applicable for individualized treatment in clinical practice.

目的 探讨多模态神经导航在经鼻蝶垂体腺瘤切除手术中的应用效果.方法 回顾性分析2019年6月至2022年5月北京大学第三医院神经外科采用神经导航下经鼻蝶入路肿瘤切除术治疗的138例垂体腺瘤患者(导航组)的临床资料,以2018年1月至2019年5月采用经鼻蝶入路肿瘤切除术治疗的48例垂体腺瘤患者作为对照组.两组患者的年龄、性别等基线资料的差异均无统计学意义(均P＞0.05).对比分析两组患者的疗效及并发症发生率等.结果 与对照组比较,导航组蝶窦开口识别率[分别为100％(138/138)、91.7％(44/48)]、视神经沟和颈动脉压迹识别率[分别为 100％(138/138)、83.3％(40/48)]均更高,手术时间更短[分别为(67.0±13.2)min、(85.6± 18.2)min],术中出血量更少[M(Q1,Q3)分别为15(15,20)ml、30(15,40)ml],差异均具有统计学意义(均P＜0.05).导航组与对照组术后脑脊液漏[分别为2.9％(4/138)、6.3％(3/48)]、短暂性尿崩[分别为4.3％(6/138)、8.3％(4/48)]发生率的差异均无统计学意义(均P＞0.05).导航组与对照组患者肿瘤全切除率的差异无统计学意义[分别为93.5％(129/138)、87.5％(42/48),x2=1.72,P=0.190].所有患者均获得临床随访,导航组的随访时间较对照组短[(10.1±5.6)个月、(22.6± 6.9)个月,t=-12.55,P＜0.001].随访期间,两组患者的临床症状均有不同程度的改善,且无激素水平低下者;导航组与对照组患者肿瘤复发率的差异无统计学意义[分别为0、4.2％(2/48),P=0.066].结论 经鼻蝶垂体腺瘤切除术中应用多模态神经导航有助于辨识解剖学结构,减少手术创伤,缩短手术时间.

目的 探讨颈动脉狭窄合并冠状动脉狭窄患者行同期颈动脉内膜切除术(CEA)联合冠状动脉旁路移植术(CABG)后脑灌注的变化情况,分析脑灌注变化的相关因素.方法 回顾性分析2014年9月至2021年3月在北京大学第三医院神经外科连续收治的35例颈动脉狭窄合并冠状动脉狭窄患者的临床资料,包括性别、年龄、既往史(吸烟、高血压病、糖尿病等)、术前实验室检查结果(血清N末端B型钠尿肽前体、三酰甘油、总胆固醇和高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、空腹血糖等)、影像学资料[包括CT血管成像(CTA)及头部CT灌注(CTP)成像、颈动脉超声、超声心动图及冠状动脉造影等检查]及治疗情况.所有患者同期行CEA+CABG.术前和术后行头颈动脉CTA及头部CTP成像检查,以脑血流量(CBF)代表脑灌注情况,计算手术前后术侧和对侧相对脑血流量(rCBF)及CBF变化率(DRCBF),通过Pearson相关性分析探讨脑灌注变化的相关因素.结果 头部CTP成像示,术前术侧CBF为(19.4±2.2)ml/(100 g·min),对侧CBF为(24.4±4.7)ml/(100 g·min),rCBF为0.52～1.00,平均0.82±0.17;术后术侧CBF为(24.6±2.8)ml/(100 g·min),对侧CBF为(28.1±5.7)ml/(100 g·min),rCBF为0.68～1.35,平均0.90±0.16;与术前比较,术后rCBF明显升高,差异有统计学意义(t=-8.194,P<0.01);DRCBF为4％ ～62％,平均(28±14)％.DRCBF与颈动脉狭窄率呈高度正相关(r=0.826,P<0.01),与颈动脉收缩期最大峰值流速(r=0.701,P<0.01)、左心室射血分数(r=0.602,P<0.01)、同型半胱氨酸水平(r=0.473,P<0.01)呈正相关,与术前rCBF呈负相关(r=-0.421,P<0.01).结论 颈动脉狭窄程度及心功能与颈动脉狭窄合并冠状动脉狭窄手术前后脑灌注改变相关,有待于大样本多因素分析进一步验证.

目的 探讨侧方非功能区人路切除功能区脑胶质瘤的安全性. 方法 2018年8月～2019年12月对36例功能区脑胶质瘤行侧方避开功能区皮层的手术入路,导航、显微镜下黄荧光指引下切除脑内胶质瘤,入路包括利用脑叶旁间隙、附近非功能区脑沟回和功能区皮层侧方进入3种方式.应用格拉斯哥预后评分(Glasgow Outcome Scale,GOS)评估术后神经功能状况. 结果 肿瘤全切除26例(72.2％),近全切除4例(11.1％),次全切5例(13.9％),大部切除1例(2.8％).术后肢体肌力较术前改善10例(27.8％),言语功能较术前改善5例(13.9％).GOS评分5分30例,4分6例.36例随访4～20个月,平均11个月.偏瘫进一步恢复3例,失语进一步恢复2例,癫痫继续发作2例,肿瘤复发8例(首次术后6～8个月复发,复发后再次手术4例).3例分别于首次手术后11、12、18个月发生继发中线播散.1例原发性胶质母细胞瘤未能进行有效的放化疗,术后11个月死亡,且6-氧-甲基鸟嘌呤-DNA-甲基转移酶阴性,异柠檬酸脱氢酶-1(isocitrate dehydrogenase 1,IDH1)野生型. 结论 侧方非功能区入路切除功能区脑胶质瘤安全可行、微创,值得推广.

ObjectiveTo analyze the risk factors associated with adverse events after carotid endarterectomy (CEA) in patients with unilateral severe carotid stenosis and contralateral occlusion.MethodsPatients were recruited for CEA between August 2014 and February 2020. CEA was performed under general anesthesia. The carotid clamp time (CCT; long CCT: >20 min) is defined as the period between clamp-on and clamp-off for the stenotic carotid artery. The perioperative factors and postoperative adverse events were recorded. All patients were followed up for 1 year after CEA.ResultsSixty subjects (65.8 ± 7.2 years; 54 males) were included. Patients with adverse events had significantly longer CCT than those without adverse events (60% vs. 40%, P = 0.013). Univariate logistic regression analysis showed that a history of diabetes was significantly associated with adverse events (OR, 0.190; 95% CI, 0.045–0.814; P = 0.025); long CCT was significantly associated with adverse events (OR, 8.500; 95% CI, 1.617–44.682; P = 0.011). After adjusting for confounding factors, including age, sex, BMI, diabetes, PSV, long CCT, non–use of shunt, and history of stroke or TIA, the associations between diabetes and adverse events (OR, 0.113; 95% CI, 0.013–0.959; P = 0.046) were statistically significant; the associations between long CCT and adverse events (OR, 1.301; 95% CI, 1.049–1.613; P = 0.017) were statistically significant.ConclusionsA longer carotid clamp time (>20 min) and a history of diabetes may increase the risk of adverse events in patients with unilateral severe carotid stenosis and contralateral occlusion after CEA. With good preoperative evaluation and intraoperative monitoring, the use of shunts may not be needed intraoperatively in patients with unilateral severe carotid stenosis and contralateral occlusion.

OBJECTIVE:To investigate the surgical strategy for large and giant recurrent meningiomas near the middle and posterior third part of the superior sagittal sinus with extracranial invading. METHODS:The clinical data of 16 patients with large and giant recurrent meningioma in the middle and posterior third part of the superior sagittal sinus with extracranial invasion who underwent surgery in the Department of Neurosurgery of Peking University Third Hospital from May 2019 to May 2022 were retrospectively analyzed. All the patients underwent brain-enhanced magnetic resonance imaging (MRI), magnetic resonance venography (MRV), computed tomography angiography (CTA) and three-dimensional skull computed tomography (CT) before, to evaluate the extent of tumor invasion, the edema of brain tissue, the degree of skull damage, the blood supply of the tumor, and the degree of compression of the superior sagittal sinus, etc, and to formulate an individualized surgical plan. The neurological function of the patients was evaluated 1 week, 1 month, and 3 months after the operation, and the tumor condition was evaluated by brain-enhanced MRI 3 months, 6 months, and 1 year after the operation. RESULTS:The tumors in the 16 patients were all located in the middle and posterior 1/3 part of the superior sagittal sinus and invaded extracranially. Among them, 8 cases were operated for the second time, 6 cases for the third time, and 2 cases for the fourth time; In the last operation, the bone flap was used to repair the skull in 4 cases, and the titanium mesh was used in 12 cases; Tumor arterials of 3 cases were embolized under digital subtraction angiography (DSA). Tumors of 10 cases were resected at Simpson grade Ⅰ, and 6 cases at Simpson grade Ⅱ; 2 cases underwent decompressive craniectomy during operation, and 14 cases underwent cranioplasty at the same time; scalp incisions of 14 cases were directly sutured, and flap transposition was used in 14 cases. When evaluating nerve function after operation, the limb muscle strength was improved compared with that before operation, and the Karnofsky performance scale (KPS) score reached 100 points 3 months after operation. During the follow-up, 1 patient's tumor recurred after 1 year and received Gamma Knife treatment, and the rest of the patients had no recurrence during the follow-up period. CONCLUSION:Surgical treatment is the first choice for large and giant recurrent meningiomas near the middle and posterior third part of the superior sagittal sinus with extracranial invading. It is a safe and effective surgical method to take individualized surgical plan after detailed preoperative assessment of cerebral edema, tumor blood supply, venous sinus compression, and scalp invasion.

Objective To summarize the effect of “four-step” method in robot-guided percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. Methods Clinical data of 20 patients with trigeminal neuralgia who underwent robot-guided percutaneous balloon compression of the gasserian ganglion from June 2020 to November 2021 were retrospectively analyzed. The median Visual Analogue Scale（VAS） score of the 20 patients before surgery was 8（range, 7-10）. Preoperative planning and surgery were performed with a “four-step” process:（1）preliminary positioning on three-dimensional images;（2）determination of puncture direction on sagittal and coronal CT images;（3）fine-tuning of the relationship between puncture path and Meckel’s sac on MRI images; and（4）low-resistance puncture. Results All the patients successfully received the operation, and the intraoperative lateral X-ray balloon showed a typical “pear shape”. The pain symptoms were relieved immediately after operation, with the VAS scores being 0 in 17 cases and 1 in 3 cases. Postoperative operation-sided numbness with unilateral sensory dysfunction of half of the tongue were observed in all the patients, masticatory muscle strength decreased in 15 patients, corneal reflex decreased in 1 patient, and oral herpes occurred in 3 patients. The patients were followed up for 3-23 months（mean, 10.7±5.1 months）. The VAS score was 0 in all the patients, and no trigeminal neuralgia recurred. Residual mild facial numbness was found in 2 cases, while facial numbness, lingual dysesthesia, masticatory muscle weakness, hypocorneal reflexes and oral herpes disappeared in the other 18 cases.Conclusion Using the “four-step” method to implement the robot-guided percutaneous balloon compression of the gasserian ganglion has satisfactory results.

BACKGROUND:The Nuclear Dbf2-related (NDR1) kinase is a member of the NDR/LATS family, which was a supplementary of Hippo pathway. However, whether NDR1 could inhibit glioblastoma (GBM) growth by phosphorylating Yes-associated protein (YAP) remains unknown. Meanwhile, the role of NDR1 in GBM was not clear. This study aimed to investigate the role of NDR1-YAP pathway in GBM.METHODS:Bioinformation analysis and immunohistochemistry (IHC) were performed to identify the expression of NDR1 in GBM. The effect of NDR1 on cell proliferation and cell cycle was analyzed utilizing CCK-8, clone formation, immunofluorescence and flow cytometry, respectively. In addition, the xenograft tumor model was established as well. Protein interaction was examined by Co-immunoprecipitation and immunofluorescence to observe co-localization.RESULTS:Bioinformation analysis and IHC of our patients' tumor tissues showed that expression of NDR1 in tumor tissue was relatively lower than that in normal tissues and was positively related to a lower survival rate. NDR1 could markedly reduce the proliferation and colony formation of U87 and U251. Furthermore, the results of flow cytometry showed that NDR1 led to cell cycle arrest at the G1 phase. Tumor growth was also inhibited in xenograft nude mouse models in NDR1-overexpression group. Western blotting and immunofluorescence showed that NDR1 could integrate with and phosphorylate YAP at S127 site. Meanwhile, NDR1 could mediate apoptosis process.CONCLUSION:In summary, our findings point out that NDR1 functions as a tumor suppressor in GBM. NDR1 is identified as a novel regulator of YAP, which gives us an in-depth comprehension of the Hippo signaling pathway.

Purpose: The NDR1(Nuclear Dbf2-related) kinase is a member of the NDR/LATS family which was a supplementary of Hippo pathway. However, whether NDR1 could inhibit glioblastoma (GBM) growth by phosphorylating YAP remains unknown. Meanwhile, the role of NDR1 in GBM was not clear. The purpose of this study was to investigate the role of NDR1-YAP pathway in GBM. Materials and Methods: Bioinformation analysis and immunohistochemistry was performed to identify the expression of NDR1 in GBM. The effect of NDR1 on cell proliferation and cell cycle was analyzed utilizing cck-8, clone formation, immunofluorescence and flow cytometry respectively. In addition, the xenograft tumor model was established as well. Protein interaction was examined by Co-ip and immunofluorescence. Results: Bioinformation analysis and immunohistochemistry of our petients’ tumor tissues showed that expression of NDR1 in tumor tissue was relatively lower than that in normal tissues and was positively related to lower survival rate. NDR1 could markedly reduce the proliferation, colony formation of U87 and U251. Furthermore, the results of flow cytometry showed that NDR1 led to cell cycle arrest at the G1 phase. Tumor growth was also inhibited in xenograft nude mouse models in NDR1-OE group. Western blotting and immunofluorescence showed that NDR1 could integrate with and phophoralate YAP at S127 site. Meanwhile, NDR1 could mediate apopptosis process. Conclusion: In summary, our findings pointed out that NDR1 functions as a tumor suppressor in GBM. NDR1 was identified as a novel regulator of YAP, which give us a in depth comprehension in Hippo signaling pathway.

Objective:To investigate the role of three-dimensional reconstruction of multi-modal images combined with neuronavigation in the operation of gliomas in eloquent regions.Methods:A retrospective analysis was conducted on the clinical data of 30 patients with gliomas in eloquent regions who underwent surgical treatment at the Department of Neurosurgery of Peking University Third Hospital from April 2018 to March 2021. Before surgery, the patient’s skull MRI with enhancement, diffusion tensor imaging (DTI), and CT angiography (or magnetic resonance angiography) data were fused to reconstruct nerve tracts, tumors, blood vessels, skulls and other structures, so as to design the optimal surgical path, and used in neuronavigation to guide tumor resection. Degree of tumor resection was evaluated by using MRI results 72 hour post operation. One week, one month, and three months after surgery, the Boston Diagnostic Aphasia Examination (BDAE) was used to assess language function, and the simplified Fugl-Meyer Assessment (FMS) was used to assess motor function.Results:Through the three-dimensional image reconstruction, the anatomical relationship in all patients between the tumor and surrounding important structures such as nerve tracts, arteries and veins were clearly shown, the displacement and destruction of the nerve tracts were clarified, and the blood supply arteries and drainage veins were shown. Among the 30 patients, the tumor involved the motor area in 21 cases and language area in 25 cases. Totally resection was achieved in 28 cases (93.3%) and subtotal resection in 2 cases (6.7%). Among the 21 patients with preoperative neurological deficits, at the last follow-up, 20 patients had improved neurological function after surgery, and 1 patient had unchanged neurological function compared with presurgical conditions. Nine patients who had no neurological deficits before surgery developed transient symptoms related to neurological deficits after surgery, which resolved after 1 week.Conclusion:The use of multimodal images to three-dimensionally reconstruct tumors and surrounding nerve fiber bundles, blood vessels and other important structures, so as to design surgical approaches and apply them to intraoperative navigation to guide the operation, could help protect the eloquent brain area and improve the efficacy of surgery.