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.

The rapid development of CRISPR genome editing technologies has established a transformative paradigm within biomedical research, drug discovery, and gene therapy. Despite the robust nuclease activity and programmable targeting exhibited by these systems, the clinical translation of CRISPR-mediated therapeutics remains substantially impeded by systemic and cellular delivery constraints. Specifically, the secure, highly efficient, and spatiotemporally controlled administration of CRISPR machinery to designated tissues or distinct cell populations constitutes the primary bottleneck in the field. Physiological and biological impediments, including rapid clearance, limited tissue penetration, endosomal entrapment, and potential adaptive immune responses, necessitate the development of highly specialized delivery vectors to ensure therapeutic viability and mitigate off-target effects. To circumvent these biological barriers, contemporary research has extensively evaluated a spectrum of delivery vehicles engineered to package and protect diverse CRISPR cargoes, including DNA, RNA, and pre-assembled ribonucleoprotein complexes. These diverse cargos are actively investigated in conjunction with established viral vectors, and an expanding array of non-viral vectors encompassing physical methods, nanoparticle‑based systems, and peptide/protein‑mediated platforms. This review delineates the recent advancements in discovery of CRISPR‑based genome editing tools, with a particular emphasis on delivery strategies across in vitro modeling, ex vivo cellular engineering, and in vivo clinical interventions.

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.

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.

Gliomas are the most common intracranial tumors characterized by highly malignant behavior. In addition to genetic and epigenetic mutations, the unique cancer microenvironment (CME) plays a pivotal role in glioma progression and resistance to therapy. Among the critical factors in the glioma CME, amino acid metabolism stands out for its significant influence, with specific amino acids suppressing anti‐cancer immune responses and promoting an immunosuppressive environment. The human microbiota affect host metabolism and immune functions, with disruptions in microbiota homeostasis leading to metabolic alterations and immune dysfunction in various diseases. Emerging evidence highlights the role of microbiota‐derived metabolites, including amino acids, in reprogramming the glioma CME and modulating oncogenic signaling pathways. This review examines the influence of the gut microbiome on specific amino acid metabolism—namely, tryptophan, tyrosine, arginine, and branched‐chain amino acids—and evaluates the potential roles of microbiome‐derived metabolites in the prognosis and diagnosis of glioma.

Complex crosstalk occurs between protein and nucleic acid modifications, with lactylation, an emerging post-translational modification (PTM), being implicated in tumor progression. However, the mechanisms mediating the crosstalk between lactylation and RNA modifications and their roles in disease pathogenesis remain largely unresolved. In this review, we summarize current advances in the regulatory interactions between lactylation and RNA modifications, explore their functional implications in cancer biology, and discuss the therapeutic potential of targeting these modifications individually or in combination. This work aims to provide a comprehensive overview of their mechanistic involvement in cancer and to inform novel strategies for precision-targeted therapy.

This study aims to assess the clinical efficacy and feasibility of the Perclose ProGlide Suture-Mediated Closure System (Abbott Vascular, Redwood City, CA, USA) for transbrachial access. A total of 100 patients from July 2020 to December 2023 were included in this retrospective study. Among them, 40 patients underwent ProGlide-guided suture closure following brachial artery (BA) puncture, while 60 patients received traditional manual compression. After successful ultrasound-guided puncture of the BA, a sheath of appropriate diameter (5–7F) was inserted. The Perclose ProGlide system was utilized in patients requiring ipsilateral upper limb intravenous infusion or dynamic blood pressure monitoring. All other patients underwent standard manual compression. No significant differences in major complications, including hematoma, pseudoaneurysm, or active bleeding, were observed between the two groups (P = 0.407). Additionally, there were no reported cases of arterial occlusion, ischemia, or venous thrombosis in either cohort. In the manual compression group, three patients required reintervention due to bleeding or hematoma, whereas no such incidents occurred in the ProGlide group (P = 0.151). Two patients in the manual compression group reported long-term numbness around the puncture site, while no similar neurological dysfunction was observed in the ProGlide group (P = 0.243). Although selection bias was present in this retrospective study, the Perclose ProGlide system presents a beneficial closure method for patients undergoing transbrachial access.

Metabolism of Branched-chain amino acids (BCAAs) is essential for the nutrient necessities in mammals. Catalytic enzymes serve to direct the whole-body BCAAs oxidation which involve in the development of various metabolic disorders. The reprogrammed metabolic elements are also responsible for malignant oncogenic processes, and favor the formation of distinctive immunosuppressive microenvironment surrounding different cancers. The impotent immune surveillance related to BCAAs dysfunction is a novel topic to investigate. Here we focus on the BCAA catalysts that contribute to metabolic changes and dysregulated immune reactions in cancer progression. We summarize the current knowledge of BCAA catalyzation, highlighting the interesting roles of BCAA metabolism in the treatment of cancers.

HNRNPA2B1 and HNRNPR stabilize ASCL1 mRNA in neuroblastoma, but whether their regulatory effects depend on m6A modification and whether their function involves ASCL1 remain unknown. This study investigated the m6A-dependent binding of HNRNPA2B1 and HNRNPR to ASCL1 and subsequent regulation, as well as the expression, clinical significance, and function of HNRNPA2B1 and HNRNPR in neuroblastoma. We revealed that METTL14 mediated ASCL1 m6A modification to stabilize ASCL1. HNRNPA2B1 and HNRNPR significantly enriched ASCL1 mRNA by binding to the 5 ' and 3 ' untranslated regions, respectively, and METTL14 knockdown reduced this enrichment. Mutations in m6A sites in the untranslated regions of ASCL1 mRNA considerably decreased probe capacity to engage HNRNPA2B1 and HNRNPR. HNRNPR interacts with IGF2BP1, and knocking down either impaired binding to ASCL1 mRNA. HNRNPA2B1 and HNRNPR knockdown suppressed neuroblastoma cell growth and invasion, while ASCL1 overexpression restored these effects. The high HNRNPA2B1 and HNRNPR expression in neuroblastoma correlated with ASCL1 expression. Thus, HNRNPA2B1 and HNRNPR bind and stabilize ASCL1 mRNA in an m6A-dependent manner to promote neuroblastoma progression. This study not only discovered a new mechanism underlying the high ASCL1 expression in neuroblastoma but also identified the HNRNPA2B1/HNRNPR/ASCL1 axis as a promising target for inhibiting neuroblastoma progression.

Glioblastoma (GBM) cells exhibit aberrant proliferative abilities and resistance to conventional therapies. However, the mechanisms underlying these malignant phenotypes are poorly understood. In this study, we identified ubiquitin-conjugating enzyme E2D1 (UBE2D1) as a crucial stimulator of GBM development. It is highly expressed in GBM and closely associated with poor prognosis in patients with GBM. UBE2D1 knockdown inhibits GBM cell growth and leads to G1 cell cycle arrest. Mechanistically, UBCH5A binds to p21 at the protein level and induces the ubiquitination and degradation of p21. This negative regulation is mediated by STUB1. Our findings are the first to identify UBE2D1 as a key driver of GBM growth and provide a potential target for improving prognosis and therapy.

ObjectiveThis study aimed to develop an arbitrary-dimensional nerve root reconstruction magnetic resonance imaging (ANRR-MRI) technique for identifying the leakage orificium of sacral meningeal cysts (SMCs) without spinal nerve root fibres (SNRFs).MethodsThis prospective study enrolled 40 consecutive patients with SMCs without SNRFs between March 2021 and March 2022. Magnetic resonance neural reconstruction sequences were performed for preoperative evaluation. The cyst and the cyst-dura intersection planes were initially identified based on the original thin-slice axial T2-weighted images. Sagittal and coronal images were then reconstructed by setting each intersecting plane as the centre. Then, three-dimensional reconstruction was performed, focusing on the suspected leakage point of the cyst. Based on the identified leakage location and size of the SMC, individual surgical plans were formulated.ResultsThis cohort included 30 females and 10 males, with an average age of 42.6 ± 12.2 years (range, 17–66 years). The leakage orificium was located at the rostral pole of the cyst in 23 patients, at the body region of the cyst in 12 patients, and at the caudal pole in 5 patients. The maximum diameter of the cysts ranged from 2 cm to 11 cm (average, 5.2 ± 1.9 cm). The leakage orificium was clearly identified in all patients and was ligated microscopically through a 4 cm minimally invasive incision. Postoperative imaging showed that the cysts had disappeared.ConclusionANRR-MRI is an accurate and efficient approach for identifying leakage orificium, facilitating the precise diagnosis and surgical treatment of SMCs without SNRFs.

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.

The aetiology of scoliosis remains unclear. Some studies have focused on the theory of possible muscular imbalance. The role of the spinal cord, which directly innervates the paraspinal muscles, in muscular imbalance has not yet been studied. Spinal astrocytomas often grow on one side of the spinal cord, destroying it asymmetrically. Asymmetrical damage to the spinal cord can lead to asymmetrical changes in paraspinal muscles. The present study investigated the effect of muscular imbalance on scoliosis by observing scoliosis caused by spinal astrocytomas. Patients diagnosed with spinal astrocytomas in a single centre were analysed, and the type and side of the symptoms, sagittal tumour position, scoliosis, end vertebrae and apical vertebrae of scoliosis were recorded. The tumour side was assumed from symptom type and side, and the cross-sectional area of the paraspinal muscles on both sides of the end vertebra was outlined and compared. The incidence of astrocytoma-induced scoliosis was significantly higher in patients with unilateral symptoms. The inferred tumour side was highly consistent with the convex side of scoliosis. The distal vertebral segments of scoliosis were consistent with the spinal cord segments involved in the astrocytomas. The apical vertebrae were more caudal in astrocytoma-induced scoliosis. The cross-sectional area of the multifidus muscle on the convex side of apical-level scoliosis was significantly smaller than that on the concave side. However, no significant differences were observed in the erector spinae muscles. Overall, spinal astrocytomas can cause asymmetric destruction of the corresponding spinal cord segment, resulting in asymmetric atrophy and weakness of the multifidus muscle innervated by the spinal cord segment, thereby causing scoliosis that is convex to the weaker side. This mechanism involves asymmetric lower neuron paralysis of the multifidus muscle. This is a type of scoliosis with several differences from idiopathic scoliosis.

Background Paraganglioma in the sellar region is an extremely rare entity, with a limited number of cases reported in the literature. Due to the paucity of clinical evidence, the diagnosis and treatment of paragangliomas in the sellar region remain challenging. Herein, we reported a case of sellar paraganglioma with parasellar and suprasellar extension. Particularly, the dynamic evolution of this benign tumor within a 7-year longitudinal observation was presented. Additionally, the relevant literature regarding sellar paraganglioma was comprehensively reviewed. Case description A 70-year-old woman presented with progressive visual deterioration and headache. Brain magnetic resonance imaging demonstrated a mass in the sellar region with parasellar and suprasellar extension. The patient refused surgical treatment. Seven years later, brain magnetic resonance imaging showed the lesion significantly progressed. Neurological examination revealed bilateral tubular contraction of visual fields. Laboratory examinations showed endocrine hormone levels were normal. Surgical decompression was performed via a subfrontal approach, and subtotal resection was achieved. Histopathological examination confirmed a diagnosis of paraganglioma. Postoperatively, she developed hydrocephalus, and ventriculoperitoneal shunting was performed. Eight months later, cranial CT showed no recurrence of the residual tumor, and the hydrocephalus had been relieved. Conclusion Paraganglioma occurring in the sellar region is rare, and the preoperative differential diagnosis is difficult. Owing to the infiltration to the cavernous sinus and internal carotid, complete surgical resection is usually impracticable. There has been no consensus regarding postoperative adjuvant radiochemotherapy for the tumor residue. In-situ recurrence and metastasis have been reported in the literature, and close follow-up is warranted.

[This corrects the article DOI: 10.3389/fonc.2020.573318.].

Introduction Sacral laminoplasty with titanium mesh and titanium screws can reduce symptomatic sacral extradural spinal meningeal cysts (SESMCs) recurrence and operation complications. However, due to a defect or thinning of the sacrum, the screws cannot be securely anchored and there are also problems with permanent metal implantation for titanium mesh and screws. We propose that sacral laminoplasty with absorbable clamps can provide rigid fixation even for a thinned or defected sacrum without leaving permanent metal implants. Methods In the direct microsurgical treatment of symptomatic SESMCs, we performed one-stage sacral laminoplasty with autologous sacral lamina reimplantation fixed by absorbable fixation clamps. Retrospectively, we analyzed intraoperative handling, planarity of the sacral lamina, and stability of the fixation based on clinical and radiological data. Results Between November 2021 to October 2022, we performed sacral laminoplasty with the absorbable craniofix system in 28 consecutive patients with SESMCs. The size of the sacral lamina flaps ranged from 756 to 1,052 mm 2 (average 906.21 ± 84.04 mm 2 ). We applied a minimum of two (in four cases) and up to four (in four cases) Craniofix clamps in the operation, with three (in 20 cases) being the most common (82.14%, 20/28) and convenient to handle. Excellent sacral canal reconstruction could be confirmed intraoperatively by the surgeons and postoperatively by CT scans. No intraoperative complications occurred. Conclusions One-stage sacral laminoplasty with absorbable fixation clamps is technically feasible, and applying 3 of these can achieve a stable fixation effect and are easy to operate. Restoring the normal structure of the sacral canal could reduce complications and improve surgical efficacy.

Postoperative delirium (POD) is a complication characterized by disturbances in attention, awareness, and cognitive function that occur shortly after surgery or emergence from anesthesia. Since it occurs prevalently in neurosurgical patients and poses great threats to the well-being of patients, much emphasis is placed on POD in neurosurgical units. However, there are intricate theories about its pathogenesis and limited pharmacological interventions for POD. In this study, we review the recent insights into its pathogenesis, mainly based on studies within five years, and the five dominant pathological theories that account for the development of POD, with the intention of furthering our understanding and boosting its clinical management.

BACKGROUND: Sacral cysts are classically divided into Tarlov cysts and meningeal diverticula. However, the pathogenesis of sacral cysts remains unclear. This study aimed to clarify a novel type of sacral extradural spinal meningeal cyst with a specific arachnoidal structure. METHODS: Nine patients with prophylactic diverticula were included in the study. All patients underwent MRI preoperative reconstruction and traditional neck transfixation. RESULTS: All patients presented with more than one symptom. The major symptom was lower extremity pain, followed by lower extremity numbness (77.8%, 7/9), lower extremity weakness (55.6%, 5/9), bowel/bladder and sexual dysfunction (55.6%, 5/9), and tenesmus (22.2%, 2/9). After long-term follow-up, the outcome was classified as improved in 9 patients (100%). CONCLUSIONS: The clinical findings of this study illustrate a special subtype and may help explain the mechanism of sacral cyst formation.

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.