Background : The suboccipital retrosigmoid approach is a classic approach for surgical access to cerebellopontine angle diseases. Previously, we identified a novel method for precise localization of keypoint, known as the "one point, two lines, two distances" theory. However, a comprehensive, safe method for craniotomy remains lacking. Objective : Based on the new landmark method of localization , this study aims to further describe the anatomical basis, surgical technique, and outcomes of the suboccipital retrosigmoid keyhole approach for craniotomy. Methods : Twelve adult specimens of skull were used for the study. The anatomical relationships between the keypoint were analyzed to establish a precise, rapid, and safe method for suboccipital retrosigmoid keyhole craniotomy. This method was then validated through cadaveric dissection. Furthermore, a retrospective analysis of surgical outcomes was performed on 122 clinical patients, assessing accuracy, safety, and exposure results. Results : Measurements from specimens of skull revealed that the up point of digastatic sulci roughly corresponds to the margin of the sigmoid sinus. In craniotomy simulations performed on 12 cadaveric specimens, we freed the bone flap in a "rear-down-front" direction after drilling at the key point. This process passed through the up point of digastatic sulci, with bone around the mastoid emissary vein being removed using a grinding drill, followed by resection of the residual bone along the margin of the sigmoid sinus. In all cadaver specimens, the formation of bone flap resulted in a well-exposed window. In the clinical cohort of 122 patients, keypoints were accurately located, and suitable bone windows were created with good exposure and without damage to important structures. Conclusion : The up point of digastatic sulci serves as a crucial reference point for keypoint localization. Craniotomy techniques based on this reference point provide a precise and safe approach for suboccipital retrosigmoid craniotomy.

OBJECTIVE:To elucidate the mechanism by which the miR-192-related axis regulates glioma immune evasion. METHODS:Factor expression was measured by PCR/Western Blotting (WB). Immunofluorescence, FISH and DLRTM were used to elucidate target regulation mechanisms. Mitophagy was observed by TEM. We performed BrdU/Transwell assays to evaluate malignant phenotypes and WB to measure stemness-related protein expression in glioma. Immune chemokine levels were measured by ELISA, and M2-TAM/CD8+ T-cell proportions were measured by immune-fluorescence. Growth curves/tumor volume in vivo and tumor weight in vitro were assessed to evaluate tumor growth in vivo. An immune microenvironment was established in nude mice via tail vein injection of immune cells. Masson's trichrome staining was performed to explore the degree of fibrosis in relevant tissues. RESULTS:MiR-192 expression was negatively correlated with glioma malignancy. The expression of downstream regulator (EGR1/HOXB9) of miR-192 was positively correlated with malignant phenotypes. MiR-192 inhibited EGR1/HOXB9 through targeted binding. The miR-192/EGR1-HOXB9 loop induced mitophagy, thus inhibited glioma cell proliferation/invasion. Moreover, this loop inhibited MT, weakening glioma cell stemness. This pathway reduced M2-TAM numbers and weakened their inhibitory effect on CD8+ T-cells by regulating immune chemokines. In vivo, miR-192 inhibited glioma proliferation and induced immune infiltration into glioma through this loop. CONCLUSION:The miR-192/EGR1-HOXB9 loop inhibited glioma stemness phenotypes, weakening glioma malignancy by regulating mitophagy. Moreover, this loop affected chemokine secretion by TAMs, weakened their inhibitory effect on CD8+ T-cells and reduced immune evasion in glioma by regulating MT.

To clarify the regulatory effects of miR-192 on the malignant phenotypes of glioma cells. We used PCR, WB and immunofluorescence to detect regulatory factors in glioma samples. Then, we chose lentiviral plasmid transfection to construct cell models. We used CCK-8 and colony formation to evaluate the proliferation ability of these cells and used Transwell/scratch tests to evaluate their invasion ability. CD133-expressing GSCs were observed under a microscope, and their stemness properties were evaluated. We constructed a tumour-bearing model via subcutaneous inoculation. Tumour growth curves and tumour weights were determined subsequently. The proteins involved in the miR-192-EGR1/HOXB9 loop were evaluated via IHC staining. MiR-192 was significantly reduced in glioma samples, and this factor downregulated EGR1 and HOXB9 via targeted binding, thus forming a semi-open loop. Moreover, the proliferation, invasion and migration of glioma cells overexpressing miR-192 were significantly decreased. These malignant phenotypes were abrogated completely with EGR1 or HOXB9 overexpression. Similarly, these changes were essentially consistent with MT marker expression and the stem-like properties in glioma cells. Meanwhile, miR-192 inhibits the tumorigenesis of glioma cells via the EGR1-HOXB9 loop. MiR-192 could inhibit MT in glioma cells through the EGR1-HOXB9 loop. Thus, it reduces their stemness and abrogates their malignant phenotypes.

IntroductionThe incidence of hemangioblastoma is low, constituting only 1-5% of all spinal cord tumors. Specifically, intradural extramedullary hemangioblastoma without Von Hippel-Lindau syndrome represents an exceedingly rare condition.MethodsWe report the first documented case of cervical intradural extramedullary hemangioblastoma in China. A 53-year-old male patient presented with a 3-year history of mild right hemiplegia, segmental muscle strength and sensation impairment, and a positive pyramidal tract sign. MRI showed an abnormal oval signal focus in the intradural and extramedullary region at the C6-C7 vertebral level. Before surgery, angiography was performed to identify the supplying arteries and draining veins. Subsequent interventional therapy achieved over 90% occlusion of blood vessels, creating optimal conditions for complete resection of the spinal tumor.ResultsThe patient demonstrated satisfactory postoperative recovery with significant restoration of sensory and motor functions. Pathological examination showed a significant upregulation of CD31 in tumor cells and a substantial presence of the neuro-specific marker S100 in the tumor stroma, consistent with the diagnostic criteria for spinal hemangioblastoma.ConclusionThe rarity of cervical intradural extramedullary hemangioblastoma without Von Hippel-Lindau syndrome was reaffirmed by a comprehensive review of the existing literature. Complete tumor resection remains the optimal approach for managing this uncommon condition, generally resulting in a favorable prognosis. Traditional open fenestration surgery is linked to elevated risks of bleeding and trauma. Meanwhile, endovascular injection of embolic agents may lead to residual lesions and an increased risk of recurrence. Therefore, we recommend a one-time combined treatment conducted in a hybrid operating room to achieve complete resection and effectively reduce intraoperative bleeding risk. Despite presenting challenges and requiring high proficiency, we still recommend this type of combined surgery as a suitable therapeutic option for such diseases.

Objective: Primary spinal cord glioblastoma (PSCGBM) is a rare malignancy with a poor prognosis. To date, no prognostic nomogram for this rare disease was established. Hence, we aimed to develop a nomogram to predict overall survival (OS) of PSCGBM.Methods: Clinical data of patients with PSCGBM was retrospectively collected from the neurosurgery department of Soochow University Affiliated Second Hospital and the Surveillance Epidemiology and End Results database. Information including age, sex, race, tumor extension, extent of resection, adjuvant treatment, marital status, income, year of diagnosis and months from diagnosis to treatment were recorded. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors for PSCGBM. A nomogram was constructed to predict 1-year, 1.5-year, and 2-year OS of PSCGBM.Results: A total of 132 patients were included. The 1-year, 1.5-year, and 2-year OS were 45.5%, 29.5%, and 18.9%, respectively. Four variables: age groups, tumor extension, extent of resection, and adjuvant therapy, were identified as independent prognostic factors. The nomogram showed robust discrimination with a C-index value for the prediction of 1-year OS, 1.5-year OS, and 2-year of 0.71 (95% confidence interval [CI], 0.61–0.70), 0.72 (95% CI, 0.62–0.70), and 0.70 (95% CI, 0.61–0.70), respectively. The calibration curves exhibited high consistencies between the predicted and observed survival probability in this cohort.Conclusion: We have developed and internally validated a nomogram for predicting the survival outcome of PSCGBM for the first time. The nomogram has the potential to assist clinicians in making individualized predictions of survival outcome of PSCGBM.

Objective:The objective of the study is to establish a new parameter that can be clearly measured on x-ray images to complement the description of the sagittal alignment of the craniocervical junction. The authors anticipate that this new parameter will enhance surgeons' understanding of the sagittal alignment of the craniocervical junction and play a positive role in the guidance of intraoperative reduction and in the evaluation of postoperative outcomes of patients with atlantoaxial instability. Methods:From November 2018 to June 2020, a total of 159 asymptomatic subjects who underwent frontal and lateral cervical x-ray examination in the Second Affiliated Hospital of Soochow University were included in the study. Age, gender, previous spinal trauma, and disease history of each subject were recorded. After screening, 127 effective samples were finally obtained. When taking lateral cervical radiographs, all subjects placed their neck in a neutral position and looked straight ahead with both eyes. On the obtained lateral x-ray images, a straight line was drawn from the radix to the anterior clinoid process; another line was made along the posterior edge of the C2 vertebral body; and the angle between the two lines was measured, which was defined as the "horizontal view-axial angle." The angle formed by the tangent of the posterior edge of the C2 vertebra and C7 vertebral body is the "C2-C7 angle," which was used to describe the curvature of the lower cervical vertebra. The normal range of horizontal view-axial angle and its relationship with C2-7 angle were evaluated. Results:The average C2-C7 angle of male subjects was (14.0° ± 7.4°), while that of female subjects was (11.09° ± 7.36°). The average horizontal view-axial angle of male subjects was (92.79° ± 4.52°), and that of female subjects was (94.29° ± 4.50°). Pearson correlation test showed that there was a significant negative correlation between horizontal view-axis angle and C2-C7 angle. Conclusions:For patients with atlantoaxial instability diseases, the horizontal view-axis angle is expected to be a sagittal parameter to guide the intraoperative reduction and evaluate postoperative outcomes.

ObjectiveWe aimed to explore a method of precise localization within craniotomy based on skull anatomical landmarks via the suboccipital retrosigmoid approach.MethodCraniometric measurements were taken from 15 adult dry skulls and eight cadaver head specimens. In the anatomical study, the keypoint corresponded to the transverse-sigmoid sinus junction's corresponding point on the external surface of the temporal mastoid process, eight cadaveric heads underwent a simulated craniotomy using the suboccipital retrosigmoid approach. The center of the burr hole is precisely oriented 12 mm vertically above the top point of the mastoid groove based on the line between the infraorbital margin and the upper edge of the external auditory canal. Clinical application was verified in clinical surgery by evaluating the accuracy, safety, rapidity, and minimal invasiveness of the procedure in 29 patients.ResultNo venous sinus injuries were observed. Within clinical application, 29 patients underwent craniotomy using the suboccipital retrosigmoid approach. The operative area was clearly exposed in all patients and the microsurgical anatomy of the intracranial region after the dura mater incision was satisfactory. No venous sinus ruptures were observed. The average craniectomy time was 27.02 ± 0.86 min. The diameter of the bone window was 1.7–2.9 cm.ConclusionWe conclude that the method can ensure safe, accurate, and rapid craniotomy with good vision while avoiding injury to the venous sinus.

The inhibition of alpha-ketoglutarate (α-KG)-dependent dioxygenases is thought to contribute to isocitrate dehydrogenase (IDH) mutation-derived malignancy. Herein, we aim to thoroughly investigate the expression pattern and prognostic significance of genes encoding α-KG-dependent enzymes for lower-grade glioma (LGG) patients. In this retrospective study, a total of 775 LGG patients were enrolled. The generalized linear model, least absolute shrinkage and selection operator Cox regression, and nomogram were applied to identify the enzyme-based signature. With the use of gene set enrichment analysis and Gene Ontology, the probable molecular abnormalities underlying high-risk patients were investigated. By comprehensively analyzing mRNA data, we observed that 41 genes were differentially expressed between IDHMUT and IDHWT LGG patients. A risk signature comprising 10 genes, which could divide samples into high- and low-risk groups of distinct prognoses, was developed and independently validated. This enzyme-based signature was indicative of a more malignant phenotype. The nomogram model incorporating the risk signature, molecular biomarkers, and clinicopathological parameters proved the incremental utility of the α-KG-dependent signature by achieving a more accurate prediction impact. Our study demonstrates that the α-KG-dependent enzyme-encoding genes were differentially expressed in relation to the IDH phenotype and may serve as a promising indicator for clinical outcomes of LGG patients.

目的 探讨分阶段目标强化训练在培养神经外科规培研究生显微血管吻合能力中的作用.方法 选取2018年6月—2020年6月我院神经外科接受培训的23名规培研究生,采取纱布缝合-3D树脂血管缝合-鸡翅血管吻合-活体大鼠血管吻合分阶段的强化训练方案,来培养他们的显微血管吻合能力.结果 在最终活体动物实验中,大鼠吻合血管愈合且通畅,血管通畅率为100％,未见血管狭窄及假性动脉瘤.结论 显微镜下实验动物模型训练有利于神经外科研究生临床操作技能的培养.应用分阶段目标强化训练能显著提高血管吻合学习效率,让研究生迅速掌握这一技巧,从而为临床应用做好基础准备.

Objective:To compare the clinical efficacy and safety of surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope in cerebral basal ganglia hemorrhage. Methods:One hundred and five patients with basal ganglia cerebral hemorrhage admitted to our hospital from January 2017 to January 2020 were chosen in our study; 51 patients underwent surgeries via frontal keyhole approach assisted by neuro-endoscope (neuro-endoscopy group) and 54 patients underwent surgeries via temporal keyhole approach assisted by microscope (microscopy group). The clinical data of these patients were retrospectively analyzed; and the differences of hematoma clearance rate, intraoperative blood loss, duration of surgery, length of hospital stays, Glasgow Coma Scale (GCS) scores one week after surgery, incidence of postoperative complications, and activity of daily living (ADL) scores 6 months after surgery were compared between the 2 groups. Results:There were no significant differences in hematoma clearance rate and length of hospital stays between the 2 groups ( P>0.05). As compared with the microscopy group, the neuro-endoscopy group had significantly lower intraoperative blood loss, significantly shorter duration of surgery, and statistically higher GCS scores one week after surgery ( P<0.05). There were no significant differences in incidence of postoperative complications and ADL scores 6 months after surgery between 2 groups ( P>0.05). Conclusion:Both surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope can effectively clear the intracranial hematoma in patients with cerebral hemorrhage in the basal ganglia and protect neurological function; however, surgeries via frontal keyhole approach assisted by neuro-endoscope has advantages of shorter duration of surgery and lower intraoperative blood loss, and earlier neurological function recovery.

Background: Glioma is the most common and aggressive primary brain tumor in adults. Proteasome 26S subunit, non-ATPase 12 (PSMD12), an important subunit in the 26S proteasome, is known to be involved in the growth and apoptosis of breast cancer cells. However, its exact function and underlying molecular mechanisms in glioma remain unknown. Methods: PSMD12 expression was detected in glioma tissue specimens by immunohistochemistry (IHC) and TCGA database. Overexpression and down-regulation of PSMD12 and Nrf2 were induced in glioma cell lines, and CCK-8 and Transwell assays were used to detect cell proliferation and invasion evaluation, respectively. Xenograft model was used to observe the effect of knockdown of PSMD12 on tumor growth. Immunohistochemical assays and TCGA database were conducted to reveal the relationships between PSMD12 expression and Nrf2. Finally, Western blot and related biological function experiments were used to explore the mechanism of PSMD12 regulating the glioma progression and Nrf2. Results: We revealed that PSMD12 is upregulated in glioma, especially in high-grade glioma, by analyzing bioinformatics data and clinical specimens. PSMD12 upregulation was associated with poor prognosis in glioma patients. Knockdown of PSMD12 inhibited the growth of glioma cells in vitro and in vivo and decreased their invasion ability, whereas PSMD12 overexpression had the opposite effect. Mechanistic analysis revealed that PSMD12 increased the expression of nuclear factor E2-related factor 2 (Nrf2), which functions as a tumor promoter in the development of glioma. Similar to PSMD12, Nrf2, which exhibited a strong positive correlation with PSMD12, was abnormally elevated in glioma tissues and contributed to worse overall survival (OS). Nrf2 overexpression reversed the inhibitory effects induced by PSMD12 knockdown. Finally, PSMD12 enhanced the proliferation and invasion of glioma cells via Akt signaling-mediated Nrf2 expression. Conclusions: These results suggest that PSMD12 is considered to be a crucial regulator of the development and progression of glioma and may serve as a potential biomarker or therapeutic target for the treatment of glioma.

Objective: To explore the precise location of the keypoint during craniotomy using the retrosigmoid keyhole approach. Methods: This study included 20 dry skulls and 10 wet cadaveric specimens. On the inner surface of dry skulls, the junction between the inferior margin of the transverse sinus (ITS) and the posterior margin of the sigmoid sinus (TSJ) was marked. The keypoint (D) was identified as the TSJ's corresponding point on the external surface of the temporal mastoid process (MP). The distance from the keypoint to the top point of the digastric groove, mastoidale, and asterion were noted (AD, BD, CD, respectively). A method to accurately locate the keypoint was developed based on these relationships. The developed method was used on the wet cadaveric specimens to evaluate its accuracy, safety, rapidity, and minimal invasion. Results: No significant difference was found between the AD, BD, and CD of the left and right sides. The drilling point was oriented on a straight line 12 mm above the top point of digastric groove, perpendicular to the Frankfort horizontal plane (FHP). In the cadaveric specimens, the operative area was clearly exposed. No venous sinus rupture occurred. The average craniotomy time was 28.74 ± 3.89 min. Conclusions: A potentially safe, accurate, and rapid craniotomy procedure was developed with the added advantage of preserving the visibility of the operating field and preventing venous sinus injury.

N6-methyladenosine (m6A) RNA modification can alter gene expression and function by regulating RNA splicing, stability, translocation, and translation. It is involved in various types of cancer. However, its role in gliomas is not well known. This study aimed to determine the prognostic value of the m6A RNA methylation regulator in gliomas and investigate the underlying mechanisms of the aberrant expression of m6A-related genes.mRNA expression profiles and clinical information of 448 glioma samples were obtained from The Cancer Genome Atlas and cBioportal. The expression of m6A-related genes in normal controls and low-grade glioma and glioblastoma was obtained from Gene Expression Profiling Interactive Analysis. Further, m6A-related gene expression and its relationship with prognosis were obtained through The Chinese Glioma Genome Atlas (CGGA). Multivariate Cox regression analyses were performed, and a nomogram was built with potential risk factors based on a multivariate Cox analysis to predict survival probability. Online tools such as Gene Set Enrichment Analysis, STRING, Cytoscape, and Molecular Complex Detection were applied for bioinformatics analysis and to investigate the underlying mechanisms of the aberrant expression of m6A-related genes. The multivariate Cox regression analysis found that higher expression levels of YTHDC2 and insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3, also called IMP3) were independent negative and positive prognostic factors for overall survival (OS), respectively. Data from the CGGA database showed that IGF2BP3 expression increased when the tumor grade increased. Receiver operating characteristic (ROC) curve was used to evaluate the predictive specificity and sensitivity. The area under the ROC curve indicated that the OS prediction was 0.92 (1-year) and 0.917 (3-years), indicating that m6A-related genes could predict patient survival. In addition, IGF2BP3 was closely related to the shorter survival period of patients. Copy number variation and DNA methylation, but not somatic mutations, might contribute to the abnormal upregulation of IGF2BP3 in gliomas. Significantly altered genes were identified, and the protein–protein interaction network was constructed. Based on the data presented, our study identified several m6A-related genes, especially IGF2BP3, that could be potential prognostic biomarkers of gliomas. The study unveiled the potential regulatory mechanism of IGF2BP3 in gliomas.

Mesenchymal stromal/stem cells (MSCs) are promising carriers in cell-based therapies against central nervous system diseases, and have been evaluated in various clinical trials in recent years. However, bone marrow-derived MSCs (BMSCs) are reportedly involved in tumorigenesis initiated by glioma stem-like cells (GSCs). We therefore established three different orthotopic models of GSC-MSC interactions in vivo using dual-color fluorescence tracing. Cell sorting and micropipetting techniques were used to obtain highly proliferative MSC monoclones from each model, and these cells were identified as transformed MSC lines 1, 2 and 3. Nineteen miRNAs were upregulated and 24 miRNAs were downregulated in all three transformed MSC lines compared to normal BMSCs. Reduced miR-146a-5p expression in the transformed MSCs was associated with their proliferation, malignant transformation and overexpression of heterogeneous nuclear ribonucleoprotein D. These findings suggest that downregulation of miR-146a-5p leads to overexpression of its target gene, heterogeneous nuclear ribonucleoprotein D, thereby promoting malignant transformation of MSCs during interactions with GSCs. Given the risk that MSCs will undergo malignant transformation in the glioma microenvironment, targeted glioma therapies employing MSCs as therapeutic carriers should be considered cautiously.

颅底外科作为近30年来逐渐发展起来的一门新兴交叉学科,是神经外科中最具挑战性的专业领域之一.近年来,伴随着鼻内镜颅底外科、3D打印技术、多模态导航技术、人工智能手术机器人系统等新技术的不断涌现,为颅底外科疾病的治疗提供了新的方法;从而进一步提高了整体治疗水平.本文主要对颅底外科辅助技术的进展进行综述.

Objective To explore the improved method of precisely locating related bony structures in intradural anterior transpetrosal approach.Methods On the 10 dry skulls,the highest point of arcuate eminence (A),the petrous apex (P),the most lateral point of groove for the greater petrosal nerve (B),foramen spinosum (C),foramen ovale (D),trigeminal impression (E) and t foramen lacerum (F) were marked.Using point A as reference point and the line AP as the baseline,the distances of AB,AC,AD,AE and AF and the angles of / BAP,/ CAP,/ DAP,/ EAP and / FAP were measured.Samples were analyzed by mean and standard deviation,and the data on both sides were compared by t test.Results 1.AB:(11.61±2.31) mm (left),10.44±2.31 mm (right),t=1.084;AC:(23.14± 3.07) mm (left),(21.08 ± 2.67) mm (right),t=1.596;AD:(24.95± 2.82) mm (left),(24.38±3.44) mm (right),t=0.408;AE:(18.98± 3.11) mm (left),(19.21± 3.09) mm (right),t=-0.164;AF:(29.68±2.62) mm (left),(29.25±2.77) mm (right),t=0.725.2.∠BAP:(49.15 ± 12.10) ° (left),(52.78 ± 14.27) ° (right),t =-0.624;∠CAP:(43.98 ±6.95) ° (left),(48.73 ±8.02)° (right),t=-1.418;∠DAP:(38.68 ±4.81)° (left),(41.48 ±3.14)° (right),t=-1.543;∠EAP:(21.93 ±5.29)° (left),(25.94 ±6.43)° (right),t=-1.523;∠∠FAP:(15.96±2.78)° (left),(17.20 ±3.44)° (right),t=-0.882.There were no significant differences between the left and right sides (P ＞ 0.05).Confusion Using point A and P as referent indexes,the bony structures which represent the corresponding nerves and blood vessels can be precisely lo cated for grinding Kawase triangle via intradural anterior transpetrosal approach.

目的 探讨改良枕下乙状窦后锁孔入路开颅时关键孔的精确定位.方法 选取干性颅骨15具和湿性头颅8具,在干性颅骨上确定颅骨内表面横窦下缘与乙状窦后缘交界处(PTSJ),于颅骨外表面确定其对应点即关键点(D),测量关键点与二腹肌沟最后点(A)的距离AD、与乳突尖(B)的距离BD、与星点(C)的距离CD;应用湿性头颅标本模拟枕下乙状窦后锁孔入路,对干性颅骨测量结果进行验证及观测.结果 测量干性颅骨标本结果如下:AD:左侧(16.79±3.50) nun,右侧(14.82±2.96) mm;BD:左侧(33.98±3.87)mm,右侧(32.78±3.29) mm;CD:左侧(19.53±3.84) mm,右侧(22.59±4.08) mm;其中CD:左侧＜右侧,两侧差异显著(P=0.02).测量湿性头颅标本结果如下:AD:左侧(16.09±2.97) mm,右侧(15.94±2.85) mm;BD:左侧(34.78±5.30) mm,右侧(33.92±4.97) mm;CD:左侧(22.08±4.37) mm,右侧(23.67±6.55) mm;两侧差异均无统计学意义(P＞0.05).同时,干性颅骨标本与湿性头颅标本同侧比较,差异均无统计学意义(P＞0.05).结论 改良枕下乙状窦后锁孔入路能够较好显露PTSJ,降低静脉窦损伤风险,为临床安全、准确、快速开颅提供依据.

目的 分析颅脑外伤患者颅内血肿清除术后并发对侧硬膜外血肿危险因素,以便为临床诊疗提供依据.方法 回顾性分析2014年01月至2017年01月在我院接受急诊颅内血肿清除术治疗的颅脑外伤患者的,依据患者术后24 h内是否并发手术区对侧硬膜外血肿分为观察组(并发手术区对侧硬膜外血肿)和对照组(未并发血肿),并比较所有患者术前一般临床资料,分析颅脑外伤患者急诊颅内血肿清除术后并发手术区对侧硬膜外血肿的危险因素.结果 共纳入90例患者,其中观察组患者45例,对照组45例.单因素分析显示:观察组患者入院时昏迷状态、Babinski征阳性、合并脑挫伤、合并颅骨骨折、合并脑疝、术前中线偏移≥1 cm、基底池受压、手术去除骨瓣比例显著高于对照组(P＜0.05);观察组患者术后手术时间、GCS评分显著低于对照组(P＜0.05);观察组患者舒张压、血浆凝血酶时间(thrombin time,TT)显著高于对照组.Logistic多因素回归模型分析显示:颅骨骨折、合并脑疝、中线偏移≥1cm、去除骨瓣、术后手术时间、GCS评分高低是颅脑外伤患者急诊颅内血肿清除后并发对侧硬膜外血肿的独立危险因素.结论 外伤性颅脑损伤患者血肿清除术后并发手术区对侧硬膜外血肿患者入院时通常为颅内占位效应明显且多合并颅骨骨折的重型颅脑损伤,合并脑疝、中线偏移≥1 cm、手术去除骨瓣、手术时机短、GCS评分低、TT时间延长是外伤性颅脑损伤术后并发对侧硬膜外血肿的高危因素,对于合并高危因素的外伤性颅脑损伤患者术后应当更加注意预测发生对侧硬膜外血肿机率.