Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications of adult spinal deformity (ASD) surgery. Hybrid fixation techniques have emerged as a potential solution to mitigate this risk. However, the biomechanical benefits of hybrid rod fixation in long-segment spinal surgery have not been fully explored or validated. This study aimed to evaluate the effect of hybrid fixation using both polyetheretherketone (PEEK) rods and titanium rods on the increased incidence of PJK and PJF after long-segment ASD surgery using finite element analysis. A three-dimensional finite element model of the adult spine (T6-S1) was developed to simulate the biomechanical effects of different fixation techniques. An intact spine (model A) and two internal fixation configurations were modeled: model B incorporated titanium rods from T10 to S1 and model C incorporated PEEK rods from T10 to T11 with titanium rods from T11 to S1. Then, the resulting stresses on the intervertebral discs, facet joints, pedicle screws, and fixation rods were analyzed. Under six physiological motion states, intervertebral mobility and maximum von Mises stress on the adjacent segment (T9-T10) intervertebral disc, endplate, and facet joint was greater in models B and C than model A. Furthermore, intervertebral mobility and maximum von Mises stress on the adjacent segment intervertebral disc and facet joint were greater in model B than model C. Under all physiological motion conditions except for extension, the maximum von Mises stress on the adjacent segment endplate was greater in model B than model C. Hybrid fixation using PEEK and titanium rods shows promise for reducing the risk of PJK and PJF after ASD surgery. By decreasing intervertebral mobility and concentration of stress on the adjacent segment, hybrid fixation could improve long-term surgical outcomes and reduce the need for revision surgery.

This guideline was developed under the auspices of the Pediatric Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association, the Neuro-oncology Expert Committee of the Chinese Society of Clinical Oncology, and the Neuro-oncology Professional Committee of the China Anti-Cancer Association. Craniopharyngioma is the most common tumor in the sellar turcica region among children, with the majority being adamantinomatous craniopharyngioma (ACP) and a smaller proportion being papillary craniopharyngioma (PCP). Management of craniopharyngioma involves not only tumor control but also the treatment of tumor-related hypothalamic dysfunction and pituitary endocrine disorders. To standardize the diagnosis and management of pediatric craniopharyngioma, this guideline incorporates evidence from 398 literature references. It provides recommendations on diagnostic evaluation, surgical strategies, radiotherapy principles, prognostic assessment, follow-up and long-term management, and targeted therapy. This guideline is intended to serve as a reference for healthcare professionals engaged in pediatric neuro-oncology. Recommendations were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, taking into account the quality of evidence, clinical applicability, and expert consensus. Key recommendations are supported by explanatory rationale. The guideline were reviewed and approved by 35 multidisciplinary experts and 6 external reviewers, followed by formal voting on each recommendation. For areas lacking high-quality evidences, future well-designed clinical trials are recommended to validate and update these recommendations.

Objective To investigate the preliminary experience of a modified neuroendoscopic dual burr-hole sequential approach for third ventriculostomy combined with pineal region tumor biopsy in the treatment of tumor marker-negative pediatric pineal region tumor with obstructive hydrocephalus. Methods and Results The clinical data of 9 children with pineal region tumor and obstructive hydrocephalus admitted to Beijing Tiantan Hospital, Capital Medical University from June 2023 to November 2025 were analyzed. Among them, 4 cases underwent the conventional single burr-hole endoscopic third ventriculostomy (ETV) combined with pineal region tumor biopsy (single burr-hole group), and 5 cases received the modified neuroendoscopic dual burr-hole sequential approach for third ventriculostomy combined with pineal region tumor biopsy (dual burr-hole group). Postoperative evaluation showed: in the single burr-hole group, the mean operative time was 2.79 h, and the pathological diagnostic success rate was 3/4. In the dual burr-hole group, the mean operative time was 2.37h, and the pathological diagnostic success rate was 5/5. Obstructive hydrocephalus was effectively relieved in all patients in both groups. In the single burr-hole group, one case had intraoperative blood loss>100 ml, 3 cases experienced mild forniceal contusion, one case had septum pellucidum vein injury, and one case developed transient postoperative memory decline. No safety events occurred in the dual burr-hole group. Conclusions The modified neuroendoscopic dual burr-hole sequential approach, with its precise anatomical design and excellent visualization, provides a safe, efficient and integrated solution for the treatment of pediatric pineal region tumor with obstructive hydrocephalus. It holds promise as one of the standard surgical approaches for such cases.

The correction of severe spinal deformities often requires osteotomy procedures such as laminectomy. This compromises the structural integrity of the spinal posterior column and may lead to complications including spinal instability, spinal cord exposure, and failure of bone graft fusion. A persistent clinical challenge is how to reconstruct the lamina to restore biomechanical stability while simultaneously protecting the spinal cord. Currently, no standardized artificial lamina repair material is available, and traditional metallic or single-component bioabsorbable materials cannot adequately balance biocompatibility, mechanical support, and physiological healing. To address this need, we designed and fabricated a novel multifunctional split-type porous biomimetic absorbable modified PLA-HA lamina (MSPBA mPLA-HA lamina). In a sheep laminectomy model, the implant-bone interface bone volume fraction in the experimental group reached 74.6% and was significantly higher than that in the control group, while the mechanical stiffness of the reconstructed lamina was comparable to that of native sheep lumbar laminae. These findings suggest that the implant can support lamina reconstruction and that its porous architecture may provide a structural basis for reducing local epidural compression. As a bioactive absorbable construct, the MSPBA mPLA-HA lamina may represent a promising strategy for more physiologically compatible spinal posterior column reconstruction.

ObjectiveTo compare recorded postoperative intracranial infection and recurrent hydrocephalus across three hydrocephalus management pathways in children with medulloblastoma and to conduct an exploratory internal prediction analysis for postoperative infection after ventriculoperitoneal (VP) shunting.MethodsThis retrospective single-center cohort and prediction-model study included 420 children with medulloblastoma and preoperative hydrocephalus treated at Beijing Tiantan Hospital from January 1, 2014, through March 1, 2018. Patients were grouped by initial definitive hydrocephalus pathway: preoperative VP shunt, upfront tumor resection without permanent preoperative diversion, or preoperative endoscopic third ventriculostomy (ETV). Pairwise propensity score matching was performed for VP shunt versus upfront resection, ETV versus upfront resection, and ETV versus VP shunt. The minimum planned postoperative follow-up was 6 months. Candidate VP-shunt infection models were evaluated by repeated stratified 5-fold cross-validation, with imputation, standardization, and sampling fitted within training folds only.ResultsThe cohort included 227 VP-shunt, 140 upfront-resection, and 53 ETV patients. Postoperative infection occurred in 55/227 patients (24.2%) after VP shunting, 31/140 (22.1%) after upfront resection, and 5/53 (9.4%) after ETV. Recurrent hydrocephalus or rescue diversion occurred in 5/227 patients (2.2%) after VP shunting, 34/140 (24.3%) after upfront resection, and 5/53 (9.4%) after ETV. In matched ETV versus VP-shunt pairs, infection occurred in 5/50 ETV patients (10.0%) versus 12/50 VP-shunt patients (24.0%; matched odds ratio [OR], 0.36; 95% confidence interval [CI], 0.12-1.14; P = 0.118), and recurrent hydrocephalus occurred in 5/50 ETV patients (10.0%) versus 4/50 VP-shunt patients (8.0%; matched OR, 1.25; 95% CI, 0.34-4.66; P = 1.000). The internally selected L2 logistic VP-shunt infection model achieved repeated cross-validation area under the receiver operating characteristic curve (AUC) 0.627 and Brier score 0.175. ETV recurrence was not modeled because only five events occurred.DiscussionThe pathway comparisons are exploratory observational associations rather than causal effects. Both matched ETV comparisons were non-significant, with wide confidence intervals compatible with clinically opposite directions and important residual imbalance. The internally evaluated VP-shunt infection model is not independently validated and must not be used for individual treatment decisions. Larger prospective, anatomy-enriched, multi-institutional studies with complete follow-up are required.

Background Risk stratification and radiotherapy optimization for medulloblastoma (MB) increasingly rely on molecular classification, yet large-scale, cross-regional, real-world evidence remains limited. Methods We assembled a global MB database (Chinese cohort: N = 729; international: N = 494). Overall survival (OS)/progression-free survival (PFS) and risk stratification were analyzed by integrating clinicopathological data with molecular subgroup-specific genetic events using Kaplan-Meier and Cox regression models. Findings While conventional clinical risk stratification effectively separated outcomes, metastatic stage alone, although a crucial factor, failed to adequately stratify survival across molecular subgroups. The average-risk group showed superior 5-year cumulative OS (84.4%) and PFS (77.5%), compared to the high-risk group (77.2% and 68.2%). Key genetic events, including TP53 mutation/17p loss (Sonic Hedgehog, SHH), MYC amplification (group_3), and CDK6 activation (group_4), were strongly associated with survival. Integrating genetic events with clinical features significantly facilitated prognostic discrimination. Importantly, radiotherapy dose-response effects were highly context dependent within defined molecular subgroups. No significant differences in OS or PFS were observed between craniospinal irradiation (CSI) doses of 30.6 and 36.0 Gy in high-risk patients with SHH, group_3, and group_4 receiving chemotherapy. In particular, 36.0 Gy CSI was warranted for aggressive MYC-amplified group_3 MB, even without dissemination. Conclusions Integrating subgroup-specific genetic events with clinical features facilitates MB risk stratification, informs context-dependent radiotherapy consideration, and provides actionable candidates for prospective validation. Funding This work was funded by the Natural Science Foundation of Beijing (JQ24040 and L2510021) and the National Natural Science Foundation of China (82273343 and 82573715).

BACKGROUND:Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery. OBJECTIVE:To evaluate the efficacy of multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) versus ERAS alone on 90-day postoperative complications in older adults undergoing elective spinal fusion. DESIGN:Multicenter, open-label, assessor-blinded, 1:1 parallel-group randomized controlled trial. (ClinicalTrials.gov: NCT06140797). SETTING:3 tertiary hospitals in China. PARTICIPANTS:Adults aged 75 years or older undergoing elective spinal fusion surgery between May 2024 and May 2025. INTERVENTION:Participants were randomly assigned to receive either preoperative Vivifrail-based, multimodal PREERAS (PREERAS group) or ERAS alone (ERAS group). The 4-week prehabilitation program integrated supervised group sessions, Vivifrail multicomponent exercise, nutritional optimization, and psychological interventions. MEASUREMENTS:The primary outcome was the occurrence of any postoperative complication within 90 days of surgery, recorded and graded per the Clavien-Dindo classification system. RESULTS:A total of 312 patients were assessed for eligibility, with 164 randomly assigned. Of the 159 patients included in the final analysis (mean age, 78.7 years; 59% women), 59 patients (74.7%) in the PREERAS group and 73 patients (91.2%) in the ERAS group experienced at least 1 complication (risk ratio, 0.80 [95% CI, 0.67 to 0.95]; risk difference, -18.0% [CI, -27.0% to -9.0%]). LIMITATIONS:Unblinded participants and clinicians. Generalizability may be limited with longer hospital stays in the Chinese health care system. CONCLUSION:The implementation of multimodal prehabilitation in 3 tertiary hospitals in China reduced 90-day postoperative complications in older adults undergoing enhanced recovery after spinal fusion surgery. However, individual sites will need to consider applicability of findings and resource requirements of prehabilitation before implementation. PRIMARY FUNDING SOURCE:Capital's Funds for Health Improvement and Research.

BackgroundMedulloblastoma (MB), the most common malignant pediatric brain tumor, lacks prognostic tools integrating clinical, molecular, and treatment-related characteristics for individualized management.MethodsWe developed machine learning models using multicenter data from 729 Chinese patients (2001-2023), of whom 509 were assigned to the training set and 220 to the testing set, and further validated the models on 201 patients from international MB consortia. To accommodate patients and researchers with varying datatypes, four application scenarios were established, including clinical-molecular-radiotherapy (CMR), clinical-molecular (CM), clinical-radiotherapy (CR), and clinical-only (CO).ResultsWe construct four model scenarios and assess their predictive performance in the testing set: an XGBoost-based CMR model (incorporating 11 features, including molecular subgroup, radiotherapy dose, and key gene expression) with a C-index of 0.612; an XGBoost-based CM (C-index = 0.609); a GBM-based CR (C-index = 0.637); and a GBM-based CO (C-index = 0.635). External validation demonstrates robust performance, with radiotherapy and molecular data contributing significantly to enhanced efficacy. In addition, interactive web-based Shiny applications have been launched to facilitate dynamic risk assessment and treatment optimization.ConclusionsBy integrating multidimensional data, our framework enables the tailored prognostication and clinical decision to meet the multidimensional requirements of research and medicine.

Lumbar disc (LD) herniation and aging are prevalent conditions that can result in substantial morbidity. This study aimed to clarify the mechanisms connecting the LD aging and herniation, particularly focusing on cellular senescence and molecular alterations in the nucleus pulposus (NP). We performed a detailed analysis of NP samples from a diverse cohort, including individuals of varying ages and those with diagnosed LD herniation. Our methodology combined histological assessments with single-nucleus RNA sequencing to identify phenotypic and molecular changes related to NP aging and herniation. We discovered that cellular senescence and a decrease in nucleus pulposus progenitor cells (NPPCs) are central to both processes. Additionally, we found an age-related increase in NFAT1 expression that promotes NPPC senescence and contributes to both aging and herniation of LD. This research offers fresh insights into LD aging and its associated pathologies, potentially guiding the development of new therapeutic strategies to target the root causes of LD herniation and aging.

BACKGROUND:Tumour-infiltrating immune cells exert both pro-tumour and anti-tumour effects on intracranial tumours. In this study, we investigated the prognostic value of various infiltrating immune cells in medulloblastoma (MB) within a large cohort. METHODS:We employed multiplex immunofluorescent (mIF) staining of tissue microarrays to assess the densities of T cells, B cells, NK cells, macrophages, and immune checkpoints in tumour samples from 249 primary paediatric patients with primary MB. Overall survival (OS) analysis, progression-free survival (PFS), and Cox regression analyses were utilised to explore potential relationships between immune cell densities and survival outcomes. Subsequently, multivariate Cox regression was validated using an external database. FINDINGS:Significant differences in the immune microenvironment among molecular groups of MB and their prognostic implications were observed. CD4+ T cell infiltration was positively correlated with improved OS prognosis (Hazard Ratiolow vs high 2.19 [95% CI 1.197-4.016]), while M2 macrophages (HRlow vs high 0.50 [95% CI 0.250-1.003]), NK cells (HRlow vs high 0.40 [95% CI 0.207-0.792]), and B cells (HRlow vs high 0.51 [95% CI 0.291-0.902]) were associated with poorer PFS prognosis. We detected the presence of early tertiary lymphoid structures in MB. The infiltration of B cells (HRlow vs high 0.50 [95% CI 0.271-0.941]) correlated with poorer OS. The prognostic significance of B cells was further corroborated in cases from external data. Additionally, multivariate Cox regression confirmed that B cells were identified as independent negative prognosticators for OS (HRhigh vs low 2.21 [95% CI 1.341-3.651]) and PFS (HRhigh vs low 2.15 [95% CI 1.28-3.61]). INTERPRETATION:Our study provides a comprehensive characterisation of the spatial distribution of certain immune cells and tumour cells within the tumour core of patients with various subtypes of MB, underscoring the prognostic significance of B cells in these individuals. FUNDING:Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes (PWD & RPP-MRI: JYY2018-7); National Natural Science Foundation of China (32300773); China Postdoctoral Science Foundation (2022M721864).

STUDY DESIGN:A retrospective study. OBJECTIVE:This study designed an innovative 3D-printed microporous lamina and aimed to evaluate the feasibility and effectiveness of kyphosis correction surgery for patients with ankylosing spondylitis (AS). BACKGROUND:Spinal osteotomy is a widely employed treatment for severe kyphotic deformities in AS. However, mitigating complications associated with osteotomy remains a significant clinical challenge. MATERIALS AND METHODS:A total of 72 consecutive patients with AS who underwent kyphosis correction surgery were analyzed. Customized 3D-printed microporous laminae were designed based on preoperative imaging and three-dimensional modeling of each patient's spinal anatomy. Patients were divided into 2 groups: group A (25 patients), treated with the 3D-printed microporous lamina technique, and group B (47 patients), treated using the traditional technique. Radiologic assessments included bone fusion rate, global kyphosis, thoracolumbar kyphosis, lumbar lordosis, osteotomy angle, pelvic index, pelvic tilt, sacral slope, and sagittal vertical axis. Clinical outcomes assessed were surgery-related complications, reoperation rates, operative time, estimated blood loss, postoperative hospital stay, and Scoliosis Research Society Outcomes Instrument-22. All patients were followed up for at least 2 years postoperatively. RESULTS:The bone fusion rate in the 3D-printed microporous lamina group was 96%. There were no statistically significant differences between the two groups in terms of surgery-related complications, reoperation rate, estimated blood loss, postoperative stay, global kyphosis, thoracolumbar kyphosis, lumbar lordosis, osteotomy angle, pelvic index, pelvic tilt, sacral slope, sagittal vertical axis, or Scoliosis Research Society Outcomes Instrument-22. Although the mean operative time was longer in group A than in group B, this difference was not statistically significant. CONCLUSION:The use of 3D-printed microporous laminae in kyphosis correction surgery for AS provides a promising method for achieving high bone fusion rates through effective laminar reconstruction.

Medulloblastoma (MB), particularly Group_3 (G3-MB), remains the most aggressive subgroup due to strong stemness and therapeutic resistance. Through genome-wide DNA methylation and transcriptomic analysis of human MB samples, we identify enhancer hypomethylation as a key feature sustaining G3-MB stemness and tumor progression. Notably, hypomethylation of the Otx2 super-enhancer (SE) is a prognostic marker and potential therapeutic target for G3-MB patients. We demonstrate that disrupting Otx2 SE activity effectively reduces tumor growth in vivo, highlighting its critical role in G3-MB maintenance. TET3, recruited by OTX2, demethylates the Otx2 SE, promoting chromatin opening and sustaining tumor proliferation and stemness. To translate these findings into therapy, we develop a liposomal nanoparticle (LNP)-based delivery system for siTET3 or a cytosine-based inhibitor of TET3, achieving significant tumor-suppressive effect in a patient-derived orthotopic xenograft model of G3-MB. Our study provides the targeted approach for Otx2-driven G3-MB and introduces LNP-based epigenetic therapy as a promising low-toxicity strategy.

Severe spinal deformities represent rare and complex conditions requiring highly individualized treatment strategies. Among these, the “reverse-folding human” deformity has never before been reported in the medical literature. This study presents the first documented case of this condition, managed successfully through a multidisciplinary team approach and staged posterior spinal instrumentation and fusion. It also establishes the first framework for risk stratification and perioperative management of such extreme deformities. Case report. A 36-year-old woman presented with progressive cervical hyperextension over 26 years and thoracolumbar deformity over 17 years. Clinical and radiological evaluation revealed severe cervical hyperextension, spinal lordosis (Cobb angle: 140.1°), scoliosis (Cobb angle: 87.6°), and severe restrictive pulmonary impairment. The patient underwent a two-stage posterior spinal fusion (C2–S1). Postoperative outcomes included substantial improvement in alignment and gait, with no neurological or mechanical complications over two years of follow-up. This case demonstrates the feasibility and efficacy of a staged full-spine surgical approach in managing unprecedented spinal deformities. The successful outcome highlights key elements for similar cases: patient-specific surgical planning, staged correction to reduce risks, and coordinated MDT involvement. This report provides a critical clinical reference and treatment framework for managing rare and severe spinal deformities, including the newly defined “reverse-folding human” condition.

Background Despite numerous studies on medulloblastoma (MB) cell heterogeneity, the spatial characteristics of cellular states remain unclear.Methods We analyze single-nucleus and spatial transcriptomes and chromatin accessibility from human MB spanning four subgroups, to identify malignant cell populations and describe the spatial evolutionary trajectories. The spatial copy number variations (CNVs) patterns and niches were analyzed to investigate the cellular interactions.Results Three main malignant cell populations were identified, including progenitor-like, cycling, and differentiated populations. Gene signatures of cell populations strongly correlate to clinical outcomes. These tumor cell populations are geographically organized as stem-like and mature regions, highlighting their spatially heterogeneous nature. Progenitor-like and cycling cells are mainly concentrated in stem-like regions, whereas various differentiated populations are primarily distributed in mature regions. By analyzing chromosomal alterations, we find that stem-like regions typically harbor a single pattern of CNVs, reflecting high originality and uniformity, which is in stark contrast to mature regions exhibiting multiple patterns with a broader range of biological functions. Projecting cellular state programs onto spatial sections fully illustrates the evolution from stem-like regions to various functional zones in mature regions, which is correlated to microenvironmental components along the paths to maintain stemness or promote differentiation.Conclusions This multi-omics database comprehensively facilitates the understanding of MB spatial evolutionary organization.

AIM:This study aims to clarify hematological parameters, transfusion requirements, and adverse events of preoperative intravenous (IVIS) versus oral iron supplementation (OIS) in elective surgery patients. METHODS:We conducted a comprehensive literature search across multiple databases up to 10 December 2023. Twelve RCTs involving 930 participants met our eligibility criteria. Our analysis focused on post-treatment hemoglobin levels, changes in hemoglobin from baseline, ferritin levels, hemoglobin attainment rates, transfusion requirements, and adverse events. We employed the random-effects model for data synthesis, calculating pooled standard mean differences (SMD) or mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). Methodological quality was assessed using the Cochrane ROB 2 tool. The GRADE approach evaluated the confidence in effect estimates. FINDINGS:IVIS significantly improved post-treatment hemoglobin levels (MD = 0.77 g/dL, 95% CI [0.30 to 1.23]), hemoglobin increments (MD = 0.69 g/dL, 95% CI [0.01 to 1.37]), and ferritin levels (MD = 260.03 ng/mL, 95% CI [119.65 to 400.42]) compared to OIS. IVIS also led to a higher hemoglobin attainment rate (RR = 1.88, 95% CI [1.24 to 2.86]). No significant differences were noted in transfusion rates or volumes. IVIS was associated with fewer digestive (RR = 0.10, 95% CI [0.05 to 0.22]; I2 = 0%) but more pain-related adverse events (RR = 7.79, 95% CI [1.78 to 34.07]; I2 = 0%). Hospital stay durations and mortality rates were similar between the two groups. INTERPRETATION:IVIS offers a superior improvement in hematological parameters for elective surgery patients but not reducing transfusion needs compared to OIS. While IVIS has fewer digestive adverse events, it increases pain-related complications. These findings highlight the importance of personalized approaches in selecting iron supplementation methods, carefully balancing time, efficacy, and adverse event profiles. REGISTRATION:PROSPERO CRD42023483284.

Medulloblastoma (MB), a heterogeneous pediatric brain tumor, poses challenges in the treatment of tumor recurrence and dissemination. To characterize cellular diversity and genetic features, we comprehensively analyzed single-cell/nucleus RNA sequencing (sc/snRNA-seq), single-nucleus assay for transposase-accessible chromatin sequencing (snATAC-seq), and spatial transcriptomics profiles and identified distinct cellular populations in SHH (sonic hedgehog) and Group_3 subgroups, with varying proportions in local recurrence or dissemination. Local recurrence showed higher cycling tumor cell enrichment, whereas disseminated lesions had a relatively notable presence of differentiated subsets. Chromosomal alteration evaluation revealed distinct genetic subclones during MB progression, such as chr7q gain and chr11 loss in Group_3 disseminations. A subpopulation termed “high cellular plasticity (HCP)” emerged during MB progression and was associated with increased dividing potential and chromatin accessibility, contributing to recurrence. Inhibiting HCP-associated markers, like protein tyrosine phosphatase receptor type Z1 (PTPRZ1), efficiently suppressed MB progression in preclinical models. These findings address critical gaps in understanding the cellular diversity, chromosomal alterations, and biological dynamics of recurrent MB, offering potential therapeutic insights.

We aimed to use artificial intelligence to accurately identify molecular subgroups of medulloblastoma (MB), predict clinical outcomes, and incorporate deep learning-based imaging features into the risk stratification. The MRI features were extracted for molecular subgroups by a novel multi-parameter convolutional neural network (CNN) called Bi-ResNet-MB. Then, MR features were used to establish a prognosis model based on XGBoost. Finally, a novel risk stratification system to stratify the patients based on the M2R Score (Machine learning-based Medulloblastoma Risk Score) was proposed. A total of 139 MB patients (36 female, average age 7.27 ± 3.62 years) were treated at Beijing Tiantan Hospital. The Bi-ResNet-MB model excelled in molecular subgroup classification, achieving an average AUC of 0.946 (95

Central nervous system germ cell tumors (CNS GCTs) are common malignancies of the central nervous system of children and adolescents. The management of CNS GCTs is complex because of varied tumor sites, clinical presentations, treatments and outcomes. Multidisciplinary integrated treatment involving radiotherapy, chemotherapy and surgery is the most commonly used approach for CNS GCTs worldwide and is essential for achieving favorable clinical outcomes. The Pediatric Oncology Committee of the Chinese Anti-Cancer Association (CACA) has formulated the guidelines for the management of CNS GCTs based on domestic and foreign clinical studies and experiences. The guidelines cover the diagnosis and treatment of primary CNS GCT in the pineal region, the sellar region, and the thalamus and basal ganglia region, recurrent, disseminated, and bifocal/multifocal CNS GCT, as well as traditional Chinese medicine. In these guidelines, different treatment regimens are proposed for secretory or non-secretory GCTs. The therapeutic concepts of primary treatment and second-look surgery are also introduced. The hope is to help standardize the diagnosis and treatment, and further improve the outcomes of CNS GCTs patients.

OBJECTIVE:Cervical instability may influence the development and progression of cervical spondylotic myelopathy (CSM). This study aimed to investigate the prevalence of cervical instability in patients with CSM and identify associated factors. METHODS:The authors examined the clinical and radiological characteristics of 167 patients aged 40-80 years diagnosed with CSM who required hospitalization between June 2022 and June 2024. Cervical spine radiography was used to evaluate cervical instability, which was defined as a ≥ 3-mm translational motion between adjacent vertebrae on flexion-extension views. Factors potentially associated with cervical instability were compared between patients with and without instability and further investigated using multivariate logistic regression. RESULTS:The mean patient age was 57.7 ± 10.3 years, and 115 patients (68.9%) were men. Cervical instability was identified in 72 patients (43.1%). Multivariate logistic regression identified cervical facet joint degeneration, a difference between the T1 slope and cervical lordosis, and visual analog scale score for neck pain as significantly associated factors for cervical instability. CONCLUSIONS:This study revealed a high prevalence (43.1%) of cervical instability among patients with CSM and identified significantly associated factors. Spine surgeons should pay special attention to these factors in the surgical decision-making process.