Background:Atherosclerotic internal carotid artery occlusion (AICAO) is associated with a high risk of stroke recurrence despite standard medical therapy. This study aimed to evaluate the predictive value of the neutrophil-lymphocyte ratio (NLR), an accessible marker of systemic inflammation, for identifying patients at higher risk of recurrent stroke. Methods:This retrospective study enrolled 136 patients with AICAO, whose NLR data were collected. Recurrent stroke was evaluated via clinical and vascular imaging follow-up. Receiver operating characteristic (ROC) analysis was performed to determine the optimal NLR cutoff value. The value of NLR in predicting stroke recurrence was determined via a Cox regression model. Results:Of the 281 initially screened patients, 136 met the study's inclusion criteria (age 62±10 years; 68% male). Among the patients, 17 (12.5%) experienced ipsilateral stroke (1-year rate, 8.8%; 2-year rate, 12.5%). The median baseline NLR was higher in patients with recurrence [3.38, interquartile range (IQR), 2.20-4.95] than in those without recurrence (2.39, IQR, 1.82-3.02) (Mann-Whitney P=0.007). The ROC analysis indicated an optimal NLR cutoff of 3.36 [area under the curve (AUC) =0.703; 95% confidence interval (CI): 0.559-0.847; P=0.007; sensitivity =0.59; specificity =0.82]. Patients were stratified into NLR-high (>3.36; n=31) and NLR-low (≤3.36; n=105) groups, with the 1-year stroke rates being 22.5% (7/31) and 5.7% (6/105), respectively, with an absolute risk difference of 16.8% (95% CI: 3.4-30.2%). In the Kaplan-Meier analysis, the log-rank P value was 0.039. In the univariate Cox analysis, an NLR >3.36 yielded a hazard ratio (HR) of 3.83 for stroke recurrence (95% CI: 1.48-9.94; P=0.006). In the multivariable Cox analysis, an NLR >3.36 remained independently associated with recurrence (HR 4.17, 95% CI: 1.59-10.91; P=0.004). When NLR was modelled as a continuous log-transformed variable, each 1-unit increase yielded an HR of 1.99 (95% CI: 1.49-2.66; P<0.001). Conclusions:In symptomatic nonacute patients with AICAO, NLR is a predictor for recurrent stroke under standard medical treatment. Moreover, an NLR >3.36 is associated with a higher risk of stroke recurrence, and intensive surveillance in high-risk patients with this marker may be necessary.

Background:Several studies have shown that spontaneous recanalization after acute intracranial arterial occlusion is not uncommon. This study aimed to investigate the predictive factors and outcomes of early spontaneous recanalization following acute middle cerebral artery occlusion. Methods:We conducted an analysis of 116 patients with acute middle cerebral artery occlusion from a prospective cohort (January 2021-December 2023). Patients aged 18-85 years with confirmed middle cerebral artery occlusion within 7 days of stroke onset who did not receive thrombolysis or thrombectomy were included. Early spontaneous recanalization was assessed by the Arterial Occlusive Lesion Scale after admission within 7 days. Outcomes included 90-day modified Rankin Scale (mRS) scores, symptomatic intracranial hemorrhage within 90 days, and mortality within 90 days. According to the degree of recanalization, early spontaneous recanalization was categorized into complete recanalization and noncomplete recanalization. The baseline characteristics and therapeutic regimen were compared between the patients with no-recanalization and early spontaneous recanalization. Outcomes were compared between the early spontaneous recanalization and no-recanalization groups and between the noncomplete recanalization and complete recanalization groups. Multivariate logistic regression analysis was conducted to identify risk factors of early spontaneous recanalization and complete recanalization. Results:Early spontaneous recanalization occurred in 20.7% of patients (24/116). The independent predictors of early spontaneous recanalization were nonatherosclerotic etiology [adjusted odds ratio (OR) 10.40; P=0.03] and higher National Institutes of Health Stroke Scale (NIHSS) score (adjusted OR 1.31; P<0.01). Complete early spontaneous recanalization occurred in 8.6% (10/116) of patients. Atrial fibrillation was an independent predictor of complete early spontaneous recanalization (OR 21.70; P=0.01). Patients with early spontaneous recanalization (n=24) did not differ significantly from those without recanalization (n=92) in terms of median 90-day mRS (3 vs. 2; effect size =0.48; P=0.35), rates of good functional outcome (mRS 0-2; 29.2% vs. 56.5%; OR 0.78; P=0.68), symptomatic intracranial hemorrhage (16.7% vs. 7.6%; OR 1.40; P=0.65), or 90-day mortality (8.3% vs. 2.2%; OR 2.97; P=0.32). Conclusions:Early spontaneous recanalization after acute middle cerebral artery occlusion is independently associated with nonatherosclerotic etiology and higher baseline NIHSS score. Spontaneous complete recanalization after acute middle cerebral artery occlusion is independently associated with atrial fibrillation. The absence of benefit or harm indicates that spontaneous recanalization is a neutral phenomenon after acute middle cerebral artery occlusion.

Objective. Accurate prediction of thermal damage extent is essential for effective and precise thermal therapy, especially in brain laser interstitial thermal therapy (LITT). Immediate postoperative contrast-enhanced T1-weighted imaging (CE-T1WI) is the primary method for clinically assessing in vivo thermal damage after image-guided LITT. CE-T1WI reveals a hyperintense enhancing rim surrounding the target lesion, which serves as a key radiological marker for evaluating the thermal damage extent. Although widely used in clinical practice, traditional thermal damage models rely on empirical parameters from in vitro experiments, which can lead to inaccurate predictions of thermal damage in vivo. Additionally, these models predict only two tissue states (damaged or undamaged), failing to capture three tissue states observed on post-CE-T1WI images, highlighting the need for improved thermal damage prediction methods. Approach. This study proposes a novel convolutional long short-term memory-based model that utilizes intraoperative temperature distribution history data measured by magnetic resonance temperature imaging (MRTI) during LITT to predict the enhancing rim on post-CE-T1WI images. This method was implemented and evaluated on retrospective data from 56 patients underwent brain LITT. Main results. The proposed model effectively predicts the enhancing rim on postoperative images, achieving an average dice similarity coefficient of 0.82 ( +/- 0.063) on the test dataset. Furthermore, it generates real-time predicted thermal damage area variation trends that closely resemble those of the traditional thermal damage model, suggesting potential for real-time prediction of thermal damage extent. Significance. This method could provide a valuable tool for visualizing and assessing intraoperative thermal damage extent.

Large language models (LLMs) show promise for biomedical text analysis, but their ability to localize the epileptogenic zone (EZ) from pre-surgical data is underexplored. We evaluated three leading LLMs on predicting the surgically validated EZ using multi-source unstructured clinical text from 154 patients (two cohorts) with drug-resistant epilepsy who achieved postoperative seizure freedom (Engel Class I). Models performed EZ laterality classification, probabilistic lobar localization, and SEEG stratification based on five presurgical text sources, with performance benchmarked against resected lobes. All models achieved 98.3% accuracy in Cohort 1 and 100% in Cohort 2 for laterality. In lobar localization, GPT-4.1 and Claude 3.7 Sonnet achieved a median score of 70, significantly higher than Deepseek-R1's 60 (p < 0.001) in Cohort 1. In Cohort 2, there were no statistically significant differences among the three models, with all models achieving a median score of 70 (p > 0.05). A modality ablation analysis revealed that GPT-4.1's performance was most significantly impaired by removing medical records (p<0.001) and MRI reports (p = 0.014). Predictions exhibited excellent test-retest reliability (ICC = 0.951), and higher SEEG stratification scores were assigned to patients who underwent invasive monitoring (p < 0.001). In conclusion, LLMs can accurately infer the surgically validated EZ from raw preoperative text and may serve as valuable clinical decision-support tools.

Epilepsy is a common chronic neurological disorder that severely impacts the quality of life and social functioning.Approximately 1/3 of patients are diagnosed with drug-resistant epilepsy(DRE),for which conventional antiepileptic seizure medicine(ASM)and traditional surgery have limited efficacy.In recent years,responsive neurostimulation(RNS),as a closed-loop neuromodulation technique,has provided a novel treatment option for DRE.The RNS utilizes invasived electrodes to monitor brain activity in real time,detect seizure precursors,and deliver electrical stimulation,effectively reducing the frequency and severity of DRE.This paper aims to review the composition of the RNS,optimization and dyanmic adjustment of stimulation parameters,long-term data recording and analysis,fusion with machine learning,clinical efficacy,and comparison with vagus nerve stimulation(VNS).It also explores the technical challenges and discusses future development directions.RNS holds promise for providing personalized and precise treatment to more DRE and expanding its application to other neurological disorders.

OBJECTIVE:This study was undertaken to anatomically categorize insulo-opercular focal cortical dysplasia (FCD) lesions according to their location and extent, and to summarize corresponding stereoelectroencephalographic (SEEG) patterns to guide preoperative evaluation and surgical planning. METHODS:Patients who underwent epilepsy surgery for insulo-opercular FCD between 2015 and 2022 were enrolled. FCD lesions were categorized into insular, peri-insular, opercular, and complex types based on their location and extent, as ascertained from electroclinical and neuroimaging data. SEEG signals from the seizure onset electrodes were collected for quantitative analysis. The normalized interictal spike counts, high-frequency oscillation (HFO) counts, and ictal epileptogenicity index (EI) values of the insular and opercular channels were calculated. The spatial patterns of the spike counts, HFO counts, and EI values were analyzed. Cluster analyses utilizing spike counts, HFO counts, and EI values were performed for automatic categorization, and the results were compared with the manual categorization from the preoperative evaluations. RESULTS:A total of 53 patients were included, comprising 10 insular, 17 peri-insular, 24 opercular, and two complex cases. Thirty-eight patients were included in the quantitative SEEG analysis. Spike, HFO, and EI analyses indicated that in insular FCDs, the values of the three parameters were higher in insular channels than in opercular channels. In peri-insular FCDs, the values in insular and opercular channels were comparable, whereas in opercular FCDs, the values were higher in opercular channels than in insular channels. The accuracies of the cluster analysis based on the spike counts, HFO counts, and EI values were 71.05% (27/38), 76.32% (29/38), and 86.84% (33/38), respectively. Surgical strategies were proposed according to the anatomical categorization, achieving a favorable postoperative seizure-free rate of 84.91%. SIGNIFICANCE:Insulo-opercular FCDs can be categorized into insular, peri-insular, opercular, and complex types. SEEG patterns can facilitate the automatic categorization of insulo-opercular FCDs, thereby enhancing preoperative planning and surgical outcomes.

This study introduces a novel in vitro model for intractable temporal lobe epilepsy (TLE) utilizing 3D bioprinting technology, aiming to replicate the complex neurobiological characteristics of TLE more accurately. Primary neural cell constructs were fabricated and subjected to epileptiform-inducing conditions, fostering synaptic proliferation and neuronal loss. Systematically electrophysiological and immunofluorescent analyses indicated that significant synaptic connectivity and sustained epileptiform activities within the constructs akin to those observed in human epilepsy models. Notably, the model responded to treatments with phenytoin and tetrodotoxin, illustrating its potential utility in drug response kinetics studies. Furthermore, we performed drug permeability simulations using COMSOL Multiphysics to analyze the diffusion characteristics of these drugs within the constructs. These results confirm that our 3D bioprinted neural model provides a physiologically relevant and ethically sustainable platform, which is beneficial for studying TLE mechanisms and developing therapeutic strategies with high accuracy and clinical relevance.

Deep brain stimulation (DBS) is an effective treatment modality for medication-refractory cervical dystonia (CD). In recent years, the asymmetric targets for lead implantation of DBS have become a more valued topic. To explore the efficacy of the asymmetric targets for lead implantation of DBS. A patient with CD underwent unilateral globus pallidus internus (GPi) combined contralateral subthalamic nucleus (STN) deep brain stimulation. Although neither unilateral GPi nor STN stimulation relieved the patient’s clinical symptoms during temporary testing after surgery, the positive effect of bilateral stimulation was substantial. At the 12-month postoperative evaluation, the patient’s clinical symptoms improved remarkably, with an improvement rate of 78% compared with the preoperative assessment. Combined with the previous kinds of literature we reviewed in this article, we propose that in addition to conventional lead implantation, the option of using asymmetric targets for lead implantation can be considered when physicians encounter special conditions and can also be effective in relieving clinical symptoms in patients with CD.

Objective: Pineal tumors are relatively rare central nervous system lesions with a predilection for the pediatric population. This article aims to explore the clinical effects of neuroendoscopic infratentorial supracerebellar approach for resecting tumors in the pineal area. Methods: This is a retrospective study that included patients who underwent neuroendoscopic infratentorial supracerebellar approach to resect nine tumors in the pineal area at the Department of Neurosurgery of the Second Hospital of Lanzhou University from December 2017 to October 2023. Results: The results of postoperative MRI revealed that all tumors were resected. Five patients received postoperative radiotherapy, three patients received radiotherapy along with chemotherapy, and one patient received neither radiotherapy nor chemotherapy. The pathological results showed that four patients were diagnosed with germinoma, two patients with teratoma, two patients with mixed germ cell tumors, and one patient with central neurocytoma. After surgery, one patient developed psychiatric symptoms, two patients developed binocular upward vision and diplopia, and one patient developed unstable walking and diplopia. With a follow-up of 1.7-4.8 years, all nine patients lived normally. Furthermore, none of them had tumor recurrence or death. Conclusion: The simple neuroendoscopic infratentorial supracerebellar approach has some safety and efficacy. It is suitable for tumors in the pineal region where the disease is mainly located below the Galen vein complex.

Objective We explored the multimodal imaging characteristics of cortical tuber in patients with tuberous sclerosis complex（TSC）for better preoperative diagnosis and surgical decision-making.Methods Patients with TSC related epilepsy（TRE）from January 2015 to December 2021 from Beijing Tiantan Hospital and Beijing Fengtai Hospital were included retrospectively.Their clinical demographics and multimodal neuroimaging data were collected.We firstly quantitatively calculated the multimodal neuroimaging signals ofcortical tubers and normal cortex, as well as the volumes of cortical tubers.We then performed the inter-group comparison and correlation analysis between multimodal neuroimaging signals of cortical tubers and normal cortex.Results Finally, 31 patients with diagnosis of TSC and verification of responsible tubers after multidisciplinary preoperative evaluationwere included.The quantitative results showed that, comparedwith homotopic cortex, tubers displayed significantly higher T2w-FLAIR density signal（Student’s t=3.643,PFDR＜0.001） and lower PET metabolic value（Student’s t =-6.162,PFDR＜0.001）.Moreover, responsible tubers shown significant correlation between T1wMPRAGE and FDG-PET（Pearson R=-0.512,PFDR= 0.027） and significantly larger volume than that of non-responsible tubers（Mann Whitney U=3.378,P＜0.001）.Conclusion T 2 w-FLAIRsignal of TSC tubers is significantly higher than that of normal cortex, which is helpful to diagnosis.The characteristic structure-metabolism coupling and larger volume, render its value in preoperative evaluation and surgicaldecision-making.

Objectives: To construct a nomogram incorporating important prognostic factors for predicting the overall survival of patients with colorectal cancer with peritoneal metastases treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), the aim being to accurately predict such patients' survival rates. Methods: This was a retrospective observational study. Relevant clinical and follow-up data of patients with colorectal cancer with peritoneal metastases treated by CRS + HIPEC in the Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University from 2007 January to 2020 December were collected and subjected to Cox proportional regression analysis. All included patients had been diagnosed with peritoneal metastases from colorectal cancer and had no detectable distant metastases to other sites. Patients who had undergone emergency surgery because of obstruction or bleeding, or had other malignant diseases, or could not tolerate treatment because of severe comorbidities of the heart, lungs, liver or kidneys, or had been lost to follow-up, were excluded. Factors studied included: (1) basic clinicopathological characteristics; (2) details of CRS+HIPEC procedures; (3) overall survival rates; and (4) independent factors that influenced overall survival; the aim being to identify independent prognostic factors and use them to construct and validate a nomogram. The evaluation criteria used in this study were as follows. (1) Karnofsky Performance Scale (KPS) scores were used to quantitatively assess the quality of life of the study patients. The lower the score, the worse the patient's condition. (2) A peritoneal cancer index (PCI) was calculated by dividing the abdominal cavity into 13 regions, the highest score for each region being three points. The lower the score, the greater is the value of treatment. (3) Completeness of cytoreduction score (CC), where CC-0 and CC-1 denote complete eradication of tumor cells and CC-2 and CC-3 incomplete reduction of tumor cells. (4) To validate and evaluate the nomogram model, the internal validation cohort was bootstrapped 1000 times from the original data. The accuracy of prediction of the nomogram was evaluated with the consistency coefficient (C-index), and a C-index of 0.70-0.90 suggest that prediction by the model was accurate. Calibration curves were constructed to assess the conformity of predictions: the closer the predicted risk to the standard curve, the better the conformity. Results: The study cohort comprised 240 patients with peritoneal metastases from colorectal cancer who had undergone CRS+HIPEC. There were 104 women and 136 men of median age 52 years (10-79 years) and with a median preoperative KPS score of 90 points. There were 116 patients (48.3%) with PCI≤20 and 124 (51.7%) with PCI>20. Preoperative tumor markers were abnormal in 175 patients (72.9%) and normal in 38 (15.8%). HIPEC lasted 30 minutes in seven patients (2.9%), 60 minutes in 190 (79.2%), 90 minutes in 37 (15.4%), and 120 minutes in six (2.5%). There were 142 patients (59.2%) with CC scores 0-1 and 98 (40.8%) with CC scores 2-3. The incidence of Grade III to V adverse events was 21.7% (52/240). The median follow-up time is 15.3 (0.4-128.7) months. The median overall survival was 18.7 months, and the 1-, 3- and 5-year overall survival rates were 65.8%, 37.2% and 25.7%, respectively. Multivariate analysis showed that KPS score, preoperative tumor markers, CC score, and duration of HIPEC were independent prognostic factors. In the nomogram constructed with the above four variables, the predicted and actual values in the calibration curves for 1, 2 and 3-year survival rates were in good agreement, the C-index being 0.70 (95% CI: 0.65-0.75). Conclusions: Our nomogram, which was constructed with KPS score, preoperative tumor markers, CC score, and duration of HIPEC, accurately predicts the survival probability of patients with peritoneal metastases from colorectal cancer treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

Objective:To analyze the therapeutic effect of mechanical thrombectomy in patients with acute ischemic strokes with low National Institute of Health stroke scale (NIHSS) scores and large vessel occlusions.Methods:The clinical data of acute ischemic stroke patients with mechanical thrombectomy admitted to the Neurointerventional Department of You'anmen Hospital from January 2020 to June 2022 were collected. Among them, 25 patients presented with low NIHSS scores and large vessel occlusions. The clinical characteristics of these patients were retrospectively analyzed and summarized. Wilcoxon rank-sum test was used to compare the difference between baseline NIHSS scores and postoperative NIHSS scores at 24 hours and 90 days after the operation.Results:Among the 25 patients, 19 were male (76.0%), aged (61±13) years. Hypertension was a common comorbidity (56.0%, 14/25). Patients with Alberta stroke program early CT score 10 accounted for 56.0% (14/25). The main etiological type was large-artery atherosclerosis (84.0%, 21/25). 22 patients (88.0%, 22/25) were successfully recanalized and 2 patients (8.0%, 2/25) had asymptomatic intracranial hemorrhage. The NIHSS score at 90 days was lower than the baseline NIHSS score [1 (0, 2) score vs 4 (3, 4) score], with a statistically significant difference (Z=-2.335, P=0.020). The good prognosis rate was 92.0% (23/25) at 90 days follow-up.Conclusion:Mechanical thrombectomy is feasible as a treatment for patients with low NIHSS scores and large vessel occlusions, and has high safety and vessel recanalization rate.

Objective:To assess the long-term outcome of the surgically remediable syndrome of frontal lobe epilepsy (FLE) associated with superior frontal sulcus (SFS)-related dysplasia.Methods:We retrospectively reviewed the medical charts and surgical features of 31 patients with drug-resistant frontal lobe epilepsy in our centers between 2016 and 2018. All patients underwent surgical resection. According to the epileptogenic zone (EZ), localization and resection extent were classified as (1) pure SFS group (PS group), (2) associated SFS group (AS group), and (3) no SFS group (NS group). The general characteristics, neuroradiological findings, morbidity, pathology, and long-term seizure outcome after surgery were analyzed to extract the potential value of the surgery for SFS-related dysplasia.Results:Of 31 patients with FLE who underwent epilepsy surgery, 15 patients (nine men) were included PS group, five patients (five men) in the AS group, and 11 patients (eight men) in the NS group. Eleven patients detected abnormal focal signals in the presurgical MRI. Six patients in the PS group demonstrated the suspected focal cortical dysplasia (FCD) in the SFS detected with MRI. All patients demonstrated focal abnormal hypometabolism foci in the PET-MR co-registration. Twenty-five patients (80.6%) were seizure-free since surgery, including all 15 patients (100%) of the PS group, three in five patients (60%) of the AS group, and seven in 11 patients (63.6%) of the NS group. The difference in outcome between different groups was significant (p = 0.004, PS vs. AS group; p = 0.005, PS vs. NS group). As of the last follow-up (mean 66.2 ± 9.7months), 25 patients (80.6%) were seizure-free since surgery (Engel's class I). In addition, antiseizure medication was withdrawn in 19 patients (61.3%). Histologic examination of resected specimens revealed FCD in all 31 patients. The percentage of FCD II type was 100, 60, and 63.6% in the three different groups, respectively.Conclusion:SFS-related dysplasia is a neuropathologic entity with a favorable postoperative outcome. FCD II is the most common type of SFS-related dysplasia. FDG-PET co-registered with MRI should be performed in patients with suspected SFS-related dysplasia, since it may depict areas of hypometabolism suggestive of dysplasia in the absence of MRI abnormalities.

Objective To explore the value of a voxel-based morphometric analysis program（MAP） in localizing epileptogenic zones in patients with MRI-negative and type Ⅱ focal cortical dysplasia（FCD）. Methods The data of 54 patients with MRI-negative and type Ⅱ FCD confirmed by pathological diagnosis from January 2019 and December 2020 at the Beijing Tiantan-Fengtai Epilepsy Center was retrospectively analyzed. The patients’ MRI images were processed with MAP software. The clinical characteristics and prognosis of the patients were compared between MAP positive and MAP negative patients. Results Among 54 patients, there were no significant differences in disease course, age at surgery, pathology, epileptogenic sites, etc. between MAP-positive and MAP-negative patients. In terms of prognosis, the Engel Ⅰ rate was 81% in MAP-positive patients, which was significantly higher than that in MAP-negative patients（P=0.032）. Among 46 patients who had stereoelectroencephalography（SEEG） electrode implantation, the prognosis was better in the patients with concordant MAP and SEEG results（P=0.049）. Conclusion MAP can be used to assist in localizing the epileptogenic sites of MRI-negative type Ⅱ FCD, guiding SEEG electrode implantation, and improving the surgical prognosis of patients.

Epilepsy is a common neurological disease in clinic. Epilepsy caused by structural causes can be cured by surgery, which has been the focus of attention in the field of epilepsy surgery. With the development of gene sequencing technology, more and more studies have found that structural etiology may be caused by somatic mutations of genes. In this paper, somatic mutation⁃related pathogenic genes of four common pathological types of epilepsy surgery, including malformation of cortical development (MCD), long⁃term epilepsy associated tumor (LEAT), hippocampal sclerosis (HS) and hypothalamic hamartoma (HH), were reviewed, and their effects on surgical protocol formulation and prognosis were reviewed, in order to provide a new idea for the treatment of epilepsy.

Objective To investigate the imaging features of patients with focal cortical dysplasia（FCD） characterized by interrupting precentral gyrus and explore the surgical strategy. Methods At Beijing Tiantan-Fengtai Epilepsy Center from January 2015 to December 2021, patients with drug-refractory epilepsy, surgical treatment, whose pathological or imaging results showing FCD, and whose imaging manifestations showing interruption of the precentral gyrus were selected. The data of the patients was documented, including imaging data, medical history, physical examination, scalp EEG, magnetic resonance imaging, positron emission computed tomography, stereoelectroencephalography, intraoperative condition, pathology and postoperative follow-up, etc. Results A total of 5 patients with FCD were included. Head MRI showed that all patients had the precentral gyri transected by the malformed sulcus. Among them, there was 1 patient with blurred gray-white matter junction, 2 patients with abnormal manifestations of transmantle sign. There were 5 patients with reduced metabolism of the malformed sulcus revealed by PET-CT. 4 patients with sulcus-centered resection and 1 patient with radiofrequency-thermocoagulation. Pathological examination showed that 4 specimens were all type Ⅱ FCD, including 2 ⅡA and 2 ⅡB. Four patients who underwent resection were followed up for 1 to 4 years without epileptic seizure. Conclusion Imaging characteristics of interrupting precentral gyrus may be unique for patients with type Ⅱ FCD in the central region. Focal excision of the gray matter of the sulcus can achieve better therapeutic effect.

Brain tumors are common in epilepsy surgery and frequently occur in the temporal lobe, but the optimal surgical strategies to remove the tumor and epileptogenic zone remain controversial. We aim at illustrating the positron emission tomography (PET) metabolism and the stereoelectroencephalography (SEEG) epileptogenicity of temporal lobe long-term epilepsy-associated tumors (LEAT). In this study, 70 patients and 25 healthy controls were included. Our analysis leveraged group-level analysis to reveal the whole-brain metabolic pattern of temporal lobe LEATs. The SEEG-based epileptogenicity mapping was performed to verify the PET findings in the epileptic network. Compared to controls, patients with a temporal lobe LEAT showed a more widespread epileptic network based on 18FDG-PET in patients with a mesial temporal lobe LEAT than in those with a lateral temporal lobe LEAT. The significant brain clusters mainly involved the paracentral lobule (ANOVA F = 9.731, p < 0.001), caudate nucleus (ANOVA F = 20.749, p < 0.001), putamen (Kruskal–Wallis H = 19.258, p < 0.001), and thalamus (ANOVA F = 4.754, p = 0.011). Subgroup analysis and SEEG-based epileptogenicity mapping are similar to the metabolic pattern. Our findings demonstrate the metabolic and electrophysiological organization of the temporal lobe LEAT epileptic network, which may assist in a patient-specific surgical strategy.

To explore the correlation of parameters derived from intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) with Ki-67 labeling index (LI) in soft tissue sarcoma (STS). Forty-one patients with STS underwent IVIM and DKI imaging at 3.0 MRI. The standard apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) were compared between Ki-67 low- and high-expression groups by two independent observers. A novel method was used to ensure the topographic correlation of histologic sections and magnetic resonance imaging slices. Receiver operating characteristic (ROC), intraclass correlation coefficient (ICC), and Spearman’s rank correlations were performed for statistical analysis. The high-expression group displayed lower standard ADC, D, and MD values and a higher MK value than the low-expression group. No significant differences were found for D∗ and f values. The areas under the curve for standard ADC, D, MD, and MK when discriminating between low- and high-expression groups were 0.736, 0.745, 0.848, and 0.894, respectively. MK was positively correlated with Ki-67 LI (r = 0.809, p < 0.001). Standard ADC, D, and MD were negatively correlated with Ki-67 LI (r = −0.541, −0.556, −0.702, respectively, p < 0.001). IVIM and DKI parameters are correlated with Ki-67 LI. MK may be the optimal imaging biomarker for assessing the Ki-67 expression of STS. • IVIM and DKI parameters are correlated with the expression of Ki-67 in STS. • The MRI-pathology control method ensured a strong correlation between MRI slices and histologic sections, resulting in a robust radiological-pathological correlation.

OBJECTIVE:Focal cortical dysplasia (FCD) represents an essential cause of drug-resistant epilepsy with surgery as an effective treatment option. This study aimed to identify the important predictors of favorable surgical outcomes and the impact of the interictal scalp electroencephalogram (EEG) patterns in predicting postsurgical seizure outcomes.METHODS:We retrospectively evaluated 210 consecutive patients between 2015 and 2019. They were diagnosed with FCD by pathology, underwent resection, and had at least one year of postsurgical follow-up. Predictors of seizure freedom were analyzed.RESULTS:Based on the information at the latest follow-up, seizure outcome was classified as Engel Class I (seizure-free) in 81.4% and Engel Class II-IV (non-seizure-free) in 18.6% of patients. There were 43, 105, and 62 cases of FCD type I, type II, and type III, respectively. The interictal EEG showed a repetitive discharge pattern (REDP) in 87 (41.4%) patients, polyspike discharge pattern (PDP) in 41 (19.5%), and the coexistence of REDP and PDP in the same location in 32 (15.2%) patients. The analyzed patterns in order of frequency were repetitive discharges lasting 5 seconds or more (32.4%); polyspikes (16.7%); RED type 1 (11.4%); continuous epileptiform discharges occupying >80% of the recording (11.4%); RED type 2 (6.2%); brushes (3.3%); focal, fast, continuous spikes (2.4%); focal fast rhythmic epileptiform discharges (1.43%); and frequent rhythmic bursting epileptiform activity (1.4%). The coexistence of REDP and PDP in the same location on scalp EEG and complete resection of the assumed epileptogenic zone (EZ) was independently associated with favorable postsurgical prognosis.SIGNIFICANCE:Resective epilepsy surgery for intractable epilepsy caused by FCD has favorable outcomes. Interictal scalp EEG patterns were revealed to be predictive of excellent surgical outcomes and may help clinical decision-making and enable better presurgical evaluation.

Objective:To investigate the predictive value of intraoperative transcranial electrical stimulation motor evoked potential (TES-MEP) monitoring for the patient′s muscle strength post craniocerebral surgery.Methods:A retrospective analysis was conducted on 59 patients with craniocerebral surgery who underwent intraoperative TES-MEP monitoring from January 2019 to December 2020 in the Department of Neurosurgery, Changzhou Second People′s Hospital Affiliated to Nanjing Medical University. Changes of intraoperative TES-MEP amplitude and muscle strength before and 1 month after surgery were documented. According to the changes of muscle strength, the patients were divided into muscle strength decreased group and muscle strength non-decreased group. Univariate analysis and binary logistic regression analysis were used to explore the influencing factors of muscle strength changes at 1 month after craniocerebral surgery.Results:The results of univariate analysis showed that the proportion of intraoperative TES-MEP amplitudes with an irreversible decrease of >50% in the muscle strength decreased group (5/8) at 1 month after surgery was higher than that of the postoperative muscle strength non-decreased group (1/50) ( P<0.001). The preoperative Glasgow coma score in the group with decreased muscle strength at 1 month after operation was lower than that in the group without postoperative muscle strength decrease ( P<0.001). Binary logistic regression analysis revealed that the intraoperative TES-MEP amplitude decrease was an independent influencing factor for muscle strength changes 1 month post surgery ( OR: 51.77, 95% CI: 4.07-658.96, P=0.002). The irreversible reduction greater than 50% in the TES-MEP amplitude predicted a decrease in muscle strength 1 month after surgery. The results of receiver operating characteristic curve analysis showed that the area under the curve for diagnosing the changes in muscle strength at 1 month after surgery was 0.803, the sensitivity was 0.625, and the specificity was 0.980. The positive predictive value was 83.3% and the negative predictive value was 94.3%. Conclusions:The change of 50% in intraoperative TES-MEP amplitude as an alarm criterion has a good predictive value for postoperative limb function changes in neurosurgical patients. The irreversible decrease greater than 50% in the TES-MEP amplitude can predict a lower muscle strength 1 month after surgery than before surgery.