Chinese Neurosurgical Journal最新文献

{"title":"Advances in local field potential research in prolonged disorders of consciousness: a narrative review.","authors":"Zhuoyang Li, Tianqing Cao, Jiwei Wang, Sipeng Zhu, Yitong Jia, Kefei Wan, Conghui Li, Yi Yang","doi":"10.1186/s41016-026-00441-x","DOIUrl":"10.1186/s41016-026-00441-x","url":null,"abstract":"<p><p>Prolonged disorders of consciousness (pDOC)-including coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS)-remain diagnostically and therapeutically challenging. Even with validated instruments such as the Coma Recovery Scale-Revised (CRS-R), behavioral assessment yields misdiagnosis rates approaching 40%, as fluctuating arousal, motor impairment, and sedation can mask preserved cognition. Because the VS/UWS-MCS distinction directly shapes prognostic counseling, rehabilitation, and decisions about life-sustaining treatment, and because the circuit-level pathophysiology of pDOC is still incompletely mapped, objective physiology-based biomarkers are urgently needed to complement bedside examination. This narrative review, informed by a structured search of PubMed, Embase, MEDLINE, and Web of Science, focuses on studies directly reporting intracranial electrophysiology-particularly local field potential (LFP) recordings from the central thalamus-in patients with pDOC. Indirect evidence from anesthesia paradigms, animal models, and related neuromodulation settings is invoked only to clarify mechanism or methodology. We group current findings into four complementary signal domains: oscillatory activity (slow oscillations and burst suppression through theta, alpha, beta, and gamma rhythms); thalamocortical and corticostriatal functional connectivity; aperiodic/scale-free dynamics reflecting excitation-inhibition balance; and nonlinear complexity measures indexing information integration. Single-unit firing, cross-frequency coupling (CFC), and evoked or perturbational responses are considered alongside these. All four are interpreted within a unifying mesocircuit-and-criticality framework, in which impaired consciousness reflects reduced arousal gain, degraded thalamocortical integration, and departure from the critical dynamical regime sustaining conscious-capable dynamics. Intracranial LFP recordings thus offer a rare mechanistic window onto thalamocortical dysfunction in pDOC and may eventually inform patient stratification, target selection, and mechanism-guided neuromodulation. The evidence base remains limited; however, small samples, etiological heterogeneity, variable recording conditions, sparse direct human data, and a predominance of group- rather than individual-level analyses constrain current inference. Translation is further complicated by unresolved ethical issues around surrogate consent, equitable access, and disclosure of diagnostic uncertainty. Meaningful progress will depend less on technical novelty than on standardized protocols, multicenter validation, and rigorous ethical frameworks.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of early postoperative outcomes of autologous pericranium versus high-density polypropylene in cranial duraplasty in a tertiary care center in Central India.","authors":"Shubham Gupta, Rakesh Gupta, Zafar Sheikh, Kapil Jain, Saksham Kumar","doi":"10.1186/s41016-026-00440-y","DOIUrl":"10.1186/s41016-026-00440-y","url":null,"abstract":"<p><strong>Background and objectives: </strong>Duraplasty is commonly required when primary dural closure is not feasible during cranial surgery. Although both autologous and synthetic dural substitutes are widely used, high-quality prospective data comparing their early postoperative safety remain limited. This study aimed to compare early postoperative complication rates following cranial duraplasty using autologous pericranium versus high-density polypropylene (G-Patch).</p><p><strong>Methods: </strong>This prospective randomized comparative study enrolled 121 consecutive patients undergoing cranial duraplasty at a tertiary care center between January and December 2021. Following exclusion of patients who died within 30 days postoperatively, 100 patients (50 per group) were included in the final analysis. Patients were allocated to receive either autologous pericranium (n = 50) or high-density polypropylene (G-Patch) (n = 50) using a standardized surgical technique. The primary outcome was the occurrence of any postoperative complication within 30 days, including cerebrospinal fluid leak, wound infection, and subdural empyema. Effect estimates were expressed as odds ratios (OR) with 95% confidence intervals (CI), and a limited adjusted analysis was performed as a sensitivity assessment.</p><p><strong>Results: </strong>Traumatic brain injury and intracranial space-occupying lesions were the most common indications for surgery. Most patients in both groups had an uneventful postoperative course. Early postoperative complications occurred in 26% of patients in the synthetic graft group and 12% in the autologous group. The unadjusted odds ratio for any complication with synthetic graft use was 2.58 (95% CI: 0.88-7.54; p = 0.08). After adjustment for primary diagnosis, graft type remained a non-significant predictor of complications. No consistent associations were observed between postoperative complications and comorbidities or substance use in exploratory analyses.</p><p><strong>Conclusion: </strong>In this prospective randomized cohort, both autologous pericranium and high-density polypropylene demonstrated acceptable short-term safety profiles. However, given the limited sample size, imbalance in underlying diagnoses, and short follow-up, these findings should be interpreted with caution and should not be considered evidence of equivalence between graft materials. Further studies with larger sample sizes, stratified analyses, and long-term outcomes are required.</p><p><strong>Trial registration: </strong>This investigator-initiated pragmatic randomized study was not prospectively registered in a clinical trial registry.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BBB-aware stimuli-responsive and biomimetic nanomedicines for glioblastoma.","authors":"Sana Javaid, Wenqi Song, Sajid Ali, Wei Hou, Xueqiong Su, Hao Wang, Yujun Song","doi":"10.1186/s41016-026-00438-6","DOIUrl":"10.1186/s41016-026-00438-6","url":null,"abstract":"<p><p>Glioblastoma (GBM) poses a tremendous challenge because it causes substantial morbidity and mortality. Treatment remains constrained by the tightly regulated blood-brain barrier (BBB) and the heterogeneous blood-brain tumor barrier (BBTB), which together severely limit drug delivery to tumor tissue. Nanomaterial-based drug delivery systems offer an opportunity to overcome the short half-life, low bioavailability, and poor BBB penetration that restrict conventional GBM therapeutics. Nanotechnology also provides safe, effective, and targeted drug delivery systems that enhance penetration, stability, and therapeutic efficacy. This review discusses biomaterials-based nanomedicine platforms for GBM, with a focus on lipid-based carriers, polymeric nanoparticles, dendrimers, inorganic nanomaterials, and biomimetic nanosystems designed to interact with the BBB/BBTB. We summarize how passive and active brain-targeting strategies are combined with endogenous and exogenous stimuli-responsive designs (pH/redox sensitivity, magnetic hyperthermia, photothermal/photodynamic therapy, and ultrasound-triggered systems) to enhance intratumoral accumulation and anti-GBM efficacy. Overall, this review discusses recent advances in BBB-aware, stimuli-responsive, and biomimetic nanomedicines for GBM, and outlines their therapeutic potential alongside persistent challenges in safety, large-scale manufacturing, and clinical translation.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and hemodynamic efficacy of the LVIS stent in the endovascular treatment of intracranial wide-necked aneurysms: a single-center retrospective study.","authors":"Bowen Dong, Xiang Xu, Dayong Wang, Jian Pei, Yu Zheng, Yun He Gao, Zhaoguo Gao","doi":"10.1186/s41016-026-00435-9","DOIUrl":"10.1186/s41016-026-00435-9","url":null,"abstract":"<p><strong>Background: </strong>Treating wide-necked aneurysms endovascularly is still difficult. Because of its high metal coverage and flow-diverting capabilities, the LVIS stent may lead to better results. We carried out this retrospective analysis to assess its hemodynamic impact, short-term efficacy, and procedural safety.</p><p><strong>Methods: </strong>An observational, exploratory retrospective study was conducted between January and December 2023 on 61 consecutive patients with intracranial wide-necked aneurysms receiving LVIS stent-assisted coiling. The group consisted of 35 patients with ruptured aneurysms and 26 people with unruptured aneurysms. The Raymond-Roy Occlusion Classification (RROC) was used to assess the initial angiographic data. At 3 to 6 months, clinical outcomes were evaluated using the modified Rankin Scale (mRS), and parent artery patency and aneurysm recurrence were evaluated using follow-up digital subtraction angiography (DSA). Furthermore, a subset of patients underwent computational fluid dynamics (CFD) analysis to measure changes in intra-aneurysmal mean flow velocity and wall shear stress (WSS) in order to quantify hemodynamic modifications.</p><p><strong>Results: </strong>This study included 35 patients with ruptured and 26 with unruptured aneurysms, with 61 patients totally. Immediate complete occlusion (RROC class I) was achieved in 80.0% (28/35) of ruptured and 84.6% (22/26) of unruptured aneurysms. Angiographic follow-up (available for 27 patients, 44.3%) at 6-12 months demonstrated stable occlusion in all initial RROC-I cases. Furthermore, in the ruptured cohort, the rate of favorable outcome (mRS 0-1) increased from 57.1% at discharge to 77.1% at follow-up, while 96.2% of unruptured patients maintained an mRS of 0-1. Procedure-related complications involved intraprocedural thrombosis (2 ruptured cases) and one fatal in-hospital stent thrombosis (unruptured case), resulting in overall morbidity and mortality rates of 16.4% and 1.6%, respectively. CFD analysis demonstrated significant and durable hemodynamic improvements. Specifically, post-operative reductions in relative inflow, aneurysm volume with high flow, and WSS were all sustained at 6-month follow-up (all P < 0.001).</p><p><strong>Conclusions: </strong>Our study provides preliminary evidence that LVIS stent-assisted coiling may be related to high aneurysm occlusion rate, functional recovery in ruptured cases, and favorable hemodynamic modification. However, this study fails to achieve causal inference due to the retrospective design, and the complication profile underscores procedural risks, highlighting the need for prospective, comparative studies to confirm its safety and efficacy profile.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratumoral hemorrhage in vestibular schwannomas post-radiosurgery: a systematic review.","authors":"Areeba Fareed, Kashif Qureshi, Solay Farhat, Bipin Chaurasia, Abdulrahmon Moradeyo, Laura Ghanem, Rayyan Vaid, Syed Muhammad Muneeb Akhtar, Issa Awaida, Abed AlRazzak Kerhani, Kivanc Yangi","doi":"10.1186/s41016-026-00439-5","DOIUrl":"10.1186/s41016-026-00439-5","url":null,"abstract":"<p><strong>Background: </strong>Vestibular schwannomas (VS) are benign tumors affecting the vestibulocochlear nerve. They cause symptoms like hearing loss and vertigo. Treatment options include surgery and stereotactic radiosurgery (SRS). However, SRS can lead to rare complications like intratumoral hemorrhage (ITH). This review aims to explore ITH post-SRS, including its incidence and risk factors, to improve patient care.</p><p><strong>Methods: </strong>This systematic review, conducted in accordance with PRISMA 2020 guidelines, examines intratumoral hemorrhage (ITH) post-radiosurgery for vestibular schwannomas. Searches encompassed PubMed, Google Scholar, the Cochrane Library, Embase, Web of Science, and Scopus up to January 2024. Inclusion criteria required documented vestibular schwannoma with confirmed ITH occurring after SRS. Data extraction involved study and participant characteristics, with discrepancies resolved by discussion. Given clinical and methodological heterogeneity, quantitative pooling was not performed; results are presented as a qualitative narrative synthesis.</p><p><strong>Results: </strong>Eleven studies comprising 47 patients met inclusion criteria. Patients ranged from 25 to 79 years of age, with clustering in the sixth decade. A subset of patients had identifiable bleeding risk factors, most commonly hypertension and anticoagulant use. Symptom profiles were heterogeneous; trigeminal neuropathy and disequilibrium were the most frequently reported presentations. Management ranged from observation to surgical resection. On descriptive analysis, approximately half of patients demonstrated outcomes classified as favorable by the reporting authors; mortality was reported in 2 of 47 patients (4.35%). These figures must be interpreted with caution given the small total sample, predominance of case reports, and absence of standardized outcome definitions across included studies.</p><p><strong>Conclusion: </strong>In conclusion, managing intratumoral hemorrhage following radiosurgery for vestibular schwannomas remains a complex clinical challenge. This review highlights varied patient outcomes, emphasizing the importance of personalized treatment approaches. Tailoring treatment decisions to individual factors such as tumor characteristics and patient preferences is crucial for optimizing outcomes and minimizing complications, underscoring the need for close collaboration among specialists in clinical practice.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024511320.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chinese consensus on the diagnosis and treatment of prolactinomas (2025 edition).","authors":"Shaojian Lin, Zhengyuan Chen, Lijin Ji, Linjie Wang, Wanyu Zhang, Xuqun Tang, Yue Wu, Qinlin Fan, Jun Li, Li Pan, Zhenwei Yao, Chengyan Deng, Hongying Ye, Sheyu Li, Huijuan Zhu, Yao Zhao, Yongfei Wang, Zhe Bao Wu","doi":"10.1186/s41016-026-00437-7","DOIUrl":"10.1186/s41016-026-00437-7","url":null,"abstract":"<p><p>Prolactinomas are the most prevalent functional pituitary adenomas. Significant advancements have been made in the diagnostic and therapeutic concepts for prolactinomas, driven by progress in surgical techniques and the accumulation of new clinical evidence-based medicine. Based on the 2014 version of the \"Chinese Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma,\" the China Pituitary Adenoma Specialist Council has revised this consensus in accordance with the latest evidence-based medical finding and clinical experience, aiming to provide standardized diagnosis and treatment recommendations for clinicians. The consensus systematically elaborates on the epidemiological characteristics, clinical manifestations, diagnostic criteria, differential diagnosis process, and treatment strategies for prolactinomas, and proposes individualized management suggestions for special populations (such as pregnant women, male patients, and refractory cases). Treatment decisions strongly advocate for comprehensive evaluation by a multidisciplinary team of experts, including neurosurgery, endocrinology, radiology, radiation oncology, pathology, ophthalmology, and obstetrics/gynecology. Through the formulation of recommendation questions, evidence summary and evaluation, formation of recommendation opinions, expert discussions, and integration with clinical practice, 36 recommendations have been developed covering aspects such as screening, assessment, diagnosis, treatment, and monitoring. This consensus balances clinical needs with international evidence-based standards, provides a highly reliable reference for diagnosis and treatment, and is expected to enhance the standardization and overall level of prolactinoma diagnosis and treatment in China.Practice guideline registrationInternational Practice Guideline Registration for Transparency (PREPARE-2025CN1518).</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13248255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-guided stereotactic single-stage evacuation of six intracranial abscesses: a rare case report with literature review.","authors":"Yuhang Wei, Chen Zhu, Huaiyuan Wang, Junqi Wang, Pan Guo, Shaowu Ou, Jun Wang","doi":"10.1186/s41016-026-00436-8","DOIUrl":"10.1186/s41016-026-00436-8","url":null,"abstract":"<p><strong>Background: </strong>Multifocal, deep-seated brain abscesses are uncommon and often lead to rapid neurological decline because of mass effects, widespread edema, and the challenge of safely accessing multiple intracranial compartments. Traditional surgical approaches may require staged operations or extensive craniotomy, increasing procedural risk. Robot-assisted stereotactic aspiration offers a minimally invasive and highly precise alternative, yet its application in single-session, multitarget drainage remains rarely reported. This case describes a young patient with extensive bilateral brain abscesses that were successfully treated through one-stage, robot-guided multisite aspiration, highlighting the potential advantages of this technique in complex infectious neurosurgical emergencies.</p><p><strong>Case presentation: </strong>A 21-year-old woman presented with rapid onset of confusion, headache, and progressive neurological deficits. Magnetic resonance imaging revealed multiple deep abscesses involving the frontal, temporal, and occipital lobes, accompanied by severe cerebral edema and midline shift. After multidisciplinary evaluation, a single session of stereotactic aspiration was performed using a robot-assisted navigation system. Six abscess cavities were drained through four precisely planned trajectories during a single operation. Broad-spectrum antimicrobial therapy was initiated empirically and later tailored according to microbiological findings. A short-course of low-dose dexamethasone was added to reduce cerebral edema while minimizing the risk of impaired infection control. The patient demonstrated marked neurological improvement within several days and achieved full functional recovery within 1 month.</p><p><strong>Conclusions: </strong>This case illustrates that robot-assisted, minimally invasive stereotactic aspiration may represent a potentially safe and effective strategy for managing multifocal deep brain abscesses in selected patients, allowing accurate multitarget drainage in a single procedure. The rapid recovery observed in this patient supports the clinical value of integrating precise surgical intervention with optimized antimicrobial therapy and controlled edema management. This approach may offer a viable treatment pathway for similarly complex intracranial infections where conventional surgery is associated with significant risk.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Astrocytic contributions to the pathogenesis of chronic traumatic encephalopathy: a scoping review.","authors":"Alex Kubiak, Kameron Hahn, Nicholas Powers, Ethan Arroyo, Carson Vandello, Joseph Martins, Ling He","doi":"10.1186/s41016-026-00434-w","DOIUrl":"10.1186/s41016-026-00434-w","url":null,"abstract":"<p><strong>Background: </strong>Chronic traumatic encephalopathy (CTE) is classically defined as a neuroglial tauopathy characterized by perivascular accumulation of hyperphosphorylated tau within neurons and astrocytes. Defining lesions localize to the depths of cortical sulci, implicating vascular and glial elements in early pathogenesis. This systematic scoping review evaluates the extent to which astrocytic dysfunction contributes to CTE pathogenesis, specifically whether astrocytic alterations precede or potentiate neuronal tauopathy.</p><p><strong>Methods: </strong>A structured search of PubMed, Embase, Web of Science, and Scopus was conducted from inception through December 2025 in accordance with PRISMA 2020 guidelines. Due to substantial heterogeneity in study design, including postmortem analyses, experimental models, and biomarker studies, a qualitative synthesis was performed.</p><p><strong>Results: </strong>Forty studies met inclusion criteria, converging on four domains: (1) interface-specific astrogliosis at perivascular sulcal depths; (2) disruption of aquaporin-4 polarization with uncertain translational relevance in humans; (3) astrocytic degeneration and impaired glutamate homeostasis; and (4) sustained neuroinflammation mediated through astrocyte-microglia signaling. Circulating GFAP emerged as a sensitive but non-specific biomarker of neuroglial injury.</p><p><strong>Conclusion: </strong>CTE is best conceptualized as a neuroglial tauopathy in which astrocytes function as integral contributors to disease progression, likely in coordination with microglia. While astrocytic dysfunction may play an early role, its mechanistic specificity relative to other tauopathies remains incompletely defined.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13192022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined internal neurolysis and targeted proximal trigeminal root glycerol delivery for refractory multiple sclerosis-related trigeminal neuralgia: a case report.","authors":"Thomas Patrick Short, Chandrasekaran Kaliaperumal","doi":"10.1186/s41016-026-00433-x","DOIUrl":"10.1186/s41016-026-00433-x","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is frequently refractory to medical and procedural therapy, particularly in the absence of neurovascular compression. Surgical options are limited when microvascular decompression is not appropriate. We report a salvage surgical approach combining internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory MS-related trigeminal neuralgia.</p><p><strong>Case presentation: </strong>A 50-year-old woman with relapsing-remitting multiple sclerosis presented with medically refractory right-sided trigeminal neuralgia predominantly involving the V2/V3 distributions. She had previously failed optimisation of pharmacotherapy, two percutaneous retrogasserian glycerol rhizotomies, and Gamma Knife radiosurgery performed within the preceding year. Posterior fossa exploration via a retrosigmoid approach demonstrated no neurovascular conflict. Internal neurolysis (nerve combing) was therefore performed and supplemented with targeted glycerol delivery to the proximal cisternal segment of the trigeminal root adjacent to the radiologically relevant demyelinating lesion. Postoperatively, the patient experienced immediate improvement in facial pain with preservation of trigeminal sensation and no new neurological deficits. Her early postoperative course was complicated by a wound infection requiring surgical washout and antibiotic therapy. At 43-month follow-up, she remained free of ipsilateral trigeminal neuralgia with substantially reduced medication requirements. She later developed contralateral facial pain controlled with low-dose carbamazepine without recurrence on the operated side.</p><p><strong>Conclusion: </strong>This report describes, to our knowledge, the first published case of combined internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory multiple sclerosis-related trigeminal neuralgia. In this highly selected case, durable ipsilateral pain control was observed. However, causal interpretation is limited by the single-case design, the combined nature of the intervention, and the potential delayed effects of prior radiosurgery. This approach should therefore be regarded as hypothesis-generating rather than practice-defining, but may merit further study as a salvage strategy in selected patients without neurovascular compression after failure of medical, percutaneous, and radiosurgical treatments.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13173917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal techniques for maximal safe resection of IDH-mutant low-grade glioma involving corpus callosum, a retrospective study and prognosis analysis.","authors":"Meng Cui, Meng Zhang, Chunhui Zhou, Guochen Sun, Jianning Zhang","doi":"10.1186/s41016-026-00432-y","DOIUrl":"10.1186/s41016-026-00432-y","url":null,"abstract":"<p><strong>Background: </strong>The IDH-mutant low-grade glioma (LGG) involving corpus callosum (ccLGG) is a rare type of LGG which has a poorer prognosis. To evaluate the efficacy of multimodal techniques (comprising neuronavigation, intraoperative MRI, and neuromonitoring) compared with the conventional approach guided solely by neuronavigation in the resection of IDH-mutant ccLGG, and to identify prognostic factors of ccLGG.</p><p><strong>Methods: </strong>The IDH-mutant ccLGG cases that received resection in our center between 2014 and 2022 were collected and reviewed retrospectively. Comparisons were made between the multimodal and conventional groups regarding patient demographics, tumor characteristics, extent of resection (EOR), neurological function, Karnofsky Performance Status (KPS), progression-free survival (PFS), and overall survival (OS). Both univariate and multivariate analysis were employed to assess potential prognostic factors.</p><p><strong>Results: </strong>Ultimately, 64 patients in the multimodal group and 34 in the conventional group were enrolled. Compared with the conventional group, the multimodal group achieved a significantly higher median EOR (100% vs. 93.55%, P = 0.001) and a greater gross total resection (GTR) rate (62.5% vs. 35.3%, P = 0.010). No significant differences were observed in postoperative neurological function or KPS between the two groups at any of the time points assessed. Compared with the conventional group, the multimodal group demonstrated significantly longer median PFS (78.5 vs. 48.1 months, P = 0.010) and OS (106.1 vs. 66.9 months, P = 0.009). Non-butterfly ccLGG, less tumor volume, genu invasion of CC (compared to splenium invasion), less volume of CC invasion, higher EOR, longer chemotherapy cycles of Temozolomide (TMZ), higher KPS on 3 months and MGMT methylation were positive factors for PFS of ccLGG. While four factors were associated with the longer OS of ccLGG, including genu of CC invasion compared to both genu and body invasion of CC, higher EOR, longer TMZ cycles and MGMT methylation.</p><p><strong>Conclusion: </strong>Multimodal techniques are useful for achieving maximal safe resection and better prognosis of ccLGG. As higher EOR independently predicts improved survival in IDH-mutant ccLGG, maximal safe resection should be suggested and achieved by appropriate means tailored to available resources. The postoperative chemotherapy should also be recommended to patients with high risks. While whether postoperative radiotherapy should be performed should consider and balance many factors.</p>","PeriodicalId":36700,"journal":{"name":"Chinese Neurosurgical Journal","volume":"12 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}