With the rapid development of society and economy and the acceleration of population aging, the global disease spectrum has undergone profound changes. Neurological diseases, especially brain functional disorders, have become major threats to human health. Neuromodulation technique, as a critical means to address this challenge, has opened new avenues for the treatment of brain functional disorders and has become one of the three innovative technologies in modern neurosurgery. This paper systematically elaborates on the concept, classification, and technological evolution of neuromodulation, focusing on the clinical application progress of invasive neuromodulation technique. It analyzes their efficacy and potential in the fields of movement disorders, epilepsy, pain, cognitive impairment, and neurorehabilitation. Additionally, it explores the integration trend between neuromodulation and brain-computer interface (BCI), pointing out that closed-loop neuromodulation has become an important component of BCI, providing new approaches for precise treatment and individualized modulation. Finally, it proposes future development directions in the field of neuromodulation, including expanding new indications, innovating target exploration models, updating treatment concepts, and conducting high-quality evidence-based medical research. Looking ahead, Chinese neuromodulation endeavors should seize current opportunities, achieve a leap from following to leading through continuous exploration and innovation, and make greater contributions to global brain health.

Craniopharyngioma is a kind of common benign intracranial tumor. Craniopharyngioma may originate anywhere in the pituitary stalk. The different origin sites of the tumor are related to its growth pattern, and the relationship between tumor and the suprasellar structures including vessels and nerves. At present, there are many different classifications of craniopharyngioma, which based on the origin of the tumor, anatomical location, and imaging characteristics. By reviewing and analyzing different classifications of craniopharyngioma, we attempt to analyze the relationship between tumor origin, growth pattern, imaging characteristics and microstructure. It was attempted to analyze the tumor origin and determine the adhesion with the surrounding structures by imaging characteristics, so as to guide the surgical method and prognosis.

Alzheimer's disease (AD) is the most common type of dementia in the elderly. The ApoE ε4 gene is the main genetic risk factors for sporadic AD, and is associated with the changes in the amyloid β-protein (Aβ) and tau protein, the core pathological features of AD. ApoE ε4 has great potential as a genetic biomarker for AD. Clinical studies have shown the important role of peripheral blood ApoE ε4 in AD risk assessment and disease detection. But in the current clinical practice, there are many weak points of insufficient understanding and insufficient attention about the clinical use of ApoE ε4. The importance of ApoE ε4 is highlighted especially with the development of high-quality clinical drug trials or the arrival of clinical drug therapy targeting Aβ for AD. So far, there is still a lack of Chinese expert consensus on the standardized application of ApoE ε4 in AD. Given that, this article systematically summarizes the current domestic and international research on the application of ApoE ε4 in AD. The consensus is written and aimed to fully reflect the clinical application value of ApoE ε4 in AD, and improve the diagnosis and treatment level of AD, and guide further clinical research.

Autonomic nerve dysfunction is a common non-motor symptom of Parkinson's disease (PD). It has a high incidence and involves multiple organ system disorders with various manifestations, seriously affecting the quality of life. Autonomic nerve dysfunction can be a major symptom of advanced PD and a major cause of disability. Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced PD, and its improvement of motor symptoms in PD patients has been widely recognized. However, the effect of STN-DBS on the symptoms of autonomic nerve dysfunction in PD patients is still unclear. Here, the efficacy of STN-DBS on PD autonomic nerve dysfunction is briefly reviewed. Therefore, we should pay more attention to the symptoms of autonomic nerve dysfunction in PD patients, and conduct preoperative evaluation of DBS in PD patients, so as to comprehensively consider the postoperative efficacy, target selection, stimulus parameter setting, drug adjustment, develop an individualized treatment plan.

Stroke can lead to long-term motor disorders and reduced quality of life. Despite advances in conventional rehabilitation, many patients are still faced with limited efficacy of rehabilitation. Neuromodulation techniques have shown breakthrough therapeutic potential. The purpose of this article is to provide an overview of the mechanism of poststroke neuroplasticity, to explore the mechanism of dentate nucleus deep brain stimulation (DN-DBS) to improve poststroke motor function, and to summarize the progress of the study, in order to provide a scientific basis and a new therapeutic perspective for clinical practice of DN-DBS.

As a mature neuromodulation technique, deep brain stimulation (DBS) has been widely used in the treatment of various neurological and psychiatric disorders. Parkinson's disease (PD) is one of the earliest indications for DBS and has received the most treatment so far. It has attracted extensive attention and in-depth research from the academic community for a long time, and has made remarkable progress in multiple fields. This review highlights the optimization of DBS for PD, focusing on two key directions: surgical technology innovation and neural circuit mechanism research. It explores the surgical technology innovation, equipment innovation, and programming strategy improvement of DBS, as well as the recognition and application of neural circuit markers. These studies not only significantly improve the efficacy of PD treatment, but also provide valuable ideas and scientific basis for the future development of neuromodulation technique.

Essential tremor (ET) is the most common movement disorder in clinical practice. Some patients' daily activities are affected because of the serious tremor. The current drug treatment for this disease is not effective, but the neuromodulation technique such as deep brain stimulation (DBS) is effective. This article provides a review of the latest developments in neuromodulation for the treatment of ET, including clinical trails on magnetic resonance-guided focused ultrasound (MRgFUS), directional-DBS and percept -DBS, as well as the optimal stimulation targets for DBS, in order to provide a reference for the treatment of ET.

Objective: Summarize the clinical and genetic characteristics of atypical Rett syndrome and developmental epileptic encephalopathy caused by IQSEC2 gene variation. Methods and Results: From May 2020 to April 2022, Anhui Provincial Children's Hospital diagnosed and treated 4 children with atypical Rett syndrome and developmental epileptic encephalopathy caused by IQSEC2 gene variation, including 2 males and 2 females were a pair of identical twins. They all had comprehensive developmental delay before onset. At the age of 2 years, all cases gradually exhibited clinical manifestations of atypical Rett syndrome, such as frequent clapping, biting, sleep disorders (increased sleep or difficulty falling asleep), and grinding teeth, followed by developmental regression and seizures. The initial age of epilepsy was from 2 years and 2 months to 2 years and 10 months. All cases started with generalized tonic-clonic seizure, with epileptic spasm occurring between 2 and 11 months of course. Case 2, Case 3 and Case 4 were also accompanied by focal seizures. Four cases with VEEG background of 4-6 Hz θ wave, the VEEG during the interictal phase was a broad multifocal sharp slow complex wave. In Case 2, Case 3 and Case 4, MRI was abnormal, mainly with increased depth of cerebral hemispheric sulcus and gyrus. The whole exome sequencing suggested pathogenicity and possible pathogenic variations in the IQSEC2 gene, Case 1 and Case 2 were frameshift mutations of c. 608dup (p. Gln204Profs*35), while Case 3 and Case 4 were nonsense mutations of c. 2231C > A (p. Ser744Ter) and c. 2521C > T (p. Gln841Ter), respectively. The four mutation sites have not been reported domestically or internationally. All cases received treatment with multiple antiepileptic seizure medicine. The last follow-up age was from 4 years and 3 months to 6 years and 3 months. All cases were unable to walk alone and had no active language. There were no seizures in Case 1 for 3 years, occasional seizures in Case 2 and Case 4, and frequent seizures in Case 3. Conclusions: IQSEC2 gene variation can manifest as atypical Rett syndrome, which can be accompanied by refractory epileptic spasms. Both males and females have severe phenotypes, and the severity of clinical phenotypes at the same mutation site varies. Our report enriches the variation spectrum and clinical phenotype spectrum of the IQSEC2 gene, expands the genetic spectrum of Rett syndrome and developmental epileptic encephalopathy, and provides value for the clinical diagnosis, treatment and subsequent research of this disease.

Cerebral revascularization is constantly being updated and iterated, but there are still many challenges: how to regulate the bypass flow quantitatively, how to reconstruct cerebral artery perforator vessels with diameter less than 0.5 mm, etc.. This paper reviews the birth of revascularization and the development of cerebral revascularization, focusing on the basic principle and innovative technology of cerebral revascularization, application and effect of cerebral revascularization in the treatment of complex intracranial aneurysms, current situation and development trend of cerebral revascularization iteration. The aim is to promote the iteration of cerebral revascularization and its application in the treatment of complex intracranial aneurysms.

Sacral neuromodulation (SNM) as an advanced form of neuromodulation technique, which has demonstrated significant efficacy in alleviating clinical symptoms for patients with pelvic floor dysfunction (PFD) who do not respond to conventional treatments. This paper provides a comprehensive review of the application and progress of SNM in the treatment of PFD. It covers its historical development, mechanisms of action, clinical applications, optimization of stimulation parameters, and several technological innovations that have facilitated its clinical adoption. The aim is to promote wider clinical application of SNM and offer more precise treatment options for patients.

The concept of subjective cognitive decline (SCD) is currently receiving much attention, as SCD has a high risk of transitioning to mild cognitive impairment (MCI) and dementia.The ATN biomarker diagnostic framework can accurately diagnose SCD as preclinical Alzheimer's disease (AD), which is an important window for precise prevention and treatment of AD.Based on the present diagnostic paradigms of clinical diagnosis and biomarker diagnosis for SCD, it is important to have fine management during the diagnostic process and precise communication and support after diagnosis for SCD patients, including diagnostic management specification, interpretation and recommendation diagnostic of biomarker disclosure, patients health management, and possible treatment for specific underlying causes.Previous studies have shown heterogeneity between clinical research and practice, and many doctors still feel unfamiliar with the concept of SCD and lack a systematic understanding.SCD diagnosis can provide patients with a certain degree of certainty, but it may also bring uncertainty about the expected risk of disease, and there is an urgent need to provide guidance to clinical doctors.So far, there is still a lack of Chinese expert consensus on diagnostic management specification, biomarker disclosure, and patient management of SCD.Based on the systematic summary of the current domestic and international research on the SCD, the consensus is written and aimed to improve the diagnosis and treatment level of SCD, guide high-quality preclinical AD research and lay the foundation for further clinical translation.

Background: Multi-modal neuroimaging examinations play a crucial role in the diagnosis and treatment of functional neurosurgery. However, there is currently a lack of effective management for these complex data in clinical practice. This study attempts to establish a feasible multi- modal neuroimaging data information management system and evaluate its application effects. Methods: By standardizing clinical diagnosis and treatment processes, analyzing the nodes where imaging data were generated, and streamlining data flow routes, establishing storage naming conventions, setting up storage servers, and training specialized personnel, we designed and applied a multi-modal neuroimaging data information management system. The primary evaluation indicators were the archiving rates of 5 types of data: structural sequences, other preoperative images, postoperative electrode CT, electrode reconstruction, and postoperative CT/MRI. The secondary evaluation indicators included the total man-hours consumed for data archiving and the average man-hours consumed per case. Results: Without multi-modal neuroimaging data information management (control group, n = 64), the total manpower consumption was 192 man-hours, with an average of 3 man-hours per case. With multi-modal neuroimaging data information management (data management group, n = 50), the total manpower consumption was 84 man-hours, with an average of 1.68 man-hours per case. The data management group had higher archiving rates compared to the control group: structural sequences [100% (50/50) vs. 32.81% (21/64); χ² = 11.383, P = 0.001], other preoperative images [96% (48/50) vs. 26.56% (17/64); χ² = 13.839, P = 0.000], postoperative electrode CT [96% (48/50) vs. 32.81% (21/64); χ² = 10.409, P = 0.001], electrode reconstruction [96% (48/50) vs. 32.81% (21/64); χ² = 10.409, P = 0.001], postoperative CT/MRI [96% (48/50) vs. 15.63% (10/64); χ² = 22.169, P = 0.000]. Conclusions: Designing a multi-modal neuroimaging data information management system that aligns with clinical practice and reasonably setting data collection and archiving nodes can effectively improve data archiving rates, save manpower resources, ensure the complete storage of clinical data, and ensure the smooth operation of clinical tasks, and enhance clinical diagnosis and treatment levels.

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.

Neuromodulation has emerged as a significant clinical treatment modality for patients with prolonged disorders of consciousness (pDOC), encompassing both non-invasive and invasive neuromodulation techniques. This paper integrates an overview of the neural mechanisms underlying consciousness, neurofunctional assessments, and categorizes the current applications and recent research findings in non-invasive and invasive neuromodulation techniques. The aim is to enhance the scientific rigor and efficacy of neuromodulation, provide robust support for the treatment of pDOC.

Cerebral vascular bypass is a key method for the treatment of complex intracranial aneurysms. After nearly 60 years of exploration, its application range now covers the whole cerebral vascular region. With the advent of detachable coils and the mature application of related assistance techniques, endovascular intervention treatment is highly favored in the treatment of routine intracranial aneurysms due to its minimally invasive and rapid characteristics. The introduction of flow diverter (FD) has further ushered in a new era in the treatment of intracranial aneurysms. This article reviews the history and development of cerebral vascular bypass in the treatment of intracranial aneurysms, elaborates on the application and promotion of flow diverter, and discusses the limitations of endovascular intervention treatment in the flow diversion era. It also explores the application and prospects of a comprehensive cerebral vascular bypass system, reaffirming the application value of the whole-region cerebral vascular bypass technique.

Traditional treatment methods for mental disorders include pharmacotherapy and psychotherapy. However, some patients are unable to effectively control their symptoms. Neuromodulation technique, which can be implemented through invasive or non-invasive approaches, have shown promise in improving the psychiatric symptoms of individuals with mental illnesses by intervening in neural circuits. This paper summarizes the current applications of neuromodulation technique for various mental disorders, including obsessive-compulsive disorder, depression, Tourette's syndrome, bipolar affective disorder, autism spectrum disorder, substance dependence and schizophrenia. Additionally, it analyzes the prospects and challenges of neuromodulation technique in the treatment of mental disorders, with the aim of guiding future neuromodulation therapy for mental disorders.

Objective: To investigate the value of ¹⁸F-FDG PET in the diagnosis and differential diagnosis of Parkinson's disease (PD) and multiple system atrophy with parkinsonism-predominant (MSA-P). Methods: Total 96 patients with PD and 52 patients with MSA-P from The First Hospital of Jilin University from May 2019 to December 2022 were included, and ¹⁸F-FDG PET data were collected from all patients and ¹⁸F-FDG PET data was analyzed using CortexID Suite software. The diagnostic and differential diagnostic efficacy of PD and MSA-P of ¹⁸F-FDG PET was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). The Z-scores of 26 brain regions were obtained, and the brain glucose metabolism patterns of patients with PD and MSA-P were finally obtained by comparing with the normal control database. The consistency between ¹⁸F-FDG PET and "gold standard" diagnosis was evaluated using the Kappa test. Results: 1) Metabolic pattern: compared with the normal control database, the PD group showed significantly hypermetabolism in pons (t=2.851, P=0.005), cerebellum (t=2.295, P=0.024) and mesial temporal (t=5.850, P=0.000), and significantly hypometabolism in lateral occipital (t=-7.116, P=0.000), superior parietal (t=-13.466, P=0.000), inferior parietal (t=-21.838, P=0.000), precuneus (t=-7.121, P=0.000), sensorimotor (t=-6.931, P=0.000) and lateral prefrontal (t=-6.778, P=0.000); while the MSA-P group showed significant hypometabolism in pons (t=-8.364, P=0.000), cerebellum (t=-9.900, P=0.000), superior parietal (t=-4.830, P=0.000) and inferior parietal (t=-11.287, P=0.000), and hypermetabolism in the primary visual (t=5.579, P=0.000). 2) Diagnosis and differential diagnosis: compared with the MSA-P group, the PD group had lower Z-score in sensorimotor (t=-0.646, P=0.008), precuneus (t=-4.516, P=0.000), superior parietal (t=-4.611, P=0.000), inferior parietal (t=-5.903, P=0.000), lateral occipital (t=-5.088, P=0.000) and primary visual (t=-3.218, P=0.002), while the Z-scores in mesial temporal (t=3.718, P=0.002), cerebellum (t=9.880, P=0.000) and pons (t=9.520, P=0.000) were higher. The ROC curve was drew for the differential diagnostic efficacy of ¹⁸F-FDG PET through the six brain regions with statistical difference and P=0.000 between the 2 groups, the result showed that the AUC of cerebellum (Z=3.595, P=0.000; Z=2.942, P=0.003; Z=2.942, P=0.003; Z=3.519, P=0.000), pons (Z=3.363, P=0.001; Z=3.237, P=0.000; Z=2.376, P=0.018; Z=3.012, P=0.003) and the combination of the six brain regions (Z=4.354, P=0.000; Z=4.242, P=0.000; Z=3.711, P=0.000; Z=4.233, P=0.000) were bigger than the AUC of precuneus, superior parietal, inferior parietal and lateral occipital; the AUC of the combination of the six brain regions was bigger than pons (Z=1.986, P=0.047). Kappa test indicated that the diagnosis of the ¹⁸F-FDG PET had good agreement with the diagnosis of the "gold standard" in the two diseases (κ=0.678, P=0.000, for all). Conclusions: The characteristic brain glucose metabolism patterns of PD and MSA-P can be obtained by ¹⁸F-FDG PET. ¹⁸F-FDG PET has good diagnostic and differential diagnostic efficacy for PD and MSA-P.

Atlantoaxial dislocation (AAD) is a common craniovertebral junction deformity that can result in severe neurological dysfunction. To better standardize the diagnosis and treatment of AAD, the Spine and Spinal Cord Group, Neurosurgical Branch, Chinese Medical Association, and the Chinese Craniovertebral Junction Malformation Research Alliance published the "Expert consensus on posterior facet distraction and fusion technique for the treatment of atlantoaxial dislocation (2024)" in August 2024. This consensus provides detailed recommendations regarding application range, preoperative evaluation, surgical techniques, and complication management for this procedure, aiming to offer practical guidance for its clinical application. The key points of the expert consensus are summarized and interpreted in this article, to provide reference for clinicians and researchers.

Objective: To investigate the imaging diagnosis and differential diagnosis methods for common tumors in the posterior fossa of children, and to propose a flow chart for the diagnosis of common tumors in the posterior fossa of children based on the limited diffusion of DWI according to the idea of localization diagnosis followed by qualitative diagnosis. Methods: A total of 118 pediatric patients with posterior fossa tumors who underwent surgical resection in Huashan Hospital, Fudan University from January 2021 to January 2024 were enrolled, and all of them underwent head CT and MRI examinations, and preoperative localization diagnosis and qualitative diagnosis were carried out accordingly. Then, based on whether DWI was diffusion limited, a flow chart for the diagnosis of common tumors in the posterior fossa of children was proposed. Results: A total of 118 children with posterior fossa tumors were localization and qualitatively diagnosed, including 41 cases of fourth ventricular tumors, including medulloblastoma (27 cases), pilocytic astrocytoma (7 cases), ependymoma (5 cases), choroid plexus papilloma (one case), and rosette-forming glioneuronal tumor (RGNT, one case). There were 38 cases of brainstem tumors, including 24 cases of diffuse midline glioma, H3 K27-altered, 5 cases of pilocytic astrocytoma, 3 cases of cavernous hemangioma, 2 cases of pediatric-type diffuse high-grade glioma (prone to diffuse midline glioma, H3 wild type), 2 cases of ganglio glioma, one case of atypical teratoid/rhabdoid tumor (AT/RT), and one case of pediatric-type diffuse low-grade glioma. There were 9 cases of cerebellopontine angle (CPA) tumors, including 3 cases of pilocytic astrocytoma, 2 cases of cholesteatoma, one case of medulloblastoma, one case of diffuse midline glioma, H3 K27-altered, one case of pilomyxoid astrocytoma, and one case of Ewing sarcoma. There were 30 cases of cerebellar tumors, including 15 cases of pilocytic astrocytoma, 7 cases of medulloblastoma, 2 cases of cavernous hemangioma, one case of ependymoma, one case of pediatric-type diffuse low- grade glioma, one case of pediatric-type diffuse high- grade glioma (prone to diffuse midline glioma, H3 wild type), one case of dysembryoplastic neuroepithelial tumor (DNT), one case of hamartoma, and one case of extrarenal rhabdomyomatoid tumor cerebellar metastases. Localization diagnosis, the accuracy of preoperative CT was 93.22% (110/118), while the accuracy of preoperative MRI was 100% (118/118). Qualitative diagnosis, 74 cases (62.71%) had accurate qualitative diagnosis, 23 cases (19.49%) had general diagnosis, and 21 cases (17.80%) had wrong diagnosis. The imaging differential diagnosis of posterior fossa tumors in children focuses on medulloblastoma, pilocytic astrocytoma, ependymoma, and diffuse midline glioma, H3 K27-altered. The incidence of limited diffusion of DWI in medulloblastoma, pilocytic astrocytoma and ependymoma outside the brainstem was 100% (35/35), 4% (1/25) and 5/6, and the difference among the three tumors was statistically significant (Z =-5.601, P = 0.000). The incidence of limited diffusion of DWI in diffuse midline glioma, H3 K27-altered and pilocytic astrocytoma in the brainstem was 79.17% (19/24) and 1/5, and the difference between the two tumors was also statistically significant (Fisher's exact possibility: P = 0.038). Conclusions: The early diagnosis of posterior fossa tumors in children is difficult, and DWI is an important basis for differential diagnosis.

Objective: To explore the correlation between functional connectivity (FC) in the brains of Parkinson's disease (PD) patients with depression and the improvement rate of depression after subthalamic nucleus deep brain stimulation (STN-DBS). Methods: This study included 38 PD patients (25 with depression and 13 without depression) who underwent STN-DBS at The First Affiliated Hospital of University of Science and Technology of China from September 2019 to April 2020. All participants underwent resting-state fMRI. The severity of depression was assessed using Hamilton Depression Rating Scale-17 Items (HAMD-17) before and 2 years after the surgery, and the improvement rate of depression was calculated. Spearman rank correlation analysis was used to investigate the relationship between FC and the improvement rate of depression in PD patients with depression. Results: There were 34 different FC between PD patients with and without depression compared to control group (P = 0.000, for all). Among patients with PD, those with depression showed 4 distinct FC compared to those without depression, including left precuneus-right supplementary motor area (t = 6.028, P = 0.000), right insula-right lateral orbital gyrus (t = 5.525, P = 0.000), left paracentral lobule-left precuneus (t = 5.545, P = 0.000), and right paracentral lobule-left precuneus (t = 5.578, P = 0.000). Spearman rank correlation analysis revealed a negative correlation between the zFC values of right precuneus-right insula (r_s = -0.544, P = 0.009) and left temporal pole-left insula (r_s = -0.765, P = 0.010) and the improvement rate of depression in PD patients with depression. Conclusions: The FC of right precuneus-right insula and left temporal pole-left insula in PD patients with depression is negatively associated with the improvement rate of depression.

Objective: To investigate the changes of retinal nerve fiber layer (RNFL) thickness and superficial vascular density in patients with Parkinson's disease (PD), and analyze the correlation between the changes and disease severity. Methods: Total 43 patients (76 eyes) with PD admitted to the Affiliated Hospital of North Sichuan Medical College from June 2021 to March 2022, and 45 patients (90 eyes) with normal neurological and visual functions from their family members were recruited as the control group. Optical coherence tomography angiography (OCTA) was used to measure RNFL thickness, retinal blood vessel length density and perfusion density, and the area and circumference of foveal avascular zone (FAZ). Disease severity was evaluated by modified Hoehn-Yahr staging, and motor function was evaluated by Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ) in PD group. Pearson and partial correlation analyses were used to investigate the correlation between retinal parameters and PD severity. Results: Comparison of OCTA related parameters between the 2 groups: RNFL thickness (t =-6.424, P = 0.000), central length density (t =-3.629, P = 0.000), inner ring length density (Z =-2.846, P = 0.004) and central perfusion density (Z =-2.703, P = 0.007) in the PD group were lower than those in the control group. Correlation analysis showed that RNFL thickness was negatively correlated with UPDRSⅢ score (r =-0.625, P = 0.000). Conclusions: RNFL thickness may be a potential indicator for early diagnosis and evaluation of the severity of PD.

Objective: To compare the agreement in judging the responsible vessels for hemifacial spasm (HFS) between the preoperative 3D Slicer 3D reconstruction and the actual intraoperative judgment of microvascular decompression (MVD). Methods: A total of 62 patients with HFS who underwent MVD in Dong'e County People's Hospital of Shandong Province from July 2018 to January 2024 were included. 3D fast inflow with the steady state precession (3D-FIESTA) and 3D time-of- flight (3D-TOF) MRA were performed before surgery. 3D Slicer software was used to fuse 3D-FIESTA and 3D-TOF MRA images and 3D reconstruction to clarify the responsible vessels. The actual intraoperative judgment was taken as the "gold standard", and the agreement between preoperative 3D reconstruction and actual intraoperative judgment was compared. Results: There were 61 cases whose responsible vessels were identified by preoperative 3D reconstruction, including anterior inferior cerebellar artery (AICA) in 47 cases, posterior inferior cerebellar artery (PICA) in 6 cases, vertebral artery (VA) in 5 cases, VA + AICA in 2 cases, and superior cerebellar artery (SCA) in one case. The 59 cases were consistent with actual intraoperative judgment. In one case, the preoperative 3D reconstruction was considered as VA compression, and the intraoperative evidence was VA + AICA compression; in one case, preoperative 3D reconstruction was AICA compression, and the intraoperative evidence was AICA + labyrinthine artery compression; no significant responsible vessels were found in one case, and the intraoperative evidence was arteriole compression. The accuracy of preoperative 3D reconstruction was 95.16% (59/62). Agreement test showed a high consistency between preoperative 3D reconstruction and actual intraoperative judgment (κ = 0.886, P = 0.000). Conclusions: It is very accurate to define the responsible vessels by 3D reconstruction before MVD in patients with HFS, which is helpful to make the surgical plan and provide the basis for the judgment of the responsible vessels during the operation.

Objective: To compare the clinical efficacy and safety of levetiracetam and oxcarbazepine in the treatment of focal epilepsy. Methods: A total of 476 patients with focal epilepsy treated at Fujian Provincial Hospital from October 2020 to October 2022 were selected. Based on their medication, they were divided into the levetiracetam group (n = 275) and the oxcarbazepine group (n = 201). Both groups underwent continuous treatment for 12 months. The overall effective rate and incidence of adverse reactions in both groups and different subgroups were analyzed. Results: The overall effective rate in the levetiracetam group was 57.82% (159/275), and in the oxcarbazepine group was 46.77% (94/201). The overall effective rate in the levetiracetam group was higher than that in the oxcarbazepine group (χ² = 5.696, P = 0.017). Efficacy analysis of levetiracetam monotherapy across different age subgroups showed statistically significant differences (χ² = 6.785, P = 0.034), with the overall effective rate in younger patients being higher than that in minors (χ² = 3.898, P = 0.048) and middle-aged/older patients (χ² = 4.946, P = 0.026). Levetiracetam was more effective in patients with initially normal imaging compared to those with abnormal imaging (χ² = 5.349, P = 0.021). In the oxcarbazepine monotherapy subgroup analysis, oxcarbazepine was also more effective in patients with initially normal imaging (χ² = 10.036, P = 0.002). Efficacy analysis of the same subgroup with different medications indicated that for younger patients with focal epilepsy, levetiracetam was superior to oxcarbazepine (χ² = 6.591, P = 0.010). In the levetiracetam group, 13 cases (4.73%) experienced adverse reactions, while the oxcarbazepine group had 19 cases (9.45%). The incidence of adverse reactions in the oxcarbazepine group was higher than that in the levetiracetam group (χ² = 4.135, P = 0.042). Conclusions: Compared to oxcarbazepine monotherapy, levetiracetam monotherapy demonstrated better clinical efficacy in treating focal epilepsy, particularly in younger patients. The incidence of adverse reactions in levetiracetam was lower. Both medications were more effective in patients with initially normal imaging compared to those with abnormal imaging.

With its high positioning accuracy, transcranial magnetic stimulation (TMS) has become an important means of non-invasive neuromodulation technique. This article analyzes the current status and challenges of precise positioning navigation technology, points out that the current navigation equipment is expensive and caliper-based simplified precision positioning method is difficult to monitor head movements in real time, and proposes the necessity of developing low-cost, high-precision navigation technology. Focus on the precise positioning technology of TMS and its application in clinical treatment and cognitive function positioning. Finally, the application prospects of precise positioning TMS in clinical treatment and cognitive function positioning are discussed, and it is pointed out that future research directions should focus on comparative studies of precise positioning and non - precise positioning treatment, as well as in - depth exploration of the precise positioning TMS treatment mechanism guided by fiber connections.

Objective: To focus on the efficacy at variable frequency stimulation (VFS) after deep brain stimulation (DBS) for the treatment of axial symptoms in Parkinson's disease (PD). Methods: Clinical data of 12 patients with PD who underwent bilateral DBS followed by VFS more than one year from January 2018 to June 2022 at Tianjin Huanhu Hospital, Tianjin University were retrospectively analyzed. Axial symptoms were assessed using Unified Parkinson's Disease Rating Scale (UPDRS)-gait posture, Timed Up and Go Test (TUGT) time and the occurrence of freezing of gait (FOG), The Freezing of Gait-Questionnaire (FOG-Q), and Berg Balance Scale (BBS). The above indicators were recorded one week before DBS surgery and in the drug "off" period (baseline), at the end of high frequency stimulation (the end of HFS), at one month follow-up of VFS (short-term VFS), and at one year or more follow-up of VFS (long-term VFS). Results: Compared with baseline, BBS scores increased at the end of HFS (t =-2.845, P = 0.008); UPDRS-gait posture (t = 12.703, P = 0.000; t = 11.737, P = 0.000), TUGT time (t = 8.923, P = 0.000; t = 8.025, P = 0.000) and the occurrence of FOG (t = 4.448, P = 0.000; t = 4.181, P = 0.000), and FOG-Q scores (t = 9.186, P = 0.000; t = 8.186, P = 0.000) decreased, while the BBS scores increased (t =-7.686, P = 0.000; t =-6.106, P = 0.000) in both short-term VFS and long-term VFS. Compared with the end of HFS, UPDRS-gait posture (t = 11.583, P = 0.000; t = 10.618, P = 0.000), TUGT time (t = 6.922, P = 0.000; t = 6.022, P = 0.000) and the occurrence of FOG (t = 3.612, P = 0.001; t = 3.344, P = 0.002), and FOG-Q scores (t = 7.915, P = 0.000; t = 6.915, P = 0.000) decreased, while the BBS scores increased (t = -4.842, P = 0.000; t =-3.262, P = 0.003) in short-term VFS and long-term VFS. Conclusions: For PD patients with HFS but poor axial symptoms efficacy after DBS, the use of VFS significantly improves multifaceted axial symptoms with reliable long-term efficacy.

Meige's syndrome (MS) is a segmental dystonia characterized by blepharospasm and oromandibular dystonia. Early treatment with medication or local injection of botulinum toxin can achieve certain therapeutic effects, but long-term use leads to decreased efficacy and adverse reactions, posing challenges to the treatment of the disease. Deep brain stimulation (DBS) has become a new treatment method for Meige's syndrome due to its safety, effectiveness, minimally invasive nature, reversibility, and controllability. This article reviews the clinical manifestations, pathogenesis of Meige's syndrome, as well as the mechanism and efficacy of DBS treatment, to improve clinical understanding of DBS treatment for Meige's syndrome.

Objective: To explore effective treatments and prognostic factors for diffuse intrinsic pontine glioma (DIPG). Methods: Clinical and imaging information and survival data of 14 DIPG patients, treated with radiotherapy combined with temozolomide and nitolizumab or radiotherapy combined with ACT001, were retrospectively analysed at Beijing Tiantan Hospital, Capital Medical University from April 2021 to January 2024. The median progression free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves, and multifactorial Cox regression analysis was used to investigate the effects of different factors on PFS and OS. Results: The objective response rate (ORR) was 10/14, and the median PFS and OS were 7.83 and 8.30 months, respectively. Multfactorial Cox regression analysis identified the absence of enhancement on baseline imaging as a good prognostic variable for both PFS (RR = 0.052, 95%CI: 0.006-0.416; P = 0.005) and OS (RR = 0.046, 95%CI: 0.005-0.413; P = 0.006), while male (RR = 0.085, 95%CI: 0.009-0.764; P = 0.028), older age (RR = 0.631, 95%CI: 0.423-0.942; P = 0.024), and the absence of symptoms of cranial nerve involvement at the onset (RR = 0.116, 95%CI: 0.017- 0.781; P = 0.027) were also good prognostic variables for OS. Conclusions: Female, younger age at diagnosis, cranial nerve involvement at the onset, and enhancement on baseline imaging are risk factors for the survival of children with DIPG.

Objective: To explore the surgical procedures and indications of intracranial-intracranial bypass for the treatment of complex aneurysms in the basilar artery (BA). Methods and Results: A retrospective analysis was conducted on the clinical data and treatment process of 6 patients with complex BA aneurysms who underwent intracranial-intracranial bypass from April 2017 to April 2023 in Tianjin Huanhu Hospital. Among the 6 aneurysms, 3 were vertebro basilar dolichoectasia aneurysms, one was an aneurysm in the upper segment of BA combined with severe stenosis at the proximal of the aneurysm, and 2 were giant dissecting aneurysms of the BA. Among them, 5 were ruptured aneurysms, with one case of Hunt-Hess grade Ⅴ, one case of grade Ⅳ, 2 cases of grade Ⅲ, and one case of grade Ⅱ, while the remaining one case was an unruptured aneurysm. One patient underwent petrous segment of internal carotid artery (ICA)-radial artery (RA)-posterior cerebral artery (PCA) bypass combined with aneurysm clipping, 4 patients underwent V3 segment of vertebral artery (VA)-RA-PCA bypass combined with aneurysm trapping, and one patient underwent middle cerebral artery (MCA)-RA-PCA bypass combined with aneurysm trapping. Four patients had good prognosis, with modified Rankin Scale (mRS) 0 to 3, one case scored 4 and one case died one week after surgery. Conclusions: For complex aneurysms of the BA that cannot be treated with conventional methods, intracranial-intracranial bypass provides a good option. It is necessary to select the appropriate surgical procedure based on the actual situation in clinical practice.

The rapid development of neurosurgery robots and navigation systems has significantly enhanced surgical precision and safety. Neurosurgery robots, based on stereotactic technology, achieve submillimeter-level positioning through multi-modal image fusion and non-invasive registration techniques. Equipped with high-degree-of-freedom robotic arms and integrated sensors, they precisely perform complex procedures such as stereo-electroencephalography (SEEG) electrode implantation, deep brain stimulation (DBS) device placement, and magnetic resonance-guided laser interstitial thermal therapy (MRgLITT). Navigation systems employ optical or electromagnetic tracking technologies combined with multi-modal imaging to assist surgeons in tracking important structures and target lesion tissue precisely. Future advancements may autonomously generate personalized surgical plans to reduce human error, while flexible robotic arms and novel endoscope-holding robots could expand endoscopic applications. Furthermore, the integration of multiple technologies will broaden neurosurgical applications. These innovations not only minimize complication risks and shorten treatment periods, but also propel the field toward intelligent, minimally invasive neurosurgery.

Pituitary adenoma is a benign intracranial tumor, commonly found in adults and occasionally in children. Pituitary adenoma is classified into secretory and non-secretory adenoma based on whether there is abnormal hormone secretion. The main manifestations include endocrine system abnormalities, visual disturbance and symptoms of intracranial hypertension. Although the incidence rate of pituitary adenoma in children is low, its physiological and psychological impact on children is obvious, diagnostic and therapeutic process is unique, and it has some characteristics, more complicated differential diagnosis than adults, such as more endocrine symptoms, poor paranasal sinus gasification, the impact of transnasal surgery on developing children, drug therapy and radiotherapy for children and individualization, postoperative endocrine regulation and subsequent development problems, etc.. Therefore, it is necessary to discuss pituitary adenoma in children independently from adults. This article reviews the clinical research progress of pediatric pituitary adenoma in recent years.

Objective: To compare the detection rates of epileptogenic foci in drug-refractory epilepsy children using video electroencephalography (VEEG), MRI and PET. Methods: The 24 h and 2 h VEEG, MRI and PET/CT or PET/MRI were conducted for 70 children with drug-refractory epilepsy in Children's Hospital of Nanjing Medical University from January 2020 to April 2022, and Raven's Standard Progressive Matrices (SPM) or Developmental Screening Test for Child under six (DST) based on their age (< 5 or ≥ 5 years old) were assessed for intelligence. Results: Among 70 children, 44 seizures were detected during 24 h VEEG, while 31 seizures were detected during 2 h VEEG, and there was statistically significant difference between the two methods (χ² = 5.760, P = 0.015). The consistency of diagnosing single location/ unilateral abnormalities, bilateral abnormalities, or normal results was poor among VEEG, MRI and PET/CT or PET/MRI (κ = 0.194, P = 0.000), and the difference among the three methods was statistically significant (χ² = 33.068, P = 0.001). The VEEG (χ² = 25.000, P = 0.000) and PET/CT or PET/MRI (χ² = 11.764, P = 0.002) had higher diagnostic capabilities than MRI, and PET/CT or PET/MRI had higher diagnostic capability than VEEG (χ² = 8.048, P = 0.014). There were 41 children (58.57%) showed mental retardation, among them children with onset age ≤ 2 years had a higher rate compared to those with onset age > 2 years (χ² = 6.193, P = 0.013), and children with abnormal VEEG background had a higher rate compared to those with normal VEEG background (χ² = 4.868, P = 0.027). Conclusions: The detection rate of epileptiform discharges and clinical seizures can be increased by lengthening VEEG time at each time and increasing the number of times of VEEG. PET/CT or PET/MRI and VEEG can provide localization information of epileptic foci of children whose MRI results are negative. The mental retardation rate of children who have onset age ≤ 2 years and of abnormal VEEG background is higher.

Objective: To compare and analyze the clinical outcomes of endovascular treatment of anterior circulation large vessel occlusion (ac-LVO) caused by large artery atherosclerosis (LAA) and simple arterial embolization. Methods: From August 2020 to September 2022, 87 patients with ac-LVO hospitalized in The Second Affiliated Hospital of Bengbu Medical University were enrolled. All patients were treated with endovascular treatment, including intravenous thrombolysis, stent thrombectomy, aspiration thrombectomy or angioplasty (balloon dilatation or stent implantation). According to intraoperative findings (etiology), they were divided into LAA group (n = 32) and simple arterial embolization group (embolization group, n = 55). The primary outcome was the 90 d modified Rankin Scale (mRS) score, and the secondary outcomes were postoperative vascular recanalization rate [modified Thrombolysis Cerebral Infarction (mTICI)] and incidence of symptomatic cerebral hemorrhage 1 d after surgery. Results: The proportions of patients with atrial fibrillation (χ² = 17.672, P = 0.000) and thrombus retrieval ≥ 3 times (χ² = 10.606, P = 0.001) in the embolization group were higher than those in the LAA group, the proportion of intravenous thrombolysis in the embolization group was less than that in the LAA group (χ² = 5.403, P = 0.020). However, the time from onset to operation (Z = 1.111, P = 0.267), the time from admission to operation (Z = 0.149, P = 0.882), preferred surgical approach for endovascular treatment (Fisher's exact probability: P = 0.153), as well as the rate of good prognosis (mRS score ≤ 2; χ² = 0.004, P = 0.950) and mortality (χ² = 0.035, P = 0.851) at 90 d after surgery, the rate of postoperative vascular recanalization (mTICI grade ≥ Ⅱ b; χ² = 0.033, P = 0.856) and symptomatic cerebral hemorrhage rate 1 d after surgery (χ² = 0.345, P = 0.557) for the secondary outcome were observed in both groups, the above differences were not statistically significant. Conclusions: The efficacy and prognosis of endovascular treatment of ac-LVO caused by LAA and simple arterial embolization has the same effect and clinical prognosis.

Electroencephalography (EEG), which can intuitively monitor and record the discharge activities of neuronal groups in the brain, is a crucial scientific and clinical diagnostic technique in the field of neuroscience. EEG has been developed and innovated for nearly a century, and it offers advantages of non-invasiveness, convenience, real-time, and continuity. The rapid advancement and multidisciplinary integration of computer technology and other imaging techniques has led to the application of EEG technology in a wide range of areas, including epilepsy, sleep disorders, and critical care. The purpose of this article is to enhance clinical comprehension and implementation of EEG technology by reviewing its development history, clinical applications, and future prospects.

Objective: To explore the long-term outcome of intracranial-intracranial side-to-side bypass for complex intracranial aneurysms. Methods: Five patients with complex intracranial aneurysms underwent intracranial-intracranial side-to-side bypass performed by the same surgeon at The First Hospital of China Medical University from January 2015 to December 2023 were included. Two cases involved the A2 segment of anterior cerebral artery (ACA) and 3 cases involved the M2 segment of middle cerebral artery (MCA). Indocyanine green angiography (ICGA) was used intraoperatively, and CTA or DSA was used postoperatively to evaluate aneurysm occlusion and blood flow reconstruction. The modified Rankin Scale (mRS) was used to evaluate the neurological prognosis at one week, 3 months and the last follow-up. CT/ MRI examination was completed on the first day, one week and 3 months after operation to evaluate whether hemorrhagic or ischemic complications occurred. Results: Five cases of complex intracranial aneurysms were all occluded accurately. Two cases underwent A3-A3 side-to-side anastomosis, and 3 cases underwent M2-M2 side-to-side anastomosis, among which one case added M1-radial artery (RA)-M2 intracranial-intracranial bypass with RA as graft on the basis of M2-M2 side-to-side anastomosis. During the operation, ICGA confirmed that the side-to-side anastomosis and M1-RA-M2 bypass were unobstructed in 5 cases. The postoperative follow-up time was 23 (14, 71) months. No aneurysm was found in cerebrovascular imaging examination one week and 3 months after operation in 5 patients, and 9 to 12 months after operation in 3 patients. Five side-to-side anastomosis stomas and one M1-RA-M2 graft were all unobstructed. At one week after operation, the mRS increased by 0-3 score compared with that before operation (4 score maintained unchanged before and after operation in one case, 2 score increased in one case, and 3 score increased in one case). In 2 unruptured cases, the mRS score was 1 score at one week after operation, and there was no change from that before operation. At 3 months after operation, the mRS scores of 5 cases were decreased (2 cases with 0 score, one case with 2 score, and 2 cases with 3 score); one case was lost at the last follow-up, and the mRS scores of other 4 cases decreased further (2 cases with 0 score, one case with 1 score, and one case with 2 score). No cerebral hemorrhage or cerebral ischemia occurred in the follow-up. Conclusions: Intracranial-intracranial side-to-side bypass has good short-term and long-term patency and stable long-term clinical effect. It is a reliable technique for surgical treatment of complex intracranial aneurysms.

Objective: To analyze the clinical prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH) patients with different amounts of hematoma. Methods: A total of 211 patients with high-grade aSAH hospitalized in Norhern Jiangsu People's Hospital from September 2013 to December 2020 were included. According to the intracerebral hematoma volume, they were divided into non-hematoma group (n = 105), hematoma volume < 50 ml group (n = 69) and hematoma volume ≥ 50 ml group (n = 37). All of them underwent aneurysm clipping or embolization. The modified Rankin Scale (mRS) was used to evaluate the clinical prognosis 6 months after surgery. Results: Among 211 cases, 139 (65.87%) underwent aneurysm clipping and 72 (34.12%) underwent aneurysm embolization. Except for 3 patients who failed to successfully clamp and underwent decompression with bone flap due to intraoperative malignant encephaloceles, the remaining 208 patients were successfully clipped, and no aneurysms ruptured and bled again after surgery. There were 58 patients (27.49%) with good prognosis, 59 patients (27.96%) with poor prognosis, and 94 patients (44.55%) with death. The difference in neurological function prognosis among the 3 groups was statistically significant (χ² = 7.424, P = 0.024). Among them, the mortality rate in hematoma volume ≥ 50 ml group was higher than that in non-hematoma group (Z =-2.655, P = 0.008). The incidence of complication was 95.73% (202/211) in all patients, including 95.24% (100/105) in non-hematoma group, 95.65% (66/69) in hematoma volume < 50 ml group, and 97.30% (36/37) in hematoma volume ≥ 50 ml group. The difference in complication among the 3 groups was not statistically significant (χ² = 0.284, P = 0.867). Conclusions: The prognosis of high-grade aSAH patients with intracerebral hematoma is poorer, especially in high-grade aSAH patients with hematoma volume ≥ 50 ml, and have a higher mortality rate.

Objective: To analyze stereo-electroencephalography (SEEG) data from patients with drug-resistant epilepsy (DRE) and explore the differences in graph theory indices of brain network between the epileptogenic zone (EZ) and the non-ictal zone (NIZ). Methods: Reviewed data from 11 patients who underwent SEEG implantation at Beijing Tiantan Hospital, Capital Medical University from August 2022 to December 2023.Based on the SEEG and structural imaging data, we calculated the epileptogenicity index and constructed epileptogenic map to differentiate the EZ from the NIZ.We then used Granger causality analysis to calculate functional adjacency matrices for both regions during interictal and epileptic periods, combining graph theory indices such as global efficiencies (Eg_lob), local efficiencies (E_loc), clustering coefficients (Cp), characteristic path length (Lp), normalized clustering coefficients (γ), normalized characteristic path length (λ), and small-world parameter (σ).We analyzed changes in the graph theory indices of patients in interictal and epileptic periods. Results: Compared with the interictal period, both γ (t=-3.730, P=0.005) and λ (t=-6.436, P=0.001) decreased in the NIZ during the epileptic period, while the differences of γ and λ in the EZ during the epileptic period were not statistically significant (P>0.05, for all).In terms of network efficiency, compared with the interictal period, Eg_lob (t=5.360, P=0.002; t=5.577, P=0.001) and E_loc (t=4.450, P=0.003; t=4.038, P=0.005) in both the EZ and NIZ increased during the epileptic period, while Lp decreased (t=-5.127, P=0.002; t=-3.912, P=0.005). Conclusions: During the epileptic period, both the EZ and NIZ exhibit increased synchronization across the whole brain network.Changes in graph theory indices, particularly the γ and λ may serve as the potential biomarkers for distinguishing the EZ and NIZ in epilepsy patients.

Objective: To explore the predictive value of intraoperative flat CT scan for intracranial hemorrhage after mechanical thrombectomy in patients with acute anterior circulation large vessel occlusion (AAC-LVO). Methods: A total of 106 patients with AAC-LVO who underwent mechanical thrombectomy at The Second Affiliated Hospital of Bengbu Medical University was conducted from March 2020 to June 2023. Intraoperative flat CT scan was performed among above patients to record CT values, high-density sign and mass effect. According to whether occurred intracranial hemorrhage after surgery, those patients were divided into intracranial hemorrhage group (n=29) and non-intracranial hemorrhage group (n=77). Univariate and multivariate stepwise Logistic regression analyses were used to screen the influencing factors of intracranial hemorrhage after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of intraoperative flat CT scan for postoperative intracranial hemorrhage. Results: Logistic regression analysis showed that hypertension was a protective factor for patients with AAC-LVO who did not experience intracranial hemorrhage after mechanical (OR=0.340, 95%CI: 0.123-0.941; P=0.038). A high National Institutes of Health Stroke (NIHSS) score at admission (OR=1.068, 95%CI: 1.010-1.129; P=0.021), as well as intraoperative flat CT high-density sign (OR=9.942, 95%CI: 2.631-37.567; P=0.001), mass effect (OR=23.564, 95%CI: 7.266-79.421; P=0.000), and CT value ≥ 90 HU (OR=9.714, 95%CI: 1.982-47.605; P=0.005) were risk factors for postoperative intracranial hemorrhage. The ROC curve showed that the area under the curve (AUC) for intraoperative flat CT value ≥ 90 HU, mass effect and their combined prediction of postoperative intracranial hemorrhage were 0.82 (95%CI: 0.734-0.889, P=0.000), 0.75 (95%CI: 0.661-0.833, P=0.000) and 0.76 (95%CI: 0.668-0.838, P=0.000), with sensitivity were 75.86%, 58.62% and 58.62%, and specificity were 88.31%, 92.21% and 93.51%. The predictive efficiency was highest for CT value ≥ 90 HU (t=48.777, P=0.000; t=43.681, P=0.000). Conclusions: In patients with AAC-LVO undergoing mechanical thrombectomy, intraoperative flat CT high-density sign such as CT value ≥ 90 HU and mass effect can predict postoperative intracranial hemorrhage, and the predictive value of CT value ≥ 90 HU is relatively high.

Objective: To investigate the efficacy and safety of the targeted drug poly ADP-ribose polymerase (PARP) inhibitor niraparib combined with low-dose chemotherapy drugs cisplatin and etoposide in the treatment of pediatric recurrent PFA-type ependymoma. Methods: A total of 12 pediatric patients with recurrent PFA-type ependymoma, treated in Children's Hospital of Fudan University from January 2022 to January 2024, were included in the study. All patients received a treatment regimen combining niraparib with low-dose cisplatin and etoposide chemotherapy. The objective response rate (ORR) of the tumor was statistically evaluated to assess treatment efficacy, and patient tolerability and safety indicators, including liver and kidney function, cardiac function, nausea and vomiting, fatigue, bone marrow suppression, gastrointestinal reactions, and infections, were recorded. Results: Among 12 pediatric patients, 10 cases showed a tumor reduction of ≥ 30%, in which 2 cases showed a tumor reduction of 100%, while one case showed no change in tumor size, and one case showed tumor progression. The overall ORR was 10/12. Adverse reactions included 5 cases of severe vomiting, primarily occurring during chemotherapy period, and 8 cases of varying degrees of bone marrow suppression, all of which were alleviated after symptomatic treatment. Conclusions: Niraparib combined with low-dose chemotherapy drugs shows good efficacy and safety in the treatment of pediatric recurrent PFA-type ependymoma.