Treatment of neurosurgical intensive care patients infected with multidrug resistant (MDR) or extensive drug resistant (XDR) Acinetobacter baumannii presents significant challenges and is associated with high mortality rates. Sulbactam has long been an effective treatment for MDR Acinetobacter baumannii, particularly due to its ability to penetrate the inflamed blood-brain barrier, making it highly suitable for use in severe neurosurgical cases. However, in recent years, increasing resistance to sulbactam among Acinetobacter baumannii strains has become a concern. There is a lack of standardized guidelines regarding the dosage, administration methods, routes and combination therapy strategies for sulbactam in the treatment of these resistant infections. Thus, Chinese Neurosurgical Intensive Care Management Collaborative Group has developed the "Chinese expert consensus on the use of sulbactam to treat patients infected with Acinetobacter baumannii in the neurosurgical intensive care unit", through a thorough review of relevant evidence-based medical literature and extensive discussion and revision. This consensus includes 28 recommendations aimed at providing scientific and feasible clinical guidance for the application of sulbactam in the management of neurosurgical intensive care patients.

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.

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.

Objective: To investigate the efficacy and neuromyelitis optica spectrum disorders (NMOSDs). Methods: The clinical data of 25 patients with NMOSDs hospitalized in The First Affiliated Hospital of Zhengzhou University from April 2022 to March 2023 and treated with ofatumumab were retrospectively analyzed. They were divided into 2 groups, Group A with 12 cases receiving regular medication, and Group B with 13 cases receiving medication based on the percentage of CD19⁺B lymphocytes. Annual relapse rate (ARR), the number of relapses, the frequency and time of relapses, and the symptoms of relapses were calculated before and at one year of medication. The neurological function was assessed by Expanded Disability Status Scale (EDSS) before and at one year of medication. The adverse drug reactions were recorded during medication. Results: After one year treatment with ofatumumab, 3 patients (12%) experienced recurrence. One patient in Group A experienced recurrence twice, one month and 5 months after treatment, respectively. At the second recurrence, the percentage of CD19⁺B lymphocytes was 2.80%. Two patients in Group B experienced recurrence, one patient relapsed twice at 2 and 6 months after medication. The percentage of CD19⁺B lymphocytes was 0.80% and 0.21%, respectively; another patient relapsed once at 2 months after medication. At the time of recurrence, the percentage of CD19⁺B lymphocytes was 0.70%. There was a statistically significant difference in ARR before and after one year treatment (F = 29.061, P = 0.000). After one year's treatment, the ARR of Group A (t = 13.215, P = 0.001) and Group B (t = 19.259, P = 0.000) was decreased than before. There were 8 cases of the injection site pain, 3 cases of fever after injection, and one case of headache after injection. There were no serious adverse reactions such as disability and death, and EDSS scores were not increased. Conclusions: Continuous administration of ofatumumab every 3 months or based on the percentage of CD19⁺B lymphocyte can reduce recurrence. Combination with corticosteroids should be alert to the risk of infection.

Parkinson's disease (PD) is a common neurodegenerative disease in clinical practice. Patients with PD are usually accompanied by non-motor symptoms (NMS) such as gastrointestinal dysfunction, hyposmia, sleep disorders, depression, pain and hallucinations, which seriously reduce the quality of life. Recent studies have found that PD patients were accompanied by diffuse pathological changes in non-dopaminergic system such as progressive degeneration of 5 -hydroxytryptamine (5-HT) ergic neurons, and 5-HT plays an important role in the regulation of emotion, cognitive function, pain and other neural functions, and is closely related to non-motor symptoms of PD. This article reviews the correlation between 5-HT and non-motor symptoms of PD and its research progress, in order to further clarify the pathogenesis of non-motor symptoms of PD and provide a theoretical basis for the treatment of PD.

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.

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.

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.

Objective: To investigate the effect of cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) in diagnosis and treatment of intracranial infection. Methods: A retrospective analysis of 117 patients with intracranial infection were admitted to Shenzhen Second People's Hospital from January 2020 to December 2022. Before initiating empirical broad-spectrum antibiotic treatment, CSF samples were collected for microbial culture (conventional culture group, n = 58) and/or mNGS (mNGS group, n = 59). The results were used to adjust the antibiotic treatment plan, and the study compared the pathogen detection rates and result reporting times of the two testing methods, as well as the antibiotic intensity grading, the intensive care unit (ICU) stay, total hospital stay, and mortality rate. Results: A total of 65 pathogens were detected from the CSF samples of all the patients through microbial culture and/or mNGS, with viruses being the most prevalent, accounting for 49.23% (32/65), followed by Gram-negative bacteria (24.62%, 16/65), Gram-positive bacteria (18.46%, 12/65) and fungi (7.69%, 5/65). The pathogen detection rate of CSF mNGS was higher than that of CSF microbial culture (χ² = 22.781, P = 0.000), and the results were reported earlier (t =-32.588, P = 0.000). Based on the results, 20 cases (33.90%) in the mNGS group adjusted antibiotic treatment plan, with 5 cases downgrading and 15 cases upgrading the intensity of antibiotic application. In the conventional culture group, 30 cases (51.72%) adjusted their antibiotic treatment plan, with 17 cases downgrading and 13 cases upgrading the intensity of antibiotic application. There was no significant difference between the 2 groups (Z =-1.917, P = 0.055). And there was no statistically significant difference in ICU stay (Z =-0.716, P = 0.474), total hospital stay (Z =-0.933, P = 0.351) and mortality rate (Fisher's exact probability: P = 0.496) between the 2 groups. Conclusions: The application of mNGS can effectively improve the detection rate of intracranial infection pathogens, which may shorten the duration of antibiotic use and reduce the intensity of broad-spectrum antibiotics, so as to help clinical effective judgment and treatment decision.

Objective: To investigate and compare the efficacy of endoscopic-assisted hematoma evacuation and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma (CSDH). Methods: A total of 38 patients with septated CSDH who were admitted in Peking Union Medical College Hospital and received endoscopic-assisted hematoma evacuation (endoscopy group, n = 19) or burr hole drainage combined with urokinase (burr hole group, n = 19) from January 2022 to December 2023. The change rate of the hematoma cavity was calculated, the modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate neurological function prognosis and abilities of daily living. In addition, postoperative drainage time, postoperative hospitalization time, total hospitalization cost and incidence of cerebrospinal fluid leakage were recorded. Results: The two treatment modalities did not show differences in the change rate of the hematoma cavity (t = 0.858, P = 0.396). Both endoscopy group (Z =-4.116, P = 0.000) and burr hole group (Z =-4.195, P = 0.000) had lower mRS scores on discharge than on admission, while the difference between the 2 groups on discharge was not significant (Z =-0.502, P = 0.616). The endoscopy group (Z =-1.557, P = 0.119) and burr hole group (Z =-0.091, P = 0.928) had no significant difference in BI scores on discharge versus on admission, and the difference in BI scores between the 2 groups on discharge was also not statistically significant (Z =-0.853, P = 0.394). Postoperative drainage time was longer in the endoscopy group (t =-2.488, P = 0.018), but postoperative hospitalization time was longer in the burr hole group (t =-3.894, P = 0.000). Total hospitalization cost in both 2 groups (t = 1.175, P = 0.248) and the incidence of cerebrospinal fluid leakage (Fisher's exact probability: P = 0.313) were not statistically significant. Conclusions: Both neuroendoscopic surgery and burr hole drainage combined with urokinase treatment are safe and effective in treating septated CSDH. They can clear the hematoma and improve neurological function; neuroendoscopic surgery can faster improve the neurological function and shorter postoperative hospitalization time.

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.

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.

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.

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.

Neurosurgical critical care is playing an increasingly pivotal role in the advancement of neurosurgery. It not only provides perioperative life support for neurosurgical patients but also addresses the treatment of severe cerebrovascular diseases and traumatic brain injury. Over the past two decades, major tertiary hospitals in China have established subspecialties dedicated to neurosurgical critical care. However, at the county level and other grassroots hospitals, the adoption of neurosurgical critical care concepts require further promotion. This paper reviews the development history of the neurosurgical critical care specialty and proposes measures to enhance the diagnostic and treatment capabilities of grassroots hospitals. These measures include standardizing core professional competencies, implementing high -quality multi-disciplinary team, and improving essential hardware configurations, with the goal of achieving standardized diagnosis and treatment in neurosurgical critical care.

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 screen factors influencing the neurological prognosis following lumboperitoneal shunt (LPS) in patients with hydrocephalus. Methods: Total 136 patients who underwent LPS in Xuanwu Hospital, Capital Medical University from October 2014 to January 2020. The short-term neurological prognosis post-surgery were evaluated by modified Rankin Scale (mRS) at discharge. Univariate and multivariate stepwise Logistic regression analyses were conducted to screen factors affecting neurological prognosis. Results: Of the 136 patients, 65 were categorized into the good prognosis group (mRS score ≤ 3), and 71 into the poor prognosis group (mRS score > 3). Logistic regression analysis indicated that an admission Glasgow Coma Scale (GCS) score of 9-12 (OR=7.800, 95%CI: 7.205-8.443; P=0.000) and 3-8 (OR=6.299, 95%CI: 5.744-6.907; P=0.006), as well as etiologies including traumatic brain injury (OR=27.681, 95%CI: 24.270-31.572; P=0.000), cerebral hemorrhage (OR=13.017, 95%CI: 11.473-14.769; P=0.005), subarachnoid hemorrhage (OR=17.682, 95%CI: 15.683-19.935; P=0.001), and other causes (OR=5.851, 95%CI: 5.166-6.628; P=0.050) were risk factors for poor short-term neurological prognosis in patients with hydrocephalus undergoing LPS. Conclusions: The neurological prognosis after LPS in patients with hydrocephalus is influenced by multiple factors. Prognoses vary among patients with different admission GCS scores and different etiologies. Personalized treatment plans should be developed based on specific circumstances.

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.

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 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.

Objective: To examine the levels of systemic inflammatory response index (SIRI) and serum lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with acute carbon monoxide poisoning (ACOP), and to explore the predictive value of SIRI, Lp-PLA2 and their combination for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods: Total 265 patients with ACOP diagnosed and treated in Harrison International Peace Hospital of Hebei Medical University, The Second People's Hospital of Hengshui and The No. 4 People's Hospital of Hengshui from March 2020 to March 2023 were included.SIRI and serum Lp-PLA2 levels were measured.According to the occurrence of DEACMP, they were divided into DEACMP group (n = 32) and non-DEACMP group (n = 233), while according to the degree of poisoning, they were divided into mild poisoning group (n = 20), moderate poisoning group (n = 107) and severe poisoning group (n = 138). Univariate and multivariate Logistic regression analyses were used to screen the risk factors of DEACMP in patients with ACOP, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of SIRI, Lp-PLA2 and their combination for DEACMP. Results: The levels of SIRI (t = 13.068, P = 0.000) and serum Lp-PLA2 (t = 8.208, P = 0.000) in DEACMP group were higher than those in non-DEACMP group, and their levels gradually increased with the severity of poisoning, the levels of SIRI (t = 8.764, P = 0.000; t = 4.586, P = 0.000) and Lp-PLA2 (t = 3.726, P = 0.000; t = 2.038, P = 0.044) in the severe poisoning group and moderate poisoning group were higher than those in the mild poisoning group, and the levels of SIRI and serum Lp-PLA2 in the severe poisoning group were also higher than those in the moderate poisoning group (t = 10.294, P = 0.000; t = 2.700, P = 0.007). Logistic regression analysis showed the severe poisoning (OR = 11. 695, 95%CI: 4.893-39.994; P = 0.000), SIRI increased (OR = 1.600, 95%CI: 1.033-2.476; P = 0.001) and Lp-PLA2 increased (OR = 11.302, 95%CI: 1.486-38.933; P = 0.000) were risk factors of DEACMP in patients with ACOP. ROC curve showed that area under the curve (AUC) predicted by Lp-PLA2, SIRI and their combination were 0.82 (95%CI: 0.754-0.894, P = 0.000), 0.82 (95%CI: 0.739-0.895, P = 0.000) and 0.87 (95%CI: 0.805-0.934, P = 0.000), sensitivity were 0.66, 0.72 and 0.84, specificity were 0.85, 0.88 and 0.90, respectively. The prediction efficiency of Lp-PLA2 combined with SIRI was better than that of Lp-PLA2 (t = 2.198, P = 0.027) or SIRI (t = 2.268, P = 0.023) alone. Conclusions: DEACMP is easy to occur when SIRI and serum Lp-PLA2 were high in patients with ACOP. The combined detection of Lp-PLA2 and SIRI can be used for early screening of DEACMP.

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.

Objective: To investigate the efficacy of cluster therapy in the treatment of severe intracranial infection. Methods: The clinical data of 43 patients with severe intracranial infection in Shenzhen University General Hospital and Shenzhen Second People's Hospital from July 2020 to June 2023 were retrospectively analyzed. Patients with intracranial infection were treated with cluster therapy: systemic broad-spectrum antibiotics were used at first; cerebrospinal fluid was obtained by multiple drainage routes for routine and biochemical testing, and then cultured and undertook next-generation sequencing (NGS); head/chest CT and brain MRI plain and enhanced scan were performed; after the NGS results were reported, precisely adjust the drug treatment according to the infection pathogen; sequentially use different drainage protocols of infected cerebrospinal fluid. Patients with severe intraventricular inflammation were treated with ventriculoscope (flexible endoscope) irrigation and fistula; cerebrospinal fluid, microbial culture and whole blood test for infection indicators were regularly extracted for laboratory test, and the type and dosage of antibiotics were adjusted one week after the indicators returned to normal, and the treatment effect of patients was judged comprehensively according to blood, cerebrospinal fluid, imaging results and clinical signs of infection. Results: Sixteen patients were administered a broad-spectrum antibiotic regimen consisting of meropenem and vancomycin.Cerebrospinal fluid analysis revealed that 12 cases (27.91%) were culture-positive for microbial organisms (bacteria, fungi, viruses), while 35 cases (81.40%) yielded positive results in NGS. Upon identification of the pathogen via NGS, 15 cases were switched to targeted, sensitive antibiotics, with 12 cases exhibiting notable improvements in symptoms, and 3 cases demonstrating no significant changes. A total of 27 patients (62.79%) underwent surgical intervention, including 7 patients (16.28%) who underwent abscess puncture drainage, 6 patients (13.95%) who received Ommaya sac implantation, 11 patients (25.58%) who underwent external ventricular drainage (8 of whom also underwent ventriculoscopic irrigation and ventriculostomy), and 3 patients (6.98%) who were treated with lumbocisterna drainage. The length of hospitalization was 30 (19, 57) d. The 37 cases (86.05%) were successfully cured, while 6 cases (13.95%) died. Conclusions: The cure rate of patients with severe intracranial infection was significantly improved after cluster therapy, and early initiation of cluster therapy can significantly improve the prognosis of patients, which is worthy of clinical application.

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.

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.

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.

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.

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.

The iteration of cerebral revascularization has been accompanied by the evolution of the concept of complex intracranial aneurysms. Cerebral revascularization has gradually changed the treatment strategy of intracranial aneurysms. This article focuses on the treatment principles and common microsurgical techniques of intracranial aneurysms, the conceptual changes and treatment difficulties of complex intracranial aneurysms, the development trend of cerebral revascularization and its application in the treatment of complex intracranial aneurysms, and the prospect of cerebral revascularization in the treatment of complex intracranial aneurysms. It aims to promote the high-quality application of cerebral revascularization in the treatment of intracranial aneurysms.

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.

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.

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.

Functional tremor is the most common subtype of functional movement disorder (FMD). At present, there is no "gold standard" for diagnosis. Most clinical manifestations coincide with organic tremor, which can easily lead to misdiagnosis and mistreatment. Characteristic electrophysiological manifestations can provide objective and repeatable diagnostic information, effectively supplement the history and physical examination, and can also be used in the differential diagnosis from organic tremor. This article reviews the electrophysiological characteristics of functional tremor and its application in diagnosis and differential diagnosis, in order to improve the clinical understanding of this disease.

Pediatric gliomas are highly heterogeneous and have unique molecular characteristics. They are not smaller versions of adult gliomas. This review emphasizes the basic points of surgery, radiotherapy, and chemotherapy for pediatric gliomas, introduces the similarities and differences with targeted therapy for adult gliomas, describes the important driver gene abnormalities involved in pediatric gliomas and the corresponding targeted therapy strategies, and focuses on the epigenetic treatment strategies for pediatric diffuse high-grade gliomas caused by histone H3 mutations, and looks forward to the future work of diagnosis and treatment of pediatric gliomas.

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 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.