Neurosurgical nursing is a high-demand specialized field requiring comprehensive professional competency. In 2023 when this study commenced, no standardized, validated competency evaluation framework existed for Chinese neurosurgical specialist nurses, and no official certification program was available. Although the Chinese Nursing Association launched neurosurgical specialist nurse certification in 2025, a structured, evidence-based assessment tool remains lacking, leaving a critical gap in clinical nursing talent training and management. This study aimed to construct competency evaluation indicators for neurosurgical specialist nurses. A mixed-methods Delphi-AHP research design was adopted. Based on systematic literature retrieval, theoretical research, and group discussions, the initial draft of Competency for Neurosurgical Specialist Nurses was preliminarily formulated. A systematic literature review was conducted in 5 domestic and foreign databases from 2018 to 2023, with clear inclusion and exclusion criteria; 15 experts with rich neurosurgical nursing experience were selected for expert consultation. Subsequently, two rounds of expert consultations using the Delphi method were conducted to modify, add, and delete indicators, and the analytic hierarchy process (AHP) was used to determine the weight of each indicator. The effective questionnaire response rates for both rounds of expert consultations were both 100%. The expert authority coefficients of the two rounds were 0.907 and 0.913, respectively. The Kendall's concordance coefficients for the two rounds were 0.164 and 0.343,< 0.01). Finally, a set of competency evaluation indicators for neurosurgical specialist nurses was developed, including 5 first-level indicators, 14 s-level indicators, and 64 third-level indicators; among them, Professional Theoretical Knowledge and Professional Skills had the highest comprehensive weights (both 0.3717). The competency evaluation indicators for neurosurgical specialist nurses constructed in this study show good expert authority, high consensus and acceptable methodological validity verified by Delphi and AHP methods, provide a structured reference for training, assessment, and management of neurosurgical specialist nurses.
Post-neurosurgical intracranial infection (PNII) is a common complication of neurosurgery, which is associated with poor outcomes. Key strategies to reduce infection rates and improve prognosis include strict perioperative infection control, early diagnosis of postoperative intracranial infections, and standardized comprehensive treatment. Based on previous guidelines and consensus, the Chinese Society of Neurosurgery, the Chinese Neurosurgery Intensive Care Management Collaboration Group, and the Beijing Neurosurgical Society convened a multidisciplinary team of experts in neurosurgery, infectious diseases, and clinical microbiology. This consensus was developed through systematic literature reviews and evidence-based medicine, integrating domestic and international epidemiological and clinical research evidence. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used for evidence evaluation and recommendation formulation. After multiple rounds of expert discussions and voting, 30 recommendations were finally established. This consensus covers the epidemiology of PNII, pathogen profiles, diagnostic criteria, perioperative prevention strategies, antimicrobial selection, multidrug-resistant organisms management, surgical interventions, and complication management. It aims to provide standardized guidance for clinical practice and to promote more standardized and refined management of PNII. 神经外科术后颅内感染（PNII）是神经外科手术常见并发症之一，严重影响患者预后。严格的围手术期感染控制、术后颅内感染的早期诊断以及采取规范化的综合治疗方式是降低感染发生率、改善预后的关键环节。在既往相关指南共识的基础上，中华医学会神经外科学分会、中国神经外科重症管理协作组及北京医学会神经外科学分会组织国内神经外科、感染病学、临床微生物学等领域专家，通过系统性文献回顾与循证医学汇总，整合国内外流行病学与临床研究证据，形成本共识，并采用推荐意见分级评价、制订与评估（GRADE）分级系统完成证据评价与推荐意见形成，经多轮专家讨论与投票，最终达成30条推荐意见。该共识涵盖了PNII的流行病学特点、病原谱变化、诊断标准、围手术期预防策略、抗菌药物选择、多重耐药菌处理、外科干预及并发症管理等，旨在为临床实践提供规范化指导意见，推动PNII管理的标准化与精细化。.
Objective: To evaluate the consistency of measurement results and diagnostic agreement of core cerebrospinal fluid (CSF) biomarkers for Alzheimer disease (AD) in a Chinese population, which were measured across a domestically developed electrochemiluminescence platform (Lifotronic eCL8000), a Japanese chemiluminescence immunoassay platform (LUMIPULSE), and an American electrochemiluminescence platform (Meso Scale Discovery, MSD). Methods: CSF samples were retrospectively collected from 253 subjects recruited at Peking Union Medical College Hospital, Xuanwu Hospital Capital Medical University, and Beijing Tiantan Hospital between July 2013 and September 2019. The cohort was comprised of 132 males and 121 females, with the age of (62.4±13.3) years. All CSF samples were collected via standardized protocols and cryopreserved at -80 ℃. Inter-assay repeatability (coefficient of variation, CV) of the Lifotronic platform on different days was validated. Spearman's rank correlation analysis was used to evaluate the degree of correlation between the results of the Pumen platform and those of the LUMIPULSE and MSD platforms, with the correlation coefficient expressed as ρ. Subsequently, 4 core CSF biomarkers [β-amyloid 40 (Aβ40), β-amyloid 42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau)] were quantitatively measured across the three platforms. The consistency of test results between platforms was evaluated using the Passing-Bablok regression model and Bland-Altman analysis. The 95% limits of agreement (LoA) were calculated by Bland-Altman analysis, with good agreement indicated when <5% of points fell outside the limits. Proportional and constant errors between the measurement systems were quantified by the Passing-Bablok regression model, utilizing a robust non-parametric method. 18F-florbetapir positron emission tomography/positron emission tomography/computed tomography (PET/CT) imaging has been performed on 40 of the 253 subjects. With the PET/CT diagnostic results utilized as the gold standard, the diagnostic agreement between the CSF results from the 3 platforms and the PET/CT findings was compared by calculating Cohen's Kappa coefficient. Furthermore, AD diagnostic reference cut-off values for each platform were determined by employing receiver operating characteristic (ROC) curves. Results: The Lifotronic platform demonstrated good repeatability in CSF testing (CV<10%). Spearman's rank correlation analysis was used to evaluate the correlation between the Lifotronic platform and the LUMIPULSE and MSD platforms, with correlation coefficients denoted by ρ. In comparison with the LUMIPULSE platform, all correlation coefficients (ρ) were>0.85. The correlation coefficient (ρ) between the MSD and Lifotronic platforms was>0.80, with a Kappa value of 0.698 (P<0.05). Bland-Altman analysis and Passing-Bablok regression models showed that for t-tau, the mean bias between Lifotronic and LUMIPULSE was 214.95 (95%LoA:-1 490.59-1 920.50), with 99.60% (252/253) of the data points falling within the 95%LoA. In the detection of t-tau, the regression slope between the Lifotronic and LUMIPULSE platforms was 2.041 (Equation: Y=2.041X-75.184), and the regression slope with the MSD platform was 2.360 (Equation: Y=2.360X-87.503). Based on PET/CT imaging validation, the CSF diagnostic results of the Lifotronic platform were consistent with the PET/CT results (Kappa=0.885, P<0.05), as were those of the MSD platform (Kappa=0.714, P<0.05). The Lifotronic platform established AD diagnostic reference thresholds based on the t-tau/Aβ42 and p-tau-181/Aβ42 ratios (the cut-off value for t-tau/Aβ42 was 0.32, and for p-tau-181/Aβ42 was 0.035). The Kappa value between the Lifotronic and LUMIPULSE platforms was 0.928 (P<0.05), and the Kappa value between the Lifotronic and MSD platforms was 0.698 (P<0.05). Conclusion: This study systematically validated the reliability of domestically developed Lifotronic electrochemiluminescence platform and its corresponding assay kits in detecting AD CSF biomarkers, as well as their comparability with international platforms, demonstrating comparable capabilities in terms of accuracy, consistency, and cost control. 目的： 比较我国自主研发的电化学发光平台普门（Lifotronic eCL8000）、日本LUMIPULSE化学发光免疫测定平台以及美国电化学发光平台Meso Scale Discovery（MSD）在检测我国人群脑脊液（CSF）阿尔茨海默病（AD）核心生物标志物检测结果和诊断的一致性。 方法： 回顾性收集2013年7月至2019年9月期间于北京协和医院、首都医科大学宣武医院和北京天坛医院招募的253例受试者的CSF样本，男132例，女121例，年龄（62.4±13.3）岁，所有CSF样本均标准化采集并于-80 ℃冻存。对普门平台进行非同日重复测量一致性（CV）验证；采用Spearman秩相关分析评估普门平台与LUMIPULSE、MSD平台间结果的相关程度，相关系数以ρ表示；随后分别在3个平台上进行CSF样本的4种核心生物标志物［β-淀粉样蛋白40（Aβ40）、β-淀粉样蛋白42（Aβ42）、磷酸化tau（p-tau）和总tau（t-tau）］定量检测；采用Passing-Bablok回归模型与Bland-Altman分析［运用Bland-Altman分析两种测量方法一致性，计算95%一致性界限（LoA），超出该界限的点数<5%，认为具有较好的一致性；Passing-Bablok回归模型利用稳健的非参数方法量化测量系统间的比例与恒定误差］。253例受试者中40例已接受18F-氟贝他苯（18F Florbetapir）正电子发射断层显像/X线计算机体层成像仪（PET/CT）的受试者，以PET/CT诊断结果作为金标准，比较3大平台的CSF生物标志物诊断结果与PET/CT结果的一致性，计算Kappa系数，并采用受试者工作特征（ROC）曲线计算各平台的AD判别cut-off值。 结果： 普门平台在CSF检测中表现出良好的重复性（CV<10%）；与LUMIPULSE平台比较，各个指标相关系数ρ均>0.85。MSD平台与普门平台相关系数ρ>0.80，Kappa值为0.698（P<0.05）。Bland-Altman分析与Passing-Bablok回归模型：t-tau在普门与LUMIPULSE比较时的平均偏差为214.95（95%LoA：-1 490.59~1 920.50），99.60%（252/253）的点位于95%LoA内；在检测t-tau时，普门平台与LUMIPULSE平台回归斜率为2.041（方程：Y=2.041X-75.184），MSD平台回归斜率为2.360（方程：Y=2.360X-87.503）。基于PET/CT影像验证，普门平台的CSF诊断结果与PET/CT结果Kappa值为0.885（P<0.05），MSD平台与PET/CT结果的Kappa值为0.714（P<0.05）。普门平台t-tau/Aβ42 cut-off值为0.32，p-tau-181/Aβ42 cut-off值为0.035；普门与LUMIPULSE平台之间Kappa值为0.928（P<0.05），普门与MSD平台Kappa值为0.698（P<0.05）。 结论： 该研究系统验证了我国自主研发的普门电化学发光平台及其配套试剂盒在AD CSF生物标志物检测中的可靠性与国际平台的可比性，显示出在准确性、一致性和成本控制等方面具有一定的对比能力。.
Post-neurosurgical central nervous system infections (PCNSIs) caused by Acinetobacter baumannii pose a significant therapeutic challenge; however, comprehensive studies focusing on this specific scenario are limited. This study aims to analyze the clinical characteristics, treatment outcomes, and prognostic factors of patients with PCNSIs caused by Acinetobacter baumannii. A retrospective cohort study was conducted at Guangdong Sanjiu Brain Hospital from January 2020 to June 2025. Patients diagnosed with Acinetobacter baumannii PCNSIs were included and stratified into carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-susceptible Acinetobacter baumannii (CSAB) groups. Clinical data, treatment regimens, and outcomes were analyzed. The primary outcome was 28-day all-cause mortality. Variables selected by LASSO regression were entered into univariate and multivariate Firth's logistic regression models to identify risk factors associated with mortality. A total of 47 cases were included in the study, with 37 (78.7%) attributed to CRAB and 10 (21.3%) to CSAB. The 28-day mortality rate for CRAB infections was 37.8% (14/37), while no deaths occurred in the CSAB group (P = 0.022). In the CRAB group, Kaplan-Meier analysis indicated that non-polymyxin B-based regimens were associated with significantly higher mortality (70.5%) compared to polymyxin B-based regimens (10.0%; P < 0.001). Univariate analysis revealed that drainage performed following infection (OR = 0.087, 95% CI:0.008-0.502, P = 0.005), polymyxin B-based regimen (OR = 0.059, 95% CI:0.009-0.274, P < 0.001) and mechanical ventilation (OR = 4.399, 95% CI:1.127-19.002, P = 0.033) differed significantly between the groups. Multivariate analysis identified polymyxin B-based regimen as an independent factor associated with lower 28-day mortality (OR = 0.075, 95% CI: 0.008-0.402, P = 0.002). CRAB-related PCNSIs are associated with significantly higher mortality compared to CSAB infections. Polymyxin B-based therapy may be associated with improved survival outcomes, while mechanical ventilation may be associated with an increased risk of mortality, warranting heightened clinical vigilance. Although post-infection drainage showed a protective effect in univariate analysis, it did not retain statistical significance as an independent predictor in the multivariable model, suggesting only a potential benefit that requires further validation. Not applicable.
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating stroke subtype. In the acute phase (< 72 h), stent-assisted coiling (SAC) carries a substantial risk of ischemic events (IEs). Early identification of high-risk patients is critical to improving outcomes. We developed and validated a practical risk score for predicting IEs, to support individual risk stratification. This prospective registry (SANE registry) included patients with aSAH at 33 advanced stroke centers across China from April 2021 to April 2024. Demographic, radiological and procedural variables collected at hospitalization were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (FLATS). Model discrimination was assessed by the area under the receiver operating characteristic curve (AUC). An independent external validation cohort was derived from a single tertiary hospital, comprising patients treated between January 2011 and December 2020. The derivation cohort included 1,469 patients (median age: 57 years; 71.0% females) and 196 patients (13.3%) developed IEs. From 18 potential predictors, 5 variables were independent predictive factors and were included in the risk score: age, modified Fisher Scale, aneurysm size and location, and time to surgery. The FLATS score demonstrated good discriminative, with an AUC of 0.808. In external validation (n = 439), the AUC was 0.853. For risk stratification, a FLATS score > 15 was defined as high risk and a score < 10 indicated as lower risk. The FLATS score is an easily applicable aid for risk stratification of IEs after SAC for acute aSAH.  TRIAL REGISTRATION: ChiCTR2000032657 (chictr.org.cn, registered by Beijing Tiantan Hospital on May 5, 2020).
This study systematically assessed the current state of research on robot-assisted stereotactic neurosurgery, identified major research focuses, and investigated evolving trends in this field, with the intention of providing useful guidance for future scientific studies and clinical practice. In this study, publications related to robot-assisted stereotactic neurosurgery published between 2005 and 2025 were retrieved from the Science Citation Index Expanded database within the Web of Science Core Collection. Descriptive and visual bibliometric analyses were conducted to evaluate publication characteristics, including research topics, journals, countries or regions, institutions, authors, and citation performance. A total of 194 publications were ultimately included in the analysis. The yearly publication output demonstrated a general upward trend over time, with a particularly noticeable increase observed after 2018. These studies were published in 88 journals, among which Operative Neurosurgery (16 publications), Acta Neurochirurgica (11 publications), and World Neurosurgery (8 publications) were the most productive journals. The most productive countries were the United States (50 publications, 25.8%), China (35 publications, 18.0%), and Germany (23 publications, 11.9%). Keyword analysis showed that recent research hotspots mainly focused on "safety," "efficacy," and "radiosurgery". Robot-assisted stereotactic neurosurgery has shown a steady increase in research activity over the past two decades and has gradually evolved toward more clinically oriented applications. However, bibliometric indicators primarily reflect publication and citation patterns rather than clinical effectiveness. Further studies based on high-quality clinical evidence are required to better evaluate its practical value and long-term outcomes.
Retraction serves as a critical mechanism for correcting flawed publications and preserving the integrity of the scientific literature. Systematic analysis focused on retractions in Central Nervous System (CNS) tumor research is still lacking. This study characterized retracted CNS tumor publications regarding temporal trends, geographic distribution, retraction reasons, citation patterns, and retraction lag. Retraction data were downloaded from the Crossref/Retraction Watch Database on December 31, 2025. CNS tumor‑related retractions were identified using tumor terms derived from the 2021 WHO Classification of Tumors of the Central Nervous System. Eligible records were screened manually, and tumor type, article type, retraction reason, first-author country, author count and time to retraction were extracted. Citation data were retrieved from Web of Science, and journal impact factor (JIF) and quartile were obtained from the 2024 Journal Citation Reports. Descriptive statistics, the Mann-Kendall test and Kruskal‑Wallis test were used. 582 CNS tumor articles were included. CNS tumor retractions increased over time and peaked in 2023. "Gliomas, glioneuronal tumors, and neuronal tumors" accounted for 74.57% (434/582). 80.58% (469/582) were retracted due to misconduct. In terms of absolute numbers, China was the leading first‑author country, followed by USA and India. Basic research accounted for 75.26% (438/582). The median time to retraction was 805.5 days (IQR: 423.25-1,711 days). A total of 515 articles received at least one citation (total citations 12,151), and 89.71% (462/515) had citation after retraction. The median pre‑retraction, post‑retraction, and total citations were 5 (IQR: 1-17), 3 (IQR: 1-7), and 10 (IQR: 3-24), respectively. Significant differences were observed in normalized citation counts and retraction lag across most retraction reason categories, JIF and quartiles, article types, author counts, and first‑author countries. CNS tumor retractions have increased markedly as the primary driver. The persistent post-retraction citation of flawed research highlights a critical gap threatening evidence-based neuro-oncology.
Delirium is a common complication among survivors of traumatic brain injury (TBI). Although prior studies have predominantly focused on delirium onset following moderate to severe TBI, mild TBI accounts for the majority of TBI cases in hospital settings. However, key risk factors for delirium in this population remain unclear. In this prospective observational study, we analyzed changes in sleep parameters and circadian rhythm during the first 7 days following mild TBI among patients in a neurosurgical ward. We further identified the key factors associated with post-TBI delirium. This study included 100 patients with mild TBI. Delirium was evaluated using the traditional Chinese version of the 4 A's Test (4AT). Sleep parameters and circadian rhythms were monitored through actigraphy for up to 7 consecutive days following admission. Risk factors for post-TBI delirium were identified through univariate and multivariate regression analyses. A total of 12 patients developed delirium, three of whom exhibited delirium onset immediately before their first nighttime sleep. Therefore, the actigraphic data of these individuals were exclusively classified as post-delirium. The remaining 97 patients were categorized into delirium and nondelirium groups. Interdaily stability was significantly lower in the delirium group than in the nondelirium group (0.27 vs. 0.48, p = 0.007). Risk factor analysis revealed that each one-unit increase in interdaily stability was associated with an 84% reduction in delirium risk (adjusted hazard ratio: 0.16, 95% confidence interval [CI]: 0.03-0.78). In summary, circadian rhythm disruptions are associated with an increased risk of delirium following mild TBI. This study underscores the importance of circadian rhythm stability and may inform targeted interventions aimed at preventing delirium in this patient population.
Due to their unique pathophysiological states, neurocritical care patients are at a significantly increased risk of acute pulmonary embolism. Typical symptoms are frequently masked by neurological deficits, resulting in delayed diagnosis. Furthermore, clinical management is highly challenging owing to the concurrent high risk of intracranial hemorrhage. On February 26, 2025, Linyi People's Hospital admitted a 67-year-old male patient who developed neurogenic stress cardiomyopathy (NSC) and acute submassive pulmonary embolism following surgery for a ruptured aneurysm. The patient presented with a chief complaint of "sudden onset headache accompanied by loss of consciousness for 6 hours." Physical examination revealed a deep coma with a Glasgow Coma Scale (GCS) score of 3 (E1V1M1), a Hunt-Hess grade of IV, and a modified Fisher grade of 4. Both pupils were 2.5 mm in diameter and reactive to light, and nuchal rigidity was positive. Cerebral computed tomography angiography (CTA) demonstrated an anterior communicating artery aneurysm, subarachnoid hemorrhage, and extensive intraventricular hemorrhage. Based on the medical history, clinical manifestations, and imaging findings, the patient was diagnosed with a ruptured anterior communicating artery aneurysm complicated by subarachnoid hemorrhage and secondary intraventricular hemorrhage. Emergent stent-assisted coil embolization of the anterior communicating artery aneurysm, cerebral angiography, and bilateral external ventricular drainage were performed under general anesthesia. Postoperatively, the patient was transferred to the neurosurgical intensive care unit (ICU) with endotracheal intubation and high-dose vasoactive support. Upon admission, concurrent NSC and severe hemodynamic instability were confirmed via bedside ultrasound and laboratory tests. Following one week of comprehensive management, including the control of inappropriate stress responses, clearance of bloody cerebrospinal fluid, management of intracranial hypertension, and optimization of vasoactive agents, the patient's hemodynamics stabilized, and vasoactive drugs were successfully discontinued. However, during the second postoperative week, the patient's condition deteriorated. Bedside echocardiography detected characteristic signs of right ventricular overload [right ventricle-to-left ventricle diameter ratio (RV/LV ratio) >1, "Notch sign," and "McConnell's sign"] that were highly suggestive of acute pulmonary embolism. This was immediately confirmed by computed tomography pulmonary angiography (CTPA). Following thorough deliberation by a multidisciplinary team (MDT) and careful balancing of the hemorrhagic and thrombotic risks, an individualized anticoagulation regimen was implemented. After three weeks of intensive intervention, the patient's condition stabilized, and he was successfully transferred out of the neurosurgical intensive care unit. At the 6-month postoperative follow-up, the patient's modified Rankin Scale (mRS) score was 3. Neurocritical care patients represent a high-risk population for acute pulmonary embolism. Bedside ultrasound facilitates the early identification of pulmonary embolism in these high-risk individuals. Utilizing an MDT to formulate individualized clinical intervention strategies is crucial for balancing the management of intermediate-to-high-risk pulmonary embolism with the risk of intracranial hemorrhage.
Paediatric brain abscess (BA) is a rare but life-threatening condition, and large-scale epidemiological studies are limited. We aimed to characterize the temporal trend of pediatric BA in China during 2016-2023. We conducted a nationwide study using the FuTang Update Medical Records (FUTURE) database, which includes face-sheets of discharge medical records from 33 tertiary children's hospitals across China. Case-identification strategies were validated, and the optimal strategy was applied to identify BA cases. Demographic information, predisposing factors, complications, and clinical outcomes of included cases were collected and analyzed. The main analytic cohort was constructed at the index qualifying episode level. A total of 799 children were identified, with 6.4-8.4 patients per 100,000 hospitalized children annually (P = 0.377). After 2020, the proportion of patients aged 1-3 years decreased, whereas the proportions of patients aged 10-12 and 13-17 years increased (all P < 0.05). Among predisposing factors, contiguous-site infections were more common in 2020-2023 than in 2016-2019 (OR, 1.997; 95% CI, 1.287-3.100; P < 0.001), whereas congenital heart disease remained stable. Neurosurgical intervention, complications, length of stay (LOS), and hospitalization costs were higher in 2020-2023 after adjustment for age, sex, and predisposing factors (all P < 0.05). Although the proportion of BA among hospitalized children in China remains stable, the distribution of its predisposing factors has changed, and increases in LOS and hospitalization costs were observed. • Bacterial meningitis was reported as the most common predisposing factor for paediatric brain abscess (BA) in a single-centre study in China during 2006-2016. • Large-scale epidemiological data on paediatric BA are limited. • This nationwide study in China showed changes in the predisposing factors for paediatric BA from 2016 to 2023. • Contiguous-site infections increased over time and were more common in 2020-2023 than in 2016-2019.
Cerebral ischemia-reperfusion injury (CIRI) represents a critical pathological challenge in the management of ischemic stroke, substantially limiting the clinical efficacy and success rates of neurosurgical interventions, brain tissue therapies, and cell transplantation strategies. The complex pathological mechanisms underlying CIRI, which include inflammatory responses, oxidative stress, ferroptosis, apoptosis, and blood-brain barrier disruption, significantly hinder neurological recovery. Mesenchymal stem cells-derived exosomes (MSC-Exos) have emerged as a promising acellular therapeutic strategy owing to their low immunogenicity, ability to cross the blood-brain barrier, and multi-target regulatory properties. This review compares MSC-Exos derived from multiple sources and summarises their mechanisms of action and therapeutic potential in CIRI. Despite ongoing challenges in standardisation and safety evaluation, accumulating preclinical evidence highlights their potential for future clinical translation and precision regenerative medicine.
The Evans index (EI) is widely used to assess ventricular enlargement and support external ventricular drainage (EVD) decision-making after subarachnoid hemorrhage (SAH), but manual measurement is time-consuming and subject to inter-reader variability. The reliability of automated EI measurement in acute SAH remains insufficiently validated. In this retrospective cohort study, admission non-contrast CT scans from 364 patients with spontaneous SAH were analyzed using TotalSegmentator (TS), an open-source nnU-Net-based deep learning pipeline, to generate automated EI measurements. Each scan underwent two independent inference runs, and two neurosurgical experts independently performed manual measurements. Agreement between TS and expert measurements was evaluated for continuous EI values and EI > 0.30 classification. External ventricular drainage (EVD) placement was used as a pragmatic endpoint reflecting contemporaneous clinical decision-making. Prespecified subgroup analyses excluded frontal horn hematoma or frontal horn periventricular edema. Multivariable logistic regression assessed the association between EI and EVD placement after adjustment for key clinical covariates. TS demonstrated excellent reproducibility between repeated inference runs (ICC = 0.996, 95% CI 0.996-0.997). Agreement between expert readers was high (ICC = 0.983, 95% CI 0.978-0.988). Between-method agreement between TS and expert EI measurements was good in the overall cohort (ICC = 0.76, 95% CI 0.73-0.81) and improved after exclusion of frontal horn hematoma (ICC = 0.87, 95% CI 0.85-0.89). For EI > 0.30 classification, TS identified more positive cases than expert assessment (29% vs. 17%), with moderate Cohen's kappa (0.57, 95% CI 0.54-0.60). TS-derived EI demonstrated discrimination for EVD placement (AUC = 0.75, 95% CI 0.73-0.79), approaching expert-derived EI (AUC = 0.80, 95% CI 0.78-0.83). After covariate adjustment, TS-derived EI remained independently associated with EVD placement (adjusted OR = 1.09, 95% CI 1.03-1.17; p = 0.009). Automated EI measurement using TS provides reproducible and clinically informative assessment of ventricular enlargement on CT in acute SAH. Although threshold-sensitive disagreement occurred near EI = 0.30, automated EI showed meaningful agreement with expert assessment and remained independently associated with contemporaneous EVD decision-making. Further SAH-specific refinement may improve robustness in hemorrhage-related ventricular distortion.
Multiple scales are available to evaluate the health status of older surgical patients; however, their relative ability to predict postoperative major adverse cardiac and cerebrovascular events (MACCE) remains unclear. To examine the association between preoperative health status, as measured by four commonly used scales, and 30-day postoperative MACCE in older surgical patients, and to compare their predictive performance and incremental value against the Revised Cardiac Risk Index (RCRI). A retrospective study of a large multicentre cohort. Nineteen tertiary hospitals across China participating in a perioperative database. Patients aged ≥65 years who underwent noncardiac, non-neurosurgical surgery between April 2020 and April 2022 were included in the analysis. The Activities of Daily Living (ADL), EuroQol Five-Dimension Five-Level (EQ-5D-5L), Metabolic Equivalent of Task (MET), FRAIL, and RCRI were evaluated preoperatively. The primary outcome was the occurrence of MACCE within 30 days after surgery, defined as any of the following: stroke, myocardial infarction, angina pectoris, congestive heart failure, cardiac arrest, or all-cause mortality. Among the 7996 patients, 126 (1.6%) experienced MACCE. Similar to the RCRI, the four health assessments were significantly associated with MACCE risk. The RCRI alone yielded an area under the curve (AUC) of 0.610 [95% confidence interval (CI): 0.563 to 0.658]. Incorporating each scale improved the predictive performance of the RCRI. The RCRI-Plus model, comprising RCRI, age, severity of anaemia, and surgical duration, achieved an AUC of 0.692 (95% CI: 0.643 to 0.741). Further addition of the four scales to the RCRI-Plus increased discrimination, with the highest AUC observed for the RCRI-Plus model incorporating FRAIL (AUC 0.724; 95% CI: 0.679 to 0.770). However, DeLong's test showed no significant differences between this model and the RCRI-Plus models incorporating ADL, EQ-5D-5L, or MET. Preoperative health status assessed by four geriatric scales was significantly correlated with postoperative MACCE and provided improved risk discrimination beyond the RCRI. Adding any of these assessments to the RCRI enhanced predictive performance, with FRAIL showing the greatest incremental benefit. These findings underscore the value of multidimensional health status evaluation for preoperative cardiac and cerebrovascular risk stratification, with frailty assessment warranting particular attention. ClinicalTrials.gov, NCT04911530.
Intracerebral hemorrhage (ICH) remains one of the most severe forms of stroke and is associated with high mortality, poor functional outcomes, and substantial healthcare burden worldwide. Despite advances in neurocritical care and minimally invasive surgical techniques, the management of ICH remains challenging because of disease heterogeneity, rapid neurological deterioration, and the lack of effective individualized treatment strategies. In recent years, artificial intelligence (AI) has emerged as a promising tool for improving the diagnosis, prognostic evaluation, and precision management of ICH. A systematic literature search was performed in PubMed, Web of Science, and Embase to identify studies on AI applications in ICH, with predefined inclusion criteria focusing on imaging analysis, prognostic prediction, clinical decision support, and minimally invasive surgery. This review summarizes the major clinical applications, limitations, and future directions of AI in ICH, including multimodal foundation models, intelligent surgical assistance, and personalized precision care. Recent studies have demonstrated that AI-based models can significantly improve the accuracy of hematoma segmentation, hematoma expansion prediction, and functional outcome prognostication compared with conventional approaches. Despite encouraging progress, several important barriers continue to limit clinical translation, including data heterogeneity, limited external validation, insufficient interpretability, ethical and regulatory concerns, and challenges in workflow integration. Overall, AI has the potential to transform ICH management from conventional experience-based practice to data-driven, personalized, and precision neurosurgical care.
Endoscopic approaches are being increasingly used for the management of intraventricular lesions. These techniques, however, have important limitations and can result in significant postoperative complications. Here, the authors describe the novel use of a nontraditional neurosurgical device to aid in the resection of an intraventricular tumor. A 13-year-old male presented with obstructive hydrocephalus and a small intraventricular meningioma. Given the lesion's round shape, the authors expected it would be difficult to resect with conventional ventriculoscopic instruments. Hence, a basket retriever, designed for the removal of urological stones, was used in an endoscopic third ventriculostomy for obstructive hydrocephalus to capture and retract the tumor. Subsequently, the lesion was successfully resected and retrieved. The use of a flexible helical basket retriever as both an ETV perforator and a stabilizing "cage" for a mobile, pedunculated angioblast meningioma enabled gross-total resection and long-term stability. The small size and maneuverability of this device were well suited to endoscopic use and may be useful for similar resections of small, mobile intraventricular lesions. https://thejns.org/doi/10.3171/CASE26283.
Preoperative differentiation of World Health Organization (WHO) Grade I meningioma subtypes is clinically needed but limited with conventional magnetic resonance imaging (MRI). A retrospective multicenter cohort of 334 patients (162 fibrous, 91 transitional, 81 meningothelial) was enrolled. T1-weighted contrast-enhanced (T1CE) and T2-weighted (T2WI) MRI were analyzed. Radiomics features were extracted and habitat analysis performed using K-Means clustering. Logistic Regression (LR), Random Forest, and XGBoost models combining radiomics and habitat features were developed and validated in an independent test set (n=67). The optimal combined T1CE+T2WI+habitat model with LR achieved an area under the curve (AUC) of 0.863 (95% CI: 0.763-0.954) and accuracy of 0.716 in the test set, outperforming unimodal radiomics (T1CE LR AUC=0.770), multimodal radiomics (T1CE+T2WI LR AUC=0.823), and habitat-only (LR AUC=0.619) models. Habitat analysis identified distinct imaging subregions corresponding to histological characteristics. Integrating multimodal radiomics and habitat analysis enables accurate noninvasive preoperative discrimination of WHO Grade I meningioma subtypes, providing a valuable tool for neurosurgical decision-making.
Glioblastoma multiforme (GBM) remains an aggressive brain malignancy with dismal prognosis despite current standard-of-care therapies. The gastrin-releasing peptide receptor (GRPR) is overexpressed in gliomas and represents a potential therapeutic target. However, systemic radionuclide delivery is limited by poor tumor penetration and off-target toxicity. GRPR expression and prognostic relevance were analyzed using Chinese Glioma Genome Atlas and a clinical-trial dataset, respectively at the transcriptomic and protein levels. [177Lu]Lu-RM26, a lutetium-177-labeled GRPR-targeting antagonist, was evaluated in vitro, and administered intratumorally via convection-enhanced delivery in an orthotopic GL261Fluc+ glioblastoma model. Pharmacokinetic characteristics, including tumor retention and biodistribution, were evaluated by serial single-photon emission computed tomography and gamma-counting. Efficacy was assessed by tumor volume, bioluminescence signal, and overall survival. Safety was evaluated through body weight monitoring, neurological scoring, rotarod testing, hematology, and immunohistochemical staining. Mechanistic insights were obtained via bulk RNA-sequencing and Western blotting. Higher GRPR expression correlated with poorer-prognosis glioma subtypes and reduced survival. In vitro assays showed dose-dependent inhibition of GL261Fluc+ cell viability, proliferation, and invasion. Locoregional [177Lu]Lu-RM26 administration led to prolonged tumor retention (74.7 h), high absorbed dose (2.71 × 106 mGy·MBq- 1), and minimal off-target uptake. Treated mice exhibited marked tumor growth inhibition, reduced bioluminescence signal, and extended survival compared to controls. No significant short-term systemic toxicity or neurological impairment was observed. Transcriptome and Western blotting findings were consistent with DNA replication stalling and G2/M arrest. Locoregional [177Lu]Lu-RM26 therapy enables sustained, tumor-specific β-radiation with minimal systemic exposure, representing a promising locoregional strategy for GRPR-positive GBM.
Cerebral venous sinus thrombosis (CVST) is a rare but potentially fatal neurological emergency during pregnancy and the puerperium. Data on its prognosis in early pregnancy and the risk of recurrence in subsequent pregnancies remain limited, particularly in Chinese populations. This study aimed to identify risk factors associated with the occurrence and prognosis of pregnancy-associated CVST and to evaluate the outcomes of subsequent pregnancies in affected women. We conducted a retrospective case-control study at a tertiary referral center in China from January 2010 to June 2024. The study included 20 consecutive pregnant or postpartum women diagnosed with CVST and 198 controls without CVST. Clinical characteristics, laboratory indicators, neuroimaging findings, and treatment outcomes were compared between groups. Surviving patients were followed up for a median of 90.6 months to assess subsequent pregnancy rates and CVST recurrence. Of the 20 CVST patients, 7 (35.0%) occurred during early pregnancy and 13 (65.0%) in the postpartum period. The early pregnancy group had higher rates of intracerebral hemorrhage (85.71% vs. 7.69%), cerebral infarction (57.14% vs. 30.77%), and mortality (42.86% vs. 7.69%) compared with the postpartum group. Lower apolipoprotein A1 (APO-A1) levels were associated with CVST occurrence (OR = 0.005, 95% CI: 0.000-0.158, p = 0.003). During follow-up, 3 of 16 surviving patients (18.75%) had subsequent pregnancies, and no CVST recurrence was observed. Early pregnancy CVST is associated with a more severe clinical course and higher mortality than postpartum CVST, warranting vigilant monitoring. Lower APO-A1 levels may serve as an associative marker for CVST risk. Based on our limited data, a prior history of CVST may not be an absolute contraindication to future pregnancy, though individual risk assessment and multidisciplinary management are essential.
Intracranial pressure (ICP) monitoring is an essential component of severe traumatic brain injury (sTBI) care. This study aimed to assess the current utilization of ICP monitoring among Chinese neurosurgeons, identify barriers to its implementation, and explore potential strategies to promote its broader adoption in the management of sTBI. We conducted a nationwide, cross-sectional, web-based survey in September 2025, targeting neurosurgeons who managed patients with sTBI. It comprised five domains: (1) Hospital characteristics (level, neurosurgery and intensive care units (ICU) capacity, ICP equipment availability); (2) Professional background (title, experience, subspecialty); (3) ICP monitoring practice (surgical and non-surgical cases); (4) Barriers and resource constraints; and (5) Training needs and preferences. Data were analyzed descriptively using frequency distributions and proportions. A total of 292 valid responses from 29 provinces were included. ICP equipment was fully sufficient in 57% of respondents, partially sufficient in 34% of respondents. Scenario-specific barriers prominently included Diagnosis Related Groups (DRG)/Big Data Diagnosis-Intervention Packet (DIP) constraints (88%). Only 36% received structured procedural training before first independent ICP insertion. Among those favoring probe-based monitoring (88%), ventricular placement was preferred (68%). Infection and tract hemorrhage ranked as the leading complications of concern. Interest in capacity building prioritized proctorship and high-fidelity simulation, with top content needs in standardized operative technique (87%), dynamic data interpretation (71%), and complication. The implementation of ICP monitoring in China is low and uneven, not only due to shortages of funds and resources but also due to cross-cutting barriers such as insufficient training.
Therapeutic HPV vaccines (TxVs) may complement existing cervical cancer prevention strategies, particularly for women already infected with HPV who derive limited benefit from prophylactic vaccination. As China advances toward the WHO 90-70-90 cervical cancer elimination targets, understanding the potential health impact of therapeutic vaccines under varying implementation scenarios is critical. We developed a two-stage hybrid model combining a dynamic HPV transmission model with a natural history model of HPV-related disease progression to project the long-term health impact of therapeutic HPV vaccines in China from 2025 to 2125. Two vaccine types aligned with WHO Preferred Product Characteristics were evaluated: one targeting HPV infection clearance (TxV1) and one targeting treatment of cervical intraepithelial neoplasia (CIN) grade 2 or 3 (TxV2). Vaccination was modelled under two use cases: population-based delivery and integration into existing national screening programmes. Outcomes included cervical cancer cases and deaths averted, relative reductions compared with no therapeutic vaccination, age-standardised incidence, and the projected year of elimination. One-way and probabilistic sensitivity analyses evaluate model uncertainty. In the base case, screening-integrated TxV1 (Use Case 2) could avert up to 834.0 thousand cervical cancer cases (12.7% reduction) and accelerate elimination by 11 years, while population-based TxV1 could avert 169.6-474.0 thousand cases (2.6-7.2% reduction). TxV2 showed more modest effects (2.4-7.4% reduction) and was highly sensitive to conventional CIN treatment coverage. Therapeutic vaccine impact was greater in scenarios with limited scale-up of prophylactic vaccination. Vaccine efficacy, coverage, genotype spectrum, and rollout timing were key drivers of impact. Therapeutic HPV vaccines with substantial efficacy could reduce the cervical cancer burden in China, particularly during the transition toward full-scale prophylactic vaccination and screening. These findings support continued investment in therapeutic HPV vaccine development and provide evidence to inform national strategy planning aligned with elimination goals.