Objective To investigate the changes of non-motor symptoms and quality of life in patients with Parkinson's disease (PD) after bilateral subthalamic nucleus deep brain stimulation (STN-DBS). Methods Questionnaires were conducted among a convenience sample of 45 PD patients who met the indications of STN-DBS in the Functional Neurosurgery Center of Ruijin Hospital,Shanghai JiaoTong University School of Medicine in Shanghai from June 1,2020 to August 31,2020.The Non-motor Symptom Scale (NMSS) and 8-item Parkinson's Disease Questionnaire (PDQ-8) were used to evaluate the patients' non-motor symptoms and quality of life preoperatively and at 3,6,12 and 24-month postoperative visits. Results Generalized estimation equation analysis showed a significant overall change of PDQ-8 and levodopa equivalent daily dose (LEDD) over five follow-up visits ( P＜0.05).Sleep/fatigue,Mood/apathy,Attention/memory,Gastrointestinal,Urinary,Sexual function and Miscellaneous subscores showed a statistically significant decreasing trend ( P＜0.05),while Cardiovascular and Perceptual subscores of NMSS were unchanged ( P>0.05). Conclusion Bilateral STN-DBS has a long-term benefit on sleep/fatigue and urinary symptoms and a short-term benefit on Sleep/fatigue,Mood/apathy,Attention/memory,Gastrointestinal,Urinary,Sexual function and Miscellaneous symptoms in PD patients.Moreover,it can reduce the medication intake and improve the patients' quality of life.

Objective To study the distribution characteristics of cerebral blood vessels in mice and the spatial relationship with adjacent nerve cells using fast three-dimensional microscopic imaging technology. Methods The adult Tie2-Cre::Ai9 hybrid transgenicmice(C57BL/6) with fluorescent protein labeled vascular endothelial cells were perfused with 4% paraformaldehyde in the heart to obtain complete brain tissue,clearing tissue,andstained the nerve cells of the whole brain.The rapid three-dimensional imaging system (VISoR) was used to obtain the microscopic images of the whole brain vessels and nerve cells in mice with 1×1×3.5 μm ³ voxel resolution,and the two-dimensional image sequence was reconstructed into a three-dimensional whole brain image.Part of cortex,hippocampus and thalamus were selected to segment and extract blood vessels and analyze their morphological characteristics;Automatically identify nerve cells and quantitatively analyze the distribution characteristics of the distance between nerve cells and the nearest blood vessels. Results The three-dimensional images of the distribution of blood vessels and nerve cells in the whole brain of mice were successfully collected.The whole brain view of C57BL/6 mouse's complex vascular network was provided through high-resolution brain atlas.The analysis showed that the density of bifurcation points and the volume fraction of blood vessels in hippocampus were smaller than those in cortex and thalamus,and the difference was statistically significant.The staining of neurons with Nissl stain showed that there were differences in the distribution of blood vessels and nerve cells in different brain regions.In the regions of interest of different brain regions,the distance between neurons and blood vessels was counted,and the results were statistically different. Conclusion The whole brain vessels and neurons of mice can be imaged by fast 3D microscopic imaging technology.Through the quantitative analysis of regional blood vessels and nerves,it was found that there were regional distribution characteristics between blood vessels and nerves in mice.

Objective To investigate the important factors affecting the early prognosis of patients over 75 years old after embolization of ruptured intracranial aneurysm. Methods A retrospective collection of 78 patients with intracranial aneurysm who were admitted to the Department of Neurosurgery of Xiamen Third Hospital from January 2016 to January 2022,all cases were over 75 years old,and relevant clinical data of embolization treatment,including gender,Weight,smoking history,hypertension,diabetes,hyperlipidemia,atrial fibrillation,cerebrovascular disease history,aneurysm location,Hunt-Hess classification,WFNSS classification,CT Fisher classification,etc.The prognosis results were divided into a good outcome group (mRS grade I-II) and a poor outcome group (mRS grade III-V) using the modified Rankin scale (mRS) scale.Statistical analysis of clinical data,screening of independent risk factors that affect the poor prognosis of patients. Results Tatistical univariate analysis showed that,compared with the good prognosis group,the higher the GCS grade,WFNSS grade and Hunt-Hess grade of the poor prognosis group,the worse the relative prognosis,and the difference was statistically significant ( P＜0.05).Logistic regression analysis showed that GCS classification (OR=1.024,95%CI:0.214~4.914, P=0.976),WFNSS classification (OR=9.021,95%CI:2.557~31.824, P=0.001) and Hunt-Hess classification (OR=6.848,95%CI:1.435~32.682, P=0.016) was a prognostic factor.ROC curve analysis showed that the combination of Hunt-Hess classification and WFNSS classification could be used as an important influencing factor for neurological recovery (AUC=0.855),When taking the best cut-off point,the sensitivity was 89.6% and the specificity was 70.0%. Conclusion For the short-term prognosis of ruptured intracranial aneurysm interventional embolization in people over 75 years old,the combination of Hunt-Hess classification and WFNSS classification is more valuable than other factors.

Objective To observe the effect of 3D-slicer software combined with microscope small bone window operation on hypertensive basal ganglia intracerebral hemorrhage. Methods The clinical data of 66 patients with hypertensive basal ganglia intracerebral hemorrhage treated in our hospital from August 2019 to August 2021 were analyzed retrospectively.According to the treatment plan,they were divided into 3D-slicer software combined with microscope group small bone window operation group(observation group n=35) and microscope small bone window operation group(control group n=31).According to the analysis of the results,the operation time,intraoperative bleed loss,incidence of postoperative complications,hematoma clearance rate,length of hospital stay and GOS,GCS and ADL scores 90 days after operation were compared between the two groups. Results The operation time,intraoperative blood loss,length of hospital stay and incidence of postoperative complications in observation group were significantly lower than those in control group ( P<0.05).The hematoma clearance rate of observation groupwas better than thatincontrol group ( P<0.05);90 days after operation,the GOS,GCS and ADLscores of observation group were better than those incontrol group ( P<0.05). Conclusion 3D-slicer software can better help locate the hematoma,clarify the blood vessels and nerve conduction bundle around the hematoma,and guide the operation to avoid important blood vessels and nerve conduction bundle.3D-slicer software can help operators find the shortest and optimal surgical path,effectively shorten the operation time,reduce the amount of intraoperative bleeding,reduce the length of hospital stay,reduce the incidence of postoperative complications,Improve the prognosis 90 days after operation,improve the clinical prognosis,and better restore self-care.

Objective Analyzing the relationship between the ratio of preoperative infarcted brain tissue volume to whole brain volume and the prognosis of patients with cerebral infarction after decompressive craniectomy,to explore the risk factors of the poor outcomes after decompressive craniectomy due to cerebral infarction based on this neuroiaging study. Methods The patients admitted to the department of neurosurgery,the first affiliated hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from January 2019 to September 2022 who underwent decompressive craniectomy for massive cerebral infarction in the cerebral hemisphere were selected,the clinical data were retrospectively analyzed,the cranial CT imaging data before and after surgery were reconstructed and analyzed using 3D Slicer software,with the aim of further exploring the risk factors of decompressive craniectomy for cerebral infarction from neuroimaging study. Results Forty-two clinical cases of massive cerebral infarction undergoing decompressive craniectomy were finally enrolled,including 23 males and 19 females;the age ranged from 36 to 68 years,with an average age of 56.21±8.57 years;the GCS score ranged from 5 to15 points,with an average age of 10.55±3.19 points,the time from emerging symptoms to operation is between 3 and 1440 hours,with an average time of 121.48±230.77 hours.The patients were divided into survival group (30 cases) and death group (12 cases) according to the survival condition one month after operation.The differences between groups were statistically significant ( P＜0.05) for preoperative infarcted brain tissue volume( t=-2.260, P=0.029),the whole brain volume before surgery( t=2.660, P=0.011),the ratio of preoperative infarcted brain tissue volume to whole brain volume( t=-3.724, P=0.001),the whole brain volume after surgery( t=-2.464, P=0.018),the ratio of postoperative infarcted brain tissue to whole brain volume(Z=-2.589, P=0.010) and the postoperative midline offset distance( t=-2.484, P=0.017).Dichotomous logistic regression analysis suggested that preoperative whole brain volume and the ratio of preoperative infarcted brain tissue volume to whole brain volume were risk factors for poor prognosis in the short term after decompressive craniectomy. Conclusion The larger ratio of preoperative infarcted brain tissue volume to whole brain volume and smaller preoperative whole brain volume are risk factors for death after decompressive craniectomy due to large cerebral infarction.Therefore,multimodal imaging monitoring is recommended for patients with massive cerebral infarction,and adequate decompression is required to reduce the mortality rate.

Objective The aim of this study was to investigate the differences in clinical response and imaging data before and after surgery in patients with Parkinson's disease and to attempt to predict clinical response using connectivity differences. Methods Connectivity analysis was performed on resting-state functional magnetic resonance imaging (rs-MRI) of 41 patients with Parkinson's disease who underwent deep brain stimulation,and the subcortical connectivity network was calculated,evaluated before and one year after surgery on the UPDRSIII scale,correlated with the above-mentioned brain connectivity network,and predicted clinical motor symptoms,and predictive performance was discussed based on actual clinical improvement. Results Functional connectivity (FC) between the subcortical nuclei of interest and the DBS response showed that FC from bilateral red nuclei to the shell nuclei correlated with overall changes in UPDRS-III (left: r=-0.44P=0.0056,right r=-0.46p=0.0029, P<0.05 after FDR correction).In addition,FC predicted the change in UPDRSIII 1 year after DBS ( r=0.5P=0.0011 error rate=0.175). Conclusion The functional connectivity between the putamen and the red nucleus can serve as an important predictor of treatment outcomes in PD patients undergoing DBS surgery.

Objective To explore the feasibility and clinical value of three-dimensional reconstruction combined with coordinate positioning method in the clinical practice of neurosurgery. Methods A total of 40 patients with neurosurgery in our hospital from March 1st to August 30th,2022,who underwent 3D reconstruction combined with coordinate positioning method were selected,including 30 cases of intracranial hematoma,6 cases of intracranial space-occupying lesions,and microvascular decompression.2 cases,2 cases of spinal tumor,analyze its value in actual clinical application. Results All patients had complete relevant imaging examinations and preoperative multi-modal image 3D reconstruction before operation.Coordinate localization method was used to locate the lesions before operation.The preoperative localization time was short and the localization was accurate. Conclusion Three-dimensional reconstruction combined with coordinate positioning method can accurately locate intracranial lesions,and combined with three-dimensional reconstruction technology can help to improve the surgical effect and reduce the occurrence of postoperative complications.

Objective Exploring the therapeutic effects,imaging,and therapeutic mechanisms of a rechargeable and remotely programmable 3.0T MRI compatible deep brain stimulation system in patients with Parkinson's disease after subthalamic nucleus stimulation surgery. Methods Analyze the clinical data of one Parkinson's patient treated with the world's first rechargeable and remote 3.0T MRI compatible deep brain stimulation system at the Neurosurgery Department of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) on October 10,2022.Follow up data for one year will be analyzed.3.0T cranial magnetic resonance imaging was performed 1 week and 1 year postoperatively to evaluate clinical symptoms,magnetic resonance imaging,and stability of electrode impedance. Results From 4 weeks after surgery to 1 year of follow-up,the improvement rates of exercise (UPDRS-III and UPDRS-IV were 95.31% and 75.00%,respectively) and non exercise symptoms (NMSS,PDSS,PDQ39,MoCA,HAMA,HAMD,CCS improvement rates were 85.42%,24.53%,91.23%,7.14%,84.61%,100.00%,57.14%,respectively) were significantly improved,and the dosage of medication was reduced (LED decreased by 34.61%),with stable stimulation parameters.3.0T magnetic resonance imaging examination (T1,T2,3DT1,DTI,rs fMRI) showed normal imaging,and the structural image could clearly display the position of electrodes and nuclei.Functional magnetic resonance imaging indicated increased local neuronal activity and enhanced brain functional connectivity in the turned on state.The electrode impedance during the inspection process is stable and no adverse events have occurred. Conclusion The application of 3.0T MRI compatible deep brain stimulation equipment in the surgical treatment of Parkinson's disease patients has a definite effect,while improving the accuracy of postoperative imaging evaluation.It is of great value for exploring the imaging mechanism of deep brain stimulation treatment for Parkinson's disease.

Objective To investigate the influences of stereotactic puncture drainage treatment and conservative treatment in clinical prognoses of patients with spontaneous intracerebral hematoma in the basal ganglia. Methods A retrospective analysis of Sixty-five patients with spontaneous basal ganglia cerebral hemorrhage(Glasgow comascale(GCS)>8 scores and hemorrhage volume 20 ml to 40 ml) admitted to our department from January 2019 to December 2021.All patients were divided into surgical group (accepted stereotactic puncture drainage with thrombolysis treatment, n=32) and conservative treatment group ( n=33).The data during hospitalization and 12 months follow-up data of patients from the 2 groups were compared.The baseline general data,average hospitalization time,complications,Glasgow outcome scale (GOS) scores,modified Rankin scale (mRS) scores and modified Barthel index (MBI)were compared after treatment. Results There were no significant differences in age,gender,volume of bleeding and hypertension related factors between the 2 groups ( P＞0.05).There were no significant differences in GCS on admission,one week after admission and discharge between the 2 groups ( P＞0.05).The hematoma clearance rate at 1 week after admission was 87.18±4.49%,average hospitalization time was (12.13±1.75)d and the rate of pulmonary infection on admission was 25% (8/32) on admission in surgical group and that in conservative treatment group with hematoma clearance rate was 25.75±3.04%,average hospitalization day was(16.97±1.64)d and the rate of pulmonary infection on admission was 48.5%(16/33),the differences between the 2 groups were statistically significant ( P＜0.05).There were significant differences in GOS scores,mRS scores and MBI between the 2 groups in the four follow-up of 1 month,3 months,6 months and 12 months afte treatment( P＜ 0.05). Conclusion The overall efficacy of stereotactic puncture drainage with thrombolysis has more obvious advantages in patients with cerebral hemorrhage volume of 20 ml to 40ml in the basal ganglia and GCS>8 scores than conservative treatment.

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

Objective To investigate the therapeutic effect of Globus pallidus internus-Deep brain stimulation (GPi-DBS) in the treatment of segmental craniocervical dystonia (SCCD) non-motor symptoms (NMS) and the improvement of quality of life (QoL). Methods A total of 16 patients undergoing GPi-DBS surgery for SCCD from March 2020 to June 2021 were collected and assessed for motor symptoms,non-motor symptoms,depression,anxiety and quality of life using the BFMDRS scale,DNMSQuest questionnaire,HAM-D scale,HAM-A scale and CDQ-24 questionnaire before surgery and at the 1st,3rd,6th,12th and 18th months after postoperative onset.Pre-operative and post-operative patients were analyzed for differences,and NMS was correlated with QoL. Results Patients had a significant reduction in NMS and improvement in QoL after surgery compared to the preoperative period ( P<0.05).The patients showed a significant correlation between each NMS and QoL ( P<0.01). Conclusion GPi-DBS was effective in treating NMS in SCCD,and QoL could be significantly improved,and NMS was significantly correlated with QoL.

Objective To evaluate the effect of neuroendoscopic surgery on patients with intraventricular hemorrhage. Methods A total of 60 patients with intraventricular hemorrhage admitted to our hospital from January 2020 to September 2021 were selected as the research objects and divided into the control group (30 cases) and the observation group (30 cases) by random number table method.The control group was treated with external ventricular drainage,and the observation group was treated with neuroendoscopic surgery on the basis of the control group.The patients in both groups were observed until discharge,and were followed up for 6 months.The perioperative indicators,complications during hospitalization and prognosis during follow-up were statistically analyzed.Intracranial pressure before surgery and 1,3 and 7 d after surgery,level of serum inflammatory factor before surgery and 3 and 7 d after surgery,and neurological function before surgery and 7,15 and 30 d after surgery were compared between the two groups. Results The surgery time,cerebrospinal fluid recovery time,drainage tube placement time and hospital stay in the observation group were shorter than those in the control group,the residual volume of hematoma at 1 d after surgery was lower than that in the control group( P＜0.05),and the proportion of patients with hematoma clearance rate >90% (36.67%) was higher than that in the control group (6.67%).The proportion of patients with hematoma clearance rate <60% (10.00%) was lower than that of the control group (60.00%, P＜0.05).Before surgery and at 1,3,7 d after surgery,the intracranial pressure of the two groups gradually decreased,and the difference was statistically significant at different time points ( P＜0.05).At 1,3,7 d after surgery,the intracranial pressure of the observation group was lower than that of the control group ( P＜0.05).The serum levels of high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) in the two groups were gradually decreased before surgery and 3 and 7 d after surgery,and the differences were statistically significant at different time points ( P＜0.05).At 3 and 7 d after surgery,the serum levels of hs-CRP,IL-6,TNF-α and PCT in the observation group were lower than those in the control group ( P＜0.05).The score of National Institutes of Health Stroke Scale (NIHSS) of the two groups showed a gradually decreasing trend before surgery and 7,15,and 30 d after surgery,and the differences at different time points were statistically significant ( P＜0.05).The score of NIHSS of the observation group was lower than that of the control group at 7,15 and 30 d after surgery ( P＜0.05).During hospitalization,there was no significant difference in the incidence of total complications between the observation group (6.67%) and the control group (20.00%).After 6 months of follow-up,the good prognosis rate of the observation group (60.00%) was significantly higher than that of the control group (26.67%, P＜0.05). Conclusion Outside the ventricle drainage on the basis of combined neural endoscopic surgery in patients with ventricular hemorrhage,which could effectively shorten the surgery time,improve the clearance of hematoma,reduce the residual amount of hematoma,at the same time the body inflammatory reaction,help improve neurologic patients,promote patients recovery and improve the prognosis of patients,had a good therapeutic effect.