Background: Radiotherapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) and may cause radiation-induced brain injury (RI). Treatment for RI remains a challenge. We conducted this study to investigate the indications of neurosurgery, operation time and prognosis of patients with RI after NPC radiotherapy who underwent neurosurgical management. Methods: This was a follow-up study between January 2005 and July 2011. Fifteen NPC cases of RI who underwent neurosurgery were collected. Brain Magnetic resonance imaging (MRI), surgery and histology were studied. The outcome was assessed by LENT/SOMA scales and modified Rankin scale. Results: Brain lesion resection (86.7%) was more common than decompressive craniotomy (13.3%). According to LENT/SOMA scale before and six months after surgery, 13 of 15, 12 of 15, 14 of 15, and 14 of 15 cases showed improvement at subjective, objective, management and analytic domains, respectively. 12 of 15 patients showed improvement of modified Rankin scale after surgery. Three patients who underwent emergency surgery showed significant improvement (average score increment of 2, 2.7, 2.7, 3 and 2 at LENT/SOMA scale subjective, objective, management, analytic, and modified Rankin scale, respectively), as compared with 12 cases underwent elective surgery (average score increment of 1, 1, 1.4, 1.8 and 1 at LENT SOMA scale subjective, objective, management, analytic, and modified Rankin scale, respectively). Conclusions: Neurosurgery, including brain necrotic tissue resection and decompressive craniotomy, improves the prognosis for RI patients, especially for those with indications of emergency surgery.

Background Clinical evidence of the potential influence of stress hyperglycemia ratio (SHR) for patients with large ischemic stroke whether or not receiving endovascular therapy is not clear. Methods This study was a subanalysis of a prospective, multicenter registry, and included 745 patients with large ischemic stroke across 38 centers in China. A total of 427 patients were included in this study, with 285 received endovascular therapy (EVT) and 142 received standard medical therapy (SMT). SHR was defined as glucose (mmol/L)/(1.59 × HbA1C)–2.59. The primary outcome was a moderate neurological outcome (modified Rankin Scale (mRS) score ≤3) at 90 days. Results A significant interaction was observed between SHR and whether received EVT (p=0.017). Among patients who received EVT (adjusted OR (aOR) 0.46; 95% CI 0.23 to 0.92; p=0.029), patients in the highest tertile of SHR were significantly less likely to achieve a moderate neurological outcome at 90 days compared with those in the lowest tertile. However, this association was not observed in patients receiving SMT (aOR 2.46; 95% CI 0.74 to 8.21; p=0.142). EVT patients with higher SHR had a significantly higher incidence of symptomatic intracranial hemorrhage compared with lower SHR (aOR 3.29; 95% CI 1.08 to 10.06; p=0.036), while such an association was not observed in the SMT group (aOR 1.52; 95% CI 0.56 to 4.12; p=0.410). Conclusions In patients with large ischemic stroke treated with EVT, SHR is associated with a reduced likelihood of achieving a moderate neurological outcome, as well as an increased risk of symptomatic intracranial hemorrhage. Trial registration number ChiCTR2100051664.

Background: The effectiveness and safety of endovascular treatment ( EVT ) compared with standard medical treatment ( SMT ) for acute basilar artery occlusion in patients with National Institutes of Health Stroke Scale ( NIHSS ) scores ≤10 remain unclear. This study aimed to investigate the effectiveness and safety of EVT versus SMT in patients with acute basilar artery occlusion with NIHSS scores ≤10. Methods: Patients with acute basilar artery occlusion and NIHSS scores ≤10 included in this study were derived from a nationwide prospective registry in China. Patients were divided into the EVT and SMT groups. The primary outcome was the distribution of modified Rankin Scale score at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage within 48 hours. Results: Among 106 patients, 78 (73.6%) received EVT. The median age was 64 (interquartile range, 59–71) years, and 23 (21.7%) were women. Compared with SMT, EVT was associated with a favorable shift in the distribution of modified Rankin Scale score at 90 days (adjusted odds ratio, 6.22 [95% CI, 2.31–16.73]) and lower 90‐day death (adjusted odds ratio, 0.23 [95% CI, 0.06–0.88]). There was no significant difference in the incidence of symptomatic intracerebral hemorrhage within 48 hours between the 2 groups. At 1‐year follow‐up, functional outcomes continued to favor EVT over SMT. In both groups, as the baseline NIHSS score increased, the probability of achieving favorable outcomes progressively decreased, while the probability of death increased. Conclusions: In patients with acute basilar artery occlusion and NIHSS scores of ≤10, EVT was associated with better functional outcomes and lower mortality rate.

Background: Endovascular treatment (EVT) achieves high rates of recanalization in acute large‐vessel occlusion (LVO) stroke, but functional recovery remains heterogeneous. While symptomatic intracranial hemorrhage ( sICH ) has been well studied, the prognostic impact of asymptomatic intracranial hemorrhage ( aICH ) after EVT is less certain. Methods: We performed a pooled analysis of individual patient data from three randomized clinical trials ( DEVT , RESCUE BT , MARVEL ). Patients with anterior circulation LVO treated with EVT within 24 h were included. Hemorrhagic events were adjudicated by a blinded core laboratory using the modified Heidelberg Bleeding Classification. The primary outcome was 90‐day modified Rankin Scale ( mRS ) distribution. Analyses included multivariable ordinal logistic regression, propensity score matching ( PSM ), and inverse probability of treatment weighting ( IPTW ). Exploratory analyses used LASSO ‐based selection to develop a risk model for a composite endpoint of aICH with poor outcome ( mRS ≥ 4). Results: Among 2562 eligible patients, 721 (28.1%) developed aICH , the median age was 68 years ( IQR , 58–76), and 57% were women. aICH was significantly associated with worse functional outcomes (adjusted odds ratio, 0.51; 95% CI , 0.44–0.60) and higher mortality (adjusted odds ratio, 1.64; 95% CI , 1.28–2.0). These associations were consistent across analytic methods and subgroups. Parenchymal hematoma carried the greatest prognostic burden. Older age, higher baseline NIHSS scores, lower baseline ASPECTS , elevated admission glucose, and unsuccessful reperfusion are independently associated with aICH combined with poor prognosis. Conclusions: AICH after EVT is independently associated with poorer functional recovery and higher mortality, highlighting its clinical significance beyond radiological detection. Trial Registration: ChiCTR.org.cn Identifier: ChiCTR‐IOR‐17013568; ChiCTR‐IOR‐17014167; ChiCTR2100051729

Background The optimal anesthetic method for endovascular therapy in acute large core stroke remains unclear. This study aimed to evaluate the impact of anesthetic methods on outcomes in patients with large core stroke. Methods This study was a subanalysis of a prospective, multicenter registry at 38 stroke centers in China. Patients with large core stroke, defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 0–5 within 24 hours of witnessed symptom onset, were analyzed. The primary outcome was favorable functional outcome (modified Rankin Scale score 0–3) at 90 days. Results 484 eligible patients were included in this analysis. General anesthesia (GA) was used in 84 patients (17.4%), while non-general anesthesia (non-GA) was used in 400 patients (82.6%). Non-GA was comparable to GA in the primary outcome (37.8% vs 32.1%; adjusted odds ratio (aOR) 1.07, 95% confidence interval (95% CI) 0.60 to 1.91, P=0.83). Mortality at 90 days was 40% in the non-GA and 52.4% in the GA (aOR 0.71, 95% CI 0.41 to 1.22, P=0.21). The proportion of symptomatic intracranial hemorrhage at 48 hours was 13.8% in the non-GA and 11.9% in the GA (aOR 1.25, 95% CI 0.62 to 2.77, P=0.56). The results remained consistent in the propensity score-matched cohort and inverse probability of treatment weighting cohort. Conclusion In this cohort study of patients with large core stroke, no significant differences were found in functional and safety outcomes between non-GA and GA.