Background: Subarachnoid hemorrhage (SAH) is a severe stroke subtype that lacks effective treatment. Exosomes derived from human dental pulp stem cells (DPSCs) are a promising acellular therapeutic strategy for neurological diseases. However, the therapeutic effects of DPSC-derived exosomes (DPSC-Exos) on SAH remain unknown. In this study, we investigated the therapeutic effects and mechanisms of action of DPSC-Exos in SAH. Materials and methods: SAH was established using 120 male Sprague-Dawley rats. One hour after SAH induction, DPSC-Exos were administered via tail vein injection. To investigate the effect of DPSC-Exos, SAH grading, short-term and long-term neurobehavioral assessments, brain water content, western blot (WB), immunofluorescence staining, Nissl staining, and HE staining were performed. The role of miR-197-3p/FOXO3 in regulating pyroptosis was demonstrated through miRNA sequencing, bioinformatics analysis, and rescue experiments. The SAH model in vitro was established by stimulating BV2 cells with hemoglobin (Hb) and the underlying mechanism of DPSC-Exos was investigated through WB and Hoechst/PI staining. Results: The expressions of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) were increased after SAH. DPSC-Exos alleviated brain edema and neuroinflammation by inhibiting the expression of FOXO3 and reducing NLRP3 inflammasome activation, leading to improved neurobehavioral functions at 24 h after SAH. In vitro, the expression of the NLRP3 inflammasome components (NLRP3 and caspase1-p20), GSDMD-N, and IL-18 was inhibited in BV2 cells pretreated with DPSC-Exos. Importantly, DPSC-Exos overexpressing miR-197-3p had a more obvious protective effect than those from NC-transfected DPSCs, while those from DPSCs transfected with the miR-197-3p inhibitor had a weaker protective effect. Functional studies indicated that miR-197-3p bound to the 3ʹ-untranslated region of FOXO3, inhibiting its transcription. Furthermore, the overexpression of FOXO3 reversed the protective effects of miR-197-3p. Conclusions: DPSC-Exos inhibited activation of the NLRP3 inflammasome and related cytokine release via the miR-197-3p/FOXO3 pathway, alleviated neuroinflammation, and inhibited microglial pyroptosis. These findings suggest that using DPSC-Exos is a promising therapeutic strategy for SAH. Graphical

Background: Microvascular decompression (MVD) is already the preferred surgical treatment for medically refractory neurovascular compression syndromes (NVC) such as hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). Endoscopy has significantly advanced surgery and provides enhanced visualization of MVD. The aim of this study is to analyze the efficacy and safety of fully endoscopic microvascular decompression (E-MVD) for the treatment of HFS, TN, and GPN, as well as to present our initial experience. Materials and methods: This retrospective case series investigated fully E-MVD performed in 248 patients (123 patients with HFS, 115 patients with TN, and 10 patients with GPN ) from December 2008 to October 2021 at a single institution. The operation duration, clinical outcomes, responsible vessels, intra- and postoperative complications, and recurrences were recorded. Preoperative and immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Shorr grading and Barrow Neurological Institute (BNI) pain score were used to evaluate clinical outcomes. The efficacy, safety, and risk factors related to the recurrence of the operation were retrospectively analysed, and the surgical techniques of fully E-MVD were summarised. Results: A total of 248 patients (103 males) met the inclusion criteria and underwent fully E-MVD were retrospectively studied. The effective rate of 123 patients with HFS was 99.1%, of which 113 cases were completely relieved and 9 cases were significantly relieved. The effective rate of 115 patients with TN was 98.9%, of which 105 cases had completely pain relieved after surgery, 5 cases had significant pain relieved, 4 cases had partial pain relieved but still needed to be controlled by medication. The effective rate of 10 patients with GPN was 100%, 10 cases of GPN were completely relieved after surgery. As for complications, temporary facial numbness occurred in 4 cases, temporary hearing loss in 5 cases, dizziness with frequent nausea and vomiting in 8 cases, headache in 12 cases, and no cerebral hemorrhage, intracranial infection, and other complications occurred. Follow-up ranged from 3 to 42 months, with a mean of 18.6 ± 3.3 months. There were 4 cases of recurrence of HFS and 11 cases of recurrence of TN. The other effective patients had no recurrence or worsening of postoperative symptoms. The cerebellopontine angle (CPA) area ratio (healthy/affected side), the length of disease duration, and the type of responsible vessels are the risk factors related to the recurrence of HFS, TN, and GPN treated by fully E-MVD. Conclusions: In this retrospective study, our results suggest that the fully E-MVD for the treatment of NVC such as HFS, TN, and GPN, is a safe and effective surgical method. Fully E-MVD for the treatment of NVC has advantages and techniques not available with microscopic MVD, which may reduce the incidence of surgical complications while improving the curative effect and reducing the recurrence rate.

Background: A clinical trial proved the clinical effectiveness of perfusion imaging-guided intravenous thrombolysis with alteplase for patients with acute ischemic stroke (AIS) with the time of onset between 4.5 and 9 hours. This study aimed to assess the lifetime cost-effectiveness of alteplase versus placebo from the perspective of Chinese and United States (US) healthcare payers.Methods: A decision-analytic model was built to estimate lifetime costs and quality-adjusted life-years (QALYs) associated with alteplase or placebo. Model inputs were extracted from published sources. Incremental costs, incremental QALYs, and incremental cost-effectiveness ratio (ICER) were calculated to evaluate the base-case scenario. One-way and probabilistic sensitivity analysis were performed to evaluate uncertainty in the results.Results: In China, alteplase yielded an additional lifetime QALY of 0.126 with an additional cost of Chinese Yuan (¥) ¥9552 compared with placebo, and the ICER was ¥83 950 (US$12 157)/QALY. In the US, alteplase had a higher QALY (difference: 0.193) with a lower cost (difference: US$−2024) compared with placebo. In probabilistic sensitivity analyses, alteplase had a 42.54% to 78.3% probability of being cost-effective compared with placebo in China when the willingness-to-pay (WTP) threshold ranged from ¥72 447/QALY to ¥217 341/QALY. In the US, alteplase had a 93.47% to 93.57% probability of being cost-effective under the WTP threshold of US$100 000/QALY to US$150 000/QALY. These findings remained robust under one-way sensitivity analysis.Conclusion: For patients with AIS with a time of onset between 4.5 and 9 hours, perfusion imaging-guided intravenous alteplase was likely to be cost-effective in China and was cost-effective in the US when compared with placebo.

Spontaneous intracerebral hemorrhage (sICH) is a severe cerebrovascular disease with high mortality and disability. And its treatment strategies have always been a hotspot in clinical research. Endoscopic surgery (ES) is widely used for treating sICH. A comprehensive review of ES for sICH is warranted to provide better understanding and guidance for clinicians. We provide an updated overview of the surgical equipment, surgical indications and timing, and technical advancements, as well as therapeutic effects and future directions. A narrative review of current literature in ES for sICH was performed based on publications from the databases of PubMed, Scopus, and Google Scholar databases up to December 2023. ES has shown promising safety and efficacy, emerging as a favorable minimally invasive alternative to conventional craniotomy. It reduces perioperative risks associated with long procedures and significant intraoperative bleeding. Recent advancements in ES techniques have led to superior outcomes in mortality reduction and functional recovery. Scholars' systematic studies and summaries underscore ES's role in improving long-term outcomes for sICH patients. However, its limitations, including reduced depth perception, difficulty in managing deep hematomas, and reduced ability to control rapid bleeding control, should be noted. ES represents a significant advancement in the treatment of sICH. Its minimally invasive features, coupled with continuous methodological refinement, contribute to a lower mortality rate and better functional recovery compared to traditional methods. ES should be considered a significant option in the surgical management of sICH, necessitating further research and standardization to enhance patient care and outcomes.

Full-endoscopic microvascular decompression (fE-MVD) is an emerging treatment option for trigeminal neuralgia (TN). However, the risk factors associated with postoperative recurrence of TN after fE-MVD procedure remain controversial. The aim of the present study was to summarize the surgical technique of fE-MVD for the treatment of TN and to develop a predictive model for recurrence at 1 year postoperatively based on independent risk factors. A total of 124 consecutive patients with TN who underwent fE-MVD procedure were enrolled in this study between December 2008 and July 2022. Imaging data such as the area of cerebellopontine angle (CPA), the length of trigeminal cisternal segment, and the angle of trigeminal nerve (TGN) were measured from preoperative magnetic resonance imaging (MRI). Patients were randomly divided into a training set and a validation set according to the 7:3 ratio, respectively. Variables that were significant in the univariate logistic analyses were, subsequently, included in the multivariate logistic regression analyses in training set. Then, we developed a predictive nomogram for the 1-year recurrence of TN for patients who treated with fE-MVD. All 124 patients experienced clinically significant pain relief (Barrow Neurology Institute (BNI) I–II) after fE-MVD. 124 patients had a follow-up time of more than 1 year, with 14 cases of recurrence. In the univariate analysis, the patients’ responsible vessels of non-arterial, clinical features of atypical, and CPA area ratio (healthy/affected side) >1 were found to be significantly associated with recurrence of TN after fE-MVD. Multivariate logistic regression analyses result showed that the patients' responsible vessels of non-arterial (odds ratio (OR) = 21.067, 95% confidence interval (CI): 1.942–228.575), clinical features of atypical (OR = 9.027, 95% CI: 1.135–71.777), and CPA area ratio >1 (OR = 19.522, 95% CI: 2.906–131.160) were independent predictors of TN recurrence. Based on the independent predictive factors, we developed a predictive nomogram that predicts the 1-year recurrence of TN after fE-MVD. In the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) of the nomograms for 1-year recurrence associated with optimal candidates prediction was 0.910 in the training set and 0.859 in the validation set. FE-MVD for the treatment of TN is a safe, reliable and effective procedure. Patients' responsible vessels of non-arterial, clinical features of atypical, and CPA area ratio (healthy/affected side) >1 are key risk factors associated with 1 year postoperative recurrence of TN after fE-MVD. Finally, we have developed a nomogram to predict the 1-year recurrence of TN for patients who treated with fE-MVD, which can be used to provide advice for patients after fE-MVD.

The objective is to evaluate the surgical outcomes of partial atlas transverse process resection, with or without additional release and perfusion techniques, in the treatment of internal jugular vein stenosis from external compression. A retrospective cohort study was conducted on patients who underwent surgery from January 2020 to September 2022 and had J3 segment stenosis of the internal jugular vein owing to osseous compression. Computed tomographic venography, contrast-enhanced magnetic resonance angiography, and Doppler ultrasonography were incorporated into the preoperative and postoperative evaluations at 1 week and 3 months to measure the diameter of the internal jugular vein and hemodynamic parameters. A visual analog scale was employed to quantify the severity of symptoms. The outcomes of 2 surgical approaches were compared: isolated lateral partial atlas transverse process resection (isolated group, n = 15) and combined resection with release and perfusion techniques (combined group, n = 32). The treatment group exhibited substantially superior outcomes at the 1-week follow-up among 47 patients (mean age 52.53 ± 13.76, including 24 males): In the treatment group, the symptom improvement rate was 62.5% (20 out of 32 patients), while in the control group, it was 20% (3 out of 15 patients). In the treatment group, 84.3% (27 out of 32 patients) of the patients experienced stenosis alleviation, while 46.67% (7 out of 15 patients) of the patients in the control group did. The control group demonstrated improvement in 40.0% (6 out of 15 patients), while the treatment group demonstrated hemodynamic improvement in 75.0% (24 out of 32 patients). All results were statistically significant (P < 0.05). The treatment group (20%) and the control group (12.5%, P = 0.815) were not significantly different in terms of complication rates during the 3-month follow-up. In comparison to isolated osseous decompression, the combined surgical protocol, which incorporates partial atlas transverse process resection, release, and perfusion techniques, exhibits superior anatomical restoration, hemodynamic recovery, and symptom relief, while maintaining comparable safety profiles.