Rationale:Patients with ankylosing spondylitis (AS) are uniquely susceptible to severe cervical spine fractures and spinal epidural hematoma (SEH) following minor trauma, leading to rapid neurological decline. The distinct biomechanical and vascular pathophysiology in AS necessitates tailored surgical management strategies.Patient concerns:A 68-year-old man with a known history of AS presented with acute neck pain and progressive weakness in both lower limbs.Diagnoses:Computed tomography and magnetic resonance imaging revealed a fracture at the C5–7 level, accompanied by an extensive cervical epidural hematoma causing significant spinal cord compression. The diagnoses were cervical spine fracture with incomplete spinal cord injury and traumatic SEH.Interventions:Due to rapid neurological deterioration culminating in grade 0 muscle strength in the lower limbs, urgent surgical intervention was performed. A combined anterior–posterior approach was utilized: anterior C7 subtotal corpectomy with fusion for stabilization, followed by posterior laminectomy for decompression. A novel technique involving gentle evacuation of the hematoma using a specialized dural catheter was employed to restore spinal cord pulsation.Outcomes:Postoperatively, the patient demonstrated significant neurological recovery, achieving grade 4/5 muscle strength in the lower limbs and the ability to walk with a walker. Two-year follow-up confirmed stable instrumentation, normal limb strength, and only transient residual plantar numbness. No major complications such as infection, cerebrospinal fluid leak, or hardware failure occurred.Lessons:Early diagnosis and urgent surgical decompression are critical for neurological recovery in AS patients with cervical fractures and SEH. The combined anterior–posterior approach provides effective decompression and robust stabilization. The technique of limited laminectomy with catheter-assisted hematoma evacuation represents an effective minimally invasive strategy for decompression while preserving posterior spinal integrity.

Retrospective multicenter cohort study. To compare the safety and efficacy of venous thromboembolism prophylaxis (VTE) strategies between two high-volume spine centers with distinct protocols. Postoperative VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a concern following spine surgery. The potential for epidural hematoma and associated neurologic compromise has limited consensus regarding the use of chemoprophylaxis. High-quality comparative data on prophylactic strategies are lacking. Patients undergoing one-to three-level lumbar fusion between 2017 and 2022 were retrospectively identified at two academic spine centers (n=3106). Patients received either mechanical-only prophylaxis or subcutaneous heparin (5,000 units three times daily) plus mechanical prophylaxis according to institutional protocol. Propensity score matching (1:1, caliper width 0.1, no replacement) was performed across demographic, surgical, and comorbidity covariates. Standardized mean differences <0.1 were considered acceptable. After matching, categorical outcomes were compared using chi-square or Fisher's exact tests as appropriate, and continuous variables were compared using two-sample t-tests. Co-primary outcomes were symptomatic epidural hematoma, DVT, and PE. Secondary outcomes included postoperative transfusion and timing of hematoma evacuation. Of 3,106 patients, 1,442 received mechanical-only prophylaxis and 1,664 received combined prophylaxis. The overall incidences of symptomatic epidural hematoma, DVT, and PE were 0.9% (n=29), 0.6% (n=18), and 0.2% (n=5), respectively. After matching, 647 pairs remained. There were no significant differences between prophylaxis groups in epidural hematoma (1.2% vs. 1.5%, P=0.81), DVT (0.2% vs. 0.9%, P=0.12), or PE (0.2% vs. 0.3%, P=1.0). Among patients undergoing one- to three-level lumbar fusion, the addition of subcutaneous heparin to mechanical prophylaxis did not reduce VTE incidence or increase the risk of symptomatic epidural hematoma. Routine chemoprophylaxis may not confer additional benefit in this population. Prognostic Level III.

Background: Acute subdural hematoma (ASDH) of the interhemispheric fissure is frequently experienced but is rarely indicated for surgery. We report a case of ASDH of the interhemispheric fissure that was treated with an endoscopic procedure. Case Description: A 73-year-old woman had undergone craniotomy for subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm and ventriculoperitoneal shunt for hydrocephalus after SAH. On X day, she fell and bruised the back of her head, resulting in weakness of the left upper and lower limbs, and she was brought to the emergency department on X + 1 day. When she came to our hospital, she was found to have left hemiplegia with lower limb dominance. Head computed tomography (CT) scan showed a 2.5 cm thick ASDH on the right side of the posterior half of the interhemispheric fissures. It was thought that paralysis was caused by this lesion, and we decided to perform surgery based on the belief that symptoms would improve if the mass effect could be alleviated. As for the surgical technique, craniotomy and ventriculoperitoneal shunt had been performed in the past; endoscopic evacuation of hematoma was performed with a small craniotomy. The day after surgery, a head CT scan confirmed that the hematoma had been successfully removed to a deep level and the pre-operative left hemiplegia had improved. Two months after surgery, the patient was discharged from the hospital with a modified Rankin Scale 2. Conclusion: We have experienced a case of interhemispheric fissure ASDH that was treated by endoscopic hematoma evacuation. Endoscopic procedure is non-invasive, and good results were achieved.

Background: Postoperative meningitis is a serious complication in neurosurgery. Early diagnosis and appropriate management are essential to reduce its significant morbidity and mortality. Case Description: We report the case of a 76-year-old patient who underwent evacuation of a posterior fossa hematoma. On postoperative day 19, he presented with fever and surgical wound necrosis. Surgical revision revealed a collection fistulized to the skin. Cerebrospinal fluid analysis and intraoperative samples confirmed postoperative meningitis caused by multidrug-resistant Klebsiella pneumoniae , susceptible only to colistin and fosfomycin. Despite treatment adjustment, the patient’s condition worsened, and he died 12 days after surgical revision due to massive pulmonary embolism. Conclusion: This case highlights the severity of postoperative meningitis due to extensively drug-resistant K. pneumoniae and underlines the importance of early diagnosis, bacteriological analysis of surgical samples, and rapid adaptation of antibiotic therapy in specialized settings.

Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in older patients and an important contributor to cognitive decline and recurrent hemorrhagic stroke. Diagnosis of CAA is commonly based on MRI findings interpreted according to established criteria. Recently, the simplified Edinburgh criteria were proposed as a CT-based alternative to detect CAA in patients presenting with lobar ICH, potentially enabling faster diagnosis in emergency settings. The aim of this study was to evaluate the diagnostic accuracy of the simplified Edinburgh criteria in patients undergoing neurosurgical hematoma evacuation using histopathologically proven CAA as reference standard. We conducted a retrospective case-control study including all patients admitted to Hannover Medical School between February 2013 and December 2023 with lobar ICH who underwent hematoma evacuation. During surgery, brain tissue samples were collected and processed by β-amyloid (Aβ) immunohistochemistry and Congo red staining. Samples lacking intact vessel wall architecture were excluded. CAA severity was graded according to the Vonsattel rating. Preoperative cranial CT scans were analyzed by a board-certified neuroradiologist blinded to clinical and histologic information, applying the simplified Edinburgh criteria. Interrater reliability between a neuroradiologist, neurologist, and medical student was also assessed. Overall, 84 patients were included, of whom 58 had biopsy-proven CAA. The median age was 76 years (interquartile range 72-81) in the CAA-positive group and 69 years (interquartile range 54-76.5) in the CAA-negative group; women accounted for 57% and 35%, respectively. Substantial interrater agreement was observed when applying the simplified Edinburgh criteria. However, these criteria showed limited discrimination between CAA-positive and CAA-negative patients (area under the curve 0.617; 95% CI 0.486-0.749; sensitivity 64%; specificity 58%). Logistic regression adjusted for age significantly improved discrimination (area under the curve 0.784; 95% CI 0.662-0.905). Congo red staining alone demonstrated a sensitivity of only 65% compared with immunohistochemistry. Validation of the simplified Edinburgh criteria in patients with surgically treated ICH revealed limited diagnostic accuracy, emphasizing the need for histopathologic confirmation when available because imaging alone may not be sufficient for reliable CAA diagnosis in this population. Limitations include the retrospective design, single-center setting, and restriction to patients with surgically treated ICH. This study provides Class II evidence that the CT scan features of the simplified Edinburgh criteria have limited diagnostic accuracy to detect CAA in patients with lobar hematoma.

Surgeries performed at night may carry higher risk due to provider fatigue and reduced staffing, but data from neurosurgical populations are limited. We evaluated whether nighttime evacuation of chronic subdural hematoma (CSDH) was associated with increased complications or recurrence. We conducted a retrospective cohort study of adults undergoing CSDH surgery at a tertiary neurosurgical center between 2006 and 2023. The primary exposure was nighttime surgery, defined by procedure start time. Primary outcomes were moderate-to-severe complications (Landriel-Ibáñez grade II-IV within 30days) and CSDH recurrence (reoperation within 6months). Multivariable logistic regression was used to adjust for confounders. Of 2860 patients, 709 (25%) underwent nighttime surgery. Nighttime surgery was independently associated with an increased risk of moderate-to-severe complications (OR 1.58, 95% CI 1.04-2.37; p = 0.028). This risk peaked during the final hours of the night shift. Although CSDH recurrence was more common after nighttime surgery in unadjusted analysis (13% vs. 10%), this difference was not significant after confounder adjustment. Nighttime surgery for CSDH was associated with an increased risk of moderate-to-severe complications. When feasible, surgery should be performed during daytime hours.

Timing of surgical intervention for chronic subdural hematoma in patients undergoing middle meningeal artery embolization: A retrospective propensity score matched study.

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, characterized by neurocutaneous lesions. NF1 has a high degree of clinical variability, which can include multiple neoplasia as well as cutaneous, vascular, osseous, and cognitive features. When vascular involvement occurs, NF1 can lead to aneurysms or arteriovenous malformations, which may rupture and cause life-threatening complications. We present a case of primary subarachnoid hemorrhage, complicated by spontaneous and rapidly progressing hemorrhage from the left subclavian artery resulting in upper airway obstruction and hypoxia in a patient with NF1. Treatment of this patient included surgical airway management, emergency hematoma evacuation, and vascular reconstructive surgery. Close collaboration between radiology, vascular surgery, and anesthesiology was essential to prevent patient's death. Awareness of rare diseases such as NF1 is essential in critical care settings. Patients presenting with café-au-lait spots or cutaneous neurofibromas are at risk of vascular complications due to vascular fragility. This case of dual bleeding sources and airway obstruction from a neck hematoma underscores the need for interdisciplinary management. The role of proactive vascular screening in critically ill NF1 patients remains uncertain. Future approaches may incorporate advanced imaging and biomarker development to better stratify vascular risk and guide individualized care.

Objective:To investigate the optimal timing of stereotactic minimally invasive surgery (SMIS) in individuals with supratentorial intracerebral hemorrhage (sICH) and brain herniation.Method:A retrospective analysis was conducted on patients with sICH and brain herniation who underwent SMIS in the emergency department of the Affiliated Hospital of Guizhou Medical University between January 2019 and October 2024. The patients were categorized into three groups based on the time from the onset of brain herniation to receiving SMIS: ≤6-h group (112 cases), 6–12-h group (57 cases), and >12-h group (32 cases). All enrolled patients were monitored over a 6-month period, and their prognoses were assessed using the Glasgow Outcome Scale Extended (GOSE), which was used for grouping. Clinical data, imaging findings, complications, comorbidities, infection markers, and outcome data were collected and analyzed comprehensively. Detailed analyses and comparisons were performed based on GOSE scores, Modified Rankin Scale (mRS) scores, and survival rates at 1, 3, and 6 months after sICH. Patients with mRS scores of 1–3 and GOSE scores of 4–8 had favorable outcomes. A detailed analysis of the six-month survival rate and post-treatment functional outcomes was conducted to draw research conclusions.Result:This study included 201 patients. At 6 months sICH, the mRS scores were 3.71 ± 1.30 for the ≤6-h group, 4.61 ± 1.25 for the 6–12-h group, and 4.18 ± 1.35 for the >12-h group, with the ≤6-h group showing markedly higher scores (p < 0.001). The GOSE scores at 6 months postoperatively were 4.05 ± 1.73 for the ≤6-h group, 3.05 ± 1.76 for the 6–12-h group, and 3.19 ± 1.73 for the >12-h group, with the ≤6-h group showed markedly higher scores (p = 0.001). The proportion of favorable outcomes at 6 months postoperatively was 47.3% for the ≤6-h group, 24.6% for the 6–12-h group, and 18.8% for the >12-h group, with the proportion of favorable outcomes highest in the ≤6-h group (p = 0.001). The Kaplan–Meier survival curve showed that the survival rate of the ≤6-h group was 80.4%, which was significantly higher than the 57.9% of the 6–12-h group and the 65.6% of the >12-h group (F = 10.060, p = 0.007).Conclusion:Undergoing SMIS intracranial hematoma evacuation within 6 h of brain herniation onset can effectively reduce neurological damage, significantly improve survival rates, and provide favorable prognosis.

Intracranial pseudoaneurysms are rare and account for approximately 1% of all intracranial aneurysms. They can occur at any age, including in children usually post-trauma. Their presence in newborns is extremely rare. This case describes a spontaneous ruptured pseudoaneurysm of the middle cerebral artery in a newborn. A 25-day-old female infant, born from a consanguineous marriage, was admitted following a generalized tonic-clonic seizure. There was no history of head trauma or infection. Neurologically, she had a Blantyre coma score of 5/5, no motor deficits, and a bulging anterior fontanelle. A transfontanellar ultrasound revealed a mixed right-sided mass displacing midline structures. This was confirmed by a brain CT scan which showed a large right frontoparietal hematoma. A cerebral CT angiography showed a probable fusiform aneurysm in the distal right middle cerebral artery (M3 segment). The patient was referred to our neurosurgery department for hematoma evacuation and aneurysm clipping. Under general anesthesia and after a linear incision was made, the bone flap was cut using a Metzenbaum scissor. The dura was opened then the large intraparenchymal hematoma was progressively evacuated. No aneurysmal sac was found, only the feeding branch with brisk arterial bleeding and clot, confirming the presence of an intracranial pseudoaneurysm. The bleeding vessel was coagulated. The patient had no postoperative deficits, possibly due to adequate collateral circulation. Pseudoaneurysms in neonates are rare. They should be suspected in infants with intraparenchymal hematoma and imaging suggestive of aneurysm. Careful imaging review is vital to guide treatment.

Cerebral amyloid angiopathy (CAA) is rarely observed in young individuals. We herein report a case involving a 39-year-old man who underwent cadaveric dura mater (LYODURA) transplantation in childhood and subsequently developed repeated cerebral hemorrhages and infarctions. At 10 months of age, he had received a cadaveric dura mater graft following head trauma. Thirty-two years later, he began experiencing seizures, intracranial hemorrhages, and cerebral infarctions over several years. Brain MRI revealed multiple lobar microbleeds, cortical superficial siderosis, and bilateral infarctions, with new lesions on follow-up scans. A brain tissue sample obtained during evacuation of a left temporal hematoma showed arteriolar amyloid deposits predominantly composed of amyloid beta (Aβ) 40. Amyloid positron emission tomography (PET) demonstrated widespread cortical amyloid deposition, not limited to the area near the childhood surgical site. These findings suggest that abnormal Aβ may have gradually propagated over decades from the transplanted cadaveric dura mater, resulting in CAA. Including this case, thirteen LYODURA-associated cases have been reported, with disease onset occurring more than 30 years after head surgery and dural transplantation. Until 1997, a large volume of LYODURA was imported into Japan, raising the possibility of additional future cases of CAA. This case highlights the importance of considering iatrogenic CAA in younger patients and demonstrates the potential value of non-invasive detection through amyloid PET.

ABSTRACTEndoscopic retrograde cholangiopancreatography (ERCP) is widely used for diagnosing and treating biliary and pancreatic disorders, yet it carries a risk of complications, including the rare development of subcapsular hepatic hematoma (SHH). We report the case of a 32‐year‐old woman who presented with abdominal pain following ERCP for gallstone pancreatitis. She was afebrile and hemodynamically stable but appeared pale and exhibited right upper quadrant and epigastric tenderness. Laboratory evaluation revealed a hemoglobin drop to 8.6 g/dL. Computed tomography demonstrated a large right‐lobe subcapsular hepatic hematoma measuring 15.5 × 7.5 cm with associated air locules. Despite initial conservative management, the hematoma enlarged, and the patient subsequently underwent laparoscopic cholecystectomy with evacuation of the infected hematoma 3 days after admission. This case highlights the importance of early clinical vigilance and prompt imaging in the detection of post‐ERCP complications. Although conservative therapy may be effective in stable cases, surgical intervention becomes essential when complications progress or infection develops.

Chronic subdural hematoma (CSDH) is a frequent neurosurgical issue, but ischemic cerebrovascular accidents (CVA) following surgery for CSDH are rare and present significant clinical challenges, especially in patients requiring oral anticoagulation (OAC). This case describes an 87-year-old male with atrial fibrillation who developed acute right-sided weakness and aphasia due to an M2 segment occlusion of the left middle cerebral artery (MCA), two weeks after bilateral CSDH evacuation and OAC cessation (the "Apixaban Gap"). The patient underwent successful mechanical thrombectomy with TICI 3 reperfusion, demonstrating marked clinical improvement and favourable functional recovery within three months. This case underscores the risks associated with perioperative anticoagulant interruption in high-risk patients and highlights the therapeutic dilemma in managing concurrent hemorrhagic and thrombotic complications. The technical feasibility and benefit of mechanical thrombectomy for medium vessel occlusions (MeVO) in the post-neurosurgical context are discussed. Ultimately, the case supports individualized, multidisciplinary decisions for early intervention and timely re-initiation of OAC, showing that neither advanced age nor recent neurosurgical history should be absolute contraindications to life-saving stroke interventions when stringent selection and rapid workflows are maintained.

Rationale:A traumatic pseudoaneurysm (TP) is a rare vascular pathology. Once diagnosed, active surgical intervention is usually required. However, in addition to growth and rupture, the natural outcomes of TPs also include spontaneous resolution. This article reports a rare case of a TP that resolved spontaneously, with the aim of informing future clinical strategies.Patient concerns:A 47-year-old female patient underwent decompressive craniectomy with hematoma evacuation following head trauma. Initial computed tomography angiography demonstrated a pointed protrusion along the ophthalmic segment of the left internal carotid artery. Two weeks post-injury, follow-up computed tomography angiography revealed a saccular protrusion at the same site, measuring 6.0 mm × 3.7 mm with a neck width of 6.3 mm. Digital subtraction angiography (DSA) at 3 weeks post-injury confirmed a saccular aneurysm in the ophthalmic segment of the left internal carotid artery.Diagnoses:The combination of a history of trauma and a rapidly growing lesion was highly suggestive of a TP.Interventions:Four weeks post-injury, follow-up DSA demonstrated a progressive reduction in the aneurysm size, prompting the family to opt for conservative management.Outcomes:Eight weeks post-injury, DSA confirmed the spontaneous disappearance of the aneurysm. A 1-month post-discharge telephone follow-up revealed no symptoms of clinical recurrence, such as headache or epistaxis.Lessons:Since spontaneous healing of TP is uncommon and its mechanism remains unclear, conservative management mandates close imaging surveillance, as a risk of recurrence persists even with the most prudent patient selection.

Nontraumatic intracerebral hemorrhage (ICH) especially in deep locations is independently associated with a long-term increased risk of major arterial ischemic events. Minimally invasive surgery (MIS) has differential impact on outcomes by location. Whether ischemic events modify outcomes after MIS and the influence of ICH location is poorly understood. We pooled individual patient data from the MISTIE III and ATACH-2 trials. The exposure was ICH location (deep vs. lobar). The outcome was a symptomatic, clinically overt ischemic stroke or coronary ischemic event. We evaluated the association between ICH location and risk of an ischemic event using Cox regression analyses after adjustment for demographics, vascular comorbidities, and ICH characteristics. We investigated whether ischemic events modified the impact of effective MIS, defined as end of treatment volume (EOT) <15 mL, on modified Rankin scale (mRS) 0-3 at one year in MISTIE III using logistic regression. Of 1470 ICH patients median hematoma volume was 17.3 mL (interquartile range, 7.2-35.7) and 1186 (80.7%) were deep. During a median follow-up of 110 days (iqr 110-365), 70 ischemic events occurred, 60 (5.0% cumulative incidence) in patients with deep ICH and 10 after lobar ICH (cumulative incidence 3.2%). In adjusted analyses, deep ICH location was associated with an increased risk of ischemic events (hazard ratio, 2.3 [95% CI, 1.1-4.8]), but MIS was not. In the full MISTIE cohort, in patients without ischemic events during follow-up, MIS with EOT<15 mL was significantly associated with favorable one year outcome (OR 1.90 (95% CI: 1.16-3.12; P for interaction = 0.04). There was no effect modification for deep location (P for interaction = 0.128). For lobar ICH, EOT ICH volume <15 mL with MIS was associated with good outcome regardless of ischemic events. In a heterogeneous cohort of patients with ICH, deep ICH location was associated with increased risk of ischemic events over the short term, but this appears to have low impact on one-year outcomes with successful surgery.

To evaluate the feasibility and safety of endoscopic middle meningeal artery (MMA) interruption combined with hematoma evacuation for the treatment of chronic subdural hematoma (CSDH), providing a fundamental basis for the standardized implementation of this new surgical technique and future multicenter studies. A retrospective analysis was conducted on four CSDH patients who underwent this surgical approach between January and April 2025. Preoperatively, 3D reconstruction was used to localize the course of the MMA. Intraoperatively, under endoscopic guidance, the anterior branch of the MMA was interrupted and the hematoma was evacuated. Postoperative neurological recovery and hematoma recurrence were assessed, with follow-up for three months. All four patients successfully underwent surgery, with a mean age of 68.75 years, and no postoperative complications were observed. Postoperative CT scans showed significant reduction of the hematoma, and neurological function gradually improved. No recurrence was detected within three months. The mean operative time was 116.75min, and the average hospital stay was approximately 15.75 days. Endoscopic MMA interruption combined with hematoma evacuation, preliminarily validated in clinical practice, can be applied to both primary and recurrent CSDH patients. This approach has the potential to overcome the limitations of failed MMA embolization (MMAE) or cases unsuitable for MMAE, and offers a novel strategy for the surgical management of CSDH.

Unlike ischemic stroke, hemorrhagic stroke in patients living with sickle cell disease is rare; still the associated mortality and morbidity are relatively high in both HIC and LMIC. Early diagnosis and prompt multidisciplinary management are key components to improve survival and mitigate neurologic deficits. We presented the case of a 14-year-old boy with sickle cell disease (SCD) who was admitted with signs and symptoms evoking acute neurologic impairment and elevated intracranial pressure without any history of head trauma. Initial assessment with a non-contrast CT scan revealed a large left temporoparietal hematoma and an associated midline shift. After conservative care, subsequent craniotomy and evacuation of hematoma were performed on day 5. The patient gradually recovered postoperatively and was completely exempt from any presenting symptoms by postoperative day 7. After a meticulous literature review, we found only a few case reports and case series on SCD hemorrhagic stroke, and most of them have not reported similar management strategies and outcomes. For this reason, we deemed it necessary to share our experience and findings in order to help narrow the knowledge gap in SCD hemorrhagic stroke management. This single case of a rare but serious complication of SCD in the pediatric population underscores the need for accurate screening tools to detect brain vasculature damage early in the SCD population, as transcranial Doppler ultrasound used for ischemic stroke has not shown satisfying results for SCD hemorrhagic stroke. Such tools will help in classifying those patients by risk group in order to permit prophylactic care for patients at high risk of hemorrhagic stroke. Before the implementation of effective screening strategies, early detection and diagnosis, and prompt multidisciplinary management remain fundamental to reducing SCD hemorrhagic stroke mortality and morbidity.

[Objective] To analyze the predictive value of serum oxidation-modified low-density lipoprotein (ox-LDL) and 25-hydroxyvitamin D[25-(OH)-D] levels before minimally invasive hematoma evacuation in patients with hypertensive intracerebral hemorrhage (HICH) for cerebral edema. [Methods] 300 patients with HICH in our hospital from August 2022 to August 2024 were selected as research subjects. Patients were divided into a high-level ox-LDL group (ox-LDL≥50 μg/dL) and a low-level ox-LDL group (ox-LDL&lt;50 μg/dL) according to their preoperative serum ox-LDL level. The patients were separated into two groups based on the amount of serum 25-(OH)-D: high-level 25-(OH)-D (25-(OH)-D≥30 ng/mL) and low-level 25-(OH)-D (25-(OH)-D&lt;30 ng/mL). The incidence of cerebral edema within 48 hours after surgery was compared among the groups. Following minimally invasive hematoma evacuation in patients with HICH, the predictive value of preoperative serum ox-LDL and 25-(OH)-D levels for cerebral edema was evaluated using the receiver operating characteristic (ROC) curve. [Results] The hematoma volume varied in statistically meaningful ways, fibrinogen level and incidence of cerebral edema among patients with different serum ox-LDL and 25-(OH)-D levels (P&lt;0.05). The results of point–bisenteric correlation analysis revealed that the occurrence of cerebral edema in HICH patients was positively correlated with the serum ox-LDL level (r=0.455, P&lt;0.05) and negatively correlated with the serum 25-(OH)-D level (r=-0.534, P&lt;0.05). Pearson correlation analysis revealed that there was a negative correlation between the serum ox-LDL level and the 25-(OH)-D level (r=-0.444, P&lt;0.05). The areas under the curve (AUCs) of preoperative serum ox-LDL, 25-(OH)-D alone, and combined detection for predicting cerebral edema following minimally invasive hematoma evacuation in patients with HICH were 0.777, 0.768, and 0.839, respectively, according to the results of the ROC curve analysis. The AUC of combined detection was the largest. [Conclusion] Before minimally invasive hematoma evacuation in patients with HICH, the serum ox-LDL level was high, and the 25-(OH)-D level was low. Preoperative serum ox-LDL and 25-(OH)-D levels have high predictive value for cerebral edema after minimally invasive hematoma evacuation in patients with HICH.

To develop and validate a novel rapid surface projection localization technique (RSPLT) using 3D Slicer and smartphone-assisted registration for precise keyhole evacuation of intracerebral hematomas. Technical workflow of RSPLT was established: (1) 3D Slicer-based hematoma reconstruction and sagittal plane optimization; (2) Transparent overlay of hematoma contours onto scalp morphology; (3) Smartphone-leveler guided via anatomical landmarks. The technique was applied in 28 consecutive ICH cases, with intraoperative validation of localization accuracy. RSPLT achieved complete hematoma projection within 7.98 ± 1.18min (range 6.1-9.8min). Intraoperative validation using caliper measurement confirmed sub-millimeter surface landmark registration error (1.2 ± 0.3mm). The technique enabled minimal access (bone window 3.10 ± 0.63cm, range 2.3-5.4cm) with 95.31 ± 5.56% clearance (range 78.2-99.74%), suggesting it may offer a potentially more efficient alternative to conventional CT-guided planning. Postoperative ADL scores improved significantly from 53.12 ± 5.63 to 83.17 ± 9.54 at three months. This proof-of-concept study demonstrates that RSPLT can provide a rapid, low-cost, and accurate approach for hematoma spatial mapping, which may aid in the precision of keyhole trajectory design. These preliminary from a single-center experience findings warrant further comparative studies to validate its clinical utility against existing methods.

Penile fracture is a rare but urgent urological emergency characterized by rupture of the tunica albuginea, typically following blunt trauma to an erect penis. Clinical features often include an audible crack, sudden detumescence, penile pain, and swelling. Surgical repair within the first 24 hours remains the preferred treatment, associated with improved functional recovery and reduced risk of long-term complications. Delayed presentation increases the likelihood of fibrosis, curvature, erectile dysfunction, and infection. Various surgical techniques are employed depending on the location and extent of injury, with the subcoronal degloving incision offering optimal exposure in most cases. The choice of suture material, thorough evacuation of hematoma, and evaluation of associated urethral injury significantly influence outcomes. Postoperative complications range from minor hematomas and wound infections to more significant sequelae such as penile curvature, palpable plaques, voiding dysfunction, and psychogenic erectile dysfunction. Bilateral corporal rupture and urethral involvement predict poorer recovery and often require more complex surgical intervention. Objective measures such as IIEF scores are commonly used to assess erectile function, but subjective satisfaction often depends on psychological resilience and partner dynamics. Factors such as early intervention, patient age, baseline comorbidities, and extent of injury serve as key predictors of postoperative recovery. Long-term follow-up highlights the importance of not only preserving anatomical integrity but also addressing emotional and sexual health. Patient education, timely diagnosis, and individualized surgical management are central to optimal outcomes in penile fracture care.