Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Objective To understand the clinical characteristics of traumatic brain injury (TBI) patients and provide fundamental data for reducing the incidence of TBI and improving its treatment efficacy.Methods Medical histories of TBI inpatients from January 2011 to December 2016 were collected from the TBI database of Neurosurgical Department at Tianjin Medical University General Hospital.Information including gender,age,causes of TBI,injury severity,sources of the inpatients,interval from injury to treatment,diagnosis,and treatment were analyzed retrospectively.Results A total of 2 368 TBI patients were enrolled,aged mainly 30-60 years.There were more male patients (n =1 741) than female patients (n =627) (2.78 ∶ 1),while the gender ratio was reversed among patients above 60 years old (2.09 ∶ 1) (P ＜ 0.05).Traffic accident (60.14％) remained the major cause of TBI,while the proportion of electric motorcycle accident was 17.35％,followed by fall from height (13.64％).The proportion of mild TBI patients from suburb counties was lower than that of patients from the six urban areas (P ＜ 0.05),while the proportion of heavy TBI patients from other provinces was higher than those of both urban and suburb counties (P ＜ 0.05).The average interval from injury to specialist treatment was 7.53 hours.Patients who received treatment within 3 hours had better improvement than those who were treated 3 hours after TBI (P ＜ 0.05).The main injuries were skull fracture (33.07％) and brain contusion (30.32％).A total of 783 patients (33.07％) underwent surgery,among which 693 patients received the most common procedure of craniotomy hematoma evacuation (including decompressive craniectomy).The improvement rate of patients with intracranial pressure monitoring was higher than those without intracranial pressure monitoring (P ＜ 0.05).The improvement rate of the surgery group was significantly higher than that of the non surgery group (P ＜0.05).Conclusions The ratio of elderly female TBI patients is on the rise;TBI presents an increase in traffic accidents;mild TBI patients choose to receive treatment in close hospitals while those with severe TBI choose comprehensive hospitals;and the interval from injury to treatment is long.The following strategies including improving the traffic facilities,strengthening the education of traffic safety on elderly females and pedestrians,and optimizing the TBI medical treatment process would reduce the incidence of TBI and improve the efficiency of treatment.

Traumatic brain injury is always associated with hemorrhage and coagulopathy, leading the occurrence of anemia, platelet function inactivation, platelet and coagulation factor consumptive reduction. Theoretically, transfusion therapy should be given to supplement the missing component in an appropriate range. However, whether the transfusion therapy can improve the prognosis of patients with traumatic brain injury, and the indications of transfusion, have been the focus of academic debate for a long time. This article reviews the latest progress of transfusion therapy in traumatic brain injury, and provides reference for better guidance of transfusion in clinical treatment.

Objective To explore the implementation styles on the therapeutic effects on the neurosurgical intensive care unit (NICU) patients. Methods Patients were enrolled during February 3, 2015 to February 3, 2016. The key point time was August 3, 2015 when the treatment in our NICU was fully implemented by NICU professional doctors. Based on this time point, all the enrolled patients were divided into non-NICU professional doctor implementing (NNPDI) group and NICU professional doctor implementing (NPDI) group. Thus non-NICU professional doctors and professional doctors were the leaders of diagnosis and treatment in tow groups. The length of hospital stay, complications, prognosis and other therapeutic outcomes were compared between two groups. Results The length of hospital stay was longer in NPDI group than that in NNPDI group (P<0.05). The incidence of water-electrolyte imbalance was lower in NPDI group than that in NNPDI group (P<0.05). There were no significant differences in the incidence of the ventilator-associated pneumonia (VAP), the hepatic and renal insufficiency, the intracranial infections and stress ulcers between the two groups (P>0.05). The proportion of referral to other wards and fatality rate were both lower in NPDI group than those in NNPDI group (P<0.05). And the discharge rate from NICU was higher in NPDI group than that of NNPDI group (P<0.05). There was no significant difference in the rate of patients left hospital without treatment between the two groups (P>0.05). Conclusion The NICU professional doctor implementing may be contribute to, at least in part, the improving of prognosis of NICU patients without obvious advantages in most complications. The level of professional management remains to be improved.

Fingolimod (FTY720) as a new immunosuppressive agent,is the prodrug of an sphingosine-1-phosphate receptor agonist.It is a potent immunosuppressant which has been approved by the US Food and Drug Administration to treat relapsing-remitting multiple sclerosis,and shows its unique and novel mechanism of action.Unlike the traditional immunosuppressive agents,fingolimod exerts immunosuppressive and immunoregulatory functions mainly through interaction with shhingosine-l-phosphate receptors on the cell surface without affecting activation and proliferation of lymphocytes.In addition,FTY720 has been shown to inhibit a variety of cancer related signal transduction pathways.It also presented significant anticancer effects in the in vivo and in vitro experiments.And in the treatment of glioblastoma multiforme (GBM) experiment,FTY720 displayed excellent activity as well had a synergistic effect in addition to temozolomid,the current standard chemotherapeutic agent to treat malignant gliomas.This article reviewed the advances in study on the anti-GBM effect and mechanism of FTY720.

Exosomes are homogeneous membrance-derived microvesicles shed by cells,their sizes ranged from 40 to 100 nm.As for microparticles,they are small heterogeneous vesicles at diameters of 100 to 1000 nm shed by cells.Both of them exist in a wide range of body fluids,including peripheral blood,urine,saliva,ascites,amniotic fluid and cerebrospinal fluid,with various kinds of biomolecules like proteins and RNAs.Exosomes and microparticles play important roles in cell-to-cell information transmissions and substance exchanges,contributing to both physiological and pathological processes.Exosomes,functioning as the carders of material transportation,serve as targeted therapy in disease treatments.Microparticle,a new type biomarker,plays an important role in diagnosing the early-stage of diseases and predicting the prognoses.The central nervous system diseases are lacked of early-stage diagnoses and effective treatments because of the complexity and unpredictability.This review is to focus on the specific comparisons between exosomes and microparticles as well as their central nervous system functions and mechanisms,and also to explore the new treatments of the central nervous system diseases.

Objective To investigate the protective effect of hypoxia-inducible factor-1α(HIF-1 α) on the neurovascular unit in rats with traumatic brain injury (TBI).Methods The fluid percussion model was applied to induce TBI in rats.A total of 600 rats were divided into sham operation group,TBI group,TBI + HIF-1 α silence group and TBI + control virus group according to the random number table,with 150 rats in each.Virus-mediated HIF-1 α silence gene and control virus were delivered 24 h before the fluid percussion injury.After 3,7 and 14 d,brain injury area and morphological changes in injured region were detected by HE staining,expressions of vascular endothelial cell markers (vWF) and HIF-1 α were detected by Western blot method,and expressions of vascular endothelial growth factor (VEGF),matrix metalloproteinase-9 (MMP-9),tumor necrosis factor-α (TNF-α),interleukin 6 (IL-6) and nuclear factor-κB (NF-κB) in peripheral blood and brain tissue were detected by ELISA method.Rat neural function was dynamically assessed using the modified neurological severity score (mNSS).Results (1) Brain injury area and edema area in TBI + HIF-1 α silence group were higher than those in TBI group at all time points (P ＜ 0.05).(2) Compared with sham operation group and TBI + control virus group,expression of HIF-1α in TBI group gradually increased and remained high at 7 and 14 d postinjury (P ＜ 0.05).Compared with TBI group,expression of vWF in TBI + HIF-1αsilence group decreased at all time points (P ＜ 0.05) and inhibited angiogenesis.(3) TBI + HIF-lα silence group versus TBI group showed remarkably decreased VEGF at all time points,increased expressions of TNF-α,IL-6 and NF-κB at all time point,and increased expression of MMP-9 at 7 and 14 d postinjury (all P ＜0.05).(4) TBI + HIF-1α silence group versus TBI group showed significant difference in mNSS at 7 and 14 d postinjury (all P ＜ 0.05).Conclusions After TBI,high expression of HIF-1αcan facilitate vascular formation and inhibit inflammatory reaction related factor expression,inducing the mitigation of brain edema and brain injury.Therefore,promoting HIF-1α expression may become a new means to improvement of neurovascular function after TBI.