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Fillers are the second major component of paper, and can give certain properties to paper-based materials. However, if we want to use fillers to develop novel functional paper-based materials, some challenges have to be considered such as filler functionality, retention rate, and the negative effects. To meet with these challenges, the present work proposed a fabrication concept of bio-based composite fillers. The concept combined the crystallization of target component and the gelation process of chitosan (CS), simultaneously. The gels carried and protected the crystals, and served as bridge between crystal of fillers and the paper matrix. To explore and demonstrate the concept, CaCO3/CS bio-based composites were successfully fabricated. The composite fillers were further optimized to be suitable for paper-making. The fabrication concept could significantly increase the filler retention rate (up to 90.57 %), the filler bondability (increased over 10 times) and the mechanical strength (59.7 % higher than paper without fillers). The fabrication concept was also applicable to functional materials. Zeolitic imidazolate framework-8 (ZIF-8)/CS composite fillers were successfully fabricated, and endowed the resulted paper with high surface area (180 times higher than pure cellulose paper). This fabrication concept would be useful to develop functional paper-based materials in the future.

The oculomotor nerve (OCN) is the main motor nerve innervating eye muscles and can be involved in multiple flammatory, compressive, or pathologies. The diffusion magnetic resonance imaging (dMRI) tractography is now widely used to describe the trajectory of the OCN. However, the complex cranial structure leads to difficulties in fiber orientation distribution (FOD) modeling, fiber tracking, and region of interest (ROI) selection. Currently, the identification of OCN relies on expert manual operation, resulting in challenges, such as the carries high clinical, time-consuming, and labor costs. Thus, we propose a method that can automatically identify OCN from dMRI tractography. First, we choose the multi-shell multi-tissue constraint spherical deconvolution (MSMT-CSD) FOD estimation model and deterministic tractography to describe the 3D trajectory of the OCN. Then, we rely on the well-established computational pipeline and anatomical expertise to create a data-driven OCN tractography atlas from 40 HCP data. We identify six clusters belonging to the OCN from the atlas, including the structures of three kinds of positional relationships (pass between, pass through, and go around) with the red nuclei and two kinds of positional relationships with medial longitudinal fasciculus. Finally, we apply the proposed OCN atlas to identify the OCN automatically from 40 new HCP subjects and two patients with brainstem cavernous malformation. In terms of spatial overlap and visualization, experiment results show that the automatically and manually identified OCN fibers are consistent. Our proposed OCN atlas provides an effective tool for identifying OCN by avoiding the traditional selection strategy of ROIs.

The aim of this study was to make a thorough investigation of the trajectory of the ansa lenticularis (AL) and its subcomponents using high-resolution fiber-tracking tractography. The subcomponents of the AL were reconstructed from one region of interest (ROI) in the area of the globus pallidus combined with another ROI in the red nucleus, substantia nigra, subthalamic nucleus, or thalamus. This fiber-tracking protocol was tested in an HCP-1065 template, 35 healthy subjects from Massachusetts General Hospital (MGH), and 20 healthy subjects from the human connectome project (HCP) using generalized q-sampling imaging (GQI)-based tractography. Quantitative anisotropy and fractional anisotropy were also computed for the AL subcomponents. The subcomponents of the AL could be reconstructed in the HCP-1065 template, 35 MGH healthy subjects, and 20 HCP healthy subjects. The AL descends from the globus pallidus and joins the ansa peduncularis for a short distance, subdividing later into fibers that continue separately to the red nucleus, substantia nigra, subthalamic nucleus, and thalamus. The study demonstrated the trajectory of the ansa lenticularis and its subcomponents using GQI-based tractography, improving our understanding of the anatomical connectivity between the globus pallidus and the thalamo-subthalamic region in the human brain. One Sentence Summary The investigation of the ansa lenticularis and its subcomponents using high-resolution diffusion images based tractography.

Heterogeneous catalytic ozonation (HCO) was a promising water purification technology. Designing novel metal-based catalysts and exploring their structural-activity relationship continued to be a hot topic in HCO. Herein, we reviewed the recent development of metal-based catalysts (including monometallic and polymetallic catalysts) in HCO. Regulation of metal based active sites (surface hydroxyl groups, Lewis acid sites, metal redox cycle and surface defect) and their key roles in activating O

Accurately positioning the sigmoid sinus (SS), transverse sinus (TS), and vertebral artery (VA) is significantly important during the retrosigmoid (RS) approach. This study aimed to use emissary vein and digastric point as landmarks in high-resolution computer topographic image to locate the SS, TS, and VA to help surgeons to avoid injuring these vascular structures during RS craniotomy. Computed topographic (CT) angiography images of 107 individuals were included, the measurement was performed on coronal, sagittal, and axis planes after the multiplanar reformation. Distance from the emissary vein and digastric point to the posterior boundary of the SS, inferior boundary of the TS were measured by CT angiography preoperatively and in the skull intraoperatively. The VA was also located by emissary vein and digastric point. No significant difference was identified between the distances measured in the CT and skull. Our findings provide anatomical information for locating the boundary of the SS, TS, and V3-VA based on the fixed bony landmarks. Verified by skull measurement, high-resolution CT scan is a cost-effective and reliable tool for identifying the location of the arteries and sinus, which could be widely used to guarantee the safety of RS approach craniectomy.

Cavernous malformations affecting the CNS occur in ∼0.16–0.4% of the general population. The majority (85%) of cavernous malformations are in a sporadic form, but the genetic background of sporadic cavernous malformations remains enigmatic. Of the 81 patients, 73 (90.1%) patients were detected carrying somatic missense variants in two genes: MAP3K3 and PIK3CA by whole-exome sequencing. The mutation spectrum correlated with lesion size (P = 0.001), anatomical distribution (P

Background This study established novel technique nuances in surgery for ventral foramen magnum meningiomas (vFMMs) via a dorsal lateral approach. Methods From July 2012 to July 2019, 37 patients with vFMMs underwent tumor resection surgery and were operated on with a dorsal lateral approach. Two safe zones were selected as the entrance of the surgical corridor. Safe zone I was located between the dural attachment of the first dental ligament (FDL) and the branches of C1; safe zone II lay between the dural attachment of the FDL and the jugular foramen. The tumor was debulked first through safe zone I and then through safe zone II. The tumor was removed through a trajectory from the caudal to cephalad to allow tumor debulking from below and downward delivery, away from the brainstem and lower cranial nerves. Results Thirty-three patients underwent gross total resection, and 4 patients underwent subtotal resection. Four patients transiently required a nasogastric feeding tube. All patients recovered within 3 months postoperatively. Three patients (8.1%) developed permanent mild hoarseness and dysphagia as a result of postoperative damage of cranial nerves IX and X. One patient underwent tracheotomy. No patient experienced tumor recurrence during the follow-up period. Conclusions We established a minimal retraction principle, in which the selection of 2 safe zones as the entrance of the surgical corridor, tumor removal from the inferior to superior direction, and debulking followed by devascularization were the key elements to implement the minimal retraction principle in vFMM surgery.

Mineral fillers hinder cellulosic fiber bonding and thus limit the increase of filler content in paper. Herein, precipitated calcium carbonate (PCC)/cellulose nanofibrils (CNF) composites were fabricated by a facile and efficient strategy, i.e., co-refining process (CRP). During this process, CNF and PCC were activated by mechanochemical effect and formed encapsulation structure by calcium ion coordination and hydrogen bonding. The encapsulation structure and H-bond/ionic coordination interactions not only endowed the composite with excellent size stability but also enhanced interfacial interaction between composite fillers and cellulosic fibers. Compare with the paper filled with only PCC, PCC + CNF mixture, the tensile index of the cellulosic paper containing PCC/CNF composite was increased by 44.48% and 12.14%, respectively. These results not only provide a facile and scalable approach to increase interaction between cellulosic fiber and mineral filler but also create more possibilities for special paper-based materials with requiring high content of inorganic materials.

The aim of this study was to investigate the trajectory of the stria terminalis and develop a protocol for mapping the stria terminalis using multi-shell diffusion images based tractography. The stria terminalis was reconstructed by combining one region of interest at the amygdala with another region of interest at the bed nucleus of stria terminalis. In addition, one region of avoidance was placed on the fornix at the interventricular foramen and another was set at the anterior perforated substance. The fiber-tracking protocol was tested in a Human Connectome Project-842 template, 35 healthy subjects from Massachusetts General Hospital, and 20 healthy subjects from the Human Connectome Project using generalized q-sampling imaging based tractography. The stria terminalis was reconstructed in the Human Connectome Project-842 template, 35 Massachusetts General Hospital healthy subjects, and 20 Human Connectome Project healthy subjects with our protocol. The stria terminalis originated from the amygdala and traveled parallel to the fornix. Then, the stria terminalis followed a C-shaped trajectory around the inferior, posterior, and dorsal surfaces of the thalamus before projecting to the bed nucleus of stria terminalis between the thalamus and caudate nucleus. There were no significant differences in the quantitative anisotropy and fractional anisotropy values between the left and right stria terminalis. The stria terminalis was accurately visualized across subjects using multi-shell diffusion images through generalized q-sampling imaging based tractography. This method could be an important tool for the reconstruction and evaluation of the stria terminalis in various neurological disorders. One Sentence Summary The visualization of the stria terminalis through the multi-shell diffusion images using generalized q-sampling imaging based tractography.

Background: We aimed to compare the outcomes of end-to-end descending hypoglossal-facial anastomosis (eeDHFA) and end-to-side hypoglossal-facial anastomosis (esHFA) in patients with complete facial paralysis after vestibular schwannoma (VS) surgery. Methods: This retrospective study included 52 patients with complete nerve damage identified during previous VS removal or on electromyography during follow-up. Postoperative facial palsy was evaluated using the House-Brackmann (HB) facial nerve grading system. Postoperative hemiglossal atrophy and swallowing were assessed using Martins’ grading system and the water-swallowing test, respectively. Hoarseness was also recorded if present. Results: The median time from VS resection to anastomosis was not significantly different between the two groups (p=0.062). The median follow-up time showed no significant differences between groups (eeDHFA: 17 months; esHFA: 14 months; p=0.446). We found no significant differences in the number of favourable (HB I-III) or unfavourable (HB IV-VI) outcomes for facial nerve function in the last follow-up (p=0.924). Only one patient from each group developed hemi-tongue myoparalysis. No patient experienced swallowing dysfunction or hoarseness. Conclusions: We concluded that eeDHFA is as effective as esHFA as a surgical method for the treatment of facial palsy after VS surgery. Since eeDHFA represents a simple technique for facial reanimation, it could therefore be considered as an alternative surgical option for patients affected by complete facial paralysis after VS surgery.

We describe a case of sporadic cavernous malformation (CM) in a patient suffering from multiple hemorrhagic intracranial lesions, including one originating from the trigeminal nerve (TN). The patient presented with left side facial pain and disturbed right limb movement. The patient was pre-operatively diagnosed with multiple cerebral CMs. This diagnosis was confirmed by postoperative pathology.

Small size and intricate anatomical environment are the main difficulties facing tractography of the facial-vestibulocochlear nerve complex (FVN), and lead to challenges in fiber orientation distribution (FOD) modeling, fiber tracking, region-of-interest selection, and fiber filtering. Experts need rich experience in anatomy and tractography, as well as substantial labor costs, to identify the FVN. Thus, we present a pipeline to identify the FVN automatically, in what we believe is the first study of the automated identification of the FVN. First, we created an FVN template. Forty high-resolution multishell data were used to perform data-driven fiber clustering based on the multishell multitissue constraint spherical deconvolution FOD model and deterministic tractography. We selected the brainstem and cerebellum (BS-CB) region as the seed region and removed the fibers that reach other brain regions. We then performed spectral fiber clustering twice. The first clustering was to create a BS-CB atlas and separate the fibers that pass through the cerebellopontine angle, and the other one was to extract the FVN. Second, we registered the subject-specific fibers in the space of the FVN template and assigned each fiber to the closest cluster to identify the FVN automatically by spectral embedding. We applied the proposed method to different acquirement sites, including two different healthy datasets and two tumor patient datasets. Experimental results showed that our automatic identification results have ideal colocalization with expert manual identification in terms of spatial overlap and visualization. Importantly, we successfully applied our method to tumor patient data. The FVNs identified by the proposed method were in agreement with intraoperative findings.

The aim of this study is to investigate the trajectory of medial longitudinal fasciculus (MLF) and explore its anatomical relationship with the oculomotor nerve using tractography technique. The MLF and oculomotor nerve were reconstructed at the same time with preset three region of interests (ROIs): one set at the area of rostral midbrain, one placed on the MLF area at the upper pons, and one placed at the cisternal part of the oculomotor nerve. This mapping protocol was tested in an HCP‐1065 template, 35 health subjects from Massachusetts General Hospital (MGH), 20 healthy adults and 6 brainstem cavernous malformation (BCM) patients with generalized q‐sampling imaging (GQI)‐based tractography. Finally, the 200 μm brainstem template from Center for In Vivo Microscopy, Duke University (Duke CIVM), was used to validate the trajectory of reconstructed MLF. The MLF and oculomotor nerve were reconstructed in the HCP‐1065 template, 35 MGH health subjects, 20 healthy adults and 6 BCM patients. The MLF was in conjunction with the ipsilateral mesencephalic part of the oculomotor nerve. The displacement of MLF was identified in all BCM patients. Decreased QA, RDI and FA were found in the MLF of lesion side, indicating axonal loss and/or edema of displaced MLF. The reconstructed MLF in Duke CIVM brainstem 200 μm template corresponded well with histological anatomy. The MLF and oculomotor nerve were visualized accurately with our protocol using GQI‐based fiber tracking. This GQI‐based tractography is an important tool in the reconstruction and evaluation of MLF., The mapping protocol of medial longitudinal fasciculus using the generalized q‐sampling imaging based tractography.

The main objectives of microsurgery for vestibular schwannoma are total tumor removal and preservation of facial and cochlear nerve function. For giant tumors, total tumor removal and facial nerve function preservation are challenging. The semisitting position has some advantages. In this video the authors show the removal of a giant vestibular schwannoma with the patient in a semisitting position. They demonstrate the advantages of the semisitting technique, such as the two-handed microsurgical dissection technique and a clear operative field. Finally, a small residual tumor in the internal auditory canal was removed by endoscopy. The patient’s facial function was House-Brackmann grade I at discharge. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2176

Background Dumbbell-shaped jugular foramen schwannomas (JFS) are rare but challenging for the treatment. Surgical resection is believed to be the optimal therapy; however, postoperative dysfunction of the lower cranial nerves (CNs), tumor residual, cerebrospinal fluid (CSF) leakage, and subcutaneous hydrops are common. The current study's objectives were to describe the optimal surgical strategies for the total removal of dumbbell-shaped JFS, the functional preservation of lower CNs, and the prevention of postoperative CSF leakage. Methods 26 consecutive patients with dumbbell-shaped JFS were surgically treated between January 2014 and June 2019. All patients were operated on via two-piece lateral suboccipital approach, vascularized muscle flap was used for the repair of the dural defect after an operation. The clinical information and radiological data of these patients were retrospectively reviewed, and the optimal surgical strategies were further evaluated and discussed. Results The tumor was completely removed in all 26 patients, one patient developed new CN Ⅶ paralysis, and 2 developed new CN IX and Ⅹ paralysis after an operation, all patients were significantly relieved during follow up. None of them developed subcutaneous hydrops and postoperative CSF leakage. No tumor recurrence was observed during a mean follow up of 38.8 (16–69) months. Conclusions Dumbbell-shaped JFS could be safely and completely removed via the two-piece lateral suboccipital approach. Postoperative CSF leakage could be effectively prevented by careful repair of the dural defect in the jugular foramen (JF) and filling the mastoid cavity with a vascularized muscular flap.

Objective Facial nerve (FN) function preservation is the primary goal during vestibular schwannoma (VS) resection. Many factors are linked to postoperative FN outcomes. In the present study, we evaluated the association between FN length and VS surgical outcomes. Methods We included 70 consecutive patients who had undergone VS microsurgery between October 2019 and November 2020. The clinical data were prospectively obtained from the patients. The relative FN (rFN) length was obtained by subtracting the contralateral FN length from the ipsilateral FN length as measured using DSI Studio software (available at: http://dsi-studio.labsolver.org/ ). Results The postoperative FN function was House-Brackmann grade I in 47 of the 70 patients (67.1%), grade II in 10 (14.3%), and grade III in 13 (18.6%). Gross total resection (GTR) was performed in 61 patients (87.1%). A residual tumor was retained to preserve FN function in 9 of the 70 patients (12.9%), and rFN length was measured (mean diameter, 20.8 mm; range, 2.5-51.5]). On multivariate analysis, the rFN length was significantly associated with the extent of tumor resection. The receiver operating characteristic curve indicated that the cutoff value for rFN length to predict for intraoperative near total resection versus GTR was 36.6 mm, with a specificity and sensitivity of 93.4% and 88.9%, respectively. Conclusions The rFN length is important for predicting surgical outcomes. An rFN length >36.6 mm might indicate difficulty in achieving GTR with preservation of FN function. Therefore, the rFN length could become an objective indicator for neurosurgeons to predict the difficulty of GTR to preserve FN function.

The popularization and application of microscopy, the in-depth study of the microanatomy of the cerebellopontine angle, and the application of intraoperative electrophysiological monitoring technology to preserve facial nerve function have laid a solid foundation for the modern era of neurosurgery. The preoperative prediction of the location of the facial nerve is a long-desired goal of neurosurgeons. The advances in neuroimaging seem to be making this goal a reality. Many studies investigating the reliability of the preoperative prediction of the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma have been reported in the last 20 years. The PubMed, Embase, and Cochrane databases were searched for articles published before March 30, 2020. A comprehensive review of published studies was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Authors performed a systematic review and meta-analysis of the reported data to assess the reliability of the preoperative prediction of the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma. The data were analyzed using a fixed-effects model. The estimated overall intraoperative verification concordance rate was 89.05% (95% confidence interval 85.06%-92.58%). Preoperatively predicting the location of the facial nerve using diffusion tensor imaging-fiber tracking in vestibular schwannoma is reliable, but the extent to which it contributes to long-term facial nerve function is still unclear. To further verify these results, studies with larger sample sizes are needed in the future, especially prospective randomized controlled trials focusing on the long-term functional preservation of the facial nerve.

Trigeminal schwannomas (TS) are rare, when compared to vestibular schwannomas. The present study aims to analyze the clinical characteristics and surgical strategies of TSThe clinical information of 43 patients diagnosed with TS, who were surgically treated from January 2008 to January 2018, was retrospectively analyzed. Then, the selection of approaches and surgical strategies were discussed.During the last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University. Facial numbness and hypoesthesia were the most common symptoms, which developed in 29 cases (67.4%). Typical trigeminal neuralgia was complained by four patients (9.3%), while trigeminal motor impairment developed in nine cases (20.9%). The tumor was totally removed in 39 patients (90.7%), near-totally removed in three patients (7.0%), and partially removed in one patient (2.3%) due to intraoperative internal carotid artery (ICA) injury. The abducens was intraoperatively damaged in two patients (4.7%). After the operation, all four patients with trigeminal neuralgia achieved total recovery, but the facial numbness still continued in 24 patients (82.8%). At a median of 45.3 ± 25.5 (6-84) months of follow up, a tumor recurred in only one patient, and this patient received a second operation.It can be concluded that total removal

Background Venous air embolism (VAE) during craniotomy operation with semi-sitting position is closely related to intracranial venous pressure. The objective of current study was to explore the relationship between intracranial venous pressure and VAE during operation with semi-sitting position. Methods Between April 2018 and January 2019, 25 patients with vestibular schwannoma and 1 patient with posterior fossa meningioma received operation under semi-sitting position. Catheterization at jugular bulb was conducted by puncture of jugular vein with central venous catheter under guidance of ultrasound. The central venous catheter was then connected to a pressure sensor to continuously monitor the jugular bulb pressure (JBP). Both JBP and VAE were continuously monitored during operation to explore the relationship between JBP and intraoperative VAE under semi-sitting position. Results Under supine position, JBP significantly increased when the head was rotated 45° to the right compared with that recorded at neutral head position. Among all 26 patients, VAE occurred in 4 (15.4%) cases during operation including 2 minor VAE and 2 moderate VAE. Among 3 patients with negative JBP relative to atmosphere pressure, 2 occurred VAE during operation; while only 2 patients occurred VAE among other 23 cases whose JBP was positive relative to atmosphere pressure (P = 0.009). Conclusion The pressure of intracranial sinus could be continuously monitored by catheterization at jugular bulb. JBP monitoring could be used for prediction of intraoperative VAE. The rate of intraoperative VAE was significantly increased when JBP was negative relative to atmosphere pressure.

Most studies reported that cystic vestibular schwannoma (CVS) surgery has a less favourable prognosis than solid vestibular schwannoma (SVS) surgery. However, some studies report that it is unclear whether surgical outcomes for these conditions exhibit significant differences. The aim of this meta-analysis was to pool the current literature and describe and analyse any differences in the clinical symptoms and surgical outcomes among CVS and SVS. PubMed, Embase, and Cochrane databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through April 22, 2020. Outcomes were analysed using a meta-analysis of the proportions. The results of the search yielded 17 studies that met the criteria for inclusion and analysis, involving 3074 participants (including 821 patients with CVSs and 2253 patients with SVSs). No significant differences in the extent of tumour resection (gross-total resection versus non-gross-total resection; RR, 0.93; 95% CI, 0.86–1.01; p = 0.096) and most other outcomes were noted between CVS and SVS cohorts. However, facial nerve function (House-Brackmann Grade I or II versus III or more) of CVS patients was worse (RR, 0.86; 95% CI, 0.78–0.93; p

Background Infectious basilar artery (BA) aneurysm has been occasionally reported to be generated from meningitis following transcranial operation. However, infectious BA aneurysm formed by intracranial infection after endoscopic endonasal operation has never been reported. Case presentation A 53-year-old man who was diagnosed with suprasellar region meningioma received tumor removal via endoscopic endonasal approach. After operation he developed cerebrospinal fluid (CSF) leak and intracranial infection. The patient ultimately recovered from infection after anti-infective therapy, but a large fusiform BA aneurysm was still formed and ruptured in a short time. Interventional and surgical measures were impossible due to the complicated shape and location of aneurysm and state of his endangerment, therefore, conservative anti-infective therapy was adopted as the only feasible method. Unfortunately, the aneurysm did not disappear and the patient finally died from repeating subarachnoid hemorrhage (SAH). Conclusion Though extremely rare, it was emphasized that infectious aneurysm can be formed at any stage after transnasal surgery, even when the meningitis is cured. Because of the treatment difficulty and poor prognosis, it was recommended that thorough examination should be timely performed for suspicious patient to make correct diagnosis and avoid fatal SAH.

Metal-organic frameworks (MOFs) have potential in the removal of air hazards such as particulate matter. Cellulose paper is low-cost, renewable and highly industrialized matrix. A facile strategy was proposed in the present work to efficiently integrate MOFs with cellulose paper, with zeolitic imidazolate framework-8 (ZIF-8) as the model. ZIF-8 was in situ synthesis in chitosan gel and subsequently added to the cellulose pulp to fabricate composite paper. The retention rate of ZIF-8 was 75.73 %, which was significantly superior to conventional filling method (4.15 %) and in situ precipitation method (6.52 %). Moreover, ZIF-8 in the composite paper functioned well in aspects of adsorption, filtration and sterilization. The PM2.5 removal efficiency was 99.68 % with basis weight 60 g·m-2, while the removal efficiency and pressure drop can be modulated by changing the basis weight of composite paper. This strategy may offer ideas to design MOFs/cellulose-based composite materials for particulate matter removal.

Filler pre-flocculation has been extensively studied in the past to increase filler content while maintaining the physical strength properties of paper. However, optical properties of paper could be negatively affected due to the filler pre-flocculation. In this work, two kinds of precipitated calcium carbonate (PCC) fillers with different particle sizes, namely PCC1 (4.2 μm) and PCC2 (7.7 μm), were used to investigate the effects of filler pre-flocculation on the strength and optical properties of paper. Results showed that pre-flocculated fillers with smaller particle size (PCC1) could improve the tensile strength of handsheets more effectively, since the tensile index was increased by 22.9 %. Meanwhile, for a given floc size, the handsheets with PCC1 flocs exhibited a better light scattering ability comparing to the ones filled with PCC2 flocs. The improved light scattering ability of handsheets filled with 24 μm PCC1 flocs compared to 24 μm flocs produced with PCC2 can be attributed to the complex micro void structure of flocs. This finding can be used as a guidance for the selection of filler particle size when using filler pre-flocculation to optimize the mechanical and optical properties of paper.

Objective The semisitting position (SSP) and lateral position (LP) in vestibular schwannoma (VS) surgery each have advantages and disadvantages, and which position is superior overall is debatable. Our objective was to determine the optimal position for surgical treatment of VSs with a diameter ≥3 cm. Methods We retrospectively evaluated consecutive patients with a large VS treated between January 2010 and July 2020. Patients were grouped by surgical position and analyzed. Results We enrolled 259 patients (LP group, n = 156; SSP group, n = 103). The resection extent was not significantly different between the SSP (gross-total resection [GTR], n = 89 [88.1%], near-total resection [NTR], n = 10 [9.9%], subtotal resection [STR], n = 2 [2.0%]) and LP (GTR, n = 125 [80.1%]; NTR, n = 24 [15.4%]; STR, n = 7 [4.5%]) groups. The rate of GTR with facial nerve (FN) functional preservation was higher in the SSP group than in the LP group (P = 0.014) at eight days after the operation. However, during follow-up (SSP group median, 31.5 months; LP group median, 19.5 months), there was no significant between-group difference in FN functional preservation. Two patients in the SSP group required conversion to the LP due to severe intraoperative venous air embolism (VAE). Conclusion Compared with the LP, the SSP did not produce significantly better FN outcomes in patients with a large VS. The duration of surgery was significantly longer in SSP cases than in LP cases. Given the risk of VAE associated with the SSP, the selection of the optimal surgical position should be made with caution on an individual basis.

Trigeminal neuralgia (TN) secondary to arterivenous malformations (AVMs) is relatively rare. We here report on a case of TN caused by cerebellar AVMs that was successfully treated by total AVMs resection in conjunction with microvasecular decompression (MVD) in one stage. In addition, we perform a review of the literature about the treatment of TN caused by cerebellar AVMs.

Background: Some problems have been found in the usually adopted combined approach for the removal of intra-extracranial tumors in skull base. Herein, we described a pure endoscopic transnasal or transoral approach (ETA) for the removal of intra-extracranial tumors in various skull base regions. Methods: Retrospectively, clinical data, major surgical complications, pre- and postoperative images, and follow-up information of a series of 85 patients with intra-extracranial tumors in various skull base regions who were treated by surgery via ETA in our skull base center during the past 10 years were reviewed and analyzed. Results: Gross total tumor removal was achieved in 80/85 cases (94.1%) in this study. All 37 cases with tumors in anterior skull base and all 14 cases with tumors in jugular foramen received total tumor removal. Thirteen and three cases with tumors in clivus received total and subtotal tumor removal, respectively. Total and subtotal tumor removal was performed for 16 cases and 2 cases in lateral skull base, respectively. The complications in this study included: cerebrospinal fluid leakage (n = 3), meningitis (n = 3), and new cranial nerve deficits (n = 3; recovered in 3 months after surgery). In the follow-up period of 40–151 months (median: 77 months), seven patients (8.8%) out of the 80 cases of total tumor removal experienced recurrence. Conclusions: Complete resection of intra-extracranial growing tumors in various skull base regions can be achieved via the pure ETA in one stage in selected cases. Surgical procedure for radical removal of tumors is feasible and safe. Key words: Endoscopy; Intra-extracranial Growth; Neoplasm; Skull Base; Surgery

Background Internal jugular vein stenosis (IJVS) results in poor venous outflow and can result in intracranial hypertension. Venous stenting has become a debated topic for correction of this pathology. Case Description A 49-year-old male merchant with bilateral IJVS presented with headache, dizziness, and pulsatile tinnitus. He was found to have intracranial hypertension and left IJVS caused by styloid process compression and right IJVS caused by damage of the venous intima. His symptoms improved after undergoing styloidectomy followed by left intra–internal jugular vein (IJV) balloon. However, 1 year later, the prior symptoms reoccurred. At this time, the patient underwent right intra-IJV stenting. After treatment of the contralateral side, the symptoms resolved during the following 3 months. Conclusions The clinical practice in this case indicated that in patients with bilateral IJVS, a 2-side intervention may be necessary when unilateral correction fails. We advise a staged approach to correction of bilateral IJVS. Styloid compression–induced IJVS should be corrected by styloidectomy in combination with balloon and/or stenting, whereas IJVS induced by venous wall issues needs only stenting.

Objective The objectives of this study were to report 4 cases diagnosed with trigeminal schwannomas (TS), among whom tumor in epidural space of middle fossa broke through dura mater into subdural space, and to analyze the potential reason for recurrence of TS in middle fossa after surgical removal by endoscopic endonasal approach (EEA) or interdural approach. Methods The information of 4 patients diagnosed with TS who were surgically treated was retrospectively analyzed and the selection of approaches, surgical strategies, and potential reason for recurrence after middle fossa TS removal by EEA and interdural approach were discussed. Results During last 10 years, 43 patients with TS received surgical treatment at Xuan Wu Hospital of Capital Medical University, among whom 1 patient with TS extending from middle fossa to infratemporal fossa was first treated by EEA, then the tumor recurred and the patient underwent a second operation via a frontotemporal subdural approach. During the second operation, we found part of tumor had broken through the dura mater into subdural space. Moreover, this phenomenon was detected in another 3 patients with middle-posterior fossa TS. Conclusions TS in middle fossa has been widely believed to be totally located at epidural space, whereas we found that it could occasionally breach into subdural space and accept blood supply from the pial artery. We believe this could be the potential reason for recurrence after tumor resection by EEA and interdural approach.

Background Electrophysiological monitoring is used routinely to protect the facial nerve during acoustic neuroma surgery. This study aimed to clarify the relationship between the facial nerve's electrophysiological monitoring parameters and its function after surgery. Methods Fifty-two patients with acoustic neuroma who underwent surgery were included. After localizing the facial nerve, its monitoring results during surgeries performed at our center were analyzed. Postoperative nerve functioning was correlated with the stimulation threshold of the facial nerve's proximal segment, proximal-to-distal amplitude ratio of the facial nerve, and proximal stimulation amplitude. Receiver-operating characteristic curves of the three parameters were calculated. Results Electrical stimulation accurately described the facial nerve's anatomic distribution after the depth of anesthesia was assessed via accessory nerve stimulation. The data recorded after resection showed that a higher proximal-to-distal amplitude ratio was associated with better facial nerve functioning (P=0.037). A lower stimulation threshold of the proximal segment correlated with better facial nerve functioning (P=0.038). Conclusions The most sensitive index to predict postoperative nerve functioning is the facial nerve's proximal-to-distal amplitude ratio. Accessory nerve stimulation can determine the appropriate depth of anesthesia, Electromyography (EMG) monitoring of the facial nerve during acoustic neuroma surgery can protect it effectively.

We designed a new type of high temperature proton exchange membrane (HT-PEM), which consists of polyethersulfone (PES)-Polyvinylpyrrolidone (PVP)-xSm0.2Ce0.8O1.9 (SDC) (x = 0, 2 wt%, 4 wt%, 6 wt%), and the effect of SDC contents was systematically studied. The incorporation of SDC nanoparticles into the membrane plays a very important role in compromising the conductivity, the mechanical strength, and the durability of the membrane, because SDC has a certain extent proton conductivity, and the SDC has flocculent structure. The single cell shows the maximum power density of 1229 mW/cm2 under a backpressure of 0.15 MPa at 160 °C, and the output performance keeps stable during the 1000 h stability test at a constant voltage of 0.7 V.

Elevating the operating temperature of polymer electrolyte fuel cells (PEFCs) can facilitate the reaction kinetics and improve the CO tolerance of catalysts, and simplify the complex water-heat management system of fuel cells. In this study, we fabricated the ionic liquid-based polymer electrolyte that can operate up to 250 °C without external humidification. The membrane utilized polybenzimidazole (PBI) as the polymer matrix, and ionic liquids as the proton conductive fillers. Among all the investigated ionic liquids, diethylmethylammonium trifluoromethanesulfonate ([dema][TfO]) shows favorable performance and stability. The PBI-[dema][TfO] composite membrane exhibits high proton conductivity of 108.9 mS cm−1 at 250 °C. The single cell with PBI-[dema][TfO] composite membrane and Pt/C as the electrode shows output performance of 144 and 62 mW/cm2 at 125 °C and 250 °C, respectively. This work demonstrates that it is very promising to fabricate high temperature PEFCs using the ionic liquid-based polymer electrolyte.

There are no large series studies identifying the locations of cranial nerves (CNs) around trigeminal schwannomas (TSs); however, surgically induced cranial neuropathies are commonly observed after surgeries to remove TSs. In this study, we preoperatively identified the location of CNs near TSs using diffusion tensor tractography (DTT). An observational study of the DTT results and intraoperative findings was performed. We preoperatively completed tractography from images of patients with TSs who received surgical therapy. The result was later validated during tumorectomy. A total of three consecutive patients were involved in this study. The locations of CNs V-VIII in relation to the tumor was clearly revealed in all cases, except for CN VI in case 3.The predicted fiber tracts were in agreement with intraoperative observations. In this study, preoperative DTT accurately predicted the location of the majority of the nerves of interest. This technique can be applied by surgeons to preoperatively visualize nerve arrangements.

Background Trigeminal neuralgia (TN) caused by a tentorial dural arteriovenous fistula (TDAVF) is quite rare. To date, only 10 cases and 2 small case series have been reported in this regard, and most were treated with either embolization or surgery. Here, we report a unique case of a TDAVF presented as TN, which was embolized with Onyx first and resected later. Case Description A 57-year-old male presented with right-sided TN. Magnetic resonance imaging revealed a variceal venous dilation occupying the right lateral pontine cistern and multiple venous flow void signals adjacent to the right trigeminal nerve root entry zone. Digital subtraction angiography revealed the right TDAVF, which was completely embolized with transarterial Onyx later. The patient remained symptom free for 1 year before TN recurred. Digital subtraction angiography did not exhibit the recurrence of fistula. After resection of embolized dilated veins, the symptom alleviated and the patient remained symptom free for the 5-month follow-up to date. Conclusions Even complete obliteration of fistula could cause the recurrence of neuralgia, and resection of embolized dilated veins might be effective for the treatment of TN in such recurrent cases.