Cerebrovascular neurosurgery is an important part of modern neurosurgery. The main disease categories include intracranial aneurysms, brain and spinal vascular malformations, moyamoya disease, and cerebrovascular stenosis and occlusion disease. In recent years, minimally invasive open surgery and endovascular treatment have made great progress in their respective fields. On one hand, the scope of cerebrovascular diseases suitable for the interventions above has been continuously expanded; on the other hand, the two treatment methods partially overlap and inevitably interact, and therefore form a mutually reinforcing and complementary treatment system. The article reviews aforementioned progress and discusses the development trend of cerebrovascular neurosurgery.

Cerebrovascular disease is one of the most common neurological complications during pregnancy. Pregnancy-related hemodynamic changes, hypercoagulable state and other factors could increase the risk of cerebrovascular disease. Pregnancy-related cerebrovascular diseases often lead to poor prognosis and high mortality, and could affect the health of the fetus/fetuses. Therefore, early recognition and treatment is necessary. In this review, we discusses the epidemiology, pathophysiological changes, clinical manifestations, treatment, and prognosis of ischemic stroke, hemorrhagic stroke, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome during pregnancy and postpartum period. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reduce the morbidity and mortality of pregnancy-related cerebrovascular diseases.

Cerebral small vessel disease (CSVD) is the most common vascular cause of cognitive impairment in the elderly. The lesion-symptom mapping studies found that the damage of strategically located white matter microstructure may be the potential pathogenesis of CSVD-related cognitive impairment, namely cortical-cortical or cortical-subcortical disconnection syndrome. Diffusion tensor imaging (DTI) provides a non-invasive fiber tracking method for the study of white matter microstructure damage. Therefore, this article reviews the study of disconnection syndrome in CSVD-related cognitive impairment and the correlation between fiber microstructure damage and different cognitive domain dysfunction in DTI studies.

Cerebral microinfarction (CMI) is a cerebrovascular disease that occurs in the elderly, and it is closely related to cognitive decline and dementia in the elderly. Due to their small size, only a part of these lesions can be recognized in low-resolution magnetic resonance imaging (MRI). Therefore, there are certain limitations in studying them on routine clinical MRI scans. While MRI scans with high magnetic field strength are applied, CMI can be identified, especially cortical CMI. This article mainly reviews the pathogenesis, imaging findings and treatment of the cerebral microinfarction and cognitive impairment, in order to better understand the relationship between CMI and cognitive impairment.

The pathogenesis of cerebral small vessel disease (CSVD) is elusive and the mechanism is complex and diverse. Studies have found that sporadic CSVD has the similar genetic susceptibility as monogenic hereditary CSVD, and genetic factors play an important role in the incidence and development of CSVD. This article summarizes the correlation between six kinds of imaging manifestations and genetic factors in sporadic CSVD, as well as the role of genetic polymorphisms and RNA in CSVD.

Subjective cognitive decline (SCD) is a state in which an individual complains of a decline in cognitive function compared with the previous, while there is no objective evidence of neuropsychological abnormalities. Numerous evidences indicate that SCD may be the earliest symptom in Alzheimer's disease (AD) spectrum. At the same time, SCD presents a strong heterogeneity. How to identify progressive SCD patients in order to achieve ultra-early prevention and intervention of AD is of difficulty in the current research. This review presents SCD-related information in terms of research criteria, cognitive progress factors, marker research status, current research limitations, and future research directions.

Both the recent surge in the number and the rapid development of technology of cardio-cerebrovascular surgery put forward higher requirements and newer challenges to the anesthesia of cardio-cerebrovascular surgery. Cerebral hypoperfusion has become an important risk factor for the prognosis of cardio-cerebrovascular surgery. In recent years, near infrared spectroscopy (NIRS), as the only noninvasive brain oxygen monitoring technology at present, has been widely used due to its advantages of being noninvasive, continuous, sensitive, and real-time. By detecting regional cerebral oxygen saturation (rScO₂), we can evaluate the balance of brain oxygen supply and demand, optimize perioperative management, reduce the incidence of postoperative neurological complications such as stroke, shorten in-patient stay and improve the prognosis of patients. In this article, we review the fundamental principles, normal value and clinical significance of monitoring cerebral oxygen saturation by NIRS, the clinical application in cardio-cerebrovascular surgery and the predictive value in postoperative cerebral ischemia.

Hyperglycemia is an independent risk factor for cognitive dysfunction and may accelerate the progression of mild cognitive impairment to dementia. Diabetes mellitus is one of the most serious public health problems in the 21st century around the world. With the number of diabetic patients increased, more attention has been paid to type 2 diabetes mellitus related cognitive dysfunction. The type 2 diabetes mellitus related cognitive dysfunction mainly displays in the memory, attention, information processing speed and executive functions, etc.. Magnetic resonance imaging (MRI) studies have shown that, compared with patients without diabetes, type 2 diabetes mellitus patients can be present more often with the reduction of the brain volume, the incidence of lacunar cerebral infarction, the loss of cerebral white matter fiber tracts integrity, and the diminishment of brain activation function, the decline of brain function of interval nuclear structure connection, and the change of the cerebral metabolic material level.

Stroke is still the leading cause of the mortality and disability of Chinese adults with the aging of society and the deterioration of cardiovascular risk factors. Carotid stenosis is the main cause of adult ischemic strokes and an independent risk factor of cognitive disorders. Carotid revascularization, including carotid endarterectomy (CEA) and carotid artery stenting (CAS), contributes to decreasing the long-term stroke risk and improving the impaired cognitive function in patients with carotid stenosis. In this article, we reviewed the mechanism of cognitive disorders caused by carotid stenosis and the effects of carotid revascularization on cognitive function.

The incidence of cerebral ischemic strokes is annually increasing, with higher and higher mortality and disability. The increasing morbidity of cerebral ischemic strokes is due to various factors such as population aging, changes in diet, climate and environment. At present, more and more researchers believe that the air pollution is an important risk factor for cerebral ischemic strokes. However, the underlying mechanisms between cerebral ischemic strokes and air pollution haven't reached a consensus yet. In-depth understanding of effect of the air pollution on cerebral ischemic strokes and its related mechanisms can help to prevent cerebral ischemic stroke, restore neurological function, and improve the prognosis of patients with cerebral ischemic strokes. Therefore, we reviewed the correlation between air pollution and cerebral ischemic strokes in recent years.

Post-stroke cognitive impairment (PSCI) brings loads of burden to patients and their families, and effective interventions can help solving the problem. The article clarified clinical and epidemiological features as well as risk factors of PSCI, and also introduced latest progress in the rehabilitation and nursing of PSCI. The incidence of cognitive impairment is high in stroke patients along with extensive cognitive impairment and specific patterns. The risk factors of PSCI were various and can be classified based on the possibility of intervention. In term of rehabilitation, various of attempts, which target at different aspects to improve cognition directly or indirectly, have shown good potential and deserve further researches and application.

Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke. The overall incidence of PSD in stroke survivors is approximately 33%. PSD has many serious effects on physical functions, cognitive functions, psychological status and social functions, and it also causes heavily burden patients, families and the society. Therefore, the early recognition and treatment of PSD is of great clinical significance. Nutrition metabolism is closely related to depression and stroke, and has been found to be closely related to PSD. However, the mechanism of nutrition metabolism in the development of PSD is not clear. In this article, we reviewed the scientific progress of the relationship between different nutritional metabolism disorders and PSD in recent years.

Metabolic syndrome is a group of clinical syndromes characterized by central obesity, impaired glucose regulation or diabetes, disorder of lipid metabolism and hypertension. Insulin resistance is the common pathophysiological basis of them. Vascular cognitive impairment (VCI) can be present as a clinical stroke or subclinical vascular brain injury, involving at least one cognitive damaged domain. It is caused by cerebrovascular disease and its risk factors. This article reviewed the relationship between metabolic syndrome and VCI, and the mechanism of metabolic syndrome leading to VCI.

Symptomatic carotid stenosis is a major cause of stroke, and carotid artery stenting (CAS) has been widely used in clinical practice. Cerebral hyperperfusion syndrome (CHS) is a severe complication post CAS. This review covers the current status and progress of CHS after CAS, including the epidemiology, pathogenesis, risk factors, clinical manifestations, assistant examination, diagnosis, prevention, and treatment, in order to guide clinical practice.

Atrial fibrillation (AF) increases the risk of ischemic stroke, heart failure, all-cause mortality and cognitive dysfunction. Identifying risk factors for incident AF is pivotal for making strategies for primary prevention, silent AF screening or detection, and improving AF-related clinical prognosis. The most common clinical risk factors for AF include age, male gender, smoking, drinking, obesity, obstructive sleep apnea, hypertension, coronary artery disease, heart failure, hyperthyroidism, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, etc. The novel HAVOC and C₂HEST score are the promising and simple clinical risk assessment tools for incident AF.

In recent years, the exploration of human brain function has been one of the research hotspots in the field of neuroscience. With the proposal of Human Connectome, the multimodal neuroimaging technology gradually becomes an important breakthrough in the study of human whole brain neural network function. From the anatomical point of view, the characteristics of neurons accompanied by blood vessels suggest that cerebral blood flow can be used as a reliable signal to reflect neurological function. Taking this as a starting point, this paper reviews the scientific progress of brain functional imaging based on intracerebral blood flow, and the significance of the interaction between neurons and concomitant vessels in cerebrovascular diseases in the case of ischemic stroke.

The effect of mean arterial pressure on acute progressive ischemic stroke was analyzed for different degrees of stenosis in the responsible vessels.

Retrospective analysis was performed on patients with acute progressive ischemic stroke who met the inclusion criteria and were admitted to the First Hospital of Baoding from January 2017 to June 2018. Blood pressure was monitored for 72 hours after admission. According to responsible vascular stenosis degree, patients with acute progressive ischemia stroke were divided into vascular moderate stenosis group and vascular severe stenosis group. The differences of mean arterial pressure before and after the progression of stenosis were compared among the groups with different responsibilities. byt-test of self-pairing

Mean arterial pressure before progression was higher in the moderate stenosis group than after progression [(113.62±10.17)mmHg vs (101.3±12.6)mmHg], the difference was statistically significant (t=3.4648, P=0.026). The mean arterial pressure before progression in the severe stenosis group was higher than that after progression, and the difference was not statistically significant (P＞0.05).

In the treatment of acute ischemic stroke patients with moderate vascular stenosis, blood pressure should be paid close attention to prevent the occurrence of hypotension leading to disease progression. Appropriate attention should be paid to blood pressure in the treatment of acute ischemic stroke patients with severe vascular stenosis.

Stroke is the leading cause of death and disability in China. Among the stroke patients, cryptogenic stroke without definite causes accounted for about one third. The incidence of patent foramen ovale (PFO) in patients with cryptogenic stroke is higher than that in patients with clear cause of stroke, which is an important risk factor in cryptogenic stroke. The main pathogenesis of stroke in patients with PFO is paradoxical embolism. In clinical practice, contrast-enhanced transcranial Doppler, contrast-enhanced transthoracic echocardiography, and contrast transesophageal echocardiography are frequently used to detect PFO. In recent years, a number of large-scale randomized controlled trials have shown that percutaneous foramen ovale occlusion combined with drug therapy significantly reduced the incidence of recurrent strokes in patients with cryptogenic stroke compared with drug therapy alone.

Cerebral microbleeds (CMBs) are one kind of neuroimaging manifestations in cerebral small vessel disease, pathologically correlated with hemosiderin deposition. Susceptibility-weighted imaging can be used to assess CMBs. CMBs are increasingly recognized in the fields of cerebrovascular diseases and neurodegenerative diseases. However, some of rare diseases can also manifest CMBs. It is therefore necessary to reliably evaluate their presence and distribution in the brain. Understanding the uncommon causes of CMBs is not only helpful in diagnosis and prognosis of these rare diseases, but can also help in better understanding different pathophysiology involved in the development of CMBs. In this article, we described uncommon causes of CMBs.