Evaluating the role of 7-Tesla magnetic resonance imaging in neurosurgery: Trends in literature since clinical approval

BACKGROUND After approval for clinical use in 2017,early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated its feasibility as well as diagnostic capabilities in neuroimaging.However,there are no to few systematic reviews covering the entirety of its neurosurgical applications as well as the trends in the literature with regard to the aforementioned application.AIM To assess the impact of 7-Tesla MRI(7T MRI)on neurosurgery,focusing on its applications in diagnosis,treatment planning,and postoperative assessment,and to systematically analyze and identify patterns and trends in the existing literature related to the utilization of 7T MRI in neurosurgical contexts.METHODS A systematic search of PubMed was conducted for studies published between January 1,2017,and December 31,2023,using MeSH terms related to 7T MRI and neurosurgery.The inclusion criteria were:Studies involving patients of all ages,meta-analyses,systematic reviews,and original research.The exclusion criteria were:Pre-prints,studies with insufficient data(e.g.,case reports and letters),non-English publications,and studies involving animal subjects.Data synthesis involved standardized extraction forms,and a narrative synthesis was performed.RESULTS We identified 219 records from PubMed within our defined period,with no duplicates or exclusions before screening.After screening,125 articles were excluded for not meeting inclusion criteria,leaving 94 reports.Of these,2 were irrelevant to neurosurgery and 7 were animal studies,resulting in 85 studies included in our systematic review.Data were categorized by neurosurgical procedures and diseases treated using 7T MRI.We also analyzed publications by country and the number of 7T MRI facilities per country was also presented.Experi-mental studies were classified into comparison and non-comparison studies based on whether 7T MRI was compared to lower field strengths.CONCLUSION 7T MRI holds great potential in improving the characterization and understanding of various neurological and psychiatric conditions that may be neurosurgically treated.These include epilepsy,pituitary adenoma,Parkinson's disease,cerebrovascular diseases,trigeminal neuralgia,traumatic head injury,multiple sclerosis,glioma,and psychiatric disorders.Superiority of 7T MRI over lower field strengths was demonstrated in terms of image quality,lesion detection,and tissue characterization.Findings suggest the need for accelerated global distribution of 7T magnetic resonance systems and increased training for radiologists to ensure safe and effective integration into routine clinical practice.

Balancing bleeding,thrombosis and myocardial injury:A call for balance and precision medicine for aspirin in neurosurgery

Perioperative management of antiplatelet therapy involves a delicate balancing of the risk of periprocedural blood loss with the cardiovascular and thrombotic risk to the patient.Due to the unique nature of neurosurgery,perioperative bleeding may have devastating consequences and cause major morbidity and mortality.The recommendation to discontinue aspirin prior to major neurosurgical procedures rests upon conventional practice,expert consensus with priority given to avoidance of any major bleed.On the contrary recent prospective data do not support the existence of additional bleeding risk in patients continuing aspirin compared to those who stop aspirin prior to procedure.Patients with cardiova-scular and metabolic comorbidities are increasingly encountered in the operation theatre these days.In these patients,prevention of myocardial injury after non-cardiac surgery(MINS)is an important focus for perioperative risk reduction.Prolonged(≥7 days)cessation of antiplatelets is one of the most important predictors of MINS.This complicated milieu of risks and benefits highlights the difficulty of practicing evidence-based medicine and minimizing harm in patients on aspirin needing neurosurgery.

神经外科重症患者四级康复护理活动方案的构建及应用

目的构建神经外科重症患者四级康复护理活动方案并评价其应用效果。方法选取2020-08—12北京市某三级甲等医院神经外科ICU收治的96例患者为试验组,患者入住ICU≥24 h且病情稳定后,根据其意识和肌力评估情况,实施四级康复护理活动方案。选取2020-03—07神经外科ICU收治的99例患者为对照组,给予常规康复护理。比较2组患者的康复状况及并发症发生情况。结果试验组机械通气时间[11(5,17)d比16(7,24)d]、ICU住院时间[13(7,25)d比20(12,30)d]、住院费用[137070(76603,219237)元比193839(129781,321362)元]和出ICU的APACHE-Ⅱ评分[(22.03±7.54)分比(25.21±6.51)分]均低于对照组(P<0.05),出院ADL评分[5(0,15)分比0(0,10)分]高于对照组(P<0.05)。在肺部感染[40(41.67%)比57(57.57%)]和下肢深静脉血栓[3(3.13%)比25(25.25%)]方面,试验组均低于对照组,差异有统计学意义(P<0.05);在ICU谵妄和压力性损伤方面,2组差异无统计学意义(P>0.05)。结论对神经外科重症患者实施四级康复护理活动方案能够改善重症患者的恢复状况,减少并发症的发生,有助于促进重症患者早期康复。

人工智能辅助CTA阅片在颅内动脉瘤诊断教学中的应用

目的探讨人工智能辅助计算机断层扫描血管造影(computed tomography angiography,CTA)阅片在神经外科颅内动脉瘤诊断教学中的应用效果。方法选取2022年3月―2023年6月在武汉大学人民医院神经外科参加住院医师规范化培训的64名学员,按照随机数字表法分为试验组和对照组,各32名。对照组采用传统的多媒体教学和影像学阅片,试验组在传统教学方式的基础上组织学员运用人工智能CTA诊断系统进行教学。教学结束后,对2组学员进行理论考试和无记名问卷调查,以评价“人工智能辅助CTA阅片”在颅内动脉瘤诊断中的教学效果。结果试验组住培学员的理论考试总成绩为(81.78±7.53)分,高于对照组住培学员的理论考试总成绩[(70.66±8.89)分],差异有统计学意义(P<0.001)。在基本知识和影像判读2种题型中,试验组住培学员的成绩均高于对照组[(33.69±5.18)分vs.(29.88±4.28)分,(48.09±6.21)分vs.(40.78±6.98)分],差异有统计学意义(P<0.05)。同时,问卷调查结果显示,在教学反馈评价调查比较中,试验组住培学员在教学满意度、学习兴趣提升度、教学启发性和教学效果的评分均高于对照组,差异有统计学意义(P<0.001)。结论在神经外科住院医师规范化培训中,应用人工智能辅助CTA阅片进行颅内动脉瘤的诊断教学,能提高教学效果和学员的教学满意度。

神经外科病人气管切开拔管影响因素及拔管指征的研究进展

对神经外科病人气管切开拔管的影响因素、拔管指征及评估方法进行综述,以期为临床实践提供参考,提高病人拔管成功率和安全性。

颅脑损伤患者术后谵妄预防及管理的证据总结

目的总结颅脑损伤患者术后谵妄(postoperative delirium,POD)预防及管理的最佳证据。方法系统检索国内外数据库及相关指南网中关于颅脑损伤患者POD预防及管理的相关文献,检索时限为建库至2023年9月30日。由2名研究者独立进行文献质量评价并提取证据。结果共纳入16篇文献,包括指南4篇、专家共识5篇、临床决策2篇、证据总结1篇、系统评价4篇。从高危因素评估、筛查、预防及管理、医护培训、健康教育、随访6个方面,总结出36条证据。结论该研究总结了颅脑损伤患者POD预防及管理的最佳证据,为临床工作者提供循证证据,从而以科学的方法预防及管理颅脑损伤患者的POD,改善临床结局。

以循证理论为基础的预见性护理在神经外科重症患者气管切开术后呼吸道护理中的应用效果

目的:分析以循证理论为基础的预见性护理在神经外科重症患者气管切开术后呼吸道护理中的应用效果。方法:选取2023年3月—2024年3月晋江市医院收治的92例神经外科重症患者作为研究对象,应用随机计算机法分为对照组与研究组,各46例。对照组实施常规护理,研究组在对照组基础上实施以循证理论为基础的预见性护理,比较两组血气指标、康复指标、不良事件、抑郁情绪。结果:护理前,两组血气指标比较,差异无统计学意义(P>0.05);护理后,两组动脉血二氧化碳分压(PaCO_(2))低于护理前,动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))高于护理前,且研究组优于对照组,差异有统计学意义(P<0.05)。研究组留置管时间、肺部感染持续时间、住院时间短于对照组,不良事件发生率低于对照组,差异有统计学意义(P<0.05)。护理前,两组情绪抑制量表(EIS)评分比较,差异无统计学意义(P>0.05);护理后,两组EIS评分低于护理前,且研究组低于对照组,差异有统计学意义(P<0.05)。结论:神经外科重症患者实施以循证理论为基础的预见性护理,能改善血气指标,促进康复,降低不良事件发生率,从而改善患者抑郁情绪。

Role of triggering receptor expressed on myeloid cells 1/2 in secondary injury after cerebral hemorrhage

Intracerebral hemorrhage(ICH)is a common severe emergency in neurosurgery,causing tremendous economic pressure on families and society and devastating effects on patients both physically and psychologically,especially among patients with poor functional outcomes.ICH is often accompanied by decreased consciousness and limb dysfunction.This seriously affects patients’ability to live independently.Although rapid advances in neurosurgery have greatly improved patient survival,there remains insufficient evidence that surgical treatment significantly improves long-term outcomes.With in-depth pathophysiological studies after ICH,increasing evidence has shown that secondary injury after ICH is related to long-term prognosis and that the key to secondary injury is various immune-mediated neuroinflammatory reactions after ICH.In basic and clinical studies of various systemic inflammatory diseases,triggering receptor expressed on myeloid cells 1/2(TREM-1/2),and the TREM receptor family is closely related to the inflammatory response.Various inflammatory diseases can be upregulated and downregulated through receptor intervention.How the TREM receptor functions after ICH,the types of results from intervention,and whether the outcomes can improve secondary brain injury and the long-term prognosis of patients are unknown.An analysis of relevant research results from basic and clinical trials revealed that the inhibition of TREM-1 and the activation of TREM-2 can alleviate the neuroinflammatory immune response,significantly improve the long-term prognosis of neurological function in patients with cerebral hemorrhage,and thus improve the ability of patients to live independently.

东西部地区三级甲等医院神经外科护士身体约束知信行比较

目的比较东西部地区三级甲等医院神经外科护士身体约束的知信行。方法采用多阶段抽样法抽取2023年1月至3月共481名神经外科护士,使用神经外科护士对患者身体约束的知信行调查问卷对其进行调查。结果本次调查中,东部地区神经外科护士214名,西部地区267名。东部地区神经外科护士的身体约束知识总得分高于西部地区神经外科护士(P=0.015)。两地区神经外科护士的身体约束态度、行为总得分无明显差异(P=0.627、0.889)。结论东部地区三级甲等医院神经外科护士的身体约束知识掌握度优于西部地区,而临床执行能力并未优于西部地区。

Neurosurgery:颈动脉内膜剥脱术后同侧瞳孔散大是怎么回事?

急性瞳孔散大往往提示脑疝,是神经外科最严重的临床征象。颈动脉内膜剥脱术（carotid endarterectomy,CEA）后,急性瞳孔散大意味着再灌注出血引起占位效应压迫动眼神经。CEA手术后出血非常罕见,不足0.5%。

择期开颅肿瘤术后患者恶心呕吐危险因素分析及预测模型的构建

目的筛查择期开颅肿瘤术后患者发生恶心呕吐(postoperative nausea and vomiting,PONV)的相关危险因素,并基于该危险因素构建风险预测列线图模型。方法回顾性收集2021年12月—2023年9月于中国科学技术大学附属第一医院行择期开颅肿瘤术的244例患者作为研究对象。根据是否发生PONV分为PONV组和非PONV组,采用LASSO回归和logistic回归方程筛选危险因素,构建PONV风险预测模型,并绘制该模型的受试者工作特征曲线和校准曲线以及行Hosmer-Lemeshow拟合优度检验。结果性别、慢性胃炎史、脑血管疾病史、术后疼痛、手术时间、ASA分级均是择期开颅肿瘤术患者发生PONV的独立危险因素,根据这6项危险因素建立Nomogram模型,曲线下面积为0.881(95%CI:0.821~0.942,P<0.001),校准曲线显示预测概率与实际概率之间具有良好的一致性,Hosmer-Lemeshow拟合优度较好,且Nomogram模型具有良好的区分度、校准度和稳定性。结论性别、慢性胃炎史、脑血管疾病史、术后疼痛、手术时间、ASA分级是择期开颅手术患者易发生PONV的危险因素。据此构建的Nomogram模型可直观、简便地为择期开颅肿瘤术后患者提供个体化的术后PONV风险预测。

临床药师参与1例神经外科术后难治性耐药铜绿假单胞菌感染患儿的治疗实践

目的:分析临床药师参与治疗神经外科术后难治性耐药铜绿假单胞菌感染患儿的实践经验。方法:回顾性分析1例临床药师全程参与神经外科术后难治性耐药铜绿假单胞菌感染患儿的治疗过程。结果:临床药师结合患儿病情、病原菌特点及抗菌药物特性,协助临床医师进行治疗方案的制定并提供药学监护,最终患儿感染得以控制。结论:在神经外科术后难治性耐药铜绿假单胞菌感染患儿的治疗过程中,临床药师结合自身专业知识,及时协助医师进行抗感染方案的制定、调整和药学监护,保障了治疗的安全性与有效性,发挥了临床药师在治疗团队中的重要作用。

动态数据驱动仿真模型在颅脑创伤护理学教学中的应用

目的探讨基于动态数据驱动仿真模型在神经外科护理学员颅脑创伤护理教学中的作用和效果。方法选取2021—2024年进入西京医院神经外科实习的共计240名护理学员为研究对象,随机分为传统教学组(对照组)和动态数据驱动仿真模型教学组(实验组),每组120名学员。通过构建动态数据驱动颅脑创伤虚拟仿真模型,利用虚实结合的仿真模型开展颅脑创伤护理教学实践。教学结束后,对比两组学生的理论知识掌握程度、实践能力和教学内容的满意度调查结果,综合评价教学效果。结果实验组学生的理论成绩和实践能力考核成绩分别为(92.50±12.37)(88.40±9.12)均高于传统教学组(86.92±7.43)(79.08±8.36)(P<0.05),理论成绩中主要是脑脊液漏护理、术后伤口护理知识掌握程度显著高于对照组(P<0.05),对教学模式及教学内容满意度调查显示,实验组对教学的总体满意率显著高于传帮带的传统教学方法组(P<0.05)。结论动态数据驱动仿真模型教学实现了颅脑损伤护理真实模拟操作教学,显著提高了教学效果,加强了护理学员的实践技能和学习兴趣,为培养合格的神经外科护理人员提供了良好的技术平台。

Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection

Since December 2019,an outbreak of coronavirus disease 2019(COVID-19)has.posed significant threats to the public health and life in China.Unlike the other 6 identified coronaviruscs,the SARS-Cov-2 has a high infectious rate,a long incubation period and a variety of manifestations.In the absence of effective treatments for the virus,it becomes extremely urgent to develop scientific and standardized proposals for prevention and control of virus transmission.Hereby we focused on the surgical practice in Neurosurgery Department,Tongji Hospital,Wuhan,and drafted several recommendations based on the latest relevant guidelines and our experience.These recommendations have helped us until now to achieve'zero infection'of doctors and nurses in our department,we would like to share them with other medical staff of neurosurgery to fight 2019-nCoV infection.

Postoperative Outcome in Children Aged between 6 and 10 Years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

Background: Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study that there were multiple predictors of postoperative outcome, including American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. Objective: To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. Methods: The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old was retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. Results: There were 88 patients with a mean age of 98.7 ± 13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphylaxis. Nine patients (10.2%) had postoperative neurologic failure, and 2 (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42 (47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5 - 16]. Conclusion: Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade 3 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.

Mycoplasma hominis meningitis after operative neurosurgery:A case report and review of literature

BACKGROUND Mycoplasma hominis(M.hominis),which causes central nervous system infections in adults,is very rare.It is also relatively difficult to culture mycoplasma and culturing requires special media,resulting in a high rate of clinical underdiagnosis.Therefore,clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens,thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.CASE SUMMARY A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year,which had worsened in the last week.After admission,brain magnetic resonance imaging(MRI)revealed a 7.0 cm×6.0 cm×6.1 cm lesion at the skull base,which was irregular in shape and had a midline shift to the left.Based on imaging findings,meningioma was our primary consideration.After lesion resection,the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid(CSF)examination.The patient was treated with the highest level of antibiotics(meropenem and linezolid),but the response was ineffective.Finally,M.hominis was detected by next-generation metagenomic sequencing(mNGS)in the CSF.Therefore,we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk,and the patient had a normal temperature the next day.CONCLUSION Mycoplasma meningitis after neurosurgery is rare.We can use mNGS to detect M.hominis in the CSF and then provide targeted treatment.

Comparison of Nasal and Frontal BIS Monitoring in Neurosurgery: Does the Site of Sensor Placement Affect the BIS Values?

Background and Goal of Study: Intraoperative awareness is a serious but preventable complication of general anaesthesia. Bispectral index (BIS) is the most widely used method monitoring anaesthesia depth. BIS monitoring requires attachment of forehead sensors, which poses a challenge when the surgical field involves the forehead. We aimed to compare the gold standard forehead position of BIS sensors with an alternative position across the nasal dorsum for neurosurgical procedures. Materials and Methods: After ethical committee approval and informed consent were obtained, 62 patients were enrolled in this prospective observational study. Frontal and nasal BIS values were compared in all patients. Results and Discussion: The mean BIS value from frontal versus nasal sensors was 49 ± 22 and 49 ± 21 respectively (n: 62). These values were statistically correlated (ICC 0.78, p < 0.001) indicating that nasal BIS measurement does not present a disadvantage for routine use when needed. Conclusion: Our data reveal that for measuring anesthesia depth, BIS sensor placement on the nasal dorsum shows comparable efficiency in comparison to standard frontal

Prolonged coexistent central diabetes insipidus and cerebral salt wasting syndrome following neurosurgery

The coexistence of different water homeostasis abnormalities following neurosurgery represents a diagnostic and therapeutic challenge for intensive care units. This paper reports the case of a 13 year-old boy who underwent surgery for a suprasellar tumour and, immediately after surgery, developed a cerebral abscess, persistent diabetes insipidus (DI) as well as cerebral salt wasting syndrome (CSWS). The early onset of CSWS following DI has been associated with a poor prognosis and increased mortality. In cases in which these abnormalities coexist, the increased polyuria secondary to the rise in natriuresis associated with CSWS might be erroneously interpreted as a sign of poor control of the DI, thereby leading to therapeutic mistakes. Treatment basically consists of restoring electrolytes and the joint administration of desmopressin and fludrocortisone.

Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Pain management using Han’s acupoint nerve stimulator combined with patient-controlled analgesia following neurosurgery A randomized case control study

BACKGROUND： Han＇s acupoint nerve stimulator （HANS） has been frequently used to relieve pain by promoting the central nerve system＇s release of endogenous opioid peptides through electric stimulation to the body surface. OBJECTIVE： To investigate the pain-relieving effects of HANS, combined with patient-controlled analgesia, following neurosurgery, and to observe adverse reactions and effects. DESIGN, TIME AND SETTING： A randomized control observation was performed at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （Ganzhou, Jiangxi Province, China） from January 2005 to February 2006. PARTICIPANTS： Forty patients, who were selected for craniotomy and required pain relief following surgery at the Department of Neurology in the First Affiliated Hospital of Gannan Medical College （China）, were included in this study. METHODS： Forty patients underwent neurosurgery and were randomly divided into two groups： patient-controlled analgesia plus HANS （＋HANS, n = 20） and patient-controlled analgesia （-HANS, n = 20）. Both groups were well matched in baseline data. Automatic syringe infusion pump ZZB-150 was the product of Nantong Aipeng Medical Instruments Co., Ltd. （China）. Patient-controlled analgesia consisted of 100 mL 0.02% lappaconitine/0.02% metoclopramide. LH-402 HANS instrument was produced in Beijing （China）, with a serial number of 402183. The HANS instrumentation was used to stimulate the Hegu-Laogong acupoint on one side and Jiaogan, Shenmen penetrating Shen, Waifei, Naogan penetrating Pizhixia ear acupoints on the affected side for one hour, with 2-hour intervals. The disperse-dense wave was alternating, with a 2/100 Hz frequency of electrical stimulation. MAIN OUTCOME MEASURE： The scores of visual analogue scale and incidence of adverse reaction were observed in two groups following surgery. RESULTS： Compared with the HANS group, the visual analogue scale scores were remarkably lower in the ＋HANS group six hours after surgery （P 〈 0.01）, and the incidence rate of adverse reactions, such as nausea and vomiting, was also decreased （P 〈 0.05）.CONCLUSION： The application of HANS to induce body surface stimulation can enhance the effect of pain relief and reduce adverse reactions when used in combination with patient-controlled analgesia following neurosurgery. The effect of combined therapy is superior to patient-controlled analgesia alone.