For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection of the epileptogenic zone because of the proximity of a functional area or the implication of a larger epileptogenic network. Initially, stereoelectroencephalography (SEEG) exploration was a method of electroencephalography recording that was used in the presurgical evaluation of epileptic patients with complex epilepsy. Later, intracerebral electrodes used for SEEG were applied to produce radio frequency thermocoagulation (RF-TC) in epileptic patients. SEEG-guided RF-TC has produced some promising results, especially in the last dacade. Now, it has become popular as a palliative treatment to reduce seizure frequency in patients with drug-resistant focal epilepsy. This article presents a review of SEEG-guided RF-TC.

Objectives: In this case report, we describe the design, fabrication and clinical outcomes of a novel bioresorbable, mineralized collagen burr-hole plug for the reconstruction of craniotomy burr-holes.
Methods: Mineralized collagen burr-hole plugs were fabricated via a biomimetic mineralization process. The biomimetic mineralized collagen has a similar chemical composition and microstructure to natural bone tissue, thereby possessing good biocompatibility and osteoconductivity. The mineralized collagen burr-hole plugs were implanted into three patients, and clinical outcomes were evaluated at one-year follow-ups.
Results: All bone defects healed very well using the mineralized collagen burr-hole plugs, and there were no adverse reactions at the surgical sites.
Conclusions: The clinical outcomes indicated that the mineralized collagen was effective for reconstructing burr-holes in the skull after craniotomy.

Without an understanding of functional musculoskeletal system recovery, the translation of knowledge concerning neurological recovery from laboratory discoveries to bedside applications will be incomplete. Because improvements in neurological function after cell transplantation are minor and can be easily ignored, this article draws attention to the minimal improvements required to allow a spinal cord injury patient or person to live a relatively independent life. These minimal improvements include (1) the key muscle power required for trunk stability; (2) the key muscle power required to allow a paraplegic to walk; and (3) the key muscle power required for hand usefulness or functionality. The system of muscle power grading promoted by the British Medical Research Council (MRC) is more sensitive and delicate than the ASIA Standards, as the latter only accept the full range of movement of a joint. The MRC system seems to be preferable to the ASIA Standards in clinical trials of cell transplantation, wherein minute improvements in function might result in large differences in the quality of life. The threshold of function is a grade 3 power level. Even if all relevant muscles fail to achieve a power higher than grade 3, the patient can be minimally functional and hence relatively independent. These relevant muscles include the latissimus dorsi, hip flexors, hip abductors, shoulder abductors and flexors, elbow flexors and extensors, and wrist extensors. These muscles are innervated by the C5-7 spinal cord segments except the latissimus dorsi, for which innervation extends to C8.

Spinal ependymomas (SEs) are common adult intramedullary tumors;however, determining the absolute boundary between the tumor and the tumor residual may be difficult.We assessed outcomes following the use of fluorescein sodium (FS) during surgical removal of SEs.We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016.Each patient received intravenous FS (3-4 mg/kg) to determine the SE boundaries during surgery.Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging (MRI) at 10 days and 3 months after surgical recovery;McCormick's spinal function classification was also performed at the 3-month follow-up.The complete tumor removal rate was 92%(103/112).Ninetyfour patients underwent tumor removal under fluorescent light,which provided distinctive tumor fluorescence.Tumor removal under white light was performed in 18 patients;fluorescent images were invisible or indistinctive in these 18 patients.At the 3-month follow-up,sensory function (85.8%(91/106)) and movement (84.3% (86/102)) were improved in patients with pre-surgical dysfunction;urination and defecation functions were improved in 66.7%(16/24).The McCormick spinal cord functional classifications,at the 3-month follow-up,showed significant differences in the percentages of patients with disease classified to each grade (I-IV),compared with preoperative classifications (each,P<0.05).There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up.FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.

Objectives: Adult medulloblastoma is a rare tumor, and few retrospective studies on medulloblastoma have been published to date. A standard treatment regimen has not yet been established. Accordingly, this study was designed to determine the treatment outcomes and prognostic factors for patients with adult medulloblastoma.
Methods: We retrospectively reviewed all cases of adult medulloblastoma at the Beijing Tiantan Hospital between 2004 and 2007. There were 33 patients in total. Tumor removal followed by radiotherapy was performed in all patients. Five patients received maintenance chemotherapy after radiotherapy. Statistical analysis was performed using the log-rank test, Kaplan-Meier method, and Cox regression analysis.
Results: The median follow-up period was 73 months. The 5-year progression-free survival (PFS) and overall survival (OS) rates were 45.5% ± 8.7% and 51.5% ± 8.7%, respectively. Recurrence or progression was observed in 21 patients, and 14 patients were still alive. Tumor location at the midline with infiltration to the floor of the fourth ventricle was associated with the worst PFS and OS (P= 0.032). Hemispheric desmoplastic/nodular medulloblastomas (DNMBs) were associated with a better outcome than midline DNMB. The average-risk group tended to have a better 5-year PFS rate than the high-risk group (P= 0.065).
Conclusions: Tumor location is an important prognostic marker for adulthood MB. We propose a molecular and clinical staging system should be established for adulthood MB. Further prospective clinical trials should be performed to draw a conclusion.

Objective: The authors report an extremely unusual presentation and management of a children pineal mixed germ cell tumor mainly composed of immature teratoma, aiming to summarize main theraptic points by literature review. Methods: A cystic lesion located in the rear of third ventricle in a child was detected 3 years ago with no other therapy performed except for a ventriculo-peritoneal shunt. During the following 3 years, intermitted regular brain MRI demonstrated no evidence of lesion aggrandizement. However from 20 days before admission to our institute the patient began to present acutely with exacerbating clinical symptoms meanwhile brain MRI showed signs of abrupt revulsions of initial lesion without any incentive cause. Neurological examination revealed a significant rising of serum tumor marker level. Then surgical resection was performed immediately after admission which was followed by correlative two-course chemotherapy. Results: Postoperative brain MRI demonstrated totally removing of the lesion in rear of third ventricle. Serum tumor marker level decreased remarkably after surgery and declined to normal level after two-course chemotherapy. No obvious neurological deficit occurred except for short-term memory difficulty which gradually recovered within two weeks. Soon after the second course chemotherapy the patient was currently asymptomatic and returned to school. Conclusions: (1) To ensure definitive diagnosis and proper therapecutic protocols benefit from grasping clinical features of mixed germ cell tumor. (2) Overall preoperative investigation including serum tumor marker level is as critical as neurological imaging examination. (3) Surgical excision is confirmed to be the key modality of treatment. With the regarding of mixed germ cell tumor, never highlight total resection too much. (4) Postoperative adjuvant chemotherapy is recommended as further intensive treatment to improve the prognosis of mix germ cell tumor.

Objective: Parkinson's disease (PD), which is one of the most common neurodegenerative disorders, is characterized by the loss of dopamine (DA) neurons in the substantia nigra in the midbrain. Experimental and clinical studies have shown that fetal neural stem cells (NSCs) have therapeutic effects in neurological disorders. The aim of this study was to examine whether cells that were differentiated from NSCs had therapeutic effects in a rat model of PD. Methods: NSCs were isolated from 14-week-old embryos and induced to differentiate into neurons, DA neurons, and glial cells, and these cells were characterized by their expression of the following markers:βⅢ-tubulin and microtubule-associated protein 2 (neurons), tyrosine hydroxylase (DA neurons), and glial fibrillary acidic protein (glial cells). After a 6-hydroxydopamine (6-OHDA)-lesioned rat model of PD was generated, the differentiated cells were transplanted into the striata of the 6-OHDAlesioned PD rats. Results: The motor behaviors of the PD rats were assessed by the number of apomorphine-induced rotation turns. The results showed that the NSCs differentiated in vitro into neurons and DA neurons with high efficiencies. After transplantation into the striata of the PD rats, the differentiated cells significantly improved the motor deficits of the transplanted PD rats compared to those of the control nontransplanted PD rats by decreasing the apomorphine-induced turn cycles as early as 4 weeks after transplantation. Immunofluorescence analyses showed that the differentiated DA neurons survived more than 16 weeks. Conclusions: Our results showed that cells that were differentiated from NSCs had therapeutic effects in a rat PD model, which suggests that differentiated cells may be an effective treatment for patients with PD.

The field of biomaterials has recently emerged to augment or replace lost or damaged tissues and organs due to the human body's limited ability to self-heal large defects. Historically, metallic components, polymers, ceramics, and composite materials were utilized as synthetic materials along with natural materials to assist in therapy. Various novel biomaterials were developed to respond to a significant amount of new medical challenges in the past decade. Therefore, there is a need to review these newly developed biomaterials and their potential to improve tissue repair and regeneration in a variety of applications. Here, we briefly review the different strategies and attempts to use novel biomaterials, including self-assembled and macromolecular biomaterials, hydrogels, metamaterials, decellularized tissues, and biomaterials obtained via synthetic biology, used either for tissue repair and regeneration or for therapeutic use by exploiting other mechanisms of healing. All these methods aim to create functional materials, devices, systems, and/or organisms with novel and useful functions on the basis of catalogued and standardized biological building blocks. This review details the various methods and introduces the applications of these biomaterials in tissue repair and regeneration, especially for bone, nerve, and skin applications.

The skull provides protection and mechanical support, and acts as a container for the brain and its accessory organs. Some defects in the skull can fatally threaten human life. Many efforts have been taken to repair defects in the skull, among which cranioplasty is the most prominent technique. To repair the injury, numerous natural and artificial materials have been adopted by neurosurgeons. Many cranioprostheses have been tried in the past decades, from autoplast to bioceramics. Neurosurgeons have been evaluating their advantages and shortages through clinical practice. Among those prostheses, surgeons gradually prefer bionic ones due to their marvelous osteoconductivity, osteoinductivity, biocompatibility, and biodegradability. Autogeneic bone has been widely recognized as the “gold standard” for renovating large-sized bone defects. However, the access to this technique is restricted by limited availability and complications associated with its use. Many metal and polymeric materials with mechanical characteristics analogous to natural bones were consequently applied to cranioplasty. But most of them were unsatisfactory concerning osteoconductiion and biodegradability owe to their intrinsic properties. With the microstructures almost identical to natural bones, mineralized collagen has biological performance nearly identical to autogeneic bone, such as osteoconduction. Implants made of mineralized collagen can integrate themselves into the newly formed bones through a process called “creeping substitution”. In this review, the authors retrospect the evolution of skull repair material applied in cranioplasty. The ultimate skull repair material should have microstructure and bioactive qualities that enable osteogenesis induction and intramembranous ossification.

Objective: Brainstem cavernous malformation (BSCM) is extremely challenging for neurosurgeons in terms of surgical approach choices.In this article,we summarized our experience in skull base approaches of BSCM,and elucidated the advance of surgical treatments of brain stem cavernous malformation through reviewing recent relevant articles.
Methods: We retrospectively reviewed 20 consecutive patients who underwent resection between May 1,2014 and April 30,2016.Only midline suboccipital,subtemporal approach and retrosigmoid approach were used in this series.The diagnoses of all patients were confirmed by radiological and histological examination.
Results: All 20 patients were completely extirpated without surgical-related mortality.The mean follow-up period was 9.5 months (range,2-20 months).Of the 20 patients,80% symptomatic patients underwent surgery after first bleeding episode within 3 months,20% after two or more bleeding episodes by magnetic resonance imaging.After resection and during follow-up,75% of patients had an improvement in their modified Rankin scale (mRS) scores,whereas 10% were worse compared with their preoperative presentation;15% were unchanged.
Conclusion: Appropriate basic surgical approach and minimally invasive techniques are necessary in preventing impairment of neurologic function.The three common basic skull base approaches,combined with minimally invasive techniques can handle most of BSCMs with good surgical results.

Post-stroke neuropsychiatric (NP) disorders are common and have complex etiologies. Multiple factors such as lesion location, personality characteristics, socioeconomic status, pre-stroke psychiatric history, and family support are the determining factors in most cases. Although depression and anxiety are more common, emotional incontinence and catastrophic reactions are also frequently observed. Post-stroke depression (PSD) has been associated with an increased risk of stroke recurrence. Despite its serious consequences and high prevalence, PSD remains undetected and untreated. Treatment options of NP disorders depend on severity, presentation at the time of diagnosis, and patient cooperation, and include antidepressants, mood stabilizers, exercise therapy, psychotherapy, and even revascularization. The efficient management of NP disorders improves outcomes, quality of life, and survival rates in post-stroke patients. However, very few studies have identified definitive treatment for these patients; therefore, further research is required.

Objective: Real-time monitoring of cytokine secretion at the single immunocyte level, based on the concept of immune cells, sociology has been recently reported. However, the relationships between glioma-initiating cells (GICs) and host immune cells and their mutual interactions in the tumor microenvironment have not been directly observed and remain unclear.
Methods: The dual fluorescence tracing technique was applied to label the co-cultured GICs and host macrophages (Mø), and the interactions between the two types of cells were observed using a live cell imaging system. Fusion cells in the co-culture system were monocloned and proliferated in vitro and their social interactions were observed and recorded.
Results: Using real-time dynamic observation of target cells, 6 types of intercellular conjunction microtubes were found to function in the transfer of intercellular information between GICs and Mø; GICs and host Mø can fuse into hybrid cells after several rounds of mutual interactions, and then these fusion cells fused with each other; Fusion cells generated offspring cells through symmetrical and asymmetrical division or underwent apoptosis. A "cell in cell" phenomenon was observed in the fusion cells, which was often followed by cell release, namely entosis.
Conclusions: Preliminary studies revealed the patterns of cell conjunction via microtubes between GICs and host Mø and the processes of cell fusion, division, and entosis. The results revealed malignant transformation of host Mø, induced by GICs, suggesting complex social relationships among tumor-immune cells in gliomas.

Objective: To construct brain tumors and their surrounding anatomical structures through the method of registration, fusion and, three-dimensional (3D) reconstruction based on multimodal image data and to provide the visual information of tumor, skull, brain, and vessels for preoperative evaluation, surgical planning, and function protection.
Methods: The image data of computed tomography (CT) and magnetic resonance imaging (MRI) were collected from fifteen patients with confirmed brain tumors. We reconstructed brain tumors and their surrounding anatomical structures using NeuroTech software.
Results: The whole 3D structures including tumor, brain surface, skull, and vessels were successfully reconstructed based on the CT and MRI images. Reconstruction image clearly shows the tumor size, location, shape, and the anatomical relationship of tumor and surrounding structures. We can hide any reconstructed images such as skull, brain tissue, blood vessles, or tumors. We also can adjust the color of reconstructed images and rotate images to observe the structures from any direction. Reconstruction of brain and skull can be semi transparent to display the deep structure; reconstruction of the structures can be axial, coronal, and sagittal cutting to show relationship among tumor and surrounding structures. The reconstructed 3D structures clearly depicted the tumor features, such as size, location, and shape, and provided visual information of the spatial relationship among its surrounding structures.
Conclusions: The method of registration, fusion, and 3D reconstruction based on multimodal images to provide the visual information is feasible and practical. The reconstructed 3D structures are useful for preoperative assessment, incision design, the choice of surgical approach, tumor resection, and functional protection.

Objective: To evaluate the clinical results of repairing skull defects with biomimetic bone (nano-hap/collagen composites, NHACs) in children. Methods: Thirteen children with skull defects were treated with NHACs in our hospital. The NHACs molded with the help of a 3D printer were used in the operations. Results: All 13 operations were successful, and patients recovered without infection. Only one patient suffered from subcutaneous hydrops post-operation. The implanted NHACs remained fixed well after 1 year, and their CT HU values raised gradually. Skull shapes of children developed normally. Recovery of neurological and cognitive function was significant. Conclusions: NHAC, chosen to repair skull defects in children, can coexist with normal skull and reduce the negative effects on growth and development. NHAC could be a good choice for children with skull defects.

Objective: Fibrous dysplasia (FD) is an unusual developmental abnormality of the skeleton. When facial and cranial bones are involved in FD, it is termed craniofacial fibrous dysplasia (CFD). Although several reports have reported that CFD has a tendency for spontaneous cerebrospinal fluid (CSF) leakage, there have been no related English-language case reports. We present the first case of post-traumatic CSF rhinorrhea associated with CFD. Methods: A 30-year-old man presented with CSF rhinorrhea after a mild head trauma. Computed tomography cisternogram located a defect in the posterior wall of the right frontal sinus. Imaging examination also showed the evident expansion of multiple skull bones, spinal scoliosis, and multiple local enlargements of ribs. Without café-au-lait cutaneous spots and endocrine abnormalities, polyostotic FD was diagnosed instead of McCune-Albright syndrome (MAS). The patient underwent craniotomy fistula repair surgery. The excised bone was contoured to be thinner to increase the cranial cavity. The patient recovered well and CSF leakage did not recur. But during a nineteen-month follow up, sight in the patient's left eye was decreased. MAS was suspected. Unfortunately the patient refused to take the proposed decompression surgery and laboratory tests of serum hormones. Conclusions: CFD, if the wall of the paranasal sinus is involved and the cranial cavity is decreased, may increase the risk of CSF rhinorrhea after head trauma. Expectant management is recommended in asymptomatic CFD patients even in the presence of optic nerve compression. As MAS may cause more problems, it should be precluded before polyostotic FD is diagnosed.

Recently, New England Journal of Medicine published an article by the famous hand surgery specialists, Yudong Gu. The important medical achievements of Gu's team include transposition of C7 nerve root of the unaffected side on the upper limbs in stroke hemiplegia, changing the brain central dominance region, and rebuilding the function of hands with spastic paralysis. These achievements are admirable because worldwide medical problems, such as stroke sequela hemiplegia, require long-term arduous efforts for any progress to be made. Any result that improves the survival quality of patients has significant social value. Their success has enabled me to feel that I am no longer alone in my years of exploration, and I am grateful to them from the bottom of my heart. At this time, I am reminded of the 40 years of my experience in this field. It has taken the efforts of many people to make this happen: Limb sequelae of stroke, especially spasmodic paralysis of upper limbs, often result in patients losing their ability to self-care, which can cause a great burden to their family and society. The need to rebuild and improve functions in such patients is urgent.

Mesenchymal stromal/stem cells (MSCs) are multipotent cells under consideration as a potential new therapy for a variety of inflammatory diseases including certain neurological disorders. It is generally thought that the efficacy of cell therapy in attenuating damage after ischemia, inflammation, or injury depends on the quantity of transplanted cells recruited to the target tissue. However, only a small number of systematically infused MSCs can effectively migrate to target sites, which significantly decreases the efficacy of exogenous cell-based therapy. In this review, we discuss specific factors influencing MSC migration, and summarize current strategies that effectively promote the motility of MSCs. In addition, we describe several protocols to improve the migration of stromal cells into the nervous system and, therefore, enhance the efficiency of engraftment as means of treating neurological disorders.

Objectives: Nerve regeneration after peripheral nerve injury is a slow process with a limited degree of functional recovery, resulting in a high disability rate. Thus, accelerating the rate of nerve regeneration and improving the degree of nerve repair is a clinical challenge. This study aimed to investigate the role of growth factor gel combined with small-gap nerve anastomosis in the regeneration of sciatic nerve injury in rats. This was achieved by injecting nerve growth factor (NGF) and basic fibroblast growth factor (bFGF) gel into a silicon chamber that bridged the transection of the nerve.
Methods: In 27 randomly chosen Sprague Dawley rats, a sharp blade was used to transect the right hind leg sciatic nerve. The rats were divided into 3 groups: in groups A and B, silicon tubes containing NGF and bFGF gel or saline, respectively, were used to bridge the nerve proximal and distal ends (3-mm gap), and in group C, the nerve proximal and distal ends were directly sutured. Eight weeks after surgery, the sciatic nerve function index, neural electrophysiology, and muscle wet weight as well as histological, ultrastructural, and immunohistochemical parameters were evaluated.
Results: The sciatic nerve function index, nerve conduction velocity, muscle wet weight, density of regenerated nerve fibers, and myelination in group A were better than those in group B or C, but the sciatic nerve function index, muscle wet weight, and thickness of myelination in the 3 groups were not significantly different (P > 0.05). There were no significant differences innerve conduction velocity between groups A and B (P > 0.05), but it was higher in both groups than that of group C (P < 0.05). The regenerated nerve fiber density in the 3 groups showed significant differences (P < 0.05).
Conclusions: Small-gap nerve anastomosis can provide a good regenerative microenvironment for rat sciatic nerve regeneration, and the combined strategy of growth factor gel with small-gap nerve anastomosis appears to have a superior effect on nerve repair.

Objective: The local regulations for conducting experimental and clinical cell therapy studies are dependent on the national and cultural approach to the issue, and may have many common aspects as well as differences with the regulations in other countries. The study reflects the latest national aspects of cell therapy in Iran and relevant regulations. Methods: The following topics are discussed in the article including sources of cell harvest, regulations for cell disposal, stem cell manufacturing, and economic aspects of stem cell, based on current practice in Iran. Results: All cell therapy trials in Iran are required to strictly abide with the ethical codes, national and local regulations, and safety requirements, as well as considering human rights and respect. Adherence to these standards has facilitated the conduct of human cell therapy trials for research, academic advancement, and therapy. Conclusions: The cell therapy trials based on the aforementioned regulations may be assumed to be ethical and they are candidates for clinical translations based on safety and efficacy issues.