Objective: Primary intracranial malignant fibrous histiocytoma (MFH) is rare. We describe the detailed clinical features of 8 cases and fully review the literature to evaluate several prognostic factors. Methods: Eight patients with pathologically confirmed primary intracranial MFH were retrospectively reviewed. We searched PubMed for relevant articles with the term "intracranial malignant fibrous histiocytoma". Results: Of the 8 patients, 4 were men and 4 were women. Three patients had received previous radiotherapy. The age of the patients ranged from 19 to 69 years, with a median age of 48 years. Most tumors could be totally resected; and only 1 tumor was subtotally resected. Six patients received postoperative radiotherapy and 3 patients received postoperative chemotherapy. Most patients died within the first year after surgery; and only 1 patient was still alive on the date of the last follow-up. We reviewed the literature and included a total of 46 patients in the Kaplan-Meier survival analysis. Young patients (less than 30 years old) seemed to have a better prognosis and survival rate than older patients (more than 30 years old) (log-rank test, P=0.008). However, sex (P=0.675), extent of resection (P=0.934), postoperative radiotherapy (P=0.592), and postoperative chemotherapy (P=0.424) did not affect patient prognosis. Conclusions: The prognosis of MFH is usually poor, and most patients die within the first year after surgery. Younger MFH patients (less than 30 years old) seem to have a better prognosis and improved survival compared to older patients.

Objectives: Objectives: Significant advances in neurosciences will result from research focused on the non-contact treatment of the nervous tissue (NT). The objective of the article is to describe a novel non-contact method of restoration of damaged NT of the human brain and spinal cord that was termed multi-wave neuro-bioengineering.
Methods: The method includes a purposeful complex program of different therapeutic ionizing and non-ionizing electromagnetic radiation effects on the damaged NT, which is approved for clinical practice. Exposure of the human brain to a stepwise algorithmized combination of different ionizing and non-ionizing radiations and simultaneous application of various types of electromagnetic radiation at the specific site of restoration considerably reduce the adverse effects of all types of radiation on NT.
Results: The technology for non-contact restoration of the injured tissue of brain or spinal cord was appiled in 30 cases of neurological disorders using the stereotaxic system, structural resonance therapy, radiotherapy and focused ultrasound. The applied methods are approved for humans and theorem programmed combination opens new perspective for the treatment of brain and spinal cord disorders.
Conclusions: The approach provides quick restoration of the disordered function of damaged brain tissue and establishes a new paradigm of radio non-contact neurorestoration of the brain and spinal cord.

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.

Objective: The frontal lobe may be involved in circuits associated with depression, apathy, aggression, and other psychiatric symptoms. Although white matter changes (WMC) are related to the severity of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD), it is unclear which part of the WMC may play the most important role in BPSD. This study was designed to investigate the relationship between the location of WMC and the severity of BPSD in AD patients. Methods: Among patients diagnosed with Alzheimer's disease between 2009 and 2014, 387 patients were retrospectively reviewed after those with pre-existing organic brain syndrome, psychiatric diseases, or toxic-metabolic encephalopathy were excluded. Patients' demographic and laboratory data, WMC measured with brain computed tomography and scored using the age-related white matter changes (ARWMC) scale, and neuropsychological tests, including the cognitive abilities screening instrument (CASI), the Mini-Mental State Examination (MMSE), the clinical dementia rating scale with sum-box (CDR-SB), and the neuropsychiatric inventory (NPI) were analyzed. Results: There was no significant difference in the NPI between patients with and without a history of stroke, hypertension, and diabetes. No significant difference in the NPI was identified between different sexes or different Apolipoprotein E (APOE) alleles. The NPI score was significantly correlated with the duration of education (r = -0.4515,P = 0.0172), CASI (r = -0.2915, P < 0.0001), MMSE (r = -0.8476, P < 0.0001), and CDR-SB (r = 2.2839, P < 0.0001). WMC in the right frontal lobe showed a significant difference in NPI in comparison to those without WMC (P = 0.0255). After adjusting for age, duration of education, and CASI, WMC in the right frontal lobe remained significantly associated with the NPI score (β = 3.8934,P = 0.042). Conclusions: WMC involving the right frontal lobe may play an important role in the BPSD in AD patients during their dementia diagnosis. Further studies are necessary to confirm whether controlling the risk factors of WMC can slow the progression of BPSD.

Objective: Drainage tubes (e.g., intracranial, abdominal cavity and thoracic) are commonly used to drain blood and fluid collections after surgery. It usually fails due to the lack of fixation perpendicular to the skin and the variety of tube materials. The objective of the article is to describe a new drainage tube device. Methods: This new device consists of a drainage tube fixator and diverter with a rotating handle. The fixator and diverter are fixed to the skin with a pair of wings, and the base comprises acircular arc with chamfering of the edge. The removable stopper and plastic diverter have a memory function. There are 2 holes on either side of the wings, by which they can be sewn to the skin or stapled for strength and stability. Results: The removable limiting stopper and plastic diverter with memory function work together to ensure that the drainage tube is firmly fixed. Therefore, the tube will not move either vertically or horizontally on the skin. Moreover, the device is fit for drainage tubes with different specifications and materials. Conclusions: The limiting stopper can be moved easily, which is conducive to local skin disinfection around the drainage tube. The device deserves clinical promotion.

Alzheimer's disease (AD) is the most prevalent type of dementia, and its neuropathology is characterized by the deposition of insoluble β-amyloid (Aβ) peptides, intracellular neurofibrillary tangles, amyloid angiopathy, age-related brain atrophy, synaptic pathology, white matter rarefaction, granulovacuolar degeneration, neuron loss, and neuroinflammation. Although much is known about the neurobiology of AD, very few conventional therapies are available to arrest or slow the disease. There is an urgent need for novel therapeutic approaches for AD. AD subjects have significantly fewer viable precursor cells in the hippocampus compared with age-matched healthy control subjects. However, the viable precursor cells that remain in AD and age-matched healthy control brain specimens can be induced to differentiate. To facilitate or mimic the natural compensatory effect in AD, cell therapy, including endogenous and exogenous stem cells, has been considered in AD. In this review, we focus on the history and development of cell therapy in AD, and consider the role of cell therapy as a potential treatment for AD.

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.

Non-invasive neuroimaging plays a crucial role in the assessment of the human spinal cord, but it is quite challenging. Magnetic resonance imaging (MRI) is an important modality to obtain both high-resolution anatomical and functional information concerning the spinal cord. Besides conventional MRI, advanced MRI techniques could provide novel information about the microstructure and neural function of the spinal cord, thereby enhancing the understanding of spinal cord neurology and pathology of various spinal disorders.

Objective: Neurocutaneous melanosis (NCM) in adult patients was rare, and few cases had been reported. In this report, we summarized the features of NCM in adult patients for providing useful information about this rare clinical entity.
Methods: In this report, we present a case of a 41-year-old woman, who was eventually diagnosed with NCM with intraspinal malignant melanoma. The clinical features, treatments, and prognosis of cases of NCM in adults were thoroughly reviewed and discussed.
Results: A 41-year-old woman was eventually diagnosed with NCM with intraspinal malignant melanoma. The post-operative course was uneventful and her symptoms significantly improved (VAS: 3 points). However, she developed symptoms of intracranial hypertension and deteriorated rapidly after 11 months of operation, and died 1 month later. To date, only 15 cases of NCM in adults have been reported in the English literature. Analyses showed that the average age was 33.8 years (range 19-65 years), and 11 patients (68.8%) were between 20 and 40 years. A slight male predominance (M:F/11:5) was found. For the 12 cases which detailed follow-up information was available, 9 patients (75%) died, with a survival time ranging from 1 day to 29 months post-operation. Death occurred within the first month of operation in 6 cases (46.2%). The median survival time was 3 months.
Conclusions: We presented a rare case of NCM with intraspinal malignant melanoma in an adult patient. Although rare, this clinical entity causes significant mortality and has poor prognosis.

Objective: Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better.
Methods: To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia.
Results: Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline.
Conclusions: With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Objective: To discuss the correlation among intracranial arterial stenosis and its risk factors.
Methods: A total of 486 patients with transient ischemic attack (TIA) or ischemic cerebral infarction were examined using color doppler flow imaging (CDFI) and transcranial doppler ultrosonography (TCD).According to the degrees of extracranial arterial stenosis,patients with mild-to-moderate extracranial stenosis were classified into group A (435 cases) while those with constant severe stenosis or occlusion were classified into group B (51 cases).The differences between the two groups of risk factors were compared,and the multi-factor logistic regression analysis of risk factors associated with moderately severe intracranial arterial stenosis was performed.
Results: ① The risk factors that were significantly associated with intracranial arterial stenosis included age (P=0.034) and gender (P=0.044).② Intracranial artery stenosis was observed in both anterior and posterior cerebral arteries in patients with hypertension,diabetes,and coronary heart disease respectively (P< 0.05).③ Compared with group A,patients in group B were older (P=0.000),with a higher proportion of men (P=0.037),and the intracranial arterial stenosis degrees were significantly higher (P=0.013).④ Multi-factor logistic regression analysis showed that diabetes is a risk factor for moderately severe intracranial arterial stenosis (P< 0.05),and hyperlipidemia is a protective factor (P=0.012).
Conclusions: Age,gender,hypertension,diabetes,coronary heart disease,and smoking are risk factors for the distribution of intracranial arterial stenosis.The degrees of intracranial arterial stenosis are related with extracranial arterial stenosis.Diabetes is a risk factor for moderately severe intracranial arterial stenosis while hyperlipidemia is a protective factor.

Objectives: Ganglioneuroma is a rare,benign neurogenic tumor arising from the sympathetic ganglia.In this report,we reviewed and summarized the clinical features, treatment,and prognosis of a posterior mediastinal ganglioneuroma.
Case:Here,we report on a 29-year-old man referred to us with transient pain in the right side of the chest,lasting for three days.Physical examination revealed no abnormalities. The results of routine laboratory tests were within the normal ranges.Thoracic spinal magnetic resonance imaging showed a well-defined,solid mass in the right paravertebral region at the T5-T8 level,measuring 7.5 cm×4.2 cm×1.5 cm.To accurately locate the lesion during surgery,O-arm intraoperative imaging was used in conjunction with the Stealth Station navigation system.The tumor was completely excised and no related complications occurred.The tumor was an encapsulated mass with a solid,homogenous,grayish-tan cut surface.Histopathological examinations confirmed that the mass was a ganglioneuroma.
Conclusions:Ganglioneuroma is a rare,benign tumor.Prior to treatment,a careful imaging evaluation is necessary in order to obtain an accurate diagnosis.A definitive diagnosis can be made by histological examination.En bloc resection is the preferred treatment for ganglioneuroma as it has an excellent prognosis.

This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion (32 cases) and thoracic/lumbar/sacral spine fixation (28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body, yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20-30 min/time. Screw implantation times were 5-7 min (cervical spine), 8-10 min (thoracic spine), and 6-8 min (lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.

Objective: Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphisms are considered biomarkers of late-onset Alzheimer's disease (AD).However,the results of studies of these polymorphisms have been inconsistent.The ACE protein directly degrades beta-amyloid and thereby slows the progression of AD and its onset.However,it also activates the renin-angiotensin-aldosterone system,which can contribute to hypertension and/or cardiovascular events that increase the risk for developing AD.
Methods: In this study,we examined the bidirectional association of the ACE gene and AD in patients with AD with and without hypertension.
Results: Patients who were clinically diagnosed with AD (n=983) underwent ACE I/D genotyping.The distribution of the ACE I/D genotypes (P=0.355 for I/I vs.D/D;P=0.888 for I/D vs.D/D) and I alleles (P=0.895) did not significantly differ between hypertensive patients with AD and patients with AD without hypertension.
Conclusions: In contrast to traditional theories,the results of this study suggested that the contribution of the ACE gene to the development of AD was not associated with hypertension and similar cardiovascular effects.

Since remote cerebellar hemorrhage,with intracerebral hemorrhage after supratentorial neurosurgery,is rare,its pathophysiology remains elusive.Here,we report a 64-year-old man who had severe bilateral symmetric remote cerebellar hemorrhage with frontal lobe hemorrhage following burr-hole evacuation for supratentorial chronic subdural hematoma.Computed tomography venography showed undeveloped left internal jugular vein and sigmoid sinus.He received 3 weeks of conservative treatment and fully recovered.Overdrainage of cerebrospinal fluid and head rotation with undeveloped internal jugular vein may have resulted in this complication.This case is the first case in the literature with this event sequence and has some significance for revealing the mechanism of remote cerebellar hemorrhage occurrence after other supratentorial surgeries.

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.

Glioblastomas are highly malignant and invasive brain tumors. Cerebral cavernous malformations (CCMs) are vascular diseases of congenital and occult vascular dysplasia, which may arise sporadically or may be inherited due to autosomal dominant condition. To the best of our knowledge, cases of glioblastoma in the cerebral hemisphere mimicking cavernous malformation have not been reported in the literature. We reported a case of glioblastoma mimicking CCM. The patient was admitted at our hospital in July 2015 due to a 9-day history of intermittent dizziness. The present study reports a case of a glioblastoma on the right temporal lobe mimicking CCM, which was confirmed by postoperative pathology. The diagnosis of glioblastoma was not determined even during surgery, and the lesion was totally resected with no complications. During the surgical procedure, the lesion was very similar to a CCM. In conclusion, it is difficult to distinguish between glioblastoma and CCM. Therefore, when a lesion is present with hemorrhage and the imaging features are very similar to a vascular disease, a tumor must be considered in the differential d ifferential diagnosis.

Objective: To observe advantages and disadvantages of the resection of intramedullary spinal cord tumor under awake anesthesia.
Methods: Two patients with intramedullary spinal cord tumor underwent resection under awake anesthesia and followed up post-operatibely for any motor deficits.
Results: Patients who underwent tumor resection under awake (AAA) anesthesia combined with intraoperative NPM had no motor deficits postoperatively. More accurate and nondelayed responses were observed in the awake cycle of anesthesia and helped guide surgery, thus avoiding injuries to the spinal cord.
Conclusion: Intramedullary spinal cord tumors are not common, but only gross total resection (GTR) can provide complete remission of symptoms and progression-free survival. However, GTR sometimes results in motor function deficits postoperatively, particularly when the cervical cord is involved, and especially if surgery is done under general anesthesia with intraoperative neurophysiological monitoring (NPM) alone, because of delayed sensory evoked potential and motor evoked potential responses. We present two cases that underwent GTR of cervical intramedullary spinal cord tumors under an asleep-awake-asleep (AAA) cycle of anesthesia, combined with intraoperative NPM in which no post-operative motor deficits were observed on 6-months hs follow up.

Microvascular decompression (MVD) surgery has been popularized as an etiological treatment around the world for more than half a century. However, as a functional operation in the cerebellopontine angle, this process should be refined to enhance cure and minimize complication. After accomplishing more than 10,000 MVDs, we have learned the following concerning the operative technique: (1) the principle of MVD is to separate the neurovascular confliction, rather than isolate with prostheses; (2) identification of the conflict relies on good exposure; (3) a satisfactory working space can be created by the appropriate positioning, i.e., either a close-to-the-sigmoid craniectomy or caudorostral approach; (4) a sharp dissection of arachnoids leads to a maximal visualization of the entire intracranial course of the nerve root; (5) all vessels contacting the trigeminal nerve root should be cleared off; (6) intraoperative electrophysiological monitoring may predict the prognosis of hemifacial spasm and guide the operation; and (7) the dura must be closed with watertight stitches at the end.

The Editor is grateful to the following,who have reviewed and/or assisted in the assessment of papers during the past year.
Russell J.Andrews
Qiang Ao
Shengde Bao
Sue Barnett
Andrey S.Bryukhovetskiy
Jianliang Chen
Shiwen Chen
Shuda Chen
Shuhua Chen
Zhiguo Chen
Fuzhai Cui
Changwu Dou
Ting Fan
Tao Feng
Guodong Gao
Guoyi Gao
Tongchao Geng
Hua Guo
Fabin Han
Xiaosheng He
Xijing He
R.Edward Hogan
Bo Hong
Baoyang Hu
Yong Hu
Hongyun Huang
Qinghai Huang
Yulun Huang
Rongcai Jiang
Zahid Hussain Khan
Tatsuya Kondo
Jiming Kong
Qingxia Kong
Jeffrey H.Kordower
Damien Kuffler
Lin Li
Luming Li
Peng Liang
Pinan Liu
Wangshen Lu
Yongchun Luo
Ying Mao
Chunyang Meng
Shaowu Ou
Yongwei Pan
Yu Pan
Komal Prasad C
Liyan Qiao
Hooshang Saberi
Nobuhito Saito
Paul R.Sanberg
Ashok K.Shetty
Huaizhang Shi
Kai Shu
Dario Siniscalco
Stephen D Skaper.
Harry W.M.Steinbusch
Tao Sun
Tiansheng Sun
Zhouping Tang
Akira Teramoto
Manjari Tripathi
Aijun Wang
Chong Wang
Dajue Wang
James Wang
Yirong Wang
Klaus R.H.von Wild
Zhanyong Wu
Guohua Xi
Bin Xu
Jing Xu
Mengzhou Xue
Qun Xue
Fuling Yan
Jun Yang
Lei Yang
Xiaofeng Yang
Yuanhan Yang
Zhongxu Yang
Zhiqiang Yi
Xinguang Yu
Yanbing Yu
Hongmei Yue
Chunyang Zhang
Nan Zhang
Wenchuan Zhang
Yuqi Zhang
Zhiwen Zhang
Yadu Zhao
Huancong Zuo

Precision minimally invasive technique in surgery of spine and spinal cord is an important branch of neurosurgery.Over the past few decades,majority of neurosurgeons only specialize in spinal cord diseases.However,with the advances in spine surgery,more and more neurosurgeons focus on spine diseases.As traditional surgery has been gradually replaced by precision surgery,open surgery has been gradually replaced by minimally invasive surgery,the diagnosis and treatment of spine diseases has been benefiting from minimally invasive techniques.With minimal surgical trauma,precise localization,MIS has become the inevitable trend of new neurosurgery.The purpose of this section is to collect articles on accurate minimally invasive techniques in spine and spinal cord,including but not limited to the following:
● O-ARM,intraoperative real-time navigation techniques
● Precision imaging techniques
● Surgical robot techniques
● Microscopic techniques
● Micro-channel techniques
● Percutaneous instrumentation techniques
● Neuroelectrophysiological monitoring techniques

There were two stages in the history of the studies on ascending reticular activating system of the brain (ARAS). The first stage began with the ARAS discovery by Magoun and Moruzzi and the following investigations using the methods of stimulation and lesion at that time mainly in acute cats. These studies led to the hypothesis of a "diffuse" and "unspecific" ARAS of the brain stem. The second stage was associated with using more precise neurophysiological and histochemical methods mainly in chronically operated free-moving cats and rats. By 2010, the idea of the ARAS as an organized hierarchy of the cerebral "waking centers" distributed along the entire cerebral axis and releasing all the known neuromediators of low molecular weight together with the most important neuropeptides was formulated. To date, the aforementioned hypothesis has been revised again. The glutamatergic activating system has been discovered and described in detail. Presumably, this system is responsible for the appearance of electroencephalogram (EEG) arousal reaction and maintenance of the neocortex in the state of tonic depolarization during wakefulness and rapid eye movement (REM) sleep. Its destruction results in a deep comatose-like state. At the same time, the activity of all other "waking centers" is probably the result of the cortical activation.

With the fast-growing aging population, dementia has become a health priority. However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated for mental health. The main and first symptom of this disorder is the loss of memory; hence, understanding the hippocampal formation is the key to tackling dementia. In 2007, a milestone book titled "Hippocampus Book" was published. One of the authors/editors is the 2014 Nobel Laureate in Physiology and Medicine, Professor John O'Keefe. It is a MUST-READ encyclopedia about the hippocampal formation, for those who wish to commit themselves to helping the patients with dementia. The formation consists of the hippocampus, entorhinal cortex, subiculum, presubiculum, parasubiculum, and dentate gyrus. The hippocampus is further divided into CA1, CA2, and CA3. The entorhinal cortex is the gateway of receiving all sensory information from the neocortex, while the subiculum is the exit for the efferent projections to the neocortex. Memory is divided into short-term and long-term memory. The former does not require protein synthesis while the latter does. The electrophysiological activities of creating these memories are short-term potentiation and long-term potentiation respectively. In most cases, the entorhinal cortex is the first structure to be damaged, and even short-term memory cannot be created. However, all except spatial memory are stored in the neocortex. Damage to the hippocampal formation would not affect the storage and retrieval of memories. Hence, past memories may remain intact in the early phases of the disorder. This devastating progressive disease has no cure. However, the highly plastic hippocampal formation may offer us some hope. It is the responsibility of the pharmaceutical industries to develop new drugs. Clinicians should add their efforts to the endeavor. The author would suggest that they explore insulin-like growth factors, brain stimulation, cell transplantation, and animal-assisted therapy to find some innovative solutions to help patients with dementia. As the current status of neuroscience stands, the animal-assisted therapy seems to stand out among all methods. It alleviates symptoms and stabilizes the ailment.

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.

A logarithmic spiral is a self-similar spiral curve, which often appears in nature, e.g., mollusk shells. In the normal tissues of the human body, the cochlea is also an approximate logarithmic spiral. However, approximate logarithmic spirals are rarely, if ever, reported in tumors. Recently, we treated a 26-year-old woman with a one-year history of headache. Preoperative magnetic resonance imaging showed a possible brain tumor with radiological characteristics similar to a typical logarithmic spiral, which has seldom been observed before. Because of the obvious clinical symptoms and discomfort, as well as the possible presence of an intracranial tumor, we performed a craniotomy and tumor resection. Perioperatively, we found an intact tumor capsule, with contents that appeared like egg-drop soup mixed with hairs. A post-operative pathological diagnosis of a dermoid cyst was made. However, more interestingly, the logarithmic spiral could be described mathematically with a high goodness of fit. In this paper, we present this case with various clinical images.

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.

Depression is a frequent comorbid syndrome in Parkinson's disease. It is a difficult symptom to manage, as patients continuously receive antiparkinsonian medication and may also have to be treated for the amelioration of the side-effects of antiparkinsonian therapy. The first-line treatment for depression in Parkinson's disease is the use of selective serotonin reuptake inhibitors (SSRIs). The clinical efficacy of these medications in patients with Parkinson's disease is questionable. In fact, based on their mechanism of action, which requires at least a functional serotonergic system, it is predicted that SSRIs will have lower efficacy in patients with Parkinson's disease. Here, we consider the mechanism of action of SSRIs in the context of Parkinson's disease by investigating the fall in the levels of serotonergic markers and the inhibitory outcomes of antiparkinsonian treatment on serotonergic nerve activity. Because certain classes of antidepressant drugs are widely available, it is necessary to perform translational research to address different strategies used to manage depression in Parkinson's disease.

Objectives: Currently, the clinical repair of sciatic nerve injury remains difficult. Previous studies have confirmed that transplantation of adipose tissue-derived stem cells promotes nerve regeneration and restoration at peripheral nerve injury sites.
Methods: In this study, adipose tissue-derived stem cells were induced to differentiate into neural progenitor cells, transfected with a green fluorescent protein-containing lentivirus, and then transplanted into the lesions of rats with sciatic nerve compression injury.
Results: Fluorescence microscopy revealed that the transplanted cells survived, migrated, and differentiated in rats. At two weeks post-operation, a large number of transplanted cells had migrated to the injured lesions; at six weeks post-operation, transplanted cells were visible around the injured nerve and several cells were observed to express a Schwann cell marker. Sciatic function index and electrophysiological outcomes of the transplantation group were better than those of the control group. Cell transplantation promoted the recovery of motor nerve conduction velocity and compound muscle action potential amplitude, and reduced gastrocnemius muscle atrophy.
Conclusions: Our experimental findings indicate that neural progenitor cells, differentiated from adipose tissue-derived stem cells, are potential seed stem cells that can be transplanted into lesions to treat sciatic nerve injury. This provides a theoretical basis for their use in clinical applications.

The origin of neurosurgery dates back to the end of the 19th century. Many prominent and pioneering neurosurgeons contributed substantially to the development of skull base neurosurgery. In the naked eye era, Harvey Cushing promoted the delicate and meticulous surgical techniques, and significantly decreased the surgical mortality. In the 1960s, the operative microscope was introduced to the neurosurgery. Neurosurgeons represented by Yasargil took full advantage of this technology and pushed skull base neurosurgery into a new era. Transnasal transsphenoidal approach has long been used to resect pituitary tumor. The use of endoscope expands the transnasal exposure from the crista galli to C-2. The endoscopic approach may represent a paradigm shift, perhaps equivalent to the introduction of the microscope, in approaching various skull base lesions.

Objectives: To discuss the bleeding mechanisms after removing a medulla oblongata hemangioblastoma. Methods: A 42-year-old male patient was diagnosed with a medulla oblongata hemangioblastoma. Preoperative cranial magnetic resonance imaging, computed tomography angiography and post-surgery computed tomography were completed during clinical procedure. We also reviewed the related literatures. Results: The preoperative computed tomography angiography did not demonstrate any intracranial aneurysm. But, the patient had a fatal subarachnoid hemorrhage with ventricular hemorrhage 4 hours after surgery following the post-surgery computed tomography. Conclusions: Subarachnoid hemorrhage after surgery of the medulla oblongata hemangioblastoma is very rare. Delayed postoperative hemorrhage seems the most reasonable explanation of Subarachnoid hemorrhage in our case.

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.

Brain function is an extremely active dynamic process. Studing a living organism is essential for explaination of the sophistication of the brain. Although there are progresses in studying living tissues of acute or cultured slice for prolonged period in vitro, clinicians prefer seeing the lesion directly on an imaging screen or material. Functional MRI (fMRI) is commonly used method to study brain pathology in dynamics.

Objective: To design a new open-end intracranial hematoma drainage tube for clinical application.
Methods: The newly developed device consists of two parts:the plunger and barrel. On one side, the barrel is bullet shaped with an opening tip. The plunger is located in the middle cavity of the tube barrel and extended out at the open-end. It was designed for strengthening the tube barrel and for convenience in performing the drainage procedure. It can be used by inserting the drainage tube into the lesion and pulling out the plunger, whereby blood will forcefully rise up inside the barrel, providing a satisfactory outcome. It is made for effusion drainage purposes. During the procedure, the drainage tip is placed at the deepest part of the intracranial hematoma to completely drain the blood. Moreover, the plunger fits tightly in the tube, preventing leakage during the operation. With the use of the device, brain can be separated. In addition, the device can help reduce the risk of cerebral damage because of the small operating area. The barrel sidewall has matching opening holes bilaterally and equally for exchanging substances between the inner and outer parts. The overlapping ratio in each horizontal pair is around 1/3-1/2. Each pair on the opposite side will form a different pressure. Thus, the opening holes will not easily get blocked with blood clot.
Results: Blood and accumulated liquid from the deepest part of the intracranial hematoma can be directly drawn through the drainage tube without damaging a large area. The tube does not get blocked easily and allows for complete removal of the hematoma.
Conclusions: The device is asuitable instrument for clinical application.

Objectives: Previous studies involving mice have demonstrated that a cholesterol-enriched diet evokes liver steatosis, dystrophy, inflammation, and aspects of non-alcoholic fatty liver disease (NAFLD). These changes are accompanied by the activation of pro-inflammatory brain and liver molecular pathways, as well as anxiety and depressive-like behaviors. Given previously reported evidence for the neurobiological relationship between the above-mentioned molecular changes and abnormalities in coping with environmental stimuli, such as interactions with other individuals and new environmental contexts, we hypothesized that novelty exploration and aggressive behavior are affected in a mouse NAFLD model.
Methods: To test this hypothesis, young female C57BL/6J mice were fed with a regular chow or a diet containing 0.2% cholesterol for 3 weeks. The mice were then assessed for new object and novel cage exploration, and social interaction in a food competition test.
Results: We found reduced object exploration in mice on the cholesterol-enriched diet. This reduction was not related to whether the new object was placed in an anxiogenic or non-anxiogenic environment. These changes were accompanied by diminished exploration of the new environment in a novel cage, and delayed approach to food after a period of food deprivation. Mice on the regular chow or cholesterol-enriched diet showed no differences in aggressive behavior towards a counter-partner in a food competition test. Food intake and body weight did not differ between the groups, thus, excluding their potential as confounders in the measured behaviors.
Conclusions: We conclude that a diet enriched with cholesterol reduces novelty exploration irrespective of the anxiogenic level of the environment and does not induce aggressive behavior in female mice.

Objectives: Recent findings have further highlighted the role of the thyroid system in the pathophysiology of depression and revealed new physiologically relevant elements of the thyroid system. Our previous study showed an antidepressant-like effect of 3,5-diiodo-L-thyronine (T2), which was previously considered to be a physiologically inactive molecule, in mice. Here, we aimed to investigate the antidepressant-like effects of T2 further.
Methods: We studied the effects of bolus injections of T2 to C57Bl6J mice at doses of 0.25 or 0.75 mg/kg with the tail suspension and forced swim models. The effects of the higher dose were investigated in CD1 mice in the forced swim test. Potential behavioral effects of these treatments were also studied using the novel cage and dark-light box tests.
Results: A reduction of depressive-like behavior was found in mice treated with 0.75 mg/kg of T2 in the tail suspension test, but not in the forced swim test. Locomotion and anxiety variables were unaltered following treatment with T2. There were no significant changes after bolus administration of 0.25 mg/kg T2 in either test for depressive-like behavior. Thus, bolus injection of T2 at the dose 0.75 mg/kg can induce antidepressant-like effects without affecting other behaviors.
Conclusions: A discrepant result in the forced swim test may be due to its different sensitivity to T2 compared with the tail suspension paradigm. Furthermore, the development of procedural modifications of this model can be useful in its application in pre-clinical studies.