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Cell replacement therapy is expected as a new and more radical treatment against brain damage. We previously reported that transplanted human cerebral organoids extend their axons along the corticospinal tract in rodent brains. The axons reached the spinal cord but were still sparse. Therefore, this study optimized the host brain environment by the adeno-associated virus (AAV)-mediated expression of axon guidance proteins in mouse brain. Among netrin-1, SEMA3, and L1CAM, only L1CAM significantly promoted the axonal extension of mouse embryonic brain tissue-derived grafts. L1CAM was also expressed by donor neurons, and this promotion was exerted in a haptotactic manner by their homophilic binding. Primary cortical neurons cocultured on L1CAM-expressing HEK-293 cells supported this mechanism. These results suggest that optimizing the host environment by the AAV-mediated expression of axon guidance molecules enhances the effect of cell replacement therapy.

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Cell-based therapies are attracting attention as alternative therapeutic options for brain damage. In this study, we investigated the therapeutic effect of a combined therapy of cell transplantation and locomotor training by evaluating the neuronal connectivity. We transplanted neural cells derived from the frontal cortex of E14.5 GFP-expressing mice into the frontal lobe of 3-week-old rats with brain injury, followed by treadmill training (TMT) for 14 days. In the TMT(-) group, graft-derived neurites were observed only in the striatum and internal capsule. In contrast, in the TMT(+) group, they were observed in the striatum, internal capsule, and the cerebral peduncle and spinal cord. The length of the longest neurite was significantly longer in the TMT(+) group than in the TMT(-) group. In the TMT(+) group, Synaptophysin+ vesicles on the neuronal fibers around the ipsilateral red nucleus were found, suggesting that neuronal fibers from the grafted cells formed synapses with the host neurons. A functional analysis of motor recovery using the foot fault test showed that, 1 week after the transplantation, the recovery was significantly better in the cell transplantation and TMT group than the cell transplantation only group. The percentage of cells expressing C-FOS was increased in the grafts in the TMT(+) group. In conclusion, TMT promoted neurite extensions from the grafted neural cells, and the combined therapy of cell transplantation and locomotor training might have the potential to promote the functional recovery of rats with brain injury compared to cell transplantation alone.

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Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base. Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed. Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3%) and a partial resection of the APF was performed on 2 (5.1%). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium. Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.

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Basal cell carcinoma (BCC) is the most common malignancy in the face. Surgical removal and reconstruction is the first choice of treatment options for BCC, but it tends to be invasive and sometimes is accompanied by a drastic change in appearance. We report here a case of BCC in the eyelid of a patient who was successfully treated by gamma knife radiosurgery (GKRS). He was 88 years old at this time. The ulcer disappeared within 3 weeks after GKRS and was covered with normal epithelium. This is the first report to describe an eyelid BCC that was treated by GKRS.

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Traumatic vertebral artery dissection (VAD) has been reported in various types of sports and recreation. However, there have been no reports of VAD in rugby players, except for those with cervical spine injuries. We experienced two cases of VAD without cervical spine injuries in high school rugby players. Attention should be paid to protect youth rugby players from VAD.

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BACKGROUND: Radiation-induced glioma arising in the spinal cord is extremely rare. We report a case of radiation-induced spinal cord glioblastoma with cerebrospinal fluid (CSF) dissemination 10 years after radiotherapy for T-cell lymphoblastic lymphoma. CASE DESCRIPTION: A 32-year-old male with a history of T-cell lymphoblastic lymphoma presented with progressive gait disturbance and sensory disturbance below the T4 dermatome 10 years after mediastinal irradiation. Gadolinium-enhanced magnetic resonance (MR) imaging revealed an intramedullary tumor extending from the C6 to the T6 level, corresponding to the previous radiation site, and periventricular enhanced lesions. In this case, the spinal lesion was not directly diagnosed because the patient refused any kind of spinal surgery to avoid worsening of neurological deficits. However, based on a biopsy of an intracranial disseminated lesion and repeated immmunocytochemical examination of CSF cytology, we diagnosed the spinal tumor as a radiation-induced glioblastoma. The patient was treated with radiotherapy plus concomitant and adjuvant temozolomide. Then, the spinal tumor was markedly reduced in size, and the dissemination disappeared. CONCLUSION: We describe our detailed diagnostic process and emphasize the diagnostic importance of immunocytochemical analysis of CSF cytology.

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BACKGROUND: Surgical treatment of endodermal cysts requires total removal of the cyst wall during the first operation to prevent recurrence. Therefore, intraoperative pathological diagnosis plays an important role in determining the optimal surgical strategy. We present a rare case of a spinal endodermal cyst and discuss its diagnostic difficulty during the intraoperative pathological examination. CASE DESCRIPTION: An 18-year-old male presented with progressive paraparesis and precordial oppression. Magnetic resonance (MR) imaging revealed an intradural extramedullary cystic mass having the same signal intensity as cerebrospinal fluid (CSF) without gadolinium enhancement at the T1-T2 level. The preoperative diagnosis was an endodermal or arachnoid cyst. The patient underwent surgery. An intraoperative frozen section showed a cyst wall consisting of loose, thin, fibrous tissue intermittently covered by flattened epithelium. The diagnosis was an arachnoid cyst. Accordingly, partial resection of the cyst wall was performed to create CSF communication between the cyst and subarachnoid space. However, the postoperative pathological diagnosis from permanent sections was an endodermal cyst, which was lined with ciliated columnar epithelium that was immunopositive for cytokeratin and epithelial membrane antigen. Subsequent paraffin embedding and immunostaining of the intraoperative frozen sample also confirmed patchy cytokeratin expression by all flattened epithelial cells. The patient's cyst had refilled 10 months after surgery, and he subsequently underwent fenestration of the cyst wall and placement of a cyst-subarachnoid shunt. CONCLUSION: Examination of multiple samples from multiple sites or intraoperative immunostaining of frozen sections is recommended for accurate intraoperative diagnosis of endodermal cysts.