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Pluripotent embryonic stem cells were shown to survive and differentiate into mature neuronal cells after implantation in experimental models of Parkinson disease and cerebral ischemia. Embryonic stem cell transplantation has also been proposed as a potential therapy for cerebral trauma, characteristic of massive loss of multiple cell types due to primary insult and secondary sequelae. Green fluorescent protein (GFP)-transfected murine embryonic stem cells were implanted into the ipsi or contralateral cortex of male Sprague-Dawley rats 72 h after fluid-percussion injury. Animals were sacrificed at day 5 or week 7 postimplantation. Brain sections were examined using conventional and fluorescent double-labelling immunohistochemistry. Five days after implantation, clusters of GFP-positive cells undergoing partial differentiation along neuronal pathway, were detected at the implantation site. However, after 7 weeks, only a few GFP-positive cells were found, indicating an extensive loss of stem cells during this time period. For the first time, we proved the observed cell loss to be mediated via phagocytosis of implanted cells by activated macrophages. Cerebral trauma, induced 3 days prior to implantation, has activated the inflammatory potential of otherwise immunologically privileged tissue. Subsequent cell implantation was accompanied by reactive astrogliosis, activation of microglia, as well as a massive invasion of macrophages into transplantation sites even if the grafts were placed into contralateral healthy hemispheres, remote from the traumatic lesion. Our results demonstrate a significant post-traumatic inflammatory response, which impairs survival and integration of implanted stem cells and has generally not been taken into account in designs of previous transplantation studies.

A meningioma was incidentally identified with computerized tomography (CT) in 17 patients without relevant clinical signs. The tumor was not removed, but biopsy confirming a meningioma was obtained from one patient. Tumor growth rate was calculated from repeat CT scans or follow-up magnetic resonance imaging. The annual growth rate ranged from less than 1% to 21%. It is concluded that in nonsymptomatic meningiomas with a low growth rate a nonsurgical approach may be warranted.

An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis. Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window. The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion.