Intraoperative High-Resolution Color-Coded Ultrasound to Identify the Posterior Median Sulcus for Midline Myelotomy in Intramedullary Spinal Cord Surgery.

A 14-year-old boy presented with a 2-year history of slowly increasing weakness and atrophy in the right forearm and leg. Magnetic resonance imaging (MRI) revealed an intramedullary diffusely infiltrating lateralized tumor at C3-7. An extended biopsy was planned. After laminotomy and durotomy, the swollen spinal cord was noted to be rotated by 45° with the right dorsal root entry zone being in the midline. A 15 MHz linear ultrasound probe was used to identify the midline by visualizing the dorsal median sulcal vein within the midline raphe. A myelotomy was made in that zone without deterioration of somatosensory evoked potentials (SEPs) and an extended biopsy was performed. Histological examination revealed a pilocytic astrocytoma. Modern intraoperative high-resolution color-coded ultrasound enables the identification of the midline in intramedullary spinal cord lesions even when the spinal cord anatomy is distorted.

Attempted Suicide with a Self-Inflicted Penetrating Stab Wound to the Medulla Oblongata Caused by a Pair of Scissors: Case Illustration.

A 78-year-old male patient with a history of psychotic depression was found in the bathroom of his apartment with a pair of scissors driven deeply into the back of his neck. He presented with tetraparesis with residual control over the left lower limb movement. Immediate skull radiograph and brain computed tomography scans revealed the tip of the scissors passing into the foramen magnum. Emergent surgery with midline suboccipital craniectomy and resection of the posterior arch of C1 was performed. The scissors were spontaneously dislocated in the course of surgery. Thereafter, debridement, placement of external ventricular drain and primary closure of the dura and skin were achieved. Post-operatively, the patient was not able to follow any instructions. On the 22nd post-operative day, the patient passed away in palliation. To our knowledge, this is the first reported case of a suicide attempt involving the use of scissors reaching the medulla oblongata.

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report / Recuperación mínimamente invasiva de una bala que se asienta en el canal espinal torácico en un paciente pediátrico: reporte de un caso

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients. (AU)

Un niño de 10 años se presentó al departamento de neurocirugía después de una herida de bala en la columna torácica superior. La bala entró por el músculo deltoides derecho y se alojó dentro del canal espinal a nivel T1. El paciente llegó consciente y obedeciendo órdenes; sin embargo, experimentó una pérdida de sensibilidad por debajo del nivel T3, pérdida de reflejos por debajo del nivel T1 lesionado, pérdida del tono del esfínter anal y paraplejía en las extremidades inferiores (American Spinal Injury Association grado-A). Los estudios de imagen revelaron una bala metálica intracanalicular a nivel T1. El paciente fue intervenido de urgencia mediante un sistema retractor tubular y el microscopio. Posteriormente, la bala se recuperó con éxito. En el postoperatorio, el paciente se recuperó significativamente y, al final del sexto mes, podía caminar de forma independiente a pesar de cierta inestabilidad en la marcha. Un enfoque mínimamente invasivo para la extracción de balas intracanaliculares en la región torácica es una técnica segura y eficaz en pacientes pediátricos. (AU)

Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report.

A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.

Spontaneous migration of retained intracranial missiles: experience with 16 cases.

Spontaneous migration of retained intracranial missiles is uncommon but a potentially serious phenomenon. Our objective is to increase awareness of the risk of spontaneous migration of retained intracranial missiles by reporting our case series of 16 patients. We performed a retrospective single-center study on patients treated for intracranial missile injuries between 2000 and 2010 in Palestine with a particular focus on the migration of retained intracranial missiles. Detailed analyses were made of patients' age, sex, type of injurious agents (metallic bullets/rubber bullets/metallic shrapnel from bomb explosion), initial missile position, site to where the missile migrated, radiological and neurological manifestations, complications, treatment modalities (surgery vs. conservative) and functional outcome by Glasgow outcome scale-extended (GOSE) classification at last follow-up. In a cohort of 190 patients with retained intracranial missiles, we identified 16 (8.4%) patients with spontaneous migration. Patients' age ranged from 10 to 30 years (mean: 18.9 ± 6.4 years). There were only 2 female patients. The missiles that migrated intracranially were metallic bullets (n = 10), rubber bullets (n = 3), and metallic shrapnel from a bomb explosion (n = 3). Among the 16 patients, 10 patients experienced symptoms due to missile migration and were treated surgically, while six patients did not develop new symptoms after missile migration and were managed conservatively. In our case series, 16/190 (8.4%) patients with retained intracranial missiles developed spontaneous migration. Neurosurgeons performing delayed surgery on patients with retained intracranial missiles should be aware of the risk of spontaneous migration and verify the location of the missile after positioning the patient for surgery.

Immunoglobulin G4-Related Hypertrophic Pachymeningitis of the Spine: A Case Report and Systematic Review of the Literature.

BACKGROUND: Spinal immunoglobulin G4-related hypertrophic pachymeningitis (IgG4-HP) is a rare disease. Little information is known regarding the diagnosis, management, and prognosis of patients with spinal IgG4-HP. METHODS: The authors present a case of spinal IgG4-HP with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies (up to April 2020) that reported patients with spinal IgG4-HP, based on the criteria of Japan College of Rheumatology, were identified from the PubMed and Cochrane Library databases. RESULTS: This systematic review identified 33 patients, including the present case, of whom 21 were male and 12 were female. The mean value of age was 51.2 (±12.6) years. Eight patients had systemic involvement. In addition, among 33 patients, 13 patients had an elevated serum IgG4. Surgery was performed in 31 patients. Steroid therapy alone and steroid therapy with immunosuppressants were effective in 94% and 100% of the cases, respectively. Furthermore, 31 of 33 patients reported improved outcomes, 1 patient died due to infection, and in 2 patients the data were not available. CONCLUSIONS: Spinal IgG4-HP is a rare entity. In addition, it should be considered in the differential diagnosis of space-occupying lesions around the spinal cord. Histopathology with immunohistochemistry results provides the most reliable evidence for diagnosis. Steroid therapy is the first line of treatment. Surgical decompression may be required in patients presenting with nerve root and/or spinal cord compression. Long-term follow-up is necessary for patients with spinal IgG4-HP.

Bexarotene Exerts Protective Effects Through Modulation of the Cerebral Vascular Smooth Muscle Cell Phenotypic Transformation by Regulating PPARγ/FLAP/LTB4 After Subarachnoid Hemorrhage in Rats.

Vascular smooth muscle cells (VSMCs) play an important role after a subarachnoid hemorrhage (SAH). The changes in VSMCs following bexarotene treatment after SAH are unknown. In the present study, neurological impairment, decreased cerebral cortical blood flow and transformation of cerebral VSMCs from a contractile to a synthetic phenotype were observed after SAH. Bexarotene reduced neurological impairment, improved cerebral cortical blood flow, inhibited VSMC phenotypic transformation and suppressed the expression of 5-lipoxygenase-activating protein (FLAP) and leukotriene B4 (LTB4), which was partly reversed by GW9662, an inhibitor of peroxisome proliferator-activated receptor gamma (PPARγ). Mechanistically, sh-PPARγ-mediated phenotypic transformation of VSMCs was partially suppressed by MK886, an antagonist of FLAP. Therefore, we conclude that bexarotene reduced neurological impairment, improved cerebral cortical blood flow and inhibited the VSMC phenotypic transformation after SAH, which was achieved by activating PPARγ-mediated inhibition of FLAP/LTB4 in VSMCs.

Protease-activated receptor-2 regulates glial scar formation via JNK signaling.

The study aimed to determine the effects of protease-activated receptor-2 (PAR-2) on glial scar formation after spinal cord injury (SCI) in Sprague-Dawley (SD) rats and the underlying mechanisms. Rivlin and Tator's acute extradural clip compression injury (CCI) model of severe SCI was established in this study. Animals were divided into four groups: 1) sham group (laminectomy only); 2) model group, treated with normal saline; 3) PAR-2 inhibitor group; 4) PAR-2 activator group. Enhanced GFAP and vimentin expression were the markers of glial scar formation. To determine whether JNK was involved in the effects of PAR-2 on GFAP and vimentin expression, we administered anisomycin (a JNK activator) in the presence of PAR-2 inhibitor and SP600125 (a JNK inhibitor) in the presence of PAR-2 activator. At 1, 7, 14 and 28 day after SCI, Basso, Beattie, and Bresnahan (BBB) locomotor score test was used to assess the locomotor functional recovery; immunofluorescence and western blot analysis were used to assess the expression level of GFAP, vimentin and p-JNK. Double immunofluorescence staining with GFAP and tubulin beta was used to assess the glial scar formation and the remaining neurons. Results suggested that PAR-2 is involved in glial scar formation and reduces neurons residues which can cause a further worsening in the functional outcomes after SCI via JNK signaling. Therefore, it may be effective to target PAR-2 in the treatment of SCI.

Georgette Kidess, the First Female Neurosurgeon in Palestine.

OBJECTIVE: The aim of this study is to detail the background, training, and career of Dr. Georgette Kidess, the first and still the only female neurosurgeon in Palestine. In addition, we mention the obstacles that women face during their neurosurgical career and how to overcome them. Also, we discuss different methods to attract female medical students to neurosurgery. METHODS: Information was gathered only from direct face-to-face interviews with Dr. Kidess. RESULTS: Georgette Kidess was born on May 2, 1952, in Nablus, Palestine. She received the degree of Doctor of Medicine (M.D.) at Eberhard Karls Universität, Tübingen, Germany in 1979. She worked as a neurosurgeon at the Hadassah EinKarem Hospital in Jerusalem and subsequently established the first neurosurgical department at the Ramallah Governmental Hospital in Ramallah in 1986. Thereafter, she has continued a career in private practice, currently at Saint Luke's Hospital, Nablus. Dr. Kidess played a major part in establishing neurosurgery in Palestine. She was among the founders of the Palestinian Neurosurgical Society in 2014. CONCLUSIONS: In this article, we recount Dr. Kidess's contributions and achievements to neurosurgery in Palestine. Her commitment, persistence, and diligence enabled her to overcome great odds and become the first female neurosurgeon in Palestine. We hope that her story will inspire and open the doors for subsequent women to enter and enhance neurosurgery, especially in the Middle East.

Significant changes in circular RNA in the mouse cerebral cortex around an injury site after traumatic brain injury.

BACKGROUND AND OBJECTIVE: Circular RNA (circRNA) is an important type of non-coding RNA that has not been widely researched in traumatic brain injury (TBI). The present study aimd to detect the altered circRNA expression around an injury site in the mouse cerebral cortex after TBI and explore its potential functions. METHOD: C57BL/6 mice were used to construct a controlled cortical impact (CCI) model to simulate TBI. At 24 h post-TBI, the cortex around the injury site was collected, and the total RNA was extracted to perform RNA sequencing (RNA-seq). The differentially expressed circRNAs were determined according to the following criteria: |log2(fold change)| > 1, P < .05 and FDR < 0.05. Among them, circRNA chr8_87,859,283-87,904,548 was preliminarily explored to determine its function. RESULTS: A total of 8036 altered circRNAs were discovered, and among them, 16 were significantly changed (5 up-regulated and 11 down-regulated). The circRNA chr8_87,859,283-87,904,548 significantly increased by approximately 4 times in the cerebral cortex around the injury site after TBI and promoted neuro-inflammation through increasing the CXCR2 protein by sponging mmu-let-7a-5p. As a result, the increased circRNA chr8_87,859,283-87,904,548 blocked the restoration of neurological function after TBI. CONCLUSION: Many circRNAs are significantly up-regulated or down-regulated in the traumatic cerebral penumbra cortex after TBI. Among them, the circRNA chr8_87,859,283-87,904,548 potentially plays a pro-inflammatory role, which may have a deleterious effect on neurological restoration after TBI. .

Vertico-horizontal atlantoaxial index (VHAI): A new craniovertebral radiographic index.

OBJECTIVE: The purpose of this study was to develop a new index that can reliably quantify the reduction of basilar invagination with atlantoaxial dislocation. PATIENTS AND METHODS: Between May 2012 and September 2017, 40 patients with congenital basilar invagination and atlantoaxial dislocation as well as 100 sex-and age-matched control subjects were recruited for this study. All patients underwent direct posterior reduction and fixation. Mid-sagittal computerized tomography scan films were obtained before and after surgery as well as the vertico-horizontal atlantoaxial index (VHAI) was measured in all patients -before and after surgery- and controls. Additionally, the pre-and postoperative Japanese Orthopedic Association (JOA) scores, Nurick grading, European Myelopathy Score (EMS) and Prolo Scale score were used to evaluate the cervical myelopathy. RESULTS: The mean follow-up was 24.75 months with a range of 6-60 months. The mean value of VHAI in the control group was 87.86 ± 24.98 mm2, while the mean values of VHAI before and after surgery were 209.45 ± 96.80 mm2 and 95.08 ± 66.95 mm2, respectively. Additionally, in the patient group, a negative correlation was observed between JOA, EMS, Prolo Scale scores and VHAI. On the other hand, a positive correlation was found between the Nurick grading and VHAI. CONCLUSION: The VHAI can be an excellent measurement tool to evaluate the reduction of basilar invagination with atlantoaxial dislocation. There was a negative correlation between VHAI and JOA, EMS and Prolo Scale scores, and a positive correlation with Nurick grading; which indicates the effectiveness of this index.

Thioredoxin-interacting protein mediates mitochondrion-dependent apoptosis in early brain injury after subarachnoid hemorrhage.

Early brain injury (EBI) was reported to be the primary cause of high mortality and poor outcomes in subarachnoid hemorrhage (SAH) patients, and apoptosis is regarded as the most important physiopathologic mechanism during EBI. Recently, our team found that thioredoxin-interacting protein (TXNIP) links endoplasmic reticulum stress (ER stress) to neuronal apoptosis and aggravates EBI. However, the other underlying mechanisms remain unknown. Mitochondria are considered to be the central points in integrating apoptotic cell death. However, whether crosstalk between TXNIP and the mitochondria-mediated intrinsic apoptotic pathway is effective on EBI has not been previously reported. Therefore, we created an endovascular perforation SAH model in Sprague-Dawley rats to determine the possible mechanism. We found that TXNIP expression in apoptotic neurons significantly increased in the SAH group compared with the sham group. In addition, increased TXNIP expression was accompanied by remarkable changes in mitochondrial-related antiapoptotic and proapoptotic factors. Furthermore, resveratrol (RES, a TXNIP inhibitor) administration significantly downregulated the expression of TXNIP and mitochondria-related proapoptotic factors. Additionally, it attenuated SAH prognostic indicators, such as brain edema, blood-brain barrier permeability, and neurological deficits. Therefore, our study further confirms that TXNIP may participate in neuronal apoptosis through the mitochondrial signaling pathway and that TXNIP may be a target for SAH treatment.

Traumatic Brain Injury Caused by Missile Wounds in the North of Palestine: A Single Institution's Experience with 520 Consecutive Civilian Patients.

BACKGROUND: Literature about traumatic brain injury caused by missile wounds is scanty. We shed some light on this field. METHODS: This retrospective study was carried out, between September 2000 and September 2010, on 520 civilian patients who sustained traumatic brain injury from missiles in the north of Palestine. Thorough detailed analyses were made of patients' admission Glasgow Coma Scale (GCS) scores, pupillary reactivity to light, site and mode of injuries, type of injurious agents, missile trajectory, method of treatment, radiologic manifestations, complications, and outcome. The GCS score was used to assess the level of consciousness, whereas the Glasgow Outcome Scale score was used to evaluate the outcome. RESULTS: Patients' age ranged from 6 months to 75 years. Only 50 (9.6%) patients were female. Patients injured by metallic bullets, rubber bullets, and shrapnel from bomb explosions numbered 351, 139, and 30, respectively. Of 384 patients who were treated conservatively, no mortality was detected, whereas of 136 surgically treated patients, 66 (48.5%) died of their injuries. Although our management of patients was not optimal because of many factors, the overall mortality was 12.7% (n = 66). CONCLUSIONS: The promptness of transport to hospital was a decisive factor with a major bearing on decreasing mortality. Brain computed tomography was invaluable in the diagnosis and follow-up of our patients. In addition, age, pupillary reactivity, admission GCS score, missile trajectory, ventricular involvement, and site and mode of injury were important prognostic factors.

Significant Injury of the Mammillothalamic Tract without Injury of the Corticospinal Tract After Aneurysmal Subarachnoid Hemorrhage: A Retrospective Diffusion Tensor Imaging Study.

OBJECTIVE: Little is known about the pathophysiologic mechanisms of white matter injury after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of this study is to investigate whether the mammillothalamic tract (MTT) or corticospinal tract (CST) is more affected by aSAH in the same patients with good outcome (Grade 5 on Glasgow Outcome Scale at 3 months) using diffusion tensor imaging (DTI). METHODS: Between June 2013 and September 2016, 21 patients with aSAH with good outcome and 21 sex- and age-matched normal healthy control participants were recruited. DTI was obtained at 8.92 ± 2.4 weeks after onset. Moreover, reconstruction of the CST and the MTT was completed with DTI-studio software. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured. In addition, the motricity index and Mini-Mental State Examination scores were obtained. RESULTS: There was no statistically significant difference detected in the ADC and FA values of the CST between the patient and control groups (P > 0.05). On the contrary, there was a statistically significant difference in ADC and FA values of the MTT between the patient and control groups (P < 0.05). In addition, in the patient group, no correlation (P > 0.05) was observed between motricity index scores and DTI parameters (ADC and FA), whereas the Mini-Mental State Examination showed a positive correlation with FA (r = 0.591, P = 0.029) without correlation to ADC (r = 0.142, P = 0.628). CONCLUSIONS: Patients with good outcomes (Grade 5 on Glasgow Outcome Scale at 3 months) after aSAH appeared to suffer an injury of the MTT without an associated injury of the CST compared with the control group. This injury showed a correlation with cognitive dysfunction.

The long non-coding RNA Neat1 is an important mediator of the therapeutic effect of bexarotene on traumatic brain injury in mice.

OBJECTIVE: Bexarotene treatments exert neuroprotective effects on mice following traumatic brain injury (TBI). The present study aims to investigate the potential roles of the long noncoding RNA Neat1 in the neuroprotective effects of bexarotene. MATERIALS AND METHODS: Adult male C57BL/6J mice (n=80) and newborn mice (within 24h after birth) (n=20) were used to generate a "controlled cortical impact" (CCI) model and harvest primary cortex neurons, respectively. The HT22 cell line and the BV2 cell line were cultured under "normal" or "oxygen/glucose-deprived" (OGD) conditions. The relationship between RXR-α and the Neat1 promoter was clarified using ChIP-qPCR and dual-luciferase reporter gene assays. The mRNA alterations induced by Neat1 knockdown were measured using next-generation RNA sequencing. Proteins were captured by Neat1, pulled down and subjected to mass spectrometry. The neurological severity score, rotarod test and water maze test were employed to measure the animals' motor and cognitive functions. RESULTS: Bexarotene prominently up-regulated the Neat1 level in an RXR-α-dependent manner. Neat1 knockdown induced significant changes in mRNA expression, and the altered mRNAs were involved in many biological processes, including synapse formation and axon guidance. In primary neurons, Neat1 knockdown inhibited and Neat1 over-expression prompted axon elongation. Multiple proteins, including Pidd1, were captured by Neat1. Neat1 inhibited cell apoptosis and restricted inflammation by capturing Pidd1. The in vitro anti-apoptotic and anti-inflammatory effects of Neat1 were further confirmed in C57BL/6 mice, which resulted in better motor and cognitive function after TBI. CONCLUSION: Bexarotene up-regulates the lncRNA Neat1, which inhibits apoptosis and inflammation, thereby resulting in better functional recovery in mice after TBI.

Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C2 Pedicle.

OBJECTIVE: We sought to investigate and report a novel surgical technique of screws insertion and posterior surgical reduction, as well as explore its clinical results. METHODS: From September 2008 to September 2012, we treated 41 cases of unstable craniovertebral junction anomalies with a narrow C2 pedicle at our department. All patients underwent "posterior reduction and internal fixation of the occipital bone with superior or inferior articular process of C2 and lateral mass of C3 on the narrowed C2 pedicle side-for non-narrowed C2 pedicle side, the screw was only inserted into C2 pedicle without extending the fixation to C3 vertebrae-using a titanium screw-rod (plate) fixation system." The preoperative and postoperative atlantodens interval, Chamberlain line, McRae line, and cervicomedullary angle were all measured. In addition, the preoperative and postoperative Japanese Orthopedic Association score was used to evaluate the cervical myelopathy. RESULTS: A total of 134 screws were inserted into the C2 pedicle (30 screws), superior (35 screws) or inferior (17 screws) articular process of C2, and lateral mass of C3 (52 screws). There was a significant statistical difference between the preoperative and postoperative results in the reduction of the odontoid process, decompression of the upper cervical spinal cord and medulla, as well as the improvement of neurologic functions (P < 0.05). All patients have exhibited a major neurologic improvement and solid bony fusion. CONCLUSION: This novel surgical technique is safe, feasible, and effective for the treatment of unstable craniovertebral junction anomalies with a narrow C2 pedicle.

History of Neurosurgery in Palestine.

BACKGROUND: Palestinian neurosurgery started with Dr. Antone Tarazi as the first Palestinian neurosurgeon. Before that, there was no organized neurosurgery specialty, and general surgeons performed neurosurgical procedures. Here we review the history of neurosurgery and neurosurgical applications in Palestine, evaluate some limitations of the current system, and discuss major challenges to improving this system. METHODS: We collected information from various sources in either English or Arabic. RESULTS: The development of neurosurgery and neurosurgical training in Palestine began in 1960 with the first center established in Jerusalem, which provided much-needed neurosurgical services and training in the fields of neurosurgery and neurology. Palestine has produced a number of its own neurosurgeons and has promoted further progress by establishing the Palestinian Neurosurgical Society in 2014. Today, there are 34 neurosurgeons (including 1 female neurosurgeon) and 17 residents providing expert care in 17 centers across Palestine, along with 1 neurosurgical residency program. CONCLUSIONS: Neurosurgery in Palestine has faced many challenges, some of which have been overcome. However, there remain many challenges, which will require much time and effort to surmount. Political stabilization is a significant factor in the progress of neurosurgery in Palestine.

Mild hypothermia as a treatment for central nervous system injuries: Positive or negative effects.

Besides local neuronal damage caused by the primary insult, central nervous system injuries may secondarily cause a progressive cascade of related events including brain edema, ischemia, oxida-tive stress, excitotoxicity, and dysregulation of calcium homeostasis. Hypothermia is a beneficial strategy in a variety of acute central nervous system injuries. Mild hypothermia can treat high intra-cranial pressure following traumatic brain injuries in adults. It is a new treatment that increases sur-vival and quality of life for patients suffering from ischemic insults such as cardiac arrest, stroke, and neurogenic fever following brain trauma. Therapeutic hypothermia decreases free radical produc-tion, inflammation, excitotoxicity and intracranial pressure, and improves cerebral metabolism after traumatic brain injury and cerebral ischemia, thus protecting against central nervous system dam-age. Although a series of pathological and physiological changes as well as potential side effects are observed during hypothermia treatment, it remains a potential therapeutic strategy for central nervous system injuries and deserves further study.