The WHO classification of central nervous system tumors has been published and revised based on the entities established by well-known morphological researchers such as Harvey W. Cushing and Lucien J. Rubinstein. Recently, the molecular information about these tumors has accumulated enormously, and so the need for the classification to include, reflect, and be based on this molecular information has increased. Accordingly, WHO is establishing a new classification in May, 2016, and the main concept is an integrated diagnosis consisting of three diagnostic points: histopathology, WHO grading, and molecular information. According to the new classification, adult diffuse gliomas will be separated into two categories of astrocytoma and oligodendroglia depending on the status of IDH & ATRX gene mutation and 1p/19q co-deletion, while the entity of oligoastrocytoma is no longer adopted because of the wide diagnostic discrepancy between morphological observations and the mutually exclusive molecular characteristics of astrocytic and oligodendroglial tumor cells.

View full abstract

  In this report, the significance of surgical treatments for gliomas will be summarized into five historical trend of the times sections as follows : 1) The predawn of surgical treatments for gliomas : before the introduction of magnetic resonance imaging, 2) Introduction of the “maximize tumor resection & minimize surgical morbidity” concept into glioma surgery, 3) Transition of surgical treatments for gliomas in last 20 years, 4) Surgical treatments for gliomas and eloquent areas, and 5) Surgical treatments for incidental gliomas and their future : the significance of the functional resection border.

View full abstract

  Surgeons continue attempts to improve treatment results with development of the individual skills and intraoperative techniques in a continuous life-long fashion. Nevertheless, a dramatic change in medical practice had happened with introduction of the novel medical technologies for advanced diagnostics and treatment, such as computed tomography, magnetic resonance imaging, stereotactic radiosurgery, endovascular coils, surgical microscope, intraoperative navigation systems, etc. The present article highlights the impact of the diagnostic surgical devices on the intraoperative judgements and actions.
  The main purpose of the diagnostic surgical devices is intraoperative visualization of the biological signals. The first step of this process, visualization itself, already contributes to clinical decision-making, but obtained information is qualitative, thus experience is required for its precise interpretation. The second step is regarded to transformation of the subjective qualitative information into objective quantitative digital data using various image analyzers and/or computer software. During the third step the quantitative digital data are converted into objective anatomical, functional, and histopathological information, which can be used for scientifically-based intraoperative decision-making, taking into consideration the thresholds of resection rate, stimulation current, malignancy index of the tissue specimen, etc.
  Since all these thresholds provide not absolute recommendations, but possible guidelines for surgical actions, the information used for intraoperative decision-making should consider the details of the individual case and include probabilistic statistical analysis based on the feedback from the multicenter databases. Development of such comprehensive support system for intraoperative decision-making carries significant potential to improve surgical results in the future.

View full abstract

  The Japan Clinical Oncology Group (JCOG) is currently the largest ongoing multicenter clinical study group for cancer treatment in Japan. It is mainly supported by the Center for Research Administration and funding from the National Cancer Center.
  The goals of the JCOG are to establish standard treatments for various types of malignant tumors by conducting nationwide multicenter clinical trials, and to improve the quality and outcomes of the management of cancer patients.
  The JCOG Brain Tumor Study Group (JCOG-BTSG) includes 35 registered hospitals and 11 institutes for stereotactic radiosurgery. The JCOG-BTSG has completed 3 studies (JCOG0305 for grade III astrocytoma and glioblastoma, JCOG0911 for glioblastoma, and JCOG0504 for brain metastases), is currently conducting another 4 studies (JCOG1016 for grade III glioma, JCOG1303 for grade II astrocytoma, JCOG1114 for primary central nervous system lymphoma, and JCOG1308 for recurrent glioblastoma) for malignant brain tumors such as glioma, brain metastases, and malignant lymphoma. On the basis of the experience and results of these clinical studies, we have developed our knowledge and expertise in conducting clinical trials for malignant brain tumors.

View full abstract

  The authors have developed percutaneous subdural tapping as a minimally invasive treatment, particularly for aged patients with chronic subdural hematomas. This treatment modality, however, has been considered to be unsuitable for multilobuled hematomas. Therefone a new technique is proposed to remove the remote hematomas by additional injection of oxygen into the primary hematoma cavity. The possible mechanism of this pathological process based on this treatment is also discussed.

View full abstract

  Usually, removal of a skull bone tumor is not so difficult, however, for those tumors with dural adhesions, the procedures become complicated because the tumor cannot be resected only by simple bone cutting alone.
  We therefore introduce a donut-shaped craniectomy and en-bloc removal for skull bone tumors with dural adhesions. After the initial skin incision, several burr holes are perforated, which are set up on the normal bone so as to encircle the tumor. Subsequently, bone cutting is performed between the adjacent burr holes along the inner and outer line, respectively, in order to expose the donut-shaped dura mater outside of the tumor adhesion. Finally, by cutting the dura mater in a circle between the bone edges, total removal of the lesion can be achieved. Because it is relatively less invasive, this procedure is considered to be a good method for removal of skull bone tumors with dural adhesions regarding handiness, curability, and invasiveness.

View full abstract

  We report a case of stroke in a patient taking dabigatran (150 mg twice daily) for management of atrial fibrillation. A 58-year-old man presented to our emergency department 35 min after onset of acute right hemiparalysis, conjugate deviation to the left, and aphasia (National Institutes of Health Stroke Scale score, 21). The patient had taken his last dose of dabigatran 4 hours before the onset of symptoms.
  Noncontrast computed tomography (CT) of the brain showed subtle, early obscuration of the left anterior lobe, insular cortex, and temporal lobe. We diagnosed acute ischemic stroke. CT angiography showed thrombotic occlusion of the left MCA (M2 segment). We did not administer recombinant tissue plasminogen activator, given the patient’s recent dabigatran use. The patient satisfied the criteria for endovascular therapy, and the procedure was begun at 108 min after onset. We obtained perfect recanalization, which resulted in rapid symptomatic improvement.
  Present guidelines offer no guidance regarding the safety of treatments for acute ischemic stroke in patients taking dabigatran. The present results suggest that endovascular therapy is a suitable treatment for such patients.

View full abstract