There have been reports in countries other than Japan on ventriculoperitoneal (VP) shunting for pediatric hydrocephalus involving statistical analysis of large amounts of data accumulated from many institutions. In Japan, however, there have been few reports on statistical studies of VP shunt prognosis with clinical data from a sufficiently large number of research institutions and children’s hospitals.

  We performed statistical analysis to identify significant factors associated with survival duration of VP shunts using data from 1,094 patients<18 years old collected from 12 hospitals by pediatric neurosurgeons. The survival duration in each case was determined via calculation of duration in days from implantation date to removal date, and Kaplan-Meier survival curves were constructed.

  Then, we compared various factors potentially associated with survival duration and identified previous infection and implantation within the past year as being significant ; in particular, shunt implantation in infancy might significantly affect the occurrence of shunt infection. Survival duration was also found to be the least in cases with VP shunting at the first implantation and longest in those at the second. Analysis of different kinds of shunt systems showed no significant differences in the incidence of shunt malfunction and indicated the ventricular catheter as the most common malfunctioning part in the systems.

  Analysis of larger amounts of data should be considered to establish indigenous guidelines for pediatric VP shunting in Japan following the Pediatric Hydrocephalus Systematic Review and Evidence-based Guidelines.

  Craniosynostosis with early closure of skull sutures is categorized either as simple or as syndromic if present with other congenital anomalies such as midface hypoplasia, syndactyly, or joint contractures. Some children have a single affected suture, whereas some have multiple affected sutures. Skull shape varies depending on the affected sutures and the treatment needs to be done in the period of skull growth, which depends on age and skull shape. No consensus has been established for treatment decisions. New less invasive treatment methods such as distraction osteogenesis and molding helmets have been developed, but unsolved problems continue to be present. Here we discuss chronological changes in treatment methods, current status and problems, treatment algorithms, and research strategies for pathophysiology and prevention.

  Myelomeningocele (MMC) is a serious congenital malformation causing spinal injury and Chiari Ⅱ malformation. MMC defect closure after birth as a treatment has limitation. On the basis of a randomized controlled trial completed in 2010, the Management of Myelomeningocele Study (MOMS), prenatal repair appears to offer significantly better results in the children than postnatal repair. Since then, fetal surgery for MMC has been a standard therapeutic option for MMC in the US and Europe.

  The field of pediatric brain tumor treatment and diagnostic analysis has been developing remarkably during the last decade. In particular, multiple tumor types have been identified from those that had been thought to be one entity due to new analysis techniques by teams studying a large number of tumor samples in Europe and North America. Although these classifications do not directly influence diagnostic differentiation and individualization of treatment, the treatment strategy can benefit in terms of (1) clear diagnosis, (2) risk classification based on the diagnosis, and (3) determining the strength of therapy depending on the risk classification. In particular, the determination of therapy strength is the most important step requiring many clinical trials.

  From the perspective of therapy maturity, many of the remarkable developments in recent years in the pediatric brain tumor field remain at the stage of diagnostic differentiation and risk classification.

  In the present review, we describe the status and future prospects in the field of pediatric brain tumors from the perspective of therapy maturity.

  We herein report the case of a 52-year-old man with progressive multifocal leukoencephalopathy (PML) associated with lung cancer and left occipital lobe brain metastasis. The patient had undergone a series of operations and radiation therapies. He was treated with steroids for radiation necrosis for approximately one year. He was hospitalized with gait disturbance and a reduced activity of daily living status ; both gradually worsened. Diffusion-weighted imaging (DWI) MRI on admission showed a subcortical area of high intensity in the left frontal lobe. We first suspected toxic leukoencephalopathy, as he had received chemotherapy for lung cancer one month previously. As clinical signs rapidly worsened, we diagnosed PML. He died two months after admission. The radiological features of PML should be better defined in order to expedite and aid diagnosis.