Prenatal surgery for fetal myelomeningocele (MMC) repair has become more common since publication of the Management of Myelomeningocele Study (MOMS) in 2011. Treatment guidelines published by the Congress of Neurological Surgeons in 2019 recommend prenatal MMC repair when possible. However, this is not practical in Japan as fetal surgery research here has just begun. Therefore, the academic research group of the Japanese Society for Pediatric Neurosurgery (JSPN) has established a subcommittee to develop guidelines for MMC treatment that focus on postnatal repair and care of the MMC patient. Important issues to be addressed include prenatal MMC diagnosis, diagnosis of tethered spinal cord, timing and method of surgery for tethered cord, and treatment of late complications. Collaboration with obstetricians, pediatric urologists, pediatric orthopedic surgeons, and pediatricians will be essential. The initial JSPN guidelines will review and discuss issues specific to neurosurgery in newborns and infants and are currently being developed in accordance with the Medical Information Network Distribution Service (MINDS) Manual for Clinical Practice Guideline Development of the Japan Council for Quality Health Care.

  The aim of craniosynostosis surgery is to release the increased intracranial pressure and normalize the cranial shape. The procedure has developed considerably from a simple strip craniectomy of the fused suture before the 1960s to total calvarial remodeling after the 1970s and other advanced methods of the 1990s, such as distraction and its modifications that are applied to the posterior cranium. According to the literature, craniofacial surgeons change their methods depending on the case to apply more effective and less invasive. For a mildly distorted cranium, an earlier diagnosis can be obtained and conservative surgical treatment must be chosen. Currently, syndromic craniosynostosis is being treated with posterior distraction to achieve cranial volume expansion effectively. For this, distractors need certain hardness and thickness of the bone ; hence, the surgery has to be postponed until 5-6 months of age. The modified Jimenez procedure is another option for the early stage of syndromic craniosynostosis. It has been applied in some cases and proven to be more effective than expected. As plastic surgeons have treated craniosynostosis for approximately three decades with neurosurgeons, we have presented our latest strategies and opinions by illustrating representative cases.

  The literature to date has described the disease concept, the latest findings, and advanced treatments for the treatment of pediatric brain tumors, which are intractable rare diseases. Currently, there are many opportunities to discuss the medical system in terms of the issue of autonomous support for children, which focus on “issues of transitional medical care associated with the treatment of pediatric malignant tumors.” This time, we will end from the time lag problem from the onset of the first sign to the first medical examination in neurosurgery, the hospitalization treatment, the treatment environment problem during the hospitalization treatment period, the problem in returning to school after recovery and discharge, or the worsening of the condition. There is a period before a patient has the initial consultation with a neurosurgeon. The duration from initial pediatric consultation through to neurosurgery is an issue. We would like to share the issues facing the pediatric brain tumor treatment environment during the period leading up to this stage.

  Head trauma among children is a common presentation encountered on a daily basis, although most of which are mild and do not require neurosurgical management. However, it is necessary to understand the pathological characteristics of head trauma peculiar to children. Radiation exposure to children should be avoided as much as possible because children have higher radiation sensitivity than adults. Three clinical decision rules derived from multicenter studies were used to identify the risk for intracranial injuries and to minimize the use of computed tomography (CT) scans. Pediatric-specific pathology such as extracranial hematoma, accessory suture, benign enlargement of the subarachnoid spaces, abusive head trauma, and bone resorption after decompressive craniotomy are also outlined. Since medico-social opinions are required as an expert of the brain, accurate diagnosis and appropriate treatment to children with up-to-date knowledge is essential.

  The creation of postoperative illustrations by residents of the neurosurgery department is helpful in improving their surgical understanding and skill levels. This report presents the educational methods that enable residents, who perform aneurysmal neck clipping via craniotomy, to create postoperative illustrations.

  A retrospective investigation of 101 patients who underwent clipping by residents as the main operator between 2016 and 2021 was performed. The education of residents for creating postoperative illustrations started in 2018, using the following three methods: (1) conveying the purpose and importance of creating postoperative illustrations and giving oral instructions on illustration production ; (2) creating postoperative illustrations of clipping procedures that were supervised and showing them as examples ; and (3) correcting postoperative illustrations prepared by the residents. The number of clippings performed, number of illustrations, and rate of creating postoperative illustrations by residents each year were calculated.

  The rate of creating postoperative illustrations by residents (number of residents' illustrations/number of clippings) was 0% (0/33) in 2016, 0% (0/16) in 2017, 0% (0/11) in 2018, 16.7% (1/6) in 2019, 83.3% (15/18) in 2020, and 100% (17/17) in 2021.

  If supervisors show a positive attitude toward creating postoperative illustrations, convey the purpose and importance of these illustrations, correct the residents' illustrations, and build an understanding that creating these illustrations is a part of the course, then residents will be self-motivated to produce them themselves.

  Mycosis fungoides (MF) is a T cell lymphoma of the skin that leads to systemic inflammation due to nonspecific inflammatory responses against tumor cells. Here, we describe the case of a 57-year-old woman with subarachnoid hemorrhage (SAH) due to the rupture of an anterior communicating artery aneurysm during MF treatment. She was diagnosed with MF 2 years ago and received molecular-targeted drug administration and regional radiation therapy for MF several times for 2 years. Immediately before the additional treatment for MF progression, she presented with sudden headache and disturbance of consciousness. Head computed tomography (CT) /CT angiography revealed SAH due to the rupture of an anterior communicating artery aneurysm ; subsequently, she underwent aneurysm coil embolization. After coil embolization, the patient experienced no obvious cerebral vasospasm. However, 8 months later, the patient died of sepsis during MF treatment. To the best of our knowledge, this is the first report of SAH associated with MF. Recently, it has been revealed that chronic inflammation is closely related to the pathogenesis of cerebral aneurysm development and rupture. Moreover, it has been reported that infiltration of T lymphocytes into the intracranial vessel walls induces aneurysm rupture. We assume that systemic inflammation due to MF was involved in the rupture of the cerebral aneurysm in this case.

  Trochlear nerve schwannomas with communicating hydrocephalus are rare. Moreover, there have been no reports of spindle cells detected in cerebrospinal fluid cytology in schwannoma cases. A 37-year-old man was referred to our department with severe hydrocephalus, and a tumor at the basal cistern was detected on magnetic resonance imaging. The patient exhibited severe dysopia and anopsia on admission ; hence, emergency extraventricular drainage was performed. Several days later, a ventriculoperitoneal shunt was placed, and the tumor was surgically removed. Histopathology confirmed trochlear nerve schwannoma diagnosis. Furthermore, cerebrospinal fluid cytology revealed spindle cells. The association between schwannoma and communicating hydrocephalus is unclear. This study helps elucidate the mechanism underlying this association.