The essence of stroke treatment is “team medicine” and the stroke unit care is a treatment system based on the integration of patients and medical personnel, early rehabilitation, and multidisciplinary stroke team medicine. The treatment of cerebral infarction is an important role for neurologists, involving high examination skills, knowledge of internal medicine (especially cardiovascular, endocrinology, metabolism, thrombosis, and hemostasis), geriatrics, radiology, and rehabilitation medicine, the latest knowledge on primary and secondary preventions, various ultrasonography skills (carotid duplex, transcranial Doppler, transesophageal echocardiography, lower extremity vein), and neuroradiological evaluation skills (CT, MRI, and angiography). Common treatment guidelines should be established for acute revascularization, craniotomy, and other surgical interventions, to establish a system in which neurosurgeons and neurologists collaborate based on information sharing and mutual understanding for identifying pathologies, determining indications, performing surgeries, and peri- and postoperative management.

  Endovascular thrombectomy for acute large vessel occlusion has gained importance with increasing evidence of efficacy over standard medical treatment in multiple randomized trials. Thrombectomy varies widely due to the variety of devices, techniques, workflows, and perioperative management chosen by operators and institutions. These differences are expected to be integrated in the future as evidence accumulates and a consensus is established. On the other hand, the medical environment depends on the local infrastructure. Since the number of primary stroke centers, facilities, human resources, and regional medical cooperation systems differ between regions, it is necessary to respond flexibly and diversely depending on the environment.

  The importance of vessel wall imaging is becoming recognized with the understanding that plaque characteristics play a vital role in treatment strategies for patients with carotid artery atherosclerosis.

  The essential component of management of patients with carotid artery stenosis is multi-faceted medical treatment including lifestyle modification. Surgical treatments such as carotid endarterectomy and carotid artery stenting are considered for some patients with advanced lesions. In recent years, there has been remarkable progress and diversification of both medical and surgical treatments.

  A cross-sectional approach to carotid artery stenosis is required for appropriate care based on the pathophysiology of systemic atherosclerosis.

  Moyamoya disease (MMD) is a unique cerebrovascular disease with unknown etiology, characterized by progressive stenosis at the internal carotid artery terminus and formation of an abnormal vascular network at the base of the brain. Superficial temporal artery-middle cerebral artery anastomosis with/without indirect pial synangiosis is a standard management option for symptomatic MMD patients, either those with ischemic or hemorrhagic onset. Occipital artery-posterior cerebral artery bypass is also a reasonable additional surgery for recurrent ischemic attack or re-bleeding after standard revascularization. Endovascular stenting or angioplasty for affected vessels is generally not recommended, but targeted embolization on the bleeding point, including periventricular anastomosis or microaneurysms, can be the management choice for patients with repeated hemorrhage. Genetic analysis of RNF213 variants may be useful to predict the postoperative development of pial synangiosis, facilitating precise treatment of MMD.

  Substantial contributions has made to improve the functional prognosis and reduce mortality rates through advances in medical treatment of ischemic cerebrovascular disease, such as alteplase and tenecteplase during the acute phase, development of cerebrovascular surgery, strengthening of regional cooperation, and standardization of treatment. However, in an aging society, it remains the leading cause of being bedridden due to the influence of underlying diseases, frailty, and the social environment, and is a major factor in rising healthcare costs. The treatment of cerebrovascular disease involves three phases : preventive, acute phase, and chronic phase therapy. Future studies should aim for the development of new treatments for the subacute to chronic phase. Regarding stem cell therapy after cerebral infarction, many basic research reports, clinical trials, and studies are underway or completed worldwide. Here, we review the basic experiments, clinical trials, and studies of stem cell therapy for ischemic cerebrovascular disease and consider future prospects.

  This study retrospectively reviewed patients with vestibular schwannoma (VS) to compare surgical outcomes of 32 patients over 65 years of age with 32 patients under 65 years. The tumor resection rate was slightly lower in older patients than in younger patients. However, the average surgical time in older patients was 5 hours and 30 minutes, about 1 hour shorter than in younger patients. Compared to the younger patients, postoperative resumption of walking was delayed and hospital stay was prolonged in the older patients. These results indicate that surgery in patients over 65 with VS can be performed safely with an acceptable outcome if preoperative examination and patient selection are made appropriately.

  Glioblastoma in Lynch syndrome is rare, and reports on the treatment experience in such a clinical setting is limited. Here, we report a Lynch syndrome patient with a glioblastoma. A 49-year-old woman presenting with a headache and gait disturbance was found to have an intracranial mass and was referred to our institution. She had a history of ovarian cancer, and her mother had been diagnosed with Lynch syndrome with genetic examination. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a ring-enhancing lesion with perifocal edema in the right temporal lobe, and gross total resection of the lesion confirmed the diagnosis of glioblastoma. The adjuvant treatment consisted of 60Gy irradiation and concomitant temozolomide. Genetic testing confirmed the identical germline mutation of MSH2 (c.1216C＞T). A screening of the colon detected an early-stage colorectal cancer, which was endoscopically resected. After 16 cycles of temozolomide, MRI detected a growing lesion ; however, resection of the lesion revealed no malignant tumor cells. A cancer genome panel examination was performed using the initial lesion at that point, which confirmed an microsatellite instability-high status. Pembrolizumab was administered, and the lesion remained stable 36 months after the initial surgery.

  Vertebral artery injuries associated with head and neck trauma, specifically sharp vertebral artery injuries including gunshot or puncture wounds, rarely occur, and account for less than 1% of trauma cases. However, based on previous reports, patients with this type of injury frequently develop massive hemorrhage and consequent airway narrowing, which are fatal. This study reports the case of a 30-year-old man, who suffered from a penetrating left neck and chest injury ten years ago. He presented at the emergency department with a chief complaint of dizziness and confusion. Computed tomography angiography (CTA) revealed a 58-mm partially thrombosed pseudoaneurysm in the left vertebral artery. The contralateral vertebral artery was essentially normal. A parent artery occlusion was performed. To embolize the long segment as much as possible, a vascular embolization device and a coil for cerebral aneurysms were used. The patient had a good outcome with no recurrence of cerebral infarction.