Several variants of coronavirus have been identified. The coronavirus disease (COVID-19) pandemic, which has been spreading since January 2020, has had a considerable impact on medical care, including neurosurgical activities. Although most communicable diseases have been well-controlled so far, we continue to encounter not only re-emerging infectious diseases, but also new ones, namely COVID-19. We should recognize that communicable diseases and non-communicable diseases have mutual influences in their pathological conditions, and systemic thrombogenesis tends to occur in patients with COVID-19. Management of COVID-19 in infectious disease law is another issue to be addressed, considering the differences between seasonal influenza and COVID-19. The control of new emerging infectious diseases is listed as one of the main health policies in the coming health plan.

  This report describes how I worked as a pediatric neurosurgeon during pregnancy and the child-bearing period. In addition, the report presents an overview of systems of maternity/childcare leave and problems of children on the waiting lists for childcare services. The number of female physicians is increasing in Japan, and they have been choosing a greater variety of clinical departments. In the neurosurgical society, the number of female neurosurgeons is also increasing, and they are working in various subspecialties. To respect different working styles and values, objective systems are recommended for evaluating personal abilities, salaries, and resources.

  It is important to retain neurosurgeons to maintain qualified neurosurgical activities for the populace.

  Under the overtime work regulations for physicians that will be enforced in April 2024, the upper limit for overtime work, including work during holidays, is 960 hours per year in principle, whereas an upper limit of 1,860 hours per year is tentatively set for some medical institutions. Medical institutions must focus on improving the working environment of hospital-employed physicians and, in particular, reducing the amount of work. Building a night-work system and obtaining approval for night or day duty from the director of the Labor Standards Office greatly affect working hours. Settling aside time from working hours for self-improvement might also be effective for shortening overtime work. Task shifting is important, but it requires a change in the mindset of neurosurgeons. Due to the new overtime regulations, neurosurgical institutions will possibly become more centralized, to manage stroke patients.

  In Japan, the meaning of informed consent is misunderstood, which has resulted in violation of patients' right to self-determination. Informed consent is defined as “agreement after receiving sufficient explanation” ; the subject who gives the consent is the patient, not the physician.

  To enable patients to give informed consent, physicians have a legal obligation to provide sufficient information based on Article 17 of the Medical Practitioners Law. This obligation is called the duty of explanation.

  Capillary hemangioma is a benign vascular tumor often observed in the skin and soft tissues of neonates and infants, and is rarely reported in the intraparenchymal central nervous system (CNS). We present a rare case of an intraparenchymal capillary hemangioma that was difficult to diagnose from preoperative imaging. A 57-year-old woman presented to the emergency department with a first episode of generalized seizure. Non-contrast computed tomography scan revealed a well-defined, high-density lesion measuring 3cm and surrounded by perifocal edema in the left pars opercularis. On magnetic resonance imaging, the lesion was hypointense on T1-weighted image and hyperintense with multiple flow voids on T2-weighted image, and showed uniform strong enhancement using gadolinium. Diffusion-weighted image (DWI) revealed a hypointense signal, and magnetic resonance spectroscopy (MRS) lacked peaks of creatinine and N-acetyl acetate within the lesion. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed a lower uptake in the tumor than in the normal cortex. Hemangioblastoma, intraparenchymal meningioma, solitary fibrous tumor, metastasis, and glioma were considered preoperative differential diagnoses, but none of these met the typical findings. Following surgery, the histopathological diagnosis was capillary hemangioma. Since only five cases of capillary hemangioma of the intraparenchymal CNS have been reported thus far, preoperative diagnosis was difficult. Advanced imaging techniques such as DWI, MRS, and FDG-PET have not been reported before this case and may be useful to differentiate this rare disease from other tumors. Accumulation of cases is necessary to establish the clinical significance of preoperative imaging to diagnose intraparenchymal capillary hemangioma before surgery.

  Various surgical materials are routinely used for hemostasis, dural closure, or cranioplasty. However, such substances have sometimes been reported to cause granulomas. We experienced a case of granuloma that developed at the placement site of an absorbable gelatin sponge. A 15-year-old male underwent neuroendoscopic biopsy via the right anterior horn of the lateral ventricle for a pineal tumor. An absorbable gelatin sponge was placed at the endoscopy tract after removal of the sheath. The pathological diagnosis was a mixed germ cell tumor, which was surgically resected and treated with radiochemotherapy. Follow-up MR imaging demonstrated a gadrinium-enhanced lesion along the endoscopic tract in the right frontal lobe, which emerged as a residual gelatin sponge and surrounding inflammation as a result of the patient's third surgery. We speculated that impaired absorption due to radiochemotherapy and excessive immune response due to his allergic predisposition may be attributed to the granuloma formation in this case.