Artificial intelligence (AI) has become indispensable in daily life. Small devices, such as smartphones, can now efficiently perform facial recognition. Neurosurgery relies heavily on radiological imaging, making AI a promising technology for its advancement. Although the definition of AI varies among scientists, it is generally recognized as an industrial technology that simulates intelligent behavior unique to humans. The invention of deep learning (DL) is a breakthrough that has expanded AI research and is characterized by multilayer computation and the autonomous fine-tuning of parameters. Although scientists provide the ground design for DL structure, a DL device tunes and learns by itself by comparing numerous sets of input and output data. Most AI research in the field of neurosurgery can be categorized into two types : 1. qualitative assessment of lesions using radiological images solved mainly by image feature extraction algorithms, such as AlexNet, and 2. segmentation and detection of abnormal lesions within images by DL designed for semantic segmentation, such as U-Net. The qualitative assessment of radiological images of gliomas has been extensively investigated, and AI reportedly improves the diagnostic accuracy of genetic alterations in gliomas by 10% compared to those of conventional radiomic approaches. Other studies demonstrated fully automated gene alteration detection using magnetic resonance imaging (MRI) for gliomas, with apparent limitations derived from overfitting. Automated lesion detection tasks can be represented by aneurysm detection using AI-assisted MRI. A U-Net-based algorithm reportedly exhibited diagnostic accuracy with a sensitivity of 85.0% and specificity of 74.6% for automated cerebral aneurysm detection. Although this performance was inferior to that of neuroradiologists or neurosurgeons in terms of specificity (by 20%), its sensitivity was 15% higher. These results are promising for clinical applications. High sensitivity, rather than specificity, is expected in AI-assisted diagnostic technology to decrease cases of missed diagnosis by humans. Other applications include automatic glioma segmentation, which is expected to be incorporated in future clinical trials. The AI technologies in the medical field require higher accuracy and robustness than those deployed in consumer markets. These results suggest that we should view AI technologies not as magic wands but rather as sophisticated statistical algorithms with pros and cons.

  The use of “big data” is gathering increasing relevance in neurosurgical research. Two types of clinical databases are available : general-purpose and neurosurgery-specific. Recently, new types of biomedical information have started being produced and accumulating at a rapid pace. As real-world data can be collected, the limitations of conventional randomized controlled trials have been identified, and learning health systems that generate findings in clinical settings and randomized trials based on registries are attracting increasing attention. In the future, artificial intelligence and digital medicine based on big data will continue developing at an accelerated pace.

  Genomic medicine has been attracting increasing attention in Japan due to the rapid development of the genomic cancer medicine system. However, genomic medicine involves various fields and ethical issues. For instance, as genomic medicine involves personal information, paying attention to discrimination and personal information protection is necessary. Furthermore, genomic tests, such as cancer gene panels and DTC tests, as well as NIPT, which have recently been attracting attention, may produce test results that differ from the expected results and may in turn have a strong psychological impact on patients. Appropriate regulation and genetic counseling are therefore necessary for effective genomic medicine testing. In the future, it will be necessary to promote genome education and eliminate regional disparities to further advance genomic medicine.

  The adolescents and young adults (AYA) generation undergoes rapid physical and emotional growth from child to adult, as well as experiencing special life events such as higher education, employment, and marriage. The characteristics of this generation also present a number of challenges when providing medical care. A survey study of AYA generation cancer patients treated in the pediatric unit found that hospital staff faced various problems, such as difficulties in communication and dealing with issues related to fertility preservation. Moreover, the patients themselves felt strongly anxious about their life events and had few people to talk to. Understanding these issues requires a multidisciplinary approach, which is considered essential for AYA patients.

  Infundibular dilatation of the posterior communicating artery (PcomA ID) is a normal anatomic variation and is not a target for therapeutic intervention. However, some reports describe subarachnoid hemorrhage due to rupture of the PcomA ID itself or rupture of an aneurysm arising from the PcomA ID. We experienced two cases of aneurysms arising from PcomA ID. PcomA ID rupture and/or aneurysm development can be attributed to the histological vulnerability of the wall and hemodynamic stress. We herein report the mechanism of aneurysm development in two of our own cases.

  Neurofibromatosis type1 is a rare disease that causes a variety of symptoms including café-au-lait spots, neurofibromas, bone lesions, and ocular lesions. We report here a case of neurofibromatosis type1 in which a sphenoid bone defect caused a frontal lobe herniation into the orbit, and pulsatile protrusion of the eyeball was observed. Surgical reconstruction of cranial and orbital defects at an early stage, without damaging the neural structures, is considered effective but the surgical method should be carefully chosen depending upon the site of the bone defect and the degree of brain herniation. In this study, orbitoplasty using a titanium plate and DuraGen^® (an artificial dural substitute) resulted in rapid elimination of the pulsating exophthalmos. Titanium plates are malleable and suitable for orbital application. Surgical intervention may reduce pulsating exophthalmos and associated ocular motility disorders.