Due to advances in imaging diagnostics and increased awareness of cervical radiculopathy in recent years, this condition is no longer rare in our aging society. Treatment begins after a high-level diagnosis based on neurological examination. Cervical radiculopathy is easy to treat conservatively, while anterior cervical decompression with fusion (ACDF) is the standard surgical technique. However, in regard to ACDF, there are concerns regarding the drawbacks of adjacent segment disease, and the importance of decompression surgery has recently increased. Herein, we describe the current state and challenges of treating cervical radiculopathy, including a description of the recent consensus, current debates, and so on.

  There are two types of surgical procedures for lumbar spondylolisthesis : fusion and decompression, but it has been debated which is better for lumbar spondylolisthesis. Although a rough consensus has been reached by instability, there are not many comprehensive studies at a high level of evidence.

  By developing various kinds of surgical support devices and the roots which pass through to reach an interbody, trends in surgical procedures, including fusion and decompression, are changing to less invasive, highly reproducible surgical techniques.

  Regarding treatment for spondylolisthesis, both neurological and imaging findings requires the evaluation that adds the dynamics. Furthermore, patient age, activity, and bone quality must also be considered.

  What is the objective in nerve decompression, fusion, and alignment correction? On this issue, we discuss appropriate surgical techniques, based on understanding of clinical conditions in individual cases.

  The pathophysiology of retro-odontoid pseudotumors (ROP) varies, and in some cases, the instability between the atlantoaxial vertebrae is unclear, making it difficult to select a surgical method. Lesions gradually shrink and disappear after posterior cervical fusion. Direct lesion resection is necessary if neurological symptoms are imminent. The surgical method must be carefully selected, taking into account the symptoms and patient background, and long-term follow-up must be conducted.

  This report summarizes the current status and challenges in the treatment of intramedullary spinal cord tumors. Herein, we report the results of a multi-institutional study conducted by the Neurospinal Society of Japan. This study retrospectively analyzed 1,033 cases of intramedullary spinal cord tumor surgeries performed at 58 facilities affiliated with the society from 2009 to 2020, and evaluated the surgical outcomes and prognostic factors. Furthermore, we introduce an ongoing physician-initiated clinical trial aimed at expanding the indications for photodynamic therapy for malignant intramedullary spinal cord tumors. Finally, we discuss the current role of genetic diagnosis and future perspectives.

  Occasionally, subarachnoid hemorrhage and acute subdural hematoma occur concurrently. Both disease entities can result from intrinsic or extrinsic factors and it is vital to evaluate each cause appropriately. A 63-year-old female presented to our hospital due to altered consciousness. Computed tomography (CT) revealed a diffuse subarachnoid hemorrhage in the basal cistern, right acute subdural hematoma, and subcutaneous hematoma around the left eyelid. Although a basilar artery-left superior cerebellar artery aneurysm had been previously noted, three-dimensional CT angiography revealed no change in the size of the aneurysm, which was 2mm in diameter. Traumatic acute subdural hematoma and traumatic subarachnoid hemorrhage were diagnosed, and hematoma removal and external decompression were performed on the same day. Cerebral angiography was conducted the day after surgery ; however, the aneurysm remained unchanged. On the 13th day of hospitalization, we performed a second cerebral angiography, which revealed dilatation of the aneurysm, suspected to be pseudoaneurysm. Emergency coil embolization was performed. The findings revealed that the subarachnoid hemorrhage was caused by the ruptured aneurysm. Thus, the possibility of rupture should be considered in patients with intracranial hemorrhage who also have an aneurysm. Multiple cerebral angiography are useful for patients with subarachnoid hemorrhage of unknown cause.

  Primary dural lymphoma, a rare malignant lymphoma within the skull, predominantly consists of low-grade B-cell lymphomas in its histological subtypes. We report a case of a 60-year-old woman with a primary dural lymphoma that occurred at the left tentorium.

  The patient had left hearing loss for 3 months. Her hearing improved after a 2-week course of steroids. Head magnetic resonance imaging (MRI) revealed a mass in her left cerebellopontine angle. Six weeks later, she again developed left hearing loss. MRI revealed rapid growth of the mass lesion. On admission, she had left trigeminal neuropathy and ataxia of her left upper extremity. Contrast-enhanced MRI revealed that the mass adhered to the left cerebellar tentorium and extended into the left internal auditory canal, with edema in the adjacent cerebellum. The mass was slightly hyperintense on diffusion-weighted MRI. Surgical excision was performed. Pathological specimens showed diffuse and dense proliferation of small to medium-sized lymphoid cells, which were CD20-positive. The tumor was diagnosed as low-grade B-cell lymphoma. Steroids were started after excision, and follow-up MRI revealed that the lesion had shrunk significantly. ¹⁸F-fluorodeoxyglucose positron emission tomography showed no abnormal accumulation in the body ; thus, it was determined that the tumor was primary dural lymphoma.

  Primary dural lymphoma should be considered as a differential diagnosis for dural lesions with relatively rapidly changing clinical symptoms and imaging findings. In patients with these characters cases, intraoperative histological diagnosis is essential.