In recent years, more cancer patients are achieving long-term survival owing to advances after cancer treatment. The effects of treatment on fertility are a great concern to many young people. For some, the loss of a future child may be more distressing than a cancer diagnosis itself, and indeed, a cancer diagnosis does not change the desire for biological children. Consultation with fertility specialists before the initiation of cancer treatment offers the potential to optimize the potential of becoming biological parents in the future and minimize the effects of fertility impairment on quality of life (QOL).

In 2006, Woodruff’s group established the Oncofertility Consortium, which is a nationwide network for coordination of oncologic and reproductive healthcare, and they also published clinical pocket guides to oncofertility for doctors and patients.

In Japan, there has been no comprehensive guideline on fertility preservation in patients with specific cancers. Clinical oncologists in Japan should recognize the importance of fertility preservation in children, adolescents, and young adults (AYA) with cancer to improve survivorship. In 2015, the Japan Society of Clinical Oncology (JSCO) started to develop guidelines that focused on cancer treatment while taking fertility preservation into consideration. In 2017, JSCO completed the “2017 Clinical Practice Guidelines for Fertility Preservation in Pediatric, AYA Cancer Patients”.

However, fertility preservation sometimes has to be abandoned depending on the stage of the cancer and the general condition of the patient, because fertility preservation procedures may unacceptably delay cancer treatment or be too risky for the patient. The clinician’s objective in most cases is to make a professional judgment regarding urgency of treatment and assess the likelihood of successful preservation in an ill individual. It is conceivable that clinicians considered discussions regarding future fertility were not considered appropriate.

The importance of the role of the clinician in discussions and decisions regarding fertility preservation cannot be underestimated.

Patients and their parents want information regarding risks, referral to fertility specialists has been contributing to lower regret and greater QOL for patients after cancer treatment and those who undergo fertility preservation believe they had made the right decision.

In addition, important aspect of fertility counseling should include the reassessment of fertility after treatment has completed. For male, this can include reassessment of sperm count and motility, and for women, pre- and post-treatment blood test of anti-Mullerian hormone (AMH) can provide an indication of ovarian function.

This article reviews the latest information concerning clinical practice guidelines around the world, including the American Society of Clinical Oncology guidelines that were to be published in neurosurgical field.

A trial that investigated prenatal versus postnatal repair of myelomeningocele (Management of Myelomeningocele Study: MOMS) reported a decrease in the combined rate of hydrocephalus and Chiari malformations. Some facilities in Japan have begun their preparations to be equipped to perform fetal surgeries for myelomeningocele (MMC). To perceive the current state of MMC in Japan before the introduction of fetal surgery, we investigated 35 cases of MMC diagnosed in our institution from 2012 to 2019. Among these cases, 32 cases were diagnosed before birth and three cases were diagnosed after birth. Among the 32 cases diagnosed before birth, abortion was performed in six cases. Among the 29 remaining cases, hydrocephalic surgery was performed in 24 (82.8%) cases and foramen magnum decompression was performed in four (13.8%) cases. Furthermore, in 63.2% alive cases, the patients later gained the ability to walk, and in 92.3% alive cases, the developmental quotient was >50. The study showed that appropriate postnatal treatment results in a relatively good functional prognosis, therefore, safer fetal treatment and maternal management are required. To promote fetal surgery for MMC in Japan, it is necessary to improve fetal diagnosis technology for obstetricians. Moreover, prenatal counseling of parents by a multidisciplinary team is mandatory, mainly by pediatric neurosurgeons who follow-up patients with MMC and are aware of the long-term prognosis of MMC.

Introduction: A combination of direct and indirect revascularization surgery is performed in Japanese modern neurosurgery. However, some disadvantages of this method include thinning of temporal components, delay in bone flap fusion, and metal plate denudation. Moreover, an aesthetic problem of this surgery is that serious complications may occur in children who have a long postoperative life. In this study, we report our plastic surgical techniques for treating pediatric patients with moyamoya disease.

Patients and Methods: This retrospective study included four children (six brain hemispheres) with moyamoya disease who underwent our combined revascularization surgery from November 2017 to March 2020. This combined revascularization surgery is characterized by less use of bipolar coagulation at a skin incision and superficial temporal artery dissection, splitting temporal muscle between deep and superficial layers, incision design of the bone flap to prevent it from sinking, and employment of an absorbable material for bone flap fixation and skin suture.

Result: The postoperative course was uneventful and good revascularization was achieved in all patients. Neither thinning nor depression was observed in temporal components.

Conclusions: Combined revascularization surgery for pediatric moyamoya disease has a risk of cosmetic problem. Our craniotomy and cranioplasty techniques were effective for revascularization and preventing cosmetic problems.

Objective: Cerebellar mutism syndrome (CMS), which consists of mutism, ataxia, and emotional disorder, is well known as a complication of the surgical procedure for pediatric medulloblastoma. Currently, risks for CMS are considered to be splitting of the vermis, younger age, and tumor size over 5 cm in diameter, but the exact mechanisms remain unknown. The aim of this study was to evaluate the risk factors for CMS occurrence in 3 CMS cases of pediatric medulloblastoma.

Patients and Methods: From 2009 to 2020, 11 pediatric medulloblastoma patients were hospitalized for resection or postoperative chemotherapy at Yokohama City University Hospital. One of the patients underwent surgery twice and 2 patients had undergone surgery at another hospital previously. The patients’ median age was 5 years (range, 2-16 years). The maximum tumor diameter ranged from 29 to 62 mm (mean, 47.8 mm). All the patients presented with obstructive hydrocephalus and severe cerebellar ataxia before surgery, but they were able to speak.

Results: Among all 12 surgical procedures, gross total resection was achieved in four; subtotal resection, in seven (residual volume <1.5 cm³, which was adherence to the brainstem and cerebellar peduncle) ; and partial resection, in one (following an additional operation). Three patients (27.2%), including the patient whose operation was performed at another hospital, presented CMS; 1 of the patients was able to speak 1 month later, and the other two patients recovered 4 months later. There was no correlation of the CMS with the maximum tumor diameter and the degree of resection (p>0.05). Splitting of the vermis was not performed in any of the cases. All 3 CMS cases presented new hyperintensity in the unilateral superior cerebellar peduncle on the MRI T2-weighted images after the operation. The hyperintensity in the unilateral superior cerebellar peduncle disappeared within several months. In the other 8 cases without CMS, hyperintensity in the T2-weighted images was visible only in one (p＝0.024). This patient showed severe cerebellar ataxia and dysarthria, but no mutism.

Conclusions: The current findings may explain the possible mechanism of CMS as involvement of the dentatothalamocortical pathway, which exists between the dentate nucleus of the cerebellum and the cerebellar cortex via the superior cerebellar peduncle. Careful retraction and coagulation especially surrounding the superior and inferior vermis is important to avoid the occurrence of CMS.

Stereotactic radiofrequency thermocoagulation (SRT) has successfully achieved favorable outcomes in patients with a hypothalamic hamartoma (HH). For obtaining excellent outcome profiles, our hypothalamic hamartoma center recently admitted many patients from abroad. The present study aimed to investigate the features of foreign patients and actual management conditions for these patients. A total of 65 foreign patients with an HH who underwent SRT were included in this study. These 65 foreign patients were compared with 159 domestic patients in the same period. A questionnaire was sent to all patients or their family members via email. In addition, a questionnaire survey was conducted for the medical staff of our hospital to identify problems encountered during the management of foreign patients.

Foreign patients had significantly lower ages at surgery and seizure onset as well as larger HH size than domestic patients. Initial surgery to eliminate seizure usually tended to be aggressive and resulted in transient complications, which resolved within 2 weeks. These transient complications, including hyperthermia and hyponatremia, occurred more frequently in foreign patients. As a result, freedom from gelastic seizure was more achieved in foreign patients than in domestic patients; however, the final results were not different.

The questionnaire given to the foreign patients revealed that majority of the patients were satisfied with our treatment. In contrast, the investigation in our medical staff disclosed problems associated with communication, hospital rule compliance, and meals. Few problems regarding money and custom matters were also revealed. Many staff members felt that managing foreign patients was a good experience.

Although the management of foreign patients is expected to be accompanied with various problems, specialization in a specific disease and treatment enables efficient management.

Patients with pediatric hydrocephalus require long-term management.

Treatment strategies should be reconsidered due to complications which often occurs during follow-up period.

We experienced two cases of repeated shunt malfunction which could be controlled by choroid plexus treatment aiming cerebrospinal fluid (CSF) volume reduction. We reported these cases and tried to consider therapeutic implications of CPC/CPR for repeated shunt malfunction.

Case 1 was a 12-year-old girl with posthemorrhagic hydrocephalus, who had severe peritoneal adhesion. After twice of CPR, she eventually underwent ventricular pleural shunt.

Case 2 was a 7-month-old girl with Dandy-Walker syndrome, who had 500-600 ml/day of CSF drainage. She underwent shunt revision after twice of CPC which succeeded in reducing CSF volume.

This study describes the case of a 6-year-old girl with a congenital dermal sinus which was diagnosed at birth. When she was nine months old, pus originating from the congenital dermal sinus was found. Although debridement and removal of the dermal sinus were performed at another medical institution three times, the lesion still existed. After that, redness was observed in the left buttock about 4 cm away from the anus, and incision and drainage was performed, but she was transferred to our hospital because there was no improvement. X-ray contrast examination (fistulography) showed that the abscess extended to the pre-sacral area. Magnetic resonance imaging findings revealed that a residual dermal sinus had developed to a presacral abscess. We planned to completely cure the presacral abscess via surgery. Because of its deep location (anterior of the coccyx and adjacent to the rectum), we planned to remove the coccyx to obtain a wide working space and to remove the fistula and dermal sinus. Surgical findings during the joint surgery by a neurosurgeon and pediatric surgeon showed that dermoid-like tissue with hair was located in the opened fistula. A cord-like structure connected the fistula and pre-sacral lesion. We removed all these structures through the pre-sacral space. Surgical treatment was performed without rectum injury and any other complications. Five years after the surgery, no recurrent abscess was found.

We report the case of a 16-year-old boy whose left neck was thrust with a bamboo sword during kendo. He had continuous neck pain and left head pain. Two days following the injury, dysarthria and right hemiplegia appeared. Brain magnetic resonance imaging (MRI) revealed a left common carotid artery occlusion and cerebral infarction in the left basal ganglia. Neurological symptoms disappeared 30 minutes after the onset, while transient motor aphasia appeared on day 4 after injury. Brain MRI showed new cerebral infarction in the left temporal lobe. Although MRA reopened both the left MCA and the common carotid artery, severe stenosis, which might have occurred due to dissection, remained in the left common carotid artery. CAS was performed on day 10. He was discharged on day 19 without any symptoms. Blunt cerebrovascular injury is a relatively rare condition that occurs in approximately 1% of all blunt trauma cases; however, it is considered a relatively frequent condition when considering only sports-related trauma. Kendo thrust trauma is often difficult to diagnose from the appearance of a patient, but the possibility of cerebrovascular injury should always be kept in mind. Traumatic cerebrovascular dissection may develop shortly after the injury due to the progression of dissociation. Although traumatic carotid artery dissection requires treatment policy examination depending on the case, CAS is considered a useful treatment option when initiating anticoagulant or antithrombotic therapy at an early stage.

This article reports a case of brainstem tumor treated by gamma knife radiosurgery (GKRS) after a pathological/genetic diagnosis. An 11-year-old boy with an extraocular movement disorder presented with a 16-mm well-defined spherical tumor protruding from the dorsal pons. An open biopsy was performed, and the histopathological diagnosis was pediatric diffuse astrocytoma, grade II, and the genetic diagnosis was K27M H3 wild type. GKRS was performed with a marginal dose of 15.00 (central dose 25.00) Gy. Post-GKRS, diplopia disappeared, and the progression of eye movement disorder stopped. A tumor size decrease was remarkable (11 mm). The patient has exhibited a stable course for 4 years. Although longer follow-up is necessary, we believe that the patient has achieved a positive outcome.

Spinal cord concussion is defined as transient paralysis and/or sensory disturbance, which usually improve within 72 hours. These two cases of transient paralysis and sensory disturbance were considered due to spinal cord concussion because of hyperextension of the neck during playing sports. Both cases showed text neck on magnetic resonance imaging and computed tomography scans, which was assumed that the posture while using the portable electronic devices caused. In the future, as the number of text neck patients increases due to the widespread use of smart phones in children, the frequency of trauma-induced spinal cord concussion is expected to increase. Therefore, future study of posture and appropriate duration of use of portable electronic devices is warranted.