The WHO classification of the brain tumors is used widely all over the world, and is helpful for the diagnosis, treatment, and research on brain tumors. The first edition of the WHO classification was published in 1979. Thereafter, revised editions werepublished in 1993, 2000, and 2007. The purpose of this review is to clarify the history of the WHO classification of the brain tumors.

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The history of the skull base surgery was reviewed. The modern techniques of the skull base surgery have been developed in the last 50 years, and the term “Skull Base Surgery” became popular around 1980. The epidural approach is one of the key concepts of the skull base surgery and the trigeminal schwannoma arising in the Meckel’s cave is the best candidate for the epidural subtemporal approach. Although this approach had been established in the last 20 years, this epidural access route was described in 1900 by Cushing. The recent advances of the surgical and diagnostic tools have made the skull base surgery safe and popular, but it is amazing that the idea of skull base surgery was described more than 100 years ago.

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Using a 3D printer, our research team has synthesized medical image data, including CT, MRI, and DSA images, to create 3D models, which are applied to operative simulations. The present paper summarizes the following methods for their creation and presents clinical examples: The positions of CT, MRI, and 3D-DSA images are first set, using 3D image analysis computer software, and their format is converted from DICOM data to the STL file format. The above-mentioned 3D models are created by powder-based 3D printing. The powder-based 3D printer allows users to create full-color, high-resolution models in a short time, effectively examine operative approaches, and understand the spatial position of a tumor relative to the surrounding vessels. On the other hand, the equipment has the disadvantage of being expensive, which needs to be addressed.

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　Department of Neurosurgery of Kansai Medical Unicversity was found in 1966 by Professor Naoki Kageyama. Since then, our department has been playing an important role in the field of neuro-oncology. Recently, several evidence-based therapeutic tools have come up to the field of glioblastoma treatment. Above all, bevacizumab has drastic effects prolonging the PFS in the first line treatment and the OS in the second line one against recurrence. In our department, patients have rights to choose whether to use bevacizumab in the first line or the second except patients with poor ADL. Patients with poor ADL are recommended to have bevacizumab from the first line treatment expecting super-steroid effect.

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We present an unusual pediatric case of cerebral glioblastoma expressing neuronal antigens. A seven-year-old girl was admitted to our hospital, presenting with headache and left hemiparesis. Computerized tomography scan showed an intra-axial mass with solid and cystic components in the right frontal lobe. Magnetic resonance imaging revealed that the solid component was low-intense on T₁–weighted image, high-intense on T₂–weighted image, and heterogeneously contrast-enhanced. The gross total removal of the tumor was performed via right high-parietal approach. Microscopically, the tumor was composed of atypical neuroepithelial cells such as small compact cells and multinucleated giant cells. Frequent mitotic figures, geographic necroses, and microvascular proliferation were also seen. The tumor cells were diffusely immunoreactive for vimentin, GFAP, Olig2, NSE and p53, but not for IDH1, NeuN, CK (CAM5.2), and p16. In addition, synaptophysin-, NFP-, and EMA- immunoreactivity were mainly recognized in some large cells. MGMT immunoreactivity was diffusely observed in small cells. MIB-1 staining index showed more than 25%. Molecular genetic analysis revealed no MGMT promoter methylation or IDH1/2, p53, H3F3A K27M, or H3F3A G34R mutations. Based on these findings, we finally diagnosed a glioblastoma with prominent expression of neuronal antigens.Although resurgery, high-dose chemotherapy with the transplantation of autologous peripheral blood stem cell, and craniospinal irradiation were performed, the tumor was early recurred. After all, she died 14 months after the first surgery.Further detailed investigation should be required for the understanding of the expression of the neuronal antigens in glioblastomas.

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Pilocytic astrocytoma is a benign World Health Organization （WHO） grade 1 tumor and usually occurs in young patients. This tumor can occur in adults, yet relatively few arise in those who are older than 50 years. The tumor histology is characterized by a biphasic pattern with compacted bipolar cells associated with Rosenthal fibers and loose-textured multipolar cells associated with microcysts and eosinophilic granular bodies/hyaline droplets. Tumor growth is always slow, and occasionally regressive changes are observed. Such spontaneous regression has been described mainly for tumors in children and associated with neurofibromatosis type 1（NF1）, yet also reported for non NF1 young adult patients.We report here a unique case of pilocytic astrocytoma diagnosed for 64-year-old woman. This case is noteworthy in following points: the patient was an elderly adult without clear comorbidity; the patient’s tumor spontaneously regressed in short term before surgery.

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The patient was a 69-year-0ld female who had had cervical pain from before, developed numbness of both hands and disturbance in walking for recent one month. MRI study revealed that a well demarcated mass lesion measuring 15-20mm in diameter adjacent to spine to the right at C1/2 level. Contrast MRI showed T1: isointensity and T2: high intensity. The mass was diagnosed clinically as benign schwannoma adjacent to cervical spine and resected piecemeal at the surgery. Observing the intraopersative and usual postoperative histopathological sections, the tumor demonstrated to be quite hypercellular and very pleomorphic including many atypical polygonal cells and some bizarre giant cells scattered. But no significant increase of mitotic figures was observed (1-3-2/10HPF). No tumor necrosis was present. But in hypocellular areas, spindle-shaped tumor cells are arranged in short bundles or interlacing fascicles with nuclear palisading, suggesting hypercellular Antoni A area, and whorling of the cells suggesting Verocay bodies. Quite rarely, Antoni B areas can also be present. Immunohistochemistry showed that the tumor was extensively and strongly positive for S-100 protein but negative for EMA...Ki-67 index was low, indicating 4% (1-7%). Therefore, we had better to diagnose paraspinal schwannoma without malignant transformation for the present case. But possibility for paraspinal schwannoma with malignant transformation could not be excluded at al.Neurofibroma and schwannoma (neuilemoma), the two most common neoplasms of the peripheral nerve sheath, differ both pathologically and clinically. Major clinical differences are that neurofibromas, unlike schwannomas, commonly present in patients with the genetic disorder designated type 1 neurofibromatosis (NF-1) and are associated with development of malignant peripheral nerve tumors (PNT). The prevailing view is that most malignant PNTs occurring in patients with NF-1 arise from neurofibromas. Schwannoma, in contrast, exceedingly rarely undergo malignant transfotmation.About half of the PNTs arose from antecedent benign peripheral nerve tumor and most of malignant PNTs arose from neurofibromas in patients with NF-1. Almost all of these tumors show proliferation of atypical spindle cells, nuclear pleomorphism and increase of mitotic figues histologically and various degree II～IV of malignancy clinically.On the other hand, quite few number of cases of malignant PNTs derived from benign schwannomas, mostly consists of atypical large epithelioid cells (rarely of neuroepitherial cells or of spindle cells), and shows high grade of malignancy in cdlinical standpoint.

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Atretic cephaloceles, which are a rare form of cranioschisis, are frequently associated with central nervous system (CNS) dysplasia. Here, we describe a case involving an atretic cephalocele without any CNS malformations. A parietal mass hadbeen observed on a 1-year-old boy since his birth. A physical examination revealed a 2-cm-round subscalp mass. A computed tomography scan revealed a defect of the skull at the parietal midline, and magnetic resonance imaging showed a T1-low- and T2-high-intensity mass that was connected to the dura without any malformation. The mass was surgically resected.Histologically, the mass comprised meningeal elements and fibrous tissue and did not include glial tissue. These findings suggested that it was a meningocele. An atretic cephalocele without CNS dysplasia has a good prognosis and can be treated by resection of the mass.

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