The occipital transtentorial approach（OTA）is performed for supracerebellar hemangioblastoma. OTA should be selected because a wide visual field for surgery of a supracerebellar lesion can be obtained, and the feeding artery can be identified early in the surgical procedure through it. The points of surgery are sufficient exposure of the superior sagittal and transverse sinuses by craniotomy, retraction of the occipital lobe after sufficient drainage of cerebrospinal fluid through a ventricular drain, retraction of the entire occipital lobe, early coagulation and transection of the feeding artery, dissection without exposing the red tumor surface while leaving gliosis on the tumor surface, and tumor excision en bloc. Ensuring these points may lead to successful surgery.

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Gliomas represent the most frequent malignant neoplasms that arise in the central nervous system. Astrocytic tumors comprise 78% of all gliomas and their histological grade (I – IV) is defined according to the current WHO classification. Although the prognosis of grade IV glioblastoma (GBM), the most malignant form of gliomas, is still detrimental, there have been progress in the management of these tumors since a number of confirming phase III clinical trials have been conducted in the last decade to provide with standard of care(SOC) therapies. Here I will focus on such pivotal trials for astrocytic tumors and discuss issues that need to be solved in the future studies.

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The authors described a current status of immunotherapy targeting Wilms tumor 1 (WT1) peptide for malignant gliomas. WT1 is expressed in various kinds of malignancies, having an oncogenic function.It provided us with a rationale for cancer immunotherapy targeting WT1. Clinical trials of WT1 peptide vaccination were started, and definite immunological / clinical responses were observed. Especially in recurrent glioblastomas, the disease control rate of 57.1% was achieved, with median progression free survival period of 20.0 weeks and progression-free survival rate at 6 months of 33.3%. Those trials showed that WT1 vaccination for malignant gliomas, which is generally believed intractable disease, was safe and had a clinical response. Further clinical studies with randomization to confirm the efficacy and immunological proof of concept in patients with malignant gliomas are warranted. An enhancement of efficacy of WT1 vaccination can be expected by combined use of other modalities of immunotherapy or anti-cancer chemotherapeutic agents.

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A previously healthy 31 years old female was admitted because of sudden onset headache. Neuroimaging studies revealed hemorrhagic lesion in the subcortical area of the left frontal lobe. Because of the difficulties distinguished from neoplastic lesion with vascular lesion on the imaging, open biopsy was performed 12 days after onset. Intraoperative frozen section showed cellular lesion with hemorrhage. A high-grade neoplasm was suggested. However, it was difficult to distinguish from astrocytic tumor with oligodndroglial tumor.Crush cytology revealed oval to round tumor cells with increased cellularity. Some tumor cells showed perinuclear halo. The differential diagnosis on the crush cytology was malignant lymphoma. However, findings from frozen section and crush cytology, we could diagnose as oligodndroglial tumor.

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