Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 56, Issue 7
Displaying 1-10 of 10 articles from this issue
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Review Articles
  • Cancer Immunotherapy for Gliomas: Overview and Future Directions
    Naoya HASHIMOTO
    2016 Volume 56 Issue 7 Pages 355-360
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: April 16, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2015-0310
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    Immunotherapy has been highlighted because we have obtained much evidence, which includes theoretical backborn as well as favorable results from clinical trials. As immunotherapy gives an apparently different cytotoxic mechanism and a little adverse event, the promising results are getting a lot of attention. In this article, cancer immunotherapy for gliomas is reviewed thoroughly from the literature, focusing on the clinical trial results.
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  • Boron Neutron Capture Therapy for Malignant Brain Tumors
    Shin-Ichi MIYATAKE, Shinji KAWABATA, Ryo HIRAMATSU, Toshihiko KUROIWA, ...
    2016 Volume 56 Issue 7 Pages 361-371
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: May 31, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2015-0297
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    Boron neutron capture therapy (BNCT) is a biochemically targeted radiotherapy based on the nuclear capture and fission reactions that occur when non-radioactive boron-10, which is a constituent of natural elemental boron, is irradiated with low energy thermal neutrons to yield high linear energy transfer alpha particles and recoiling lithium-7 nuclei. Therefore, BNCT enables the application of a high dose of particle radiation selectively to tumor cells in which boron-10 compound has been accumulated. We applied BNCT using nuclear reactors for 167 cases of malignant brain tumors, including recurrent malignant gliomas, newly diagnosed malignant gliomas, and recurrent high-grade meningiomas from January 2002 to May 2014. Here, we review the principle and history of BNCT. In addition, we introduce fluoride-18-labeled boronophenylalanine positron emission tomography and the clinical results of BNCT for the above-mentioned malignant brain tumors. Finally, we discuss the recent development of accelerators producing epithermal neutron beams. This development could provide an alternative to the current use of specially modified nuclear reactors as a neutron source, and could allow BNCT to be performed in a hospital setting.
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  • Surgical Resectability of Skull Base Meningiomas
    Takeo GOTO, Kenji OHATA
    2016 Volume 56 Issue 7 Pages 372-378
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: April 14, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2015-0354
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    With recent advances in surgical technology such as preoperative imaging, neuro-monitoring, and surgical instruments, the surgical resectability of intracranial meningiomas has increased over the last two decades. This study reviewed clinical articles regarding the surgical treatment of meningiomas to clarify the role of surgical excision, with a focus on skull base meningiomas. We sub-classified clinical articles about skull base meningiomas into two categories (anterior and middle fossa meningiomas; and posterior fossa meningiomas) and reviewed papers in each category. In cases with anterior and middle fossa meningiomas, surgical resectability has reached a sufficient level to maximize functional preservation. In cases of posterior fossa meningioma, however, surgical respectability remains insufficient even with full use of recent surgical modalities. Continuous refining of operative procedures is required to obtain more satisfactory outcomes, especially for posterior fossa meningioma. In addition, recent long-term outcomes of stereotactic radiosurgery (SRS) were acceptable for controlling the skull base meningiomas. Therefore, combination with surgical excision and SRS should be considered in complicated skull base meningiomas.
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  • Neural Basis of Language: An Overview of An Evolving Model
    Masazumi FUJII, Satoshi MAESAWA, Sumio ISHIAI, Kenichiro IWAMI, Miyako ...
    2016 Volume 56 Issue 7 Pages 379-386
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: April 16, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2016-0014
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    The neural basis of language had been considered as a simple model consisting of the Broca’s area, the Wernicke’s area, and the arcuate fasciculus (AF) connecting the above two cortical areas. However, it has grown to a larger and more complex model based upon recent advancements in neuroscience such as precise imaging studies of aphasic patients, diffusion tensor imaging studies, functional magnetic resonance imaging studies, and electrophysiological studies with cortical and subcortical stimulation during awake surgery. In the present model, language is considered to be processed through two distinct pathways, the dorsal stream and the ventral stream. The core of the dorsal stream is the superior longitudinal fasciculus/AF, which is mainly associated with phonological processing. On the other hand, semantic processing is done mainly with the ventral stream consisting of the inferior fronto-occipital fasciculus and the intratemporal networks. The frontal aslant tract has recently been named the deep frontal tract connecting the supplementary motor area and the Broca’s area and it plays an important role in driving and initiating speech. It is necessary for every neurosurgeon to have basic knowledge of the neural basis of language. This knowledge is essential to plan safer surgery and preserve the above neural structures during surgery.
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  • Phenotypic Transition as a Survival Strategy of Glioma
    Tomotsugu ICHIKAWA, Yoshihiro OTANI, Kazuhiko KUROZUMI, Isao DATE
    2016 Volume 56 Issue 7 Pages 387-395
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: May 11, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2016-0077
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    Malignant glioma is characterized by rapid proliferation, invasion into surrounding central nervous system tissues, and aberrant vascularization. There is increasing evidence that shows gliomas are more complex than previously thought, as each tumor comprises considerable intratumoral heterogeneity with mixtures of genetically and phenotypically distinct subclones. Heterogeneity within and across tumors is recognized as a critical factor that limits therapeutic progress for malignant glioma. Recent genotyping and expression profiling of gliomas has allowed for the creation of classification schemes that assign tumors to subtypes based on similarity to defined expression signatures. Also, malignant gliomas frequently shift their biological features upon recurrence and progression. The ability of glioma cells to resist adverse conditions such as hypoxia and metabolic stress is necessary for sustained tumor growth and strongly influences tumor behaviors. In general, glioma cells are in one of two phenotypic categories: higher proliferative activity with angiogenesis, or higher migratory activity with attenuated proliferative ability. Further, they switch phenotypic categories depending on the situation. To date, a multidimensional approach has been employed to clarify the mechanisms of phenotypic shift of glioma. Various molecular and signaling pathways are involved in phenotypic shifts of glioma, possibly with crosstalk between them. In this review, we discuss molecular and phenotypic heterogeneity of glioma cells and mechanisms of phenotypic shifts in regard to the glioma proliferation, angiogenesis, and invasion. A better understanding of the molecular mechanisms that underlie phenotypic shifts of glioma may provide new insights into targeted therapeutic strategies.
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  • Usefulness of positron emission tomographic studies for gliomas
    Keisuke MIYAKE, Daisuke OGAWA, Masaki OKADA, Tetsuhiro HATAKEYAMA, Tak ...
    2016 Volume 56 Issue 7 Pages 396-408
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: May 31, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2015-0305
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    Non-invasive positron emission tomography (PET) enables the measurement of metabolic and molecular processes with high sensitivity. PET plays a significant role in the diagnosis, prognosis, and treatment of brain tumors and predominantly detects brain tumors by detecting their metabolic alterations, including energy metabolism, amino acids, nucleic acids, and hypoxia. Glucose metabolic tracers are related to tumor cell energy and exhibit good sensitivity but poor specificity for malignant tumors. Amino acid metabolic tracers provide a better delineation of tumors and cellular proliferation. Nucleic acid metabolic tracers have a high sensitivity for malignant tumors and cellular proliferation. Hypoxic metabolism tracers are useful for detecting resistance to radiotherapy and chemotherapy. Therefore, PET imaging techniques are useful for detecting biopsy-targeting points, deciding on tumor resection, radiotherapy planning, monitoring therapy, and distinguishing brain tumor recurrence or progression from post-radiotherapy effects. However, it is not possible to use only one PET tracer to make all clinical decisions because each tracer has both advantages and disadvantages. This study focuses on the different kinds of PET tracers and summarizes their recent applications in patients with gliomas. Combinational uses of PET tracers are expected to contribute to differential diagnosis, prognosis, treatment targeting, and monitoring therapy.
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Technical Note
  • A New Irrigation System (Endosplash) for a Rigid Endoscope in Trans-sphenoidal Endoscopic Surgery
    Rintarou KURODA, Takeshi NAKAJIMA, Takashi YAMAGUCHI, Eiju WATANABE
    2016 Volume 56 Issue 7 Pages 409-415
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: April 11, 2016
    DOIhttps://doi.org/10.2176/nmc.tn.2015-0218
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    Obstruction of the visual field by blood is a major hindrance during endonasal endoscopic surgery, and a rapid and effective method for cleaning the lens is needed. We developed a new lens-cleaning system that does not employ a sheath or an irrigation-suction system. It is a 20-mm long cylinder with side holes that is attached to the barrel of the endoscope and is connected to a syringe containing saline. When the syringe is pressed, saline flows down to the tip along the barrel and washes the lens without requiring a sheath. We report the use of the system in six cases of endonasal endoscopic surgery. The lens was wiped significantly less often than during similar surgery performed without the use of this system. The Endosplash is simple and enables the surgeon to clean the lens with a single press of a syringe, thereby greatly enhancing the efficacy of endoscopic surgery.
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Review Articles
  • Research into the Physiology of Cerebrospinal Fluid Reaches a New Horizon: Intimate Exchange between Cerebrospinal Fluid and Interstitial Fluid May Contribute to Maintenance of Homeostasis in the Central Nervous System
    Mitsunori MATSUMAE, Osamu SATO, Akihiro HIRAYAMA, Naokazu HAYASHI, Ken ...
    2016 Volume 56 Issue 7 Pages 416-441
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: May 27, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2016-0020
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    Cerebrospinal fluid (CSF) plays an essential role in maintaining the homeostasis of the central nervous system. The functions of CSF include: (1) buoyancy of the brain, spinal cord, and nerves; (2) volume adjustment in the cranial cavity; (3) nutrient transport; (4) protein or peptide transport; (5) brain volume regulation through osmoregulation; (6) buffering effect against external forces; (7) signal transduction; (8) drug transport; (9) immune system control; (10) elimination of metabolites and unnecessary substances; and finally (11) cooling of heat generated by neural activity. For CSF to fully mediate these functions, fluid-like movement in the ventricles and subarachnoid space is necessary. Furthermore, the relationship between the behaviors of CSF and interstitial fluid in the brain and spinal cord is important. In this review, we will present classical studies on CSF circulation from its discovery over 2,000 years ago, and will subsequently introduce functions that were recently discovered such as CSF production and absorption, water molecule movement in the interstitial space, exchange between interstitial fluid and CSF, and drainage of CSF and interstitial fluid into both the venous and the lymphatic systems. Finally, we will summarize future challenges in research. This review includes articles published up to February 2016.
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  • Criteria for CT and Initial Management of Head Injured Infants: A Review
    Naoto SHIOMI, Tadashi ECHIGO, Akihiko HINO, Naoya HASHIMOTO, Tarumi YA ...
    2016 Volume 56 Issue 7 Pages 442-448
    Published: 2016
    Released on J-STAGE: July 15, 2016
    Advance online publication: May 17, 2016
    DOIhttps://doi.org/10.2176/nmc.ra.2015-0318
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    Criteria for computed tomography (CT) to head injured infants have not been established. Since the identification of neurological findings is difficult in infants, examination by CT may be necessary in some cases, but it may be difficult to perform CT because of problems with radiation exposure and body movement. Moreover, even though no intracranial abnormality was found immediately after injury, abnormal findings may appear after several hours. From this viewpoint, course observation after injury may be more important than CT in the initial treatment of head trauma in infants. The complaints and neurological manifestations of infants, particularly those aged 2 or younger, are frequently unclear; therefore, there is an opinion that CT is recommended for all pediatric patients. However, the appropriateness of its use should be determined after confirming the mechanism of injury, consciousness level, neurological findings, and presence/absence of a history of abuse. Among the currently available rules specifying criteria for CT of infants with head trauma, the Pediatric Emergency Care Applied Research Network (PECARN) study may be regarded as reliable at present. In Japan, where the majority of emergency hospitals are using CT, it may be necessary to develop criteria for CT in consideration of the actual situation. CT diagnosis for pediatric head trauma is not always necessary. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on a state of the patients by telephone is useful for both patients and physicians.
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Editorial Committee
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