Ependymoma, a rare neuroepithelial malignancy of the central nervous system, affects both children and adults and may occur anywhere along the neuroaxis. This study aimed to analyze the treatment outcomes of adult intracranial ependymoma cases in Japan using data from the Brain Tumor Registry of Japan between 2001 and 2008. The dataset comprised 169 eligible patients after applying exclusion criteria, such as subependymoma and myxopapillary ependymoma cases. Patient data encompassed demographic details, tumor classification, treatment strategies, extent of resection, WHO grade, and survival outcomes.

Kaplan-Meier and multivariate Cox proportional hazards analyses identified key prognostic factors influencing overall survival and progression-free survival. Gross total resection and near-total resection were associated with better outcomes, while EOR less than 95% and preoperative Karnofsky performance status score below 70 were significantly correlated with poorer OS. WHO grade 2 tumors were more prevalent in posterior fossa and demonstrated better survival outcomes than grade 3 tumors in univariate analyses. However, WHO grade did not remain significant in multivariate analysis when adjusted for tumor location.

This study highlights the critical impact of radical resection on ependymoma prognosis. While CNS WHO grade showed correlations with tumor location and survival, its role in predicting outcomes remains uncertain and may depend on molecular subtypes. Updated molecular classifications are recommended for future research.

The timing of aneurysmal obliteration may be influenced by post-admission rebleeding rates and patient characteristics associated with delayed hospital arrival in cases of aneurysmal subarachnoid hemorrhage. This study compared the rebleeding rate and characteristics between delayed and early hospital arrivals in cases of aneurysmal subarachnoid hemorrhage. Data from patients with aneurysmal subarachnoid hemorrhage recorded in the Nagasaki SAH Registry (1989-2018) were retrospectively analyzed. Patients were categorized into early (admission ≤72-hr post-onset) and late (admission >72-hr post-onset) groups. To assess the rebleeding rate after admission, data from a hospital that delayed the treatment protocol (1989-2002) were analyzed by using the log-rank test before and after propensity-score matching. To compare the characteristics of the late and early groups, data from 11 hospitals in the registry (2001-2018) were analyzed using multivariable analysis. The rebleeding analysis included 446 patients. Rebleeding occurred in 28/410 (6.8%) and 0/36 (0.0%) patients in the early and late groups, respectively, with no significant differences in cumulative rebleeding rates between the groups (11.5%/month vs. 0.0%/month, respectively). Of the 5,101 patients with aneurysmal subarachnoid hemorrhage admitted from 2001 to 2018, 289 (5.7%) were categorized into the late group. Multivariable analysis identified lower World Federation of Neurosurgical Societies/Fisher grade, anterior circulation aneurysm, fewer small aneurysms, late aneurysmal obliteration treatment, and pre-admission repeated ictus as independent factors associated with the late group. Patients with aneurysmal subarachnoid hemorrhage with delayed hospital arrival are uniquely characterized by a less severe subarachnoid hemorrhage grade, regardless of repeated pre-admission ictus.

Moyamoya disease is a progressive steno-occlusive cerebrovascular disease. Intrinsically, its shifts the brain's vascular supply from the internal carotid to the external carotid system, known as internal-to-external carotid conversion, which is categorized by Suzuki's angiographic staging system. Although Suzuki's staging system remains the global standard for assessing longitudinal angiographic progression, the clinical characteristics of patients in the advanced stages, particularly in stage 6, are not well understood. Therefore, in this study, we investigated the incidence and clinical features in patients with moyamoya disease in advanced Suzuki stages. We retrospectively analyzed 280 hemispheres from 156 patients diagnosed with moyamoya disease through cerebral angiography between 1980 and 2023 at our institution. Angiographic features, including Suzuki disease stage and collateral pathways, were evaluated. Clinical outcomes, surgical indications, and postoperative courses were also assessed. Seventeen hemispheres (6.1%) were classified as Suzuki stage 5, and 6 hemispheres (2.1%) as stage 6, all in adult patients. Transdural collaterals, including ethmoidal and vault moyamoya vessels, were found in more than 80% of these advanced cases. Leptomeningeal collaterals from the posterior cerebral artery were frequently observed, whereas posterior cerebral artery stenosis was rare. Approximately half of the patients underwent revascularization surgery. No postoperative stroke recurrence was observed during the follow-up period of median 84 months. Suzuki stages 5 and 6 of moyamoya disease are rare; cases with stage 6 are particularly uncommon but show distinct angiographic features marked by internal-to-external carotid conversion and increased reliance on posterior circulation. Surgical revascularization is feasible and may be performed safely without stroke recurrence, even in patients with advanced disease stages.

Embolization of intracranial tumors is predominantly performed in Japan, primarily before neurosurgical resection. The Japanese Registry of NeuroEndovascular Therapy (JR-NET) Study Group, established in 2005, aims to clarify the factors influencing the outcomes of neuroendovascular treatment. Japanese Registry of NeuroEndovascular Therapy 4 is a nationwide, multicenter retrospective observational study that evaluates real-world data on intracranial tumor embolization in Japan. Japanese Registry of NeuroEndovascular Therapy 4 is based on data collected from 166 neurosurgical centers in Japan between January 2015 and December 2019. Of 63,230 patients, 2,664 (4.2%) with intracranial tumors underwent embolization. The primary endpoint was the proportion of patients with a modified Rankin scale (mRS) score of 0-2 at 30 days post-procedure. Secondary endpoints included procedure-related complications. Among the 2,664 patients, 61 records lacked sufficient data, leaving 2,603 patients (1,612 females, median age: 61 years [interquartile range 51-71]). The proportion of patients with mRS scores ≤2 at 30 days after the procedure was 86.9%. The overall incidence of procedure-related complications was 4.8%, with 1.8% hemorrhagic, 2.0% ischemic, and 1.0% classified as other complications. In the multivariate analysis, general anesthesia and embolization of vessels other than the external carotid artery were identified as risk factors for the development of complications. Meningioma cases had a complication rate of 4.3%, with major complications occurring in 3.5%. Hemangioblastoma cases had a 14.9% complication rate, with major complications at 9.9%. Japanese Registry of NeuroEndovascular Therapy 4 provides comprehensive real-world data on intracranial tumor embolization in Japan, identifying risk factors to inform and improve the safe practice of intracranial tumor embolization in neuroendovascular therapy.

Tarsal tunnel syndrome is an entrapment neuropathy at the tarsal tunnel. The diagnosis and the prediction of the surgical outcome are difficult. We compared preoperative magnetic resonance imaging findings with the postoperative results. We examined preoperative magnetic resonance imaging findings in 38 consecutive patients with Tarsal tunnel syndrome (47 feet); their mean age was 73.8 years. We inspected the nerve width on the slice showing the most compressed nerve, and the hyperintensity of that nerve on preoperative T2* fat-suppressed axial magnetic resonance imaging images and examined the role of magnetic resonance imaging in the diagnosis and of the surgical outcomes in patients with Tarsal tunnel syndrome. Postoperatively, there was significant symptom improvement. On preoperative magnetic resonance imaging scans the mean width of the most compressed nerve was 0.99 ± 0.37 mm. There was no significant correlation between the preoperative symptom severity and postoperative symptom improvement. In 29 feet (61.7%) we observed hyperintensity of the compressed nerve. In all but one foot the hyperintense area was displayed on 3 axial slices adjacent to the strongest nerve compression point. There was no significant difference in the preoperative symptom severity in patients with (group 1, n = 29) or without hyperintensity (group 2, n = 18). The nerve width at the point of greatest compression was significantly thinner, and postoperative symptom improvement was significantly greater in group 1 patients. Although there was no correlation between the preoperative nerve compression severity and the surgical results, nerve hyperintensity on magnetic resonance imaging scans may help with the diagnosis of Tarsal tunnel syndrome.

This study reports the treatment outcomes of patients with lumbar spinal canal stenosis who underwent lumbar stabilization surgery and evaluates the radiological effects of the surgery at least 1 year post-surgery. Forty consecutive patients with lumbar spinal canal stenosis underwent lumbar stabilization surgery using a titanium alloy interspinous spacer between August 2021 and October 2023. The cohort included 19 males and females, respectively, with a mean age of 75.2 years. The surgical level was L1 in 20 patients and L2 in 18 patients. Patients were operated using general anesthesia in 20 patients and local anesthesia in 18. We evaluated their surgical outcomes using the numerical rating scale for pain, the Roland-Morris Disability Questionnaire, and the Japanese Orthopedic Association scores, before surgery and at 6 and 12 months postoperatively. Radiological effects were also evaluated. All outcomes for the patient showed significant improvement at 6- and 12-months post-surgery. There was no significant change in the area of the dural sac before and after surgery; but the surgical level angle markedly decreased in both neutral and extended positions. Two patients underwent additional treatment post-surgery. This method does not require the removal of the lamina and yellow ligament, does not expose the nerves, and surgery can be performed without suspending antithrombotic drugs. It can also be performed under local anesthesia for patients at high risk for general anesthesia. However, general anesthesia is preferable as local anesthesia may lead to discomfort during surgery.