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It is often difficult to distinguish infectious disease of the central nervous system from a wide variety of non-infectious diseases, as neurosurgeons have few opportunities to treat them. Differentiation of infectious diseases from neoplastic diseases is often challenging. Since it often takes time to eliminate infectious diseases, it is necessary to utilize all the obtained medical information to make a proper diagnosis to avoid missing the appropriate chance of surgical treatment. In this paper, we describe tips for and pitfalls of accurately distinguishing such diseases, including brain abscess versus glioblastoma, meningitis versus dural lesions, and infection versus lymphoproliferative disorders in immunocompromised patients. In these cases, it is difficult to make a decision based only on the examination and imaging findings on admission, and it is important to make a diagnosis based on medical history and patient background.

The current status and future prospects of glioblastoma treatment were explained through the understanding of the pivotal and important papers from the brain tumor guideline.

In this paper, we review the current status of immunotherapy targeting Wilms' tumor 1 (WT1) peptide in malignant brain tumors as well as in other hematological and solid malignancies. WT1 is expressed in various kinds of malignancies, and is involved in oncogenesis. The titers of antibodies against WT1 and the frequency of WT1-specific cytotoxic T lymphocytes (CTLs) were higher in cancer patients than in healthy donors, indicating that WT1 protein has immunogenic function. These findings provided us with a rationale for developing cancer immunotherapy that targets the WT1 peptide. Clinical trials of the WT1 peptide vaccination were initiated, and definite immunological and clinical responses were observed. The disease control rate of 57.1% was obtained especially in the case of recurrent glioblastomas, with a median progression-free survival period of 20.0 weeks and progression-free survival rate at 6 months of 33.3%. The trial showed that WT1 vaccination for malignant gliomas, which is generally believed to be an intractable disease, was safe and elicited a favorable clinical response. Further clinical studies of WT1 vaccination in patients with malignant gliomas as well as other cancers are warranted. An enhancement of the efficacy of WT1 vaccination can be expected with a combined treatment using the WT1-specific helper peptide or anti-cancer chemotherapeutic agents. Administration of WT1 vaccination along with other therapeutic modalities during initial treatment or in the case showing minimal residual disease may prolong the survival time of the cancer patients.

A 57-year-old male was urgently carried to our hospital because of sudden loss of consciousness, lasting about 10 minutes. He had resumed consciousness before he arrived at our hospital. Neurologically, he had mild muscle weakness of the right arm. Deep tendon reflexes in the right upper extremity were reduced. In high level functions, speech disturbance, dysgraphia (disturbed ability to write Hiragana), and constructive apraxia were noted. A brain MRI upon admission showed a poorly demarcated, high signal intensity area in the cortical and subcortical layers of the left temporal and parietal lobes. This was visible on T 2 weighted images(T 2 WI), although no abnormalities were visible on T 1 weighted images(T 1 WI). No contrast enhancement was effected by Gd-DTPA. The patient was therefore suspected of having a tumor or degenerative disease and was monitored closely. About 4 months later after onset, his symptoms became aggravated, and brain MRI disclosed a marked low signal intensity area on T 1 WI and a heterogeneous high signal intensity area on T 2 WI. The abnormal signal intensity area was surrounded by extensive edema and mass effect. Ring-shaped, irregular, contrast enhanced areas were also visible. Cerebral angiography revealed a poorly demarcated tumor stain in the area supplied by the middle cerebral artery. The tumor was removed surgically and was histopathologically rated as glioblastoma multiforme(GBM). Because this case represents a valuable example of early stage of GBM, it will be discussed in this paper, along with differential diagnoses.

The long-term therapeutic results in patients with glioblastoma multiforme and malignant astrocytoma were compared between 15 cases of levamisole treated group and 18 cases of control group similar in method and time of treatment to the levamisole treated group. As the result, it was found that the prolongation of life was noted in the levamisole treated group compared with the control. In adult patients, the levamisole treated group survived significantly longer than the control group (p less than 0.05). There is, however, no significant difference of prolongation of the survival time between the levamisole treated (8 cases) and control (8 cases) groups, both which were pretreated by chemoradiotherapy using ACNU and vincristine. This paper refers also to side effects of levamisole.