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Objective: Glioblastomas contacting the subventricular zone (SVZ) are associated with poor prognosis, and the impact of ventricular entry (VE) during resection remains controversial. Since glioblastomas with SVZ involvement often require VE, both SVZ involvement and VE are confounding factors. This study aimed to evaluate the effect of VE during glioblastoma resection by comparing patients with and without SVZ involvement., Methods: This multi-institutional retrospective study reviewed newly diagnosed isocitrate dehydrogenase-wildtype glioblastoma who underwent resection. The focus was on VE, complications, and recurrence patterns based on SVZ status., Results: A total of 418 patients were included with 278 (66.5%) undergoing VE and 140 (33.5%) without. Patients with VE had significantly shorter overall survival (OS) than those without VE (18.6 vs. 25.6 months, P = 0.008). VE was more common in patients with SVZ tumors (94.2%) compared to non-SVZ tumors (26.3%, P < 0.0001). Notably, 44 patients with non-SVZ tumors experienced VE, whereas 15 patients with SVZ tumors did not. Regardless of SVZ status, VE did not affect the rates of complications, such as symptomatic subdural effusion, hydrocephalus, infection, or nonlocal recurrence. OS was similar for each group: for SVZ tumors, OS was 17.7 months with VE versus 19.9 months without VE (P = 0.34), and for non-SVZ tumors, OS was 30.8 months with VE versus 25.6 months without VE (P = 0.63)., Conclusions: VE during glioblastoma resection does not impact complications or nonlocal recurrence. Surgeons may safely perform VE during resection of both SVZ and non-SVZ glioblastomas without adverse effects., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Occipital lobectomy is a widely accepted procedure for treatment of occipital gliomas and occipital lobe epilepsy, 1 , 2 but its technical nuances are not well discussed. Anatomically, the occipital lobe, also known as the cuneus or visual area, is an isolated region in terms of vascular supply. The terminal branches of posterior cerebral arteries, including parieto-occipital and calcarine arteries, 3-6 are the major vessels supplying this region. The parieto-occipital fissure (POF) comprises the anterior border of the occipital lobe and has been identified as a useful landmark for glioma invasion and tumor resection. 7-13 In recent years, glioma surgery focused on achieving an extent of resection beyond gross total resection. 14-16 Therefore, focusing on the POF during occipital lobectomy enables handling feeding arteries before tumor resection and accurately defining the resection boundaries beyond the contrast-enhanced lesion, considering the highly invasive nature of glioblastoma. A right-handed 57-year-old man presented with left homonymous hemianopsia. Radiological assessment demonstrated a highly vascular tumor with random enhancement in the right occipital lobe, suggestive of glioblastoma. Computed tomography angiography indicated that the parieto-occipital arteries ran anteriorly to the tumor, and the calcarine artery was identified as the main feeder of the tumor. The surgical procedure involved the dissection of the entire POF along with the parieto-occipital artery and early coagulation of the calcarine artery (Video 1). Postoperative magnetic resonance imaging confirmed the occipital lobectomy with the POF as the anterior border of the resection cavity. The patient exhibited no new neurological deficits postoperatively., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study examined the clinical significance of residual hyperintense area on T2-weighted magnetic resonance imaging (T2R) without gadolinium-enhanced lesions at the end of initial treatment (debulking surgery, concomitant radiotherapy, and temozolomide) in patients with glioblastoma., Methods: Among 150 glioblastoma cases, 77 cases without enhanced lesions at the end of initial treatment and without factors modifying the distribution of residual hyperintense area or pattern of recurrence were included. We retrospectively reviewed the relationship of residual hyperintense area after initial treatment with progression-free survival (PFS), overall survival (OS), and pattern of recurrence., Results: In these 77 cases, the median PFS and OS were 12.4 and 27.4 months, respectively. At the end of initial treatment, 55 (71.4%) cases had residual hyperintense area (T2 residual group, T2R), whereas 22 (28.6%) showed no hyperintense area (T2 disappeared group, disappeared hyperintense area on T2-weighted magnetic resonance imaging [T2D]). Based on univariate and multivariate analyses, the residual hyperintense area after initial treatment was not a prognostic factor for PFS or OS. Distant recurrences occurred more frequently in the T2D group than in the T2R group 50.0% versus 9.5%. In the T2R group, the recurrence site coincided with the residual hyperintense area in 36 (85.7%) of 42 recurrences., Conclusions: The T2R at the end of initial treatment can predict local recurrence. However, the distant recurrence occurred frequently in T2D group. Thus, attention should be paid to local recurrences in T2R group and distant recurrences in T2D group., (Copyright © 2024. Published by Elsevier Inc.)

Background: Bone flap resorption is an issue after autologous cranioplasty. Critical temperatures above 50°C generated by power-driven craniotomy tools may lead to thermal osteonecrosis, a possible factor in resorption. This ex vivo study examined whether the tools produced excessive heat resulting in bone flap resorption., Methods: Using swine scapulae maintained at body temperature, burr holes, straight and curved cuts, and wire-pass holes were made with power-driven craniotomy tools. Drilling was at the conventional feed rate (FR) plus irrigation (FR-I + ), at a high FR plus irrigation (hFR-I + ), and at high FR without irrigation (hFR-I - ). The temperature in each trial was recorded by an infrared thermographic camera., Results: With FR-I + , the maximum temperature at the burr holes, the cuts, and the wire-pass holes was 69.0°C, 56.7°C, and 46.2°C, respectively. With hFR-I + , these temperatures were 53.1°C, 52.1°C, and 46.0°C, with hFR-I - they were 56.0°C, 66.5°C, and 50.0°C; hFR-I - burr hole- and cutting procedures resulted in the highest incidence of bone temperatures above 50°C followed by FR-I + , and hFR-I + . At the site of wire-pass holes, only hFR-I - drilling produced this temperature., Conclusions: Except during prolonged procedures in thick bones, most drilling with irrigation did not reach the critical temperature. Drilling without irrigation risked generating the critical temperature. Knowing those characteristics may be a help to perform craniotomy with less thermal bone damage., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Butterfly glioblastoma (bGB) poses significant surgical challenges, yet recent findings have highlighted the potential of surgical decompression in extending patient survival. 1-10 The selection of a surgical strategy for bGB varies across studies. Generally, the side with a larger tumor volume is a preferred approach route, and the nondominant hemisphere is preferred when both tumors are similar in size. The contralateral tumor is removed via the resection cavity of the ipsilateral side, 11 with successful utilization of endoscopic-assisted techniques. 8 In the case of deep-seated bGB covered with a thick intact brain, accessing the tumor requires creating an invasive corridor, therefore minimizing the damage to the intact brain is ideal. A man in his 70s presented the new-onset seizure. Preoperatively, the patient exhibited a Karnofsky performance status of 50% without any motor deficits, and magnetic resonance imaging demonstrated a deep-seated anterior bGB with a larger tumor volume on the left dominant side. Imaging showed the tumor located just beneath the bilateral superior frontal sulci. Therefore we used these sulci to access the tumor with the minimum cut of the intact brain while preserving the frontal aslant tracts and used bilateral interhemispheric approaches to protect the cingulate bundles. We conducted the same technique for another deep-seated anterior bGB case, both resulting in postoperative Karnofsky performance status improvements (Video 1). Tailoring the surgical approach to the unique characteristics of each bGB case is important. The patients consented to the procedure and the publication of their images., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: At craniotomy, the dura shrinks due to the drying effect of illumination and air exposure, rendering its primary closure difficult. When the opening is narrow, it can be patched with autologous grafts. However, tissue harvesting and meticulous suturing take time. As the cost-effectiveness of using dural substitutes is poor, we developed a new technique that involves dural scratching for the primary closure of dural openings., Methods: We applied our technique because in 53 adults who underwent supratentorial craniotomy we encountered difficulties with the primary closure of a dural opening 5 mm or less in width. With a scalpel, we placed several fine scratches parallel to the edge of the opening on the surface of the dura, taking care not to perforate the deep layer. This relieved dural tension and the tissue was stretched enough to permit closing with sutures., Results: Our technique achieved primary dural closure in 46 of 53 patients (87%) who primarily had undergone narrow supratentorial craniotomies. The other 7 additionally required small autologous grafts to patch narrow residual openings at the intersection of the durotomy. There were no procedure-related complications such as cerebrospinal fluid leakage and persistent headache due to tension of the closed dura., Conclusions: Dural scratching is simple, safe, requires no special instrumentation, facilitates primary closure of the shrunken dura by stretching, and reduces the need for patch grafting., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Preoperative identification of the carotid bifurcation (CB) location and plaque and stenosis distal end of the cervical internal carotid artery in relation to bony structures is essential for carotid endarterectomy (CEA). However, for patients with contrast contraindications, cervical 3-dimensional computed tomography angiography (3D-CTA) is unavailable. In this study, we created fusion images of magnetic resonance angiography (MRA), black-blood (BB) magnetic resonance imaging (MRI), and CT to determine if these noncontrast agent images are superior to 3D-CTA for preoperative CEA planning., Methods: The fusion images showed vascular structures obtained by MRA, plaque observed by BB-MRI, and bone structures shown by CT. Spatial localization accuracy was verified by directly overlaying contrast-enhanced 3D-CTA images on the fusion images. We validated this technique in 50 patients with unilateral ICA stenosis, 28 of whom underwent CEA. The 2D-distance CB MRA-CTA (the 2D distance difference between CB MRA and CB CTA perpendicular to the long axis of the carotid artery) was measured. We also compared the findings of the fusion image regarding the CB location and plaque distal end with the operative findings., Results: The median 2D distance CB MRA-CTA was 1 mm. CB MRA was located distal and proximal to CB CTA in 21and 29 patients, respectively. The CB location and fusion-image plaque were consistent with the intraoperative findings in all CEA patients., Conclusions: Fusion images created from MRA, BB-MRI, and noncontrast CT were feasible as an alternative to 3D-CTA for patients with contrast contraindications., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: The exact location of the leg motor area is still in debate due to the lack of landmarks such as 'precentral knob' in the medial cortex. This study tried to identify the leg motor area based on intraoperative neurophysiological data and neuroimaging techniques., Methods: Intraoperative data of somatosensory evoked potential (SEP) elicited by tibial nerve stimulation and motor evoked potential (MEP) of the leg muscles induced by direct cortical stimulation were recorded using subdural electrodes placed in the medial cortex. We displayed the neurophysiological data on the individual MR images and the MNI52., Results: Definite N40-P40 phase reversal was observed with the shallow grooves in the medial cortex in 5 cases. Leg MEP was successfully obtained in all 12 cases preserving the leg motor function. Superimposed SEP and leg MEP data on the MNI152 indicated the leg motor area was predominantly located in the posterior two-thirds between the vertical lines passing through the anterior commissure and the posterior commissure (VCP)., Conclusions: Our study revealed the location of the leg motor area and the presence of the 'medial central sulcus' in the medial cortex., Significance: The VCP can be useful landmark to identify the sensorimotor border in the medial cortex., (Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Background: Despite holding soft tissue away from high-speed drills during surgery, tissue can unexpectedly wrap around the drill shaft. We performed experiments to examine what precipitates such mishaps., Methods: In a windless environment, a Signature Drill System (Stryker) featuring a 4-mm diameter coarse diamond or cutting bit was placed parallel to a suspended strip of polypropylene. The distance between the end of the strip and the drill shaft or bits was 4 or 8 mm. In another experiment, we placed the drill horizontally 10 mm above the top of dry-ice fog. The maximum drill speed was 75,000 rpm, and the horizontal motion of the polypropylene strip and the vertical motion of the dry-ice fog were recorded by a video camera., Results: In the experiments, the strip parallel to the vertical shaft and the dry-ice fog were pulled toward the shaft; the higher the revolving drill speed, the faster its motion. On the other hand, in experiments where the end of the strip was next to either bit, no such motion was observed., Conclusions: The pulling force generated by revolving high-speed drill shafts may result in tissue wraparound even when soft tissue is held away from the shaft., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Chronic subdural hematomas (CSDHs) with narrow or multilayered hematomas must be accurately localized for burr hole drainage. We present a simple alternative localization method using conventional computed tomography (CT) scans acquired for the initial diagnosis and a commercially available carpenter's square (CS)., Methods: Using our novel method, we localized 77 narrow or multilayered CSDHs. A single burr hole site on the thickest portion of narrow hematomas or on the site allowing access to both the isolated superficial layer and the deep layer of multilayered hematomas was identified on axial CT images; the image was parallel to the orbitomeatal line (OML). On the target CT slice, the level from the OML and from the surface of the forehead to the intended burr hole (sagittal distance) was measured. The OML and the level of the CT target slice were marked using the CS. Then, the CS was placed at the marked target level; the 2 edges of the CS were situated on the frontal and temporal scalp and parallel to the OML and the sagittal line. The sagittal distance was then marked., Results: All burr holes reached the CSDHs. The mean deviation of the burr holes was 4.7 mm inferior and 1.4 mm anterior to the intended site. In 65 instances (84.4%), a deviation within 10 mm was observed in both the superoinferior and the anteroposterior directions., Conclusions: Our simple and inexpensive method can localize narrow or multilayered CSDHs with acceptable accuracy and increases the efficiency of routine clinical work., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare clinical entity. We report an unusual case of intraparenchymal bifrontal CAPNON coexisting with interhemispheric lipoma and agenesis of the corpus callosum., Case Description: A 64-year-old woman presented with slight weakness of her left leg. Computed tomography and magnetic resonance imaging showed massive nodular intraparenchymal calcifications at both sides of the interhemispheric lipoma associated with partial agenesis of the corpus callosum. Enhancement was observed at the periphery and within the calcification. Massive perifocal edema was also demonstrated. The enhanced lesion with calcification was partially resected. Histologic analysis of the resected specimen disclosed nodular calcification with fibro-osseous components and histiocytic reaction, consistent with CAPNON. A high ratio of M2 macrophages was observed among the infiltrating macrophages. 11 C-methionine positron emission tomography demonstrated high uptake of the tracer at the lesion corresponding to the calcified lesion on computed tomography. Postoperatively, massive perifocal edema was decreased and maintained without progression for a year., Conclusions: The high M2 macrophage activity verified by histopathologic analysis suggests that CAPNON is not a silent but a more active, tumefactive disease involving the immune response. This hypothesis may be supported by the high uptake of 11 C-methionine positron emission tomography., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Maximal safe resection prolongs the survival of patients with glioblastoma (GB). However, whether total resection of the enhanced lesion is pursued or abandoned depends on preoperative judgments based on the findings of magnetic resonance imaging (MRI). Anatomically, medial temporal tumor tends to invade toward the temporal stem, insula, and basal ganglia, representing tumor with high surgical risk. In the present study, we describe the key radiologic features of medial temporal GB to achieve extent of resection., Methods: We reviewed all GB cases located in the temporal lobe (tGB) treated between April 2013 and March 2018 at Kitasato University Hospital. On the basis of MRI, tGB was simply classified into 3 groups: medial tGB and nonmedial tGB, and medial tGB was further subdivided into invading type and mimicking type. We focused on the resectability of medial tGB., Results: Twenty-seven patients with tGB were identified. Twenty were included in the nonmedial tGB, and 7 were in the medial tGB. All medial tGB seemed to invade into the basal ganglia and/or the lenticulostriate arteries, but detailed examination revealed 2 types of tumor, invading type (3 cases) and mimicking type (4 cases). The invading type had true involvement of the basal ganglia and/or lenticulostriate arteries, whereas the mimicking type had no involvement of these structures. This new classification is highly effective, as the former is unresectable, but the latter is totally resectable., Conclusions: Medial tGB is a challenging tumor for maximal safe resection, so our classification will help to identify cases of removable medial tGB., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Thrombosed cerebral aneurysm (TCA) can cause cerebral infarction. However, treatment of cerebral infarction due to embolism from TCA is controversial because of the risk of rupture, and no consensus has been established for the treatment of patients with this condition., Case Description: A 75-year-old woman suffered left hemiparesis. Computed tomography (CT) showed a high-density round mass in the right sylvian fissure, which was suspected to be a nonruptured TCA. Magnetic resonance (MR) angiography and CT angiography demonstrated an aneurysm in the distal part of the right middle cerebral artery with poor opacification of most of the aneurysm, suggesting partial thrombosis. Diffusion-weighted MR imaging revealed high intensity in the right frontal lobe, in a distribution distal to the aneurysm. The diagnosis was cerebral infarction due to embolism from a partially thrombosed aneurysm. She was treated with antithrombotic therapy. On day 4, she suddenly became comatose. CT and CT angiography revealed subarachnoid hemorrhage (SAH) and enlarged opacification in the aneurysm, respectively. She underwent neck clipping of the aneurysm, but her neurologic improvement was poor. TCA causing ischemic stroke followed by SAH is extremely rare, with only 4 previous reported cases. All patients had received antithrombotic therapies, and most aneurysms had ruptured within a few days after starting antithrombotic therapy. The outcomes were extremely poor., Conclusions: We suggest that antithrombotic therapy might be avoided for these patients. Early surgical treatment without antithrombotic therapy is recommended to prevent aneurysm rupture and recurrent distal embolism from the TCA., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Hypertrophic olivary degeneration (HOD) is a rare neurological condition of trans-synaptic degeneration caused by disruption of the dentatorubro-olivary pathway. We present new radiologic findings of HOD in 2 cases of brainstem lymphoma., Case Description: A 35-year-old woman (Case 1) and a 69-year-old man (Case 2) presented with remarkably similar clinical courses. The primary lesion was located at the dorsal pons extending to the midbrain. Pathologic diagnosis of diffuse large B-cell lymphoma was obtained after surgical resection. Complete remission of the primary lesion was achieved by treatment with 3 courses of high-dose methotrexate and radiotherapy. Arterial spin-labeling and T 2 -weighted imagings showed high signal intensity in the inferior olive (IO) at some time after the operation. Slight contrast enhancement in the IO was also found in Case 1. These radiologic findings nearly misled us into a diagnosis of recurrence of lymphoma. Signal intensity in the IO on arterial spin-labeling imaging changed with time. Normalized regional cerebral blood flow (rCBF) in the IO was defined as a percentage of rCBF to the global cerebral blood flow calculated using automated software. Chronologic change in normalized rCBF in the IO revealed a large peak in Case 1, but only a mild increase in Case 2. Neurological findings demonstrated severe oculopalatal tremor in Case 1 and mild palatal tremor in Case 2., Conclusions: Hyperperfusion and contrast enhancement in the IO were found in 2 patients with HOD. These findings may be confused with recurrence of malignant tumor., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: We previously disclosed that damage to the subependymal arteries (SEAs) caused by coagulation of the choroid plexus at the atrium can result in infarction within the lateral posterior choroidal artery territory, followed by hemiparesis. The present study describes the intraoperative anatomical findings of the SEAs and choroid plexus at the atrium, which were verified only by a few cadaveric studies., Methods: Locations of the SEA and descending motor pathway were determined with the neuronavigation system and subcortical electrical stimulation in 8 cases of periatrial brain tumor. Indocyanine green videoangiography was performed to verify the blood flow in the choroid plexus and SEAs., Results: Intraoperative visualization of the SEAs was performed successfully in all patients. The neuronavigation system and subcortical electrical stimulation mapping demonstrated that these SEAs penetrated into the descending motor pathway. Indocyanine green depicted the blood flow of the SEAs entering the wall of the lateral ventricle and adjacent brain parenchyma. The blood flow directions between the SEAs and choroid plexus were not uniform, because the SEAs were filled ahead of the choroid plexus in 3 cases, whereas the choroid plexus was filled first in the other 2 cases., Conclusions: Manipulations to the inner side of the choroid plexus at the transition from the atrium to the body of lateral ventricle can damage the SEAs. Not only coagulation of the SEAs themselves, but also coagulation of choroid plexus itself may reduce the blood flow in the SEAs, resulting in ischemic complications at descending motor pathway., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Approximately 60 cases of schwannoma unrelated to the cranial nerve have been reported, and only 12 arose from the tentorium. We present a case of tentorial schwannoma extending into the pons and midbrain without cranial nerve involvement, which was almost totally resected with an occipital transtentorial approach., Case Description: A 37-year-old man was admitted to our institution with memory disturbance beginning 2 years ago and gait disturbance from 1 year ago. Magnetic resonance imaging on admission revealed a heterogeneously enhanced 33 × 33 × 35 mm tumor in the pons and midbrain, and a dural tail sign connecting the lesion to the tentorial edge. Gross total resection of the tumor was performed with an occipital transtentorial approach. The trochlear nerve was identified and preserved, and the tumor did not involve this cranial nerve. The tumor was firmly attached to the edge of tentorium, and extended into the pons with sharp tumor border. Postoperative recovery was good, and brain magnetic resonance imaging performed 2 months after the surgical procedure revealed gross total removal of the lesion without signs of recurrence, but a slightly enhanced lesion in the right edge of the tentorium., Conclusions: The occipital transtentorial approach provides a direct approach to tentorial schwannoma, resulting in total resection even if the tumor extends into the pons and midbrain., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We described clinical course of a 24-year-old woman with 3p deletion syndrome associated with cerebellar hemangioblastoma at the age of 16 years old. She presented dysmorphic facial features, growth retardation and severe psychomotor retardation associated with 3p deletion syndrome. We identified de novo 3p deletion encompassing p25 by using array-based comparative genomic hybridization, where causative gene of von Hippel-Lindau (VHL) disease located. Surgical therapy for cerebellar hemangioblastoma was performed, and histological examination was consistent in cerebellar hemangioblastoma. She showed no other tumors associated VHL disease till 24 years old. This is the first case report of a patient with 3p deletion syndrome whose cerebellar hemangioblastoma may be associated with VHL disease. Repeat imaging studies were recommended for the patients with 3p deletion syndrome., (Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Background: Facial nerve schwannomas are rare lesions that constitute only 0.8% of all intrapetrous mass lesions. The least frequent lesions are tumors originating in the greater petrosal nerve (GPN). We present a case of a GPN schwannoma with temporal lobe edema in which the patient was operated on using an extradural and intradural approach to prevent complications., Case Description: A 66-year-old woman with vertigo and abnormal magnetic resonance imaging findings was referred to our department. Computed tomography scan revealed an isodense subtemporal mass with partial rim calcification and petrosal bone apex erosion. Magnetic resonance imaging confirmed a 22-mm left middle fossa lesion with heterogeneous enhancement and edema of the temporal lobe. A left temporal craniotomy to the middle fossa was performed. The initial extradural exploration revealed the tumor to be in the Glasscock triangle, mainly involving the location of the GPN. The tumor was removed through an intradural approach in piecemeal fashion. Finally, using an extradural and intradural middle fossa approach, the tumor was totally removed, leaving the capsule on the middle fossa floor with continuous facial nerve monitoring. The postoperative course was uneventful without complications of xerophthalmia and facial palsy., Conclusions: GPN schwannomas are very rare lesions. The extradural and intradural middle fossa approach was used to preserve the tumor capsule around the GPN. Using this technique, one can safely protect the geniculate ganglion and the GPN., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Object: Damage to the deep venous system, occipital lobe, and/or corpus callosum is well known to cause complications associated with the occipital transtentorial approach (OTA), but ischemic complications are not well documented. The authors investigated the high incidences of ischemic complications associated with removal of pineal/tectal/thalamic tumors through the OTA., Methods: Clinical records of 29 patients who underwent 31 surgeries using the OTA from December 2001 to May 2011 were retrospectively studied. Tumor locations were the pineal/tectal/thalamic region for 19, cerebellum for 7, and medial temporal lobe for 3., Results: Postoperative diffusion-weighted magnetic resonance images obtained within 72 h after surgery detected infarction in the tectal/splenial/thalamic region, presumably representing the medial posterior choroidal artery (MPChA) territory, in 10 patients. All these patients had tumor in the pineal/tectal/thalamic region. Deteriorated or newly developed eye symptoms including vertical gaze palsy tended to persist in these patients compared to those without ischemic complications., Conclusions: A relatively high incidence of MPChA territory infarction was associated with removal of tumors in the pineal/tectal/thalamic region through the OTA. Eye symptoms often occurred post-surgery and tended to persist in these patients. Neurosurgeons must be aware of the possibility of MPChA territory infarction to further increase the safety of the OTA., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Isocitrate dehydrogenase 1/2 (IDH1/2) mutations have been detected in gliomas, cartilaginous tumors, and leukemias. IDH1/2 mutations are early and frequent genetic alterations, are specific to a single codon in the conserved and functionally important Arginine 132 (R132) in IDH1 and Arginine 172 (R172) in IDH2. We previously established several monoclonal antibodies (mAbs), which are specific for IDH1 mutations: clones IMab-1 or HMab-1 against IDH1-R132H or clone SMab-1 against IDH1-R132S. However, specific mAbs against IDH2 mutations have not been reported. To establish IDH2-mutation-specific mAbs, we immunized mice or rats with each mutation-containing IDH2 peptides including IDH2-R172K and IDH2-R172M. After cell fusion, IDH2 mutation-specific mAbs were screened in Enzyme-Linked Immunosorbent Assay (ELISA). Established mAbs KMab-1 and MMab-1 reacted with the IDH2-R172K and IDH2-R172M peptides, respectively, but not with IDH2-wild type (WT) in ELISA. Western-blot analysis also showed that KMab-1 and MMab-1 reacted with the IDH2-R172K and IDH2-R172M recombinant proteins, respectively, not with IDH2-WT or other IDH2 mutants, indicating that KMab-1 and MMab-1 are IDH2-mutation-specific. Furthermore, MMab-1 specifically stained the IDH2-R172M-expressing cells in immunocytochemistry, but did not stain IDH2-WT and other IDH2-mutation-containing cells. In immunohistochemical analysis, MMab-1 specifically stained IDH2-R172M-expressing glioma. This is the first report to establish anti-IDH2-mutation-specific mAbs, which could be useful in diagnosis of mutation-bearing tumors., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Temporo-parietal theta activity (TPTA), often detected in hemispheres with internal carotid (ICA) or middle cerebral artery (MCA) occlusive lesions, is more clearly separated from occipital alpha activity by magnetoencephalography (MEG) than electroencephalography. The present study investigated whether TPTA is correlated with misery perfusion, a surgically correctable type of hemodynamic impairment., Methods: Awake MEG was measured in 56 patients with ICA or MCA occlusive lesions. Regional cerebral blood flow (rCBF) and regional cerebrovascular reactivity (rCVR) to acetazolamide were measured in the MCA territory by xenon-133 single-photon emission computed tomography. MEG was repeated in 10 patients after vascular reconstruction surgery., Results: Fourteen patients showed TPTA in the lesion hemisphere (n=13) or bilaterally (n=1). The presence of TPTA was significantly correlated with both reduced rCBF and reduced rCVR (P=0.0009). After surgery, TPTA disappeared in 7 of the 10 studied patients., Conclusions: The presence of TPTA suggests misery perfusion, which is characterized by reduced rCBF and reduced rCVR., Significance: MEG can detect the presence of reversible and surgically remediable cerebral ischemia before the development of complete infarction.

Background: Focal vasospasm is reportedly involved in a high incidence of acute coronary syndrome (ACS) as compared with diffuse vasospasm. No adequate studies have been conducted on the mechanism underlying the higher incidence of ACS involving focal vasospasm than of those involving diffuse vasospasm in patients with coronary spastic angina., Methods and Results: Blood samples were collected from the aortic root (Ao) and the coronary sinus (CS) before provoking left coronary vasospasm using intracoronary administration of acetylcholine. After relief of vasospasm, volumetric analyses of vasospastic lesions were evaluated with 3-dimensional intravascular ultrasound in 64 patients. The percent plaque volume was more prominent in focal (n=31) than in diffuse vasospasm (n=33) (40.9+/-9.4 vs. 23.3+/-9.2%, p<0.0001). The Cs-Ao difference of malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, as a marker of atherothrombosis, in focal vasospasm increased significantly as compared with diffuse vasospasm (6.9+/-6.7 vs. 1.2+/-5.7 U/L, p=0.001). In a multiple-logistic regression analysis with the traditional risk factors, the Cs-Ao difference of MDA-LDL level was a variable differing independently between the 2 types of vasospasm., Conclusions: Higher MDA-LDL levels were observed in the coronary circulation in patients with focal vasospasm than in those with diffuse vasospasm. Under these conditions, the dramatically increased percent plaque volume in cases with focal vasoconstriction may play an important role in the development of acute coronary events.

Background/aims: Currently, focal nodular hyperplasia (FNH)-like nodules in cirrhotic liver is spotlighted. Unique hypervascular nodules mimicking FNH-like nodule in alcoholic liver cirrhosis were clinicopathologically clarified., Methods: Six resected and six biopsy cases of small hypervascular nodules found in alcoholic cirrhosis were studied clinicopathologically., Results: All cases were male and consumed 90-150 g/day of ethanol for longer than 20 years, and hepatitis virus markers were negative. The nodules, 9-21 mm in diameter, were detected by ultrasonography during follow-up of alcoholic cirrhosis, and showed hypervascularity on angiography. Six patients were diagnosed as hepatocellular carcinoma and six were as hyperplastic nodule by biopsy, and the former six cases received partial hepatectomy. All of the resected nodules were completely or incompletely encapsulated. Histologically, all resected and biopsy nodules showed moderate increase of cell-density with an irregular trabecular pattern, and scar-like fibrosis with anomalous blood vessels, and unpaired arteries. All nodules showed marked or mild iron deposits in hepatocytes and/or kupffer cells, and a diffuse capillarization of the sinusoids., Conclusions: The nodules in the present series seem to fall in the same category as FNH-like nodules in cirrhotic liver, and should be taken account in screening programs including patients with alcoholic cirrhosis.

Heme oxygenase-1, a key enzyme in heme catabolism, and inducible nitric oxide synthase (iNOS) are responsible for production of carbon monoxide and nitric oxide (NO), respectively. Expression of each enzyme has been shown to be modulated by heme and NO, raising a possibility for the coordinated regulation of the two enzymes. We therefore analyzed the expression levels of both mRNA in humans using brain tumors. Either heme oxygenase-1 or iNOS mRNA was expressed at higher levels in brain tumors compared to the brain tissue, but their expression levels were not apparently correlated. In the brain tumor cell lines, treatment with cytokines increased the expression of iNOS mRNA but not heme oxygenase-1 mRNA, whereas treatment with an NO donor increased the expression of heme oxygenase-1 mRNA but not iNOS mRNA. These results suggest the separate regulation of expression of both enzyme mRNA in humans.