Primary central nervous system lymphoma(PCNSL)develops more often in the elderly population. Its incidence has been increasing in recent years and it is accounting for 4.9% of brain tumors. Most PCNSLs are histologically classified as diffuse large B‒cell lymphomas. Among these, CD10 positivity is lower and MUM1 positivity is higher in PCNSL than in non‒PCNSL, which results in higher dominance of the non‒ germinal‒center B‒cell‒like type in PCNSLs. The frequency of mutations in MYD88 and CD79B genes is higher in PCNSL than in non‒PCNSL, which leads to the activation of the B‒cell‒receptor signaling pathway. Bruton’s tyrosine kinase(BTK)is a key molecule in the B‒cell‒receptor signaling pathway. Therefore, it is a potential molecular target for the treatment of PCNSL. Tirabrutinib, a second‒generation BTK inhibitor, has been developed and approved in Japan for the treatment of recurrent or refractory PCNSL. Current challenges include increasing the intensity of chemotherapy while reducing the dose or avoidance of whole‒brain radiotherapy(WBRT), as brain damage and late effects, including leukoencephalopathy, are not negligible not only in elderly patients but also in young patients. In Japan, the combination of rituximab, high‒dose methotrexate, procarbazine, and vincristine, the so‒called R‒MPV therapy, is being recognized as a new standard induction chemotherapy. R‒MPV therapy followed by reduced‒dose WBRT and high‒dose cytarabine is well tolerated and shows better outcomes than the previous standard high‒dose methotrexate therapy followed by WBRT. High‒dose chemotherapy with autologous peripheral blood stem cell transplantation in young patients and appropriate treatment selection at the time of recurrence are essential for further improvement of treatment outcomes. (Received July 15, 2021;accepted August 4, 2021)
{"title":"Primary Central Nervous System Lymphoma : An Update","authors":"F. Yamasaki","doi":"10.7887/jcns.31.20","DOIUrl":"https://doi.org/10.7887/jcns.31.20","url":null,"abstract":"Primary central nervous system lymphoma(PCNSL)develops more often in the elderly population. Its incidence has been increasing in recent years and it is accounting for 4.9% of brain tumors. Most PCNSLs are histologically classified as diffuse large B‒cell lymphomas. Among these, CD10 positivity is lower and MUM1 positivity is higher in PCNSL than in non‒PCNSL, which results in higher dominance of the non‒ germinal‒center B‒cell‒like type in PCNSLs. The frequency of mutations in MYD88 and CD79B genes is higher in PCNSL than in non‒PCNSL, which leads to the activation of the B‒cell‒receptor signaling pathway. Bruton’s tyrosine kinase(BTK)is a key molecule in the B‒cell‒receptor signaling pathway. Therefore, it is a potential molecular target for the treatment of PCNSL. Tirabrutinib, a second‒generation BTK inhibitor, has been developed and approved in Japan for the treatment of recurrent or refractory PCNSL. Current challenges include increasing the intensity of chemotherapy while reducing the dose or avoidance of whole‒brain radiotherapy(WBRT), as brain damage and late effects, including leukoencephalopathy, are not negligible not only in elderly patients but also in young patients. In Japan, the combination of rituximab, high‒dose methotrexate, procarbazine, and vincristine, the so‒called R‒MPV therapy, is being recognized as a new standard induction chemotherapy. R‒MPV therapy followed by reduced‒dose WBRT and high‒dose cytarabine is well tolerated and shows better outcomes than the previous standard high‒dose methotrexate therapy followed by WBRT. High‒dose chemotherapy with autologous peripheral blood stem cell transplantation in young patients and appropriate treatment selection at the time of recurrence are essential for further improvement of treatment outcomes. (Received July 15, 2021;accepted August 4, 2021)","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prenatal surgery for fetal myelomeningocele （ MMC ） repair has become more common since publication of the Management of Myelomeningocele Study （ MOMS ） in 2011. Treatment guidelines published by the Congress of Neurological Surgeons in 2019 recommend prenatal MMC repair when possible. However, this is not practical in Japan as fetal surgery research here has just begun. Therefore, the academic research group of the Japanese Society for Pediatric Neurosurgery （ JSPN ） has established a subcommittee to develop guidelines for MMC treatment that focus on postnatal repair and care of the MMC patient. Important issues to be addressed include prenatal MMC diagnosis, diagnosis of tethered spinal cord, timing and method of surgery for tethered cord, and treatment of late complications. Collaboration with obstetri-cians, pediatric urologists, pediatric orthopedic surgeons, and pediatricians will be essential. The initial JSPN guidelines will review and discuss issues specific to neurosurgery in newborns and infants and are currently being developed in accordance with the Medical Information Network Distribution Service （ MINDS ） Manual for Clinical Practice Guideline Development of the Japan Council for Quality Health Care.
{"title":"Guidelines of the Japanese Society for Pediatric Neurosurgery for Treatment of Myelomeningocele","authors":"A. Gomi, M. Nonaka","doi":"10.7887/jcns.31.212","DOIUrl":"https://doi.org/10.7887/jcns.31.212","url":null,"abstract":"Prenatal surgery for fetal myelomeningocele （ MMC ） repair has become more common since publication of the Management of Myelomeningocele Study （ MOMS ） in 2011. Treatment guidelines published by the Congress of Neurological Surgeons in 2019 recommend prenatal MMC repair when possible. However, this is not practical in Japan as fetal surgery research here has just begun. Therefore, the academic research group of the Japanese Society for Pediatric Neurosurgery （ JSPN ） has established a subcommittee to develop guidelines for MMC treatment that focus on postnatal repair and care of the MMC patient. Important issues to be addressed include prenatal MMC diagnosis, diagnosis of tethered spinal cord, timing and method of surgery for tethered cord, and treatment of late complications. Collaboration with obstetri-cians, pediatric urologists, pediatric orthopedic surgeons, and pediatricians will be essential. The initial JSPN guidelines will review and discuss issues specific to neurosurgery in newborns and infants and are currently being developed in accordance with the Medical Information Network Distribution Service （ MINDS ） Manual for Clinical Practice Guideline Development of the Japan Council for Quality Health Care.","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Revascularization by Carotid Endarterectomy in the Case of Common Carotid Artery Occlusion","authors":"Katsuhiro Yamashita, Y. Soejima","doi":"10.7887/jcns.31.594","DOIUrl":"https://doi.org/10.7887/jcns.31.594","url":null,"abstract":"","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
and choroid plexus coagulation, which are frequently indicated in low ‒ and middle ‒ income countries to avoid cerebral spinal fluid shunt. A unique holder for a rigid endoscope with a passive robotic arm system has been designed in collaboration with neurosurgeons and Japanese companies. This enables the surgeons to effortlessly release and fix the scope with nitrogen gas pres-sure. Currently, it is widely used for keyhole and skull base surgeries in foreign countries. Second, transparent sheath is a simple and world ‒ famous device. This sheath transformed the hematoma removal surgery into an endoscope solo procedure in Japan. The procedure has been disseminated worldwide and applied to the biopsy or excision of intraparenchymal lesions. Finally, the novel concept of cylinder neurosurgery was developed. Along with the development of equipment and techniques, the first certified system for neuroendoscopy was established in Japan. Some training courses using simulation models were designed simultane-ously to standardize basic procedures and guarantee safety. This serves as a useful reference for education and training in foreign countries. Pioneers in Japan encouraged ‘ glocalization ’ of some equipments and techniques ridiculed as Galápagos syndrome. Next generation should take pride in this history and continue best original inventions.
{"title":"Glocalization of Neuroendoscopic Surgery in Japan","authors":"K. Nishiyama","doi":"10.7887/jcns.31.618","DOIUrl":"https://doi.org/10.7887/jcns.31.618","url":null,"abstract":"and choroid plexus coagulation, which are frequently indicated in low ‒ and middle ‒ income countries to avoid cerebral spinal fluid shunt. A unique holder for a rigid endoscope with a passive robotic arm system has been designed in collaboration with neurosurgeons and Japanese companies. This enables the surgeons to effortlessly release and fix the scope with nitrogen gas pres-sure. Currently, it is widely used for keyhole and skull base surgeries in foreign countries. Second, transparent sheath is a simple and world ‒ famous device. This sheath transformed the hematoma removal surgery into an endoscope solo procedure in Japan. The procedure has been disseminated worldwide and applied to the biopsy or excision of intraparenchymal lesions. Finally, the novel concept of cylinder neurosurgery was developed. Along with the development of equipment and techniques, the first certified system for neuroendoscopy was established in Japan. Some training courses using simulation models were designed simultane-ously to standardize basic procedures and guarantee safety. This serves as a useful reference for education and training in foreign countries. Pioneers in Japan encouraged ‘ glocalization ’ of some equipments and techniques ridiculed as Galápagos syndrome. Next generation should take pride in this history and continue best original inventions.","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Subcortical Hemorrhage due to Cerebral Venous Sinus Thrombosis with Multiple Thrombotic Risks : A Case Report","authors":"Keita Matsuoka, Shota Nishimoto, Takahito Nakajou","doi":"10.7887/jcns.31.720","DOIUrl":"https://doi.org/10.7887/jcns.31.720","url":null,"abstract":"","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Nakada, M. Kinoshita, Riho Nakajima, H. Shinohara
{"title":"Role of White Matter Fiber Anatomy in Preservation of Higher Cognitive Function during Neurosurgery","authors":"M. Nakada, M. Kinoshita, Riho Nakajima, H. Shinohara","doi":"10.7887/jcns.31.356","DOIUrl":"https://doi.org/10.7887/jcns.31.356","url":null,"abstract":"","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vascular Anatomy of Anterior Communicating Artery Complex for Microsurgery","authors":"T. Horiuchi","doi":"10.7887/jcns.31.378","DOIUrl":"https://doi.org/10.7887/jcns.31.378","url":null,"abstract":"","PeriodicalId":39918,"journal":{"name":"Japanese Journal of Neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71348135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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