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A recent study reported on mutations in the active site of the isocitrate dehydrogenase 1 (IDH1) gene in several types of gliomas. All mutations detected resulted in an amino acid exchange at position 132. We analyzed the genomic region spanning wild‐type R132 of IDH1 by direct sequencing in 125 glial tumors. A total of 39 IDH1 mutations were observed. Mutations of the IDH2 gene, homologous to IDH1, were often detected in gliomas without IDH1 mutations. In the present study, R172 mutation of the IDH2 gene was detected in one anaplastic astrocytoma. IDH1 or IDH2 mutations were frequently in oligodendrogliomas (67%), anaplastic astrocytomas (62%), anaplastic oligoastrocytomas (75%), anaplastic oligodendrogliomas (50%), secondary glioblastomas (67%), gangliogliomas (38%), and anaplastic gangliogliomas (60%). Primary glioblastomas were characterized by a low frequency of mutations (5%) at amino acid position 132 of IDH1. Mutations of the IDH1 or IDH2 genes were significantly associated with improved outcome in patients with anaplastic astrocytomas. Our data suggest that IDH1 or IDH2 mutation plays a role in early tumor progression of several types of glioma and might arise from a common glial precursor. The infrequency of IDH1 mutation in primary glioblastomas revealed that these subtypes are genetically distinct entities from other glial tumors. (Cancer Sci 2009; 100: 1996–1998)

Background Little is known about the difference in the severity of cardioembolic (CE) stroke between patients with paroxysmal atrial fibrillation (PAF) and persistent/permanent AF (PerAF). We assessed stroke severity in patients with CE stroke divided by the type of AF. Methods Three hundred and fifty-eight consecutive patients with CE stroke within 48 h of onset and with a modified Rankin Scale (mRS) score ≤ 1 before onset were studied. We compared basic characteristics, stroke severity, and functional outcome between patients with PAF ( n  = 127) and PerAF ( n  = 231). Results Patients with PerAF were more likely to take oral anticoagulants (OACs) than those with PAF (37% vs. 13%, P  <  0.0001), even though still underuse of OAC in both patients. Regarding stroke severity on admission, patients with PerAF exhibited a tendency toward a higher score on the National Institutes of Health Stroke Scale (NIHSS) compared with patients with PAF (12 [5–20] vs. 9 [4–18]; P  = 0.12). Mortality and mRS score at discharge were higher in the PerAF than in the PAF group (13% vs. 4%; P  = 0.005, and 3 [1–5] vs. 2 [1–4]; P  = 0.01, respectively). Multivariate analyses confirmed that PerAF was a significant determinant of severe stroke (NIHSS score  >  8) on admission (odds ratio [OR] to PAF = 1.80; 95% confidence interval [CI] 1.08–2.98; P  = 0.02) and of an mRS score ≥ 3 at discharge (OR = 2.07; 95% CI 1.24–3.46; P  = 0.006). Patients with PerAF had three times more internal carotid artery occlusion evaluated by magnetic resonance angiography, which indicated a more severe cerebral embolism compared with patients with PAF. Conclusions We found underuse of OAC in high risk AF patients with CE stroke. PerAF is significantly associated with severe stroke on admission and an unfavorable functional outcome at discharge in Japanese patients with CE stroke.

Some cases of aneurysms originating from the fenestrated A1 segment of the anterior cerebral artery (ACA) have been reported, but the pitfalls of the surgical procedure have not been well determined. We herein report 2 cases of a saccular aneurysm arising from the fenestrated A1 segment. Case 1 was a 72-year-old man incidentally diagnosed with an unruptured left ACA aneurysm on magnetic resonance imaging (MRI). Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the left A1 segment. He underwent surgical clipping via the left pterional approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one small fenestrated trunk, preserving the other fenestrated trunk and perforators around the fenestration. Case 2 was a 73-year-old man incidentally diagnosed with an unruptured ACA aneurysm on MRI. Cerebral angiography revealed a saccular aneurysm arising from the proximal end of the fenestrated left A1 segment. He underwent surgical clipping via the interhemispheric approach. The aneurysm originated from the proximal bifurcation of the fenestrated left A1 segment. A fenestrated ring clip was applied to obliterate the aneurysmal neck and one hypoplastic fenestrated trunk, preserving the other fenestrated trunk and perforators around the aneurysm. Detailed intraoperative evaluations of the anatomical structure and hemodynamics around the fenestration are important. The intentional obliteration of a fenestrated trunk and application of fenestrated clips need to be considered in difficult cases in order to expose the aneurysmal neck.

The efficacy of combined serum d -dimer level measurement and Doppler ultrasonography of the lower extremity was investigated for screening of venous thromboembolism (VTE) in patients with neuroepithelial tumor. Eighty-one patients with neuroepithelial tumor were prospectively studied. All patients underwent measurement of serum d -dimer levels and Doppler ultrasonography of the lower extremity. The serum d -dimer level was measured every week, and Doppler ultrasonography was performed two and two weeks after surgery, then every two weeks until discharge, or every two weeks for patients who did not undergo surgery. If the serum d -dimer level increased over 10.0 μg/ml, Doppler ultrasonography or computed tomography was performed to detect VTE. VTE occurred in 12 (14.8%) patients (seven males and five females; age 34–75, mean 59.0 years). Only one patient was symptomatic, whereas 11 patients identified by the screening were without symptoms. Five patients were treated with anticoagulant therapy, one with prophylactic inferior vena cava filter placement with anticoagulant therapy, and the other six were closely followed up without medication. No patient died of pulmonary embolism. Serial Doppler ultrasonography showed thrombus regression or organization and no thrombus extension. The maximum serum d -dimer value was significantly higher in patients with VTE than in those without VTE (mean 14.5 vs. 3.46 μg/ml, P  < 0.001). The d -dimer cutoff value of 5.4 μg/ml could be used to identify VTE with 83% sensitivity and 84% specificity. The combination of sequential serum d -dimer measurement and Doppler ultrasonography of the lower extremity is an efficient and non-invasive procedure for identifying asymptomatic VTE in patients with neuroepithelial tumor.

We report a rare case of a dumbbell-shaped mesenchymal chondrosarcoma (MCS) in the lumbar canal. A 29-year-old man presented with lower back pain and pain in the left leg. Magnetic resonance imaging (MRI) showed a homogeneously enhanced dumbbell-shaped mass at the left L2-3 level. The mass was intradurally located and extended extradurally into the extraforaminal space through the left L2-3 intervertebral foramen. Computed tomography (CT) showed a calcified portion in the intradural mass. We exposed and excised the tumor via a posterior approach through a hemi-laminectomy of the left L2-3. The tumor had penetrated the dura mater and required repair. Following surgery, his symptoms resolved completely. The most likely histopathological diagnosis was MCS. Histologic examination of our surgical samples revealed the typical biphasic pattern, but there was also cartilage matrix resembling osteoid. Finally, molecular assays confirmed the presence of the HEY1::NCOA2 fusion gene. Although spinal intradural extramedullary MCS is rare, only a few reports in the literature mention spinal dumbbell-shaped MCS. Following the removal of dumbbell-shaped MCS, the dura mater may require repair. While histopathological evaluation remains the gold standard for confirming a diagnosis of MCS, the HEY1::NCOA2 fusion gene is a specific molecular marker for MCS, and the presence of this gene has become a powerful tool for diagnosis.

This case report describes a novel cranioplasty technique using calcium phosphate paste. The patient was a man in his 50s with a convexity meningioma with skull invasion extending to the diploic layer. Craniotomy was performed, and the area of skull invasion was removed. Afterward, the skull defect was filled with calcium phosphate bone paste to maximize bone strength. To prevent the bone paste from falling off postoperatively, the area of skull invasion was removed more widely from the diploic plate side than from the inner side. This method may be a useful option for strengthening the skull in cases of cranioplasty for meningiomas with skull invasion.

An aberrant right subclavian artery (ARSA) is a rare variant of the normal aortic arch anatomy. Right transradial carotid artery cannulation is extremely challenging in patients with ARSA. Herein, we present a case of a right falcine meningioma with an ARSA that was successfully accessed with a 3-French Simmons guiding sheath via the left transradial approach. Additionally, preoperative embolization of the feeding middle meningeal artery (MMA) was performed. Here, we report our surgical technique. An 80-year-old woman was diagnosed with a right falcine meningioma with ARSA. The meningioma exhibited tumor staining in the parietal branch of the left MMA. We planned a preoperative MMA embolization via the left radial artery. After the 3-French Simmons guiding sheath was engaged in the left common carotid artery (CCA) using the pull-back technique, a triaxial system (3-French Simmons guiding sheath/3.2-French distal access catheter/microcatheter) was implemented. The 3-French guiding sheath to the left CCA was successfully achieved using the pull-back technique. Distal access catheter guidance to the proximal left MMA was successfully achieved without catheter kinking or systemic instability. However, guiding the microcatheter beyond the pterional segment of the left MMA parietal branch because of the severe curvature and tortuosity of the vessel was difficult. Thus, embolization with liquid and particulate embolic materials was abandoned, and tumor flow reduction was performed using coil embolization of the MMA. Three days after the neurointervention, craniotomy tumor removal was successfully performed achieving near-total resection of the tumor. Thereafter, no radial artery occlusion was observed at the puncture site. The patient was discharged from our hospital two weeks after craniotomy surgery. The left transradial artery approach using a 3-French Simmons guiding sheath is useful for left carotid artery cannulation in patients with ARSA.

Intracerebral hematomas (ICHs) can complicate ruptured cerebral aneurysms. The standard approach for these cases has traditionally involved craniotomy with clipping and hematoma evacuation. Recently, however, a combination of coil embolization and neuroendoscopic hematoma removal has shown promise. We report a case of a ruptured internal carotid artery aneurysm with ICH successfully treated using coil embolization and neuroendoscopic hematoma removal under intravenous sedation. A woman in her late 70s presented to our hospital with severe consciousness disturbance and was diagnosed with subarachnoid hemorrhage (SAH) and an intratemporal hematoma caused by a ruptured aneurysm at the left internal carotid-posterior communicating artery bifurcation. Her condition was complicated by low cardiac output and hypotension due to Takotsubo cardiomyopathy, making general anesthesia unfeasible. Coil embolization was performed the same day under local sedation with dexmedetomidine hydrochloride. The next day, we used a neuroendoscope to evacuate the intratemporal hematoma under local anesthesia. Despite the severity of the SAH, the patient survived and was later transferred to a long-term care hospital. This approach appears effective for patients with ruptured cerebral aneurysms and ICH who are not suitable candidates for general anesthesia.

Beginning in April 2024, work-style reforms were implemented for doctors. We analyzed the changes in our medical practice resulting from the assignment of a designated care nurse, called nursing designated care (NDC), to the Department of Neurosurgery, in line with work-style reforms. This study aimed to evaluate whether introducing an NDC into a neurosurgical department could redistribute perioperative tasks and improve workflow efficiency in subarachnoid hemorrhage (SAH) management under Japan's physician work-style reforms. We compared medical care over a one-year period from April 2022, when our department had three neurosurgeons, and over a one-year period from April 2023, under a new system in a four-member team consisting of three neurosurgeons and one NDC. The target disease was a SAH. We compared medical care from initial treatment in the emergency room (ER) to the operating room, medical care from leaving the operating room to postoperative management after returning to the intensive care unit, and management of the cerebral vasospasm phase. Some of the work that had been performed by the neurosurgeons was taken over by the NDC, and the duties of the neurosurgeons were shared. Clinical intervention by the NDC in the ER for patients with SAH may contribute to shortening the treatment time from the start of treatment in the ER to admission in the operating room. In the management of the cerebral vasospasm phase, the NDC was able to intervene with multiple specified acts, and the neurosurgeon's duties were shared. We introduced our department's current treatment methods in line with the work-style reforms for doctors. Through collaboration with the NDC, it may be possible to divide work in line with the work-style reforms for neurosurgeons.

Deci-hertz Interferometer Gravitational Wave Observatory (DECIGO) is the future Japanese space mission with a frequency band of 0.1 Hz to 10 Hz. DECIGO aims at the detection of primordial gravitational waves, which could be produced during the inflationary period right after the birth of the universe. There are many other scientific objectives of DECIGO, including the direct measurement of the acceleration of the expansion of the universe, and reliable and accurate predictions of the timing and locations of neutron star/black hole binary coalescences. DECIGO consists of four clusters of observatories placed in the heliocentric orbit. Each cluster consists of three spacecraft, which form three Fabry-Perot Michelson interferometers with an arm length of 1,000 km. Three clusters of DECIGO will be placed far from each other, and the fourth cluster will be placed in the same position as one of the three clusters to obtain the correlation signals for the detection of the primordial gravitational waves. We plan to launch B-DECIGO, which is a scientific pathfinder of DECIGO, before DECIGO in the 2030s to demonstrate the technologies required for DECIGO, as well as to obtain fruitful scientific results to further expand the multi-messenger astronomy.