Neurological Surgery最新文献_第4页

[Novel Treatment for Primary Central Nervous System Lymphoma]. [原发性中枢神经系统淋巴瘤的新疗法]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040802

Nobuyoshi Sasaki

{"title":"[Novel Treatment for Primary Central Nervous System Lymphoma].","authors":"Nobuyoshi Sasaki","doi":"10.11477/mf.030126030540040802","DOIUrl":"10.11477/mf.030126030540040802","url":null,"abstract":"Primary central nervous system lymphoma (PCNSL) is a form of aggressive extranodal lymphoma confined to the central nervous system. Outcomes have substantially improved thanks to the introduction of high-dose methotrexate-based induction chemotherapy and consolidation strategies (including autologous stem cell transplantation); however, therapeutic challenges remain, particularly in elderly patients and those with relapsed or refractory disease. Recent genomic studies have indicates that PCNSL is characterized by frequent MYD88 and CD79B mutations, resulting in constitutive activation of the B-cell receptor and NF-κB signaling pathways, concurrent with an immunosuppressive tumor microenvironment. These insights provide a rationale for the development of targeted therapies and immunotherapies. Bruton's tyrosine kinase inhibitors and immunomodulatory drugs have shown promising activity in both relapsed and frontline settings, and are currently being evaluated in combination with maintenance strategies. CD19-directed chimeric antigen receptor T-cell therapy and CD20×CD3 bispecific antibodies have also emerged as potential therapeutic options for relapsed/refractory PCNSL, with encouraging efficacy and manageable toxicity profiles. This review summarizes the molecular pathogenesis of PCNSL, current standard treatments, and recent advances in targeted therapies and immunotherapeutic strategies that could improve treatment outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"802-810"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765404","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}

引用次数: 0

[Genomic and Epigenomic Research on Brain Tumors]. [脑肿瘤的基因组和表观基因组研究]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040864

Masashi Nomura

引用次数: 0

[Surgical Management of Glioblastoma:Evolving with Advances in Surgical Support Technologies]. 胶质母细胞瘤的外科治疗：随着手术支持技术的进步而发展。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040726

Kuniaki Saito

{"title":"[Surgical Management of Glioblastoma:Evolving with Advances in Surgical Support Technologies].","authors":"Kuniaki Saito","doi":"10.11477/mf.030126030540040726","DOIUrl":"https://doi.org/10.11477/mf.030126030540040726","url":null,"abstract":"Glioblastoma is the most common and aggressive primary brain tumor. Despite advances in multimodal treatment, including surgery, radiotherapy, and temozolomide-based chemotherapy, the prognosis remains poor. Surgical resection plays a central role in glioblastoma management, with the primary objective of achieving maximal safe resection by maximizing tumor removal while preserving neurological function. Recent advances in surgical support technologies have substantially improved the safety and efficacy of glioblastoma surgery. Neuronavigation, tractography, intraoperative neurophysiological monitoring, awake mapping, and 5-aminolevulinic acid fluorescence-guided surgery enable surgeons to accurately visualize tumor boundaries and critical functional structures. Furthermore, emerging technologies, including augmented reality, image enhancement systems, and rapid intraoperative molecular diagnostics, provide additional anatomical and biological information that may facilitate precise surgical decision-making. This review summarizes the principles of glioblastoma surgery and discusses the recent innovations in surgical support technologies. The integration of anatomical, functional, vascular, and molecular information is transforming glioblastoma surgery into a more sophisticated form of information-guided surgery, with the goal of improving both oncological and functional outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"726-736"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766522","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}

引用次数: 0

[Treatment of CNS Germ Cell Tumors]. [中枢神经系统生殖细胞肿瘤的治疗]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040789

Hirokazu Takami

{"title":"[Treatment of CNS Germ Cell Tumors].","authors":"Hirokazu Takami","doi":"10.11477/mf.030126030540040789","DOIUrl":"10.11477/mf.030126030540040789","url":null,"abstract":"Central nervous system (CNS) germ cell tumors (GCTs) are rare neoplasms that predominantly affect adolescents and young adults and occur at a notably higher incidence in East Asian populations. They are classified into two major categories: germinomas and non-germinomatous GCTs (NGGCTs). Germinomas are highly radiosensitive and chemosensitive, with long-term survival rates exceeding 90% following combined chemoradiotherapy. Current therapeutic focus on reducing radiation exposure, particularly whole-ventricular irradiation, while maintaining excellent tumor control, as exemplified by the ongoing CNSGCT2021 trial in Japan. In contrast, NGGCTs require intensified multimodal treatment incorporating alkylating-agent-based chemotherapy and craniospinal irradiation, and second-look surgery for residual disease. Despite these advances, outcomes for relapsed NGGCTs remain poor, underscoring the urgent need for novel therapeutic approaches. Recent genomic studies have identified recurrent activating mutations in the KIT/RAS/MAPK and PI3K/AKT/mTOR pathways, particularly in germinomas, providing potential targets for precision oncology approaches. The germinoma tumor microenvironment is characterized by abundant immune infiltration and PD-L1 expression, which has generated interest in immune checkpoint inhibitors. Additionally, liquid biopsy biomarkers, including circulating tumor DNA and microRNAs, show promise for less invasive diagnosis and disease monitoring. Long-term follow-up remains essential, given the risk of late relapse beyond 10 years and accumulation of treatment-related complications over decades.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"789-800"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762787","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}

引用次数: 0

[Translational Research in Brain Tumors:Development towards Integrated Precision Medicine]. [脑肿瘤转化研究：向整合精准医学发展]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040872

Kensuke Tateishi

{"title":"[Translational Research in Brain Tumors:Development towards Integrated Precision Medicine].","authors":"Kensuke Tateishi","doi":"10.11477/mf.030126030540040872","DOIUrl":"10.11477/mf.030126030540040872","url":null,"abstract":"Translational research on malignant brain tumors provide a bidirectional framework that links basic science with clinical practice to advance precision medicine. Despite progress in surgery, radiotherapy, chemotherapy, and molecular classification, outcomes remain poor, particularly for diffuse high-grade gliomas, because of treatment resistance, intratumoral heterogeneity, and the limited clinical implementation of molecular insights. Recent advances have highlighted the value of integrating intraoperative molecular diagnostics, molecular imaging, and patient-derived models into a unified translational platform. Rapid intraoperative assessment of key molecular alterations can support real-time surgical and therapeutic decision-making. Molecular imaging, including amino acid and hypoxia PET, enables the noninvasive evaluation of tumor biology and spatial heterogeneity. Patient-derived xenograft models and primary cultured cells retain tumor-specific molecular and phenotypic characteristics, enabling functional analyses of drug sensitivity, resistance mechanisms, and potential therapeutic strategies. Together, these approaches establish a multidimensional precision-medicine framework that integrates temporal, spatial, and functional information. Continued progress will require progress close collaboration across medicine, basic science, and data science, supported by systems that efficiently translate research findings back into clinical care. This integrated strategy is poised to accelerate the development of more effective personalized therapies for malignant brain tumors.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"872-878"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765495","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}

引用次数: 0

[Meningioma Management in the Era of Molecular Classification:From Risk Stratification to Personalized Treatment]. [分子分类时代的脑膜瘤管理：从风险分层到个性化治疗]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040833

Satoru Miyawaki, Daisuke Sato, Yu Sakai, Nobuhito Saito

{"title":"[Meningioma Management in the Era of Molecular Classification:From Risk Stratification to Personalized Treatment].","authors":"Satoru Miyawaki, Daisuke Sato, Yu Sakai, Nobuhito Saito","doi":"10.11477/mf.030126030540040833","DOIUrl":"https://doi.org/10.11477/mf.030126030540040833","url":null,"abstract":"Meningiomas have traditionally been classified and treated according to histopathological grade and extent of resection. However, recent advances in molecular biology have revealed that histology alone does not fully explain the clinical behavior of these tumors. The 2021 World Health Organization classification introduced molecular criteria for meningioma grading, including CDKN2A/B homozygous deletion and TERT promoter mutation as defining features of grade 3 disease. In parallel, large-scale multi-omics studies integrating genomic, epigenomic, and transcriptomic data have established biologically and clinically meaningful molecular subgroups. These findings indicate that copy number alterations, including 22q loss, 1p loss, and 1q gain, may provide practical markers for risk stratification in daily practice. Molecular profiling is also beginning to refine therapeutic decision-making, including the role of surgery, radiotherapy, and systemic treatment. Emerging approaches such as molecular targeted therapy, radioligand therapy, immune checkpoint inhibition, and CDK pathway inhibition suggest a transition from conventional grade-based management toward precision medicine. This review summarizes recent progress in the molecular classification and personalized treatment of meningiomas.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"833-842"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762943","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}

引用次数: 0

[Drug Therapy for Glioblastoma:Standard and Novel Treatments]. [胶质母细胞瘤的药物治疗：标准和新疗法]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040737

Yoshihiro Otani, Shuichiro Hirano, Joji Ishida, Shota Tanaka

引用次数: 0

[Recent Advances in the Classification and Treatment of Pediatric Gliomas]. 小儿胶质瘤的分类与治疗进展

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040755

Keita Terashima

{"title":"[Recent Advances in the Classification and Treatment of Pediatric Gliomas].","authors":"Keita Terashima","doi":"10.11477/mf.030126030540040755","DOIUrl":"10.11477/mf.030126030540040755","url":null,"abstract":"Pediatric gliomas constitute the largest group of pediatric brain tumors and are biologically distinct from adult gliomas. The 2021 fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5) introduced a molecularly integrated classification system and recognized pediatric-type gliomas as distinct entities. In pediatric low-grade gliomas, activation of the MAPK pathway is a common molecular hallmark, with BRAF V600E mutations, BRAF fusions, FGFR1 alterations, and NF1-associated abnormalities representing major driver events. These discoveries have supported the development of targeted therapies, including dabrafenib plus trametinib, tovorafenib, and MEK inhibitors. In pediatric high-grade gliomas, diffuse midline glioma, H3 K27-altered, remains one of the most devastating tumors, although recent advances have led to the approval of dordaviprone in the United States. In addition, infant-type hemispheric gliomas frequently harbor NTRK, ROS1, or ALK fusions and may respond markedly to corresponding targeted therapies. Comprehensive molecular diagnostics have therefore become essential for accurate classification and treatment selection. This review summarizes the current WHO CNS5 classification of pediatric gliomas and highlights recent advances in molecularly guided therapeutic strategies.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"755-763"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763507","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}

引用次数: 0

[The Next Frontier of Medical AI in Brain Tumor Care:From Prediction to Trust]. [医疗人工智能在脑肿瘤治疗中的下一个前沿：从预测到信任]。

Neurological Surgery Pub Date : 2026-07-01 DOI: 10.11477/mf.030126030540040879

Satoshi Takahashi, Nobuji Kouno, Hirokazu Takami, Masamichi Takahashi, Ryuji Hamamoto

{"title":"[The Next Frontier of Medical AI in Brain Tumor Care:From Prediction to Trust].","authors":"Satoshi Takahashi, Nobuji Kouno, Hirokazu Takami, Masamichi Takahashi, Ryuji Hamamoto","doi":"10.11477/mf.030126030540040879","DOIUrl":"10.11477/mf.030126030540040879","url":null,"abstract":"Artificial intelligence (AI) is rapidly reshaping the diagnosis and treatment of malignant brain tumors. Within the molecularly defined 2021 World Health Organization (WHO) framework, deep learning now supports several tasks: noninvasive, rapid prediction of molecular alterations from MRI and intraoperative optical imaging (radiogenomics); integrated interpretation of histology and genomics for prognosis; and accelerated treatment development through pathology foundation models, drug discovery, and large language model-based clinical trial matching and decision support. Across these advances, one recurring obstacle remains: distribution shift, or domain shift. Models whose performance depends on the provenance of their training data often perform less well at external institutions, and high discriminatory performance, as measured by the receiver operating characteristic area under the curve (ROC AUC), does not guarantee clinical reliability. We illustrate this issue through our study of IDH mutation prediction, which compared convolutional and transformer models with physicians using an international dataset and a Japanese cohort. External discrimination remained moderate, yet probability calibration deteriorated, whereas experienced clinicians maintained better calibration. We argue that the next frontier is not higher point-estimate accuracy but trustworthy AI: models that express well-calibrated uncertainty, abstain or defer in ambiguous cases, and request additional data within a human-in-the-loop workflow. Brain tumor care must move from prediction to trust.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 4","pages":"879-888"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765296","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}

引用次数: 0

[A Practical Approach to Quality of Life and Higher Brain Function Assessment in Neurosurgical Practice]. [神经外科实践中生活质量和高级脑功能评估的实用方法]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030502

Yoshiko Okita

{"title":"[A Practical Approach to Quality of Life and Higher Brain Function Assessment in Neurosurgical Practice].","authors":"Yoshiko Okita","doi":"10.11477/mf.030126030540030502","DOIUrl":"https://doi.org/10.11477/mf.030126030540030502","url":null,"abstract":"Advances in neurosurgical techniques and perioperative management have improved survival and neurological outcomes in several neurosurgical diseases. Nonetheless, even when objective functional scales, such as the modified Rankin Scale or Karnofsky Performance Status, indicate favorable outcomes, patients may experience persistent impairments in quality of life (QOL) and higher brain function, affecting daily activities, social participation, and treatment satisfaction. Conventional neurological examinations and imaging often fail to capture subtle cognitive, emotional, and psychosocial difficulties. Moreover, patient-reported outcomes and health-related QOL assessments provide a complementary perspective that reflects patients'subjective experiences, including fatigue, attention deficits, anxiety, and depressive symptoms. This review outlines a practical framework for incorporating QOL and higher brain function assessments into routine neurosurgical practice. Appropriate timing for preoperative and postoperative evaluations, commonly used general and disease-specific QOL instruments, and brief cognitive screening tools applicable in busy clinical settings are discussed. Notably, emphasis is placed on stepwise assessment strategies and multidisciplinary collaboration due to limited manpower. Integrating objective functional measures with patient-centered QOL evaluations enables a more comprehensive understanding of treatment outcomes and supports individualized clinical decision-making aimed at optimizing long-term patient well-being.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"502-507"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139201","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}

引用次数: 0