廣瀬 雄一

The lateralized efficacy of vagus nerve stimulation (VNS) remains insufficiently explored. We report a case of drug-resistant epilepsy with bilateral frontal lobe seizure onset, treated with left cervical VNS. Preoperative video- electroencephalogram revealed predominant interictal discharges in the right hemisphere and frequent seizures from both hemispheres. Following VNS, overall seizure frequency decreased. Notably, stereo-electroencephalography performed 15 months postoperatively showed a marked reduction in right-sided seizures, while left-sided seizures remained frequent. This case highlights the potential lateralized effect of VNS in a single patient with bilateral frontal lobe epilepsy, suggesting that VNS may preferentially suppress seizures originating from the right hemisphere.

Compared to oligodendrogliomas, astrocytomas may have a relatively higher frequency of intracranial remote recurrence, despite generally favorable prognoses. Previous studies identified 8q gain, particularly in the terminal region, as a poor prognostic factor. This study evaluated MYC expression and its relationship with copy number gain at 8q24.21, in relation to recurrence patterns in astrocytomas, with a particular focus on intracranial remote recurrence. A retrospective analysis was conducted on 27 patients treated between 2006 and 2019. MYC expression was assessed by immunohistochemistry (IHC), and copy number status by metaphase comparative genomic hybridization and next-generation sequencing. Recurrence patterns were categorized as local or remote.Among 43 specimens analyzed by IHC, MYC expression was observed in 72%, with higher positivity in recurrent (80%) than initial (61%) specimens, though the difference was not statistically significant (p = 0.30). Copy number analysis showed a significant increase in 8q24.21 copy number in specimens from cases with remote recurrence compared to those with local recurrence (p = 0.033). However, no significant correlation was found between MYC copy number and protein expression (p = 0.055). These findings suggest that MYC is frequently expressed in astrocytomas, but its expression does not significantly reflect 8q gain or recurrence pattern.

OBJECTIVE: Knowledge of the location of tumor-feeding arteries is necessary for the safe surgery of intracranial meningiomas. Hence, this retrospective study aimed to comprehensively analyze the distribution of tumor-feeding arteries. METHODS: Patients who underwent intracranial meningioma surgery at our institution between 2015 and 2023 were included in this study. The tumor attachment sites and tumor-feeding arteries were evaluated based on the results of preoperative examinations. The tumor attachment sites were classified as non-skull bases (convexity, parasagittal, and falx) or skull bases (anterior skull base, sphenoid ridge, sphenopetroclival, petrous, tentorial, cerebellar convexity, and foramen magnum). These tumors were further subdivided according to their attachment areas. RESULTS: Among the 180 patients included, the tumor-feeding arteries were identified in 177 patients (98.3%). In 67 patients with non-skull base meningiomas, the middle meningeal artery primarily functioned as a tumor-feeding artery in the anterior and middle regions (78 of 108 feeding arteries, 72.2%), while the extracranial artery served as a tumor-feeding artery in the posterior region (20 of 37 feeding arteries, 54.1%). Conversely, skull base meningiomas exhibited a higher frequency of having tumor-feeding arteries derived from the internal carotid artery (132 of 278 feeding arteries; 47.5%); these tumor-feeding arteries are often found at the deepest part of the surgical field during tumor resection and require careful intraoperative handling. CONCLUSIONS: Tumor-feeding arteries originate from different dural arteries depending on the tumor attachment site. These findings could help enhance surgical safety, especially in patients with meningiomas who have not undergone preoperative angiography.

Karnofsky Performance Status (KPS) is a widely used scale to assess performance status. KPS ≥ 50% implies that patients can live at home. Therefore, maintaining KPS ≥ 50% is important to improve the quality of life of patients with glioblastoma, whose median survival is less than 2 years. This study aimed to identify the factors associated with survival time with maintenance of KPS ≥ 50% (survival with KPS ≥ 50%) in patients with glioblastoma, IDH-wildtype. Ninety-eight patients with glioblastomas, IDH-wildtype, who were treated with concomitant radiotherapy (RT) and temozolomide (TMZ) followed by maintenance TMZ therapy, and whose KPS at the start of RT was ≥ 50%, were included. The median survival with KPS ≥ 50% was 13.3 months. In univariate analysis, preoperative KPS (≥ 80%), KPS at the start of RT (≥ 80%), residual tumor size (< 2 cm3), methylated MGMT promotor, and implantation of BCNU wafer were associated with survival with KPS ≥ 50%. In multivariate analysis, KPS at the start of RT (≥ 80%), methylated MGMT promotor, and residual tumor size (< 2 cm3) were significantly associated with increased survival with KPS ≥ 50%. A strategy of maximum possible tumor resection without compromising KPS is desirable to prolong the survival time with KPS ≥ 50%.