Kohei Suzuki

Background: Delayed cerebrovascular complications after radiotherapy have been well-documented. However, optimal management of acute ischemic stroke secondary to radiation-induced intracranial arterial stenosis remains unclear. Case Description: A 17-year-old girl developed an acute ischemic stroke secondary to delayed middle cerebral artery stenosis following radiotherapy for recurrent craniopharyngioma after tumor resection. Intravenous alteplase (rt-PA) was administered 4 h after symptom onset, resulting in neurological improvement, and she was discharged with a modified Rankin Scale score of 0. Conclusion: This case suggests that rt-PA may be an effective treatment option for acute ischemic stroke associated with post-radiotherapy arterial stenosis, provided that the standard eligibility criteria are met.

本研究では，悪性リンパ腫細胞株（Raji, HKBML, TK）を用いて，通常酸素および5% O2低酸素環境下における5-アミノレブリン酸（aminolevulinic acid: ALA）誘導プロトポルフィリンIX（protoporphyrin IX: PpIX）の蓄積と5-ALA放射線力学療法（radiodynamic therapy: RDT）の効果を検討した．いずれの細胞株でも5-ALA処理によりPpIXが細胞質に集積し，5-ALA/RDTは酸素条件に関わらず生存率を低下させた．放射線照射後には遅発性ROS産生の増強がみられ，特にミトコンドリア密度の高いRaji細胞株で顕著であった．この結果から，5-ALA/RDTではPpIX蓄積とそれに続くROS産生およびその伝播は重要な役割を果たしていることが示唆される．5-ALA/RDTは，低酸素環境下での放射線抵抗性を克服する可能性があり，中枢神経系原発悪性リンパ腫に対する新規治療戦略となり得る．

BACKGROUND: The craniopharyngeal canal (CPC) is a rare developmental remnant of Rathke’s pouch and is occasionally associated with Rathke’s cleft cysts (RCCs) and ectopic pituitary tissue. Although embryological and radiological studies have proposed a developmental continuum among these entities, pathological characterization of residual pituitary tissue within CPC remnants in adult patients remains limited. OBSERVATIONS: A 40-year-old woman presented with visual field impairment secondary to suprasellar RCC. Endoscopic endonasal surgery revealed a bony canal extending through the sphenoid sinus from the sellar floor to the posterior pharyngeal wall, consistent with a persistent CPC. Histologically, the canal tissue contained nests of adenohypophyseal cells within a fibromuscular stroma. Immunohistochemical analysis expressed pituitary lineage–specific transcription factors, including PIT-1, with focal SF-1 and T-Pit positivity, which indicate multiple adenohypophyseal lineages. Intraoperative observations of the cystic cavity revealed a dimple-like structure at the corresponding anatomical site. LESSONS: This case demonstrates that pituitary tissue may persist within a type 1 CPC on imaging. Moreover, residual adenohypophyseal cells within the canal can exhibit multiple lineage-specific transcription factor profiles, supporting a spectrum of developmental arrest in Rathke’s pouch remnants. https://thejns.org/doi/10.3171/CASE25671

BACKGROUND: Optic pathway–hypothalamic glioma (OPHG) typically presents as a suprasellar lesion, and posterior fossa involvement, such as tonsillar herniation or syringomyelia, is extremely rare. The underlying mechanism and optimal surgical strategy for such cases remain unclear. OBSERVATIONS: A teenage patient with a history of partial tumor resection and ventriculoperitoneal shunt placement presented with tumor regrowth extending into the basal cistern, resulting in marked narrowing of the prepontine cistern, secondary brainstem displacement, tonsillar herniation, and syringomyelia. Extended endoscopic endonasal transplanum-transtuberculum surgery was performed to decompress the suprasellar and basal cisterns of the brain. Postoperatively, adequate tumor debulking was achieved with preservation of the optic apparatus and pituitary structures. Brainstem compression was relieved, and syringomyelia showed marked improvement without new neurological deficits. LESSONS: OPHG can cause Chiari-like pathophysiology by obstructing CSF pathways at the suprasellar and basal cistern levels. Extended endoscopic endonasal surgery provides a safe, minimally invasive route for direct ventral decompression, restoration of CSF dynamics, and effective management of selected OPHG with posterior fossa manifestations. https://thejns.org/doi/10.3171/CASE2623

Optic pathway–hypothalamic glioma (OPHG) typically presents as a suprasellar lesion, and posterior fossa involvement, such as tonsillar herniation or syringomyelia, is extremely rare. The underlying mechanism and optimal surgical strategy for such cases remain unclear. A teenage patient with a history of partial tumor resection and ventriculoperitoneal shunt placement presented with tumor regrowth extending into the basal cistern, resulting in marked narrowing of the prepontine cistern, secondary brainstem displacement, tonsillar herniation, and syringomyelia. Extended endoscopic endonasal transplanum-transtuberculum surgery was performed to decompress the suprasellar and basal cisterns of the brain. Postoperatively, adequate tumor debulking was achieved with preservation of the optic apparatus and pituitary structures. Brainstem compression was relieved, and syringomyelia showed marked improvement without new neurological deficits. OPHG can cause Chiari-like pathophysiology by obstructing CSF pathways at the suprasellar and basal cistern levels. Extended endoscopic endonasal surgery provides a safe, minimally invasive route for direct ventral decompression, restoration of CSF dynamics, and effective management of selected OPHG with posterior fossa manifestations. https://thejns.org/doi/10.3171/CASE2623

Talaporfin sodium (mono-L-aspartyl chlorin e6; NPe6), a second-generation photosensitizer, is clinically used in photodynamic therapy (PDT). It accumulates preferentially in tumors and exhibits deep tissue penetration, rapid systemic clearance, and minimal photosensitivity. However, treatment of deep-seated malignancies remains challenging. Here, we demonstrate that talaporfin sodium undergoes physicochemical reactions with X-rays to generate reactive oxygen species, a mechanism analogous to that of 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX in radiodynamic therapy (RDT). To evaluate its therapeutic efficacy, we employed a pancreatic cancer xenograft model using MIA PaCa-2 cells in mice. Talaporfin sodium was administered intravenously 2 h before X-ray exposure, followed by fractionated X-ray irradiation (3 Gy daily for 3 consecutive days). Talaporfin-mediated RDT significantly inhibited tumor growth compared with radiation therapy alone. Furthermore, an exploratory RNA-seq analysis of xenografts revealed transcriptional signatures of stress and immune activation, suggesting that talaporfin-mediated RDT enhances oxidative and immunogenic responses within the tumor microenvironment. These findings highlight the potential of talaporfin sodium as a clinically translatable radiosensitizer for RDT, offering a promising strategy for the treatment of deep-seated cancers such as pancreatic carcinoma.

Glioblastoma (GBM) is the most aggressive primary malignant tumor of the adult central nervous system with poor survival outcomes despite multimodal standard treatment. Tumor‑treating fields (TTFields) therapy prolongs survival in patients with newly diagnosed GBM; however, sustained adherence is essential to achieve therapeutic benefits. The risk factors for early discontinuation of TTFields remain poorly understood, as patients with treatment durations of <2‑3 months have been typically excluded from previous analyses. In the present single‑center retrospective study, the clinical and molecular factors associated with early discontinuation of TTFields were investigated in 16 consecutive adult patients with supratentorial GBM treated between September 2019 and February 2025. Early discontinuation was defined as the cessation of treatment within 90 days without resumption. Clinical variables, activities of daily living, neurocognitive assessments and molecular profiles were evaluated. Early discontinuation occurred in five patients (31.3%). Comparative analysis revealed that hemiparesis at treatment initiation (P=0.018), attentional impairment (P=0.036), lower baseline Karnofsky performance status (P=0.005) and Barthel Index (P=0.013) were significantly more frequent in the early discontinuation group than in the continuation group. Furthermore, overall survival was significantly shorter in the early discontinuation group (hazard ratio 8.857, 95% confidence interval 1.56‑50.29, P=0.004), and progression‑free survival showed a non‑significant trend toward a shorter duration. No significant differences were found in the other neurocognitive test scores or molecular alterations. These findings indicated that specific neurological deficits and functional impairments may hinder treatment persistence. Therefore, early identification of at‑risk patients and implementation of supportive strategies, including enhanced caregiver involvement and welfare support, may improve adherence and optimize the clinical benefits of TTFields in GBM.

This study investigated the return-to-work (RTW) rates and associated factors following endoscopic transsphenoidal surgery (eTSS) among patients with pituitary and hypothalamic tumors in Japan. The primary research question aimed to determine the variables affecting early RTW post-surgery. A retrospective analysis was conducted on 44 preoperatively employed patients who underwent eTSS at a single center between April 2018 and January 2025. Clinical data, including demographics, tumor characteristics, comorbidities, and perioperative variables, were extracted from the medical records. The primary outcome was RTW within 3 months of surgery. Statistical analyses were performed using t-tests and Fisher’s exact tests. The median time to RTW was 5 weeks, and the RTW rates were 38.6%, 69.5%, and 75.0% at 1, 3, and 6 months, respectively, with an overall RTW rate of 84.1%. Factors such as a prolonged length of hospital stay (LOS), mental disorders, and the absence of prior TSS were significantly linked to delayed RTW at 3 months. Mental disorders also tended to decrease RTW at 6 months. No significant associations were found between adequate hormone replacement and age, sex, tumor type, or endocrinological dysfunction. Patients receiving multidisciplinary support for RTW tended to experience longer recovery periods, possibly reflecting a greater need. In patients undergoing eTSS for pituitary region tumors, a history of mental disorders, prolonged LOS, and no history of prior TSS were key factors could be associated with delayed RTW. Early identification of these factors may facilitate tailored multidisciplinary RTW support strategies.

Background: Primary leptomeningeal gliomatosis (PLG) is a rare neoplasm characterized by the diffuse spread of glial tumor cells throughout the leptomeninges without any evidence of a primary tumor source in the brain or spinal cord parenchyma. Here, we present a case of PLG potentially linked to prior interventional radiotherapy. Case Description: The patient was a 75-year-old woman with a history of interventional radiology for a left internal carotid cavernous sinus fistula 13 years before presentation. Routine follow-up fluid-attenuated inversion recovery magnetic resonance imaging revealed a high intensity region spreading from the deep white matter of the subventricular zone (SVZ) to the insular cortex and medial temporal lobe. Subsequently, contrast-enhanced T1-weighted imaging revealed an enhanced effect consistent with extensive leptomeninges extending from the basilar cistern to the left Sylvian fissure. The patient underwent surgery, and subsequently histological examination of extracted tissue revealed a glioblastoma (GBM). Despite postoperative concurrent chemoradiotherapy and adjuvant temozolomide chemotherapy, the tumor increased in size, and the patient died 2 months postoperatively. Conclusion: This case highlights the importance of careful follow-up and early therapeutic intervention in PLG, as it can be difficult to diagnose leptomeningeal lesions alone. This case also raises the possibility of radiation-induced GBM, and the criteria for diagnosis were fully met. The progression of PLG from the SVZ to the leptomeningeal site was tracked using imaging, providing valuable insights into the pattern of spread of this rare condition.