Malignant glioma is one of the most lethal diseases in adulthood. The median survival of patients with the Grade IV glioma, glioblastoma multiforme (GBM), is shorter than 15 months and the current first-line therapies for this devastating disease have only a palliative effect. The cancer stem cell hypothesis has recently attracted a great deal of attention, owing to the promise of a novel cellular target for the treatment of tumors including GBM. Recent studies have demonstrated that existence of cancer stem cells in brain tumors (BTSC) accounts, at least in part, for the intractability of malignant glioma. From the therapeutic standpoint, characterization of the mechanism for tumor initiation and maintenance of the "stem-like state" of BTSC is crucial. However, multiple heterogeneous subtypes of cancer stem cells have recently been identified from malignant glioma, making the idea of cancer stem cell complicated. In addition, in some cancer types (e.g. melanoma), a considerable proportion of tumor cells may possess the stem cell property, indicating cancer stem cells may not be a rare cell population in tumors, at least in some organs. Based on the extensive genetic and epigenetic characterization of tumor growth mechanisms, various molecularly-targeted therapies have already been applied for patients, demonstrating a varying degree of success in cancer treatment. A significant improvement in patient prognosis was achieved in several cancer types including leukemia and breast cancer. It is no doubt that continuous effort is required to bring hope for patients with malignant glioma. In this study, we summarize the recent findings and approaches in the cancer stem cell field, mainly focusing on malignant glioma stem cells, and also describe potential future directions in this area.

We described three cases with hemorrhagic complication during simultaneous multi-track microelectrode recording (MER) for stereotactic implantation of a subthalamic nucleus electrode. Although preoperative planning with gadolinium-enhanced T1-weighted MR images is recommended to prevent the occurrence of intracerebral hemorrhage, it should be noted that the danger from cerebral vasculatures is still underestimated. Multiple nonspecific white matter hyperintensities and asymptomatic lacunar infarcts may be suspected as potential risk factors, so, it is suggested that the number of MER penetrations should be restricted in such cases.

Translational Research is the research to apply and mediate a fundamental research result to the clinical field effectively. The integration of the diagnosis and the treatment is an important item in the life science field from the viewpoint of quality of therapy and minimally invasive therapy. The standardization of mechanical interface of the medicine related machine, system and a medical information system are important from the viewpoint such as prevention of medical malpractice. A high function operating robot (manipulator) as an endoscopic robot and image-guided minimally invasive device are important in the point of view of the development of a medical device shown with a medical device industry vision. We describe an outline of our ongoing development of endoscope system, intraoperative MRI (intelligent operating theater) and robot surgery system in neurosurgical field.

A case of atrial myxoma with cerebral oncotic aneurysms was presented. A 37 year-old woman was admitted complaining of right hemiparesis, and episodes of syncope. Neurological examination on admission revealed a right arm monoparesis, a right hemisensory disturbance, and a motor aphasia. Computed tomography (CT) demonstrated low density areas in the left fronto-parietal region, and multiple discrete enhancing high density spots scattered bilaterally in the parietal lobes. Cerebral angiography showed multiple fusiform peripheral aneurysms especially in the distribution of the bilateral middle cerebral arteries. Cerebral emboli from the cardiac source were suspected, and an echocardiography was performed, which disclosed a huge villous mass in the left atrium. The cardiac mass was resected uneventfully under cardiopulmonary bypass. It proved to be a left atrial myxoma. Postoperatively, her neurological deficit persisted. After the resection of the cardiac tumor, follow-up angiographies were undertaken twice. The second angiography performed 6 months later revealed spontaneous resolution or stabilization of most of the aneurysms detected before. On the other hand, newly-developed aneurysms were seen at the sites which had seemed normal previously on the first angiography. No remarkable changes were seen on the third one except the slight enlargement of one of the aneurysms in the middle cerebral territory. At 3 years she was neurologically stable. Because of the paucity of knowledge concerning the natural history of cerebral oncotic aneurysms and lack of definite treatment for them, long-term follow-up including serial angiography is mandatory after the resection of left atrial myxoma.