Faculty Profiles - SAITO Ryuta

An Approach to Superior Petrosal Sinus via Contralateral Superior Petrosal Sinus in a Case of Dural Arteriovenous Fistulas with Difficulty in Access Open Access

Other Link： http://academic.oup.com/noa/article-pdf/3/1/vdab038/37929606/vdab038.pdf

覚醒下手術中痙攣発作コントロールにおけるレベチラセタム・ペランパネル併用療法の有効性について

本村和也, 齋藤竜太

神経治療学 Vol. 38 ( 6 ) page： S211 - S211 2021

SUZUKI Keita, NISHIHORI Masahiro, IZUMI Takashi, SUZUKI Osamu, MUTO Manabu, ARAKI Yoshio, UDA Kenji, YOKOYAMA Kinya, SAITO Ryuta

No Kekkannai Chiryo Vol. 6 ( 3 ) page： 161 - 168 2021

Language：Japanese Publisher：The Japanese Society for Neuroendovascular Therapy

Objective: Herein, we report a case of multiple dural arteriovenous fistulas (DAVFs) in the left superior petrosal sinus (SPS) successfully treated by transvenous embolization via the right SPS.Case Presentation: A 60-year-old woman was diagnosed with multiple DAVFs with deep venous reflux to evaluate consciousness disturbance. We performed packing of the left transverse sinus, which was chiefly involved in reflux to the straight sinus. However, consciousness continued to be mildly disturbed, and DSA was performed again. A shunt was inserted into the left SPS, and the subsequently occurring deep venous reflux was clearly revealed. Because the ipsilateral transverse sinus and both inferior petrosal sinuses were already occluded and unavailable as access routes, we used the contralateral SPS and both cavernous sinuses to navigate the microcatheter into the shunt. We achieved occlusion of the SPS and stopped the reflux by inserting the intermediate catheter firmly into the bilateral SPS.Conclusion: An access route through the contralateral SPS might successfully enable transvenous embolization of DAVF cases without an ipsilateral access route.

DOI： 10.20626/nkc.tn.2021-0009

CiNii Research

Corpus Callosum Swelling after Resection of Intraventricular Central Neurocytoma.

Daiki Aburakawa, Masayuki Kanamori, Toshiaki Akashi, Shiho Sato, Ryuta Saito, Teiji Tominaga

NMC case report journal Vol. 8 ( 1 ) page： 535 - 543 2021

Language：English

Corpus callosum swelling has been reported to occur after ventriculoperitoneal shunting for long-standing hydrocephalus. This report presents a case of corpus callosum swelling after intraventricular tumor resection. A 34-year-old woman presented with a headache that worsened over 1 month. Magnetic resonance (MR) images revealed a mass lesion in the left lateral ventricle and obstructive hydrocephalus. She underwent subtotal resection with a transcallosal approach. After tumor resection, she had long-lasting status epilepticus followed by consciousness disturbance. T2-weighted MR images obtained 8 hr after the operation showed a hyperintense area in the corpus callosum. The patient then presented with bilateral dilated pupils 14 hr after the operation due to acute hydrocephalus and tension pneumocephalus. An emergent re-craniotomy was performed and a ventricular drain was placed. The patient recovered consciousness 3 days after the operation. However, she experienced progressive corpus callosum swelling 25 days after the operation, which improved since then. Approximately 4 months after the operation, she returned to her usual workplace with no neurocognitive functional decline. Two years later, she was doing well with no radiological abnormal findings except corpus callosum thinning. Thus, corpus callosum swelling can develop not only after shunting for chronic hydrocephalus but also after intraventricular tumor resection. It occurred relatively acutely and there was no decline in intelligence after long-term follow-up. This case suggests that corpus callosum swelling after intraventricular tumor resection is a rare but noteworthy complication that can improve without intervention.

DOI： 10.2176/nmccrj.cr.2020-0369

Survival Benefit of Supratotal Resection in a Long-term Survivor of IDH-wildtype Glioblastoma: A Case Report and Literature Review. Open Access

Junya Yamaguchi, Kazuya Motomura, Fumiharu Ohka, Kosuke Aoki, Kuniaki Tanahashi, Masaki Hirano, Lushun Chalise, Tomohide Nishikawa, Hiroyuki Shimizu, Atsushi Natsume, Toshihiko Wakabayashi, Ryuta Saito

NMC case report journal Vol. 8 ( 1 ) page： 747 - 753 2021

Language：English Publisher：The Japan Neurosurgical Society

Glioblastoma multiforme (GBM) is an aggressive cancer type, with fewer than 3-5% of patients surviving for more than 3 years. We describe a 48-year-old right-handed man who presented with generalized seizure attacks. Magnetic resonance imaging (MRI) revealed a heterogeneous gadolinium-enhancing lesion in the left inferior parietal lobule. The patient underwent awake surgery, and tumor resection included abnormalities on T2-weighted MRI, with subcortical mapping used to identify the deep functional boundaries. After supratotal resection, the tumor was diagnosed as GBM without isocitrate dehydrogenase (IDH) 1 and 2 mutations. At a follow-up evaluation, 9 years and 2 months after the surgery, the patient appeared healthy, and no relapse or recurrence was observed. We present the case of a long-term survivor of IDH-wildtype GBM. This case suggests that supratotal resection with intraoperative awake brain mapping can improve survival without impairing the patient's neurological functions.

DOI： 10.2176/nmccrj.cr.2021-0120

Management of Asymptomatic Vertebral Artery Injury Caused by a Cervical Pedicle Screw Malposition: Two Case Reports. Open Access

Takafumi Otsuka, Takashi Izumi, Masahiro Nishihori, Tetsuya Tsukada, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Shunsaku Goto, Mizuka Ikezawa, Naoki Kato, Mizuki Nakano, Ryuta Saito

NMC case report journal Vol. 8 ( 1 ) page： 713 - 717 2021

Language：English Publisher：The Japan Neurosurgical Society

Iatrogenic vertebral artery (VA) injury in cervical fusion is an extremely rare complication but can lead to serious sequelae. We present two successful cases of internal trapping for preventing delayed-onset ischemic stroke after iatrogenic VA stenosis caused by a cervical pedicle screw. A 34-year-old female underwent posterior cervical fusion for C4/C5 dislocation fracture. No neurological deficits were observed after the operation. However, the postoperative images revealed that the left C5 pedicle screw perforated the transverse foramen, and the left VA was suspected to be occluded at the screw insertion site. Before revision surgery, we tried to embolize the injured VA with coils. A microcatheter could be navigated from the ipsilateral VA to the distal of the screw, and internal trapping was performed with coils. Another case is that of a 50-year-old male with cervical spondylosis, who underwent posterior decompression and cervical fusion. The neurological symptoms did not deteriorate after the operation. However, the postoperative computed tomography images revealed the perforation of the right C3 transverse foramen by the pedicle screw. In right vertebral angiography, about 70% stenosis was observed at the screw insertion site. Although revision surgery was not planned due to good stability, we embolized the right VA after balloon occlusion test, to prevent the delayed-onset thromboembolic complications. Both the patients recovered without any neurological deficits. Iatrogenic VA injuries, even if asymptomatic immediately after surgery, can lead to serious sequelae in case of delayed-onset ischemic stroke. Therefore, careful attention should be paid when the screw perforates the transverse foramen.

DOI： 10.2176/nmccrj.cr.2021-0062

Postoperative Cervicothoracic Kyphosis Following Infantile Intramedullary Tumor Resection Accelerates Neurological Deterioration. Open Access

Tomomi Gonda, Yoshitaka Nagashima, Yusuke Nishimura, Hiroshi Ito, Tomoya Nisii, Takahiro Oyama, Masahito Hara, Ryuta Saito

NMC case report journal Vol. 8 ( 1 ) page： 705 - 711 2021

Language：English Publisher：The Japan Neurosurgical Society

Intramedullary spinal cord tumors are rare in children. Regardless of the type of tumor, surgical removal is thought to improve progression-free survival. However, postoperative kyphosis is a serious problem in children, who can expect long-term survival. We present a pediatric case of neurofibromatosis type 2-related spinal ependymoma at the cervicothoracic regions where acute neurological deterioration was developed due to a combination of tumor recurrence and postoperative kyphotic deformity. In the first surgery, subtotal tumor resection was performed via osteoplastic laminotomy. Postoperative radiological evaluation at several months showed cervicothoracic junctional kyphosis, which subsequently made a significant improvement by lifestyle instructions. However, 22 months after the surgery, he exhibited rapid neurological deterioration caused by the regrowth of the recurrent tumor and re-emergence of kyphotic deformity, which led to the fixed laminar flap sank into the spinal canal. Therefore, a second surgery was performed 23 months after the first surgery, and gross total removal was achieved. Osteoplastic laminotomy is presumed to reduce the occurrence of postoperative kyphosis compared with laminectomy, but there have been no reports on the spinal cord compression by plunging of the re-fixed laminar flap into the spinal canal. The kyphosis deformity increases the chance of re-fixed laminar flap coming off, thereby accelerating neurological injury on top of the neural damage by tumor recurrence itself. Therefore, pediatric patients with spinal cord tumors should be carefully managed in terms of recurrent tumors and postoperative kyphosis, and timely surgical intervention is necessary before kyphotic deformity becomes evident.

DOI： 10.2176/nmccrj.cr.2021-0086

TERT promoter mutation confers favorable prognosis regardless of 1p/19q status in adult diffuse gliomas with IDH1/2 mutations International journal Open Access

Hideyuki Arita, Yuko Matsushita, Ryunosuke Machida, Kai Yamasaki, Nobuhiro Hata, Makoto Ohno, Shigeru Yamaguchi, Takashi Sasayama, Shota Tanaka, Fumi Higuchi, Toshihiko Iuchi, Kuniaki Saito, Masayuki Kanamori, Ken ichiro Matsuda, Yohei Miyake, Kaoru Tamura, Sho Tamai, Taishi Nakamura, Takehiro Uda, Yoshiko Okita, Junya Fukai, Daisuke Sakamoto, Yasuhiko Hattori, Eriel Sandika Pareira, Ryusuke Hatae, Yukitomo Ishi, Yasuji Miyakita, Kazuhiro Tanaka, Shunsaku Takayanagi, Ryohei Otani, Tsukasa Sakaida, Keiichi Kobayashi, Ryuta Saito, Kazuhiko Kurozumi, Tomoko Shofuda, Masahiro Nonaka, Hiroyoshi Suzuki, Makoto Shibuya, Takashi Komori, Hikaru Sasaki, Masahiro Mizoguchi, Haruhiko Kishima, Mitsutoshi Nakada, Yukihiko Sonoda, Teiji Tominaga, Motoo Nagane, Ryo Nishikawa, Yonehiro Kanemura, Aya Kuchiba, Yoshitaka Narita, Koichi Ichimura

Acta Neuropathologica Communications Vol. 8 ( 1 ) page： 201 - 201 2020.12

Language：English Publishing type：Research paper (scientific journal)

TERT promoter mutations are commonly associated with 1p/19q codeletion in IDH-mutated gliomas. However, whether these mutations have an impact on patient survival independent of 1p/19q codeletion is unknown. In this study, we investigated the impact of TERT promoter mutations on survival in IDH-mutated glioma cases. Detailed clinical information and molecular status data were collected for a cohort of 560 adult patients with IDH-mutated gliomas. Among these patients, 279 had both TERT promoter mutation and 1p/19q codeletion, while 30 had either TERT promoter mutation (n = 24) or 1p/19q codeletion (n = 6) alone. A univariable Cox proportional hazard analysis for survival using clinical and genetic factors indicated that a Karnofsky performance status score (KPS) of 90 or 100, WHO grade II or III, TERT promoter mutation, 1p/19q codeletion, radiation therapy, and extent of resection (90–100%) were associated with favorable prognosis (p < 0.05). A multivariable Cox regression model revealed that TERT promoter mutation had a significantly favorable prognostic impact (hazard ratio = 0.421, p = 0.049), while 1p/19q codeletion did not have a significant impact (hazard ratio = 0.648, p = 0.349). Analyses incorporating patient clinical and genetic information were further conducted to identify subgroups showing the favorable prognostic impact of TERT promoter mutation. Among the grade II-III glioma patients with a KPS score of 90 or 100, those with IDH-TERT co-mutation and intact 1p/19q (n = 17) showed significantly longer survival than those with IDH mutation, wild-type TERT, and intact 1p/19q (n = 185) (5-year overall survival, 94% and 77%, respectively; p = 0.032). Our results demonstrate that TERT promoter mutation predicts favorable prognosis independent of 1p/19q codeletion in IDH-mutated gliomas. Combined with its adverse effect on survival among IDH-wild glioma cases, the bivalent prognostic impact of TERT promoter mutation may help further refine the molecular diagnosis and prognostication of diffuse gliomas.

DOI： 10.1186/s40478-020-01078-2

A multinodular and vacuolating neuronal tumor in the right temporal lobe with positive methionine uptake: A case report Open Access

Taketo Nishizawa, Ryuta Saito, Masashi Chonan, Masayuki Kanamori, Kentaro Takanami, Mika Watanabe, Teiji Tominaga

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Vol. 22 2020.12

Publishing type：Research paper (scientific journal)

Multinodular and vacuolating neuronal tumor (MVNT) is a recently recognized type of neural tumor that was first documented in 2013. This tumor type is characterized by multiple nodules of neuronal cells with vacuolar degeneration localized in the subcortical white matter. Here, we report a case of MVNT in the right temporal lobe of a 26-year-old female. Magnetic resonance imaging (MRI) revealed a high-intensity lesion on a T2- weighted image of the right temporal lobe without contrast enhancement. Positron emission tomography revealed increased 11C-methionine uptake in the lesion, which was pathologically diagnosed as MVNT.

DOI： 10.1016/j.inat.2020.100861

Scopus

がん遺伝子パネル検査でSMARCB1変異を認め、INI-1蛋白陽性のAT/RTと考えられた一例(Clinical sequencing revealed two distinct mutations in SMARCB1, in an INI-1 positive AT/RT)

Kaino Akira, Niizuma Hidetaka, Moriya Kunihiko, Katayama Saori, Irie Masahiro, Rikiishi Takeshi, Saito Ryuta, Kanamori Masayuki, Sasahara Yoji, Kure Shigeo

日本小児血液・がん学会雑誌 Vol. 57 ( 4 ) page： 245 - 245 2020.10

Orengedokuto and shosaikoto for intractable intracranial carmustine implant-induced fever in a patient with brain tumor: A case report. International journal Open Access

Satoko Suzuki, Shin Takayama, Akiko Kikuchi, Ryutaro Arita, Michiaki Abe, Ryuta Saito, Masayuki Kanamori, Teiji Tominaga, Tadashi Ishii

Explore (New York, N.Y.) Vol. 17 ( 3 ) page： 236 - 238 2020.8

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Anaplastic astrocytoma has a dismal prognosis with conventional treatment. Multidisciplinary treatment is needed to control the disease; however, side effects of the treatment reduce a patient's quality of life (QOL). Carmustine-impregnated wafers (Gliadel®, Eisai Co., Ltd., Tokyo, Japan), one of the treatment modalities for anaplastic astrocytoma, has been reported to have drug-induced fever as a side effect. CASE REPORT: A 36-year-old man underwent excision for a recurrent brain tumor. Histopathological examination established a diagnosis of anaplastic astrocytoma and an intracranial carmustine implant was placed for local chemotherapy. Postoperatively, the patient developed high fever, which could not be controlled using antipyretics. The high fever ameliorated dramatically after the administration of Kampo medicines, specifically orengedokuto and shosaikoto, and the patient could continue chemotherapy. CONCLUSION: To the best of our knowledge, this is the first report of successful treatment of intractable carmustine implant-induced fever using Kampo medicine. In this case, Kampo medicine led to an improvement of QOL.

DOI： 10.1016/j.explore.2020.08.014

視床高悪性度神経膠腫におけるヒストン変異と予後についての検討

長田佳整, 齋藤竜太, 庄司拓大, 長南雅志, 柴原一陽, 金森政之, 園田順彦, 隈部俊宏, 渡邉みか, 冨永悌二

Brain Tumor Pathology Vol. 37 ( Suppl. ) page： 130 - 130 2020.8

IDH変異型膠芽腫自験連続9例の検討

齋藤竜太, 長田佳整, 柴原一陽, 金森政之, 園田順彦, 隈部俊宏, 渡辺みか, 冨永悌二

Brain Tumor Pathology Vol. 37 ( Suppl. ) page： 092 - 092 2020.8

Frequent Clinical and Radiological Progression of Optic Pathway/Hypothalamic Pilocytic Astrocytoma in Adolescents and Young Adults. Reviewed Open Access

Takuhiro Shoji, Masayuki Kanamori, Ryuta Saito, Yuko Watanabe, Mika Watanabe, Miki Fujimura, Yoshikazu Ogawa, Yukihiko Sonoda, Toshihiro Kumabe, Shigeo Kure, Teiji Tominaga

Neurologia medico-chirurgica Vol. 60 ( 6 ) page： 277 - 285 2020.5

Language：English Publishing type：Research paper (scientific journal)

Most cases of optic hypothalamic pilocytic astrocytoma (OHPA) develop during childhood, so few cases of histologically verified OHPA have been described in adolescents and young adults (AYA). To elucidate the clinical features of OHPA with histological verification in AYA, we reviewed the clinical and radiological finding of OHPA treated at our institute from January 1997 and July 2017. AYA are aged between 15 and 39 years. The clinical courses of 11 AYA patients with optic hypothalamic glioma (OHG) without neurofibromatosis type 1 were retrospectively reviewed. About six patients were diagnosed in childhood and followed up after 15 years of age, and five patients developed OHPA during AYA. Histological diagnosis, verified at initial presentation or recurrence, was pilocytic astrocytoma in 10 and pilomyxoid astrocytoma in one. After initial treatment including debulking surgery and/or chemotherapy, tumor progression occurred 16 times in seven patients as cyst formation, tumor growth, and intratumoral hemorrhage. Five of 10 patients suffered deterioration of visual function during AYA. One of 10 cases had endocrinopathies requiring hormone replacement at last follow-up examination. In conclusion, histological diagnoses of OHG before and in AYA were pilocytic astrocytoma or pilomyxoid astrocytoma. Both pediatric and AYA-onset OHPA demonstrate high incidences of tumor progression and visual dysfunctions in AYA, so that long-term follow up is essential after the completion of treatment for pediatric and AYA-onset OHPA. The optimal timing of debulking surgery and radiation therapy should be established to achieve the long-term tumor control and to preserve the visual function.

DOI： 10.2176/nmc.oa.2019-0208

Regression of Recurrent Spinal Cord High-Grade Glioma After Convection-Enhanced Delivery of Nimustine Hydrochloride: Case Reports and Literature Review. International journal

Toshiki Endo, Tomoo Inoue, Shinichiro Sugiyama, Ryuta Saito, Teiji Tominaga

Operative neurosurgery (Hagerstown, Md.) Vol. 18 ( 4 ) page： 451 - 459 2020.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Spinal cord high-grade glioma has poor prognosis. Especially, no treatment protocols have been established for recurrent cases. OBJECTIVE: To apply a novel treatment method, convection-enhanced delivery (CED), for recurrent high-grade glioma. CED can deliver chemotherapeutic agents directly into the intramedullary lesion and possibly lead to remarkable regression of enlarging tumors that are, otherwise, difficult to control. METHODS: Two patients developed high-grade glioma in the thoracic spinal cord. Partial resection and chemotherapy and radiotherapy induced remission of the disease. However, following the initial treatment, recurrence was noted in the spinal cord at 6 and 12 mo, respectively. No effective treatment was available for these recurrent lesions. Therefore, the authors decided to use CED to infuse nimustine hydrochloride (ACNU) directly into the spinal cord. During the procedure, the infusion cannula was inserted into the spinal cord lesion under intraoperative computed tomography scan. RESULTS: After ACNU CED, successive magnetic resonance imaging confirmed remarkable shrinkages of the tumors in both cases. However, the patient's preinfusion symptoms, including bilateral lower extremity weakness, did not change after the treatment. Importantly, overall survivals of the 2 patients were as long as 67 and 33 mo. CONCLUSION: The authors report the first 2 cases of recurrent spinal cord high-grade glioma. ACNU CED dramatically regressed enhanced mass lesions and provided local tumor controls in the spinal cord.

DOI： 10.1093/ons/opz172

髄芽腫の放射線療法中に合併した難治性ITPに対し,rituximabが奏功した一例

戒能明, 新妻秀剛, 入江正寛, 片山紗乙莉, 森谷邦彦, 力石健, 齋藤竜太, 金森政之, 笹原洋二, 呉繁夫

日本小児科学会雑誌 Vol. 124 ( 2 ) page： 321 - 321 2020.2

髄芽腫の放射線療法中に合併した難治性ITPに対し,rituximabが奏功した一例

戒能明, 新妻秀剛, 入江正寛, 片山紗乙莉, 森谷邦彦, 力石健, 齋藤竜太, 金森政之, 笹原洋二, 呉繁夫

日本小児科学会雑誌 Vol. 124 ( 2 ) page： 321 - 321 2020.2

Phase I trial of convection-enhanced delivery of nimustine hydrochloride (ACNU) for brainstem recurrent glioma International journal Open Access

Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Yoji Yamashita, Kenichi Nagamatsu, Takaki Murata, Shunji Mugikura, Toshihiro Kumabe, Eva Wembacher-Schröder, Rowena Thomson, Teiji Tominaga

Neuro-Oncology Advances Vol. 2 ( 1 ) page： vdaa033 2020.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press (OUP)

<title>Abstract</title>
<sec>
<title>Background</title>
Treatment options for patients suffering brainstem gliomas are quite limited as surgery is not an option against intrinsic tumors at brainstem and chemotherapy generally failed to demonstrate its efficacy. Intracerebral convection-enhanced delivery (CED) is a novel approach for administering chemotherapy to patients with brain tumors. We present the results of phase I trial of CED of nimustine hydrochloride (ACNU), designed to determine the maximum tolerable concentration of ACNU, for patients with recurrent brainstem gliomas.

</sec>
<sec>
<title>Methods</title>
Sixteen patients, aged 3–81 years old, suffering from recurrent brainstem gliomas, including diffuse intrinsic pontine glioma patients as well as patients with recurrent gliomas that originated from non-brainstem sites, were enrolled in this trial between February 2011 and April 2016. The dose/concentration escalation trial included 3 dose/concentration groups (0.25, 0.5, and 0.75 mg/mL, all at 7 mL) to determine the safety and tolerability of CED of ACNU. Real-time monitoring of drug distribution was performed by mixing gadolinium-tetraazacyclododecanetetraacetic acid (Gd-DOTA) in the infusion solution. CED of ACNU was given in combination with oral or intravenous temozolomide chemotherapy.

</sec>
<sec>
<title>Results</title>
CED of ACNU demonstrated antitumor activity, as assessed by radiographic changes and prolonged overall survival. The recommended dosage was 0.75 mg/mL. Drug-associated toxicity was minimal.

</sec>
<sec>
<title>Conclusions</title>
Intracerebral CED of ACNU under real-time monitoring of drug distribution, in combination with systemic temozolomide, was well tolerated among patients with recurrent brainstem gliomas. The safety and efficacy observed suggest the clinical benefits of this strategy against this devastating disease. Based on this phase I study, further clinical development of ACNU is warranted.

</sec>

DOI： 10.1093/noajnl/vdaa033

Other Link： http://academic.oup.com/noa/article-pdf/2/1/vdaa033/33171642/vdaa033.pdf

TERT promoter mutation associated with multifocal phenotype and poor prognosis in patients with IDH wild-type glioblastoma International journal Open Access

Zensho Kikuchi, Ichiyo Shibahara, Tetsu Yamaki, Ema Yoshioka, Tomoko Shofuda, Rintaro Ohe, Ken-ichiro Matsuda, Ryuta Saito, Masayuki Kanamori, Yonehiro Kanemura, Toshihiro Kumabe, Teiji Tominaga, Yukihiko Sonoda

Neuro-Oncology Advances Vol. 2 ( 1 ) page： vdaa114 2020.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press (OUP)

<title>Abstract</title>
<sec>
<title>Background</title>
Although mutations in the promoter region of the telomerase reverse transcriptase (TERTp) gene are the most common alterations in glioblastoma (GBM), their clinical significance remains unclear. Therefore, we investigated the impact of TERTp status on patient outcome and clinicopathological features in patients with GBM over a long period of follow-up.

</sec>
<sec>
<title>Methods</title>
We retrospectively analyzed 153 cases of GBM. Six patients with isocitrate dehydrogenase 1 (IDH1) or H3F3A gene mutations were excluded from this study. Among the 147 cases of IDH wild-type GBM, 92 (62.6%) had the TERTp mutation. Clinical, immunohistochemical, and genetic factors (BRAF, TP53 gene mutation, CD133, ATRX expression, O6-methylguanine-DNA methyltransferase [MGMT] promoter methylation) and copy number alterations (CNAs) were investigated.

</sec>
<sec>
<title>Results</title>
GBM patients with the TERTp mutation were older at first diagnosis versus those with TERTp wild type (66.0 vs. 60.0 years, respectively, P = .034), and had shorter progression-free survival (7 vs. 10 months, respectively, P = .015) and overall survival (16 vs. 24 months, respectively, P = .017). Notably, magnetic resonance imaging performed showed that TERTp-mutant GBM was strongly associated with multifocal/distant lesions (P = .004). According to the CNA analysis, TERTp mutations were positively correlated with EGFR amp/gain, CDKN2A deletion, and PTEN deletion; however, these mutations were negatively correlated with PDGFR amp/gain, CDK4 gain, and TP53 deletion.

</sec>
<sec>
<title>Conclusions</title>
TERTp mutations were strongly correlated with multifocal/distant lesions and poor prognosis in patients with IDH wild-type GBM. Less aggressive GBM with TERTp wild type may be a distinct clinical and molecular subtype of IDH wild-type GBM.

</sec>

DOI： 10.1093/noajnl/vdaa114

Other Link： http://academic.oup.com/noa/article-pdf/2/1/vdaa114/35106481/vdaa114.pdf

Cystic Glioblastoma Rupturing into the Ventricle.

Yoshimichi Sato, Ryuta Saito, Masayuki Kanamori, Teiji Tominaga

NMC case report journal Vol. 7 ( 1 ) page： 39 - 41 2020.1

Language：English Publishing type：Research paper (scientific journal)

Cystic tumors, such as craniopharyngiomas and Rathke's cleft cysts, as well as arachnoid cysts have been reported to rupture occasionally. Approximately 8-10% of glioblastomas (GBMs) are known to have a significant cystic component; however, to the best of our knowledge, no studies have reported cystic rupturing of GBMs. Here, we describe a unique case of cystic GBM rupturing and penetrating into the cerebral ventricle. A 77-year-old man with a right frontal lobe lesion suspected as GBM with a large cyst was referred to our hospital. At admission, disorientation and left facial weakness were detected. Consciousness disturbance worsened on the 8th day of hospitalization. Computed tomography (CT) revealed prominent shrinkage of the tumor and intratumoral cyst. Signs of meningeal irritation were observed, and chemical meningitis due to cystic tumor rupture and leakage of necrotic components into the ventricle was highly suspected. Surgical resection of the right frontal lobe tumor was performed on the 10th day of hospitalization. During the surgery, clear and colorless cerebrospinal fluid was obtained upon penetration of the tumoral cyst, suggesting traffic of tumor cysts and cerebral ventricle. Adjuvant chemoradiation therapy was initiated postoperatively. Local recurrence was noted at the corpus callosum 7 months postoperatively and was treated with a gamma knife. Further therapy was performed after this recurrence. However, his condition gradually deteriorated 15 months postoperatively, and he was subjected to terminal care. To the best of our knowledge, this is the first report on a cystic GBM rupture.

DOI： 10.2176/nmccrj.cr.2019-0043