國井 尚人

BACKGROUND: Redo awake surgery is ideal for recurrent malignant gliomas in the language-dominant hemisphere, but it may not always be optimal because of inadequate awake mapping. In this report, the authors describe a case of recurrent language-dominant frontal glioma in which a super-selective Wada (ssWada) test and super-selective cone-beam CT angiography (ssCBCTA) enabled successful tumor removal under general anesthesia after awake surgery. OBSERVATIONS: A woman in her 30s underwent awake surgery for left frontal glioma recurrence 2 years after the initial resection. Three years after another recurrence, the ssWada test and ssCBCTA revealed that the tumor-supplying artery did not perfuse the functional cortex, allowing safe and maximal resection under general anesthesia. Postoperatively, she had mild motor aphasia but recovered quickly with minimal sequelae. LESSONS: The combined use of the ssWada test and ssCBCTA enables precise preoperative language mapping and safe tumor resection. Originally developed for epilepsy surgery, the ssWada test is valuable for functional mapping and, when paired with ssCBCTA, provides a 3D understanding of the lesions. This combination serves as a critical preoperative tool for tumors in the language-dominant hemisphere. https://thejns.org/doi/10.3171/CASE25384.

Somatic PIK3CA and MAP3K3 mutations in cerebral and spinal cavernous malformations (CMs) have been identified in recent studies. However, their significance in the clinical presentation and risk of hemorrhage in CMs remains poorly understood. We aimed to analyze the association between these mutations and the clinical characteristics of CMs. Among patients with CMs who underwent surgical resection of lesions between July 2002 and March 2022, those with complete clinical and radiological data at the time of initial surgery were included. Somatic PIK3CA and MAP3K3 mutations were detected using droplet digital polymerase chain reaction. Subsequently, the clinical and radiological characteristics correlated with these mutations were assessed. Furthermore, the effect of these mutations on the first symptomatic intraparenchymal hemorrhage during follow-up was evaluated. In total, 72 patients were included; among them, 50 had sufficient mutation data. PIK3CA E542K, E545K, and H1047R mutations were identified in 7 (14%), 7 (14%), and 15 (30%) patients, respectively. MAP3K3 I441M was identified in 10 (20%) patients (8 [16%] had both PIK3CA and MAP3K3 mutations). MAP3K3 I441M was more common in patients with Zabramski classification type II lesions than in those with CMs of other types (p = 0.024). Multivariate Cox regression analyses identified the presence of a PIK3CA mutation as a risk factor for early (re)hemorrhage. The results suggest that PIK3CA and MAP3K3 mutations are associated with clinical and radiological characteristics in patients with CMs and that the presence of a somatic PIK3CA mutation increases susceptibility to hemorrhage. These findings may help guide future therapeutic strategies.

Delusional misidentification, a rare syndrome in which a patient displays persistent delusional misidentification of individuals or objects, occurs in several types of dementia. However, the pathology of delusional misidentification is still unclear, and there was no data pertaining to striate-frontal projection. Here, we report a case of delusional misidentification following frontotemporal dementia in which complex striate-frontal and some specific frontal gyrus dysfunction were observed. In our presented case, delusional misidentification progressed following frontal atrophy. Believing that her actual daughter had been replaced by her niece, her symptoms of delusional misidentification and frontal atrophy progressed in the short term, and social arrangement was necessary three months after the onset. There were no abnormal neurological findings including parkinsonism and general cognitive function test scores were preserved. Validated by dopamine transporter single-photon emission computed tomography, right unilateral striatal uptake decreased significantly without parkinsonism or Parkinson's disease. In addition, of specific concern, functional magnetic resonance images showed left opercular inferior frontal gyrus and right superior frontal gyrus dysfunctions. Our case study highlights complex striate-frontal projection and specific frontal gyrus dysfunctions associated with the pathology of delusional misidentification syndrome.

BACKGROUND: Chronic inflammation of the thorax, as in tuberculosis-related pyothorax, can cause secondary malignant lymphomas. However, primary malignant lymphoma of the central nervous system, specifically of the dura mater, developing after intracranial infection or inflammation has rarely been reported. Herein, the authors describe a case of primary dural lymphoma that developed secondary to subdural empyema, with an initial presentation mimicking a chronic subdural hematoma. OBSERVATIONS: A 51-year-old man had undergone single burr hole drainage for subdural empyema 2 years prior. The patient subsequently underwent multiple craniotomy and drainage procedures, with successful remission of the subdural empyema. He was subsequently referred to the authors' hospital approximately a year after his initial treatment because of a recollection of subdural fluid, which was suspected to be recurrent empyema. After another single burr hole drainage, which revealed only a subdural hematoma, a histopathological diagnosis of B-cell lymphoma of the dural/subdural membrane was made. Subsequent radiation therapy was completed, with good local control and no recurrence of the subdural hematoma confirmed at 2 months posttreatment. LESSONS: Intracranial lymphoma triggered by chronic inflammation is rare but should be considered a differential diagnosis in subdural hematomas for which the background pathology is unclear. https://thejns.org/doi/10.3171/CASE24153.

Sound frequency and duration are essential auditory components. The brain perceives deviations from the preceding sound context as prediction errors, allowing efficient reactions to the environment. Additionally, prediction error response to duration change is reduced in the initial stages of psychotic disorders. To compare the spatiotemporal profiles of responses to prediction errors, we conducted a human electrocorticography study with special attention to high gamma power in 13 participants who completed both frequency and duration oddball tasks. Remarkable activation in the bilateral superior temporal gyri in both the frequency and duration oddball tasks were observed, suggesting their association with prediction errors. However, the response to deviant stimuli in duration oddball task exhibited a second peak, which resulted in a bimodal response. Furthermore, deviant stimuli in frequency oddball task elicited a significant response in the inferior frontal gyrus that was not observed in duration oddball task. These spatiotemporal differences within the Parasylvian cortical network could account for our efficient reactions to changes in sound properties. The findings of this study may contribute to unveiling auditory processing and elucidating the pathophysiology of psychiatric disorders.