4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Special lecture 2

Folate supplementation in Japan and AASPN countries
Shunsuke Ichi
Japanese Red Cross Medical Center18

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room C
Educational session 2: From basic to advanced management—
neurosurgical management of spina bifida

Impact of the new classification of spinal lipoma
Mihoko Kato, MD, Ph.D., Tomoki Nawashiro, MD, Masamune Nagakura MD,
Michihiro Kurimoto MD, Ph.D.
Department of Neurosurgery, Aichi Children’s Health and Medical Center

Spinal conus lipomas have been classified in various ways over the years. The classification
currently in use is based on the Chapman classification, which is a morphological classification
based on surgical findings. With the widespread use of MRI, Arai and colleagues added LMMC
(lipomyelomeningocele) and filar lipomas to this classification. Subsequently, a classification thatincorporated embryological elements into the morphological classification was proposed by Pangand others. In 2017, Morota and colleagues introduced a new classification based on embryology.
This was driven by the gradually emerging insights into neurulation.
In the case of congenital conditions, understanding their etiology and basing treatment on that
understanding is a reasonable strategy. In this sense, the significance of the Morota classification
is substantial. In our institution, we have previously used the Chapman classification to investigate
whether there is a correlation between lipoma type and the need for orthopedic lower extremity
orthosis. At the start of school age, there was no correlation with lipoma type, as all lipoma types
required orthopedic lower extremity orthosis. However, at the end of school age, there was a trendof orthopedic lower extremity orthosis requirement for LMMC and transitional types. On the other
hand, when the classification was changed to the Morota classification and a similar investigation
was conducted, all cases that required orthopedic lower extremity orthosis at both the start andend of school age were classified as Morota Type 2, suggesting that this classification is excellent
for predicting functional outcomes. This trend was also confirmed in terms of the need for cleanintermittent self-catheterization (CISC), indicating that the Morota classification allows for moreaccurate prognosis prediction in terms of urinary function. This fact is believed to have a significant
impact on future treatment decisions. Surgical strategies using the Morota classification should beconsidered.
Furthermore, there is still ongoing debate about the natural course of the condition, and the evaluation
using the Morota classification is necessary. For example, although radical resection is recommended
for Type 1, there are reports that the neurological prognosis is not bad even with conservative followup, and there is reluctance to perform prophylactic surgery Using the Morota classification, which isbased on embryological causes, to predict the natural history may help determine the necessity ofsurgery.
Additionally, considering the embryological basis, Type 1, which is primarily a primary neurulation
failure, may have a preventive effect similar to folic acid as seen in MMC cases. Therefore, we await
reports on changes in the number of Type 1 cases in regions that have dramatically reduced MMC
incidence through folic acid supplementation.

2

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Educational Background
Fujita Health University Faculty of Medicine 1993.03 GraduatedNagoya University Graduate School of Medicine 2002.03 GraduatedGreat Ormond Street Hospital, Neurosurgery 2007.02-03
Work History
Nagoya Daini Red Cross Hospital, Neurosurgery 1993.04-1997.01
Nagoya Ekisaikai Hospital, Neurosurgery 1997.02-1998.03
Gifu Social Insurance Hospital, Neurosurgery 2002.04-2004.03
Aichi Prefectural Colony Central Hospital, Neurosurgery 2004.04-2010.03
Aichi Children's Health Care Center, Neurosurgery 2010.04-Present(2014.04- Chief of Neurosurgery)(2021.04- Director of Health Center)
Qualifications
Medical License (1993)
Board Certification in Neurosurgery (1999)
Board Certification in Neuroendoscopy
Board Certification in Pediatric Neurosurgery (2017)
Certified in Clinical Ethics, Japanese Society of Clinical Ethics (2016)
Registered societies
Japan Neurosurgical Society
Japanese Congress of Neurosurgery
Japanese Society of Pediatric Neurosurgery (Director)
Japanese Society for Hydrocephalus and CSF Disorders (Director)
Japanese Society of Child Abuse Medicine (Councilor)
Japanese Association of Neurosurgeons for Children's Hospital (Board member)
Japanese Society for the Study of Craniosynostosis (Board member)
Japanese Society for Spina Bifida Research (Board member)International Society for Pediatric Neurosurgery (Active member) etc.
Academic positions
Clinical Associate Professor, Nagoya University
Visiting Professor, Aichi Medical University

34th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room C
Educational session 3: From basic to advanced management—
Pediatric epilepsy

Pediatric epilepsy surgery in Japan
Masaki Iwasaki, MD, PhD
Department of Neurosurgery, National Center of Neurology and Psychiatry, Kodaira,Tokyo, Japan

Pediatric epilepsy surgery differs from adult epilepsy surgery in terms of the etiology of epilepsy
and surgical procedures. Malformation of cortical development and low-grade tumors are themost common etiology in the pediatric candidates for epilepsy surgery. Radical procedures suchas hemispherotomy and multilobar disconnection are more common in pediatric epilepsy surgery
than in adults. The goal of epilepsy surgery is to control seizures and thereby to improve children’sdevelopment. Thus, the prompt surgical indication is important in children with drug-resistant epilepsy
with a focal epileptogenic lesion. Focal lesions may cause generalized seizures and/or generalized
epileptiform discharges in young children. The presence of generalized or diffuse findings does notalways omit surgical indication.
The number of epilepsy surgeries per population in Japan is less than half that of the United States,
and hence surgical treatment of epilepsy is likely underutilized for pediatric population. In Japan,
most pediatric epilepsy surgeries are performed by functional neurosurgeons, especially by thosespecialized for epilepsy surgery; pediatric neurosurgeons do not typically perform epilepsy surgery.
Japanese “epilepsy surgeons” operate without much regard to the age of the patient, but the decision
to perform surgery on infants depends on the surgeon's experience and proficiency. Epilepsy surgery
in infants and young children is thought to be practiced in a limited number of epilepsy centers.
Some pediatric neurologists lack experience in determining the indications for epilepsy surgery,resulting in fewer patient referrals. This is partly due to the fact that neurosurgeons are often
responsible for surgical indication in Japan.
Stereoelectroencephalography (SEEG) is increasingly used for pre-surgical evaluation of epilepsy
after the introduction of stereotactic robotic system in 2020. This has led to increased interest in
stereotactic ablation surgery. Stereotactic radio-frequency thermocoagulation is used to treat deepseated epileptogenic lesion such as insular focal cortical dysplasia and hypothalamic hamartoma.
However, laser interstitial thermal therapy (LITT) is not yet available in Japan. Stereotactic surgery isless invasive and preferable for pediatric patients.
Vagus nerve stimulation and deep brain stimulation are approved in Japan for the treatment of
epilepsy without age restriction. However, corpus callosotomy is often the preferred palliative
treatment of choice for severe generalized or multifocal epilepsy.

44th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Current Appointments:
Director, Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
Visiting Professor, Department of Neurosurgery, Tohoku University School of Medicine
Visiting professor, Department of Neurosurgery, Yokohama City University School of Medicine
Education and Professional experience:
M.D., 1997
Tohoku University School of Medicine, Sendai, 1991-1997
1997-1999
Residency, Tohoku University School of Medicine, Sendai, Kohnan Hospital, Sendai, Aomori Prefectural
Hospital, Aomori
1999-2001
Research staff, MEG laboratory, Kohnan Hospital, Sendai
Ph.D., 2001
Tohoku University School of Medicine, Sendai, 1998-2001
2001-2004
Research Fellowship, Epilepsy and Clinical Neurophysiology, Department of Neurology, Cleveland Clinic
Foundation
2006-2009
Neurosurgery staff, Kohnan Hospital, Sendai
2009-2014
Assistant Professor, Department of Neurosurgery, Tohoku University School of Medicine
2014-2016
Associate professor, Department of Neurosurgery, Tohoku University School of Medicine
2016-present Director, Department of Neurosurgery, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan2017-present Visiting professor, Department of Neurosurgery, Tohoku University School of Medicine
2019-present Visiting professor, Department of Neurosurgery, Yokohama City University School of Medicine

54th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Meet experts 1 (Luncheon seminar): Epilepsy management in Tuber Sclerosis Complex

mTOR inhibitor, VNS and open cranial surgery
Ayataka Fujimoto
Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital11

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Meet experts 1 (Luncheon seminar): Epilepsy management in Tuber
Sclerosis Complex

Clinical practice guidelines for TSC-associated SEGA
by the Japanese Society for Neuro-Oncology
Tomotsugu Ichikawa
Department of Neurosurgery, Kagawa Prefectural Central Hospital

Subependymal giant cell astrocytoma (SEGA) is a benign brain tumor occurring specifically intuberous sclerosis complex (TSC) patients. SEGA usually arises around the caudothalamic groove
near the foramen of Monro, and thus can cause life threatening complications such as acuteobstructive hydrocephalus. SEGA develops due to complete loss of a function of TSC1/TSC2
complex through a two-hit mechanism of biallelic inactivation of TSC1 or TSC2 gene, leading toactivation of the mammalian target of rapamycin (mTOR). Until recently, surgical resection has been
the standard therapy for SEGAs but the introduction of mTOR inhibitors to clinical practice changed
the therapeutic landscape of these tumors.
The present guidelines were prepared by the Japanese Society for Neuro-Oncology in accordancewith the "Guidance for preparing treatment guidelines" published by Minds (2014 version). SEGA
requires well-considered decisions regarding the clinical condition and modality of treatment. Clinicalconditions were divided into four groups; (1) acutely symptomatic, (2) non-acute symptomatic, (3)asymptomatic (growing), (4) asymptomatic (non-growing). Clinical questions according treatment
options such as surgical, pharmacological, and radiological treatment were prepared for each clinicalcondition. In summary, individuals with SEGA presenting with acute deterioration due to obstructivehydrocephalus should undergo urgent surgical treatment. The mTOR inhibitors treatment is primarily
recommended for individuals with non-acute symptomatic or asymptomatic growing or large SEGAs,
and those who are not surgical candidates or prefer medical treatment over surgery.
The surgical risks, potential side effects of mTOR inhibitors, and effect on other TSC manifestations
should be considered to select the best treatment option. We hope that the guidelines will provide
guiding principles for the treatment of TSC-associated SEGA to many clinicians.
EDUCATION:
1990 Kanazawa University Medical School
2001 Okayama University Doctor of Philosophy No 3563
FELLOWSHIP:
1997/November - 2000/September, Molecular NeuroOncology Laboratory, Massachusetts General Hospital
LICENSURE and CERTIFICATION:
National Board of Medicine, Registration No. 337117
Japanese Board of Neurosurgery No. 5394
Japanese Board of Cancer Therapy No.10100265

12

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

MEMBERSHIPS:The Japan Neurosurgical Society
The Japanese Congress of Neurological Surgeons
The Japan Society for Neuro-Oncology
Japanese Society for Pediatric Neurosurgery
The Japanese Congress for Brain Tumor Surgery
The Japanese Society of Tuberous Sclerosis Complex
HONORS and AWARDS:
Young investigator award of 1st meeting of American Society of Gene Therapy (1998)
Hospital director award of Okayama University hospital (2015)
Kawabuchi Award of Japanese Society for Pediatric Neurosurgery (2017)
Hospital Bureau Award of Kagawa Prefectural Central Hospital (2020)13

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room C
Meet experts 2 (Luncheon seminar): Intravascular surgery in pediatric CNS lesions

Management of Vein of Galen Aneurysm
Yuo Iizuka
Kashiwa Tanaka Hospital

14

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Symposium 4: Neurosurgical management of intracranial cystic lesions

What is the best practice? Endoscopic or microsurgery or shunt?
Jun Kurihara
Department of Neurosurgery, Saitama Children’s Medical Center23

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Symposium 6: Non-accidental head injury in children

Minor head trauma and acute subdural hemorrhage(SDH) in relation with non-AHI in children
Nobuyuki Akutsu
Hyogo Prefectural Kobe Children’s Hospital

Many studies have reported that acute subdural hematoma (ASDH) in infants is characteristic ofabusive head trauma (AHT). However, it is difficult to diagnose AHT based on radiological imaging
alone. In Japan, it has been reported since the 1960s that ASDH can also be caused by minor headtrauma in infants. It usually occurs in infants between 6 and 10 months of age when they fall backwhile standing and bruise the back of their head. However, these reports have been criticized for not
being fully investigated for child abuse. In recent years, there have been similar reports of ASDH in
infants due to accidental minor head trauma from other countries. In particular, the presence of ASDH
from minor head trauma, such as falling from a height of about 90 cm (3 ft) is becoming accepted.
ASDH caused by AHT is often associated with rotational acceleration/deceleration force and blunt
impact. However, the type and threshold of impact able to cause tearing of the bridging veins remain
unclear. In rare cases, a bruise on the back of the head caused by short falls may also cause ASDH.
AHT should not be underdiagnosed. However, it is true that it is not so easy to clearly distinguishbetween AHT and non-AHT cases.
EDUCATION:
Kobe University Graduate School of Medicine: Hyogo, Japan (2007–2012)
PhD, Dept. of Neurosurgery
Kobe University School of Medicine: Hyogo, Japan (1996–2002)
Doctor of Medicine (MD)WORK EXPERIENCE
Apr 2014–Present: Dept. of Neurosurgery, Hyogo Prefectural Kobe Children’s HospitalOct 2012–March 2014: Dept. of Neurosurgery, Kobe University HospitalOct 2011–Sep 2012: Dept. of Neurosurgery, Nishiwaki Municipal Hospital
Jul 2010–Sep 2011: Dept. of Neurosurgery, Hyogo Prefectural Kakogawa Medical CenterApr 2007–Jun 2010: Dept. of Neurosurgery, Kobe University Hospital
Apr 2006–Mar 2007: Dept. of Neurosurgery, Nishiwaki Municipal Hospital
Apr 2005–Mar 2006: Dept. of Neurosurgery, Kobe City Nishi-Kobe Medical Center
Jun 2004–Mar 2005: Dept. of Neurosurgery, Shizuoka Children’s HospitalJun 2003–May 2004: Dept. of Neurosurgery, Yodogawa Cristian HospitalJun 2002–May 2003: Dept. of Neurosurgery, Kobe University Hospital
Nov 2019: Traveling fellow ship in Pediatric Neurosurgery at Seoul National University Children’s Hospital24

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Symposium 6: Non-accidental head injury in children

What is Nakamura type 1 infantile acute SDH?
Young-Soo Park
Department of Neurosurgery and Children’s Medical Center, Nara Medical University

25