Glioblastoma multiforme (GBM) is one of the most aggressive tumors known to occur in the brain. Metabolism is one of the driving factors enabling the successful proliferation of tumor cells, thus increasing the tumor mass. Tumor metabolism is now recognized as a major hallmark of oncogenesis. Since the brain largely relies on its glucose supply for growth, glucose metabolism significantly contributes to oncogenesis in brain cancers. Here, we review the major metabolic pathways seen in normal brain physiology in addition to the Warburg effect, aberrant tricarboxylic acid cycle, and oxidative phosphorylation observed in GBM. We highlight the important differences in glucose metabolism between the normal and cancerous environments. In addition, we provide insights into lactate shuttling, the pentose phosphate pathway, and immune interactions with glucose metabolism, which drive the nutritional pathways in both the normal and cancerous environment.

Glioma is a highly heterogeneous disease with yet unknown mechanisms. It is imperative to provide individualized and precise treatment based on the multidisciplinary diagnosis and treatment model and the basic principles of evidence-based medicine for these patients. In 2018, the Glioma Society Affiliated to Chinese Medical Doctor Association led the development of the "Chinese Expert Consensus on Multidisciplinary Team (MDT) Management of Glioma," which significantly promoted the application of the MDT approach in China. To standardize the diagnosis and treatment of MDT for glioma in different regions and grades of hospitals, we plan to update the "Chinese Expert Consensus on MDT Management of Glioma" based on the currently available evidence-based medical evidence. This new version will update the standards of surgical procedures, clinical management, and quality control for the implementation of MDT for glioma to provide guidelines and recommendations for clinicians. The Consensus Committee will follow the policies of the Evidence-Based Clinical Practice Guidelines development, form a multidisciplinary expert team, and utilize Evidence-Based Management in line with the Oxford University Center for Evidence-Based Medicine Levels of Evidence and Grades of Recommendation to develop the evidence-based expert consensus on MDT for glioma. The proposal emphasizes the significance, purpose, members of the Consensus Committee, identification of clinical problems, evidence acquisition, evaluation and integration, and recommendation generation.

Surgical resection is the core of the comprehensive treatment of glioma. However, with infiltrative growth features, glioma often invades the surrounding area, making surgical resection more difficult. This review introduces relevant topics presented at the World Federation of Neurosurgical Societie Foundation Asian Congress of Neurological Surgeons (ACNS) Minimally Invasive Neurosurgery Web Seminar in 2022. First, we review assistive surgical techniques' characteristics, advantages, and disadvantages. Second, we summarize some state-of-the-art surgical views in glioma resection. Advanced modalities and surgical theories in glioma resection make better “maximum safe resection” achievable.

Rosai–Dorfman disease (RDD) is a nonneoplastic histiocytic proliferation. RDD is CD1a negative as opposed to Langerhans cell histiocytosis (LCH). The lesion was positive for CD1a immunohistochemistry in our RDD patient, suggesting an overlap with LCH. In addition, our case exhibited granulomatous angiitis (GA) on microscopy. We report the first triad of coexistent intracranial RDD-LCH-GA. A 30-year-old man presented with seizures, limb weakness, and violent behavior for 3 months. There was no fever, lymphadenopathy, or hepatosplenomegaly. Laboratory test results were normal. Radioimaging revealed an 8.6 cm × 7.4 cm × 3.2 cm mass in the parietotemporal lobe. It was hypointense on T1W1 and hypointense on T2W1, suggestive of glioma or tumefactive demyelination. A subtotal resection was performed. Histopathology exhibited mature lymphocytes, plasma cells, and histiocytes with emperipolesis. Vessels showed transmural granulomatous inflammation. Fungal and mycobacterial stains were negative. Immunohistochemistry revealed positivity for CD68, S100, and CD1a. The patient refused to undergo postoperative adjuvant radiotherapy. He remained asymptomatic for 6 months but was lost to follow-up thereafter. RDD-LCH concurrence may represent a clonal transformation in a common precursor histiocyte. Coexistent GA requires resection followed by steroid or cyclophosphamide therapy to prevent disease progression.

The clinical hallmarks of tumor growth, angiogenesis, and invasion were identified in a patient with isocitrate dehydrogenase-1 wild-type glioblastoma at initial diagnosis and management issues were examined. The head magnetic resonance imaging (MRI) showed multiple solid and cystic contrast enhancements in the rostral portion of the tumor located within the left motor gyrus and the adjacent brain. Extensive tumor invasion was noted along the left corticospinal tract extending into the cerebral peduncle and pons. After an open craniotomy for tissue biopsy, the patient underwent external beam radiotherapy and concomitant temozolomide, and his motor deficit was stabilized with concurrent bevacizumab infusion while dexamethasone was weaned off. After two cycles of adjuvant temozolomide, the patient experienced worsening motor deficit in the right hand. A repeat gadolinium-enhanced head MRI revealed increased fluid-attenuated inversion recovery hyperintensity in the left cerebral peduncle indicating tumor progression. This case illustrates the extensive invasion from a glioblastoma that cannot be adequately quantified or effectively treated. A wider margin of radiation may be needed to cover microscopic and infiltrative tumor cells. The early use of bevacizumab can also reverse neurological deficits and obviate the long-term use of dexamethasone and insulin in this patient. This study was approved by the Institutional Review Board at Dana Farber Cancer Institute #12-519 onMay 5, 2020.

Significant new progress was made 10 years ago in the hypothesis that neuroglial cells, neural stem cells, and glioma stem cells (GSCs) depend on the tumor microenvironment (TME) transformation: (1) Because GSCs also have heterogeneity, they are a state, not an entity. (2) The importance of the border niche among many tumor niches is emphasized because it is a shelter for tumor resistance to radiotherapy and chemotherapy. (3) The plasticity of GSCs and TME cells allows TME cells to become GSC-initiating cells. (4) Future development will entail a close interaction between high-throughput molecular biology and artificial intelligence. In this review, we summarize recent advances in GSCs and their microenvironment from the following three aspects: the constantly updated of concept of stem cells, the concept of TME and niche, and the plasticity of GSCs and TME cells.

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Dear Editor, We read with great interest the article published by Weller et al.[1] entitled "Neuro-oncology during the coronavirus disease 2019 (COVID-19) pandemic," wherein the authors commented on the impact of the COVID-19 pandemic on neuro-oncology practice in Europe and discussed challenges encountered and findings learned during this pandemic. We thank the authors for their insightful comments. However, the tools and strategies found in high-income countries may bias the true global impact of the delayed approach to the neuro-oncology patient, whether due to cancellation of elective surgery, delays in early diagnosis, and timely treatment. We would like to discuss the issue regarding neuro-oncology patients' access to health services during the COVID-19 pandemic in low- and middle-income countries, where many difficulties with respect to adequate care and follow-up existed even before the pandemic, which severely intensified during this time, and also the need to design specialized neuro-oncology units. The development of neurosurgery and its branches in low- and middle-income countries is one of the main objectives of global neurosurgery.[2,3] It is a mandatory requirement because of the disease burden caused by cerebrovascular diseases and tumors in these countries.[2,3] During the COVID-19 pandemic, many of the objectives were delayed, and new goals were set with modifications needed to control the approaching disease burden owing to confinement and other public health security measures. However, this became a double-edged sword because even if the risk of severe acute respiratory syndrome coronavirus 2 infection was controlled, the development or progression of neurosurgical diseases for example could not be stopped, with evidence soon showing this to be true.[4,5,6] In the case of neuro-oncology patients, both the patients themselves and their caregivers were affected. Binswanger et al.[4] conducted a prospective study to evaluate the psychological burden of caregivers and neuro-oncology patients and observed that caregivers developed a median distress score of 8 (on a scale of 0–10) owing to tumor pathology compared with a score of 3 for COVID-19; furthermore, patients had a median score of 7 compared with a score of 5 for COVID-19.[4] Qualitatively, both groups mentioned that private and public restrictions and limited interaction with contacts were aspects of greatest concern.[4] Mrugala et al.[5] conducted a global survey regarding the impact of COVID-19 on neuro-oncology and found that approximately 70% of specialists discontinued enrollment and participation in clinical trials, 69% of trainees developed distress, and approximately 50% did not receive professional support from their institutions. More than 30% of these professionals had their salaries reduced and 63% suspended their work.[5] All of these occurred because of organizational modifications in general hospitals and redistribution of resources among front-line departments, mainly owing to limitations in the development of high-quality research studies. Similarly, the CovidNeuroOnc study,[6] one of the most important studies of neuro-oncology in the world during the pandemic, found changes in the management of patients who were previously classified as suitable for surgery (16%) and chemotherapy (28%); this occurred because of institutional modifications and redistribution of resources, thus allowing the authors to conclude that the disruption in neuro-oncology practice delayed diagnosis and treatment, thereby compromising survival rates and functional outcomes of these patients.[6] However, these and the vast majority of similar data are obtained from high-income countries, and the real impact on third-world countries is unknown. Based on the above findings, we propose the need to develop specialized neuro-oncology units with solid resources directed exclusively to this patient group to avoid the redistribution of resources and medical spaces, which compromises the normal practice of neuro-oncology. In addition, having specialized units will allow adaptation to social and public modifications in times of crisis in a more agile manner and maintain the recruitment and development of clinical trials and other research types.[7] In addition, having permanent teams of trained professionals dedicated to a specific discipline facilitates follow-up, data processing, and appointment and intervention scheduling to ensure that neuro-oncology patients have access to quality specialized services promptly, increase the probability of medium-term survival, decrease the risk of complications, and improve education and support for both patients and their caregivers.[8] There is much work to be performed currently in neuro-oncology, and the pandemic demonstrated that more funding and administrative and organizational research in neuro-oncology are needed. These specialized units could be an innovative option for improving health care processes, especially in times of crisis.

Although the 2021 World Health Organization classification update of the central nervous system tumors redefined "pilomyxoid astrocytoma" as high-grade astrocytoma with piloid features (HGAP), the craniocerebral HGAP exhibits poorer clinical outcomes when compared to pilocytic astrocytoma. However, in the spinal cord, the paucity of information of HGAP cases inhibits the judgment of prognosis and optimal management approaches for patients with spinal HGAP. Here, we summarized the clinical characteristics, management methods, and prognosis of ten cases of spinal HGAP reported in the literature and two cases of spinal HGAP who underwent tumor surgery in our institution. Here, the detailed clinical information we provided may help clinical decision-making for such rare childhood lesions. This study was approved by the Human Research Ethics Committees in our institution on June 29, 2021.