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Shigeaki Kobayashi and Akio Morita

, Aoki N, Fukuhara S, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474-82. 31. Greving JP, Wermer MJ, Brown RJ, Morita A, Juvela S, Yonekura M, et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol. 2014;13(1):59-66. 32. Shojima M, Oshima M, Takagi K, Torii R, Hayakawa M, Katada K, et al. Magnitude and role of wall shear stress on cerebral aneurysm: computational

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Tetsuya Goto, Chika Ndubuisi, Tatsuya Kobayashi, Takafumi Kiuchi, Kunihiko Kodama, Keiichi Sakai and Kazuhiro Hongo

lesion (upper). Functional MRI by moving foot joint showing that hot spot of lower left and lower right looks almost as a mirror image. Four months later, the tumor rapidly extended to the pyramidal tract, basal ganglia and corpus callosum four months after the fourth surgery ( Figure 3 , upper). She had mild motor aphasia and right hemiparesis: proximal U/E MMT 2, distal U/E MMT 4, lower extremity (L/E) MMT 2. Her Karnofsky performance state score was 70%. Figure 3 MRI before fifth operation revealing that the enhanced lesion invades to the basal