著者

Shigeki YAMADA Mitsuhito MASE

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0331, (Released:2023-03-01)

参考文献数

40

被引用文献数

6

---

Cerebrospinal fluid (CSF) production and absorption concept significantly changed in the early 2010s from "third circulation theory" and "classical bulk flow theory" to a whole new one as follows: First, CSF is mainly produced from interstitial fluid excreted from the brain parenchyma, and CSF produced from the choroid plexus plays an important role in maintaining brain homeostasis. Second, CSF is not absorbed in the venous sinus via the arachnoid granules, but mainly in the dural lymphatic vessels. Finally, the ventricles and subarachnoid spaces have several compensatory direct CSF pathways at the borders attached to the choroid plexus, e.g., the inferior choroidal point of the choroidal fissure, other than the foramina of Luschka and Magendie. In idiopathic normal pressure hydrocephalus (iNPH), the lateral ventricles and basal cistern are enlarged simultaneously due to the compensatory direct CSF pathways. The average total intracranial CSF volume increased from about 150 mL at 20 years to about 350 mL at 70 years due to the decrease in brain volume with aging and further increased above 400 mL in patients with iNPH. CSF movements are composed of a steady microflow produced by the rhythmic wavy movement of motile cilia on the ventricular surface and dynamic pulsatile flow produced by the brain and cerebral artery pulsation, respiration, and head movement. Pulsatile CSF movements might totally decrease with aging, but it in the ventricles might increase at the foramina of Magendie and Luschka dilation. Aging CSF dynamics are strongly associated with ventricular dilatation in iNPH.

著者

Kazuma DOI Satoshi TANI Toshiyuki OKAZAKI Junichi MIZUNO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0325, (Released:2023-04-06)

参考文献数

16

---

Cylindrical cages were known to cause subsidence after anterior cervical discectomy and fusion (ACDF); hence, they were gradually replaced by box-shaped cages. However, this phenomenon has been inconclusive due to limited information and short-term results. Therefore, this study aimed to clarify risk factors for subsidence after ACDF using titanium double cylindrical cages with mid-term follow-up periods. This retrospective study included 49 patients (76 segments) diagnosed with cervical radiculopathy or myelopathy caused by disc herniation, spondylosis, and ossification of the posterior longitudinal ligament. These patients underwent ACDF using these cages from January 2016 to March 2020 in a single institution. Patient demographics and neurological outcomes were also examined. Subsidence was defined as a ≥3-mm segmental disc height decrease at the final follow-up lateral X-ray compared to that on the next day postoperatively. Subsidence occurred in 26 of 76 segments (34.7%) within the follow-up periods of approximately three years. Multivariate analysis using a logistic regression model demonstrated that multilevel surgery was significantly associated with subsidence. The majority of patients achieved good clinical outcomes based on the Odom criteria. This study demonstrated that multilevel surgery was the only risk factor of subsidence post-ACDF with double cylindrical cages. Despite the relatively high subsidence rates, the clinical outcome was almost good at least during the mid-term period.

著者

Yusuke OTSU Sosho KAJIWARA Aya HASHIMOTO Kiyohiko SAKATA Tetsuya NEGOTO Yu HASEGAWA Hideo NAKAMURA Masaru HIROHATA Motohiro MORIOKA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0288, (Released:2023-04-06)

参考文献数

22

被引用文献数

2

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Pharmacotherapy is frequently selected over surgical interventions for late elderly patients with trigeminal neuralgia (TN). However, medication may affect these patients' activities of daily living (ADL). Hence, we investigated the effect of the surgical treatment of TN on ADL in older patients. This study included 11 late elderly patients >75 years old and 26 nonlate elderly patients who underwent microvascular decompression (MVD) for TN at our hospital from June 2017 to August 2021. We evaluated pre- and postsurgical ADL using the Barthel Index (BI) score, side effects of antineuralgic drugs, the BNI pain intensity score, and perioperative medication. The BI score of late elderly patients significantly improved postoperatively, particularly in transfer (pre: 10.5; post: 13.2), mobility (pre: 10; post: 12.7), and feeding (pre: 5.9 points; post: 10 points). Additionally, antineuralgic drugs caused preoperative disturbances of transfer and mobility. Trends of a longer disease duration and frequent occurrence of side effects were observed in all patients in the elderly group, compared to only 9 out of 26 patients in the younger group (100% vs. 35%, p = 0.0002). In addition, drowsiness was observed more frequently in the late elderly group (73% vs. 23%, p = 0.0084). However, the change in scores indicating improvement after surgery was significantly greater in the late elderly group, although both pre- and postoperative scores were higher in the nonlate elderly group (11.4 ± 1.9 vs. 6.9 ± 0.7, p = 0.027). Surgical treatment can improve older patients' ADL because it relieves pain and facilitates discontinuation of antineuralgic drugs. Consequently, MVD can be positively recommended for older patients with TN if general anesthesia is acceptable.

著者

Satoshi MAESAWA Tomotaka ISHIZAKI Manabu MUTOH Yoshiki ITO Jun TORII Takafumi TANEI Daisuke NAKATSUBO Ryuta SAITO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0271, (Released:2023-03-31)

参考文献数

54

---

Stereotactic electroencephalography (SEEG) is receiving increasing attention as a safe and effective technique in the invasive evaluation for epileptogenic zone (EZ) detection. The main clinical question is whether the use of SEEG truly improves outcomes. Herein, we compared outcomes in our patients after three types of intracranial EEG (iEEG): SEEG, the subdural electrode (SDE), and a combined method using depth and strip electrodes. We present here our preliminary results from two demonstrative cases. Several international reports from large epilepsy centers found the following clinical advantages of SEEG: 1) three-dimensional analysis of structures, including bilateral and multilobar structures; 2) low rate of complications; 3) less pneumoencephalopathy and less patient burden during postoperative course, which allows the initiation of video-EEG monitoring immediately after implantation and does not require resection to be performed in the same hospitalization; and 4) a higher rate of good seizure control after resection. In other words, SEEG more accurately identified the EZ than the SDE method. We obtained similar results in our preliminary experiences under limited conditions. In Japan, as of August 2022, dedicated electrodes and SEEG accessories have not been approved and the use of the robot arm is not widespread. The Japanese medical community is hopeful that these issues will soon be resolved and that the experience with SEEG in Japan will align with that of large epilepsy centers internationally.

著者

Koji YAMAGUCHI Takayuki FUNATSU Yosuke MOTEKI Taku NONAKA Akihiro NIWA Kosuke IMANAKA Kilsoo KIM Tatsuya ISHIKAWA Tatsuki MOCHIZUKI Yoshikazu OKADA Takakazu KAWAMATA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0307, (Released:2023-03-31)

参考文献数

18

被引用文献数

1

---

Various surgical treatments are available for occlusive subclavian and common carotid artery diseases. Nevertheless, to date, when cerebral endovascular treatment is utilized, revascularization via direct surgery may be required. This study reported five symptomatic cases of revascularization for CCA and SCA occlusive and stenotic lesions that were expected to be challenging to treat with endovascular treatment. We performed subclavian artery-common carotid artery or internal carotid artery bypass using artificial blood vessels or saphenous vein grafts in five patients with subclavian steal syndrome, symptomatic common carotid artery occlusion, and severe proximal common carotid artery stenosis. In this study, good bypass patency was achieved in all five cases. Although there were no intraoperative complications, one patient had a postoperative lymphatic leak. Moreover, there was no recurrence of stroke during postoperative follow-up for an average of 2 years. Conclusively, subclavian artery-common carotid artery bypass can be an effective surgical treatment for common carotid artery occlusion, proximal common carotid artery stenosis, and subclavian artery occlusion.

著者

Kazuhiro WAKAMATSU Sumio ISHIAI Nobuko AIHARA Sho KUROKAWA Yusuke KIMURA Nobuhiro MIKUNI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0319, (Released:2023-03-01)

参考文献数

40

---

Language tasks for monitoring intraoperative language symptoms have not yet been established. This study aimed to examine whether the quantitative evaluation of language function with visual and auditory naming during awake craniotomy predicts early postoperative language function in patients. Thirty-seven patients with brain tumors in the language-dominant hemisphere were included. They underwent visual and auditory naming preoperatively and at the end of tumor resection for intraoperative evaluation. Using the Western Aphasia Battery, their overall language functions were evaluated preoperatively, early postoperatively (within 1 week), and late postoperatively (after 1 month). The preoperative and intraoperative changes in the visual and auditory naming scores were significantly correlated with most of the Western Aphasia Battery score changes between the preoperative and early postoperative evaluations, which was more remarkable for auditory naming. Multiple linear regression analysis showed that changes in the auditory naming score predicted the preoperative to early postoperative changes in the aphasia quotient of the Western Aphasia Battery. Receiver operating characteristics analysis showed a higher area under the curve or discriminative power for auditory than visual naming in predicting the development or exacerbation of aphasia in the early postoperative period. Considering the analyses applied separately for low- and high-grade glioma, auditory naming, which taps into a wider range of linguistic functions, may be more informative than visual naming as language evaluation in awake craniotomy for the early postoperative development of aphasia, especially for patients with high-grade glioma.

著者

Takato TAJIRI Kyongsong KIM Toyohiko ISU Fumiaki FUJIHARA Takao KITAMURA Takeshi TAKAHASHI Takahito SUZUKI Masanori ISOBE Tooru INOUE

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0112, (Released:2023-03-01)

参考文献数

28

---

In idiopathic tarsal tunnel syndrome (TTS), walking seems to make symptoms worse. The findings imply that an ankle movement dynamic component may have an impact on the etiology of idiopathic TTS. We describe how the ankle movement affects the nerve compression caused by the surround tissue, particularly the posterior tibial artery. We enrolled 8 cases (15 sides) that had TTS surgery after tarsal tunnel (TT) MRI preoperatively. Dorsiflexion and plantar flexion were the two separate ankle positions used for the T2* fat suppression 3D and MR Angiography of TT. Based on these findings, we looked at how the two different ankle positions affected the posterior tibial artery's ability to compress the nerve. Additionally, we assessed the posterior tibial artery's distorted angle. We divided the region around the TT into four sections: proximal and distal to the TT and proximal half and distal half to the TT. Major compression cause was posterior tibial artery. Most severe compression point was proximal half in the TT in all cases without one case. In each scenario, the nerve compression worsens by the plantar flexion. The angle of the twisted angle of the posterior tibial artery was significantly worsened by the plantar flexion. In idiopathic TTS, deformation of posterior tibial artery was the primary compression component. Nerve compression was exacerbated by the plantar flexion, and it was attributable with the change of the distorted angle of the posterior tibial artery. This could be a contributing factor of the deteriorating etiology by walking in idiopathic TTS.

著者

Satoshi YOSHIKAWA Yusuke NISHIMURA Yoshitaka NAGASHIMA Hiroshi ITO Takahiro OYAMA Tomoya NISHII Tomomi GONDA Hiroshi RYU Kei NOMURA Masahito HARA Masakazu TAKAYASU Howard J GINSBERG Tokumi KANEMURA Ryuta SAITO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2021-0390, (Released:2023-03-01)

参考文献数

28

---

The goal of this study is to perform correlation analysis of Computed tomography (CT) and magnetic resonance imaging (MRI) results in posterior ligament complex (PLC) injury and define the morphological traits of thoracolumbar (TL) burst fractures connected to PLC injury. Forty patients with surgically repaired TL burst fractures between January 2013 and December 2020 were retrospectively analyzed. The patients were split into two groups for comparison based on MRI (Group P: patients with a confirmed or suspected PLC injury; Group N: patients with PLC injury denied). The radiographic morphological examination based on CT scans and clinical evaluation was performed and compared between two groups. The thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores, and the number of patients with neurological impairments were considerably greater in Group P. Loss of height of the fracture (loss height), local kyphosis of the fracture (local kyphosis), and supraspinous distance were significantly higher in Group P and significantly associated with PLC injuries indicating severe vertebral body destruction and traumatic kyphosis in multivariate logistic analysis [odds ratio: 1.90, 1.06, and 1.13, respectively]. Cutoff value for local kyphosis obtained from the receiver operating characteristic curve was 18.8. If local kyphosis is greater than 18.8 degrees on CT scans, we should take into account the probability of the highly damaged burst fracture associated with PLC injury. In this situation, we should carefully assess MRI to identify the spinal cord injury or spinal cord compression in addition to PLC injury because these instances likely present with neurological abnormalities.

著者

Makoto SATOH Takeshi NAKAJIMA Eiju WATANABE Kensuke KAWAI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0278, (Released:2023-01-20)

参考文献数

28

被引用文献数

4

---

Stereotactic neurosurgery is an established technique, but it has several limitations. In frame-based stereotaxy using a stereotactic frame, frame setting errors may decrease the accuracy of the procedure. Frameless stereotaxy using neuronavigation requires surgeons to shift their view from the surgical field to the navigation display and to advance the needle while assuming a physically uncomfortable position. To overcome these limitations, several researchers have applied augmented reality in stereotactic neurosurgery. Augmented reality enables surgeons to visualize the information regarding the target and preplanned trajectory superimposed over the actual surgical field. In frame-based stereotaxy, a researcher applies tablet computer-based augmented reality to check for the setting errors of the stereotactic frame, thereby improving the safety of the procedure. Several researchers have reported performing frameless stereotaxy guided by head-mounted-display-based augmented reality that enables surgeons to advance the needle at a more natural posture. These studies have shown that augmented reality can address the limitations of stereotactic neurosurgery. Conversely, they have also revealed the limited accuracy of current augmented reality systems for small targets, which indicates that further development of augmented reality systems is needed.

著者

Hiroshi KARIBE Ayumi NARISAWA Arata NAGAI Satoshi YAMANOUCHI Motonobu KAMEYAMA Atsuhiro NAKAGAWA Teiji TOMINAGA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0327, (Released:2023-01-20)

参考文献数

34

被引用文献数

1

---

Anti-thrombotic drugs may increase the risk for chronic subdural hematoma (CSDH). However, whether to continue or discontinue/counteract these drugs has not been investigated in patients with mild head trauma. CSDH incidence after mild head trauma, as well as the risk for CSDH in patients with anti-thrombotic drugs, were investigated in this study. The study included 765 consecutive elderly (>65 y.o.) patients with mild head trauma and an initial Glasgow Coma Scale (GCS) score of 14 or 15. All patients received initial CT within 24 hours after trauma and were re-examined 30 days after trauma to detect CSDH formation, repeating for every 30 days to examine symptomatic CSDH progression. Patients were divided into two groups, with anti-thrombotic drugs (n = 195) or without them (n = 263), to investigate the influence of pre-traumatic conditioning with anti-thrombotic drugs on CSDH. The whole sample was 458 out of 765 cases. The incidence of CSDH formation was 91 out of 458 cases (19.9%) after mild head trauma, with no significant difference between with and without anti-thrombotic drugs. CSDH progressed as symptomatic in 21 out of 458 cases (4.6%), with no significant difference between with and without anti-thrombotic drugs. Pre-traumatic conditioning with anti-thrombotic drugs and its continuation after trauma did not affect the incidence of formation or symptomatic progression of CSDH. This finding suggests that discontinuing and/or counteracting anti-thrombotic drugs may be unnecessary in patients with mild head trauma.

著者

Motoaki FUJIMOTO Shoichi TANI Hideki OGATA Kampei SHIMIZU Shota YOSHIDA Satoko YAMAGUCHI Yoshihito HIRATA Yoshinori AKIYAMA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0246, (Released:2023-01-20)

参考文献数

19

---

To improve the success of mechanical thrombectomy, three-dimensional turbo spin-echo (3D-TSE) sequences on T2WI can be employed to estimate the vascular structure of the posterior circulation. In addition to the short imaging time of 3D-TSE T2WI (33 sec), it can visualize the outer diameter of the main cerebral artery, including the occluded vessels. However, to date, the efficacy of mechanical thrombectomy in the posterior circulation remains unclear, and safer and more efficient mechanical thrombectomy procedures are required. Assessment of the anatomical variations in the posterior circulation using 3D-TSE T2WI is valuable for access decisions, device selection, and safe device guidance and retrieval techniques to the target vessel. Herein, we present representative cases of basilar artery and posterior cerebral artery occlusions in our institute and describe the utility of preoperative 3D-TSE T2WI in these patients.

著者

Yuta MITOBE Ken-ichiro MATSUDA Yukihiko SONODA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0179, (Released:2023-01-20)

参考文献数

26

---

Serum soluble interleukin-2 receptor (sIL-2R) is a practical tumor marker that is elevated in hematogenous tumors. The purpose of this study was to determine the usefulness of serum sIL-2R for differentiating among malignant brain tumors, including primary central nervous system lymphoma (PCNSL) and secondary central nervous system lymphoma (SCNSL). This study retrospectively investigated the sIL-2R levels in 130 patients with various types of malignant brain tumors, including PCNSL patients (n = 48) and SCNSL (n = 8); metastatic brain tumors (MTs, n = 16); and glioblastoma (GBM, n = 58). The median sIL-2R level (U/mL) of the PCNSL, SCNSL, MTs, and GBM groups were 489.7, 1024.8, 413.3, and 332.7 respectively. The sIL-2R level was significantly higher in the SCNSL group than in the PCNSL or other groups. The area under the ROC curve generated from the sIL-2R level was 0.826 (sensitivity: 0.875, specificity: 0.667, cutoff value: 521 U/mL) for differentiating SCNSL from PCNSL and 0.685 (sensitivity: 0.667, specificity: 0.707, cutoff value: 342 U/mL) for differentiating PCNSL from GBM. Measurement of sIL-2R level was convenient and useful to differentiate between SCNSL and PCSNL, both of which demand different treatment strategies.

著者

Ryohei CHIBA Rei ENATSU Aya KANNO Tomoaki TAMADA Takuro SAITO Ryota SATO Nobuhiro MIKUNI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0252, (Released:2022-11-25)

参考文献数

16

---

Intraoperative electrocorticography (iECoG) is widely performed to identify irritative zones in the cortex during brain surgery; however, several limitations (e.g., short recording times and the effects of general anesthesia) reduce its effectiveness. The present study aimed to evaluate the utility of iECoG for localizing epileptogenic zones. We compared the results of iECoG and chronic electrocorticography (cECoG) in 25 patients with refractory epilepsy. Subdural electrodes were implanted with iECoG under general anesthesia (2% sevoflurane). cECoG recordings were performed for 3-14 days. The distribution of iECoG spikes was compared with cECoG spike, seizure onset zone, and resection areas. The concordance patterns of each distribution were classified into four patterns: Group 1: No spike in iECoG, Group 2: concordant (2a: iECoG smaller, 2b: iECoG larger, Group 3: discordant >50%). The concordance rate of interictal spikes, seizure onset zones, and resection areas were 88.0% (Group 2a: 72.0%, Group 2b: 16.0%), 70.0% (Group 2a: 25.0%, Group 2b: 45.0%), and 81.0% (Group 2a: 42.9%, Group 2b: 38.1%), respectively. The resection of iECoG spike areas significantly correlated with good surgical outcomes. The indication and limitations of iECoG need to be realized, and the complementary use of iECoG and cECoG may enhance clinical utility.

著者

Yohei NOUNAKA Shigeyuki TAHARA Kazuma SASAKI Akio MORITA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.63, no.1, pp.37-41, 2023-01-15 (Released:2023-01-15)

参考文献数

6

---

Indocyanine green (ICG) is a cyanine dye useful for visualizing blood vessels; it has been developed for endoscopy and is used in skull base surgery. Endoscopy is widely used for hematoma removal after an intracerebral hemorrhage since it is minimally invasive and has a shorter operation time than craniotomy. However, with this technique the surgical field is limited and it is difficult to obtain an adequate orientation; thus, it is challenging to locate the bleeding point, and postoperative rebleeding has been reported. We performed intraoperative ICG near-infrared fluorescence imaging to locate the bleeding point. This purpose of this study was to evaluate the usefulness of ICG angiography during endoscopic hematoma removal in two patients, using two endoscope types and comparing their visualization of perforating branches during the procedure. ICG angiography was performed in two different cases of putaminal hemorrhage, using the SPIES NIR/ICG-System and IMAGE1 S Rubina (both KARL STORZ, Tuttlingen, Germany) at the intraoperative bleeding site. The intraoperative use of ICG allowed the clear visualization of the perforating branches and real-time confirmation of active bleeding. We could also distinguish an old hematoma from the active bleeding point. The IMAGE1 S Rubina has adequate brightness for contrast enhancement, allowing surgical manipulation simultaneously to the enhancement phase.ICG fluorescence angiography is useful to identify the damaged vessel and perform hemostasis. We expect other similar devices to be developed in the future, accompanied by flexible and thin rigid endoscopes.

著者

Takao KOISO Yoji KOMATSU Daisuke WATANABE Go IKEDA Hisayuki HOSOO Masayuki SATO Yoshiro ITO Tomoji TAKIGAWA Mikito HAYAKAWA Aiki MARUSHIMA Wataro TSURUTA Noriyuki KATO Kazuya UEMURA Kensuke SUZUKI Akio HYODO Eichi ISHIKAWA Yuji MATSUMARU

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0253, (Released:2023-01-05)

参考文献数

15

---

The influence of aneurysm size on the outcomes of endovascular management (EM) for aneurysmal subarachnoid hemorrhages (aSAH) is poorly understood. To evaluate the outcomes of EM for ruptured large cerebral aneurysms, we retrospectively analyzed the medical records of patients with aSAH that were treated with coiling between 2013 and 2020 and compared the differences in outcomes depending on aneurysm size. A total of 469 patients with aSAH were included; 73 patients had aneurysms measuring ≥10 mm in diameter (group L), and 396 had aneurysms measuring <10 mm in diameter (group S). The median age; the percentage of patients that were classified as World Federation of Neurological Surgeons grade 1, 2, or 3; and the frequency of intracerebral hemorrhages differed significantly between group L and group S (p = 0.0105, p = 0.0075, and p = 0.0458, respectively). There were no significant differences in the frequencies of periprocedural hemorrhagic or ischemic events. Conversely, rebleeding after the initial treatment was significantly more common in group L than in group S (6.8% vs. 2.0%; p = 0.0372). The frequency of a modified Rankin Scale score of 0-2 at discharge was significantly lower (p = 0.0012) and the mortality rate was significantly higher (p = 0.0023) in group L than in group S. After propensity-score matching, there were no significant differences in complications and outcomes between the two groups. Rebleeding was more common in large aneurysm cases. However, propensity-score matching indicated that the outcomes of EM for aSAH may not be affected markedly by aneurysm size.

著者

Takao YASUHARA Satoshi MURAI Nobuhiro MIKUNI Susumu MIYAMOTO Isao DATE

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.60, no.7, pp.337-350, 2020 (Released:2020-07-15)

参考文献数

14

被引用文献数

4 5

---

Cranial implants are commonly used throughout the world, yet the data on complications remain partly clarified. The aim of this study was to gather real data in 2018 on complications related to cranial implants in neurosurgery. The survey population consisted of 1103 institutes supplying neurosurgical treatment. The survey consisted of two-stage questionnaire. First the incidence of complications was investigated, then the secondary questionnaire was e-mailed to the respondents about the detailed of the complications. As the result, the annual incidence of complications related to cranial implants was 0.558% in Japan. Titanium plate and mesh were used predominantly in craniotomy and cranioplasty, respectively. The second survey collected data on 449 cases with complications (infection: 63%, implant exposure: 46%, multiple answer). Postoperative infection was associated with male sex, brain tumor, short interval between surgery and complication, usage of ceramics, hydroxyapatite, resin, and artificial dura, hyponutrition, multiple surgeries, dirty wound, and sinusitis as patient factors, and CSF leakage, ruptured sutures, and sinus maltreatment as surgery factors. Meanwhile, long hospital stay was associated with age, male sex, mRS 3–5 before complication, short interval between initial surgery and complication, large craniotomy, long operative time, usage of ceramics and artificial dura, multiple surgeries and dirty wound as patient factors, ruptured suture as a surgical factor, and bacterial infection, especially MRSA infection, as the complication and treatment consisting of removal as complication factors. In conclusion, this is the first Japanese national survey on complications related to cranial implants in neurosurgery. It is important to recall that complications may arise years after surgery and to be aware of the risk factors associated with complications.

著者

元持 雅男 牧田 泰正 鍋島 祥男 板垣 徹也 鄭 台項 欅 篤

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.23, no.4, pp.282-288, 1983 (Released:2006-11-10)

参考文献数

51

被引用文献数

5 5

---

Cystic meningiomas are rare. The authors presented a case of cystic meningioma in the right frontal convexity of a 36-year-old female. The patient was admitted because of progressive headache, foggy sight, diplopia, and left-sided motor weakness of two months' duration. The preoperative diagnosis of cystic meningioma was made by plain skull X-rays, CT scans, and cerebral arteriograms. At surgery, a tumor was found adherent to the dura in the right frontal convexity with multiloculated intratumoral cysts containing xanthochromic fluid. Histologically, the tumor was a transitional meningioma with intratumoral infarction in the vicinity of the cysts. The pathogenesis of the intratumoral cysts in this particular case were considered intratumoral infarction resulting in microcysts and then finally macrocysts. Ninety-six cases of cystic meningiomas reported in the literature were reviewed and the pathogenesis of cyst formation was discussed. Nauta's classification of four types of cystic meningiomas is important when considering the different pathogenesis of cyst formation in meningiomas. Adding to the four types of cystic meningiomas classified by Nauta et al., the authors suggested another type, namely, the subdural cyst mainly seen in infant meningiomas.

著者

Takuma HARA Hiroyoshi AKUTSU Shuho TANAKA Hiroyoshi KINO Hidetaka MIYAMOTO Rieko II Shingo TAKANO Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0132, (Released:2022-11-25)

参考文献数

25

---

This study analyzed risk factors for postoperative cerebrospinal fluid (CSF) leak after graded multilayer cranial base repair method with dural suturing. We performed surgery via the endoscopic endonasal approach (EEA) from 2012.6 to 2018.4, and those consecutive clinical data were prospectively accumulated and retrospectively analyzed. We tailored the repair method according to the intraoperative CSF leak grade. Among 388 surgeries via the EEA, there were 10 (2.6%) cases of postoperative CSF leak after graded repair with suturing. Postoperative CSF leak occurred in two of the 150 cases without intraoperative CSF leak (grade 0), one of the 104 cases with small (grade 1) intraoperative CSF leak, two of the 60 cases with moderate (grade 2) leak, and five of the 74 cases with large (grade 3) leak. Univariate analysis indicated that chordoma (P = 0.023), estimated tumor volume ≥ 7400 mm3 (P = 0.003), and maximum tumor diameter ≥ 32.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Additionally, among cases with intraoperative grade 3 CSF leak, chordoma (P = 0.021), estimated tumor volume ≥ 23000 mm3 (P = 0.003), and maximum tumor diameter ≥ 45.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Maximum tumor diameter, estimated tumor volume, and chordoma tumor pathology are related to a higher risk of postoperative CSF leak.

著者

Yasuo MURAI Fumihiro MATANO Koshiro ISAYAMA Yohei NOUNAKA Akio MORITA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.62, no.11, pp.530-534, 2022-11-15 (Released:2022-11-15)

参考文献数

25

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Crystal violet (CV) ink has been used as a skin marker worldwide. It has been reported to be useful for vessel wall visualization of microvascular anastomoses. Contrastingly, it has been found to be carcinogenic and inhibit migration and proliferation of venous cells. In some countries, its use in the medical field has been restricted. Therefore, it is necessary to consider alternatives to CV. In this present study, we compared the time required for the anastomosis of a 0.8-1 mm diameter vessel in the chicken wrist artery using CV and a CV-free dye (ethyl violet; EV). The surgeon, microscope, and anastomosis microsurgical tools were standardized for comparison. CV and EV were changed for each anastomosis. The same surgeon performed 30 anastomoses using each dye. No visually obvious differences were noted in the vascular transections with CV and EV. As per the results, no statistically significant difference was observed in the time required for anastomosis using CV and EV. EV conforming to California Proposition 65 may be an effective alternative to CV for vascular visualization of microvascular anastomoses. However, further studies on the effectiveness of the EV in clinical cases are needed.

著者

Yasutaka IMADA Chie MIHARA Hitoshi KAWAMOTO Kaoru KURISU

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.62, no.11, pp.502-512, 2022-11-15 (Released:2022-11-15)

参考文献数

37

被引用文献数

1

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The sylvian fissure stem and its deep cisternal part (SDCP) consist mainly of the orbital gyrus (OG) and anterior medial portion of the temporal lobe. SDCP's adhesion has been found to make a trans-sylvian approach difficult due to the various patterns of adhesion. Thus, in this study, we aim to clarify the morphological features of the SDCP, and to guide a safe trans-sylvian approach. We retrospectively classified the morphology of the SDCP in 81 patients into 3 types (tight, moderate, loose type) according to the degree of adhesion of the arachnoid membrane and analyzed the morphological features of the OG and the temporal lobe using intraoperative video images. In addition, we have retrospectively measured each width of the SDCP's subarachnoid space at the three points (Point A, lateral superior portion; Point B, downward portion; Point C, medial inferior portion of SDCP) and analyzed their relationship to the degree of adhesion using the preoperative coronal three-dimensional computed tomography angiography (3D-CTA) images of 44 patients. As per the results, SDCP's adhesions were determined to be significantly tighter in cases with large OG and young cases. The temporal lobe had four surfaces (posterior, middle, anterior, and medial) that adhered to the OG in various patterns. The tighter the adhesion between the OG and each of the three distal surfaces of the temporal lobe, the narrower the width of the subarachnoid space at each point (A, B, C). Understanding of the morphological features of the SDCP, and estimating its adhesion preoperatively are useful in developing a surgical strategy and obtaining correct intraoperative orientation in the trans-sylvian approach.