著者

Yutaka MITSUHASHI Koji HAYASAKI Taichiro KAWAKAMI Takashi NAGATA Yuta KANESHIRO Ryoko UMABA Kenji OHATA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.56, no.6, pp.326-339, 2016 (Released:2016-06-15)

参考文献数

75

被引用文献数

13 25

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The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage.

著者

Shinichi YOSHIMURA Kazutaka UCHIDA Nobuyuki SAKAI Hiroshi YAMAGAMI Manabu INOUE Kazunori TOYODA Yuji MATSUMARU Yasushi MATSUMOTO Kazumi KIMURA Reiichi ISHIKURA Takeshi MORIMOTO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.rc.2021-0311, (Released:2021-12-24)

参考文献数

19

被引用文献数

13

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Endovascular therapy is strongly recommended for acute cerebral large vessel occlusion (LVO) with an Alberta stroke program early computed tomography score (ASPECTS) ≥6 due to occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of endovascular therapy for patients with a large ischemic core with an ASPECTS ≤5 (0–5) was not established. A multicenter, randomized, open-label, parallel-group trial was conducted to investigate the superiority of endovascular therapy over medical therapy without endovascular therapy for a large ischemic core with ASPECTS (3–5). Patients were randomly assigned to receive endovascular therapy or without endovascular therapy at a ratio of 1:1. The primary outcome was a moderate functional outcome, defined as a modified Rankin scale (mRS; scores ranging from 0 [no symptoms] to 6 [death]) ≤3 after 90 days. The secondary outcomes were defined as ordinal mRS, good functional outcome (mRS ≤2), excellent functional outcome (mRS ≤1), mRS shift analysis after 90 days, and early improvement of neurological findings at 48 hours. A total sample size of 200 was estimated to provide a power of 0.9 with a two-sided alpha of 0.05, for the primary outcome, considering a 15% dropout rate. This randomized clinical trial reported the applicability of endovascular therapy in patients with acute cerebral LVO with a large ischemic core.

著者

Toru YOSHIURA Satoru TAKEUCHI Terushige TOYOOKA Arata TOMIYAMA Kojiro WADA Yasuaki NAKAO Takuji YAMAMOTO Kentaro MORI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2023-0157, (Released:2023-11-08)

参考文献数

28

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In Japan, brain docking has enhanced the detection of unruptured intracranial aneurysms in healthy adults. At our institution, surgical clipping is the first-line treatment for unruptured intracranial aneurysms (UIA). In this study, the differences in neurological and radiological outcomes, as well as cognitive and psychological results, between standard clipping and keyhole clipping for these aneurysms detected via brain docking were evaluated. The study included 131 aneurysms detected via "brain dock." Of these, 65 were treated with keyhole clipping surgery (keyhole clipping group), and 66 were treated with standard clipping surgery (standard clipping group). Evaluations at 3 months included the National Institutes of Health Stroke Scale, modified Rankin Scale, Mini-Mental State Examination, Hasegawa's Dementia Scale-revised, Beck Depression Inventory, Hamilton Rating Scale for Depression, and radiological abnormalities. The mean operative time and postoperative hospitalization period were significantly shorter in the keyhole clipping group than in the standard clipping group (p < 0.001). Between the groups, no significant differences in postoperative neurological complications or radiological abnormalities were found. The keyhole clipping group demonstrated slightly but significantly better Beck Depression Inventory and Hamilton Rating Scale for Depression scores than the standard clipping group (Beck Depression Inventory, p = 0.046; Hamilton Rating Scale for Depression, p < 0.01). Both the Beck Depression Inventory and Hamilton Rating Scale for Depression scores at 3 months were significantly enhanced (p < 0.001) in the keyhole clipping group. These findings propose that keyhole clipping could be considered a new therapeutic option for small UIA detected via brain docking.

著者

Ai NISHIYAMA Hidetaka WAKABAYASHI Shinta NISHIOKA Ayano NAGANO Ryo MOMOSAKI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2019-0002, (Released:2019-05-22)

参考文献数

23

被引用文献数

17

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Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.

著者

Rintaro HASHIZUME

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.ra.2017-0018, (Released:2017-06-07)

参考文献数

98

被引用文献数

34

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Diffuse intrinsic pontine glioma (DIPG) is a rare but uniformly fatal cancer of the brain, with peak incidence in children of 5–7 years of age. In contrast to most types of human cancer, there has been no significant improvement in treatment outcomes for patients with DIPG. Since DIPG occurs in the brainstem, a vital region of the brain, there are no surgical options for providing relief to patients, and chemotherapy as well as radiation therapy provide palliative relief at best. To date, more than 250 clinical trials evaluating radiotherapy along with conventional cytotoxic chemotherapy, as well as newer biologic agents, have failed to improve the dismal outcome when compared with palliative radiation alone. The recent discovery of somatic oncogenic histone gene mutations affecting chromatin regulation in DIPG has dramatically improved our understanding of the disease pathogenesis in DIPG, and these findings have stimulated the development of novel therapeutic approaches targeting epigenetic regulators for disease treatment. This review will discuss about the role of histone modification in chromatin machinery and epigenetic therapeutic strategies for the treatment of DIPG.

著者

Zheng ZHANG Wenwei REN Bei SHAO Huiqin XU Jianhua CHENG Qiongzhang WANG Yingying GU Beilei ZHU Jincai HE

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2016-0188, (Released:2017-02-10)

参考文献数

34

被引用文献数

17

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Whether leukoaraiosis burden retards short-term recovery after minor stroke is unclear. We investigated the association between leukoaraiosis and early recovery of neurological function after a first minor ischemic stroke in 217 acute stroke patients (National Institutes of Health Stroke Scale (NIHSS) score ≤5). Leukoaraiosis severity was graded according to the Fazekas scale and categorized into none to mild (0–2; n = 143) or severe (3–6; n = 74) groups. NIHSS and Minimum Mental State Examination (MMSE) were assessed at baseline and at 30 days. Univariate analysis revealed that the severe leukoaraiosis group was older in age (P < 0.001) and had fewer low MMSE patients than non-mild group at baseline (39.1% vs 55.9%, P = 0.003). However, the MMSE improved in none to mild group but not in the severe group at 30-day (15.4% vs 36.5%, P < 0.001). At 30-day, the severe leukoaraiosis group had higher NIHSS scores than the none-mild group (P = 0.04). Multiple linear regression analyses demonstrated that leukoaraiosis severity and admission NIHSS were independently associated with the NIHSS score on day 30 (P = 0.034, 95% CI 0.004–0.091 and P = 0.001, 95% CI 0.011–0.04). Binary regression analyses showed that leukoaraiosis severity and admission MMSE were significantly associated with MMSE (dichotomized) at 30-day (OR 2.1, P < 0.01, 95% CI 1.7–2.6 and OR 5.1, P < 0.01, 95% CI 2.1–12.8). Leukoaraiosis burden is an independent predictor of worse short-term functional and cognitive recovery after a minor ischemic stroke.

著者

Jun MARUYA Keiichi NISHIMAKI Jun-ichi NAKAHATA Hiroko SUZUKI Yasuo FUJITA Takashi MINAKAWA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.48, no.3, pp.114-117, 2008 (Released:2008-03-25)

参考文献数

19

被引用文献数

4 7

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A 43-year-old woman suffered clinical brain death after severe head injury. The patient met the criteria for the diagnosis of clinical brain death on Day 3. Aggressive hemodynamic and respiratory managements coupled with triple hormone therapy were performed at the family’s request, resulting in continued cardiac activity for a prolonged period. Spinal reflexes and automatisms were observed until cardiac arrest. Ventilatory support was discontinued on Day 168, when cardiac death was confirmed, and her kidneys and eyeballs were removed for transplantation. The patient survived for 165 days after the diagnosis of clinical brain death, which is an extremely prolonged period of somatic support for an adult patient after brain death. An extensive and informed discussion on the end-of-life treatment of clinically brain-dead patients is urgently required in Japan to establish treatment guidelines for such patients.

著者

Madoka NAKAJIMA Shigeki YAMADA Masakazu MIYAJIMA Kazunari ISHII Nagato KURIYAMA Hiroaki KAZUI Hideki KANEMOTO Takashi SUEHIRO Kenji YOSHIYAMA Masahiro KAMEDA Yoshinaga KAJIMOTO Mitsuhito MASE Hisayuki MURAI Daisuke KITA Teruo KIMURA Naoyuki SAMEJIMA Takahiko TOKUDA Mitsunobu KAIJIMA Chihiro AKIBA Kaito KAWAMURA Masamichi ATSUCHI Yoshihumi HIRATA Mitsunori MATSUMAE Makoto SASAKI Fumio YAMASHITA Shigeki AOKI Ryusuke IRIE Hiroji MIYAKE Takeo KATO Etsuro MORI Masatsune ISHIKAWA Isao DATE Hajime ARAI The research committee of idiopathic normal pressure hydrocephalus

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.61, no.2, pp.63-97, 2021 (Released:2021-02-15)

参考文献数

286

被引用文献数

88 189

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Among the various disorders that manifest with gait disturbance, cognitive impairment, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. The first edition of these guidelines for management of iNPH was published in 2004, and the second edition in 2012, to provide a series of timely, evidence-based recommendations related to iNPH. Since the last edition, clinical awareness of iNPH has risen dramatically, and clinical and basic research efforts on iNPH have increased significantly. This third edition of the guidelines was made to share these ideas with the international community and to promote international research on iNPH. The revision of the guidelines was undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project. This revision proposes a new classification for NPH. The category of iNPH is clearly distinguished from NPH with congenital/developmental and acquired etiologies. Additionally, the essential role of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in the imaging diagnosis and decision for further management of iNPH is discussed in this edition. We created an algorithm for diagnosis and decision for shunt management. Diagnosis by biomarkers that distinguish prognosis has been also initiated. Therefore, diagnosis and treatment of iNPH have entered a new phase. We hope that this third edition of the guidelines will help patients, their families, and healthcare professionals involved in treating iNPH.

著者

Etsuro MORI Masatsune ISHIKAWA Takeo KATO Hiroaki KAZUI Hiroji MIYAKE Masakazu MIYAJIMA Madoka NAKAJIMA Masaaki HASHIMOTO Nagato KURIYAMA Takahiko TOKUDA Kazunari ISHII Mitsunobu KAIJIMA Yoshihumi HIRATA Makoto SAITO Hajime ARAI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.11, pp.775-809, 2012 (Released:2012-11-25)

参考文献数

253

被引用文献数

149 467

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Among the various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. After the publication of the first edition of the Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus in 2004 (the English version was published in 2008), clinical awareness of iNPH has risen dramatically, and the number of shunt surgeries has increased rapidly across Japan. Clinical and basic research on iNPH has increased significantly, and more high-level evidence has since been generated. The second edition of the Japanese Guidelines was thus published in July 2011, to provide a series of timely evidence-based recommendations related to iNPH. The revision of the Guidelines has been undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project on “Studies on the epidemiology, pathophysiology, and treatment of normal pressure hydrocephalus.” This English version of the second edition of the Guidelines was made to share these ideas with the international community and to promote international research on iNPH.

著者

Ayaka SASAGAWA Takeshi MIKAMI Yusuke KIMURA Yukinori AKIYAMA Shintaro SUGITA Tadashi HASEGAWA Masahiko WANIBUCHI Nobuhiro MIKUNI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2020-0309, (Released:2020-12-29)

参考文献数

23

被引用文献数

2

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Gliomas are sometimes difficult to differentiate from strokes and are often misdiagnosed on magnetic resonance imaging (MRI); thus, the terms “stroke mimics” and “stroke chameleons” have been introduced. In this study, we analyzed stroke mimics and stroke chameleons in glioma and discussed the diagnostic perplexity.We retrospectively reviewed cases that were removed from lesions that were considered to be brain tumors. This study enrolled 214 patients who underwent tumor resection for suspected glioma. Clinical characteristics and radiological findings of the patients were compared between the masquerade findings group, which was further divided into two groups: the stroke chameleons and stroke mimics according to their final diagnosis, and the intelligible findings group.Stroke chameleons and stroke mimics were significantly higher in age and smaller in lesion size than the intelligible findings group. In the multivariate analysis, the predictive factor of the masquerade finding group was higher age and smaller size. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different.Proper diagnosis of glioma and stroke affects a patient’s prognosis, and should be diagnosed as soon as possible. However, stroke mimics and stroke chameleons caused by glioma can occur. Thus, the diagnosis of a stroke should take into consideration the possibility of a glioma in real clinical situations.

著者

Shota YAMASHITA Ryuta SAITO Shin-ichiro OSAWA Kuniyasu NIIZUMA Kazushi UKISHIRO Masayuki KANAMORI Kazuo KAKINUMA Kyoko SUZUKI Teiji TOMINAGA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.61, no.11, pp.661-666, 2021 (Released:2021-11-15)

参考文献数

21

被引用文献数

2

---

In cases of malignant gliomas located at language eloquent area, it is often difficult to preoperatively detect those area with functional MRI. Awake surgery is often used to spare the language eloquent area during surgery for such tumors; it is not available for a patient whose intracranial pressure is elevated due to the malignant tumor. The Wada test involves infusing anesthetic agents into the internal carotid artery to determine language dominancy before surgery for epilepsy or brain tumor. The super-selective Wada test is a technique to detect more detailed functional localization by infusing anesthetics into far distal middle cerebral artery branches. We present a 37-year-old man suffering from a left frontal lobe glioblastoma, in whom detection of an artery supplying Broca’s area was attempted by a super-selective Wada test. The super-selective Wada test successfully detected the branch of middle cerebral artery supplying Broca’s area. Total resection of the contrast-enhancing area was achieved without damaging the artery supplying Broca’s area without any neurological sequelae. This is the first report describing the usefulness of the super-selective Wada test in glioblastoma treatment. Our findings suggest that the super-selective Wada test is a powerful and useful means to distinguish the artery that supplies the language area from the tumor feeding artery in cases of tumors in the language eloquent area.

著者

Ichiro NAKAGAWA Masashi KOTSUGI Shohei YOKOYAMA Ryosuke MAEOKA Kentaro TAMURA Yasuhiro TAKESHIMA Ryosuke MATSUDA Shuichi YAMADA Fumihiko NISHIMURA Young-Soo PARK Hiroyuki NAKASE

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2023-0017, (Released:2023-06-08)

参考文献数

74

被引用文献数

1

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Chronic subdural hematoma (CSDH) is a common pathology that typically affects the elderly in Japan, an aging society. Burr-hole irrigation is the standard treatment, but middle meningeal artery (MMA) embolization is a minimally invasive alternative. MMA embolization for CSDH has frequently been reported in recent years, and many technical innovations to improve clinical outcomes have been described. Embolic materials reaching more distally are found to avoid recurrences after MMA embolization. As a result, various studies have described the superiority of embolizing the anterior and posterior branches of the MMA, the advantages of embolic materials reaching beyond the midline, and a high degree of distal penetration using a "sugar rush technique" in which 5% soluble glucose is injected through an intermediate catheter during MMA embolization. Radiographically, reports have described the importance of a "bright falx" sign obtained by infiltrating embolic material beyond the midline and post-embolization enhancement of the dura, capsular membrane, septations, and subdural hematoma fluid as indicators of the spread of embolic materials. This review provides an overview of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.

著者

Kazuhiro ANDO Hitoshi HASEGAWA Bumpei KIKUCHI Shoji SAITO Jotaro ON Kohei SHIBUYA Yukihiko FUJII

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2019-0051, (Released:2019-07-04)

参考文献数

14

被引用文献数

10

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We retrospectively reviewed the cases of three patients with infectious intracranial aneurysms (IIAs), and discuss the indications for surgical and endovascular treatments. We treated two men and one woman with a total of six aneurysms. The mean age was 43.3 years, ranging from 36 to 51 years. One patient presented initially with an intraparenchymal hemorrhage, one with mass effect, and the other one had four aneurysms (one causing subarachnoid hemorrhages and the other causing delayed intraparenchymal hemorrhages). The average size of all aneurysms was 12.2 mm (range, 2–50 mm). They were preferentially located in the distal posterior cerebral artery, and then, in the middle cerebral artery. All cases were caused by infective endocarditis. We selected endovascular treatments for five aneurysms and treated all but one within 24 h from detection. One aneurysm was treated by combined therapy with endovascular intervention and surgery. After treatment, none of the IIAs presented angiographical recurrence or re-bleeding. If feasible, endovascular treatment is probably the first choice, but a combined surgical and endovascular approach should be considered if surgery or endovascular treatment alone are not feasible. The method of treatment should be individualized. For cases with high risk of aneurysm rupture, treatment should be performed as soon as possible.

著者

永関 慶重 深町 彰 小泉 英仁 田崎 健 若尾 哲夫

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.20, no.12, pp.1239-1246, 1980 (Released:2006-11-10)

参考文献数

30

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The authors reported a case of acute epidural hematoma which developed four hours after irrigation of the chronic subdural hematoma. A 56-year-old man was admitted. He was drowsy and disorientated with a one-month history of headache and dysarthria, but no other neurological deficits were noted. Laboratory data including bleeding and coagulating time, were all within the normal ranges. CT scanning and left carotid angiography showed a large left subdural hematoma. Irrigation of the subdural hematoma was performed the next day through two burr holes in the left fronto-parietal region under local anesthesia. About 150 ml of subdural hematoma was removed. Four hours after irrigation, he was semicomatose with right hemiplegia. CT scanning was immediately performed and reveled a epidural hematoma in the left parieto-occipital region. About 120 g of epidural hematoma was removed by left parieto-occipital craniotomy nine hours after the first operation. He gradually improved, and was discharged ambulant on the 51st postoperative day. The presumptive pathogenesis responsible for the development of the epidural hematoma in this case was bleeding from small dural vessels after detachment of the dura from the skull in the left parieto-occipital region. It was considered that the detachment occurred at the posterior burr hole in the beginning and was then accelerated by postoperative intensive evacuation of the hematoma through a closed-system drain.

著者

Atsushi UMEMURA Tomonao SUZUKA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.40, no.1, pp.65-68, 2000 (Released:2005-09-02)

参考文献数

20

被引用文献数

6 6

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A 74-year-old female with cerebral infarction and a 78-year-old female with cerebral glioblastoma suffered complex partial seizure. Ictal perfusion single photon emission computed tomography in these patients showed the interesting phenomenon of ‘crossed cerebellar hyperperfusion, ’ a reversed crossed cerebellar diaschisis. The mechanism is probably spread of electrical seizure through efferent projections, and may be related to the cerebellar atrophy seen in patients with long-standing partial epilepsy.

著者

Takuro SAITO Takeshi MIKAMI Tsukasa HIRANO Hiroshi NAGAHAMA Rei ENATSU Katsuya KOMATSU Satoshi OKAWA Yukinori AKIYAMA Nobuhiro MIKUNI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0372, (Released:2023-04-06)

参考文献数

35

---

Impaired reperfusion in ischemic brain disease is a condition that we are increasingly confronted with owing to recent advances in reperfusion therapy. In the present study, rat models of reperfusion were investigated to determine the causes of acute seizures using magnetic resonance imaging (MRI) and histopathological specimens. Rat models of bilateral common carotid artery ligation followed by reperfusion and complete occlusion were created. We compared the incidence of seizures, mortality within 24 h, MRI, and magnetic resonance spectroscopy (MRS) to evaluate ischemic or hemorrhagic changes and metabolites in the brain parenchyma. In addition, the histopathological specimens were compared with those observed on MRI. In multivariate analysis, the predictive factors of mortality were seizure (odds ratios (OR), 106.572), reperfusion or occlusion (OR, 0.056), and the apparent diffusion coefficient value of the striatum (OR, 0.396). The predictive factors of a convulsive seizure were reperfusion or occlusion (OR, 0.007) and the number of round-shaped hyposignals (RHS) on susceptibility-weighted imaging (SWI) (OR, 2.072). The incidence of convulsive seizures was significantly correlated with the number of RHS in the reperfusion model. RHS on SWI was confirmed pathologically as microbleeds in the extravasation of the brain parenchyma and was distributed around the hippocampus and cingulum bundle. MRS analysis showed that the N-acetyl aspartate level was significantly lower in the reperfusion group than in the occlusion group. In the reperfusion model, RHS on SWI was a risk factor for convulsive seizures. The location of the RHS also influenced the incidence of convulsive seizures.

著者

Junzo NAKAO Aiki MARUSHIMA Keisi FUJITA Hiroyuki FUJIMORI Ryota MASHIKO Takao KAMEZAKI Naoaki SATO Yasushi SHIBATA 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.2022-0229, (Released:2022-10-25)

参考文献数

19

被引用文献数

2

---

Most asymptomatic patients with chronic subdural hematoma (CSDH) are followed conservatively but can require surgical treatment if the hematoma expands. We conducted a retrospective evaluation of the effect of Gorei-san on CSDH. This study included patients treated between April 2013 and March 2015. In total, 289 patients were diagnosed with CSDH and 110 patients received conservative management. Finally, 39 patients who met the requirements were registered. We retrospectively examined the age, gender, medical history, hematoma thickness, clarity of sulci below hematomas, and midline shift of the patients. The primary outcome was the median surgery-free interval, and the secondary results were the rate of CSDH shrinkage and surgery avoidance. A comparison of patient characteristics between the Gorei-san (G) and non-Gorei-san (NG) groups found no significant differences in the percentage of men, average ages, past history, thickness of CSDH (15.0 ± 3.1 mm vs. 15.3 ± 2.6 mm, p = 0.801), or midline shift (2.0 ± 2.7 mm vs. 4.0 ± 5.0 mm, p = 0.230). The median surgery-free interval was significantly different between the G and NG groups [n. r. vs. 41 days (95% CI: 5-79), log-rank p = 0.047]. The CSDH avoidance rate was not significantly different between the two groups (70.0% vs. 34.4%, p = 0.071). Additionally, the CSDH shrinkage rate was significantly different between the two groups (60.0% vs. 10.3%, p = 0.004). This retrospective study demonstrated that CSDH treatment with Gorei-san reduces hematoma significantly more than treatment that does not include Gorei-san.

著者

Elizabeth OGANDO-RIVAS Paul CASTILLO Jesus Q. BELTRAN Rodolfo ARELLANO Isabel GALVAN-REMIGIO Victor SOTO-ULLOA Roberto DIAZ-PEREGRINO Diana OCHOA-HERNANDEZ Pablo REYES-GONZÁLEZ Elias SAYOUR Duane MITCHELL

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0116, (Released:2022-10-25)

参考文献数

93

被引用文献数

2

---

We understand only a small fraction of the events happening in our brains; therefore, despite all the progress made thus far, a whole array of questions remains. Nonetheless, neurosurgeons invented new tools to circumvent the challenges that had plagued their predecessors. With the manufacturing boom of the 20th century, technological innovations blossomed enabling the neuroscientific community to study and operate upon the living brain in finer detail and with greater precision while avoiding harm to the nervous system. The purpose of this chronological review is to 1) raise awareness among future neurosurgeons about the latest advances in the field, 2) become familiar with innovations such as augmented reality (AR) that should be included in education given their ready applicability in surgical training, and 3) be comfortable with customizing these technologies to real-life cases like in the case of mixed reality.

著者

松本 勝美 滝本 洋司 正木 伸 中谷 進

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.26, no.6, pp.491-494, 1986-06-15 (Released:2006-09-21)

参考文献数

31

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A case of thrombosis of the dural sinus resulting in hydrocephalus is reported. This 60-year-old female had suffered from chronic right otitis media for 40 years. Recently she suddenly developed headache, vertigo and vomiting. The otitis media was treated surgically and with antibiotics. Thrombosis of the right sigmoid sinus was found at the time of operation. Headache persisted after the operation. Postoperative computed tomography (CT) scan showed ventricular dilatation and periventricular lucency. Cerebral angiography revealed stenosis of the superior sagittal sinus, the straight sinus, the right lateral sinus, and the right sigmoid sinus. After a ventriculo-peritoneal shunt operation, her symptoms and hydrocephalus were alleviated. It was suggested that hydrocephalus in this case was induced by sinus hypertension associated with dural sinus thrombosis secondary to recurrent otitis media. This phenomenon is known to occur usually in infants, but rarely in adults. Possible mechanisms accounting for the development of hydrocephalus secondary to sinus hypertension are discussed.

著者

Shogo DOFUKU Daisuke SATO Rika NAKAMURA Shotaro OGAWA Seiei TORAZAWA Masayuki SATO Takahiro OTA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0164, (Released:2022-10-13)

参考文献数

30

被引用文献数

4

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Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) is a novel, minimally invasive treatment. The indications and treatment practices for MMAE are variable and remain controversial. This study aimed to evaluate a strategy involving sequential MMAE after burr hole surgery for treating recurrent CSDH. We performed a retrospective analysis of data from consecutive patients who had undergone MMAE using liquid embolic agents within approximately 2 weeks after burr hole surgery for recurrent CSDH from September 2020 to March 2022. We analyzed patient characteristics, procedural details, CSDH recurrence after MMAE, surgical rescue, and complications. Six of the nine patients who underwent MMAE for CSDH recurrence were male, and the median age was 85 (range, 70-94) years. Five of the nine patients were being administered antithrombotic agents. The median duration between the burr hole surgery and MMAE procedure was 10 (range, 3-25) days. Anterior and posterior convexity branches were targeted for embolization using low-concentration N-butyl cyanoacrylate (NBCA), and the abnormal vascular networks with a cotton wool appearance disappeared after embolization in all cases. The NBCA distribution was observed by high-resolution computed tomography during the procedure; in three of nine cases, the NBCA penetrated not only the MMA but also the inner membrane. No recurrence, surgical rescue, or complications were observed in any patient during the median follow-up period of 3 months. As a minimally invasive treatment for recurrent CSDH, sequential MMAE after burr hole surgery may be a safe and effective option for preventing recurrence.