著者

Issei TAKEUCHI Takafumi TANEI Kyoko KUWABARA Takenori KATO Takehiro NAITO Yuta KOKETSU Kento HIRAYAMA Toshinori HASEGAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.123-128, 2022-12-31 (Released:2022-05-31)

参考文献数

22

被引用文献数

1

---

An 85-year-old woman presented with ataxia and deterioration of cognitive functions. She had no history of autoimmune diseases or viral infections. Magnetic resonance imaging showed a solitary mass lesion at the cerebral falx on contrast-enhanced T1-weighted imaging. Gross total resection of the lesion involving the dura mater was performed by bifrontal craniotomy. Histological examination showed diffuse infiltration of small lymphocytes and plasma cells. There was also some proliferation of large lymphocytes with folded nuclei, high-density chromatin, and inconspicuous nucleoli. The large atypical B lymphocytes did not demonstrate diffuse dense sheet findings. Meningothelial components were not detected. Immunohistochemistry was positive for pan B-cell antigens. The analysis of the kappa/lambda ratio indicated kappa immunoglobulin light chain-restricted B-cell proliferation. The final histopathological diagnosis was mucosa-associated lymphoid tissue lymphoma. Systemic screening examinations were then performed. Histological findings of the bone marrow showed normal findings without atypical lymphocytes. A chromosomal study of the bone marrow showed 46, XX. 18F fluoro-2-deoxyglucose positron emission tomography showed high accumulations at the left pterygoid muscle and the right transverse processes of the thoracic vertebrae, and mild accumulation at the right ilium bone, which indicated disseminated lesions. One year later, thickening of the dura mater was detected. Therefore, gamma knife surgery was performed. Two years later, she was alive without neurological deterioration, and magnetic resonance imaging showed no evidence of recurrence.

著者

Hikaru NAKAMURA Kei SATO Kosuke HIRAYAMA Hiroko KITANOSONO Yukishige HAYASHI Yoshiharu TOKUNAGA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.135-138, 2022-12-31 (Released:2022-05-31)

参考文献数

5

被引用文献数

1

---

An 85-year-old man underwent emergency right trepanation and drainage for a symptomatic chronic subdural hematoma. Pseudohypoxic brain swelling (PHBS) was suspected because magnetic resonance imaging revealed diffuse brain swelling. Although cerebrospinal fluid (CSF) leakage was not obvious during or after surgery, most of the reported PHBS cases have leaked CSF during craniotomy or spine surgery. PHBS has not been previously reported in patients without obvious CSF leakage or after unilateral burr hole drainage. Herein, we report an extremely rare case with a literature review investigating its pathogenesis and clinical features.

著者

Minami SASAKI Seiichiro HIRONO Yue GAO Izumi SUDA Tomoo MATSUTANI Masayuki OTA Takashi KISHIMOTO Jun-Ichiro IKEDA Hideaki YOKOO Yasuo IWADATE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.101-109, 2022-12-31 (Released:2022-05-18)

参考文献数

29

被引用文献数

2

---

Intracranial myxoid mesenchymal tumors (IMMTs) with EWSR1-CREB1 family gene fusion are rare brain neoplasms characterized by gene fusion between the EWSR1 gene and one of the cyclic AMP response element-binding (CREB) family transcription factor (CREB1, ATF1, or CREM) genes. Although half of reported cases are pediatric, the clinical, histologic, and genomic features of IMMTs with EWSR1 rearrangement in pediatric populations are not yet well clarified. Here we describe the case of a 7-year-old girl who presented with seizures due to an extra-axial tumor in the left parietal convexity. Gross total resection was achieved, and the tumor displayed a multilobular structure with solid hypercellular and myxoid hypocellular areas, separated by a variable amount of stroma. The hypercellular areas consisted of round to polygonal cells, whereas the myxoid areas were ovoid to spindled cells. Immunophenotypically, the tumor cells were positive for vimentin, desmin, and EMA. Next-generation sequencing of tumoral DNA revealed EWSR1-CREM gene fusion and a pathogenic mutation of MAP3K13. No recurrence was detected 9 months after resection, without chemotherapy or radiotherapy. In comparison to other pediatric and adult patients with EWSR1 rearrangement, many clinical, radiological, and immunohistochemical features were shared. However, signs of elevated intracranial pressure were more frequently observed, and postoperative radiation was less frequently administered for pediatric patients. Gross total resection (GTR) was the key prognostic factor for better disease control especially among pediatric patients. Further reports of cases with EWSR1 rearrangement with detailed genetic profiles are essential for clarifying the oncogenic pathway and establishing a standard treatment strategy.

著者

Satoshi MAESAWA Epifanio BAGARINAO Daisuke NAKATSUBO Tomotaka ISHIZAKI Sou TAKAI Jun TORII Sachiko KATO Masashi SHIBATA Toshihiko WAKABAYASHI Ryuta SAITO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.62, no.1, pp.45-55, 2022 (Released:2022-01-15)

参考文献数

31

被引用文献数

3

---

Resting-state functional MRI (rs-fMRI) has been utilized to visualize large-scale brain networks. We evaluated the usefulness of multitier network analysis using rs-fMRI in patients with focal epilepsy. Structural and rs-fMRI data were retrospectively evaluated in 20 cases with medically refractory focal epilepsy, who subsequently underwent surgery. First, structural changes were examined using voxel-based morphometry analysis. Second, alterations in large-scale networks were evaluated using dual-regression analysis. Third, changes in cortical hubs were analyzed and the relationship between aberrant hubs and the epileptogenic zone (EZ) was evaluated. Finally, the relationship between the hubs and the default mode network (DMN) was examined using spectral dynamic causal modeling (spDCM). Dual-regression analysis revealed significant decrease in functional connectivity in several networks including DMN in patients, although no structural difference was seen between groups. Aberrant cortical hubs were observed in and around the EZ (EZ hubs) in 85% of the patients, and a strong degree of EZ hubs correlated to good seizure outcomes postoperatively. In spDCM analysis, facilitation was often seen from the EZ hub to the contralateral side, while inhibition was seen from the EZ hub to nodes of the DMN. Some cognition-related networks were impaired in patients with focal epilepsy. The EZ hub appeared in the vicinity of EZ facilitating connections to distant regions in the early phase, which may eventually generate secondary focus, while inhibiting connections to the DMN, which may cause cognitive deterioration. Our results demonstrate pathological network alterations in epilepsy and suggest that earlier surgical intervention may be more effective.

著者

Keitaro CHIBA Takashi SUGAWARA Daisuke KOBAYASHI Akihito SATO Yasuhiro MUROTA Taketoshi MAEHARA

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.647-651, 2021 (Released:2021-11-15)

参考文献数

22

被引用文献数

3

---

The significance of atypical histological features (AHF) as risk factors for recurrence in benign meningioma is not well understood. This study examined risk factors of World Health Organization (WHO) Grade I meningioma (GIM) recurrence, focusing on AHF. We investigated 150 consecutive newly diagnosed GIM patients who had more than one year of follow-up after resection in our hospital between January 2007 and March 2018. The following factors were reviewed retrospectively: age, sex, tumor location, extent of resection, MIB-1 index, mitotic figures, number and distribution of AHF, and recurrence. The patients were grouped according to the presence or absence of recurrence and comparatively examined. Recurrence was observed in 10 cases (6.7%). Univariate analysis showed that patients with recurrence had a significantly higher MIB-1 index (2.0 vs. 4.3; p = 0.006) and a significantly higher proportion of male patients (21.4% vs. 70.0%; p = 0.002) and patients with sheet-like growth (6.42% vs. 30.0%; p = 0.04). In multivariate analysis, skull base location (odds ratio [OR] 31.424; 95% confidence interval [CI] 1.74–569), gross total resection (OR 0.130; 95% CI 0.0189–0.897), and MIB-1 index (OR 1.939; 95% CI 1.19–3.15) were significantly associated with recurrence. Our study revealed that skull base location, subtotal resection, and high MIB-1 index were independent risk factors for recurrence. Only the presence of sheet-like growth had a significantly higher incidence in patients with recurrence in univariate analysis of AHF. Multivariate analysis found no significant association. Sheet-like growth may be involved in malignancy and recurrence of benign meningioma.

著者

Azuna TOMIOKA Satoshi TAKAHASHI Ryotaro IMAI Hirotsugu NOGAWA Hajime OKITA Akihisa UENO Masahiro TODA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.111-116, 2022-12-31 (Released:2022-05-18)

参考文献数

32

被引用文献数

1

---

Chronic encapsulated intracerebral hematoma (CEIH) is a rare cerebrovascular disease featuring progressively expanding intracranial hematoma. We treated a man in his 70s with bilateral cerebellar CEIH. He had presented at another hospital with dizziness, and imaging showed two independent hemorrhagic space-occupying lesions in the bilateral cerebellar hemispheres. The symptoms progressed relatively rapidly, and there were signs of impending cerebellar herniation; he was transferred to our institution, and emergency surgery was performed. The operative findings included a hematoma with partial capsulation. We diagnosed CEIH from preoperative magnetic resonance imaging and computed tomography findings, clinical course, and pathological findings. The postoperative course was satisfactory. We present this case of bilateral cerebellar CEIH, as an extensive search of the literature suggests that this has not been reported before. Although CEIH is a condition that is usually hard to diagnose preoperatively, good outcomes can be achieved with appropriate surgical treatment. It is therefore important to keep this clinical entity in mind and not miss the right timing to operate.

著者

Masaki IWAKURA Tetsuro KAWAGUCHI Kohkichi HOSODA Yuji SHIBATA Hideki KOMATSU Akira YANAGISAWA Eiji KOHMURA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.45, no.3, pp.172-175, 2005 (Released:2005-03-22)

参考文献数

14

被引用文献数

20 22

---

A 28-year-old man attempted to kill himself with a knife stab into the parietal area. Neuroimaging showed no vascular impairment except slow venous flow around the knife due to tamponading. After obtaining informed consent, the knife was removed through a craniotomy without new brain injury. Postoperative neurological findings showed no deficit. Follow-up angiography revealed no vascular impairment. No infection occurred. Brain stab wounds cause numerous complications, such as intracranial hemorrhage, injury of important vessels, and infections. Minimal blade movement during removal and precautions to prevent massive hemorrhage are essential.

著者

Masamichi ENDO Shunya HANAKITA Soichi OYA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.73-76, 2022-12-31 (Released:2022-04-21)

参考文献数

8

---

There are various causes of ventriculoperitoneal shunt (VPS) failures. Patients who receive shunt placement during childhood need follow-up for decades as they grow, especially in the early periods of life. Herein, we report a rare case of mechanical shunt obstruction in a pediatric patient in whom a cramped burr hole and skull growth compressed the tube and obstructed cerebrospinal fluid flow. A 6-year-old girl presented to our hospital with nausea and headache. She was born preterm and developed intraventricular hemorrhage followed by VPS placement for hydrocephalus; thereafter, she had no need for shunt revision until this admission. After careful evaluation of the patency of the shunt system, the presence of tube stenosis was suspected at the site of the shunt tube penetrating the burr hole of the skull. During the operation to revise the shunt tube, a compressed tube was observed at the exit from the skull. After enlarging the narrowed burr hole and reconstructing the proximal catheter, her symptoms immediately improved. Previously, only one case of shunt malfunction due to tube compression from bone growth has been reported in a pediatric patient with osteopetrosis. To the best of our knowledge, such a condition has never been described in pediatric patients with no metabolic bone disease. Although it is rare, obstruction at the exit from the skull due to bone growth should be included in differential diagnoses for young patients during a long follow-up after VPS.

著者

Hiroyasu INOUE Masahiro OOMURA Yusuke NISHIKAWA Mitsuhito MASE Noriyuki MATSUKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.49-53, 2022-12-31 (Released:2022-04-01)

参考文献数

11

---

Internal carotid artery occlusion rarely recanalizes spontaneously. Awareness of signs of recanalization is important, as it may necessitate changing the treatment strategy. We report a case of new cortical infarction outside the border zone, which led to the realization of internal carotid artery recanalization and revascularization.A 76-year-old woman presented with mild dysarthria. Magnetic resonance imaging showed cerebral infarction in the left-hemispheric border zone and occlusion of the internal carotid artery origin. Cerebral angiography performed showed complete occlusion of the internal carotid artery origin and intracranial collateral blood flow from the external carotid artery through the ophthalmic artery. She was diagnosed with infarction due to a hemodynamic mechanism caused by internal carotid artery occlusion and was treated with supplemental fluids and antithrombotic drugs. Four days after hospitalization, the right paralysis worsened and a new cerebral infarction was observed in the cortex, outside the border zone. This infarction appeared to be embolic rather than hemodynamic; thus, we suspected recanalization of the internal carotid artery. The patient underwent emergency cerebral angiography again, which revealed slight recanalization. Thus, emergency revascularization and carotid artery stenting were performed. New cortical infarcts outside the border zone in patients with complete internal carotid artery occlusion is an important finding, suggesting spontaneous recanalization of the occluded internal carotid artery.

著者

Kokyo SAKURADA Akio TERANISHI Eisuke TSUKAGOSHI Satoshi IIHOSHI Hiroki KURITA Shinya KOHYAMA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.37-41, 2022-12-31 (Released:2022-04-01)

参考文献数

9

被引用文献数

1

---

Stent-assisted coil embolization (SACE) is useful for treating wide-necked aneurysms. Most superior cerebellar artery (SCA) aneurysms have a wide neck, but there are few reports of SCA aneurysms treated with SACE.One reason is that the anatomical characteristic of SCA aneurysm is not suitable for standard SACE. It is often challenging to deliver a stent to SCA via the basilar artery in an anterograde manner. In contrast, it is not difficult to deliver a stent to SCA from the anterior circulation via the posterior communicating artery. This method, in which a catheter is navigated from the anterior to the posterior circulation, is called a transcirculation technique.We report two cases of SCA aneurysm successfully treated with SACE using transcirculation technique. This approach is helpful for wide-necked SCA aneurysms.

著者

Tomotaka OHSHIMA Mao YOKOTA Koichiro OGURA Megumi KOIWAI Naoki MATSUO Shigeru MiYACHI

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.43-47, 2022-12-31 (Released:2022-04-01)

参考文献数

12

被引用文献数

1

---

Hemorrhagic isolated dural arteriovenous fistulas (DAVFs) are often challenging to treat. Here, we report a case of the lateral cavernous sinus (CS) DAVF successfully treated by transarterial intravenous coil embolization using a curved multiplanar reconstruction (MPR) image assistance. A 54-year-old man presented with a severe headache and was diagnosed with subarachnoid hemorrhage caused by CSDAVF. Angiography indicated that the fistula was fed by branches of the left external carotid artery and drained into cortical veins. There were multiple shunting points at the left sphenobasal vein accompanied by varicose veins. Using curved MPR images, the left accessory meningeal artery was chosen for the endovascular approach into the affected veins, including ruptured varix. The shunt was completely occluded by detachable coils.When the curved MPR image indicates a developing feeding artery and a large shunting point, transarterial intravenous coil embolization becomes a good treatment option for CSDAVF, which has no venous access.

著者

Takayuki ISHIKAWA Kazuhito TAKEUCHI Yuichi NAGATA Keishi ITO Taiki YAMAMOTO Ryusuke KABEYA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.77-82, 2022-12-31 (Released:2022-04-21)

参考文献数

19

被引用文献数

5

---

Here we report a rare case of capillary hemangioma (CH) in a 28-year-old woman suffering from gradual worsening diplopia at 28 weeks of pregnancy. Magnetic resonance imaging (MRI) showed a mass lesion (about 3 cm in diameter) in the right parasellar region. We decided to observe as she was pregnant, and had no symptoms other than right abducent nerve palsy. Fortunately, her symptoms did not worsen until delivery. Computed tomography, enhanced MRI, and angiography after delivery revealed that the lesion was highly calcified and vascularized. A dorsum sellae meningioma or highly calcified pituitary adenoma was suspected and the endoscopic transsphenoidal approach was used for tumor removal.The postoperative course was uneventful. The histological diagnosis was CH.Intracranial CHs or CHs of skull are rare vascular tumors. These tumors are reportedly more common in female patients and may change in size in adults according to menstrual cycle and pregnancy. Only six cases, including that of the present study, were diagnosed during the perinatal period. Some of them experienced rapid symptom progression and tumor growth in their course; thus, we should pay further attention to pregnant or peripartum patients with brain tumor, suspected hemangiomas.

著者

Masazumi FUJII Satoshi MAESAWA Sumio ISHIAI Kenichiro IWAMI Miyako FUTAMURA Kiyoshi SAITO

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.56, no.7, pp.379-386, 2016 (Released:2016-07-15)

参考文献数

57

被引用文献数

24 41

---

The neural basis of language had been considered as a simple model consisting of the Broca’s area, the Wernicke’s area, and the arcuate fasciculus (AF) connecting the above two cortical areas. However, it has grown to a larger and more complex model based upon recent advancements in neuroscience such as precise imaging studies of aphasic patients, diffusion tensor imaging studies, functional magnetic resonance imaging studies, and electrophysiological studies with cortical and subcortical stimulation during awake surgery. In the present model, language is considered to be processed through two distinct pathways, the dorsal stream and the ventral stream. The core of the dorsal stream is the superior longitudinal fasciculus/AF, which is mainly associated with phonological processing. On the other hand, semantic processing is done mainly with the ventral stream consisting of the inferior fronto-occipital fasciculus and the intratemporal networks. The frontal aslant tract has recently been named the deep frontal tract connecting the supplementary motor area and the Broca’s area and it plays an important role in driving and initiating speech. It is necessary for every neurosurgeon to have basic knowledge of the neural basis of language. This knowledge is essential to plan safer surgery and preserve the above neural structures during surgery.

著者

Yusuke MORINAGA Hiroyoshi AKUTSU Hiroyoshi KINO Shuho TANAKA Hidetaka MIYAMOTO Masahide MATSUDA Eiichi ISHIKAWA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.55-61, 2022-12-31 (Released:2022-04-01)

参考文献数

18

被引用文献数

1

---

We report the use of endoscopic endonasal surgery for dural reconstruction following a cerebrospinal fluid leak in a 33-year-old patient with recurrent meningitis since at age of 2 years. Magnetic resonance imaging showed osteolytic changes in the left temporal and sphenoid bones, including the left pterygoid plate, a few left temporal encephaloceles, and cerebrospinal fluid-like fluid in the expanded Meckel's cave and the parapharyngeal space. After endoscopic endonasal surgery, Gorham-Stout disease was diagnosed. No recurrence of cerebrospinal fluid leakage or meningitis has been observed. Thus, endoscopic endonasal surgery might improve clinical outcomes in patients with Gorham-Stout disease and skull base defects.

著者

Sosho KAJIWARA Yu HASEGAWA Tetsuya NEGOTO Kimihiko ORITO Takayuki KAWANO Munetake YOSHITOMI Kiyohiko SAKATA Nobuyuki TAKESHIGE Yukako YAMAKAWA Hirofumi JONO Hideyuki SAITO Nobuhisa HIRAYU Osamu TAKASU 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.oa.2021-0097, (Released:2021-06-01)

参考文献数

21

被引用文献数

4

---

This study aimed to examine the beneficial effects of a novel prophylactic barbiturate therapy, step-down infusion of barbiturates, using thiamylal with normothermia (NOR+sdB), on the poor outcome in the patients with severe traumatic brain injuries (sTBI), in comparison with mild hypothermia (MD-HYPO). From January 2000 to March 2019, 4133 patients with TBI were admitted to our hospital. The inclusion criteria were: a Glasgow coma scale (GCS) score of ≤8 on admission, age between 20 and 80 years, intracranial hematoma requiring surgical evacuation of the hematoma with craniotomy and/or external decompression, and patients who underwent management of body temperature and assessed their outcome at 6–12 months. Finally, 43 patients were included in the MD-HYPO (n = 29) and NOR+sdB (n = 14) groups. sdB was initiated intraoperatively or immediately after the surgical treatment. There were no significant differences in patient characteristics, including age, sex, past medical history, GCS on admission, type of intracranial hematoma, and length of hospitalization between the two groups. Although NOR+sdB could not improve the patient’s poor outcome either at discharge from the intensive care unit (ICU) or at 6–12 months after admission, the treatment inhibited composite death at discharge from the ICU. The mean value of the maximum intracranial pressure (ICP) in the NOR+sdB group was <20 mmHg throughout the first 120 h. NOR+sdB prevented composite death in the ICU in patients with sTBI, and we may obtain novel insights into the beneficial role of prophylactic barbiturate therapy from suppression of the elevated ICP during the first 120 h.

著者

香川 泰生 神野 哲夫 佐野 公俊 片田 和広 MOHAMAD YUSUF SHAH 藤本 和夫 戸田 孝

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.17pt2, no.3, pp.243-251, 1977 (Released:2006-12-28)

参考文献数

17

被引用文献数

1 1

---

Diagnosis of thalamic hemorrhage has become more accurate by CT scan, and the precise location and extent of hematoma can be visualized preoperatively, as well as postoperatively, i.e. the follow-up study showing the outcome of hematoma and secondary changes of the brain is more readily available. Operative procedure for such a lesion should be reevaluated. Thalamic hemorrhage constituted 27% of all hypertensive intracerebral hemorrhages in our series (the reported incidence was not so high). According to CT findings (except for 3 cases with giant hematoma), we could classify their main locations into 3 types as follows; —1) anterior type — located in the anterior nuclear group of the thalamus — 2 cases, 2) medial type located in the medial nuclear group of the thalamus — 2 cases, 3) posterolateral type located in the lateral nuclear group of the thalamus — 5 cases. As to the extention of hematoma, we devided all cases into the following 5 types; Type I — localized in the thalamus, Type II — medially extending & perforating into the third ventricle, Type III — laterally extending into the internal capsule and the basal ganglia, Type IV — spreading into all directions, Type V giant hematoma. This classification was found useful in relation to the clinical picture, the operative decision, the choice of operative method and the postoperative prognosis. The onset of the clinical picture was always sudden and included disturbance of consciousness and hemiparesis or hemiplegia. Of 8 cases which allowed a satisfactory clinical examination of sensory and motor function, only few cases showed signs of the thalamic syndrome. In 2 cases of giant hematoma with extensive spread, downward deviation of the eyeballs was noticed. Surgery should be performed; with exceptions to the following conditions — 1) no agreement of family, 2) over 75 years of age, 3) already representing the symptoms of brain stem, 4) severe associated deseases, 5) mild case (mainly level of consciousness). Based on CT findings the most suitable operative procedure should be adopted, — that is, only unilateral C.V.D. (continuous ventricular drainage) on localized type, bilateral or unilateral C.V.D. on medial type, trans-paracallosal approach on anterior type and posterolateral type, trans-temporal approach on lateral extention type, trans-paracallosal or trans-temporal approach combining irrigation-evacuation of the intraventricular clots on giant hematoma type and all extention type. Out of 12 cases six survived, and 3 cases have useful life. Relatively better prognosis was obtained in medial type, and in posterolateral type, but giant hematoma type and all extention type resulted in the worst outcome. In marked lateral extention type of posterolateral type improvement of hemiplegia was not good. Except for the massive intraventricular hemorrhage, the prognosis was dependent on the grade of deterioration of the thalamus, hypothalamus, and the midbrain rather than the ventricular perforation. Even if hematoma was not so large, delayed surgical treatment for C.S.F. obstruction due to ventricular perforation carried the poor prognosis on mortality and morbidity.

著者

Shingo MATSUDA Fusao IKAWA Hideo OHBA Michitsura YOSHIYAMA Toshikazu HIDAKA Kaoru KURISU Susumu MIYAMOTO Isao DATE Hiroyuki NAKASE

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.59, no.6, pp.197-203, 2019 (Released:2019-06-15)

参考文献数

42

被引用文献数

1 6

---

Various guidelines regarding surgical site infection (SSI) have recently been established. However, perioperative management of the wound and use of antibiotics have never been standardized completely in departments of neurosurgery in Japan. This survey investigated current perioperative management and administration of surgical antibiotic prophylaxis (SAP) and compared with guidelines intended to reduce SSI associated with neurosurgery in Japan. Questionnaires were distributed to members of the conference on Neurosurgical Techniques and Tools and the Japan Society of Aesthetic Neurosurgery via internet. The questionnaires asked about methods of perioperative management. A total of 255 members returned answers to the questionnaires. The questionnaires revealed that partial or no removal of the hair and hair shampooing at the day before surgery were performed in 96.1% and 88.1% of each institute following the World Health Organization (WHO) guidelines. Use of SAP at just before, during, and after surgery were 65.0%, 86.2%, and 63.0%, respectively. The postoperative period of use of intravenous SAP prolonged beyond 24 h in 80.0% against the recommendation of WHO. Perioperative management of wounds and use of SAP varies in institutes in Japan and some procedures were far different from the WHO guidelines. Japanese neurosurgeons should notice the prolonged SAP and comply with the WHO guidelines.

著者

Totaro TAKEUCHI Kozo YAJIMA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.59, no.7, pp.281-286, 2019 (Released:2019-07-15)

参考文献数

25

被引用文献数

5 19

---

A total of 482 operated idiopathic normal pressure hydrocephalus (iNPH) patients were divided into those aged <80 years at the time of surgery (group A: 400 cases; and male-to-female ratio, 259:141) and ≥80 years (group B: 82 cases; male-to-female ratio, 43:39) and comparatively investigated based on the following variables: (1) temporal changes in shunt efficacy rates, and (2) temporal changes in each symptom, including the patient’s fall frequency and preoperative modified Rankin Scale (mRS) score and during follow-up at 3, 6 months, 1–4 years postoperatively. (1) The shunt efficacy rates at 3 months and 4 years postoperatively were 93% and 82%, respectively, in group A and 92.3% and 70.7%, respectively, in group B. This demonstrates a decrease in shunt efficacy at 4 years postoperatively, regardless of the persistence of shunt function or adjustments in setting pressure. This trend was particularly observed in group B. In group A, 41 (9.8%) cases had decreased efficacy rate, compared with 21 (25.6%) cases in group B, which occurred due to complications with an extracranial or intracranial disease. (2) Gait disturbance (G) and urinary incontinence (U) showed signs of improvement in the early postoperative stage, while dementia (D) and mRS score began to gradually improve from 6 months postoperatively. Patient’s fall frequency tended to become higher until 6 months postoperatively than the preoperative rate. In group A, symptom improvement was comparatively maintained until 4 years postoperatively, while in group B, all symptoms and mRS tended to gradually deteriorate beginning at 3 years postoperatively.

著者

Yasutaka IMADA Kaoru KURISU Toru TAKUMI Hirohiko AOYAMA Takashi SADATOMO Keisuke MIGITA Kiyoshi YUKI

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.59, no.7, pp.264-270, 2019 (Released:2019-07-15)

参考文献数

24

被引用文献数

1 8

---

In this study, we used 45 adult cadaveric cerebral hemispheres to investigate the anatomical classification of the superficial middle cerebral vein (SMCV) based on the number of stems, course, and anastomosis at the distal portion. We classified the SMCVs into five types based on embryological concept. Type A (18 cases, 40.0%) is that the frontosylvian veins (FSVs) merge with the vein of Trolard (VT) and the vein of Labbé (VL) at the distal portion of the sylvian fissure. Type B (5 cases, 11.1%) is that the temporosylvian veins (TSVs) merge with the VT and the VL at the distal portion. Type C (13 cases, 28.9%) is that no vein merge with the VT and the VL at the distal portion. The VT merges with the SMCV from the FSV and the VL merges with the SMCV from the TSV. They course along the sylvian fissure and merge at the proximal portion. In Type D (eight cases: 17.8%), the VT and the VL merge at the distal portion, and the SMCV from the FSV and the SMCV from the TSV join their confluence without merging. Type E (one case, 2.2%) show an undeveloped SMCV. Formation rate of intravenous anastomoses or bridging veins(BVs) at the distal portion between the frontosylvian trunk (FST) and the temporosylvian trunk (TST), between the FST and the temporal lobe, and between the TST and the frontal lobe was very low, because these formation may be difficult to occur during the embryological process in which the SMCV is formed from the telencephalic vein.

著者

Masaaki UNO Kenji YAGI Hiroyuki TAKAI Naoki OYAMA Yoshiki YAGITA Keita HAZAMA Hideki NAKATSUKA Shunji MATSUBARA

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.124-133, 2021 (Released:2021-02-15)

参考文献数

35

被引用文献数

4

---

We compared the rate of selective shunt and pattern of monitoring change between single and dual monitoring in patients undergoing carotid endarterectomy (CEA). A total of 121 patients underwent 128 consecutive CEA procedures. Excluding five procedures using internal shunts in a premeditated manner, we classified patients according to the monitoring: Group A (n = 72), patients with single somatosensory evoked potential (SSEP) monitoring; and Group B (n = 51), patients with dual SSEP and motor evoked potential (MEP). Among the 123 CEAs, an internal shunt was inserted in 12 procedures (9.8%) due to significant changes in monitoring (Group A 5.6%, Group B 15.7%, p = 0.07). The rate of shunt use was significantly higher in patients with the absence of contralateral proximal anterior cerebral artery (A1) on magnetic resonance angiography (MRA) than in patients with other types of MRA (p <0.001). Significant monitor changes were seen in 16 (12.5%) in both groups. In four of nine patients in Group B, SSEP and MEP changes were synchronized, and in the remaining five patients, a time lag was evident between SSEP and MEP changes. In conclusion, the rate of internal shunt use tended to be more frequent in patients with dual monitoring than in patients with single SSEP monitoring, but the difference was not significant. Contralateral A1 absence may predict the need for a shunt and care should be taken to monitor changes throughout the entire CEA procedure. Use of dual monitoring can capture ischemic changes due to the complementary relationship, and may reduce the rate of false-negative monitor changes during CEA.