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Neurologia Medico-chirurgica

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https://www.readbyqxmd.com/read/28845040/surgical-anatomy-for-the-endoscopic-endonasal-approach-to-the-ventrolateral-skull-base
#1
Kenichi Oyama, Shigeyuki Tahara, Toshio Hirohata, Yudo Ishii, Daniel M Prevedello, Ricardo L Carrau, Sebastien Froelich, Akira Teramoto, Akio Morita, Akira Matsuno
The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel's cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area...
August 25, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28845039/preoperative-and-postoperative-pituitary-function-in-patients-with-tuberculum-sellae-meningioma-based-on-pituitary-provocation-tests
#2
Shingo Fujio, Hirofumi Hirano, Mami Yamashita, Satoshi Usui, Yasuyuki Kinoshita, Atsushi Tominaga, Tomoko Hanada, Hitoshi Yamahata, Hiroshi Tokimura, Ryosuke Hanaya, Kaoru Kurisu, Kazunori Arita
Given the anatomical proximity of tuberculum sellae meningioma (TSM) to the hypothalamo-pituitary system, pituitary function impairments are of great concern. We retrospectively investigated pituitary function changes following surgery in patients with TSM using pituitary provocation tests (PPTs). Thirty-one patients (27 females and 4 males) with TSM underwent initial transcranial surgery (29 patients) or transsphenoidal surgery (two patients); surgeries were performed carefully to avoid injuring the pituitary stalk...
August 25, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28845038/treatment-recommendations-for-adult-patients-with-diffuse-gliomas-of-grades-ii-and-iii-according-to-the-new-who-classification-in-2016
#3
Hikaru Sasaki, Kazunari Yoshida
With advanced understanding of molecular background and correlation with therapeutic outcomes, the revised 4th edition of World Health Organization (WHO) classification of central nervous system (CNS) tumors incorporated molecular information into the definition of diffuse gliomas. Indeed, oligodendroglioma and astrocytoma are now defined by molecular signature, with diagnosis of glioblastoma being made by histology. In parallel, numerous clinical trials are underway all over the world, and important findings are being produced every year that have an impact on patient outcomes...
August 25, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28835576/serial-arterial-spin-labeling-may-be-useful-in-assessing-the-therapeutic-course-of-cerebral-venous-thrombosis-case-reports
#4
Sho Furuya, Masahito Kawabori, Noriyuki Fujima, Kikutaro Tokairin, Shuho Goto, Motoyuki Iwasaki, Yoshimasa Niiya, Shoji Mabuchi
We report two cases of cerebral venous thrombosis (CVT) which serial arterial spin labeling (ASL) was useful in evaluating the clinical course of the disease. A 48-year-old female presented with acute seizure, and was diagnosed as transverse-sigmoid sinus thrombosis. ASL imaging revealed low signal intensity in the right temporal lobe, suggesting the decreased perfusion by elevated venous pressure. Soon after the treatment, while the development of venous collateral has not fully observed by magnetic resonance (MR) angiography, low ASL signal within the right temporal lobe have shown remarkable improvement...
August 23, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28835583/aneurysmal-subarachnoid-hemorrhage-in-the-elderly-over-age-75-a-systematic-review
#5
Hiroki Ohkuma, Norihito Shimamura, Masato Naraoka, Takeshi Katagai
The number of elderly patients with an aneurysmal subarachnoid hemorrhage (aSAH) has been increasing in aging- or aged societies in many countries. A treatment strategy for the elderly with aSAH has not been established, although many studies have been published emphasizing poor outcome for aSAH. The aim of this study was to analyze the factors and treatments affecting outcome in aSAH in the elderly in a systematic review of the literature by investigating patients over age 75. A literature search was done for "elderly aSAH" in PubMed and Embase...
August 22, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28819091/review-of-current-evidence-regarding-surgery-in-elderly-patients-with-meningioma
#6
Fusao Ikawa, Yasuyuki Kinoshita, Masaaki Takeda, Taiichi Saito, Satoshi Yamaguchi, Fumiyuki Yamasaki, Koji Iida, Kazuhiko Sugiyama, Kazunori Arita, Kaoru Kurisu
The Japanese population features the highest rate of elderly individuals worldwide. Moreover, Japan has the highest number of computed tomography/magnetic resonance imaging devices in the world, which has led to an increase in the incidental detection of meningioma in healthy elderly patients. Many previous papers have discussed the risks and indications for surgery in this patient population, but available information remains insufficient, and the definition of "elderly" has not been standardized. This review tried to clarify the published evidence and challenges associated with elderly meningioma based on a search of the PubMed database using the terms "meningioma," "elderly," and "surgery" for English-language clinical studies and collected related papers published from 2000 to 2016...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28819090/management-of-spontaneous-intracerebral-hematoma
#7
Motohiro Morioka, Kimihiko Orito
The incidence of spontaneous intracerebral hematoma (SICH) is even now high worldwide, especially higher in Japan than in Western countries, despite the development of advances in blood pressure (BP) management and food/alcohol intake education. Although mortality and morbidity for SICH are high, some controversies remain regarding the appropriate acute phase of treatment. Recent studies have revealed that BP lowering treatment than 140 mmHg resulted in better outcomes. However the efficacy of surgical treatment for SICH has not been well established, with the exception of that for cerebellar SICH over 3 cm in diameter and life-saving procedures, although many randomized control studies and systematic reviews focused on surgical treatment have been reported...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28768920/neuronavigation-guided-frameless-stereoelectroencephalography-seeg
#8
Ayataka Fujimoto, Tohru Okanishi, Sotaro Kanai, Keishiro Sato, Mitsuyo Nishimura, Hideo Enoki
Stereoelectroencephalography (SEEG) is an invasive surgical procedure used to identify epileptogenic zones. The combination of both subdural grids and depth electrodes (DEs) is currently used for invasive intracranial monitoring in many epilepsy centers. To perform DE implantation, some centers use frame-based stereotactic techniques and others use stereotactic robotic techniques. However, not all epilepsy centers have access to these tools. We hypothesized that DE implantation using a neuronavigation system can be utilized for subsequent epilepsy surgery...
August 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28768919/pediatric-craniovertebral-junction-surgery
#9
Nobuhito Morota
The craniovertebral junction (CVJ) has attracted more attention in pediatric medicine in recent years due to the progress in surgical technologies allowing a direct approach to the CVJ in children. The CVJ is the site of numerous pathologies, most originating in bone anomalies resulting from abnormal CVJ development. Before discussing the surgical approaches to CVJ, three points should be borne in mind: first, that developmental anatomy demonstrates age-dependent mechanisms and the pathophysiology of pediatric CVJ anomalies; second, that CT-based dynamic simulations have improved our knowledge of functional anatomy, enabling us to locate CVJ lesions with greater certainty; and third, understanding the complex structure of the pediatric CVJ also clarifies the surgical anatomy...
August 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28768918/advantages-and-disadvantages-of-multi-axis-intraoperative-angiography-unit-for-percutaneous-pedicle-screw-placement-in-the-lumbar-spine
#10
Hiroto Kageyama, Shinichi Yoshimura, Kazutaka Uchida, Tomoko Iida
We analyzed clinical usefulness of the high resolution imaging system in a hybrid operation room (OR) for posterior lumbar interbody fusion. A total of 17 patients with lumbar spondylolisthesis between February 2014 and August 2016 were included. Multi-axis imaging system in a hybrid OR was used in 12 patients (hybrid OR group); the conventional C-arm fluoroscopy, in 5 patients (C-arm group). The time to confirm the first percutaneous pedicle screw (PPS) angle (hybrid OR, 80 vs C-arm, 249 s; P = 0.0026) and the second to the last PPS angle (77 vs 90 s; P = 0...
August 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28757539/electrophysiological-assessment-for-splinting-in-the-treatment-of-carpal-tunnel-syndrome
#11
Mitsuhiko Nanno, Norie Kodera, Yuji Tomori, Yusuke Hagiwara, Shinro Takai
An electrophysiological study is commonly used to decide a therapeutic strategy for carpal tunnel syndrome (CTS). In this study, the electrophysiological parameter measurement as a prognostic indicator for CTS after wrist splinting was assessed to identify appropriate candidates for wrist splinting for CTS. One hundred and six hands in 78 patients with CTS were treated by wrist splinting, and three electrophysiological parameters; median distal motor latency (DML) of the abductor pollicis brevis (APB) muscle, median distal sensory latency (DSL) of the index finger, and second lumbrical-interossei latency difference (2L-INT LD); were statistically analyzed to compare with clinical results by Kelly's evaluation respectively...
July 28, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28747589/what-is-the-most-representative-parameter-for-describing-the-size-of-the-atlas-ct-morphometric-analysis-of-the-atlas-with-special-reference-to-atlas-hypoplasia
#12
Hitoshi Yamahata, Hirofumi Hirano, Satoshi Yamaguchi, Masanao Mori, Tadaaki Niiro, Hiroshi Tokimura, Kazunori Arita
The spinal canal diameter (SCD) is one of the most studied factors for the assessment of cervical spinal canal stenosis. The inner anteroposterior diameter (IAP), the SCD, and the cross-sectional area (CSA) of the atlas have been used for the evaluation of the size of the atlas in patients with atlas hypoplasia, a rare form of developmental spinal canal stenosis, however, there is little information on their relationship. The aim of this study was to identify the most useful parameter for depicting the size of the atlas...
July 27, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28747588/surgical-site-infection-after-malignant-brain-tumor-resection-a-multicenter-study-for-induction-of-a-basic-care-bundle
#13
Takeo Uzuka, Hideaki Takahashi, Yoko Nakasu, Takeshi Okuda, Koichi Mitsuya, Nakamasa Hayashi, Takayuki Hirose, Hanako Kurai
Patients with malignant brain tumors are possibly at increased risk for surgical site infections (SSIs) considering the various medical situations associated with the disease. However, the actual rate of SSI after malignant brain tumor resection has not been well established, despite the potential impact of SSI on patient outcome. To investigate the incidence of SSI following malignant brain tumor surgery, we performed a retrospective study in 3 neurosurgical units. Subsequently, aiming at the reduction of incidence of SSI, we performed a prospective study using a care bundle technique in the same units...
July 26, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28740054/the-walking-recovery-one-year-after-surgical-management-of-thoracolumbar-burst-fracture-in-paraplegic-patients
#14
Mohamed AbdelRahman AbdelFatah
The aim of this study was to highlight the walking recovery after surgical management of traumatic burst fractures at the thoracolumbar junction (T10 or T11 or T12 or L1) in paraplegic patients to decide what surgeons should tell their patients to help them develop realistic expectations and potentially improve their outcome. This is a series of adult patients presented with paraplegia from isolated thoracolumbar fracture and underwent surgical intervention from August 2009 to August 2015. Patients with preexisting disability from previous neurologic condition, patients with associated severe head injury or major medical comorbidities or life-threatening injuries were excluded...
July 21, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28659547/balloon-kyphoplasty-under-three-dimensional-radiography-guidance
#15
Daisuke Umebayashi, Yu Yamamoto, Yasuhiro Nakajima, Masahito Hara
Percutaneous balloon kyphoplasty (PBKP) is generally performed under two-dimensional (2D) radiography guidance (lateral- and anteroposterior (A-P) views) using C-arm fluoroscopy. However, 2D images taken by single-plane or bi-plane fluoroscopy cannot provide information regarding axial views, particularly the Z axis. Lack of information regarding the Z axis prevents the creation of three-dimensional (3D) images. Currently, there has been a progress in interventional X-ray systems, and they are capable of providing 3D radiographic images using a rotational angiography mode which is used to create 3D angiographies...
June 28, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28679968/clinical-characteristics-and-outcome-in-elderly-patients-with-traumatic-brain-injury-for-establishment-of-management-strategy
#16
Hiroshi Karibe, Toshiaki Hayashi, Ayumi Narisawa, Motonobu Kameyama, Atsuhiro Nakagawa, Teiji Tominaga
In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28674346/diagnosis-and-treatment-of-traumatic-cerebrovascular-injury-pitfalls-in-the-management-of-neurotrauma
#17
Hitoshi Kobata
Traumatic cerebrovascular injury (TCVI) is an uncommon clinical entity in traumatic brain injury (TBI), yet it may cause devastating brain injury with high morbidity and mortality. Early recognition and prioritized strategic treatment are of paramount importance. A total of 1966 TBI patients admitted between 1999 and 2015 in our tertiary critical care center were reviewed. Screening of TCVI was based on the Guidelines for the Management of Severe Head Injury in Japan. TCVI was confirmed in 33 (1.7%) patients; 29 blunt and 4 penetrating injuries...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28674345/trend-of-malpractice-litigation-against-neurosurgeons-in-japan-an-analysis-of-disclosed-database-by-courts-in-japan-from-2001-through-2015
#18
Hisashi Nagashima, Yoshitaka Wada, Kazuhiro Hongo
Following the modern raising of public awareness, the numbers of malpractice litigation are increasing in the health care delivery system in Japan despite the extensive efforts of physicians. Authors reviewed the issues of litigation and the reasons for court decision from the healthcare-related negligence lawsuits in the past 15 years in Japan and investigated the cautionary points for reducing potential litigation. Healthcare-related negligence lawsuits between January 2001 and December 2015 were retrieved and sorted in each clinical field from the database in Courts in Japan and investigated on the proportional factors of the claims and court decisions in the neurosurgical field...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28659546/focused-ultrasound-treatment-present-and-future
#19
Keiichi Abe, Takaomi Taira
The discovery that ultrasound waves could be focused inside the skull and heated to high temperatures at a focal point goes back to 1944. However, because the skull causes the ultrasound waves to attenuate and scatter, it was believed that application of this technology would be difficult, and that it would be impossible to use this approach in the surgical treatment of intracranial diseases. Eventually, magnetic resonance image guided focused ultrasound (MRgFUS) surgery began being used to treat uterine fibroids, breast cancer and bone metastasis and locally confined prostate cancer...
August 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28652561/chronic-subdural-hematoma-in-elderly-patients-is-this-disease-benign
#20
Masaaki Uno, Hiroyuki Toi, Satoshi Hirai
As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH...
August 15, 2017: Neurologia Medico-chirurgica
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