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Neurologia Medico-chirurgica

Nobuyuki Sakai, Shinzo Ota, Yasushi Matsumoto, Rei Kondo, Tetsu Satow, Michiya Kubo, Tomoyuki Tsumoto, Yukiko Enomoto, Taketo Kataoka, Hirotoshi Imamura, Kenichi Todo, Mikito Hayakawa, Hiroshi Yamagami, Kazunori Toyoda, Yasushi Ito, Kenji Sugiu, Yuji Matsumaru, Shinichi Yoshimura
REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a...
March 9, 2018: Neurologia Medico-chirurgica
Yoshiro Ito, Wataro Tsuruta, Yasunobu Nakai, Tomoji Takigawa, Aiki Marushima, Tomohiko Masumoto, Yuji Matsumaru, Eiichi Ishikawa, Akira Matsumura
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are not appropriate treatment procedure for internal carotid artery stenosis (ICAS) in some patients. The importance of plaque vulnerability and the treatment risk evaluation has been reported. We analyzed whether treatment selection contributes to the outcome. We retrospectively examined 121 patients who underwent CEA or CAS. Treatment was selected based on plaque vulnerability and the treatment risk evaluation. We selected CAS for patients with stable plaques and CEA for patients with unstable plaques, and considered the other treatment for high-risk patients...
March 3, 2018: Neurologia Medico-chirurgica
Masanori Yonenaga, Shingo Fujio, Mika Habu, Hiroshi Arimura, Takaaki Hiwatari, Shunichi Tanaka, Yasuyuki Kinoshita, Hiroshi Hosoyama, Hirofumi Hirano, Kazunori Arita
The criteria for surgical cure of acromegaly have become more stringent during the past decades and a change from Cortina to new consensus criteria has recently been proposed. However, the superiority of the new consensus over Cortina criteria with respect to postoperative metabolic parameters remains to be ascertained. We retrospectively assessed metabolic parameters, the body habitus, and other health-related parameters of 48 patients with surgically controlled acromegaly who met the Cortina criteria [normalized insulin-like growth factor-1 (IGF-1) level and nadir growth hormone (GH) level <1...
February 23, 2018: Neurologia Medico-chirurgica
Tsuyoshi Ohta, Masanori Morimoto, Kenji Okada, Maki Fukuda, Hirokazu Onishi, Noritaka Masahira, Toshiki Matsuoka, Takaya Tsuno, Mitsuhiro Takemura
The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blinded, cohort study. From September 2012 to August 2016, 83 consecutive patients of acute anterior circulation occlusion were treated with thrombectomy using second-generation devices or medical management. The DWI-ASPECTS was scored after the first MRI...
February 23, 2018: Neurologia Medico-chirurgica
Yoshinori Maki, Ryota Ishibashi, Hitoshi Fukuda, Miyako Kobayashi, Masaki Chin, Sen Yamagata
Vertebral arteriovenous fistula (VAVF), which can cause subarachnoid hemorrhage (SAH) when having a perimedurally drainage, has been reported as a rare vascular abnormality in patients with neurofibromatosis type 1 (NF-1). In addition, extracranial vertebral aneurysm (EVAn) coexisting with VAVF and NF-1 is considered rare, and further complication with SAH is extremely rare in patients. There is only one reported case of NF-1 complicated with SAH from VAVF with an EVAn. Here, we present a case of a middle-aged patient with NF-1...
February 23, 2018: Neurologia Medico-chirurgica
Daisuke Ichinose, Satoru Tochigi, Toshihide Tanaka, Tomoya Suzuki, Jun Takei, Keisuke Hatano, Ikki Kajiwara, Fumiaki Maruyama, Hiroki Sakamoto, Yuzuru Hasegawa, Satoshi Tani, Yuichi Murayama
A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted...
February 23, 2018: Neurologia Medico-chirurgica
Yu Yamamoto, Masahito Hara, Yusuke Nishimura, Shoichi Haimoto, Toshihiko Wakabayashi
Transvertebral foraminotomy (TVF) combined with anterior cervical decompression and fusion (ACDF) can be used to treat multilevel cervical spondylotic myelopathy and radiculopathy; however, the radiological outcomes and effectiveness of this hybrid procedure are unknown. We retrospectively assessed 22 consecutive patients treated with combined TVF and ACDF between January 2007 and May 2016. The Japanese Orthopedic Association (JOA) score and Odom's criteria were analyzed. Radiological assessment included the C2-7 sagittal Cobb angle (CA) and range of motion (ROM)...
February 7, 2018: Neurologia Medico-chirurgica
Toshiyuki Okazaki, Hiroshi Nakagawa, Hitoshi Hayase, Shinsuke Irie, Toru Inagaki, Osamu Saito, Motoshige Yamashina, Shinji Nagahiro, Koji Saito
Spontaneous and chronic epidural hematoma (SSEH) in the lumbar spine is rare, and idiopathic and chronic SSEH in the lumbar spine is extremely rare disease. Most of lumbar SSEH were acute and secondary with trauma, hematologic disorders, drug, and surgical procedure. Only 20 cases of chronic SSEH in the lumbar spine have been reported and 14 cases among them were considered to be idiopathic. Definitive guidelines for management of this condition are not clear and surgical total evacuation was performed in most of the cases...
February 7, 2018: Neurologia Medico-chirurgica
Ryota Sasaki, Yasushi Motoyama, Ichiro Nakagawa, Young-Su Park, Hiroyuki Nakase
To present a unique case of the internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysm penetrating the oculomotor nerve presenting a pure acute subdural hematoma (ASDH) without any oculomotor dysfunction. A 71-year-old woman presented with a sudden headache and drowsiness. She had no history of head trauma and did not manifest any neurological deficits including oculomotor nerve palsy. Computed tomography (CT) of her head revealed left ASDH. Subsequent CT angiography showed an aneurysm originating from the left ICA with an inferior projection having continuity with the hematoma...
January 29, 2018: Neurologia Medico-chirurgica
Toshiaki Hayashi, Tomomi Kimiwada, Misaki Kohama, Reizo Shirane, Teiji Tominaga
Filum terminale lipoma (FTL) causes various spinal symptoms known as tethered cord syndrome. The treatment for FTL is surgical untethering by sectioning the FTL, which can prevent symptom progression and often results in improvement of symptoms. This report describes a minimally invasive surgical strategy that we have introduced for FTL sectioning. The pediatric patients with FTL since 2007 were treated using this minimally invasive surgical strategy, which we refer to as an interlaminar approach (ILA). In summary, the surgical technique involves: minimal skin incision to expose the unilateral ligamentum flavum in the lower lumbar region; ligamentum flavum incision to expose the dural sac, and dural incision followed by identification and sectioning of the filum...
January 23, 2018: Neurologia Medico-chirurgica
Jun Hyong Ahn, Jin Pyeong Jeon, Jeong Eun Kim, Eun Jin Ha, Won-Sang Cho, Young Joo Park, Nam Han Cho, Hoon Sung Choi, Hyun-Seung Kang, Young-Je Son, Jae Seung Bang, Chang Wan Oh
The aim of this study was to investigate the specific thyroid condition and thyroid autoantibodies in adult moyamoya disease (MMD) according to clinical presentation (ischemia vs. hemorrhage stroke). In addition, a meta-analysis was performed to reveal the association between adult MMD and elevated thyroid function, or autoantibodies. Prospectively collected data on 169 consecutive patients with MMD at a single institution were analyzed. Community-based controls matched for age and sex were selected for comparison...
January 19, 2018: Neurologia Medico-chirurgica
Mauro Dobran, Davide Nasi, Stefano Chiriatti, Maurizio Gladi, Lucia di Somma, Maurizio Iacoangeli, Massimo Scerrati
The prognostic relevance of epilepsy at glioblastoma (GBMs) onset is still under debate. In this study, we analyzed the value of epilepsy and other prognostic factors on GBMs survival. We retrospectively analyzed the clinical, radiological, surgical and histological data in 139 GBMs. Seizures were the presenting symptoms in 50 patients out of 139 (35.9%). 123 patients (88%) were treated with craniotomy and tumor resection while 16 (12%) with biopsy. The median overall survival was 9.9 months from surgery. At univariable Cox regression, the factors that significantly improved survival were age less than 65 years (P = 0...
January 16, 2018: Neurologia Medico-chirurgica
Kazuta Yamashita, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Masatoshi Morimoto, Yutaka Kinoshita, Akihiro Nagamachi, Takashi Chikawa, Hiroshi Yonezu, Kosaku Higashino, Tadanori Sakamaki, Koichi Sairyo
Lumbar spondylolysis usually occurs as a stress fracture in the pars interarticularis of the vertebra. It is a prevalent sports-related disorder and a common cause of low back pain. We encountered five athletes (4 males, 1 female) with severe low back pain. Mean age was 14.5 years. All five patients were found to have bilateral pars fracture. In all cases, staging based on the findings from computed tomography scan of the right and left pars fracture was different. On short tau inversion recovery magnetic resonance imaging (STIR-MRI) of the comparatively newer more recently injured side, high signal intensity changes were obvious and dominant at the intra- and extraosseous area, which would indicate tissue edema and/or bleeding...
December 25, 2017: Neurologia Medico-chirurgica
Kouhei Nii, Hayatsura Hanada, Fumihiro Hiraoka, Ayumu Eto, Takafumi Mitsutake, Masanori Tsutsumi
We investigated the safety and efficacy of consciousness sedation with dexmedetomidine (DEX) during the endovascular treatment of patients with acute cerebral infarction. Between April 2014 and November 2016, 38 stroke patients underwent endovascular thrombectomy (EVT) under local anesthesia and DEX consciousness sedation. The continuous intravenous administration of low-dose DEX (0.3-0.4 μg/kg/h) was started before entering the operating room. Patients not completely immobilized received an iv bolus of pentazocine (PTZ) and/or DEX (0...
February 15, 2018: Neurologia Medico-chirurgica
Hiroyuki Toi, Nobuhisa Matsushita, Yukari Ogawa, Keita Kinoshita, Kohei Satoh, Hiroki Takai, Satoshi Hirai, Keijiro Hara, Shunji Matsubara, Masaaki Uno
Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes...
February 15, 2018: Neurologia Medico-chirurgica
Masahiko Nishimura, Shigetaka Kobayashi, Yuki Kinjo, Yohei Hokama, Kenichi Sugawara, Yukio Tsuchida, Daisuke Tominaga, Shogo Ishiuchi
The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients...
January 15, 2018: Neurologia Medico-chirurgica
Shoichi Haimoto, Yusuke Nishimura, Masahito Hara, Yasuhiro Nakajima, Yu Yamamoto, Howard J Ginsberg, Toshihiko Wakabayashi
A single-center retrospective comparative study was designed to identify the risk factors for restenosis of lumbar foraminal stenosis (LFS) after microscopic foraminal decompression (MFD). 21 consecutive patients who underwent single-level MFD with an average of 19-month follow-up were divided into two study groups based on clinical outcomes; group 1 (7 patients with poor outcomes requiring revision surgery), group 2 (14 patients with good outcomes with no revision surgery required). Changes of lumbar spinal alignment on plain standing radiographs were compared and analyzed between two study groups to investigate the pathology and risk factors associated with restenosis after MFD...
January 15, 2018: Neurologia Medico-chirurgica
Norihiro Isogai, Shunji Asamoto, Satoshi Nakamura, Kiminori Sakurai, Shinichi Ishihara, Masayuki Ishikawa, Makoto Nishiyama, Fumitaka Yoshioka, Kazuhiro Samura, Masatou Kawashima
There are few cases of spinal cord injury with ankylosing spondylitis (AS). This study investigated the clinical results of a spinal cord injury with a fracture in elderly patients with AS. Nine patients who had sustained a spinal cord injury with vertebral fractures in ankylosed spines were included in this study. The mean age was 79.3 years; two were male and seven were female. The mechanism of injury, the level of vertebral fractures, clinical methods, the follow-up period, and treatment outcomes were investigated...
December 19, 2017: Neurologia Medico-chirurgica
Takeo Uzuka, Fumi Higuchi, Hadzuki Matsuda, Ryohei Otani, Phyo Kim, Keisuke Ueki
Intravascular lymphoma (IVL) has been characterized in many case reports by multiple white matter lesions reflecting ischemic changes. In contrast, there are very few case reports of cerebral or cerebellar hemorrhage resulting from IVL. A 56-year-old woman was referred to our department with two-week history of headache, nausea, and poor appetite. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed dilated veins on the cerebellar surface. No ischemic lesions were detected on diffusion-weighted images...
December 15, 2017: Neurologia Medico-chirurgica
Ken Takizawa, Mitsunori Matsumae, Naokazu Hayashi, Akihiro Hirayama, Fumiya Sano, Satoshi Yatsushiro, Kagayaki Kuroda
The advent of magnetic resonance imaging (MRI) enables noninvasive measurement of cerebrospinal fluid (CSF) motion, and new information about CSF motion has now been acquired. The driving force of the CSF has long been thought to be choroid plexus (CP) pulsation, but to investigate whether this phenomenon actually occurs, CSF motion was observed in the ventricular system and subarachnoid space using MRI. Eleven healthy volunteers, ranging in age from 23 to 58 years, participated in this study. The MRI sequences used were four-dimensional phase-contrast (4D-PC) and time-spatial labeling inversion pulse (t-SLIP)...
November 16, 2017: Neurologia Medico-chirurgica
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