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Neurologia Medico-chirurgica

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https://www.readbyqxmd.com/read/28679968/clinical-characteristics-and-outcome-in-elderly-patients-with-traumatic-brain-injury-for-establishment-of-management-strategy
#1
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...
July 5, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28674346/diagnosis-and-treatment-of-traumatic-cerebrovascular-injury-pitfalls-in-the-management-of-neurotrauma
#2
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...
June 30, 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
#3
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...
June 30, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28659547/balloon-kyphoplasty-under-three-dimensional-radiography-guidance
#4
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/28659546/focused-ultrasound-treatment-present-and-future
#5
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...
June 28, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28652561/chronic-subdural-hematoma-in-elderly-patients-is-this-disease-benign
#6
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...
June 26, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28637947/neurosurgical-virtual-reality-simulation-for-brain-tumor-using-high-definition-computer-graphics-a-review-of-the-literature
#7
Taichi Kin, Hirofumi Nakatomi, Naoyuki Shono, Seiji Nomura, Toki Saito, Hiroshi Oyama, Nobuhito Saito
Simulation and planning of surgery using a virtual reality model is becoming common with advances in computer technology. In this study, we conducted a literature search to find trends in virtual simulation of surgery for brain tumors. A MEDLINE search for "neurosurgery AND (simulation OR virtual reality)" retrieved a total of 1,298 articles published in the past 10 years. After eliminating studies designed solely for education and training purposes, 28 articles about the clinical application remained. The finding that the vast majority of the articles were about education and training rather than clinical applications suggests that several issues need be addressed for clinical application of surgical simulation...
June 22, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28637943/stereoelectroencephalography-indication-and-efficacy
#8
Koji Iida, Hiroshi Otsubo
Stereoelectroencephalography (SEEG) is a method for invasive study of patients with refractory epilepsy. Localization of the epileptogenic zone in SEEG relied on the hypothesis of anatomo-electro-clinical analysis limited by X-ray, analog electroencephalography (EEG), and seizure semiology in the 1950s. Modern neuroimaging studies and digital video-EEG have developed the hypothesis aiming at more precise localization of the epileptic network. Certain clinical scenarios favor SEEG over subdural EEG (SDEEG). SEEG can cover extensive areas of bilateral hemispheres with highly accurate sampling from sulcal areas and deep brain structures...
June 20, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28603224/proton-beam-therapy-for-pediatric-brain-tumor
#9
Masashi Mizumoto, Yoshiko Oshiro, Tetsuya Yamamoto, Hidehiro Kohzuki, Hideyuki Sakurai
Cancer is a major cause of childhood death, with central nervous system (CNS) neoplasms being the second most common pediatric malignancy, following hematological cancer. Treatment of pediatric CNS malignancies requires multimodal treatment using a combination of surgery, chemotherapy, and radiotherapy, and advances in these treatments have given favorable results and longer survival. However, treatment-related toxicities have also occurred, particularly for radiotherapy, after which secondary cancer, reduced function of irradiated organs, and retarded growth are significant problems...
June 9, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28592714/the-2016-who-classification-of-tumours-of-the-central-nervous-system-the-major-points-of-revision
#10
Takashi Komori
The updated 2016 edition of the World Health Organization (WHO) Classification of Tumours of the Central Nervous System (CNS) uses molecular parameters and the histology to define the main tumor categories for the first time. This represents a shift from the traditional principle of using neuropathological diagnoses, which are primarily based on the microscopic features, to using molecularly-oriented diagnoses. Major restructuring was made with regard to diffuse gliomas, medulloblastomas and other embryonal tumors...
June 8, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28592748/epigenetic-targeted-therapy-for-diffuse-intrinsic-pontine-glioma
#11
Rintaro Hashizume
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...
June 7, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28579577/evaluation-of-venous-drainage-patterns-for-skull-base-meningioma-surgery
#12
Kazuhide Adachi, Mitsuhiro Hasegawa, Yuichi Hirose
The evaluation of venous drainage patterns prior to surgery for skull base meningioma is important owing to their deep location and the vulnerability of surrounding vascular structures. In recent years, the microsurgical skull base approach has matured as a surgical technique, making it an important option for reducing complications related to skull base meningioma surgery. In addition, knowledge of the venous anatomy can prevent venous drainage route disturbance and potentially life-threatening complications...
June 5, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28539528/prospect-of-immunotherapy-for-glioblastoma-tumor-vaccine-immune-checkpoint-inhibitors-and-combination-therapy
#13
Eiichi Ishikawa, Tetsuya Yamamoto, Akira Matsumura
To date, clinical trials of various vaccine therapies using autologous tumor antigens or tumor-associated/specific antigen peptide with adjuvants have been performed to treat patients with high-grade gliomas (HGG). Furthermore, immune checkpoint pathway-targeted therapies including anti- programmed cell death 1 (PD-1) antibody have been remarkably effective in other neoplasms, and various clinical trials with anti-PD-1 antibody in patients with HGG have started to date. It is possible that up-regulation of immune checkpoint molecules in tumor tissues after vaccine therapy may be one of the mechanisms of vaccine failure...
May 24, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28529246/surgical-outcome-of-laminoplasty-for-cervical-spondylotic-myelopathy-in-an-elderly-population-potentiality-for-effective-early-surgical-intervention-a-meta-analysis
#14
Yasuhiro Takeshima, Ryuta Matsuoka, Ichiro Nakagawa, Fumihiko Nishimura, Hiroyuki Nakase
A systematic review and meta-analysis was conducted to determine differences in surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) between elderly and non-elderly patients. PubMed and Google Scholar searches were performed using several key words and phrases related to cervical laminoplasty in elderly populations. Included studies were written in English, addressed laminoplasty for cervical spondylotic myelopathy, and evaluated outcomes of the treatment. Statistical analysis was performed using a random-effect model...
May 19, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28515372/spinal-arteriovenous-shunts-angioarchitecture-and-historical-changes-in-classification
#15
Keisuke Takai
The purposes of this study were to review historical changes in the classification of spinal arteriovenous (AV) shunts and to propose a practical classification system. The associated literature regarding the classification of spinal AV shunts was reviewed in the angiography era between 1967 and 2015. The classification systems of spinal AV shunts and a proposed classification system were presented with neuroradiological imaging and medical illustrations. There have been seven major classification systems based on the evolution of diagnostic methods as well as treatments for spinal AV shunts: the first description of spinal AV shunts diagnosed and classified using spinal angiography in 1971; the second classification based on a case report of intradural direct perimedullary arteriovenous fistulas (AVFs) treated by microsurgery in 1987; the third classification based on a case series of intradural perimedullary AVFs treated by endovascular interventions in 1993; the fourth and fifth classification systems based on a case series of spinal AVFs and arteriovenous malformations (AVMs) treated by microsurgery or endovascular interventions in 2002; the sixth classification based on a case series of cranio-spinal dural AV shunts in 2009; and the seventh classification based on a case series of extradural AVFs treated by microsurgery and endovascular interventions in 2011...
May 18, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28484132/unilateral-trans-cerebellomedullary-fissure-approach-for-occipital-artery-to-posterior-inferior-cerebellar-artery-bypass-during-aneurysmal-surgery
#16
Hiroshi Abe, Koichi Miki, Hiromasa Kobayashi, Toshiyasu Ogata, Mitsutoshi Iwaasa, Toshio Matsushima, Tooru Inoue
Occipital artery (OA) to the posterior inferior cerebellar artery (PICA) bypass is indispensable for the management of complex aneurysms of the PICA that cannot be reconstructed with surgical clipping or coil embolization. Although OA-PICA bypass is a comparatively standard procedure, the bypass is difficult to perform in some cases because of the location and situation of the PICA. We describe the usefulness of the unilateral trans-cerebellomedullary fissure (CMF) approach for OA-PICA bypass. Thirty patients with aneurysms in the vertebral artery (VA) or PICA were treated using OA-PICA bypasses between 2010 and 2015...
May 9, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28458386/carotid-vertebrobasilar-anastomoses-with-reference-to-their-segmental-property
#17
Katsunari Namba
The primitive carotid-vertebrobasilar anastomoses are primitive embryonic cerebral vessels that temporarily provide arterial supply from the internal carotid artery to the longitudinal neural artery, the future vertebrobasilar artery in the hindbrain. Four types known are the trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries. The arteries are accompanied by their corresponding nerves and resemble an intersegmental pattern. These vessels exist in the very early period of cerebral arterial development and rapidly involute within a week...
May 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28458385/recent-trends-in-neuro-endovascular-treatment-for-acute-ischemic-stroke-cerebral-aneurysms-carotid-stenosis-and-brain-arteriovenous-malformations
#18
Yuji Matsumaru, Eiichi Ishikawa, Tetsuya Yamamoto, Akira Matsumura
The efficacy of mechanical thrombectomy with stent retrievers for emergent large vessel occlusion has been proved by randomized trials. Mechanical thrombectomy is increasingly being adopted in Japan since stent retrievers were first approved in 2014. An urgent clinical task is to offer structured systems of care to provide this treatment in a timely fashion to all patients with emergent large vessel occlusion. Treatment with flow-diverting stents is currently a preferred treatment option worldwide for large and giant unruptured aneurysms...
May 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28458384/clinical-utility-of-positron-emission-tomography-in-patients-with-malignant-glioma
#19
Hirohito Yano, Jun Shinoda, Toru Iwama
Positron emission tomography (PET) is being increasingly utilized for the management of brain tumors. Herein, we primarily review our previous studies on the use of PET in glioma that utilize three types of tracers: (11)C-methionine (MET), (11)C-choline, and (18)F-fluorodeoxyglucose. These studies included aspects such as tumor behavior, diagnosis, grade of malignancy, spread and invasion, viability, and genetic deletions; moreover, they also evaluated PET as a tool for planning radiation therapy (RT) and determining its outcome...
May 1, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28458383/efficacy-of-fiber-tractography-in-the-stereotactic-surgery-of-the-thalamus-for-patients-with-essential-tremor
#20
Susumu Sasada, Takashi Agari, Tatsuya Sasaki, Akihiko Kondo, Aiko Shinko, Takaaki Wakamori, Mihoko Okazaki, Ittetsu Kin, Ken Kuwahara, Masahiro Kameda, Takao Yasuhara, Isao Date
Several targets and targeting methods are utilized in stereotactic surgery to achieve tremor suppression for patients with intractable tremor. Recent developments in magnetic resonance imaging, including diffusion tensor imaging, have enabled the setting of appropriate targets in stereotactic surgery. In this retrospective study, the optimal target to suppress tremors in stereotactic surgery was explored using diffusion tensor image-based fiber tractography. Four tracts were focused on in this study, namely: the cerebello-thalamo-premotor cortical fiber tract, cerebello-thalamo-primary motor cortical fiber tract, spino-thalamo-somatosensory cortical fiber tract, and pyramidal tract...
May 1, 2017: Neurologia Medico-chirurgica
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