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Neurologia Medico-chirurgica

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https://www.readbyqxmd.com/read/28428448/unruptured-cerebral-aneurysms-in-elderly-patients
#1
Tomohito Hishikawa, Isao Date
The prevalence of unruptured cerebral aneurysms (UCAs) in elderly patients is increasing in our aging population. UCA management in elderly patients has some difficulties, such as reduced life expectancy, increased comorbidities and treatment risks, and poor prognosis in case of rupture. In this review article, we summarize the most recent findings on the natural history, therapeutic options and treatment results for UCAs exclusively in elderly patients, and describe possible medical treatments for patients with UCAs...
April 19, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28413181/review-of-past-reports-and-current-concepts-of-surgical-management-for-craniosynostosis
#2
Shigeo Kyutoku, Takayuki Inagaki
The purposes of surgery for craniosynostosis are to release increased intracranial pressure and to normalize cranial shape. The procedure was developed from a simple strip craniectomy in practice which ranged from the removal of the fused suture before the 1960s to total calvarial remodeling after 1970s and later methods of the 1990s, such as distraction and its modifications. According to its history, craniofacial surgeons might be changing their procedures with more effective, than less invasive ways. Since the late 1990s, when the distraction was applied to the craniofacial surgery, the gradual expansion, in particular of the anterior cranium, common in Japan, has long been controversial until the Caucasians accepted its use for the posterior cranium...
April 12, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28381654/disorder-of-executive-function-of-the-brain-after-head-injury-and-mild-traumatic-brain-injury-neuroimaging-and-diagnostic-criteria-for-implementation-of-administrative-support-in-japan
#3
Jun Shinoda, Yoshitaka Asano
The diagnotic criteria for disorder of the executive function of the brain (DEFB) as a syndrome of sequela were administratively established (ad-DEFB) in Japan in 2006 to support disabled patients whose impairment, limited to cognition (memory, attention, execution, and behavior), emerges after organic brain injuries regardless of physical deficits. However, some patients suffering from traumatic brain injury (TBI) have been excluded from receiving medico-social services. In particular, this tendency is more prominent in patients with mild TBI because no lesions are apparent on conventional computed tomography (CT) or magnetic resonance imaging (MRI) in the chronic phase...
April 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28381653/hands-on-simulation-versus-traditional-video-learning-in-teaching-microsurgery-technique
#4
Yusuke Sakamoto, Sho Okamoto, Kenzo Shimizu, Yoshio Araki, Akihiro Hirakawa, Toshihiko Wakabayashi
Bench model hands-on learning may be more effective than traditional didactic practice in some surgical fields. However, this has not been reported for microsurgery. Our study objective was to demonstrate the efficacy of bench model hands-on learning in acquiring microsuturing skills. The secondary objective was to evaluate the aptitude for microsurgery based on personality assessment. Eighty-six medical students comprising 62 men and 24 women were randomly assigned to either 20 min of hands-on learning with a bench model simulator or 20 min of video-learning using an instructional video...
April 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28381652/treatment-outcome-of-carotid-artery-stenting-underwent-within-14-days-of-stroke-onset-consideration-of-safety-and-efficacy-of-urgent-carotid-artery-stenting-for-neurologically-progressing-patients
#5
Yasuhisa Kanematsu, Junichiro Satomi, Kazuyuki Kuwayama, Izumi Yamaguchi, Shotaro Yoshioka, Tomoya Kinouchi, Yoshiteru Tada, Nobuaki Yamamoto, Shunji Matsubara, Koichi Satoh, Shinji Nagahiro
As the safety and effectiveness of urgent carotid artery stenting (CAS) for neurologically progressing patients remain controversial, we retrospectively analyzed the outcome of urgent CAS based on the patients' pathophysiological condition and neuroimaging findings. We divided 71 patients who underwent CAS within 14 days of stroke onset into two groups. Group 1 (n = 35) was comprised of patients with progressing neurologic signs and a reversible ischemic penumbra on magnetic resonance images (MRI). They were treated by urgent CAS...
April 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28367840/the-effect-of-irrigation-solutions-on-recurrence-of-chronic-subdural-hematoma-a-consecutive-cohort-study-of-234-patients
#6
Masashi Kuwabara, Takashi Sadatomo, Kiyoshi Yuki, Keisuke Migita, Yasutaka Imada, Kiyoharu Shimizu, Takeshi Hara, Hideo Oba, Kaoru Kurisu
Chronic subdural hematomas (CSDHs) occur often in elderly persons and can occur with mild head trauma. With burr-hole irrigation as standard treatment, symptoms usually improve and can be cured, and outcomes are good, but postoperative recurrences are a common problem. This study investigated the effectiveness and recurrence rates when using artificial cerebrospinal fluid (ACF) instead of normal saline (NS) as an irrigation solution for burr-hole irrigation in patients with CSDH. This prospective study included 234 consecutive patients who underwent initial surgical treatment by burr-hole irrigation for a CSDH between April 2008 and June 2015...
March 30, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28331101/immunotherapy-of-nivolumab-with-dendritic-cell-vaccination-is-effective-against-intractable-recurrent-primary-central-nervous-system-lymphoma-a-case-report
#7
Motomasa Furuse, Naosuke Nonoguchi, Naoki Omura, Mitsuaki Shirahata, Koichi Iwasaki, Toshio Inui, Toshihiko Kuroiwa, Hiroko Kuwabara, Shin-Ichi Miyatake
We report effective treatment with nivolumab of a patient with recurrent primary central nervous system lymphoma (PCNSL) after multiple therapies. A 41-year-old woman with a right parietal PCNSL underwent treatment with high-dose methotrexate and radiotherapy. After recurrence in the left frontal lobe, the patient received several chemotherapies, including methotrexate and rituximab, and underwent surgery. The tumor was refractory to these treatments, and the patient then underwent intensity-modulated radiotherapy (IMRT)...
March 23, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28250282/a-single-center-experience-with-coil-embolization-for-cerebral-aneurysms-greater-than-10-mm-in-the-internal-carotid-artery
#8
Kensuke Suzuki, Ryotaro Suzuki, Tomoji Takigawa, Nobuyuki Shimizu, Yoshiyuki Matsumoto, Yoshiko Fujii, Yuki Inoue, Yoshiki Sugiura, Koji Hirata, Kyoji Tsuda, Yosuke Kawamura, Issei Takano, Ryuta Nakae, Masaya Nagaishi, Yoshihiro Tanaka, Akio Hyodo
We investigated endovascular treatment for 10 mm or larger aneurysms in the internal carotid artery (IC), including the cavernous portion, the paraclinoid portion, and the posterior communication artery (PC). Between 2011 and 2014 at our hospital, there were 35 cases of aneurysms that were 10 mm or larger in the carotid artery. We analyzed these 35 cases retrospectively based on the size and location of the aneurysms, method of treatment, number of coils implanted, use of a stent, complications, rupture after treatment, ophthalmologic symptoms, and need for re-treatment...
March 2, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28250281/why-a-catheter-can-be-correctly-placed-in-the-anterior-horn-of-lateral-ventricle-by-inserting-perpendicular-to-the-frontal-bone-on-the-ventricular-drainage-demonstration-of-the-accuracy-of-an-inserting-path-by-computed-tomographic-image-study-and-clinical-practices
#9
Kiyonobu Ikeda, Takashi Asahi, Takaaki Iida, Jiro Yamamoto, Tsuyoshi Tsukada, Nobutaka Yamamoto, Fumihiko Takeuchi, Shigeru Munemoto, Shu-Ji Sato, Shuichi Akaike, Katsuo Shoin
Why a catheter can be correctly placed in the ventricle by inserting perpendicular to the frontal bone on the ventricular drainage? We performed a study on the accuracy of a path perpendicular to the skull surface into the anterior horn using computed tomography (CT), and a clinical study. Twenty patients were studied on CT images. Using the curved multi-planar reconstruction method, the curved frontal skull and brain were reconstructed to flat structures, and perpendicular lines were drawn from the flat surface to the foramen of Monro on the reconstructed images...
March 2, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28239067/recent-evolution-of-endoscopic-endonasal-surgery-for-treatment-of-pituitary-adenomas
#10
Hiroshi Nishioka
For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the "gold standard" since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors...
February 24, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28179598/the-current-status-of-microvascular-decompression-for-the-treatment-of-hemifacial-spasm-in-japan-an-analysis-of-2907-patients-using-the-japanese-diagnosis-procedure-combination-database
#11
Yoshifumi Mizobuchi, Keiji Muramatsu, Makoto Ohtani, Junichiro Satomi, Kiyohide Fushimi, Shinya Matsuda, Shinji Nagahiro
Microvascular decompression (MVD) is widely used as a safe and effective treatment for hemifacial spasm (HFS). However, the extent of application of this therapeutic method and its outcomes in Japan are currently unclear. To address these questions, we analyzed the utilization of MVD for the treatment of HFS during the 33- month period from July 2010 to March 2013. We conducted an analysis on data contained in the Diagnosis Procedure Combination database in Japan. This analysis showed that MVD was used for the treatment of HFS in 2907 cases (men, 916; women, 1991) with 2...
February 9, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28154344/importance-of-recognizing-carpal-tunnel-syndrome-for-neurosurgeons-a-review
#12
Masatoshi Yunoki, Takahiro Kanda, Kenta Suzuki, Atsuhito Uneda, Koji Hirashita, Kimihiro Yoshino
Idiopathic carpal tunnel syndrome (CTS) is a common complaint, reflecting entrapment neuropathy of the upper extremity. CTS produces symptoms similar to those of other conditions, such as cervical spondylosis or ischemic or neoplastic intracranial disease. Because of these overlaps, patients with CTS are often referred to a neurosurgeon. Surgical treatment of CTS was started recently in our department. Through this experience, we realized that neurosurgeons should have an increased awareness of this condition so they can knowledgeably assess patients with a differential diagnosis that includes CTS and cervical spinal and cerebral disease...
February 2, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28154341/predictive-factors-for-long-term-outcome-of-subthalamic-nucleus-deep-brain-stimulation-for-parkinson-s-disease
#13
Chikashi Fukaya, Mitsuru Watanabe, Kazutaka Kobayashi, Hideki Oshima, Atsuo Yoshino, Takamitsu Yamamoto
Despite the recognition of the usefulness of subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson's disease (PD), preoperative predictive factors for the long-term outcome of STN-DBS are not sufficiently established. We performed this study to determine such predictive factors. The subjects were 66 patients who were classified into two groups on the basis of their activities of daily living (ADL) evaluated five years after the STN-DBS surgery: 33 patients were assigned to the independent ADL group (group I) and the remaining 33 patients to the dependent ADL group (group D)...
January 31, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28190826/leukoaraiosis-is-associated-with-worse-short-term-functional-and-cognitive-recovery-after-minor-stroke
#14
Zheng Zhang, Wenwei Ren, Bei Shao, Huiqin Xu, Jianhua Cheng, Qiongzhang Wang, Yingying Gu, Beilei Zhu, Jincai He
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...
March 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28179597/sinus-pericranii-with-dominant-venous-outflow-in-the-superior-eyelid
#15
Eiji Ito, Syuntaro Takasu, Kenichi Hattori
Sinus pericranii (SP) located in the superior eyelid is an unusual clinical presentation. Here, we report a case of 72-year-old woman with an unruptured cerebral aneurysm presented with an SP located in the left superior eyelid. The SP was found to have a dominant venous outflow from the bilateral frontal region with an arterialized blood flow pattern on color Doppler ultrasonography (CDUS). During the aneurysmal surgery, intraoperative monitoring of the dominant venous outflow with CDUS was useful for the prevention of venous outflow obstruction...
March 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28154343/surgical-outcome-of-cerebral-aneurysm-clipping-treated-with-immunosuppressants-report-of-11-cases-and-review-of-the-literature
#16
Masaaki Hokari, Naoki Nakayama, Ken Kazumata, Toshiya Osanai, Hideo Shichinohe, Takeo Abumiya, Kiyohiro Houkin
There are no reports on the outcomes of clippings in patients who receive immunosuppressants, for example, due to connective tissue diseases or following organ transplantation. We thoroughly reviewed these cases focusing on the perioperative management phase. The study included 11 patients with intracranial aneurysms who were taking immunosuppressants; between 2007 and 2014. We performed 12 clipping surgeries. Their clinical records were reviewed for age and gender, aneurysms' location and size, perioperative management of the immunosuppressive drugs, and surgical complications...
March 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28154342/complications-and-predictors-of-hypotension-requiring-vasopressor-after-carotid-artery-stenting
#17
Masataka Nanto, Yudai Goto, Hiroyuki Yamamoto, Seisuke Tanigawa, Hayato Takeuchi, Yoshikazu Nakahara, Hiroshi Tenjin, Michiko Takado
A significant controversy exists regarding the clinical impact of hemodynamic depression on major adverse events after carotid artery stenting (CAS). The purpose of this study was to evaluate the incidence, predictors, and clinical significance of hypotension after CAS. A total of 118 cases of carotid artery stenosis were treated with CAS. Hypotension was defined as sustained systolic blood pressure <80 mmHg and requiring intravenous administration of vasopressor to maintain adequate systolic blood pressure after the procedure...
March 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28132961/does-reducing-the-duration-from-symptom-onset-to-recanalization-improve-the-results-of-intracranial-mechanical-thrombectomy-in-the-elderly
#18
Koichiro Komatsubara, Tomohisa Dembo, Eishi Sato, Hiroki Sasamori, Masataka Torii, Yoshiaki Shiokawa, Teruyuki Hirano
Endovascular recanalization for acute major cerebral artery occlusion is effective within a short time after symptom onset. However, its efficacy in the elderly remains unknown. We assessed the efficacy of our comprehensive stroke center's reduction of this time in 28 consecutive patients for elderly patients (defined as patients aged ≥75 years) with acute major cerebral artery occlusion treated with intravenous injection of tissue plasminogen activator, followed by thrombus retrieval by endovascular therapy...
March 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28025467/mechanical-thrombectomy-using-the-trevo-provue-in-50-consecutive-patients-with-anterior-circulation-stroke-a-single-center-experience-after-approval-of-the-stent-retriever-in-japan
#19
Taichiro Imahori, Kazuhiro Tanaka, Junji Koyama, Atsushi Arai, Ryoji Shiomi, Hirofumi Iwahashi, Akiyoshi Yokote, Kazushi Matsushima, Daisaku Matsui, Makoto Kobayashi, Atsushi Fujita, Kohkichi Hosoda, Eiji Kohmura
Mechanical thrombectomy using the stent retriever has been proven to be effective for select patients with acute ischemic stroke. We evaluated our early experience using the device after its approval in 2014 in Japan, with a special emphasis on the occlusion site. Fifty consecutive endovascular revascularization procedures for treating anterior acute large vessel occlusion were performed using the Trevo ProVue as the first-line device at our institute between April 2015 and March 2016. Focusing on the involvement of the M1-M2 bifurcation with deployment or retrieval of the stent retriever, we regarded the middle cerebral artery M1 mid-portion as the boundary and divided the cases into proximal (n = 26) and distal (n = 24) groups...
March 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28111406/pediatric-traumatic-brain-injury-characteristic-features-diagnosis-and-management
#20
Takashi Araki, Hiroyuki Yokota, Akio Morita
Traumatic brain injury (TBI) is the leading cause of death and disability in children. Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Evidence suggests that children exhibit a specific pathological response to TBI with distinct accompanying neurological symptoms, and considerable efforts have been made to elucidate their pathophysiology...
February 15, 2017: Neurologia Medico-chirurgica
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