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Neurologia Medico-chirurgica

Hidenori Oishi, Kosuke Teranishi, Kenji Yatomi, Takashi Fujii, Munetaka Yamamoto, Hajime Arai
Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients' mean age was 63.4 years (range, 19-88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments...
October 6, 2018: Neurologia Medico-chirurgica
Toshiyuki Okazaki, Hiroshi Nakagawa, Hideo Mure, Kenji Yagi, Hitoshi Hayase, Yasushi Takagi, Koji Saito
This study was to assess the efficacy of microdiscectomy, cage fixation, and right tranuncal foramintomy for the patients suffering from right radiulo-myelopathy. Anterior cervical foraminotomy was reported to be an effective option for the treatment of cervical degenerative radiculopathy but with the problem of recurrence. Since Hakuba reported the method of trans-unco-discal approach in 1976, it was designed as keyhole foraminotomy which was called transuncal approach, transpedicular approach or transvertebral approach...
October 6, 2018: Neurologia Medico-chirurgica
Koichi Torihashi, Shigeo Sora, Hiroaki Sato, Michihiro Kohno
Preservation of facial nerve (FN) function is the most important goal in acoustic neuroma (AN) surgery. We have been using intraoperative continuous facial nerve monitoring (ICFNm) of evoked electromyography during AN surgery. ICFNm is very useful, and we can identify the real-time functions of the FN. Some surgeons have experienced difficulty with placing the ICFN stimulating electrode (SE). We therefore show how to place the ICFN SE. We mostly perform AN surgery with a retrosigmoid approach (RSA). A craniotomy with four burr holes is performed...
September 21, 2018: Neurologia Medico-chirurgica
Yasuyoshi Shimada, Daigo Kojima, Jun Yoshida, Masakazu Kobayashi, Kenji Yoshida, Shunrou Fujiwara, Kuniaki Ogasawara
Cerebral hyperperfusion syndrome following arterial bypass surgery is known as a surgical complication of moyamoya disease (MMD). How cerebral hyperperfusion affects neural function and causes neurological deficits remains unknown. We report here a case with cerebral hyperperfusion syndrome after arterial bypass surgery for ischemic MMD. Chronological changes of brain perfusion and central benzodiazepine receptor biding potential were observed using single-photon emission computed tomography. A 20-year-old woman with ischemic MMD underwent arterial bypass surgery...
November 15, 2018: Neurologia Medico-chirurgica
Shabierjiang Jiapaer, Takuya Furuta, Shingo Tanaka, Tomohiro Kitabayashi, Mitsutoshi Nakada
Glioblastoma (GBM) is a highly malignant type of primary brain tumor with a high mortality rate. Although the current standard therapy consists of surgery followed by radiation and temozolomide (TMZ), chemotherapy can extend patient's post-operative survival but most cases eventually demonstrate resistance to TMZ. O6 -methylguanine-DNA methyltransferase (MGMT) repairs the main cytotoxic lesion, as O6 -methylguanine, generated by TMZ, can be the main mechanism of the drug resistance. In addition, mismatch repair and BER also contribute to TMZ resistance...
October 15, 2018: Neurologia Medico-chirurgica
Satoshi Maesawa, Daisuke Nakatsubo, Masazumi Fujii, Kentaro Iijima, Sachiko Kato, Tomotaka Ishizaki, Masashi Shibata, Toshihiko Wakabayashi
Epilepsy surgery aims to control epilepsy by resecting the epileptogenic region while preserving function. In some patients with epileptogenic foci in and around functionally eloquent areas, awake surgery is implemented. We analyzed the surgical outcomes of such patients and discuss the clinical application of awake surgery for epilepsy. We examined five consecutive patients, in whom we performed lesionectomy for epilepsy with awake craniotomy, with postoperative follow-up > 2 years. All patients showed clear lesions on magnetic resonance imaging (MRI) in the right frontal (n = 1), left temporal (n = 1), and left parietal lobe (n = 3)...
October 15, 2018: Neurologia Medico-chirurgica
Kouhei Nii, Ritsurou Inoue, Yusuke Morinaga, Takafumi Mitsutake, Hayatsura Hanada
Stent-assisted coil embolization (SACE) is used to address wide-necked or complex aneurysms. However, periprocedural and/or late in-stent thrombosis (IST) elicit neurological events. We investigated the incidence and timed the development of acute IST during SACE with braided- or laser-cut stents in a retrospective study. Between May 2013 and April 2018, we evaluated 11 ISTs that occurred in the course of 185 SACE procedures (self-expandable laser-cut stent, n = 128; braided stent, n = 57). The onset of IST was measured from the time of stent placement...
October 15, 2018: Neurologia Medico-chirurgica
Takafumi Tanei, Yasukazu Kajita, Satoshi Maesawa, Daisuke Nakatsubo, Kosuke Aoki, Hiroshi Noda, Shigenori Takebayashi, Norimoto Nakahara, Toshihiko Wakabayashi
The long-term effects of motor cortex stimulation (MCS) and spinal cord stimulation (SCS) remain unknown. To identify the long-term effects after MCS or SCS and determine any associated predictive factors for the outcomes. Fifty patients underwent MCS (n = 15) or SCS (n = 35) for chronic neuropathic pain. The degree of pain was assessed preoperatively, at 1, 6, and 12 months after surgery, and during the time of the last follow-up using Visual Analog Scale (VAS). Percentage of pain relief (PPR) was calculated, with "long-term effect" defined as PPR ≥ 30% and the presence of continued pain relief over 12 months...
October 15, 2018: Neurologia Medico-chirurgica
Satoru Yonekura, Takayuki Anno, Nobuyuki Kobayashi
We report a case of head injury with posterior reversible encephalopathy syndrome (PRES), followed by Guillain-Barré syndrome (GBS). A 74-year-old man was brought to our hospital after a fall. Computed tomography revealed intracranial hemorrhage. Magnetic resonance imaging showed bilateral reversible intensities with features of vasogenic edema in parietooccipital areas, suggesting PRES. After admission, weakness and areflexia of extremities and respiratory muscles developed gradually, which favored a diagnosis of GBS...
October 15, 2018: Neurologia Medico-chirurgica
Tomoo Watanabe, Yasuyuki Kawai, Asami Iwamura, Naoki Maegawa, Hidetada Fukushima, Kazuo Okuchi
Traumatic brain injury (TBI) is a leading cause of death and disability in trauma patients. Patients with TBI frequently sustain concomitant injuries in extracranial regions. The effect of severe extracranial injury (SEI) on the outcome of TBI is controversial. For 8 years, we retrospectively enrolled 485 patients with the blunt head injury with head abbreviated injury scale (AIS) ≧ 3. SEI was defined as AIS ≧ 3 injuries in the face, chest, abdomen, and pelvis/extremities. Vital signs and coagulation parameter values were also extracted from the database...
September 15, 2018: Neurologia Medico-chirurgica
Kenji Sugiyama, Takao Nozaki, Tetsuya Asakawa, Tetsuro Sameshima, Schinichiro Koizumi, Hisaya Hiramatsu, Hiroki Namba
Deep brain stimulation (DBS) is used to treat symptoms by modulating the cortico-striato-thalamo-cortical (CSTC) loop in the central nervous system (CNS), and attempts to research loop circuit disorders have been globally initiated among the intractable neurological and psychiatric disorders. DBS treatment has been evaluated for all these newly found CNS loop circuit disorders. In 2011, neurosurgical treatments for psychiatric disorders were renamed from "psychosurgery" to "neurosurgery for psychiatric disorders (NPD)" by the World Society for Stereotactic and Functional Neurosurgery (WSSFN)...
September 15, 2018: Neurologia Medico-chirurgica
Naotaka Usui, Akihiko Kondo, Naoki Nitta, Takayasu Tottori, Yushi Inoue
The amygdala and uncus are located close to important neurovascular structures. We describe a safe technique for resection of amygdala and uncus. Under general anesthesia, the patient is positioned supine, with the head rotated approximately 20 degrees to the unoperated side and slightly extended. By using a trans-anterior T1 subpial approach, the inferior horn of the lateral ventricle is opened, and hippocampectomy is performed. We treat an imaginary plane formed by the inferior circular sulcus of the insula, the endorhinal sulcus, and the inferior choroidal point as the upper border of amygdalar resection...
September 15, 2018: Neurologia Medico-chirurgica
Takatsugu Abe, Kuniyasu Niizuma, Atsushi Kanoke, Daisuke Saigusa, Ritsumi Saito, Akira Uruno, Miki Fujimura, Masayuki Yamamoto, Teiji Tominaga
We performed metabolomic analyses of mouse brain using a transient middle cerebral artery occlusion (tMCAO) model with Matrix Assisted Laser Desorption/Ionization (MALDI)-mass spectrometry imaging (MSI) to reveal metabolite changes after cerebral ischemia. We selected and analyzed three metabolites, namely creatine (Cr), phosphocreatine (P-Cr), and ceramides (Cer), because these metabolites contribute to cell life and death. Eight-week-old male C57BL/6J mice were subjected to tMCAO via the intraluminal blockade of the middle cerebral artery (MCA) and reperfusion 60 min after the induction of ischemia...
September 15, 2018: Neurologia Medico-chirurgica
Kensuke Takada, Yoshinori Maki, Masanori Kinosada, Ryota Ishibashi, Masaki Chin, Sen Yamagata
Metronidazole induced encephalopathy (MIE), an encephalopathy brought by an antibiotic, is characterized with cerebellar dysfunction, altered mental status and extrapyramidal symptoms. MIE can result in an acute manifestation, but MIE has not been reported as a stroke mimic. An 86-year-old patient undergoing metronidazole therapy for Clostridium difficile enteritis presented to our hospital with sudden disoriented status and motor weakness of the left extremities. Computed tomography (CT) was unrevealing of intracranial hemorrhagic change, and CT angiography did not show any apparent major occlusion or stenosis of the intracranial vessels...
September 15, 2018: Neurologia Medico-chirurgica
Takufumi Yanagisawa, Ryohei Fukuma, Ben Seymour, Koichi Hosomi, Haruhiko Kishima, Takeshi Shimizu, Hiroshi Yokoi, Masayuki Hirata, Toshiki Yoshimine, Yukiyasu Kamitani, Youichi Saitoh
A brachial plexus root avulsion (BPRA) causes intractable pain in the insensible affected hands. Such pain is partly due to phantom limb pain, which is neuropathic pain occurring after the amputation of a limb and partial or complete deafferentation. Previous studies suggested that the pain was attributable to maladaptive plasticity of the sensorimotor cortex. However, there is little evidence to demonstrate the causal links between the pain and the cortical representation, and how much cortical factors affect the pain...
August 15, 2018: Neurologia Medico-chirurgica
Daisuke Maruyama, Hiroharu Kataoka, Tetsu Satow, Hisae Mori, Yoshiro Ito, Eika Hamano, Shunichi Tanaka, Taichi Ishiguro, Hidekazu Chikuie, Jun C Takahashi
Antithrombotic treatment has substantial risks, even in pediatric patients. We retrospectively evaluated the management and outcomes of consecutive pediatric patients who underwent neurosurgical treatment for cerebrovascular disease with cardiovascular disease between 1998 and 2017. Patients were divided into patients with comorbid cardiovascular disease (group I); and patients with cardiovascular disease as a primary disease of intracranial complication, without (group IIa) or with (group IIb) extracorporeal circulations...
August 15, 2018: Neurologia Medico-chirurgica
Yasuhisa Kanematsu, Junichiro Satomi, Masaaki Korai, Toshiyuki Okazaki, Izumi Yamaguchi, Yoshiteru Tada, Masaaki Uno, Shinji Nagahiro, Yasushi Takagi
Surgery for- and endovascular treatment of vertebral artery (VA) dissecting aneurysms involving the origin of the posterior inferior cerebellar artery (PICA) remain challenging. Their ideal treatment is complete isolation of the aneurysm by surgical or endovascular trapping plus PICA reconstruction. However, postoperative lower cranial nerve palsy and medullary infarction are potential complications. We report four patients with VA dissecting aneurysms involving the PICA origin who were treated by occipital artery (OA)-PICA bypass followed by proximal occlusion of the VA and clip ligation of the PICA origin instead of trapping...
August 15, 2018: Neurologia Medico-chirurgica
Ichiro Takumi, Masataka Akimoto, Kouhei Hironaka, Koji Adachi, Takashi Kon, Takashi Matsumori, Yuichiro Tanaka, Akio Morita
This technical note aims to demonstrate the usefulness, indications and its limitations of augmentation technique by bipedicle galeo-pericranial rotation flap and by monopedicle galeo-pericranial flap, both in STA (superficial temporal artery) branch compromised hosts in salvage frontotemporal cranioplasty. Although these flaps are not always idealistically vascularized owing to accidental injuries to the STA branches during previous surgeries, they are properly augmenting after salvage frontotemporal craniotomy when infection is not active...
August 15, 2018: Neurologia Medico-chirurgica
Ayumu Yamaoka, Kei Miyata, Naofumi Bunya, Hirotoshi Mizuno, Hideto Irifune, Naoya Yama, Yukinori Akiyama, Takeshi Mikami, Masahiko Wanibuchi, Nobuhiro Mikuni
In blunt cerebrovascular injury, reported traumatic basilar artery occlusions have involved dissection of the basilar artery, distal embolization due to traumatic vertebral artery dissection, or entrapment of the basilar artery into the clivus fracture. To date, however, there are no reports of traumatic basilar artery entrapment without a clivus fracture. Here, we report the first case of traumatic basilar artery occlusion caused by entrapment into an originally existing bone defect. A 67-year-old man with a history of treatment for intracranial aneurysm suffered multiple traumatic injuries in a fall...
August 15, 2018: Neurologia Medico-chirurgica
Fumiaki Kanamori, Takashi Yamanouchi, Yuya Kano, Naoki Koketsu
Although vascular complications after head trauma is well recognized, basilar artery entrapment within the longitudinal clivus fracture is rare. A 69-year-old man presented with progressive disturbance of consciousness and right hemiplegia after trauma. Computed tomography scan showed a right-sided acute subdural hematoma and multiple skull fractures, including a longitudinal clivus fracture. Magnetic resonance imaging revealed basilar artery occlusion and a small infarction at the ventral part of the pons...
August 15, 2018: Neurologia Medico-chirurgica
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