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Neurologia Medico-chirurgica

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https://www.readbyqxmd.com/read/28239067/recent-evolution-of-endoscopic-endonasal-surgery-for-treatment-of-pituitary-adenomas
#1
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/28190826/leukoaraiosis-is-associated-with-worse-short-term-functional-and-cognitive-recovery-after-minor-stroke
#2
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...
February 10, 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
#3
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/28179597/sinus-pericranii-with-dominant-venous-outflow-in-the-superior-eyelid
#4
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...
February 9, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28154344/importance-of-recognizing-carpal-tunnel-syndrome-for-neurosurgeons-a-review
#5
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/28154343/surgical-outcome-of-cerebral-aneurysm-clipping-treated-with-immunosuppressants-report-of-11-cases-and-review-of-the-literature
#6
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...
January 31, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28154342/complications-and-predictors-of-hypotension-requiring-vasopressor-after-carotid-artery-stenting
#7
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...
January 31, 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
#8
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/28132961/does-reducing-the-duration-from-symptom-onset-to-recanalization-improve-the-results-of-intracranial-mechanical-thrombectomy-in-the-elderly
#9
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...
January 27, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28111406/pediatric-traumatic-brain-injury-characteristic-features-diagnosis-and-management
#10
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...
January 20, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28070115/proposal-for-a-prospective-registry-for-moyamoya-disease-in-japan
#11
Ken Kazumata, Masaki Ito, Haruto Uchino, Hiroshi Nishihara, Kiyohiro Houkin
The number of clinical research papers published worldwide on moyamoya disease (MMD) has increased recently. However, the majority of the literature comprises retrospective single-center studies collecting data on small numbers of patients. Several multi-center studies are ongoing in Japan; however, the current data are insufficient for comprehensively outlining the various characteristics of MMD. To enhance our knowledge on epidemiologic, vascular, and genetic aspects of MMD, a prospective multicenter registry will be established in Japan that will help to streamline clinical research as well as improve clinical treatments and long-term outcomes...
January 6, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28070114/development-of-database-and-genomic-medicine-for-von-hippel-lindau-disease-in-japan
#12
Shunsaku Takayanagi, Akitake Mukasa, Hirofumi Nakatomi, Hiroshi Kanno, Jun-Ichi Kuratsu, Ryo Nishikawa, Kazuhiko Mishima, Atushi Natsume, Toshihiko Wakabayashi, Kiyohiro Houkin, Shunsuke Terasaka, Masahiro Yao, Nobuo Shinohara, Taro Shuin, Nobuhito Saito
von Hippel-Lindau (VHL) disease is a hereditary tumor disease in which tumors develop in multiple organs, not only as hemangioblastomas (HBs) in the central nervous system, but also as kidney tumors, pheochromocytomas, and so on. Much about the epidemiology of VHL disease remained unknown until fairly recently in Japan, leading to calls for the establishment of a VHL disease epidemiological database in Japanese. To elucidate its epidemiology in Japan, the Japanese Ministry of Health, Labour and Welfare created the VHL Disease Study Group, which was put in charge of carrying out a nationwide epidemiological survey...
January 6, 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
#13
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...
December 27, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28025426/life-and-medical-ethics-in-pediatric-neurosurgery
#14
Mami Yamasaki
Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child's condition accurately and evaluate the outcome...
December 26, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28003570/correlations-between-cognitive-impairments-and-employment-status-in-patients-with-diffuse-axonal-injury
#15
Shin Hirota, Motoki Inaji, Tadashi Nariai, Mutsuya Hara, Masashi Tamaki, Taketoshi Maehara, Hiroki Tomita, Osamu Tone
Patients with diffuse axonal injury (DAI) may initially present with prominent physical impairments, but their cognitive dysfunctions are more persistent and are attributable to later unemployment. In this study, we analyzed how the findings of early and delayed neuropsychological assessments correlated with employment outcome of patients with DAI. A total of 56 patients with DAI without motor or visual dysfunction were included in this study. The neuropsychological battery consisted of the Wechsler Adult Intelligent Scale - Revised (WAIS-R), Wechsler Memory Scale - Revised (WMS-R), Trail Making Test (TMT), Wisconsin Card Sorting Test (WCST), and Word Fluency Test (WFT)...
December 22, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27980285/convection-enhanced-delivery-of-therapeutics-for-malignant-gliomas
#16
Ryuta Saito, Teiji Tominaga
Convection-enhanced delivery (CED) circumvents the blood-brain barrier by delivering agents directly into the tumor and surrounding parenchyma. CED can achieve large volumes of distribution by continuous positive-pressure infusion. Although promising as an effective drug delivery method in concept, the administration of therapeutic agents via CED is not without challenges. Limitations of distribution remain a problem in large brains, such as those of humans. Accurate and consistent delivery of an agent is another challenge associated with CED...
January 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27980284/roles-of-the-wada-test-and-functional-magnetic-resonance-imaging-in-identifying-the-language-dominant-hemisphere-among-patients-with-gliomas-located-near-speech-areas
#17
Tatsuya Ishikawa, Yoshihiro Muragaki, Takashi Maruyama, Kayoko Abe, Takakazu Kawamata
This study examined the accuracy of functional magnetic resonance imaging (fMRI) in identifying the language-dominant hemisphere and the situations in which the Wada test can be skipped among patients with gliomas located near speech areas. We examined 74 patients [48 men (64.9%); mean ± standard deviation age of 42.7 ± 13.6 years (range: 13 to 70 years); 71 right-handed, 2 left-handed, and 1 ambidextrous] with gliomas located near speech areas. All patients underwent the Wada test and fMRI, and 34 patients underwent awake surgery...
January 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27928096/extremely-late-recurrence-21-years-after-total-removal-of-immature-teratoma-a-case-report-and-literature-review
#18
Yui Mano, Masayuki Kanamori, Toshihiro Kumabe, Ryuta Saito, Mika Watanabe, Yukihiko Sonoda, Teiji Tominaga
Immature teratoma (IMT) is normally treated by resection and adjuvant therapy. The present unusual case of recurrent germinoma occurred 21 years after total resection of pineal IMT. A 3-year-old boy presented with headache, disturbance of consciousness, and Parinaud's syndrome. Magnetic resonance (MR) imaging revealed a pineal mass lesion, and total resection of the tumor was achieved. The histological diagnosis was mature teratoma. He did not receive further treatment, and did well without recurrence for 20 years...
January 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27725524/phase-i-ii-study-of-temozolomide-plus-nimustine-chemotherapy-for-recurrent-malignant-gliomas-kyoto-neuro-oncology-group
#19
Tomokazu Aoki, Yoshiki Arakawa, Tetsuya Ueba, Masashi Oda, Namiko Nishida, Yukinori Akiyama, Tetsuya Tsukahara, Koichi Iwasaki, Nobuhiro Mikuni, Susumu Miyamoto
The objective of this phase I/II study was to examine the efficacy and toxicity profile of temozolomide (TMZ) plus nimustine (ACNU). Patients who had received a standard radiotherapy with one or two previous chemo-regimens were enrolled. In phase I, the maximum-tolerated dose (MTD) by TMZ (150 mg/m(2)/day) (Day 1-5) plus various doses of ACNU (30, 35, 40, 45 mg/m(2)/day) (Day 15) per 4 weeks was defined on a standard 3 + 3 design. In phase II, these therapeutic activity and safety of this regimen were evaluated...
January 15, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/27666154/national-registry-of-designated-intractable-diseases-in-japan-present-status-and-future-prospects
#20
Yasuhiro Kanatani, Naoko Tomita, Yoko Sato, Akiko Eto, Hiroe Omoe, Hiroshi Mizushima
Japan promotes research related to intractable diseases and financially supports patients with these diseases. Intractable diseases are designated as those that fulfill the following criteria: (1) rarity (affecting less than 0.1% of the population in Japan), (2) unknown etiology, (3) lack of effective treatment, (4) necessity of long-term treatment, and (5) existence of objective diagnostic criteria and not necessarily equal to rare diseases in other countries. The construction of a national database is required to promote research to clarify the pathogenesis of these diseases and to develop pharmaceutical products and medical devices...
January 15, 2017: Neurologia Medico-chirurgica
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