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Neurologia Medico-chirurgica

Tetsuya Asakawa, Kenji Sugiyama, Takao Nozaki, Tetsuro Sameshima, Susumu Kobayashi, Liang Wang, Zhen Hong, Shujiao Chen, Candong Li, Hiroki Namba
Dramatic breakthroughs in the treatment and assessment of neurological diseases are lacking. We believe that conventional methods have several limitations. Computerized technologies, including virtual reality, augmented reality, and robot assistant systems, are advancing at a rapid pace. In this study, we used Parkinson's disease (PD) as an example to elucidate how the latest computerized technologies can improve the diagnosis and treatment of neurological diseases. Dopaminergic medication and deep brain stimulation remain the most effective interventions for treating PD...
February 13, 2019: Neurologia Medico-chirurgica
Motonori Kohno, Yuichi Iwamura, Riki Inasaka, Kanichiro Kaneko, Masamitsu Tomioka, Takuya Kawai, Yoichi Aota, Tomoyuki Saito, Yutaka Inaba
The purpose of this study was to investigate the clinical and radiological features of osteoporotic burst fractures affecting levels below the second lumbar (middle-low lumbar) vertebrae, and to clarify the appropriate surgical procedure to avoid postoperative complications. Thirty-eight consecutive patients (nine male, 29 female; mean age: 74.8 years; range: 60-86 years) with burst fractures affecting the middle-low lumbar vertebrae who underwent posterior-instrumented fusion were included. Using the Magerl classification system, these fractures were classified into three types: 16 patients with superior incomplete burst fracture (superior-type), 11 patients with inferior incomplete burst fracture (inferior-type) and 11 patients with complete burst fracture (complete-type)...
February 13, 2019: Neurologia Medico-chirurgica
Kenji Sugiu, Tomohito Hishikawa, Satoshi Murai, Yu Takahashi, Naoya Kidani, Shingo Nishihiro, Masafumi Hiramatsu, Isao Date, Tetsu Satow, Koji Iihara, Nobuyuki Sakai
Embolization for intracranial tumor is performed as a standard endovascular treatment. A retrospective, multicenter, observational study was conducted to clarify the nature, frequency, and risk factors of complications in intracranial tumor embolization. Patients were derived from the Japanese Registry of NeuroEndovascular Therapy (JR-NET3) using data taken from January 2010 through December 2014 in Japan. A total of 40,169 patients were enrolled in JR-NET3, of which, 1,545 patients (3.85%) with intracranial tumors underwent embolization...
January 26, 2019: Neurologia Medico-chirurgica
Satoshi Nakasu, Takeshi Onishi, Sawako Kitahara, Hisayuki Oowaki, Ken-Ichi Matsumura
Predicting the growth rate of meningiomas is important in treatment planning. Although calcification may be an important sign of slow growth in meningiomas, the developmental process and its relation to the tumor growth pattern have not been elucidated. We retrospectively examined the location and degree of calcification in 150 meningiomas (131 asymptomatic tumors) using computed tomography (CT) scans and mean Hounsfield units (mHU). Tumor growth was evaluated using serial imaging studies wherein we calculated tumor doubling time (Td) and identified the growth curve pattern as exponential, intermediate, or decelerating...
January 26, 2019: Neurologia Medico-chirurgica
Hiroaki Manabe, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Koichi Sairyo
The purpose of this study was to assess the usefulness of radiofrequency thermal annuloplasty (TA) using percutaneous endoscopic discectomy/TA (PED/TA) in elite athletes with discogenic low back pain. Twelve patients (11 men, 1 woman; mean age 27.9 years) underwent PED/TA under local anesthesia. Clinical data for these patients (17 affected intervertebral discs), including type of sport played, average duration of low back pain, disc level affected, presence or absence of a high signal intensity zone on magnetic resonance imaging, and whether the patient returned to playing competitive sport, were retrospectively reviewed...
January 23, 2019: Neurologia Medico-chirurgica
Eiichi Suehiro, Yuichi Fujiyama, Miwa Kiyohira, Yukari Motoki, Junzo Nojima, Michiyasu Suzuki
d-dimer is a potential biomarker for the detection of traumatic brain injury (TBI). However, the mechanisms that trigger elevation of d-dimer in TBI remain unclear. The purpose of this study was to evaluate the reliability of d-dimer in blood as a biomarker for TBI and to determine the mechanisms involved in regulating its blood levels. Nine patients with moderate to severe isolated TBI (Glasgow Coma Scale [GCS] score 7-13) were admitted to our hospital from May 2013 to June 2014. Blood samples were collected from systemic arteries on arrival and at 1, 3, 5, and 7 days after injury...
January 23, 2019: Neurologia Medico-chirurgica
Tsukasa Hirano, Rei Enatsu, Satoshi Iihoshi, Takeshi Mikami, Toshimi Honma, Hirofumi Ohnishi, Nobuhiro Mikuni
Epilepsy after aneurysmal subarachnoid hemorrhage (post-SAH epilepsy) is a critical complication that influences clinical and social prognoses. However, the underlying mechanisms remain unclear. We investigated the relationship between hemosiderosis and the incidence of post-SAH epilepsy. About 50 patients with aneurysmal SAH who were admitted to Sapporo Medical University and Oji General Hospital between April 2010 and June 2016 were enrolled in this retrospective study. Hemosiderosis detected by T2*-weighted magnetic resonance imaging(MRI) and the incidence of post-SAH epilepsy were retrospectively analyzed...
December 18, 2018: Neurologia Medico-chirurgica
Min Woo Kim, Su Bum Lee, Jin Hoon Park
This paper describes two patients with cervical spondyloptosis with severe spinal cord injury treated with cervical pedicle screw (CPS) through a single-stage operation, posterior approach. A 60-year-old male patient with quadriparesis due to trauma 1 day before visited the emergency room. Cervical spine computed tomography (CT) and magnetic resonance imaging showed complete dislocation of the C7 and T1 vertebrae with severe spinal cord compression, disc injury, and disc herniation at the C7-T1 level. Cervical pedicle screw with freehand technique was done on C6 and T1 vertebrae, and bilateral distraction for a reduction was performed with a screw distractor...
December 15, 2018: Neurologia Medico-chirurgica
Haruka Miyata, Kampei Shimizu, Hirokazu Koseki, Yu Abekura, Hiroharu Kataoka, Susumu Miyamoto, Kazuhiko Nozaki, Shuh Narumiya, Tomohiro Aoki
Subarachnoid hemorrhage due to rupture of a pre-existing intracranial aneurysm has quite a poor outcome in spite of intensive medical care. Hemodynamic stress loaded on intracranial arterial walls is considered as a trigger and a regulator of formation and progression of the disease, but how intracranial arterial walls or intracranial aneurysm walls behave under hemodynamic stress loading remains unclear. The purpose of this study was to visualize and analyze the wall motion of intracranial aneurysms to detect a pathological flow condition...
December 15, 2018: Neurologia Medico-chirurgica
Hidehisa Nishi, Akira Ishii, Tetsu Satow, Koji Iihara, Nobuyuki Sakai
Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014...
December 7, 2018: Neurologia Medico-chirurgica
Hajime Nakamura, Toshiyuki Fujinaka, Takeo Nishida, Haruhiko Kishima, Nobuyuki Sakai
Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93...
December 7, 2018: Neurologia Medico-chirurgica
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2019: Neurologia Medico-chirurgica
Hirotoshi Imamura, Nobuyuki Sakai, Tetsu Satow, Koji Iihara
Endovascular treatments for vasospasm after subarachnoid hemorrhage are typically performed for patients who are refractory to recommended medical therapies. We analyzed the current status of endovascular treatments based on the data of Japanese Registry of Neuroendovascular Therapy (JR-NET)3, and evaluated factors related to improvement of imaging findings and neurological condition, and to mechanical hemorrhage complications. We collected data of 1211 treatments performed from 2010 to 2014. Target vessels for treatments were anterior circulation (n = 1079), posterior circulation (n = 91), and both (n = 32); the distribution of vasospasm was the proximal vessel (n = 754) to the Circle of Willis, distal vessel (n = 329), and both (n = 119)...
November 21, 2018: Neurologia Medico-chirurgica
Hiroyuki Shiba, Koji Takeuchi, Ryo Hiramatsu, Motomasa Furuse, Naosuke Nonoguchi, Shinji Kawabata, Toshihiko Kuroiwa, Natsuko Kondo, Yoshinori Sakurai, Minoru Suzuki, Koji Ono, Shiro Oue, Eiichi Ishikawa, Hiroyuki Michiue, Shin-Ichi Miyatake
Recurrent malignant gliomas (RMGs) are difficult to control, and no standard protocol has been established for their treatment. At our institute, we have often treated RMGs by tumor-selective particle radiation called boron neutron capture therapy (BNCT). However, despite the cell-selectivity of BNCT, brain radiation necrosis (BRN) may develop and cause severe neurological complications and sometimes death. This is partly due to the full-dose X-ray treatments usually given earlier in the treatment course. To overcome BRN following BNCT, recent studies have used bevacizumab (BV)...
November 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
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...
November 15, 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...
November 15, 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...
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
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