Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 10 , Issue 5
Showing 1-24 articles out of 24 articles from the selected issue
  • Type: Cover
    2001 Volume 10 Issue 5 Pages Cover21-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Cover
    2001 Volume 10 Issue 5 Pages Cover22-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Index
    2001 Volume 10 Issue 5 Pages 311-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 312-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Takamasa Kayama, Shinya Sato, Megumi Okochi
    Type: Article
    2001 Volume 10 Issue 5 Pages 313-319
    Published: May 20, 2001
    Released: June 02, 2017
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    To assess distribution and conditions of neurosurgeons in training, questionnaires were sent to 336 "Category A" facilities of the Japan Neurosurgical Society (JNS). The category represents acadmic and non-academic hospitals satisfying conditions such as staff numbers (more that five) and number of procedures (more than 200 per year). 86.3% of the academic Category A hospitals (69/80) and 55.5% (142/256) of non-academic Category A hospitals responded to our questionnaire. Geographical distribution of the academic centers were as follows : 4.3% in Hokkaido district, 10.1% in Tohoku district (Akita, Aomori, Iwate, Fukushima, Miyagi, Niigata, Yamagata, prefectures), 29.0% in Kanto district (Chiba, Gunma, Ibaragi, Kanagawa, Saitama, Tochigi, Tokyo, Yamanashi), 17.5% in Chubu (Aichi, Fukui, Gifu, Ishikawa, Mie, Nagano, Shizuoka, Toyama), 14.5% in Kinki (Hyogo, Kyoto, Nara, Osaka, Shiga, Wakayama), 10.1% in Chugoku (Hiroshima, Okayama, Shimane, Tottori, Yamaguchi)/Shikoku, and 14.5% in the Kyushu and Okinawa districts Distribution of the non-academic hospitals is 9.2%, 9.2%, 26.0%, 15.4%, 20.4%, 11.3%, and 8.5% correspondingly. Curriculum of the training programs was assessed : the training period consists of 6 years prior to the board examination by JNS. The trainees by average spend 3 years in the university/medical college hospitals and 3 years in the affiliated hospitals. The latter period typically includes 1 year in Category A hospitals and 2 years in Category C facilities, which represent smaller neurosurgical hospitals and clinics. Average number of procedures in the non-academic Category A hospitals was 200 per year. Their number for cerebrovascular procedures matches to that of the academic centers, but spinal, pediatric, endoscopic or endovascular procedures are less common in those hospitals. Official curriculum requirements are yet to be outlined by the JNS, a provision felt to be desirable by many of the respondents to our questionnaire.
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 319-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Takumi Abe, Youichi Imaizumi, Yosinori Nakamura, Noriyoshi Kawamura, M ...
    Type: Article
    2001 Volume 10 Issue 5 Pages 320-325
    Published: May 20, 2001
    Released: June 02, 2017
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    Objective : We have reported the usefulness of a micro-pressure-suction-irrigation system (MPSIS) in the direct transnasal pituitary surgery. This system was, however, less useful for the removal of fibrous pituitary adenomas, especially during transnasal reoperation. Recently, an ultrasonic surgical aspirator with a needle-type probe (OUSA, Olympus Optical Co.) has been developed. We report our preliminarily experiences using MPSIS and OUSA in direct transnasal reoperations for fibrous pituitary adenomas. Methods : MPSIS can effectively dissect the usual soft pituitary adenoma tissue with a rapid flow and remove it by suction by one-hand manipulation. This system is especially useful when it is used in combination with a micromirror or a neuroendoscope for a direct inspection of the eccentric tumor sites, such as for a tumor in the cavernous sinus. We use OUSA for the removal of the remainder of the fibrous adenoma that MPSIS is not able to extirpate. The weight of the handpiece is reduced to 90 g. The needle type M probe has a 171-mm length, a 1.9-mm tip diameter, and a 3.3-mm sheath diameter and produces a tip amplitude of 70 μm. We performed direct transnasal reoperation using MPSIS and OUSA in 4 patients with fibrous nonfunctioning pituitary adenomas. Results : We could fairly reduce the mass in fibrous nonfunctioning adenomas with MPSIS and OUSA. Visual field defects were improved. There was no surgical morbidity of mortality. Conclusion : MPSIS combined with OUSA seems to be useful for the removal of fibrous pituitary adenomas in direct transnasal reoperation.
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  • Genichiro Ohhashi, Masami Kamio, Toshiaki Abe, Nobuyoshi Otori, Shinic ...
    Type: Article
    2001 Volume 10 Issue 5 Pages 326-329
    Published: May 20, 2001
    Released: June 02, 2017
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    Recently there has been an increase in the use of endoscopic transnasal surgery to treat pituitary lesions. It is a minimally invasive technique that enables the surgeon to directly any observe the residual tumor on the lateral and superior walls of the sella, which could not otherwise be viewed using a conventional operative microscope. However, for surgeons who are familiar with performing the usual transsphenoidal approach, it may be difficult to confirm the positional relationship within the surgical field utilizing the transnasal approach. We have performed the endoscopic transnasal surgery on 44 patients and the InstaTrak^<TM> navigation system was used to confirm the positional relationship within the surgical fields in 31 of these cases. We believe that the endoscopic surgery will be the main mode of surgery for the treatment of pituitary lesions in the future. The use of a navigation system will be especially effective in cases in which the structure of the paranasal sinus is complicated or damaged from repeated surgery.
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  • Kenji Sugiyama, Tetsuo Yokoyama, Hiroshi Ryu, Hiroki Namba
    Type: Article
    2001 Volume 10 Issue 5 Pages 330-338
    Published: May 20, 2001
    Released: June 02, 2017
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    Intraoperative monitoring methods of the lower cranial nerves (from the VII th nerve to the XII th nerve) were reviewed. All of the lower cranial nerves except the VIII th cranial nerve could be monitored intraoperatively using evoked muscle responses. It was essential to use low amplitude monopolar stimulation (less than 0.6mA) for obtaining adequate intraoperative evoked facial muscle response (EFMR). Postoperative facial function was correlated to the FEMR amplitude obtained with stimulation at most proximal sites of the facial nerve in the cerebello-pontine (CP) cistern after removal of the CP angle tumors. When the amplitude was more than 99 microvolts, the patient's facial functions was preserved. Auditory brainstem responses (ABR) were used for intraoperative cochlear nerve monitoring during microvascular decompression surgery for the VII th cranial nerve. As criteria for warning the surgeon, we adopted such changes as the disappearance or marked decrease in amplitude of the wave V. Cochlear nerve compound action potentials (CNAP) were also used for cochlear intraoperative monitoring. Cochlear nerves within the cisternal portion of the VIII th cranial nerve could be identified using CNAPs. CNAP had another advantage when cochlear function remained but could not be monitored by ABR in a case of CP angle tumor. The IX th and the X th cranial nerve functions could be monitored using evoked pharyngeal muscle response (EPMR). More studies are required to determine the precise relationship between EPMR and the IX th and the X th cranial nerve functions. Intraoperative lower cranial nerve monitorings has become am essential method to achieve greater safety and more successful outcomes in posterior fossa surgery.
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  • Fumitaka Matsuda, Akira Sugie, Hiroshi Kajikawa, Kunio Yamamura, Osamu ...
    Type: Article
    2001 Volume 10 Issue 5 Pages 339-342
    Published: May 20, 2001
    Released: June 02, 2017
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    A case of a large traumatic pseudoaneurysm of the superficial temporal artery is reported. An 80-year-old female was hit by a car and suffered a large subcutaneous hematoma of the right parietotemporal region as well as a right frontal acute epidural hematoma. Although the epidural hematoma had resolved spontaneously, over the next 3 months, the subcutaneous hematoma gradually grew in size and became pulsatile. Neuroradiological studies revealed a large aneurysm of the superficial temporal artery, which was successfully removed at surgery. The pathological specimen showed a pseudoaneurysm. Previous reports on the traumatic aneurysms of the scalp are reviewed briefly, with regard to their etiology, diagnosis and management.
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  • Setsuko Nakagawa, Makoto Tomokiyo, Yoshihiko Furukawa, Shoko Shimokawa ...
    Type: Article
    2001 Volume 10 Issue 5 Pages 343-347
    Published: May 20, 2001
    Released: June 02, 2017
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    We report 5 cases of traumatic intracerebellar hematoma. Four cases underwent posterior fossa decompression and evacuation of the hematoma. One patient with diffuse subarachnoid hemorrhage died, but the remaining 3 patients recovered. The site of impact was the occipital region in all 4 cases. Occipital bone fracture was seen in 4 cases, and dural laceration was also seen in 3 cases. A crushing blow to the occiput might cause traumatic intracerebellar hematoma. When encountering a severely injured patient with an occipital bruise and/or occipital bone fracture on X-ray, the possibility of posterior fossa hematoma should be considered. One patient with a small hematoma in the cerebellar hemisphere was treated conservatively and recovered without any deficits. In this case, different mechanisms from other cases in the development of cerebellar hematoma due to blunt trauma are suggested. We review reported cases of traumatic intracerebellar hematoma and discuss the clinical features and mechanisms in the development of hematoma in this lesion.
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  • Momoko Kataoka, Hiroyuki Asada, Yasuhiro Kojima, Kin Kitamura
    Type: Article
    2001 Volume 10 Issue 5 Pages 348-352
    Published: May 20, 2001
    Released: June 02, 2017
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    A 40-year-old man was admitted to our institute with convulsions. Magnetic resonance imaging (MRI) on admission demonstrated a tumor mass in the right fronto-parietal region that showed as hypointense on the T1-weighted images and hyperintense on the T2-weighted images, without enhancement by gadolinium-diethylene-triaminepenta-acetic acid (Gd-DTPA). Serial MRI showed localized enhancement in the posterior rim of the tumor 1 month later, which subsequentry disappeared a month later. Subtle enhancement in the deep posterior portion of the tumor appeared 3 months later, which again vanished 1 month later. His convulsions subsequently occurred more frequently, and he developed left hemiparesis. Therefore, a biopsy of the mass was performed through a craniotomy 10 months after admission. MRI just before the operation showed enhancement in the lateral rim of the tumor. The histological diagnosis was anaplastic astrocytoma according to the World Health Organization Classification. This case of repeated appearance and disappearance of enhancement on MRI is unique.
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  • Masaru Ohta, Iwao Takeshita, Kenichi Matsumoto
    Type: Article
    2001 Volume 10 Issue 5 Pages 353-357
    Published: May 20, 2001
    Released: June 02, 2017
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    We present a 58-year-old woman with left optic disc edema and diplopia caused by spontaneous intracranial hypotension (SIH) accompanied by bilateral chronic subdural hematoma (CSH). She had an operation for the CSH because of increasing size of the hematoma. Brain magnetic resonance (MR) imaging showed no characteristic abnormalities of SIH 1 week after onset but MR imaging 1 month after onset showed a pachymeningeal enhancement and downward brain displacement. We considered hypothesis of the occurrence of the optic disc edema and diplopia. We believe that the CSH continued to add more etiologic factors such as the failure of the axonal flow to the injured optic and abducent nerves in the state of SIH. We should be born in mind that SIH may manifest with unpredictable symptoms such as suddenly suffered severe headaches, convulsions, consciousness disturbances, or cranial nerve impairments.
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 357-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Hiromu Hokaku, Goro Nagashima, Ryuta Suzuki, Jun-ichiro Asai, Tsukasa ...
    Type: Article
    2001 Volume 10 Issue 5 Pages 358-363
    Published: May 20, 2001
    Released: June 02, 2017
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    Clear cell meningioma is one of a variant of meningiomas, which sometimes shows clinical aggressiveness and high proliferative activity. At the present time, its detailed clinical nature and histological characteristics are still unknown. We report a case of sphenoidal ridge clear cell meningioma, and present results of immunohistochemical analysis of the tumor sample in regard to its growth regulation. MIB-1 SI (staining indices) were high ranging from 7 to 10% in meningothelial portion to 3 to 4% in clear cell portion. Graphic analyses, used to determine the proportion of clear cells versus meningothelial cells and the distribution of MIB-1 positive cells, showed striking differences in proliferative activity between meningothelial portion and clear cell portion. Moreover, additional immunohistochemical studies revealed that clear cells specifically expressed HAM (antibody against CD-68), TGF-α and progesteron receptor (PgR). These results suggest that the clinical aggressiveness of clear cell meningioma may be controlled by meningothelial, but not clear cells, and that clear cells may possess several growth factors such as TGF-α, and contribute to the growth of meningothelial cells.
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  • [in Japanese]
    Type: Article
    2001 Volume 10 Issue 5 Pages 364-365
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 366-367
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 367-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 368-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 369-370
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 371-372
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 373-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Appendix
    2001 Volume 10 Issue 5 Pages 374-
    Published: May 20, 2001
    Released: June 02, 2017
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  • Type: Cover
    2001 Volume 10 Issue 5 Pages Cover23-
    Published: May 20, 2001
    Released: June 02, 2017
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