Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 14, Issue 5
Displaying 1-24 of 24 articles from this issue
  • Article type: Cover
    2005 Volume 14 Issue 5 Pages Cover20-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Cover
    2005 Volume 14 Issue 5 Pages Cover21-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
    JOURNAL FREE ACCESS
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  • Article type: Index
    2005 Volume 14 Issue 5 Pages Toc3-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages App35-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Takamitsu Yamamoto, Yoichi Katayama
    Article type: Article
    2005 Volume 14 Issue 5 Pages 295-301
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    In our experience, placing a 15-mm diameter burr-hole at a position 35 mm anterior to the bregma with head up at under 30 degrees from the horizontal plane of the ground is useful for reducing leakage of cerebrospinal fluid and air influx into the subdural space during stereotactic operations, and for protecting against brain shift. Furthermore, such an anterior location for the burr-hole is necessary in order to insert the DBS electrode at an angle of about 45 degrees from the horizontal plane of the AC-PC line, to pass through not only the subthalamic nucleus (STN) but also Forel H2. This makes it possible for the STN, zona incerta, and Forel H2 to be stimulated together. A new dual-floor burr-hole technique for use in deep brain stimulation therapy has also been developed by us. The thalamic Vim/Vop nucleus, globus pallidus interna (GPi), and subthalamic nucleus (STN) are selected as stimulation points for the treatment of Parkinson's disease. In the present paper, we mainly introduce our method and results for STN stimulation in the treatment of advanced Parkinson's disease.
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  • Isao Date
    Article type: Article
    2005 Volume 14 Issue 5 Pages 302-309
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    It has long been considered that central nervous system would not regenerate after injury, but this concept has recently been changing due to the development of neuroscience research. Cell grafting, gene transfer and neurotrophic factor administration into the brain and spinal cord are the examples of methods to perform protection and repair. These techniques are expected to be applied to certain neurological disorders such as Parkinson's disease, cerebral ischemia and spinal cord injury. Parkinson's disease is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the nigrostriatal system. Fetal neurons, chromaffin cells, cell lines, certain genes, neural stem cells, ES cells and bone marrow cells have been investigated as donor cells and vectors to treat Parkinson's disease. This review will summarize the history of neural transplantation in Parkinson's disease and features and prospects of each donor will be discussed.
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 309-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Ryuji Kaji
    Article type: Article
    2005 Volume 14 Issue 5 Pages 310-315
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    Involuntary movements result from disturbed feedback control in several loops in the brain and spinal cord. Among them, the motor loop controls motor output by adjusting the sensory input relevant to the task intended. Parkinson's disease is caused by abnormal scaling, and dystonia being related to abnormal sensorimotor matching in motor control.
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  • Takaomi Taira, Tomokatsu Hori
    Article type: Article
    2005 Volume 14 Issue 5 Pages 316-322
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    Background : Writer's cramp is NOT a mental disorder but a type of focal dystonia due to dysfunction of the pallido-thalamo-cortical circuit. Not only writing but other tasks such as playing musical instruments and using chopsticks may induce dystonic contractions of the hand. Therefore, it may be called task-specific focal hand dystonia. The symptom is refractory to most conservative treatment, though botulinum toxin injection is generally used for symptomatic relief. As a neurosurgical treatment of dystonia, we have performed stereotactic nucleus ventro-oralis (Vo) thalamotomy for dystonic cramp of the hand. Methods : Twenty-two patients (15 men, 7 women; age 22-57 years, mean 32.1 years) with medically intractable task-specific focal dystonia of the hand underwent Vo thalamotomy. The stereotactic target was chosen at the junction of the anterior and posterior Vo nuclei. The procedure was performed with MRI/CT fusion stereotaxis under complete local anesthesia. Results : The duration of the symptom ranged from 3 to 6 years (mean 4.5 years). All patients had complained of difficulty in writing. Ten patients were professionals, such as a comic artist, guitarist and barber, and, because of the dystonic symptoms occurring during their work, they had stopped pursuing their profession. All but one patients showed significant improvement of dystonic symptoms immediately after the operation. The effect sustained during the follow-up period (1-44 months, mean 13.1 months), except in three cases. The three patients showed partial recurrence of the symptom and underwent second thalamotomy 5-6 months after the initial surgery. There was no mortality or permanent morbidity. Conclusion : With modern stereotactic method, Vo thalamotomy is a useful and safe therapeutic option for writer's cramp. The ventro-oralis nucleus receiving the pallidal input is considered to be a key structure in task-specific focal hand dystonia.
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  • Ryuzo Shiobara, Takayuki Ohira, Satoshi Onozuka, Takeshi Kawase
    Article type: Article
    2005 Volume 14 Issue 5 Pages 323-330
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    Safety and practical use of the irrigation fluids used for neurosurgical patients in 8 hospitals were investigated by a questionary study. For the patients who underwent neuroendoscopic surgery (neuroendoscopic surgery group), an artificial cerebrospinal fluid or lactated Ringer's solution was used, and for the patients receiving cisternal irrigation therapy (cisternal irrigation group), an artificial cerebrospinal fluid was used. For the remaining neurosurgical patients (rinse group) who were not included either in the above two groups, an ordinary saline solution, lactated Ringer's solution, or artificial cerebrospinal fluid was used. In the rinse group, no adverse reactions (AR) were observed. In the neuroendoscopic surgery group, ARs (ex : fever, nausea, vomiting) were observed 6 times in total in the 3 patients administered lactated Ringer's solution; however, no ARs were found in the patients administered the artificial cerebrospinal fluid. In the cisternal irrigation group, ARs (ex : elevated AST, nausea, vomiting) were observed 15 times in total in 7 patients. In this group, the possibility of the relations between the ARs and the artificial cerebrospinal fluid was not excluded; however, the underlying diseases or the cisternal irrigation therapy might be the causes of ARs. In conclusion, the artificial cerebrospinal fluid, which is most similar to the cerebrospinal fluid regarding electrolyte concentrations, pH, and osmotic pressure, was thought to be the most physiological and safe irrigation fluid without bad effects on the patients.
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  • Goro Nagashima, Ryuta Suzuki, Tsukasa Fujimoto, Kazuhisa Ugajin, Setsu ...
    Article type: Article
    2005 Volume 14 Issue 5 Pages 331-335
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    Appropriate use of antimicrobials is strongly recommended in many fields, to prevent antimicrobial resistant strains. In the surgical field, it becomes important to reduce SSI (surgical site infection), from the view point of infection control, and also from the view point of a DRG-directed medical system. In this study, we focused on post-operative meningitis as neurosurgical SSI, and investigated the type of detected strains, antimicrobial susceptibility results, and treatment against the meningitis. In 39 cases of meningitis treated at our hospital between January 2001 and April 2004, 19 cases were meningitis occurring after neurosurgical interventions. Over 70% of these postoperative meningitis cases were caused by multi-drug resistant Staphylococcus strains such as coagulase-negative Staphylococcus (CNS) and methicillin-resistant Staphylococcus aureus (MRSA), and susceptibility test revealed that more than 40% of the CNS strains detected in the neurosurgical department were gentamycin (GM) registant strains. Contrary to this, from the susceptibility test against CNS detected in other departments, the rate of resistant strains was much lower than that found in the neurosurgical department. Infectious complications also become more important in neurosurgical field, and post-operative meningitis as SSI was caused mainly by low-toxic multidrug resistant strains such as CNS and MRSA. Lack of blood brain barrier (BBB) disruption in such cases indicates the difficulty of treating them only by intravenous administration of antimicrobials. Taken together, intrathecal vancomycin (VCM) administration must be considered as first choice treatment against post-operative meningitis in neurosurgical fields, and a Japanese guideline must be developed for the treatment against post-operative infectious complications such as meningitis.
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  • Yoshiyasu Iwai, Masaki Yoshimura, Kazuhiro Yamanaka, Yuji Honda, Yasuh ...
    Article type: Article
    2005 Volume 14 Issue 5 Pages 336-340
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    The surgical approach for olfactory groove meningiomas is usually bifrontal craniotomy. We operated using the pterional approach and present our findings about the usefulness of this approach for the treatment of these tumors. We operated on three consecutive patients between January 2002 and October 2003 using the pterional approach. The maximum tumor diameter was mean 58 mm (41 to 80 mm). The clinical presentations were mental dysfunction in two patients, epilepsy, visual impairment and motor disturbance in one patient and minor manifestation in one patient. In one patient the tumor was removed totally and in the other patients they were removed subtotally. There was no mortality. Transient memory disturbance occurred in one patient postoperatively. The advantage of this approach is that it enables early identification of the optic nerve and of the posterior vascular complex situated behind the tumors. We propose the pterional approach as a useful approach for olfactory groove meningiomas.
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  • Keisuke Tsutsumi, Tsutomu Yoshioka, Takeshi Hiu, Yoshitaka Matsuo, Hir ...
    Article type: Article
    2005 Volume 14 Issue 5 Pages 341-346
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    We report a rare case of a peritumoral cyst that appeared with a recurrent meningioma after subtotal resection. A 62-year-old man presented with a total aphasia and right hemiparesis. He had undergone a subtotal removal of a left sphenoid ridge meningioma when he was 49 years old. Nine years after his initial operation, a peritumoral cyst emerged from the surrounding brain with perifocal edema, and gradually enlarged with the growing residual tumor. The cyst subsequently became symptomatic. He and his family refused aggressive surgical treatment, and selected the therapeutic option of cyst-aspiration through an Ommaya reservoir system placed under the scalp. As a result, progression of the cyst was arrested, and his symptoms completely disappeared. Four years later, the cyst grew again immediately after head trauma. However, it was successfully treated using the same procedure. We discuss the possible mechanism of this rare event during the clinical course. The present findings strongly suggest that long-standing brain edema plays a significant role in the underlying mechanism of formation of peritumoral cysts associated with meningiomas.
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  • Yuji Hashimoto, Sonen Kin, Koichi Haraguchi, Jun Niwa
    Article type: Article
    2005 Volume 14 Issue 5 Pages 347-351
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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    Common carotid artery (CCA) occlusion is a rare form of ischemic cerebrovascular disease. The authors report two symptomatic cases of CCA occlusion, describing one patient in the acute phase and another in the chronic phase. The first patient, a 63-year-old female with a two-month history of right side visual disturbance came to our hospital for investigation. MRI demonstrated multiple cerebral infarctions in the right subcortical white matter. Angiography confirmed nearly occlusion of the right CCA at its bifurcation and filling of the external carotid artery (ECA) via collaterals from the occipital artery. Single photon emission computed tomography showed hemodynamic cerebral ischemia in the affected cerebral hemisphere. Seventy-three days after the first examination, the patient performed CCA to the middle cerebral artery (MCA) radial artery bypass without new neurological complications. The patient recovered normal vision of right eye after surgery. The second patient, a 42-year-old female was admitted to our hospital with motor-dominant aphasia and mild right hemiparesis. MRI did not demonstrate lesions causing these neurological deficits. Angiography confirmed occlusion of the left CCA at its origin, which had been normal three years before onset, and filling of ECA and internal carotid artery from an occipitovertebral anastomosis. The patient was not indicated for revascularization therapy in the acute period and medical therapy was administered. However, her symptoms gradually progressed and infarction extended almost to the MCA territory. Surgical treatment for chronic CCA occlusion is a prophylactic method for cerebral infarction and the procedures are decided based on the occluded position of CCA and patent arteries. However, it is difficult to perform surgery in acute CCA occlusion because of the limited therapeutic window and invasiveness of surgery.
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 352-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 352-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 353-354
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 355-356
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages App36-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages App37-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 359-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 359-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Appendix
    2005 Volume 14 Issue 5 Pages 360-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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  • Article type: Cover
    2005 Volume 14 Issue 5 Pages Cover22-
    Published: May 20, 2005
    Released on J-STAGE: June 02, 2017
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