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Article type: Cover
2006 Volume 15 Issue 5 Pages
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Article type: Cover
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Etsuro Mori
Article type: Article
2006 Volume 15 Issue 5 Pages
381-383
Published: May 20, 2006
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In this article, conditions to justify preventive neurosurgical measures were discussed in terms of safety, efficacy, effectiveness, efficiency, and outcome/informed consent.
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Yoshihiro Muragaki, Takashi Maruyama, Ryoichi Nakamura, Hiroshi Iseki, ...
Article type: Article
2006 Volume 15 Issue 5 Pages
384-395
Published: May 20, 2006
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The relationship between radical resection of glioma and patient outcomes has been controversial, partly because of selection bias, publication bias, and methodological flaws, particularly in regard to the estimation of the glioma removal rate. A recent study used volumetric analysis of removal rate to demonstrate that radical removal resulting in better patient outcomes. However, new removal strategies to maximize removal rate and minimize complication rates are needed to further improve outcomes. The goal of the present study was to develop an algorithm for "information-guided surgery", in which surgeons rely on objective information rather than subjective experience to determine whether glioma removal is feasible. An operating system (intelligent operating theater) was developed that detects anatomical, functional, and histological information obtained by intraoperative magnetic resonance images/navigation, mapping/monitoring data, and data from frozen section, evaluate the validity of the data, and subsequently integrates the data with update navigation. The present study focused on the benefits and drawbacks of functional information and introduces illustrative cases of information-guided surgery.
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Mitsuhiro Hasegawa, Mitsutoshi Nakada, Naoyuki Uchiyama, Hironori Fuji ...
Article type: Article
2006 Volume 15 Issue 5 Pages
396-402
Published: May 20, 2006
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Advances in skull base surgical techniques and radiosurgery have led to significant improvements in the treatment of skull base meningioma. However, as the natural history and the biological behavior of skull base meningiomas are not well known, the selection of and timing for postoperative additional treatment are still controversial. Herein we discuss our experiences in the treatment of skull base meningiomas, the natural history together with a literature review, and the invasion-related factors, especially matrix metalloproteinases (MMPs), for use as a new biological marker for skull base meningiomas.
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Kiyoshi Saito, Tetsuya Nagatani, Jun Yoshida
Article type: Article
2006 Volume 15 Issue 5 Pages
403-407
Published: May 20, 2006
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We have treated 61 patients during the past 16 years. With a review of the literature, we present epidemiology, selection of treatments, surgical approaches, radiation, postoperative management, and treatment of recurrent tumors, and discuss the required standard treatments and outcomes. Craniopharyngioma usually requires surgical resection or resection with radiotherapy (either conventional radiation or radiosurgery). In the literature, 10-year recurrence free survival rates were 47〜81% after total resection and 56〜84% after incomplete resection with radiation. However, 10-year survival rates of incomplete resection with radiation (65〜72%) were worse than those of total resection (92〜98%). Although total resection isideal, complications included surgical mortality (1〜2.5%), diabetes insipidus (79〜93%), hypopituitarism (79〜89%), and deterioration of visual function (15〜38%). Various surgical approaches could be selected. A transsphenoidal approach is suitable for intrasellar tumors or tumors with enlarged sella. A pterional approach is selected for relatively small tumors. Large or retrochiasmatic tumors require an anterior interhemispheric approach. Postoperative management of both the hypothalamus and any pituitary dysfunction is one of the important factors behind a good outcome. Recurrent tumors need surgical resection (ideally complete resection) or radiation therapy.
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Sunao Takemura, Shinya Sato, Kaori Sakurada, Takamasa Kayama
Article type: Article
2006 Volume 15 Issue 5 Pages
408-414
Published: May 20, 2006
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The long-term outcome of the treatment of Rathke's cleft cysts is reviewed. Fifty-one consecutive patients with Rathke's cleft cysts were treated in our department since the advent of computed tomography, including 16 symptomatic cases and 35 asymptomatic cases diagnosed radiographically. The 16 symptomatic cases underwent partial resection of the cyst wall through a transsphenoidal approach along with aspiration of cystic contents; only 3 of these cysts recurred. Of these 3 recurring cases, 2 patients presented with symptomatic recurrence and were successfully treated with additional surgery and radiation therapy. No cystic enlargement was noted for the 35 asymptomatic patients over 44 months of follow-up. These results suggest that the choice of treatment for symptomatic cysts would be a combination of partial resection of the cyst wall and aspiration of the cystic contents, while patients with asymptomatic Rathke's cleft cysts should be followed with radiographic observation.
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Shoshi Satoh, Nobuhiro Moro, Yutaka Shigemori, Toshiki Obuchi, Tatsuro ...
Article type: Article
2006 Volume 15 Issue 5 Pages
415-419
Published: May 20, 2006
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Primary intraosseous cavernous hemangiomas of the orbit are rare tumors and the preoperative diagnosis is sometimes difficult. We report a case of an intraosseous cavernous hemangioma of the superolateral orbital rim, and the characteristic appearance on CT and MRI is described. A 61-year-old woman presented with a painless tumor on the frontal bone involving the right superolateral orbital rim. Bone window CT demonstrated a 2.5cm expansile, rounded, and well-marginated bony lesion with internal radiating trabeculations, forming a so-called sunburst pattern. The lesion was removed en bloc by the frontolateral approach. A brief epidemiological and radiological review of the literature is presented.
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Jin Momoji, Hiroshi Shimabukuro, Naoki Tomiyama
Article type: Article
2006 Volume 15 Issue 5 Pages
420-426
Published: May 20, 2006
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We reported a rare case of posttraumatic trigeminal-cavernous fistula. A 17-year-old man was involved a motorcycle accident and he was admitted in a comatose state to our emergency room, and then recieved a craniotomy and removal of acute epidural hematoma at the posterior fossa. After the operation, his condition but improved he had left facial palsy and a hearing disturbance due to a skull base fracture. As he complained of a tinnitus twenty days after the operation, he underwent a magnetic resonans angiogram (MRA), which suggested a carotid-cavernous fistula. A cerebral angiogram disclosed a persistent primitive trigeminal artery (PPTA) and fistula from the PPTA to the cavernous sinus (trigeminal-cavernous fistula). The cause of the fistula was thought to be a skull base fracture around the foramen lacerum. This lesion was successfully treated by coil embolization via transarterial route. We reviewed the reports of 8 traumatic TCP and 7 spontaneous TCF cases.
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
427-428
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
429-430
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Appendix
2006 Volume 15 Issue 5 Pages
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Article type: Cover
2006 Volume 15 Issue 5 Pages
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Published: May 20, 2006
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