Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 17 , Issue 6
Showing 1-24 articles out of 24 articles from the selected issue
  • Type: Cover
    2008 Volume 17 Issue 6 Pages Cover25-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Cover
    2008 Volume 17 Issue 6 Pages Cover26-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Index
    2008 Volume 17 Issue 6 Pages 427-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 428-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Yuichi Hirose, Kuniaki Ogasawara
    Type: Article
    2008 Volume 17 Issue 6 Pages 429-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Douglas Kondziolka, L. Dade Lunsford, John C. Flickinger
    Type: Article
    2008 Volume 17 Issue 6 Pages 430-439
    Published: June 20, 2008
    Released: June 02, 2017
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    The incorporation of stereotactic radiosurgery into neurosurgery represents a fundamental paradigm shift in our specialty. Intracranial radiosurgery has been the most developed model for a minimal access procedure that seeks to treat disease on a biologic rather than mechanical basis. Over the last 20 years at our center, over 8,000 patients had radiosurgery for disorders that included cerebrovascular malformations, benign and malignant intracranial tumors, and selected functional disorders. Approximately 600 to 700 procedures are performed annually. Metastatic tumors represent the fastest growing indication for radiosurgery. Neurosurgeons should be exposed to formal training in stereotactic radiosurgery, either within residency or practice if a new program is instituted. At our center, residents complete a four month educational experience, and for practicing physicians, we conduct six one-week immersion courses each year. Radiosurgery should be incorporated into residency training and general neurosurgical practice because it has important roles in the majority of intracranial disorders managed by neurosurgeons. We discuss the indications, techniques, and expectations of stereotactic radiosurgery for brain disorders, either as primary or adjuvant management.
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  • Azusa Hasegawa, Jun-Etsu Mizoe, Hirohiko Tsujii
    Type: Article
    2008 Volume 17 Issue 6 Pages 440-448
    Published: June 20, 2008
    Released: June 02, 2017
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    Purpose: To report the preliminary results of phase I / II clinical trials for patients with skull base and paracervical tumors and central nervous system (CNS) tumors, treated with carbon ion radiotherapy. Materials and Methods: In carbon ion radiotherapy for skull base and paracervical tumors, dose escalation trials were performed up to the fourth-stage dose level: 48.0GyE (n = 4), 52.8GyE (n = 6), 57.6GyE (n = 9) and 60.8GyE (n = 9). Diffuse astrocytomas (Grade II) were treated with carbon ion radiotherapy alone. Carbon ion dose was escalated to the second stage - 50.4GyE (n = 9), and 55.2GyE (n = 5). For malignant gliomas, carbon ion radiotherapy was administered after x-ray therapy (50 Gy/25 fractions/5 weeks) by way of dose escalation up to the fifth stage (16.8, 18.4, 20.0, 22.4, and 24.8GyE). Results: Acute and late reactions were of a minor nature in all clinical trials. Carbon ion radiotherapy can therefore be described as presenting no clinical problems. Five-year local control rate by prescribed tumor dose of skull base and paracervical tumors was 75% for 48GyE, 67% for 52.8GyE, 78% for 57.6GyE, and 88% for 60.8GyE. Five-year overall survival rate of skull base and paracervical tumors was 50% for 48GyE, 100% for 52.8GyE, 100% for 57.6GyE, and 74% for 60.8GyE. Five-year progression free survival (PFS) rates of diffuse astrocytomas were 11% for the 50.4GyE group and 80% for the 55.2GyE group. Five-year overall survival rates were 22% for the 50.4GyE and 80% for the 55.2GyE. The 16 anaplastic astrocytoma (AA) patients had a median PFS time of 18 months and the 32 glioblastoma (GB) patients had a median PFS time of 7 months. The median survival time was 35 months for AA and 17 months for GB. These findings indicate that the survival rate tends to improve with higher carbon ion dose, and can be taken as evidence for the effectiveness of carbon ion radiotherapy for the treated diseases. Conclusion: The therapeutic effectiveness of carbon ion radiotherapy was particularly outstanding for CNS tumors and skull base and paracervical tumors, tumors that are intractable to photon radiotherapy. In view of these findings, it was decided to precede to the next phase I / II clinical trial a stage, for malignant gliomas stage consisting of carbon ion radiotherapy alone from April 2002. The phase I / II clinical trial for skull base and paracervical tumors was concluded in February 2004, and in April 2004 a phase II clinical trial was initiated under the Highly Advanced Medical Technology scheme with an irradiation schedule of 60.8GyE/16 fractions/4 weeks.
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  • Takayuki Matsuo, Yukishige Hayashi, Tomohito Hirao, Kenta Ujihuku, Izu ...
    Type: Article
    2008 Volume 17 Issue 6 Pages 449-454
    Published: June 20, 2008
    Released: June 02, 2017
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    Field-shaping technology and linac micro-multileaf collimator (MMLC) integration have contributed to the advance of Linac based radiosurgery. In many cases, the dose to surrounding structures can be reduced with a conformal static or dynamic arc approach as compared to conventional multiple isocenter and circular arc techniques. Thus, in Linac based radiosurgery, a fractionation technique is now available for selective cases. We reviewed the long-term results of conventional linac based radiosurgeries which were performed in our institute. The problems with conventional linac based radiosugery and future prospects were discussed.
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  • Keisuke Maruyama, Tomoyuki Koga, Masahiro Shin, Nobuhito Saito
    Type: Article
    2008 Volume 17 Issue 6 Pages 455-460
    Published: June 20, 2008
    Released: June 02, 2017
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    The primary role of Gamma knife radiosurgery is to control small, benign or metastatic brain tumors while pre-serving critical neuronal functions. Controlling functional disorders is another role of Gamma knife radiosurgery. It can provide high-quality radiosurgery as it is based on 40-years of treatment history and it has a high level of maneuverability. On the other hand, the limitations of Gamma knife radiosurgery include a difficulty to control large lesions or malignant tumors, a relatively slow treatment effect, a risk of radiation injury to the optic nerve, and a limit of treat-able range. Extra long-term results of more than 20 years also have to be clarified in the future.
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  • Hidefumi Jokura
    Type: Article
    2008 Volume 17 Issue 6 Pages 461-471
    Published: June 20, 2008
    Released: June 02, 2017
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    Knowledge about complications that may happen after radiosurgery is important for appropriate decision making during the follow-up period. In this paper, we present our experiences with the occurrence of hydrocephalus and formation of some types of cysts after radiosurgery and discuss management policy of these conditions. Unlike open surgical procedures, serious complications seldom happen during the procedure itself in radiosurgery, but may instead manifest themselves long after the procedure has been completed. Among them, radiation optic neuropathy and radiation induced malignant tumors or the malignant progression of benign tumors are very rare but serious and life-threatening complications. The incidences and risks of such complications are evaluated.
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  • Hiroshi Nakagawa
    Type: Article
    2008 Volume 17 Issue 6 Pages 472-474
    Published: June 20, 2008
    Released: June 02, 2017
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  • Hajime Touho, Nobuko Yanagawa, Toshihiko Kuroiwa
    Type: Article
    2008 Volume 17 Issue 6 Pages 475-478
    Published: June 20, 2008
    Released: June 02, 2017
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    Skin necrosis sometimes occurs along a scalp artery prepared for the treatment of childhood moyamoya disease. In the present study, the subcutaneous injection of physiological saline along the scalp artery was introduced to prevent the necrosis. From January 7, 2007 to October 20, 2007, twenty-two children with moyamoya disease were operated on 29 times in total. About 10 ml of physiological saline was injected along the scalp artery in the skin flap to elevate it from the outer layer of the skin before preparing in for transplant, in the all patients except a 7-year-old girl whose skin was relatively thick. There was no necrosis in the skin flaps in the former. However, skin necrosis over the prepared scalp artery occurred in the latter. The present method is simple and thought to be clinically useful for preventing of skin necrosis along scalp arteries prior to harvesting.
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  • Ryonoshin Hirooka, Takashi Inoue, Masakazu Kobayashi, Taku Okuguchi, T ...
    Type: Article
    2008 Volume 17 Issue 6 Pages 479-483
    Published: June 20, 2008
    Released: June 02, 2017
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    A 52-year-old man suffered a transient ischemic attack with left hemiparesis. Cerebral angiography demonstrated moyamoya disease and no evidence of a right middle cerebral artery aneurysm. The patient underwent a right superficial temporal artery-middle cerebral artery anastomosis. Intraoperatively, a collapsed unruptured aneurysm was noted in the M1-M2 bifurcation of the right middle cerebral artery and was clipped. The present aneurysm was located distal to the stenotic carotid fork caused by the moyamoya disease. These findings suggested that the aneurysm developed prior to the development of the moyamoya disease.
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  • Shunsuke Ishizaka, Ichiro Kawahara, Nobuhiro Yagi, Yoshiharu Tokunaga, ...
    Type: Article
    2008 Volume 17 Issue 6 Pages 484-488
    Published: June 20, 2008
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Fungal infections, which generally occur in immunocompromised patients, are increasing in prevalence secondary to the widespread use of immunosuppressant or steroid therapies. Although a breakdown in the focus of an old infection in the lung or paranasal sinus is a common source of the organism, fungal infections sometimes manifest as an invasive form. Particularly, in patients in whom the central nervous system is involved, the prognosis is very poor. The author describes a rare case of internal carotid artery occlusion caused by invasive fungal paranasal sinusitis. The patient was received a long-term steroid therapy for intractable Vogt-Koyanagi-Harada syndrome. On magnetic resonance imaging (MRI), a mass lesion was seen in right orbital apex, ethmoid sinus, and sphenoid sinus. On angiography, the right internal carotid artery (supraclinoid portion) revealed severe stenosis and the ophthalmic artery was occluded, and the internal carotid artery was also found to be occluded on follow-up magnetic resonance angiography (MRA). Endoscopic biopsy of the sphenoid sinus was performed and demonstrated Aspergillus hyphae. With aggressive antifungal treatments and irrigation of the paranasal sinus, the patient had a good course of recovery without any recurrence as shown on MRI. Early detection and treatment of these disorders is very important because invasive fungal paranasal sinusitis has a high mortality rate. We should consider the possibility of fungal infections in immunocompromised patients.
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  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 489-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 490-
    Published: June 20, 2008
    Released: June 02, 2017
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    Download PDF (74K)
  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 490-
    Published: June 20, 2008
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (74K)
  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 490-
    Published: June 20, 2008
    Released: June 02, 2017
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    Download PDF (74K)
  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 491-492
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 493-499
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 500-
    Published: June 20, 2008
    Released: June 02, 2017
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  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 501-
    Published: June 20, 2008
    Released: June 02, 2017
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    Download PDF (115K)
  • Type: Appendix
    2008 Volume 17 Issue 6 Pages 501-
    Published: June 20, 2008
    Released: June 02, 2017
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    Download PDF (115K)
  • Type: Cover
    2008 Volume 17 Issue 6 Pages Cover27-
    Published: June 20, 2008
    Released: June 02, 2017
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