Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 20 , Issue 3
Showing 1-29 articles out of 29 articles from the selected issue
  • Type: Cover
    2011 Volume 20 Issue 3 Pages Cover16-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Cover
    2011 Volume 20 Issue 3 Pages Cover17-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages App9-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 153-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 153-
    Published: March 20, 2011
    Released: June 02, 2017
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    Download PDF (66K)
  • Type: Appendix
    2011 Volume 20 Issue 3 Pages App10-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Nobuhito Saito, Yuichi Hirose
    Type: Article
    2011 Volume 20 Issue 3 Pages 155-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Hidefumi Jokura, Jun Kawagishi
    Type: Article
    2011 Volume 20 Issue 3 Pages 156-163
    Published: March 20, 2011
    Released: June 02, 2017
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    More than forty years has passed since the Gamma Knife was first introduced to the field of neurosurgery. Since then, numerous papers have been published and wealth of procedural evidence has been accumulated. For skull base benign tumors including meningiomas, pituitary adenomas and vestibular schwannomas, steady and long lasting tumor control with few complications can be achieved by Gamma Knife and it has also established an important role for newly diagnosed and residual tumors after surgical decompression. The evolution in Gamma Knife technology, dose planning systems and imaging continues to improve the quality of treatment and there is still room for further improvement of the results. Skull base tumors touching short segments of the optic nerves and optic chiasm can be treated safely by single fraction Gamma Knife.
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  • Tomio Sasaki, Yojiro Akagi, Shinji Nagata, Koji Yoshimoto
    Type: Article
    2011 Volume 20 Issue 3 Pages 164-169
    Published: March 20, 2011
    Released: June 02, 2017
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    Clinoidal meningioma is one of the most challenging skull base tumors for neurosurgeons. When the tumor encases the internal carotid artery, middle cerebral artery, or the anterior cerebral artery and their perforators, total removal of the tumor is particularly difficult. Nevertheless, the achievement of total removal at the first operation is especially important, because adhesion of the tumor to important vessels and nerves becomes more severe when it recurs. In this article, the authors describe some surgical techniques to achieve total removal with preservation of the encased arteries. At the initial stage of the surgery, devascularization of the tumor is performed to reduce the blood loss. Thereafter, we start debulking the tumor and dissecting the encased arteries. In order to dissect the arteries encased by the tumor safely, the following techniques are recommended: 1) split the tumor above the encased arteries and the perforators, 2) dissect the divided tumors from the arteries one by one, 3) cut the intervening fibers around the perforators after aspiration of the soft components of the tumor. When numerous draining veins are observed around the large tumor in angiography, those veins can be observed as red veins in the operation. It is important to find out the correct part of the vein to cut without damaging the venous drainage of the normal surrounding brain. And also, more attention should be paid in these cases to achieve complete hemostasis during the tumor removal.
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  • Kiyoshi Saito, Eiji Ito, Taku Sato, Masahiro Ichikawa, Tadashi Watanab ...
    Type: Article
    2011 Volume 20 Issue 3 Pages 170-176
    Published: March 20, 2011
    Released: June 02, 2017
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    Recently, various radiation therapies, such as stereotactic radiosurgery, fractionated stereotactic radiotherapy, intensity-modulated radiation therapy, and proton-beam radiation, are available for treating skull base meningiomas. The role of skull base surgery for cavernous sinus and/or petroclival meningiomas is a maximal resection of the tumor while preserving the neurological functions since we can expect better growth control for the smaller remnant tumor. To reduce the volume of the remnant tumor, we should resect cavernous sinus meningiomas until the meningeal layer of the lateral cavernous wall. If the tumor can be dissected from the trigeminal nerve, any tumor in the Meckel's cave should be removed. Functioning cranial nerves and vessels must be preserved. If the tumor cannot be dissected from the neurovascular structures, the neurovascular structures should be preserved by leaving the tumor around them. When preoperative images show a pial blood supply or severe brainstem edema, the tumor should not be dissected from the brainstem. During surgical procedures, we should stop dissection if the motor evoked potential amplitude deteriorates or if the tumor involves the branches of or perforators from the basilar artery. On the other hand, tumor that extends into the extracranial space should be removed since the extracranial tumor usually shows aggressive invasion to the skull base bone, the muscles, nerves, or mucous membranes. It is important to clarify the strategy and the goal of tumor resection for individual patients
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  • Eiji Kohmura
    Type: Article
    2011 Volume 20 Issue 3 Pages 177-182
    Published: March 20, 2011
    Released: June 02, 2017
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    Many patients with vestibular schwannomas are now treated by radiosurgery owing to its less invasivenature and good functional preservation. Tumor control rate is reported to be about 90% or over. However, we should consider the natural course of the disease. Tumor control reported with radiosurgery might include the result of the tumor's natural course. It should be carefully evaluated. In the era of radiosurgery, microsurgery should be refined to obtain comparable or superior results to natural course and radiosuregry. In this paper, some problems related to radiosurgery and advances in microsurgery are discussed.
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  • Kazunari Yoshida
    Type: Article
    2011 Volume 20 Issue 3 Pages 183-189
    Published: March 20, 2011
    Released: June 02, 2017
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    Recent advances in skull base surgery and insight to the membranous structures surrounding the trigeminal nerve have contributed to the safe and complete removal of the trigeminal schwannomas. We have proposed a MPE classification for the trigeminal schwannomas according to their origin and extension patterns. Types M, P, and E are tumors involving a single compartment, that is, the middle fossa, posterior fossa, or extracranial space, respectively. Types MP (middle and posterior fossae), ME (middle fossa and extracranial space), or MPE (middle and posterior fossae and extracranial space) are tumors involving multiple compartments. The surgical strategy for these various trigeminal schwannomas based on the analysis of their developmental patterns is described.
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  • Nancy McLaughlin, Daniel M. Prevedello, Daniel F. Kelly, Ricardo L. Ca ...
    Type: Article
    2011 Volume 20 Issue 3 Pages 190-199
    Published: March 20, 2011
    Released: June 02, 2017
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    Excessive morbidity related to extensive skull base approaches is unfortunately still widely encountered around the world. There is a global tendency for less aggressive approaches in order to minimize surgical morbidity in skull base surgery. The main concern associated with this trend is related to the ability of maintaining surgical effectiveness and respecting oncological principles while trying to reduce tissue exposure, manipulation and disruption. Endoscopic endonasal surgery has enabled surgeons to reach skull base lesions beyond the sella turcica avoiding facial incisions and craniotomies. The expanded endonasal approaches (EEA) safely provide access along the sagittal and coronal plane to the anterior, middle and posterior cranial fossa with minimal neural tissue manipulation. Skull base surgeons should be able to recognize when a transcranial, endonasal, or a combination of such approaches is best suited for a specific patient. A multicorridor 360 degree strategy is favored to treat skull base lesions, in which the most direct and least destructive route or routes are chosen in order to facilitate the most complete resection with less morbidity possible. This manuscript details the foundations of the 360-degree concept and provides an overview of the most commonly used transcranial approaches and endonasal approaches that similarly enable to reach the anterior, middle and posterior fossa.
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  • Hidekazu Tanaka, Masahiro Kawanishi, Masatsugu Kamo, Kentaro Nishihara ...
    Type: Article
    2011 Volume 20 Issue 3 Pages 200-206
    Published: March 20, 2011
    Released: June 02, 2017
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    Objective: How to treat osteoporotic vertebral compression fractures with significant canal stenosis and neurologic compromise remains controversial. In this article, we present a less invasive method to treat such cases by performing vertebroplasty with polymethyl methacrylate (PMMA) and a decompression procedure at the same time without fusion. Clinical Materials and Methods: Seven patients (seven women) with a mean age of 74.0 years (age range, 59 to 85 years) were included in this study. All patients suffered severe back pain, compression-induced radicular deficits and gait disorder. The surgical treatment consisted of percutaneous transpedicular vertebroplasty with PMMA followed by microsurgical fenestration, and decompression of the spine. We evaluated back pain, JOA score, gait function and vertebral body height before and shortly after surgery. Results: The mean duration from the onset of symptoms to surgery was 5.3 months (range, 2-10 months). All patients showed pain relief. Mean JOA score significantly improved from 10.6 on admission to 20.3 at discharge. The average increase in vertebral body height 1 week after surgery was 4.5mm anteriorly, 4.6mm centrally, and 1.1mm posteriorly. Three nonambulatory patients became ambulatory following surgery, and three of four patients with neurogenic claudication had no postoperative limitations. Conclusion: This less invasive method could reduce back pain, increase vertebral body height and improve gait function at least in the short duration followed after surgery. This study is too small and the follow-up period is too short to substantiate this method. Although a larger series should be evaluated in the future, this approach may be possibly useful for vertebral compression fractures in elderly patients particularly those with high risk of instrument failure because of severe osteoporosis.
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  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 3 Pages 207-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Kazuhisa Yoshifuji, Satoko Ochi, Tomohiro Murakami, Takahisa Kaneko, I ...
    Type: Article
    2011 Volume 20 Issue 3 Pages 208-215
    Published: March 20, 2011
    Released: June 02, 2017
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    Introduction: The shape and structures surrounding lumbosacral spinal lipoma have a variety of morphologies, including neural tissues and the dural sac. In determining how best to manage lumbosacral spinal lipomas, it is necessary to compare the natural course of the disease and the outcomes associated with surgery (e.g., incomplete untethering, the risk of surgical complications and the remaining risk of retethering). In this study, we compared the morphological implications associated with the natural course and operative results in patients with lipoma. Methods: Thirty-four consecutive patients with spinal lipomas (20 cases of conus lipomas and 14 cases of filum lipomas), aged 0 months to 13 years, were studied retrospectively. We analyzed the association of 3 morphological features-protrusion of the spinal cord from the spinal canal, widespread adhesion between the spinal cord and lipoma, and abnormal exit of the nerve root from the dural sac-with preoperative symptoms and surgical outcomes. Results: Preoperative symptoms of conus lipomas were more significantly associated with the existence of any of the 3 morphological features (92%) than their absence (0%) (p<0.05). Surgical outcomes for conus lipomas, such as incomplete untethering, neurological complications, and remaining narrow subarachnoid space, were more significantly associated with the existence of any of the 3 morphological features (46%) than their absence (0%) (p<0.05). None of the 3 morphological features were observed in patients with filum lipomas. Preoperative MRI demonstrated spinal cord herniation and widespread adhesion of the lipoma in all of the patients with these morphologies but failed to demonstrate abnormal root exits in 50% of the patients. Conclusion: The morphological features of the spinal lipomas presented in this study may be important factors for predicting the difficulty of untethering surgery and the clinical course of conus lipomas.
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  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 3 Pages 216-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Yoshitaka Kurosaki, Kazumichi Yoshida, Tsuyoshi Ohta, Hiroki Toda, Tom ...
    Type: Article
    2011 Volume 20 Issue 3 Pages 217-221
    Published: March 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    The usefulness of the carotid Black-blood (BB) MRI to evaluate plaque vulnerability has been reported. However, 2D spin-echo sequence at 1.5 tesla MRI, high-resolution BB MRI, need long scanning time and is restricted scanning range. We report two symptomatic carotid stenosis cases that underwent BB MRI at 3 tesla using 3D turbo spin-echo sequence. The scanning time was 4 minutes 30 seconds, and the lumen from the common carotid artery to the intra-cranial internal carotid artery was detected. In addition to the plaque morphology and the extent of the plaque, we could evaluate the lumen of the distal portion of the plaque in the near occlusion case. BB MRI at 3 tesla using 3D turbo spin-echo sequence may be a useful tool for detection of carotid plaque.
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  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 3 Pages 222-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 223-224
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 225-226
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 226-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 227-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 227-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 228-229
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 230-233
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 234-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Appendix
    2011 Volume 20 Issue 3 Pages 234-
    Published: March 20, 2011
    Released: June 02, 2017
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  • Type: Cover
    2011 Volume 20 Issue 3 Pages Cover18-
    Published: March 20, 2011
    Released: June 02, 2017
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