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Article type: Cover
2011 Volume 20 Issue 4 Pages
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Article type: Cover
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Yoshihiro Muragaki, Toshihiro Kumabe
Article type: Article
2011 Volume 20 Issue 4 Pages
237-
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Taichi Kin, Hiroshi Oyama, Masaaki Shojima, Masahiro Shin, Nobuhito Sa ...
Article type: Article
2011 Volume 20 Issue 4 Pages
238-246
Published: April 20, 2011
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This report examines the basic knowledge, reconstruction techniques, usefulness, and limitations of the three-dimensional (3D) fusion imaging method. The 3D fusion imaging method uses multiple modalities, but is still in the early stages of development due to limitations of computer hardware, image processing software, and reconstruction methods. Standard 3D image reconstruction by comparatively simple processing from one kind of image data is widely used and has excellent spatial information and simplicity of construction. However, this information is insufficient for use in a preoperative simulation due to the relatively low resolution of the anatomical information. In contrast, there have been several reports of the usefulness of 3D fusion images using multiple modalities in neurosurgical preoperative simulations. This report will compare and contrast these two methods by illustrating results from each in clinical cases.
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Yukihiko Fujii, Hitoshi Matsuzawa, Makoto Oishi, Takeo Uzuka, Tsutomu ...
Article type: Article
2011 Volume 20 Issue 4 Pages
247-253
Published: April 20, 2011
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Visualization of neural fibers using diffusion tensor imaging (DTI) is becoming an indispensable tool in neurosurgery. Currently, two techniques, three-dimensional anisotropy contrast (3DAC) imaging and tractography, are frequently utilized. 3DAC images provide three-dimensional fiber-directional information in true color contrast and exquisitely high anatomical resolution sensitive to physiological anisotropism. Images are obtained by performing processes in image form (pictorial mathematics) without the necessity of eigenvalue estimation. Hence, image quality is identical to conventional magnetic resonance images such as T1 weighted and T2 weighted images. 3DAC has been shown to provide images with extraordinary contrast to detect not only major neural tracts but also fine neural fibers and nuclei, including in the brainstem and spinal cord. Tractography is widely used in neurosurgical settings, especially for presurgical planning to identify neural tracts. The direction of the largest diffusion determined by DTI parallels the dominant fiber orientation in each voxel, representing the mean longitudinal direction of neural fibers, which can be utilized for fiber tract tracing, i.e., tractography. Tractography is generally performed in two different ways, i.e., by deterministic or probabilistic methods. Advantages of the latter method over the former include the ability to clearly represent uncertainty and to reconstruct crossing fibers in the data, though the former is computationally intensive because of its requirement of thousands of iterations. There is widespread misunderstanding that tractography images actually represent real tracts and their pathology. In order to avoid such a potentially serious mistake, clinicians should clearly understand that, unlike 3DAC, tractography is in fact an artificial image. Recently, functional neuronavigation, i. e., intraoperative navigation integrated with preoperative functional images, was introduced into neurosurgical practice. Functional neuronavigation combined with visualization of the fiber tract is also expected to significantly reduce postoperative neurological deficits. In this venue, accuracy of the navigation is critical. It is, therefore, imperative that neurosurgeons understand the pros and cons of each of the techniques to be incorporated. The most reliable scenario will be the combination of intraoperative images, such as computed tomographic images and magnetic resonance images, appropriately integrated with functional data obtained preoperatively.
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Yuichi Murayama, Toshihiro Ishibashi, Takayuki Saguchi, Masaki Ebara, ...
Article type: Article
2011 Volume 20 Issue 4 Pages
254-258
Published: April 20, 2011
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Endovascular therapies and microsurgical clipping technique have proven to be successful in treating most neurovascular diseases. However, more complex shaped aneurysms still exist and these types of aneurysm should be treated by using high-end endovascular, surgical technique, and combined use of both techniques with modern imaging assistance. A newly designed surgical digital subtraction angiography system was installed in a hybrid operating room. The system is used as an intra-operative imaging tool for various neurosurgical procedures such as aneurysm clipping or spine instrumentation. During surgical procedures, intra-operative 2D/3D angiography and C-arm based CT imaging (Dyna-CT) are performed and newly developed virtual navigation soft-ware to treat deep seated intracranial lesions and needle placement. We report the current status and future direction of modern imaging technology in hybrid operating rooms.
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Masazumi Fujii, Satoshi Maesawa, Yuichiro Hayashi, Norimoto Nakahara, ...
Article type: Article
2011 Volume 20 Issue 4 Pages
259-269
Published: April 20, 2011
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In glioma surgeries, it is important to achieve maximal resection of the tumor and simultaneously avoid post-operative neurological deficits. Intraoperative magnetic resonance imaging (iMRI), introduced worldwide in 1995, is an effective tool that aids in achieving precision and safety in many operations, thus playing a major role in quality assurance of neurosurgery. We installed 2 iMRI operation rooms (ORs) in 2006 at our institutes, and have performed more than 500 operations. An analysis of 56 consecutive patients with newly diagnosed glioblastomas at our hospitals showed prolonged survival in those treated in iMRI ORs as compared to those treated in conventional ORs. Using a high-field iMRI, we also observed good correlation between intraoperative tractography of the pyramidal tract and motor evoked potential with direct white-matter stimulation. Here, we describe our experiences in using iMRI and a new imaging technique developed by us-Reshape & fuse. We have also discussed the current status of iMRI and its future perspective.
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Kazuhiro Hongo, Tetsuya Goto, Yukinari Kakizawa, Jun-ichi Koyama
Article type: Article
2011 Volume 20 Issue 4 Pages
270-274
Published: April 20, 2011
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Surgical robotics has been widely used in the field of abdominal and urological surgeries to achieve less invasiveness. In neurosurgery, however, there are no such surgical robotics systems available clinically. We have been developing a surgical robotics system for treating deep-seated lesions in collaboration with Hitachi Co. Ltd., as well as the Department of Neurosurgery, Tokyo Women's Medical University, the Department of Engineering, University of Tokyo, etc. The system, named NeuRobot, consists of our main parts, i. e., a micromanipulator (slave manipulator), a manipulator-supporting device, an operation-input device (master manipulator), and a display monitor. Three 1-mm forceps and an endoscope, which can be remotely controlled with three degrees of freedom (rotation, neck swinging, and forward/backward motion), were installed in the slave manipulator. After conducting animal experiments and receiving permission from the Ethical Committee, this system has been applied for clinical cases including convexity meningioma, obstructive hydrocephalus, etc. Further modification has been carried out installing a 6-axis robotic arm to hold the slave manipulator, this is just for the experimental set-up, though. Although there are several hurdles to overcome such as approval from the government and usability of the system, surgical robotics must have a promising future to achieve less invasive neurosurgery.
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Junkho Yamashita
Article type: Article
2011 Volume 20 Issue 4 Pages
275-277
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Hiromichi Kuwabara, Ryou Sumioka, Hajime Arai, Hiroyuki Kobayashi
Article type: Article
2011 Volume 20 Issue 4 Pages
278-288
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Thirty neurosurgical malpractice cases in Japan were analyzed. Among the several types of judicial disputes, breach of accountability has been shown to be comparatively readily acknowledged rather than other controversial issues. Lawsuits involving minimally invasive procedures warrant caution when interpreting accounts that laud the advantages of such procedures. Neurosurgeons involved in malpractice lawsuits suffer untold psychological stress in spite of the recent acceleration of settlements. An increase in lawsuits concerning medical negligence related to procedural errors translates a the reduction of surgical interventions performed as well as discouraging aspiring surgeons. Hence, the extant no-fault compensation system employed in obstetrics should be considered for other surgical fields including neurosurgery. However, the greatest challenge will be in determining the compensation cost based on the primary disease and the degree of surgical sophistication.
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Tamio Ito, Yoshimaru Ozaki, Ken-ichi Sato, Mitsuteru Oikawa, Hirohiko ...
Article type: Article
2011 Volume 20 Issue 4 Pages
289-298
Published: April 20, 2011
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Introduction: The gliosarcoma (GS) is a rare variant of glioblastoma (GB) containing distinct gliomatous and sarcomatous components. While uncommon, gliosarcomas have been known to arise secondarily, following conventional adjuvant therapy of malignant gliomas. We report a clinicopathological study of three secondary GS (SGS) cases. Clinical findings: All three patients were women, with a mean age of 44.3 years. Two had previously been diagnosised with GB, and the third had anaplastic astrocytoma (AA). As initial treatment, all patients underwent resection, followed by radiation and chemotherapy. GS was diagnosed at the first recurrence in one patient, and at the second recurrence in the other two. The mean latency of SGS induction, calculated from the diagnosis of GB/AA to the appearance of SGS, was 13 months. The mean length of survival from the time of SGS diagnosis was 6.7 months. The mean overall survival from the initial GB/AA diagnosis was 19.7 months. Clinically, in the final stage, fibrosarcomatous components were seen to characteristically grow into the subgalea or protrude out of the scalp after several recurrences. Pathological findings: In the two cases diagnosed with SGS at the second recurrence, fibroblastic cells had previously been recognized around the vessels at the first recurrence. Both cases also later exhibited abundant glial fibrillary acidic protein (GFAP) in the glial areas, and reticulin and fibronectin. in the fibrosarcomatous area. In the one SGS case diagnosed at the 1st recurrence, tumor cells showed gliosarcoma composed of chondrosarcomatous elements. Conclusions: SGS is a rare clinical entity that occasionally occurs after conventional adjuvant therapy for malignant gliomas. While the scarcity of cases makes research into the pathogenetic mechanism of SGS very difficult, the strikingly poor survival rates of patients who have undergone combined therapy raise questions concerning the value of such therapeutic radiation. A larger number of patients would be valuable in helping to elucidate the role of radiotherapy, and patient response to treatment.
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[in Japanese]
Article type: Article
2011 Volume 20 Issue 4 Pages
299-
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Shougo Kaku, Teruo Ichikawa, Yasuhiro Uriu, Akemi Tsutaki, Tomu Okada, ...
Article type: Article
2011 Volume 20 Issue 4 Pages
300-305
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Although the pathogenesis of dural arteriovenous fistula (DAVF) remains controversial, a few recent articles have reported in support of the viewpoint that it is an acquired lesion. These include a range of different theories regarding the mechanism of occurrence of acquired DAVF, but few articles have discussed the mechanism of its disappearance in detail. We describe two cases of the disappearance of DAVF of the transverse-sigmoid sinus after removal of the associated tentorial meningioma on the same side, and speculate that the vascular structures surrounding the acquired DAVF that associated the tumor may have contributed to the disappearance of the acquired DAVE However, as it is difficult to assess such structures preoperatively, this speculation must be supported in future with studies of further cases, including diagnostic imaging.
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[in Japanese]
Article type: Article
2011 Volume 20 Issue 4 Pages
305-
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
306-308
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
309-310
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
312-313
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
314-317
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Appendix
2011 Volume 20 Issue 4 Pages
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Article type: Cover
2011 Volume 20 Issue 4 Pages
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