Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 20 , Issue 7
Showing 1-28 articles out of 28 articles from the selected issue
  • Type: Cover
    2011 Volume 20 Issue 7 Pages Cover28-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (33544K)
  • Type: Cover
    2011 Volume 20 Issue 7 Pages Cover29-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (33544K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages App14-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (68K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages App15-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (68K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages App16-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (89K)
  • Yuji Matsumaru, Hiroaki Shimizu
    Type: Article
    2011 Volume 20 Issue 7 Pages 483-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (178K)
  • Akio Morita, UCAS II Study Group
    Type: Article
    2011 Volume 20 Issue 7 Pages 484-490
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Introduction: To identify the risks in managing unruptured cerebral aneurysms in Japan, we conducted a prospective multi-center study. Method: Patients with newly diagnosed UCA during January 2006 to January 2007 in 31 institutions were prospectively registered. Patients were regularly followed up and registered at 3 months, 12 months and at 60 months (scheduled) after registration. At the same time, three dimensional images, periodic health related quality of life (SF-8, EQ5D) and cognitive function data were collected. Source documents were confirmed by outside reviewers. Results: 1,056 patients were registered. The 3 months registration was recorded in 1007, 12 months in 946 cases. Aneurysms were repaired in 558 patients; by clipping in 81% and coiling in 19% of cases. Severe morbidity (Modified Rankin scale worse than 1) was observed in 4.5% of cases and was significantly related with the size, location and history of the subarachnoid hemorrhage. Management morbidity was most frequently caused by perforator injury of the parent artery occlusion. Conclusion: With multiple prospective studies conducted in Japan, we can now delineate high risk UCA group for management. With such data, adequate risk communication with the patient can be achieved.
    Download PDF (1345K)
  • Yoshiaki Shiokawa
    Type: Article
    2011 Volume 20 Issue 7 Pages 491-498
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Considering treatment modality, timing and surgeons for the obliteration of unruptured cerebral aneurysms (UCA), there seems to be a wide variety of treatment options available in modern neurosurgery. UCA themselves are not a single pathological entity, but rather they are complex vascular lesions that range from small, incidentally found asymptomatic aneurysms to giant thrombosed lesions presenting life threatening brainstem compression. Treatment strategies for UCA should be determined depending on individual pathological factors such as aneurismal characteristics and patient background and their philosophy for life harbouring UCA. In this article, the authors focused on the surgical treatment for small asymptomatic UCA and discussed their current status and future perspective. Especially for incidentally found small asymptomatic UCA not suitable for interventional treatment, current state-of-the-art surgical techniques and supporting devices such as intraoperative monitoring and imaging can obtain almost zero operative mortality and only a few percent of morbidity. Prophylactic surgical obliteration of small, asymptomatic UCA should be justified only under the very small risk of perioperative adverse events. Clinical priorities avoiding any complication rather than tight neck clipping seem to be widely accepted.
    Download PDF (1291K)
  • Hidenori Oishi, Hajime Arai
    Type: Article
    2011 Volume 20 Issue 7 Pages 499-505
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Endosaccular coil embolization (ESCE) of intracranial aneurysms has become an alternative to surgery. The international subarachnoid hemorrhage trial (ISAT) proved the efficacy and safety of the ESCE of ruptured intracranial aneurysms. However, there is little evidence regarding the ESCE of unruptured intracranial aneurysms (UIAs). We reviewed our own experiences to elucidate the efficacy and safety of the ESCE of asymptomatic UIAs. Immediate angiographic outcomes showed complete occlusion in 59.6%, residual neck in 16.3%, residual aneurysm in 20.6%, and failure in 3.4%. Radiological follow-up (mean, 26.3 months) with conventional angiography and/or magnetic resonance angiography showed unchanged in 64.4%, minor recurrence in 5.9%, major recurrence in 11.4%, and improved in 18.3%. The risk factors of radiological recurrence were large size, wide neck and terminal type aneurysms. Overall procedure related complications occurred in 7.8%. Permanent morbidity and mortality rates were 0.9% and 0.2%, respectively. There were no patients who suffered from aneurysmal bleeding after the ESCE during a mean clinical follow-up period of 24.2 months. The ESCE of asymptomatic UIAs is feasible in a high percentage of cases with low complication rates and has the efficacy of preventing aneurysmal bleeding in a short-midterm follow-up period. However, the recurrence after treatment is still an issue, the patients should be kept on long-term follow-up.
    Download PDF (1173K)
  • Taketo Hatano, Susumu Miyamoto, Jun Takahashi, Koji Iihara
    Type: Article
    2011 Volume 20 Issue 7 Pages 506-512
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Surgical treatment is considered necessary for the treatment of giant cerebral aneurysms as the natural course of development for the disorder is extremely poor. However, there are numerous cases in which clipping is unpractical despite attempts to fully utilize various techniques currently available. A treatment strategy employing flow alteration treatment for complex giant aneurysms in the anterior cerebral circulation is presented and explained by referring to actual cases, especially regarding the importance of flow outlet intended to prevent ischemic complication.
    Download PDF (69605K)
  • Waro Taki
    Type: Article
    2011 Volume 20 Issue 7 Pages 513-516
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    The progress of interventional treatments is rapid and succession of techniques and knowledge is achieved by the deliberate consideration of three factors. The first is the improvement and development of innovative medical devices. The second factor is the educational system for the development of the interventional physicians and the generalization of cutting-edge techniques. The third factor is the medical policies adopted by the administrative sectors. Though there are newly imported devices in recent years and physicians are occupied with obtaining new knowledge and techniques, these are imported items and Japan has been losing its international leading role in this medical area. The most urgent and important issue is to construct a system for cultivating cutting-edge medical technology. The clear differentiation of the cutting-edge medical technology from generalized medical practice is essential to the medical policies in the Japanese government. Cooperation of the medical society, medical industry and government as well as their respective efforts are important for the succession of the endovascular workmanship.
    Download PDF (555K)
  • Toshisuke Sakaki
    Type: Article
    2011 Volume 20 Issue 7 Pages 517-518
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (445K)
  • Hideyuki Ishihara, Fumiaki Oka, Satoshi Shirao, Hirokazu Sadahiro, Sho ...
    Type: Article
    2011 Volume 20 Issue 7 Pages 519-522
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    【Purpose】 We evaluated cerebral circulatory dynamics in cases of subclavian artery stenosis or occlusion using dual-table autoradiography (ARG) to investigate the characteristics of cerebral circulatory dynamics of subclavian steal syndrome. 【Subjects and methods】 The study population consisted of 9 cases of subclavian steal syndrome (2 cases of subclavian artery stenosis, 5 cases of subclavian artery occlusion, 2 cases of brachiocephalic artery stenosis) treated by percutaneous transluminal arterial angioplasty and stenting (PTA/stent) at our department in the 3-year period from April 2006. In all cases, quantitative determination of cerebral blood flow was performed using ^<123>I-labeled N-isopropyl-p-iodoamphetamine (^<123>I-IMP) before and after PTA/stent. Quantitative determination of cerebral blood flow was performed using dual-table ARG, which consecutively measures the amounts of cerebral blood flow at rest and during acetazolamide loading. Stereotactic extraction estimation analysis (SEE) was used for statistical image analysis on cerebral blood flow single-photon emission computed tomography (SPECT), and the amounts of cerebral blood flow at rest and cerebral perfusion reserve, both from the region of interest, were calculated. 【Results】 PTA/stent was successful in all cases, with subclavian steal phenomenon resolved, and the symptoms improved in all cases. In cerebral blood flow evaluation, the amount of cerebral blood flow at rest before treatment (mL/100g/min) was 34.5±5.4 in the cerebral hemisphere, and 36.8±4.3 in the cerebellar hemisphere; cerebral blood flow reserve (%) was 40.8%±18.4% in the cerebrum and 26.9%±21.8% in the cerebellum. After the treatment, cerebral blood flow at rest in the cerebellum was 37.2±5.5mL/100g/min and did not change from revascularization achieved by PTA/stent. However, a significant improvement was observed in cerebral blood flow reserve, which was 36.4%±19.2%. 【Conclusion】 Subclavian steal syndrome can be evaluated using ^<123>I-IMP SPECT dual-table ARG, and the results can be understood as decreases in cerebral blood flow reserve in the cerebellum. The cerebral circulation in the vertebral-basilar system appeared to have been improved through revascularization achieved by PTA/stent, causing improvement in the symptoms. ^<123>I-IMP SPECT dual-table ARG may be a useful index in determining the treatment.
    Download PDF (475K)
  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 7 Pages 523-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (144K)
  • Kentaro Mori
    Type: Article
    2011 Volume 20 Issue 7 Pages 524-530
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    The procedures are shown to make a skull base model (M-model) for training in skull base surgery. The commercially available prototype dissectable skull model is used. The periorbita and inner layer of the cavernous sinus are made of yellow silicone. The cavernous sinus and its related structures are reconstructed with a double layer of silicone, cranial nerves made of rubber fiber, and carotid artery made of vinyl tube. The artificial oculomotor nerve should be located in the infero-lateral part of the anterior clinoid process. The periosteal bridge is also made of yellow silicone. The dural sinuses are made of blue silicone. The dura propria is reconstructed with brown silicone brushed onto the inner surface of the skull. Cranial nerves made of rubber fibers are positioned in the corresponding foramina. The vertebro-basilar artery made of wire is fixed with glue. Finally, the tentorium made of silicone is positioned and the outer layer of the cavernous sinus made of brown silicone. The processes to make the skull base structures facilitate better understanding of the three-dimensional cranial anatomy. This M-model is a useful training model for skull base surgery.
    Download PDF (110564K)
  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 7 Pages 530-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (145K)
  • Hiroyuki Toi, Takeshi Miyamoto, Kimihiko Yokosuka, Kazuhito Matsuzaki, ...
    Type: Article
    2011 Volume 20 Issue 7 Pages 531-535
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Extracranial internal carotid artery pseudoaneurysms are rare in pediatric patients, but carry great potential for embolic stroke and rupture. An 11-year-old girl presented to our hospital with a laceration on the right neck. Three-dimensional computed tomography angiography (3D-CTA) indicated a large pseudoaneurysm (diameter, 20mm) at the right extracranial internal carotid artery. The patient was treated surgically with external-internal carotid artery transposition, achieving complete obliteration of the aneurysm. This report illustrates the importance of surgical management of extracranial internal carotid artery pseudoaneurysm in pediatric patients. External-internal carotid artery transposition appears to represent one of the best treatments for this pseudoaneurysm.
    Download PDF (23390K)
  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 7 Pages 536-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (124K)
  • [in Japanese]
    Type: Article
    2011 Volume 20 Issue 7 Pages 537-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (164K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 538-539
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (248K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 539-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (102K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 540-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (126K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 540-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (126K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 541-542
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (383K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 543-547
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (511K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 548-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (111K)
  • Type: Appendix
    2011 Volume 20 Issue 7 Pages 548-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (111K)
  • Type: Cover
    2011 Volume 20 Issue 7 Pages Cover30-
    Published: July 20, 2011
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (73K)
feedback
Top