Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 21 , Issue 7
Showing 1-30 articles out of 30 articles from the selected issue
  • Type: Cover
    2012 Volume 21 Issue 7 Pages Cover18-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (33260K)
  • Type: Cover
    2012 Volume 21 Issue 7 Pages Cover19-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (33260K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages App25-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (78K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages App26-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (78K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages App27-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (68K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages App28-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (68K)
  • Nobuhiro Mikuni, Isao Date
    Type: Article
    2012 Volume 21 Issue 7 Pages 515-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (175K)
  • Hiroyoshi Hara
    Type: Article
    2012 Volume 21 Issue 7 Pages 516-526
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    One of the most important objects of stroke rehabilitation is motor recovery from acute stage to chronic stage. Early rehabilitation intervention after stroke onset should be started during the critical time window phase. Herein, a theory concerning motor circuit reorganization in the cerebral cortex contributing to recovery following stroke is proposed. In the acute stage, motor recovery depends on residual corticospinal tract excitability from onset to 3 months (1st stage recovery). In the next stage, alternative output systems are used according to intracortical excitability depending on intracortical disinhibition at the peak of 3 months (2nd stage recovery). At 6 months and beyond training-induced synaptic strengthening becomes better established, and new networks are better reorganized (3rd stage recovery). Stroke rehabilitation programs commencing from the acute stage are required according to this stage theory. With each stage, selecting and performing the most effective rehabilitation programs is essential to successful recovery. Two motor recovery obstruction factors are indicated. One of them is Wallerian degeneration of the corticospinal tract. Early Wallerian degeneration of the corticospinal tract that is seen on diffusion-weighted MRI was reported. With the appearance of Wallerian degeneration at the acute stage, more attention should be directed to motor recovery inhibition. The second obstruction factor is the development of spasticity from the acute stage. Spastic paresis over time leads to immobilization of the paretic body part and chronic disuse of the paretic body part, which are avoidable through early rehabilitation intervention. Recently, various interventions were proposed for motor recovery dependent on the cortical plasticity theory. The combination of repetitive transcranial magnetic stimulation and intensive occupational therapy (NEURO-15) reported by Abo (2010) are recommended to recover hand functions at the chronic stage as 3rd stage recovery. The NEUROSIS is a promising method for stroke rehabilitation.
    Download PDF (75072K)
  • Masahiro Abo
    Type: Article
    2012 Volume 21 Issue 7 Pages 527-533
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Objective: Recently, low-frequency repetitive totnscranial magnetic stimulation (rTMS) which can suppress neural activity of selected brain areas, has been introduced for stroke patients with aphasia as a therapeutic tool. To assess the therapeutic effects of an 11-days in-hospital protocol of intensive speech therapy (ST) combined with low-frequency rTMS on language function in patients with poststroke aphasia. Method: Twenty patients with left-hemispheric stroke and aphasia were included in this study. During their 11-day hospitalization, each patient received 10 treatment sessions consisting of 40-min of 1 Hz repetitive low-frequency TMS and 60-min of intensive ST (one session/day), excluding Sundays. The scalp area for stimulation was selected based oe functional (f) MRI and determination of the type of aphasia. Repetitive low-frequency-TMS was applied to the inferior frontal gyrus (IFG) for patients with motor-dominant aphasia and to the superior temporal gyrus (STG) for patients with sensory-dominant aphasia. Language function was evaluated by the Japanese version of the Western Aphasia Battery (WAB), the Standard Language Test of Aphasia (SLTA) and the supplementary test of SLTA at one week before admission, 1 hr after the last rTMS session and 4 weeks after discharge from the hospital. Results: On pretreatment fMRI, the most activated areas were in the left hemisphere (n=11) and the right hemisphere (n=9). Aphasia types were sensory-dominant (n=9) and motor-dominant (n=11). The repetitive low-frequency TMS was applied to the right STG (n=5), left STG (n=4), right IFG (n=8) and left IFG (n=3). All patients with motor-dominant aphasia showed improvement while those with sensory-dominant aphasia showed improvement in spontaneous speed only. Conclusion: Our fMRI-based repetitive low-frequency TMS strategy for aphasic stroke patients seems to be a novel neurorehabilitative approach facilitating the reorganization of language function with a low risk of adverse effects.
    Download PDF (27350K)
  • Kenji Hachisuka
    Type: Article
    2012 Volume 21 Issue 7 Pages 534-540
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Robot-assisted training for stroke patients is a new method to improve hemiparesis. The MIT-M ANUS, Ann Trainer (Bi-Manu-Track^[○!R]), ARM Guide, ReoGo^[○!R], NeReBot. and others have been used for training of the upper extremities, and the Therapeutic Exercise Machine^[○!R], Gait Trainer^[○!R], Driven gait orthosis (Lokomat^[○!R]), LOPES Exoskeleton Robot, and the Gait Assistance Robot have been used for training of the lower extremities. The advantages of robot-assisted training are being able to perform a significant amount of training without requiring excessive physical burden from the therapist and being able to exactly repeat movements over and over. Randomized controlled trials by several researchers have demonstrated that robot-assisted training is useful in rehabilitation for stroke patients, but further studies are still needed to optimize the training methods and generalize the outcomes to daily living.
    Download PDF (2776K)
  • Masayuki Hirata, Takufumi Yanagisawa, Kojiro Matsushita, Morris Shayne ...
    Type: Article
    2012 Volume 21 Issue 7 Pages 541-549
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    The brain-machine interface (BMT enables us to control machines and to communicate with others, not with the use of input devices, but through the direct use of brain signals. This paper describes the integrative approach we used to develop a BMI system with brain surface electrodes for real-time robotic arm control in severely disabled people, such as amyotrophic lateral sclerosis patients. This integrative BMI approach includes effective brain signal recording, accurate neural decoding, robust robotic control, a wireless and fully implantable device, and a noninvasive evaluation of surgical indications. We have previously shown that power in the high gamma band (80-150 Hz) gave the highest decoding accuracy. We succeeded in generating voluntary control over the grasping and releasing of objects, using a successive decoding and control algorithm that achieves smooth robotic hand movements. Even in patients with severe motor disturbances, merely imagining hand movements was enough to induce clear, high gamma band responses that were similar to those induced by real movements. A fully-implantable wireless system is indispensable for the clinical application of invasive BMI in order to reduce the risk of infection. We have developed a prototype which is a 128-channel fully-implantable wireless system that includes many new technologies such as a 64-channel integrated analog amplifier chip, a Bluetooth wireless data transfer circuit, a wirelessly rechargeable battery, 3 dimensional tissue-fitting high density electrodes, a titanium head casing, and a fluorine polymer body casing. We are planning clinical trials and the introduction of our BMI system after the completion of a two-staged clinical research program using wired and then wireless systems.
    Download PDF (76406K)
  • Masaaki Mikamoto, Kenji Kamiyama, Yusuke Nakagaki, Emiko Muramoto, Dai ...
    Type: Article
    2012 Volume 21 Issue 7 Pages 550-554
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    In Japan, intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute ischemic stroke was approved in October 2005. rt-PA therapy improves stroke outcomes and has become the standard therapy in many hospitals. However, the therapeutic time window is limited to 3 hours after stroke onset, and many patients do not have the opportunity to receive therapy within that time. 210 patients received rt-PA therapy in our hospital between October 2005 and October 2010. We analyzed their sex, age, National Institute of Health Stroke Scale (NIHSS) before rt-PA therapy, type of stroke, time between detection and door, time between door and drug administration, and prognosis (defined by the modified Ranking Scale score at discharge: 0-1 as good, 2-6 as poor). We divided patients into a weekday/daytime shift group and a holiday/nighttime shift group, and compared the above factors between the two groups. Of 210 patients (mean age, 70.7 years ; 124 males, 86 females) who received rt-PA therapy, NIHSS before therapy was 0-39 (mean, 12.1), and the most frequent type was cardiogenic embolism (154 patients; 73.3%). Mean time between onset and Emergency Department (ED) arrival was 51.2 minutes, and mean time between door and drug administration was 93.8 minutes. Thirteen patients (6.2%) were administered rt-PA within 60 minutes after ED arrival. There were 77 (36.7%) patients with good prognosis, and 133 (63.3%) with poor prognosis. Between the two groups, there was no significant difference in any of the factors other than age. At our hospital, availability of rt-PA therapy is the same during the holiday/night shift and the weekday/daytime shift because more than three doctors are on duty at any time. However, the mean time between door and drug administration was over 90 minutes in both groups: therefore, more effort is needed to shorten the time before treatment to increase the chances for patients to receive rt-PA therapy.
    Download PDF (769K)
  • [in Japanese]
    Type: Article
    2012 Volume 21 Issue 7 Pages 555-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (115K)
  • Takuro Inoue, Hisao Hirai, Toshiki Shimizu, Masayuki Tsuji, Teppei Ues ...
    Type: Article
    2012 Volume 21 Issue 7 Pages 556-561
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    We report on the usefulness of preoperative 3D-MR imaging for treating microvascular decompression of trigeminal neuralgia due to venous angioma. A 38-year-old man had trigeminal neuralgia in his right jaw for 8 years. Although medication was initially effective, his pain became intolerable 1 year before admission to our hospital. MRI revealed venous angiomas in the cerebellum and pons with a draining stem vein running adjacent to the nerve. In addition, a collateral of the draining vein to the superior petrosal vein was compressing the root entry zone (REZ) of the trigeminal nerve. The 3D-MR imaging obtained by Gamma Plan^[○!R] clearly depicted neurovascular conflict of the collateral vein at the REZ and the anatomical relation between this vein and the transparenchymal draining vein through the pons. Microvascular decompression was performed by dividing the collateral vein at the REZ, and then the adjacent vessels were transposed away from the nerve using Teflon felt. His pain was relieved immediately after the surgery. Trigeminal neuralgia due to venous angioma is rarely reported. The usefulness of preoperative 3D-MR imaging for microvascular decompression has recently been reported. As division of the culprit vein carries the possible risk of venous infarction, it is crucial to understand the microanatomy around the trigeminal nerve in order to perform secure surgery. Preoperative 3D-MR imaging is useful to evaluate the anatomical relation between the nerve and veins in trigeminal neuralgia due to venous angiomas.
    Download PDF (31986K)
  • [in Japanese]
    Type: Article
    2012 Volume 21 Issue 7 Pages 562-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (115K)
  • Katsuaki Gunge, Jun Morioka, Kei Harada, Shiegnari Kin
    Type: Article
    2012 Volume 21 Issue 7 Pages 563-569
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    A 59-year-old female presented with a subarachnoid hemorrhage and was admitted to our institution. The right vertebral angiogram showed a dissecting aneurysm involving the origin of the posterior inferior cerebellar artery (PICA). The left vertebral artery was of small caliber. Stent-assisted coil embolization of the aneurismal dilatation using a coronary stent was performed on the day of its rupture while preserving the patency of the parent artery and the origin of the PICA. The patient recovered completely without any episodes of re-rupture or infarction. Although the follow-up angiogram temporarily demonstrated partial recanalization, the aneurysm was excluded from the circulation, with good patency of the vertebral artery and PICA, after withholding anticoagulants. The efficacy of stent-assisted coil embolization in the prevention of rebleeding in the acute stage is still uncertain, however, this technique may offer a potential method for treating patients who are for high risk of developing ischemic complications due to parent artery occlusion.
    Download PDF (3674K)
  • [in Japanese]
    Type: Article
    2012 Volume 21 Issue 7 Pages 570-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (123K)
  • Taro Suzuki, Tsukasa Wada, Kuniaki Ogasawara, Yuichi Sato, Noriyuki Ue ...
    Type: Article
    2012 Volume 21 Issue 7 Pages 571-577
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    IgG4-related disease is often characterized by hypophysitis or pachymeningitis. A 63-year-old man presented with dysphagia and left hemiparesis. Magnetic resonance imaging demonstrated a tumor located at the bilateral jugular foramina that compressed the medulla oblongata, and thickened dura mater in the bilateral cavernous sinuses was also observed. Left suboccipital craniotomy was performed, and the tumor was confirmed to have originated from the left jugular foramen to involve the glossopharyngeal and vagal nerves. Histopathological examination of the surgical specimen showed massive infiltration of IgG4-positive lymphocytes and plasma cells. Based on these histopathological findings and extreme elevation of serum IgG4, the patient was diagnosed with IgG4-related disease. IgG4-related disease can include the development of symptomatic tumor-like lesions in the posterior fossa.
    Download PDF (21144K)
  • [in Japanese]
    Type: Article
    2012 Volume 21 Issue 7 Pages 578-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (135K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 579-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (112K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 579-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (112K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 580-581
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (312K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 581-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (134K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 582-583
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (731K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 584-588
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (621K)
  • Type: Bibliography
    2012 Volume 21 Issue 7 Pages 589-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (10813K)
  • Type: Bibliography
    2012 Volume 21 Issue 7 Pages 589-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (10813K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 590-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (102K)
  • Type: Appendix
    2012 Volume 21 Issue 7 Pages 590-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (102K)
  • Type: Cover
    2012 Volume 21 Issue 7 Pages Cover20-
    Published: July 20, 2012
    Released: June 02, 2017
    JOURNALS FREE ACCESS
    Download PDF (666K)
feedback
Top