Functional neurosurgery, including deep-brain stimulation (DBS), stereotactic surgery, and epilepsy surgery, have entered a new era in the 21st-century following the development of technology and investigation in neuroscience. In particular, advances in surgical techniques and devices are essential for the evolution of functional neurosurgery. In this century, magnetic resonance imaging (MRI) -guided targeting for stereotactic surgery has become a common method. The implantable stimulation device (IPG) and stimulus electrode for DBS and spinal cord stimulation have greatly progressed. A rechargeable IPG and directional electrodes have already been used. MRI-guided focused ultrasonography is one of the minimally invasive methods to visualize brain lesions and has been applied to control essential tremor. In addition, implantable drug delivery pump has been used as an intrathecal baclofen therapy for spasticity, and vagus nerve stimulation has become a possible therapy for epilepsy. The advancement and introduction of these devices contribute not only to better therapeutic effect but also to the expansion of indication. The development of computational technology leads to progression in neuroscience. With this progression, the evolution of functional neurosurgery is expected to contribute to a wide range of patients with dementia and mental illness.
The recent three decades in Japan were marked by a rapid decline in the pediatric population. Therefore, neurosurgeons, except those in children’s hospitals, have less frequently experienced diseases in pediatric neurosurgery. As a result, the disparities in medical treatment levels of pediatric neurosurgery among institutions and regions in Japan appear to be worsening. To address this issue, the Japanese Society for Pediatric Neurosurgery (JSPN) in collaboration with the Japan Neurosurgical Society (JNS) has established the system of certified member of JSPN to maintain and improve the medical treatment levels in pediatric neurosurgery. JSPN has been trying to develop clinical practice guidelines for pediatric brain tumors with the help of the Japan Society for Neuro-Oncology (JSNO) and those for other major pediatric neurosurgical diseases. In addition, to provide more advanced medical treatments, JSPN in cooperation with JSNO has established Japan Pediatric Molecular Neuro-oncology Group to perform molecular classifications of pediatric tumors in the central nervous system. JSPN is also supporting multicenter joint clinical trials on pediatric brain tumors, which has been conducted by the Brain Tumor Committee of the Japan Children’s Cancer Group. With the support of JNS, JSPN has recently started a clinical research on the long-term results of shunted hydrocephalic children in Japan. Moreover, JSPN has been trying to strengthen active relationships of the academic societies between Japan and foreign countries to improve the international position of Japan in the field of pediatric neurosurgery. The abovementioned activities could provide increased chances and experiences for young neurosurgeons in pediatric neurosurgery. More importantly, at least two certified members of JSPN are supposed to be continuously working in university hospitals, which are teaching hospitals for young neurosurgeons. JSPN sincerely requests that in all university hospitals, as in children’s hospitals, a number of certified members of JSPN intensively show the charms of pediatric neurosurgery to neurosurgical trainees and young board-certified neurosurgeons. The author hopes that such efforts derived from JSPN will foster successors of pediatric neurosurgeons to dispel concerns about the near future in the field of pediatric neurosurgery in Japan.
Authors evaluated the present state of neurotrauma research in Japan retroactively to the past and searched corridors to the future. The Japan Neurotrauma Data Bank had first clarified an increased risk of talk and deterioration in elderly patients owing to the increased incidence of tumble/falls, instead of traffic accidents, and the frequent use of antithrombotic agents. Through the “Think FAST” campaign, urgent image analysis, such as computed tomography and neutralization of antithrombotic activity, when bleeding is found, is highly recommended to prevent the expansion of hematoma. This campaign also discussed how to establish neurocritical care as a distinct medical sector in Japan to achieve standards set by the countries of United States or European Union, how to treat and follow patients with intellectual impairment after trauma, and how to develop temperature management concept, including focal brain cooling or transient receptor potential family. Especially, we stressed on a paradigm shift from hypothermia therapy based on our experience of temperature management therapy. Japan is a well-developed and ultra-aging country ; therefore, we have encountered drastic changes in neurotrauma similar to that encountered by other developed countries. Hence, we have to mention this change globally and implement countermeasures for it.
Removal, irrigation, and reconstruction of the damaged parts are performed for open cranial injuries. These procedures are highly dependent on the cause and effect of the injuries. Herein, we report a case of neuroendoscopic surgery performed for the craniofacial injury caused by a grass cutter. A 60-year-old male accidentally collapsed while operating the grass cutter and suffered from left facial injury due to a direct cut by an engine-driven cutting blade.
His level of consciousness on emergency admission was GCS E3V5M6. The facial incised wound extending from the left forehead to the zygomatic bone was 15 cm long and 4 cm deep. His left eyeball was also injured. Head computed tomography (CT) revealed linear bone fracture along the open wound, left frontal lobar contusion, and pneumocephalus. Emergency surgery was performed by neurosurgeons, ophthalmologists, and plastic surgeons.
Craniectomy of 3 cm width was performed on the frontal bone utilizing the open incised wound. Rigid neuroendoscope was inserted through the damaged dural opening. Under observation by a rigid neuroendoscope, contusional hematoma and fractured bony pieces were removed. The damaged dura mater of the frontal cranial base was peeled off, trimmed, and sutured. After the peeling off of the frontal sinus mucosa, the frontal sinus was filled with periosteum. Cranioplasty was performed using a titanium plate. Neither wound infection nor spinal fluid leakage followed. The patient was discharged on day 16.
In conclusion, the neuroendoscopic procedure was useful in the restoration of injured deep dura mater and skull base from the limited surgical opening.
The main cause of pituitary apoplexy is hemorrhagic infarction in adenoma, and this condition is rarely accompanied by chemical meningitis as the cerebrospinal fluid (CSF) is generally reported to be dominated by polymorphocytes. Here, we report the case of a 49-year-old male with pituitary apoplexy and panhypopituitarism, who was initially treated as viral meningitis with increased monocytes in the CSF at a neurology department in an outside institution. The patient subsequently developed ptosis, eye movement disorder, and loss of sight in the right eye and mass lesion was identified at the parasellar region on MRI. The tumor with extensive hematoma was removed at our department via endoscopic trans-nasal approach. The patient recovered immediately except for panhypopituitarism. We reviewed the literature for previous cases of pituitary apoplexy with monocyte dominanting meningitis and speculated that this condition is triggered when pituitary apoplexy occurs in a gradual fashion. We suspect that monocyte dominant CSF implies the later phase of inflammation in meningitis.
A 59-year-old woman presented with rapid progression of short-term memory impairment. CT and MRI scans showed a large cystic lesion at the anterior cranial base with dissemination of fatty droplets into the subarachnoid space and ventricles. Since no solid component was detected, preoperative clinical diagnosis was ruptured dermoid cyst. The patient underwent craniotomy for resection of the lesion. After removal of fatty component inside the cyst, a small solid tumor was found at the suprasellar region and resected. The surgical specimen was pathologically diagnosed as a mature teratoma.
Although a ruptured dermoid cyst with dissemination of fatty droplets into the subarachnoid space or ventricles is known to occur, a ruptured intracranial teratoma is very rare. Because mature teratoma is a neoplasm and can potentially recur, it is important to recognize that determining whether solid components are present in a cyst may be critical for an accurate diagnosis.