We have been organizing the Academic Science Unit infrastructure that enables medical and healthcare developers to identify bedside needs that have commercial potential. Since its inception in 2014, we have accepted over 1,200 corporate researchers in Tohoku University Hospital to identify medical needs with the support of medical professionals. We are trying to develop ways to create new value for the patients and medical professionals by educating more medical professionals to become liaisons in other fields, including business and technology. We are also trying to accommodate emerging technology, such as augmented reality to medical environment, and are changing our workstyle.
What does “research” mean to clinical neurosurgeons? To address this question, the career path of a highly motivated basic researcher is described in this article. This researcher was not in the least interested in (basic) research and instead chose to become a clinical neurosurgeon after graduating from medical school. Being a basic researcher was indeed the last profession he ever wanted to be while he was a medical student. By looking into what drove the young neurosurgeon towards research, we can learn that, by nature, research is inherent in clinical practice. If a neurosurgeon says that he is not interested in research, he is as good as confessing that neurosurgery means little to him. For some neurosurgeons, research could also be a viable means of self-fulfillment, by allowing them to express themselves in an original manner just like artists.
Cell therapy for central nervous system (CNS) diseases including stroke, traumatic brain injury, spinal cord injury, and Parkinson's disease are now shifting from “basic research” to “clinical trials and approved therapies”. The results obtained from the clinical research promise to alleviate CNS damage which have long been considered as unrecoverable. Autologous bone marrow derived mesenchymal stem cell product “Stemirac” was approved for insurance-covered therapy against acute spinal cord injury under the new Japanese regulation, and many more clinical trials focused especially on ischemic stroke are currently executed in Japan. However, there persist several unsolved issues including ideal cell types, transplantation routes, transplantation timing, and types of disease, which need to be clarified to maximize the effect of cell therapy. Hence, it is important for neurosurgeons to understand the current status of stem cell therapy as a treatment for patients suffering from CNS diseases.
The dynamism of research in the fields of neurosurgery is challenging to grasp ; thus, an overhead view of the trends is imperative for designing successful research strategies. In this study, we evaluated the data of articles published in the Journal of Neurosurgery from the last 70 years by using PubMed and partially text-mining word frequency analysis.
As a result, we recognized that each neurosurgical research field has undergone various types of developments in the history of more than half a century. The neurosurgical trauma field has shrunk slightly since the 1970s as traffic safety improves. The brain tumor field is expanding, but the rates of expansion of other fields are faster. The cerebrovascular field showed great expansion with the establishment of endovascular mechanical thrombectomy treatment in the mid-2010s. Regarding the treatment for subarachnoid hemorrhage, a firm expansion of the endovascular research field was observed. Function and epilepsy fields have shown steady expansion, which seems to be related to the increasing emphasis on quality of life (QOL) of neurosurgical patients. The expansion of the emerging medical fields was also intense, especially in the field related to medical safety and QOL. Their territorial expansion has increased 30 times over the last 30 years. The worldwide increase in the number of medical lawsuit cases and the amount of compensation, as well as the increased awareness of patients' rights, seemed to have an impact on this enormous expansion. Molecular and precision medicine field of neurosurgery had also recent expansion. Large-scale text-mining word frequency analysis revealed an interesting tendency that the term for “patient” used in articles has been changing over the past 50 years. This terminological change was found not only in the field of neurosurgery but also in comprehensive all-medical fields.
The present study detected the various trends of many neurosurgical research fields during this half of the century. Major factors that influenced the trend of each field were the development of new devices or surgical methods, as well as the changes in the social situation surrounding medicine. Demonstrably, the research fields of neurosurgery are ever-expanding, as new findings and fields for innovation continue to emerge. Analysis using Pubmed, a public search engine, is an easy-to-access and useful method for grasping trends of neurosurgical research fields.
The natural history of acute stroke caused by tandem occlusion of the cervical ICA and a major intracranial artery leads to poor outcomes. The technical approaches for tandem occlusions are usually complicated and not well-established. It remains controversial whether the intracranial or extracranial lesions should be treated first or whether to place the carotid stent for extracranial lesions at the time of initial treatment. We treated 11 patients with tandem occlusion with the following two types of approaches : the antegrade approach (from 2013-2018), which treats carotid lesions first, and the retrograde approach (from 2019 onward), which treats the intracranial lesions first. The patients included 8 men and 3 women with a mean age of 59 years (range : 30-77 years). The mean National Institute of Health Stroke Scale (NIHSS) score at admission was 16 (range : 3-25). The median puncture-to-reperfusion time was 81 minutes (IQR : 59-93.8) and tended to be shorter in the retrograde than in the antegrade approach group (43 minutes [IQR : 40-57.5] vs 90 minutes [IQR : 80.5-117] ).
We routinely employed a combined technique with a large-diameter aspiration catheter and a stent retriever. First, we aimed to recanalize the intracranial lesion ; if crossing the lesions was difficult, we changed the strategy to pass the extracranial lesion first. In this article, we introduce our detailed procedures and their outcomes evaluated in our institute.
Fifteen years have elapsed since the start of the postgraduate clinical resident training program in Japan. Although the program has become established, the needs of residents continue to evolve because of the development of medical technology and changes in social circumstances. In the present study, we report the results of a survey conducted over a 7-year period to assess the needs of junior residents who had completed neurosurgery training. We found that junior residents wish to learn general care approaches for patients with severe illness of the central nervous system, including during the perioperative period, as well as acute care approaches, such as surgical procedures, but within limited work hours. The results also suggest that junior residents are greatly troubled by endovascular thrombectomy in the setting of hyperacute cerebral infarction. Therefore, instructing physicians should modify their activities and guidance to align with the needs of junior residents.