Advances in mechanical thrombectomy have been rapidly progressing in medical treatment systems for acute ischemic stroke. Based on the 5-year plan for stopping CVD published in 2016, the Japan Stroke Society certified 975 centers in Japan as primary stroke centers for uniform iv t-PA therapy for 24 h/day, every day. Linking the 5-year plan with a plan for promoting cardiovascular diseases will facilitate uniform primary care for stroke and adoption of advanced medical care.
The surgical microscope has been the gold-standard visual equipment for neurosurgical procedures since its introduction in the 1960s. Although it undoubtedly has made enormous contribution to the field, this medical device still offers room for improvement. In particular, physical size and weight restrict the relationship between surgeons and patient positions. The exoscope is a newly developed medical tool for microneurosurgery. The fundamental concept of this device is to provide excellent ergonomics during neurosurgical procedures while preserving the numerous advantages that surgical microscopes provide to surgeons. It is composed of a small stereo camera and a 4K three-dimensional large display. Although its clinical impact remains debatable, this device may completely replace surgical microscopes in the coming years. The exoscope enables :
1. shallow-angle surgical approaches without compromising the surgeon posture ;
2. assistance in deep-seated surgical fields ;
3. the collection of three-dimensional surgical field data with quantitative measurement of surgical maneuvers.
This review article provides an overview of the advantages mentioned above using clinical cases operated with exoscope assistance to help understand its clinical and technological impact on neurological surgery.
The unexpected coronavirus pandemic has markedly reduced travel to and from Japan ; however, we expect that the problem will be resolved in time and the global era will return to normal. The number of neurosurgeons studying abroad was on an upward trend compared to previous years. This article presents the results of a questionnaire survey on Japanese neurosurgeons studying abroad. In addition, it included advantages and disadvantages of studying abroad, the direction at which academia is heading in the global era, the importance of English as a communication language, and global activities of the Japan Neurosurgical Society and Japanese Congress of Neurological Surgeons. Finally, the concept of global neurosurgery is introduced.
The Act on the Arrangement of Related Acts to Promote Work-Style Reform was enacted in 2017 to reduce the practice of long working hours. However, medical doctors are exempted for five years due to legal obligations of providing medical treatment, work duty, and self-improvement that are unique characteristics of the medical profession, difficult to control through regulations for working hours.
According to the Health Ministry expert panel proposal for medical doctors' work-style reform, the overtime cap will be set to 960 hours a year in general hospitals after 2024. However, this proposal allows some doctors to work overtime up to 1,860 hours a year at individual designated medical institutions supporting regional areas. This overtime will be allowed under the condition that doctors have at least nine hours of rest between work shifts and never work more than 28 consecutive hours. In this paper, several measures are presented to stop overwork and promote reform of neurosurgeons' work-style.
Among 300 consecutive cases of clipped unruptured cerebral aneurysms, asymptomatic (silent) hemorrhaging was detected intraoperatively in 8 cases (2.7%). The aneurysms with silent hemorrhaging were smaller (mean maximum diameter : 5.4mm) and exhibited a lower bleb detection rate on preoperative 3D-CT angiography (25%). In multivariate analysis, aneurysmal size and hypertension demonstrated trends towards significant associations with silent rupturing. Therefore, aneurysms with silent hemorrhagic bleb (blister) tend to cause minor leaks, which are hard to detect on preoperative 3D-CT angiography.
Facial nerve palsy is a rare symptom of vestibular schwannoma, even when there is substantial tumoral compression of the facial nerve. Here, we describe two cases of large vestibular schwannomas who presented with facial nerve palsy. Both patients experienced post-operative improvement of facial motility, from grade Ⅲ before surgery to grade Ⅰ afterward, according to the House-Brackmann grading system. Although surgical resection of these tumors tends to be difficult, owing to insufficient intraoperative electromyographic responses of the facial nerve, surgical neural decompression may improve long-term facial motility.