巻号一覧
51 巻, 3 号
選択された号の論文の21件中1～21を表示しています
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Original Articles
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Takato MORIOKA, Tetsuro SAYAMA, Nobutaka MUKAE, Takeshi HAMAMURA, Kuni ...原稿種別: Original Article
2011 年 51 巻 3 号 p. 171-179
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスNonconvulsive status epilepticus (NCSE) is generally defined as a change in behavior and/or mental process from the baseline, which is associated with ongoing seizure activity or continuous epileptiform discharges on electroencephalography (EEG) in the absence of convulsive seizures. The present study investigated NCSE incidence using serial EEG during the perioperative periods of cerebrovascular surgery at a medium-sized, local hospital. A total of 54 patients were admitted to our department and underwent various neurosurgical procedures over a course of one year. If clinical symptoms worsened without clear explanation, EEG was performed, resulting in a diagnosis of NCSE in four patients (7.4%). The EEG abnormalities included periodic lateralized epileptiform discharges in 1 patient, triphasic waves in 2 patients, and repeated ictal discharges in 1 patient. Improved mental status and consciousness level, together with disappearance of EEG abnormalities, after appropriate anticonvulsant treatment supported the diagnosis of NCSE. The present study stressed the importance of EEG if no adequate explanation for neurological deterioration can be determined from the clinical course, laboratory data, or neuroimaging examination.
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Christoph M. WOERNLE, Jan-Karl BURKHARDT, David BELLUT, Niklaus KRAYEN ...原稿種別: Original Article
2011 年 51 巻 3 号 p. 180-186
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスPlacement of external ventricular drainage (EVD) catheters is the gold standard for managing acute hydrocephalus, but the range of complications varies in different studies. The objective of this present single institute study is to analyze iatrogenic factors, which may influence the EVD device placement and the patient's outcome. A total of 137 EVD placements in 120 patients at the University Hospital Zurich were analyzed retrospectively. Discriminative findings between the pre- and postoperative imaging were obtained and evaluated in detail with regards to the postoperative course, ventriculostomy-related infection, and acute neurological deterioration directly related to the EVD placement. These findings were correlated to iatrogenic factors including education level of the neurosurgeon and surgical setting. Overall EVD-related complication rate was 16.1%, including infection rate of 10.2%, catheter malplacement rate of 2.2%, and hemorrhage rate of 3.6%. Although not statistically significant, catheter-associated hemorrhages and malplacements were found mostly in primary EVD surgery, with a higher complication rate associated with junior residents as the performing surgeon. In contrast, ventriculostomy-related infection was most likely present in patients with more than one EVD placement and in patients treated by more experienced physicians. Complications related to EVD are common. The rate and character of the complication depends on the education level of the surgeon.
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Taku SATO, Tatsuya SASAKI, Jun SAKUMA, Tadashi WATANABE, Masahiro ICHI ...原稿種別: Original Article
2011 年 51 巻 3 号 p. 187-194
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスSubarachnoid hemorrhage (SAH) volume was measured by three-dimensional computed tomography (3D-CT) and the correlation examined between the SAH volume and the occurrence of symptomatic vasospasm (SVS). Experimental (in vitro) hematomas were made with blood obtained from 10 volunteers. The hematoma volume was determined by actual measurements and by 3D-CT using a CT number in the range of 40-80 Hounsfield units (HU) on days 1, 4, 7, 11, and 14. The coefficients on days 1 and 4 were relatively high and the correlation between measured and estimated volumes was significant on days 7, 11, and 14. 3D-CT was also performed in 50 patients with SAH at onset (day 0) and on days 1, 4, 7, and 14. The hematoma volume including the volume of normal structures was automatically calculated (V1). The volume of normal structures (V2) with CT numbers of 40-80 HU was calculated in another 50 patients without intracranial lesions as 12 ml. The total hematoma volume was defined as V1 minus mean V2. The mean SAH volume was 44, 36, 21, 11, and 8 ml on days 0, 1, 4, 7, and 14, respectively. The hematoma volumes were significantly larger in patients with SVS than in patients without SVS at all time points. The minimum hematoma volume in patients with SVS was 92, 76, 42, 24, and 12 ml on days 0, 1, 4, 7, and 14, respectively. This method allows the quantitative determination of SAH volume based on 3D-CT, and may be useful in clinical studies of cerebral vasospasm.
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Qianna JIN, Tomoyuki NOGUCHI, Hiroyuki IRIE, Masatou KAWASHIMA, Masash ...原稿種別: Original Article
2011 年 51 巻 3 号 p. 195-200
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセス3.0-T magnetic resonance (MR) angiography and MR imaging were compared with conventional angiography for the evaluation of moyamoya disease in 13 preoperative patients (26 hemispheres) with moyamoya disease (4 males and 9 females aged 21-54 years). The correlation between MR angiography scores determined by modified Houkin's grading system (MRA score) and conventional angiography stages determined by Suzuki's grading system (CA stage) was analyzed. Other MR findings such as moyamoya vessel scores, “ivy sign” scores, and the presence of small, medium, and large cerebrovascular attack (CVA) lesions were compared with CA stages. MRA scores were significantly correlated with CA stages (p < 0.01). Moyamoya vessel scores correlated well with CA stages (p < 0.01). There was no significant correlation between “ivy sign” scores and CA stages, and no significant differences in CA stages with the presence and absence of CVA lesions of any size. 3.0-T MR angiography can be used as a vascular assessment in moyamoya disease with its priority of noninvasive nature and visual clarity compared with conventional angiography. The findings of 3.0-T MR angiography may reflect the steno-occlusive changes in moyamoya disease.
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Makoto OISHI, Masafumi FUKUDA, Go ISHIDA, Akihiko SAITO, Tetsuya HIRAI ...原稿種別: Original Article
2011 年 51 巻 3 号 p. 201-207
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスThe surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. Imaging data were collected from computed tomography, magnetic resonance imaging, and digital subtraction angiography. Skull data was processed to imitate actual bone resection and integrated with various structures extracted from appropriate imaging modalities by image-analyzing software. The simulated views were compared with the views obtained during surgery. All craniotomies and bone resections except opening of the acoustic canal in 2 patients were performed as simulated. The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.
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Kyongsong KIM, Toyohiko ISU, Atsushi SUGAWARA, Daijiro MORIMOTO, Ryoji ...原稿種別: Original Article
2011 年 51 巻 3 号 p. 208-213
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスDetailed changes involved in the worsening of the fused segment angle were assessed after application of the Williams-Isu method using autologous bone grafts from cervical vertebral bodies in 30 patients with cervical disease treated by single-level anterior fusion. The mean follow-up duration was 25.4 months. The fused segment angle was measured on serial radiographs. Whole cervical spine alignment changed from 12.8° to 9.9°. The alignment of the fused segment worsened by mean 3.3°. To elucidate the characteristics of worsening of the fused segment, the 30 patients were divided into 2 groups: Group I (n = 20) without and Group II (n = 10) with postoperative worsening of the fused segment. The loss in the fused segment angle was significantly greater in Group II (8.0°) than Group I (0.9°). Preoperative range of motion and disc height were significantly greater in Group II than Group I. Worsening of the fused segment angle occurred within 1 month in Group I, whereas stabilization was observed after 3 months in Group II. Graft subsidence was primarily posterior and inferior. Our results indicate that the preoperative range of motion and disc height of the fused segment must be considered to prevent worsening in that segment after anterior fusion. Such detailed information is useful for the selection and postoperative monitoring of patients eligible for treatment by the Williams-Isu method.
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Case Reports
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—Case Report—Kentaro HAYASHI, Kazuhiko SUYAMA, Izumi NAGATA原稿種別: Case Report
2011 年 51 巻 3 号 p. 214-216
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 45-year-old woman presented with a rare case of traumatic carotid cavernous fistula (CCF) complicated with intracerebral hemorrhage after injury in a car accident. She had multiple injuries including facial bone fracture and slight subarachnoid hemorrhage around the left sylvian fissure. Emergent plastic surgery for the facial deformity was performed. Next day, she suffered intracerebral hemorrhage in the left frontal lobe. Angiography revealed CCF, predominantly draining to the left superficial sylvian vein. The left internal carotid artery was occluded by endovascular treatment. The clinical triad of traumatic CCF is orbital bruit, exophthalmos, and chemosis. Hemorrhagic complication such as subarachnoid hemorrhage, epistaxis, and otorrhagia may occur according to the venous drainage pattern. Traumatic CCF may be accompanied by intracerebral hemorrhage.
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—Case Report—Won-Sang CHO, Batbold BATCHULUUN, Seung Jin LEE, Hyun-Seung KANG, Jeon ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 217-221
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 67-year-old man presented with a case of recurrent subdural hematomas (SDHs) from a pseudoaneurysm at the cortical artery after mild head trauma. He had undergone two episodes of burr hole trephination and evacuation of SDH in a 6-day interval. Review of previous imaging findings and additional cerebral angiography then identified a pseudoaneurysm arising from the precentral branch of the middle cerebral artery. Acute rebleeding suddenly occurred, and the leak point on the cortical artery was completely repaired with a single suture. SDH from pseudoaneurysm after mild head injury is very unusual. The high morbidity and mortality rates necessitate early detection, but the rarity of this type of injury makes detection difficult. If the clinical course is not easily explainable and is worse than the severity of trauma, repeated SDHs occur, or abnormal lesions and/or subarachnoid hemorrhage are identified, computed tomography or magnetic resonance imaging with contrast medium should be performed to identify the underlying cerebrovascular diseases and determine whether cerebral angiography is necessary.
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—Case Report—Mika KOMATSU, Fuminari KOMATSU, Luigi M. CAVALLO, Domenico SOLARI, Vit ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 222-225
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 38-year-old woman presented with a case of post-traumatic ethmoidal cerebrospinal fluid (CSF) leak that was repaired using a purely endoscopic endonasal approach. Six weeks after a mild domestic maxillofacial trauma, she started complaining of clear, watery discharge from the left nostril and headache. Neuroimaging investigations disclosed a linear fracture of the left anterior ethmoidal roof without evidence of large bony breaches or any brain tissue damage. After conservative medical treatment with carbonic anhydrase inhibitors failed, she was referred to our hospital for surgical repair of the osteodural defect. An endoscopic endonasal transethmoidal approach was successfully performed, and an overlay technique was used to reconstruct the defect. The patient was discharged without clinical evidence of CSF rhinorrhea and no leaks were apparent at the 3-month follow-up clinical and radiological examinations. Post-traumatic CSF rhinorrhea occurs in cases of dural tears associated with small bone breaks, most frequently involving the anterior skull base. Recovery is often spontaneous following only bed rest, or with medical treatments such as inhibitors of carbonic anhydrase diuretics, steroids, or eventually stool softeners to help reduce CSF pressure. Surgical repair is required when first-line conservative treatment proves ineffective. The present case shows that the endoscopic endonasal technique for the management of CSF leaks provides a less invasive surgical route to achieve valid dural repair.
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—Case Report—Hidenori ENDO, Miki FUJIMURA, Takashi INOUE, Yasushi MATSUMOTO, Yoshik ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 226-229
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm.
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—Case Report—Yukiko NAKAHARA, Atsushi OGATA, Yukinori TAKASE, Kenji MAEDA, Hiroaki ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 229-232
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 76-year-old woman presented with a dural arteriovenous fistula (DAVF) manifesting as typical symptoms of normal pressure hydrocephalus such as progressive dementia, gait disturbances, and urinary incontinence. The cerebrospinal fluid pressure during lumbar puncture was 120 mmH2O. Computed tomography and magnetic resonance imaging showed ventricular dilation and diffuse white matter changes, which were consistent with the symptoms of hydrocephalus. Cerebral angiography revealed a DAVF in the transverse-sigmoid sinuses with severe cortical venous reflux into the superior sagittal sinus. Transarterial embolization of the feeding arteries reduced the venous flow from the cortical veins into the superior sagittal sinus. Her symptoms improved with reduction in ventricle size. However, she suffered recurrence of the same symptoms several months later. Computed tomography and magnetic resonance imaging demonstrated ventricular dilation associated with hydrocephalus. Angiography revealed a fistulous channel in the left transverse-sigmoid junction. Transvenous embolization was performed resulting in complete obliteration of the fistula. Magnetic resonance image findings such as ventricular dilation and diffuse white matter disappeared and the symptoms of hydrocephalus improved. Although DAVFs often present as venous hypertensive encephalopathy, this case presented with ventricular dilation and diffuse white matter changes, which are the typical neurological signs of normal-pressure hydrocephalus. Venous hypertension associated with the DAVF in the transverse-sigmoid sinuses may have been caused by normal pressure hydrocephalus.
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—Case Report—Tatsuya ISHIKAWA, Takakazu KAWAMATA, Akitsugu KAWASHIMA, Kohji YAMAGUC ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 233-235
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 38-year-old male presented with a meningioma within the internal auditory canal (IAC) manifesting as rapidly progressive hearing loss over a period of one month. He had a 2-year history of tinnitus. Magnetic resonance imaging revealed a 10-mm intracanalicular tumor, which was surgically resected by a retrosigmoid lateral suboccipital approach. The histological findings showed meningothelial meningioma. The patient had no facial palsy after surgery, but his cochlear function did not recover. Common symptoms of IAC meningiomas are tinnitus and hearing loss, but rapidly progressive hearing loss is very rare. IAC meningioma is rare but should be taken into consideration as a cause of rapidly progressive hearing loss.
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—Case Report—Nobuhiro HATA, Kei HISADA, Rina TORISU, Satoshi O. SUZUKI, Katsuharu K ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 236-238
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 72-year-old man presented with a space-occupying lesion at the site of the prior craniotomy one year after removal of a convexity meningioma with an extracranial extension. The lesion had grown outside the duraplasty with extracranial extension through the degenerative cranioplasty, and was removed. The histological diagnosis was granulation. The original dura-cranioplasty had been performed using Goretex dura substitute, hydroxyapatite cement, and fibrin glue-bonded autologous bone dust. This rare case of foreign body granuloma occurring after craniotomy with dura-cranioplasty indicates that detailed preoperative evaluation of tissue destruction based on neuroimaging is essential for construction of a suitable cranioplasty.
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—Case Report—Naoki NITTA, Akihiko SHIINO, Mitsuaki ISHIDA, Hidetoshi OKABE, Kazuhik ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 239-243
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 64-year-old woman presented with the history of transient global amnesia. Magnetic resonance imaging with contrast medium showed a lobulated heterogeneously enhanced cystic lesion attached to the superior surface of the right tentorium, indenting the right temporal lobe laterally and midbrain medially. A small part of the lesion was located under the right tentorium and did not involve the right trigeminal nerve. The lesion was subtotally resected via the subtemporal approach and did not affect the trochlear and trigeminal nerves. Histological examination showed that the lesion was schwannoma. Intracranial schwannomas usually arise from the cranial nerves. The present case of tentorial schwannoma not associated with the cranial nerves is extremely rare. Schwannoma should be included in the differential diagnosis of tumors arising from the tentorium.
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—Case Report—Fuminari KOMATSU, Hiroshi KAWAGUCHI, Hitoshi TSUGU, Shinya OSHIRO, Mik ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 243-246
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 23-year-old man was admitted with a rare case of radiation-induced astrocytoma manifesting as 3-month history of unstable gait. He had received 50 Gy of irradiation therapy for a germ cell tumor in the right basal ganglia 13 years earlier. Magnetic resonance (MR) imaging on admission showed a non-enhanced mass lesion in the right cerebellar hemisphere with expansion to the vermis. The histological diagnosis of the stereotaxic biopsy specimen was grade II astrocytoma. Two months later, he developed drowsiness, and MR imaging demonstrated that the tumor had enlarged and was enhanced after gadolinium injection. The clinical diagnosis was high-grade glioma resulting from malignant transformation. The tumor had compressed the mesencephalic aqueduct, leading to obstructive hydrocephalus. Endoscopic third ventriculostomy was performed to improve the cerebrospinal fluid circulation. He underwent chemotherapy with temozolomide postoperatively, but died 8 months after the initial diagnosis of astrocytoma. The clinical course of radiation-induced astrocytoma is not benign. The potential for malignant transformation necessitates careful postoperative follow up for patients with this tumor.
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—Case Report—Mayu TAKAHASHI, Yoshiteru SOEJIMA, Junkoh YAMAMOTO, Takeshi SAITO, Shi ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 247-250
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 58-year-old woman presented with 4 lesions of pulmonary adenocarcinoma which were curatively resected. No adjuvant therapy was needed because the lesions were all in the early stage. Magnetic resonance (MR) imaging of the brain, taken 10 months after the curative surgery, disclosed focal enhancement along the right central sulcus. Cerebrospinal fluid examination was normal. The lesion remained stable for 16 months, then began to spread out. She underwent open biopsy and the histological diagnosis was leptomeningeal metastasis from adenocarcinoma. She was treated with gefitinib at first because the lesion expressed epidermal growth factor receptor domain mutation. However, the lesion continued to enlarge, so she underwent whole cranial irradiation which was not effective. She died 2 years 10 months after the first detection of the metastasis. Early histological diagnosis is important even though the MR imaging lesion is not likely to be metastasis after curative surgery of the primary lesions.
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—Case Report—Yasunori FUJIMOTO, Yu HARADA, Shingo TOYOTA, Akatsuki WAKAYAMA, Hiroyu ...原稿種別: Case Report
2011 年 51 巻 3 号 p. 250-252
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 40-year-old man presented with a history of diplopia due to left abducens nerve palsy persisting for a few days. Neuroimaging examinations revealed a cystic mass in the clivus and erosion of its posterior wall. Drainage of the lesion was accomplished through a small bone defect in the anterior wall of the clivus using the endoscopic endonasal transsphenoidal approach. This procedure improved the symptoms of the patient. Intraoperative and histological findings led to a diagnosis of mucocele. A mucocele localized only in the clivus is uncommon and the pathogenesis may be closely related to pneumatization of the clivus.
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—Case Report—Muneyoshi YASUDA, Takahiro NAKURA, Taeko KAMIYA, Masakazu TAKAYASU原稿種別: Case Report
2011 年 51 巻 3 号 p. 253-255
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA 38-year-old male was referred because of pain in the left 5th lumbar (L5) root territory. Physical examination found moderate motor weakness in the left extensor hallucis longus (EHL) and the left tibialis anterior muscles. Magnetic resonance imaging found no stenotic lesion between L4-L5, but disc herniation was observed on the left between L1-L2. An L5 nerve root block provided temporary relief of the pain but the left foot weakness was exacerbated. Therefore, surgery was performed. Partial laminectomy and left herniotomy were performed at L1-L2, L2-L3, and L3-L4 with motor evoked potential (MEP) monitoring. The MEP amplitude of the left EHL muscle increased immediately after L1-L2 herniotomy. The MEP amplitude of the right EHL muscle also increased after both laminectomy and herniotomy. The postoperative course was uneventful. The left leg pain and motor weakness disappeared. The patient has been doing fine without recurrence for 12 months. Since the MEP of both left and right EHL muscles improved after the L1-2 herniotomy, circulatory insufficiency might have caused the L5 symptoms. Monitoring of the MEP during the surgery was useful for confirming the responsible lesion and also for predicting the postoperative course.
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—Case Report—Ryoma MORIGAKI, Kyong-Hon POOH, Yoshinobu NAKAGAWA原稿種別: Case Report
2011 年 51 巻 3 号 p. 256-259
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスA neonate with hydrocephalus associated with Dandy-Walker malformation was successfully treated with an endoscopic placement of a transaqueductal ventricular single catheter. The modified catheter was provided with additional fenestration on its proximal side to allow simultaneous drainage from both the supra- and infratentorial compartments. This technique is well known for isolated fourth ventricles, but has not been applied to hydrocephalus associated with Dandy-Walker malformation. The cyst-ventriculoperitoneal shunt effectively drained both compartments. The patient was doing well 18 months after the surgical procedure. Endoscopic transaqueductal shunt placement can be considered, especially in patients with aqueductal patency.
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Technical Note
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—Technical Note—Satoru SHIMIZU, Osamu TANAKA, Koji KONDO, Tomoya YAMAZAKI, Kenji NAKAY ...原稿種別: Technical Note
2011 年 51 巻 3 号 p. 260-262
発行日: 2011年
公開日: 2011/03/25
ジャーナル オープンアクセスDuring microneurosurgical procedures, surgeons sitting on a stool may experience muscular fatigue in the lower half of the body due to repeat manipulation of foot switches controlling the surgical microscope. The mechanisms contributing to this fatigue were examined and a method developed for fatigue reduction. The switch panel harboring the pedals was originally designed to be placed horizontally, but was inclined toward the surgeon with a sandbag placed under the panel. The modified panel was used in consecutive surgeries by 3 surgeons. Surface electromyographs of the bilateral gastrocnemius and gluteus maximus muscles were obtained during simulated activation of the switches on horizontal and inclined panels using the left foot. Inclined panels facilitated stepping on the pedals, required less muscle power, and lessened fatigue and hip pain. Electromyographs obtained during stepping on the switches on the horizontal panel showed contraction of the left gluteus maximus, and the right gastrocnemius and gluteus maximus, muscles that do not directly contribute to stepping, in addition to contraction of the left gastrocnemius, a main muscle in the stepping motion, i.e. flexion of the ankle. Electromyographs obtained during stepping on the switches on the inclined panel showed muscle contraction was limited to the left gastrocnemius with lower frequency and amplitude motor unit potentials compared to those elicited during use of the horizontal panel. Our simple modification facilitates operating microscope manipulation and reduces surgeon fatigue.
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Editorial Committee
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2011 年 51 巻 3 号 p. EC5-EC6
発行日: 2011年
公開日: 2013/02/20
ジャーナル オープンアクセスPDF形式でダウンロード (55K)
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