Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 55, Issue 4
Displaying 1-12 of 12 articles from this issue
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Review Articles
  • Current Trends in Health Insurance Systems: OECD Countries vs. Japan
    Toshiyuki SASAKI, Masahiro IZAWA, Yoshikazu OKADA
    2015 Volume 55 Issue 4 Pages 267-275
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.ra.2014-0317
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    Over the past few decades, the longest extension in life expectancy in the world has been observed in Japan. However, the sophistication of medical care and the expansion of the aging society, leads to continuous increase in health-care costs. Medical expenses as a part of gross domestic product (GDP) in Japan are exceeding the current Organization for Economic Co-operation and Development (OECD) average, challenging the universally, equally provided low cost health care existing in the past. A universal health insurance system is becoming a common system currently in developed countries, currently a similar system is being introduced in the United States. Medical care in Japan is under a social insurance system, but the injection of public funds for medical costs becomes very expensive for the Japanese society. In spite of some urgently decided measures to cover the high cost of advanced medical treatment, declining birthrate and aging population and the tendency to reduce hospital and outpatients’ visits numbers and shorten hospital stays, medical expenses of Japan continue to be increasing.
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  • Japanese Neurosurgeons and Microsurgical Anatomy: A Historical Review
    Toshio MATSUSHIMA, Masatou KAWASHIMA, Ken MATSUSHIMA, Masahiko WANIBUC ...
    2015 Volume 55 Issue 4 Pages 276-285
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.ra.2014-0408
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    Research in microneurosurgical anatomy has contributed to great advances in neurosurgery in the last 40 years. Many Japanese neurosurgeons have traveled abroad to study microsurgical anatomy and played major roles in advancing and spreading the knowledge of anatomy, overcoming their disadvantage that the cadaver study has been strictly limited inside Japan. In Japan, they initiated an educational system for surgical anatomy that has contributed to the development and standardization of Japanese neurosurgery. For example, the Japanese Society for Microsurgical Anatomy started an annual educational meeting in the middle of 1980s and published its proceedings in Japanese every year for approximately 20 years. These are some of the achievements that bring worldwide credit to Japanese neurosurgeons. Not only should Japanese neurosurgeons improve their educational system but they should also contribute to the international education in this field, particularly in Asia.
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  • Trends and Outcomes in the Treatment of Gliomas Based on Data during 2001–2004 from the Brain Tumor Registry of Japan
    Yoshitaka NARITA, Soichiro SHIBUI, On Behalf of the Committee of Brai ...
    2015 Volume 55 Issue 4 Pages 286-295
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.ra.2014-0348
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    The committee of Brain Tumor Registry of Japan (BTRJ) was founded in 1973 and conducts surveys and analyses of incidence, therapeutic methods, and treatment outcomes of primary and metastatic brain tumors with the cooperation of the Japan Neurosurgical Society members. Newly diagnosed 3,000–4,000 primary brain tumors and 600–1,000 brain metastases patients were enrolled in each year. This report describes the trends and treatment outcomes of gliomas from BTRJ volume 13, including 13,431 patients with primary brain tumors who newly started treatment from 2001 to 2004. Data from 382 diffuse astrocytomas (DAs), 121 oligodendrogliomas (OLs), 90 oligoastrocytomas (OAs), 513 anaplastic astrocytomas (AAs), 126 anaplastic oligodendrogliomas (AOs), 106 anaplastic oligoastrocytomas (AOAs), and 1,489 glioblastomas (GBMs) were analyzed for overall survival (OS) and progression free survival (PFS) depending on age, symptoms, Karnofsky performance status, location of the tumor, extent of resection (EOR), initial radiotherapy and chemotherapy. The 5-year PFS rates of the patients with DA, OL + OA, AA, AO + AOA, and GBM were 57.0%, 74.6%, 28.7%, 54.0%, and 9.2%, and the 5-year OS rates were 75.0%, 90.0%, 41.1%, 68.2%, and 10.1%, respectively. Higher EOR ≥ 75% in DA and OL + OA and that ≥ 50% in AA, AO + AOA, and GBM significantly prolonged OS. Complications and cause of death were also reported. BTRJ had been edited for all the patients, researchers, and especially for clinicians at bedside to give useful information about brain tumors and to contribute to the advances in brain tumor treatment. This report revealed various clinical problematic issues pertaining to the diagnosis and treatment of gliomas.
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  • Recent Progress and Future Issues in the Management of Abusive Head Trauma
    Hiroshi NISHIMOTO
    2015 Volume 55 Issue 4 Pages 296-304
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.ra.2014-0349
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    Head trauma is the leading cause of death in child abuse cases and one of the important issues in the care of abused children. Since the Child Abuse Prevention Law was enforced in 2000 in Japan, various measures have been taken to prevent child abuse over the following decade. Accordingly, medical research on abusive head trauma (AHT) has advanced, leading to significant progress in the medical diagnosis of AHT. This progress has been brought about by (1) the widespread establishment of child protection teams (CPTs) at core hospitals, (2) the progress in neuroradiological imaging and ophthalmoscopic technologies, and (3) the introduction of postmortem imaging. However, the pathological condition of patients with AHT, particularly that of the diffuse brain swelling type, still remains poorly understood. As a result, no clear treatment strategies for AHT have been developed and no treatment outcomes have been improved to date. The development of new treatment strategies for AHT and the construction of a comprehensive database that supports clinical studies are required in the future.
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Original Articles
  • Efficacy of Monitoring Patient’s Position during Neurosurgical Procedures: Introduction of Real-time Display and Record
    Mitsuhiro HASEGAWA, Mohsen NOURI, Hironori FUJISAWA, Yutaka HAYASHI, J ...
    2015 Volume 55 Issue 4 Pages 305-310
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2014-0256
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    There are many reports on position-related complications in neurosurgical literature but so far, continuous quantification of the patient’s position during the surgery has not been reported. This study aims to explore the utility of a new surgical table system and its software in displaying the patient’s body positions during surgery on real-time basis. More than 200 neurosurgical cases were monitored for their positions intra-operatively. The position was digitally recorded and could be seen by all the members in the operating team. It also displayed the three-dimensional relationship between the head and the heart positions. No position-related complications were observed during the study. The system was able to serve as an excellent indicator for monitoring the patient’s position. The recordings were analyzed and even used to reproduce or improve the position in the subsequent operations. The novel technique of monitoring the position of the head and the heart of the patients and the operating table planes are considered to be useful during delicate neurosurgical procedures thereby, preventing inadvertent procedural errors. This can be used to quantify various surgical positions in the future and define safety measures accordingly.
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  • An Armrest is Effective for Reducing Hand Tremble in Neurosurgeons
    Yosuke HARA, Tetsuya GOTO, Jun OKAMOTO, Hideki OKUDA, Hiroshi ISEKI, K ...
    2015 Volume 55 Issue 4 Pages 311-316
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2014-0384
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    Experienced neurosurgeons reduce hand tremble by placing their hand beside the operative field when performing microneurosurgery conventionally. Another solution to reduce hand tremble is an armrest. However, the reduction of hand tremble by using an armrest or finger-placing technique has not been rigorously measured in microneurosurgery. This study was performed to provide a quantitative assessment of the efficacy of an armrest to reduce hand tremble in comparison with the finger-placing technique. Hand tremble was evaluated in 11 board-certified neurosurgeons in a simulated microneurosurgery. The loci of surgical forceps handled by neurosurgeons were measured by a three-dimensional optical coordinate measuring machine. A static task was performed under four conditions: with/without the finger-placing technique and/or an armrest. The radius of an imaginative sphere including 95% of each locus was calculated and reviewed according to the four conditions. Hand tremble was significantly larger when the finger-placing technique was not implemented compared to when the technique was used (P < 0.05). The armrest also reduced hand tremble (P < 0.05) similar to the finger-placing technique. Non-inferiority was retained between the finger-placing technique and the armrest. Concomitant use of the armrest and the finger-placing technique did not interfere with the efficacy of the technique to reduce neurosurgeon’s hand tremble. The finger-placing technique was confirmed to reduce hand tremble. Resting the neurosurgeon’s forearm on an armrest also reduced the hand tremble. An armrest is a device that reduces hand tremble in neurosurgeons like the finger-placing technique.
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Review Article
  • Surgical Management of Spinal Intramedullary Tumors: Radical and Safe Strategy for Benign Tumors
    Toshihiro TAKAMI, Kentaro NAITO, Toru YAMAGATA, Kenji OHATA
    2015 Volume 55 Issue 4 Pages 317-327
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.ra.2014-0344
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    Surgery for spinal intramedullary tumors remains one of the major challenges for neurosurgeons, due to their relative infrequency, unknown natural history, and surgical difficulty. We are sure that safe and precise resection of spinal intramedullary tumors, particularly encapsulated benign tumors, can result in acceptable or satisfactory postoperative outcomes. General surgical concepts and strategies, technical consideration, and functional outcomes after surgery are discussed with illustrative cases of spinal intramedullary benign tumors such as ependymoma, cavernous malformation, and hemangioblastoma. Selection of a posterior median sulcus, posterolateral sulcus, or direct transpial approach was determined based on the preoperative imaging diagnosis and careful inspection of the spinal cord surface. Tumor-cord interface was meticulously delineated in cases of benign encapsulated tumors. Our retrospective functional analysis of 24 consecutive cases of spinal intramedullary ependymoma followed for at least 6 months postoperatively demonstrated a mean grade on the modified McCormick functional schema of 1.8 before surgery, deteriorating significantly to 2.6 early after surgery (< 1 month after surgery), and finally returning to 1.7 in the late postoperative period (> 6 months after surgery). The risk of functional deterioration after surgery should be taken into serious consideration. Functional deterioration after surgery, including neuropathic pain even long after surgery, significantly affects patient quality of life. Better balance between tumor control and functional preservation can be achieved not only by the surgical technique or expertise, but also by intraoperative neurophysiological monitoring, vascular image guidance, and postoperative supportive care. Quality of life after surgery should inarguably be given top priority.
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Original Articles
  • Surgical Treatment of Intraspinal Angiomatous Meningiomas from a Single Center
    Liang WU, Tao YANG, Chenlong YANG, Xiaofeng DENG, Jingyi FANG, Yulun X ...
    2015 Volume 55 Issue 4 Pages 328-335
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2014-0274
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    Intraspinal angiomatous meningiomas (AMs) are rare lesions, and no case series have been reported. We retrospectively reviewed the data of 12 patients with intraspinal AMs. All patients underwent magnetic resonance imaging (MRI) of the spine. Computed tomography angiography was performed for three cases with cervical lesion. The series included six females and six males with a mean age of 49.6 years. Five tumors were located in the cervical, one in the cervicothoracic, five in the thoracic, and one in the thoracolumbar spine. The most common symptom was motor deficits and the mean duration of symptoms was 18 months. All patients were treated surgically with gross total resection (GTR) (Simpson grade I and II resection). No patients underwent embolization. After surgery immediately, the neurological function was improved in five patients, remained stable in six patients, and was deteriorated in one patient. During an average follow up of 78.6 months, 11 patients experienced an improvement in the neurological function and one patient maintained preoperative status. No tumor recurrence was observed on MRI. Compared to conventional meningiomas, AMs have no special clinical and radiological features. The accurate diagnosis depends on pathology. Timely GTR (en bloc resection) is the best treatment and embolization is not necessary for most patients. Radiotherapy is not recommended after GTR (Simpson grade I and II resection), and the risk of tumor recurrence is low.
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  • Endoscopic Transnasal Interseptal Approach for Invasive Clival Tumors: Development of an Approach Method Regarding Maximal Preservation of the Nasal Anatomy
    Masahiro SHIN, Kenji KONDO, Taichi KIN, Keigo SUZUKAWA, Nobuhito SAITO
    2015 Volume 55 Issue 4 Pages 336-344
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.oa.2014-0280
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    Asian people frequently show small noses, narrow nasal apertures, and congestive mucosa on the turbinates and septum. To reduce the risk of nasal morbidity with increased radicality for skull base tumors in these patients, we developed endoscopic transnasal interseptal approach (ETISA) in transsphenoidal surgery for invasive clival tumors (ICTs). Indication for ETISA is radical resection for tumors occupying deep ventral skull base regions, confined posterior to the level of the middle turbinates. After removing ethmoidal air cells, the middle turbinates are laterally deflected. A linear incision is made vertically on each side of the septal mucosa, which is separated from the bony septum as far as the sphenoid rostrum. The blades of an adjustable speculum are inserted submucosally, and the bony septum is temporarily displaced. The surgical pathway is widely maintained from the entrance to the deep surgical field without sacrificing the nasal mucosa and turbinates. Thirty-two consecutive patients with clival tumors (18 chordomas, 11 chondrosarcomas, 3 others) were treated. Bilateral middle turbinectomy was routinely performed in the initial 3 patients, but in only 4 of the remaining 29 (3 unilaterally, 1 bilaterally). Tumor was sufficiently resected in 29 patients (90.6%; gross total removal n = 25, subtotal resection n = 4). As complications, 6 patients showed mild and transient worsening of cranial nerve symptoms. Nasal complications arose in 3 patients, persisting > 3 months in 2 (5.7%). This approach allows fine bimanual handling and swift delivery of surgical equipment while reasonably preserving the nasal anatomy, which is useful in endoscopic transsphenoidal surgery for ICT.
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Technical Notes
  • Superior Turbinectomy: Role for a Two-surgeon Technique in Endoscopic Endonasal Transsphenoidal Surgery—Technical Note
    Yasunori FUJIMOTO, Henrique F. RAMOS, Pedro P. MARIANI, Fabrizio R. RO ...
    2015 Volume 55 Issue 4 Pages 345-350
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.tn.2014-0159
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    We describe a practical technique of superior turbinectomy followed by posterior ethmoidectomy as a less invasive procedure for two-surgeon technique on endoscopic endonasal transsphenoidal surgery. After identification of the superior turbinate and the sphenoid ostium, the inferior third portion of the superior turbinate was coagulated and resected. This partial superior turbinectomy procedure exposed the posterior ethmoidal sinus. Resection of the bony walls between the sphenoid and posterior ethmoid sinuses provided more lateral and superior exposure of the sphenoid sinus. This technique was performed in 56 patients with midline skull base lesions, including 49 pituitary adenomas and 7 other lesions. Meticulous manipulation of instruments was performed in all cases without surgical complications such as permanent hyposmia/anosmia or nasal bleeding. Our findings suggested that the partial superior turbinectomy followed by retrograde posterior ethmoidectomy is a simple and safe technique providing a sufficient surgical corridor for two-surgeon technique to approaching midline skull base regions, mainly involving pituitary adenomas.
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  • Petrous Apex Cholesterol Granuloma: Importance of Pedicled Nasoseptal Flap in Addition to Silicone T-tube for Prevention of Occlusion of Drainage Route in Transsphenoidal Approach—A Technical Note
    Shunsuke SHIBAO, Masahiro TODA, Toshiki TOMITA, Katsuya SAITO, Kaoru O ...
    2015 Volume 55 Issue 4 Pages 351-355
    Published: 2015
    Released on J-STAGE: April 15, 2015
    Advance online publication: March 23, 2015
    DOIhttps://doi.org/10.2176/nmc.tn.2014-0254
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    Recently, petrous apex cholesterol granulomas (CGs) have been treated via the endoscopic endonasal transsphenoidal approach (EEA) using a silicone tube, to prevent drainage route occlusion. Occlusion of the drainage route has led to problems with recurrence. The aim of this report is to describe the use of a surgical technique to prevent drainage route occlusion. In surgical technique, the posterolateral wall of the sphenoid sinus was opened by EEA. After cyst debridement, a vascularized nasoseptal flap with a width of approximately 4 cm was inserted into the lumen with a silicone T-tube with a diameter of 7 mm. This technique was used in two patients: the first patient during the second operation after recurrence following occlusion of the drainage route, and the second patient during the first operation. Opening of the cyst wall was confirmed endoscopically in both patients 12–24 months after surgery, even after removal of the T-tube. In conclusion, the use of a pedicled nasoseptal flap with a silicone tube is useful to prevent CG recurrence, by paranasal cavitization of the cystic cavity.
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Editorial Committee
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