Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 57 , Issue 4
Showing 1-7 articles out of 7 articles from the selected issue
Review Article
  • Hiroshi NISHIOKA
    2017 Volume 57 Issue 4 Pages 151-158
    Published: 2017
    Released: April 15, 2017
    [Advance publication] Released: February 24, 2017
    JOURNALS OPEN ACCESS

    For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors.

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Original Articles
  • Hong Bum KIM, Moon Kyu LEE, Young-Seok LEE, Jun-Young SOHN, Sang Ku JU ...
    2017 Volume 57 Issue 4 Pages 159-165
    Published: 2017
    Released: April 15, 2017
    [Advance publication] Released: October 11, 2016
    JOURNALS OPEN ACCESS

    The most important factor for cervical pedicle screw placement (CPS) is creating a sufficient medial angle. We aimed to know the medial angle of the inserted subaxial CPS during surgery using intraoperative AP X-rays. From March 2012 to September 2014, we performed posterior cervical fusions using CPS on 75 patients, including a total of 389 CPS insertions. Using preoperative CT scanning, we determined the θlat (i.e., an angle between a vertical line and a line to connect the planned entry point and the axial middle point of the pedicle) and θmed (i.e., an angle between a vertical line and a line to connect a new medial entry point and the axial middle point of the pedicle; this angle was regarded as minimally acceptable and a safe medial angle). The actual inserted medial angle (θins) was checked and we determined whether it was between the θmed and θlat in the accurately placed CPS, and not in the laterally violated CPS. We measured the horizontal distance of the CPS body (l; using an intraoperative AP X-ray). If the actual screw length (L) was known, we could calculate the medial angle (θAP) as sin−1 l / L. We checked the θAP and θins for all of the same levels. Intra- and inter-observer agreement was analyzed. Among 368 accurately inserted CPSs, we found that 360 of the θins values were greater than or equal to the θmed on the same level (P <0.001). The intra-observer agreements were 0.781 and 0.847. The inter-observer agreements were 0.917 and 0.949. It was important that θins was greater than or equal to the θmed. Our suggested formula, θAP = sin−1 l / L, seems to be useful for predicting the medial angle of the inserted CPS and for comparing it with θmed during surgery based on an AP X-ray and preoperative CT scan.

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  • Chikashi FUKAYA, Mitsuru WATANABE, Kazutaka KOBAYASHI, Hideki OSHIMA, ...
    2017 Volume 57 Issue 4 Pages 166-171
    Published: 2017
    Released: April 15, 2017
    [Advance publication] Released: January 31, 2017
    JOURNALS OPEN ACCESS

    Despite the recognition of the usefulness of subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson’s disease (PD), preoperative predictive factors for the long-term outcome of STN-DBS are not sufficiently established. We performed this study to determine such predictive factors. The subjects were 66 patients who were classified into two groups on the basis of their activities of daily living (ADL) evaluated five years after the STN-DBS surgery: 33 patients were assigned to the independent ADL group (group I) and the remaining 33 patients to the dependent ADL group (group D). Group I patients showed a Schwab and England (S&E) scale score of more than 70 during the off-period, indicating that these patients can maintain their independent ADL all the time. Group D patients showed a score of 70 or lower during the off-period, indicating that these patients cannot maintain their independent ADL for an entire day. We studied the differences in the preoperative state between these two groups. Statistically significant differences were noted in PD onset age, age at surgery, preoperative unified Parkinson’s disease rating scale (UPDRS) part I score, part II score, total subscore for axial symptoms in part III, mini-mental state examination (MMSE) score and S&E score. Multiple logistic regression analysis showed that the significant independent variables related to long-term independent ADL were the age at surgery, MMSE score and preoperative S&E scale score during the off-period. The PD onset age, age at surgery, preoperative high-level ADL, cognitive function, and axial symptoms are important predictive factors for the long-term outcome of STN-DBS.

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Review Article
  • Masatoshi YUNOKI, Takahiro KANDA, Kenta SUZUKI, Atsuhito UNEDA, Koji H ...
    2017 Volume 57 Issue 4 Pages 172-183
    Published: 2017
    Released: April 15, 2017
    [Advance publication] Released: February 02, 2017
    JOURNALS OPEN ACCESS

    Idiopathic carpal tunnel syndrome (CTS) is a common complaint, reflecting entrapment neuropathy of the upper extremity. CTS produces symptoms similar to those of other conditions, such as cervical spondylosis or ischemic or neoplastic intracranial disease. Because of these overlaps, patients with CTS are often referred to a neurosurgeon. Surgical treatment of CTS was started recently in our department. Through this experience, we realized that neurosurgeons should have an increased awareness of this condition so they can knowledgeably assess patients with a differential diagnosis that includes CTS and cervical spinal and cerebral disease. We conducted a literature review to gain the information needed to summarize current knowledge on the clinical, pathogenetic, and therapeutic aspects of CTS. Because the optimal diagnostic criteria for this disease are still undetermined, its diagnosis is based on the patient’s history and physical examination, which should be confirmed by nerve conduction studies and imaging modalities such as magnetic resonance imaging and ultrasonography. Treatment methods include observation, medication, splinting, steroid injections, and surgical intervention. Understanding the clinical features and pathogenesis of CTS, as well as the therapeutic options available to treat it, is important for neurosurgeons if they are to provide the correct management of patients with this disease.

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Original Article
  • Yoshifumi MIZOBUCHI, Keiji MURAMATSU, Makoto OHTANI, Junichiro SATOMI, ...
    2017 Volume 57 Issue 4 Pages 184-190
    Published: 2017
    Released: April 15, 2017
    [Advance publication] Released: February 09, 2017
    JOURNALS OPEN ACCESS

    Microvascular decompression (MVD) is widely used as a safe and effective treatment for hemifacial spasm (HFS). However, the extent of application of this therapeutic method and its outcomes in Japan are currently unclear. To address these questions, we analyzed the utilization of MVD for the treatment of HFS during the 33- month period from July 2010 to March 2013. We conducted an analysis on data contained in the Diagnosis Procedure Combination database in Japan. This analysis showed that MVD was used for the treatment of HFS in 2907 cases (men, 916; women, 1991) with 2.2 times more women treated than men. MVD for HFS was most frequently performed in women aged 50 to 69 years; however, most men were aged between 40 and 59 years at the time of the procedure. The numbers of procedures performed per 100,000 population/year were 0.83 overall in Japan, with the numbers larger in prefectures with larger populations. Regarding discharge outcomes, the mortality rate was 0.1%. The mean length of hospital stay in patients undergoing MVD for HFS was 14.7 days. This analysis provides preliminary information regarding the trends in the performance of MVD for the treatment of HFS in Japan. Further studies on other registries that contain data obtained by standardized assessment methods and that include long-term outcomes and postoperative complications are required.

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Case Report
  • Motomasa FURUSE, Naosuke NONOGUCHI, Naoki OMURA, Mitsuaki SHIRAHATA, K ...
    2017 Volume 57 Issue 4 Pages 191-197
    Published: 2017
    Released: April 15, 2017
    [Advance publication] Released: March 23, 2017
    JOURNALS OPEN ACCESS

    We report effective treatment with nivolumab of a patient with recurrent primary central nervous system lymphoma (PCNSL) after multiple therapies. A 41-year-old woman with a right parietal PCNSL underwent treatment with high-dose methotrexate and radiotherapy. After recurrence in the left frontal lobe, the patient received several chemotherapies, including methotrexate and rituximab, and underwent surgery. The tumor was refractory to these treatments, and the patient then underwent intensity-modulated radiotherapy (IMRT). Multiple small, new recurrent tumors appeared in the right frontal lobe and the left frontoparietal region 2 months after IMRT. The patient received nivolumab 3 mg/kg with dendritic cell vaccination. Complete remission of the tumors was achieved after six cycles of nivolumab, and remission was maintained for 10 months after the initiation of nivolumab. Nivolumab could be a novel treatment for intractable recurrent PCNSL in the future.

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