Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 58, Issue 11
Displaying 1-5 of 5 articles from this issue
Original Articles
  • Hidenori OISHI, Kosuke TERANISHI, Kenji YATOMI, Takashi FUJII, Munetak ...
    2018 Volume 58 Issue 11 Pages 461-467
    Published: 2018
    Released on J-STAGE: November 15, 2018
    Advance online publication: October 06, 2018
    JOURNAL OPEN ACCESS

    Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients’ mean age was 63.4 years (range, 19–88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments. Mean aneurysm size and neck width were 16.9 ± 6.8 mm and 8.3 ± 4.4 mm, respectively, in 40 symptomatic and 60 asymptomatic aneurysms. Follow-up catheter angiographies of 85 patients with 90 aneurysms showed no filling in 62 aneurysms (68.9%), entry remnant in 16 (17.8%), subtotal filling in 11 (12.2), and total filling in 1 (1.1%) with a mean follow-up of 10.2 ± 5.6 months. In-stent stenosis occurred in 1 patient and parent artery occlusion in 2 during follow-up. Hemorrhagic complications occurred in 4 (4.3%): delayed aneurysm rupture (2) and intraparenchymal hemorrhage (2). Ischemic complications with neurological symptoms occurred in 2 (2.1%): very delayed device occlusion (1) and intraprocedural distal embolism (1). Eighteen patients (45%) showed improvement in pre-existing cranial nerve dysfunction because of the aneurysm’s mass effect, 3 patients (7.5%) worsened. One patient died of systemic organ failure unassociated with the procedure. Morbidity and mortality rates were 4.3% and 1.1%, respectively. PED embolization for unruptured large and giant ICA aneurysms is safe and efficacious. Physicians should be observant of characteristic risks associated with FD therapy.

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  • Toshiyuki OKAZAKI, Hiroshi NAKAGAWA, Hideo MURE, Kenji YAGI, Hitoshi H ...
    2018 Volume 58 Issue 11 Pages 468-476
    Published: 2018
    Released on J-STAGE: November 15, 2018
    Advance online publication: October 06, 2018
    JOURNAL OPEN ACCESS

    This study was to assess the efficacy of microdiscectomy, cage fixation, and right tranuncal foramintomy for the patients suffering from right radiulo-myelopathy. Anterior cervical foraminotomy was reported to be an effective option for the treatment of cervical degenerative radiculopathy but with the problem of recurrence. Since Hakuba reported the method of trans-unco-discal approach in 1976, it was designed as keyhole foraminotomy which was called transuncal approach, transpedicular approach or transvertebral approach. In the anterior approach, we usually use the right-sided approach because most of us are right-handed surgeons. We retrospectively investigated our patients who had the right foraminal stenosis causing radiculopathy and were treated with microdiscectomy, cage fixation, and right keyhole transuncal foraminotomy. Since 2011, 23 patients were treated with the manner. All of the 23 patients who had central canal stenosis and among the 23 patients, 8 patients showed only right radiculopathy and 15 patients showed radiculo-myelopathy. In all patients, the radiculopathy disappeared or significantly improved without any complications postoperatively. The average of VAS scores was 7.6 ± 2.2 in preoperative state, 2.8 ± 2.2 at discharge, and 1.1 ± 1.6 in 1 month after surgery. The average of follow-up time was 38.3 months and they had no recurrence of radiculopathy. We showed that this manner is effective and one option for the combined disease of right foraminal and canal stenosis and we believe that this manner is not complex and safe if we can understand the anatomy.

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Technical Note
  • Koichi TORIHASHI, Shigeo SORA, Hiroaki SATO, Michihiro KOHNO
    2018 Volume 58 Issue 11 Pages 477-480
    Published: 2018
    Released on J-STAGE: November 15, 2018
    Advance online publication: September 21, 2018
    JOURNAL OPEN ACCESS

    Preservation of facial nerve (FN) function is the most important goal in acoustic neuroma (AN) surgery. We have been using intraoperative continuous facial nerve monitoring (ICFNm) of evoked electromyography during AN surgery. ICFNm is very useful, and we can identify the real-time functions of the FN. Some surgeons have experienced difficulty with placing the ICFN stimulating electrode (SE). We therefore show how to place the ICFN SE. We mostly perform AN surgery with a retrosigmoid approach (RSA). A craniotomy with four burr holes is performed. We dissect the arachnoid membrane along the accessory nerve from the cisterna magna to the glossopharyngeal nerve. When we are able to identify the root exit zone (REZ) of the FN near the brainstem, we place the ICFN SE on it. However, when a large tumor covers the REZ, we have to debulk the tumor to create a space between the tumor and the glossopharyngeal nerve. After that, we can place the SE on the REZ. A method for placement of the ICFN SE is needed for some techniques of AN surgery. Once we learn how to place the SE, we can identify continuous FN function during AN surgery. This method is useful for the preservation of postoperative FN function in AN surgery.

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Case Report
  • Yasuyoshi SHIMADA, Daigo KOJIMA, Jun YOSHIDA, Masakazu KOBAYASHI, Kenj ...
    2018 Volume 58 Issue 11 Pages 481-484
    Published: 2018
    Released on J-STAGE: November 15, 2018
    Advance online publication: October 25, 2018
    JOURNAL OPEN ACCESS

    Cerebral hyperperfusion syndrome following arterial bypass surgery is known as a surgical complication of moyamoya disease (MMD). How cerebral hyperperfusion affects neural function and causes neurological deficits remains unknown. We report here a case with cerebral hyperperfusion syndrome after arterial bypass surgery for ischemic MMD. Chronological changes of brain perfusion and central benzodiazepine receptor biding potential were observed using single-photon emission computed tomography. A 20-year-old woman with ischemic MMD underwent arterial bypass surgery. Six days later, cerebral hyperperfusion syndrome developed. During this syndrome, contralateral-to-ipsilateral cerebellar asymmetry of blood flow and a decrease in central benzodiazepine receptor binding potential in the area with hyperperfusion were observed. Four months later, these two findings resolved and a neurological examination revealed no abnormal signs. Cerebral hyperperfusion after arterial bypass surgery for ischemic MMD may lead to transient, reversible reduction of cerebral metabolism and downregulation of cortical neurotransmitter receptor function, resulting in transient neurological deficits.

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Editorial Committee
  • 2018 Volume 58 Issue 11 Pages EC21-EC22
    Published: 2018
    Released on J-STAGE: November 15, 2018
    JOURNAL FREE ACCESS
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