Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 60, Issue 9
Displaying 1-8 of 8 articles from this issue
Review Articles
  • Masaaki UNO, Hiroki TAKAI, Kenji YAGI, Shunji MATSUBARA
    2020 Volume 60 Issue 9 Pages 419-428
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 15, 2020
    JOURNAL OPEN ACCESS

    Over the last 60 years, many reports have investigated carotid endarterectomy (CEA) and techniques have thus changed and improved. In this paper, we review the recent literature regarding operational maneuvers for CEA and discuss future problems for CEA. Longitudinal skin incision is common, but the transverse incision has been reported to offer minimal invasiveness and better cosmetic effects for CEA. Most surgeons currently use microscopy for dissection of the artery and plaque. Although no monitoring technique during CEA has been proven superior, multiple monitors offer better sensitivity for predicting postoperative neurological deficit. To date, data are lacking regarding whether routine shunt or selective shunt is better. Individual surgeons thus need to select the method with which they are more comfortable. Many surgical techniques have been reported to obtain distal control of the internal carotid artery in patients with high cervical carotid bifurcation or high plaque, and minimally invasive techniques should be considered. Multiple studies have shown that patch angioplasty reduces the risks of stroke and restenosis compared with primary closure, but few surgeons in Japan have been performing patch angioplasty. Most surgeons thus experience only a small volume of CEAs in Japan, so training programs and development of in vivo training models are important.

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  • Isamu MIURA, Eric T.N. OVERTON, Nobuhiro NAKAI, Takakazu KAWAMATA, Mas ...
    2020 Volume 60 Issue 9 Pages 429-438
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 31, 2020
    JOURNAL OPEN ACCESS

    Social behavior includes a variety of behaviors that are expressed between two or more individuals. In humans, impairment of social function (i.e., social behavior and social cognition) is seen in neurodevelopmental and neurological disorders including autism spectrum disorders (ASDs) and stroke, respectively. In basic neuroscience research, fluorescence monitoring of neural activity, such as immediate early gene (IEG)-mediated whole-brain mapping, fiber photometry, and calcium imaging using a miniaturized head-mounted microscope or a two-photon microscope, and non-fluorescence imaging such as functional magnetic resonance imaging (fMRI) are increasingly used to measure the activity of many neurons and multiple brain areas in animals during social behavior. In this review, we overview recent rodent studies that have investigated the dynamics of brain activity during social behavior at the whole-brain and local circuit levels and studies that explored the neural basis of social function in healthy, in brain-injured, and in autistic human subjects. A synthesis of such findings will advance our understanding of brain mechanisms underlying social behavior and facilitate the development of pharmaceutical and functional neurosurgical interventions for brain disorders affecting social function.

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Original Articles
  • Masahito KATSUKI, Yukinari KAKIZAWA, Akihiro NISHIKAWA, Keiko KUNITOKI ...
    2020 Volume 60 Issue 9 Pages 439-449
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 15, 2020
    JOURNAL OPEN ACCESS

    We report cases of acute subdural hematoma (ASDH) treated by endoscopic hematoma removal with a small craniotomy under local anesthesia. From 2015 to 2019, we retrospectively analyzed 15 ASDH patients who were 70 years or older and met our criteria for endoscopic treatment: (1) comorbidities indicated risks associated with a large craniotomy under general anesthesia; (2) decompressive craniectomy was unlikely; and (3) an enlarging hematoma was absent. We also performed a case–control study using the inverse probability weighting method to compare the 15 patients to 20 ASDH patients who were 70 years or older, met criteria (2) and (3), and were treated by craniotomy between 2012 and 2019. Among the 15 ASDH patients, the median age was 86 (range, 70–101) years, and fall was the common cause. The median Glasgow Coma Scale score on admission, operative time, stay time in the operation room, and bleeding amount were 8 (6–15), 91 (48–156) min, 120 (80–205) min, and 20 (5–400) mL, respectively. The extraction rates of all the hematomas exceeded 90%. No patients required conversion to craniotomy under general anesthesia. Three patients had favorable outcomes, and five died. The comparison with craniotomy revealed that the endoscopic procedure reduced the intraoperative bleeding amount, operative time, and stay time in the operation room (p <0.001, p = 0.02, and p <0.001, respectively). In summary, endoscopic hematoma removal for selected ASDH patients aged 70 years or older did not improve functional outcomes but reduced the bleeding amount and the operative time compared with craniotomy.

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  • Hiroto OKOSHI, Takashi YAMAUCHI, Machi SUKA, Kiyoshi SAITO, Chikako NI ...
    2020 Volume 60 Issue 9 Pages 450-457
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 15, 2020
    JOURNAL OPEN ACCESS

    Although it is important for patients with neurofibromatosis type 2 (NF2) to live independently and maintain good quality of life (QOL), no study has examined the social independence status in this patient population. This study aimed to examine the state of social independence and its contributing factors in patients with NF2 using data from a national registry in Japan during the past decade. A database provided by the Ministry of Health, Labour and Welfare of Japan that contained information about all patients with newly submitted claims for medical expense subsidies for NF2 in Japan between fiscal years 2004 and 2013 was analyzed. Individuals aged 6 to 64 years were deemed eligible for the present study. Categories of “employed,” “studying,” and “housekeeping” were classified as “socially independent.” Multivariate logistic regression analysis was performed to examine associations between demographic variables, neurological features, and social independence status. Of 334 participants, 79% were socially independent at the time of registration. Socially dependent participants had more neurological features than those who were socially independent, whereas sex, age, and family history had no significant associations with social independence status. Multivariate logistic regression analysis revealed that participants with bilateral hearing loss, unilateral hearing loss, blindness, hemiplegia, or seizures had significantly higher odd ratios for being socially dependent compared to participants without these features. Our findings, which suggest that these neurological features could restrict social independence, could contribute to the maintenance of better social functioning and QOL in patients with NF2.

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  • Hiroyuki YAMADA, Takashi MARUYAMA, Yoshiyuki KONISHI, Ken MASAMUNE, Yo ...
    2020 Volume 60 Issue 9 Pages 458-467
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 15, 2020
    JOURNAL OPEN ACCESS

    The mass of residual tumors has previously been estimated using time-series records of the position of surgical instruments acquired from neurosurgical navigation systems (navigation log). This method has been shown to be useful for rapid evaluation of residual tumors during resection. However, quantitative analysis of the method’s reliability has not been sufficiently reported. The effect of poor log coverage is dominant in previous studies, in that it did not highlight other disturbance factors, such as intraoperative brain shift. We analyzed 25 patients with a high log-acquisition rate that was calculated by dividing the log-available time by the instrument-use time. We estimated the region of resection using the trajectory of surgical instrument that was extracted from the navigation log. We then calculated the residual tumor region and measured its volume as log-estimation residual tumor volume (RTV). We evaluated the correlation between the log-estimation RTV and the RTV in the post-resection magnetic resonance (MR) image. We also evaluated the accuracy of detecting the residual tumor mass using the estimated residual tumor region. The log-estimation RTV and the RTV in the post-resection MR image were significantly correlated (correlation coefficient = 0.960; P <0.001). The presence of patient-wise residual tumor mass was detected with a sensitivity of 81.8% and a specificity of 92.9%. The individual residual tumor mass was detected with a positive predictive value of 72%. Estimation of residual tumor with adequate log coverage appears to be a suitable method with a high reliability. This method can support rapid decision-making during resection.

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  • Kenichi AMAGASAKI, Tatsuya UCHIDA, Atsushi HOSONO, Hiroshi NAKAGUCHI
    2020 Volume 60 Issue 9 Pages 468-474
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 15, 2020
    JOURNAL OPEN ACCESS

    The present study evaluated the indications for microvascular decompression (MVD) in elderly patients based on the new classification of the elderly population proposed by the joint committee of the Japan Gerontological Society and the Japan Geriatrics Society in 2017.

    Retrospective analysis of 171 patients with hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN) who underwent MVD in 2018. Patients were divided into three groups based on the proposal: old group, 75–89 years; pre-old group, 65–74 years; and not-old group, 64 years or younger. Preoperative comorbidities were divided into five types and the American Society of Anesthesiologists Physical Status (ASA-PS) was recorded. Outcome of the surgery and neurological complications were evaluated in June 2019.

    No decrease in activity of daily living occurred in any patient and surgical results showed no difference among the three groups. Rate of preoperative cardiovascular diseases was higher in both the pre-old and old groups compared with the not-old group (p <0.001 and Cramer V = 0.429). In terms of ASA-PS classification, only ASA-PS I and II were found, and rate of ASA-PS II was higher in the pre-old and old groups compared with the not-old group (p <0.001 and Cramer V = 0.407). Some patients suffered from elevated blood pressure after surgery, but were successfully managed.

    In conclusion, MVD for elderly patients can be achieved safely with careful patient selection and perioperative management. Data should be continuously accumulated for the future development of decision-making algorithm for MVD in the elderly.

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Case Report
  • Mutsumi NAGAI, Mami ISHIKAWA, Eiji MATSUMOTO, Fumihiro ARAI, Hirofumi ...
    2020 Volume 60 Issue 9 Pages 475-481
    Published: 2020
    Released on J-STAGE: September 15, 2020
    Advance online publication: August 31, 2020
    JOURNAL OPEN ACCESS

    Decompressive craniectomy (DC) is performed to alleviate intracranial hypertension as much as possible. There are two additional goals that surgeons should strive to achieve: minimization of operating time (i.e., the time issue) and avoidance of manually pushing on the surface of the bulging brain to prevent iatrogenic brain injury (i.e., “stuffing risk”). Many authors have made progress on the time issue, but stuffing risk remains largely unmitigated. We recently presented a new DC method that resolved both issues, but the incision design was too complicated for general use. A recent study has presented a duraplasty method that does not use watertight sutures and does not exacerbate the risk associated with DC. Employing the simplified method without sutures, we developed a new, easy-to-perform DC method that resolves stuffing risk. We analyzed the incision design geometrically and verified it by simulations generated with a physics engine. Three patients with massive cerebral infarction, subarachnoid hemorrhage, and hemorrhagic infarction underwent the new procedure. The targeted incision design was composed of four or five curved incision lines. Expansion of the dura resulted in transformation into a centroclinal form with spiral rifts and canopy. The dura expanded as expected in each case, and no cases required manual stuffing of the bulging brain. The operative time was acceptable, and no complications were reported. The concept of the incision design could be applied to any polygonal duraplasty in DC. We developed a new DC method that involves a simple and easily executed incision design, avoided stuffing risk.

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Editorial Committee
  • 2020 Volume 60 Issue 9 Pages EC17-EC18
    Published: 2020
    Released on J-STAGE: September 15, 2020
    JOURNAL OPEN ACCESS
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