Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Advance online publication
Displaying 1-9 of 9 articles from this issue
  • Takeshi KINKORI, Kenichi WATANABE, Kojiro ISHIKAWA, Takashi SAKUMA, Yu ...
    Article ID: 2022-0083
    Published: 2022
    Advance online publication: June 24, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Distal transradial approach (dTRA) for neuroendovascular procedures has received much attention in recent years as a newer and less invasive alternative to the conventional transfemoral or transradial approaches. We present the case of an 89-year-old woman with a basilar artery aneurysm requiring simultaneous catheterization of the bilateral vertebral arteries who was successfully embolized using bilateral dTRA. The aneurysm was accessed from the right vertebral artery using the right dTRA. Control angiograms during the procedure were performed from the left vertebral artery via the left dTRA. The operator's posture was ergonomically comfortable, and the catheters were easy to handle during the procedure. To the best of our knowledge, this is the first case of a bilateral dTRA used for neuroendovascular procedures. Bilateral dTRA is a safe and minimally invasive method for patients and ergonomically comfortable for operators.

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  • Takeshi YOSHIMOTO, Hiroshi YAMAGAMI, Nobuyuki SAKAI, Kazunori TOYODA, ...
    Article ID: 2022-0099
    Published: 2022
    Advance online publication: June 24, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.

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  • Rio HIGAKI, Shinya YAMAGUCHI, Hironori HARUYAMA, Masato OSAKI, Shuji A ...
    Article ID: 2021-0335
    Published: 2022
    Advance online publication: May 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Cerebral venous thrombosis (CVT) is a rare cause of stroke, and the first-line treatment is systemic anticoagulation. Patients unresponsive to standard therapy for CVT present with rapid neurological deterioration and require endovascular treatment. We encountered two patients with severe CVT who underwent endovascular treatment. In our cases, the thrombus was too hard and extensive to pass through using currently existing techniques. We performed the "digging through thrombus technique" using an aspiration catheter and stent retriever and achieved rapid sinus recanalization and favorable outcomes.

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  • Manabu SASAKI, Takanori FUKUNAGA, Koshi NINOMIYA, Masao UMEGAKI, Katsu ...
    Article ID: 2021-0395
    Published: 2022
    Advance online publication: May 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    This study aims to present our surgical technique of lateral lumbar interbody fusion (LLIF) without corpectomy for lumbar vertebral fracture (LVF) associated radiculopathy. This study includes three patients treated with LLIF (mean age of 77.3 years, Group L) and three patients treated with PLIF (mean age of 75.7 years, Group P) to compare the surgical outcomes. The cartilage on the fractured vertebrae was aggressively resected with attention to avoid injury to the ring apophysis. The central cavity of the fractured endplate was filled with a bone graft substitute made of hydroxyapatite and collagen composite, followed by interbody fusion achieved by utilizing of a cage with sufficient length spanning the bilateral edges of the fractured vertebra. PLIF was performed with a standard technique using two interbody cages, and vertebroplasty was combined in one patient. Comparing to PLIF, LLIF could be performed with less estimated blood loss in shorter surgical time. Local kyphotic angle improved in all cases of Group L immediately after the surgery, but correction loss was observed at the final examination. The lordotic angle was lost in Group P postoperatively. Arthrodesis was achieved in all the cases. The mean VAS score for leg pain was 85.3 mm in Group L and 82.0 mm in Group P at preoperation and decreased to 8.7 mm and 11.3 mm, respectively, at postoperation. LLIF is an effective surgical option that enables stabilization of the fractured vertebra and reduces radicular pain by indirect neural decompression.

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  • Yu FUJII, Toshihiro OGIWARA, Hiroto KATO, Yoshiki HANAOKA, Ridzky Firm ...
    Article ID: 2021-0398
    Published: 2022
    Advance online publication: May 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Factors predicting adverse events following implantation with wafers containing 1,3-bis (2-chloroethyl) -1-nitrosourea (carmustine, BCNU), which is used in local chemotherapy for malignant gliomas (MGs), are unknown. The association between cerebral edema (CE), which often occurs after implantation, and perioperative seizures, which are often observed in MG cases, is under debate. This study investigated risk factors for CE associated with BCNU wafer implantation and their relationship with perioperative seizures. A total of 31 surgical cases involving 28 adult patients who underwent BCNU wafer implantation for MGs were investigated and classified into those with and without postoperative transient CE. We assessed the correlations between CE caused by BCNU implantation and various factors, including postoperative epileptic seizures. World Health Organization (WHO) grade III MGs significantly affected postoperative CE (p = 0.003) and the occurrence of seizures (p = 0.0004). Factors predictive of postoperative seizures were WHO grade III MGs (p = 0.0026), increased postoperative CE (p = 0.0272), and history of preoperative seizures (p = 0.0316). Postoperative CE, WHO grade III MGs, and a history of preoperative seizures might predict the postoperative occurrence of seizures, necessitating stringent management of seizures and CE in the affected patients.

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  • Yuichiro KOJIMA, Takehiro UDA, Toshiyuki KAWASHIMA, Saya KOH, Masato H ...
    Article ID: 2022-0010
    Published: 2022
    Advance online publication: May 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    The use of robot-assisted frameless stereotactic electroencephalography (SEEG) is becoming more common. Among available robotic arms, Stealth Autoguide (SA) (Medtronic, Minneapolis, MN, USA) functions as an optional instrument of the neuronavigation system. The aims of this study were to present our primary experiences with SEEG using SA and to compare the accuracy of implantation between SA and navigation-guided manual adjustment (MA). Seventeen electrodes from two patients who underwent SEEG with SA and 18 electrodes from four patients with MA were retrospectively reviewed. We measured the distance between the planned location and the actual location at entry (De) and the target (Dt) in each electrode. The length of the trajectory did not show a strong correlation with Dt in SA (Pearson's correlation coefficient [r] = 0.099, p = 0.706) or MA (r = 0.233, p = 0.351). De and Dt in SA were shorter than those in MA (1.99 ± 0.90 vs 4.29 ± 1.92 mm, p = 0.0002; 3.59 ± 2.22 vs 5.12 ± 1.40 mm, p = 0.0065, respectively). SA offered higher accuracy than MA both at entry and target. Surgical times per electrode were 38.9 and 32 min in the two patients with SA and ranged from 51.6 to 88.5 min in the four patients with MA. During the implantation period of 10.3 ± 3.6 days, no patients experienced any complications.

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  • Satoshi KURODA, Miki FUJIMURA, Jun TAKAHASHI, Hiroharu KATAOKA, Kuniak ...
    Article ID: 2022-0072
    Published: 2022
    Advance online publication: May 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    In this report, we, the Research Committee on Moyamoya Disease (Spontaneous Occlusion of the circle of Willis), describe in detail the changes in the new "Diagnostic Criteria 2021" for moyamoya disease and its scientific basis to make it widely known to the world. The revised criteria cover all aspects of the disease, including a definition of the disease concept, diagnostic imaging, and the concept of quasi-moyamoya disease (moyamoya syndrome).

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  • Eiichirou URASAKI, Yasushi MIYAGI, Shogo MURAMATSU, Yasutaka EZAKI
    Article ID: 2021-0298
    Published: 2022
    Advance online publication: May 10, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Spinal cord stimulations have been used widely to treat intractable neuropathic pain. The conventional spinal cord stimulation paradigm, the "tonic" type, suppresses excessive activation of wide dynamic range neurons in the dorsal horn via the collateral branch from the dorsal column. Therefore, preserved dorsal column function is an important prerequisite for tonic spinal cord stimulations. A tonic spinal cord stimulation requires eliciting paresthesia in the painful area due to stimulation of the dorsal column and dorsal root. Recent spinal cord stimulation paradigms, including burst and high-dose, are set below the paresthesia threshold and are proposed to have different pain reduction mechanisms. We conducted an interference study of these different stimulation paradigms on the somatosensory evoked potential (SEP) to investigate differences in the sites of action between tonic and new spinal cord stimulations. We recorded posterior tibial nerve-stimulated SEP in seven patients with neuropathic pain during tonic, burst, and high-dose stimulations. The total electrical energy delivered was calculated during SEP-spinal cord stimulation interference studies. High-dose stimulations could not reduce the SEP amplitude despite higher energy delivery than tonic stimulation. Burst stimulation with an energy similar to the tonic stimulation could not reduce SEP amplitude as tonic stimulation. The study results suggested different sites of action and effects on the spinal cord between the conventional tonic and burst or high-dose spinal cord stimulations.

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  • Takahiro SASAKI, Yuji UEMATSU, Junya FUKAI, Shota TANAKA, Akitake MUKA ...
    Article ID: 2022-0027
    Published: 2022
    Advance online publication: May 10, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    To assess the clinicopathological features and prognostic factors of pediatric intracranial ependymomas and to explore the current diagnostic practice, we analyzed clinical data from the Brain Tumor Registry of Japan (BTRJ). Data of fifty children under 18 years of age diagnosed with intracranial ependymoma were extracted from the BTRJ database. Cases were reviewed for overall survival (OS) and progression-free survival (PFS), with attention to gender, preoperative Karnofsky performance status score, location of the tumor, the extent of resection, World Health Organization (WHO) histopathological grading, and adjuvant therapy. The median age at diagnosis was 6.1 years, ranging from 7 months to 17.6 years. Based on the WHO histopathological grading, 27 patients were classified under grade 2 (54%) and 23 patients were classified under grade 3 (46%). Gross total resection (GTR) was achieved in 30 patients (60%). The median follow-up time was 65 months. Five-year PFS and OS were 47.2 ± 7.3% and 73.3 ± 6.7%, respectively. GTR was associated with longer OS (P = 0.02). The histopathological grading was not an independent prognostic factor for the OS. Mitosis and microvascular proliferation were higher among patients with grade 3 than in those with grade 2, which aided in deciding the WHO grade. This nationwide study revealed the characteristics and outcomes of patients with childhood ependymomas. GTR was the factor most consistently associated with improved survival. In contrast, the histopathological grading in this cohort was not a significant prognostic factor. More reproducible and practical criteria for the diagnosis of intracranial ependymomas should be further pursued in future studies.

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