Neurologia medico-chirurgica最新文献

{"title":"Real-world Experience of Embolization for Intracranial Tumors in Japan: Analysis of 2,756 Cases from Japanese Registry of NeuroEndovascular Therapy 4.","authors":"Jun Haruma, Kenji Sugiu, Tomohito Hishikawa, Yuta Soutome, Yuki Ebisudani, Ryu Kimura, Hisanori Edaki, Masato Kawakami, Satoshi Murai, Masafumi Hiramatsu, Shota Tanaka, Tetsu Satow, Koji Iihara, Hirotoshi Imamura, Akira Ishii, Yuji Matsumaru, Chiaki Sakai, Shinichi Yoshimura, Nobuyuki Sakai","doi":"10.2176/jns-nmc.2025-0081","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0081","url":null,"abstract":"<p><p>Embolization of intracranial tumors is predominantly performed in Japan, primarily before neurosurgical resection. The Japanese Registry of NeuroEndovascular Therapy (JR-NET) Study Group, established in 2005, aims to clarify the factors influencing the outcomes of neuroendovascular treatment. Japanese Registry of NeuroEndovascular Therapy 4 is a nationwide, multicenter retrospective observational study that evaluates real-world data on intracranial tumor embolization in Japan. Japanese Registry of NeuroEndovascular Therapy 4 is based on data collected from 166 neurosurgical centers in Japan between January 2015 and December 2019. Of 63,230 patients, 2,664 (4.2%) with intracranial tumors underwent embolization. The primary endpoint was the proportion of patients with a modified Rankin scale (mRS) score of 0-2 at 30 days post-procedure. Secondary endpoints included procedure-related complications. Among the 2,664 patients, 61 records lacked sufficient data, leaving 2,603 patients (1,612 females, median age: 61 years [interquartile range 51-71]). The proportion of patients with mRS scores ≤2 at 30 days after the procedure was 86.9%. The overall incidence of procedure-related complications was 4.8%, with 1.8% hemorrhagic, 2.0% ischemic, and 1.0% classified as other complications. In the multivariate analysis, general anesthesia and embolization of vessels other than the external carotid artery were identified as risk factors for the development of complications. Meningioma cases had a complication rate of 4.3%, with major complications occurring in 3.5%. Hemangioblastoma cases had a 14.9% complication rate, with major complications at 9.9%. Japanese Registry of NeuroEndovascular Therapy 4 provides comprehensive real-world data on intracranial tumor embolization in Japan, identifying risk factors to inform and improve the safe practice of intracranial tumor embolization in neuroendovascular therapy.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome and Postoperative Outcomes.","authors":"Kyongsong Kim, Toyohiko Isu, Atsushi Sugawara, Kenta Koketsu, Minoru Ideguchi, Hiroyuki Dan, Riku Mihara, Yasuo Murai","doi":"10.2176/jns-nmc.2025-0115","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0115","url":null,"abstract":"<p><p>Tarsal tunnel syndrome is an entrapment neuropathy at the tarsal tunnel. The diagnosis and the prediction of the surgical outcome are difficult. We compared preoperative magnetic resonance imaging findings with the postoperative results. We examined preoperative magnetic resonance imaging findings in 38 consecutive patients with Tarsal tunnel syndrome (47 feet); their mean age was 73.8 years. We inspected the nerve width on the slice showing the most compressed nerve, and the hyperintensity of that nerve on preoperative T2* fat-suppressed axial magnetic resonance imaging images and examined the role of magnetic resonance imaging in the diagnosis and of the surgical outcomes in patients with Tarsal tunnel syndrome. Postoperatively, there was significant symptom improvement. On preoperative magnetic resonance imaging scans the mean width of the most compressed nerve was 0.99 ± 0.37 mm. There was no significant correlation between the preoperative symptom severity and postoperative symptom improvement. In 29 feet (61.7%) we observed hyperintensity of the compressed nerve. In all but one foot the hyperintense area was displayed on 3 axial slices adjacent to the strongest nerve compression point. There was no significant difference in the preoperative symptom severity in patients with (group 1, n = 29) or without hyperintensity (group 2, n = 18). The nerve width at the point of greatest compression was significantly thinner, and postoperative symptom improvement was significantly greater in group 1 patients. Although there was no correlation between the preoperative nerve compression severity and the surgical results, nerve hyperintensity on magnetic resonance imaging scans may help with the diagnosis of Tarsal tunnel syndrome.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Clinical Characteristics of Moyamoya Disease in Advanced Suzuki Disease Stages.","authors":"Haruto Uchino, Masaki Ito, Miki Fujimura","doi":"10.2176/jns-nmc.2025-0112","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0112","url":null,"abstract":"<p><p>Moyamoya disease is a progressive steno-occlusive cerebrovascular disease. Intrinsically, its shifts the brain's vascular supply from the internal carotid to the external carotid system, known as internal-to-external carotid conversion, which is categorized by Suzuki's angiographic staging system. Although Suzuki's staging system remains the global standard for assessing longitudinal angiographic progression, the clinical characteristics of patients in the advanced stages, particularly in stage 6, are not well understood. Therefore, in this study, we investigated the incidence and clinical features in patients with moyamoya disease in advanced Suzuki stages. We retrospectively analyzed 280 hemispheres from 156 patients diagnosed with moyamoya disease through cerebral angiography between 1980 and 2023 at our institution. Angiographic features, including Suzuki disease stage and collateral pathways, were evaluated. Clinical outcomes, surgical indications, and postoperative courses were also assessed. Seventeen hemispheres (6.1%) were classified as Suzuki stage 5, and 6 hemispheres (2.1%) as stage 6, all in adult patients. Transdural collaterals, including ethmoidal and vault moyamoya vessels, were found in more than 80% of these advanced cases. Leptomeningeal collaterals from the posterior cerebral artery were frequently observed, whereas posterior cerebral artery stenosis was rare. Approximately half of the patients underwent revascularization surgery. No postoperative stroke recurrence was observed during the follow-up period of median 84 months. Suzuki stages 5 and 6 of moyamoya disease are rare; cases with stage 6 are particularly uncommon but show distinct angiographic features marked by internal-to-external carotid conversion and increased reliance on posterior circulation. Surgical revascularization is feasible and may be performed safely without stroke recurrence, even in patients with advanced disease stages.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Base Transdural Anastomosis in Moyamoya Disease: A Potential Association with Posterior Cerebral Artery Involvement and Clinical Importance.","authors":"Yusuke Otsu, Sosho Kajiwara, Jin Kikuchi, Tetsuya Negoto, Kimihiko Orito, Kiyohiko Sakata, Shuichi Tanoue, Masaru Hirohata, Motohiro Morioka","doi":"10.2176/jns-nmc.2025-0113","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0113","url":null,"abstract":"<p><p>Moyamoya disease is associated with the formation of collateral pathways, including transdural anastomosis, such as vault and ethmoidal moyamoya. However, temporal base transdural anastomosis remains unrecognized. This study investigates the imaging characteristics and features of temporal base transdural anastomosis in moyamoya disease. This retrospective review was conducted on 164 hemispheres from 82 patients with moyamoya disease admitted to our institution between 2012 and 2024. Digital subtraction angiography helped identify temporal base transdural anastomosis, which is classified as \"obvious\" or \"faint\" types based on digital subtraction angiography findings. Affected hemispheres and patients were grouped based on the presence or absence of temporal base transdural anastomosis, and their clinical characteristics were analyzed. Both types of temporal base transdural anastomosis were found in 10 of 164 hemispheres (6.1%) and 10 of 82 patients (12.2%). The obvious-type temporal base transdural anastomosis was detected in three hemispheres (1.8%) among three patients (3.7%). Temporal base transdural anastomosis was predominantly associated with advanced-stage moyamoya disease (Suzuki stage ≥4) and posterior cerebral artery involvement (p < 0.01). Although no significant association was found between the presence of temporal base transdural anastomosis and previous bypass surgery (p = 0.26), obvious temporal base transdural anastomosis was frequently found in cases without bypass surgery (two of three cases; 66.7%), and all obvious temporal base transdural anastomosis cases received no direct bypass surgery. Temporal base transdural anastomosis is considered to compensate for blood flow to the temporal lobe and is associated with posterior cerebral artery involvement. In addition, temporal base transdural anastomosis may receive high hemodynamic stress due to blood flow from the middle meningeal artery main trunk that may be related to aneurysmal formation or an unknown origin intracranial hemorrhage.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poor Prognostic Factors of Cervical Fracture among Nonagenarians Using the Japanese Diagnosis Procedure Combination Database.","authors":"Kazuma Doi, Naoki Otani, Norihiko Inoue, Junichi Mizuno, Kiyohide Fushimi, Atsuo Yoshino","doi":"10.2176/jns-nmc.2025-0051","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0051","url":null,"abstract":"<p><p>Japan has become a super-aging society compared with other countries, with many healthy super-older people surpassing the average life expectancy. Among this population, there are some patients aged >90 years with cervical fracture. However, few clinical studies have investigated cervical fracture among patients aged >90 years, and its clinical features and outcomes have not been fully elucidated. Therefore, this study aimed to explore the descriptive epidemiology of cervical fracture among patients aged >90 years in Japan using a nationwide database. This retrospective study used the Diagnosis Procedure Combination database, which is a nationwide inpatient database covering more than half of all acute-care hospitals in Japan. A total of 977 patients aged >90 years with a confirmed diagnosis of cervical fracture were included in this study. Data were collected, including medical history, diagnoses, treatments, complications, and outcomes. The results showed that the complication rates among patients aged >90 years with cervical fracture were almost the same as those in previous studies, whereas in-hospital mortality in patients with cervical fracture was higher (15.5%). Furthermore, half of the patients aged >90 years with cervical fracture had polytrauma. Older patients with head and spinal cord injuries and cardiac and respiratory complications were more likely to have a poor prognosis. These findings should be considered when treating patients at high risk regardless of surgery. These novel findings provide valuable insights into cervical fracture in patients aged >90 years based on extensive real-world data from Japan, a country with a rapidly aging population.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Blood Pressure and Hemorrhagic Complications after Brain Tumor Biopsies: An Observational Study Using a Propensity Score-matched Analysis.","authors":"Narushi Sugii, Masahide Matsuda, Takao Tsurubuchi, Eiichi Ishikawa","doi":"10.2176/jns-nmc.2025-0009","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0009","url":null,"abstract":"<p><p>Brain tumor biopsies are essential for pathological diagnosis. However, hemorrhagic complications after biopsies may occur, leading to suboptimal outcomes. This study evaluated the relationship between intraoperative blood pressure, especially anesthesia awakening, and hemorrhagic complications after brain tumor biopsies. We retrospectively collected data on consecutive patients with brain tumors (malignant lymphoma or glioma) who underwent a biopsy from 2011 to 2020. During the first half of the study period (until 2015), we managed patients with a mild blood pressure-lowering policy during awakening from general anesthesia, while in the latter half (after 2016), we aggressively lowered blood pressure below 140 mmHg. This blood pressure management was performed as a best practice. After propensity score matching using logistic regression analysis, 122 patients were included. With the aggressive blood pressure-lowering policy, the values of blood pressure-related parameters during the recovery from general anesthesia were drastically reduced (median maximum blood pressures were 165 [mmHg] until 2015 vs. 135 after 2016, p < 0.001). Accordingly, the overall bleeding rate decreased after 2016 (ALL bleeding, 54.1 vs. 31.1%, p = 0.017; symptomatic bleeding, 16.4% vs. 6.6%, p = 0.154). Abrupt blood pressure rise during anesthesia awakening (mmHg/min) was significantly associated with symptomatic postsurgical hemorrhages (p = 0.012). An aggressive blood pressure-lowering policy reduced blood pressure during recovery from general anesthesia and the overall bleeding rates. Avoiding rapid blood pressure rises during anesthesia awakening may be necessary by focusing on both blood pressure and the speed of any changes.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Patients with Aneurysmal Subarachnoid Hemorrhage with Delayed Hospital Arrival.","authors":"Susumu Yamaguchi, Kazuhiko Suyama, Hajime Maeda, Yoichi Morofuji, Makio Kaminogo, Takeo Anda, Tsuyoshi Izumo, Takayuki Matsuo","doi":"10.2176/jns-nmc.2025-0075","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0075","url":null,"abstract":"<p><p>The timing of aneurysmal obliteration may be influenced by post-admission rebleeding rates and patient characteristics associated with delayed hospital arrival in cases of aneurysmal subarachnoid hemorrhage. This study compared the rebleeding rate and characteristics between delayed and early hospital arrivals in cases of aneurysmal subarachnoid hemorrhage. Data from patients with aneurysmal subarachnoid hemorrhage recorded in the Nagasaki SAH Registry (1989-2018) were retrospectively analyzed. Patients were categorized into early (admission ≤72-hr post-onset) and late (admission >72-hr post-onset) groups. To assess the rebleeding rate after admission, data from a hospital that delayed the treatment protocol (1989-2002) were analyzed by using the log-rank test before and after propensity-score matching. To compare the characteristics of the late and early groups, data from 11 hospitals in the registry (2001-2018) were analyzed using multivariable analysis. The rebleeding analysis included 446 patients. Rebleeding occurred in 28/410 (6.8%) and 0/36 (0.0%) patients in the early and late groups, respectively, with no significant differences in cumulative rebleeding rates between the groups (11.5%/month vs. 0.0%/month, respectively). Of the 5,101 patients with aneurysmal subarachnoid hemorrhage admitted from 2001 to 2018, 289 (5.7%) were categorized into the late group. Multivariable analysis identified lower World Federation of Neurosurgical Societies/Fisher grade, anterior circulation aneurysm, fewer small aneurysms, late aneurysmal obliteration treatment, and pre-admission repeated ictus as independent factors associated with the late group. Patients with aneurysmal subarachnoid hemorrhage with delayed hospital arrival are uniquely characterized by a less severe subarachnoid hemorrhage grade, regardless of repeated pre-admission ictus.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Magnetic Resonance Imaging Changes in Spinal Ependymomas and Their Impact on Surgical Planning.","authors":"Yuki Sunohara, Yoshitaka Nagashima, Yusuke Nishimura, Masahito Hara, Hiroyuki Kato, Eisuke Tsukamoto, Kazuichi Terao, Naoto Kawaguchi, Takafumi Tanei, Ryuta Saito","doi":"10.2176/jns-nmc.2024-0328","DOIUrl":"10.2176/jns-nmc.2024-0328","url":null,"abstract":"<p><p>Spinal ependymomas are common intramedullary tumors that can show dynamic changes in magnetic resonance imaging findings over time. This study aimed to analyze these imaging changes and their implications for perioperative management. The retrospective study included patients diagnosed with World Health Organization grade 2 spinal ependymoma who underwent surgical resection and had at least 2 preoperative magnetic resonance imaging scans. Patients were divided into 2 groups based on the presence or absence of radiographic changes on magnetic resonance imaging. Magnetic resonance imaging analyses included non-contrast T1- and T2-weighted images, as well as gadolinium-enhanced T1-weighted images when available. Key features evaluated included intraparenchymal edema, hemosiderin deposition, syringomyelia, and cyst components. Changes in tumor size and contrast enhancement patterns were documented. Radiographic changes were identified in 4 out of 15 cases (26.7%). All cases with imaging changes exhibited hemosiderin deposition or hemorrhage, significantly higher than in cases without changes (100% vs. 18.2%, p < 0.05). No significant differences were observed in the presence of cystic components, syringomyelia, or edema between the groups. In the group with radiographic changes, the timeframe for these changes in the images ranged from 3 days to several years. Spinal ependymomas can demonstrate dynamic magnetic resonance imaging changes during the preoperative period, including both growth and reduction in tumor size. The presence of hemosiderin deposition or hemorrhage might be associated with these imaging changes. Proper timing of magnetic resonance imaging is crucial for informing surgical planning and optimizing treatment strategies for patients with spinal ependymomas.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"310-318"},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Survey of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma in Japan.","authors":"Satoshi Murai, Yuki Ebisudani, Jun Haruma, Masafumi Hiramatsu, Tomohito Hishikawa, Tetsu Satow, Kenji Sugiu","doi":"10.2176/jns-nmc.2025-0003","DOIUrl":"10.2176/jns-nmc.2025-0003","url":null,"abstract":"<p><p>Middle meningeal artery embolization has increasingly been used to treat chronic subdural hematoma. However, the current state of its application and outcomes in Japan remains unclear. We conducted a multicenter observational study involving facilities affiliated with the Japanese Society for Neuroendovascular Therapy to assess current practices and clarify the usefulness and safety of middle meningeal artery embolization for chronic subdural hematoma. A total of 466 patients from 40 facilities were included. The mean age of the patients was 78.0 ± 10.5 years, and bleeding risks, including antithrombotic therapy or bleeding predisposition, were present in 36.1% of patients. The most common timing for middle meningeal artery embolization was after the second burr hole surgery, accounting for 34.8% of cases. N-butyl-2-cyanoacrylate was used as the embolic material in 67% of cases. The complication rate was 5.2%, with complication-related morbidity at 0.9%. Hematomas were stable in 91.5% of cases at 30 days post-middle meningeal artery embolization. The symptomatic recurrence rate was 8.9%. Cases that underwent middle meningeal artery embolization after the second or subsequent burr hole surgeries were significantly associated with symptomatic recurrence. This study is the first nationwide survey investigating the real-world clinical practice of middle meningeal artery embolization for chronic subdural hematoma in Japan. While it included many elderly patients, recurrent cases, and those with bleeding risks, the safety and usefulness of middle meningeal artery embolization were deemed acceptable. However, symptomatic recurrence was common even in cases with middle meningeal artery embolization when performed after the second or subsequent burr hole surgeries. A further prospective study will be warranted to clarify treatment indications, optimal timing, and treatment techniques of middle meningeal artery embolization.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"319-325"},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questionnaire Survey of Facilities Conducted among Members of the Japanese Society for Stroke Surgery on Surgical Intervention for Hypertensive Intracerebral Hemorrhage.","authors":"Kazutaka Uchida, Shuntaro Kuwahara, Shoichiro Tsuji, Fumihiro Sakakibara, Manabu Shirakawa, Shinichi Yoshimura","doi":"10.2176/jns-nmc.2024-0340","DOIUrl":"10.2176/jns-nmc.2024-0340","url":null,"abstract":"<p><p>There is limited high-level evidence guiding the surgical treatment of hypertensive intracerebral hemorrhage, leaving the decision to the clinician's discretion. To understand treatment practices, a questionnaire survey was conducted among members of the Japanese Society on Surgery for Cerebral Stroke. This survey examined stroke care systems at various institutions, stroke numbers, and treatment details of patients with hypertensive intracerebral hemorrhage from January 2021 to December 2023. We examined data from 42 facilities, compared with 10 primary stroke centers cores and 32 non-primary stroke center cores. The total number of physicians involved in stroke care (primary stroke center cores vs. non-primary stroke center cores, median interquartile range; 18 [11-26] vs. 8 [4-14], p = 0.01), stroke specialists (8 [5-12] vs. 4 [2-7], p = 0.03), and supervising stroke surgeons (2 [1-2] vs. 1 [0-2], p = 0.008) was significantly higher in the primary stroke center cores group. Overall, 36,412 patients with stroke were hospitalized: 68% had cerebral infarction, 22% cerebral hemorrhage, 8% subarachnoid hemorrhage, and 2% other strokes. The locations of hypertensive intracerebral hemorrhage varied, with the putamen (31%), thalamus (25%), and lobe (24%) being predominantly affected. Non-invasive treatment was more prevalent in non-primary stroke center cores for most hypertensive intracerebral hemorrhage types, except for putaminal and brainstem hemorrhages. Surgical interventions were more common in primary stroke center cores, with craniotomies, neuroendoscopic surgeries, and ventricular drainage being preferred for cerebellar hemorrhage (28%), caudate nucleus hemorrhage (20%), and intraventricular hemorrhage (41%). This study highlights the treatment variability of hypertensive intracerebral hemorrhage between primary stroke center and non-primary stroke center cores.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"303-309"},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}