Neurologia medico-chirurgica最新文献

{"title":"Lumbar Stabilization with Interspinous Process Devices for Lumbar Spinal Canal Stenosis.","authors":"Taisuke Yoshinaga, Kyongsong Kim, Takato Tajiri, Fumiaki Fujihara, Masanori Isobe, Hiroshi Abe, Toyohiko Isu","doi":"10.2176/jns-nmc.2024-0314","DOIUrl":"10.2176/jns-nmc.2024-0314","url":null,"abstract":"<p><p>This study reports the treatment outcomes of patients with lumbar spinal canal stenosis who underwent lumbar stabilization surgery and evaluates the radiological effects of the surgery at least 1 year post-surgery. Forty consecutive patients with lumbar spinal canal stenosis underwent lumbar stabilization surgery using a titanium alloy interspinous spacer between August 2021 and October 2023. The cohort included 19 males and females, respectively, with a mean age of 75.2 years. The surgical level was L1 in 20 patients and L2 in 18 patients. Patients were operated using general anesthesia in 20 patients and local anesthesia in 18. We evaluated their surgical outcomes using the numerical rating scale for pain, the Roland-Morris Disability Questionnaire, and the Japanese Orthopedic Association scores, before surgery and at 6 and 12 months postoperatively. Radiological effects were also evaluated. All outcomes for the patient showed significant improvement at 6- and 12-months post-surgery. There was no significant change in the area of the dural sac before and after surgery; but the surgical level angle markedly decreased in both neutral and extended positions. Two patients underwent additional treatment post-surgery. This method does not require the removal of the lamina and yellow ligament, does not expose the nerves, and surgery can be performed without suspending antithrombotic drugs. It can also be performed under local anesthesia for patients at high risk for general anesthesia. However, general anesthesia is preferable as local anesthesia may lead to discomfort during surgery.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"413-419"},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"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":"407-412"},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497515/pdf/","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":"OA","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":"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":"389-395"},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497690/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exoscopic Keyhole Clipping of Unruptured Middle Cerebral Artery Aneurysms Using Multiple 4K 3-dimensional Monitors.","authors":"Shingo Toyota, Tomoaki Murakami, Kosei Okochi, Koichi Nakashima, Shuki Okuhara, Motoki Nakamura, Shuhei Yamada, Takamune Achiha, Takanori Fukunaga, Maki Kobayashi, Haruhiko Kishima","doi":"10.2176/jns-nmc.2025-0064","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0064","url":null,"abstract":"<p><p>We aimed to report our experience with exoscopic keyhole clipping of unruptured middle cerebral artery aneurysms using multiple 4K 3-dimensional monitors.We performed sphenoid ridge keyhole clipping of unruptured middle cerebral artery aneurysms using the ORBEYE exoscope (Sony Olympus Medical Solutions, Inc., Tokyo, Japan) with multiple 4K 3-dimensional monitors in 19 patients in our institution from 2020 to 2023. A 55-inch monitor was placed facing the surgeon at the end of an imaginary line extending through the Sylvian fissure ipsilateral to the target aneurysm. Two 32-inch movable sub-monitors were placed facing the surgeon at 45° angles to the left and right. Comparisons were made with a historical control group that comprised 21 patients who underwent the same procedure as above from 2017 to 2019 but with a surgical microscope rather than an exoscope.All exoscope group procedures were successfully accomplished using ORBEYE alone. Mean aneurysm diameter, craniotomy size, duration of intradural procedure, blood loss volume, and times of indocyanine green video angiography were similar in the exoscope and microscope groups. The mean indocyanine green dose was significantly lower in the exoscope group.Keyhole clipping for unruptured middle cerebral artery aneurysms using an exoscope and multiple 4K 3-dimensional monitors was safe and efficient, and not inferior to using a surgical microscope, suggesting that there are no major barriers for neurosurgeons to switch from microscopic to exoscopic keyhole clipping.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015838","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":"The Transventricular Preforniceal Approach Can Be Used in Cases Where the Space between the Anterior Commissure and the Venous Angle Is Enlarged.","authors":"Ryuta Saito, Masayuki Kanamori, Yukihiko Sonoda, Toshihiro Kumabe, Shunji Mugikura","doi":"10.2176/jns-nmc.2025-0012","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0012","url":null,"abstract":"<p><p>Surgical treatment for tumors located at the third ventricle and/or hypothalamic regions is significantly challenging due to the surrounding crucial neural and vascular structures. In 2013, the transventricular preforniceal approach was reported for exophytic chiasmatic/hypothalamic astrocytomas extending into the anterior third ventricle. Although this approach may be safe and effective for selected patients, this approach can only be applied when the space between the anterior commissure and the fornix is stretched by the tumor. Here, we report an easy method to preoperatively identify patients who are amenable to tumor removal via the transventricular preforniceal approach. Four glioma cases whose tumors were successfully removed via the transventricular preforniceal approach were studied. This included a hypothalamic glioblastoma case and three optic hypothalamic pilocytic astrocytoma cases. Preoperative three-dimensional contrast-enhanced magnetization-prepared rapid gradient echo was obtained from all cases for use in the surgical navigation system. Using this image, we analyzed the method to preoperatively define the cases for whom this approach is applicable. We were able to preoperatively identify the anterior commissure in three cases and the venous angle in all cases using the magnetization-prepared rapid gradient echo images. Posterior shift of the venous angle detected in these cases indicated that the space between the anterior commissure and fornix was stretched by the tumor. The tumor was successfully removed in these cases without severe neurological deterioration. Using three-dimensional contrast-enhanced magnetic resonance imaging to detect the posterior shift of the venous angle assists in preoperatively identifying hypothalamic glioma patients who are amenable to the transventricular preforniceal approach.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015881","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":"Autologous Fibrin Glue in Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm.","authors":"Ken Matsushima, Kyosuke Matsunaga, Nobuyuki Nakajima, Michihiro Kohno","doi":"10.2176/jns-nmc.2025-0146","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0146","url":null,"abstract":"<p><p>Adhesive materials are widely used in microvascular decompression for treating neurovascular compression syndromes. They play an important role in the critical step of vessel fixation. Recently, completely autologous fibrin glue produced solely from a patient's own plasma was developed. It can theoretically reduce the risks of viral or prion transmission and allergic reactions, while potentially providing more stable long-term adhesion. This study reports our initial experience with completely autologous fibrin glue in microvascular decompression and evaluates its efficacy and safety. Twenty-seven consecutive patients (12 with trigeminal neuralgia and 15 with hemifacial spasm) underwent microvascular decompression using autologous fibrin glue, including 8 trigeminal neuralgia treated using a fully endoscopic supracerebellar infratentorial approach. Autologous cryoprecipitate and thrombin were prepared (average: 4.8 mL each) from preoperative blood collection (average: 388.9 mL) without adverse events. All offending arteries, including 5 vertebral arteries, were securely transposed using polytetrafluoroethylene and autologous fibrin glue. The fibrin glue was also used to support dural closure with a collagen matrix. All patients experienced complete symptom relief, with no need for postoperative medication, except for 1 patient with mild recurrence despite maintained vascular fixation confirmed on magnetic resonance imaging. No new permanent neurological deficits, cerebrospinal fluid leakage, infections, allergic reactions, or systemic complications were observed. These findings suggest that completely autologous fibrin glue is safe and effective for both vessel fixation and dural sealing in microvascular decompression, without complications related to its use.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015868","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":"Chronological Changes in Intra-aneurysmal Signal Intensity on T1-weighted Black Blood Images after Endovascular Treatment for Unruptured Intracranial Aneurysms.","authors":"Yukishige Hashimoto, Toshinori Matsushige, Reo Kawano, Masahiro Hosogai, Hiroki Takahashi, Shinichiro Oku, Mayumi Kaneko, Chiaki Ono, Nobutaka Horie","doi":"10.2176/jns-nmc.2025-0087","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0087","url":null,"abstract":"<p><p>Intra-aneurysmal thrombus formation is crucial for the healing of endovascularly treated aneurysms. This study evaluated whether T1-weighted black blood imaging can monitor thrombus formation by examining the relationship between chronological signal intensity changes and aneurysm occlusion status after flow diverter stenting and coil embolization. We retrospectively analyzed 78 patients with 83 aneurysms (flow diverter stenting: 28, coil embolization: 55) who underwent T1-weighted black blood imaging at 1 week, 3 months, and 6 months post-treatment. Relative signal intensity was calculated as the signal intensity of the aneurysmal sac divided by the signal intensity of the genu of the corpus callosum. Satisfactory occlusion (O'Kelly-Marotta grades C or D) at 6 months was the primary endpoint for flow diverter stenting, while residual intra-aneurysmal blood flow during the follow-up was defined as recurrence after coil embolization. In flow diverter stenting cases, relative signal intensity was elevated at 3 months and remained stable. Relative signal intensity 3 months after flow diverter stenting was significantly higher in the satisfactory occlusion group than the non-satisfactory occlusion group (0.99 ± 0.55 vs. 0.51 ± 0.34, p = 0.03) and independently associated with satisfactory occlusion (adjusted odds ratio per 0.1 increase = 1.35, p = 0.01). In coil embolization cases, relative signal intensity was highest at 1 week and decreased linearly. Higher relative signal intensity 1 week after coil embolization was associated with lower recurrence rates (0.60 ± 0.22 vs. 0.41 ± 0.12, p = 0.002) and independently linked to aneurysm recurrence (adjusted odds ratio per 0.1 increase = 0.55, p = 0.004). Relative signal intensity changes on T1-weighted black blood imaging differ between flow diverter stenting and coil embolization. High relative signal intensity 3 months after flow diverter stenting and relative signal intensity 1 week after coil embolization were significantly correlated with favorable outcomes.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015891","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":"Preliminary Safety Study of a Single-dose Perampanel Drip Infusion in Brain Tumor Patients to Prevent Early Postoperative Seizures: The poSTOP Seizure-1 SF Study.","authors":"Narushi Sugii, Kota Araki, Eiichi Ishikawa","doi":"10.2176/jns-nmc.2025-0079","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0079","url":null,"abstract":"<p><p>Early postoperative seizures, defined as occurring within 7 days after surgery, are a significant complication that occurs following neurosurgical procedures involving cerebral manipulation. As a result, short-term antiseizure medication is typically administered in Japan despite the lack of consensus regarding its prophylactic use. Perampanel hydrate, an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist, was recently introduced in an intravenous formulation in Japan, providing new potential for early postoperative seizures prevention during the perioperative period. This study aimed to evaluate the safety and feasibility of a single-dose intravenous infusion of perampanel hydrate during brain tumor surgery. We conducted a single-arm, open-label, exploratory safety trial involving 10 adult patients undergoing brain tumor resection. Each participant received a 6 mg intravenous dose of perampanel hydrate during surgery, with no additional antiseizure medication administered postoperatively unless clinically indicated. The primary endpoint was the incidence of grade 3 or higher adverse events related to the study drug. Secondary endpoints included hematological toxicity, the incidence of early postoperative seizures, anesthetic recovery time, and perampanel hydrate blood concentration profiles. No grade 3 or higher adverse events were observed. Minor adverse events included transient grade 2 liver enzyme elevations and postoperative restlessness, both of which resolved within a week. Notably, no cases of early postoperative seizures occurred, and perampanel hydrate blood levels remained high even 7 days after a single administration. Intravenous perampanel hydrate appears safe and well tolerated in the perioperative setting and may effectively prevent early postoperative seizures. Further studies are planned to evaluate its efficacy in larger patient cohorts.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015862","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":"Stereotactic Step-by-step Dissection of the Anterior Transpetrosal Approach: A Three-dimensional Photogrammetry-based Educational Tool for Neurosurgeons.","authors":"Yoshifumi Takatsume, Shunsuke Shibao, Takashi Horiguchi","doi":"10.2176/jns-nmc.2025-0110","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0110","url":null,"abstract":"<p><p>Skull base surgery requires precise spatial recognition; however, existing educational tools remain limited. To address this issue, we developed a step-by-step stereotactic three-dimensional anatomical model of the anterior transpetrosal approach using digital photogrammetry. Cadaveric dissection was subsequently performed in 17 steps, of which 10 were reconstructed into three-dimensional models. The images were processed using 3DF Zephyr and Blender to create interactive three-dimensional portable document-format models, enabling dynamic anatomical visualization. The three-dimensional models provided high-resolution visualization of the complex skull base structures, including the trigeminal nerve, trochlear nerve, geniculate ganglion, semicircular canal, and internal carotid artery. Additionally, they supported keyhole surgery simulations by allowing users to manipulate and explore anatomical structures from multiple perspectives. However, the compatibility and performance varied depending on the device and software used. This study demonstrated the feasibility of a three-dimensional photogrammetry-based educational tool for skull base anatomy. By providing interactive three-dimensional visualization, this tool may complement existing surgical training methods and enhance anatomical understanding. However, further studies are required to evaluate its practical impact in structured educational settings.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015835","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":"Efficacy of Step-down Infusion Method of a Novel Barbiturate Therapy for Severe Subarachnoid Hemorrhage with Intracerebral Hematoma.","authors":"Jin Kikuchi, Yu Hasegawa, Sosho Kajiwara, Yusuke Otsu, Tetsuya Negoto, Kimihiko Orito, Osamu Takasu, Masaru Hirohata, Motohiro Morioka","doi":"10.2176/jns-nmc.2025-0111","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0111","url":null,"abstract":"<p><p>Currently, there is no effective treatment for elevated intracranial pressure in the acute phase of subarachnoid hemorrhage. Recently, we developed \"step-down infusion of barbiturate,\" a therapeutic strategy for severe traumatic brain injury, which decreased intracranial pressure and significantly reduced mortality without serious side effects. This study aimed to examine the efficacy of step-down infusion of barbiturate in patients with severe subarachnoid hemorrhage. Of the 342 patients with subarachnoid hemorrhage treated surgically at our hospital from January 2010 to May 2022, 17 with ruptured middle cerebral artery aneurysms and intracerebral hematoma graded as World Federation of Neurosurgical Societies Grade IV or V underwent hematoma removal, aneurysmal clipping or coiling, and external decompression. These patients were divided into 2 groups: the step-down infusion of barbiturate group and the control group, which was treated without step-down infusion of barbiturate. Thiamylal sodium was initiated immediately after surgery at 4 mg/kg/h and tapered to 3, 2, 1.5, and 1 mg/kg/h every 24 hrs after the start of normothermia administration. We evaluated the modified Rankin scale and Extended Glasgow Outcome Scale scores 1 year after admission. The step-down infusion of barbiturate group showed significantly better outcomes and well-controlled intracranial pressure (<20 mm Hg); moreover, cerebral perfusion pressure was maintained above 50 mm Hg, and there were no deaths or serious side effects associated with barbiturate use. Our novel method of prophylactic step-down infusion of barbiturate with normothermia for severe subarachnoid hemorrhage can safely lower intracranial pressure while maintaining cerebral perfusion pressure without serious side effects. This method may improve the outcomes in severe subarachnoid hemorrhage with intracerebral hematoma, although further studies are needed to confirm its efficacy and safety.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015843","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}