Neurologia medico-chirurgica最新文献

{"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":"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":"366-372"},"PeriodicalIF":2.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415185/pdf/","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":"OA","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":"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":"348-354"},"PeriodicalIF":2.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412030/pdf/","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":"OA","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":"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":"355-365"},"PeriodicalIF":2.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412026/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apolipoprotein A1 Levels Are Inversely Associated with Aneurysm Wall Enhancement in Unruptured Intracranial Aneurysms.","authors":"Masahiro Hosogai, Toshinori Matsushige, Saya Tsuchigauchi, Hiroki Takahashi, Shinichiro Oku, Nobutaka Horie","doi":"10.2176/jns-nmc.2024-0258","DOIUrl":"10.2176/jns-nmc.2024-0258","url":null,"abstract":"<p><p>Current magnetic resonance vessel wall imaging enables the detection of atherosclerotic changes in the walls of intracranial aneurysms. Lipid accumulation in the intracranial aneurysm wall is involved in aneurysm neovascularization and chronic inflammation and may lead to aneurysm enlargement and rupture. Therefore, in the present study, we examined the relationship between atherosclerotic changes identified by vessel wall imaging and systemic atherosclerosis-related risk factors. A total of 111 patients with 156 unruptured intracranial aneurysms who underwent magnetic resonance vessel wall imaging and atherosclerotic protein examinations between April 2021 and November 2023 were reviewed. Data on atherosclerotic proteins were obtained from peripheral blood samples. The relationships between aneurysm wall enhancement and patient demographic data, aneurysm morphology, and atherosclerosis-related risk factors were assessed. Fifty-seven of 156 unruptured intracranial aneurysms (36.5%) showed aneurysm wall enhancement. In a univariate logistic regression analysis, age (p = 0.007), male sex (p = 0.023), morphological factors such as maximum diameter (p < 0.001) and irregular shape (p < 0.001), and the levels of apolipoprotein A1 (<0.001) and apolipoprotein B/apolipoprotein A1 (0.004) correlated with aneurysm wall enhancement. In the multivariate logistic regression analysis, age (odds ratio: 1.05, 95% confidence interval: 1.02-1.10), male sex (odds ratio: 3.83, 95% confidence interval: 1.46-10.01), maximum diameter (odds ratio: 1.19, 95% confidence interval: 1.01-1.45), irregular shape (odds ratio: 5.01, 95% confidence interval: 2.10-12.73), and apolipoprotein A1 levels (odds ratio: 0.97, 95% confidence interval: 0.94-0.99) correlated with aneurysm wall enhancement. Low levels of apolipoprotein A1, which may function as an atherosclerotic protein, were associated with specific aneurysm wall features in vessel wall imaging. In future studies, these results will contribute to the identification of factors that promote the destabilization of unruptured intracranial aneurysms.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"340-347"},"PeriodicalIF":2.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302592","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":"The Declining Incidence Rate of Subarachnoid Hemorrhage in Four Local Japanese Regions Is Greater in Women than in Men: Japan Incidence of Subarachnoid Hemorrhage Study.","authors":"Shingo Matsuda, Fusao Ikawa, Toshikazu Hidaka, Shuhei Yamaguchi, Tetsuji Inagawa, Nobutaka Horie, Kaoru Kurisu, Nao Ichihara, Yoshihito Goto, Takeo Nakayama, Hitoshi Fukuda, Tetsuya Ueba, Masahiro Sasaki, Tatsuya Ishikawa, Norihito Shimamura, Hiroki Ohkuma","doi":"10.2176/jns-nmc.2025-0014","DOIUrl":"10.2176/jns-nmc.2025-0014","url":null,"abstract":"<p><p>Female sex is an independent risk factor for subarachnoid hemorrhage. Additionally, the global decline in the incidence rate of subarachnoid hemorrhage is more apparent in men than in women, except in Japan. We examined sex-specific trends in the incidence rates of subarachnoid hemorrhage in four Japanese regions. An epidemiological study was conducted to identify the estimated age-adjusted incidence rate of subarachnoid hemorrhage per 100,000 person-years by sex in Aomori, Akita, Kochi, and Shimane Prefectures from 2000 to 2017, calculated by the age-adjusted mortality and case-fatality rates (assumed to be 35%). The estimated age-adjusted incidence rate of subarachnoid hemorrhage in each region decreased in both sexes between 2000 and 2017; the rates of change were significantly higher in women (43.1%) than in men (36.6%; p = 0.021). This study revealed declining trends in the estimated age-adjusted incidence rate of subarachnoid hemorrhage in four Japanese prefectures from 2000 to 2017; this was more apparent in women. The underlying etiology for the female-dominant declining trend in the estimated age-adjusted incidence rate of subarachnoid hemorrhage should be further investigated.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"333-339"},"PeriodicalIF":2.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302593","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":"Actual Circumstances of In-hospital Stroke Set-up Using Rapid Response System for Stroke in the Endovascular Thrombectomy Era.","authors":"Yasuhiro Takahashi, Takeshi Mikami, Kei Miyata, Ryohei Saito, Ayumu Yamaoka, Yusuke Kimura, Katsuya Komatsu, Sangnyon Kim, Rei Enatsu, Yukinori Akiyama, Akiyoshi Hashimoto, Nobuhiro Mikuni","doi":"10.2176/jns-nmc.2025-0049","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0049","url":null,"abstract":"<p><p>With the widespread adoption of mechanical thrombectomy, the public expects an increasingly high level of stroke care. This study aimed to investigate the current status of in-hospital stroke following the initiation of a \"Stroke Call,\" which is a Rapid Response System for stroke. We analyzed 330 consecutive cases of \"Stroke Call\" among 110,142 patients hospitalized at our institute from June 2017 onward. Of the 330 patients, 187 (56.6%) had confirmed stroke and 143 (43.3%) had stroke mimics. Data on age, sex, use of antithrombotic agents, perioperative status, presence of cancer, department, hospitalization ward, and the identity of the calling staff were obtained from admission records. Multivariate analysis of risk factors for real stroke and diagnostic delays showed that stroke was significantly associated with the use of antithrombotic agents, departments with a higher frequency of \"Stroke Call\" (>5 cases) and calls initiated by medical doctor staff, while diagnostic delays were significantly associated with the departments with a lower frequency of \"Stroke Call\" (≤5 cases), hospitalization in the intensive care unit, and a history of hypertension. Among ischemic stroke cases, 61 (32.6%) occurred during the perioperative period, and 88.3% occurred within 7 days postoperatively. In conclusion, our study highlights the clinical characteristics, management challenges, and risk factors associated with in-hospital stroke in our hospital and offers valuable insights for improving in-hospital stroke care. In-hospital stroke is a frequent occurrence and requires sustained awareness campaigns and systemic intervention by the healthcare insurance system.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847883","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 Functional Neurosurgery Combining Sedation and Awake Procedures Using Remimazolam Besylate and Flumazenil: A Technical Note.","authors":"Kazuaki Yamamoto, Hiroki Higuchi, Kimiya Fukui, Masahiko Wanibuchi","doi":"10.2176/jns-nmc.2025-0011","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0011","url":null,"abstract":"<p><p>Current anesthesia methods for stereotactic functional neurosurgery face significant limitations. Local anesthesia and mild sedation often lead to patient discomfort, while general anesthesia precludes real-time neurological assessments critical for optimizing therapeutic outcomes. This technical note introduces a novel sedation protocol using remimazolam besylate combined with flumazenil in 30 patients with movement disorders undergoing stereotactic functional neurosurgery between November 2022 and March 2024. Remimazolam besylate was administered intravenously for sedation while maintaining spontaneous respiration, with doses adjusted based on patient response and bispectral index values. Sedation was reversed using flumazenil, allowing patients to awaken for neurological assessments; the procedures then continued with patients awake. Fentanyl was used for analgesia, and no muscle relaxants were employed. All patients successfully tolerated the procedures, reporting no intraprocedural discomfort or pain. The mean time to awakening after flumazenil injection was 130.3 ± 73.9 secs. No significant adverse events, including respiratory depression or re-sedation, were observed. One patient experienced a panic attack due to severe claustrophobia, necessitating re-sedation with propofol. The absence of muscle relaxants facilitated effective intraoperative neurological assessments. Postoperative outcomes were positive for all patients. This sedation protocol demonstrated feasibility and safety, offering a promising solution to challenges associated with intraoperative sedation and neurological assessment in stereotactic functional neurosurgery. Further research involving larger cohorts is warranted to confirm these findings and explore broader applications of this technique.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847886","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":2.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322308/pdf/","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":"OA","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":2.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322309/pdf/","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":"OA","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":2.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12322522/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}