Neurologia medico-chirurgica最新文献

{"title":"C2 Laminoplasty with Reconstruction of the Deep Extensor Muscles for Preventing Cervical Kyphosis after High Cervical Spinal Tumor Removal: Technical Notes.","authors":"Keisuke Takai, Takeaki Endo, Shinsuke Yoshida, Ayako Isoo","doi":"10.2176/jns-nmc.2026-0028","DOIUrl":"10.2176/jns-nmc.2026-0028","url":null,"abstract":"<p><p>Cervical kyphosis after an intradural spinal tumor is a significant complication, especially for high cervical tumors that require a C2 laminectomy. This study presents our new surgical approach: a C2 laminoplasty with reconstruction of the cervical deep extensor muscles. We investigated whether the C2 reconstruction technique contributes to maintaining cervical alignment.Consecutive adult patients (≥18 years) who underwent the C2 reconstruction technique for intradural high cervical tumors between 2015 and 2024 were included. The preoperative and postoperative C2/7 angles were compared.A total of 21 patients (median age 50 years, interquartile range 44-75 years; 10 men) were included. Histological diagnoses included 11 intramedullary and 10 intradural extramedullary tumors, with schwannoma (29%) and ependymoma (24%) being the 2 most frequent tumors. The tumor center was located between C1 and C3 in 90% of patients, and the median tumor size was 29 mm. The C2 spinous processes were split in the midline from the C2 lamina without detaching the attached muscles. At the end of surgery, the C2 lamina was fixed, and the bilateral C2 spinous processes were sutured back to the C2 lamina along with their attached muscles. The pre- and postoperative C2/7 angles did not significantly differ (11.5 vs 10.6°, p = 0.65). No patients had cervical kyphosis that required instrumented fusion at the median follow-up of 37 months (interquartile range 14-63 months).For patients with cervical spinal tumors, the reconstruction of the C2 deep extensor muscles may contribute to maintaining cervical alignment.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"573-578"},"PeriodicalIF":1.6,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412360","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":"Facial Nerve Conduction Block During Vestibular Schwannoma Surgery: Could it be Caused by the Unintended Effect of Medicines?","authors":"Evgeny A Levin","doi":"10.2176/jns-nmc.2026-0060","DOIUrl":"https://doi.org/10.2176/jns-nmc.2026-0060","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562151","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":"Reply to the Editor: Facial Nerve Conduction Block during Vestibular Schwannoma Surgery: A Rare and Unclarified Transient Neural Dysfunction.","authors":"Yudai Morisaki, Ken Matsushima, Michihiro Kohno","doi":"10.2176/jns-nmc.2026-0117","DOIUrl":"10.2176/jns-nmc.2026-0117","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562332","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":"Screening for Mild Vertebral Artery Dissection Using 3-Dimensional T1-weighted Black-blood Magnetic Resonance Imaging: A Retrospective Observational Study of 3,049 Consecutive Walk-in Patients Presenting with Headache.","authors":"Masanori Wada, Takeshi Asano, Iwao Yamakami, Hajime Yokota, Kentaro Horiguchi, Yoshinori Higuchi","doi":"10.2176/jns-nmc.2025-0301","DOIUrl":"10.2176/jns-nmc.2025-0301","url":null,"abstract":"<p><p>Vertebral artery dissection is a rare but potentially life-threatening condition. However, many cases of mild vertebral artery dissection-an early disease stage-may be overlooked. 3-dimensional T1-weighted black-blood magnetic resonance imaging has recently emerged as a promising diagnostic tool, yet it remains underutilized. This study investigated the impact of vertebral artery dissection screening in patients presenting with headache, the most common chief complaint encountered in general neurosurgery outpatient clinics, and an initial symptom of vertebral artery dissection, in a real-world clinical setting. We retrospectively reviewed 3,049 consecutive patients with headache who visited a neurosurgical outpatient center in Chiba, Japan (October 2021-October 2023). In the first year, 1,527 patients underwent brain magnetic resonance imaging and magnetic resonance angiography. In the second year, 1,522 patients received these examinations as well as brain and neck black-blood magnetic resonance imaging. Vertebral artery dissection detection rates were compared between the 2 groups.Vertebral artery dissection was diagnosed in 0.5% and 1.6% of the former and latter groups, respectively (relative risk: 3.42, 95% confidence interval 1.48-7.92, p = 0.003), indicating an over threefold increase in detection. Among patients with intracranial vertebral artery dissection, 96% reported occipital headache rather than nonspecific/generalized headache. Among high-risk individuals aged 40-55 years with occipital or posterior neck pain, the detection rate reached 7.5%. Vertebral artery dissection accounted for 93% of head and neck arterial dissections. The addition of black-blood magnetic resonance imaging significantly improved early detection and may enhance screening accuracy for patients presenting with headache at elevated risk.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"434-444"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964314","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 Outcomes of Flow Diverter Braid Deformation following Treatment with Non-DFT Wire Devices.","authors":"Shoko Fujii, Sakyo Hirai, Kyohei Fujita, Hikaru Wakabayashi, Hirotaka Sagawa, Satoru Takahashi, Kazutaka Sumita","doi":"10.2176/jns-nmc.2025-0435","DOIUrl":"10.2176/jns-nmc.2025-0435","url":null,"abstract":"<p><p>Flow diverter braid deformation is occasionally observed after flow diverter placement. However, the frequency and clinical significance of flow diverter braid deformation in non-drawn filled tube wire devices remain unclear. This retrospective, single-center study analyzed 139 consecutive patients (median age, 60 years; 82.7% women) who underwent flow diverter placement for intracranial aneurysms between 2017 and 2024. Follow-up angiography and cone-beam computed tomography images were compared with those obtained immediately after flow diverter deployment to identify flow diverter-related morphologic changes. The identified morphologic changes were classified into 4 major patterns (fish mouthing, bump, collapse, and shortening) as flow diverter braid deformation and 2 variants (distal tapering and edge flare) as minor morphologic changes. Cases with fish mouthing or collapse were classified as a high-risk flow diverter braid deformation category because of their association with thromboembolic complications. Flow diverter-related morphologic changes were detected in 31 patients (22.3%), including flow diverter braid deformation in 24 patients (17.3%), at the first angiographic follow-up, and no progression was detected during subsequent observations. The most common pattern was shortening (12.9%), followed by distal tapering (5.0%), and high-risk flow diverter braid deformation was rare (fish mouthing, 1.4%; collapse, 1.4%). Neointimal hyperplasia was more frequent in the flow diverter braid deformation group, whereas the rates of in-stent stenosis, aneurysm occlusion (O'Kelly-Marotta grades C-D), retreatment, and favorable functional outcomes (modified Rankin Scale, 0-2) did not differ significantly between the groups. Younger age and proximal stent oversizing were independent predictors of flow diverter braid deformation. Given the rarity of the high-risk category and the absence of adverse outcomes, flow diverter braid deformation represents a benign and stable morphological change in non-drawn filled tube wire flow diverters.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"456-465"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043238","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":"Thalamic Volume Asymmetry as a Potential Predictor of Vagus Nerve Stimulation Outcomes in Refractory Epilepsy.","authors":"Masaki Ujihara, Masahito Kawabori, Midori Nakajima, Yuki Ueda, Toru Horinouchi, Kiyoshi Egawa, Takahiro A Kato, Miki Fujimura","doi":"10.2176/jns-nmc.2025-0409","DOIUrl":"10.2176/jns-nmc.2025-0409","url":null,"abstract":"<p><p>Vagus nerve stimulation is an established treatment for refractory epilepsy, but predictors of treatment response remain unclear. Given that left-sided vagus nerve stimulation preferentially modulates the left thalamus and that epileptic networks induce thalamic structural damage, we investigated whether preoperative thalamic volume asymmetry predicts vagus nerve stimulation outcomes. This retrospective study included 17 patients with refractory epilepsy who underwent vagus nerve stimulation implantation. Patients were classified as responders (≥50% seizure reduction at 24 months, n = 9) or non-responders (n = 8). Thalamic volumes were manually segmented on preoperative T2-weighted magnetic resonance imaging by 2 blinded raters, and we used the rater-averaged values to calculate the left/right volume ratio and asymmetry index. The mean thalamic volume ratio (left/right) was significantly higher in responders than non-responders (1.00 [95% confidence interval 0.97-1.03] vs 0.96 [95% confidence interval 0.92-0.99], p = 0.027), and the asymmetry index also differed between groups (0.00 [95% confidence interval -0.015 to 0.017] vs -0.023 [95% confidence interval -0.040 to -0.006], p = 0.027). Inter-rater reliability was acceptable for absolute volumes but was lower for ratio-based asymmetry indices, suggesting that these derived metrics may be more suitable for group-level comparisons than for single-patient prediction. Epileptogenic laterality determined by electroencephalography did not predict thalamic asymmetry. Relative left thalamic volume reduction was associated with poor vagus nerve stimulation treatment response. Assessment of preoperative thalamic asymmetry on routine structural magnetic resonance imaging may represent a candidate biomarker for predicting vagus nerve stimulation efficacy, pending validation in larger cohorts.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"490-499"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043312","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":"From Non-linear Prognostic Visualization to Frailty-aware Shared Decision-making in Aneurysmal Subarachnoid Hemorrhage.","authors":"Fusao Ikawa","doi":"10.2176/jns-nmc.2026-0056","DOIUrl":"10.2176/jns-nmc.2026-0056","url":null,"abstract":"","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"502-503"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964305","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 Role of Indocyanine Green Videoangiography in Intramedullary Spinal Cord Tumor Surgery: Focus on Lesion Localization Accuracy.","authors":"Jungbo Sim, Chang-Hyun Lee, Ayoung Yoo, Yunhee Choi, Woojin Kim, Hosung Myeong, Hangeul Park, Jun-Hoe Kim, Chi Heon Kim, Chun Kee Chung","doi":"10.2176/jns-nmc.2025-0318","DOIUrl":"10.2176/jns-nmc.2025-0318","url":null,"abstract":"<p><p>Intramedullary spinal cord tumors/lesions are rare, but they present significant surgical challenges owing to the high risk of spinal cord injury during myelotomy. Conventional techniques are often limited by positional discrepancies and anatomical variations. Indocyanine green videoangiography provides real-time fluorescence imaging of the lesion vasculature. This study aimed to evaluate the safety and efficacy of intraoperative indocyanine green videoangiography and to determine which pathological subtypes are most amenable to this technique. We enrolled patients with intramedullary spinal cord tumors, excluding those with hemangioblastoma. A 2-step approach was used for lesion localization: initial delineation using conventional methods, followed by indocyanine green videoangiography, in which indocyanine green was administered intravenously, and lesion boundaries were re-marked using fluorescence imaging. The outcome measure was the prediction error distance between conventional localization and indocyanine green videoangiography localization, and the impact of lesion characteristics on localization accuracy. This study included 15 patients with intramedullary spinal cord tumors. The mean prediction error distance was 3.63 mm for the conventional method and 2.77 mm for indocyanine green videoangiography. The mean prediction error distance difference between the 2 methods was 0.87 mm (p = 0.047). Tumor size correlated with greater reductions in prediction error distance using indocyanine green videoangiography (height, p = 0.005). Larger tumors (23.4 mm in height) tended to demonstrate a mean prediction error distance reduction of 2.0 mm (p = 0.085). Minor adverse events that could be related to indocyanine green videoangiography were observed in 3 cases, all of which resolved spontaneously. Intraoperative indocyanine green videoangiography performed before myelotomy may improve the accuracy of tumor localization with minimal risk in patients with intramedullary spinal cord tumors/lesions. It might be particularly effective at minimizing errors in large intramedullary spinal cord tumors. By reducing unnecessary myelotomy, indocyanine green videoangiography may improve surgical outcomes.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"426-433"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964337","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":"Retrospective Comparative Analysis of Diffusion Tensor and Constrained Spherical Deconvolution Tractography Models in a Clinical Neurosurgical Navigation Platform.","authors":"Aoi Watanabe, Madoka Furukawa, Ryo Hiruta, Yosuke Kuromi, Mudathir Bakhit, Masazumi Fujii","doi":"10.2176/jns-nmc.2026-0025","DOIUrl":"10.2176/jns-nmc.2026-0025","url":null,"abstract":"<p><p>Tractography is a technique for visualizing the trajectories of white matter pathways. The most widely used model, the diffusion tensor imaging, assumes a single fiber orientation within each voxel. In contrast, the constrained spherical deconvolution model enables the estimation of multiple fiber orientations. Recently, constrained spherical deconvolution was added to a widely used neurosurgical navigation platform alongside the diffusion tensor imaging model, allowing both approaches to be applied within the same clinical environment. In this study, we compared the volumes of white matter tracts reconstructed using these 2 models. Magnetic resonance imaging data from 37 patients were used to reconstruct 5 white matter tracts-the corpus callosum, the bilateral inferior fronto-occipital fasciculi, and the bilateral corticospinal tracts. Volumetric and visual analyses were conducted to assess differences in tract reconstruction between constrained spherical deconvolution and diffusion tensor imaging. Across all bundles, constrained spherical deconvolution consistently yielded significantly greater tract volumes, with a mean percentage volume difference of 158.6% (p < 0.001), most prominently in the inferior fronto-occipital fasciculi. Visual assessments favored constrained spherical deconvolution-based reconstructions in approximately 80% of the cases, and volumetric and visual measures demonstrated strong concordance (Spearman's ρ = -0.766, p < 0.001). In contrast, differences between constrained spherical deconvolution and diffusion tensor imaging were less pronounced in the corticospinal tracts. Lowering the fractional anisotropy threshold in diffusion tensor imaging did not improve reconstruction quality and produced anatomically implausible streamlines. Tract type was the primary determinant of inter-method differences (p < 0.001). Integration of constrained spherical deconvolution into clinical navigation can enhance visualization of white matter organization and may improve preoperative planning and risk evaluation in neurosurgical practice.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"445-455"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964309","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":"Time-to-maximum Analysis Using Rapid Processing of Perfusion and Diffusion Software for Assessment of the Risk of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage.","authors":"Shimpei Tsuboki, Tatemi Todaka, Yukihiro Imaoka, Satoshi Namitome, Seigo Shindo, Yasuyuki Kaku, Akitake Mukasa","doi":"10.2176/jns-nmc.2026-0010","DOIUrl":"10.2176/jns-nmc.2026-0010","url":null,"abstract":"<p><p>Perfusion computed tomography predicts and diagnoses delayed cerebral ischemia after subarachnoid hemorrhage, but challenges in precision and interpretation limit its adoption. This study investigated whether tissue time-to-maximum analysis during the peak term of cerebral vasospasm, processed via Rapid Processing of Perfusion and Diffusion, can stratify delayed cerebral ischemia risk in patients with subarachnoid hemorrhage.In this retrospective cohort study, patients with subarachnoid hemorrhage treated surgically or endovascularly from March 2021 to March 2025 at the Japanese Red Cross Kumamoto Hospital underwent perfusion computed tomography approximately 10 days after the onset. Time-to-maximum parameters were computed via Rapid Processing of Perfusion and Diffusion and analyzed using logistic regression to assess their association with subsequent delayed cerebral ischemia. The primary endpoint was the development of delayed cerebral ischemia.Of the 181 patients initially screened, 101 were included in the study. The cohort included 81 women, with a mean age of 65 years. Among the 101 patients, 22 developed delayed cerebral ischemia. Compared with those without delayed cerebral ischemia, the delayed cerebral ischemia group had higher preoperative World Federation of Neurosurgical Societies grades and a higher frequency of significant cerebral vasospasm. The volume of time-to-maximum > 4 sec showed the strongest independent association with delayed cerebral ischemia. Receiver operating characteristic analysis identified a threshold of 31 mL for time-to-maximum > 4 sec, yielding a sensitivity of 0.91 and a specificity of 0.96. In multivariable logistic regression adjusting for World Federation of Neurosurgical Societies grade and cerebral vasospasm, time-to-maximum > 4 sec was associated with delayed cerebral ischemia development.The incorporation of time-to-maximum analysis via Rapid Processing of Perfusion and Diffusion may standardize perfusion computed tomography interpretation and enable delayed cerebral ischemia risk assessment.</p>","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"480-489"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042681","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}