Neurologia medico-chirurgica最新文献_第9页

Direction-selective Resistance to Cerebrospinal Fluid Flow as the Cause of Syringomyelia. 脑脊液流向选择性阻力是鞘膜积液症的病因。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-02-15 Epub Date: 2024-01-15 DOI: 10.2176/jns-nmc.2023-0149

Han Soo Chang

{"title":"Direction-selective Resistance to Cerebrospinal Fluid Flow as the Cause of Syringomyelia.","authors":"Han Soo Chang","doi":"10.2176/jns-nmc.2023-0149","DOIUrl":"10.2176/jns-nmc.2023-0149","url":null,"abstract":"The pathophysiology of syringomyelia remains poorly understood. Two prevailing challenges stand out: the need for a comprehensive understanding of its diverse types and the yet-to-be-explained mechanism of cerebrospinal fluid (CSF) retention in the syrinx despite its higher pressure than that in the adjacent subarachnoid space. Expanding on our previous proposal that direction-selective resistance to subarachnoid CSF flow drives syringomyelia genesis, this study uses a computer model to explore this mechanism further. We developed a computer simulation model to study spinal CSF dynamics, employing a lumped parameter approach with multiple compartments. This model replicated the to-and-fro movement of CSF in the spinal subarachnoid space and within an intraspinal channel. Subsequently, a direction-selective resistance-opposing only the caudal subarachnoid CSF flow-was introduced at a specific location within the subarachnoid space. Following the introduction of the direction-selective resistance, a consistent pressure increase was observed in the intraspinal channel downstream of the resistance. Importantly, this increase in pressure accumulated with every cycle of to-and-fro CSF flow. The accumulation results from the pressure drop across the resistance, and its effect on the spinal cord matrix creates a pumping action in the intraspinal channel. Our findings elucidate the mechanisms underlying our hypothesis that a direction-selective resistance to subarachnoid CSF flow causes syringomyelia. This comprehensively explains the various types of syringomyelia and resolves the puzzle of CSF retention in the syrinx despite a pressure gradient.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"93-99"},"PeriodicalIF":1.9,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10918455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466885","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}

引用次数: 0

Synergistic Interaction of Thyroid Autoantibodies and Ring Finger Protein 213 Variant in Moyamoya Disease. 甲状腺自身抗体与环指蛋白213变异在烟雾病中的协同作用

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-15 Epub Date: 2023-12-06 DOI: 10.2176/jns-nmc.2023-0169

Thiparpa Thamamongood, Shoko Hara, Hiroyuki Akagawa, Motoki Inaji, Yoji Tanaka, Tadashi Nariai, Taketoshi Maehara

{"title":"Synergistic Interaction of Thyroid Autoantibodies and Ring Finger Protein 213 Variant in Moyamoya Disease.","authors":"Thiparpa Thamamongood, Shoko Hara, Hiroyuki Akagawa, Motoki Inaji, Yoji Tanaka, Tadashi Nariai, Taketoshi Maehara","doi":"10.2176/jns-nmc.2023-0169","DOIUrl":"10.2176/jns-nmc.2023-0169","url":null,"abstract":"Recently, thyroid autoantibodies were found to be associated with moyamoya disease (MMD). The ring finger protein 213 (RNF213) p.R4810K variant represents the most important susceptibility genotype of this disease, but its relationship with thyroid autoantibodies remains to be elucidated. Thus, in this study, we aimed to evaluate the clinical relevance of thyroid autoantibodies in each RNF213 genotype in patients with MMD. Included in this study were patients with MMD without a thyroid disease history and in euthyroid status; they were then classified into the mutated or nonmutated based on the RNF213 p.R4810K genotype and positive or negative based on thyroid autoantibody (thyroperoxidase and thyroglobulin) levels. Clinical data of each group were thereafter evaluated. Among the 209 patients, the mutated RNF213 p.R4810K variant and positive thyroid autoantibodies were detected in 155 and 41 patients, respectively. Positive thyroid autoantibodies were found to be more common in the nonmutated patients than in the mutated patients (31.5% vs. 15.5%; P = 0.011). In the mutated patients, as compared to autoantibody-negative patients, autoantibody-positive patients were determined to be more likely to have advanced disease with posterior cerebral artery involvement (54.2% vs. 29.0%; P = 0.017), white matter infarction (58.3% vs. 37.6%; P = 0.046), and a higher modified Rankin Scale at last visit (16.7% vs. 3.1%; P = 0.021). These results suggest that thyroid autoantibodies can act as an immunity inducer in patients with MMD lacking the susceptibility gene RNF213 p.R4810K variant. Moreover, the simultaneous presence of thyroid autoantibodies and the variant seems to aggravate the disease, which indicates synergy between thyroid autoantibodies and the variant.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"43-49"},"PeriodicalIF":1.9,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10835577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138499017","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}

引用次数: 0

Platelet-derived Growth Factor Activates Pericytes in the Microvessels of Chronic Subdural Hematoma Outer Membranes. 血小板衍生生长因子激活慢性硬膜下血肿外膜微血管中的周细胞。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-15 Epub Date: 2023-11-30 DOI: 10.2176/jns-nmc.2023-0079

Mao Yokota, Koji Osuka, Yusuke Ohmichi, Mika Ohmichi, Chiharu Suzuki, Masahiro Aoyama, Kenichiro Iwami, Satoru Honma, Shigeru Miyachi

{"title":"Platelet-derived Growth Factor Activates Pericytes in the Microvessels of Chronic Subdural Hematoma Outer Membranes.","authors":"Mao Yokota, Koji Osuka, Yusuke Ohmichi, Mika Ohmichi, Chiharu Suzuki, Masahiro Aoyama, Kenichiro Iwami, Satoru Honma, Shigeru Miyachi","doi":"10.2176/jns-nmc.2023-0079","DOIUrl":"10.2176/jns-nmc.2023-0079","url":null,"abstract":"Angiogenesis is one of the growth mechanisms of chronic subdural hematoma (CSDH). Pericytes have been implicated in the capillary sprouting during angiogenesis and are involved in brain ischemia and diabetic retinopathy. This study examined the pericyte expressions in CSDH outer membranes obtained during trepanation surgery. Eight samples of CSDH outer membranes and 35 samples of CSDH fluid were included. NG2, N-cadherin, VE-cadherin, Tie-2, endothelial nitric oxide synthase (eNOS), platelet-derived growth factor (PDGF) receptor-β (PDGFR-β), a well-known marker of pericytes, phosphorylated PDGFR-β at Tyr751, and β-actin expressions, were examined using western blot analysis. PDGFR-β, N-cadherin, and Tie-2 expression levels were also examined using immunohistochemistry. The concentrations of PDGF-BB in CSDH fluid samples were measured using enzyme-linked immunosorbent assay kits. NG2, N-cadherin, VE-cadherin, Tie-2, eNOS, PDGFR-β, and eNOS expressions in CSDH outer membranes were confirmed in all cases. Furthermore, phosphorylated PDGFR-β at Tyr751 was also detected. In addition, PDGFR-β, N-cadherin, and Tie-2 expressions were localized to the endothelial cells of the vessels within CSDH outer membranes by immunohistochemistry. The concentration of PDGF-BB in CSDH fluids was significantly higher than that in cerebrospinal fluid. These findings indicate that PDGF activates pericytes in the microvessels of CSDH outer membranes and suggest that pericytes are crucial in CSDH angiogenesis through the PDGF/PDGFR-β signaling pathway.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"50-55"},"PeriodicalIF":1.9,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10835575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138461200","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}

引用次数: 0

Effectiveness of Keyhole Clipping of Unruptured Intracranial Aneurysms Detected by "Brain Dock" in Healthy Japanese Adults. “脑码头”检测未破裂颅内动脉瘤锁孔夹闭术在日本健康成年人中的疗效。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-15 Epub Date: 2023-11-08 DOI: 10.2176/jns-nmc.2023-0157

Toru Yoshiura, Satoru Takeuchi, Terushige Toyooka, Arata Tomiyama, Kojiro Wada, Yasuaki Nakao, Takuji Yamamoto, Kentaro Mori

{"title":"Effectiveness of Keyhole Clipping of Unruptured Intracranial Aneurysms Detected by \"Brain Dock\" in Healthy Japanese Adults.","authors":"Toru Yoshiura, Satoru Takeuchi, Terushige Toyooka, Arata Tomiyama, Kojiro Wada, Yasuaki Nakao, Takuji Yamamoto, Kentaro Mori","doi":"10.2176/jns-nmc.2023-0157","DOIUrl":"10.2176/jns-nmc.2023-0157","url":null,"abstract":"In Japan, brain docking has enhanced the detection of unruptured intracranial aneurysms in healthy adults. At our institution, surgical clipping is the first-line treatment for unruptured intracranial aneurysms (UIA). In this study, the differences in neurological and radiological outcomes, as well as cognitive and psychological results, between standard clipping and keyhole clipping for these aneurysms detected via brain docking were evaluated. The study included 131 aneurysms detected via \"brain dock.\" Of these, 65 were treated with keyhole clipping surgery (keyhole clipping group), and 66 were treated with standard clipping surgery (standard clipping group). Evaluations at 3 months included the National Institutes of Health Stroke Scale, modified Rankin Scale, Mini-Mental State Examination, Hasegawa's Dementia Scale-revised, Beck Depression Inventory, Hamilton Rating Scale for Depression, and radiological abnormalities. The mean operative time and postoperative hospitalization period were significantly shorter in the keyhole clipping group than in the standard clipping group (p < 0.001). Between the groups, no significant differences in postoperative neurological complications or radiological abnormalities were found. The keyhole clipping group demonstrated slightly but significantly better Beck Depression Inventory and Hamilton Rating Scale for Depression scores than the standard clipping group (Beck Depression Inventory, p = 0.046; Hamilton Rating Scale for Depression, p < 0.01). Both the Beck Depression Inventory and Hamilton Rating Scale for Depression scores at 3 months were significantly enhanced (p < 0.001) in the keyhole clipping group. These findings propose that keyhole clipping could be considered a new therapeutic option for small UIA detected via brain docking.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"28-35"},"PeriodicalIF":1.9,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10835578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71522225","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}

引用次数: 0

Differentiation between Anterior and Posterior Roots Using Compound Muscle Action Potential in Intradural Extramedullary Spinal Tumor Surgery. 利用复合肌动作电位在硬膜内髓外脊柱肿瘤手术中鉴别前后根。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-15 Epub Date: 2023-11-30 DOI: 10.2176/jns-nmc.2023-0135

Naoyuki Harada, Yuki Sakaeyama, Yutaka Fuchinoue, Mitsuyoshi Abe, Sayaka Terazono, Chie Matsuura, Shuhei Kubota, Masataka Mikai, Nobuo Sugo, Kunio Sugiyama, Kosuke Kondo, Masaaki Nemoto

{"title":"Differentiation between Anterior and Posterior Roots Using Compound Muscle Action Potential in Intradural Extramedullary Spinal Tumor Surgery.","authors":"Naoyuki Harada, Yuki Sakaeyama, Yutaka Fuchinoue, Mitsuyoshi Abe, Sayaka Terazono, Chie Matsuura, Shuhei Kubota, Masataka Mikai, Nobuo Sugo, Kunio Sugiyama, Kosuke Kondo, Masaaki Nemoto","doi":"10.2176/jns-nmc.2023-0135","DOIUrl":"10.2176/jns-nmc.2023-0135","url":null,"abstract":"This study aims to determine the cutoff values for the compound muscle action potential (CMAP) stimulus in anatomically identified anterior (motor nerve) and posterior roots (sensory nerve) during cervical intradural extramedullary tumor surgery. The connection between CMAP data from nerve roots and postoperative neurological symptoms in thoracolumbar tumors was compared with data from cervical lesions. The participants of the study included 22 patients with intradural extramedullary spinal tumors (116 nerve roots). The lowest stimulation intensity to the nerve root at which muscle contraction occurs was defined as the minimal activation intensity (MAI) in the CMAP. In cervical tumors, the MAI was measured after differentiating between the anterior and posterior roots based on the anatomical placement of the dentate ligament and nerve roots. The MAIs for 20 anterior roots in eight cervical tumors were between 0.1 and 0.3 mA, whereas those for 19 posterior roots were between 0.4 and 2.0 mA. The cutoff was <0.4 mA for both the anterior and posterior roots, and sensitivity and specificity were both 100%. In thoracolumbar tumors, the nerve root was severed in 12 of 14 cases. All MAIs were determined to be at the dorsal roots as their scores were higher than the cutoff and did not indicate motor deficits. The MAIs of the anatomically identified anterior and posterior root CMAPs were found to have a cutoff value of <0.4 mA in the cervical lesions. Similar MAI cutoffs were also applicable to thoracolumbar lesions. Thus, CMAP may be useful in detecting anterior and posterior roots in spinal tumor surgery.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"36-42"},"PeriodicalIF":1.9,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10835576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138461199","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}

引用次数: 0

Erratum. 勘误。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-01 DOI: 10.2176/jns-nmc.er.2023-0069

引用次数: 0

Guidelines for Awake Surgery. 清醒手术指南。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-01 DOI: 10.2176/jns-nmc.2023-0111

引用次数: 0

Nationwide All-case Survey on the Efficacy and Safety of Flow Diverter: Multicenter Study Conducted by the Japan Neurosurgical Society. 关于血流转向器有效性和安全性的全国性全病例调查：日本神经外科学会开展的多中心研究。

IF 2.4 4区医学

Neurologia medico-chirurgica Pub Date : 2024-01-01 DOI: 10.2176/jns-nmc.2023-0246

Kenji Ohata, Hajime Arai, Masayuki Ezura, Koji Iihara, Hiroyuki Kinouchi, Shigeki Kobayashi, Teiji Tominaga, Kazuo Minematsu, Yuichi Murayama, Naoki Nakayama, Nobuyuki Sakai, Masahiro Yasaka, Yuhei Yoshimoto, Takamasa Kayama

引用次数: 0

Lateral Lumbar Interbody Fusion within Three-level for Patients with Neurological Symptoms due to Vertebral Fragility Fractures in the Lumbar Spine. 腰椎脆性骨折引起的神经系统症状患者的三级腰外侧融合术。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2023-12-15 Epub Date: 2023-10-18 DOI: 10.2176/jns-nmc.2023-0064

Yoshitaka Nagashima, Yusuke Nishimura, Tokumi Kanemura, Nobuhiro Hata, Kotaro Satake, Sho Akahori, Motonori Ishii, Takafumi Tanei, Masakazu Takayasu, Ryuta Saito

{"title":"Lateral Lumbar Interbody Fusion within Three-level for Patients with Neurological Symptoms due to Vertebral Fragility Fractures in the Lumbar Spine.","authors":"Yoshitaka Nagashima, Yusuke Nishimura, Tokumi Kanemura, Nobuhiro Hata, Kotaro Satake, Sho Akahori, Motonori Ishii, Takafumi Tanei, Masakazu Takayasu, Ryuta Saito","doi":"10.2176/jns-nmc.2023-0064","DOIUrl":"10.2176/jns-nmc.2023-0064","url":null,"abstract":"There is a lack of agreement on whether minimally invasive lateral lumbar intervertebral fusion (LLIF) is a suitable treatment option for vertebral fragility fractures (VFFs). Hence, we sought to evaluate the efficacy and safety of LLIF in the management of VFF with neurological deficits in the lumbar spine. Between April 2015 and March 2020, we conducted a retrospective observational study of patients with VFF treated with three-level or less LLIF. The participants had previously received conservative treatment but had not been able to control their neurological symptoms. To assess the outcomes of the LLIF procedures, the patients were followed up for a minimum of 1 year. Clinical and radiological results, which include the timing and location of the bony fusion, were analyzed. The study involved 19 patients with 23 vertebral fracture levels. The residual height of the fractured vertebra was found to be 57.0 ± 12.3% of the height of the adjacent level. The mean Japanese Orthopedic Association score significantly improved postoperatively. Postoperative radiological parameters were significantly maintained at 1 year, and lumbar lordosis was maintained at the last follow-up (45.0 ± 26.7). In total 31 LLIF levels, bone fusion was observed in four levels at 6 months postoperatively, in 16 levels at 1 year, and in 23 levels at the last follow-up. The facet joint had the highest bony fusion location. LLIF within three levels can be safely performed in certain VFF cases with sufficient residual vertebral height.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"548-554"},"PeriodicalIF":1.9,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10788486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49680295","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}

引用次数: 0

Long-term Patency of Retrograde Bypass Using a Distal Stump of the Parietal Superficial Temporal Artery for Moyamoya Disease. 颞浅动脉远端残端逆行转流治疗Moyamoya病的长期专利。

IF 1.9 4区医学

Neurologia medico-chirurgica Pub Date : 2023-12-15 Epub Date: 2023-09-23 DOI: 10.2176/jns-nmc.2023-0070

Takeshi Shimizu, Shingo Toyota, Motohide Takahara, Kazuhiro Touhara, Tatsuya Hagioka, Yuhei Hoshikuma, Takamune Achiha, Tomoaki Murakami, Maki Kobayashi, Haruhiko Kishima

{"title":"Long-term Patency of Retrograde Bypass Using a Distal Stump of the Parietal Superficial Temporal Artery for Moyamoya Disease.","authors":"Takeshi Shimizu, Shingo Toyota, Motohide Takahara, Kazuhiro Touhara, Tatsuya Hagioka, Yuhei Hoshikuma, Takamune Achiha, Tomoaki Murakami, Maki Kobayashi, Haruhiko Kishima","doi":"10.2176/jns-nmc.2023-0070","DOIUrl":"10.2176/jns-nmc.2023-0070","url":null,"abstract":"There have been a number of anastomosis methods of bypass techniques reported for moyamoya disease. However, there are yet no randomized controlled trials conducted on the anastomosis method. Retrograde blood flow of the superficial temporal artery (STA) may be used as one of the donor options. Here, we examined the tolerability of retrograde bypass using a distal stump of the parietal STA (dsPSTA). Anastomosis between the dsPSTA and middle cerebral artery (MCA) was performed for consecutive patients with moyamoya disease whose parietal STA was visualized to be longer than 10 cm using contrast-enhanced computed tomography preoperatively. Retrospectively, we have examined its patency and clinical outcome. Retrograde dsPSTA-MCA bypass was performed in 22 hemispheres of 17 patients. The patency of retrograde dsPSTA-MCA bypass in all 22 anastomoses could be confirmed during follow-up periods (mean: 5.5, range: 2-15 years). No recurrence of ischemic events was observed. The dsPSTA-MCA bypass using retrograde blood flow has been determined as one of the many promising anastomosis methods, and long-term patency was achieved in moyamoya disease.","PeriodicalId":19225,"journal":{"name":"Neurologia medico-chirurgica","volume":" ","pages":"542-547"},"PeriodicalIF":1.9,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10788485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122088","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}

引用次数: 0