Neurological Surgery最新文献

[History and Clinical Significance of Perfusion Imaging in Acute Ischemic Stroke:From the Penumbra Concept to Tissue-Based Patient Selection]. [灌注成像在急性缺血性脑卒中中的历史和临床意义：从半暗带概念到基于组织的患者选择]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050964

Manabu Inoue

{"title":"[History and Clinical Significance of Perfusion Imaging in Acute Ischemic Stroke:From the Penumbra Concept to Tissue-Based Patient Selection].","authors":"Manabu Inoue","doi":"10.11477/mf.030126030540050964","DOIUrl":"10.11477/mf.030126030540050964","url":null,"abstract":"Perfusion imaging has transformed acute ischemic stroke management by enabling a paradigm shift from a time-based to a tissue-based treatment. The concept of the ischemic penumbra, originally established through experimental studies and positron emission tomography (PET), provided the physiological basis for identifying potentially salvageable brain tissue. Subsequent advances in computed tomography and magnetic resonance perfusion imaging have allowed quantitative assessment of cerebral hemodynamics in clinical practice. The introduction of perfusion mismatch enables the estimation of ischemic core and penumbra, facilitating individualized patient selection for reperfusion therapy. Landmark trials, including DAWN and DEFUSE 3, have demonstrated that treatment decisions based on tissue viability, rather than the time from symptom onset, can safely extend the therapeutic window. More recently, studies involving large ischemic cores, such as the RESCUE-Japan LIMIT, have challenged traditional treatment boundaries and refined the concept of malignant profile. Despite these advances, the implementation of perfusion imaging in Japan remains limited, because of insufficient reimbursement and restricted access to automated analysis software. This review summarizes the historical evolution, physiological basis, clinical applications, and future perspectives of perfusion imaging and highlights its pivotal role in modern tissue-based stroke care.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"964-976"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Long-Term Management for Secondary Prevention of Ischemic Stroke]. 缺血性脑卒中二级预防的长期管理。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051056

Toshinori Matsushige

引用次数: 0

[Epidemiology and Pathophysiology of Acute Ischemic Stroke]. [急性缺血性脑卒中的流行病学和病理生理学]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050955

Ryoma Inui, Kanta Tanaka

{"title":"[Epidemiology and Pathophysiology of Acute Ischemic Stroke].","authors":"Ryoma Inui, Kanta Tanaka","doi":"10.11477/mf.030126030540050955","DOIUrl":"10.11477/mf.030126030540050955","url":null,"abstract":"Over the past few decades, the treatment of acute ischemic stroke (AIS) has advanced significantly. Although age-standardized stroke incidence and mortality rates have declined globally thanks to improved preventive and acute therapies, population growth and aging have meant that the absolute disease burden continues to increase. In Japan, data from the Japan Stroke Data Bank indicate a trend towards milder neurological severity at onset and improved functional outcomes at discharge. However, approximately 80% of all patients with AIS remain ineligible for acute reperfusion therapies such as intravenous thrombolysis and endovascular therapy, highlighting the critical importance of appropriate medical management based on pathophysiological assessments. To deliver optimal medical treatment, physicians must precisely understand the different stroke subtypes. Although the conventional TOAST classification remains the standard for identifying primary stroke etiologies, in clinical practice, it commonly fails to account for overlapping pathologies. ASCOD phenotyping addresses this limitation by categorizing overlapping etiologies in a graded fashion. Neurosurgeons who frequently manage such complex cases must accurately evaluate the diverse pathophysiological backgrounds and foster multidisciplinary team approaches to optimize both acute care and secondary prevention in patients with AIS.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"955-963"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Acute-Phase Medical Treatment:Treatment to "Reduce" the Risk of Symptom Worsening]. 【急性期医学治疗：“降低”症状恶化风险的治疗】。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050988

Satoru Fujiwara

{"title":"[Acute-Phase Medical Treatment:Treatment to \"Reduce\" the Risk of Symptom Worsening].","authors":"Satoru Fujiwara","doi":"10.11477/mf.030126030540050988","DOIUrl":"10.11477/mf.030126030540050988","url":null,"abstract":"Acute medical management after acute ischemic stroke (AIS) is often perceived as a supportive or conservative treatment, following decisions regarding intravenous thrombolysis and mechanical thrombectomy. However, it should be regarded as an active strategy to reduce the risk of neurological deterioration and support subsequent recovery. Acute medical treatment can be divided into two components: prevention of recurrent stroke or infarct expansion, and prevention of systemic complications that may delay recovery. This approach mainly aims at preventing early neurological deterioration (END), a clinically important but variably defined phenomenon associated with poor functional outcomes. Estimating the risk of END at admission using the clinical background, comorbidities, frailty, stroke mechanism, vascular imaging, and infarct distribution guides treatment intensity and monitoring. In patients with non-cardioembolic AIS with a high risk of END, antithrombotic strategies, including prasugrel and argatroban, may be considered while balancing the risk of bleeding. Recent randomized trials support earlier initiation of direct oral anticoagulants in selected patients with cardioembolic stroke. General medical care, including hemodynamic management, mobilization, swallowing assessment, and nutrition, is essential to prevent deterioration and promote recovery.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"988-995"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Evaluation Method for Ascertaining Mechanical Thrombectomy]. 【确定机械取栓的评价方法】。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051014

Takeru Umemura, Yu Abekura, Taketo Hatano

引用次数: 0

[Fundamentals of Therapy for Acute Ischemic Stroke:Basic Knowledge for the Practical Assessment of Eligibility]. 【急性缺血性脑卒中治疗基础：资格实际评估的基础知识】。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050977

Soya Iwamoto, Tomohide Yoshie

{"title":"[Fundamentals of Therapy for Acute Ischemic Stroke:Basic Knowledge for the Practical Assessment of Eligibility].","authors":"Soya Iwamoto, Tomohide Yoshie","doi":"10.11477/mf.030126030540050977","DOIUrl":"10.11477/mf.030126030540050977","url":null,"abstract":"Acute ischemic stroke (AIS) requires rapid and appropriate imaging techniques to guide reperfusion therapy. This article provides a practical approach for the neuroimaging interpretation of AIS, focusing on the evaluation and integration of imaging findings into clinical decision-making. In MRI-first settings, diffusion-weighted imaging is applied first to identify acute ischemic lesions, followed by magnetic resonance angiography to identify the responsible vessel, with FLAIR and T2*-weighted imaging providing complementary information on lesion evolution, hemodynamics, and hemorrhagic findings. In CT-first settings, noncontrast CT, CT angiography, and CT perfusion are used to assess hemorrhage, early ischemic changes, vessel occlusion, collateral circulation, and tissue perfusion. Perfusion imaging can further estimate the ischemic core and hypoperfused tissue; however, automated results should not be interpreted in isolation. Understanding the characteristics and limitations of each imaging modality and integrating the imaging findings with neurological symptoms and time courses are essential to ensure the appropriate selection of reperfusion therapy.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"977-986"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Current Evidence of Mechanical Thrombectomy for Acute Cerebral Artery Occlusion]. [急性脑动脉闭塞机械取栓的最新证据]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051005

Hitoshi Fukuda

{"title":"[Current Evidence of Mechanical Thrombectomy for Acute Cerebral Artery Occlusion].","authors":"Hitoshi Fukuda","doi":"10.11477/mf.030126030540051005","DOIUrl":"10.11477/mf.030126030540051005","url":null,"abstract":"Following previous negative randomized controlled trials (RCTs), the validity of mechanical thrombectomy (MT) for large-vessel occlusion (LVO) of the anterior circulation was established by multiple positive RCTs in 2015. The success of these RCTs was achieved by introducing a stent retriever, which enabled a safer procedure and higher revascularization rate. Since then, novel evidence has been accumulated by several emerging RCTs to expand the indication of MT. First, the time limit for MT was extended based on RCTs demonstrating the efficacy of MT in patients with a longer penumbra on radiological imaging. Thus, rescuing patients with a larger ischemic core using MT has been justified by RCTs revealing sufficient functional recovery and acceptable hemorrhagic complications in this subgroup. Basilar artery occlusion, which has a poor prognosis under conservative treatment, was also approved as a good candidate for MT. However, evidence of MT for medium vessel occlusion or less severe neurological deficits remains unelucidated, presumably due to a relatively better natural history and non-negligible hemorrhagic complications. Further evidence-based expansion of MT indications is anticipated, although the application of novel evidence to real-world treatments remains a concern.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1005-1013"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Neuroendovascular Skill Training That Does Not Rely on Case Volume:Strategies to Maximize Learning Density per Case]. [不依赖病例量的神经血管内技能训练：最大化每个病例学习密度的策略]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051110

Masaaki Shojima

{"title":"[Neuroendovascular Skill Training That Does Not Rely on Case Volume:Strategies to Maximize Learning Density per Case].","authors":"Masaaki Shojima","doi":"10.11477/mf.030126030540051110","DOIUrl":"10.11477/mf.030126030540051110","url":null,"abstract":"Neuroendovascular trainees face two constraints: limited time for procedural training and fewer cases per operator. Traditional volume-based apprenticeship is becoming untenable, yet case volume alone does not determine competence. The primary qualification for an operator is sound clinical judgment rather than manual dexterity, and judgment is cultivated through deliberate engagement with each case. Because thrombectomy allows little time for case-specific rehearsal, learning depends heavily on postprocedural reflection. Multisource recording of hand movements, fluoroscopy, and vital signs, together with frame-by-frame video editing, AI-transcribed audio recordings, and eye tracking, can increase the granularity of reflective analysis. For off-the-job training, methods should be selected based on a balance among anatomical fidelity, haptics, immersion, convenience, and cost. Polyvinyl alcohol vascular models offer realistic friction, while strain gauge-embedded phantoms can translate experts' subjective perceptions of resistance into quantitative feedback. During on-the-job training, real-time video monitoring, gaze sharing, and computer vision may augment the observational capacity of trainees and supervisors. Objective criteria for initiating or terminating procedures performed by trainees, together with an ethical framework for training-related practice, remain to be established.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1110-1119"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Emerging Therapeutic Strategies for Central Nervous System Regeneration]. [中枢神经系统再生的新兴治疗策略]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051102

Kuniyasu Niizuma

{"title":"[Emerging Therapeutic Strategies for Central Nervous System Regeneration].","authors":"Kuniyasu Niizuma","doi":"10.11477/mf.030126030540051102","DOIUrl":"https://doi.org/10.11477/mf.030126030540051102","url":null,"abstract":"Reperfusion therapy has markedly improved outcomes after acute ischemic stroke; however, many patients remain ineligible for treatment or sustain irreversible brain injury despite successful recanalization. Regenerative medicine therefore represents an important strategy for restoring damaged neural tissue and promoting functional recovery. Stem cell therapies may exert therapeutic effects through multiple mechanisms, including cell replacement, secretion of neurotrophic factors, modulation of inflammation and immune responses, angiogenesis, and intercellular transfer of mitochondria and other bioactive molecules. Several regenerative medical products have received conditional, time-limited approval in Japan for central nervous system (CNS) disorders, including traumatic spinal cord injury, traumatic brain injury, and Parkinson disease. However, no stem cell product has yet been approved for ischemic stroke. Recent randomized, placebo-controlled trials have evaluated several cell-based therapies. The TREASURE trial evaluating allogeneic multipotent adult progenitor cells and the J-REPAIR trial evaluating allogeneic dental pulp stem cells failed to meet their primary efficacy endpoints. In contrast, a phase 2 trial of CL2020, an allogeneic Muse cell-based product, demonstrated acceptable safety and promising signals of functional recovery in patients with subacute ischemic stroke. Further studies are required to optimize cell type, dose, timing, route of administration, and patient selection, and to establish efficacy in adequately powered clinical trials.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1102-1109"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Technological Evolution of Mechanical Thrombectomy Devices and Techniques in Endovascular Stroke Therapy:An Integrated Review of PMDA-Approved Devices and Major Techniques]. [血管内卒中治疗中机械取栓装置和技术的技术演变：pmda批准的装置和主要技术的综合回顾]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051034

Daisuke Watanabe

引用次数: 0