Neurological Surgery最新文献

[Surgical Setup and Perioperative Management for Endoscopic Transsphenoidal Surgery]. [内镜下经蝶窦手术的手术设置及围手术期管理]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020240

Ryutaro Makino, Shingo Fujio, Ryosuke Hanaya

{"title":"[Surgical Setup and Perioperative Management for Endoscopic Transsphenoidal Surgery].","authors":"Ryutaro Makino, Shingo Fujio, Ryosuke Hanaya","doi":"10.11477/mf.030126030540020240","DOIUrl":"https://doi.org/10.11477/mf.030126030540020240","url":null,"abstract":"Endoscopic transsphenoidal surgery has been the most commonly performed neuroendoscopic procedure in Japan since its reimbursement category was introduced in 2012. Although the surgical technique is now largely standardized, perioperative management and operating room setup still vary among institutions. At our center, patients are positioned in a semi-Fowler's posture with the head elevated to reduce venous bleeding from the cavernous sinus, while carefully monitoring the risk of venous air embolism. A slight vertex-up angle facilitates a natural instrument trajectory and is adjusted according to lesion location. Surgery is performed using a four-hand technique, with the assistant controlling the endoscope and coordinating movements with the surgeon, adapting to anatomical constraints and the use of straight or angled endoscopes. We also describe our approach to perioperative glucocorticoid supplementation, postoperative endocrine management for pituitary disorders, and the prevention and treatment of delayed postoperative hyponatremia. Collaboration with otolaryngologists is preferred for postoperative nasal care. These strategies aim to enhance surgical safety, infection control, endocrine stability, and patient comfort while supporting continued advances in endoscopic skull base surgery.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"240-248"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783616","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

[Head and Neck Surgery Approach : Prelacrimal Approach, Direct Approach to the Anterior and Lateral Part of the Maxillary Sinus with an Endoscope (DALMA), and Trans-Cribriform Approach]. [头颈部手术入路：泪前入路，直接入路上颌窦前部和外侧与内窥镜（DALMA），和经筛状入路]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020295

Kazuhiro Omura

引用次数: 0

[Endoscopic Combined Transcranial and Endonasal Approach]. [经颅鼻联合内镜入路]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020448

Tadashi Watanabe

引用次数: 0

[Optimization of the Surgical Environment and Perioperative Management in Endoscopic Intraventricular Surgery]. 内窥镜脑室手术手术环境优化及围手术期处理

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020249

Masahiro Tanji

{"title":"[Optimization of the Surgical Environment and Perioperative Management in Endoscopic Intraventricular Surgery].","authors":"Masahiro Tanji","doi":"10.11477/mf.030126030540020249","DOIUrl":"https://doi.org/10.11477/mf.030126030540020249","url":null,"abstract":"Neuroendoscopic intraventricular surgery provides a minimally invasive approach but is inherently challenging, as it is performed within a fragile, three-dimensional ventricular space while relying on a limited two-dimensional endoscopic view. Loss of orientation and subtle technical errors can result in hemorrhage or neural injury. This chapter describes practical strategies for achieving stable and reproducible neuroendoscopic intraventricular surgery, with emphasis on operating room setup, instrumentation, teamwork, and perioperative management. Key principles include aligning the surgeon, patient, and monitor to maintain visuomotor consistency; proactive use of navigation and intraoperative ultrasound to prevent misplacement; and gentle, deliberate manipulation of the vulnerability of ventricular structures. Instrument selection, including rigid scopes, channel-based rigid endoscopic systems, and coagulation-suction devices, is discussed from a safety-oriented perspective. A central emphasis is placed on the role of the assistant, whose responsibilities extend beyond irrigation control ( \"water management\" ) to include verbal cues and optimization of the surgical environment. Perioperative management, particularly external ventricular drainage (EVD) strategies, postoperative fever, and the role of neuroendoscopic ventricular irrigation in ventriculitis, are also reviewed. Collectively, these concepts highlight that successful neuroendoscopic surgery depends not only on technical proficiency but also on comprehensive surgical design and effective team coordination.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"249-256"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783568","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

[Pediatric Neuroendoscopic Surgery]. [小儿神经内窥镜外科]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020402

Tomoru Miwa

{"title":"[Pediatric Neuroendoscopic Surgery].","authors":"Tomoru Miwa","doi":"10.11477/mf.030126030540020402","DOIUrl":"https://doi.org/10.11477/mf.030126030540020402","url":null,"abstract":"Pediatric neuroendoscopic surgery involves a wide range of indications and surgical techniques. Neuroendoscopy has become an essential tool in the management of hydrocephalus in children. Given the heterogeneity of clinical presentations, surgical strategies must be individualized for each case. Additionally, the procedures must consider the fragility of the pediatric brain and emphasize minimally invasive approaches. Such surgeries often involve a high proportion of intraventricular manipulation under continuous irrigation, requiring the appropriate selection of endoscopes and specialized devices suited for such environments. Furthermore, compared with adults, pediatric patients are more prone to complications, including infection, cerebrospinal fluid leakage, and subdural hematoma, necessitating meticulous management during intraoperative cerebrospinal fluid irrigation and wound closure. In this study, we describe the characteristics and key considerations of pediatric neuroendoscopic surgery based on our experience with endoscopic third ventriculostomy (ETV) for noncommunicating hydrocephalus, fenestration of arachnoid cysts, and combined procedures using flexible scopes and rigid ventriculoscopes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"402-415"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783608","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

[Endoscopic Surgery for Trigeminal Schwannoma]. 内镜手术治疗三叉神经鞘瘤

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020384

Hiroyoshi Akutsu

{"title":"[Endoscopic Surgery for Trigeminal Schwannoma].","authors":"Hiroyoshi Akutsu","doi":"10.11477/mf.030126030540020384","DOIUrl":"https://doi.org/10.11477/mf.030126030540020384","url":null,"abstract":"Minimally invasive surgical techniques, including the endoscopic endonasal transmaxillary-pterygoid approach (EETMPA), the endoscopic transorbital approach (ETOA), and the endoscopic keyhole approach (EKA), have recently been applied to the surgical treatment of trigeminal schwannomas. However, criteria for patient selection and technical nuances remain sparsely reported; therefore, we describe these aspects based on our previous work. For patient selection, a sufficient surgical corridor to the tumor from the paranasal sinus must be identified on magnetic resonance imaging to perform EETMPA. To create an adequate working space, wide sphenoidotomy and ethmoidectomy are required, along with removal of the medial and posterior walls of the maxillary sinus and opening of the pterygopalatine fossa. These steps allow access to Meckel's cave through the quadrangular space, formed by the cavernous and petrous internal carotid arteries, the abducens nerve, and V2. During tumor resection, intracapsular dissection is essential to preserve normal trigeminal nerve fibers. Precise patient selection and intracapsular resection may have contributed to the favorable surgical outcomes of EETMPA for non-vestibular schwannoma. With the accumulation of further clinical experience, criteria for selecting EETMPA, ETOA, or EKA are expected to become clearer.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"384-392"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783634","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

[Craniopharyngioma : Current Perspectives Including Recent Advances in Molecular Targeted Therapy]. [颅咽管瘤：分子靶向治疗的最新进展]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020353

Shingo Fujio, Ryutaro Makino, Ryosuke Hanaya

{"title":"[Craniopharyngioma : Current Perspectives Including Recent Advances in Molecular Targeted Therapy].","authors":"Shingo Fujio, Ryutaro Makino, Ryosuke Hanaya","doi":"10.11477/mf.030126030540020353","DOIUrl":"https://doi.org/10.11477/mf.030126030540020353","url":null,"abstract":"Craniopharyngiomas are benign sellar and parasellar tumors and clinically challenging to treat because of their proximity to the critical neurovascular and hypothalamic structures. Recently, distinct driver mutations, including CTNNB1 in adamantinomatous craniopharyngiomas and BRAF V600E in papillary craniopharyngiomas, have led to a paradigm shift in treatment strategies. Endoscopic endonasal transsphenoidal surgery, supported by advances in surgical instruments and techniques, has expanded the indications for this minimally invasive surgical strategy, which has become an important approach in contemporary surgical management. Radiotherapy remains an effective adjuvant option for residual or recurrent tumors and contributes to durable local tumor control if combined with function-preserving surgical strategies. Molecular targeted therapy combining BRAF and MEK inhibitors results in marked tumor shrinkage in papillary craniopharyngiomas harboring the BRAF V600E mutation. These agents have emerged as promising therapeutic options, potentially as neoadjuvant therapies for enhancing surgical safety or achieving non-surgical tumor control in selected cases. Future management of craniopharyngiomas requires an individualized, multimodal approach that integrates the molecular subtype, patient age, functional status, and long-term quality of life to choose a treatment course that balances durable tumor control with optimal functional outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"353-362"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783639","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

[Basic Approach : Transsphenoidal Approach (Nasal and Sphenoid Phase)]. 【基本入路：经蝶窦入路（鼻及蝶窦期）】。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020273

Shunya Hanakita, Hirotaka Hasegawa

{"title":"[Basic Approach : Transsphenoidal Approach (Nasal and Sphenoid Phase)].","authors":"Shunya Hanakita, Hirotaka Hasegawa","doi":"10.11477/mf.030126030540020273","DOIUrl":"https://doi.org/10.11477/mf.030126030540020273","url":null,"abstract":"Endoscopic endonasal transsphenoidal surgery has become a cornerstone of minimally invasive skull base surgery, particularly for pituitary neuroendocrine tumors. Advances in endoscopic visualization, navigation systems, and surgical instruments have enabled safe and effective use of a direct transnasal corridor to the sella and adjacent skull base structures. However, successful execution of this approach requires a precise understanding of nasal and paranasal sinus anatomy, as well as meticulous surgical technique during the nasal and sphenoid phases of the procedure. This chapter describes the basic concepts and step-by-step techniques of the endoscopic endonasal transsphenoidal approach, with a special emphasis on nasal cavity expansion, sphenoid sinus access, and sellar floor opening. Key anatomical landmarks, including the lamellar concept of the ethmoid sinus, the sphenoid sinus natural ostium, and the relationship between the internal carotid artery and surrounding structures, are highlighted to enhance intraoperative orientation and safety. Practical guidance on mucosal incision, septal cartilage preservation, bone removal, and reconstruction strategies to prevent cerebrospinal fluid leakage is also provided. This chapter aims to establish a practical foundation for novice and intermediate surgeons, facilitating a safe transition to more advanced endoscopic skull base procedures through systematic anatomical understanding and standardized surgical techniques.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"273-283"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783558","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

[Neuroendoscopic Evacuation of Intracerebral Hematomas : Approaches and Clinical Strategies by Lesion Location]. [神经内窥镜下脑内血肿清除术：病灶位置的方法和临床策略]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020416

Yoshiaki Goto, Masahiro Shin

{"title":"[Neuroendoscopic Evacuation of Intracerebral Hematomas : Approaches and Clinical Strategies by Lesion Location].","authors":"Yoshiaki Goto, Masahiro Shin","doi":"10.11477/mf.030126030540020416","DOIUrl":"https://doi.org/10.11477/mf.030126030540020416","url":null,"abstract":"Intracerebral hemorrhage (ICH), a hemorrhagic stroke subtype, is associated with high mortality and severe disability. Conventional craniotomy has long been the standard surgical approach; however, its invasiveness often results in postoperative complications and prolonged recovery time. Neuroendoscopic hematoma evacuation has emerged as a minimally invasive alternative that offers reduced blood loss, shorter operative time, and improved neurological outcomes if appropriately applied. Recent meta-analyses and international guidelines supports its role in lowering mortality, shortening hospital stay, and decreasing infection rates compared to craniotomy. Careful preoperative evaluation, including patient background, anticoagulant or antiplatelet status, and vascular imaging, is essential to determine suitability and exclude vascular malformations or tumor-related hemorrhages. Surgical strategies must balance endoscopic and open approaches according to the hematoma location, volume, consistency, and associated pathology. Superficial, large, or firm hematomas often require small craniotomies and two-hand techniques, whereas deeper or ventricular lesions require burr hole surgery. Additionally, instrument selection and operative maneuvers are critical for safe and effective evacuation. Neuroendoscopic hematoma removal, if performed properly, represents a promising standard of care for ICH, combining minimal invasiveness with favorable clinical outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"416-427"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783611","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

[Endoscopic Endonasal Management of Rathke's Cleft Cysts: Surgical Strategies and Long-Term Outcomes]. [鼻内窥镜治疗Rathke's裂囊肿：手术策略和长期结果]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020333

Hiroyoshi Kino

{"title":"[Endoscopic Endonasal Management of Rathke's Cleft Cysts: Surgical Strategies and Long-Term Outcomes].","authors":"Hiroyoshi Kino","doi":"10.11477/mf.030126030540020333","DOIUrl":"https://doi.org/10.11477/mf.030126030540020333","url":null,"abstract":"Rathke's cleft cysts (RCCs) are non-neoplastic cystic lesions of the sellar region in which the primary pathological mechanism is the mass effect caused by cyst fluid accumulation. Although endoscopic endonasal surgery is the standard treatment for symptomatic RCCs, postoperative recurrence remains relatively frequent, and optimal surgical strategies remain debated. To improve long-term cyst control, we developed a mucosal coupling (MC) method, establishing a persistent drainage route from the cyst cavity to the sphenoid sinus using the sphenoid sinus mucosa. However, the MC method is not applicable in all cases, particularly in patients with intraoperative cerebrospinal fluid (CSF) leakage. We retrospectively analyzed 77 patients who had undergone endoscopic endonasal surgery for RCCs at our institution since 2010. Surgical strategies were selected based on preoperative magnetic resonance imaging findings and intraoperative assessment of CSF leakage, including conventional cyst fenestration with dural closure, the MC method, and cyst fenestration into the cistern through the opening of the diaphragma sellae. Surgical outcomes, recurrence, and complications were evaluated. The MC group demonstrated the lowest rate of symptomatic recurrence and required reoperation. Visual function improved in almost all patients, whereas postoperative endocrine deterioration occurred in a few patients. Postoperative CSF leakage remains a critical concern, emphasizing the importance of strict intraoperative evaluation and careful patient selection. Tailored surgical strategies focusing on preventing cyst fluid reaccumulation are essential for the optimal management of RCCs.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"333-341"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783625","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