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[Cerebral Hemodynamics and Metabolism: A Practical Guide for Neurosurgeons]. 脑血流动力学和代谢：神经外科医生的实用指南。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010211
Yasuyuki Kaku, Yukihiro Imaoka
{"title":"[Cerebral Hemodynamics and Metabolism: A Practical Guide for Neurosurgeons].","authors":"Yasuyuki Kaku, Yukihiro Imaoka","doi":"10.11477/mf.030126030540010211","DOIUrl":"10.11477/mf.030126030540010211","url":null,"abstract":"<p><p>Cerebral hemodynamics and metabolism are central to neurosurgical decision-making and directly influence management in cerebrovascular disease, revascularization, and perioperative care. Powers'classification offers a physiological basis for hemodynamic ischemia, and quantitative positron emission tomography remains the gold standard for evaluating cerebral blood flow, cerebral blood volume, oxygen extraction fraction, and the cerebral metabolic rate of oxygen. Single photon emission computed tomography with acetazolamide, computed tomography/magnetic resonance perfusion, and arterial spin labeling have improved clinical accessibility and allow assessment of cerebrovascular reserve, time-to-peak, mean transit time, and time-to-maximum. In acute ischemic stroke, perfusion imaging has advanced treatment selection from a time-based to a tissue-based paradigm, supporting thrombectomy in patients with large ischemic cores. Post-recanalization phenomena, including hyperperfusion and no-reflow, illustrate the complexity of microcirculatory dynamics. Perfusion studies also inform decisions in bypass surgery and carotid revascularization. For neurosurgeons, understanding these modalities and their complementary interpretations is essential for safe and effective practice. Future integration of imaging metrics with physiological data through artificial intelligence may facilitate patient-specific strategies, standardized protocols, multicenter validation, and ultimately reduce complications while improving outcomes.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"211-228"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207940","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
[Microcatheter User's Manual]. [微导管用户手册]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010035
Masahiro Nishihori
{"title":"[Microcatheter User's Manual].","authors":"Masahiro Nishihori","doi":"10.11477/mf.030126030540010035","DOIUrl":"10.11477/mf.030126030540010035","url":null,"abstract":"<p><p>Although flow diverter stents are gaining prominence in unruptured aneurysms, intrasaccular coil embolization remains the fundamental strategy for treating ruptured cases. In this context, precise selection and manipulation of microcatheters (MCs) are pivotal determinants of procedural success. This article provides a comprehensive overview of the mechanical properties of MCs-particularly the balance between proximal stiffness and distal flexibility-their specifications, and selection criteria for devices widely available in Japan, with a specific focus on manual shaping techniques. We present experimental data comparing the shape-memory capabilities and shape-retention durability of various commercially available MCs following heat-gun and steam processing. Furthermore, we introduce practical \"spiral shaping\" methods tailored for paraclinoid aneurysms with complex geometric axis misalignments, and discuss decision-making strategies for intraoperative MC repositioning to achieve optimal coil distribution. A thorough understanding of MC mechanics and mastery of appropriate shaping techniques are vital for neurointerventionists to ensure safe and effective treatment outcomes.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"35-45"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207773","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
[Balloon-Assisted Coil Embolization for Cerebral Aneurysms]. [球囊辅助线圈栓塞治疗脑动脉瘤]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010087
Hirotaka Okumura
{"title":"[Balloon-Assisted Coil Embolization for Cerebral Aneurysms].","authors":"Hirotaka Okumura","doi":"10.11477/mf.030126030540010087","DOIUrl":"10.11477/mf.030126030540010087","url":null,"abstract":"<p><p>Balloon-assisted coil embolization is widely used for cerebral aneurysms. Compared to other treatment techniques, such as stent-assisted coiling, flow diverters, and intrasaccular devices, this method offers numerous advantages. Given the availability of multiple balloon catheter products, understanding the characteristics of each product and selecting the appropriate device are essential. Balloon catheters are primarily classified based on the number of lumens and balloon compliance. Devices with single and double lumens differ significantly in terms of the priming procedures, usage methods, and mechanical properties. The compliance type of the balloon determines its suitability for specific aneurysm morphologies. In this article, we present a comprehensive review of the structure, properties, and distinctions among currently available balloon catheters.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"87-95"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207920","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
[Intrasaccular Device "WEB" Expands Indications for Aneurysm Treatment: Details and Future Developments]. [囊内装置“WEB”扩展了动脉瘤治疗的适应症：细节和未来发展]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010080
Tomoji Takigawa
{"title":"[Intrasaccular Device \"WEB\" Expands Indications for Aneurysm Treatment: Details and Future Developments].","authors":"Tomoji Takigawa","doi":"10.11477/mf.030126030540010080","DOIUrl":"10.11477/mf.030126030540010080","url":null,"abstract":"<p><p>Endovascular treatment for wide-neck bifurcation aneurysms has improved with device advancements, yet it remains technically challenging. The Woven EndoBridge (WEB) device is establishing itself as a treatment capable of achieving both high efficacy and safety for these types of aneurysms. Future advancements in WEB are expected to broaden its applicability to smaller and lower-lying aneurysms, positioning it as an increasingly important treatment option for cerebral aneurysms.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"80-86"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207500","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
[Future Perspectives of Middle Meningeal Artery Embolization for Meningioma and Chronic Subdural Hematoma]. [脑膜中动脉栓塞治疗脑膜瘤和慢性硬膜下血肿的未来展望]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010167
Shunsuke Tanoue
{"title":"[Future Perspectives of Middle Meningeal Artery Embolization for Meningioma and Chronic Subdural Hematoma].","authors":"Shunsuke Tanoue","doi":"10.11477/mf.030126030540010167","DOIUrl":"10.11477/mf.030126030540010167","url":null,"abstract":"<p><p>Middle meningeal artery embolization (MMAE) has emerged as an important endovascular intervention, though its applications differs between meningiomas and chronic subdural hematomas (CSDH). For meningiomas, MMAE serves as a preoperative adjunct aimed at tumor devascularization and softening to facilitate resection. However, given conflicting evidence regarding its ability to reduce blood loss, careful case selection based on tumor characteristics is essential. Conversely, for CSDH, MMAE targets the inhibition of membrane neovascularization to prevent hematoma recurrence. Recent randomized controlled trials have demonstrated its efficacy as an adjunct to standard treatment, while its role as a standalone treatment continues to show promise. Technical safety relies on a thorough understanding of \"dangerous anastomoses\" to prevent complications. Furthermore, the transradial approach is highlighted as a viable access route, offering reduced puncture-site complications, particularly for the elderly demographic common to these conditions. This article reviews the current evidence, technical considerations, and future perspectives of MMAE, emphasizing that optimized patient selection is paramount for maximizing therapeutic benefit in both conditions.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"167-177"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207519","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
[Balloon and Conventional Guide Catheters]. [球囊和常规导尿管]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010113
Yusuke Egashira
{"title":"[Balloon and Conventional Guide Catheters].","authors":"Yusuke Egashira","doi":"10.11477/mf.030126030540010113","DOIUrl":"10.11477/mf.030126030540010113","url":null,"abstract":"<p><p>A balloon guide catheter (BGC) is commonly used for thrombectomy in acute ischemic stroke (AIS) of the anterior circulation. However, the findings supporting BGC usage remain unclear. The primary purpose of BGC use is preventing embolization in a new area; the BCG is also used as a balloon expansion technique to anchor devices during navigation and delivery to distal vessels. Conventional guide catheters are often used in cases of posterior circulation occlusion or with a transradial approach. Balloon and conventional guide catheters are reviewed, providing evidence supporting their use in treating AIS, describing the characteristics of each, and outlining guidelines for selecting the most appropriate guide catheter.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"113-123"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207883","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
[Viewing Endovascular Devices at the Microscale]. [在微观尺度上观察血管内装置]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010203
Satoru Takahashi, Kazutaka Sumita
{"title":"[Viewing Endovascular Devices at the Microscale].","authors":"Satoru Takahashi, Kazutaka Sumita","doi":"10.11477/mf.030126030540010203","DOIUrl":"10.11477/mf.030126030540010203","url":null,"abstract":"<p><p>In recent years, neuroendovascular therapy has advanced rapidly, enabling precise and minimally invasive treatments. A major driving force behind this progress is the evolution of devices, such as microcatheters, microwires, coils, and flow diverters. Understanding the specific characteristics of these devices and their appropriate use is essential to achieve optimal clinical outcomes. Current understanding is largely based on package inserts, manufacturing materials, schematic illustrations, and optical microscopy images. However, as these devices are extremely small, their true structural details are difficult to visualize. This article presents the direct observations of neuroendovascular devices using scanning electron microscopy, providing insights into their microscale architecture. By re-evaluating the device characteristics from this microscopic perspective, we aim to clarify their clinical significance and enhance understanding of device selection in neuroendovascular practice.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"203-209"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207892","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
[Devices for Transvenous Embolization of Dural Arteriovenous Fistulas]. 经静脉栓塞硬脑膜动静脉瘘的装置。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010149
Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka
{"title":"[Devices for Transvenous Embolization of Dural Arteriovenous Fistulas].","authors":"Masafumi Hiramatsu, Jun Haruma, Kenji Sugiu, Shota Tanaka","doi":"10.11477/mf.030126030540010149","DOIUrl":"10.11477/mf.030126030540010149","url":null,"abstract":"<p><p>When approaching an occluded sinus during transvenous embolization of dural arteriovenous fistulas, it is important to employ a combination of appropriate guiding and distal access catheters to ensure adequate support and effective navigation. When navigating a long and tortuous venous route, careful attention must be given to the backup support and lengths of the coaxial catheters and connectors. Effective embolization can be achieved by selecting coils according to the stage of the embolization procedure and using liquid embolic agents when indicated.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"149-156"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207516","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
[Characteristics of Devices Used in Carotid Artery Stenting and Our Ingenuity]. 颈动脉支架植入术中器械的特点及我们的独创性
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010125
So Tokunaga
{"title":"[Characteristics of Devices Used in Carotid Artery Stenting and Our Ingenuity].","authors":"So Tokunaga","doi":"10.11477/mf.030126030540010125","DOIUrl":"10.11477/mf.030126030540010125","url":null,"abstract":"<p><p>Carotid artery stenting (CAS) has advanced through improvements in devices, refinement of techniques, and better patient selection. Understanding the characteristics and appropriate use of each device is essential for maximizing procedural safety and outcomes. This review summarizes the features of major devices used in CAS-including balloon-guiding catheters, angioplasty balloons, distal embolic protection devices, and carotid stents-and discusses practical strategies for device selection based on lesion morphology and clinical context. In addition, we describe several technical tips and institutional approaches that have contributed to more stable and reproducible results in our practice. Although detailed troubleshooting and rare complications could not be fully covered due to space limitations, awareness of device behavior and potential pitfalls is crucial for preventing perioperative ischemic events. We hope this review helps clinicians refine their procedural strategies and contributes to further reductions in CAS-related complications.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"125-131"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207873","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
[Perspectives on Device Selection in Japan:Artificial Intelligence Utilization, Distribution Systems, and Future Challenges]. [对日本设备选择的看法：人工智能的利用、分配系统和未来挑战]。
Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010195
Keiichiro Ohara, Soichiro Fujimura, Toshihiro Ishibashi, Yuichi Murayama
{"title":"[Perspectives on Device Selection in Japan:Artificial Intelligence Utilization, Distribution Systems, and Future Challenges].","authors":"Keiichiro Ohara, Soichiro Fujimura, Toshihiro Ishibashi, Yuichi Murayama","doi":"10.11477/mf.030126030540010195","DOIUrl":"10.11477/mf.030126030540010195","url":null,"abstract":"<p><p>Device selection in neuroendovascular therapy has traditionally relied on operator experience and institutional routines, leading to variability and limited reproducibility. Advances in artificial intelligence (AI), particularly machine learning, now allow analysis of complex clinical and morphological data to support optimal device selection. AI can visualize and share tacit expert knowledge, enhance decision-making, and promote procedural standardization and education. However, its recommendations remain probabilistic, and final clinical responsibility must rest with the physician. Reliable application requires adequate multi-institutional data and improved interpretability. In addition to supporting clinical judgment, AI-based prediction can optimize medical device logistics by forecasting necessary items and reducing excessive deliveries and returns. Such efficiency is increasingly important in the context of workforce shortages and transportation constraints, including Japan's \"2024 logistics problem.\" We developed an integrated system combining AI-driven device selection with an electronic ordering platform, enabling real-time information sharing among physicians, distributors, and logistics providers. In preliminary validation involving unruptured aneurysm cases, this approach reduced delivered items by 20-55% without compromising safety. AI-assisted device selection therefore represents both a clinical advancement and a pathway toward more sustainable medical supply chains, linking healthcare, industry, and logistics through data-driven optimization.</p>","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"195-202"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207901","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
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