Neurological Surgery最新文献_第2页

[Acute Stroke Rehabilitation:Clinical Recommendations and Practical Guidance for Stroke Specialists]. 急性卒中康复：卒中专家的临床建议和实践指导。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051045

Naoki Oyama

{"title":"[Acute Stroke Rehabilitation:Clinical Recommendations and Practical Guidance for Stroke Specialists].","authors":"Naoki Oyama","doi":"10.11477/mf.030126030540051045","DOIUrl":"10.11477/mf.030126030540051045","url":null,"abstract":"Acute stroke rehabilitation is essential for preventing disuse syndrome and other post-stroke complications, promoting neurological recovery, improving activities of daily living, and facilitating social reintegration. However, acute stroke rehabilitation programs and service-delivery systems vary considerably among institutions in Japan. To address this issue, the Japan Stroke Society established a project team to promote the standardization and equitable provision of acute stroke rehabilitation. Based on a nationwide cross-sectional web-based questionnaire survey of 959 primary stroke centers and a literature review, the first clinical recommendations for acute stroke rehabilitation were made publicly available on the Japan Stroke Society's website in June 2023. In this article, we summarize the key concepts and clinical considerations of the acute stroke recommendations with a focus on issues relevant to stroke specialists. In-bed exercises and dysphagia screening should be promptly initiated after admission. Mobilization is generally appropriate 24-48 h after stroke onset, whereas very early, high-dose mobilization within 24 h should be performed cautiously. In selected patients with acute complications, rehabilitation training may be continued provided that neurological symptoms and systemic conditions remain stable. Adequate training duration and frequency, provision of rehabilitation on nonworking days, early dysphagia management, and nutritional support are also important components of acute stroke rehabilitation. Safe and effective rehabilitation requires a multidisciplinary approach and standardized institutional protocols. Stroke specialists should assess neurological and systemic stability, complications, comorbidities, and stroke pathophysiology to determine when rehabilitation training and mobilization can be initiated safely.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1045-1055"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228821","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

[Ethical Issues in Mechanical Thrombectomy for Acute Ischemic Stroke]. 急性缺血性脑卒中机械取栓的伦理问题

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051066

Koichi Arimura

{"title":"[Ethical Issues in Mechanical Thrombectomy for Acute Ischemic Stroke].","authors":"Koichi Arimura","doi":"10.11477/mf.030126030540051066","DOIUrl":"10.11477/mf.030126030540051066","url":null,"abstract":"Mechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion, and its indications have expanded substantially over the past decade. Recent randomized controlled trials (RCTs) have extended eligibility to patients presenting in extended time windows, those with large ischemic cores, and other populations previously considered unsuitable for intervention. However, the expansion of MT indications has also raised important ethical challenges. Patients with AIS often lack decision-making capacity, requiring physicians to balance respect for patient autonomy with the principles of beneficence, nonmaleficence, and justice under severe time constraints. Moreover, RCTs have enrolled highly selected populations, and evidence remains limited for many patients encountered in clinical practice. This review discusses ethical issues related to MT across clinical contexts involving treatment beyond conventional time windows, large ischemic cores, medium or distal vessel occlusions, futile recanalization, active malignancy, and prestroke disability. Representative cases illustrate situations in which ethical considerations extend beyond guideline recommendations. Whenever possible, treatment decisions should incorporate each patient's premorbid functional status, values, anticipated quality of life, procedural risks, and expected neurological recovery. Continued evidence generation in understudied populations will be essential to support the ethically sound, patient-centered application of MT.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1066-1075"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228855","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

[Novel Drugs and Therapeutic Strategies for Acute Ischemic Stroke:Focus on Tenecteplase]. [急性缺血性卒中的新药和治疗策略：以替奈普酶为重点]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051093

Yoshito Arakaki, Kazunori Toyoda

{"title":"[Novel Drugs and Therapeutic Strategies for Acute Ischemic Stroke:Focus on Tenecteplase].","authors":"Yoshito Arakaki, Kazunori Toyoda","doi":"10.11477/mf.030126030540051093","DOIUrl":"10.11477/mf.030126030540051093","url":null,"abstract":"Intravenous thrombolysis remains a cornerstone of acute ischemic stroke treatment, but alteplase has a short half-life and requires complex administration. Tenecteplase (TNK) , a genetically modified variant of alteplase, is regarded as a next-generation recombinant tissue-type plasminogen activator. TNK has greater fibrin specificity, a longer half-life, and greater resistance to plasminogen activator inhibitor-1, enabling single-bolus administration. Several randomized trials have supported its efficacy and safety, and its clinical use has expanded internationally. However, in Japan, alteplase at 0.6 mg/kg is the approved standard dose, and direct evidence comparing this regimen with TNK has been lacking. The investigator-initiated T-FLAVOR trial directly compared TNK 0.25 mg/kg with alteplase 0.6 mg/kg in patients with large-vessel occlusion scheduled for mechanical thrombectomy. In the T-FLAVOR trial, TNK achieved a higher rate of reperfusion on initial angiography, with comparable safety outcomes. These findings provide important evidence supporting the potential regulatory approval and clinical implementation of TNK in Japan. Other emerging therapies, including thrombolytic agents (JX10), neuroprotective agents (nerinetide), anti-edema drugs (glibenclamide), and antithrombotic agents such as factor XIa inhibitors (milvexian and asundexian), may further broaden treatment options across the acute treatment and secondary prevention phases of ischemic stroke.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1093-1101"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228955","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 Systems and Challenges in Acute Ischemic Stroke]. [当前系统和挑战急性缺血性卒中]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051076

Yukiko Enomoto

引用次数: 0

[Acute Stroke Care Systems:Pre-Hospital and In-Hospital Management]. [急性中风护理系统：院前和院内管理]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051025

Masanori Goto, Hirotoshi Imamura

{"title":"[Acute Stroke Care Systems:Pre-Hospital and In-Hospital Management].","authors":"Masanori Goto, Hirotoshi Imamura","doi":"10.11477/mf.030126030540051025","DOIUrl":"10.11477/mf.030126030540051025","url":null,"abstract":"Acute ischemic stroke care has evolved substantially since mechanical thrombectomy was established as an effective reperfusion therapy. As clinical outcomes are strongly dependent on the time to reperfusion, the optimization of pre-hospital and in-hospital stroke care systems has become increasingly important. In this review, the key components of an effective acute stroke care pathway are summarized, with a focus on pre-hospital triage using large-vessel occlusion scales, regional stroke networks, and institutional workflow optimization. Effective pre-hospital management includes standardized stroke assessment, rapid communication through dedicated stroke hotlines, and coordination among primary stroke centers, community hospitals, and telestroke networks. Key in-hospital strategies include early activation of multidisciplinary teams, streamlined imaging protocols, rapid decision-making for intravenous thrombolysis and mechanical thrombectomy, and standardized procedural workflows. Continuous case review and feedback involving stroke teams and emergency medical services further support quality improvement. The integration of efficient pre-hospital triage, coordinated multidisciplinary care, and standardized workflows is essential for minimizing treatment delays and improving outcomes in patients with acute ischemic stroke.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1025-1033"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228826","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

[Intravenous Thrombolysis for Acute Ischemic Stroke: Current Evidence and Perspectives]. 静脉溶栓治疗急性缺血性卒中：目前的证据和观点。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050996

Hidetsugu Maekawa

{"title":"[Intravenous Thrombolysis for Acute Ischemic Stroke: Current Evidence and Perspectives].","authors":"Hidetsugu Maekawa","doi":"10.11477/mf.030126030540050996","DOIUrl":"10.11477/mf.030126030540050996","url":null,"abstract":"Since its introduction, intravenous thrombolysis (IVT) with alteplase has remained a mainstay of reperfusion therapy in the hyperacute management of acute ischemic stroke (AIS). Recent clinical evidence has driven a major paradigm shift from a strictly \"time-based\" approach to a \"tissue-based\" approach. Advanced neuroimaging techniques, including diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR mismatch) and perfusion mismatch analyses, have enabled extension of the treatment window beyond 4.5 h and treatment of patients with strokes of unknown onset, particularly benefiting those who are ineligible for endovascular thrombectomy (EVT). Furthermore, the treatment criteria have been refined to recommend IVT for disabling deficits regardless of the baseline stroke severity score while withholding it from patients with minor, nondisabling presentations. An emerging challenge in clinical practice is determining whether IVT should be contraindicated in patients receiving novel amyloid-targeting therapies for Alzheimer's disease. Meanwhile, prehospital protocols involving mobile stroke units (MSUs) may help reduce onset-to-needle time in selected regions. IVT continues to evolve through personalized patient selection aimed at maximizing safety and improving functional outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"996-1004"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228889","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

[Overview of MELT-Japan]. [MELT-Japan概述]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050933

Chiaki Sakai, Nobuyuki Sakai

引用次数: 0

[The History of Evolution of Mechanical Thrombectomy Device Design and Introduction to Japanese Market]. 【机械取栓装置设计的演变历史及日本市场的引进】。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050941

Nobuyuki Sakai, Chiaki Sakai

引用次数: 0

[Artificial Intelligence in Acute Ischemic Stroke:Time-Oriented Diagnostic Support and Treatment Prediction]. 人工智能在急性缺血性脑卒中中的应用：基于时间的诊断支持与治疗预测

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540051084

Hidehisa Nishi

{"title":"[Artificial Intelligence in Acute Ischemic Stroke:Time-Oriented Diagnostic Support and Treatment Prediction].","authors":"Hidehisa Nishi","doi":"10.11477/mf.030126030540051084","DOIUrl":"10.11477/mf.030126030540051084","url":null,"abstract":"Artificial intelligence (AI) and machine learning (ML) are increasingly used in acute ischemic stroke. Their clinical value depends not only on diagnostic accuracy but also on whether these systems improve time-critical decision-making. Current applications include prehospital triage, detection of large-vessel and medium-vessel occlusions, automated ASPECTS assessment, estimation of ischemic core and penumbra, collateral evaluation, and workflow notification using CT, CT angiography, CT perfusion, and MRI. AI is also being investigated to predict treatment response, futile recanalization, symptomatic intracranial hemorrhage, brain edema, and final infarct volume after reperfusion therapy. In clinical practice, prognostic prediction must be distinguished from treatment-effect prediction. Useful AI systems should report uncertainty and calibration and provide actionable outputs at the clinically relevant time point while remaining embedded in a human-in-the-loop workflow. Future multimodal platforms may integrate imaging, clinical data, transfer information, procedure-related variables, and device characteristics to support individualized acute stroke workflows and endovascular procedural planning.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"1084-1092"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228798","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

[The Background of rt-PA Implementation and Its Impact on Nationwide Adoption in Japan]. [日本实施rt-PA的背景及其对全国采用的影响]。

Neurological Surgery Pub Date : 2026-09-01 DOI: 10.11477/mf.030126030540050923

Kazumi Kimura

{"title":"[The Background of rt-PA Implementation and Its Impact on Nationwide Adoption in Japan].","authors":"Kazumi Kimura","doi":"10.11477/mf.030126030540050923","DOIUrl":"10.11477/mf.030126030540050923","url":null,"abstract":"Around the year 2000, Japan became a global leader in clinical research on intravenous recombinant tissue plasminogen activator (rt-PA). However, due to patent-related issues surrounding the drug, domestic development came to a standstill, plunging the country into a prolonged \"dark age\" for reperfusion therapy. In contrast, alteplase was approved in the United States in 1996, and rt-PA treatment soon became widely adopted worldwide. Japan, however, could not introduce rt-PA until 2005. Following its approval, stroke care in Japan underwent a dramatic transformation. The concept that \"time is brain\" became deeply ingrained in the field, and minimizing the time from symptom onset to intravenous rt-PA administration emerged as the most critical challenge for the entire healthcare system. This shift represented far more than the addition of a new therapeutic option; it catalyzed sweeping reforms across multiple domains, including public awareness, establishment of prehospital emergency medical services (EMS), improvements in hospital triage and acceptance processes, acute management in stroke units and stroke care units (SU/SCUs), development of stroke centers, revisions to emergency reimbursement under the national insurance system, and education and training of medical personnel. The advent of rt-PA marked a watershed moment in acute stroke care, fundamentally reshaping treatment paradigms.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 5","pages":"923-932"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228904","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