Neurological Surgery最新文献_第2页

[Functional Pituitary Adenoma/Neuroendocrine Tumors]. [功能性垂体腺瘤/神经内分泌肿瘤]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020324

Hiroshi Nishioka

{"title":"[Functional Pituitary Adenoma/Neuroendocrine Tumors].","authors":"Hiroshi Nishioka","doi":"10.11477/mf.030126030540020324","DOIUrl":"https://doi.org/10.11477/mf.030126030540020324","url":null,"abstract":"Recently, the therapeutic outcomes of most patients with functioning pituitary neuroendocrine tumors have significantly improved because of advanced surgical and medical treatments. Surgical progress is due to the evolution of endoscopic techniques, refinement of surgical instruments, and continued technical innovations. The primary therapeutic goal for functioning tumors is endocrine remission, and treatment should be implemented within a comprehensive therapeutic strategy, in which surgery is crucial. Endoscopic endonasal surgery is a microsurgical procedure and its success relies on securing an adequately wide surgical corridor while respecting the nasal cavity. In enclosed, non-invasive, functioning tumors, selective total resection should be pursued, with meticulous identification of the tumor-normal tissue interface, including extracapsular dissection, if feasible. Tumor invasion of the cavernous sinus remains the most significant independent predictor of unfavorable outcomes; however, in some cases, resection of the medial wall may offer a high likelihood of achieving remission. For large invasive tumors, surgery aims to achieve maximal safe debulking and tumor control along with adjuvant medical and/or radiation therapies.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"324-332"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783581","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

[Mathematical Models for Evidence-Based Primary Prevention Policy of Cerebrovascular and Cardiovascular Disease : An Integrated Analysis of Bayesian APC and IMPACT_NCD-JPN]. [基于证据的脑血管疾病一级预防政策的数学模型：Bayesian APC和IMPACTNCD-JPN的综合分析]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020469

Soshiro Ogata

{"title":"[Mathematical Models for Evidence-Based Primary Prevention Policy of Cerebrovascular and Cardiovascular Disease : An Integrated Analysis of Bayesian APC and IMPACTNCD-JPN].","authors":"Soshiro Ogata","doi":"10.11477/mf.030126030540020469","DOIUrl":"https://doi.org/10.11477/mf.030126030540020469","url":null,"abstract":"Cardiovascular diseases, including stroke and coronary heart disease (CHD), remain the leading causes of mortality in Japan. Although age-standardized mortality rates have declined, population aging has likely resulted in higher crude mortality rates and an increased absolute number of deaths. To provide quantitative policy evidence, we apply two modeling approaches: the Bayesian age-period-cohort (BAPC) model and the IMPACTNCD-JPN microsimulation model. The BAPC model projects mortality trends until 2040 by incorporating age, period, and cohort effects using Bayesian inference, offering probabilistic forecasts that capture uncertainty. These results suggest a gradual national decline in stroke and CHD deaths, while highlighting persistent regional disparities that may be linked to salt intake and lipid levels. IMPACTNCD-JPN quantified the contributions of changes in risk factors and showed that improvements in blood pressure control and smoking reduction substantially prevented cardiovascular events and deaths between 2001 and 2019. Together, these models clarify not only \"how much mortality will decline\" but also \"how to achieve further reductions\" through risk factor interventions. Their integration enables scenario-based evaluation of prevention strategies, medical resource planning, and cost-effectiveness. This evidence-based framework can strengthen the Japanese National Plan for the Promotion of Measures Against Cerebrovascular and Cardiovascular Diseases and illustrate the value of combining predictive and explanatory modeling for future health policies.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"469-483"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783648","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 Surgery for Skull Base Chordomas and Chondrosarcomas : Basic to Advanced Cases]. 内窥镜鼻内手术治疗颅底脊索瘤和软骨肉瘤：基础到晚期病例。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020373

Masahiro Shin

引用次数: 0

[Endoscopic Anterior Transpetrosal Approach]. [内窥镜经骨前入路]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020438

Satoshi Suehiro

{"title":"[Endoscopic Anterior Transpetrosal Approach].","authors":"Satoshi Suehiro","doi":"10.11477/mf.030126030540020438","DOIUrl":"https://doi.org/10.11477/mf.030126030540020438","url":null,"abstract":"The anterior transpetrosal approach (ATPA) is the standard technique for treating lesions around the petrous apex. Conventional microscopic ATPA is associated with limited linear visibility and enhanced risks related to temporal lobe retraction. This article reviewed endoscopic ATPA (eATPA) and addressed some of the limitations. The eATPA utilizes a panoramic endoscopic view through a small craniotomy, significantly reducing the need for brain retraction and eliminating blind spots in the ventral brainstem. The procedure centers on precise extradural drilling of Kawase's triangle. The primary indications include small petroclival meningiomas, dumbbell-shaped trigeminal schwannomas, and epidermoid cysts. This review detailed the surgical anatomy, operative nuances, and strategies for avoiding critical complications, specifically venous congestion, regarding the superficial middle cerebral vein, superior petrosal vein, and cerebrospinal fluid leakage. Although currently indicated for small lesions, eATPA is a minimally invasive skull base surgery. eATPA is a vital component of future multicorridor strategies, offering safer, tailor-made treatments for complex skull base pathologies when combined with endovascular or transnasal approaches.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"438-447"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783572","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 Surgery for Tumors in the Posterior Fossa and Cerebellopontine Angle]. 后窝及桥小脑角肿瘤的鼻内窥镜手术。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020363

Hirotaka Hasegawa, Shunya Hanakita

{"title":"[Endoscopic Endonasal Surgery for Tumors in the Posterior Fossa and Cerebellopontine Angle].","authors":"Hirotaka Hasegawa, Shunya Hanakita","doi":"10.11477/mf.030126030540020363","DOIUrl":"https://doi.org/10.11477/mf.030126030540020363","url":null,"abstract":"Endoscopic endonasal surgery (EES) has rapidly evolved as a minimally invasive option for ventral posterior fossa lesions, offering a direct midline corridor while avoiding soft-tissue dissection, cerebellar or temporal lobe retraction, and the extensive petrosectomy required in traditional open approaches. However, the indications, anatomical concepts, and technical nuances for safely applying EES to intradural posterior fossa tumors have not yet been standardized. This article presents a practical, stepwise overview of EES for posterior fossa intradural tumors arising around the clivus and ventral brainstem. Based on a three-level clival classification (high, middle, and low clivus defined by Dorello's canal and glossopharyngeal meatus), we outlined the rational selection and execution of transsphenoidal transclival, transpharyngeal transclival, and combined approaches with pituitary transposition. Detailed descriptions of the nasal and skull base exposure, management of high-flow venous and CSF bleeding, and multilayer reconstruction using fascia, rigid buttress, fat graft, and a robust rhinopharyngeal flap. By sharing a reproducible high-resolution strategy grounded in anatomical principles and reconstructive techniques, we aimed to facilitate the safe expansion of EES indications for complex posterior fossa tumors.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"363-372"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783589","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

[Minimally Invasive Endoscopic Surgery: The Anterolateral Approach]. 微创内镜手术：前外侧入路。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020429

Daisuke Kuga

{"title":"[Minimally Invasive Endoscopic Surgery: The Anterolateral Approach].","authors":"Daisuke Kuga","doi":"10.11477/mf.030126030540020429","DOIUrl":"https://doi.org/10.11477/mf.030126030540020429","url":null,"abstract":"The anterolateral keyhole approach has evolved as a minimally invasive strategy for lesions of the anterior skull base and surrounding circulation. In particular, the supraorbital eyebrow approach allows direct access to the frontal skull base through a small craniotomy, while preserving cosmetic outcomes and minimizing surgical morbidity. This review outlined the anatomical concepts, surgical indications, technical nuances, and limitations of the supraorbital eyebrow approach, with particular emphasis on cerebrospinal fluid drainage, instrument selection, and endoscope positioning in a narrow operative corridor. Additionally, the mini-pterional and extended-eyebrow approaches are discussed as complementary options that expand the operative field toward the lateral and Sylvian regions when required. Although minimally invasive approaches offer clear advantages, they should be selected only when surgical efficacy, including the extent of tumor resection, is equivalent to that of a standard craniotomy. Surgeons must also recognize that the management of intraoperative complications, such as bleeding, can be more challenging in a restricted field. Therefore, careful patient selection, thorough anatomical understanding, and stepwise development of experience (from simple cases to complex cases) are essential, particularly for young neurosurgeons. When applied appropriately, the anterolateral keyhole approach is a safe and effective extension of conventional cranial surgery.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"429-437"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783596","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

[Intraventricular Tumor Surgery in the Neuroendoscopic Era]. [神经内窥镜时代的脑室肿瘤手术]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020393

Shota Tanaka

{"title":"[Intraventricular Tumor Surgery in the Neuroendoscopic Era].","authors":"Shota Tanaka","doi":"10.11477/mf.030126030540020393","DOIUrl":"https://doi.org/10.11477/mf.030126030540020393","url":null,"abstract":"Neuroendoscopic surgery, which allows tumor removal through a narrow surgical corridor, has been increasingly applied to intraventricular tumors. Although this approach is often regarded as minimally invasive, the restricted operative field and proximity to critical deep brain structures necessitate precise surgical manipulation. Periventricular vein injury can result in serious postoperative neurological deficits, underscoring the importance of meticulous dissection and hemostasis. During tumor removal, preservation of venous drainage should be prioritized. Aggressive resection should be avoided when strong adhesion to the veins is encountered. Gentle counterpressure using small cotton patties, combined with irrigation and suction, facilitated safe dissection and effective venous bleeding control. Hemostasis in neuroendoscopic surgery demands patience. The accurate identification of bleeding points is key. Blind coagulation in a blood-filled field should be avoided. Temporary packing with cotton patties can be effective without interrupting surgical workflow. The appropriate use of angled endoscopes and flexible transitions between the dry and wet fields is important for the reliable assessment of residual tumors and hemostasis. Furthermore, careful consideration of surgical instruments and timely conversion to microscopic surgery, when necessary, are critical for minimizing complications. Mastery of these principles can facilitate a safer neuroendoscopic management of intraventricular tumors.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"393-401"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783599","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 Surgery for Intraparenchymal Lesions]. 脑实质内病变的神经内窥镜手术。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020457

Kazuhito Takeuchi

{"title":"[Neuroendoscopic Surgery for Intraparenchymal Lesions].","authors":"Kazuhito Takeuchi","doi":"10.11477/mf.030126030540020457","DOIUrl":"https://doi.org/10.11477/mf.030126030540020457","url":null,"abstract":"Neuroendoscopic surgery using a tubular retractor system (cylinder) offers a minimally invasive approach for deep-seated intraparenchymal brain lesions. By distributing retraction forces circumferentially, the cylinder enables safe access to deep lesions while minimizing injury to the surrounding brain tissue. If combined with neuroendoscopy, this technique provides bright, close-up visualization even within a narrow surgical corridor, allowing for further reduction in cylinder diameter and surgical invasiveness. Preoperative planning is critical, because the operative field is limited to the cylinder tip. Multimodal imaging, including magnetic resonance imaging, computed tomography angiography, and diffusion tensor imaging, facilitates an accurate understanding of lesion characteristics, surrounding vascular structures, and white matter tracts. Simulation-based trajectory planning and appropriate patient positioning further enhance surgical safety and maneuverability. Intraoperatively, different combined surgical techniques (one or two hands) and operative environments (dry or wet field) can be selected according to lesion consistency, bleeding tendency, and surgical objectives, allowing the cylinder to be applied for biopsy and selected tumor resections. With careful case selection and stepwise technical acquisition, neuroendoscopic cylinder surgery is a valuable option for treating intraparenchymal brain lesions.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"457-466"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783621","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

[Building High-Quality Evidence in Endoscopic Neurosurgery : Practical Clinical Research Strategies and Multicenter Collaboration]. [建立高质量的内窥镜神经外科证据：实用临床研究策略和多中心合作]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020257

Yuki Shinya

{"title":"[Building High-Quality Evidence in Endoscopic Neurosurgery : Practical Clinical Research Strategies and Multicenter Collaboration].","authors":"Yuki Shinya","doi":"10.11477/mf.030126030540020257","DOIUrl":"https://doi.org/10.11477/mf.030126030540020257","url":null,"abstract":"Endoscopic neurosurgery has advanced rapidly over the past three decades and now represents a core minimally invasive approach in modern neurosurgical practice. Despite technical progress, high-certainty evidence has often lagged, partly because outcome variability is driven not only by disease characteristics but also by procedure-specific complexity, surgeon proficiency, learning curves, and institution-dependent factors such as multidisciplinary team structure and perioperative workflows. This study provides a practical framework for building reproducible clinical evidence in endoscopic neurosurgery. We highlight (1) the design of high-quality clinical databases and the deliberate selection of electronic data capture (EDC) platforms to ensure standardization, completeness, auditability, and future reanalysis; (2) team-based infrastructure and governance, including clearly defined roles (e.g., surgeons, ENT collaborators, coordinators, data managers, biostatisticians) and multicenter mechanisms for oversight, data coordination, and formalized data-sharing agreements and quality-control procedures; and (3) analytical strategies for bias control, integrating appropriate statistical testing with survival analysis, multivariable modeling, propensity-based methods, effect size reporting, and learning-curve evaluation. By aligning robust data infrastructure, effective governance, and rigorous analytical methods, endoscopic neurosurgery can progress beyond anecdotal experience toward transparent, reproducible, and generalizable clinical evidence that informs clinical practice, training, and patient safety.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"257-271"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783556","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

[Surgical Strategies for Suprasellar Meningiomas in the Endoscopic Era]. 内窥镜时代鞍上脑膜瘤的手术策略

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020342

Kentaro Horiguchi, Tatsuma Matsuda, Shinichi Origuchi, Toshiki Ishikura, Yoshinori Higuchi

{"title":"[Surgical Strategies for Suprasellar Meningiomas in the Endoscopic Era].","authors":"Kentaro Horiguchi, Tatsuma Matsuda, Shinichi Origuchi, Toshiki Ishikura, Yoshinori Higuchi","doi":"10.11477/mf.030126030540020342","DOIUrl":"https://doi.org/10.11477/mf.030126030540020342","url":null,"abstract":"Surgical management of suprasellar meningiomas is challenging because of their proximity to critical neurovascular structures, including the optic apparatus and internal carotid artery. Ttreatment aims to preserve visual and neurological functions, while achieving durable tumor control. This review classified suprasellar meningiomas into medial and lateral types to clarify surgical strategies. Medial-type tumors, including tuberculum sellae, planum sphenoidale, and olfactory groove meningiomas, often compress the optic nerves inferiorly and may be suitable for endoscopic endonasal approaches in select cases. Contrastingly, lateral-type tumors, such as sphenoid wing and anterior clinoid meningiomas, frequently involve the internal carotid artery and cavernous sinus, and are best managed through transcranial approaches. Keyhole surgery may be considered in select cases to reduce surgical invasiveness. Endoscopic endonasal surgery for lateral-type tumors is generally not indicated, except in combined approaches for selective decompression of medial components. Optimal management requires an individualized approach based on tumor location, extension, and neurovascular involvement, prioritizing functional preservation over radical resection.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"342-352"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783602","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