Neurological Surgery最新文献_第3页

[Deep Dural Suturing and Multilayer Skull Base Reconstruction]. [深硬脑膜缝合及多层颅底重建]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020302

Masahiko Tosaka

{"title":"[Deep Dural Suturing and Multilayer Skull Base Reconstruction].","authors":"Masahiko Tosaka","doi":"10.11477/mf.030126030540020302","DOIUrl":"https://doi.org/10.11477/mf.030126030540020302","url":null,"abstract":"This review described the principles and techniques of dural suturing and multilayer skull base reconstruction in extended endoscopic endonasal surgery, with an emphasis on the Japanese tradition of deep suturing. Secure watertight reconstruction is a fundamental requirement in extended transsphenoidal and endonasal skull base surgery because persistent cerebrospinal fluid (CSF) leakage can result in life-threatening meningitis. Since its introduction in 2007, multilayer reconstruction using various materials combined with a pedicled nasoseptal flap has become the standard approach. In contrast, Japanese surgeons had long emphasized direct dural closure using deep suturing techniques, even before the widespread adoption of endoscopy. This culture of suturing has been incorporated into modern endoscopic surgery and remains a key component of skull base reconstruction in Japan. Deep suturing provides reliable fixation of patch materials, contributes to both major and minor CSF leak control, and may reduce the dependence on large vascularized flaps in selected cases. This review described the fundamental techniques of deep suturing, including needle handling, control of the needle holding angle, knot-sliding methods, and suturing in multilayer reconstruction strategies. It also discussed the management of CSF pulsation and training methods. Although technically demanding, deep suturing is a highly reliable and versatile technique that continues to play a critical role in endoscopic skull base surgery.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"302-311"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783613","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

[Clinically Non-Functioning Pituitary Adenoma/Pituitary Neuroendocrine Tumor (PitNET)]. [临床无功能垂体腺瘤/垂体神经内分泌瘤（PitNET）]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020313

Shigeyuki Tahara

{"title":"[Clinically Non-Functioning Pituitary Adenoma/Pituitary Neuroendocrine Tumor (PitNET)].","authors":"Shigeyuki Tahara","doi":"10.11477/mf.030126030540020313","DOIUrl":"https://doi.org/10.11477/mf.030126030540020313","url":null,"abstract":"Clinically non-functioning pituitary neuroendocrine tumors (PitNETs), the most common subtype of pituitary tumors, are frequently detected because of mass effects, such as visual impairment and incidental findings. In the World Health Organization classification in 2022, pituitary adenomas have been termed PitNETs, reflecting their biological diversity. This review summarizes the diagnostic evaluations, surgical indications, pathological characteristics, and surgical techniques for non-functioning PitNETs on endoscopic endonasal transsphenoidal surgery (eTSS). Preoperative assessment requires a meticulous endocrine evaluation and detailed magnetic resonance imaging to define tumor extension and invasion, and its relationship with the surrounding neurovascular structures. Surgery is the first-line treatment for symptomatic tumors. Asymptomatic patients with radiological risk factors were selected. Pathologically, non-functioning PitNETs comprise heterogeneous subtypes defined by transcription factors, including gonadotroph, silent corticotroph, and Pit-1 lineage tumors, with some exhibiting aggressive behavior. Technical aspects of eTSS, including intrasellar and extracapsular tumor removal and extended approaches for suprasellar extension, are discussed, highlighting safe and effective tumor resection. Individualized surgical strategies based on tumor characteristics are essential to achieve optimal outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"313-323"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783643","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

[Coating Technology for Flow Diverter Devices]. 导流装置涂层技术

Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010072

Kazuhiko Ishihara

{"title":"[Coating Technology for Flow Diverter Devices].","authors":"Kazuhiko Ishihara","doi":"10.11477/mf.030126030540010072","DOIUrl":"https://doi.org/10.11477/mf.030126030540010072","url":null,"abstract":"Flow diverter (FD) devices have become a standard treatment for cerebral aneurysms. FDs are braided metallic stents designed to redirect blood flow, thereby reducing intra-aneurysmal pressure, promoting vascular remodeling, and preventing rupture. Although their safety and efficacy are well established, thromboembolic risk still requires dual antiplatelet therapy (DAPT). However, DAPT increases hemorrhagic risk and mortality, even when intracranial circulation is not directly affected. To address this limitation, recent FD designs focus on improving surface biocompatibility through chemical modifications that suppress coagulation and thrombosis. The long-term objective is to enable treatment under single antiplatelet therapy, which may broaden use to ruptured aneurysms where DAPT is contraindicated. Coating metallic devices with functional polymers has been investigated to modulate biological responses, including coagulation and endothelialization. Among these materials, 2-methacryloyloxyethyl phosphorylcholine (MPC) polymers, inspired by the phospholipid structure of cell membranes, demonstrate strong hemocompatibility and clinical reliability. This article reviews the interfacial properties of MPC polymers, their applications in medical devices, and their recent integration into an FD device.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"72-79"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207144","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 and Techniques for Transarterial Embolization of Dural Arteriovenous Fistulas: Current Trends in the Use of Liquid Embolic Agents and Microcatheters]. [硬脑膜动静脉瘘经动脉栓塞的装置和技术：液体栓塞剂和微导管的使用趋势]。

Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010157

Naoki Akioka

{"title":"[Devices and Techniques for Transarterial Embolization of Dural Arteriovenous Fistulas: Current Trends in the Use of Liquid Embolic Agents and Microcatheters].","authors":"Naoki Akioka","doi":"10.11477/mf.030126030540010157","DOIUrl":"https://doi.org/10.11477/mf.030126030540010157","url":null,"abstract":"Transarterial embolization (TAE) of dural arteriovenous fistulas (DAVFs) has evolved significantly following insurance approval of liquid embolic agents such as OnyxTM and Histoacryl® (n-butyl-2-cyanoacrylate[NBCA]). Onyx allows prolonged injection and controlled penetration into the venous side, whereas NBCA offers rapid polymerization and thrombogenicity. The success of TAE depends on the selection of appropriate delivery devices. The ultra-fine microcatheter, DeFrictor® nano, provides superior distal access to small feeders near the shunt point, thereby facilitating effective embolization. In cases where the affected sinus serves as a normal venous drainage route, sinus protection balloon-assisted TAE is useful for achieving both shunt occlusion and preservation of venous function. This technique allows retrograde embolization of multiple feeders through the venous side. Understanding the characteristics of various liquid embolic agents and specialized devices is essential for achieving complete cure and preventing recurrence. This review discusses the latest devices and effective strategies for TAE of DAVFs.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"157-165"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207493","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

[Basics and Applications of Neuromonitoring Required for Neuroendovascular Therapy]. 神经血管内治疗所需的神经监测基础与应用

Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010187

Ichiro Nakagawa

引用次数: 0

[Medical Devices for Evaluating Cerebral Blood Flow and its Evaluation Method]. 脑血流评价的医疗器械及其评价方法

Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010097

Hiroyuki Kawano

{"title":"[Medical Devices for Evaluating Cerebral Blood Flow and its Evaluation Method].","authors":"Hiroyuki Kawano","doi":"10.11477/mf.030126030540010097","DOIUrl":"https://doi.org/10.11477/mf.030126030540010097","url":null,"abstract":"Neuroimaging studies prior to endovascular treatment for acute ischemic stroke provide essential information for determining eligibility (treatment triage) and procedural strategies. A fundamental concept of recanalization therapy is the mismatch between the ischemic core (irreversibly damaged tissue) and ischemic penumbra (severely hypoperfused, functionally impaired, at-risk, but not yet infarcted tissue). The goal of recanalization therapy is to recanalize an occluded blood vessel, restore blood flow to penumbral tissue before the ischemic core expands, and save the penumbra tissue. Perfusion imaging allows noninvasive evaluation of the ischemic core and penumbral tissue, although the ischemic penumbra is difficult to discern clinically or based on noncontrast imaging alone. Automated postprocessing software can quickly calculate the location and volume of the ischemic core and penumbra. Optimal thresholds vary depending on the specific perfusion software platform. CT perfusion occasionally overestimates or underestimates ischemic core volume. Discordance among CT perfusion findings, clinical symptoms, and CT angiography findings can provide an additional suggestion for the diagnosis of a stroke mimic.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 1","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207852","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 Current Status and Future of Transcarotid Artery Revascularization]. 经颈动脉血运重建术的现状与展望

Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010132

Sakyo Hirai, Kazutaka Sumita

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

引用次数: 0

[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":"https://doi.org/10.11477/mf.030126030540010211","url":null,"abstract":"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.","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

[Coil Embolization Strategy Based on Aneurysm Morphology: Roles of Framing, Filling, and Finishing Coils]. [基于动脉瘤形态的线圈栓塞策略：框架、填充和整理线圈的作用]。

Neurological Surgery Pub Date : 2026-01-01 DOI: 10.11477/mf.030126030540010046

Masatoshi Takagaki, Hajime Nakamura, Tomohiko Ozaki, Haruhiko Kishima

引用次数: 0