Neurological Surgery最新文献_第5页

[Practical Guide to Antiseizure Medication Management]. [抗癫痫药物管理实用指南]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030567

Aya Kanno

{"title":"[Practical Guide to Antiseizure Medication Management].","authors":"Aya Kanno","doi":"10.11477/mf.030126030540030567","DOIUrl":"10.11477/mf.030126030540030567","url":null,"abstract":"Perioperative seizure management is an important component of neurosurgical care. Antiseizure medications (ASMs) have historically been used prophylactically in many neurosurgical patients; however, current evidence does not support routine prophylaxis in seizure-naïve individuals. Recent guidelines recommend ASM administration primarily for patients with a history of seizures or for short-term use during the immediate perioperative period in selected high-risk conditions. Accordingly, prophylactic treatment should be individualized based on seizure risk and generally limited to short-term use to avoid unnecessary long-term exposure. This review summarizes three clinically relevant areas. First, we summarize evidence-based strategies for perioperative seizure prophylaxis in major neurosurgical conditions, including brain tumors, traumatic brain injury, and cerebrovascular disease. Second, we review the pharmacological properties of newer ASMs commonly used in neurosurgical practice, including levetiracetam, lacosamide, brivaracetam, and perampanel, with emphasis on their mechanisms of action, adverse-effect profiles, and practical advantages in perioperative settings, such as the availability of intravenous formulations. Finally, we discuss the clinical applications of long-term video electroencephalographic monitoring (VEEG), including evaluation for epilepsy surgery, detection of nonconvulsive status epilepticus, and differential diagnosis of seizure-like events such as syncope and functional/dissociative seizures. Risk-based ASM management combined with appropriate utilization of VEEG is essential for optimizing perioperative neurological care.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"567-576"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138832","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

[Ideal Model of Neurosurgical Clinical Pathways:From a Basic Inpatient Pathway and Add-on Pathways to a Multilayered System]. [神经外科临床路径的理想模型：从基本住院路径和附加路径到多层系统]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030508

Masatomo Kaji, Shigeo Yamashiro, Hiroshi Seto, Toru Nishi

{"title":"[Ideal Model of Neurosurgical Clinical Pathways:From a Basic Inpatient Pathway and Add-on Pathways to a Multilayered System].","authors":"Masatomo Kaji, Shigeo Yamashiro, Hiroshi Seto, Toru Nishi","doi":"10.11477/mf.030126030540030508","DOIUrl":"10.11477/mf.030126030540030508","url":null,"abstract":"Background: In acute neurosurgical care, clinical courses often deviate from expected pathways, and patient safety, reassurance, and comfort may be insufficiently ensured after conventional pathways end.Objective: To present an ideal, implementable model of neurosurgical clinical pathways in an electronic medical record (EMR) environment.Methods: Based on real-world implementation in 2013 at a regional core hospital, the framework was organized into four components: (1) a basic inpatient pathway applied to all patients; (2) physician-applied add-on pathways covering disease-, condition-, and procedure-specific elements; (3) outcome-oriented documentation using the Outcome-Task-Assessment framework; and (4) a multilayered system enabling stepwise additions without creating duplicate tasks.Results: Separating basic inpatient and add-on pathways improved feasibility in emergency settings and reduced physician application time from 16 min to 2 min. Additionally, an add-on pathway application rate of approximately 95% was maintained by emphasizing generalizability while developing dedicated add-ons for representative conditions.Conclusions: In an EMR setting, a multilayered pathway model can sustain minimum standards of care for all patients while allowing stepwise, patient-specific additions, thereby balancing standardization and individualized management without compromising usability in acute care.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"508-516"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139244","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

[Endocrinological Tests for Neurosurgery Practice]. [神经外科实践的内分泌测试]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030537

Yasuo Sasagawa, Mitsutoshi Nakada

{"title":"[Endocrinological Tests for Neurosurgery Practice].","authors":"Yasuo Sasagawa, Mitsutoshi Nakada","doi":"10.11477/mf.030126030540030537","DOIUrl":"https://doi.org/10.11477/mf.030126030540030537","url":null,"abstract":"Endocrinological evaluation is essential in neurosurgery for pituitary-hypothalamic disorders and intracranial conditions, such as tumors, trauma, hemorrhagic/ischemic events, inflammatory diseases, and iatrogenic injuries. Appropriate selection and interpretation of hormonal tests influence diagnosis, treatment strategies, perioperative care, and long-term outcomes. Baseline assessments should include measurements of anterior pituitary hormones (ACTH, TSH, GH, LH/FSH, and prolactin) and their corresponding peripheral hormones (cortisol, free thyroxine, IGF-1, and sex steroids). Because adrenal insufficiency is life-threatening, the ACTH-cortisol axis must be prioritized, with thyroid hormone replacement initiated only after adrenal function is confirmed. If baseline tests are inconclusive, dynamic stimulation tests are used to evaluate each axis; however, test selection must consider safety, as some stimulation tests are associated with rare complications, such as pituitary apoplexy, in patients with large Pit-NETs. This review summarizes the practical aspects of endocrine testing that are relevant to neurosurgeons, including typical endocrine profiles in intracranial diseases, indications and pitfalls of stimulation tests, and perioperative monitoring and hormone replacement, in collaboration with endocrinologists.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"537-542"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139167","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

[Perioperative Management to Avoid Complications in Endovascular Treatment of Cerebrovascular Diseases]. 脑血管病血管内治疗的围手术期处理及避免并发症

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030629

Taichi Ikedo, Masakazu Okawa

引用次数: 0

[Neuroimaging to Understand Surgical Anatomy]. [神经影像学理解外科解剖学]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030577

Yoshiteru Shimoda, Masayuki Kanamori, Hidenori Endo

{"title":"[Neuroimaging to Understand Surgical Anatomy].","authors":"Yoshiteru Shimoda, Masayuki Kanamori, Hidenori Endo","doi":"10.11477/mf.030126030540030577","DOIUrl":"https://doi.org/10.11477/mf.030126030540030577","url":null,"abstract":"Recent advances in neuroimaging have made radiological evaluations indispensable for preoperative assessment and surgical planning in the field of neurosurgery. Recent improvements in imaging resolution and three-dimensional visualization now allow the detailed anatomical structures encountered during surgery to be recognized preoperatively. This enables e design of surgical approaches, avoidance of critical neurovascular structures, and function-preserving strategies. In this chapter, imaging modalities are organized according to the major anatomical structures relevant to the surgical anatomy, including the bone structures, cerebrospinal fluid spaces, arteries, perforating arteries, veins, venous sinuses, and white matter fiber tracts. The advantages and limitations of each modality are discussed, together with their practical applications in tumor and vascular surgeries. Particular emphasis is placed on the integration of multimodal images. When combined with a thorough understanding of anatomy, these imaging datasets facilitate three-dimensional reconstruction and interpretation of complex anatomical relationships. Recent developments in 3D reconstruction and fusion imaging technologies have made preoperative simulations increasingly accessible, providing valuable educational opportunities, particularly for young neurosurgeons. Integrating anatomical knowledge with multimodal imaging interpretation improves the intraoperative orientation and contributes to safer and more reliable surgical outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"577-586"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139250","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

[Precautions During Pediatric Neurosurgery]. 【小儿神经外科注意事项】。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030598

Chisato Yokota

{"title":"[Precautions During Pediatric Neurosurgery].","authors":"Chisato Yokota","doi":"10.11477/mf.030126030540030598","DOIUrl":"10.11477/mf.030126030540030598","url":null,"abstract":"Pediatric patients are not simply small adults; pediatric neurosurgical care requires specific considerations based on developmental anatomy, physiology, and psychosocial contexts. This review summarizes the practical points frequently encountered by early career neurosurgeons, focusing on clinical assessment, imaging, and perioperative management. Clinical presentation varies markedly with age: infants often exhibit nonspecific signs, such as poor feeding, irritability, or progressive head enlargement, whereas school-aged children may report headaches, nausea, gait disturbance, or behavioral changes. Imaging should prioritize low invasiveness and radiation exposure. MRI is preferred when feasible; however, sedation is often required in infants and young children, and safe practice should follow the established recommendations regarding fasting, airway risk assessment, and monitoring. Perioperative management includes weight-based fluid and medication dosing, judicious prophylactic antibiotics, and meticulous intraoperative care. Particular attention is required to prevent hypothermia, airway complications during positioning, pressure injuries, adhesive-related skin damage, and head-fixation-related complications in patients with thin cranial bones. Finally, building trust with caregivers is essential. Clinicians should recognize the profound burden of discussions about diagnosis and surgery and continuously refine their communication skills to deliver bad news.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"598-607"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138924","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

[Comprehensive Perioperative Management in Craniotomy: Practical Strategies to Optimize Surgical Outcomes]. 开颅手术围手术期综合管理：优化手术效果的实用策略

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030621

Hideaki Ono

{"title":"[Comprehensive Perioperative Management in Craniotomy: Practical Strategies to Optimize Surgical Outcomes].","authors":"Hideaki Ono","doi":"10.11477/mf.030126030540030621","DOIUrl":"10.11477/mf.030126030540030621","url":null,"abstract":"Craniotomy is a fundamental procedure in neurosurgical practice, and optimal perioperative management is essential for improving surgical outcomes and minimizing complications. Comprehensive care requires meticulous attention to intracranial pressure control, cerebral edema management, fluid and electrolyte homeostasis, hemodynamic stability, infection prophylaxis, and nutritional support. Adequate preoperative evaluation and correction of systemic conditions, optimization of antithrombotic therapy, and appropriate use of osmotic agents and corticosteroids are critical for ensuring safe surgical intervention. Prompt neurological assessment, timely neuroimaging, and close monitoring of intracranial dynamics are essential for the early detection of postoperative complications. Electrolyte disturbances, particularly hyponatremia, caused by the inappropriate antidiuretic hormone secretion or cerebral salt-wasting syndrome, remain common and require accurate differentiation and tailored management. Glycemic control, blood pressure regulation, prevention of postoperative seizures, and antimicrobial prophylaxis play pivotal roles in reducing postoperative morbidity. In elderly patients, preoperative assessment of sarcopenia and nutritional status is increasingly recognized as a key determinant of functional recovery. This review provides a practical, evidence-based framework for the perioperative management of craniotomy, integrating current guidelines and clinical experience, and aims to serve as a comprehensive reference for neurosurgeons in routine clinical practice.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"621-628"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139152","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

[Essentials and Pitfalls of Neurological Examination:From Symptoms to Lesion Localization]. 【神经学检查的要点与陷阱：从症状到病变定位】。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030518

Miyuki Fukuda

引用次数: 0

[Medical Safety and Informed Consent Management During Neurosurgery]. [神经外科手术中的医疗安全和知情同意管理]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030494

Daina Kashiwazaki

引用次数: 0

[Pitfalls of Emergency Management for Stroke Patients]. [卒中患者急诊管理的陷阱]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030608

Takeru Umemura, Taketo Hatano

引用次数: 0