Neurological Surgery最新文献_第6页

[Perioperative Management of Spine and Spinal Cord Surgery]. [脊柱脊髓外科围手术期管理]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030647

Yusuke Nishimura

{"title":"[Perioperative Management of Spine and Spinal Cord Surgery].","authors":"Yusuke Nishimura","doi":"10.11477/mf.030126030540030647","DOIUrl":"10.11477/mf.030126030540030647","url":null,"abstract":"Spinal surgery is primarily performed to improve neurological function; compared with intracranial surgery, it is rarely conducted to address life-threatening conditions. As the goal of treatment is functional recovery, postoperative complications must be minimized. Appropriate perioperative management is therefore essential, and includes careful preoperative neurological evaluation; postoperative monitoring of neurological, respiratory, and circulatory status; and early detection and management of complications. Several complications of spinal surgery require attention. Firstly, airway obstruction caused by cervical swelling after anterior cervical surgery, postoperative epidural hematoma leading to neurological deterioration, and cerebrospinal fluid (CSF) leakage are the major complications requiring urgent intervention. Cervical spine surgery has several characteristic complications, depending on the surgical approach; for example, anterior procedures may cause airway compromise, esophageal injury, or recurrent laryngeal nerve palsy, whereas posterior procedures are more commonly associated with C5 palsy and surgical site infection. Thoracic spine surgery requires careful postoperative management as the spinal canal is relatively narrow, while the spinal cord is vulnerable to ischemia. In lumbar spine surgery, symptoms primarily involve the cauda equina, while major complications include epidural hematoma, CSF leakage, and surgical site infection. Appropriate perioperative evaluation and prompt management of complications at the spinal level are essential for achieving favorable surgical outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"647-656"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138828","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 of Endoscopic Endonasal Surgery]. 鼻内窥镜手术的围手术期处理

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030637

Hiroki Morisako, Atsufumi Nagahama, Takeo Goto

引用次数: 0

[Management of Severe Traumatic Brain Injury]. [严重创伤性脑损伤的处理]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030666

Eiichi Suehiro

{"title":"[Management of Severe Traumatic Brain Injury].","authors":"Eiichi Suehiro","doi":"10.11477/mf.030126030540030666","DOIUrl":"https://doi.org/10.11477/mf.030126030540030666","url":null,"abstract":"In the management of traumatic brain injury (TBI), even when the injury initially appears isolated to the head, occult injuries may be present; therefore, a comprehensive evaluation in accordance with the Japan Advanced Trauma Evaluation and Care is essential. Traumatic coagulopathy is frequently observed in patients with TBI, particularly in severe cases. In addition, the aging population has increased in recent years, and many elderly patients are taking antithrombotic medications. Patients with a tendency to bleed may develop severe symptoms due to hematoma growth or challenging surgical hemostasis, necessitating appropriate perioperative measures. Traditionally, large craniotomies were performed to achieve adequate hemostasis and decompression. However, mini-craniotomy combined with neuroendoscopy has recently been adopted to minimize surgical invasiveness, particularly in elderly patients. Postoperative management focuses on visualizing intracranial pathology through neuromonitoring and implementing neurocritical care to prevent secondary brain injury through optimal systemic management. Although the number of severe TBI cases has decreased in recent years and opportunities for clinical experiences may be limited, understanding the fundamental principles of severe TBI management remains essential for neurosurgeons.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"666-673"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139298","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

[Emergent Surgery for Brain Tumors]. [脑肿瘤急诊外科]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030679

Ichiyo Shibahara, Ryota Shigeeda, Toshihiro Kumabe

引用次数: 0

[Essentials of Cerebral Angiography:A Review in the Era of 3D Imaging]. 【脑血管造影要点：三维成像时代回顾】。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030552

Nobuyuki Mitsui, Manabu Kinoshita

{"title":"[Essentials of Cerebral Angiography:A Review in the Era of 3D Imaging].","authors":"Nobuyuki Mitsui, Manabu Kinoshita","doi":"10.11477/mf.030126030540030552","DOIUrl":"10.11477/mf.030126030540030552","url":null,"abstract":"In the era of advanced three-dimensional imaging technologies, cerebral angiography remains a fundamental modality for understanding dynamic cerebral hemodynamics. Although computed tomography angiography (CTA), magnetic resonance angiography (MRA), and 3D reconstruction techniques have markedly improved anatomical visualization, the ability to interpret two-dimensional angiographic images and mentally reconstruct vascular structures is increasingly important. This article revisits the core principles of diagnostic cerebral angiography, with an emphasis on practical insights that are often under-recognized in routine training. Key topics include preprocedural risk assessment, evaluation of vascular access route, radiation safety, optimal imaging angles for aneurysms visualization and mechanical thrombectomy planning, assessment of dural arteriovenous fistulas, and dynamic assessment of collateral circulation. By reorganizing these fundamental concepts, we highlight practical \"Kandokoro\" that bridge basic angiographic technique with therapeutic decision-making. This review aims to support the development of clinical judgment and angiographic interpretation skills in the era of advanced 3D imaging.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"552-558"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139193","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

[Concepts of Cerebrospinal Fluid Management Based on a Paradigm Shift in CSF Dynamics:From the Third Circulation to the Glymphatic System and Meningeal Lymphatic Drainage]. [基于脑脊液动力学范式转变的脑脊液管理概念：从第三循环到淋巴系统和脑膜淋巴引流]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030674

Shigeki Yamada

{"title":"[Concepts of Cerebrospinal Fluid Management Based on a Paradigm Shift in CSF Dynamics:From the Third Circulation to the Glymphatic System and Meningeal Lymphatic Drainage].","authors":"Shigeki Yamada","doi":"10.11477/mf.030126030540030674","DOIUrl":"https://doi.org/10.11477/mf.030126030540030674","url":null,"abstract":"Over the past century, cerebrospinal fluid (CSF) dynamics have largely been interpreted through the \"third circulation theory,\" which posits that CSF is produced by the choroid plexus that flows from ventricles to the subarachnoid space and is absorbed mainly through arachnoid granulations. The concepts of the glymphatic system and meningeal lymphatic drainage have since driven a paradigm shift in this framework. In the glymphatic pathway, CSF enters periarterial spaces and, via aquaporin-4 channels on astrocytic endfeet, is exchanged with interstitial fluid to promote parenchymal waste clearance. Waste-laden fluid then exits along perivenous routes and is drained extracranially through meningeal lymphatics. Importantly, lymphatic pathways are not mechanically \"plugged\" by hemorrhagic CSF, and impaired clearance is more plausibly attributable to disrupted physiological pulsatility and sustained low-pressure conditions. Therefore, CSF management after subarachnoid hemorrhage should shift from prioritizing the removal of bloody CSF to restoring physiological CSF dynamics. Clinically, this supports minimizing drainage duration, pursuing early removal, and favoring intermittent over continuous drainage when feasible. Patients presenting with acute hydrocephalus constitute a distinct subgroup in whom ventricular drainage is often unavoidable, and subsequent shunt dependency is more likely.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"674-678"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139150","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 State and Challenges of Digital Health in Japan]. [日本数字医疗的现状和挑战]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030689

Nice Ren

{"title":"[Current State and Challenges of Digital Health in Japan].","authors":"Nice Ren","doi":"10.11477/mf.030126030540030689","DOIUrl":"10.11477/mf.030126030540030689","url":null,"abstract":"Japan faces significant challenges, including an aging population, rising healthcare costs, and strained healthcare sustainability. Digital health is an indispensable strategic imperative. Telemedicine, such as telestroke networks, reduces regional care disparities for acute stroke and is supported by national guidelines and reimbursement policies. Evidence-based digital therapeutics and software-based treatments are approved for conditions, such as hypertension and nicotine dependency, aiding chronic disease management by fostering sustained behavioral change. Artificial intelligence-driven data analysis improves prognostic accuracy and offers insights into more precise preventive interventions. However, systemic barriers hinder the widespread adoption of digital health, including 1) limited resources for implementation and maintenance, 2) stakeholder resistance because of low digital literacy, lack of confidence, and \"change fatigue,\" 3) persistent technical and ethical challenges, including data interoperability issues, and 4) inadequate insurance reimbursement for digital health services. Achieving \"digital maturity\" requires moving beyond technological acquisitions. It is measured by how well systems use technology to improve patient and provider experiences and population health and reduce costs. Therefore, government, industry, and clinical stakeholders must collaborate to create a resilient and sustainable future for Japan.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"689-704"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139127","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

[Quantitative Assessment for Brain Lesion by Perfusion and Metabolic Imaging]. [脑损伤灌注与代谢成像定量评估]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030543

Shigeru Yamaguchi, Kota Kurisu, Masaki Ujihara, Miki Fujimura

{"title":"[Quantitative Assessment for Brain Lesion by Perfusion and Metabolic Imaging].","authors":"Shigeru Yamaguchi, Kota Kurisu, Masaki Ujihara, Miki Fujimura","doi":"10.11477/mf.030126030540030543","DOIUrl":"10.11477/mf.030126030540030543","url":null,"abstract":"Advances in neuroimaging have improved the diagnosis and management of structural brain diseases, including cerebrovascular disorders and brain tumors. Although conventional computed tomography and magnetic resonance imaging (MRI) provide essential morphological information, functional and metabolic imaging enables the qualitative assessment of tissue physiology. Integrating morphological and qualitative imaging has become increasingly important for optimizing diagnostic strategies, treatment selection, and therapeutic response evaluation. However, excessive imaging may increase cost and complexity without improving clinical outcomes, thereby necessitating appropriate modality selection. This review summarizes perfusion and metabolic imaging modalities, including MRI-based arterial spin labeling, and nuclear medicine techniques. These techniques enable the evaluation of cerebral blood flow, oxygen metabolism, and tumor metabolic characteristics. Clinical applications include differentiating tumor from non-tumor lesions, predicting glioma grade and infiltration, performing preoperative functional mapping, distinguishing tumor recurrence from radiation necrosis, assessing the ischemic penumbra in acute stroke, evaluating chronic cerebral ischemia, and localizing epileptic foci. Qualitative imaging complements morphological imaging and is crucial in modern neurodiagnostic techniques. Appropriate selection and interpretation of these modalities are crucial in improving patient management in clinical practice.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"543-551"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138991","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

[Preoperative and Intraoperative Electrophysiological Monitoring During Neurosurgery]. [神经外科术前及术中电生理监测]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030559

Ryosuke Matsuda, Tsunenori Takatani

引用次数: 0

[Essential Diagnostic Tests in Neurological Emergencies]. [神经急症的基本诊断试验]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030527

Shun Tanaka, Ai Muroi

{"title":"[Essential Diagnostic Tests in Neurological Emergencies].","authors":"Shun Tanaka, Ai Muroi","doi":"10.11477/mf.030126030540030527","DOIUrl":"https://doi.org/10.11477/mf.030126030540030527","url":null,"abstract":"Neurological emergencies are time-sensitive conditions in which rapid diagnosis and early intervention critically influence survival and functional outcomes. This review summarizes essential diagnostic strategies for neurosurgeons involved in acute care, guided by the principles of Emergency Neurological Life Support (ENLS). Initial management prioritizes stabilization of the airway, breathing, and circulation, followed by focused neurological assessment, with particular attention to pupillary findings and quantitative monitoring such as the Neurological Pupil index. Laboratory evaluation aims to promptly identify reversible systemic causes, including metabolic disturbances and coagulation abnormalities that directly affect treatment decisions in acute ischemic stroke and intracerebral hemorrhage, particularly in patients receiving anticoagulants. Neuroimaging plays a central role; non-contrast computed tomography (CT) remains the first-line modality, while CT angiography, perfusion imaging, and magnetic resonance imaging (MRI) provide complementary information for therapeutic decision-making. Imaging markers of hematoma expansion and etiological evaluation are essential in hemorrhagic stroke. Electroencephalography (EEG) is crucial for detecting nonconvulsive status epilepticus in patients with unexplained persistent impaired consciousness. Integrating clinical, laboratory, and imaging findings while recognizing common diagnostic pitfalls is essential for optimizing early neurocritical care management.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"527-536"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139112","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