Neurological Surgery最新文献_第7页

[Management of Cerebral Vasospasm in Subarachnoid Hemorrhage]. [蛛网膜下腔出血脑血管痉挛的处理]。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030657

Atsushi Kanoke, Hidenori Endo

{"title":"[Management of Cerebral Vasospasm in Subarachnoid Hemorrhage].","authors":"Atsushi Kanoke, Hidenori Endo","doi":"10.11477/mf.030126030540030657","DOIUrl":"https://doi.org/10.11477/mf.030126030540030657","url":null,"abstract":"Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of delayed cerebral ischemia (DCI) and remains a critical determinant of neurological outcomes. DCI pathophysiology is multifactorial and involves large artery vasospasm and microcirculatory dysfunction, including endothelial injury, microthrombosis, impaired autoregulation, and cortical spreading depolarization. In Japan, pharmacological management has traditionally included fasudil hydrochloride and other agents targeting the vascular tone or platelet aggregation, often combined with strategies to remove subarachnoid blood. The recent approval of clazosentan, a selective endothelin A receptor antagonist, has introduced a new therapeutic approach to prevent vasospasm after aSAH. Clinical trials conducted in Japan have demonstrated that clazosentan reduces vasospasm-related morbidity and mortality, as well as improves clinical outcomes. However, large international trials have shown reductions in angiographic vasospasms without consistent improvements in functional outcomes, highlighting DCI's complex pathophysiology beyond large vessel narrowing. In clinical practice, clazosentan has been associated with favorable outcomes, but requires careful management because of adverse events such as fluid retention and pulmonary complications. Future strategies should focus on optimizing treatment protocols centered on clazosentan and identifying effective combination therapies that target multiple mechanisms underlying DCI.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"657-665"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139211","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 Preoperative Preparation for Awake Craniotomy]. 【清醒开颅术前综合准备】。

Neurological Surgery Pub Date : 2026-05-01 DOI: 10.11477/mf.030126030540030587

Masashi Kinoshita

{"title":"[Comprehensive Preoperative Preparation for Awake Craniotomy].","authors":"Masashi Kinoshita","doi":"10.11477/mf.030126030540030587","DOIUrl":"10.11477/mf.030126030540030587","url":null,"abstract":"Awake craniotomy requires comprehensive preoperative preparation that differs fundamentally from conventional tumor resection performed under general anesthesia. Successful awake surgery depends not only on the technical expertise of the neurosurgeon but also on close multidisciplinary collaboration among anesthesiologists, neuropsychologists, nurses, and technical staffs, as well as active patient participation. Preoperative planning plays a crucial role in ensuring intraoperative safety and preserving neurological function. Careful patient selection is essential and includes assessment of neurological status, seizure history, age, and anesthetic risk factors. Detailed neuropsychological evaluation is required to establish baseline cognitive function, select appropriate intraoperative tasks, and define functional targets for preservation. Integration of structural imaging, diffusion tensor tractography, and functional magnetic resonance imaging enables individualized surgical planning based on functional brain networks. Preoperative simulation in the operating room setting enhances team coordination and reduces patient anxiety. Anesthetic strategies should prioritize airway safety, reliable awakening, and seizure prevention. As intraoperative electrical stimulation carries a risk of seizures, appropriate antiepileptic management and troubleshooting strategies are necessary. Through systematic preparation, task selection, imaging integration, and multidisciplinary communication, awake craniotomy can achieve maximal tumor resection while preserving critical cognitive and functional networks. This review summarizes key preoperative considerations for neurosurgeons beginning to perform awake craniotomy.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 3","pages":"587-597"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139195","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 Setup and Perioperative Management for Endoscopic Transsphenoidal Surgery]. [内镜下经蝶窦手术的手术设置及围手术期管理]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020240

Ryutaro Makino, Shingo Fujio, Ryosuke Hanaya

{"title":"[Surgical Setup and Perioperative Management for Endoscopic Transsphenoidal Surgery].","authors":"Ryutaro Makino, Shingo Fujio, Ryosuke Hanaya","doi":"10.11477/mf.030126030540020240","DOIUrl":"10.11477/mf.030126030540020240","url":null,"abstract":"Endoscopic transsphenoidal surgery has been the most commonly performed neuroendoscopic procedure in Japan since its reimbursement category was introduced in 2012. Although the surgical technique is now largely standardized, perioperative management and operating room setup still vary among institutions. At our center, patients are positioned in a semi-Fowler's posture with the head elevated to reduce venous bleeding from the cavernous sinus, while carefully monitoring the risk of venous air embolism. A slight vertex-up angle facilitates a natural instrument trajectory and is adjusted according to lesion location. Surgery is performed using a four-hand technique, with the assistant controlling the endoscope and coordinating movements with the surgeon, adapting to anatomical constraints and the use of straight or angled endoscopes. We also describe our approach to perioperative glucocorticoid supplementation, postoperative endocrine management for pituitary disorders, and the prevention and treatment of delayed postoperative hyponatremia. Collaboration with otolaryngologists is preferred for postoperative nasal care. These strategies aim to enhance surgical safety, infection control, endocrine stability, and patient comfort while supporting continued advances in endoscopic skull base surgery.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"240-248"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783616","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

[Head and Neck Surgery Approach : Prelacrimal Approach, Direct Approach to the Anterior and Lateral Part of the Maxillary Sinus with an Endoscope (DALMA), and Trans-Cribriform Approach]. [头颈部手术入路：泪前入路，直接入路上颌窦前部和外侧与内窥镜（DALMA），和经筛状入路]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020295

Kazuhiro Omura

引用次数: 0

[Endoscopic Combined Transcranial and Endonasal Approach]. [经颅鼻联合内镜入路]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020448

Tadashi Watanabe

引用次数: 0

[Pediatric Neuroendoscopic Surgery]. [小儿神经内窥镜外科]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020402

Tomoru Miwa

引用次数: 0

[Endoscopic Surgery for Trigeminal Schwannoma]. 内镜手术治疗三叉神经鞘瘤

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020384

Hiroyoshi Akutsu

{"title":"[Endoscopic Surgery for Trigeminal Schwannoma].","authors":"Hiroyoshi Akutsu","doi":"10.11477/mf.030126030540020384","DOIUrl":"10.11477/mf.030126030540020384","url":null,"abstract":"Minimally invasive surgical techniques, including the endoscopic endonasal transmaxillary-pterygoid approach (EETMPA), the endoscopic transorbital approach (ETOA), and the endoscopic keyhole approach (EKA), have recently been applied to the surgical treatment of trigeminal schwannomas. However, criteria for patient selection and technical nuances remain sparsely reported; therefore, we describe these aspects based on our previous work. For patient selection, a sufficient surgical corridor to the tumor from the paranasal sinus must be identified on magnetic resonance imaging to perform EETMPA. To create an adequate working space, wide sphenoidotomy and ethmoidectomy are required, along with removal of the medial and posterior walls of the maxillary sinus and opening of the pterygopalatine fossa. These steps allow access to Meckel's cave through the quadrangular space, formed by the cavernous and petrous internal carotid arteries, the abducens nerve, and V2. During tumor resection, intracapsular dissection is essential to preserve normal trigeminal nerve fibers. Precise patient selection and intracapsular resection may have contributed to the favorable surgical outcomes of EETMPA for non-vestibular schwannoma. With the accumulation of further clinical experience, criteria for selecting EETMPA, ETOA, or EKA are expected to become clearer.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"384-392"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783634","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

[Craniopharyngioma : Current Perspectives Including Recent Advances in Molecular Targeted Therapy]. [颅咽管瘤：分子靶向治疗的最新进展]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020353

Shingo Fujio, Ryutaro Makino, Ryosuke Hanaya

{"title":"[Craniopharyngioma : Current Perspectives Including Recent Advances in Molecular Targeted Therapy].","authors":"Shingo Fujio, Ryutaro Makino, Ryosuke Hanaya","doi":"10.11477/mf.030126030540020353","DOIUrl":"10.11477/mf.030126030540020353","url":null,"abstract":"Craniopharyngiomas are benign sellar and parasellar tumors and clinically challenging to treat because of their proximity to the critical neurovascular and hypothalamic structures. Recently, distinct driver mutations, including CTNNB1 in adamantinomatous craniopharyngiomas and BRAF V600E in papillary craniopharyngiomas, have led to a paradigm shift in treatment strategies. Endoscopic endonasal transsphenoidal surgery, supported by advances in surgical instruments and techniques, has expanded the indications for this minimally invasive surgical strategy, which has become an important approach in contemporary surgical management. Radiotherapy remains an effective adjuvant option for residual or recurrent tumors and contributes to durable local tumor control if combined with function-preserving surgical strategies. Molecular targeted therapy combining BRAF and MEK inhibitors results in marked tumor shrinkage in papillary craniopharyngiomas harboring the BRAF V600E mutation. These agents have emerged as promising therapeutic options, potentially as neoadjuvant therapies for enhancing surgical safety or achieving non-surgical tumor control in selected cases. Future management of craniopharyngiomas requires an individualized, multimodal approach that integrates the molecular subtype, patient age, functional status, and long-term quality of life to choose a treatment course that balances durable tumor control with optimal functional outcomes.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"353-362"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783639","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

[Optimization of the Surgical Environment and Perioperative Management in Endoscopic Intraventricular Surgery]. 内窥镜脑室手术手术环境优化及围手术期处理

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020249

Masahiro Tanji

{"title":"[Optimization of the Surgical Environment and Perioperative Management in Endoscopic Intraventricular Surgery].","authors":"Masahiro Tanji","doi":"10.11477/mf.030126030540020249","DOIUrl":"10.11477/mf.030126030540020249","url":null,"abstract":"Neuroendoscopic intraventricular surgery provides a minimally invasive approach but is inherently challenging, as it is performed within a fragile, three-dimensional ventricular space while relying on a limited two-dimensional endoscopic view. Loss of orientation and subtle technical errors can result in hemorrhage or neural injury. This chapter describes practical strategies for achieving stable and reproducible neuroendoscopic intraventricular surgery, with emphasis on operating room setup, instrumentation, teamwork, and perioperative management. Key principles include aligning the surgeon, patient, and monitor to maintain visuomotor consistency; proactive use of navigation and intraoperative ultrasound to prevent misplacement; and gentle, deliberate manipulation of the vulnerability of ventricular structures. Instrument selection, including rigid scopes, channel-based rigid endoscopic systems, and coagulation-suction devices, is discussed from a safety-oriented perspective. A central emphasis is placed on the role of the assistant, whose responsibilities extend beyond irrigation control ( \"water management\" ) to include verbal cues and optimization of the surgical environment. Perioperative management, particularly external ventricular drainage (EVD) strategies, postoperative fever, and the role of neuroendoscopic ventricular irrigation in ventriculitis, are also reviewed. Collectively, these concepts highlight that successful neuroendoscopic surgery depends not only on technical proficiency but also on comprehensive surgical design and effective team coordination.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"249-256"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783568","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 Management of Rathke's Cleft Cysts: Surgical Strategies and Long-Term Outcomes]. [鼻内窥镜治疗Rathke's裂囊肿：手术策略和长期结果]。

Neurological Surgery Pub Date : 2026-03-01 DOI: 10.11477/mf.030126030540020333

Hiroyoshi Kino

{"title":"[Endoscopic Endonasal Management of Rathke's Cleft Cysts: Surgical Strategies and Long-Term Outcomes].","authors":"Hiroyoshi Kino","doi":"10.11477/mf.030126030540020333","DOIUrl":"10.11477/mf.030126030540020333","url":null,"abstract":"Rathke's cleft cysts (RCCs) are non-neoplastic cystic lesions of the sellar region in which the primary pathological mechanism is the mass effect caused by cyst fluid accumulation. Although endoscopic endonasal surgery is the standard treatment for symptomatic RCCs, postoperative recurrence remains relatively frequent, and optimal surgical strategies remain debated. To improve long-term cyst control, we developed a mucosal coupling (MC) method, establishing a persistent drainage route from the cyst cavity to the sphenoid sinus using the sphenoid sinus mucosa. However, the MC method is not applicable in all cases, particularly in patients with intraoperative cerebrospinal fluid (CSF) leakage. We retrospectively analyzed 77 patients who had undergone endoscopic endonasal surgery for RCCs at our institution since 2010. Surgical strategies were selected based on preoperative magnetic resonance imaging findings and intraoperative assessment of CSF leakage, including conventional cyst fenestration with dural closure, the MC method, and cyst fenestration into the cistern through the opening of the diaphragma sellae. Surgical outcomes, recurrence, and complications were evaluated. The MC group demonstrated the lowest rate of symptomatic recurrence and required reoperation. Visual function improved in almost all patients, whereas postoperative endocrine deterioration occurred in a few patients. Postoperative CSF leakage remains a critical concern, emphasizing the importance of strict intraoperative evaluation and careful patient selection. Tailored surgical strategies focusing on preventing cyst fluid reaccumulation are essential for the optimal management of RCCs.","PeriodicalId":35984,"journal":{"name":"Neurological Surgery","volume":"54 2","pages":"333-341"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783625","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