Neurologia Medico-Chirurgica is a professional journal focused on neurosurgery and related fields, dedicated to publishing high-quality research papers, reviews, and clinical cases to promote advancements and developments in neurology.

《Neurologia Medico-Chirurgica》是一本专注于神经外科和相关领域的专业期刊，致力于发表高质量的研究论文、综述和临床案例，以促进神经医学的进步和发展。

Neurologia Medico-Chirurgica

Traumatic brain injury (TBI) is the leading cause of death and disability in children. Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Evidence suggests that children exhibit a specific pathological response to TBI with distinct accompanying neurological symptoms, and considerable efforts have been made to elucidate their pathophysiology. In addition, recent technical advances in diagnostic imaging of pediatric TBI has facilitated accurate diagnosis, appropriate treatment, prevention of complications, and helped predict long-term outcomes. Here a review of recent studies relevant to important issues in pediatric TBI is presented, and recent specific topics are also discussed. This review provides important updates on the pathophysiology, diagnosis, and age-appropriate acute management of pediatric TBI.

Takashi ARAKI

Hiroyuki YOKOTA

Akio MORITA

Neurologia medico-chirurgica

Neurol. Med. Chir.(Tokyo)

Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management

儿童创伤性脑损伤：特征、诊断与管理

Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief is one of its main issues. We previously evaluated the morphology of the lateral spread response (LSR) and reported correlation between delayed relief after MVD and polyphasic morphology of the LSR. This study aimed to investigate the morphology of LSR and the course of recovery of the compound motor action potential (CMAP), to better understand the pathophysiology of delayed healing of HFS. Based on the pattern of the initial LSR morphology on temporal and marginal mandibular branches stimulation, patients were divided into two groups: the monophasic and polyphasic groups. The results of MVD surgery and sequential changes in the CMAP were evaluated 1 week, 1 month, 1 year, and final follow-up after the surgery. Significantly higher rates of persistent postoperative HFS were observed in patients with the polyphasic type of initial LSR at 1 week and 1 month after the surgery (P < 0.05, respectively). In the polyphasic group, the amplitude of the CMAP tended to gradually improve with time, while in the monophasic group, the amplitude of the CMAP decreased on the seventh postoperative day, followed by its gradual improvement. There is a significant correlation between delayed relief after MVD and polyphasic morphology of the initial LSR in patients with HFS. In the polyphasic group, CMAP recovered earlier and showed less reduction in amplitude, suggesting segmental demyelination, with less damage to peripheral nerves.

Yuki AMANO

Bunsho ASAYAMA

Shusaku NORO

Takenori ABE

Masahiro OKUMA

Kaori HONJO

Yoshinobu SEO

Hirohiko NAKAMURA

Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Lateral Spread Response in Patients with Hemifacial Spasm-Further Examination with Compound Motor Action Potentials

微血管减压术后缓解延迟与半面痉挛患者侧方扩散反应形态的相关性——复合运动动作电位的进一步研究

To date, deep brain stimulation (DBS) has already been performed on more than 120,000 patients worldwide and in more than 7,000 patients in Japan. However, fundamental understanding of DBS effects on the pathological neural circuitry remains insufficient. Recent studies have specifically shown the importance of cortico-striato-thalamo-cortical (CSTC) loops, which were identified as functionally and anatomically discrete units. Three main circuits exist in the CSTC loops, namely, the motor, associative, and limbic circuits. From these theoretical backgrounds, it is determined that DBS sometimes influences not only motor functions but also the cognitive and affective functions of Parkinson's disease (PD) patients. The main targets of DBS for PD are subthalamic nucleus (STN) and globus pallidus interna (GPi). Ventralis intermedius (Vim)-DBS was found to be effective in improving tremor. However, Vim-DBS cannot sufficiently improve akinesia and rigidity. Therefore, Vim-DBS is seldom carried out for the treatment of PD. In this article, we review the present state of DBS, mainly STN-DBS and GPi-DBS, for PD. In the first part of the article, appropriate indications and practical effects established in previous studies are discussed. The findings of previous investigations on the complications caused by the surgical procedure and on the adverse events induced by DBS itself are reviewed. In the second part, we discuss target selection (GPi vs. STN) and the effect of DBS on nonmotor symptoms. In the final part, as issues that should be resolved, the suitable timing of surgery, symptoms unresponsive to DBS such as on-period axial symptoms, and the related postoperative programing of stimulation parameters, are discussed.

Chikashi FUKAYA

Takamitsu YAMAMOTO

Deep Brain Stimulation for Parkinson’s Disease: Recent Trends and Future Direction

帕金森病深部脑刺激：近期趋势与未来方向

Although reconstructive laminoplasty is commonly performed after resection of spinal intramedullary tumors of the cervical spine, its biomechanical rigidity of laminoplasty framework remains unclear. The objective of this study was to examine the structural reliability of our unique method of cervical lift-up basket laminoplasty by using computed tomography (CT)-based finite element analysis (FEA) and clinical radiological evaluation. A finite element model of cervical laminoplasty was created based on CT images using FEA software. Cervical lift-up basket laminoplasty (Basket) was compared with the standard style of open-door basket laminoplasty (Open-door). Clinical subjects for radiological evaluation comprised 33 patients who underwent cervical lift-up basket laminoplasty after resection of spinal intramedullary tumors. An FEA-equivalent stress histogram showed that stress was moderately dispersed around the basket. Virtual displacement of the spinous process of the Basket model was equivalent to that of the Open-door model in any direction of posterior-to-anterior, right-to-left, or top-to-bottom force. In the clinical analysis, radiological data with a minimum postoperative period of 6 months were obtained in a total of 28 out of 33 patients. No patients underwent revision surgery because of implant-related complications. No significant differences in C2-C7 angle or cervical tilt angle were observed between pre- and postoperatively. The structural rigidity of cervical lift-up basket laminoplasty was equivalent to the open-door style on the FEA. Clinical radiological evaluation suggested that there were no serious adverse events associated with cervical laminoplasty, although the longer postoperative follow-up is mandatory.

Kentaro NAITO

Yuta NAKANISHI

Toshihiro TAKAMI

Cervical Lift-up Basket Laminoplasty after Resection of Spinal Intramedullary Tumors: A Finite Element Analysis and Clinical Image Evaluation

脊髓内肿瘤切除术后颈椎提篮式椎板成形术的有限元分析与临床影像评估

In every hospital in Japan, until 2022, the primary treatment for preventing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) involved a combination of ozagrel sodium (Oz), fasudil hydrochloride (Fs), cilostazol, and statins. However, with the approval of clazosentan in January 2022, it has been used as a first-choice drug more frequently. Despite this shift, limited evidence exists regarding the use of clazosentan as the first choice for DCI prevention. In this study, we analyzed the efficacy and outcomes of these two treatments in aSAH patients. Patients treated with Oz+Fs were enrolled between January 2014 and March 2022. In April 2022, clazosentan was prescribed to prevent DCI. Clinical data were collected, and propensity-score matching was conducted based on the clazosentan group. The primary endpoint was the functional outcome at discharge and 6-12 months after admission; the secondary endpoints were the incidence of cerebral vasospasm (CV) and DCI. In this study, 221 patients were included, and 27 were selected from both groups after matching. The incidence of CV was significantly lower in the clazosentan group (11.1% vs. 55.6%, p<0.01), and the incidence of DCI tended to be lower in the clazosentan group (3.7% vs. 25.9%, p=0.05). No significant difference was observed in the primary endpoint of functional outcome at discharge; however, a significant improvement in functional outcome was observed in the clazosentan group at 6 months (96.3% vs. 70.4%, p<0.05). Clazosentan significantly reduced the incidence of CV and improved functional outcomes in patients with aSAH compared to Oz+Fs.

Sosho KAJIWARA

Takayuki KAWANO

Yu HASEGAWA

Yukihiko NAKAMURA

Kiyohiko SAKATA

Jin KIKUCHI

Masaru HIROHATA

Motohiro MORIOKA

Impact of Clazosentan on Vasospasm Reduction and Functional Recovery after Aneurysmal Subarachnoid Hemorrhage

动脉瘤性蛛网膜下腔出血后Clazosentan对血管痉挛减少及功能恢复的影响

Nationwide all-case survey on the efficacy and safety of flow diverter" was conducted to collect the initial clinical use results (referring to the course of treatment for a total of 200 consecutive patients over 3 years) of Pipeline Flex (Medtronic, Irvine, CA, USA), approved on April 17, 2015, to investigate the usefulness and the safety of the device.Treatment with FD was performed according to the guidelines for proper use (2 nd edition) established by the Japanese Society for Neuroendovascular Therapy, the Japan Stroke Society, and the Japan Neurosurgical Society.This device was used for endovascular therapy for large (> 10 mm in maximum aneurysm diameter) and wide neck (at least 4 mm in neck diameter) intracranial aneurysms from the petrous section to the superior hypophyseal section of the internal carotid artery (excluding the acute stage of rupture) according to the indication covered by insurance.The first 120 consecutive patients of the 200 patients were also subjected to post-marketing surveillance in accordance with the conditions pro

Kenji OHATA

Hajime ARAI

Masayuki EZURA

Koji IIHARA

Hiroyuki KINOUCHI

Shigeki KOBAYASHI

Teiji TOMINAGA

Kazuo MINEMATSU

Yuichi MURAYAMA

Naoki NAKAYAMA

Nobuyuki SAKAI

Masahiro YASAKA

Yuhei YOSHIMOTO

Takamasa KAYAMA

Nationwide All-case Survey on the Efficacy and Safety of Flow Diverter: Multicenter Study Conducted by the Japan Neurosurgical Society

全国性全病例调查：日本神经外科学会开展的支架分流器疗效与安全性多中心研究

Dural dryness makes suturing difficult during dural closure after craniotomy. In this case, dural plasty is often performed using a membrane taken from the surrounding tissue (e.g., fascia or periosteum) or an artificial replacement membrane. Herein, we introduce our novel "roll-up technique" to reduce the utilization of substitute membranes and explore its effectiveness in dural closure. We retrospectively examined the medical records of 50 patients who underwent craniotomy for the first time for supratentorial intracranial lesions between 2015 and 2022. Furthermore, we divided them into two groups: (1) the conventional technique group, which consisted of patients in whom the dura mater was flipped after incision and protected with a moistened gauze (n = 23), and (2) the roll-up technique group, which consisted of patients in whom the dura mater was incised in a U shape, rolled up, and protected with a moist gauze (n = 27). After surgery, we compared the success rates of primary closure, operating time, craniotomy area, and percentage of complications (e.g., cerebrospinal fluid [CSF] leakage or infection) between the groups. Dural closure without dural substitutes using the roll-up technique had a higher success rate than that using the conventional technique (26/27 [96.3%] cases vs. 14/23 [60.9%] cases; P = 0.003). Postoperative CSF leakage or infection did not occur, and no statistically significant difference was observed in the operating time between the groups (P = 0.247). The roll-up technique for dural closure may effectively prevent post-incisional dural shrink after craniotomy.

Yuki YASUOKA

Ushio YONEZAWA

Shinya NABIKA

Takeshi TAKAYASU

Akira TAGUCHI

Naohiko OHBAYASHI

Fumiyuki YAMASAKI

Nobutaka HORIE

Preventing Post-incisional Dural Shrink in Craniotomy: Introducing the "Roll-up Technique"

预防开颅术后硬脑膜回缩：介绍“卷起技术”

Internal neurolysis (IN) is a surgical procedure in which the trigeminal fibers are separated between the pons and porus trigeminus to relieve trigeminal neuralgia (TN). Recent investigations revealed that the number of nerve bundles made by IN varies, and immediate postoperative hypesthesia exceeded 90% and pain control rate at 1 year was 77%-93.5%. We present the preliminary experience of 18 patients who underwent IN for TN between June 2020 and June 2022. The Barrow Neurological Institute pain scale (BNI-PS) was recorded preoperatively and in June 2023, and the Barrow Neurological Institute hypesthesia scale (BNI-HS) was recorded preoperatively, immediate postoperatively and in June 2023. Intraoperatively, the number of bundles made by IN was reviewed. Preoperative BNI-PS ranged between VI and V. Two patients experienced BNI-HS II due to percutaneous procedure prior to IN. Intraoperatively, 3 bundles were made by IN in 7 patients, 4 bundles in 5, and 5 bundles in 6. Immediate postoperative BNI-HS I was recorded in 6 patients and II in 12 (66.7%). The last follow-up revealed that BNI-PS I and II were recorded in 13 patients (72.2%) and BNI-HS I and II in 6 patients, respectively. Our results demonstrated that the rates of immediate postoperative hypesthesia (66.7%) and pain control (72.2%) at 1 year or later were below those of previous reports. Therefore, we are currently combing to make at least 6 bundles. Detailed surgical technique and cardiac reflex alerts during the procedure are described.

Kenichi AMAGASAKI

Kyoko TATEBAYASHI

Kazuaki NAEMURA

Internal Neurolysis for Trigeminal Neuralgia: A Preliminary Single-institution Experience in Japan

三叉神经痛的内科神经松解术：日本单中心初步经验

The indication for surgical intervention in spontaneous intracerebral hemorrhage remains controversial. Although many clinical trials have failed to demonstrate its efficacy over medical treatment, less invasive endoscopic treatment is expected to demonstrate its superiority. A novel endoscopic system for hematoma removal consisting of a 3.1-mm-diameter 4K high-resolution rigid endoscope was used.

Hiroto OKUBATA

Masaaki TANIGUCHI

Naoki IRIZATO

Hidekazu NAKATA

Tomofumi TAKENAKA

Shogo FUKUYA

Katsunori ASAI

Akihiro TATEISHI

Kazumi YAMAMOTO

Akatsuki WAKAYAMA

The Usefulness of the 3.1-mm-diameter 4K Rigid Endoscope for Intracerebral Hematoma Evacuation

3.1毫米直径4K硬质内窥镜在脑内血肿清除中的应用价值

Brain tumor-related epilepsy (BTRE) is a complication that significantly impairs the quality of life and course of treatment of patients with brain tumors. Several recent studies have shed further light on the mechanisms and pathways by which genes and biological molecules in the tumor microenvironment can cause epilepsy. Moreover, epileptic seizures have been found to promote the growth of brain tumors, making the control of epilepsy a critical factor in treating brain tumors. In this study, we summarize the previous research and recent findings concerning BTRE. Expectedly, a deeper understanding of the underlying genetic and molecular mechanisms leads to safer and more effective treatments for suppressing epileptic symptoms and tumor growth.

Abbreviation	Neurol. Med. Chir.(Tokyo)
Journal Impact	2.45
Quartiles(Global)	SURGERY(Q2)

ISSN	0470-8105, 1349-8029
h-index	62

Publication Information	Publisher: Japan Neurosurgical Society，Publishing cycle: Monthly，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 1971，Proportion of original research papers: 92.59%，Self Citation Rate:4.20%， Gold OA Rate: 98.29%
Journal Fees	$Details
Average review cycle	12 weeks
Average recruitment ratio	网友分享经验：容易

Neurologia Medico-Chirurgica

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