No Shinkei Geka. Neurological Surgery[JOURNAL]
Sun
200 papers
[Full-Endoscopic Spine Surgery for Lumbar Lesions; Basics and Applications].
Yoshimura M, Nishimura Y, Sato H … +1 more , Takami T
No Shinkei Geka · 2025 Jan · PMID 39884688 · Publisher ↗
Full endoscopic spine surgery is a technique to perform hernia extraction using a single-hole-type endoscope with a coaxial operation system of a sheath, endoscope, and surgical instrument in reflux water. In the lumbar...
Full endoscopic spine surgery is a technique to perform hernia extraction using a single-hole-type endoscope with a coaxial operation system of a sheath, endoscope, and surgical instrument in reflux water. In the lumbar region, the ventral side of the dura mater can be directly approached via the lateral route. Not only is the skin incision small, but damage to muscle tissue is also minimal, which is why it is a minimally invasive surgery. For beginners, the learning curve is gentle because the operation field(2D image, ultra-magnified field of view, underwater), which differs from microsurgery, is developed and a special tool is used. It is important to understand the structure of a tool and select an appropriate tool according to the situation. By rotating the sheath and endoscope, it is possible to ensure the safety of important structures and expand the operation range.
[Surgical Procedure and Indication of Microendoscopic Discectomy].
Imae S, Miki J
No Shinkei Geka · 2025 Jan · PMID 39884687 · Publisher ↗
Standard microscopic posterior decompression(MD) for lumbar disc herniation has been well established and is a familiar procedure to virtually all spinal neurosurgeons. Traditional surgical treatments are often associate...
Standard microscopic posterior decompression(MD) for lumbar disc herniation has been well established and is a familiar procedure to virtually all spinal neurosurgeons. Traditional surgical treatments are often associated with severe postoperative pain, disability, and dysfunction. This study aimed to describe the microendoscopic discectomy(MED) technique for lumbar disc herniation and report its surgical indications. This technique has been shown to provide symptomatic relief equivalent to that of microdiscectomy, with obvious reductions in operative hospital stay and narcotic use. No significant differences in outcome data between the two groups were observed. However, several patients in the MED group required surgical conversion to MD. The size of the disc herniation was the most important factor in the conversion. MED is an effective microendoscopic system with good long-term outcomes for the treatment of lumbar disc herniation. The endoscopic approach allows for smaller incisions and less tissue trauma than the standard open microdiscectomy. Strict adherence to well-defined preoperative selection criteria ensures optimal postoperative outcomes.
[Lumbar Foraminal Stenosis: Diagnosis and Microsurgical Decompression].
Chang HS
No Shinkei Geka · 2025 Jan · PMID 39884686 · Publisher ↗
Lumbar foraminal stenosis is a common problem; however, correct diagnosis and appropriate surgical treatment are difficult. This article describes the author's techniques for imaging diagnosis using thin-slice magnetic r...
Lumbar foraminal stenosis is a common problem; however, correct diagnosis and appropriate surgical treatment are difficult. This article describes the author's techniques for imaging diagnosis using thin-slice magnetic resonance imaging(MRI) and the microsurgical technique of foraminal decompression through the intermuscular approach. Thin-slice MRI consists of 1-mm thickness continuous images of the lumbar spine using a T2-weighted-image-based sequence. With multiplanar reconstruction in three planes, all nerve roots are carefully observed from the lateral recess to the extraforaminal area. This technique provides the correct diagnosis of subtle nerve root compression in the foramen. The outlet of the intervertebral foramen is exposed using Wiltse's intermuscular approach. To avoid disorientation, several surgical landmarks and two basic routes to reach the outlet of the foramen are established. The foramen is carefully unroofed by using an ultrasonic bone curette. For complete decompression of the nerve root and ganglion, the inferomedial aspect of the pedicle and its medial and lateral limits should be determined. In addition, the yellow ligament must be completely removed, and the intertransverse ligament lateral to the nerve root should be sufficiently decompressed.
[Posterior Decompression Surgery for Degenerative Lumbar Disease:Basic Principles and Advantages/Disadvantages of Exoscopic Surgery].
Inui T, Tominaga Y, Tominaga S
No Shinkei Geka · 2025 Jan · PMID 39884685 · Publisher ↗
This paper examines advancements in minimally invasive posterior decompression techniques for lumbar degenerative diseases. It focuses on the unilateral approach for bilateral decompression and bilateral approach for con...
This paper examines advancements in minimally invasive posterior decompression techniques for lumbar degenerative diseases. It focuses on the unilateral approach for bilateral decompression and bilateral approach for contralateral decompression, in which the entry side is determined independently of the symptomatic side to achieve a facet joint preservation rate of ≥ 70%, while also emphasizing contralateral foraminal decompression(CFD). These techniques address spinal instability by minimizing facet joint resection, reducing postoperative instability. CFD is noteworthy because it enables single-stage decompression in the same surgical field as foraminal stenosis, which frequently coexists with spinal canal stenosis. Additionally, this paper discusses the effectiveness of real-time 3D CT navigation in enhancing surgical precision, especially in complex cases, to improve long-term outcomes by minimizing postoperative instability. Furthermore, exoscopic surgery is evaluated as a future standard, highlighting its superior ergonomics and flexible viewing angles, including steep oblique angles, which are challenging with conventional microscopes. Although exoscopic technology offers many advantages, it also has certain drawbacks and remains in the developmental stage; however, it holds the potential to become a new paradigm in spinal surgery. Balancing minimally invasive approaches with spinal stability remains critical for optimizing patient recovery, reducing complications, and minimizing reliance on spinal fusion surgery.
[Posterior Cervical Fixation:Indications, Fixation Methods, and Surgical Safety].
Shimokawa N, Sato H
No Shinkei Geka · 2025 Jan · PMID 39884684 · Publisher ↗
It is important to be aware of the indications, surgical procedure selection, and associated complications. This chapter focuses on basic screw placement techniques, emphasizing on safety with each anchor placement. Fami...
It is important to be aware of the indications, surgical procedure selection, and associated complications. This chapter focuses on basic screw placement techniques, emphasizing on safety with each anchor placement. Familiarity with managing surgical accidents is also important. After learning the fundamental methods for placing anchors in posterior cervical fixation, surgeons should proceed stepwise to more complex fixation procedures.
[Cervical Cord/Root Decompression:Posterior Approach/Variation of Surgical Procedure].
Kawamoto T
No Shinkei Geka · 2025 Jan · PMID 39884683 · Publisher ↗
Posterior cervical decompression surgery is safe and effective. It was developed to safely and reliably decompress nerve tissues. Maximising the reconstruction and maintenance of the posterior neck tissue has been report...
Posterior cervical decompression surgery is safe and effective. It was developed to safely and reliably decompress nerve tissues. Maximising the reconstruction and maintenance of the posterior neck tissue has been reported and developed. Complete reconstruction of the posterior musculoskeletal unit can minimise postoperative complications and spinal alignment changes. Here, we introduced laminoplasty which completely preserved the posterior cervical spinal tissue, and discussed its variations. Although posterior cervical decompression is a basic and safe surgical technique that can be used in many diseases, it has limitations. The factors of nerve compression should be carefully examined, and the most appropriate procedure should be selected considering total spinal alignment.
[Cervical Artificial Disc Replacement].
Hara M
No Shinkei Geka · 2025 Jan · PMID 39884682 · Publisher ↗
In Japan, cervical artificial disc replacement was approved by the Pharmaceuticals and Medical Devices Agency in December 2017, and two products, Mobi-C by Zimmer Biomet and Prestige LP by Medtronic, are on the market. C...
In Japan, cervical artificial disc replacement was approved by the Pharmaceuticals and Medical Devices Agency in December 2017, and two products, Mobi-C by Zimmer Biomet and Prestige LP by Medtronic, are on the market. Cervical artificial disc replacement preserves cervical motion; however, the device must be place carefully on the midline to take full advantage of its features. In addition, a reliable foraminotomy is required to cure or prevent radiculopathy due to residual foraminal stenosis. Artificial disc replacement(ADR) is now available for up to two consecutive intervertebral spaces, and it is now possible to combine ADR with anterior cervical discectomy(decompression) and fusion or anterior cervical discectomy as a hybrid procedure. Although the number of surgical options has increased, it may be difficult to choose a surgical method until further experience is gained. Even with cervical artificial disc replacement, age-related facet degeneration progresses reduce the range of motion, and cause adjacent segment disease. In addition, heterotopic ossification, a frequent complication of ADR, also causes a reduction in the range of motion; therefore, further investigation of its causes and improvements in equipment is needed.
[Anterior Cervical Decompression and Fusion:Surgical Concept of Anterior Decompression and Selection of Internal Fixation Devices].
Sugawara T
No Shinkei Geka · 2025 Jan · PMID 39884681 · Publisher ↗
Anterior cervical fixation is an excellent surgical technique for the removal of anterior compressive elements affecting the spinal cord and nerve roots while addressing cervical instability. However, it is important to...
Anterior cervical fixation is an excellent surgical technique for the removal of anterior compressive elements affecting the spinal cord and nerve roots while addressing cervical instability. However, it is important to recognize the unique challenges posed by the proximity of critical structures, including the trachea, esophagus, carotid sheath, and recurrent laryngeal nerve. Access to the upper cervical spine is often limited to the mandible. A thorough understanding of the relevant anatomy is essential for careful consideration of surgical indications when selecting an appropriate technique. By ensuring accurate decompression and stabilization, optimal postoperative outcomes in terms of neural symptom relief and spinal stability can be achieved.
[Digital Transformation in Healthcare].
Kuroda T
No Shinkei Geka · 2024 Nov · PMID 39622335 · Publisher ↗
Digital transformation, a term coined by Erik Stolterman and Anna Croon Fors, means the changes of social systems by using information and communication technologies. The healthcare industry has changed through the intro...
Digital transformation, a term coined by Erik Stolterman and Anna Croon Fors, means the changes of social systems by using information and communication technologies. The healthcare industry has changed through the introduction of hospital information systems, and the Internet of Things is now dissolving hospitals in society. Recent advancements in medical artificial intelligence have increased expectations of disruptive changes in clinical practice and medical science. Therefore, all nations devote their efforts to the establishment of a key factor: a real-world data platform. A clear vision of gradually navigating citizens to a bright future and the courage to change the legislation quickly to realize the vision are keys to success.
[Post-Stroke Epilepsy and Vascular Dementia].
Tanaka T, Ihara M
No Shinkei Geka · 2024 Nov · PMID 39622334 · Publisher ↗
Epilepsy and cognitive impairment are major post-stroke complications. As society ages, the number of stroke survivors increases, leading to a greater interest in these complications. Post-stroke epilepsy accounts for ap...
Epilepsy and cognitive impairment are major post-stroke complications. As society ages, the number of stroke survivors increases, leading to a greater interest in these complications. Post-stroke epilepsy accounts for approximately half of all epilepsy cases in older adults and is associated with physical disability and mortality, emphasizing the importance of controlling seizures. Research is progressing on diagnostic methods, primary prevention, and secondary prevention of post-stroke epilepsy. Vascular dementia and Alzheimer's disease are the two major types of dementia and can be prevented and treated by addressing vascular risk factors such as hypertension, dyslipidemia, and diabetes. Currently, there are no available treatments to reverse vascular dementia, and many challenges remain unresolved. This review discusses the information necessary for clinical practice, including diagnostic criteria, classification, risk factors, measurements, and appropriate treatments for post-stroke complications.
[Gastroesophageal Reflux Disease and Functional Dyspepsia].
Hoshikawa Y, Iwakiri K
No Shinkei Geka · 2024 Nov · PMID 39622333 · Publisher ↗
Gastroesophageal reflux disease(GERD)and functional dyspepsia are common gastrointestinal disorders. GERD primarily manifests as heartburn and regurgitation, whereas functional dyspepsia is diagnosed in the absence of a...
Gastroesophageal reflux disease(GERD)and functional dyspepsia are common gastrointestinal disorders. GERD primarily manifests as heartburn and regurgitation, whereas functional dyspepsia is diagnosed in the absence of a discernible organic disease, despite persistent epigastric discomfort. Both GERD and functional dyspepsia can substantially worsen the patient's quality of life, although they do not typically influence prognosis. It is crucial to consider organic diseases, such as malignancies, particularly in patients who present with high-risk factors, including advanced age and weight loss. Patients with stable general health who are amenable to regular follow-ups and invasive procedures, such as endoscopy, should be advised to seek care at specialized facilities. This is particularly relevant if the initial treatment regimen fails to alleviate symptoms. This approach ensures optimal patient care and effective symptom management.
[Sleep Disorders].
Suzuki K, Hida R, Morito N
No Shinkei Geka · 2024 Nov · PMID 39622332 · Publisher ↗
Insomnia is a common sleep disorder that, owing to difficulties falling asleep or maintaining sleep and/or early morning awakening, causes daytime functional impairment. Other sleep disorders include sleep-related breath...
Insomnia is a common sleep disorder that, owing to difficulties falling asleep or maintaining sleep and/or early morning awakening, causes daytime functional impairment. Other sleep disorders include sleep-related breathing disorders; sleep-related movement disorders, such as periodic limb movement disorder and restless legs syndrome; parasomnias, such as rapid eye movement sleep behavior disorder and sleepwalking; and central disorders of hypersomnolence, such as narcolepsy. This article describes sleep disorders that are routinely observed in daily clinical practice.
[Sarcopenia and Frailty in Stroke and Cardiovascular Disease].
Watanabe H, Naoi T, Tanaka R
No Shinkei Geka · 2024 Nov · PMID 39622331 · Publisher ↗
Sarcopenia is a progressive skeletal muscle disorder involving an accelerated loss of muscle mass and function. Frailty is characterized by a decline in the functioning of multiple physiological systems and an increased...
Sarcopenia is a progressive skeletal muscle disorder involving an accelerated loss of muscle mass and function. Frailty is characterized by a decline in the functioning of multiple physiological systems and an increased vulnerability to stressors. The incidence of these pathological conditions increases with age and is often accompanied by various acute or chronic disorders. The presence of sarcopenia or frailty in patients with other diseases is associated with poor outcomes. For example, frailty is highly prevalent in patients with heart failure and is linked to an increased risk of hospital admission and mortality. Among stroke patients, pre-stroke frailty is frequently observed and is associated with higher mortality, extended hospitalization, and stroke recurrence. Furthermore, the risk of sarcopenia and frailty is high in stroke survivors. Poststroke frailty is associated with increased mortality, hospital admissions, and stroke recurrence. Managing sarcopenia and frailty after stroke is crucial for improving patient outcomes. Multidisciplinary support, including aggressive rehabilitation, nutritional support, and continuous rehabilitation during the chronic stage, is important. As Japan is a super-aging country, effective management of sarcopenia and frailty, alongside disease treatment, is essential for further improving patient prognosis.
[Osteoporosis].
Saito T
No Shinkei Geka · 2024 Nov · PMID 39622330 · Publisher ↗
Osteoporosis, the most prevalent bone disease, increases an individual's risk of fractures. Various factors, such as a past history of fractures, smoking, alcohol consumption, use of steroid medications, genetic backgrou...
Osteoporosis, the most prevalent bone disease, increases an individual's risk of fractures. Various factors, such as a past history of fractures, smoking, alcohol consumption, use of steroid medications, genetic background, and physical activity level, are associated with fracture risk. Notably, reduced physical activity should be emphasized for patients with brain or other neurological disorders, as impaired body balance and decreased muscle strength contribute to falls and fractures. The emergence of many effective treatments for osteoporosis has enabled patient-tailored treatments. Even physicians who do not specialize in osteoporosis, such as neurosurgeons, are expected to assess patient condition, estimate the risk of osteoporosis or fractures, and consult specialists when necessary.
[Interaction Between Oral Diseases(Dental Caries and Periodontitis)and Metabolic Syndrome as an Underlying Mechanism of Cerebrovascular Diseases].
Tonomura S, Ihara M
No Shinkei Geka · 2024 Nov · PMID 39622329 · Publisher ↗
Oral health is fundamentally linked to systemic health, with dental caries and periodontal diseases playing critical roles in the overall well-being. In Japan, a concerted effort to enhance oral health through a comprehe...
Oral health is fundamentally linked to systemic health, with dental caries and periodontal diseases playing critical roles in the overall well-being. In Japan, a concerted effort to enhance oral health through a comprehensive initiative that started in 2024 emphasizes the prevention of oral diseases by fostering closer collaboration between medical and dental care providers. This initiative acknowledges the intricate connection between oral health and systemic conditions, including metabolic disorders and cerebrovascular and cardiovascular diseases. Recent research has underscored the significant impact of oral health on these systemic diseases, drawing attention to the interplay between oral health and the brain, as well as the complex oral-gut-brain axis. These studies offer valuable insights into how oral diseases can influence, and potentially exacerbate, systemic health issues. The review of current evidence highlights the critical need for maintaining oral health not only for the sake of dental well-being but also as an integral part of overall health. This also highlights the necessity for continued research to fully comprehend the multifaceted relationship between oral health and systemic diseases. Such understanding is paramount for developing more effective prevention, intervention, and treatment strategies, ultimately contributing to better health outcomes.
[Clinical Management of Respiratory Diseases in Neurosurgical Settings].
Yagyu H, Hara Y, Kaneko T
No Shinkei Geka · 2024 Nov · PMID 39622328 · Publisher ↗
Respiratory diseases, such as chronic obstructive pulmonary disease(COPD)and asthma, are becoming increasingly prevalent in super-aging societies. In Japan, the estimated prevalence of COPD among individuals aged 40 year...
Respiratory diseases, such as chronic obstructive pulmonary disease(COPD)and asthma, are becoming increasingly prevalent in super-aging societies. In Japan, the estimated prevalence of COPD among individuals aged 40 years and above is 8.6%, while asthma affects about 10% of adults. These statistics highlight the similarities between COPD and asthma in clinical settings. Both diseases involve chronic airway inflammation and present with symptoms such as chronic cough, sputum production, wheezing, and dyspnea. Exacerbations of these symptoms and complications are critical concerns during the perioperative period. COPD, often caused by long-term smoking, leads to irreversible airway and lung damage, while asthma is characterized by episodic and reversible airway constriction due to chronic inflammation. COPD diagnosis involves spirometry and the exclusion of other diseases, with treatment goals focusing on symptom improvement and risk reduction through smoking cessation, pharmacotherapy(mainly bronchodilators), and non-pharmacological methods(such as pulmonary rehabilitation). Asthma management aims to control inflammation and prevent exacerbations using inhaled corticosteroids and bronchodilators as standard treatments. Perioperative management of both diseases involves improving respiratory function with pharmacotherapy, careful anesthesia selection, and early postoperative mobilization. Consultation with respiratory specialists is recommended for effective management, especially in complex cases.
[Recent Topics Concerning Alcoholic Liver Disease].
Kakazu E, Kanto T
No Shinkei Geka · 2024 Nov · PMID 39622327 · Publisher ↗
Alcoholic liver disease(ALD)is caused by liver damage due to excessive alcohol consumption in varying forms and severities. In Japan, although overall alcohol consumption is decreasing owing to population decline and agi...
Alcoholic liver disease(ALD)is caused by liver damage due to excessive alcohol consumption in varying forms and severities. In Japan, although overall alcohol consumption is decreasing owing to population decline and aging, the number of heavy drinkers remains almost unchanged. Consequently, the total number of patients with ALD is decreasing, whereas the number of patients with alcoholic cirrhosis is increasing. In a national survey on cirrhosis conducted in 2023, the proportion of alcoholic cirrhosis has increased to 35%, surpassing that of hepatitis C virus-related cirrhosis as the leading cause. The primary treatment for ALD is abstinence from alcohol; however, social and medical approaches to alcohol dependence and nutritional management of improper alcohol intake are essential. Various clinical trials of ALD at different stages are being conducted, particularly in Western countries.
[Update on Research and Treatment of Chronic Kidney Disease].
Yamashita J, Tanaka S, Inagi R
No Shinkei Geka · 2024 Nov · PMID 39622326 · Publisher ↗
The kidney and brain share strain vessels, which are short and small arterioles that branch out of larger arteries. These vessels are vulnerable to risk factors such as atherosclerosis, old age, hypertension, diabetes, d...
The kidney and brain share strain vessels, which are short and small arterioles that branch out of larger arteries. These vessels are vulnerable to risk factors such as atherosclerosis, old age, hypertension, diabetes, dyslipidemia, and smoking. The nervous system and the kidneys interact to maintain homeostasis. Many chronic kidney disease(CKD)-specific and nonspecific factors contribute to structural and functional cerebral changes in patients with CKD. In contrast, vagus nerve stimulation has been reported to alleviate inflammatory diseases, including kidney disease. Several new drugs have recently become available for the treatment of CKD: sodium-glucose co-transporter-2 inhibitors for CKD; finerenone, a mineralocorticoid receptor antagonist for CKD with type 2 diabetes; and a hypoxia-inducible factor prolyl-hydroxylase inhibitor for anemia in patients with CKD.
[Recent Topics on Heart Failure].
Seo Y
No Shinkei Geka · 2024 Nov · PMID 39622325 · Publisher ↗
Japan is currently experiencing a significant increase in the number of patients with heart failure driven by its rapidly aging population, a phenomenon termed the heart failure pandemic. This trend is particularly alarm...
Japan is currently experiencing a significant increase in the number of patients with heart failure driven by its rapidly aging population, a phenomenon termed the heart failure pandemic. This trend is particularly alarming because heart failure severely affects life expectancy, making it a critical public health issue. The rising number of heart failure cases has highlighted the importance of early diagnosis and intervention, with heart failure now classified into distinct stages to better tailor treatment strategies. Recent advancements in treatment, including new pharmacological options such as SGLT2 inhibitors and non-pharmacological approaches such as transcatheter aortic valve implantation and catheter ablation, have significantly improved patient outcomes. These treatments are particularly effective in managing the complexities of heart failure, especially in older patients. However, the success of these treatments also relies on a comprehensive approach involving multidisciplinary teams working together to provide holistic care. These therapeutic innovations underscore the importance of continued adaptation and research to sustain the effectiveness of heart failure treatment in the evolving healthcare environment of Japan's aging population.
[Arrhythmia].
Kusano K
No Shinkei Geka · 2024 Nov · PMID 39622324 · Publisher ↗
The basic principles of atrial fibrillation(AF)treatment are stroke prevention with appropriate anticoagulation, rhythm and rate control with drugs, and non-pharmacological therapy. The current guidelines have been prese...
The basic principles of atrial fibrillation(AF)treatment are stroke prevention with appropriate anticoagulation, rhythm and rate control with drugs, and non-pharmacological therapy. The current guidelines have been presented. Non-pharmacological treatment(catheter ablation)for AF, originally developed to eliminate motivational symptoms, has been shown to improve life outcomes, and indications for ablation are expanding rapidly. Catheter ablation has evolved remarkably from conventional radiofrequency to balloon ablation. Minimal complications are expected to occur with pulsed-field ablation. Ablation strategies for paroxysmal AF are almost established and approaches for persistent AF are becoming increasingly important. Surgical approaches have also evolved significantly, with robotic surgery, the thoracoscopic Wolf-Ohtsuka procedure, and minimally invasive cardiac surgery, becoming less invasive. Future studies should prioritize a system for better function and treatment options for the heart team.
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