No Shinkei Geka. Neurological Surgery[JOURNAL]
Sun
200 papers
[Ideal Model of Neurosurgical Clinical Pathways:From a Basic Inpatient Pathway and Add-on Pathways to a Multilayered System].
Kaji M, Yamashiro S, Seto H … +1 more , Nishi T
No Shinkei Geka · 2026 May · PMID 42220179 · Publisher ↗
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 pr...
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.
[A Practical Approach to Quality of Life and Higher Brain Function Assessment in Neurosurgical Practice].
Okita Y
No Shinkei Geka · 2026 May · PMID 42220178 · Publisher ↗
Advances in neurosurgical techniques and perioperative management have improved survival and neurological outcomes in several neurosurgical diseases. Nonetheless, even when objective functional scales, such as the modifi...
Advances in neurosurgical techniques and perioperative management have improved survival and neurological outcomes in several neurosurgical diseases. Nonetheless, even when objective functional scales, such as the modified Rankin Scale or Karnofsky Performance Status, indicate favorable outcomes, patients may experience persistent impairments in quality of life (QOL) and higher brain function, affecting daily activities, social participation, and treatment satisfaction. Conventional neurological examinations and imaging often fail to capture subtle cognitive, emotional, and psychosocial difficulties. Moreover, patient-reported outcomes and health-related QOL assessments provide a complementary perspective that reflects patients'subjective experiences, including fatigue, attention deficits, anxiety, and depressive symptoms. This review outlines a practical framework for incorporating QOL and higher brain function assessments into routine neurosurgical practice. Appropriate timing for preoperative and postoperative evaluations, commonly used general and disease-specific QOL instruments, and brief cognitive screening tools applicable in busy clinical settings are discussed. Notably, emphasis is placed on stepwise assessment strategies and multidisciplinary collaboration due to limited manpower. Integrating objective functional measures with patient-centered QOL evaluations enables a more comprehensive understanding of treatment outcomes and supports individualized clinical decision-making aimed at optimizing long-term patient well-being.
[Medical Safety and Informed Consent Management During Neurosurgery].
Kashiwazaki D
No Shinkei Geka · 2026 May · PMID 42220177 · Publisher ↗
Adverse events associated with neurosurgery remain a major concern in clinical practices. Most morbidity and mortality events are directly related to surgical procedures and can be broadly classified as avoidable or unav...
Adverse events associated with neurosurgery remain a major concern in clinical practices. Most morbidity and mortality events are directly related to surgical procedures and can be broadly classified as avoidable or unavoidable. Based on our experience, morbidity and mortality conferences can significantly reduce avoidable morbidity among both residents and experienced neurosurgeons. The ultimate goal of surgical education is to enhance patient safety and improve outcomes by systematically identifying problems and developing appropriate solutions. Morbidity and mortality conferences therefore represent an essential component of neurosurgical education, contributing to better neurosurgical practice and improved patient safety.
[Mathematical Models for Evidence-Based Primary Prevention Policy of Cerebrovascular and Cardiovascular Disease : An Integrated Analysis of Bayesian APC and IMPACT].
Ogata S
No Shinkei Geka · 2026 Mar · PMID 42036869 · Publisher ↗
Cardiovascular diseases, including stroke and coronary heart disease (CHD), remain the leading causes of mortality in Japan. Although age-standardized mortality rates have declined, population aging has likely resulted i...
Cardiovascular diseases, including stroke and coronary heart disease (CHD), remain the leading causes of mortality in Japan. Although age-standardized mortality rates have declined, population aging has likely resulted in higher crude mortality rates and an increased absolute number of deaths. To provide quantitative policy evidence, we apply two modeling approaches: the Bayesian age-period-cohort (BAPC) model and the IMPACT microsimulation model. The BAPC model projects mortality trends until 2040 by incorporating age, period, and cohort effects using Bayesian inference, offering probabilistic forecasts that capture uncertainty. These results suggest a gradual national decline in stroke and CHD deaths, while highlighting persistent regional disparities that may be linked to salt intake and lipid levels. IMPACT quantified the contributions of changes in risk factors and showed that improvements in blood pressure control and smoking reduction substantially prevented cardiovascular events and deaths between 2001 and 2019. Together, these models clarify not only "how much mortality will decline" but also "how to achieve further reductions" through risk factor interventions. Their integration enables scenario-based evaluation of prevention strategies, medical resource planning, and cost-effectiveness. This evidence-based framework can strengthen the Japanese National Plan for the Promotion of Measures Against Cerebrovascular and Cardiovascular Diseases and illustrate the value of combining predictive and explanatory modeling for future health policies.
[Neuroendoscopic Surgery for Intraparenchymal Lesions].
Takeuchi K
No Shinkei Geka · 2026 Mar · PMID 42036868 · Publisher ↗
Neuroendoscopic surgery using a tubular retractor system (cylinder) offers a minimally invasive approach for deep-seated intraparenchymal brain lesions. By distributing retraction forces circumferentially, the cylinder e...
Neuroendoscopic surgery using a tubular retractor system (cylinder) offers a minimally invasive approach for deep-seated intraparenchymal brain lesions. By distributing retraction forces circumferentially, the cylinder enables safe access to deep lesions while minimizing injury to the surrounding brain tissue. If combined with neuroendoscopy, this technique provides bright, close-up visualization even within a narrow surgical corridor, allowing for further reduction in cylinder diameter and surgical invasiveness. Preoperative planning is critical, because the operative field is limited to the cylinder tip. Multimodal imaging, including magnetic resonance imaging, computed tomography angiography, and diffusion tensor imaging, facilitates an accurate understanding of lesion characteristics, surrounding vascular structures, and white matter tracts. Simulation-based trajectory planning and appropriate patient positioning further enhance surgical safety and maneuverability. Intraoperatively, different combined surgical techniques (one or two hands) and operative environments (dry or wet field) can be selected according to lesion consistency, bleeding tendency, and surgical objectives, allowing the cylinder to be applied for biopsy and selected tumor resections. With careful case selection and stepwise technical acquisition, neuroendoscopic cylinder surgery is a valuable option for treating intraparenchymal brain lesions.
[Endoscopic Combined Transcranial and Endonasal Approach].
Watanabe T
No Shinkei Geka · 2026 Mar · PMID 42036867 · Publisher ↗
Surgical treatment for massive lobulated lesions arising in the sella turcica carries various risks of complications and requires careful surgical planning. In particular, for giant pituitary neuroendocrine tumors, bleed...
Surgical treatment for massive lobulated lesions arising in the sella turcica carries various risks of complications and requires careful surgical planning. In particular, for giant pituitary neuroendocrine tumors, bleeding from residual tumor tissue poses a significant clinical challenge. We describe a combined approach using endoscopic keyhole surgery and trans nasal surgery for cases in which resection through a single corridor is difficult, such as tumors extending laterally beyond the internal carotid artery or those extensively invading the brain parenchyma or ventricles. We explain the technique, its practical application, and its variations.
[Endoscopic Anterior Transpetrosal Approach].
Suehiro S
No Shinkei Geka · 2026 Mar · PMID 42036866 · Publisher ↗
The anterior transpetrosal approach (ATPA) is the standard technique for treating lesions around the petrous apex. Conventional microscopic ATPA is associated with limited linear visibility and enhanced risks related to...
The anterior transpetrosal approach (ATPA) is the standard technique for treating lesions around the petrous apex. Conventional microscopic ATPA is associated with limited linear visibility and enhanced risks related to temporal lobe retraction. This article reviewed endoscopic ATPA (eATPA) and addressed some of the limitations. The eATPA utilizes a panoramic endoscopic view through a small craniotomy, significantly reducing the need for brain retraction and eliminating blind spots in the ventral brainstem. The procedure centers on precise extradural drilling of Kawase's triangle. The primary indications include small petroclival meningiomas, dumbbell-shaped trigeminal schwannomas, and epidermoid cysts. This review detailed the surgical anatomy, operative nuances, and strategies for avoiding critical complications, specifically venous congestion, regarding the superficial middle cerebral vein, superior petrosal vein, and cerebrospinal fluid leakage. Although currently indicated for small lesions, eATPA is a minimally invasive skull base surgery. eATPA is a vital component of future multicorridor strategies, offering safer, tailor-made treatments for complex skull base pathologies when combined with endovascular or transnasal approaches.
[Minimally Invasive Endoscopic Surgery: The Anterolateral Approach].
Kuga D
No Shinkei Geka · 2026 Mar · PMID 42036865 · Publisher ↗
The anterolateral keyhole approach has evolved as a minimally invasive strategy for lesions of the anterior skull base and surrounding circulation. In particular, the supraorbital eyebrow approach allows direct access to...
The anterolateral keyhole approach has evolved as a minimally invasive strategy for lesions of the anterior skull base and surrounding circulation. In particular, the supraorbital eyebrow approach allows direct access to the frontal skull base through a small craniotomy, while preserving cosmetic outcomes and minimizing surgical morbidity. This review outlined the anatomical concepts, surgical indications, technical nuances, and limitations of the supraorbital eyebrow approach, with particular emphasis on cerebrospinal fluid drainage, instrument selection, and endoscope positioning in a narrow operative corridor. Additionally, the mini-pterional and extended-eyebrow approaches are discussed as complementary options that expand the operative field toward the lateral and Sylvian regions when required. Although minimally invasive approaches offer clear advantages, they should be selected only when surgical efficacy, including the extent of tumor resection, is equivalent to that of a standard craniotomy. Surgeons must also recognize that the management of intraoperative complications, such as bleeding, can be more challenging in a restricted field. Therefore, careful patient selection, thorough anatomical understanding, and stepwise development of experience (from simple cases to complex cases) are essential, particularly for young neurosurgeons. When applied appropriately, the anterolateral keyhole approach is a safe and effective extension of conventional cranial surgery.
[Neuroendoscopic Evacuation of Intracerebral Hematomas : Approaches and Clinical Strategies by Lesion Location].
Goto Y, Shin M
No Shinkei Geka · 2026 Mar · PMID 42036864 · Publisher ↗
Intracerebral hemorrhage (ICH), a hemorrhagic stroke subtype, is associated with high mortality and severe disability. Conventional craniotomy has long been the standard surgical approach; however, its invasiveness often...
Intracerebral hemorrhage (ICH), a hemorrhagic stroke subtype, is associated with high mortality and severe disability. Conventional craniotomy has long been the standard surgical approach; however, its invasiveness often results in postoperative complications and prolonged recovery time. Neuroendoscopic hematoma evacuation has emerged as a minimally invasive alternative that offers reduced blood loss, shorter operative time, and improved neurological outcomes if appropriately applied. Recent meta-analyses and international guidelines supports its role in lowering mortality, shortening hospital stay, and decreasing infection rates compared to craniotomy. Careful preoperative evaluation, including patient background, anticoagulant or antiplatelet status, and vascular imaging, is essential to determine suitability and exclude vascular malformations or tumor-related hemorrhages. Surgical strategies must balance endoscopic and open approaches according to the hematoma location, volume, consistency, and associated pathology. Superficial, large, or firm hematomas often require small craniotomies and two-hand techniques, whereas deeper or ventricular lesions require burr hole surgery. Additionally, instrument selection and operative maneuvers are critical for safe and effective evacuation. Neuroendoscopic hematoma removal, if performed properly, represents a promising standard of care for ICH, combining minimal invasiveness with favorable clinical outcomes.
[Pediatric Neuroendoscopic Surgery].
Miwa T
No Shinkei Geka · 2026 Mar · PMID 42036863 · Publisher ↗
Pediatric neuroendoscopic surgery involves a wide range of indications and surgical techniques. Neuroendoscopy has become an essential tool in the management of hydrocephalus in children. Given the heterogeneity of clini...
Pediatric neuroendoscopic surgery involves a wide range of indications and surgical techniques. Neuroendoscopy has become an essential tool in the management of hydrocephalus in children. Given the heterogeneity of clinical presentations, surgical strategies must be individualized for each case. Additionally, the procedures must consider the fragility of the pediatric brain and emphasize minimally invasive approaches. Such surgeries often involve a high proportion of intraventricular manipulation under continuous irrigation, requiring the appropriate selection of endoscopes and specialized devices suited for such environments. Furthermore, compared with adults, pediatric patients are more prone to complications, including infection, cerebrospinal fluid leakage, and subdural hematoma, necessitating meticulous management during intraoperative cerebrospinal fluid irrigation and wound closure. In this study, we describe the characteristics and key considerations of pediatric neuroendoscopic surgery based on our experience with endoscopic third ventriculostomy (ETV) for noncommunicating hydrocephalus, fenestration of arachnoid cysts, and combined procedures using flexible scopes and rigid ventriculoscopes.
[Intraventricular Tumor Surgery in the Neuroendoscopic Era].
Tanaka S
No Shinkei Geka · 2026 Mar · PMID 42036862 · Publisher ↗
Neuroendoscopic surgery, which allows tumor removal through a narrow surgical corridor, has been increasingly applied to intraventricular tumors. Although this approach is often regarded as minimally invasive, the restri...
Neuroendoscopic surgery, which allows tumor removal through a narrow surgical corridor, has been increasingly applied to intraventricular tumors. Although this approach is often regarded as minimally invasive, the restricted operative field and proximity to critical deep brain structures necessitate precise surgical manipulation. Periventricular vein injury can result in serious postoperative neurological deficits, underscoring the importance of meticulous dissection and hemostasis. During tumor removal, preservation of venous drainage should be prioritized. Aggressive resection should be avoided when strong adhesion to the veins is encountered. Gentle counterpressure using small cotton patties, combined with irrigation and suction, facilitated safe dissection and effective venous bleeding control. Hemostasis in neuroendoscopic surgery demands patience. The accurate identification of bleeding points is key. Blind coagulation in a blood-filled field should be avoided. Temporary packing with cotton patties can be effective without interrupting surgical workflow. The appropriate use of angled endoscopes and flexible transitions between the dry and wet fields is important for the reliable assessment of residual tumors and hemostasis. Furthermore, careful consideration of surgical instruments and timely conversion to microscopic surgery, when necessary, are critical for minimizing complications. Mastery of these principles can facilitate a safer neuroendoscopic management of intraventricular tumors.
[Endoscopic Surgery for Trigeminal Schwannoma].
Akutsu H
No Shinkei Geka · 2026 Mar · PMID 42036861 · Publisher ↗
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...
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.
[Endoscopic Endonasal Surgery for Skull Base Chordomas and Chondrosarcomas : Basic to Advanced Cases].
Shin M
No Shinkei Geka · 2026 Mar · PMID 42036860 · Publisher ↗
Skull base chordomas and chondrosarcomas are rare bone tumors predominantly found in the petroclival areas and involve the cranial nerves, internal carotid arteries, and brain stem. Their clinical aggressiveness and high...
Skull base chordomas and chondrosarcomas are rare bone tumors predominantly found in the petroclival areas and involve the cranial nerves, internal carotid arteries, and brain stem. Their clinical aggressiveness and high risk of recurrence necessitate multimodal treatments, including extensive surgical resection and high-dose radiotherapy. Surgery is commonly the first step in their treatment, and ABCD rules should be respected; anatomical preservation of the innocent nasal anatomy for potential repeated surgeries in case of recurrence, block-by-block resection, coverage of the intradural residual tumor to prevent surgical site dissemination and cerebrospinal fluid dissemination, and drilling of the marginal bone. Here, we present our surgical strategy for skull base chordomas and chondrosarcomas for radical surgical resection and extirpation of the tumor.
[Endoscopic Endonasal Surgery for Tumors in the Posterior Fossa and Cerebellopontine Angle].
Hasegawa H, Hanakita S
No Shinkei Geka · 2026 Mar · PMID 42036859 · Publisher ↗
Endoscopic endonasal surgery (EES) has rapidly evolved as a minimally invasive option for ventral posterior fossa lesions, offering a direct midline corridor while avoiding soft-tissue dissection, cerebellar or temporal...
Endoscopic endonasal surgery (EES) has rapidly evolved as a minimally invasive option for ventral posterior fossa lesions, offering a direct midline corridor while avoiding soft-tissue dissection, cerebellar or temporal lobe retraction, and the extensive petrosectomy required in traditional open approaches. However, the indications, anatomical concepts, and technical nuances for safely applying EES to intradural posterior fossa tumors have not yet been standardized. This article presents a practical, stepwise overview of EES for posterior fossa intradural tumors arising around the clivus and ventral brainstem. Based on a three-level clival classification (high, middle, and low clivus defined by Dorello's canal and glossopharyngeal meatus), we outlined the rational selection and execution of transsphenoidal transclival, transpharyngeal transclival, and combined approaches with pituitary transposition. Detailed descriptions of the nasal and skull base exposure, management of high-flow venous and CSF bleeding, and multilayer reconstruction using fascia, rigid buttress, fat graft, and a robust rhinopharyngeal flap. By sharing a reproducible high-resolution strategy grounded in anatomical principles and reconstructive techniques, we aimed to facilitate the safe expansion of EES indications for complex posterior fossa tumors.
[Craniopharyngioma : Current Perspectives Including Recent Advances in Molecular Targeted Therapy].
Fujio S, Makino R, Hanaya R
No Shinkei Geka · 2026 Mar · PMID 42036858 · Publisher ↗
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, in...
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.
[Surgical Strategies for Suprasellar Meningiomas in the Endoscopic Era].
Horiguchi K, Matsuda T, Origuchi S … +2 more , Ishikura T, Higuchi Y
No Shinkei Geka · 2026 Mar · PMID 42036857 · Publisher ↗
Surgical management of suprasellar meningiomas is challenging because of their proximity to critical neurovascular structures, including the optic apparatus and internal carotid artery. Ttreatment aims to preserve visual...
Surgical management of suprasellar meningiomas is challenging because of their proximity to critical neurovascular structures, including the optic apparatus and internal carotid artery. Ttreatment aims to preserve visual and neurological functions, while achieving durable tumor control. This review classified suprasellar meningiomas into medial and lateral types to clarify surgical strategies. Medial-type tumors, including tuberculum sellae, planum sphenoidale, and olfactory groove meningiomas, often compress the optic nerves inferiorly and may be suitable for endoscopic endonasal approaches in select cases. Contrastingly, lateral-type tumors, such as sphenoid wing and anterior clinoid meningiomas, frequently involve the internal carotid artery and cavernous sinus, and are best managed through transcranial approaches. Keyhole surgery may be considered in select cases to reduce surgical invasiveness. Endoscopic endonasal surgery for lateral-type tumors is generally not indicated, except in combined approaches for selective decompression of medial components. Optimal management requires an individualized approach based on tumor location, extension, and neurovascular involvement, prioritizing functional preservation over radical resection.
[Endoscopic Endonasal Management of Rathke's Cleft Cysts: Surgical Strategies and Long-Term Outcomes].
Kino H
No Shinkei Geka · 2026 Mar · PMID 42036856 · Publisher ↗
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 i...
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.
[Functional Pituitary Adenoma/Neuroendocrine Tumors].
Nishioka H
No Shinkei Geka · 2026 Mar · PMID 42036855 · Publisher ↗
Recently, the therapeutic outcomes of most patients with functioning pituitary neuroendocrine tumors have significantly improved because of advanced surgical and medical treatments. Surgical progress is due to the evolut...
Recently, the therapeutic outcomes of most patients with functioning pituitary neuroendocrine tumors have significantly improved because of advanced surgical and medical treatments. Surgical progress is due to the evolution of endoscopic techniques, refinement of surgical instruments, and continued technical innovations. The primary therapeutic goal for functioning tumors is endocrine remission, and treatment should be implemented within a comprehensive therapeutic strategy, in which surgery is crucial. Endoscopic endonasal surgery is a microsurgical procedure and its success relies on securing an adequately wide surgical corridor while respecting the nasal cavity. In enclosed, non-invasive, functioning tumors, selective total resection should be pursued, with meticulous identification of the tumor-normal tissue interface, including extracapsular dissection, if feasible. Tumor invasion of the cavernous sinus remains the most significant independent predictor of unfavorable outcomes; however, in some cases, resection of the medial wall may offer a high likelihood of achieving remission. For large invasive tumors, surgery aims to achieve maximal safe debulking and tumor control along with adjuvant medical and/or radiation therapies.
[Clinically Non-Functioning Pituitary Adenoma/Pituitary Neuroendocrine Tumor (PitNET)].
Tahara S
No Shinkei Geka · 2026 Mar · PMID 42036854 · Publisher ↗
Clinically non-functioning pituitary neuroendocrine tumors (PitNETs), the most common subtype of pituitary tumors, are frequently detected because of mass effects, such as visual impairment and incidental findings. In th...
Clinically non-functioning pituitary neuroendocrine tumors (PitNETs), the most common subtype of pituitary tumors, are frequently detected because of mass effects, such as visual impairment and incidental findings. In the World Health Organization classification in 2022, pituitary adenomas have been termed PitNETs, reflecting their biological diversity. This review summarizes the diagnostic evaluations, surgical indications, pathological characteristics, and surgical techniques for non-functioning PitNETs on endoscopic endonasal transsphenoidal surgery (eTSS). Preoperative assessment requires a meticulous endocrine evaluation and detailed magnetic resonance imaging to define tumor extension and invasion, and its relationship with the surrounding neurovascular structures. Surgery is the first-line treatment for symptomatic tumors. Asymptomatic patients with radiological risk factors were selected. Pathologically, non-functioning PitNETs comprise heterogeneous subtypes defined by transcription factors, including gonadotroph, silent corticotroph, and Pit-1 lineage tumors, with some exhibiting aggressive behavior. Technical aspects of eTSS, including intrasellar and extracapsular tumor removal and extended approaches for suprasellar extension, are discussed, highlighting safe and effective tumor resection. Individualized surgical strategies based on tumor characteristics are essential to achieve optimal outcomes.
[Deep Dural Suturing and Multilayer Skull Base Reconstruction].
Tosaka M
No Shinkei Geka · 2026 Mar · PMID 42036853 · Publisher ↗
This review described the principles and techniques of dural suturing and multilayer skull base reconstruction in extended endoscopic endonasal surgery, with an emphasis on the Japanese tradition of deep suturing. Secure...
This review described the principles and techniques of dural suturing and multilayer skull base reconstruction in extended endoscopic endonasal surgery, with an emphasis on the Japanese tradition of deep suturing. Secure watertight reconstruction is a fundamental requirement in extended transsphenoidal and endonasal skull base surgery because persistent cerebrospinal fluid (CSF) leakage can result in life-threatening meningitis. Since its introduction in 2007, multilayer reconstruction using various materials combined with a pedicled nasoseptal flap has become the standard approach. In contrast, Japanese surgeons had long emphasized direct dural closure using deep suturing techniques, even before the widespread adoption of endoscopy. This culture of suturing has been incorporated into modern endoscopic surgery and remains a key component of skull base reconstruction in Japan. Deep suturing provides reliable fixation of patch materials, contributes to both major and minor CSF leak control, and may reduce the dependence on large vascularized flaps in selected cases. This review described the fundamental techniques of deep suturing, including needle handling, control of the needle holding angle, knot-sliding methods, and suturing in multilayer reconstruction strategies. It also discussed the management of CSF pulsation and training methods. Although technically demanding, deep suturing is a highly reliable and versatile technique that continues to play a critical role in endoscopic skull base surgery.
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