No Shinkei Geka. Neurological Surgery[JOURNAL]
Sun
200 papers
[Current State and Challenges of Digital Health in Japan].
Ren N
No Shinkei Geka · 2026 May · PMID 42220199 · Publisher ↗
Japan faces significant challenges, including an aging population, rising healthcare costs, and strained healthcare sustainability. Digital health is an indispensable strategic imperative. Telemedicine, such as telestrok...
Japan faces significant challenges, including an aging population, rising healthcare costs, and strained healthcare sustainability. Digital health is an indispensable strategic imperative. Telemedicine, such as telestroke networks, reduces regional care disparities for acute stroke and is supported by national guidelines and reimbursement policies. Evidence-based digital therapeutics and software-based treatments are approved for conditions, such as hypertension and nicotine dependency, aiding chronic disease management by fostering sustained behavioral change. Artificial intelligence-driven data analysis improves prognostic accuracy and offers insights into more precise preventive interventions. However, systemic barriers hinder the widespread adoption of digital health, including 1) limited resources for implementation and maintenance, 2) stakeholder resistance because of low digital literacy, lack of confidence, and "change fatigue," 3) persistent technical and ethical challenges, including data interoperability issues, and 4) inadequate insurance reimbursement for digital health services. Achieving "digital maturity" requires moving beyond technological acquisitions. It is measured by how well systems use technology to improve patient and provider experiences and population health and reduce costs. Therefore, government, industry, and clinical stakeholders must collaborate to create a resilient and sustainable future for Japan.
[Emergent Surgery for Brain Tumors].
Shibahara I, Shigeeda R, Kumabe T
No Shinkei Geka · 2026 May · PMID 42220198 · Publisher ↗
Brain tumors are relatively rare when compared with other malignancies. However, because the central nervous system governs the functions of the entire body, brain tumors can lead to significant morbidity and, ultimately...
Brain tumors are relatively rare when compared with other malignancies. However, because the central nervous system governs the functions of the entire body, brain tumors can lead to significant morbidity and, ultimately, mortality if they are not treated appropriately and in a timely manner. These conditions are referred to as "neuro-oncologic emergencies," in which neurosurgeons play a central role in management. This review outlines the pathophysiological mechanisms underlying neuro-oncologic emergencies and discusses the role of emergent surgical intervention in supratentorial tumors, infratentorial tumors, and pituitary apoplexy, with reference to the current literature.
[Concepts of Cerebrospinal Fluid Management Based on a Paradigm Shift in CSF Dynamics:From the Third Circulation to the Glymphatic System and Meningeal Lymphatic Drainage].
Yamada S
No Shinkei Geka · 2026 May · PMID 42220197 · Publisher ↗
Over the past century, cerebrospinal fluid (CSF) dynamics have largely been interpreted through the "third circulation theory," which posits that CSF is produced by the choroid plexus that flows from ventricles to the su...
Over the past century, cerebrospinal fluid (CSF) dynamics have largely been interpreted through the "third circulation theory," which posits that CSF is produced by the choroid plexus that flows from ventricles to the subarachnoid space and is absorbed mainly through arachnoid granulations. The concepts of the glymphatic system and meningeal lymphatic drainage have since driven a paradigm shift in this framework. In the glymphatic pathway, CSF enters periarterial spaces and, via aquaporin-4 channels on astrocytic endfeet, is exchanged with interstitial fluid to promote parenchymal waste clearance. Waste-laden fluid then exits along perivenous routes and is drained extracranially through meningeal lymphatics. Importantly, lymphatic pathways are not mechanically "plugged" by hemorrhagic CSF, and impaired clearance is more plausibly attributable to disrupted physiological pulsatility and sustained low-pressure conditions. Therefore, CSF management after subarachnoid hemorrhage should shift from prioritizing the removal of bloody CSF to restoring physiological CSF dynamics. Clinically, this supports minimizing drainage duration, pursuing early removal, and favoring intermittent over continuous drainage when feasible. Patients presenting with acute hydrocephalus constitute a distinct subgroup in whom ventricular drainage is often unavoidable, and subsequent shunt dependency is more likely.
[Management of Severe Traumatic Brain Injury].
Suehiro E
No Shinkei Geka · 2026 May · PMID 42220196 · Publisher ↗
In the management of traumatic brain injury (TBI), even when the injury initially appears isolated to the head, occult injuries may be present; therefore, a comprehensive evaluation in accordance with the Japan Advanced...
In the management of traumatic brain injury (TBI), even when the injury initially appears isolated to the head, occult injuries may be present; therefore, a comprehensive evaluation in accordance with the Japan Advanced Trauma Evaluation and Care is essential. Traumatic coagulopathy is frequently observed in patients with TBI, particularly in severe cases. In addition, the aging population has increased in recent years, and many elderly patients are taking antithrombotic medications. Patients with a tendency to bleed may develop severe symptoms due to hematoma growth or challenging surgical hemostasis, necessitating appropriate perioperative measures. Traditionally, large craniotomies were performed to achieve adequate hemostasis and decompression. However, mini-craniotomy combined with neuroendoscopy has recently been adopted to minimize surgical invasiveness, particularly in elderly patients. Postoperative management focuses on visualizing intracranial pathology through neuromonitoring and implementing neurocritical care to prevent secondary brain injury through optimal systemic management. Although the number of severe TBI cases has decreased in recent years and opportunities for clinical experiences may be limited, understanding the fundamental principles of severe TBI management remains essential for neurosurgeons.
[Management of Cerebral Vasospasm in Subarachnoid Hemorrhage].
Kanoke A, Endo H
No Shinkei Geka · 2026 May · PMID 42220195 · Publisher ↗
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 an...
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.
[Perioperative Management of Spine and Spinal Cord Surgery].
Nishimura Y
No Shinkei Geka · 2026 May · PMID 42220194 · Publisher ↗
Spinal surgery is primarily performed to improve neurological function; compared with intracranial surgery, it is rarely conducted to address life-threatening conditions. As the goal of treatment is functional recovery,...
Spinal surgery is primarily performed to improve neurological function; compared with intracranial surgery, it is rarely conducted to address life-threatening conditions. As the goal of treatment is functional recovery, postoperative complications must be minimized. Appropriate perioperative management is therefore essential, and includes careful preoperative neurological evaluation; postoperative monitoring of neurological, respiratory, and circulatory status; and early detection and management of complications. Several complications of spinal surgery require attention. Firstly, airway obstruction caused by cervical swelling after anterior cervical surgery, postoperative epidural hematoma leading to neurological deterioration, and cerebrospinal fluid (CSF) leakage are the major complications requiring urgent intervention. Cervical spine surgery has several characteristic complications, depending on the surgical approach; for example, anterior procedures may cause airway compromise, esophageal injury, or recurrent laryngeal nerve palsy, whereas posterior procedures are more commonly associated with C5 palsy and surgical site infection. Thoracic spine surgery requires careful postoperative management as the spinal canal is relatively narrow, while the spinal cord is vulnerable to ischemia. In lumbar spine surgery, symptoms primarily involve the cauda equina, while major complications include epidural hematoma, CSF leakage, and surgical site infection. Appropriate perioperative evaluation and prompt management of complications at the spinal level are essential for achieving favorable surgical outcomes.
[Perioperative Management of Endoscopic Endonasal Surgery].
Morisako H, Nagahama A, Goto T
No Shinkei Geka · 2026 May · PMID 42220193 · Publisher ↗
The application of endoscopic endonasal surgery is gradually expanding to include lesions located in the midline of the skull base in addition to those in the sella turcica. Meticulous preoperative preparation and preven...
The application of endoscopic endonasal surgery is gradually expanding to include lesions located in the midline of the skull base in addition to those in the sella turcica. Meticulous preoperative preparation and prevention and early detection of postoperative complications are important to optimize perioperative management of endoscopic endonasal surgery. Appropriate and careful treatment of any complications is required. Preoperative management predominantly involves imaging and endocrine, visual function, eye movement, and nasal cavity evaluations. Conversely, postoperative management focuses on ensuring pituitary dysfunction, while preventing cerebrospinal fluid leakage, meningitis, and nasal complications. In addition, the method of expansion of the surgical field and skull base reconstruction to reduce postoperative complications are also important. This section explains current perioperative management strategies, focusing on the preoperative and postoperative periods, for endoscopic endonasal surgery for parasellar and midline skull base lesions.
[Perioperative Management to Avoid Complications in Endovascular Treatment of Cerebrovascular Diseases].
Ikedo T, Okawa M
No Shinkei Geka · 2026 May · PMID 42220192 · Publisher ↗
Neuroendovascular therapy is a minimally invasive treatment for various cerebrovascular diseases; however, its outcomes depend heavily on perioperative management. Antithrombotic control is particularly important in proc...
Neuroendovascular therapy is a minimally invasive treatment for various cerebrovascular diseases; however, its outcomes depend heavily on perioperative management. Antithrombotic control is particularly important in procedures using high-metal-burden devices such as stents and flow diverters. Although dual antiplatelet therapy (DAPT) is the standard strategy, variability in the clopidogrel response, especially due to polymorphisms, necessitates individualized management supported by platelet function testing. Careful access evaluation and ultrasound-guided femoral puncture can also reduce access-site complications. Overall, a tailored and risk-balanced perioperative approach is essential to improve safety and outcomes.
[Comprehensive Perioperative Management in Craniotomy: Practical Strategies to Optimize Surgical Outcomes].
Ono H
No Shinkei Geka · 2026 May · PMID 42220191 · Publisher ↗
Craniotomy is a fundamental procedure in neurosurgical practice, and optimal perioperative management is essential for improving surgical outcomes and minimizing complications. Comprehensive care requires meticulous atte...
Craniotomy is a fundamental procedure in neurosurgical practice, and optimal perioperative management is essential for improving surgical outcomes and minimizing complications. Comprehensive care requires meticulous attention to intracranial pressure control, cerebral edema management, fluid and electrolyte homeostasis, hemodynamic stability, infection prophylaxis, and nutritional support. Adequate preoperative evaluation and correction of systemic conditions, optimization of antithrombotic therapy, and appropriate use of osmotic agents and corticosteroids are critical for ensuring safe surgical intervention. Prompt neurological assessment, timely neuroimaging, and close monitoring of intracranial dynamics are essential for the early detection of postoperative complications. Electrolyte disturbances, particularly hyponatremia, caused by the inappropriate antidiuretic hormone secretion or cerebral salt-wasting syndrome, remain common and require accurate differentiation and tailored management. Glycemic control, blood pressure regulation, prevention of postoperative seizures, and antimicrobial prophylaxis play pivotal roles in reducing postoperative morbidity. In elderly patients, preoperative assessment of sarcopenia and nutritional status is increasingly recognized as a key determinant of functional recovery. This review provides a practical, evidence-based framework for the perioperative management of craniotomy, integrating current guidelines and clinical experience, and aims to serve as a comprehensive reference for neurosurgeons in routine clinical practice.
[Pitfalls of Emergency Management for Stroke Patients].
Umemura T, Hatano T
No Shinkei Geka · 2026 May · PMID 42220190 · Publisher ↗
Emergency management of acute stroke involves various clinical scenarios, and determining the optimal treatment can sometimes be challenging. However, rapid diagnosis and timely intervention are essential to achieve favo...
Emergency management of acute stroke involves various clinical scenarios, and determining the optimal treatment can sometimes be challenging. However, rapid diagnosis and timely intervention are essential to achieve favorable outcomes. Therefore, a structured summary of emergency evaluation and management of patients with stroke is necessary to support physicians. At the same time, recent advances in stroke research have significantly changed management strategy. In brain hemorrhage, reversal agents have become available, and the concept of door-to-needle time is also adapted to brain hemorrhage. In cerebral infarction, the ischemic core is now recognized as heterogeneous, and new concepts for evaluating viable regions have emerged. Accordingly, it is important to integrate these evolving concepts into clinical practice. This article reviews current strategies for emergency stroke management, highlights common pitfalls in critical care, and illustrates practical approaches through representative clinical cases.
[Precautions During Pediatric Neurosurgery].
Yokota C
No Shinkei Geka · 2026 May · PMID 42220189 · Publisher ↗
Pediatric patients are not simply small adults; pediatric neurosurgical care requires specific considerations based on developmental anatomy, physiology, and psychosocial contexts. This review summarizes the practical po...
Pediatric patients are not simply small adults; pediatric neurosurgical care requires specific considerations based on developmental anatomy, physiology, and psychosocial contexts. This review summarizes the practical points frequently encountered by early career neurosurgeons, focusing on clinical assessment, imaging, and perioperative management. Clinical presentation varies markedly with age: infants often exhibit nonspecific signs, such as poor feeding, irritability, or progressive head enlargement, whereas school-aged children may report headaches, nausea, gait disturbance, or behavioral changes. Imaging should prioritize low invasiveness and radiation exposure. MRI is preferred when feasible; however, sedation is often required in infants and young children, and safe practice should follow the established recommendations regarding fasting, airway risk assessment, and monitoring. Perioperative management includes weight-based fluid and medication dosing, judicious prophylactic antibiotics, and meticulous intraoperative care. Particular attention is required to prevent hypothermia, airway complications during positioning, pressure injuries, adhesive-related skin damage, and head-fixation-related complications in patients with thin cranial bones. Finally, building trust with caregivers is essential. Clinicians should recognize the profound burden of discussions about diagnosis and surgery and continuously refine their communication skills to deliver bad news.
[Comprehensive Preoperative Preparation for Awake Craniotomy].
Kinoshita M
No Shinkei Geka · 2026 May · PMID 42220188 · Publisher ↗
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...
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.
[Neuroimaging to Understand Surgical Anatomy].
Shimoda Y, Kanamori M, Endo H
No Shinkei Geka · 2026 May · PMID 42220187 · Publisher ↗
Recent advances in neuroimaging have made radiological evaluations indispensable for preoperative assessment and surgical planning in the field of neurosurgery. Recent improvements in imaging resolution and three-dimensi...
Recent advances in neuroimaging have made radiological evaluations indispensable for preoperative assessment and surgical planning in the field of neurosurgery. Recent improvements in imaging resolution and three-dimensional visualization now allow the detailed anatomical structures encountered during surgery to be recognized preoperatively. This enables e design of surgical approaches, avoidance of critical neurovascular structures, and function-preserving strategies. In this chapter, imaging modalities are organized according to the major anatomical structures relevant to the surgical anatomy, including the bone structures, cerebrospinal fluid spaces, arteries, perforating arteries, veins, venous sinuses, and white matter fiber tracts. The advantages and limitations of each modality are discussed, together with their practical applications in tumor and vascular surgeries. Particular emphasis is placed on the integration of multimodal images. When combined with a thorough understanding of anatomy, these imaging datasets facilitate three-dimensional reconstruction and interpretation of complex anatomical relationships. Recent developments in 3D reconstruction and fusion imaging technologies have made preoperative simulations increasingly accessible, providing valuable educational opportunities, particularly for young neurosurgeons. Integrating anatomical knowledge with multimodal imaging interpretation improves the intraoperative orientation and contributes to safer and more reliable surgical outcomes.
[Practical Guide to Antiseizure Medication Management].
Kanno A
No Shinkei Geka · 2026 May · PMID 42220186 · Publisher ↗
Perioperative seizure management is an important component of neurosurgical care. Antiseizure medications (ASMs) have historically been used prophylactically in many neurosurgical patients; however, current evidence does...
Perioperative seizure management is an important component of neurosurgical care. Antiseizure medications (ASMs) have historically been used prophylactically in many neurosurgical patients; however, current evidence does not support routine prophylaxis in seizure-naïve individuals. Recent guidelines recommend ASM administration primarily for patients with a history of seizures or for short-term use during the immediate perioperative period in selected high-risk conditions. Accordingly, prophylactic treatment should be individualized based on seizure risk and generally limited to short-term use to avoid unnecessary long-term exposure. This review summarizes three clinically relevant areas. First, we summarize evidence-based strategies for perioperative seizure prophylaxis in major neurosurgical conditions, including brain tumors, traumatic brain injury, and cerebrovascular disease. Second, we review the pharmacological properties of newer ASMs commonly used in neurosurgical practice, including levetiracetam, lacosamide, brivaracetam, and perampanel, with emphasis on their mechanisms of action, adverse-effect profiles, and practical advantages in perioperative settings, such as the availability of intravenous formulations. Finally, we discuss the clinical applications of long-term video electroencephalographic monitoring (VEEG), including evaluation for epilepsy surgery, detection of nonconvulsive status epilepticus, and differential diagnosis of seizure-like events such as syncope and functional/dissociative seizures. Risk-based ASM management combined with appropriate utilization of VEEG is essential for optimizing perioperative neurological care.
[Preoperative and Intraoperative Electrophysiological Monitoring During Neurosurgery].
Matsuda R, Takatani T
No Shinkei Geka · 2026 May · PMID 42220185 · Publisher ↗
Intraoperative neuromonitoring is an indispensable surgical support tool for safe neurosurgical procedures. Although various monitoring techniques exist, motor-evoked potentials (MEPs) and somatosensory-evoked potentials...
Intraoperative neuromonitoring is an indispensable surgical support tool for safe neurosurgical procedures. Although various monitoring techniques exist, motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) are the most commonly used. MEPs are classified into transcranial, direct cortical, and subcortical stimulation, which require case-specific selection based on each case. Furthermore, to ensure proper intraoperative monitoring, it is desirable to share information beforehand with the monitoring technician regarding which monitoring techniques should be used and which procedures carry a higher risk. This article describes the practical applications of intraoperative neuromonitoring, including its classification and intraoperative troubleshooting.
[Essentials of Cerebral Angiography:A Review in the Era of 3D Imaging].
Mitsui N, Kinoshita M
No Shinkei Geka · 2026 May · PMID 42220184 · Publisher ↗
In the era of advanced three-dimensional imaging technologies, cerebral angiography remains a fundamental modality for understanding dynamic cerebral hemodynamics. Although computed tomography angiography (CTA), magnetic...
In the era of advanced three-dimensional imaging technologies, cerebral angiography remains a fundamental modality for understanding dynamic cerebral hemodynamics. Although computed tomography angiography (CTA), magnetic resonance angiography (MRA), and 3D reconstruction techniques have markedly improved anatomical visualization, the ability to interpret two-dimensional angiographic images and mentally reconstruct vascular structures is increasingly important. This article revisits the core principles of diagnostic cerebral angiography, with an emphasis on practical insights that are often under-recognized in routine training. Key topics include preprocedural risk assessment, evaluation of vascular access route, radiation safety, optimal imaging angles for aneurysms visualization and mechanical thrombectomy planning, assessment of dural arteriovenous fistulas, and dynamic assessment of collateral circulation. By reorganizing these fundamental concepts, we highlight practical "Kandokoro" that bridge basic angiographic technique with therapeutic decision-making. This review aims to support the development of clinical judgment and angiographic interpretation skills in the era of advanced 3D imaging.
[Quantitative Assessment for Brain Lesion by Perfusion and Metabolic Imaging].
Yamaguchi S, Kurisu K, Ujihara M … +1 more , Fujimura M
No Shinkei Geka · 2026 May · PMID 42220183 · Publisher ↗
Advances in neuroimaging have improved the diagnosis and management of structural brain diseases, including cerebrovascular disorders and brain tumors. Although conventional computed tomography and magnetic resonance ima...
Advances in neuroimaging have improved the diagnosis and management of structural brain diseases, including cerebrovascular disorders and brain tumors. Although conventional computed tomography and magnetic resonance imaging (MRI) provide essential morphological information, functional and metabolic imaging enables the qualitative assessment of tissue physiology. Integrating morphological and qualitative imaging has become increasingly important for optimizing diagnostic strategies, treatment selection, and therapeutic response evaluation. However, excessive imaging may increase cost and complexity without improving clinical outcomes, thereby necessitating appropriate modality selection. This review summarizes perfusion and metabolic imaging modalities, including MRI-based arterial spin labeling, and nuclear medicine techniques. These techniques enable the evaluation of cerebral blood flow, oxygen metabolism, and tumor metabolic characteristics. Clinical applications include differentiating tumor from non-tumor lesions, predicting glioma grade and infiltration, performing preoperative functional mapping, distinguishing tumor recurrence from radiation necrosis, assessing the ischemic penumbra in acute stroke, evaluating chronic cerebral ischemia, and localizing epileptic foci. Qualitative imaging complements morphological imaging and is crucial in modern neurodiagnostic techniques. Appropriate selection and interpretation of these modalities are crucial in improving patient management in clinical practice.
[Endocrinological Tests for Neurosurgery Practice].
Sasagawa Y, Nakada M
No Shinkei Geka · 2026 May · PMID 42220182 · Publisher ↗
Endocrinological evaluation is essential in neurosurgery for pituitary-hypothalamic disorders and intracranial conditions, such as tumors, trauma, hemorrhagic/ischemic events, inflammatory diseases, and iatrogenic injuri...
Endocrinological evaluation is essential in neurosurgery for pituitary-hypothalamic disorders and intracranial conditions, such as tumors, trauma, hemorrhagic/ischemic events, inflammatory diseases, and iatrogenic injuries. Appropriate selection and interpretation of hormonal tests influence diagnosis, treatment strategies, perioperative care, and long-term outcomes. Baseline assessments should include measurements of anterior pituitary hormones (ACTH, TSH, GH, LH/FSH, and prolactin) and their corresponding peripheral hormones (cortisol, free thyroxine, IGF-1, and sex steroids). Because adrenal insufficiency is life-threatening, the ACTH-cortisol axis must be prioritized, with thyroid hormone replacement initiated only after adrenal function is confirmed. If baseline tests are inconclusive, dynamic stimulation tests are used to evaluate each axis; however, test selection must consider safety, as some stimulation tests are associated with rare complications, such as pituitary apoplexy, in patients with large Pit-NETs. This review summarizes the practical aspects of endocrine testing that are relevant to neurosurgeons, including typical endocrine profiles in intracranial diseases, indications and pitfalls of stimulation tests, and perioperative monitoring and hormone replacement, in collaboration with endocrinologists.
[Essential Diagnostic Tests in Neurological Emergencies].
Tanaka S, Muroi A
No Shinkei Geka · 2026 May · PMID 42220181 · Publisher ↗
Neurological emergencies are time-sensitive conditions in which rapid diagnosis and early intervention critically influence survival and functional outcomes. This review summarizes essential diagnostic strategies for neu...
Neurological emergencies are time-sensitive conditions in which rapid diagnosis and early intervention critically influence survival and functional outcomes. This review summarizes essential diagnostic strategies for neurosurgeons involved in acute care, guided by the principles of Emergency Neurological Life Support (ENLS). Initial management prioritizes stabilization of the airway, breathing, and circulation, followed by focused neurological assessment, with particular attention to pupillary findings and quantitative monitoring such as the Neurological Pupil index. Laboratory evaluation aims to promptly identify reversible systemic causes, including metabolic disturbances and coagulation abnormalities that directly affect treatment decisions in acute ischemic stroke and intracerebral hemorrhage, particularly in patients receiving anticoagulants. Neuroimaging plays a central role; non-contrast computed tomography (CT) remains the first-line modality, while CT angiography, perfusion imaging, and magnetic resonance imaging (MRI) provide complementary information for therapeutic decision-making. Imaging markers of hematoma expansion and etiological evaluation are essential in hemorrhagic stroke. Electroencephalography (EEG) is crucial for detecting nonconvulsive status epilepticus in patients with unexplained persistent impaired consciousness. Integrating clinical, laboratory, and imaging findings while recognizing common diagnostic pitfalls is essential for optimizing early neurocritical care management.
[Essentials and Pitfalls of Neurological Examination:From Symptoms to Lesion Localization].
Fukuda M
No Shinkei Geka · 2026 May · PMID 42220180 · Publisher ↗
In neurosurgical practice, neurological examinations must be tailored to the disease type and stage, with emphasis on findings most relevant to clinical decision-making. In spinal surgery, neurological assessment plays a...
In neurosurgical practice, neurological examinations must be tailored to the disease type and stage, with emphasis on findings most relevant to clinical decision-making. In spinal surgery, neurological assessment plays a crucial role in identifying the precise level and localization of lesions. Accurate evaluation requires systematic assessment of sensory disturbances based on dermatomal distribution, strength testing of key muscles with attention to myotomal innervation, evaluation of deep tendon reflexes, and assessment of bladder and bowel dysfunctions. A structured and focused examination enables clinicians to translate symptoms into accurate lesion localization. This review summarizes the essential components of neurological examinations required to identify spinal lesions and highlights the common pitfalls that may lead to diagnostic errors. Practical strategies to improve diagnostic accuracy are discussed, with particular emphasis on supporting early-career neurosurgeons in developing reliable clinical reasoning skills.
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