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

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

Neurologia Medico-Chirurgica

For severe traumatic brain injury (TBI) patients, no effective treatment method replacing hypothermia therapy has emerged, and hypothermia therapy still plays the major role. To increase its efficacy, first, early introduction is important. Since there are diverse pathologies of severe TBI, it is necessary to appropriately control the temperature in the hypothermia maintenance and rewarming phases by monitoring relative to the pathology. Currently, hypothermia is considered appropriate for severe TBI patients requiring craniotomy for removal of hematoma, while induced normothermia is appropriate for severe TBI patients with diffuse brain injury. Induced normothermia is expected to exhibit a cerebroprotective effect equivalent to hypothermia, as well as reduce the complexity of whole-body management and systemic complications. According to the Japan Neurotrauma Data Bank of the Japan Society of Neurotraumatology, the brain temperature was controlled in 43.9% of severe TBI patients (induced normothermia: 32.2%, hypothermia: 11.7%) in Japan. Brain temperature management was performed mainly in young patients, and the outcome on discharge was favorable in patients who received brain temperature management. Particularly, patients who need craniotomy for removal of hematoma were a good indication of therapeutic hypothermia. Improvement of therapeutic outcomes with widespread temperature management in TBI patients is expected.

Eiichi SUEHIRO

Hiroyasu KOIZUMI

Yuichi FUJIYAMA

Michiyasu SUZUKI

Neurologia medico-chirurgica

Recent Advances and Future Directions of Hypothermia Therapy for Traumatic Brain Injury

The differences between brain and bladder temperature (delta T), and the relationship of delta T to cerebral perfusion pressure (CPP) and jugular venous oxygen saturation (SjO(2)) were studied during hypothermia in 11 patients with severe traumatic brain injury, of whom 5 underwent conservative treatment for diffuse axonal injury (DAI) (DAI group) and 6 who underwent decompressive craniectomy for hematoma (SDH group). All patients underwent hypothermia treatment. Brain temperature was monitored via an intraparenchymal catheter. Bladder temperature was used as the core temperature. SjO(2) was measured continuously. The outcome of all patients was evaluated at discharge using the Glasgow Outcome Scale. Delta T in the SDH group was significantly lower than that in the DAI group. No relationship was found between delta T and CPP during the investigation period. A significant correlation between delta T and SjO(2) was seen in the DAI group, but not in the SDH group. Decompressive craniectomy affects the brain temperature through external environmental factors. Measurement of brain temperature may be a reliable indicator of cerebral blood flow and brain metabolism in patients with DAI and closed cranium during hypothermia. Further experience is required to test this proposal.

Hirosuke FUJISAWA

Sadahiro NOMURA

Koji KAJIWARA

Masami FUJII

Significance of Differences Between Brain Temperature and Core Temperature (Delta T) During Mild Hypothermia in Patients With Diffuse Axonal Injury

Postoperative hemorrhage is one of the most dangerous complications following microvascular decompression (MVD), and usually occurs within the first 24 hours after MVD operation, whereas delayed hemorrhage is extremely rare. The possible mechanisms of acute and delayed postoperative hemorrhage following MVD seem to be different. Three of 685 patients treated by MVD developed delayed hematoma more than 24 hours after surgery, including two cases at the operative site and one at a remote site. The possible causes of such delayed hemorrhage are discussed. Postoperative monitoring is extremely important after the MVD procedure. If any hemorrhage can be identified at the early stage, valuable time can be won for treatment and better outcome.

Ning LI

Weiguo ZHAO

Chunhua PU

Jiankang SHEN

Delayed Hemorrhage Following Microvascular Decompression-Three Case Reports-

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

Takashi ARAKI

Hiroyuki YOKOTA

Akio MORITA

Neurol. Med. Chir.(Tokyo)

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

儿童创伤性脑损伤：特征、诊断与管理

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

Yuki AMANO

Bunsho ASAYAMA

Shusaku NORO

Takenori ABE

Masahiro OKUMA

Kaori HONJO

Yoshinobu SEO

Hirohiko NAKAMURA

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

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

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

Kenji OHATA

Hajime ARAI

Masayuki EZURA

Koji IIHARA

Hiroyuki KINOUCHI

Shigeki KOBAYASHI

Teiji TOMINAGA

Kazuo MINEMATSU

Yuichi MURAYAMA

Naoki NAKAYAMA

Nobuyuki SAKAI

Masahiro YASAKA

Yuhei YOSHIMOTO

Takamasa KAYAMA

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

全国性全病例调查：日本神经外科学会开展的支架分流器疗效与安全性多中心研究

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

Yuki YASUOKA

Ushio YONEZAWA

Shinya NABIKA

Takeshi TAKAYASU

Akira TAGUCHI

Naohiko OHBAYASHI

Fumiyuki YAMASAKI

Nobutaka HORIE

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

预防开颅术后硬脑膜回缩：介绍“卷起技术”

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

Kenichi AMAGASAKI

Kyoko TATEBAYASHI

Kazuaki NAEMURA

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

三叉神经痛的内科神经松解术：日本单中心初步经验

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

Hiroto OKUBATA

Masaaki TANIGUCHI

Naoki IRIZATO

Hidekazu NAKATA

Tomofumi TAKENAKA

Shogo FUKUYA

Katsunori ASAI

Akihiro TATEISHI

Kazumi YAMAMOTO

Akatsuki WAKAYAMA

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

3.1毫米直径4K硬质内窥镜在脑内血肿清除中的应用价值

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

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

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

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

Neurologia Medico-Chirurgica

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