Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Congress of Neurological Surgeons  

Peripheral nerve neuropathy due to nerve entrapment is not uncommon. Peripheral nerve entrapment (PN-EN) must be differentiated from brain and spinal cord diseases
its treatment requires less invasive microsurgery. As many patients with numbness or paralysis of the extremities are seen in the neurosurgery outpatient clinic, we recommend that neurosurgeons incorporate the treatment of PN-EN into their daily practice and provide some suggestions. The diagnosis of PN-EN is performed in 5 steps. (1) Does the patient present with a single neuropathy. (2) Is the symptom exacerbated when a load is applied (the provocation test may be useful).(3) Is there a Tinel-like sign at the suspected entrapment site. (4) Nerve blocks may be diagnostic. (5) Electrophysio-logical and magnetic resonance studies may be useful. When patients report to the outpatient clinic complaining of hand numbness, carpal tunnel syndrome must first be ruled out. When they present with numbness of the lower limbs, 3 areas must be checked. (1) The anterior lateral thigh (lateral femoral cutaneous neuropathy),(2) the instep from the outside of the lower leg (common peroneal neuropathy), and (3) the sole of the foot (tarsal tunnel syndrome). Para-lumbar spine diseases are also often encountered in patients seen on an outpatient basis. We recommend that the neurosurgeon divide the pain area into 3 areas, (1) around the iliac crest (superior cluneal neuropathy),(2) the medial buttock (middle cluneal neuropathy), and (3) the lateral buttock (gluteus medius muscle pain and piriformis syndrome). The diagnosis and treatment of these diseases require the elucidation of the pathological background and the development of diagnostic tools. We encourage Japanese neurosurgeons to incorporate the diagnosis and treatment of PN-EN into their daily practice and suggest that PN-EN treatment be recognized as an area of Japanese neurosurgery.

DOI： 10.7887/jcns.30.562

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Petrous internal carotid aneurysm (PA) concomitant with a mass lesion and cranial nerve palsy is relatively rare. Flow-diverter stent implantation is now widely used as an alternative treatment for PA. However, alternative treatments sometimes cannot be used because of tortuosity of the carotid artery, allergies to contrast material, and high costs. The outcomes of different treatment methods should therefore be assessed. Here, we review the available literature on treatments for PA. METHODS: In a search using the terms "aneurysm", "carotid artery", and "petrous" on PubMed, MEDLINE, and databases such as OvidSP, 221 articles were identified. We also performed a literature review and discuss and compare the causes, symptoms, treatment methods, and clinical outcomes of PA. RESULTS AND CONCLUSIONS: Onset of secondary aneurysm was generally heralded by bleeding (p<0.001), while onset of primary aneurysm was heralded by cranial nerve deficit (p= 0.0014). Outcomes after treatment of 34 cranial nerve palsies in 25 patients are reported.

DOI： 10.1272/jnms.JNMS.2020_87-407

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by compression around the inguinal ligament. We report a surgical alternative for the treatment of meralgia paresthetica under local anesthesia and its outcomes. METHODS: We operated on 12 patients with unilateral meralgia paresthetica whose age at surgery ranged from 62 to 75 years. The mean postoperative follow-up period was 19 months. Microsurgical deep decompression of LFCN was performed with the patient under local anesthesia. Clinical outcomes of surgical treatment were assessed based on the patient's most recent follow-up visit and were classified into 3 categories: complete, partial, or no relief of symptoms. Symptoms of pain or numbness in the anterolateral part of the thigh were evaluated, using a visual analog scale, before surgery and after surgery, i.e., at the most recent follow-up visit. RESULTS: All patients reported symptom improvement: complete relief in 9 patients (75%) and partial relief in 3 patients (25%). In the 3 patients with partial relief, the remaining symptoms did not affect their daily living. Overall, the visual analog scale scores were significantly improved in all patients (P < 0.05), and no patient experienced postoperative recurrence of their symptoms at the time of the last follow-up visit. CONCLUSIONS: Symptoms of meralgia paresthetica can resemble those of a lumbosacral disorder. Microsurgical deep decompression under local anesthesia produces good surgical outcomes. The use of local anesthesia contributes not only to reduction of pain during surgery but also eliminates excessive surgical procedures and reduces the duration of hospital stay.

DOI： 10.1016/j.wneu.2018.06.252

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We report a surgical case of entrapment neuropathy of lateral femoral cutaneous nerve (LFCN) with anatomical variation. CASE DESCRIPTION: This 53-year-old man had a 10-year history of paresthesia and pain in the right anterolateral thigh exacerbated by prolonged standing and walking. His symptoms improved completely but transiently by LFCN block. The diagnosis was LFCN entrapment. Because additional treatment with drugs and repeat LFCN block was ineffective, we performed surgical decompression under local anesthesia. A nerve stimulator located the LFCN 4.5 cm medial to the anterior superior iliac spine. It formed a sharp curve and was embedded in connective tissue. Proximal dissection showed it to run parallel to the femoral nerve at the level of the inguinal ligament. The inguinal ligament was partially released to complete dissection/release. Postoperatively, his symptoms improved and the numeric rating scale fell from 8 to 1. CONCLUSION: We report a rare anatomical variation in the course of the LFCN.

DOI： 10.1016/j.wneu.2018.04.159

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The clinical features and etiology of low back pain(LBP)and buttock pain(BuP)has been poorly understood. We report a case of long-term BuP that was successfully treated with gluteus medius muscle(GMeM)decompression under local anesthesia. A 71-year-old man was referred to our hospital because of long-term BuP and claudication. Left BuP that radiated to the left thigh was observed. The pain was mostly triggered by palpation at the middle of the iliac crest and greater trochanter. Lumbar and pelvic radiograms showed no significant lesions. Lumbar magnetic resonance imaging revealed a mild lumbar spinal canal stenosis at the L4/L5 segment. Based on the evidence of a trigger point and pain relieved after GMeM block injection, we made a diagnosis of GMeM pain. Although several GMeM block injections relieved his pain, the analgesic effect was transient and the claudication remained. Then, we decided to perform GMeM decompression. We made a 5-cm-long skin incision across the trigger point on the buttock. After confirming a wide exposure of the gluteal aponeurosis over the GMeM, we cut and opened it for sufficient GMeM decompression, and the GMeM expansion was confirmed. After surgery, his symptoms immediately improved. No evidence of recurrence was observed 6 months after his treatment. For the treatment of LBP and BuP, GMeM pain would be considered a causative factor. We report that it can be treated with a less invasive surgical technique, which would contribute to good clinical outcome.

DOI： 10.11477/mf.1436203724

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital vascular disorder characterized by the classic triad of cutaneous nevi, venous varicosities, and osseous and soft tissue hypertrophy of the affected limb. Various vascular anomalies of the central nervous system have also been described in patients with KTWS. The English language literature to date contains 6 reports of associations between KTWS and spinal cord cavernous angioma (CA), but management of these patients has not been well described. CASE DESCRIPTION: A 23-year-old woman was admitted to our institution with acute onset of leg weakness accompanied by upper back pain. Thoracic magnetic resonance imaging of the spinal cord showed a heterogeneous mass with a slit component at the T1-2 level. The patient underwent left hemilaminectomy followed by removal of the tumor, and her neurologic symptoms improved postoperatively. Pathologic examination showed the spinal lesion was characterized by hemosiderin deposition and thin-walled vascular channels surrounded by fibrous tissue. CONCLUSIONS: This is the first report to provide a detailed pathologic description of the features of spinal CA in a patient with KTWS. Assessment of the clinical features and management of CA associated with KTWS are discussed. This syndrome is rare, and further experience in the treatment of these patients is needed. However, considering that the pathologic findings of spinal CA in patients with KTWS include the typical features of CA, the management of CA in patients with KTWS may be identical to management of isolated CA.

DOI： 10.1016/j.wneu.2017.10.040

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Congress of Neurological Surgeons  

Although worldwide, peripheral nerve entrapment neuropathy is not uncommon, it is rarely encountered by Japanese neurosurgeons. Carpal tunnel syndrome and ulnar neuropathy at the elbow are treated at relatively many Japanese neurosurgical institutions
their incidence is lower than of superior cluneal nerve neuropathy, common peroneal nerve neuropathy, and tarsal tunnel syndrome. We describe our surgical approach to treat carpal tunnel syndrome, ulnar neuropathy, superior cluneal nerve neuropathy, common peroneal nerve neuropathy, and tarsal tunnel syndrome. Since surgery for these typical peripheral entrapment neuropathies can be performed less invasively under local anesthesia, it can be used to treat elderly patients. It requires sufficient decompression under a microscope using microsurgical techniques. If dynamic neuropathy is involved, dynamic factors must be considered. After this type of surgery, neither external fixation nor restriction of the activities of daily living is needed. We obtained drastic symptom improvement that satisfied both patients and surgeons. We suggest that our method of addressing typical peripheral entrapment neuropathies be added to existing neurosurgical treatments.

DOI： 10.7887/jcns.27.307

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Common peroneal nerve (CPN) entrapment neuropathy (CPNEN) is the most common peripheral neuropathy of the lower extremities. The pathological mechanisms underlying CPNEN remain unclear. We sought to identify dynamic factors involved in CPNEN by directly measuring the CPN pressure during stepwise CPNEN surgery. METHODS: We enrolled seven patients whose CPNEN improved significantly after CPN neurolysis. All suffered intermittent claudication, and the repetitive plantar flexion test, used as a CPNEN provocation test, was positive. During decompression surgery we directly measured the CPN pressure during several decompression steps. RESULTS: Before CPN decompression, plantar flexion elicited a statistically significant increase in the CPN pressure (from 1.8 to 37.3, p < 0.05), as did plantar extension (from 1.8 to 23.1, p < 0.05). The CPN pressure gradually decreased during step-by-step surgery; it was lowest after resection of the peroneus longus muscle (PLM) fascia. CONCLUSIONS: Dynamic factors affect idiopathic CPNEN. The CPN pressure decreased at each surgical decompression step, and removal of the PLM fascia resulted in adequate decompression of the CPN. Our findings shed light on the etiology of idiopathic CPNEN and recommend adequate CPNEN decompression procedures.

DOI： 10.1007/s00701-017-3265-2

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 60-year-old woman presented with a 1-year history of pain and numbness in the left anterolateral thigh. The symptoms aggravated on walking and standing. Her visual analogue scale(VAS)score was 7.1/10. Tinel's like sign was positive over the lateral femoral cutaneous nerve(LFCN), in the inguinal ligament region. LFCN block at the trigger point, in the inguinal ligament, resulted in relief of the symptoms and we diagnosed meralgia paresthetica(MP), which is the entrapment neuropathy of the LFCN. Initially, we performed observation therapy with oral medication and LFCN blocks. However, these treatments failed to relieve the symptoms. Therefore, we performed neurolysis with a microscope under local anesthesia. The symptoms improved immediately after surgery and her VAS score of thigh symptom improved from 7.1 to 1.9 after 3 months. Conservative and surgical treatment for MP generally yield good outcome and we should pay attention to the MP as a differential diagnosis for thigh numbness and pain.

DOI： 10.11477/mf.1436203528

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

We experienced two cases in which aneurysm clips sprang from the applier. In case 1, a subdural haematoma from a ruptured anterior cerebral artery aneurysm was detected. When the clip was opened for final positioning, it suddenly sprang from the applier and ruptured the aneurysm. In case 2, the clip suddenly sprang from the applier as the surgeon opened the applier to clip an unruptured anterior cerebral aneurysm. These accidental phenomena are rare but dangerous. We present these cases to help prevent similar occurrences in the future. Video recordings of actual procedures can point to potential mechanisms and help reduce the incidence of this complication.

DOI： 10.1017/cjn.2016.434

PubMed

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Language：English  

DOI： 10.1007/s00701-016-2770-z

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Infundibular dilatation (ID) is a funnel-shaped enlargement of the origin of cerebral arteries. The coexistence of an aneurysm and ID is relatively rare. Patients with IDs are rarely followed up. However, some IDs have been reported to develop into aneurysms with subsequent rupture. Here we report on a case of an aneurysm that coexisted with ID of the posterior communicating artery. CASE PRESENTATION: A 51-year-old woman underwent magnetic resonance imaging (MRI) to check for aneurysms and other problems. MRI revealed an unruptured aneurysm of the right internal carotid artery, for which the patient was admitted to our hospital. Three-dimensional computed tomographic angiography revealed an aneurysm, which protruded outward, and ID of the posterior communicating artery, which protruded inward. A right pterional craniotomy was performed with aneurysm clipping. The postoperative course was uneventful. In this report, we demonstrate operative views of the aneurysm and ID with the use of neuroendoscopy. CONCLUSION: ID can develop into a true arterial aneurysm and potentially rupture. Therefore, we need to observe the patients with IDs carefully, particularly in young women.

DOI： 10.1272/jnms.83.268

PubMed

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

下垂体細胞腫(pituicytoma)の手術6例を対象に、臨床的検討を行った。全例が男性で、手術時年齢は平均58.6歳であった。症状は視野障害、副腎不全、性欲減退、偶発腫など多様であった。下垂体前葉ホルモンの3種(LH、FSH、GH)の低下を1例に認めた他は、いずれも汎下垂体機能低下を呈していた。MRI画像上の特徴は全例に腫瘍ないし腫瘍内にflow voidを認め、強いガドリニウム造影効果を示した。術前診断として、手術経験順に並べた時の前半2例は下垂体腺腫を考えて手術を行い、後半4例はpituicytomaも鑑別に挙げた上で手術を行った。前半2例は術中に予期せぬ出血に苦慮し、腫瘍は部分摘出に留まった。術中出血量は平均1350mlで、1例が術中輸血を必要とした。後半4例はワーキングスペースを広く確保する工夫を行い、術中出血量を平均212mlに抑えることができた。4例とも肉眼的に全摘出が可能で、その後の再発を認めていない。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01160&link_issn=&doc_id=20190708500001&doc_link_id=10.1507%2Fendocrine.95.S.HPT_5&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.95.S.HPT_5&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：(株)医学書院  

症例は71歳男性で、左臀部を中心とした腰臀部痛が出現した。症状は左側臀部から大腿外側部の痛みで、左側臀部の腸骨稜と大転子からほぼ等距離のところに強い圧痛点を認めた。立位および歩行で症状は増悪し、間歇性跛行は500mと連続歩行は制限されていた。骨盤X線では軽度の変性変化、腰椎MRIではL4/5レベルに軽度の脊柱管狭窄を認めた。臨床症状および理学所見より左側中殿筋障害を疑い、左側中殿筋ブロックを行ったところ、NRS 2点まで痛みは改善した。ブロックによる鎮痛効果から左側中殿筋障害と診断した。その後痛みは再燃し、合計5回のブロックを施行したが、鎮痛効果は一時的であった。日常生活に支障があることから、左側中殿筋除圧術を施行した。術直後より座位や歩行は許可し、ADLの制限や外固定などは行わなかった。手術に伴う合併症は生じなかった。皮下ドレーンを術翌日に抜去し自宅退院した。退院後は長距離歩行や駆け足も可能となった。疼痛の再燃はみられていない。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01228&link_issn=&doc_id=20180427180010&doc_link_id=10.11477%2Fmf.1436203724&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203724&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本脳神経外科コングレス  

末梢神経障害は、頻度は少なくないものの接する機会が少ないためか、脳神経外科診療で一般的に治療されているとはいいがたい。手根管症候群や肘部尺骨神経障害は、比較的多くの施設で治療されつつあるが、上臀皮神経障害や総腓骨神経障害、足根管症候群などはあまり普及していないのが現状であろう。本稿では、これら代表的な5つの末梢神経障害の手術について解説した。これらは、局所麻酔下に低侵襲に行えるため、高齢者にも積極的に適応できる。ときに劇的な症状の改善をもたらし、患者、医師ともに高い満足度が得られる。手術の難度はそれほど高いものではないため、ぜひ興味をもち、脳神経外科診療の1つのツールとして取り入れていただきたい。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J02632&link_issn=&doc_id=20180403310005&doc_link_id=10.7887%2Fjcns.27.307&url=https%3A%2F%2Fdoi.org%2F10.7887%2Fjcns.27.307&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(株)医学書院  

60歳女。左側大腿外側前面の痺れ、腰痛を主訴とした。数年来の腰痛と1年前より出現した左側大腿外側前面に限局する痺れがあり、症状は立位および歩行で悪化した。左側鼠径部のTinel様徴候が陽性であることから、左側外側大腿皮神経(LFCN)障害が疑われ、診断を兼ねた左側鼠径部圧痛点へのLFCNブロックが奏功したことよりLFCN障害と診断した。鎮痛薬服用やLFCNブロックによる保存的治療に抵抗性であり、日常生活に支障をきたしていることから外科的治療の適応と判断して左側LFCN神経剥離術を行ったところ、術後3ヵ月には左側大腿外側前面の痺れは消失し、術後1年経過現在、症状の再燃なく良好に経過している。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01228&link_issn=&doc_id=20170525170013&doc_link_id=1390283684977537152&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390283684977537152&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

Language：Japanese   Publisher：(一社)日本脳卒中の外科学会  

症例1(69歳女性)。左内頸動脈瘤に対する左前頭側頭開頭によるクリッピング術後5日頃より左側の聴力低下を自覚した。症例2(69歳女性)。左中大脳動脈瘤に対する左前頭側頭開頭によるクリッピング術後3日目より左聴力の低下を自覚した。いずれも耳鼻咽喉科を受診し、鼓室内血腫による伝音性難聴と診断され、カルボシステイン、アンブロキソール塩酸塩内服による保存的加療を行ったところ、20〜30日で自覚症状や聴力検査所見が改善した。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02079&link_issn=&doc_id=20160614290010&doc_link_id=%2Fcp4strok%2F2016%2F004403%2F010%2F0229-0234%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2016%2F004403%2F010%2F0229-0234%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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Presentation type：Oral presentation (general)  

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