Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been reported with no review of the relevant literature. Therefore, we reviewed the relevant literature and our own experience with non-traumatic MCA dissection cases to determine appropriate treatment strategies. At our institution and affiliated institutions, we encountered six cases of MCA dissection—five with infarction and one with hemorrhage. Two patients underwent revascularization, and one underwent an aneurysmectomy. We reviewed English and Japanese articles in PubMed and Medical Journal Web and summarized the results based on the relationships among age, sex, location, the presence of an aneurysm, the presence of angiography, history, treatment, and mode of onset. The clinical course, changes in imaging, treatment strategies, and prognosis were discussed. Eighty cases were included in the review. Cerebral aneurysms were more common distal to the M2 area (p = 0.00) and were correlated with hemorrhage (p < 0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults. Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed up, and antithrombotic treatment should be considered with particular care in older adults.

DOI： 10.1007/s10143-023-02139-5

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Other Link： https://link.springer.com/article/10.1007/s10143-023-02139-5/fulltext.html

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Indocyanine green (ICG) is a cyanine dye useful for visualizing blood vessels; it has been developed for endoscopy and is used in skull base surgery. Endoscopy is widely used for hematoma removal after an intracerebral hemorrhage since it is minimally invasive and has a shorter operation time than craniotomy. However, with this technique the surgical field is limited and it is difficult to obtain an adequate orientation; thus, it is challenging to locate the bleeding point, and postoperative rebleeding has been reported. We performed intraoperative ICG near-infrared fluorescence imaging to locate the bleeding point. This purpose of this study was to evaluate the usefulness of ICG angiography during endoscopic hematoma removal in two patients, using two endoscope types and comparing their visualization of perforating branches during the procedure. ICG angiography was performed in two different cases of putaminal hemorrhage, using the SPIES NIR/ICG-System and IMAGE1 S Rubina (both KARL STORZ, Tuttlingen, Germany) at the intraoperative bleeding site. The intraoperative use of ICG allowed the clear visualization of the perforating branches and real-time confirmation of active bleeding. We could also distinguish an old hematoma from the active bleeding point. The IMAGE1 S Rubina has adequate brightness for contrast enhancement, allowing surgical manipulation simultaneously to the enhancement phase.ICG fluorescence angiography is useful to identify the damaged vessel and perform hemostasis. We expect other similar devices to be developed in the future, accompanied by flexible and thin rigid endoscopes.

DOI： 10.2176/jns-nmc.2022-0135

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

Crystal violet (CV) ink has been used as a skin marker worldwide. It has been reported to be useful for vessel wall visualization of microvascular anastomoses. Contrastingly, it has been found to be carcinogenic and inhibit migration and proliferation of venous cells. In some countries, its use in the medical field has been restricted. Therefore, it is necessary to consider alternatives to CV. In this present study, we compared the time required for the anastomosis of a 0.8-1 mm diameter vessel in the chicken wrist artery using CV and a CV-free dye (ethyl violet; EV). The surgeon, microscope, and anastomosis microsurgical tools were standardized for comparison. CV and EV were changed for each anastomosis. The same surgeon performed 30 anastomoses using each dye. No visually obvious differences were noted in the vascular transections with CV and EV. As per the results, no statistically significant difference was observed in the time required for anastomosis using CV and EV. EV conforming to California Proposition 65 may be an effective alternative to CV for vascular visualization of microvascular anastomoses. However, further studies on the effectiveness of the EV in clinical cases are needed.

DOI： 10.2176/jns-nmc.2022-0188

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Authorship：Lead author   Publisher：Ovid Technologies (Wolters Kluwer Health)  

With the development of stereotactic radiotherapy, opportunities to perform craniotomies for brain tumors under a microscope are decreasing, making it difficult to learn surgical techniques in clinical practice. For safety and ethical reasons, it is useful to create a brain tumor training model for hands-on practice. We created a sphenoidal ridge meningioma model with the following parameters: (1) the location of the tumor should be distinguishable using neuronavigation, (2) the feeding artery should allow for confirmation and hemostasis, (3) the tumor and brain should be properly adherent and dissectable, and (4) the tumor can be decompressed and removed using an ultrasonic surgical device. We created the model out of polyvinyl alcohol and produced a mold using a 3-dimensional printer. Thirteen young neurosurgeons used these models, and a questionnaire survey was conducted. It was possible to train neurosurgeons for tumor removal using this model. The results of the questionnaire showed that the model, usefulness of the clinical application, and willingness to participate again were highly rated. This model was created to practice procedures with realty and designed to be visualized by navigation systems, to be removed with ultrasonic surgical instruments, and to be dissected using microinstruments. This model is useful to learn surgical techniques and strategies and to test and develop new surgical equipment. Training using a brain tumor model should be good off-the-job training for young neurosurgeons.

DOI： 10.1227/neuopn.0000000000000003

J-GLOBAL

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Language：Japanese   Publisher：日本脳腫瘍病理学会  

J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本レーザー医学会  

J-GLOBAL

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J-GLOBAL

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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：日本脳腫瘍病理学会  

J-GLOBAL

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J-GLOBAL

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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)日本感染症学会  

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J-GLOBAL

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J-GLOBAL

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