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

DOI： 10.7759/cureus.76863

Open Access

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1227/ons.0000000000001472

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Scientific Scholar  

Background:

Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow.

Methods:

A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch – right MCA anastomosis, followed by a right STA frontal branch – left radial artery graft (RAG) – left MCA bonnet bypass using small intermittent skin incisions.

Results:

We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications.

Conclusion:

The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

DOI： 10.25259/sni_528_2024

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Other Link： http://surgicalneurologyint.com/surgicalint-articles/less-invasive-bonnet-bypass-with-subcutaneous-tunneling-method-for-common-carotid-artery-occlusion-a-technical-note/

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

The surgical techniques for treatment of chronic subdural hematoma (CSDH), a common neurosurgical condition, have been discussed in a lot of clinical literature. However, the recurrence proportion after CSDH surgery remains high, ranging from 10 to 20%. The standard surgical procedure for CSDH involves a craniostomy to evacuate the hematoma, but irrigating the hematoma cavity during the procedure is debatable. The authors hypothesized that the choice of irrigation fluid might be a key factor affecting the outcomes of surgery. This multicenter randomized controlled trial aims to investigate whether intraoperative irrigation using artificial cerebrospinal fluid (ACF) followed by the placement of a subdural drain would yield superior results compared to the placement of a subdural drain alone for CSDH.

Methods

The study will be conducted across 19 neurosurgical departments in Japan. The 1186 eligible patients will be randomly allocated to two groups: irrigation using ACF or not. In either group, a subdural drain is to be placed for at least 12 h postoperatively. Similar to what was done in previous studies, we set the proportion of patients that meet the criteria for ipsilateral reoperation at 7% in the irrigation group and 12% in the non-irrigation group. The primary endpoint is the proportion of patients who meet the criteria for ipsilateral reoperation within 6 months of surgery (clinical worsening of symptoms and increased hematoma on imaging compared with the postoperative state). The secondary endpoints are the proportion of reoperations within 6 months, the proportion being stratified by preoperative hematoma architecture by computed tomography (CT) scan, neurological symptoms, patient condition, mortality at 6 months, complications associated with surgery, length of hospital stay from surgery to discharge, and time of the surgical procedure.

Discussion

We present the study protocol for a multicenter randomized controlled trial to investigate our hypothesis that intraoperative irrigation with ACF reduces the recurrence proportion after the removal of chronic subdural hematomas compared with no irrigation.

Trial registration

ClinicalTrials.gov jRCT1041220124. Registered on January 13, 2023.

DOI： 10.1186/s13063-023-07889-7

Open Access

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Other Link： https://link.springer.com/article/10.1186/s13063-023-07889-7/fulltext.html

Language：Japanese  

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Neurosurgical Society  

DOI： 10.2176/jns-nmc.2022-0321

Open Access

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Scientific Scholar  

Background:

One-third of spinal epidural hematomas occur spontaneously, and these may be associated with the acute onset of severe paralysis. Here, we present a case of T4-L4 symptomatic spontaneous spinal epidural hematoma which was successfully removed using a flexible neuroendoscope after hemilaminectomy.

Case Description:

Using flexible neuroendoscopy, we successfully treated a T4-L4 spinal epidural hematoma in an 89-year-old Japanese female who spontaneously developed back pain and paraparesis. The hematoma was removed utilizing a hemilaminectomy at three vertebral levels (T11, T12, and L1), while the remaining hematoma debris was completely evacuated with flexible neuroendoscopy. Neurological improvement was observed immediately postsurgery.

Conclusion:

Flexible neuroendoscopy provided a less extensive surgical method for removing a T4-L4 spontaneous epidural hematoma.

DOI： 10.25259/sni_749_2023

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Other Link： http://surgicalneurologyint.com/surgicalint-articles/widespread-spontaneous-spinal-epidural-hematoma-treated-with-a-combined-technique-using-a-flexible-neuroendoscope-after-hemilaminectomy-a-case-report/

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

DOI： 10.7759/cureus.45326

Open Access

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Scientific Scholar  

Background:

Traumatic pseudoaneurysms are rare but have a high mortality rate; therefore, immediate diagnosis is vital. Most pseudoaneurysms are in the internal carotid artery or peripheral arteries, while proximal middle cerebral artery pseudoaneurysms have rarely been reported. We present a case of ruptured traumatic pseudoaneurysm located at the M1-M2 bifurcation.

Case Description:

A 42-year-old man was injured in a motorcycle accident and his Glasgow coma scale score on admission was 7 (Eye opening1, Verbal response2, Motor response4 [E1V2M4]). Head computed tomography (CT) showed thick subarachnoid hemorrhage (SAH). We suspected a ruptured aneurysm, but three-dimensional CT angiography (3D-CTA) did not detect any vascular defects. Head magnetic resonance angiography showed progressive right M1 stenosis suggesting arterial dissection. 3D-CTA on day 20 showed a small aneurysm in the proximal portion of the M2. Although surgery was scheduled for day 26, suddenly left hemiparesis appeared on day 24. Head CT detected fresh SAH and emergency surgery was performed on day 25. We dissected around the ruptured point under M1 temporary occlusion with superficial temporal artery-M2 assist bypass. Contrary to our expectations, there was only a small laceration in the right M2 superior trunk. We trapped the laceration and the proximal portion of the M2 superior trunk while preserving antegrade blood flow from the M1 to the M2 inferior trunk. On the 5-month follow-up, the patient was able to walk independently.

Conclusion:

Unreasonably thick traumatic SAH or spastic stenosis after head injury may indicate a traumatic pseudoaneurysm and require repeated neurovascular evaluation. If a pseudoaneurysm is detected, immediate surgical intervention is mandatory.

DOI： 10.25259/sni_344_2023

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Other Link： http://surgicalneurologyint.com/surgicalint-articles/ruptured-proximal-middle-cerebral-artery-traumatic-pseudoaneurysm-treated-with-bypass-assisted-trapping-surgery-a-case-report/

Authorship：Lead author,　Corresponding author   Language：English  

DOI： 10.18999/nagjms.85.2.380

Open Access

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Neurosurgical Society  

DOI： 10.2176/jns-nmc.2022-0028

Open Access

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.inat.2022.101554

Open Access

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Scientific Scholar  

Background:

Symptomatic common carotid artery (CCA) occlusion is rare and its treatment remains unestablished. Although cases of subclavian-to-carotid bypass have been reported, very few cases of carotid-tocarotid crossover bypass have been reported, despite its advantages. We report a case of Riles type 1A symptomatic CCA occlusion after aortic arch replacement that was treated with carotid-to-carotid crossover bypass with favorable outcomes.

Case Description:

A 65-year-old woman with a history of hypertension, hyperlipidemia, diabetes, and total arch replacement for thoracic aortic aneurysm was admitted to our hospital with a complaint of the right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed a fresh infarction in the left cerebral hemisphere. Cervical computed tomography (CT) angiography revealed left CCA occlusion. Thoracic CT angiography showed severe stenosis of the left subclavian artery. SPECT showed a general decrease in blood flow in the left cerebral hemisphere. We performed a carotid-to-carotid crossover bypass with a synthetic graft that was passed through the subcutaneous tunnel. First, the right carotid artery-synthetic graft end-to-side anastomosis was performed. Subsequently, we performed synthetic graft-left CCA end-to-side anastomosis. The postoperative course was uneventful. Cervical computed tomography angiography showed perfect patency of the crossover bypass. The patient recovered almost completely and was independently performing daily activities.

Conclusion:

Carotid-to-carotid crossover bypass is a durable treatment for symptomatic CCA occlusion. Further studies are needed to compare its outcomes with those of other methods and to confirm our findings with larger sample size.

DOI： 10.25259/sni_415_2022

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Other Link： http://surgicalneurologyint.com/surgicalint-articles/a-case-of-symptomatic-carotid-artery-occlusion-after-aortic-arch-replacement-treated-with-carotid-carotid-crossover-bypass/

Publishing type：Research paper (scientific journal)   Publisher：Japanese Society on Surgery for Cerebral Stroke  

DOI： 10.2335/scs.50.399

Open Access

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

DOI： 10.1016/j.wneu.2018.07.061

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

DOI： 10.1016/j.wneu.2018.01.117

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.wneu.2017.09.204

Open Access

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Neurosurgical Society  

DOI： 10.2176/nmc.oa.2016-0317

Open Access

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Presentation type：Poster presentation  

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Presentation type：Symposium, workshop panel (public)  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Symposium, workshop panel (public)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Symposium, workshop panel (nominated)  

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Language：English   Presentation type：Symposium, workshop panel (nominated)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Symposium, workshop panel (nominated)  

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Presentation type：Oral presentation (general)  

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Presentation type：Symposium, workshop panel (public)  

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