脳神経外科速報
Volume 21, Issue 6, 2011
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目次
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Techniques & Arts
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【手術のコツとピットフォール 一流術者のココが知りたい】 聴力温存を企図した聴神経腫瘍摘出術― 後頭下開頭法:腫瘍の摘出方法 ―
21巻6号(2011);View Description Hide Description -
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【How do you Neurosurgical テクニック? 小児編 第2回】 はじめての脊髄脂肪腫手術
21巻6号(2011);View Description Hide Description
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Current Knowledge
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【専門医に求められる最新の知識 脳血管障害】 TIA の新展開
21巻6号(2011);View Description Hide Description近年,一過性脳虚血発作(TIA)の定義としてtissue-based TIA が提示され,臨床的には急性脳血管症候群(ACVS)として脳梗塞と区別なく取り扱う必要がある.ABCD2 スコア,頚動脈狭窄の有無,MRI,DWI の結果などを用いて危険度を評価し,TIA クリニックなどの専門機関で,早期の検査,病態に沿った治療を行うことで完成型脳梗塞発症の危険性を低下させることができる.社会全体でのTIA 診療体制づくりと,一般住民,医療従事者へのTIA に関する認識の啓発が必要である. -
【専門医に求められる最新の知識 脳腫瘍】 がんゲノムアトラスと脳腫瘍
21巻6号(2011);View Description Hide Descriptionがんは,細胞の設計図であるゲノム情報の誤りにより正常な増殖制御が破綻して生じるが,急速に発展した解析技術を用いて,その異常をくまなく明らかにし,がんをより深く理解するとともに治療に結びつけるのが,がんゲノムアトラス計画の目標である.これはさまざまながんを対象として,米国発のThe Cancer Genome Atlas をはじめ,国際がんゲノムコンソーシアムも結成されるなど世界的な広がりをみせており,種々の大規模解析が行われている.これにより,ゲノムのDNA 配列のみならず,エピジェネティックな変化やマイクロRNA に及ぶまで,新たな異常が次々と明らかになってきている.脳腫瘍に対しても精力的な解析が行われ,膠芽腫では腫瘍化を引き起こす重要な経路の異常が体系的に解明されるなど,理解がさらに進んだ.また,このような機運のなか発見されたIDH遺伝子の高頻度の異常は非常に画期的なものであった.現在こうした解析は,小児脳腫瘍などへとさらなる展開を見せている. -
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Contribution
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【投稿論文 Original Article】 頭蓋底外科手術における3D-multifusion image を使った術前評価の有用性
21巻6号(2011);View Description Hide DescriptionThe importance of understanding normal anatomy and constructing adequate surgical simulations for skull base surgery has been increasingly reported.However, during surgery, normal anatomy is lost in most of the cases, making preoperative simulation extremely difficult. In our institution, we perform preoperative evaluation of skull base surgery patients by means of 3D-multifusion images produced by using an AZE workstation(VirtualPlace Plus) to process MRI/MRA/MRV and CT images. Unlike previous workstations, this model has added new automatic image stitching functions and 3D multi-volume endoscope functions, enabling clinicians to produce fusion images easily and to view the operative field from any desired angle. The spatial relationships between tumors, blood vessels, nerves, and bone structures are clearly depicted and these images can be simply deleted, added, or made transparent, enabling easy memorization of visual images. These techniques are quite useful not only for surgical simulations by operators but also for training young neurosurgeons. -
【投稿論文 Original Article】 頭蓋内巨大内頚動脈瘤の治療方針と問題点
21巻6号(2011);View Description Hide DescriptionGiant intracranial aneurysms have traditionally been associated with a higher morbidity and mortality than smaller lesions. Although several different strategies are currently available to manage giant aneurysms, this stems from the fact that no single technique is effective in dealing with all giant aneurysms. There have also been a few reports about intracranial giant aneurysms treated by intracranial direct approaches. Especially, for giant aneurysms of the internal carotid artery, direct operation has been thought to be difficult to perform because of the anatomical particularity and the danger of rupture during surgery. More recently, intracranial bypass procedures have been described for reconstruction of the carotid artery with artery or vein grafts or aneurysm resection with middle cerebral artery reconstruction. If the surgical treatment is chosen, careful consideration should be given prior to treatment of any giant aneurysm regarding specific anatomic features. It is well known that critical perforating vessels can arise from the aneurysm itself. Above all, surgical procedure for the aneurysms located in the C1 portion of the ICA has many problems at the point that the essential perforators should be preserved morphologically and how to keep those effective blood flows intact. In this study, we report the strategies of surgical treatment for giant intracranial aneurysms of the internal carotid artery, and we discuss their technical considerations.
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Lecture & General Information
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