Volume 28,
Issue 12,
2018
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目次
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Source:
脳神経外科速報 28巻12号, 1170-1171 (2018);
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Techniques & Arts
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Source:
脳神経外科速報 28巻12号, 1172-1184 (2018);
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覚醒下手術は,生きたヒトの脳に直接アプローチできる唯一の方法で,脳神経外科医だけに与えられた特権です.ここで得られた知見は,neuroscience に生かせると考えています.高次脳機能の局在や可塑性という未知の領域を解明できるのはおそらくわれわれ脳神経外科医だけ.この手術,治療を通して,脳神経外科医の立場でneuroscience に貢献できればと思っています.( 中田光俊)
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Source:
脳神経外科速報 28巻12号, 1186-1196 (2018);
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Source:
脳神経外科速報 28巻12号, 1198-1206 (2018);
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Current Knowledge
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Source:
脳神経外科速報 28巻12号, 1207-1212 (2018);
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グリオーマ,特にWHO GradeⅣに分類される膠芽腫は最も予後不良の悪性新生物の一つである.幸い悪性新生物のなかでは頻度は低く,稀少疾患になるが,逆にそのために治療開発が進まず,予後改善の速度は遅い.それでも分子生物学的知見の集積により,病理診断は遺伝学的分類を導入したものとなり,より生存と密接にかかわるものとなった.また,手術支援システムや術中モニタリングの発展により手術安全性は向上した.さらに2000 年代に入り,テモゾロミド,カルムスチン脳内留置用薬,ベバシズマブ,腫瘍電場治療と次々に新規後療法が投入され,ようやく全生存期間中央値で20カ月を超えるようになってきた.本稿では,診断,手術,後療法,再発時治療の各項目に関して,グリオーマ診療における最近の進歩・変化をまとめた.
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Source:
脳神経外科速報 28巻12号, 1213-1220 (2018);
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頭蓋底は脳神経外科と耳鼻科の接点となる領域である.経鼻内視鏡頭蓋底手術は多くの施設で導入され,さらに適応が拡大されつつある.この手術においては,内視鏡下副鼻腔手術の歴史の長い耳鼻科から学ぶことが多く,脳神経外科と耳鼻科の合同手術とすることで,互いの科の長所,特性を活かした手術が可能である.当施設の経験をもとに,合同手術の概略について述べる.
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Source:
脳神経外科速報 28巻12号, 1221-1229 (2018);
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てんかんの画像診断は難しいと言われる.一般的に脳神経外科で扱われる血管性疾患や腫瘍などと比べて読影能力もさることながらよりシビアな撮像条件が必要であり,てんかん外科にとって必要な画像がどのようなものかは理解しておく必要がある.てんかん外科の症例は全体の6 割を限局性皮質異形成(focal cortical dysplasia:FCD)と海馬硬化症で占める.FCDはMRI上軽微な変化であることが多く同定が難しい.皮質の肥厚や強い信号上昇等特徴的な所見をとらえることでFCDの病理分類を予測することが可能となる.海馬硬化症においては,まず海馬を評価可能な高画質なT2強調冠状断像の撮影と海馬の解剖の理解が必須である.
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Source:
脳神経外科速報 28巻12号, 1230-1239 (2018);
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Source:
脳神経外科速報 28巻12号, 1240-1246 (2018);
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その他
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Source:
脳神経外科速報 28巻12号, 1247-1247 (2018);
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Contribution
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Source:
脳神経外科速報 28巻12号, 1248-1254 (2018);
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Adipose tissue mass was processed into the shape of a plane sheet by pressing and extending it. This study reports the utility of sheet-shaped fat grafts in various neurosurgical surgeries. Adipose tissue from the abdomen was held between two stainless boards and was then pressed and extended. Fibrin glue was thinly sprayed over both sides of the sheet-shaped adipose tissue to increase durability and improve utility. This fat sheet was cut into an optimal shape for use at the time of grafting. It was useful for purposes such as closing frontal sinuses opened in craniotomy, as a dural substitute for large dural defects, filling of the sellar cavity in transsphenoidal surgery, and preventing cerebrospinal fluid leakage in spinal surgery. By processing it into a sheet and cutting into optimal sizes, the adipose tissue was able to fill the closed cavity. In addition, it was used for suturing, enabling grafting in close proximity to the surface of surgical sites such as dural defects. The sheet-shaped fat graft is considered to have a broad range of applications including skull base and spinal surgeries.
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Source:
脳神経外科速報 28巻12号, 1255-1261 (2018);
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Objectives: We report a role of intraoperative visual evoked potential (VEP) monitoring in transsphenoidal surgery (TSS). Correlation between VEP data and postoperative visual function was evaluated. Materials and Methods: Sixteen patients (10 nonfunctional pituitary adenomas, 3 Rathke's cleft cysts, 3 craniopharyngiomas) underwent TSS under total venous anesthesia with propofol from 2011 to 2018. VEP was recorded using light-stimulating devices (Unique Medical Co.). We paid attention to the largest negative peak that appeared -100 msec after stimulation onset. The criterion for amplitude changes was defined as a > 50% increase or 50% decrease in amplitude compared with the control level. Results: Stable and reproducible VEP data were obtained in 30 of 32 eyes. In 2 eyes, VEP data could not be obtained, probably due to preexisting severe visual dysfunction (finger motion and corrected visual acuity 0.03). Among 30 eyes, VEP amplitude increased in 4 eyes and postoperative visual function improved. The amplitude decreased in 1 eye, and the visual function deteriorated postoperatively. Amplitudes were unchanged in the other 25 eyes. Improvement in visual function was recognized in 9 eyes whereas remained unchanged in 16 eyes. Conclusion: We were able to acquire satisfactory intraoperative VEP recording in eyes without severe preoperative visual dysfunction. In TSS, VEP monitoring is useful for judgment of visual function intraoperatively.
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その他
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Source:
脳神経外科速報 28巻12号, 1268-1269 (2018);
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Source:
脳神経外科速報 28巻12号, 1270-1271 (2018);
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Source:
脳神経外科速報 28巻12号, 1280-1280 (2018);
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