Joint neurosurgical convention

Transcription

Joint neurosurgical convention
the 7th international MT.bandai symposium for neuroscience
the 8th Pan-pacific neurosurgery congress
program and abstracts
2016
date
April 7(thr) - 10(san), 2016
venue
phnom penh hotel, phnom penh, cambodia
Mt. B A ND A I
Presi de nt Y o k o
P P NC
K a to , M . D .
Fuj i ta H eal t h Uni v er s i ty
Banbuntane H otok uk ai H os pi tal
http://jnc2016.umin.ne.jp/welcome.html
P r e s id e n t S h i ge mi
K i ta h ara, M .D.
P r e s id e n t, Kita h a r a N e u r o su r g i ca l I nsti t ute
E-mail [email protected]
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JNC2 01 6
Joint Neurosurgical Convention
First Sentence
The 7 th International Mt. BANDAI Symposium for Neuroscience
April 7(Thu) - 10(Sun) , 2016
abstract
Symposium
Luncheon Semnar Speakers
Hands on
Phnom Penh Hotel, Phnom Penh, Cambodia
Special Lecture Speakers
Program
The 8 th Pan-Pacific Neurosurgery Congress
Mt. BA N DA I
Presi dent Y o k o
P P NC
K a to , M . D .
Pro fe ssor, Depart ment of N eur os ur ger y
Fu jita Healt h Uni versi ty Banbuntane H otok uk ai H os p ita l
P r e s id e n t S hi g e mi
K i ta h a r a , M.D.
P r e s id e n t, Kita h a r a N e u r o su r g ic a l I n sti t ute
J o in t N eu r o s u r g ic a l C o n v en tio n 2 01 6 01
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Welcome Adress
D ear m y co l l e agues,
abstract
Symposium
Hands on
Program
First Sentence
I t i s m y g r eat e st pleasure to cordially w e lc o m e y o u to jo in th e 5 th M t. B a n d a i a n d P a n - p a c if ic
Jo i n t N eu r o s u r gical Convention (JNC) 2 0 1 6 h e ld in P h n o m P e n h , C a m b o d ia . A ll o f u s g a th e r ed
h er e wi t h a u nified aim to deliver the kn o w le d g e o f n e u r o su r g e r y to a ll o f th e p a r tic ip a n ts
e s p eci al l y t h e young neurosurgeons who n e e d to le a r n th e c o r e c o n c e p ts f o r im p r o v e m e n t the
p r act i ce. Gai n ing sophisticated clinical a p p lic a tio n is n o t p o ssib le w ith o u t th e k n o w le d g e o f
b as i c s ci en ce in disease. The good pract ic e o f n e u r o su r g e r y sh o u ld b e c o m b in e d b o th o f th e m.
A s al l o f u s k n ow, the knowledge and te c h n iq u e s u se d in n e u r o su r g ic a l f ie ld s a r e th e m o st
c h al l en g i n g f actor especially in this mod e r n e r a . H o w e v e r , th e n e u r o su r g ic a l sk ill is so
i mp o rt an t t o o for applying with the basi c a n d a d v a n c e k n o w le d g e to tr e a t th e p a tie n ts. W e
c an n o t g ai n a successful achievement wh e n u sin g o n ly o n e . A d v a n c e d p r o c e d u r e s a r e a lw a y s
b as ed o n t h e b asic knowledge especially th e c lin ic a l b a sic sc ie n c e , th e n e u r o su r g e o n s w h o c an
u n d er s t an d an d apply to optimize the cli n ic a l u se , th e b e st o u tc o m e o f tr e a tm e n t w ill o c c u r .
W e p ro v i d e t h e hand-on course for 2 day s in c lu d in g th e se v e r a l le c tu r e s th a t c o v e r f r o m th e
b as i c t o ad v an ce knowledge in neurosurg e r y . T h e p a r tic ip a n t c a n d ir e c tly le a r n th e p h ilo so p hy
f r o m t h e m as t e r who is the best practice in th e w o r ld a n d b e sp e c ia liz in g o n th e ir f ie ld . H o w
c an we p r act i ce on the right way is very im p o r ta n t a f te r w e h a v e le a r n t f r o m th e th e o r ie s.
F u r t h er m o re, the effectiveness of learni n g p r o c e ss f o r y o u n g n e u r o su r g e o n s is n o t o n ly u sin g
t h e o n e-way c ommunication from the tea c h e r . P a r tic ip a tio n o r sh a r in g th e e x p e r ie n c e a n d id eas
i n t h e cl as s i s meaningful for young neu r o su r g e o n s w h o n e e d to k n o w . N o t o n ly to b e g a in ing
t h e n ew k n o w ledge, but also a new frien d sh ip w ill o c c u r a m o n g th e so c ie ty a f te r m a k in g th e
c o m m u n i cat i o n.
Nowadays, the new issue of neurosurgery is coming and everybody should be accepted.
Y ear b y y ear we have the increasing num b e r o f w o m e n n e u r o su r g e o n a r o u n d th e w o r ld a lth o ugh
t h ey ar e v er y f ew when compared with me n . T h e so c ie ty is su p p o r tin g th e W o m e n in
N eu ro s u r g er y (WIN) project and also is p r o m o tin g th e m to g e t a h ig h e r a c a d e m ic p o sitio n
i n cl u d ed t h e salary so we should preciou sly ta k e c a r e a ll o f th e m .
O n b eh al f o f the organizing committee o f th e JN C 2 0 1 6 a n d m y se lf , I w o u ld lik e to e x p r e ss my
t h an k s t o al l p articipants for sharing a g o o d e x p e r ie n c e to g e th e r o n th is c o n g r e ss a n d I
t r u t h f u l l y wel c ome you to enjoy this cou r se a n d h o p e it c a n b e a n in sp ir a tio n f o r y o u n g
n eu ro s u r g eo n s to move forward on their c a r e e r .
Yoko Kato, M.D.,Ph.D
President, the 7th International Mt. Bandai symposium for neuroscience.
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I n t h i s M ay , we, Kitahara group, are goin g to o p e n a m e d ic a l c e n te r c a lle d “ S u n r ise Ja p a n
h o s p i t al ” i n P hnom P enh. We would like to b o th e sta b lish a n d d e v e lo p th e n e u r o su r g e r y o f t he
i n t er n at i o n al standard there together with th e C a m b o d ia n sta f f w h o r e c e iv e d tr a in in g in
K i t ah ara In t ernational Hospital in Tokyo .
S i n ce I h ap p en ed to be the chairperson o f th is so c ie ty , I w a s a b le to h a v e th is in P h n o m P e n h to
e n co u rag e a p roject that is supported by Ja p a n e se G o v e r n m e n t a n d Ja p a n e se c o m p a n ie s.
O u r s t aff m ay not be used to holding a s o c ie ty in a f o r e ig n c o u n tr y , b u t I w o u ld a p p r e c ia te i f
y o u can u n d er stand their disposition and c o o p e r a te so th a t th is so c ie ty b e c o m e s a sig n if ic a n t
o n e. Yo u are of course welcomed to visit th e site a n d in te r a c t w ith th e o p e n in g sta f f .
O u r o f fi ce s t a ff will do our best to make th is so c ie ty f r u itf u l f o r a ll o f y o u . P le a se u n d e r stand
t h e p u rp o s e o f this society and take a pa r t.
Program
abstract
Symposium
I l o o k f o r ward to seeing you in P hnom P e n h . L e t' s h a v e a ta lk , h a v e f u n , a n d d e e p e n o u r
f r i en d s h i p .
T o ach i ev e t h is goal, I established the sy m p o siu m c a lle d " M e d ic in e in A sia n C o u n tr ie s –
C u r ren t C o n d itions, P roblems, and F utur e o f N e u r o su r g e r y " p a r tic u la r ly f o r th is so c ie ty . I
w o u l d l i k e t h e young medical profession a ls a n d p e o p le f r o m m e d ic a l c o m p a n ie s to h a v e a c tive
d i s cu s s i o n s and share information. If I c o u ld c o n tr ib u te to th e m e d ic a l d e v e lo p m e n t o f A sian
c o u n t r i es i n cl u ding Japan, I would very m u c h a p p r e c ia te it.
Hands on
U n t i l n o w , t h e Japanese brain surgeons a n d m e d ic a l c o m p a n ie s h a v e b e e n f o c u sin g o n A m e r ica
a n d E u r o p e. Now that Asian countries h a v e b e e n d e v e lo p e d r e m a r k a b ly , I f e e l th a t it is
e s s en t i al t o u nderstand the medical syste m o f e a c h o th e r ’ s c o u n tr y a n d su p p o r t e a c h o th e r s o
t h at t h e p eo p l e in every Asian country c a n r e c e iv e th e b e n e f it o f b r a in su r g e r y .
T h i s s o ci et y h as been held in Hawaii, bu t w ith th e c o o p e r a tio n o f m a n y p e o p le I a m g la d to
h av e t h i s fo r the first time in Asia, in C a m b o d ia .
First Sentence
Welcome Adress
Shigemi Kitahara M.D.PhD
President, the 8th Pan-Pacific Neurosurgery Congress
J o in t N e u r o s u r g ic a l C o n v en tio n 2 01 6 03
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First Sentence
Welcome Adress
D ear Di s t i n g uished Guests
D ear In t ern at ional and National College s
O n b eh al f o f C ambodian S ociety of Neur o su r g e r y ( C .S .N .) I w a r m ly w e lc o m e o u r e n tir e
N at i o n al an d I nternational Guests comin g to a tte n d th e 5 th M t.B a n d a i & P a n - P a c if ic Jo in
Program
N eu r o l o g i cal Convention P hnom-P enh, A p r il 7 - 1 0 . 2 0 1 6 . I t is a g r e a t h o n o r a n d p r iv ile g e to be
g i v en an o p p o rtunity to welcome all of y o u to b e h e r e .
T h i s i s an ex c ellence opportunity for ou r ju n io r - se n io r a n d N a tio n a l - I n te r n a tio n a l
n eu r o s u r g eo n s to meet each other sharin g th e e x p e r ie n c e s, b u ild in g u p th e te r m c lo se f r ie n ds hip
a n d s t ren g t h en the fruitful cooperation b e tw e e n C a m b o d ia n S o c ie ty o f n e u r o su r g e r y a n d
Jap an es e N eu r osurgery S ociety. There a c tiv itie s w e r e a im in g to im p r o v e th e sk illf u ln e ss u p
d at ed k n o w l ed ge in new modality of tech n iq u e in n e u r o su r g e r y f ie ld a n d a ssiste d d e v e lo p in g
Cam b o d i a.
A ct u al l y , N eurosurgery in C ambodia wa s sta r tin g in r e c e n t y e a r w ith sm a ll g r o u p m e m b e r a nd
Hands on
d i f fi cu l t co n d ition but we try our best to tr e a t o u r p e o p le s a n d jo in I n te r n a tio n a l N e u r o su r g e r y
Co m m u n i t y i n our goal to join developm e n t o f th e w o r ld .
Cam b o d i a i s l ocated in the heart mainlan d o f S o u th e a st A sia in th e so u th e r n p a r t o f I n d o c h i na,
w h i ch co n j u r es images of a glorious and m y ste r io u s p a st a n d r ic h o f th e c u ltu r a l h e r ita g e s,
p art i cu l arl y t h e world's renowned ancien t te m p le c ity w h o se m a g ic a l im a g e d r a w s
e v er -i n creas i ngly tourists from all over th e w o r ld
W e ex t en d a warm welcome to all progra m p a r tic ip a n ts. I ’ m su r e th a t a ll o f y o u w ill h a v e a
abstract
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mem o rab l e s t ray during your visit in P h n o m - P e n h , C a m b o d ia .
Iv-Vycheth MD,PhD
Department of Neurosurgery, Preahkossamak Hospital
University of Health Sciences, Phnom-Penh, Cambodia.
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COMMITTEE
President
(The 7th International Mt. BANDAI symposium for Neuroscience)
Professor of Department of Neurosurgery, Fujita Health University
President
First Sentence
Yoko Kato
(The 8th Pan-Pacific Neurosurgery Congress)
Shigemi Kitahara
Program
KNI Medical Group President
Sadayoshi Watanabe
Preah kossamak hospital,P.Penh Cambodia
Tokyo General Hospital
Kee Park
Salman Shari
WFNS
Pakistan
Kentaro Mori
Eka Julianta Wahjoepramono
National Defense Medical College
Indonesia
Satoshi Iwabuchi
Hands on
Iv-Vycheth
Vice President
Honorary Advisor
Kazuo Watanabe
Carolina Skull Base Surgery Center / Duke University
Southern Tohoku General Hospital
Advisory Board
Masamichi Atsuchi
Hideyuki Ohnishi
Atsuchi Neurosurgical Hospital
Ohnishi Neurosurgical Center
Seiichi Kobayashi
Hirotoshi Sano
Kobayasi Neurosurgical Hospital
Synthesis Shinkawabashi Hospital
Kazuo Hashi
Tomokatsu Hori
Pacific Neurosurgical Consulting Inc.
Moriyama Memorial Hospital
Akira Yamaura
Matsudo City Hospital / Chiba University
abstract
Symposium
Takanori Fukushima
Toho University Ohashi Medical Center
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COMMITTEE
Head of the Administration office
First Sentence
Yoshifumi Hayashi
Kitahara International Hospital / Sunrise Japan Hospital Phnom Penh
abstract
Symposium
Hands on
Program
Organizing Committee
Yoshimasa Niiya
Masanori Aihara
Otaru General Hospital
Gunma University Hospital
Fusao Ikawa
Shoichiro Ishihara
Hiroshima University
Saitama Medical University International Medical Center
Katsuhiro Ito
Joji Inamasu
Hirosaki University
Fujita Health University
Yasutaka Imada
Hidenori Endo
Yamada Memorial Hospital
Kohnan Hospital
Kenji Ohata
Soichi Ohya
Osaka City University
Saitama Medical Center
Hidehiro Oka
Yoshifumi Okada
Kitazato University Medical Center
Kitahara International Hospital
Hitoshi Obata
Hidetoshi Kasuya
Osaka Mishima Emergency Critical Care Center
Tokyo Women’ s Medical University Medical Center East
Kyosuke Kamada
Hiroyuki Kinouchi
Asahikawa Medical University
University of Yamanashi
Yoshihiro Kitahama
Eiji Kimura
Omaezaki Municipal Hosipital
Kobe University Graduate School of Medicine
Taichi Kin
Kaoru Kurisu
Tokyo University
Hiroshima University
Naoya Kuwayama
Michihiro Kono
University of Toyama
Tokyo Medical University Hospital
Eiji Kohmura
Fuminari Komatsu
Kobe University Hospital
Tokai University Hachioji Hospital
Tetsuro Sameshima
Kazuaki Shimoji
Hamamatsu University School of Medicine
Juntendo University Hospital
06 Joint Neuro s ur gi ca l C onv e n ti on 2 0 1 6
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COMMITTEE
Chiba Kashiwa Tanaka Hospital
Japanese Red Cross Asahikawa Hospital
Michihiro Tanaka
Daisuke Suyama
Kameda Medical Center
Fuchu Kenjinkai Hospital
Joji Nakagawara
Hirofumi Nakatomi
National Cerebral and Cardiovascular Center
Tokyo University
Yoshihiro Natori
Yasuhiko Hayashi
Iizuka Hospital
Kanazawa University
Miki Fujimura
Takeshi Maeda
Tohoku University
Nihon University
Taketoshi Maehara
Takashi Maruyama
Tokyo Medical and Dental University
Tokyo Women’ s Medical University
Junichi Mizuno
Chie Mihara
Shin-Yurigaoka General Hospital
Hibino Hospital
Yasuhiro Yamada
Kojiro Wada
Fujita Health University Banbuntane Hotokukai Hospital
National Defense Medical College
Takeya Watabe
Tadashi Watanabe
Aichi Medical University
Japanese Red Cross Nagoya Daini Hospital
Amar Saxena
Mohsen Nouri
United Kingdom
Iran
Basant K. Misra
Atul Goel
India
India
Eka julianta wahjoepramono
Michael Morgan
Indonesia
Australia
Andrew Kaye
Charlie Teo
Australia
Malaysia
Program
Katsumi Takizawa
Kiyoshi Takagi
Hands on
Nakamura Memorial Hospital
Symposium
Takaomi Taira
abstract
Yoshinobu Seo
First Sentence
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COMMITTEE
abstract
Symposium
Hands on
Program
First Sentence
Kyu-Sung LEE
Hyeun Sung Kim
Korea
Korea
Ittichai Sakarunchai
Chaiwit Thanapaisal
Thai land
Thai land
Sakchai Saeheng
Yong-Kwang TU
Thai land
Taiwan
Ling Feng
Mao Ying
China
China
Shu Guowei
Ivan Nｇ
China
Singapore
Basant PANT
Iype Cherian
Nepal
Nepal
salman sharif
Kanak Kanti BARUA
Pakistan
Bangladesh
Gerardo Dizon LEGASPI
Apio Claudio Martins ANTUNES
Philippines
Brazil
Haroon M. Pillay
NHO VO VAN
Brunei
Vietnam
SAFI UR REHMAN
Azmi Alias (Kuala Lumpur)
Hong Kong
Malaysia
Chee Pin Chee
Myat Thu
Malaysia
Myanmar
Alexander Potapov
Zakharova Natalia
Russia
Russia
Albert Sufianov
Jamilr zaev
Russia
Russia
0 8 Joint Neuro s ur gi ca l C onv e n ti on 2 0 1 6
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COMMITTEE
Ng Wai Hoe
K. SelvakumarVice
Singapore
India
Gene Bolles
First Sentence
abstract
Symposium
Hands on
Program
USA
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First Sentence
Floor map
Program
Room 1
Booth 8
Amazing Cambodia
Lift
Hands on
Cristal Room
Booth 6
coffee brake
Booth 9
GE Healthcare
Concierge desk
Booth 1
J NC 2016
Registration
Symposium
Booth 7
Sunrise Japan Hospital
Room 3
Registration
Booth 4
Ono & Co., Ltd.
Carnation Room
abstract
Booth 5
Max System
Booth 10
EBM
Booth 2
Integra
LifeSciences
Corporation
Booth 3
Europ Continents
Room 2
Toilet
10
Toilet
Jasmin Room
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Guidance
Conference Date
First Sentence
April 7th (Thu) – 10th (Sun), 2016
Venue
Phnom Penh Hotel Program
No. 53, Monivong Boullavard, Sangkat Srah Chok P.O. Box 1 13 1,
Phnom Penh Kingdom of Cambodia
Tel: + 855 (0)23 991 868 / Fax. +855 (0) 23 991 8 1 8
E-mail: [email protected]
Official Language
Hands on
English
Congress Dress Code
Business Casual
(No jackets or ties are required both during the sessions and the parties)
Contact to Congress Office (Cambodia)
mail to : [email protected]
abstract
Symposium
mobile : ＋855 (0) 10 23 1 476
J o in t N e u r o s u r g ic a l C o n v en tio n 2 01 6
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Guidance
Registration
First Sentence
The staff at the conference registration desk is happy to assist you in all matters of
registration. If you pre-registered, please pick up your congress kit at registration
Program
desk.The opening hours of the registration desk are as follows.
April 6th (Wed)
13:00 – 18:00
April 7th (Thu)
8:00 – 17:00
April 8th (Fri) & 9th (Sat)
7:00 - 17:00
April 10th (Sun)
8:00 - 14:00
Hands on
Registration Fee
Physicians (1)
JPY 55,000
Residents, Fellows, and Para-medical (1)
JPY 30,000
Accompanying adults (2)
JPY 5,000
Accompanying children (2) (3)
JPY 5,000
For participants from ASEAN countries
Physicians (1)
US 100 dollars
Residents, Fellows, and para-medicals (1)
US 20 dollars
※We accept cash only (either on JPY or USD **USD will be calculated using
today’ s exchange rate) for the on-site registration. If the participants request any
other method other than cash payment, please arrange pre-registration through
Symposium
our website prior to the congress dates. (http://jnc2016.umin.ne.jp/index.html)
(1) Registration fee for Physicians, Residents Fellows and Nurses incudes the
following items:
abstract
● Admission to all Sessions and Exhibition
● Program and Abstracts
● Free admission Gala Dinner (8th April)
● Lunch
● Coffee and Beverages
1 2
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Guidance
(2) Registration fee for Accompanying adults and children includes the following
items:
● Free admission to Gala Dinner (8th)
First Sentence
Registration
(3) Children fee applies to the ages between 6-12 years old. Children under 6 years
●Social Events
Welcome Party
Date: April 7th (Thu)
Time: 18:30 – 20:00
Venue: Phnom Penh Hotel, Crystal Ballroom
Program
old is free.
Participation fee: JPY 5,000 or US dollars 42
Gala Dinner
Date: April 8th (Fri)
Time: 19:00 – 21:00
Venue: Bopha Phnom Penh - Restaurant “Titanic”
Participation fee: Included in Registration Fee
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Symposium
Transportation: Shuttles will be departing from the hotel at 18:30
Hands on
(including Dinner Buffet & flow of drinks)
J o in t N eu r o s u r g ic a l C o n v en tio n 2 01 6 1 3
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Presentation Guideline
First Sentence
Oral Presentation Guidelines
Below are some guidelines to help you prepare your oral presentation
1. All presentation will be given in English.
Hands on
Program
2. Each presentation has the different allotted time. Please check the congress program
for your assigned time.
3. All presentation must be made by on a computer using Power Point. Please use
Power Point 2003, 2007, or 2010.
4. The Conference venue will have the computerized LCD projection system.
Speakers are required to bring their own laptop computers (PC or Mac) or bring
data on USB.
5. There is no limitation on the use of images or moving images in presentation;
however, please note that there is a possibility for not outputting correctly if the data
size is too big.
6. Please note that there is no sound output function from PC.
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Symposium
7. Please make sure that your computer is equipped with D-sub (15 pins). If your
computer is not equipped with D-sub, please bring the connector.
8. Please make sure to bring AC adopter of your PC by yourself.
9. To avoid losing your presentation data, we strongly recommend you to bring your
data by USB as well.
10. Please deactivate your screen saver or power setting to avoid any trouble
during your presentation.
1 1. Please directly bring your laptop with presentation data to the PC operation desk
located in the presentation hall anteriorly, 15 minutes before your presentation.
1 2. If you prefer to do PC preview before your presentation, please bring your
presentation data and laptop to the registration desk.
1 3. The congress has very tight schedules, so we would be grateful for your punctuality.
1 4
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Poster Guidelines
1. Poster session will be held on 8th (Fri).
Please post your posters at assigned place between 11:00 – 15:00, April 8th (Fri) .
First Sentence
Poster Guidelines
5. The posters left on the poster boards at the end of congress program will be taken
down and disposed by the JNC office management team.
Please make sure to take down your posters by yourself if you want to keep.
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6. The JNC office management team is not responsible for posters thatare left on the
poster boards at the end of the conference.
Symposium
4. JNC office management team will prepare double sided tape to post your
presentation poster.
Hands on
3. The size of each poster board is as below (about A0 size) :
Program
2. Poster session will be held on 8th (Fri) 16:00 – 17:30. Please stand in
front of your poster and make presentation at your assigned time.
J NC2 0 16
room1
Crystal Room
7.April
room2
Jasmine Room
room3
room1
8.April
room2
Carnation Room
Crystal Room
Jasmine Room
room3
Carnation Room
Opening
Ceremony
8 : 00
Special Presentation1 [8SP1]
(8 : 30-9 : 00)
First Sentence
9 : 00
Scientific
Session1[8SS1]
Program
10 : 00
Hands-on
Seminar1[7HO1]
Hands-on
Seminar3[7HO3]
Interventional
Neuroradiology
Hands-on part1
Brain Surgery
Anatomy
Workhop
(9 : 00-1 2 : 00)
(9 : 30-1 1 : 45)
Microsurgical
decompression
(9 : 00-1 0 : 1 5)
(9:00-10:30)
Scientific
Session2[8SS2]
Scientific
Session5[8SS5]
Trauma1
Pediatric
Neurosurgery
(10 : 30-1 1 : 1 5)
NF2, CSDH and
others
Coffee Break
1 1 : 00
1 2 : 00
Scientific
Session4[8SS4]
(1 0 : 30-1 1 : 30)
Scientific
Session3[8SS3]
Scientific
Session6[8SS6]
CVD1
Surgical Strategy
and Approach
(1 1 : 1 5-1 2 : 30)
Luncheon Seminar1[7LS1]
(1 1 : 30-1 2 : 30)
Hydrocephalus
(1 2 : 10-1 3 : 00)
Poster Display
※Corridor
Medical Images
1 3 : 00
(1 2 : 30-1 3 : 30)
(1 1 : 00-1 5 : 00)
Symposium
Hands on
(1 3 : 30-1 4 : 00)
1 4 : 00
Hands-on
Seminar1[7HO1]
Hands-on
Seminar2[7HO2]
Hands-on
Seminar4[7HO4]
Interventional
Neuroradiology
Hands-on part2
Skull Base
Surgery Drilling
Workshop
Neuroendoscopy
(1 3 : 00-1 6 : 00)
(1 3 : 00-1 7 : 00)
Workhop
(1 3 : 00-1 6 : 00)
1 5 : 00
Symposium[8SY]
Scientific
Session7[8SS7]
Now and Future of Neuroendoscopy
(1 4 : 00-1 5 : 00)
Neurosurgery and
Healthcare
(1 4 : 00-1 5 : 40)
Scientific
Session8[8SS8]
Trauma2
Coffee Break
1 6 : 00
Hands-on
Seminar5[7HO5]
Anatomy of
Cerebral artery
(1 5 : 00-1 6 : 00)
Poster Session
[8PS1, 2, 3]
(1 6 : 00-1 7 : 00)
Wire model making
1 7 : 00
Workhop
(1 6 : 00-1 8 : 00)
abstract
1 8 : 00
1 9 : 00
Welcome
Reception
(1 8 : 30-20 : 00)
Gala Dinner
20 : 00
1 6
at Restaurant “Titanic”
(1 9 : 00-2 1 : 00)
JNC2 01 6
room1
9.April
room2
room3
Crystal Room
Jasmine Room
Carnation Room
room1
10.April
room2
room3
Crystal Room
Jasmine Room
Carnation Room
8 : 00
Pathophysiology 1
(9 : 00-1 0 : 00)
Hands-on
Seminar6[10HO6]
Pathophysiology 2
PNLS
Bypass
Clipping
(9 : 00-1 2 : 00)
(9 : 00-1 2 : 00)
(9 : 00-1 2 : 00)
CVD3・Aneurysm Anatomy, Images
(10 : 00-10 : 45)
Coffee Break
Scientific
Session3[9SS3]
CVD4
Aneurysm
and AVM
(1 1 : 00-1 2 : 1 5)
Hands-on
Seminar7[10HO7]
Hands-on
Seminar9[10HO9]
10 : 00
(1 0 : 00-1 1 : 00)
1 1 : 00
Scientific
Session9[9SS9]
Anatomy, Images
Pathophysiology 3
(1 1 : 00-1 2 : 1 5)
1 2 : 00
Neuroendoscopy
(1 2 : 1 5-1 3 : 00)
1 3 : 00
Special Presentation2[9SP2]
(1 3 : 00-1 3 : 30)
Scientific
Session4[9SS4]
Nurse Session[9NS]
(1 3 : 30-1 4 : 00)
Skull Base
Surgery
Scientific
Session10[9SS10]
(1 3 : 30-1 4 : 45)
Brain Tumor3
(1 4 : 00-1 4 : 45)
Scientific
Session11[9SS11]
Scientific
Session5[9SS5]
Brain Tumor1
(1 4 : 45-1 6 : 00)
Coffee Break
Spine ＆
Spinal Cord
Hands-on
Seminar10[10HO10]
Hands-on
Seminar8[10HO8]
Spine surgery
workshop
CEA
(1 3 : 00-1 5 : 00)
1 4 : 00
(1 3 : 00-1 6 : 00)
1 5 : 00
(1 4 : 45-1 5 : 45)
1 6 : 00
Scientific
Session6[9SS6]
Brain Tumor2
(1 6 : 1 5-1 7 : 30)
Program
Scientific
Session8[9SS8]
Scientific
Session2[9SS2]
Anatomy, Images
Hands on
(9 : 00-10 : 00)
1 7 : 00
CVD2・Aneurysm
9 : 00
Scientific
Session7[9SS7]
Symposium
Scientific
Session1[9SS1]
First Sentence
(8 : 30-9 : 00)
Closing
Ceremony
abstract
1 8 : 00
1 9 : 00
20 : 00
J o in t N e u r o s u r g ic a l C o n v en tio n 2 01 6 1 7
abstract
Symposium
Hands on
Special Presentation
Program
First Sentence
J NC2 0 16
Program
1 8
JNC2 01 6
program
Day 1 （April 7 Thursday）
LS1
Kiyoshi Takagi(Kashiwa-Tanaka Hospital)
13:00-16:00
Hands-on Seminar 1 Interventional Neuroradiology Hands-on part 2
Program
Luncheon seminar 1 “Hydrocephalus”
Moderators : Yoshihiro Natori (Department of Neurosurgery, Iizuka Hospital)
Naoya Kuwayama(University of Toyama, Japan)
Satoshi Iwabuchi (Toho University Ohashi Medical Center)
Michihiro Tanaka (Kameda Medical Center)
Welcome Reception
17:00-20:00
Room 2 Jasmine
9:00-12:00
Hands-on Seminar 1 Interventional Neuroradiology Hands-on part 1
Naoya Kuwayama(University of Toyama, Japan)
13:30-17:00
Hands-on Seminar 2 Skull Base Surgery Drilling workshop
Yoshinobu Seo(Nakamura Memorial Hospital)
Shuzo Sato (Sato clinic)
Room 3 Carnation
9:30-11:45
Hands on
12:10-13:00
First Sentence
Room 1 Crystal ballroom
Hands-on Seminar 3 Brain Surgery Anatomy workshop
13:30- 16:00
Symposium
Takashi Maruyama(Tokyo Women’ s Medical University)
Hands-on Seminar 4 Neuroendoscopy workshop
Daisuke Suyama (Department of Neurosurgery, Fuchu Keijinkai Hospital, Tokyo,Japan)
Tadashi Watanabe (Nagoya Daini Red Cross Hospital )
Yoshihiro Natori (Department of Neurosurgery, Iizuka Hospital)
Yasuhiko Hayashi (Kanazawa University Hospital)
16:00-18:00
abstract
Azmi Alias (Tunku Abdul Rahman Neuroscience Institute, Hospital)
Hands-on Seminar 5 Anatomy of Cerebral artery Wire model making Workshop
Yoshifumi Hayashi (Sunrise Japan Hospital Phnom Penh)
J o in t N e u r o s u r g ic a l C o n v en tio n 2 01 6
19
J N C 2 016
program
Program
First Sentence
Day 2 （April 8 Friday）
8:00 ∼ 8:30
Opening Ceremony
8:30 ∼ 9:00
Special Presentation 1
Kazuo Watanabe (Minami Tohoku Hospital)
Moderators : Hiroyuki Kinouchi (Yamanashi University Hospital)
9:00-10:15
Scientific Session 1 Microsurgical Decompression
Moderators : Takashi Maruyama (Tokyo Women’ s Medical University Medical Center East)
8SS1-1 Three different approaches and the stitched sling retraction technique for the microvascular
decompression procedures
Toshio Matsushima(Neuroscience Center, Fukuoka Sanno Hospital)
8SS1-2 A Significant Correlation between Delayed Cure after Microvascular Decompression and Positive
Response to Preoperative Anticonvulsant Therapy in Patients with Hemifacial Spasm
Shunsuke Terasaka (Department of Neurosurgery, Hokkaido University Graduate School of Medicine)
8SS1-3 Usefulness of vessel transposition using the tissue sealing sheet (Tachocomb) with fibrin glue for
Hands on
microvascular decompression
Yohei Otsuka(Dept. of Neurosurgery, National Defense Medical College)
8SS1-4 Examination of trigeminal neuralgia which did not improve by microvascular decompression
Satoru Hiroshima(Department of Neurosurgery、Asahikawa Medical) University)
8SS1-5 Introduction of modified techniques of microvascular decompression in patients with trigeminal
neuralgia: Recent encounters with 189 consecutive patients.
Hidetoshi Kasuya (Tokyo Women’ s Medical University Medical Center East)
10:30-11:15
Scientific Session 2 Trauma 1
Moderators : Yoshifumi Okada (Kitahara International Hospital)
8SS2-1 TRANSPORTATION OF TRAUMATIC BRAIN INJURED PATIENTS FROM REFERRAL HOSPITAL TO
TERTIARY HOSPITAL
Symposium
YEE Yit Cheng(Department of Neurosurgery, Kuala Lumpur Hospital, Malaysia)
8SS2-2
Clinical Characteristics of 8 Patients Who Had Bilateral Surgical Removal of Traumatic Intracranial
Hematoma
Yasuhiro Kuroi (Department of Neurosurgery, Tokyo Women's Medical University Medical Center)
8SS2-3 The importance of Timing & outcome in the management of Severe Head Injuries in Developing
abstract
Countriesport
Prof. K. Selvakumar (Sri Ramachandra Medical University, Chennai, INDIA)
8SS2-4 Delayed onset of intracerebral tension pneumocephalus 2 years after an anterior skull base fracture:
Case report
Vantha Tho (Jeremiah’ s Hope Center Jeremiah’ sNeurosurgical Resident, UHS)
11:15-12:30
Scientific Session 3 CVD （CEA
1
and ischemic stroke）
Moderators : Kazuo Watanabe (Minami Tohoku Hospital)
8SS3-1
Trans-diaphragmatic approach for high position carotid endarterectomy
Kojiro Wada(Dept. of Neurosurgery, National Defense Medical College)
8SS3-2
Outcome of mechanical thrombectomy after approval of stent retrievers
20
JNC2 01 6
program
8SS3-3
Surgical management of cerebral arteriovenous malformations with preoperative
NBCA embolization.
Hideyuki Ohnishi(Ohnishi Neurological Center)
8SS3-4
Surgical strategy for common carotid artery occlusion with an arterial graft.
Yasuhiro Sanada M.D. (Department of Neurosurgery, Kindai University, Osaka, Japan)
8SS3-5
PET/SPECT imaging for cerebral ischemia
Jyoji Nakagawara(National Cerebral & Cardiovascular Center)
12:30 ∼ 13:30
Luncheon seminar2 Medical Images
LS2-1
Basic Approach to Neuroimaging
Symposium Now and Future of Neurosurgery and Healthcare
SY-1
Challenge of southern TOHOKU group
Moderators : Kazuo Watanabe (Minami Tohoku Hospital)
Sadayoshi Watanabe(Tokyo General Hospital (JAPAN))
SY-2
The importance of Timing and outcome in the management of Severe Head
Injuries in Developing Countries
Prof. K. Selvakumar (Sri Ramachandra Medical University, Chennai, INDIA)
SY-3
Global Neurosurgery: the Unmet Need
Kee Park (World Federation of Neursurgical Societies (USA)
SY-4
Neurosurgery in Cambodia, the role of Cambodian Society of Neurosurgeons
in providing neurosurgical care to all Cambodians
Iv Vycheth (Preah Kossamak Hospital (CAMBODIA))
Hands on
14:00-15:40
Shigemi Kitahara (Kitahara International hospital)
Moderators : ThyLy Heng (Arakawa)
Symposium
13:30-14:00
Moderators : Yoshihumi Okada(Kitahara International Hospital)
Samuel Ng ( Senior Consultant Radiologist and Clinical Director of Medi-Rad Associates Ltd)
Poster Session 1 Tumor & Spine
Moderators : Yoshihiro Kitahama (Spine Center, Omaezaki Municipal, Hospital)
Poster Session 2 Function & Education
Moderators : Taketoshi Maehara
(Department of Neurosurgery, Tokyo Medical and Dental UniversityHospital)
Poster Session 3 Stroke & Internal
Moderators : Kyousuke Kamada (Neurosurgery, Asahikawa Medical University)
abstract
16:00-17:00
Program
First Sentence
J NC2 0 16
program
First Sentence
Room 2 Jasmine
9:00-10:30
Scientific Session 4 NF2, CSDH, and others
Moderators : Jyoji Nakagawara (National Cerebral & Cardiovascular Center)
8SS4-1 Recurrence rate of chronic subdural hematoma after twist drill craniostomy
Mami Yamashita (Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences)
Program
8SS4-2 Transcranial and epidural approach for spontaneous cerebrospinal fluid leakage due to
meningoencephalocele : two cases reports
Ryosuke Shintoku (Department of Neurosurgery, Gunma University Graduate School of Medicine)
8SS4-3 Treatment of neurofibromatosis type 2 patients with analysis of nationwide registry data in Japan
Jun Sakuma (Department of Neurosurgery, Fukushima Medical University)
8SS4-4 Measurement of intrasellar pressure for patients with pituitary adenomas associated with headache
Yasuhiko Hayashi (Department of Neurosurgery, Kanazawa University)
8SS4-5 Intra-operative rapid immunohistochemistry of brain tumors using alternating current electric field
method
Katsushi Taomoto (Department of Neurosurgery, Ohnishi Neurological Center, Japan)
Hands on
8SS4-6 Yellow-560 Fluorescence-guided Glioma Surgery
Ng Wai Hoe(Medical Director, National Neuroscience Institute)
10:30-11:30
Scientific Session 5 Pediatric Neurosurgery
Moderators : Ng Wai Hoe (National Neuroscience Institute)
8SS5-1 Indication and limitation of Neuroendoscopic surgery for Pediatric Hydrocephalus.
Kazuaki shimoji (Juntendo University Hospital)
8SS5-2 Craniosynostosis in Children : Indication and Techniques
AZMI ALIAS (HOSPITAL KUALA LUMPUR, MALAYSIA)
8SS5-3 Evaluation of intracranial volume after expansion of the posterior cranial vault distraction
osteogenesis (PVDO) in craniosynostosis patients
Takaoki Kimura(Department of Neurosurgery, Juntendo University, Tokyo, Japan)
Symposium
8SS5-4 BRAIN TUMORS IN CHILDREN: A REVIEW OF 93 CASES OPERATED IN KANTHA BOPHA CHILDREN
HOSPITAL 2012-2014
KONG Vuthy (Kantha Bopha Children’ Hospital, Phnom Penh, Cambodia)
11:30-12:30
Scientific Session 6 Surgical Strategy and Approach
Moderators : Iype Cherian (MCH Neurosurgery, Nepal)
8SS6-1 Our surgical procedure for safe and accurate antero medial temporal lobectomy
abstract
Taketoshi Maehara (Department of Neurosurgery, Tokyo Medical and Dental University)
8SS6-2 confocal endomicroscopy in neurosurgery
Cleopatra Charalampaki (Cologne Medical Center, Germany)
8SS6-3 Sylvian fissure’ s dissection according to the morphological feature of the orbital gyrus
Yasutaka Imada(Department of Neurosurgery, Yamada memorial hospital)
8SS6-4 Surgical strategy for craniopharyngiomas by hybrid surgery using endoscope and microscope
Hidehiro OKA ( Department of Neurosurgery, Kitasato University Medical Center)
22
JNC2 01 6
program
Room 2 Jasmine
14:00-15:00
Scientific Session 7 Neuroendoscopy
Moderators : Cleopatra Charalampaki (Cologne Medical Center, Germany)
First Sentence
8SS7-1 Indication and limitation of Neuroendoscopic surgery for Pediatric Hydrocephalus.
8SS7-2 Intracranial Endoscopic Neurosurgery
AZMI ALIAS (HOSPITAL KUALA LUMPUR, MALAYSIA)
Program
Tadashi Watanabe (Endoscopic combined endonasal and transcranial approach for parasellar lesions)
8SS7-3 Neuroendoscopic Surgery for Intracerebral Hematomas Using a Transparent Sheath
8SS7-4 Fully endoscopic cylinder approach for cavernous angiomas using transparent sheath
Yuichi Nagata(Department of Neurosurgery, Nagoya university)
15:00-16:00
Scientific Session 8 Trauma 2
Moderators : Kaoru Kurisu (Hiroshima University Hospital)
Daisuke Suyama(Department of Neurosurgery, Fuchu Keijinkai Hospital, Tokyo, Japan)
8SS8-2 Head-injured patients who talk and deteriorate in Japan
Takeshi Maeda (Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.)
8SS8-3 Treatment of mild traumatic brain injury by Epidural Saline and Oxygen Injection
Kiyoshi Takagi(Kashiwa-Tanaka Hospital)
Symposium
Iype Cherian (MCH Neurosurgery, Nepal)
abstract
8SS8-4 Cisternostomy in head trauma
YEE Yit Cheng(Department of Neurosurgery, Kuala Lumpur Hospital, Malaysia)
Hands on
8SS8-1 CEREBRAL PROTECTION FOR TRAUMATIC BRAIN INJURY PATIENTS
J N C 2 016
program
Day 3 （April 9 Saturday）
First Sentence
Yoko Kato(Fujita Health University Banbuntane Hotokukai Hospital)
Moderators : Iv-Vycheth
9:00-10:00
Scientific Session 9 CVD2 Aneursym
Program
8:30 ∼ 9:00
Moderators : Satoshi Iwabuchi (Toho University Ohashi Medical Center)
9SS1-1 Novel Large Cerebral Aneurysm Model Rat with Intraperitoneal Beta-AminoPropioNitril-Fumarate.
Yusuke Shimoda(Hokkaido University Graduate School of Medicine)
9SS1-2 2 cases of giant aneurysms operated via transpetrosal approach in posterior fossa.
Microanatomy and actual operative procedures
Kazumi Ohmori (Nishinomiya Watanabe Cardiovascular Center)
9SS1-3 Preoperative Simulation For Cerebral Aeurysms And Skull Base Tumor - Usefulness and Limitation Fusao Ikawa, M.D. (Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University)
Symposium
Hands on
9SS1-4 The Possibilities of Computational Fluid Dynamics for the Assist of Diagnosis and
Treatment of an Intracerebral Aneurysm.
Yoshifumi Hayashi. (Sunrise Japan Hospital Phnom Penh)
10:00-10:45 Scientific Session 10 CVD3 Aneursym
Moderators : Gopal Raman Sharma (National Academy of Medical Sciences ( NSMS), Bir H ospital, Nepal)
9SS2-1 Cerebral blood flow after acute bypass with parent artery occlusion in patients with unclippable ruptured
internal carotid artery aneurysms
Hidenori Endo(Department of Neurosurgery, Kohnan hospital, Sendai, Japan)
9SS2-2 Long-term neurological and radiological results of consecutive 63 unruptured anterior communicating
artery aneurysms clipped via lateral supraorbital keyhole mini-craniotomy
Kentaro Mori (Department of Neurosurgery, National Defense Medical College)
9SS2-3 Targeted Temperature Management for Grade V Subarachnoid Hemorrhage with Combined
Surface and Endovascular Cooling
10:45-12:15
Gen Futamura (Osaka Mishima Emergency Critical Care Center)
Scientific Session 1 1 CVD4 Aneursym and AVM
Moderators : Kentaro Mori (Department of Neurosurgery, National Defense Medical College)
9SS3-1 Transformation from intracranial acute dissecting aneurysm to chronic fusiform aneurysm
Hideaki Ono (Department of Neurosurgery, The University of Tokyo Hospital)
abstract
9SS3-2 Surgical management of cerebral AVMs
Gopal Raman Sharma (National Academy of Medical Sciences (NAMS), Bir Hospital)
9SS3-3 Surgical Strategy for Blister-like Aneurysms Originating from the Anterior Wall of the Internal Carotid
Artery
Masanori Aihara (Department of Neurosurgery, Gunma University Graduate School of Medicine)
9SS3-4 Surgical Strategies for Treatment of Giant or Large Cerebral Aneurysms ~ Bypass surgery and
Transient Cardiac Stand Still
Yoshimasa Niiya(Otaru General Hospital Department of Neurosurgery)
24
Jo int Neuro s u r gi ca l C onv e n ti on 2 0 1 6
JNC2 01 6
program
11:15-12:30
Luncheon seminar3 Neuroendoscopy
Moderators : Yoshifumi Hayashi (Sunrise Japan Hospital Phnom Penh)
LS3-1
First Sentence
13:00 ∼ 13:30
Special Presentation 4 Advancement to improve the safety and durability in neurosurgery
Program
Principles of Endoscopic Skull base surgery Tips and tricks
Sunil Verma (Karl Storz Endoscopy, India)
Hiroyuki Kinouchi
(Department of Neurosurgery Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi)
13:30-14:45
Scientific Session 1 2 Skull Base Surgery
Moderators : AZMI ALIAS (HOSPITAL KUALA LUMPUR, MALAYSIA)
9SS4-1 Safe surgical strategy for petroclival meningiomas
Moderators : Shigemi Kitahara (Kitahara Neurosurgical Institute)
Yoshinobu Seo(Nakamura Memorial Hospital)
the two
Toshio Matsushima (Neuroscience Center, Fukuoka Sanno Hospital)
Hands on
9SS4-2 Transcondylar fossa approach, transcerebellomedullary fissure approach and combined approach of
9SS4-3 Technical tips for feasible skull base surgeries
9SS4-4 Surgical strategy for skull base tumors based on preoperative 3-dimensional simulation
Hiroki Morisako
(Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, JAPAN)
9SS4-5 Surgery for cerebellopontine angle tumors
Michihiro Kohno ( Professor & Chairman, Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan )
Scientific Session 1 3 Brain Tumor 1
Moderators : Ipye Cherian (MCh Neurosurgery, Nepal)
9SS5-1 Surgical indication of combined endoscopic-microscopic surgery for skull base tumors.
Yugo Kishida(Fukushima Medical University)
Symposium
14;45 ∼ 16;00
Hidehito Kimura (Kobe University Graduate school of Medicine)
9SS5-2 Hearing preservation after acoustic neuroma surgery
9SS5-3 Treatment strategy and outcome for insular glioma in one institution
Shunsuke Tsuzuki (Department of Neurosurgery, Tokyo Women’ s Medical University)
9SS5-4 Location of the orbital tumor was deeply related to the symptom.
Yoshihiro Natori (Department of Neurosurgery, Iizuka Hospital)
abstract
Hiroshi Tokimura (Department of Neurosurgery, Kagoshima University)
J N C 2 016
program
First Sentence
16:15 ∼ 17:30
Scientific Session 1 4 Brain Tumor 2
Moderators : Hidehiro Oka (Kitasato University Medical Center)
9SS6-1 An overview of the surgical treatment of brain abscess at Jeremiah’ s Hope Center, Phnom
Sim Sokchan (Jeremiah’ s Hope Center)
Program
9SS6-2 Basics in management of micro-instruments under microscope
-how to get effective and stable use of them Kaoru Kurisu (Hiroshima University Hospital)
9SS6-3 Surgical innovation of transsphenoidal surgery for pituitary adenoma.
Kosaku Amano (Department of Neurosurgery, Tokyo Women's Medical University, Japan)
9SS6-4 Influence of pseudocapsular resection in non-functioning pituitary adenomas with a focus on
postoperative pituitary functions
Yasuyuki Kinoshita (Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University)
9SS6-5 Contribution of language mapping in glioma surgery: methodology and functional considerations in
Hands on
awake surgery.
Closing Ceremony
abstract
Symposium
17:30-18:00
Takashi Maruyama (Tokyo Women’ s Medical University)
26
JNC2 01 6
program
Room 2 Jasmine
9:00 ∼ 10:00
Scientific Session 1 5 Anatomy, Images and Pathophysiology 1
Moderators : Michihiro Tanaka (Kameda Medical Center)
First Sentence
9SS7-1 Surgical simulation of aneurysm clipping with multimodal fusion 3-dimensional computer graphics.
9SS7-2 Multi spectral imaging in aneurysm surgery.
Cleopatra Charalampaki (Cologne Medical Center, Germany)
Program
Daichi Nakagawa M.D. (Nakamura Memorial Hospital)
9SS7-3 An Innovative Neurosurgical Simulation Using Computer Graphics by Multimodal Fusion Imaging
9SS7-4 Visualization of perforating arteries on navigation with intra-arterial CT angiography in the brain tumor
surgery
Tomoyuki Kawataki (Department of Neurosurgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan)
10:00 ∼ 11:00
Integrated Time, Space, and Real
Taichi Kin (Department of Neurosurgery, The University of Tokyo Hospital)
Moderators : Cleopatra Charalampaki (Cologne Medical Center, Germany)
planning in patients with Arteriovenous malformations and Arteriovenous fistulas.
Hirofumi Nakatomi (The University of Tokyo Hospital, Department of Neurosurgery, Tokyo, Japan)
Hands on
9SS8-1 The usefulness of high-resolution three-dimensional multi-fusion medical imaging for preoperative
so called mega dolicho basilar anomaly: Clinicopathological and long term follow-up study.
Hirofumi Nakatomi (The University of Tokyo Hospital, Department of Neurosurgery, Tokyo, Japan)
9SS8-3 Super-passive language mapping combining real-time oscillation analysis with coortico-cortical
evoked potentials for awake craniotomyClinicopathological and long term follow-up study.
Kyousuke Kamada (Neurosurgery, Asahikawa Medical University)
9SS8-4 Edematous changes associated with craniopharyngioma as predictor of
9SS8-2 Giant / large fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction;
11:00 ∼ 12:15
Moderators : K. Selvakumar (Sri Ramachandra Medical University, India)
Symposium
pre- and post-hypothalamic involvement
Yasuhiko Hayashi (Kanazawa University Hospital)
9SS9-1 Intra-arterial Injection Fluorescence Videoangiography in Cerebral Arteriovenous Malformation Surgery
Hideyuki Yoshioka (Department of Neurosurgery, University of Yamanashi)
ICG.
Masayuki Gekka (Department of Neurosurgery, Hokkaido University Graduate Sch ool of Medicine)
9SS9-3 Multimodal fusion image based surgical navigation system
Toki Saito (Department of Clinical Information Engineering, Health Services Science, School of Public Health, Graduate School of Medicine, The University of Tokyo)
9SS9-4 Preoperative evaluation of meningioma with 4DCT angiography and whole brain CT perfusion
imaging: A comparative study with DSA Keiko Suzuki (Department of Neurosurgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan)
9SS9-5 Skull base technique needed for cisternal approach in a tight brain
Iype Cherian (Department of Neurosurgery College of Medical Sciences, Bharatpur, Chitwan, Nepal)
abstract
9SS9-2 The cause of incomplete cerebral aneurysm clipping on ICG videoangiography and false-negative
J N C2 0 16
program
Room 2 Jasmine
13:30 ∼ 14:00
Program
First Sentence
Nurse Session
Moderators : Yoko Kato (Fujita Health University Banbuntane Hotokukai
NS1-1
Cerebral Vasospasm ? Nursing Management
Yee Yit Cheng (Department of Neurosurgery, Kuala Lumpur Hospital, Malaysia)
NS1-2
Report of the medical internship project for Cambodian
Akemi Nishioka (Sunrise Japan Hospital, Phnom Penh, Cambodial)
14:00 ∼ 14:45
Scientific Session 1 8 Brain Tumor 3 Moderators : Hidetoshi Kasuya (Tokyo Women’ s Medical University, Medical Center East)
9SS10-1 Advances in Glioma Surgery
Ng Wai Hoe (National Neuroscience Institute (Singapore))
9SS10-2 Meningioma Surgery at Calmette hospital
Tararith Nay (Calmette Hospital, Phnom Penh, Cambodia)
9SS10-3 Implantation of neurosurgery into Cambodian society
Hands on
14:45 ∼ 15:45
Yoshifumi Okada (Kitahara International Hospital)
Scientific Session 1 9 Spine & Spinal Cord
Moderators : Kee Park (WFNS)
9SS11-1 The change of sagittal spinal alignment of lumbar spine after reposition type of spinous process splitting
posterior decompression for lumbar canal stenosis.
Keisuke Ito (Toho university ohashi medical center. Dept neurosurgery)
9SS11-2 The efficacy of interlaminar percutaneous endoscopic laminectomy (ILPEL) against lumbar canal
restenosis by the postoperative hypertrophic osteophyte.
Yoshihiro Kitahama (Spine Center, Omaezaki Municipal, Hospital)
9SS11-3 Percutaneous endoscopic lumbar discectomy for the pyogenic discitis
Takeshi Hara (Department of Neurosurgery, Juntendo university)
Symposium
9SS11-4 The operation for lumbar spinal stenosis
abstract
~Which operation shotuld you select if you a beginner ? ~
Masato Noji ( The department of Neurosurgery, Ashigarakami prefectual Hospital)
28
JNC2 01 6
program
9:00-12:00
Hands-on Seminar 6 Primary Neurosurgical Life Support (PNLS)
First Sentence
Day 4 （April 10 Sunday）
Masaaki Iwase (Kansai Medical University Takii Hospital)
Hiroshi Okudera
Program
(Department of Crisis Medicine and Patient Safety, Graduate School of Medicine, University of Toyama)
Jun Sakuma ( Department of Neurosurgery, Fukushima Medical University )
Hisato Ikeda (Department of neurosurgery, Showa university Koto Toyosu hospital)
9:00-12:00
Hands-on Seminar 7 Microvascular Anastomosis (Bypass Surgery)
Fusao Ikawa
(Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University )
13:00-16:00
Room 2 Jasmine
Hands-on Seminar 8 Spine surgery workshop
9:00-12:00
Hands-on Seminar 9 Cerebral aneurysmal clipping
Kentaro Mori (Department of Neurosurgery, National Defense Medical College)
Kojiro Wada (Department of Neurosurgery, National Defense Medical College, Japan)
Hands-on Seminar 10 Carotid Endoarterectomy (CEA)
Fusao Ikawa
(Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University )
abstract
13:00-15:00
Room 3 Carnation
Symposium
Yoshihiro Kitahama (Spine Center, Omaezaki Municipal, Hospital)
Yasuhiro Takeshima (Nara Medical University)
Masato Noji (The department of Neurosurgery, Ashigarakami prefectual Hospital)
Takeshi Hara (Department of Neurosurgery, Juntendo university)
Hands on
J NC2 0 16
posters
8PS1-1 Usefulness and histopathological changes in the preoperative tumor embolization in meningioma surgery
Katsushi Taomoto (Department of Neurosurgery, Ohnishi Neurological Center, Japan)
First Sentence
8PS1-2 The risk of aging in intracranial meningiomas surgery
Hiromi Goto (Southern TOHOKU Research Institute for Neuroscience)
8PS1-3 Post embolization neurological syndrome: one of important reaction after preoperative embolization of intracranial
and skull base tumor
Yujiro Tanaka (Neurosurgery of Tokyo Medical University)
Program
8PS1-4 Intraoperative monitoring of vestibular schwannoma
Miki HIOKI (Department of Neurosurgery, Tokyo Medical University Hospital)
8PS1-5 Installation of a Neuromate Robot for Stereotactic Surgery：Efforts to Conform to Japanese Specifications and an
Approach for Clinical Use ー Technical Notes
Toshiya Nagai (Aichi Prefectural Colony Central Hospital)
8PS1-6 Effects of fractionated radiation on murine glioma stem cell metabolism
Satoshi Fujita (Department of Neurosurgery (Ohashi), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan)
8PS1-7 Strategy of instrumental surgery and management for upper cervical spine fracture
Masaaki IWASE (Kansai Medical University Takii Hospital)
8PS1-8 The clinical results of the Percutaneous Endoscopic Lumbar Discectomy (PELD) with Electromyogram under general anesthesia.
Manabu Minami (Spine Center, Omaezaki Municipal Hospital)
8PS2-1 Treatment for vertebral artery injuries associated with cervical spine injuries.
Hirofumi Okada (Tokyo medical university, department of neurosurgery)
Hands on
8PS2-3 Trigeminal neuralgia due to compression of trigeminocerebellar artery: Report of 6 cases
Ichimasu Norio (Tokyo Medical University)
8PS2-2 Successful therapy of thalamotomy for intractable thalamic pain. Case report
Shohei Noro (Department of Neurosurgery,Asahikawa Medical University,Japan)
8PS2-5 Results of 5 years follow up in Clanioplasty using subcutaneous expander for the skin flap contracture
Hisato Ikeda (Department of neurosurgery, Showa university Koto Toyosu hospital)
8PS2-4 Report of international PNLS ( Primary Neurosurgical Life Support ) course
Masaaki IWASE (Kansai Medical University Takii Hospital)
8PS2-6 Newly revised neuroresuscitation guidelines in Japan. Resuscitation Guidelines 2015
Hiroshi Okudera (Toyama University)
8PS2-7 Concept of Primary Neurosurgical Life Support
Mayumi Hashimoto, R.N. (Department of Nursing, Kanagawa Institute of Technology)
8PS2-8 Newly developed EEG Monitoring Head Set for Neurosurgical Care
Symposium
Mie Sakamoto (Department of Crisis Medicine and Patient Safety, Graduate School of Medicine, University of Toyama)
8PS3-1 Complication Avoidance in unruptured middle cerebral artery M1 segment superior wall Aneurysm Surgery
Yasuhiro YAMADA (Department of Neurosurgery,Fujita Health University Banbuntane Hotokukai Hospital)
abstract
8PS3-2 Stroke Rehabilitation in Cambodia: A case study of stroke patient focus on relearning activities of daily life
Yusuke Hirai (Kitahara Neurosurgical Institute )
8PS3-3 A new experience with flow diverters for cerebral giant aneurysm treatment in southern Thailand: Challenge of rural area
Ittichai Sakarunchai （Prince of Songkla University, Songkhla, Thailand）
8PS3-4 The new trend of vascular hybrid neurosurgeon, is it easy?
Ittichai Sakarunchai (Prince of Songkla University, Songkhla, Thailand)
8PS3-5 PDGFR-β plays a key role in the ectopic migration of neuroblasts in cerebral stroke
Hikari Satou (TOKYO GENERAL HOSPITAL)
8PS3-6 Nutrition management and NST (Nutritional Support Team) activity for neurosurgical patients
Chie Mihara (Department of Neurosurgery, Hibino Hospital)
8PS3-7 Investigation of prothrombin time-international normalized ratio variation factor in patients treated with warfarin
Teppei Shimizu (Department of Hospital Pharmacy, Kitahara International Hospital, Tokyo, Japan)
8PS3-8 Complications of Pneumonia in acute phase adversely affect the activity of daily living in the sub-acute phase.
Masaki Nishio (Department of Rehabilitation, Kitahara International Hospital, Tokyo, Japan)
3 0 Joint Neuro s u r gi ca l C onv e n ti on 2 0 1 6
Program
First Sentence
JNC2 01 6
abstract
Symposium
Hands on
Special Presentation Speakers
J N C 2 016
First Sentence
S pecial P resentation S peakers
abstract
Symposium
Hands on
Program
Yoko KATO, M.D., Ph.D.
Present Position
Professor and chair, Department of Neurosurgery
Secretary and Consortium member of WFNS Foundation
President, Asian Congress of Neurological Surgeons (ACNS)
Chairperson of WFNS Fund-Raising Committee
Editor in Chief of Asian Journal of Neurosurgery
Exective board member of The Japan Neurosurgical Society
Cerebral Aneurysm Treatment
Professor Yoko Kato,MD.,Ph.D.
Fujita Health University, Banbuntane Hotokukai hospital, Japan
Introduction: The treatment of unruptured cerebral aneurysm is still debate either surgical clipping or endovascular
coiling. The largest randomized study preferred to perform coiling in ruptured case but equivocal in treatment
options in unruptured aneurysm. According to the complication of endovascular procedure is more than clipping,
the treatment for unruptured aneurysm is more popular for surgical procedure.
Objective: To analyze the results of clipping and coiling of unruptured cerebral aneurysms and discuss about the
advantages and disadvantages of both procedures.
Material & Methods: We enrolled 383 patients who were diagnosed unruptured cerebral aneurysm in Fujita Health
University Hospital, Japan, between January 1999 and December 2002. All patients were detected the aneurysm
by non-invasive imaging and underwent either surgical clipping or coiling. We assigned to analyze for the
patient’ s demographic data and aneurysmal characteristics in sex, age, symptomatic, location, size, shape and
anatomical related perforating arteries. We compared the outcome and complication rates of both modalities of
treatment.
Results: The method of treatment (clip or coil) was chosen following the guideline that refers to the indication of
the patient such as the posterior circulation aneurysms or complex aneurysm that located in the difficult to access,
the endovascular coiling was used to treat in these patient. After we included the outcome of both groups after
treatment, the patient of our series had morbidity and mortality rate of 1.6% and 0.52%, respectively.
Conclusions:
The morbidity after treatment of unruptured cerebral aneurysm is very low for the treatment with surgical clipping
or endovascular coiling. The endovascular coiling is suitable in the cases who cannot or difficult to approach by
direct clipping. However, the coiling also has some limitations, when the neck is wide, wall is thin or aneurysm too
small.
Joint Neurosurgical convention 2016
32
JNC2 01 6
Topic: Now and Future of Healthcare around the world
1) Current situation and the future of Japanese Healthcare
What does social development, and aging society and falling birth-rate would cause?
Hands on
After having graduated in medical department of Tokyo University,
Dr. Kitahara trained at Tokyo University Medical School Hospital.
In 1995, He opened "Kitahara International Hospital" in Hachioji, Tokyo.
As of now, He managed 5 hospitals in Japan to offer consistant healthcare service
from critical care to home care. Also, He is engaged in "Healthcare and Human Resource
Development Project" in Cambodia,
which aims to construct Phnom Penh's first international-standard critical care center and
train Cambodia's medical staff.
He is one of the presidents of this Joint Neurosurgical Congress 2016, representative of 8th
Pan-Pacific Neurosurgery Congress
Shigemi KITAHARA
Chairman, Kitahara Neurosurgical Institute, Japan, Neurosurgeon
Symposium
Shigemi kitahara, M.D., Ph.D.
Program
First Sentence
3) Healthcare business development around the world.
How we make Win-Win business between the country and the investors, with
explanation of our Cambodia project.
abstract
2) The vision and the concept of Kitahara group's Healthcare project
Healthcare as total Life Support Service
J N C 2 016
First Sentence
abstract
Symposium
Hands on
Program
Kazuo watanabe, M.D.
Kazuo Watanabe
Origin of the International Mt.BANDAI Symposium for Neuroscience and Pan-Pacific
Neurosurgery Congress
Southern TOHOKU Research Institute for Neuroscience CEO
Southern TOHOKU General Hospital CEO
Southern TOHOKU Public Welfare Enterprises Foundation (PWEF) CEO
Southern TOHOKU Kasuga Hospital CEO
Southern TOHOKU Fukushima Hospital CEO
Southern TOHOKU Hospital CEO
Southern TOHOKU Public Welfare Foundation "Ekoda-no-Mori" CEO
TOKYO MEDICAL CLINIC CEO
Membership Medical & Wellness Club "Medi-Compass Club" CEO
Southern TOHOKU Shin-yurigaoka General Hospital CEO
Japan Clinical Health Care and Welfare Association CEO (H25.6)
(NPO) Japan Coordinating Developmental Organization (JCDO) CEO
Japanese Society for Detection of Asymptomatic Brain Diseases the 3rd CEO(H20 ∼ the current director
Japan Brain Foundation Councilor
The 17th Annual Meeting of Japanese Society for Detection of Asymptomatic Brain Diseases Chairman
Japan Neurosurgical Society Adviser of Insurance Committee
Japan Neurosurgical Society Special member
Japan Neurosurgical Society Member of Medical treatment problem advisory committee
Japanese Society on Surgery for Cerebral Stroke Councilor
The Japan Stroke Society Councilor
The Japan Society of Neurosurgical Emergency Honored Guest
Japan Geriatric Neurosurgery Society Management committee
TOHOKU CVD Conference Member
International Mt.BANDAI Symposium for Neuroscience Secretary-general
Panpacific Neurosurgeon Congress Secretary-general
CNS. AANS Member
Kanto Neurosurgical Conference Adviser
Japan Neurosurgical Society Specialist
Akita University Graduate School of Medicine Docent
Peking University Guest chief professor
Punan Medical center(Shanghai) Guest professor
Department of Neurosurgery School of Medicine, Fujita Health University Clinical professor
34
JNC2 01 6
Hiroyuki Kinouchi, M.D., Ph.D.
Current position: Professor and Chairman, Department of Neurosurgery
Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
Advancement to improve the safety and durability in neurosurgery
Hiroyuki Kinouchi,, M.D.
Program
First Sentence
EDITORIAL BOARD
Cerebrovascular diseases 2014∼、Associate editor 201 5∼
Neurologia Medico-Chirurgica: Executive Editorial Board 20 1 1∼
Japanese Journal of Neurosurgery: Editor-in-chief 2009∼
Journal of Stroke and Cerebrovascular Diseases: Editorial Board 2005∼
Journal of Cerebral Blood Flow and Metabolism: Editorial Board2002 2013
University of California, San Francisco, CA, USA
University of California, San Francisco, CA, USA
Symposium
COUNCIL MEMBER
The Japan Neurosurgical Society: Board of Director,
Chair of Public Relation Committee and Research Ethics committee
Japanese Congress of Neurological Surgeons: 30th President 2009∼2010
International Society of Cerebral Blood Flow and Metabolism:
Chair of Education Committee 2009~2011, Publication Committee 2013∼2015,
abstract
ACADEMIC APPOINTMENTS
1 983-1 989 Neurosurgery Residency, Division of Neurosurgery, Tohoku University, School of Medicine
1 989-1 99 1
Visiting Assistant Research, Departments of Neurology and Neurosurgery
1 991-1 99 2
Postgraduate Research Neurosurgeon, Departments of Neurology and Neurosurgery
1992-1 995
Assistant Professor, Department of Neurosurgery, Tohoku University School of Medicine
1 995-1 997
Chief, Department of Neurosurgery, Kohnan Hospital, Sendai
1 997-2002
Associate Professor, Department of Neurosurgery. Akita University School of Medicine
2002-2003
Department of Neurosurgery, Stanford University, CA, USA
2003-2005
Associate Professor, Department of Neurosurgery, Akita University School of Medicine
2005Professor and Chairman, Department of Neurosurgery,
Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi,
20 1 5∼
Vice President of the Yamanashi University Hospital
Hands on
EDUCATION
983 M.D. Akita University School of Medicine, Akita, Japan
1987 Ph.D. Postgraduate School of Medicine, Tohoku University School of Medicine, Sendai, Japan
Program
First Sentence
J N C2 0 16
abstract
Symposium
Hands on
Hands on
36
JNC2 01 6
Coil embolization for ruptured aneurysm, retrieving clot
from acute stroke patients, putting stent at a narrow
carotid artery,,, they are all procedure of Interventional
Neuroradiology.
In this course Prof Kuwayama and other doctors teach
basic knowledge of anatomy and procedure first and then
participants move to have hands-on session.
Program
abstract
Symposium
Prof. Kuwayama have experienced the same hands-on
training all over the world and you can understand the
essence of the world of Interventional Neuroradiology.
Time: April 7 9:00-16:00
Participants: 24 (Maximum)
Course Director: Prof. Naoya Kuwayama (Toyama University)
Trainer: Prof. Satoshi Iwabuchi (Toho University Ohashi Medical Center)
Dr. Michihiro Tanaka (Kameda Medical Center)
Hands on
Interventional Neuroradiology Hands-on Course
Supporting Companies: Medtronic, Mentis
First Sentence
5th Mt. Bandai & Pan-Pacific Joint Neurosurgical Convention 2016
(JNC2016) at Phnom Penh Hotel
Hands on Seminar 1
If you want to participate in this course, please fill in the Workshop
Registration form: http://jnc2016.umin.ne.jp/program.html
or connect from this QR code.
Please email to: [email protected] or tell :
010-385-101 if there are any questions.
J NC2 0 16
First Sentence
Hands on Seminar 2
Supporting Company: Ono & Co., Ltd
J&J, Aesclup.
Skull Base Surgery Drilling Course
Program
Time: April 7 13:00-17:00
Course Director: Dr. Yoshinobu Seo (Nakamura Memorial Hospital)
Dr. Shuzo Sato (Sato Hospital)
To perform skull base surgery in safe, surgeon should simulate drilling skulls.
KEZLEX temporal bone model is a well established according the real clinical
3D data. The feeling of drilling is also simulated.
Symposium
Hands on
During this course participants can practice drilling the temporal bone, according to
the direction of skillful neurosurgeon in full of experience.
abstract
KEZLEX
38
JNC2 01 6
Brain Anatomy Course: Using 3D brain models
Time: April 7 9:30-11:45
Course Director: Dr. Takashi Maruyama (Tokyo Women’s Medical University)
To perform craniotomy for glioma or other
brain tumor, you should understand where the
tumor is locating and you should recognize the
landmark of the bone and brain.
Program
Supporting Company: Ono & Co., Ltd.
First Sentence
Hands on Seminar 3
Symposium
Hands on
During this course participants can attend the
lecture from Dr. Maruyama. After the lecture
participants can see 3D brain models,
KEZLEX, which is specially made especially
for these training course.
KEZLEX
abstract
Lecture Slide
J NC2 0 16
First Sentence
Hands on Seminar 4
Supporting Company: Karl-Storz
Ono & Co., Ltd.
Neuroendoscopy Hands-on Course
Program
Time: April 7 13:00-16:00
Course Director: Dr. Daisuke Suyama (Fuchu Keijinkai Hospital, Japan)
Dr. Tadashi Watanabe (Nagoya Daini Red Cross Hospital, Japan)
Dr. Yoshihiro Natori (Iizuka Hospital)
Neuroendoscopy is a very useful technique for brain tumor and intracerebral hematoma.
During this course participants can learn the indication of neuroendoscopy and practice the
technique of neuroendoscopy using the real machine by Karl-Storz
abstract
Symposium
Hands on
We use a model made by Ono & Co., Ltd. which is made especially for this course.
40
JNC2 01 6
Understanding 3D anatomy is very difficult. However, if
you make 3D model of it, you can enjoy studying anatomy
and naturally understand it while making.
This wire model making course is very popular in Japan and
now more than 1100 participants attends this course in the
world as well as Japan.
Program
abstract
Symposium
During this course all participants can make 1 set of the
cerebral arteries with using well-prepared materials by
wrapped wires. After making the model, you can review the
knowledge of anatomy of the cerebral arteries concisely
by Japanese neurosurgeon Dr. Michihiro Tanaka, well known as a master of neuroanatomy.
After finishing the course, you can also bring it home or your hospital and use it
in a clinical situation as a daily reference.
Time: April 7 16:00-18:00
Course Director: Dr. Yoshifumi Hayashi (Sunrise Japan Hospital Phnom Penh)
Lecturer: Dr. Michihiro Tanaka (Kameda Medical Center, Japan)
Hands on
Anatomy of Cerebral Arteries : Wire Model Making Course
Supporting Company: MEDETA Co.,Ltd
First Sentence
Hands on Seminar 5
J N C 2 016
First Sentence
Hands on Seminar 6
Primary Neurosurgical Life Support (PNLS) Course
Program
Time: April 10 9:00-12:00
Course Director: Dr. Masaaki Iwase (Kansai Medical University Takii hospital)
Prof. Hiroshi Okudera (University of Toyama)
Dr. Jun Sakuma (Fukushima Medical University)
Dr. Hisato Ikeda (Showa University Koto Toyosu Hospital)
Symposium
Hands on
PNLS (Primary Neurosurgical Life Support) is a simulation based training
systems for neurosurgical diseases. It is well organized and participants can
understand the assessment and management for emergency neurosurgical
patients. This course is certified by official organization of PNLS and wellexperienced instructors will come to teach.
abstract
T.Nakamura et. al.Asian J Neurosurg. 2011
42
JNC2 01 6
EBM
First Sentence
Hands on Seminar 7
Use Artificial vessels
abstract
Symposium
To perform microscopic neurosurgery, surgeons have to practice how to use instruments
under microscopic situation. This course is a practice for microvascular anastomosis,
which means a participant practice to suture donor artery to recipient artery. Dr.
Kimura and Dr. Ikawa are very well experienced neurosurgeons as well as many
experience of this hands-on course.
Hands on
Time: April 10 9:00-12:00
Course Director: Dr. Hidehito Kimura (Kobe University)
Dr. Fusao Ikawa (Hiroshima University)
Program
Hands-on Course for Microvascular anastomosis (bypass surgery)
J N C2 0 16
First Sentence
Hands on Seminar 8
Program
Workshop of cerebral aneurysmal clipping
using 3D artificial skull with aneurysms
Time: April 10 9:00-12:00
Course Director: Dr. Kentaro Mori, Dr. Kojiro Wada
(Department of Neurosurgery, National Defense Medical College, Japan)
Symposium
Hands on
It is our pleasure to hold the workshop of aneurysmal clipping for
young neurosurgeon in Cambodia. We have performed same workshops
over the world as a part of WFNS education course.
In this course, we will show you how to use clip applicator and clip
remover and how to clip cerebral aneurysms using 3D artificial aneurysms.
We prepare the real clip applicator and many kinds of clip.
In this course we use the products of Ono&Co., Ltd. which are
specially made for this course.
abstract
KEZLEX
44
JNC2 01 6
abstract
Symposium
This course is for the Spine Beginner, Spine Basic course.
You will have mini lectures (13:00-14:00) and Hands on seminar (14:00-16:00).
You can try to the Cervical anterior approach, Lumbar decompressions,
Lumbar fixations and Lumbar percutaneous endoscopic approaches with dry
models and real equipments..
Program
Time: April 10 13:00-16:00
Course Director: Dr. Yoshihiro Kitahama (Spine Center, Omaezaki Municipal Hospital)
Dr. Yasuhiro Takeshima ( Nara Medical University)
Dr. Masato Noji (Ashigarakami prefectual Hospital)
Dr. Manabu Minami (Omaesaki General Hospital)
Dr. Takeshi Hara (Juntendo University)
Spine Workshop
Hands on
First Sentence
Hands on Seminar 9
J NC2 0 16
First Sentence
Hands on Seminar 10
Carotid Endoarterectomy (CEA) Workshop Course
Program
Time: April 10 13:00-15:00
Course Director: Dr. Fusao Ikawa (Hiroshima University)
Dr. Hidehito Kimura (Kobe University)
abstract
Symposium
Hands on
Carotid Endoarterectomy (CEA) is a
surgery for patients with
stenosis at internal carotid artery, which
is one of a main cause of stroke.
To understand how to do CEA and
practice, participants first learn from a
lectures and then move to hands-on
session using a model of carotid artery
stenosis, which is specially made for this
practice.
46
abstract
Symposium
Hands on
L uncheon s eminar S peakers
Program
First Sentence
JNC2 01 6
JNC2 01 6
J N C2 0 16
presented by Ono co.,ltd.
First Sentence
Program
Dr. kiyoshi takaki
Treatment of normal pressure hydrocephalus (NPH) by ventriculoatrial (VA) shunt
Co-Author : Kiyoshi Takagi
1,2
1,2
Department of Neurosurgery, Kashiwa-Tanaka Hospital
Hands on
Department of Neurosurgery, Fujita Health University
Ventriculoperitoneal (VP) shunt is most frequently applied and ventriculoatrial (VA)
shunt is almost abandoned in order to treat normal pressure hydrocephalus (NPH).
However, VA shunt has many advantages such as; (1) narrow operative field that
can reduce infection rate, (2) no influence of obesity, (3) no influence of intraabdominal high pressure that may be a cause of shunt dysfunction, (4) low intraatrial pressure may guarantee constant flow, and (5) low flow resistance because
Symposium
of short catheter length. I will present the technical aspect and long terme outcome
abstract
of VA shunt.
48
J NC2 016
JNC2 01 6
presented by GE
Dr. Samuel Ng
Basic Approach to Neuroimaging
Program
First Sentence
Specialty Areas
・Magnetic Resonance Imaging
・Neuro-Radiology Imaging
Hands on
・Bone Mineral Densitometry
Medi-Rad Associates Ltd. His main areas of interest are in Advanced Brain MRI
（Magnetic Resonance Imaging), PET-MRI, CTP(Computer Tomography Perfusion) and
BMD(Bone Mineral Desitometry).
Dr. SAMUEL NG ENG SOO is a senior consultant radiologist and clinical director of
post-graduate degree in radiology from the Royal College of Radiologists in UK. He
completed his subspeciallty training in Neuroradiology at the University of Pennsylvania
Symposium
A graduate from the National University of Singapore, Dr. Ng obtained his
and Stanford University. He is also affiliated to the International Society of Clinical
dynamics in the brain, language processing and mind mapping.
MR neuro imaging : new applications benefits
Mr Frederic Henaff - Region MR Product Marketing Manager of GE Healthcare
abstract
Densitometry. He has pioneered MRI reserch in euroscience projects focusing on flow
J N C 2 016
JNC2 01 6
presented by Storz
First Sentence
Program
Dr. Sunil Verma
-Principles of Endoscopic Skull base surgery Tips and tricks
-Basic and Advance ventriculoscopy techniques in ETV and advance tumor
Name:-Sunil Verma
Senior Marketing Manager for India, Subcontinent & South East Asian countries in
abstract
Symposium
Hands on
Neuro & Spine surgery (In total i cover 18 countries in Asia)
KARL STORZ ENDOSCOPY (INDIA & ASIA Marketing ).
Education Qualification: Mechanical Engineer, and hold MBA in marketing Management.
Working in Endoscopy field since Oct, 24th, 1994, over 20 years of experiences.
Has experienced working in Ethicon Endosurgery division of Johnson & Johnson Ltd
before working in Karl Storz Endoscopy.
From 1st June1998 Joined as All India Product Marketing Manager handling marketing of all specialties
of Karl Storz till july 2005.
From July 2005 till Dec,2010, handling Marketing of Neuro & spine ,Cardio vascular & Thoracic
Surgery dept of
Karl Storz.
Promoted to Marketing Manager for India ,China & Asia on 1st Jan,2011 and started working directly
with the headquarters of Karl storz Tuttlingen ,Germany and Handling Neurosurgery & Spine surgery
dept.
Awarded as International sales ward from Storz Germany Head quarters in 2008,2009 & 2010, and
Best Marketing Manager of South East Asia Award.
Recently, Mr Sunil was invited as an International Speaker to various kind of remarkable events as
following:
- 2015 Asian-Australasian Society for Stereotactic and Functional Neurosurgery (AASSFN) Interim
Meeting
- Bali International Convention Centre (BICC), Nusa Dua, Bali, Indonesia
- Training lectures conducted in CEBU (Philippines) from 25th to 27th July,2014
abstract
Symposium
Hands on
Symposium
Program
First Sentence
JNC2 01 6
J N C 2 016
symposium
First Sentence
"Now and Future of Neurosurgery and Healthcare
Program
Moderator : Kazuo Watanabe
Sadayoshi Watanabe
Tokyo General Hospital (JAPAN)
"Challenge of southern TOHOKU group"
Hands on
K. Selvakumar
Sru Ramachandra Medical University (INDIA)
" The importance of Timing and outcome in the management
of Severe Head Injuries in Developing Countries"
Symposium
Kee Park
World Federation of Neursurgical Societies (USA)
abstract
"Global Neurosurgery: the Unmet Need"
Iv Vycheth
Preah Kossamak Hospital (CAMBODIA)
"Neurosurgery in Cambodia, the role of Cambodian Society of Neurosurgeons
in providing neurosurgical care to all Cambodians"
52
abstract
Symposium
Hands on
Scientific Session
Program
First Sentence
JNC2 01 6
J N C2 0 16
8SS 1-1
Three different approaches and the stitched sling retraction technique
for the microvascular decompression procedures
Toshio MATSUSHIMA
First Sentence
Neuroscience Center, Fukuoka Sanno Hospital
In order to successfully perform microvascular decompression (MVD) procedures for neurovascular
compression syndromes such as trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal
neuralgia (GPN), surgeons should be extremely familiar with the anatomical relationships between blood
vessels and cranial nerves and the approaches to the cranial nerves related to these syndrome. Regarding
Program
the approaches, I have used three different approaches, namely, the infratentorial lateral supracerebellar
approach for TN, the infrafloccular approach for HFS, and the transcondylar fossa approach for GPN.
Though each approach is a variation of the lateral suboccipital approach, each has a different site of bony
Hands on
opening, a different surgical direction, and a different route along the cerebellar surface. As an
incomplete decompression is one of the big problems in the MVD, I use the stitched sling retraction
technique to make the transposition of offending arteries complete. This technique is not difficult but
reliable.I will explain the anatomy necessary for the MVD, three different approaches and the stitched
sling retraction technique especially for TN.
8SS 1-2
A Significant Correlation between Delayed Cure after Microvascular Decompression
and Positive Response to Preoperative Anticonvulsant Therapy in Patients with Hemifacial Spasm
Shunsuke TERASAKA 1, Katsuyuki ASAOKA 2, Shigeru YAMAGUCHI 3, Hiroyuki KOBAYASHI 4,
Hiroaki MOTEGI 5, Masayuki GEKKA 6, Yusuke SHIMODA 7, Kiyohiro HOUKIN 8
Department of Neurosurgery, Hokkaido University Graduate School of Medicine
Department of Neurosurgery, Teine Keijinkai Hospital
1,3,4,5,6,7,8
2
Introduction - Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), the
postoperative course is varied. We retrospectively analyzed the resolution pattern of the spasm and specified predictors for
Symposium
delayed cure after MVD.Methods - This study included 114 consecutive patients with typical HFS. All of them were followed-up
for at least one year after operation. Patients were divided into three groups depending on the postoperative course: immediate
cure, delayed cure, and failure. To identify the predictive factors for delayed cure after MVD, logistic regression analyses were
applied using candidate clinical factors, such as, duration of symptom, tendency of the spasm, preoperative medical treatment
and offending vessels. Results - Among the 114 patients, 107 patients were cured. For those cured, 65 patients were classified as
immediate cure and 42 patients were classified as delayed cure. Cumulative spasm free rate at one week, one month, and 3
abstract
months after MVD was 70%, 88%, and 97%, respectively. There were no predictive factors between the cured and failure groups.
According to multivariate analysis, preoperative anticonvulsant therapy was found to be the sole significant predictive factor for
delayed cure after MVD (p = 0.025). Conclusions ? Our result of a significant correlation between delayed cure and preoperative
anticonvulsant therapy suspects that hyperexcitation of the facial nucleus plays an important role for pathogenesis of delayed
cure. If a patient who has a positive response to preoperative anticonvulsant therapy showed a persistent spasm after MVD,
reoperation should be delayed for at least 3 months after the initial operation. (254 words)
54
JNC2 01 6
8SS 1-3
Usefulness of vessel transposition using the tissue sealing sheet (Tachocomb)
with fibrin glue for microvascular decompression
Yohei Otsuka, Naoki Ootani, Terushige Toyooka, Kojiro Wada, Arata Tomiyama, Satoshi Tomura,
Hideaki Ueno, Kentaro Mori
[Introduction] Microvascular decompression (MVD) for the treatment of trigeminal neuralgia (TN) and hemifacial spasm (HFS)
has been established. In particular, the transposition technique is a standard procedure to avoid the adhesions and granuloma
First Sentence
Dept. of Neurosurgery, National Defense Medical College
around the decompression site, however, is more complex and difficult. We herein show a simple and safe MVD transposition
procedure that uses the tissue sealing sheet (TachoSil?) soaked with the fibrin glue and discuss about the usefulness of this
22 consecutive patients with TN (6 pts) and HFS (16 pts) underwent MVD with transposition procedure using TachoSil? soaked
with the fibrin glue between October 2012 and October 2015. Operations were performed according to Janneta’ s procedure.
After confirmation that the offending artery were sufficiently transposed and fixed to the dura matter of the petrosal bone using
Program
technique and surgical results. [Ptients and methods] We retrospectively reviewed medical charts and radiographical findings of
TachoSil? soaked with the fibrin glue. After operation, postoperative MRI CISS image require the evaluation of the MVD due to
In one TN case, incomplete cure was confirmed due to the petrosal vein as an offending vessel. [Conclusion] TachoSil? with
fibrin glue enable us to perform the vessel transposition easily and precisely for MVD.
8SS 1-4
Examination of trigeminal neuralgia which did not improve
by microvascular decompression
Satoru Hiroshima, Noro Shouhei, Natsuki Yamaguchi, Hiroshi Ogawa, Kyousuke Kamada
Department of Neurosurgery、Asahikawa Medical Universit
Background: Trigeminal neuralgia (TN) is a popular pathology, which induces chronic and momentary pain on one side of the
face. The origin of the pain is compression of the trigeminal nerve by arteries, veins, tumors and arachnoid adhesion. In order to
reduce the compression of TN, it is indispensable to confirm release of any compression for trigeminal nerve during operation.
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During the up to 24 month’ s follow-up, no recurrences, adhesions, or any dysfunction of cranial nerves were observed in all pts.
performed in all pts. There were no recurrent cases and severe complications. In all pts, postoperative course was uneventful.
the change of the position of the offending artery. [Results] The transposition of the offending artery were easily and safely
decompression, showing rare pathology such as tumor compression and arachnoid adhesion. Method: 29 patients with idiopathic
TN, three with symptomatic TN. Patients preoperatively underwent detailed MRI including Gd-DTPA enhanced heavy T2
weighted imaging and MR angiography. We always create three-dimensional fusion images with both sequences to visualize
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However, technology using neurophysiological monitoring is not established. Here we explain tips and pitfalls of the
offending arteries or other origins. Our original strategy for TN was to transpose the arteries, taking the fusion images account
before operation. If it was unclear to identify offending arteries, we planned to dissect arachnoid adhesion or vein transposition.
of 29 patients (82.7%) became free of pain, 4 patients suffered from mild TN after the surgery. Intraoperative findings and
postoperative MRI of them demonstrated trigeminal nerve was redundant or still distorted by adhesion or some reasons, despite
complete transposition of the arteries. Consideration: Gold standard of TN treatment was complete decompression of trigeminal
nerve. We, have to, however, pay careful attention to postoperative shapes of trigeminal nerves. In order to improve the
treatment results, we have to dissect surrounding arachnoid membrane of nerves, preserving tiny arteries. The remaining patients
showed an improved effect when the trigeminal nerve was in a straight line, indicating the importance of a straight line the
trigeminal nerve for the treatment of TN
abstract
Result: The fusion images provided preoperative simulation, which suggested the pathology of TN in all 29 patients. Although 25
J NC2 0 16
8SS 1-5
Introduction of modified techniques of microvascular decompression in patients
with trigeminal neuralgia: Recent encounters with 189 consecutive patients.
Hidetoshi Kasuya, Yasuhiro Kuroi, Shigeru Tani
Objective: Recurrence and unsuccessful rates of microvascular decompression for trigeminal neuralgia established by Janneta
have been reported to be about 20-25%. We examined whether modified techniques improve surgical results.
Materials and Methods: Based on surgery for recurrent trigeminal neuralgia and complications caused by the conventional
approach, we have applied the following modified techniques for improving success rate: not use a prosthesis but move the
compressed artery distally and attach to the dura using Teflon sheet with fibrin glue; dissect at least the medial part of the
horizontal fissure to visualize REZ of the trigeminal nerve; coagulate or move compressed veins even if arterial compression is
clear. For a reduction in complications related to cerebellar and cranial nerve injury, preserve the petrosal vein as much as
possible and do not use a retractor. Since April 2007, we have encountered 189 consecutive patients with essential trigeminal
neuralgia. Sixty-five patients were >70 in age (26-93); 128 were female; 133 involved the right side; 154 involved the second
and/or third branch of the trigeminal nerve.
Results: A prosthesis was not used in all 189; the horizontal fissure could be dissected in 136; the vein was moved or coagulated
together with transposition of the artery in 90. The main trunk of the petrosal vein could be preserved in all except for two.
Complete cure without medication was achieved in 174 patients at an average follow-up of 4 years. Facial numbness was found
in 15; hearing disturbance in 2.
Conclusion: Our modified techniques may improve surgical results.
abstract
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Tokyo Women’ s Medical University Medical Center East
56
JNC2 01 6
8SS 2-1
TRANSPORTATION OF TRAUMATIC BRAIN INJURED PATIENTS
FROM REFERRAL HOSPITAL TO TERTIARY HOSPITAL
YEE Yit Cheng
Pre- hospital management is a critical step in the overall care of acute brain injury. Early institution of
optimal care will minimize secondary injury while the patient is transported to a tertiary care facility.
Pillars of pre-hospital care are restoring and maintaining airway, breathing and circulation (ABC)
First Sentence
Department of Neurosurgery, Kuala Lumpur Hospital, Malaysia
(Dewall 2010).
Assessment of the GCS and pupillary response in pre hospital allows the emergency medical personnel to
communicate to the receiving hospital the neurological status of the patient, screen for cerebral herniation
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Hypotension accelerates secondary injury, and must be promptly recognized and treated.
Therefore, timely transport of these patients to tertiary care center is critical to a favorable outcome.
8SS 2-2
Clinical Characteristics of 8 Patients Who Had Bilateral Surgical Removal of
Traumatic Intracranial Hematoma
Yasuhiro Kuroi, Mayuko Inatsuka, Tatsuya Maegawa, Yuichi Takahashi, Naoyuki Arai, Atsushi Sasahara,
Shinji Hagiwara, Motohiro Hirasawa, Shigeru Tani, Hidetoshi Kasuya
Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
We retrospectively reviewed 8 patients requiring bilateral surgery from among 168 patients who
underwent surgery for traumatic intracranial hematoma in our institution. The mean age was 55.3years
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appropriately qualified personnel, and selection and availability of appropriate equipment.
Risk can be minimized and outcomes improved with careful planning, communication, the use of
and trend the brain injury.
surgery was 4.8% among those who had surgery of traumatic intracranial hematoma. Injuries were due to
traffic accident in 7 cases and a fall in one case. Preoperative Glasgow coma scale (GCS) were 7 or less
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(range 30-74 years) with no gender difference (4 males, 4 females). The overall frequency of bilateral
in all patients. Acute subdural hematoma (ASDH) following contralateral acute epidural hematoma
(AEDH) was seen in 2 patients. All patients had the complication of cerebral contusion. 2 patients
died. Clinical course was classified into 2 groups. (1) Simultaneous group; requiring bilateral surgery on
admission, (2) Postoperative group; requiring contralateral surgery after initial surgery. All patients in
simultaneous group died in spite of intensive treatment including surgery but 2 of 4 patients in
postoperative group had good outcomes. Early diagnosis and consecutive appropriate treatment is
indispensable in patients with bilateral traumatic intracranial hematoma, especially in postoperative
group.
abstract
showed moderate disability, 2 showed severe disability, assessed by Glasgow outcome scale (GOS), and 4
J NC2 0 16
8SS 2-3
The importance of Timing & outcome in the management
of Severe Head Injuries in Developing Countriesport
Prof. K. Selvakumar
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Sri Ramachandra Medical University, Chennai, INDIA
India is one of the most diversified countries with very high growing population, total population crossing 108 crores with daily
death of 62,389; an average of the daily birth is 86,000. It has been facing major issue an economic factor especially in 2
important areas like health & education.
My experience in the last 30 years as a Neurosurgeon, I have seen a tremendous change in the lifestyle of people and there is
large gap between various economic group, leading to lot of issues in common life.
As you are aware, a death related to trauma has been gradually increasing and has been one of the 8th deadly killing diseases in
the world today & this affects badly the economy of the country, especially in developing countries like India.
At the same time, India has the most number of accident & fatalities when compared to any other part of the world. For the past 2
And most of these fatal accidents take place in highways and grievous accidents taken place in other smaller roads. The urban
area has more accidents as per our statistics.
As you are aware, in the management of poly-trauma where head injuries has been one of the main issue where the patients who
are on unconscious state, may have a wider issue in the management. Wider & longer stay leading to lot of disturbance to the
family, leading to variable issues.
My experience in the last 3 decades in neurosurgery where an average of 8 to 10 thousand patients are seen mainly as Head
Injuries in which about 10% of them who requires ICU management, surgical care & close monitoring with regular follow-up for
a longer duration with poor GCS this will be discussed in this paper with regard to the timing of admission, the place and type of
accident, Transportation time from the accident zone to nearest hospital, Timing of the surgery, Type of Surgery, outcomes, ICU
management, Associated Injuries, Long term follow-up, Economical Factors will be discussed.
The ultimate vision to provide prompt integration of emergency services for Public Safety & society for which the Govt. is trying
to provide services with special number to dial for ambulance, so that the patient could reach the nearest hospital at the earliest
with better outcome will be discussed.
8SS 2-4
Delayed onset of intracerebral tension pneumocephalus
2 years after an anterior skull base fracture: Case report
Vantha Tho 1, Dr. Sokchan Sim 2, Dr. Yoshifumi Okada 3, Dr. Sothea Hong 4
Jeremiah’ s Hope Center Jeremiah’ sNeurosurgical Resident, UHS
Kitahara Neurosurgical Institute
4
Neurosurgical Resident, UHS
1,2
3
Pneumocephalus, the presence of air within cranial cavity, is most commonly caused by trauma, tumor,
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infection and fistulation into the intracranial cavity or secondary to neurosurgery.We describe an
unusually delayed neurological deficit from intracerebral tension pneumocephalus, following a head
trauma with anterior skull base fracture. A young 22 year -old man presented to our neurosurgical
consultation with recurrent seizures and progressive right hemiparesis.The brain CT scan without iv
contrast revealed an intrecerebral tension pneumocephalus in the left frontal lobe,nad a persistence
abstract
hole in the left anterior frontal skull base connecting to puneumocephalus.We performed a left frontal
craniotomy,and duraplasty using galeal flap to cover the bone defect .The patient has recovered gradually
from his motor deficit after this surgery,finally to the level that he can play his favorite guitar. This is a
rare case of a delayed development neurological deficit due to puneumocephalus from a “ball -valve”
effect secondary to an old anterior skull base fracture.
58
JNC2 01 6
8SS 3-1
Trans-diaphragmatic approach for high position carotid endarterectomy
Kojiro Wada, Kentaro Mori, Terushige Toyooka, Naoki Ootani, Arata Tomiyama, Satoshi Tomura,
Hideaki Ueno, Youhei Ootsuka
[introduction] We Japanese has been reported that the carotid bifurcation is one vertebral body higher than that of
Caucasian. So, we have more chance to meet high position internal carotid artery (ICA) stenosis. 30-40 % of carotid
First Sentence
Dept. of Neurosurgery, National Defense Medical College
endarterectomy (CEA) is recognized as high position which is categorized the level of the distal of internal carotid
retro-mandibular space is important. However, after opening of retro-mandibular space, styloid diaphragm is hidden
the distal ICA of high position patients. For revealing the distal ICA of high position patients, manipulation of
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artery stenosis is above the 2nd vertebral body or higher. For the safety dissection of the distal ICA, the opening of
styloid diaphragm is necessary. The styloid diaphragm is consisted 4 muscles and 2 ligaments. Both the posterior
how length we can get to dissect styloid diaphragm. [Materials and Methods] We investigated how length we can get
to cut the posterior belly of digastric muscle and the stylo-hyoid muscle which are two components of 4 muscles of
styloid diaphragm to use 14 cadaver necks. [Results] We can get 14±5.1 mm more length compare to without cut
both the posterior belly of digastric muscle and the stylo-hyoid muscle. [Discussion] The trans-styloid approach may
belly of digastric muscle and the stylo-hyoid muscle is covered the distal ICA. So, in this study, we investigated
Outcome of mechanical thrombectomy after approval of stent retrievers .
Satoshi Iwabuchi
Toho University Ohashi Medical Center
Purpose
In July 2014, stent retrievers were able to use for clot retrieval after acute ischemic stroke in Japan. We verified our experiences
of mechanical thrombectomy after approval of stent retrievers.
8SS 3-2
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be helpful to get the distal ICA of high position patients.
Results
Thirteen men and 10 women with a mean initial National Institutes of Health Stroke Scale (NIHSS) score of 19 (range, 4-32) and
mean age of 74.4 (range, 31-91) years were included in this study. Thirteen patients were treated with intravenous tissue-type
plasminogen activator (t-PA) before thrombectomy. Occlusion site were as follows: internal carotid artery 8, middle cerebral
artery 13 (M1 proximal 7, M1 distal 2, M2 3), and tandem lesion (IC and MCA) 2. Successful revascularization (>TICI IIb) rate
was 87.0% (20/23) and independent outcome (modified Rankin Scale 0-2) rate at 30 days was 39.1% (9/23). No symptomatic
intracerebral hemorrhage occurred after the procedure. Reducing time to reperfusion was associated with good clinical outcome.
Discussion
If the time to reperfusion is short, the mechanical thrombectomy in the treatment of acute ischemic stroke with major vessel
occlusion will achieve better outcome in even over 80 years old. However, the number of doctors who can perform endovascular
treatment is not enough. It is extremely important to structure the interhospital transfer system after use of intravenous t-PA
(drip, ship, and retrieve) in each medical area.
abstract
We conducted a retrospective review of 23 consecutive patients who underwent thrombectomy procedure for acute ischemic
strokes between October 2014 and January 2016. We evaluated the clinical characteristics, time course from onset to
recanalization, treatment results, and early outcome at 30 days.
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Materials and Methods
J NC2 0 16
8SS 3-3
Surgical management of cerebral arteriovenous malformations
with preoperative NBCA embolization.
Hideyuki Ohnishi 1, Yoshihiro Kuga 2, Yuji Kodama 3, Kenkichi Takahashi 4, Ryosuke Maeoka 5,
Toshiharu Murakami 6, Katsushi Taomoto 7, Hiroyuki Ohnishi 8, Ken-ichi Murao 9
Ohnishi Neurological Center
Osaka Medical college
9
Shiroyama Hospital
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1,2,3,4,5,6,7
8
During the past 14 years, we managed 123 cases of cerebral AVMs. Among these patients, we totally removed 21
AVMs in eloquent and deep seated areas combined with preoperative NBCA embolization.Our recent series of
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preoperative embolization with NBCA followed by microsurgical removal included 8 men and 13 women. Their
ages ranged 16 to 72 years with mean aged were 43.3 years. 16 cases were ruptured and 5 cases were unruptured.
Their Spetzler-Martin grade was: I, 1 case; II, 7 cases; III, 5 cases; IV, 6 cases; V, 2 cases. Preoperative
embolization successfully completed at single stage in 12 cases and the others at multiple stages. All AVMs were
removed completely at one stage without any complication and remarkable bleeding. Modified Rankin-Scale at
discharge included 0 in 10 cases, I in 4 cases, II in 2 cases, III in 1 case and IV in 4 cases. There was no worsening
case.In typical case, main feeders filled with NBCA material and surrounding tissue revealed fibro inflammatory
response by CD68 positive cells. I’ d like to present some representative cases by these techniques and discuss on
the risk and benefit of preoperative NBCA embolization following microsurgical removal of AVM. I also refer to
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the histological studies of the removed AVM.
8SS 3-4
Surgical strategy for common carotid artery occlusion with an arterial graft.
Yasuhiro Sanada, Hisashi Kubota, Amami Kato
Department of Neurosurgery, Kindai University, Osaka, Japan
Common carotid artery (CCA) occlusion is one of the challenging situations for bypass surgery. Various bypass
procedures have been reported for CCA occlusion, but systematic surgical strategy for common carotid artery
occlusion is still unclear.The most important part of surgical strategy for CCA occlusion is what artery is available
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as a donor artery. In terms of donor arteries, CCA occlusion can be categorized into three groups according to the
patency of the ipsilateral external carotid artery (ECA) and the vertebral artery (VA). In the group A, the ipsilateral
ECA is patent due to the collateral flow from other cervical arteries. In this group, we can concentrate on ECA
augmentation followed by STA-MCA bypass to treat CCA occlusion. Augmentation of ECA blood flow can be
achieved from cervical arteries with or without a radial artery graft. The group B consists of cases that the
abstract
ipsilateral ECA is occluded, but the ipsilateral VA is patent. In this setting, VA-MCA bypass with a radial artery
graft can be performed. In the group C, both of the ipsilateral ECA and the VA are occluded. Although the donor
artery should be selected from contralateral arteries in this group, the “bonnet” bypass with radial artery graft can be
performed. This categorization allows us to decide what kind of bypass surgery should be done, even with
approximately 20cm of a radial artery graft.Representative cases and practical procedures would be introduced.
JNC2 01 6
8SS 3-5
PET/SPECT imaging for cerebral ischemia
Jyoji Nakagawara, Jun Takahashi, Hidehiro Iida, Nobuo Hashimoto
Hemodynamic cerebral ischemia has been conceptually confirmed by PET imaging, and its original stages were only defined by
an elevation of oxygen extraction fraction (OEF) which indicates decreased metabolic reserve, not defined by an increase of CBV
which indicates decreased vascular reserve (VR) using CBF-SPECT. In this presentation, responses of these compensatory
reserve capacities in different type of cerebral ischemia were estimated using recent PET/SPECT studies in view point of the
First Sentence
National Cerebral & Cardiovascular Center
therapeutic time window (TTW).In penumbra, maximal increase of OEF occur to response for marked decreased CBF and
metabolic demand, but no significant increase of CBV fail to maintain cerebral circulation , TTW is extremely limited to several
circulation and metabolism, so TTW is limited to several days. In chronic misery perfusion, moderate increase of both OEF and
CBV which indicates moderate decreased VR using CBF-SPECT can maintain stage II ischemia, TTW could be opened to several
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hours. In acute misery perfusion, marked increase of OEF and limited increase of CBV can maintain critical level of cerebral
months. In long-standing misery perfusion which observed in moyamoya disease, marked increase of CBV (decreased VR) and
mild increase of OEF can maintain hemodynamic ischemia, and then OEF increase in response to the degree of progression, so
of cerebral ischemia.Hemodynamic cerebral ischemia has been defined by an increase of OEF, but the engagement of
compensatory vasodilation or decreased VR could be different between short-term and long-term compromise of hemodynamic
ischemia. Compensatory vasodilation could contribute endurable reserve for cerebral ischemia; on the contrary OEF could play
abstract
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not only endurable but also instantaneous reserve for cerebral ischemia.
TTW could be opened to several years. Compensatory reserve capacities could response with different manner in different type
J N C 2 016
8SS 4-1
Recurrence rate of chronic subdural hematoma after twist drill craniostomy
Mami Yamashita 1, Natsuko Tanoue 2, Kenichiro Tajitsu 3, Hiroto Kawano 4, Yushi Nagano 5,
Hiroshi Tokimura 6, Kazunori Arita 7
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1,2,6,7
3,4,5
Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences
Sendai Medical Association Hospital
Introduction: Surgical intervention of twist drill craniostomy for chronic subdural hematoma is a minimally invasive technique
and attainable to quick surgery. In this study, we retrospectively reviewed recurrence rate, surgical technique, and patients’
background factors in the patients who underwent evacuation of chronic subdural hematoma by this method. Materials and
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Methods: All patients treated for chronic subdural hematoma with twist drill craniostomy from April 2014 to December 2015
were analyzed in this study. In this method, craniostomy point is placed at parietal side of temporal line. After puncture of the
skull, hematoma is drained by itself. After drainage, the residual hematoma was either slowly substituted by oxygen or irrigated
by saline. All patients were classified into two groups by the difference in the order of surgical procedures received. Group A
underwent the procedure by first, the puncture, substitution by oxygen, followed by irrigation by saline. Group B, on the other
hand, in the order of puncture, irrigation, and substitution by oxygen. The recurrence rate was calculated for each group to
evaluate the possible difference in effectiveness between the two groups. The recurrence was defined as the occurrence of
hematoma on the previously operated side, needing another surgery. Results: This study included 74 patients (52 men and 22
women), and total of 86 sides’ twist drill craniostomy was performed. The recurrence rate for group A was 16.0%, 8/42 sides.
The recurrence rate for group B was 11.1%, 4/32 sides. Conclusion: Evaluation of our results showed twist drill craniostomy has
low enough recurrence rate maintaining its low mortality and morbidity. Even compared to burr hole craniotomy which is
revealed to be the most effective procedure. This study also showed a possibility that recurrence rate may be further reduced by
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same technique with difference in the order of the surgical procedures.
8SS 4-2
Transcranial and epidural approach for spontaneous cerebrospinal fluid leakage
due to meningoencephalocele : two cases reports.
Ryosuke Shintoku, Masahiko Tosaka, Masanori Aihara, Tatsuya Shimizu, Yuhei Yoshimoto
Department of Neurosurgery, Gunma University Graduate School of Medicine
We experienced two cases of skull base meningoencephalocele manifesting as severe cerebrospinal fluid (CSF) rhinorrhea.
Case1A 35-year-old man became aware of serous nasal discharge one year previously, which had gradually worsened. The nasal
discharge was diagnosed as CSF rhinorrhea. Head computed tomography (CT) showed several small depressions in the bone of
the left middle cranial fossa, and the largest depression passed through the bone to the lateral sphenoid sinus. Head magnetic
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resonance imaging (MRI) revealed that the meningoencephalocele projected to lateral sphenoid sinus, through the small bone
defect of the middle cranial fossa. Case2A 35-year-old man became aware of serous nasal discharge and repeated meningitis.
Head CT showed deficit of frontal base bone and head MRI revealed that the meningoencephalocele projected to ethmoid sinus,
through the bone defect of the frontal skull base.In case1, we performed a combined craniotomy and epidural approach without
intradural procedures using neuronavigation. Multiple meningoencephaloceles protruded into the small depressions in the middle
skull base. Small protrusions not passing through the sphenoid sinus were coagulated. The largest protrusion causing the CSF
abstract
leakage was identified by neuronavigation. This meningoencephalocele was cut. Both the dural and bone sides were closed as a
double layer to prevent CSF leakage. In case2, we first performed intradural approach, confirmed meningoencephaloceles
protruded into ethmoid sinus. We cut this meningoencephalocele, then closed both the dural and bone sides as a double layer by
epidural approach. In both cases, CSF rhinorrhea was completely stopped after the surgery.In case1, identification of the leak site
was easy with neuronavigation based on bone window CT. And in both cases, the epidural approach also has significant
advantages with double layer closure, including both the dural and bone sides. We recommend this safe and effective method
using neuronavigation.
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JNC2 01 6
8SS 4-3
Treatment of neurofibromatosis type 2 patients with analysis of nationwide
registry data in Japan
Jun Sakuma, Kensho Iwatate, Masahiro Ichikawa, Taku Sato, Yugo Kishida, Keiko Oda,
Shinya Jinguji, Masazumi Fujii, Kiyoshi Saito
Objective: Neurofibromatosis type 2 (NF2) is an autosomal-dominant genetic disease characterized by multiple, progressive, and
recurrent schwannomas and meningiomas with significant long-term morbidity and mortality. From personal experiences and
First Sentence
Department of Neurosurgery, Fukushima Medical University
nationwide registry data, we elucidate the clinical situation of NF2 patients in Japan.Methods: For 23 years, we treated 20 NF2
patients, 12 females and 8 males, with ages from 13 to 76 (median 29). Nationwide registry data of 805 NF2 patients in Japanese
oncological, and 13 neurological features.Result: A total 27 surgical procedures for various tumors were performed in 16
patients. Three patients died and 3 were lost follow-up. Bevacizumab (5mg/kg, 4 times in 2 weeks interval) was used in 7
patients. About half of the vestibular schwannomas showed shrinkage >20%, persisted for about 6 months. Registry data in Japan
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Ministry of Health, Labor, and Welfare between 2009-2013 were analyzed. The data include clinical score from 4 clinical, 5
demonstrated the following features: mean age 28 ± 16 years, male/female ratio 43%/56%, onset-age <25/>25 42%/45%
conditions. Vestibular schwannomas presented in 87% of patients, trigeminal schwannomas in 37%, and meningiomas in 43%.
Clinical score deteriorated by ? 3 points in 86% of patients over the 4-year study period. Significant risk factors for clinical
deterioration included younger age at diagnosis (p=0.002) and presence of intracranial meningioma (p=0.033), hearing loss
(p=0.001), facial paralysis (p=0.008), dysphasia/dysarthria (p=0.025), vision loss (p<0.001), and hemiparesis
(unknown 13%), and family history yes/no 24%/48% (unknown 28%). 58% of patients marked deterioration of clinical
(p=0.006).Conclusion: NF2 is a formidable disease. Our previous survey showed 10-year survival of 60% in patients with
onset-age <25. Bevacizumab treatment is effective in about half of patients. For growing tumors, we recommend early surgical
Measurement of intrasellar pressure for patients with pituitary adenomas
associated with headache
Yasuhiko Hayashi, Issei Fukui, Yasuo Sasagawa, Osamu Tachibana, Mitsutoshi Nakada
Department of Neurosurgery, Kanazawa University
[Introduction] Developmental mechanisms of headache associated with pituitary adenomas have been speculated as the extension
of the sellar dural components, such as diaphragm sellae and medical wall of the cavernous sinus, and the compression of the
trigeminal nerves in the cavernous sinus. But, there were few reports describing the measurement of the intrasellar pressure (ISP)
8SS 4-4
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resection with preserving neurological function if possible.
and the occurrence of headache.
including 11 patients manifested with headache (mean age 43.0 ys, male:female = 3:8). The radiological evaluation was
performed in the following aspects; 1) dural defects of the diaphragm sellae, 2) invasion of pituitary adenoma into the cavernous
sinus or the sphenoid sinus, 3) presence of the intratumoral hemorrhage or the cyst. Measurement of the intraoperative ISP was
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[Methods] This retrospective study included 60 patients with pituitary adenomas treated in our institutes from 2013 to 2015,
performed using with ICP Express and Sensor (Codman, Johnson & Johnson) both after opening of the small window and full
removal of the sellar floor.
significantly higher than those without headache. 3) ISP measured after full removal of the sellar floor significantly decreased
before removal. 4) Dural defects with headache were smaller that those without headache on MRI. 5) No invasion of the adenoma
into the cavernous sinus and the sphenoid sinus were found. 6) 9 out of 11 cases with headache harbored intratumoral
hemorrhages or cysts. 7) All these cases were relieved from headache after surgery.
[Conclusion] A small foramen of the diaphragm sellae superiorly, an intact medial wall of the cavernous sinus laterally can work
as a structural barrier. All these factors, recognized on MRI, may have contributed to confining the adenoma to the sellar region
and increasing ISP.
abstract
[Results] 1) Tumor sizes with headache are significantly smaller than those without headache. 2) ISP with headache was
J NC2 0 16
Intra-operative rapid immunohistochemistry of brain tumors using alternating
current electric field method
8SS 4-5
Katsushi Taomoto, M.D. 1, Hideyuki Ohnishi,M.D. 2, Yoshihiro Kuga, M.D 3, Yuji Kodama, M.D. 4,
Masato Hayashi, M.D. 5, Kenkichi Takahashi,M.D. 6, Shinji Yamamoto, M.D. 7, Yasuko Hirayama,PhD 8,
First Sentence
Takanori Hirose,M.D 9.
Department of Neurosurgery, Ohnishi Neurological Center, Japan
Dept. of Pathology, Hyogo Cancer Center
1,2,3,4,5,6,7,8
9
Intraoperative histopathological diagnosis is very important not only for the method of surgical removal but also for
intra/postoperative adjuvant therapy. Immunohistochemistry has also a critical role for correct pathological diagnosis in waver
cases of brain tumors by H&E staining.
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We examined the rapid immunohistochemistry (R-IHC) for intraoperative diagnosis of brain tumors using a recently developed
tool based on alternating current electric field.
【Material and method】77 cases of brain tumor frozen specimens were used to evaluate the intraoperative diagnostic accuracy
comparing with formalin-fixed paraffin-embedded permanent specimens of the same cases. 39 brain tumors were stoked as frozen
tissues and 38 cases were taken as fresh specimen for intra-operative rapid histo-pathological diagnosis. R-IHC was performed
using a newly developed machine (Hist-Tek: Akita EPSON & Sakura Finetek Co.Ltd). GFAP, p53, CD3, CD20, EMA, AE1/3,
CK7, CK20 and Ki-67 were used as primary antibodies.
【Results】35 gliomas, 7 malignant lymphomas, 24 meningiomas, 10 metastatic tumors and 1 chordoma were examined using
R-IHC and evaluated for diagnostic accuracy by a combination of H&E staining and R-IHC in frozen section.
Diagnostic accuracy by using GFAP was 97% in glioma and that of CD3 & CD20 was 100% each in malignant lymphoma as well
as EMA was 100% in meningioma. MIB-1 index of Ki-67 staining seemed to decrease in stoked frozen tissue compared with
fresh intra-operative specimen. AE1/3, CK7, CK20 stainings were very useful for deciding the primary lesion.
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【Conclusion】R-IHC for frozen specimens can provide useful information for intraoperative diagnosis of CNS tumors.
8SS 4-6
Yellow-560 Fluorescence-guided Glioma Surgery
Wai-Hoe NG
National Neuroscience Institute (Singapore)
Gliomas, particularly high-grade gliomas are highly invasive and infiltrative tumours. Radical excision
can reduce pressure effects and lead to symptomatic relief. Furthermore, gross total resection in gliomas
Symposium
with minimal morbidity can confer survival benefit and facilitate adjuvant therapy.
The infiltrative nature of gliomas make it difficult to distinguish between tumour and normal tissue.
Leaving remnant tumour can preclude good oncological resection and resection of normal tissue in
eloquent cortex can lead to devastating neurological deficit. 5-ALA has been used as a fluorescence
agent to guide glioma resection. It is however limited by health regulation and cost.
abstract
Yellow-560 has been used for over a decade in patients with a proven safety profile. It is also taken up
by glioma tissue and hence can be used to guide glioma surgery. We describe our experience in the use of
Yellow-560 for glioma surgery.
64
JNC2 01 6
8SS 5-1
Indication and limitation of Neuroendoscopic surgery
for Pediatric Hydrocephalus.
Kazuaki Shimoji
Juntendo University Hospital
The technological development of neuroendoscope has given an option for treating pediatric hydrocephalus without implanting a shunt. In our
institute, we have treated more than180 cases with neuroendoscope (mainly Endoscopic third ventriclostomy (ETV)) from 2000 to 2014. We
would like to show couple of cases that we had to devote a contrivance.
Cases
First Sentence
Objection
In general, ventriclo-peritoneal shunt, cyst-peritoneal shunt or the combinations of the two are the first choice for the treatment of hydrocephalus
due to DWS. On the other hand there are some reports that ETV may also be an option for this pathology. We had treated four cases during this
period. The pre-pontine cistern is narrowed due to the posterior fossa cyst, so that one should pay extra attention during the procedure. Although,
one case had to undergo multiple re-ETVs, all of the cases were shunt free.
<Myelomeningocele (MMC)>
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<Dandy-Walker syndrome (DWS)>
<Intraventricular hemorrhage (IVH) >
ETV is considered that it will not be effective while the patient is under 18 months old. We had applied ETV in patients who suffered with
hydrocephalus due to IVH in this age if the child has an obvious obstructive hydrocephalus. 2 cases out of 4 cases remained shunt free in this
cohort.
Summary
During the follow up in MMC patients many patients encounter shunt malfunction. During these conditions, we try to apply ETV instead of
simply re-shunting the patient. Anatomical abnormality of the ventricles in MMC patients makes the procedure complicated. So that careful
evaluation the MR image is important. 11 cases were treated an 63% of the cases achieved shunt free.
Craniosynostosis in Children : Indication and Techniques
AZMI ALIAS, Mohd Ali Mohd Zain, Siti Suriyati Buang, Fadzlishah Johanabbas
HOSPITAL KUALA LUMPUR, MALAYSIA
Craniosynostosis is caused by premature closure of one or more cranial sutures resulted in growth restriction of the underlying
brain, increase intracranial pressure, cranial venous outflow obstruction and disfigurement of skull in a young children.
8SS 5-2
Hands on
To achieve ” The best shunt is no shunt” , it is necessary to expand the indication for ETV. However, on the other hand, careful follow up is
necessary because not all the cases follow the same course.
This rare craniofacial malformations can be broadly classified into syndromic and non syndromic craniosynostosis eg. Apert,
face hypoplasia, hydrocephalus, Chiari malformation, platybasia with brain stem compression, proptosis (which later lead to
progressive visual impairment ) and upper airways obstruction (which can be caused by narrowing of the upper airways passage,
choanal atresia and adenoid hyperplasia).
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Crouzon, Muenke and Saethre- Chotzen . The syndromic type is also associated with more complex abnormalities such as mid
Management of craniosynostosis requires multidisciplinary approach involving various subspecialty including Neurosurgery,
surgery. Early surgery is indicated to release the intracranial pressure , reduce venous outflow obstruction and proptosis by
creating additional room for the brain to grow through cranial expansion surgery such as Fronto-orbital Advancement (FOA) and
Cranial Vault reshaping (CVR).
We describe our 10 years experience in treating children with craniosynostosis at Pediatric Institute, Hospital Kuala Lumpur,
Malaysia as a combined effort between Department of Neurosurgery and Plastic Reconstructive Surgery.
abstract
Plastic Reconstructive Surgery, pediatrician, respiratory physician, anesthesiologist, genetician, ENT, dental and maxiilofacial
J N C 2 016
Evaluation of intracranial volume after expansion of the posterior cranial vault
distraction osteogenesis (PVDO) in craniosynostosis patients
8SS 5-3
Takaoki Kimura 1, Azusa Shimizu 2, Kazuaki Shimoji 3, Masakazu Miyajima 4, Yuzou Komuro 5,
Hajime Arai 6
Department of Neurosurgery, Juntendo University, Tokyo, Japan
Department of Plastic surgery, Teikyo University, Tokyo, Japan
1,2,3,4,6
First Sentence
5
ObjectiveRecently, there are reports that posterior cranial vault distraction osteogenesis (PVDO) is useful for expanding the
posterior area of the skull to gain intracranial volume in craniosynostosis patients. This method seems that it could obtain lager
volume compared with fronto-orbital advancement (FOA).As a neurosurgical point of view, expanding this volume is important
to control intracranial pressure. In our current study, we evaluated the pre- and post-operative intracranial volume of the
Program
craniosynostosis patients who underwent PVDO.Material and Methods7 children were treated in Juntendo University Hospital
from 2011 to 2014.All cases had the expansion of PVDO and underwent 3DCT scan at pre- and post-operation. Expansion was
performed 1mm/day over 2-4 weeks and the cranium was distracted posteriorly from 20 to 30 mm.ResultsThree cases were boys
and four cases were girls. Two cases were diagnosed pancraniosynostosis and the others were Saetre-Chotzen, frontonasal
dysplasia, Apert Syndrome, plagiocephaly and trigonocephaly. They had operation at 5 to 39 month, the mean age was 23 month.
Hands on
The mean distraction length was 31.05 mm, and the mean expansion of volume was 192 cm3. The mean post-operative change
rate of intracranial volume was 121%. This increase was close to the volume expansion curve of normal children.ConclusionIn
our study the expanded volume and rate was higher than FOA. The expansion of PVDO will allow to obtain intracranial volume
and increasing intracranial volume first may exclude the obstacle for the developing brain in craniosynostosis children.The
expansion of PVDO before anterior lesion helps us to focus on reconstructing anterior lesion more cosmetically without
considering the expansion of intracranial volume by expanding anteriorly.
BRAIN TUMORS IN CHILDREN: A REVIEW OF 93 CASES
OPERATED IN KANTHA BOPHA CHILDREN HOSPITAL 2012-2014
8SS 5-4
Kong Vuthy
Kantha Bopha Children’ Hospital, Phnom Penh, Cambodia
Aims: Present the current status of the technical platform in Pediatric Neurosurgery in Cambodia and review our experience in
management of brain tumors during a period of 18 months (1st January 2012 - 30th June 2014).
Method: This is a retrospective chart review of 93 children with brain tumors inpatient hospitals KBH (Phnom Penh) and treated
surgically. The analyzes include age, sex, clinical signs, the location of the tumor, pathological types of tumors, and the results
Symposium
of post-operative follow-up.
Result: Among the 93 cases, there were 43 girls and 50 boys. 51% of brain tumors located in supratentorial area and 49% in
infratentorial region. 22 cases (24%) were malignant, 62 cases (67%) were benign. Medulloblastoma and astrocytoma are the
most frequent tumors accounted for 18% each, followed by ependymoma 17% and craniopharyngioma 14%. The short-term
results are very encouraging: Complete resection 32 cases, 23 cases subtotal resection and partial resection 2 cases. Postoperative
abstract
are uneventful in 80% of cases, death is 1 case. The symptoms-free rate was 77%. The average hospital stayed was 16 days.
During follow-up, 15 cases or 16% were recurrent, most of the cases are the six months postoperative, the mortality rate was 14%
(13 cases).
Conclusion: In Cambodia, the brain tumors in children are no longer a dead sentences. Some of which are curable by our
available neurosurgical ability, but in order to improve the prognostic of some malignant tumors we need to develop others
related fields, particularly pediatric neuro-oncology, neuro-intensive care and pediatric endocrinology.
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JNC2 01 6
8SS 6-1
Our surgical procedure for safe and accurate antero medial temporal lobectomy
Taketoshi Maehara, Motoki Inaji
Temporal lobectomy is the most common surgical procedure for patients with intractable temporal lobe epilepsy
(TLE) and unilateral focus. Almost 70 to 80 % of patients obtain seizure-free outcome. Surgical procedures for
medial temporal epilepsy is divided into antero medial temporal lobectomy and selective
First Sentence
Department of Neurosurgery, Tokyo Medical and Dental University
amygdalohippocampectomy, although recently new less invasive procedures such as hippocampal transection and
laser ablation are reported. When comparing the two major procedures, the former is easier procedure while
learn this method first. In this presentation, I present our surgical procedure for safe and accurate antero medial
temporal lobectomy using operative video. This surgical method is divided into 5 steps, I.e., craniotomy, lateral
Program
surgical outcomes and memory outcomes are almost same. Therefore, it is recommended that epilepsy surgeons
temporal resection, opening inferior horn, removal of hippocampal head along with anterior portion of amygdala,
horn by suctioning white matter just anterior and along the collateral sulcus, resection of fimbria from choroidal
fissure to anterior end of fimbria, and removal of hippocampal body after changing patient’ s position. For safe
procedure, I stress 2 points that are preservation of superior parietal sinus during lateral temporal resection, and
preservation of anterior choroidal artery during resection of fimbria. To learn safe and accurate antero medial
and removal of hippocampal body. For accurate operation, I propose 3 important points, I.e., opening of inferior
8SS 6-2
Confocal endomicroscopy in neurosurgery
Cleopatra Charalampaki
Hands on
temporal lobectomy is the first step to save patients who are suffered from medication-resistant TLE.
abstract
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Cologne Medical Center, Germany
J N C2 0 16
8SS 6-3
Sylvian fissure’ s dissection according to the morphological feature
of the orbital gyrus
Yasutaka Imada, Toru Yamada, Chie Mihara, Hitoshi Kawamoto
First Sentence
Department of Neurosurgery, Yamada memorial hospital
Background: The deep cisternal part of the sylvian fissure stem is more complex. More developed posterior orbital
gyrus（pOG）makes the dissection of that part more difficult, because adhesion between the pOG and the temporal
lobe becomes stronger and larger in that case. The purpose of this presentation is to evaluate the difficulty of the
sylvian fissure stem’ s dissection according to the morphological feature of the orbital gyrus and to demonstrate the
technical tips of the sylvian fissure’ s dissection in trans-sylvian approach.Methods: We retrospectively classified
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thirty-two patients, who underwent clipping of anterior circulation aneurysms via the trans-sylvian approach at our
institution, in three types（Type A:difficult, Type B:normal, Type C:easy）according to the degree of difficulty of
the sylvian fissure stem’ s dissection by the operative videos.Results: 5 cases were Type A, in which adhesion
between the pOG and the temporal lobe was stronger and larger, so we needed to start to dissect the sylvian fissure
from more distal portion in order to get the wide operative field. 11 cases were Type B, in which adhesion between
the pOG and the temporal lobe was strong partially. 16 cases were Type C, in which adhesion between the pOG and
the temporal lobe was little, so we could get the wide operative field easily. Conclusion: Morphological feature of
pOG is very important factor to determine the degree of difficulty of the sylvian fissure stem’ s dissection in
trans-sylvian approach. It is useful to start to dissect the sylvian fissure from more distal portion than usual in case
Hands on
which pOG has developed very much.
8SS 6-4
Surgical strategy for craniopharyngiomas
by hybrid surgery using endoscope and microscope
Hidehiro OKA, Mari KUSUMI, Koji KONDO
Department of Neurosurgery, Kitasato University Medical Center
Subjective: We describe our surgical strategy for craniopharyngioma using hybrid surgery of microscope and
neuroendoscope.Materials and methods: Ninety one patients with cranipahrynigoma were treated our Hospital (38
patients operated by only microscope from 1974 to 2000, 53 patients operated by hybrid surgery using microscope
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and endoscope from 2011 to 2012). We analyzed recurrence rate of only microscopic surgery (1974-2000) vs.
hybrid surgery. Result: Samii’ s grade of 91 patients was as follows; Grade I-1, II-16, III-37, IV-31, V-6. Expedient
surgical approaches were 40 pterional/subfrontal, 30 interhemispheric, 16 transshenoidal approaches, so on. Eight
(21%) in 38 patients were recognized tumor recurrence from 1974 to 2000 by only microscopic surgery. On the
other hand, 5 (9.4%) in 53 patients recognized tumor recurrence from 2001 to 2012 operated by hybrid surgery using
abstract
microscope and neuroendoscope. Advantage of hybrid surgery is as follows; wide and clear view, fit to deep-seated
tumors, ordinary instruments can use, microscopic surgical education to junior Neurosurgeon can do, and residual
tumor of dead space for example under optic chiasm by hybrid surgery. On the other hand, disadvantage of this
surgery is as follows; 2D, special practice is needed, narrow space, adhesion, ossified tumor, or vascular tumor.
Conclusion: We introduce expedient approaches and our hybrid surgery using microscope and neuroendoscope for
craniopharyngioma. This procedure is useful to do conventional microneurosurgery for surgical education,
moreover, it can remove residual tumor by hybrid surgery.
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8SS 7-1
Endoscopic combined endonasal and transcranial approach for parasellar lesions
Tadashi Watanabe 1, Tetsuya Nagatani 2, Kazuhito Takeuchi 3, Yuichi Nagata 4
3,4
Center for Neuroendoscopic surgery, Dpartment of Neurosurgery, Nagoya Daini Red Cross Hospital
Nagoya University
Introduction: Endoscopic endonasal approach to the parasellar lesions has become almost standard neurosurgery within the last
decade. Tumor extending superiorly or laterally can be removed by endoscopic surgery with wide surgical view angle.
Nevertheless, parasellar tumors extending far laterally beyond carotid artery or growing into the brain are hardly removed totally
First Sentence
1,2
by endoscopic endonasal approach even with extended skull base technique. On the other hand, Endoscopic minimally invasive
transcranial approaches including supraorbital approach and trans cylinder approach are effective for parasellar lesions and
lesions Methods: Endoscopic endonasal approach and endoscopic transcranial approach are performed simultaneously in one
session. Two neurosurgical teams and two endoscopic systems with two monitors are required. As the endoscopic system is
smaller than microscopic system, layout of the operation room is more simple compared with microsurgery. Small opening of
Program
intraparenchymal lesions. We report our experience of combined endonasal and transcranial approach for parasellar complicated
endoscopic transcranial surgery allows both surgical fields simple. Surgeons can talk and cooperate each other during the
other.Results: we experienced 23 combined endonasal and transcranial approach. Among them 15 surgeries were performed by
fully endoscopic surgery. 14 pituitary adenomas, 3 craniopharyngiomas, 3 chordomas, 2 meningiomas, 1 chondrosarcoma were
included. Gross total resection or subtotal resection was achieved in most of the cases. We experienced 1 case of post-operative
hemorrhage in huge pituitary adenoma, and 1 case of visual function deterioration in skull base meningioma. Conclusion: In
combined endonasal and transcranial surgery, safe and effective cooperative manipulation within two corridors are available for
surgery. Surgery proceed favourably because instruments come from different directions and surgeons can support each
giant lobular paraseller lesions. Supraorbital keyhole approach or minimum invasive cylinder approach can be combined with
Intracranial Endoscopic Neurosurgery
AZMI ALIAS
HOSPITAL KUALA LUMPUR, MALAYSIA
The technological advancement and refinement of neuroendoscopic technique has resulted in safer and effective way
of treating various pathology through the intracranial potential spaces. It allows direct visualization of the surgical
corridor, meticulous handling and assessment of intracranial spaces and its related critical structures through a
8SS 7-2
Hands on
Endoscopic endonasal approach.
outcome.
The intracranial potential spaces applicable to endoscopic Neurosurgical procedures include normal CSF spaces
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keyhole entry point resulted in minimal tissue traumatization, preservation of functions, improved cosmesis and
(e.g. ventricles, cisterns) or expanded by disease process such as Hydrocephalus, intraventricular Hemorrhage, intra
cerebral hemorrhages and penetrating injury. Pathological obstruction along CSF pathway gradually resulted in
endoscopic surgery.
Various key hole neuroendoscopic techniques will be demonstrated including endoscopic removal of the obstructive
lesion such as colloid cysts and intraventricular tumor, removal of bullet fragment in gunshot head injury,
fenestration of the intraventricular arachnoid cyst, endoscopic CSF diversion, biopsy for intraventricular and pineal
region tumor, simplification of compartmentalized hydrocephalus, evacuation of hematoma and ventricular lavage in
pyogenic ventriculitis and intra ventricular hemorrhage.
abstract
hydrocephalus and dilatation of CSF potential spaces, particularly ventricles and provides a working space for
J N C 2 016
8SS 7-3
Neuroendoscopic Surgery for Intracerebral Hematomas
Using a Transparent Sheath
Daisuke Suyama 1, Jun Hiramoto 2, Kei Yamashiro 3, Yasuhiro Yamada 4, Tsukasa Kawase 5, Yoko Kato 6
1,2
Department of Neurosurgery, Fuchu Keijinkai Hospital, Tokyo, Japan
Department of Neurosurgery, Fujita Health University Banbuntane Hotokukai Hosupital
First Sentence
3,4,5,6
Nishihara et al and Higashi et al reported on the use of a transparent sheath for neuroendoscopic surgery in surgical
evacuation of intracerebral hematomas in 2000. Between June 2000 and May 2015, we performed endoscopic
hematoma evacuation using this transparent sheath in 231 cases of intracerebral hemorrhage. These cases involved
120 putaminal, 38 thalamic, 67 lobar and 6 cerebellar hemorrhages. Surgical technique and results in cases of
Program
putaminal, thalamic, lobar and cerebellar hemorrhages are reported herein.For putaminal hemorrhage, mean
operative time was 72 minutes, mean evacuation rate was 82%, and operative complications comprised rebleeding
(n=8) and micro-AVM (n=1). For thalamic hemorrhage, mean operative time was 86 minutes, mean evacuation rate
was 76%, and operative complications comprised intraventricular venous injury (n=3). For lobar hemorrhage, mean
operative time was 45 minutes, mean evacuation rate was 82%, and operative complications comprised rebleeding
(n=3). For cerebellar hemorrhage, mean operative time was 90 minutes, mean evacuation rate was 85%, and no
operative complications were encountered. Endoscopic hematoma evacuation using transparent sheaths for
intracerebral hemorrhages involves less invasive surgery. The important points when performing this surgery were
position of burr-holes for key-hole surgery and evacuation and orientation methods using a transparent sheath.
Putaminal, thalamic, lobar and cerebellar hemorrhages each require specific techniques for safe and effective
Hands on
surgery.
8SS 7-4
Fully endoscopic cylinder approach
for cavernous angiomas using transparent sheath
Yuichi Nagata 1,Tetsuya Nagatani 2, Tadashi Watanabe 3, Kazuhito Takeuchi 4, Jonsu Chu 5,
Toshihiko Wakabayashi 6
Department of Neurosurgery, Nagoya university
Japanese Red Cross Nagoya Daini Hospital
4,5,6
Nagoya university
1
2,3
Cavernous angiomas are detected in 0.4-0.8% of the entire population in Japan. Although most of the patients with cavernous angiomas present
Symposium
no symptoms, those with repetitive hemorrhage of the angiomas or with progressive neurological deficits should be surgically treated.
Conventional microsurgery has been performed for intraparenchymal or intraventricle cavernous. The modern endoscopic surgery has been
established in many fields of neurosurgery since the early 1990s. Neuroendoscopic surgery was adopted for intraparenchymal lesions such as
intracerebral hematoma, and brain tumors.We have performed fully endoscopic cylinder approach for intraparenchymal or intraventricle
cavernous angiomas using transparent sheath in 11 cases since 2006. Transparent sheath was inserted into the brain toward the lesion using
navigation guide with minimum craniotomy and cortical incision. We used various size of sheaths, 6mm to 12mm in diameter, those are
abstract
commercially available in Japan. Surgery was performed inside the sheath with 2.7mm 0 degree endoscope, a sucker, and monoshaft forceps or
thin bipolar coagulators. All the lesions were removed as planned preoperatively. We experienced post-operative hemorrhage in a case of cystic
cavernous angioma.The most important benefits of endoscopic surgery are minimum corridor, wide surgical view with illumination of deep area.
In addition, manipulation under water (wet field surgery) is available only in endoscopic surgery. Both dry field surgery and wet field surgery are
available in this cylinder approach. In wet field surgery, the water pressure inflate the surgical cavity with clear visualization and allows
one-hand manipulation including dissection or bipolar coagulation. On the other hand, one drawback of this approach is interference of
instruments and endoscope insde the narrow corridor. Further development of the instruments is required in this field.Endoscopic cylinder
approach for intraparenchymal and intraventricle cavernous angioma is safe and feasible.
70 Jo int Neuro s ur gi ca l C onv e n ti on 2 0 1 6
JNC2 01 6
8SS 8-1
CEREBRAL PROTECTION FOR TRAUMATIC BRAIN INJURY PATIENTS
YEE Yit Cheng
Traumatic brain injury is a significant cause of mortality and mobility in patients below the age of 40
years and also a socio-economic burden to the society as well as to the country. Patients with severe head
injury require comprehensive care. The first 72 hours being an important period for prevention of further
First Sentence
brain damage. The long-term quality of life in this group of patients may be affected by, not only the
Therefore good nursing care will limit and prevent secondary damage thus reducing the probability of
Head-injured patients who talk and deteriorate in Japan
Takeshi Maeda,Takahiro Kumagawa, Masahiro Tado, Yoshino Atsuo
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. The Japan Neurotrauma Data Bank
Committee (The Japan Society of Neurotraumatology)
The clinical course of talk and deteriorate (T&D) reflects serious progression of secondary brain injury. The treatment of
traumatic brain injuries (TBI) is nothing but to prevent the secondary injury. It is important to understand the pathophysiology of
8SS 8-2
Hands on
long term disability.
Program
primary injury, but also secondary injury which may be preventable.
we reviewed 1091 patients with TBI who were registered in Japan Neurotrauma Data Bank from 2009 to 2011. One hundred
ninety two (18%) patients presented T&D, and 160 deteriorated in to coma (GCS?8). In majority cases, CT scans revealed
development of focal lesion(s) with mass effect and resultant midline sift. One hundred six patients (55%) had a subdural
Symposium
T&D in establishing the treatment of the severe TBI. In order to clarify the clinical profile of TBI patients who T&D into coma,
hematoma, 45 (23%) had an epidural hematoma, 26 (14%) had cerebral contusion / intracerebral hematoma and 15 (8%) had DBI.
The GOS was GR in 26 (14%), MD in 27 (14%), SD in 50 (26%), VS in 27 (14%), and D in 62 (32%). The latent periods to
than those reported in previous studies. One hundred forty nine patients (78%) underwent surgery, I.e. evacuation of hematoma,
and / or contusion necrotomy. The predictors for a poor outcome were a low GCS following deterioration, subdural hematoma,
and being an elderly patient. In contrast, GCS during lucid intervals, and the length of time until deterioration or until operative
intervention did not influence the final result. A majority of cases showed deterioration within 6 hours post trauma, caused by a
progressive mass effect. Deterioration into a low GCS resulted in a poor outcome, so that early operative intervention is strongly
recommended prior to the inevitable deterioration.
abstract
deterioration were ? 3 hours in 110 (57%), 3-6 hours in 33 (17%), and > 6 hours in 49 (26%), demonstrating a shorter latency
J NC2 0 16
8SS 8-3
Treatment of mild traumatic brain injury by Epidural Saline and Oxygen Injection
Kiyoshi Takagi 1, Yasuhiro Yamada 2, Kei Yamashiro 3, Daisuke Suyama 4, Tsukasa Kawase 5, Yoko Kato 6
Kashiwa-Tanaka Hospital
4
Fuchu Keijinkai Hospital
1
First Sentence
2,3,5,6
Introduction: Mild traumatic brain injury is still common complication of minor head and neck injuries such as whiplash injury.
We have reported the limitation of epidural blood patching for chronic post-traumatic headache (Eur J Med Res 12; 249, 2007).
We have developed epidural saline and oxygen injection (ESOI) treatment and and reported two cases treated by ESOI with good
outcome (Acta Neurochir Suppl 118; 293, 2013). Here we report the effectiveness of ESOI for mTBI with extended number of
Program
cases.
Patients and Treatment: We have treated 18 cases fulfilling the diagnostic criteria of mTBI. They received brain MRI.
Lumbar puncture was performed to measure the intracranial pressure (ICP) and remove cerebrospinal fluid (CSF). ESOI was
performed at lumbar level. The effectiveness was evaluated 3 months after the treatment subjectively in 6 categories; Complete
cure (C; return to normal life without headache), Excellent (E; return to normal life with occasional headache), Good (G;
diminished symptoms but still disturbed normal life), Fair (F; diminished symptoms with recurrence), No (N; no effectiveness),
Results: Mean age was 37.8 years old and 17 cases suffered from traffic accident. MRI did not show
responsive abnormalities. Mean ICP was 160.0 mmH2O. In 14 patients, CSF removal ameliorated their symptoms such as
headache and blurred vision and in one case improvement of hand movement was observed. The treatment outcome was as
follows: C = 6, E = 4, G = 6, F = 2. No patients worsened. Conclusions: ESOI can be a new and safe treatment for mTBI. Our
results indicate that the signs and symptoms of mTBI may not derive form brain damage itself but from disturbed CSF circulation
dynamics.
8SS 8-4
Cisternostomy in head trauma
Iype Cherian
COMS, Bharatpur, Nepal
Severe head injuries are one of the biggest killers in Neurosurgery, especially in thedeveloping world.
The surgical option for this condition is primitive, over hundred years old, done by residents with no
microsurgical technique..Opening cisterns in severe head injury with or without decompressive
hemicraniectomy reduces brainswelling and gives much better results.
The anatomy and physiology behind this surgery will be discussed along with some images.
abstract
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Hands on
and Poor (P; worsened).
72
JNC2 01 6
9SS1-1
Novel Large Cerebral Aneurysm Model Rat with Intraperitoneal
Beta-AminoPropioNitril-Fumarate.
Yusuke SIMODA, Takuya MORIWAKI, Naoki NAKAYAMA, Takeo ABUMIYA, Masayuki
GEKKA,Yasuhiro ITO, Shunsuke TERASAKA, Kiyohiro HOUKIN
Mechanisms of formation, developing and rupture of cerebral aneurysm (CA) are poorly understood. Unveiling this mechanism
leads to the prevention of a life-threating subarachnoid hemorrhage. Several model rats have been reported previously, but none
First Sentence
Hokkaido University Graduate School of Medicine,
is sufficient. To establish the suitable model rats are essential for the close investigation of Cas. Methods - A new model rat was
designed by modifying the Hashimoto model in that high-dose β-aminopropionitril fumarate (BAPN-F) is administrated
intraperitonealy. Seven-week-old male Sprague-Dawley rats were deeply anesthetized, the left common carotid artery was
sodium chloride and divided into 4 groups according to the weekly dose amount of BAPN-F and the breeding periods (group 1:
400mg/kg for 4 weeks, group 2: 400mg/kg for 8 weeks, group 3: 2800mg/kg for 8 weeks, group 4: 2800mg/kg for 12 weeks). We
Program
dissected and the bilateral posterior branches of the renal artery were ligated. After the operation rats were fed on food with 8%
analyzed the change of blood pressure, mortality, induction rate of Cas. Results - Continuous hypertension were induced in all
and the CA induction rate was 19.4% vs 29% (P=0.374) respectively. Cas were detected at the anterior circulation only. While
comparison the high-dose group 3(n=27) with 4(n=13), it came higher induction rate (85.2% vs 84.6%, P=0.962) with lower
mortality (7.4% vs 30.1%, P=0.053). Cas were induced at both the anterior and the posterior circulation, moreover large Cas
were detected in 9 rats at the communicating arteries. Conclusions – Intraperitonealy BAPN-F administration succeeded in high
induction rate, low mortality and establishing a novel model rat with large Cas. The minute investigation of this model has a
groups. Between the low-dose administration of group 1(n=31) and 2(n=31), the mortality rate were 12.9% vs 16.1% (P=0.719)
1,2,3
Nishinomiya Watanabe Cardiovascular Center, 4Kinki University Hospital
For most neurosurgeons, aneurysms of the posterior fossalesion are the most challenging ones carrying
the highest level of risk in surgery. In large or giant cases, especially, not only is the complexity of the
anatomy an issue, but narrow and deep operative field causes the operation to be difficult and increases
the risks. There are various approaches reported in many types of literature for posterior
fossalesionaneurysms, such as subtemporal, suboccipital, transpetrosal, combined transpetrosal approach,
and so on. However, even if combined transpetrosal approach, we cannot tell the operative space is wide
enough in such a severe case. If the patient has severe dysfunction or on severe condition, a
translabyrinth or transcochlear approach may be done in addition to combined transpetrosal approach.
Furthermore, we can expand the operative view by total petrosectomy, using the extended skull base
approach techniques.We show some photos of microanatomy of transpetrosal approachstepwisely by
using cadaver heads, and actual operative videos of 2 cases in posterior fossa operated via transpetrosal
approach. The goal of this study is to be a clue for operations in posterior fossa giant aneurysms.
Kazumi OHMORI 1, Shizuka KAMIYOSHI², Shouhei TSUCHIDA³, Yasuhiro SANADA ⁴ Symposium
2 cases of giant aneurysms operated via transpetrosal approach in posterior fossa.
~Microanatomy and actual operative procedures~
abstract
9SS1-2
Hands on
possibility of unveiling the underlying mechanism of Cas.
J N C 2 016
9SS1-3
Preoperative Simulation For Cerebral Aeurysms And Skull Base Tumor
- Usefulness and Limitation -
Fusao IKAWA, Kaoru KURISU
First Sentence
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences Hiroshima University
Introduction:Now intravascular coil embolization for cerebral aneurysm is increasing in number in all over the world. So surgical
clipping cases decreased gradually. From educational viewpoint, it’ s a serious problem. Nowadays, development of information
technology is remarkable especially in imaging diagnosis modality. So, we investigated the usefulness and limitation of
preoperative simulation for cerebral aneurysm and skull base tumor by 3D-MDCT, 3D-DSA and 3T MRI as the substitutional
tool.Subjects, Methods and Results: From 2008 to 2015, we experienced totally 212 surgical clipping and 32 skull base tumor
with preoperative simulation by CTA,DSA and MRI. 320 MDCT Aquilion ONE by TOSHIBA, DSA Allura XperFD20 by Phillips
Program
and 3T MRI MAGNETOM Skyra by SIEMENS were used. 3D Imaging server and PACKs server were same company of
FUJIFILM. The software is SYNAPSE VINCENT. Immediately after CTA imaging, we can reconstruct and simulate
preoperatively everywhere on PC medical recording system in same institute. By using CISS image, we can find the cranial nerve
identification and fusion image with CTA or DSA was useful. In case of hypervascular tumor like large hemangioblastoma,
fusion image CTA with 3D-DSA was useful for surgical strategy. Preoperative simulation by operator himself is most important,
hedge. Some small vessels were not able to visible due to increased ICP or other reasons.
Conclusions:We have evolved a strategy of surgery for difficult cerebral aneurysms and skull base tumor due to development of
information technology, however, we should pay attention to several pitfalls and remained problems.
Hands on
and imaging more uncomfortable situation is recommended. Preoperatively operator should be positive for surgery after all risk
9SS1-4
The Possibilities of Computational Fluid Dynamics for the Assist of Diagnosis and
Treatment of an Intracerebral Aneurysm.
Yoshifumi Hayashi 1, Hirotaka Yoshida², Kazutoshi Nishitani³, Yoshifumi Okada ⁴ Takanobu Yagi5, Yasutaka Tobe6, Takuma Sugiura7, Shigemi Kitahara8
Sunrise Japan Hospital Phnom Penh
Kitahara International Hospital
5
Waseda University TWIns, EBM
6,7
Waseda University TWIns
1
2,3,4,8
Symposium
To research a mechanism of initiation, growth and rupture risk of an intracerebral aneurysm, or to assist
diagnosis and treatment of an intracerebral aneurysm, nowadays the hemodynamics by Computational
Fluid Dynamics (CFD) are considered to be essential. We have been researching to make a comparison
between the pathological findings and the hemodynamics by CFD, based on the hypothesis that a blood
stream in the aneurysm is affecting the thickness of the wall. Also we have been comparing the outcome
abstract
of coil embolization according to the preoperative status of CFD.
In this presentation I will review our studies and articles related to CFD of an aneurysm and show the
future possibilities for the CFD assisted diagnosis and treatment.
74
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9SS2-1
Cerebral blood flow after acute bypass with parent artery occlusion in patients
with unclippable ruptured internal carotid artery aneurysms
Hidenori ENDO 1, Miki FUJIMURA², Hirokai SHIMIZU³, Kenichi SATO ⁴ , Takashi INOUE 5, Teiji
TOMINAGA 6
Department of Neurosurgery, Kohnan hospital, Sendai, Japn, 2,6Department of Neurosurgery, Tohoku University Graduate
School of Medicine, Sendai, Japan, ³Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan,
⁴Department ofNeuroendovascular Therapy, Kohnan Hospital, Sendai, Japan, ⁵Department of Neurosurgery, National Hospital
Organization Sendai Medical Center, Sendai, Japan
Object: Acute bypass with parent artery occlusion is alternative treatment methods for unclippable ruptured internal carotid
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1
artery (ICA) aneurysms. However, efficacy and safety of the bypass with parent artery occlusion is undetermined in light of the
hemodynamic status during early postoperative period.Methods: A retrospective review of 955 consecutive patients presenting
ruptured ICA aneurysms. All cases were treated with bypass with parent artery occlusion within 72 hours after the onset (bypass
group). We treated 26 cases with ruptured PCoA aneurysms by clipping during the same period (clipping group). Postoperative
cerebral blood flow (CBF) was assessed by IMP-SPECT, which was undertaken at two time points: 1 week (first SPECT) and 2
Program
aneurysmal subarachnoid hemorrhage (SAH) at our institution between 2006 and 2014 identified 17 patients with unclippable
weeks (second SPECT) after the onset of SAH for both groups. The cerebellar index (CI, %) was calculated as CI=
outcomes for both groups.Results: Postoperative rebleeding did not occur in any cases of both groups. First SPECT indicated that
the CI in the bypass group (CI=89.4%) was significantly lower than that in the clipping group (CI=95.8%) (p=0.0157). In
contrast, second SPECT indicated that the CI in the bypass group (CI=94.2%) did not differ from that in the clipping group
(CI=98.9%) (p=0.12). The rate of delayed cerebral ischemia did not differ between 2 groups (p=0.23). The favorable clinical
outcomes at 6 months (modified Rankin scale 0-2) were 82.4% in the bypass group and 81% in the clipping group
CBFipsilateral cerebrum/CBFbilateral cerebellum×100. We analyzed the postoperative hemodynamic status and the clinical
(p=1.00).Conclusions: Acute bypass with parent artery occlusion is safe and effective treatment methods for unclippable ruptured
Long-term neurological and radiological results of consecutive 63 unruptured anterior
communicating artery aneurysms clipped via lateral supraorbital keyhole mini-craniotomy
Kentaro MORI, Kojiro WADA, Yohei OTSUKA, Naoki OTANI, Arata TOMIAMA, Terushige
TOYOOKA
Department of Neurosurgery, National Defense Medical College
OBJECT The lateral supraorbital keyhole approach (LSOKA) for safe and complete clipping of unruptured AcomA aneurysm was
assessed by long-term neurological and radiological follow up.METHODS A total of 63 patients (aged 41–79 years, mean 64
9SS2-2
Hands on
ICA aneurysms, though transient CBF decrease was observed within one week after surgery.
treated by clipping via the LSOKA from 2005 to 2014. Neurological and cognitive functions were examined by several scales
including mRS and MMSE at a few days before the operation, at 3 months and 1 year, and then every few years after the
operation. The depression state was assessed at a few days before and 3 months after the operation using the Beck Depression
Symposium
years) harboring relatively small AcomA aneurysms (mean maximal size 6.4±1.7 mm) were prospectively and consecutively
Inventory and Hamilton Depression Scale. CT, 3DCTA, MR (DWI) imaging were performed on the day after the operation. The
state of clipping was assessed 1 year and then every few years after the operation by 3DCTA.RESULTS Complete neck clipping
was confirmed in 62 aneurysms (98.4%) and one aneurysm with residual neck (1.6%) without brain contusion or ischemic
patient showed persistent anosmia and one patient showed MMSE score 22 at 1 year after the operation. Three patients showed
mild frontalis muscle weakness, which resolved in two at 1 year. No patient showed mRS score more than 2 and all were
completely independent in daily life. The depression scores were significantly improved after surgery. The overall
operation-related mortality was 0% and overall morbidity (mRS score >2 or MMSE score <24) was 1.6%. All completely clipped
aneurysms did not show any recurrence during the mean follow up period of 4.9±2.1 years.CONCLUSIONS LSOKA to clip
relatively small unruptured AcomA aneurysm promises less invasive and durable treatment.
abstract
complication except for 2 chronic subdural hematomas (3.2%). The mean clinical follow-up period was 5.2±2.1 years. One
J N C2 0 16
9SS2-3
Targeted Temperature Management for Grade V Subarachnoid Hemorrhage
with Combined Surface and Endovascular Cooling
Gen FUTAMURA, Seiji OGITA, Makiko FUKUDA, Hitoshi KOBATA
First Sentence
Osaka Mishima Emergency Critical Care Center
Purpose: Fever in subarachnoid hemorrhage (SAH) is associated with vasospasm and poor outcome. We sought to study the
feasibility and safety of prolonged targeted temperature management (TTM) with combined surface- and endovascular-cooling in
patients with severe SAH.Methods: TTM (body core temperature at 34.0 ˚C) was initiated by surface cooling in patients with
WFNS Grade V SAH immediately after diagnosis. The ruptured aneurysm was surgically clipped as soon as feasible. After
rewarmed to 36 ˚C around the 7th postoperative day, the endovascular catheter with two cooling balloons (CoolLine Catheter)
Program
was inserted into the left internal jugular vein to maintain normothermia (body core temperature at 36.0-37.0 ˚C) with
Thermogard XP Temperature Management System (Asahi Kasei ZOLL Medical Co.,Ltd.). Prospectively collected data were
reviewed and analyzed.Results: 11 patients (6 females, mean age of 63.8 ± 6.4 years, range 50-73) were enrolled. Endovascular
cooling was initiated 8.0 ± 1.4 days after admission on average (range 6-11 days) and continued for 7 days. Dexmedetomidine
was administered for shivering control and acetaminophen was added to avoid rebound fever in 10 patients. No patients showed
catheter-related sepsis nor thromboembolic events occurred. After removal of cooling catheter, one patient developed
vasospasm-related cerebral infarction and another patient suffered fatal bacterial meningitis in relation to spinal drainage
placement. The outcome at 3 months was; good recovery, 2; moderate disability, 5; severe disability, 1; vegetative state, 1; death,
2. Conclusion: Prolonged TTM was safely performed in patients with SAH. Antipyretics and shivering control was needed during
endovascular cooling to reduce fever burden.
abstract
Symposium
Hands on
clinical or radiological findings suggesting vasospasm or new-onset cerebral infarction during endovascular cooling. Neither
76
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9SS3-1
Transformation from intracranial acute dissecting aneurysm
to chronic fusiform aneurysm
Hideaki ONO, Hirofumi NAKATOMI, Seijiro SHIMADA, Masaaki SHOJIMA, Nobuhito SAITO
Results
Age of the 4 patients ranged from 40 to 49 years at initial onset. There were 3 men and 1 woman. Initial manifestations were
headache in two cases, dizziness, and cerebral infarction. There was no hemorrhage at onset. All aneurysms were located at
vertebral artery. Managements of the acute dissecting aneurysms were medical treatment in three cases and endovascular
trapping in one case. Follow-up periods ranged from 3 to 20 years. Treatment at the time diagnose as chronic fusiform aneurysm
was proximal clipping in three cases, endovascular proximal occlusion in one case, and medical treatment in one case.
Conclusion
In this study, we reported four cases we could follow from initial acute dissecting aneurysm to chronic fusiform aneurysm. The
development of chronic fusiform aneurysm from acute dissecting aneurysm is rare according to our previous study of 143
patients with intracranial arterial dissections in which only one patient developed a large dolichoectatic aneurysm. Although
Program
Methods
We treated four patients with chronic fusiform aneurysm whose initial onset of acute dissecting aneurysm was diagnosed before.
Medical records including all imaging studies were reviewed.
Introduction
Fusiform cerebral aneurysms can be divided into two clinical categories on the basis of their clinical course and pathological
findings, acute dissecting aneurysms and chronic fusiform aneurysms such as dolichoectasia. Pathophysiology of chronic
fusiform aneurysms remains largely unknown while the primary causes of acute dissecting aneurysm turned out to be disruption
of internal elastic lamina. Although some studies indicate the transformation from acute dissecting aneurysms to chronic fusiform
aneurysm, there are few reports actually showed that relationships.
First Sentence
Department of Neurosurgery, The University of Tokyo Hospital,
acute dissecting aneurysm is not responsible for all chronic fusiform aneurysm, breakdown of a restoration process of acute
National Academy of Medical Sciences ( NAMS ), Bir Hospital, Kathmandu, Nepal
Cerebral arteriovenous malformations ( AVMs ) are one- seventh as common as cerebral aneurysms. 50% of death
of patients with cerebral AVMs are due to intracranial hemorrhage. There are different modalities of treatment of
cerebral AVMs which include microsurgery, radiosurgery and embolisation. In experienced hands best treatment
option is microsurgical resection that usually makes the patient disease free immediately and prevents future
bleeding. Aim of this study is to discuss the outcome of microsurgical resection of cerebral AVMs in our institute.
Over a period of nearly four years, between November 2009 and July 2015, we performed microsurgical excision of
cerebral AVMs on 28 patients at our institute. Follow up period ranged from 8 months to 5 years and surgical
outcome was measured by GOS.
The male female ratio was 1:0.26 and mean age was 30. 25 patients were presented with intracerebral hematoma (
ICH ) and 3 patients with seizure disorder. On cerebral angiogram 2 patients had Spetzler – Martin grade I, 18
patients had grade II, 7 had grade III and 1 had grade IV. 26 AVMs were located in supratentorial and 2 in
infratentorial region. One patient had developed intracerebral haematoma as a postoperative complication.
Favorable outcome after surgical excision was achieved in 85.7% , 14.3% were severely disabled and there was no
mortality.Postoperative CT angiogram showed no residual lesions.
Surgical excision is the best treatment option for cerebral AVMs except giant AVMs which requires multimodality
treatment approaches.
Gopal Raman Sharma, Rajiv Jha, Prakash Bista
Symposium
Surgical management of cerebral AVMs
abstract
9SS3-2
Hands on
dissecting aneurysm may be result in chronic fusiform aneurysm formation.
J NC2 0 16
9SS3-3
Surgical Strategy for Blister-like Aneurysms Originating
from the Anterior Wall of the Internal Carotid Artery
Masanori Aihara, Tatsuya Shimizu, Ryosuke Shintoku, Yuhei Yoshimoto
Hands on
Program
First Sentence
Department of Neurosurgery, Gunma University Graduate School of Medicine
Patients and MethodsTherapeutic strategy for blood blister-like aneurysm (BBA) in our hospital is firstly
performance of high-flow bypass (HFB) in the acute stage of rupture, followed by aneurysm clipping with
preservation of the internal carotid artery if possible, or trapping or obliteration of the parent vessel proximal to the
aneurysm if aneurysm clipping is difficult. The therapeutic approaches and results were evaluated in 13 patients
with subarachnoid hemorrhage caused by BBA during the past 5 years. We report our treatment results.ResultsFour
of the 13 patients were males, and mean age was 52 years. Four patients underwent aneurysm clipping. One of these
four patients did not receive HFB and developed brain infarction due to postoperative cerebral vasospasm. Nine
patients underwent trapping or parent vessel obliteration proximal to the aneurysm, and four of these nine patients
developed brain infarction. Brain infarction affected the outcome in two of the four patients, and one of these two
patients did not receive HFB. Postoperative rebleeding occurred in one patient treated by parent vessel obliteration
proximal to the aneurysm. Outcome at 3 months after the operation was modified Rankin scale score 2 or less in 10
patients, and score 3 or more in 3 patients.DiscussionAneurysm trapping is considered to be the most reliable
treatment strategy for BBA. Aneurysm clipping can be performed but carries the risk of parent vessel occlusion, so
combination with HFB is strongly encouraged as a countermeasure against postoperative cerebral vasospasm. Parent
vessel obliteration proximal to the aneurysm combined with HFB has uncertain preventive effects against rebleeding
because blood flow volume of the bypass and pattern of the collateral circulation are vary in individuals, so analysis
of further cases is required.
9SS3-4
Surgical Strategies for Treatment of Giant or Large Cerebral Aneurysms
~ Bypass surgery and Transient Cardiac Stand Still ~
Yoshimasa Niiya 1, Masato Kawabori 2, Motoyuki Iwasaki 3, Shoji Mabuchi 4, Kiyohiro Houkin 5
Otaru General Hospital Department of Neurosurgery, 5OHokkaido University graduate school of Medicine Department of
Neurosurgery
1,2,3,4
Introduction:In clipping surgery for large cerebral aneurysms, transient deflation of the cerebral aneurysm is
helpful. There are several ways for flow control of parent artery. In some cases with giant aneurysms, bypass
Symposium
surgery is needed when temporary occlusion of the parent artery is prolonged or when parent artery can not
preserved. Aims: We describe our surgical strategies for giant or large cerebral aneurysms.Methods: We usually use
temporary occlusion of the parent artery to reduce the pressure of the large aneurysm. However, parent artery
occlusion might not be feasible in some case. For such cases, we used a bolus injection of adenosine to provoke a
short period of cardiac arrest. We also used tachypacing for transient cardiac output reduction as an alternative way.
ECA- ICA high flow bypass was mainly used for permanent occlusion of the ICA in cases with a giant aneurysm.
abstract
Results: 320 consecutive patients with cerebral aneurysms (ruptured: 147, unruptured: 173) were surgically treated
between 2007 and 2015. In these, 26 patients underwent microsurgery with transient cardiac stand still. We
observed 3–40 seconds of cardiac arrest and noted remarkable softening or collapse of the aneurysms in all 26 cases.
15 patients were treated with high flow bypass graft for replacement of parent artery. Conclusions: Adenosine
injection and tachypacing facilitated safe and quick dissection of the aneurysm and clip application. These methods
can control arterial flow pressure and are quite useful when temporary occlusion of the parent artery is not feasible.
Bypass surgery is effective if direct neck clipping is difficult.
78
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9SS4-1
Safe surgical strategy for petroclival meningiomas
Yoshinobu SEO, Keiji HARA, Shusaku NORO, Masana MAEDA, Hirohiko NAKAMURA
[Introduction] Transpetrosal approach for skull base tumors, such as petroclival meningiomas, is more complicated than other
approaches. One of hazardous complications is injury of venous system. Cranial nerve injury also deteriorates quality of life. It
goes without saying that the pia mater and perforating arteries around the brain stem should be preserved. In order to make it
simpler and safer, the procedure should be arranged. [Materials and Methods]Since 2006 through 2014, we experienced 226 skull
First Sentence
Nakamura Memorial Hospital
base tumors by lateral skull base approaches. Of 226, we carried out transpetrosal approach in 28 cases. Three-dimensional
computed tomographic angiography and magnetic resonance imaging (constructive interference in steady state, diffusion tensor
manner of dural incision was changed individually to preserve main drainage of superficial middle cerebral veins, such as the
sphenopetrosal vein and sphenobasal vein, and also to preserve the petrosal veins. We took procedural steps during removing the
Program
imaging) were carried out pre-operation in all cases, which can detect the veins, arteries, and cranial nerves around tumor. The
tumor. We compartmentalized the tumor into 4 parts and removed tumor systematically. First part consisted of tumor above the
Ivth nerve. Second part was tumor between the Ivth nerve and the Vth. Third part was between Vth and VII-VIII complex.
[Conclusions] Preoperative imaging and systematic procedure of tumor removal were very useful in traspetrosal approach for
tumors around the petrosal apex.
9SS4-2
Transcondylar fossa approach, transcerebellomedullary fissure approach
and combined approach of the two
Toshio MATSUSHIMA
Neuroscience Center, Fukuoka Sanno Hospital
When I started to use the lateral foramen magnum approach, I had difficulties in removing the bone in the lateral
foramen magnum because I did not have any intraoperative anatomical landmarks. I started to use the posterior
Hands on
Karnofsky performance status (KPS) was significantly better than preoperative mean KPS (86.1 vs. 81.4, p=0.028).
hazardous complications. [Results] In 28 cases with transpetrosal approach, no case was deteriorated. Postoperative mean
Fourth, the last part was below the VII-VIII complex. We were able to preserve cranial nerves, perforators, and veins without any
condylar fossa to the junction of the sigmoid sulcus and the jugular foramen in the boundary between the jugular
tubercle and the occipital condyle. I realized that the canal could be a good landmark during removal of the bone.
Then, I proposed the transcondylar fossa approach (trans-CF App.), in which the condylar fossa and the posterior
Symposium
condylar canal as an anatomical landmark. The canal containing the emissary vein courses from the bottom of
half of the jugular tubercle were removed. Through the approach I only remove the jugular tubercle superior to the
condyle. In most cases, however, this approach can be applicable. We have used the approach mainly for VA
fissure approach (trans-CMF App.), which I proposed originally for removal of the fourth ventricular tumors located
in the midline. Since the CMF is gradually continuous to the cerebellomedullary cistern (CMC), I started to open
the almost entire unilateral CMF for removal of the tumors extending from the fourth ventricle to the CMC. Now I
use the unilateral trans-CMF App., the almost entire opening of the unilateral CMF, combined with the trans-CF
App., to obtain a wide surgical field for vascular lesions in the CMC. Along with the surgical anatomy, I am going
to explain the trans-CF App., trans-CMF App. And the combined approach of the two.
abstract
aneurysms and most of foramen magnum tumors. On the other hand, I have developed the transcerebellomedullary
J N C2 0 16
9SS4-3
Technical tips for feasible skull base surgeries
Hidehito KIMURA, Eiji KOHMURA
First Sentence
Kobe University Graduate school of Medicine
OBJECTIVE: Recent advances in skull base surgery have decreased surgical morbidity and mortality not only in
removing skull base tumors but also treating deeply situated vascular lesions. There should be various kinds of
technical tips to be learned and inherited. Some of them, of course, may be learned from textbooks, practical
surgeries, and operative videos, in which the experts demonstrate the cutting edge of skull base surgery.
Additionally, we think the most effective way to acquire skull base technique is to perform a simulated surgery
Program
using a cadaver head, which plays an important role not only in understanding micro-skull base anatomy but also
mastering surgical techniques. We have annually cadaver dissection course for skull base surgery at our university
hospital in order to educate young neurosurgeons.METHOD: In this presentation, various technical tips will be
demonstrated in performing basic skull base surgeries, such as anterior clinoidectomy, exposure and drilling of
middle fossa rhomboid, and mastoidectomy showing both in the cadaver head and actual surgery.RESULTS:
Cadaver head always gives us clear bloodless surgical field, which facilitate us to visualize and understand the
normal microanatomy. Unfortunately this leads us to misunderstanding as if we became a skillful surgeon. However,
we can never obtain clear surgical field in the practical surgery without indomitable maneuver for hemostasis. The
technical tips for hemostasis may be learned only by the practical surgery.CONCLUSIONS: Accurate understanding
Hands on
of skull base microanatomy and precise maneuver are essential for the safe and reliable skull base surgery.
9SS4-4
Surgical strategy for skull base tumors based on preoperative 3-dimensional
simulation
Hiroki MORISAKO, Takeo GOTO, Kenji OHATAN
Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, JAPAN
Objective : Skull base tumors are among the most challenging intracranial lesions to treat surgically. The
purpose of this paper is to report on our presurgical simulation technique using a 3D computer graphics
Symposium
model for skull base surgery.Methods : We performed simulation prior to surgery in patients with skull
base tumors. The 3D computer graphics models for simulation were composed of the brainstem,
cerebrum, cerebellum, tentorium, cranial nerves, vessels, and skull individually created by the image
analysis, including segmentation, surface rendering, and data fusion for data collected by MRI and CT.
Virtual simulation was performed by computer-aided design software to imitate the surgical procedures
abstract
of bone drilling and retraction of the cerebrum and cerebellum. The findings were compared with
intraoperative findings.Results : Surgical planning and simulation operation of all cases were performed
as well. The real operations of all patients were conducted according to the simulation with well
outcomes.Conclusion : According to the presurgical virtual simulation, neurosurgeons could get more
anatomic information about skull base tumors and its surrounding important structures, and choose the
best approach for tumor resection, which would lead to better prognosis for patients.
80 Joint Neuro s ur gi ca l C onv e n ti on 2 0 1 6
JNC2 01 6
9SS4-5
Surgery for cerebellopontine angle tumors
Michihiro Kohno, MD, PhD
【Results】In acoustic neuroma surgery, overall functional preservation rate of the facial nerve (House and Brackmann grade 1 or
2 at 1 year after surgery) was 98% and hearing preservation rate was 62% with a 98% mean resection rate. In most of all
meningioma cases, tumor was removed extensively, and functional facial nerve preservation rate of 1year after surgery was 97%,
hearing function improved in 34%, and worsened in 18% of patients postoperatively.
abstract
Symposium
Hands on
【Conclusions】Selecting an appropriate surgical approach and using intraoperative continuous monitoring of evoked facial nerve
EMGs are useful to increase the tumor excision rate while avoiding severe postoperative facial nerve palsy in CPA tumor
surgery. Even in a case in which preoperative hearing function was poor, we should avoid selecting a translabyrinthine approach,
with a hope for postoperative hearing improvement.
Program
【Methods】My personal surgical experience of cerebellopontine angle tumors is 1341 cases including 974 vestibular
schwannomas, 132 other schwannomas, 137 meningiomas, and 98 other kinds of tumors. Retrosigmoid approach was used in
vestibular schwannoma surgery in 95% of our series, in contrast with the other CPA tumors, in which various approaches were
selected (retrosigmoid: 32%, transmastoid: 30%, middle cranial fossa: 29%, para- / transcondylar: 9%). Matoidectomy procedure
was used in 175 cases, middle cranial fossa approach in 163, combined transpetrosal approach in 74 cases. I have been using
strict intraoperative continuous facial nerve monitoring in vestibular schwannoma surgery, which is a method for checking EMG
【Objective】Surgery for cerebellopontine angle (CPA) tumors is very difficult to obtain good surgical results, and it requires tips
and devices to achieve both high resection rate and high preservation ratio of cranial nerves function.
First Sentence
Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
J N C2 0 16
9SS5-1
Surgical indication of combined endoscopic-microscopic surgery
for skull base tumors.
Yugo KISHIDA, Kenichiro IWAMI, Kiyoshi SAITO
First Sentence
Fukushima Medical University
Object ： Combined endoscopic-endonasal and microscopic-transcranial surgery may improve radical
resection rates of skull base tumors. On the other hand, there are several issues such as complicated
setup, restriction of head position and invasiveness. We present detailed methods and indication of
combined endoscopic-microscopic surgery.Methods ： 8 combined endoscopic-microscopic surgeries were
Program
performed in 7 patients between 2010 and 2016. Skull base reconstruction and separation of exposed
structures from nasal cavity were performed using galeal flap and nasomucosal flap.Results:Posterolateral
region of foramen lacerum was approached via transcranial route, and inferomedial or contralateral
Hands on
lesions were resected via endonasal corridor. Combined surgery was helpful for identifying anatomical
landmarks and residual tumors especially in deep region. Gross total removal of tumors were achieved in
6 surgeries, whereas 2 severe complications were observed(brains stem infarction and infection).
Conclusion:Combined surgery is useful for improving safety and radical resection of a tumor surrounding
important structures because of two different visual axis reducing blind corners.
9SS5-2
Hearing preservation after acoustic neuroma surgery
Hiroshi TOKIMURA, Natsuko TANOUE, Hitoshi YAMAHATA, Sei SUGATA, Kennichiro TAJITSU,
Mika HABU,Kazunori ARITA
Department of Neurosurgery, Kagoshima University
Background:The aim of this study was to analyze the effect of acoustic neuroma microsurgery via the retrosigmoid approach with
special reference to the postoperative hearing outcome.Patients and Methods:A total of 38 among 106 consecutive patients with
acoustic neuroma and preserved hearing underwent retrosigmoid tumor removal in an attempt to preserve hearing and facial
Symposium
nerve function by use of intraoperative auditory monitoring of auditory brainstem responses and facial nerve monitoring of facial
motor evoked potential by cortical and direct facial nerve stimulation. All patients had serviceable hearing preoperatively.
According to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology–Head
and Neck Surgery Foundation, preoperative hearing levels of the 38 patients were as follows: Class A, 10 patients; Class B, 14;
and Class C, 14. The surgical technique for curative tumor removal with preservation of hearing and facial nerve function
included debulking of the tumor and sharp or subcapsular dissection.Results:The removal rate of the 38 tumors was 91.6% which
abstract
was not statistically different from that of all 106 tumors. Postoperative hearing levels were Class A, 3 patients; Class B, 6;
Class C, 8; and Class D, 21. Postoperatively, serviceable (Class A, B, or C) and useful (Class A or B) levels of hearing were
preserved for 44.7% and 23.7% of the patients, respectively. Better preoperative hearing resulted in higher rates of postoperative
hearing preservation; preservation rates were 70% among patients with preoperative Class A hearing, 35.7% among Class B, and
35.7% among Class C. Follow-up by MRI with Gd administration showed only one patient with tumor recurrence, who was
treated by gamma knife surgery as an aftertreatment.Conclusions:Retrosigmoid removal of acoustic neuromas can lead to
successful curative tumor removal without recurrence and with relatively good hearing outcome.
82
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9SS5-3
Treatment strategy and outcome for insular glioma in one institution
Shunsuke TSUZUKI 1, Takashi MARUYAMA 2, Masayuki NITTA³, Soko IKUTA ⁴ , Manabu TAMURA ⁵ ,
Yoshihiro MURAGAKI ⁶ , Takakazu KAWAMATA ⁷
Department of Neurosurgery, Tokyo Women´s Medical University,
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of
Medicine, Tokyo Women´s Medical University
4,5,6
＜Background＞Glioma located such as basal ganglia or insula are difficult to resect, so biopsy has been main treatment
considering a complication. Insula is surrounded by frontal and temporal operculum and middle cerebral artery (surface),
First Sentence
1,2,3,7
superior longitudinal fasciculus (superior), claustrum and lenticulostriate artery (LSA) (medial), pyramidal tract (posterior), and
we should be carful for resection of this part glioma. In our department, we remove the insular glioma aggressively with
subject of this study include 44 cases located in insula since 2009, recurrent case were excluded this study. Awake surgery was
performed in 16 cases. The tumor were classified as 1- insular localized type (5 cases), 2-frontal type (7 cases), 3-temporal type
Program
intraoperative MRI and awake surgery since 2000. We reviewed the outcome and morbidity retrospectively.＜Method＞The
(15 cases), 4-multiple lobule type (15 cases), and basal ganglia type (2 cases). We remove the tumor especially considering about
technique and aggressive removal with information-guided surgery enables us to remove the insular glioma such as a cerebral
cortex glioma.
9SS5-4
Location of the orbital tumor was deeply related to the symptom
Yoshihiro NATORI
Department of Neurosurgery, Iizuka Hospital
The intra-orbital tumor may cause an exophthalmos only. But sometimes it cause the acute visual
disturbance. In this paper, we focus on the tumor loction and the patient symptom.Material and method:
Hands on
were recovered by rehabilitation. The mean period return to the work was 7.1 months (2-28 months).＜Conclusion＞Appropriate
hemiparesis, language disorder (aphasia, paraphasia, perseveration) , disorientation were occurred as morbidity. These symptom
LSA and medial border. ＜Result＞The mean removal rate was 87.4% and there was no difference between other region.
Temporal type and multiple lobule type were tended to be lower removal rate. After surgery, cognitive dysfunction, mild
size, pathology, tumor location in the orbit, and the symptom of the patient in 47 consecutive
patients.Results: Among the 47 case, regarding the location in the orbit, 27 were intraconal, 8 were
Symposium
We reviewed surgical cases of primary orbital tumors at our institution past 10 years, and studied the
extraconal, and 12 were in the lacrimal gland area. Among the intraconal tumor, 6 were located orbital
apex area. The size of the tumor of the apically located were 1.6+/-1.6ml. The size of the non-apical and
tumor. Regarding the symptom of the patient, all of the apically located tumor cases show the visual
disturbance preoperatively. On the other hand, the patent with the non-apically located tumor were show
the disturbance 3 among 21 cases.Conclusions: The visual disturbance was the main symptom of the
apically located intra-orbital tumor. Even the small tumor in the apex area may cause the visual loss.
abstract
intraconal tumor were 7.5+/- 4.4ml. The tumor in the apex were significantly smaller than the non-apex
J N C2 0 16
An overview of the surgical treatment of brain abscess
at Jeremiah’ s Hope Center, Phnom Penh.
9SS6-1
Sim Sokchan
First Sentence
Jeremiah’ s Hope Center, Phnom Penh.
Brain abscess is a life threatening condition, demanding rapid diagnosis and treatment. Its development
requires seeding of an organism into the brain parenchyma, often in an area of damaged brain tissue or in
a region with poor microcirculation. The lesion evolves from a cerebritis stage to capsule formation.
Brain abscesses can be caused by contiguous or haematogenous spread of an infection, or by head trauma/
Program
neurosurgical procedure. The most common presentation is that of headache and vomiting due to raised
intracranial pressure. Seizures have been reported in the majority of the cases. Focal neurological deficits
may be present, depending on the location of the lesion. Treatment of a brain abscess involves aspiration
Hands on
or excision, along with parenteral antibiotic therapy. The outcome has improved dramatically in the last
decades due to improvement in diagnostic techniques, neurosurgery, and broad-spectrum antibiotics. The
authors provide an overview of the surgical treatment of brain abscess treated at Jeremiah’ s Hope
Center.
9SS6-2
Basics in management of micro-instruments under microscope-how to get
effective and stable use of them
Kaoru KURISU, Takahito OKAZAKI, Fusao IKAWA
Hiroshima University Hospital
It is well known that basic procedures in neurosurgery should be done under operative microscope. First,
we should know the mechanisms of microscope, especially balance system and lighting system. Also it is
Symposium
crucial for us to use micro-instruments under operative microscope effectively and safely. In that
meaning, we should be aware of basic maneuver of usage of micro-instruments for example, how to hold,
how to rotate, how to dissect, and so on. In this lecture, I would like to show the basic maneuver about
how to use them effectively and safely. Basic concept of usage of micro-instruments is very similar to
that of using chopsticks. We, Japanese, are very familiar to use chopsticks from childhood. I think that
abstract
would be one of causes that shows our ability to adjust our basic technique to use micro-instruments
under operative microscope.
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JNC2 01 6
9SS6-3
Surgical innovation of transsphenoidal surgery for pituitary adenoma.
Kosaku AMANO 1, Tomokatsu HORI 2, Takakazu KAWAMATA 3
Department of Neurosurgery, Tokyo Women's Medical University, Japan, 2Shin-Yurigaoka general Hospital
Transsphenoidal surgery (TSS) has a long history for more than a century. It became safe and effective in patients with pituitary
adenomas (PA). We report our recent technical innovations of TSS for PA.Material and Method The study includes 751 TSSs for
PA consecutively operated between 1998 and 2015. Men: Women = 316: 435. Age: 9-85 (average 49.4) years. Non-functioning
adenomas (NFA): 378, functioning adenomas (FA): 373 (GH: 206, PRL: 91, ACTH: 60, and TSH: 16). Since 2008, we have
First Sentence
1,3
removed NFA not only to improve the visual acuity, but also aiming at preservation or improvement of endocrine functions. In
Ghomas, we removed the main bulk, the microsurgical pseudocapsule of the tumor, and the residual tumor at far lateral and
have not only attempted to remove the tumor completely, but also taken care of not inducing severe GH deficiency. Ghomas were
divided into three periods: early cases (I), intermediate cases (II), and recent cases (III) and evaluated by means of remission
Program
superior sides using curved, angled, and flexible instruments under angled rigid endoscopic view (30-70 degrees). Recently, we
rates based on the Cortina consensus. High-definition type endoscope has been used at our institution since 2011.
Results Endocrine function of NFA after surgery in 1998-2007 and 2008-2015 demonstrated improvement: 39.8 and 43.5%, no
complications, and proficiency in endoscopic manipulations contribute to preservation of endocrine functions in NFA and
improvement of Ghoma remission rates.
9SS6-4
Influence of pseudocapsular resection in non-functioning pituitary adenomas
with a focus on postoperative pituitary functions
Yasuyuki KINOSHITA 1, Atsushi TOMINAGA 2, Satoshi USUI 3, Tetsuhiko SAKOGUCHI 4, Kazunori
ARITA 5, Kaoru KURISU 6
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Department of Neurosurgery, Hiroshima Prefectural Hospital, 4Department of Neurosurgery, Hiroshima Prefectural Hospital
5
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
1,3,6
2
Hands on
series III. Conclusions Our data confirm that technical innovations, surgical technological advancement, techniques preventing
III, indicating 46.3%, 67%, and 87% for the series I, II and III respectively. Severe GH deficiency was found in only 9.3% for
change: 38 and 49.3%, deterioration: 22.4 and 7.2%. The remission rate of Ghoma showed improvement comparing series of I to
Objective. Pseudocapsular resection is accepted as a useful surgical technique for the removal of functioning pituitary adenomas,
clarify the influence of pseudocapsular resection in non-functioning pituitary adenomas.Method. Between January 2008 and July
2015, a total of 143 patients received initial surgery for non-functioning pituitary adenoma with preoperative and postoperative
pituitary provocation tests. These 143 patients were categorized into three groups as follows: 1) Total group, 65 cases: the
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however, the significance of the procedure in non-functioning pituitary adenomas had not been well discussed. We attempted to
removal rate of the pseudocapsule was over 80%; 2) Partial group, 11 cases: 20-80%; and 3) None group, 67 cases: under 20%.
The main outcome measure was the incidence of surgical complications and postoperative pituitary functions.Results.
frequently than in the None group (CSF leakage; 40.0% vs 23.9%, temporary DI; 21.5% vs 13.4%), however, these differences
were not significant. Furthermore, there was no difference between the Total and None groups regarding the incidences of any
other complications, such as postoperative CSF leakage, permanent DI, postoperative hyponatremia, visual deterioration, or
postoperative hematoma. The postoperative anterior pituitary functions slightly improved to the same degree in both the Total
and None groups. Univariate and multivariate analyses revealed that pseudocapsular resection was not a factor in deteriorating
postoperative pituitary functions.Conclusions. Pseudocapsular resection of non-functioning pituitary adenomas dose not increase
the risk of surgical complications or deteriorate the postoperative pituitary functions. Thus, pseudocapsular resection is
recommended for non-functioning pituitary adenomas in order to prevent tumor recurrence.
abstract
Intraoperative cerebrospinal fluid (CSF) leakage and temporary diabetes insipidus (DI) in the Total group occurred more
J N C2 0 16
9SS6-5
Contribution of language mapping in glioma surgery: methodology
and functional considerations in awake surgery.
Takashi MARUYAMA, Yoshihiro MURAGAKI, Masayuki NITTA, Manabu TAMURA, Shunsuke
TSUZUKI, Takakazu KAWAMATA
First Sentence
Goal of glioma surgery is to maximize the extent of resection, while minimizing surgical complication. Advances of
functional mapping have allowed noninvasive cortical language mapping. To study language function after glioma
resection with brain mapping, we retrospectively analyzed 200 glioma patients who underwent awake surgery. The
awake surgeries were performed with guidance of intraoperative MRI. Performance status (PS), diagnosis and extent
Program
of resection were examined before and three months after surgery. For the infraparietal region tumor, brain mapping
with grid electrode implantation was carried out prior to surgical removal.112 out of the 200 tumors (56%) located
near the language area. These included three WHO grade 1, 37 grade 2, 46 grade 3, 17 grade 4 and 3 others. 79 and
33 tumors located in or near broca and wernicke area, respectively. 7.6% (6/79) of broca and 12.1% (4/33) of
wernicke cases lost 1 point or more of their PS three months after surgery. These included three GBM, two grade 3
and one grade 2 for Broca location and two GBM, one grade3 and one grade2 for Wernicke location. Removal rate
were 89.9% for Broca and 88.9% for Wernicke. Total removal rate were 31 of 79 (39.2%) for Broca and 17 of 33
(51.5%) for Wernicke. Awake surgery containe two stage surgery such as grid electrode implantation for wernicke
area and intentional partial removal for functional plasticity. In conclusion, language function mapping increase the
abstract
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Hands on
impact of surgery on the glioma treatment, to preserve the quality of life, and to better surgical outcome.
86
JNC2 01 6
9SS7-1
Surgical simulation of aneurysm clipping with multimodal fusion
3-dimensional computer graphics.
Daichi NAKAGAWA 1, Taichi TIN 2, Masaaki SHOJIMA 3, Seiji NOMURA 4, Naoyuki SHONO 5, Toki
SAITO 6, Hiroshi OYAMA 7, Nobuhito SAITO 8
6,7
The University of Tokyo
BACKGROUND : Morbidity and mortality in surgical aneurysm clipping depend on preoperative assessment of aneurysm. It is
very important to understand the three-dimensional(3D) structure of the aneurysm, small arteries such as perforating arteries,
First Sentence
1,2,3,4,5,8
intracranial nerves and thrombus. However, 3D visualization of these structures are technically difficult. In this report, we
present a new method to visualize 3D structure of these structures to help estimate the risk of intraoperative
complications.CLINICAL PRESENTATION: The study population consisted of 3 patients scheduled for surgical aneurysm
normalized mutual information method, and then reconstructed by a hybrid method combining surface rendering and volume
rendering methods. With surface rendering, multimodality and multithreshold techniques for 1 tissue were applied. The
Program
clipping. Data from preoperative imaging (MRI, CT, and 3D rotational angiography) were automatically fused using a
completed interactive computer graphics were used for simulation of surgical approaches and assumed surgical fields. RESULTS:
mode required approximately 15 minutes. Detailed anatomical information for operative procedures, from the craniotomy to
microsurgical operations, could be visualized and simulated three-dimensionally as 1 computer graphic using interactive
computer graphics. Virtual surgical views were consistent with actual operative views. This technique was very useful for
examining various surgical approaches.CONCLUSION: The authors report a new method for automatic registration of
preoperative imaging data from CT, MRI, and 3D rotational angiography for reconstruction into 1 computer graphic. Interactive
The time required for reconstruction of 3D images was 2–4 hours for interactive computer graphics. Observation in interactive
9SS7-2
Multi spectral imaging in aneurysm surgery.
Cleopatra Charalampaki
Hands on
computer graphics was useful in helping to plan the surgical access corridor.
abstract
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Cologne Medical Center, Germany
J N C 2 016
9SS7-3
An Innovative Neurosurgical Simulation Using Computer Graphics
by Multimodal Fusion Imaging Integrated Time, Space, and Real
Taichi KIN 1, Hirofumi NAKATOMI 2, Naoyuki SHONO 3, Seiji NOMURA 4, Daichi NAKAGAWA 5, Toki
SAITO 6, Masaaki SHOJIMA 7, Hiroshi OYAMA 8, Nobuhito SAITO 9
First Sentence
1,2,3,4,5,7,9
6,8
University of Tokyo Graduate School of Medicine
Introduction: We report an innovative neurosurgical simulation system using computer graphics with a high spatial
resolution integrated time, space, and real. Subjects: 695 neurosurgical patients. Method: All the imaging data
required for preoperative examination such as CT, MRI, angiography, PET, diffusion based tractography, functional
MRI, flow dynamics study, and real image were fused for each case. All the images were automatically fused by the
Program
normalized mutual information or non-rigid registration method. The visualization of CG is used hybrid rendering
method in which surface rendering and volume rendering were combined. Segmentation is applied to multimodal
individualizing tissue threshold method in which surface rendering is performed to the same tissue using multiple
thresholds. The real image such as cortical surface was textured to the CG by thin-plate spline method. Our
mesh-editing for virtual retraction of brain. Results: Our proposed method enabled all image data set to be
integrated one CG, which contributed to the spatial understanding of the pathological condition and was useful in
the planning of surgical strategy. We found that there were many findings that could not be understood in
conventional imaging. Conclusion: Our proposed CG was extremely useful in preoperative planning.
Hands on
proposed CGs were simulated pre- and intraoperatively on workstation such as zooming, rotating, transparent,
9SS7-4
Visualization of perforating arteries on navigation with intra-arterial CT angiography
in the brain tumor surgery
Tomoyuki KAWATAKI 1 , Masakazu OGIWARA 2, Satoshi SAKATSUME 3, Mitsuto HANIHARA 4,
Hiroyuki KINOUCHI 5
1
Department of Neurosurgery, Faculty of Medicine, University of Yamanashi, Japan,
2,3,4,5
University of Yamanashi
【Background】The preservation of perforating artery during brain tumor surgeries is quite important to keep the neuro-functional
prognosis. However, the visualization of perforating arteries on navigation is insufficient with data from the conventional
Symposium
intra-venous enhanced CT angiography (IV-CTA), because the concentration of contrast medium was low in the fine artery
and/or because venous information sometimes disturbs the arterial contrast. So the methodological improvement was required to
achieve clearer perforating arteries on the navigation imaging. Recently, CT angiography have been set up beside the digital
subtraction angiography unit and these system makes it possible to take a CT angiography with catheter insertion of the targeting
artery. We studied the visualization of perforating arteries on the navigation during the tumor surgery. 【Method】Eight cases
were studied including glioma, meningioma and cavernous angioma. Intra-arterial enhanced CT angiography (IA-CTA) was
performed following the conventional cerebral angiography. Imaging was performed with Aquilion LB 16 row with the following
abstract
conditions; 120kV, 300mA, 0.5s scan time, 0.5mm width slice. The catheter was placed into the target artery, and 3 times dilated
contrast medium was injected. The visualization of four perforating arteries on the navigation system (Stealth Station7);
meningohypophyseal trunk (MHT), anterior choroidal artery (Ach), lenticulostoriate artery (LSA) and Heubner artery (HA) were
observed and the visualization of these arteries on navigation imaging with IA-CTA data was compared with the imaging by
IV-CTA.【Results】The visualization on navigation improved with IA-CTA; 7 cases of Ach and LSA, 4 cases of MHT and 3
cases of HA showed better observations among the 8 cases. Especially, it was useful to recognize LSA in basal ganglion glioma
and MHT/ACH in meningioma. The visualized quality was improved in the IA-CTA compared with IV- CTA.【Conclusion】
IA-CTA is useful to visualize the perforating arteries on navigation in brain tumor surgeries.
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JNC2 01 6
9SS8-1
The usefulness of high-resolution three-dimensional multi-fusion medical imaging for
preoperative planning in patients with Arteriovenous malformations and Arteriovenous fistulas.
Hirofumi NAKATOMI, Masanori Yoshino, Taichi Kin, Toki Saito, Naoyuki Shono, Seiji Nomura, Daichi
Nakagawa, Synsaku Takayanagi, Hideaki Imai, Hiroshi Oyama, Nobuhito Saito
Background;To extirpate cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) from normal brain
circulation completely, the precise number and location of all the feeders and drainers must be known. However, when AVMs
First Sentence
The University of Tokyo Hospital, Department of Neurosurgery, Tokyo, Japan
and AVFs carry the perforating vessel feeders deep inside of the brain, it can be difficult to visualize them preoperatively just by
conventional angiography alone.Objective;To validate the usefulness of a virtual operation field (VOF) of cerebral AVMs and
AVFs by high-spatial-resolution three-dimensional computer graphics (hs-3DCG).Methods;Presurgical simulation with VOF was
surgical strategy to them. For hs-3DCG, the necessary preoperative radiographic images were fused. A hybrid model of volume
and surface rendering was created from the fused images. The simulation results were compared with the operative results, and
Program
performed for 45 AVMs and AVFs to assess the number and location of all the potential feeders and drainers and the appropriate
the MVA estimation rate was compared between VOF and contrast-enhanced fast imaging employing steady-state
9SS8-2
Giant / large fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction;
so called mega dolicho basilar anomaly: Clinicopathological and long term follow-up study .
Hirofumi NAKATOMI 1, Hideaki Ono 2, Minoru Tanaka 3, Nobuhito Saito 4, Kelly Flemming 6,
David G. Piepgras 7
The University of Tokyo Hospital, Department of Neurosurgery, Tokyo, Japan
Mayo clinic, Rochester, Department of Neurology, Minnesota, USA
1,2,3,4,5
6,7
Background and Purpose: Giant/large fusiform and dolichoectatic aneurysms of basilar trunk and vertebrobasilar junction (GLFDBTVBJAn), so
called mega dolicho basilar anomaly are extremely difficult to treat. We retrospectively analyzed our series to elucidate factors affecting the
long term survival.
Methods: Thirty two cases of GLFDBTVBJAn were analyzed. Clinicopathological characteristics, treatment measures and the results were based
on the medical records and all available imaging studies. In nine cases, we obtained autopsied tissues and histologically examined the aneurysm
and adjacent brain tissue.
Results: Eleven cases did not undergo surgery occluding the parent artery, of which ten (90.9 %) died; three of progressive brainstem
compression, four of subarachnoid hemorrhage (SAH), two of brainstem infarction and one of accompanying atherosclerotic disease. Patients
who received surgical intervention had significantly longer overall survival compared with those who received conservative therapy (adjusted
hazard ratio 2.616 [95% CI 1.093?6.260], p=0.031. Twenty one cases underwent four types of surgical treatments consisting of immediate
proximal parental artery occlusion, remote proximal parent artery occlusion, with or without bypass procedures, reconstructive clipping, distal
bypass with or without branching artery occlusion. Five cases showed good recovery without major neurological deficit. Of those, three had
staged bilateral at remote sites with or without construction of high-flow bypass. On the other hand, seven of eight cases which underwent
parental artery occlusion at the site immediate proximal to the aneurysm developed brainstem infarction. Histopathological examination of the
aneurysms demonstrated staged clots, an open lumen, and intrathrombotic channels with endothelial lining. In addition, there were small vascular
networks in the adventitia which were apparently connected to the vessels in the brainstem parenchyma.
Conclusions: Parental artery occlusion for this grave disease should be performed at the remote sites from the aneurysm, and achieving the ideal
hemodynamic condition within the aneurysm to maintain sufficient but not excess blood supply should be considered based on the hemodynamics
of each case, both Pcoms and perforating vessel collaterals.
Hands on
of the most appropriate surgical strategy to achieve complete obliteration of AVMs and AVFs.
cerebral AVMs and AVFs. This method may facilitate estimation of all the feeders and drainers, and may aid in the determination
Symposium
same way as simulated preoperatively. Conclusion;The hs-3DCG method was of sufficiently high quality to enable VOF of
abstract
this information, the best surgical strategy was invented. All patients underwent obliteration of all the feeders and drainers in the
acquisition.Results;By using VOF, the number and location of all the feeders and drainers were estimated in all cases, and using
J NC2 0 16
9SS8-3
Super-passive language mapping combining real-time oscillation analysis
with coortico-cortical evoked potentials for awake craniotomy
Kyousuke KAMADA 1, Yukie TAMURA 2, Hiroshi OGAWA 3, Ryogo ANEI 4, Christoph GUGER 5
First Sentence
1,2,3,4
Neurosurgery, Asahikawa Medical University, 5Guger Technology
Object. Electrocortical stimulation (ECS) is the gold standard for functional brain mapping; however, precise functional mapping
is still difficult in patients with language deficits. High gamma activity (HGA) between 80 and 140 Hz on electrocorticogram
(ECoG) is assumed to reflect localized cortical processing, while cortico-cortical evoked potential (CCEP) can reflect
bidirectional responses evoked by monophasic pulse stimuli to the language cortices when there is no patient cooperation. We
propose the use of “Passive” mapping by combining HGA mapping and CCEP recording without active tasks during conscious
resections of brain tumors.Methods. Eight patients, each with an intraaxial tumor in their dominant hemisphere, underwent
Program
conscious lesion resections with Passive mapping. We performed functional localization for the receptive language area, using
real-time HGA mapping by listening passively to linguistic sounds. Furthermore, single electric pulses were delivered to the
identified receptive temporal language area to detect CCEP in the frontal lobe. All mapping results were validated by ECS and
the sensitivity and specificity were evaluated.Results. Linguistic HGA mapping quickly identified the language area in the
temporal lobe. Electric stimulation by linguistic HGA mapping to the identified temporal receptive language area evoked CCEP
small case series, the sensitivity and specificity were 93.8% and 89%, respectively.Conclusions. The described technique allows
for simple and quick functional brain mapping with higher sensitivity and specificity than ECS mapping. We believe that this
could improve the reliability of functional brain mapping and facilitate rational and objective operations. Passive mapping also
sheds light on the underlying physiological mechanisms of language in the human brain.
9SS8-4
Edematous changes associated with craniopharyngioma as predictor of
pre- and post-hypothalamic involvement
Yasuhiko Hayashi, Osamu Tachibana, Issei Fukui, Yasuo Sasagawa, Mitsutoshi Nakada
Department of Neurosurgery, Kanazawa University
Symposium
[Introduction] Edematous change derived from craniopharyngioma, which is called as “moustache sign” , can extend from the
hypothalamus to the optic tract and the internal capsule. The development of this edema was speculated as disturbance of
circulation at the hypothalamus, however the clinical significance remains unclarified.
[Methods] This retrospective study included 47 patients with craniopharyngioma treated in our institutes from 1989 to 2015
(mean age 42.4 ys, male:female = 26:21). The edema was identified as hyperintensity on axial and coronal section of T2WI or
FLAIR images on MRI, and classified into the following three types; 1) no edema type, 2) restricted edema type: edema was
restricted to the surrounding hypothalamus, 3) extended edema type: edema extended into the optic tract or the internal capsule.
Patients’ demographics, tumor size, solid or cyst, ICP elevation, visual function, endocrinological function, diabetes insipidus,
electrolytes abnormalities, hydrocephalus, recognitive abnormality, obese, and histology of tumors were garnered from their
clinical charts.
abstract
Hands on
on the frontal lobe. The combination of linguistic HGA and frontal CCEP did not need any patient cooperation or effort. In this
[Results] 1) Edema appeared frequently in adults than in children. 2) No correlation was found this edema with tumor size, cyst,
ICP elevation, visual function, and endocrinological function. 3) All cases with preoperative DI harbored edema, and
postoperative DI appeared most often in extended edema type. 4) Postoperative electrolyte abnormalities were also detected most
often in extended edema type. 5) Edema has statistical association with hydrocephalus and obese, and especially significant in
extended edema type. 6) Both surgery and radiation can decrease the amount of edema significantly.
[Conclusion] Edematous change derived from craniopharyngioma can appear not simply because of the compression to the
hypothalamus, but affect the hypothalamic function remarkably. If the edematous change can be recognized preoperatively,
neurosurgeons keep in mind that the dissection of the tumor surroundings should be prudent to avoid hypothalamic involvement.
JNC2 01 6
9SS9-1
Intra-arterial Injection Fluorescence Videoangiography in Cerebral
Arteriovenous Malformation Surgery
Hideyuki YOSHIOKA, Hiroyuki KINOUCHI, Kazuya KANEMARU, Koji HASHIMOTO, Takashi YAGI
【Background】Fluorescence videoangiography has been reported to be effective in cerebral arteriovenous malformation (AVM)
surgery. However, the image contrast of the procedure with ordinary intra-venous injection is diminished by repeated studies,
which makes it difficult to evaluate precise blood flow in AVM during surgery. To overcome this shortcoming, we have
introduced intra-arterial fluorescence videoangiography (IA-FVAG) that can be repeated within a short time. In this study, we
First Sentence
Department of Neurosurgery, University of Yamanashi
evaluated its effectiveness in AVM surgery.【Methods】Fourteen AVM cases were enrolled in this study. Catheters for
intraoperative digital subtraction angiography (DSA) were introduced to the internal carotid artery (ICA) and/or the vertebral
and after resection of AVM.【Results】Intraoperative DSA was performed twice in a surgery (before and after resection),
whereas IA-FVAG was carried out 3 to 15 (mean 7.0) times. The time required to obtain each IA-FVAG (1.4 minutes) was
Program
artery (VA) proximal to the main feeders. Fluorescein sodium solution was administered through DSA catheters before, during,
statistically shorter than that of intraoperative DSA (27.1 minutes). Since IA-FVAG provided excellent spatial and temporal
contrast, it clearly detected feeders, niduses and drainers during surgery. Videoangiography could be repeated when necessary
images and availability of repeated study to fluorescence video angiography. Since these advantages allow us the precise
identification of feeders and the real-time assessment of blood flow in AVM during resection, IA-FVAG would contribute the
improvement of safety in AVM surgery.
9SS9-2
The cause of incomplete cerebral aneurysm clipping on ICG videoangiography
and false-negative ICG.
Masayuki GEKKA, Naoki NAKAYAMA, Haruto UCHINO, Yusuke SHIMODA, Shunsuke TERASAKA,
Kiyohiro HOUKIN
Department of Neurosurgery, Hokkaido University Graduate School of Medicine
Object. We investigated causes of intraoperative incomplete aneurysm closure in the clipping surgery using indocyanine green
videoangiography (ICG-V). ICG-V is easy and useful modality to judge completeness of aneurysmal clipping. However,
Hands on
compatible with the findings of intraoperative DSA.【Conclusion】Intra-arterial injection method brings excellent contrast of
in AVM during resection. IA-FVAG disclosed no residual shunt into the drainers after resection in all cases, which was
because of the quick clearance of the dye, and then AVM was safely removed in all cases, confirming the decrease of blood flow
occasionally, continuous blood leakage can occur when the aneurysmal wall is punctured in spite of ICG-V having been negative,
clipping in which ICG-V was used to confirm aneurysm closure (at a single institution between 2012 to 2015) were examined. In
58 cases within this sample, after confirming that ICG-V was negative, further confirmation of completeness of closure by direct
puncture of the aneurysmal wall was performed. The aneurysm location, dome size (maximum height and length), neck width
Symposium
a so called false-negative ICG-V. Its frequency and causes were also investigated. Methods. One hundred six cases of aneurysmal
(parallel direction and orthogonal direction), wall thickness around the neck, bifurcation angle, and direction of clipping closure
line were compared between complete closure and incomplete closure judged by ICG-V, as well as between true-negative and
and completion was achieved through modifications of the clipping design. False-negative ICG-V was found in 9 of 58 cases
(15.5%, major=2 and minor=7). Main causes of incomplete closure on ICG-V and a false-negative ICG-V were heterogeneous
arteriosclerosis around the neck, direction of clipping closure line which is parallel to bifurcated vessels , wide width to be
closed of the neck. Conclusions. Wall thickness around the neck and neck width have an influence on completeness of
aneurysmal closure. Additionally, although ICG-V is convenient to confirm aneurysmal closure intraoperatively, it is necessary
to pay attention of the possibility of its false-negative finding.
abstract
false-negative ICG-V. Results. In 6 of the 106 cases (5.7%), clipping was judged to be incomplete on ICG-V intraoperatively,
J N C 2 016
9SS9-3
Multimodal fusion image based surgical navigation system
Saito TOKI, Taichi KIN, Naoyuki SHONO, Seiji NOMURA, Daisuke ICHIKAWA, Yoshikazu
NAKAJIMA,Hirofumi NAKATOMI, Nobuhito SAITO, Hiroshi OYAMA
Department of Clinical Information Engineering, Health Services Science, School of Public Health,
Graduate School of Medicine, The University of Tokyo, 2,3,4,7,8Department of Neurosurgery, the University of Tokyo
5
Social Medicine, Graduate School of Medicine and Faculty of Medicine, the University of Tokyo, 6Department of
Bioengineering, School of Engineering, The University of Tokyo , 9Department of Clinical Information Engineering, Health
Services Science, School of Public Health, Graduate School of Medicine, The University of Tokyo
First Sentence
1
[Background]Targets of neurosurgery are small structures such as blood vessels, nerves and so on. In order to avoid hurting the
Program
non-related area, it is important to make a detailed surgical planning and refer it in surgery. To achieve it, we have developed a
computer added surgery system which provides multimodal fusion image based navigation image.[Method]We have developed
and tested a multimodal fusion image based navigation system for neuro-endoscopic surgery. A phantom model made by 3D
printer was used. The system had three phases: multimodality fusion phase, shape extraction phase and navigation phase. In
multimodality fusion phase, X-ray computer tomography (CT) image and magnetic resonance image (MRI) were used. The
coordinate system of each modality images was combined in a same coordinate system (we called image-CS) using normalized
mutual information registration. In extraction phase, marching cubes method was applied to each modality images, and organ
shapes such as vessel and cortex in image-CS were determined. In navigation phase, surface registration between image-CS and
intra operative coordinate system was performed by using extracted organ shapes. It provided intra operative position in
image-CS.[Result and Discussion]The system could provide the same eyesight with endoscopic image, and subjects could
estimate the structure positions which were hidden behind the observable structures. It appeared that the system help surgeons
Hands on
not to hurt non-related areas.
9SS9-4
Preoperative evaluation of meningioma with 4DCT angiography and whole
brain CT perfusion imaging: A comparative study with DSA Keiko SUZUKI, Sato HIROKI, Tomoyuki KAWATAKI, Mitsuto HANIHARA, Satoshi SAKATSUME,
Masakazu OGIWARA, Hiroyuki KINOUCHI
Department of Neurosurgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
Background and purpose: For safer removal of meningioma, identification of feeding arteries is important. Although digital
subtraction angiography (DSA) has been the gold standard preoperative examination, safer and less invasive method is expected.
Symposium
The aim of this study is to evaluate the usefulness of four-dimensional dynamic whole brain CT angiography (4DCTA) and whole
brain CT perfusion (CTP) by comparing with conventional DSA. Methods: Sixteen consecutive patients who had histologically
verified meningioma and underwent both DSA and 4DCTA for preoperative workup were evaluated in this study. 4DCTA and
CTP parameter maps were obtained simultaneously using a 320-detector-row CT scanner. 4DCTA images were constructed by
volume rendering and maximum intensity projections image. Elevated sites of the blood flow in the tumor were determined from
the color map of cerebral blood flow and volume values obtained from the CTP. Results: 75% of the feeding arteries that were
abstract
confirmed by DSA could be visualized by 4DCTA. The sensitivity of 4DCTA method was; 76.9% in the ICA brunches, 70.0% in
the ECA brunches, and 100% in the VA-BA brunches. The majority of arteries that could not be detected by 4DCTA belonged to
the ECA territory. Overall detection sensitivity of the tumor beds by 4DCTA and CTP was 83.3%.92.3% of pial supplying
arteries seen by DSA were detectable also by 4DCTA. Small arteries located at skull base or peripheral arteries were described
better by DSA than 4DCTA.Conclusion: Both 4DCTA and CTP provided high capability in detection of feeding arteries
including pial supply of the meningioma, in comparison with DSA. 4DCTA and CTP provide valuable information for planning
the surgical strategy for meningioma.
92
JNC2 01 6
Skull base technique needed for cisternal approach in a tight brain
9SS9-5
Iype Cherian
In tight brains due to aneurysms or trauma, it is desirable to open the cisterns which would render the
brain lax. To do this, one should employ a skull base technique similar to Dolencs technique. This
abstract
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Hands on
Program
technique will be discussed along with a video
First Sentence
COMS, Bharatpur, Nepal
J NC2 0 16
9NS1
Cerebral Vasospasm – Nursing Management
YEE Yit Cheng
First Sentence
Cerebral vasospasm following Subarachnoid Haemorrhage is narrowing of a cerebral blood vessel and
causes reduced blood flow which can lead to cerebral ischemic and cerebral infarction. It is also an
important cause of morbidity and mortality.
Nursing intervention in detecting cerebral vasospasm include neurological assessment, vital sign
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monitoring, airway & oxygenation, it aims to maintain adequate oxygenation and ventilation without
compromising both intracranial and cerebral perfusion pressures
Triple H therapy (hypervolaemia, hypertension, haemodilution) is crucial following cerebral vasospasm
100-120 mmHg, haematocrit 30
Continuous close monitoring is essential due to potential risk of sudden deterioration. Any deterioration
or subtle changes must be notified to the surgeon promptly, so immediate action can be taken to prevent
morbidity and mortality.
Hands on
to maintain adequate cerebral perfusion & cerebral blood flow by maintaining CVP 8-10mmHg, MAP
9NS2
Report of the medical internship project for Cambodian
Akemi NISHIOKA, Yuri KANG, Miharu TAMAOKI, Akane KATO
Sunrise Japan Hospital, Phnom Penh, Cambodia
In spite of increase in demands of medical service due to recent radical economic development, the quality and quantity of
medicine are insufficient. Accordingly, we decided to build a hospital in Phnom Penh so as to provide Japanese style medical
care. Therefore, we would report the result of a long-term internship project.
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The program was focused on four points below; language, conception, ethic and knowledge/skills. Regard to the language,
Japanese lessons had been provided before and after coming to Japan. About conception and ethical education, lectures, group
discussions and outside training were done. As for knowledge and skills, guidance had been done by on the job training. Mentors
scored those four elements before coming Japan, at intermediate and at the end of the training.
Each element was evaluated with grading 1 to 10. Above 7 points is regarded as a level of leader nurse, 6points is as staff nurse,
and 5 points is as a new graduate nurse. At the end of the training, trainees who achieved over 5 were 45% for language, 74% for
abstract
conception and ethic, and 78% for knowledge/skills.
It could know that a language skill can be acquired in a short time. On the other side, understanding Japanese idea was difficult.
Through the project, we could know that the ethical education is the most essential so that they reconsider attitude and idea as a
medical staff. In terms of knowledge and skills, they have possibility of improving from now on. Additionally, the internship
gave Japanese staff good effect that they understood Cambodian culture and idea deeper than before.
To conclude, the most vital thing for accepting the long-term internship is education about conception and ethic.
94
JNC2 01 6
9SS10-1
Advances in Glioma Surgery
Wai-Hoe NG
Gliomas, particularly high-grade gliomas are highly invasive and infiltrative tumours. Radical excision
can reduce pressure effects and lead to symptomatic relief. Furthermore, gross total resection in gliomas
with minimal morbidity may confer survival benefit and facilitate adjuvant therapy.
First Sentence
National Neuroscience Institute (Singapore)
radical resection. Modern imaging such as functional MRI (fMRI) and diffusion tensor imaging (DTI) can
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Unfortunately, gliomas frequently encroach into highly eloquent regions which make increases the risk of
localize critical structures pre-operatively. Advanced neuronavigation with brain mapping techniques can
Meningioma Surgery at Calmette hospital
Tararith Nay Calmette Hospital, Phnom Penh, Cambodia
Meningioma is the most common type of primary brain tumor. Meningiomas originate in the meninges,
which are the outer three layers of tissue between the skull and the brain that cover and protect the brain
Hands on
9SS10-2
Awake craniotomy with incorporation of all other available imaging and physiological techniques is able
further augment anatomical and physiological localization of motor and speech areas.
Meningioma afflict women more often than men. The male-to-female ratio ranges from 1:1.4 to 1:2.8.
My presentation is going to cover some cases of Meningioma surgery process which are surgery with less
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just under the skull. Meningiomas grow out of the middle layer of the meninges, called the arachnoid.
abstract
and unconventional equipment and surgery with enough equipment.
J N C 2 016
9SS10-3
Implantation of neurosurgery into Cambodian society
Yoshifumi Okada 1, Yoshifumi Hayashi 2, Sim Sokchan 3, Shigemi Kitahara 4
Kitahara International Hospital, Japan,
Sunrise Japan Hospital Phnom Penh, Cambodia
3
Jeremiah’ s Hope Hospital, Cambodia
1,4
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2
Authors have periodically collaborated and perfomed neurosurgical operations in Cambodia since 2012.
To implant, facilitate and nurture Cambodia-made neurosuregery, high-tech tools have not been brought
in, (tools brought from Japan were limited to magnifying glasses, brain self-retractors and Rhoton’ s
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dissector set), and treatment schedules and perioperative care have been planned mainly by local staff.
Fourteen cases have been treated (nine brain tumors, two spinal tumors, one foreign body with epilepsy,
one pneumocephalus with liquorrhea, and one facial spasm), several kinds of surgical approaches have
and three major complications have occurred (two acute subdural hematoma, and one infection.)
We will review and show some representative surgical cases and discuss on their applications and
complications to further facilitate neurosurgery in Cambodia.
abstract
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been chosen (five suboccipital, three interhemispheric, one subtemporal, one pterional, and four others),
96
JNC2 01 6
9SS11-1
The change of sagittal spinal alignment of lumbar spine after reposition type
of spinous process splitting posterior decompression for lumbar canal stenosis.
Keisuke Ito 1, Yoshiro Musha 2, Satoshi Fujita 3, Satoshi Iwabuchi 4
Toho university ohashi medical center. Dept neurosurgery
Toho university ohashi medical center. Dept orthopedics
Results
The improvement rate of the JOA score and lumbago was 82% and 84.0%, respectively. The postoperative radiography findings revealed that
lumbar alignment had lordosis and the union rate of reconstructed spinous process and the bases were 87% at 12 months.
Conclusion
The surgical results of this procedure were satisfactory with only little postoperative lumbago. In decompression of the spinal canal in lumbar
spinal canal stenosis, preservation of back muscle and reconstruction of spinous process are crucial for satisfactory outcome in postoperative
lumbar spinal lordosis.
Our surgical method is effective in reduction of the postoperative lumbago.
9SS11-2
The efficacy of interlaminar percutaneous endoscopic laminectomy (ILPEL)
against lumbar canal restenosis by the postoperative hypertrophic osteophyte
Yoshihiro KITAHAMA, Manabu MINAMI, Taigo KAWAOKA
Spine Center, Omaezaki Municipal, Hospital
Microsurgery is one of the best procedure approach to the deep lesion. The technique provides for bright and clear
operation field even if reoperation. But the approach to the lesion, it’ s sometimes difficult to dissect granulation
scar on he way to the lesion. For the safety approach, skin incision is often extended to approach via intact bone
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Methods
Surgical techniques
After making a 2.5cm skin incision, the spinous process was split and a tubular retractor (METRx○R quadrant system)was inserted. Following
neuro-decompression, the separated spinous processes was reconstructed at their base in the laminae.
We observed postoperatively 100 patients (woman 54,men 46, average age 69.2 years ) who underwent our surgical method between January
2009 and March 2012. Patients were followed up for more than one year after surgery.
The clinical evaluation was determined by the Japanese Orthopedic Association (JOA) score (15 points)and the presence of lumbar spinal
lordosis and instability in radiography images.
Hands on
Objective
In order to decompress the spinal canal in lumbar spinal canal stenosis, we have used reposition type of spinous process splitting posterior
decompression using tubular retractor (METRx○R quadrant system). Conventional surgery may cause abnormality of lumbar sagittal alignment
which may result in postoperative lumbago, and its treatment is difficult. The aim of this study was to compared lumbar spinal sagittal alignment
and clinical results between our surgical method and the conventional laminectomy for lumbar spinal canal stenosis.
2
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1,3,4
surgery.Interlaminar percutaneous endoscopic laminectomy (ILPEL) is one of the minimally invasive surgery has
been introduced since the late 1990's. In this procedure, for the approach to the lesion, an atraumatic spinal cannula
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into the lesion. As the reason for this, the reoperation with the microscope sometimes more invasive than the initial
is inserted via the 6 mm skin incision and then a surgical sheath is placed by the same fashion. As this process is the
same not only virgin case but also reoperation case., it is not needed to extend skin incision, to expose an intact
A 69-year-old male had a past history of twice lumber surgery was referred to our institute with bilateral leg pain,
motor weakness for 8 years by hypertrophic bone at the L4/5 around the implanted cancerous bone that had been
placed as a inter body fusion performed 10 years ago. The compressed thecal sac was decompressed effectively by
the ILPEL.Case 2: A 61-year-old female had L4 radiculopathy by hypertrophy of the L5 superior facet that had been
developed after L4/5 lumbar discectomy 10 tears ago. By the ILPEL, the hypertrophic L5 superior facet was
removed, the L4 nerve root was well decompressed.
abstract
bone even if reoperation. We present two cases of lumbar reoperation cases to have an advantage of ILPEL.Case 1:
J N C2 0 16
Percutaneous endoscopic lumbar discectomy for the pyogenic discitis
9SS11-3
Takeshi HARA 1, Yukoh OHARA 2, Hidenori MATSUOKA 3, Junichi MIZUNO 4
First Sentence
1
Department of Neurosurgery, Juntendo university,
2,3,4
Shin-yurigaoka general hospital
Pyogenic discitis is usually have been treated by antibiotic agents. Surgical intervention is in general
reserved for cases that are unresponsive to antibiotic therapy which develops progressive spinal
deformity or instability, epidural abscess, and neurological impairment. On the other hand, there are some
reports of percutaneous endoscopic lumbar discectomy (PELD) for the pyogenic discitis which describing
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immediate pain reduction and early subsidence of spinal infection. We present three cases which we
performed PELD for the pyogenic discitis.
Three patients have been treated with posterolateral transforaminal approach for pyogenic discitis. After
Hands on
the operation, all patients showed immediate and remarkable pain reduction. The organism was identified
by this procedure in one patient. Percutaneous endoscopic lumbar discectomy and irrigation brought
immediate pain reduction and detection of organism .We will discuss about the comparison with the
conservative therapy
The operation for lumbar spinal stenosis
~Which operation shotuld you select if you a beginner ? ~
9SS11-4
Masato NOJI
The department of Neurosurgery, Ashigarakami prefectual Hospital
Objective; It is inevitable that Asia will great further aging society in future, and the demand for spinal surgery rises
more and more. It is necessary to fix the environment of safe surgery for not only the specialist in spinal surgery but
also young generation of neurosurgeons. To teach the operation to beginner of spinal surgery in a lumbar disease in
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future, we need to limit our standardized operations to minimal requirement among variety of operative procedure.
Here we evaluated three procedures statistically from this point, Spinous process splitting laminectomy(SPS),
Unilateral approach Bilateral Decompression(UBD), Muscle preserving Interlaminar Decompression
(MILD).Patients and Methods; Since April 2006 to March 2013, 275 patients with lumbar canal stenosis undergone
the operation, of whom 132(76 men and 56 women) with simple level lesion were selected for this study. Average
abstract
age at operation was 68.1 years. Operation time, estimated blood loss, Recovery rate in JOA, elevation rate of CK,
hospital stay, Quantity of the NSAIDs were all evaluated.Results; UBD tended to be longer than two other
operations by operation time. The CK determinates were low in MILD predominantly in comparison with UBD.
Requirements for NSAIDs were much less in MILD compared with other methods.Conclusion; To lead off for spinal
surgery in future, It is important to guide beginner of spinal surgery with standardized operative procedure .As a
standard operation of the lumbar spinal stenosis, MILD is recommended in simple level lesion, and SPS is also
recommended in multiple level lesions.
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JNC2 01 6
Usefulness and histopathological changes in the preoperative tumor
embolization in meningioma surgery
8PS1-1
Katsushi TAOMOTO 1, Hideyuki OHNISHI 2, Yoshihiro KUGA 3, Yuji KODAMA 4
Kenkichi TAKAHASHI 5, Masato HAYASHI 6, Ryosuke MAEOKA 7, Hiroyuki OHNISHI 8
Department of Neurosurgery, Ohnishi Neurological Center, Japan
Osaka Medical Collage, 8Hyogo Cancer Center
7
We examined the surgical usefulness of embolization of tumor vessels by IVR and histological changes in the tumor due to the
difference in the period of time until removed from the tumor vascular embolization.【Materials and Methods】We examined 32
First Sentence
1,2,3,4,5,6
cases of hypervascular meningiomas, which were performed IVR embolization before removal of the tumors. Embolization was
performed with the ED coil and 13 ~ 15% NBCA during 1~199 days before removal of the tumors. Removal tissue was
and Ki-67 immunohistochemical staining in comparing with the IVR-Op interval.[Result] Bleeding amount during surgery was
100ml or less in most of cases. Except for the three cases, embolization with NBCA to intra-tumoral blood vessels was
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histologically examined by dividing the suitably embolized site and insufficient area with HE staining and EMA, CD34, CD68,
successful. Simpson grade I and II removal of the tumor was performed in 22 cases, grade III in 8 cases and grade IV in 2 cases.
Histologically, the intratumoral embolic materials and extension of capillary blood vessels as well as vacuolated degeneration
round cell infiltration revealed mainly in the case with short interval of IVR-OP. Immunohistochemically, EMA was positive in
all cases. In CD68 staining, many positive cells were observed in not only the vicinity of the vacuolar degeneration and necrosis
part but also in the site to be considered lysosome in the tumor cells. [Conclusion] Preoperative embolization was very helpful on
the point of decreased bleeding volume and shortening of the surgical time resulting in improved the patient’ s outcome.
Histologically, early infiltration of macrophage as well as the ischemic findings was remarkable with embolization, which was
were observed in all cases. Large necrosis was mainly observed in the case more than one month of IVR-OP interval. Small
Hiromi GOTO, Shunsuke SATO, Yuki KITADA, Koh YAMMOTO, Kazuo WATANABE
Southern TOHOKU Research Institute for Neuroscience
OBJECTIVE: The aim of this study is to assess the risk of meningiomas surgery in patients over 65 years of age. PATIENTS
AND METHOD: We retrospectively review a series of 161 patients over 65 years of age who underwent the surgical removal of
intracranial meningioma between January, 2000 and November, 2015 in our institution. We analyze the incidence of
The risk of aging in intracranial meningiomas surgery
8PS1-2
Hands on
changed by the IVR-Op interval.
postoperative complication in elderly patients comparing with the patients under 65 years of age. We divide the elderly patients
complication and performance status in every group. We compare the surgical risk between 4 groups and analyze the surgical risk
of aging. 101 patients were female and 60 were male. 50 patients were located in convexity, 40 falx/parasagital area, 28
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into 4 groups; A: 65-69 year-old, B: 70-74 year-old, C: 75-79 year old and D: over 80 years of age and analyze the postoperative
sphenoidal , 12 C-P angle, 11tuberclum&clinoidal, 6 tent, 6 petroclival and 8 in others sites. RESULT: The incidence of
postoperative complication in elderly patients is significantly higher than that of patients under 65 year of age. The incidence of
KPS occurs 4 % in elderly patients and 2 % in patients under 65 year of age. It is higher in elderly patients, but not significantly
high. The severe complication presents 9% in patients over 80 years of age. It is significantly higher than the patients under 65
years of age. CONCLUSION: The aging is a risk factor of the meningioma surgery. The risk of postoperative complication is
significantly high in patients over 80 years of age. We should consider carefully the indication of the meningioma surgery in over
80 years of age.
abstract
complication tends to increase as the patients’ age are increasing, but it is not significant. The severe complication which affect
J N C 2 016
8PS1-3
Post embolization neurological syndrome: one of important reaction after
preoperative embolization of intracranial and skull base tumor
Yujiro TANAKA, Takao HASHIMOTO, Hitoshi IZAWA, Hiroaki NAMATAME, Hirofumi OKADA
Yusuke ARAI, Michihiro KOHNO
Hands on
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First Sentence
Neurosurgery of Tokyo Medical University
PURPOSE;Preoperative embolization for hypervascular tumor of intracranial and skull base is great useful supportive procedure.
But neurological complications result from tumor and peritumoral brain swelling, cranial nerve ischemia or hemorrhage are
critical problems of this procedure. On the other hand, minor adverse events like a fever, headache or rising inflammatory
reactions are common. We considered the relation of neurological complications and minor adverse events references from “post
embolization syndrome (PES)” that is common incidents after arterial embolization for abdominal tumor.METHODS36
consecutive patients had preoperative embolization. Mean tumor size were 40.6±14.2mm. Embolic source were elected on the
result of provocative test by lidcaine (33mg). We examined effect of embolus using four classifications (none, slight, partial,
significant) classified by degree to the disappearance of contrast area of enhanced MRI. Major and minor adverse events were
recorded.RESULTSNeurological complications were occurred in 8 cases. Effects of embolus were “partial” or “significant” in all
8 cases. Their mean maximum fever was 38.0±0.59℃, mean time to maximum fever was 44±24.5 hours. Five cases were
exacerbation of existing neurological symptom. Mean time to onset was 37.2 hours. Symptoms were self-limited except for one
case that became emergency surgery. The other three cases were new neurological symptom that didn’ t exist before procedure,
and that equate with transient symptom in provocative test. Mean time to onset was 3.0 hours. In the former cases, exacerbation
of existing neurological symptom came concurrently with general inflammatory change, transiently. In the latter cases, ischemia
of vasa nervorum is suspected. CONCLUSIONSExacerbation of existing neurological symptom with tumor inflammatory change
is one of important neurological complications after preoperative embolization, which should be distinguished from ischemic or
hemorrhagic complication. We define this neurological reaction caused by mechanism similar to PES, as “post embolization
neurological syndrome (PENS)” .
8PS1-4
Intraoperative monitoring of vestibular schwannoma
Miki HIOKI, Yoshifumi KAWAGUCHI, Yujiro TANAKA, Hirofumi OKADA, Hitoshi IZAWA,
Nobuyuki NAKAJIMA, Hiroaki NAMATAME, Jiro AKIMOTO, Michihiro KOHNO
Department of Neurosurgery, Tokyo Medical University Hospital
ObjectiveWe evaluated the predictors for facial nerve palsy or hearing preservation immediately after vestibular schwannoma
surgery.MethodsFrom July 2013 to May 2015, of the 104 continuous patients with vestibular schwannoma who underwent
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surgery, we evaluated 100 patients excluding 4 who presented with facial nerve paralysis preoperatively. For intraoperative
monitoring, facial electromyography (EMG) to extract electrical impulses from the facial muscle was performed by optional
electrical stimulation using a silver ball electrode-induced facial EMG. Hearing function evaluated by auditory brainstem
responses (ABRs).We evaluated facial nerve palsy using House-Brackmann facial nerve grading (HB grade), intraoperative facial
nerve sparing rate [(after tumor resection M-Max)/(Max intraoperative M-Max) ×100(%)], and hearing using the Pure-Tone
Average (PTA), Speech Discrimination Score, and American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)
abstract
classification.ResultsThe tumor resection range was 90%-100% (average 97%). In patients with worsened facial nerve function
above HB grade 3, although there was no significant difference in the intraoperative facial nerve preservation rate in the frontalis
and orbicularis muscles, a significant difference was observed in the eye ring muscle (p = 0.0278). There were 14 patients with
preserved V wave on ABR, and the median V wave latency prolongation was 0.94 ms (0.12-2.61). Although the V wave was
preserved intraoperatively among 4 patients, the hearing loss indicated a median V wave latency prolongation of 2.02 ms
(0.75-2.75). A significant difference was not observed neither of the method.ConclusionThese findings suggested the
preservation of the facial and hearing function by intraoperative monitoring, but these findings should be warranted by further
study.
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JNC2 01 6
8PS1-5
Installation of a Neuromate Robot for Stereotactic Surgery :Efforts to Conform
to Japanese Specifications and an Approach for Clinical Use - Technical Notes
Toshiya NAGAI 1, Yasukazu KAJITA 2, Daisuke NAKATSUBO 3, Hirotada KATAOKA 4, Takahiro
NAKURA 5, Wakabayashi TOSHIHIKO 6
1
Aichi Prefectural Colony Central Hospital
Nagoya University, Postgraduate School of Medicine, 4Anjo Kosei Hospital, 5Aichi Medical University
The neuromate is a commercially available, image-guided robotic system for use in stereotactic surgery and is
employed in Europe and North America. In June 2015, this device was approved in accordance with the
First Sentence
2,3,6
Pharmaceutical Affairs Law in Japan. The neuromate can be specified to a wide range of stereotactic procedures in
table that provides lateral and anteroposterior images to verify the positions of the recording electrodes. The
neuromate is designed to be used with the patient in the supine position on a flat operating table. In Japan, deep
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Japan. The stereotactic X-ray system, developed by a Japanese manufacturer, is normally attached to the operating
brain stimulation surgery is widely performed with the patient’ s head positioned upward so as to minimize
position (by 25 degrees) to accommodate the operating table at proper angle to hold the patient’ s upper body. After
these modifications, the accuracy of neuromate localization was examined on a computed tomography phantom
preparation, showing that the root mean square error was 0.12 ± 0.10 mm. In our hospital, robotic surgeries, such as
those using the Da Vinci system or neuromate, require operative guidelines directed by the Medical Risk
cerebrospinal fluid leakage. The robot base where the patient’ s head is fixed has an adaptation for a tilted head
Management Office and Biomedical Research and Innovation Office. These guidelines include directions for use,
Effects of fractionated radiation on murine glioma stem cell metabolism
Satoshi FUJITA 1, Oltea SAMPETREAN 2, Satoshi IWABUCHI 3, Hideyuki SAYA 4
Department of Neurosurgery (Ohashi), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
3
Dept. of Neurosurgery (Ohashi), School of Medicine, Faculty of Medicine, Toho University
1
2,4
Cancer stem cells (CSCs) are undifferentiated cancer cells with a high tumorigenic activity, the ability to undergo self-renewal,
8PS1-6
Hands on
procedural manuals, and training courses.
and a multilineage differentiation potential. CSCs are responsible for the development of tumor cell heterogeneity, a key feature
(GSCs) play an important role in tumor recurrence after treatment. We recently reported that GSCs are able to change their
secretory profile and modulate survival signaling to adapt to repeated radiation. Since irradiated GSCs were also characterized by
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for resistance to anticancer treatments including conventional chemotherapy, radiation therapy. Also in glioma, glioma stem cells
slower proliferation, here we investigated whether these changes required a specific adaptation of their energy metabolism.
Initial tumors were established by orthotopic implantation of Ink4a/Arf null neural stem cells overexpressing H-RASV12.
radiation group exhibited lower glucose consumption and lactate production than those of the non-treated group, suggesting a
differential use of glycolysis. Among intracellular metabolites, the abundance of intermediates of glycolysis and nucleoside
metabolism was reduced in the irradiated clones, whereas that of essential amino acids was largely unchanged.
Our results suggest that repeated radiation does change the metabolic preferences of GSCs to accommodate their relative
quiescence, warranting investigation of intra- and extracellular metabolites in order to determine potential therapeutic targets.
abstract
Subclones were established from GSCs purified from the tumors and GSCs irradiated with 60 Gy after isolation. Subclones in the
J NC2 0 16
8PS1-7
Strategy of instrumental surgery and management for upper cervical spine
fracture
Masaaki IWASE, Akio ASAI
First Sentence
Kansai Medical University Takii Hospital
Objectives;There have been several classifications described for upper cervical spine fracture. We report the recent surgical
strategy for each classification of upper cervical spine fracture experienced.Materials and Methods;We experienced 20 cases of
upper cervical spine fracture between 1994 and 2015. We followed the guideline when we decided the surgical methods;
posterior fixation using rod and screw system, anterior fixation, and halo application.Results;In our institution, upper cervical
fracture ratio in total cervical fracture cases during same period was 16%. In 9 cases, we selected posterior fixation using the rod
and screw system. In 4 cases, we performed anterior fixation. And chose halo application for the other 7 cases. 1) O-C2
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posterior fixation for 2 cases of O-C1 dislocation, 2) 5 cases of halo application for C1 fracture, 3) 4 cases of O-C2 / C1-C2
posterior fixation for C1 C2 complex fracture, 4) 3 cases of Odontoid screw for C2 Odontoid fracture, 5) 2 / 1/ 3 cases of halo
application / anterior / posterior for C2 Hangman’ s fracture. We succeeded in most of the cases. But we had some problems; I)
In case of using halo application, it took 9 – 16 weeks before bone union, ii) In 2 inappropriate screw cases needed
reoperation.Discussion;Frequency of O-C1 dislocation is uncertain, C1 fracture represents ~ 10%, sum of 3 types of C2 fractures
Hands on
represent ~25% of all cervical fractures in the literature. We had the similar occurring rate in our institute. We used the
guidelines of Dickman, 1993, and some newer ones. As we followed the new technique, we had successful surgical result.
Conclusions;Posterior fixation technique using the newer rod and screw system and technique for upper cervical spinal fracture
achieved good results.
8PS1-8
The clinical results of the Percutaneous Endoscopic Lumbar Discectomy
(PELD) with Electromyogram under general anesthesia.
Manabu MINAMI, Yoshihiro KITAHAMA, Taigo KAWAOKA
Spine Center, Omaezaki Municipal Hospital
The percutaneous endoscopic spine surgery is one of many newly developed minimally invasive spine surgery technique. This
techniques require only a small skin incision, present less approach site tissue trauma, and allow an early recovery after the
procedure. We present the clinical results of the PELD in our institute.A total of 101 patients with lumbar degenerative diseases
who underwent PELD under our institution between June 2012 and December 2015, and then mean follow up period was 12.4
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(range 1-30) months at our institution, were investigated for their clinical outcomes. During the procedure, the free running
electromyography (EMG) monitoring performed our institution under general anesthesia. Forty cases’ outcomes of the single
level TF-PELD examined. There were 21 male and 19 female patients with mean age of 51.0 (range 17-88) years. One patient
underwent TF-PELD at L1-2 level, 2 at L2-3 level, 7 at L3-4 level , 23 at L4-5 level and 7 at L5-S level. The clinical outcomes
were evaluated by the numeric rating scale (NRS) for affected leg pain and day1 wound pain and MacNab’ s criteria were
measured on the first examination and on the final follow-up. Two social parameters such as return to walk and work were also
abstract
assessed. The preoperative NRS score for the affected leg improved significantly from 6.5 to 0.6, and the mean NRS score of day
1 morning wound pain was 0.7. Excellent or good results stated by 87.5% of the patients and Fair was rated by 12.5% of the
MacNab’ s criteria. The mean operation time were 66.7 (range 38-152) minutes and bleeding of all cases were uncountable little.
The mean days spent till return to walk were 0.4(range 2-20 hours) days, the average hospital stay was 3.5 (range 1-24) days and
the mean days spent till return to original work 16.0 (range 5-56) days. No serious complication occurred, three patients (7.5%)
having a transient paresis that had disappeared after 3 months. A patient had additional decompression surgery. Recurrence rate
was 0.0%.
1 02
JNC2 01 6
8PS2-1
Treatment for vertebral artery injuries associated with cervical spine injuries
Hirofumi OKADA, Takao HASHIMOTO, Yujiro TANAKA, Hiroaki NAMATAME, Michihiro KOHNO
Objective: We report two case of vertebral artery dissection due to a cervical spine fracture dislocation. Case 1: A
61-year-old man with tetraplegia due to cervical spinal cord injury was brought for emergent care. Computed
tomography (CT) revealed a cervical dislocation at the C4/5 level. Reduction of the dislocation was done by an
First Sentence
Tokyo medical university, department of neurosurgery
orthopedist. The patient developed consciousness disturbance 28 hours after the procedure. CT angiography
revealed bilateral vertebral artery dissection and occlusion at the top of the basilar artery. Mechanical thrombectomy
consciousness improved immediately after the recanalization. Case 2: A 55-year-old man with left hemiplegia due to
cervical spinal cord injury was brought for emergent care. Computed tomography revealed a cervical dislocation at
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using Penumbra system was performed under local anesthesia and TICI 2b recanalization was achieved. Patient’ s
the C4/5 level. Magnetic resonance imaging (MRI) revealed left vertebral artery dissection. Parent artery occlusion
ischemia. Awareness of potential VAIs after cervical spine injury, prompt diagnosis, and successive treatment are
important.
8PS2-2
Successful therapy of thalamotomy for intractable thalamic pain. Case report
Shohei NORO, Hideaki ISHIBASHI, Satoru HIROSHIMA, Kyousuke KAMADA
Department of Neurosurgery,Asahikawa Medical University,Japan
【Background】In the elderly, pain of a widespread nature can often be debilitating. Characteristic widespread pain
is common the sequelae of a central nervous system lesion such as a “Thalamic Pain Syndrome” . Patients usually
suffered from intractable and burning pain in parts of body areas, which interferes their routine lives. Although
Hands on
(VAIs) can occur as a result of the cervical spine injury and have the potential to cause cerebral or brainstem
embolization. The patient didn’ t develop cerebral infarction and discharged.Conclusion: Vertebral artery injuries
using coil for left vertebral artery before reduction of the dislocation was performed for preventing artery to artery
and thalamotomy by stereotactic surgery, we have not yet established the best option for the symptom. Here, we
demonstrate our experience of successful treatment by thalamotomy after SCS in a case with intractable facial
thalamic pain. This report shows sequential changes of the symptoms following treatments and show thalamotomy
Symposium
there have been several the treatments of medication, electric stimulation to the motor cortex or spinal cord (SCS),
might have a potential to be one of treatment option for "Thalamic Syndrome".【Case Report】A 56-year-old man
has suffered from intractable left facial pain after a small right thalamic infarction since one year ago. After several
pairs and stimulus conditions, SCS did not work to relieve the pain. Second option of left thalamotoy in Vpm was
done half year later. For the thalamotomy, we coagulated the previous infarcted lesion. Although we found unclear
effect for the pain during operation, we finally decided to coagulate the target. Since the next day after operation,the
pain became milder day by day.. Two weeks later he discharged with no pain or complications.The effect has still
lasted since half a year.【Conclusion】Thalamotomy is consider to be one of treatment options for thalamic
syndrome. We describe a case report with literature reviews.
abstract
medications, he accepted SCS with 2 subdural electrodes between C4 and C1. Although we controlled electrode
J NC2 0 16
8PS2-3
Trigeminal neuralgia due to compression of trigeminocerebellar artery
Report of 6 cases
Norio ICHIMASU 1, Yutaka TAKUSAGAWA 2, Michihiro KOHNO 3
Tokyo Medical University
Kosei Chuo Hospital
1,3
First Sentence
2
Abstract Introduction: Trigeminocerebellar artery (TCA) is a unique branch of the basilar artery supplying both CN V and the
cerebellar hemisphere. Previous cadaveric studies have reported that TCA is identified in about 10% of the specimens, pointing
out that TCA may cause trigeminal neuralgia considering their close anatomical relationship. However, only 5 cases of the
trigeminal neuralgia by TCA have been reported thus far. In this study, we examined the anatomical characters of TCA as an
offending artery and discussed operative techniques of the microvascular decompression (MVD) for these cases, from our
Program
experiences of 5 cases of trigeminal neuralgia due to compression of TCA.Materials and Methods: We retrospectively examined
5 patients (1 males and 4 females; mean age, 52.4 [range, 46-57]; all right side) with trigeminal neuralgia due to compression of
TCA, who were treated with MVD between April 2012 and March 2014, at Tokyo Medical University Hospital and Kosei Chuo
Hospital. All cases were operated by one neurosurgeon (T. Y). In all of the cases, the offending vessel was identified and
confirmed as TCA from operative findings.Results: Symptomatic areas were located in V1 and 2 for 2, and in only V2 for 3. In
In 2 cases, the offending vessel: the main trunk of TCA, penetrated CN V root. These characteristics make complete
decompression of the TCA difficult or impossible. In all our cases, complete resolution of symptoms was achieved.Conclusions:
From our experience, trigeminal neuralgia caused by TCA has unique pathological characters. Detailed anatomical knowledge of
this abnormal artery, careful preoperative assessment, and case by case surgical strategy is essential for treatment.
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all cases, TCA made several sharp turns on the pons around CN V and gave perforating arteries to the root entry zone of CN V.
8PS2-4
Report of international PNLS ( Primary Neurosurgical Life Support ) course
Masaaki IWASE 1,Akio ASAI 2
1
2
Kansai Medical University,Takii Hospital
Kansai Medical University
We plan the joint hosting PNLS course in 11th ACNS 2016.
History and future of PNLS course
International PNLS course
Symposium
We performed the first trial International PNLS course in 2009 in Japan.
As for ACNS, We had the first joint course in the 8th ACNS 2010 in Malaysia.
We are planning to have serial joint courses in the future ACNS meetings.
Japanese PNLS course
In 2008, the Japan Society of Neurosurgical Emergency (JSNE) started a project of simulation training for acute neurosurgical
diseases that is called the Primary Neurosurgical Life Support (PNLS) course. PNLS has been developed as a 4-hour hands-on
abstract
education course for medical staff in the neurosurgical field. We designed the following four subjective behavior objects: 1)
enforcement of basic life support; 2) enforcement of safe defibrillation; 3) enforcement of neurological signs and management of
cerebral herniation in the acute phase; and 4) learning about basic treatments. We performed the first trial course of PNLS with
the 14th annual meeting of the JSNE on January 16, 2009.
In resent 7 years, 22 courses and 15workshops have been performed in Japan, including the joint course in 69th,71th,72th,73th,
74th Annual Meeting of the Japan Neurosurgical Society 2010-2015.
1 04
JNC2 01 6
8PS2-5
Results of 5 years follow up in Clanioplasty using subcutaneous expander
for the skin flap contracture
Hisato IKEDA 1, Takaharu OTSUKA 2
2
Department of Neurosurgery, Showa university Koto Toyosu hospital
Department of plastic surgery, Showa university northern Yokohama hospital
The skin flap contracture may occur with the result of post operative infection. One of the problems about the skin flap
contracture is the ischemia of skin flap which sometimes promotes infectious complication in case of clanioplasty. However, this
ischemia is due to the excessive extension of the flap, we plan for stage operation to this problem. The results of five years
First Sentence
1
follow up in this staged operation were analyzed. Materials and Method) The cases of clanioplasty associated with skin flap
contracture from April 2001 to Decmber 2011 were subjected and followed for more than five years. Skin plasty using
operations of clanioplasty to skin flap contracture were performed in 5 cases (male 2, female 3). The reasons of first operation
are acute epidural hematoma (2 cases), cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage (1 case each).
Decompressive clanionectomy is performed in 3 cases. All cases complicated postoperative epidural abscess and craniectomy are
Program
subctaneous expander was performed before clanioplasty. These cases were summarized and reported. Result) The staged
performed. The promoting factor of infection are infection from near the skin wound (2 case), unknown (2 cases), deformed
course with no serious complication during the follow up period for 5 years. Conclusion) The staged operations of clanioplasty
using subcutanous expander to the skin slap contracture are performed in 5 cases with good postoperative course.
8PS2-6
Newly revised neuroresuscitation guidelines in Japan Resuscitation Gudelines 2015
Hiroshi Okudera, Masahiro WAKASUG, Megumi TAKAHASHI, Mie SAKAMOTO
Department of Crisis Medicine and Patient Safety, Graduate School of Medicine, University of Toyama
Since 2010, Japan Resuscitation Council (JRC), a member of Resuscitation Council of Asia, developed original resuscitation
guidelines. On 16th October,2015, JRC provided new JRC Guidelines 2015 at the same time of AHA (American Heart
Assocition) and ERC (European Resuscitation ouncil). In JRC Guidelines 2015, we provides an origical chapter named
Hands on
the skin gradually helps vascular reconstruction which minimize ischemic problem. However, all cases are in good postoperative
years. Discussion) The skin ischemia obstacles defensive system of skin flap. Skin plasty using subcutaneous expander extend
titanium plate. The expanding period is 13.8 week in average. There is no serious complication during the follow up period for 5
"Neuroresuscitation" as same in JRC Guidelines 2010.
1)2.Symcope in II Neurological manifestations at around resuscitation (adults)
2)1-4.Transient Ischemic Attacks in 1.Cerebrovascular diseases of III Diseases and conditions which needs neuroresuscitation
(adults)
Symposium
Newly added contents in Neuroresuscitation 2015 (Table) is as follows:
3)4-3.Critical illness neuromyopathy in 4.Neuromuscular diseases of III Diseases and conditions which needs neuroresuscitation
(adults)
5)7-1.Intensive care for increaed intracrania pressure by head injury in 7.Head Injury including
6)7-2.Thronmnohematological treatment for head injury in 7.Head Injury including
5)8.Spinal Emergency
Total concept of Neuroresuscitation 2015 will be presented.
abstract
4)4-4.Crush syndrome in 4.Neuromuscular diseases of III Diseases and conditions which needs neuroresuscitation (adults)
J NC2 0 16
8PS2-7
Concept of Primary Neurosurgical Life Support
Mayumi Hashimoto, R.N., Ph.D.M.1, Hiroshi Okudera2, Mie Sakamoto3, Megumi Takahashi4,
Masaaki Iwase5
Department of Nursing, Kanagawa Institute of Technology
5
Neurosurgery and Stroke Center, Takii Hospital, Kansai Medical University
1
Hands on
Program
First Sentence
2,3,4
In Japan, Japan Neurosurgical Society (JNS) has been defined neurosurgery as a basic clinical department such as internal
medicine and surgery. Therefore, neurosursurgeons has been covering wide field such as neurological emergency medicine,
neurosurgical practices, neuroradiological procedures, in-hospital patient management including neurointensive care,
neurophysiological monitoring and neurorehabiliration and hospital management. For training the residents and co-medical staff
in neurosurgical procedures, airway management including difficult airway and early detection of cerebral herniation should be
important skills which should be included the neurosurgical training.
Primary Neurosurgical Life Support(PNLS) is developed based on Immediate Strole Life Support (ISLS), by the committee of
PNLS course, Japan Society of Neurosurgical Emergency in 2009. The committee designed the PNLS as half day training course
with simulation-based curriculums with learning and assessment objectives which are to be accomplished, and published PNLS
course guide book. Basic structure of GIO and SBOs of PNLS is designed as follows:
GIO: Learn an appropriate response to acute stage of neurosurgical patients and a
leadership in team management in Neurosurgical team.
SBOs 1) Life support skills including BLS (Basic Life Support) and AED
2) Airway management and monitoring
3) Early detection and management of cerebral herniation
4) Learn and discuss the representative neurosurgical cases
We developed a basic training course, primary neurosurgical life support (PNLS), for neurosurgeon and co-medical staff. PNLS
course will provide appropriate response and management on acute management of neurosurgical patients and may improve
patient safety4). Furthermore, PNLS course may have potentials for training of neurosurgical staff in developing countries in
Asia, as international collaboration.
8PS2-8
Newly developed EEG Monitoring Head Set for Neurosurgical Care
Mie Sakamoto, M.D., Hiroshi Okudera, Masahiro Sakamoto, Megumi Takahashi
INTRODUCRION: In Japan, the first step of neurocritical care in hospital is mainly provided by resuscitation team consisting of
emergency physicians, neurologists and neurosurgeons.
Therefore, Japan Resuscitation Council (JRC) described an independent chapter termed "neuroressuscitation"(NR) in the first
Symposium
and original ressuscitation guideline 2010.
NR refers to cerebrovascular diseases, acute encephalopathies, Infection of the central nervous system, acute neuromuscular
diseases, neuroleptic malignant syndrome, heat emergencies, persistent consciousness disturbance and brain death. Among of
them, non convulsive status epilepticus(NCSE) is difficult to identify in ER. Thus the treatment for NCSE tends to be late.
To minimize the secondary brain injury, Emergency physicians should diagnose NCSE in early stage. To identify the patient of
NCSE, simple and easy monitoring with electroencephalography (EEG) in ER should be required.
abstract
METHODS: We developed new digital EEG monitoring system with portable electrode head set to realized simple and easy EEG
monitoring in Emergency Room(ER). The system is wireless by Bluetooth commnication technology. Portable head set consists
of electrodes with newly developed attachment electrode.
RESULTS: Development of prototype of the EEG Electrode Head Set for use in ER was successful. We should have brushup of
total system for commercial products.
CONCLUSIONS: We developed a new digital EEG monitoring system with portable and wireless head set. The new EEG head
set consists of eight electrodes with newly developed attachment electrode.
1 0 6 Joint Neuro s ur gi ca l C onv e n ti on 2 0 1 6
JNC2 01 6
8PS3-1
Complication Avoidance in unruptured middle cerebral artery M1 segment
superior wall Aneurysm Surgery
Yasuhiro YAMADA 1, Sandeep TALARI 2, Kei YAMASHIRO 3, Daisuke SUYAMA 4, Tsukasa KAWASE 5
Wu RILE 6, Vladimir BALIK 7,Yoko KATO 8
Department of Neurosurgery,Fujita Health University Banbuntane Hotokukai Hospital
Andhra Medical College, Visakhapatnam,India, 6Inner Mongolia People´s Hospital,Hohhot,China
7
University Hospital Olomouc, Olomouc, Czech Republ
2
【Background】M1 segment aneurysms are one of the challenging surgeries. M1 segment aneurysms account for
First Sentence
1,3,4,5,8
only 2-3 percent of the total aneurysms and M1 superior wall aneurysms are even more rare.M1 superior wall
aneurysms are difficult to clip due to their close relation with the lenticulostriate arteries.Involvement of the small
clip unruptured M1 superior wall aneurysms thereby avoiding complications and morbidity【Methods】This is a
retrospective study in a neurovascular centre with an experienced neurovascular team.22Cases of unruptured M1
Program
perforators while clipping the aneurysm can lead to major morbidity.【Objective】To understand the safe ways to
superior wall aneurysms operated in 3 years from september 2012 to september 2015 were included in the study.CT
【Conclusions】Other than meticulous preoperative simulation and intraoperative technique , adjunctive use of
endoscope, ICG-VA, doppler ultrasonography and MEP has reduced the chances of complications.
8PS3-2
Stroke Rehabilitation in Cambodia: A case study of stroke patient focus on
relearning activities of daily life
Yusuke HIRAI 1, Muy Vanny 2, Heang Peng Hong 3
1
Kitahara Neurosurgical Institute
Kitahara Japan Clinic
2,3
Kitahara Neurosurgical Institute (KNI) provides medical service specialized in neurosurgery and cardiology in
Hachioji-shi, Tokyo, Japan. Kitahara Japan Clinic KNI group established opened at Cambodia in December 2014.
Hands on
hemiparesis in 3 patients which improved.There was no permanent morbidity or mortality in the series.
clipped using a standard pterional craniotomy and transylvian approach.There was transient contralateral
angiogram,MRI and in some cases DSA was done .【Results】22 cases of M1 superior wall aneurysms were
study of a 50’ s Cambodian male who had cerebral infarction (Basal ganglia) 2 years ago. He is at home after he
stayed at hospital for 3 days to be on medication. He has hemiplegia of left side. He already got the ability he can
walk independently and can do activities of daily life without help of another person before we provide
Symposium
KJC also provides medical service focused on rehabilitation for Cambodian. This case study is a rehabilitation case
rehabilitation for him. His needs are to improve hand and arm function and the ability of walking further. He cannot
use left arm during doing daily activities. We used Fugl-Meyer assessment to understand arm function. His ability
treatment this time focused on regaining normal movement through re-education. We tried to improve the rolling
pattern with developing neuromuscular control and coordination of core. Result of this case study is that he
improved not only the rolling pattern but also arm function and walking speed. Some of the stroke patients cannot
receive rehabilitation enough in Cambodia. They may increase abnormal posture and movement pattern in
compensation for hemiplegia. A case study may aid in understanding the importance of learning activities of daily
life properly for the stroke patient.
abstract
of balance was measured by one-legged stance test. Walking function is measured by 10-meter walk test. The
J NC2 0 16
8PS3-3
A new experience with flow diverters for cerebral giant aneurysm treatment
in southern Thailand: Challenge of rural area
Ittichai Sakarunchai, Kittipong Riabroi, Rujimas Kumthong
Program
First Sentence
Prince of Songkla University, Songkhla, Thailand
Background: Endovascular coiling of cerebral aneurysm has become popular trend in the present era. The limitation of
conventional coiling is classified by board neck, fusiform morphology and large size of cerebral aneurysm. Flow diverters is a
new technique of redirecting flow away from aneurysm and back into the parent artery is very safe and effective for giant
aneurysm treatment. Altering in-flow and out-flow jets, to introduce aneurysm thrombosis. Unfortunately, we never used this
device before and we have to start flow diverters in the first time to treat the giant cerebral aneurysm patients who presented with
pressure symptom. The success technique and treatment outcome was reported from our institute.
Methods: We reported the first 2 patients who were performed the flow diverter placement for giant cerebral aneurysm treatment
in Prince of Songkla University Hospital, Southern Thailand. Both of them presented with cavernous sinus syndrome from mass
effect of aneurysm. The first patient is male 42 year-old presented with completed ptosis and extraocular muscle dysfunction of
right eye. Follow up with cerebral angiography revealed of right partially thrombosed large internal carotid artery (ICA)
aneurysm (lacerum segment). The flow diverters device (Pipeline®) was introduced to treat the aneurysm. The second patient is
46 year-old, female presented with headache and complete ptosis of right eye. The cerebral angiogram was revealed the giant
aneurysm of ICA cavernous segment. We performed the flow diverters device (Silk®) placement. The clinical outcome was
evaluated for neurological deficit including the radiographic result at 6 months.
Results: Both of patients didn't have any complication for immediately and late of post procedure. The follow up cerebral
angiography was obtained in the first patient. The completely gone of large aneurysm was detected and the completed recovery
of third nerve palsy was noted in clinical follow up period. The second case is scheduled for angiography next two months.
abstract
Symposium
Hands on
Conclusion: Flow diverters represent a major role for giant, fusiform and untreatable cerebral aneurysm treatment. The safety of
treatment was accepted in the worldwide and the outcome of treatment is also satisfied. A challenging for device application is
excellent for a difficult case and need a minimally invasive treatment.
8PS3-4
The new trend of vascular hybrid neurosurgeon, Is it easy?
Ittichai Sakarunchai
Prince of Songkla University, Songkhla, Thailand
Background:The trend of cerebrovascular treatment with endovascular technique is popular due to less invasive and good
outcome. However, the limitations of endovascular treatment should be concerned such as recurrence of treatment and difficult to
definite cure in the complex cases so the combined of treatment (hybrid) is ideal of cerebrovascular management. Nowadays, the
surgeons who can perform both of microsurgical and endovascular technique are very rare. Almost of endovascular training is
separated and provided by the society of Radiologist in the several countries. Dual-trained for hybrid vascular neurosurgeons
who are expert in multiple treatment modalities can safely combine treatments when beneficial, as well as recognize the
limitations of each therapeutic modality. I would like to present my responsibility as a first hybrid neurosurgeon of Southern
Thailand to manage of cerebrovascular patients.
Methods: I collected the number of the cerebrovascular patients who need to treat with either microsurgery or endovascular
technique and categorized what is novel as a hybrid neurosurgeon can do in Prince of Songkla University Hospital, Southern
Thailand from 2014-2016. Furthermore, I also summarized the system of hybrid neurosurgeon training in Thailand.
Results: Only 4 official neurosurgeons in whole country can perform a full course of neurointervention procedures. On the other
hand, more than 20 radiologists can take care the patient with endovascular treatment. The only 3 hospitals in the country can
deal with hybrid operation room. For my institute, from July 2014- March 2016 we had 224 patients who were treated with the
criteria of cerebral aneurysm, ischemic stroke, dural arteriovenous fistula, arteriovenous malformation and spinal vascular
disease. All responsibility of treatment was managed and discussed with radio-interventionists by only one hybrid neurosurgeon
in my hospital. By the way, 2% of cases needed abrupt changes the plan of treatment during endovascular procedure such as
intra-arterial vasodilator for cerebral vasospasm, aneurysm ruptured during coiling or AVM ruptured during glue embolization.
Conclusion: We consider that microsurgical and endovascular therapies are complementary techniques for managing the
cerebrovascular disorders. It is important for cerebrovascular surgeons in training to master both microsurgical and endovascular
techniques. Not only how to set the system for the pioneer neurosurgeon who must take responsibility both skills, but also they
should should work hard simultaneously. The encouragement the growing number of young hybrid neurosurgeons for developing
country is really needed.
1 08
JNC2 01 6
8PS3-5
PDGFR-β plays a key role in the ectopic migration of neuroblasts
in cerebral stroke
Hikari SATOU 1, Yamamoto S 2, Kuroda S 3, Sasahara M 4, Watanabe S 5, Watanabe K 6
The neuroprotective agents and induction of endogenous neurogenesis remain to be the urgent issues to be established for the
care of cerebral stroke. Platelet-derived growth factor receptor beta (PDGFR-b) is mainly expressed in neural stem/progenitor
cells (NSPCs), neurons and vascular pericytes of the brain; however, the role in pathological neurogenesis remains elusive. To
this end, we examined the role of PDGFR-b in the migration and proliferation of NSPCs after stroke. A transient middle
First Sentence
1,5
TOKYO GENERAL HOSPITAL, 2,4Department of Pathology, University of Toyama, 3Department of Neurosurgery, University
of Toyama, 6SOUTHERN TOHOKU HEALTHCARE GROUP
cerebral-arterial occlusion (MCAO) was introduced into the mice with conditional Pdgfrb-gene inactivation, including
N-PRb-KO mice where the Pdgfrb-gene was mostly inactivated in the brain except that in vascular pericytes, and E-PRb-KO
subventricular zone toward the ischemic core was highly increased in N-PRb-KO, but not in E-PRb-KO as compared to
Pdgfrb-gene preserving control mice. We showed that CXCL12, a potent chemoattractant for CXCR4-expressing NSPCs, was
Program
mice with tamoxifen-induced systemic Pdgfrb-gene inactivation. The migration of the doublecortin (DCX) neuroblasts from the
upregulated in the ischemic lesion of N-PRb-KO mice. Furthermore, integrin a3 intrinsically expressed in NSPCs that critically
medi- ates extracellular matrix-dependent migration, was upregulated in N-PRb-KO after MCAO. NSPCs isolated from
molecular events may be able to improve neurogenesis in injured brain for further functional recovery.
8PS3-6
Nutrition management and NST (Nutritional Support Team) activity
for neurosurgical patients
Chie MIHARA 1, Hitoshi SATO 2, Atsushi SUKEKANE 3
Department of Neurosurgery, Hibino Hospital
DDepartment of Rehabilitation, Hibino Hospital
1,2
3
[Introduction] In acute phase of stroke, the nutritional management is often delayed because of the high priority of treatment for
stroke. But same as in other medical fields, the nutritional management from the early phase is effective for improving the
Hands on
lesion-derived chemoattractant as well as intrinsic signal of NSPCs, and we believe that a coordinated regulation of these
ischemic core. PDGFR-b was suggested to be critically involved in pathological neurogenesis through the regulation of
N-PRb-KO rapidly migrated on the surface coated with collagen type IV or fibro- nectin that are abundant in vascular niche and
outcome. So NST (nutritional support team) has been recently spread in neurosurgical area in Japan.[Method of nutrition
easily occur, so treatment is top priority. The nutritional management is often started after cerebral treatment. However, for
prevention of complications, nutritional management, especially enteral nutrition, should be performed from early period. (2)
Symposium
administration] (1) Acute period: For about a week after onset (surgery), the cerebral blood flow disorder and cerebral edema
Subacute period (convalescence): For 1 month from the onset, neurological symptoms calm down and rehabilitation starts. Then
enteral nutrition and/or oral intake should be main nutritional administration. Enteral nutrition usually starts through naso-gastric
route. Before oral intake, swallowing function should be evaluated to prevent aspiration. (3) Chronic (maintenance) period: More
energy and prepare of discharge from the hospital. If the patient has dysphagia or unconsciousness, enteral nutrition though
naso-gastric route will be prolonged. Some patients need PEG (percutaneous endoscopic gastrostomy) to obtain enough energy
and water during training of eating. We call this situation as “PEG for eating” . [Nutritional goal and the role of NST
(nutritional support team)] The true goal of nutrition is full dose of oral intake. However, the combination of enteral nutrition
through PEG and oral intake is the shortest and safest way to the goal. From the acute period of stroke, the role of NST is very
important to prevent malnutrition and complications. Since NST consists of multidisciplinary, delicate deal is available.
abstract
than 1month from the onset, aggressive rehabilitation is performed. Nutritional management is important for obtain enough
J N C2 0 16
8PS3-7
Investigation of prothrombin time-international normalized ratio variation
factor in patients treated with warfarin
Teppei SHIMIZU 1, Michiko INABA 2, Kouhei ONUKI 3, Megumi ISHIKAWA 4,Emi YODA 5
Keiko HIRANO 6, Nobukazu HOKAMURA 7
Department of Hospital Pharmacy, Kitahara International Hospital, Tokyo, Japan
Department of Digestive Surgery, Kitahara International Hospital, Tokyo, Japan
First Sentence
1,2,3,4,5,6
7
Objective:Warfarin is still used for many patients as an anticoagulant. Although drug effect can be monitored by prothrombin
time-international normalized ratio (PT-INR), it changes depending on various factors. In this study, we investigated variation of
PT-INR and considered factors affecting PT-INR variation.Method:All patients who were admitted in Kitahara International
Hospital from January 2012 to December 2014 and prescribed warfarin were included. We investigated use of antibiotics,
Program
vitamin K intake, use of probiotics, use of nonsteroidal anti-inflammatory drugs (NSAIDs) within one week before measurement
of PT-INR. We analyzed relationship between abnormal high level of PT-INR and these factors. We set normal range of PT-INR
is 2.0 - 3.0 for patients under 70, and 1.6 - 2.6 over 70. Patients who were treated with warfarin more than one week were
included for analysis. Patients who were treated with heparin or other anticoagulants within 2 days before and after measurement
of PT-INR were excluded. Patients with hepatic cirrhosis were also excluded.Results:217 patients were included for this analysis.
The mean age was 75.4 years. 134 inpatients were older than 70 years. The odds ratio (OR) of use of antibiotics was 5.11 (95 %
confidence interval (CI) 2.66-10.1). No statistically significant relationship was detected in any other factors.Discussion and
Conclusion:Use of antibiotics was independently associated with abnormal high level of PT-INR during a period of warfarin use.
It could be presumed that use of antibiotics deteriorates intestinal bacterial flora, and decreases synthesis of vitamin K resulting
in high level PT-INR. As another reason, some kinds of antibiotics could directly enhance warfarin effect through inhibiting
breakdown of warfarin. In conclusion, it is necessary to monitor the effect of warfarin carefully in patients treated with
Hands on
antibiotics.
8PS3-8
Complications of Pneumonia in acute phase adversely affect
the activity of daily living in the sub-acute phase.
Masaki NISHIO, Ryoma FUJITA, Ryuichi KATO
Department of Rehabilitation, Kitahara International Hospital, Tokyo, Japan
＜Back Ground＞Our previous study, Existence of complications in acute phase related to activity of daily living(ADL)
improvement in sub-acute phase.Japanese Stroke Guideline 2015 indicates that to prevent complications in acute phase is
important.However, previous studies didn’ t reveal complications in acute phase related to ADL improvement in sub-acute
Symposium
phase.＜Purpose＞In this study, we reveal that complications in acute phase related to ADL improvement in the sub-acute phase.
＜Methods＞This study carried out a retrospective study of consecutive discharge to the recovery rehabilitation hospital during
one year period from 2013 to 2014(n＝93). Patients with first-onset stroke were included. Patients at not independence before
onset, mild case of onset severity(modified Rankin Scale:mRS≦2), independence movement of indoor at the time of admission
recovery rehabilitation hospital, out of the standard deviation of age, neuropsychological deficit such as difficulty understanding
therapist indications were excluded in the study.The following measures were extracted from clinical charts: age, sex, type of
abstract
stroke, mRS before and after onset, Barthel Index (BI) gain in recovery rehabilitation hospital, and complications in acute phase
(diabetic mellitus, undernutrition, convulsions, pneumonia, decubitus, deep vein thrombosis, and cardiac dysrhythmia).＜Results
＞We determined the correlation between the complications in the acute phase and BI gain in the sub-acute phase. As a result of the multiple regression analysis, only pneumonia(p<0.05) was selected significantly.(ANOVA；p＜0.05).＜Conclusion＞
Stimulating effectively paralyzed side and preventing the atrophy of corticospinal tract are important for stroke patients in acute
phase. In this study, patients with pneumonia tended to delay out-of-bed. Therefore, the patients didn’ t receive rehabilitation
sufficiently in the acute phase, and a decrease ADL gain in the sub-acute phase was caused.
1 10
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Joint neurosurgical convention

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