A preliminary study of the diagnostic efficacy and safety of the novel boring biopsy for brain lesions.

Existing methods for biopsy of intraparenchymal brain lesions, including stereotactic biopsy and open block biopsy, have advantages and disadvantages. We propose a novel biopsy method, called "boring biopsy," which aims to overcome the drawbacks of each conventional method. This method is less invasive and allows obtaining continuous specimens of sufficient volume.

[Optic neuropathy from connected intra- and extraorbital lesions in IgG4-related disease].

We present the case of a 74-year-old woman complaining of blurred vision in the left eye who was found to have a unilateral, continuous lesion of the optic nerve and nerve sheath accompanied by an intracranial mass next to the cavernous sinus and meninges. Surgical decompression of the left optic nerve in the optic canal and partial resection of the mass followed by prednisolone administration were successful. Immunohistochemical analysis disclosed abundant infiltration of IgG4-positive plasma cells at >10 cells/high power field.

Intraoperative Test Occlusion as Adjustment of Extracranial-to-Intracranial Bypass Strategy for Unclippable Giant Aneurysm of the Internal Carotid Artery.

Background: There is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms.

Case Description: A 61-year-old woman presented with a 1-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery.

Single-channel 7.68 Tbit/s, 64 QAM coherent Nyquist pulse transmission over 150 km with a spectral efficiency of 9.7 bit/s/Hz.

We achieved a record capacity of 7.68 Tbit/s in a single-channel OTDM transmission with a 9.7 bit/s/Hz spectral efficiency, where a polarization-multiplexed 640 Gbaud, 64 QAM coherent Nyquist pulse has been transmitted over 150 km.

Single-channel 3.84 Tbit/s, 64 QAM coherent Nyquist pulse transmission over 150 km with a spectral efficiency of 10.6 bit/s/Hz.

We report a polarization-multiplexed 320 Gbaud, 64 QAM coherent Nyquist pulse transmission with a frequency-stabilized mode-locked laser and a modified digital back-propagation method for pulse transmission. Using a combination consisting of a mode-locked laser and a pulse shaper, we obtained a Nyquist pulse with a high OSNR of 51 dB. We achieved error free operation under a back-to-back condition with the OSNR improvement.

Open Embolectomy of Large Vessel Occlusion in the Endovascular Era: Results of a 12-Year Single-Center Experience.

Background: Mechanical endovascular embolectomy using stent retrievers has gained popularity for treatment of large vessel occlusion in acute ischemic stroke. Use of open embolectomy as a direct surgical treatment has been limited, likely owing to the technical difficulty, therapeutic time window, and time-consuming procedure.

Methods: We retrospectively reviewed clinical and radiographic records of patients who underwent open embolectomy for major artery occlusion at an acute stage.

Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke.

Previous studies have shown that extracranial-intracranial (EC-IC) bypass surgery has no preventive effect on subsequent ipsilateral ischemic stroke in patients with symptomatic atherosclerotic internal carotid occlusion and hemodynamic cerebral ischemia. A few studies have assessed whether an urgent EC-IC bypass surgery is an effective treatment for main trunk stenosis or occlusion in acute stage. The authors retrospectively reviewed 58 consecutive patients who underwent urgent EC-IC bypass for symptomatic internal carotid artery or the middle cerebral artery stenosis or occlusion between January 2003 and December 2011.

Mattress anastomosis in micro vascular reconstruction: technical note.

Background: Superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis is a common procedure for neurosurgeons. The surgery necessarily requires accurate and speedy manipulation of microscope, for which a specific training is needed. Unexpected bypass occlusion sometimes happen during surgery.

Cutaneous malignant melanoma "recurred as" or "in coexistence" with meningioma?

Background: The authors report a rare case of a patient with previously treated cutaneous malignant melanoma that recurred 1 year later as an intracranial meningioma.

Case Description: A 20-year-old woman presented with exophthalmos, diplopia and a mass in the left supraorbital area. Imaging study revealed an enhanced intracranial extradural mass with bone destruction.

Urgent open embolectomy for cardioembolic cervical internal carotid artery occlusion.

Acute ischemic stroke attributable to cervical internal carotid artery (ICA) occlusion is frequently associated with severe disability or death and is usually caused by atherosclerosis. By contrast, the cardioembolic cervical ICA occlusion is rare, and feasibility of urgent recanalization remains unclear. We present the first study in the literature that focuses on urgent open embolectomy for the treatment of cardioembolic cervical ICA occlusion.

Outcome predictors of open embolectomy in middle cerebral artery occlusion.

Objective: The purpose of this paper was to analyse the outcome of the patients with acute middle cerebral artery (MCA) occlusion treated by open embolectomy.

Methods: A clinical chart review was retrospectively conducted for 30 patients who had MCA occlusion and were treated with open embolectomy. According to the Glasgow Outcome Scale, the patients' outcome at discharge is divided in two groups: favorable outcome (good recovery and moderate disability) or unfavorable outcome (severe disability, vegetative state and death).

Horizontal contralateral approach for the distal anterior cerebral artery aneurysm: technical note.

Background: The authors present a modified interhemispheric approach for the distal ACA aneurysm to resolve several problems including the narrow surgical corridor, the difficulty of proximal control, and the aneurysmal projection toward the surgeon.

Methods: We refined the positions of the patient's head and the surgeon. The patient's head is fixed with flexion and tilted to the contralateral side.

Intraoperative angiography through the occipital artery and muscular branch of the vertebral artery: technical note.

Background: Intraoperative cerebral angiography has been known as a useful tool for diagnosing neurovascular diseases. There are few reports of intraoperative angiography in the prone position. Intraoperative angiograms through the occipital artery and muscular branch of the vertebral artery have not also previously been described.

Emergency revascularization for acute main-trunk occlusion in the anterior circulation.

We report the surgical results in patients with acute cerebral main-trunk occlusion in the anterior circulation. Between April 2004 and March 2005, 26 patients were surgically treated within 24h after the onset. The occlusion occurred in the internal carotid artery in 10 patients, in the middle cerebral artery in 15, and in the anterior cerebral artery in 1.

Emergency embolectomy for treatment of acute middle cerebral artery occlusion.

Object: The authors evaluated the efficacy of emergency embolectomy in patients with acute middle cerebral artery occlusion (MCAO).

Methods: A retrospective review of the charts for patients undergoing embolectomy at the authors' institution was performed. Between October 1997 and May 2004, 12 patients (mean age 70 years) with acute MCAO were treated using embolectomy.

Retraction suture technique for carotid endarterectomy.

We propose a retraction suture technique as a safe and effective surgical procedure for carotid endarterectomy. Retraction sutures of the skin flap, the carotid sheath and the adventitia of the carotid artery are used to obtain an adequate operative field without the use of retractors or assistants. This technique is useful for carotid endarterectomy.

Characteristics of distal posteroinferior cerebellar artery aneurysms.

Objective: Distal posteroinferior cerebellar artery (PICA) aneurysms are rare and have not been well investigated previously. We report our series of 24 patients with 27 distal PICA aneurysms.

Methods: All patients with distal PICA aneurysms that were surgically treated at Shinshu University Hospital and its affiliated hospitals between 1983 and 2001 were reviewed retrospectively.

Double-insurance bypass for internal carotid artery aneurysm surgery.

Objective: The aim of this article is to present the usefulness of a double-bypass method in the surgical treatment of complex internal carotid artery (ICA) aneurysms. For patients with clippable but complex aneurysms of the ICA having poor collateral circulation, bypass surgery is needed before temporary occlusion of the ICA. We propose a double bypass for safety.

[The efficacy of prophylactic administration of SBT/ABPC for postoperative infection in neurosurgical operations].

We investigated prospectively the efficacy of sulbactam sodium/ampicillin sodium (SBT/ABPC), which is a combination drug of ampicillin and beta-lactamase inhibitor, as a preventive drug against postoperative infection in the field of neurological surgery. One hundred and six patients were given SBT/ABPC as follows: Before anesthetic induction at surgery, 1.5 g of SBT/ABPC was administrated by intravenous drip infusion, and further doses were continued at 12-hour intervals for 5 to 7 days.

Modified, multipurpose, radiolucent sugita head frame for intraoperative cerebral angiography.

Objective: Although several radiolucent head-fixation devices have been developed to allow intraoperative cerebral angiography, no device provides satisfactory freedom to obtain the most suitable head position. We recently designed a multipurpose radiolucent Sugita head frame (modified radiolucent Sugita frame) with satisfactory degrees of freedom and rigidity for intraoperative head positioning and head holding, respectively.

Description Of Instrumentation: A short arm and a ring joint, made of engineering plastic, were added to the prototype radiolucent Sugita frame, to permit side-tilting movements of the frame.

Aneurysm originating from the fenestration of the posterior cerebral artery: case report.

Objective And Importance: A rare case of an aneurysm arising at the fenestration of the P2 segment of the posterior cerebral artery is reported.

Clinical Presentation: A 37-year-old man presented with severe headache and disturbance of consciousness. Computed tomographic scanning showed diffuse subarachnoid hemorrhage.