Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Cost-effectiveness analysis of intrathecal baclofen therapy in Japan.
Intrathecal baclofen (ITB) therapy was approved for health insurance coverage in 2005 for the treatment of patients whose spasticity could not be adequately controlled by conventional therapy, and is currently being used to treat around 300 patients nationwide in Japan. Various reports have examined the efficacy and safety of ITB therapy, but no report has evaluated the patient quality of life and medical costs in Japan. ⋯ The average cost of ITB therapy per quality-adjusted life year (QALY; number of years survival in perfect health) 5 years after surgery was 1,554,428 yen, below the 6 million yen willingness-to-pay threshold for 1 QALY. This study shows that ITB therapy in Japan is an outstanding treatment in medicoeconomic terms.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
External carotid artery stenting and superficial temporal artery to middle cerebral artery anastomosis for internal carotid artery occlusion with external carotid artery severe stenosis: case report.
Superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis may have inadequate effects in patients with internal carotid artery (ICA) occlusion and severe stenosis of the ipsilateral external carotid artery (ECA), because poor blood flow in the STA leads to insufficient flow to the MCA. In these patients, dilation of the stenotic ECA is required to improve the blood flow in the STA before STA-MCA anastomosis. A 71-year-old man presented with left hemiparesis and dysarthria. ⋯ Postoperative SPECT demonstrated marked improvement of hemodynamic insufficiency in the right MCA territory. After treatment, the patient had no ischemic events. This case suggests external CAS together with STA-MCA anastomosis is a good therapeutic option for a patient with symptomatic ICA occlusion and severe stenosis of the ipsilateral ECA if external CEA is difficult to perform.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Review Case ReportsNavigation-guided endoscopic biopsy for intraparenchymal brain tumor.
To evaluate the efficacy of intraparenchymal brain tumor biopsy using endoscopy and a navigation system (navigation-guided endoscopic biopsy) as a diagnostic tool, a case series of intraparenchymal tumor biopsies was reviewed. Navigation-guided endoscopic biopsy was applied in 9 cases, stereotactic needle biopsy in 16 cases, and open biopsy with or without navigation system in 34 cases. In all biopsy cases, 84.7% of biopsy points were sampled accurately, and 93.2% of diagnoses by biopsy were correct. ⋯ Older patients, histological diagnosis of high-grade glioma or malignant lymphoma, positive photodynamic diagnosis, and positive intraoperative pathology were significant factors in improving the sampling accuracy. Navigation-guided endoscopic biopsy could provide a larger sample volume within a relatively short operation time. The biopsy can be easily combined with both photodynamic diagnosis and intraoperative pathology, significantly improving the histological diagnostic yield.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyPrediction of the microsurgical window for skull-base tumors by advanced three-dimensional multi-fusion volumetric imaging.
The surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. ⋯ The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.