Neurological Surgery最新文献

Older adults have a higher prevalence of both dementia and epilepsy. Epilepsy and dementia have a bidirectional relationship. Epidemiological studies have shown that elderly patients with epilepsy have approximately twice the risk of developing dementia compared to controls. Conversely, patients with dementia have twice the risk of developing epilepsy compared to controls. Seizure types in older adults with newly diagnosed epilepsy include focal-onset generalized tonic-clonic seizures and focal impaired awareness seizures without convulsions. The differential diagnosis between epilepsy and dementia can be challenging. Temporal lobe epilepsy may be overlooked in patients visiting dementia clinics. In some cases, temporal lobe epilepsy with frequent seizures may be misdiagnosed as dementia. Additionally, temporal lobe epilepsy in patients already diagnosed with dementia may go unrecognized. Diagnostic difficulties may also arise due to a lack of medical history or absence of eyewitness accounts. In older adults with newly diagnosed epilepsy, antiseizure medications are highly effective in controlling seizures. Accurate diagnosis is essential for effective seizure management and an improved quality of life.

The accumulation of cerebrovascular events, such as cerebral infarction, hemorrhage, and subarachnoid hemorrhage, can result in cognitive decline. Therefore, successful preventive cerebrovascular surgery may contribute to reducing the future occurrence of cognitive decline, whereas perioperative adverse effects may cause cognitive decline. We investigated the influence of cerebrovascular surgery (carotid endarterectomy, extracranial-intracranial bypass, and aneurysmal clipping) on cognitive function. Here, we present and discuss our case series.

Recent studies have reported the types, evidence levels, and recommendation levels of non-pharmacological therapies for neurocognitive diseases. (1) An overview of non-pharmacological therapies for neurocognitive disease, including exercise, occupational, cognitive stimulation (including so-called "brain training"), music, and reminiscence, was introduced, and the evidence levels were reported. Exercise and occupational therapies were found to have a high level of evidence and strong recommendations. (2) As a dementia rehabilitation method, rather than relying on a single program, a complex program that combines exercise therapy and multiple occupational therapies in a variety of ways is more effective. Thus, "short-term intensive dementia rehabilitation" was recommended. (3) The theoretical background of the effectiveness of exercise therapy was considered and the ideal form of exercise for the senior generation was described. (4) Team Orange's activities for preventing individuals with dementia from becoming isolated and lonely were described.

Bypass surgery for common carotid artery occlusion presents significant challenges. In cases of internal carotid artery occlusion, superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass is the standard approach, as the STA blood flow remains intact. However, in common carotid artery occlusion, the STA blood flow is generally insufficient for a donor artery, necessitating alternative and more complex surgical strategies. This paper discusses the surgical approach for common carotid artery occlusion, focusing on donor artery selection and the relevant surgical anatomy.

Idiopathic normal pressure hydrocephalus (iNPH), also known as Hakim's disease, is a major cause of reversible dementia in adults. iNPH primarily affects frontal lobe-related cognitive functions, including attention, executive function, and working memory, even in early stages. Although memory impairment is also present, recognition memory is often preserved, distinguishing iNPH from Alzheimer's disease (AD). Behavioral and psychological symptoms of dementia (BPSD), especially apathy, depression, and anxiety, are common in iNPH and are generally less active than those seen in AD. Neuropsychological assessments reveal significant impairments in frontal lobe tests such as the Frontal Assessment Battery and Trail Making Test-B. Shunt surgery leads to substantial improvement in attention and executive function, reflecting the reversible nature of iNPH. However, memory functions, particularly delayed recall, show limited recovery, indicating possible overlap with neurodegenerative mechanisms. Early surgical intervention is associated with better outcomes, while delayed treatment or advanced brain atrophy may reduce effectiveness. Comprehensive cognitive evaluation is essential for assessing treatment response, planning rehabilitation, and providing appropriate patient and family guidance.

Dementia is classified into various types with corresponding underlying pathologies, including Alzheimer's disease, dementia wiht Lewy bodies, and vascular dementia; final diagnosis is often possible only after a pathological examination during an autopsy. Furthermore, older adults often have comorbid pathologies that make clinical diagnosis even more difficult. While protein-targeted treatments are emerging, different dementia types have varying pathologies and prognoses, necessitating efforts to improve diagnostic accuracy while the patient is alive. To achieve this, autopsy diagnosis information must be correlated with clinical biomarker data.

Brain tumors are an uncommon but treatable cause of dementia, accounting for 0.8% of cases in Japan. Cognitive impairment in patients with brain tumors may result from focal neurological symptoms, increased intracranial pressure, or involvement of critical regions such as the prefrontal cortex and limbic system. Bilateral or midline lesions, including medial frontal gliomas, meningiomas, or suprasellar tumors affecting limbic circuits, often produce more prominent cognitive symptoms than unilateral lesions. Awake surgery has become a key technique for preserving higher cognitive functions by enabling intraoperative mapping of cortical and subcortical networks, particularly in lower-grade gliomas with potential for neuroplasticity. However, when preoperative deficits are already severe or bilateral damage is present, postoperative cognitive impairment may persist and affect daily functioning. In this report, we discuss the clinical manifestations of tumor-related cognitive dysfunction, including misdiagnoses as dementia, and illustrate how white matter tractography and awake surgery contribute to understanding and preserving cognitive networks. We also present cases of glioma patients whose cognitive function improved following awake surgery, and others in whom functional impairment remained due to surgical limitations or limited plasticity. Comprehensive preoperative assessment and tailored surgical planning are essential for optimizing both survival and neurocognitive outcomes in patients with brain tumors.

Traumatic brain injury (TBI)-associated dementia refers to cognitive dysfunction resulting from brain injury caused by head trauma. With advances in medical care, the survival rate of TBI patients has increased. Additionally, the growing elderly population has led to a rise in cases of cognitive dysfunction following TBI. As a result, the assessment and management of such conditions have become urgent issues. Accurate diagnosis of TBI-related cognitive impairment requires objective evaluation, primarily through radiological neuroimaging. This paper provides an overview of cognitive dysfunction caused by traumatic brain injury and discusses relevant conditions encountered in neurosurgical practice.

We are now in an era where neurosurgeons play an active role in the treatment of dementia. One of the most effective ways to gather essential clinical information during the initial consultation is through a structured questionnaire. This helps establish a comprehensive picture of the patient's condition, supports differential diagnosis, and aids in assessing disease severity. With the advent of anti-amyloid-beta antibody therapies, it is now possible to offer targeted treatment for certain types of dementia. Eligibility criteria for administration include a Mini Mental State Examination score of 22-30 for Rekenbi^® and 20-28 for Kesanra^®, measured within one month prior to treatment initiation. Additionally, patients should have a Clinical Dementia Rating of 0.5 or 1.

In Japan, anti-amyloid β (Aβ) monoclonal antibodies, including lecanemab and donanemab, have recently been approved as disease-modifying therapies for early-stage Alzheimer's disease (AD). These drugs, developed based on the amyloid cascade hypothesis, target toxic Aβ aggregates: lecanemab selectively binds to soluble protofibrils, while donanemab targets Aβ plaques. The Ministry of Health, Labour and Welfare (MHLW) has issued Optimal Use Guidelines that specify criteria for administration: informed consent from both patients and caregivers; cognitive assessments (MMSE and CDR); confirmation of Aβ pathology via amyloid PET or cerebrospinal fluid (CSF) testing; and MRI screening to assess the risk of amyloid-related imaging abnormalities (ARIA). ARIA is a significant adverse event and requires regular MRI monitoring. Initial administration is limited to certified facilities staffed by experienced specialists and equipped with the necessary diagnostic infrastructure. After six months, treatment may be continued at collaborating institutions. The APOEε4 genotype is a known risk factor for ARIA but is not covered by insurance. Caution is advised when co-administering anticoagulants or antiplatelet agents. The guidelines also require the use of official treatment cards to inform healthcare providers. This article summarizes the clinical precautions, diagnostic requirements, and facility standards necessary for implementing anti-Aβ antibody therapy in accordance with current MHLW Guidelines in Japan.