Neurological Surgery最新文献

Sarcopenia is a progressive skeletal muscle disorder involving an accelerated loss of muscle mass and function. Frailty is characterized by a decline in the functioning of multiple physiological systems and an increased vulnerability to stressors. The incidence of these pathological conditions increases with age and is often accompanied by various acute or chronic disorders. The presence of sarcopenia or frailty in patients with other diseases is associated with poor outcomes. For example, frailty is highly prevalent in patients with heart failure and is linked to an increased risk of hospital admission and mortality. Among stroke patients, pre-stroke frailty is frequently observed and is associated with higher mortality, extended hospitalization, and stroke recurrence. Furthermore, the risk of sarcopenia and frailty is high in stroke survivors. Poststroke frailty is associated with increased mortality, hospital admissions, and stroke recurrence. Managing sarcopenia and frailty after stroke is crucial for improving patient outcomes. Multidisciplinary support, including aggressive rehabilitation, nutritional support, and continuous rehabilitation during the chronic stage, is important. As Japan is a super-aging country, effective management of sarcopenia and frailty, alongside disease treatment, is essential for further improving patient prognosis.

Digital transformation, a term coined by Erik Stolterman and Anna Croon Fors, means the changes of social systems by using information and communication technologies. The healthcare industry has changed through the introduction of hospital information systems, and the Internet of Things is now dissolving hospitals in society. Recent advancements in medical artificial intelligence have increased expectations of disruptive changes in clinical practice and medical science. Therefore, all nations devote their efforts to the establishment of a key factor: a real-world data platform. A clear vision of gradually navigating citizens to a bright future and the courage to change the legislation quickly to realize the vision are keys to success.

Epilepsy and cognitive impairment are major post-stroke complications. As society ages, the number of stroke survivors increases, leading to a greater interest in these complications. Post-stroke epilepsy accounts for approximately half of all epilepsy cases in older adults and is associated with physical disability and mortality, emphasizing the importance of controlling seizures. Research is progressing on diagnostic methods, primary prevention, and secondary prevention of post-stroke epilepsy. Vascular dementia and Alzheimer's disease are the two major types of dementia and can be prevented and treated by addressing vascular risk factors such as hypertension, dyslipidemia, and diabetes. Currently, there are no available treatments to reverse vascular dementia, and many challenges remain unresolved. This review discusses the information necessary for clinical practice, including diagnostic criteria, classification, risk factors, measurements, and appropriate treatments for post-stroke complications.

In patients without cardiovascular disease(primary prevention), the diagnosis of dyslipidemia is the initial step in lipid management. The 2022 guidelines for atherosclerotic disease prevention provide a validated clinical scoring tool to estimate the 10-year risk of atherosclerotic disease derived from the Hisayama study. For primary prevention, patients are classified into the categories of low(<2%), intermediate(2 to<10%)and high(≧10%)risk. Patients with diabetes mellitus, chronic kidney disease, or peripheral arterial disease are considered at high risk without calculating the risk score. Lifestyle intervention is initiated, followed by low-density lipoprotein cholesterol(LDL-C)-lowering therapy with statins aimed at the target levels. Secondary prevention of acute coronary syndrome, diabetes mellitus, and atherosclerotic brain infarction is associated with the highest risk of cardiovascular disease. High-intensity statin therapy is recommended as the first-line treatment in this group to achieve less than 70 mg/dL of LDL-C levels. The addition of ezetimibe is recommended first if LDL-C levels remain elevated with maximal statins. The addition of a Proprotein Convertase Subtilisin/Kexin type 9 inhibitor to strong statins is recommended for patients with coronary artery disease whose LDL-C levels remain elevated despite the administration of maximal LDL-C-lowering therapy. Secondary dyslipidemia should be managed using causative diseases or drugs. Patients with familial hypercholesterolemia should be referred to specialists.

Obesity, metabolic syndrome, and fatty liver disease, particularly nonalcoholic fatty liver disease(NAFLD), are significant health issues in current society. These conditions are linked to lifestyle changes such as overeating and lack of exercise, and their prevalence is increasing. Obesity is defined using body mass index(BMI), with a BMI of 25 kg/m² or higher considered obese in Japan due to the higher health risks in this population. Obesity significantly increases the risk of diabetes, hypertension, dyslipidemia, cardiovascular disease, and cancer. Metabolic syndrome involves visceral fat accumulation along with high blood glucose levels, dyslipidemia, and hypertension. NAFLD, which is related to metabolic abnormalities such as obesity and diabetes, can progress to non-alcoholic steatohepatitis(NASH), cirrhosis, and liver cancer. Recent concepts, such as metabolic dysfunction-associated fatty liver disease and metabolic dysfunction-associated steatotic liver disease, provide new diagnostic criteria that better identify high-risk patients. The effective management of these diseases involves lifestyle changes and targeted medical treatments. Ongoing research and new diagnostic criteria are expected to improve prevention, diagnosis, and treatment and enhance patient outcomes and quality of life.

Oral health is fundamentally linked to systemic health, with dental caries and periodontal diseases playing critical roles in the overall well-being. In Japan, a concerted effort to enhance oral health through a comprehensive initiative that started in 2024 emphasizes the prevention of oral diseases by fostering closer collaboration between medical and dental care providers. This initiative acknowledges the intricate connection between oral health and systemic conditions, including metabolic disorders and cerebrovascular and cardiovascular diseases. Recent research has underscored the significant impact of oral health on these systemic diseases, drawing attention to the interplay between oral health and the brain, as well as the complex oral-gut-brain axis. These studies offer valuable insights into how oral diseases can influence, and potentially exacerbate, systemic health issues. The review of current evidence highlights the critical need for maintaining oral health not only for the sake of dental well-being but also as an integral part of overall health. This also highlights the necessity for continued research to fully comprehend the multifaceted relationship between oral health and systemic diseases. Such understanding is paramount for developing more effective prevention, intervention, and treatment strategies, ultimately contributing to better health outcomes.

Insomnia is a common sleep disorder that, owing to difficulties falling asleep or maintaining sleep and/or early morning awakening, causes daytime functional impairment. Other sleep disorders include sleep-related breathing disorders; sleep-related movement disorders, such as periodic limb movement disorder and restless legs syndrome; parasomnias, such as rapid eye movement sleep behavior disorder and sleepwalking; and central disorders of hypersomnolence, such as narcolepsy. This article describes sleep disorders that are routinely observed in daily clinical practice.

The kidney and brain share strain vessels, which are short and small arterioles that branch out of larger arteries. These vessels are vulnerable to risk factors such as atherosclerosis, old age, hypertension, diabetes, dyslipidemia, and smoking. The nervous system and the kidneys interact to maintain homeostasis. Many chronic kidney disease(CKD)-specific and nonspecific factors contribute to structural and functional cerebral changes in patients with CKD. In contrast, vagus nerve stimulation has been reported to alleviate inflammatory diseases, including kidney disease. Several new drugs have recently become available for the treatment of CKD: sodium-glucose co-transporter-2 inhibitors for CKD; finerenone, a mineralocorticoid receptor antagonist for CKD with type 2 diabetes; and a hypoxia-inducible factor prolyl-hydroxylase inhibitor for anemia in patients with CKD.

Intracranial aneurysms occur frequently; however, only a few of these rupture to cause subarachnoid hemorrhage. This presents a dilemma regarding the course of appropriate treatment. In the last decade, the wide utilization of magnetic resonance imaging-based vessel wall imaging(VWI) has facilitated the assessment of aneurysm wall enhancement(AWE), which has garnered significant attention. In 2013, initial reports highlighted that AWE was characteristic of ruptured aneurysms whereas, in 2014, AWE was identified as a characteristic feature of unruptured aneurysms with a high risk of rupture. Several studies have supported these findings since then. VWI, a novel modality that visualizes the inflammation of the aneurysmal wall, is considered highly useful for the diagnosis of aneurysms. This review discusses the key literature on AWE. Long-term prospective studies are warranted to determine whether AWE is an independent risk factor for aneurysmal progression.

Ruptured cerebral aneurysms have a higher incidence of direct surgery-related adverse events compared to unruptured aneurysms owing to challenging surgical conditions, such as difficulties in surgical exposure, cerebral edema, and intraoperative aneurysmal rupture, that increase the intraprocedural difficulty. The most common surgical adverse event is intraoperative rupture, with uncontrolled ruptures(during pre-dissection or from a tear in the aneurysm neck) often resulting in poor clinical outcomes. The key strategies for intraoperative rupture include staying calm, controlling bleeding, and ensuring hemostasis through appropriate methods. Given the advances in endovascular therapy for intracranial aneurysms, the number of microsurgical procedures has been decreasing. Thus, neurosurgeons at each facility need to prepare and gain experience in handling intraoperative ruptures.