Neurosurgery

Overview of the department

The Department of Neurosurgery is responsible for the treatment of patients with neurological diseases, involving the brain, spinal cord, peripheral nervous system, and associated organs (blood vessels, bones), for which surgery should be indicated.

Consultation system/therapeutic strategies

Medical services are provided by 10 neurosurgeons (including 8 specialists certified by the Japan Neurosurgical Society).
In addition to the treatment of patients with cerebral aneurysms, intracerebral hemorrhage, or head trauma, surgery for brain tumors, cerebral arteriovenous malformation (AVM), stenosis/occlusion of the internal carotid artery, and moyamoya disease, which are difficult to treat in other hospitals, is actively performed. Favorable results have been obtained. For emergencies, initial treatment is promptly started in cooperation with physicians in the Emergency Outpatient Unit, and emergency surgery is performed based on a 24-hour system. For severe-status patients, strict systemic management is conducted in the intensive care unit.
Outpatient services are provided in the morning of Monday, Wednesday, and Friday. On Tuesday and Thursday, surgery is performed, and physicians are responsible for consultations based on a shift system.

Fields of expertise

Concerning surgery, our department is equipped with the most advanced techniques and instruments in Japan. Physicians skilled in cerebrovascular, brain tumor, skull base, spinal cord, neuroendoscopic, and cerebral intravascular surgery are responsible for disease-specific surgical treatment. Two operating rooms are available for neurosurgical interventions . One is equipped with an intraoperative CT system (Siemens, 64-row multidetector CT), and the other is equipped with a digital subtraction angiography system (“hybrid operating room”). The intraoperative CT system was introduced as a first in Japan in 1997. It has been used for more than 1,000 patients as of 2014. In addition, the operating rooms are equipped with two surgical microscopes (Carl Zeiss, Leica) : with which fluorescence angiography, and tumor fluorescence labeling is possible, a neuronavigation system (Brainlab), and 3 neuroendoscopes. We have developed surgical instruments, such as microscissors, in collaboration with Charmant Co., Ltd., which is located in Fukui Prefecture. As a specialized technician is stationed, almost intraoperative nervous function tests (motor evoked potential, somato sensory evoked potential, visual evoked potential, brainstem auditory evoked potential, and cranial nerve monitoring) are possible. These facilitate accurate and safe surgery.

Advanced medical practice

-Cerebrovascular surgery: High flow bypass-combined surgery for large cerebral aneurysms, surgery for paraclinoid/vertebro-basilar artery aneurysms using skull-base approaches, removal of AVM , external-internal carotid artery bypass, and carotid endarterectomy (CEA)
-Brain tumor surgery: Surgery for glioma using tumor fluorescence labeling (5-aminolevulinic acid:5-ALA), and awake surgery technique. Surgery for skull base meningioma, various schwannomas, craniopharyngioma, and other tumors occurring in central nervous system.
-Endoscopic pituitary surgery: Craniotomy is not necessary as pituitary lesions are extirpated transnasally through the sphenoid sinus using neuroendoscopy.
-Neuroradiological intervention (Cerebral intravascular surgery): Vascular lesions are treated using a catheter without craniotomy. Coil embolization for ruptured cerebral aneurysms, carotid artery stenting (CAS) for stenosis of the cervical internal carotid artery, and transvenous embolization for dural arteriovenous fistula(dAVF)

Symptoms/diseases treated in our department

Cerebral aneurysms (clipping, intravascular coil embolization), cerebral AVM(resection, intravascular surgery, stereotactic radiosurgery), stenosis of the internal carotid artery (CEA, CAS), moyamoya disease/occlusion of the cerebral arteries (external carotid artery-internal carotid artery bypass), hemifacial spasm/trigeminal neuralgia (microvascular decompression), brain tumors (surgery, radiation therapy), pituitary tumors (transnasal transsphenoidal surgery), intraorbital tumors (surgery), Chiari malformation/syringomyelia (foramen magnum decompression), spinal tumors/ AVM/dAVF (surgery, intravascular surgery), and intracerebral hemorrhage/head trauma (emergency surgery). In particular, surgery for cerebrovascular diseases and skull base tumors, which are difficult to treat in other hospitals, is actively performed (refer to “Advanced medical practice”).