Explore the vast range of titles available.

We report a rare case of a dumbbell-shaped mesenchymal chondrosarcoma (MCS) in the lumbar canal. A 29-year-old man presented with lower back pain and pain in the left leg. Magnetic resonance imaging (MRI) showed a homogeneously enhanced dumbbell-shaped mass at the left L2-3 level. The mass was intradurally located and extended extradurally into the extraforaminal space through the left L2-3 intervertebral foramen. Computed tomography (CT) showed a calcified portion in the intradural mass. We exposed and excised the tumor via a posterior approach through a hemi-laminectomy of the left L2-3. The tumor had penetrated the dura mater and required repair. Following surgery, his symptoms resolved completely. The most likely histopathological diagnosis was MCS. Histologic examination of our surgical samples revealed the typical biphasic pattern, but there was also cartilage matrix resembling osteoid. Finally, molecular assays confirmed the presence of the HEY1::NCOA2 fusion gene. Although spinal intradural extramedullary MCS is rare, only a few reports in the literature mention spinal dumbbell-shaped MCS. Following the removal of dumbbell-shaped MCS, the dura mater may require repair. While histopathological evaluation remains the gold standard for confirming a diagnosis of MCS, the HEY1::NCOA2 fusion gene is a specific molecular marker for MCS, and the presence of this gene has become a powerful tool for diagnosis.

This case report describes a novel cranioplasty technique using calcium phosphate paste. The patient was a man in his 50s with a convexity meningioma with skull invasion extending to the diploic layer. Craniotomy was performed, and the area of skull invasion was removed. Afterward, the skull defect was filled with calcium phosphate bone paste to maximize bone strength. To prevent the bone paste from falling off postoperatively, the area of skull invasion was removed more widely from the diploic plate side than from the inner side. This method may be a useful option for strengthening the skull in cases of cranioplasty for meningiomas with skull invasion.

An aberrant right subclavian artery (ARSA) is a rare variant of the normal aortic arch anatomy. Right transradial carotid artery cannulation is extremely challenging in patients with ARSA. Herein, we present a case of a right falcine meningioma with an ARSA that was successfully accessed with a 3-French Simmons guiding sheath via the left transradial approach. Additionally, preoperative embolization of the feeding middle meningeal artery (MMA) was performed. Here, we report our surgical technique. An 80-year-old woman was diagnosed with a right falcine meningioma with ARSA. The meningioma exhibited tumor staining in the parietal branch of the left MMA. We planned a preoperative MMA embolization via the left radial artery. After the 3-French Simmons guiding sheath was engaged in the left common carotid artery (CCA) using the pull-back technique, a triaxial system (3-French Simmons guiding sheath/3.2-French distal access catheter/microcatheter) was implemented. The 3-French guiding sheath to the left CCA was successfully achieved using the pull-back technique. Distal access catheter guidance to the proximal left MMA was successfully achieved without catheter kinking or systemic instability. However, guiding the microcatheter beyond the pterional segment of the left MMA parietal branch because of the severe curvature and tortuosity of the vessel was difficult. Thus, embolization with liquid and particulate embolic materials was abandoned, and tumor flow reduction was performed using coil embolization of the MMA. Three days after the neurointervention, craniotomy tumor removal was successfully performed achieving near-total resection of the tumor. Thereafter, no radial artery occlusion was observed at the puncture site. The patient was discharged from our hospital two weeks after craniotomy surgery. The left transradial artery approach using a 3-French Simmons guiding sheath is useful for left carotid artery cannulation in patients with ARSA.

Intracerebral hematomas (ICHs) can complicate ruptured cerebral aneurysms. The standard approach for these cases has traditionally involved craniotomy with clipping and hematoma evacuation. Recently, however, a combination of coil embolization and neuroendoscopic hematoma removal has shown promise. We report a case of a ruptured internal carotid artery aneurysm with ICH successfully treated using coil embolization and neuroendoscopic hematoma removal under intravenous sedation. A woman in her late 70s presented to our hospital with severe consciousness disturbance and was diagnosed with subarachnoid hemorrhage (SAH) and an intratemporal hematoma caused by a ruptured aneurysm at the left internal carotid-posterior communicating artery bifurcation. Her condition was complicated by low cardiac output and hypotension due to Takotsubo cardiomyopathy, making general anesthesia unfeasible. Coil embolization was performed the same day under local sedation with dexmedetomidine hydrochloride. The next day, we used a neuroendoscope to evacuate the intratemporal hematoma under local anesthesia. Despite the severity of the SAH, the patient survived and was later transferred to a long-term care hospital. This approach appears effective for patients with ruptured cerebral aneurysms and ICH who are not suitable candidates for general anesthesia.

Beginning in April 2024, work-style reforms were implemented for doctors. We analyzed the changes in our medical practice resulting from the assignment of a designated care nurse, called nursing designated care (NDC), to the Department of Neurosurgery, in line with work-style reforms. This study aimed to evaluate whether introducing an NDC into a neurosurgical department could redistribute perioperative tasks and improve workflow efficiency in subarachnoid hemorrhage (SAH) management under Japan's physician work-style reforms. We compared medical care over a one-year period from April 2022, when our department had three neurosurgeons, and over a one-year period from April 2023, under a new system in a four-member team consisting of three neurosurgeons and one NDC. The target disease was a SAH. We compared medical care from initial treatment in the emergency room (ER) to the operating room, medical care from leaving the operating room to postoperative management after returning to the intensive care unit, and management of the cerebral vasospasm phase. Some of the work that had been performed by the neurosurgeons was taken over by the NDC, and the duties of the neurosurgeons were shared. Clinical intervention by the NDC in the ER for patients with SAH may contribute to shortening the treatment time from the start of treatment in the ER to admission in the operating room. In the management of the cerebral vasospasm phase, the NDC was able to intervene with multiple specified acts, and the neurosurgeon's duties were shared. We introduced our department's current treatment methods in line with the work-style reforms for doctors. Through collaboration with the NDC, it may be possible to divide work in line with the work-style reforms for neurosurgeons.

Several recent studies have investigated DNA instability in malignancies including deletions and duplications of part of the chromosome using array-based comparative genomic hybridization (CGH) analysis. Using the same approach on oral squamous cell carcinoma (OSCC) tissue samples, we found a frequent deletion at chromosome 3q26.1 in OSCC patients; this polymorphism showed a gene frequency of 0.293-0.368 in healthy volunteers (n=60) and 0.129-0.195 in OSCC patients (n=54). Detailed analysis around the polymorphic region revealed the deletion breakage point. A significant association of gene frequency for the deletion polymorphism between healthy volunteers and patients implicated genetic factors related to this polymorphism in the development of OSCC. Currently, no gene is predicted to lie within the 3,606-kbp region around the polymorphism. Thus, although a single-gene model could not explain the occurrence of OSCC, we believe that examining this polymorphism could be useful in identifying risk factors for OSCC.