Neurosurgery

• Our hospital accepts all stroke patients 24 hours a day, 365 days a year.
• A state-of-the-art hybrid operating room is available 24 hours a day.
• We use three angiography rooms dedicated to cranial nerves.
• We have 9 specialists from Neurosurgery Society, 8 specialists from the Japanese Stroke Society, 8 specialists from the Japanese Society of Endovascular Therapy (4 of whom are instructors), and 4 Technology Certified Physician from the Japanese Society of Stroke Surgery (1 of whom is an instructor).

What is stroke

A stroke is a condition in which a blood vessel in the brain is blocked or ruptures and bleeds, resulting in partial loss of brain function. It is roughly divided into cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage. Treatment strategies vary depending on the condition, size, and location of the disease, but early diagnosis and early treatment are necessary in all cases.

At our hospital, we practice unreserved medical care 24 hours a day, 365 days a year, with the cooperation of doctor in the emergency department. Using the direct telephone "Stroke Hotline" with the emergency services in Kobe City, Stroke Specialist directly provide medical care from the time of transportation to treatment, and the treatment is carried out in a short time without delay. In addition, two or more Stroke Specialist are always on duty at all times, even on holidays and at night, to ensure prompt diagnosis and treatment at any time. In addition, we work closely with the Department of Neurology to provide appropriate systemic management, such as drug selection and adjustment, to prevent recurrence of stroke.

There are three angiography rooms in our hospital, and endovascular treatment, which has made rapid progress in recent years, can be performed quickly. In addition, a hybrid operating room that can perform both endovascular treatment and craniotomy can be used 24 hours a day, allowing safe diagnosis and treatment under general management by an Anesthesiology.

Acute cerebral infarction (major cerebral artery occlusion)

• A disease in which a cerebral blood vessel is blocked by a blood clot caused by an arrhythmia.
• Treatment is catheterization and administration of tPA.
• The prognosis is determined by how early treatment is given.

Acute occlusion of large blood vessels in the brain caused by thrombus (blood clot), which is mainly caused by arrhythmia. It is the most serious type of cerebral infarction, and sequelae are likely to remain, requiring infusion of tPA (a drug that dissolves blood clots) and removal of clots by catheter treatment.

The prognosis of this disease depends on how early tPA administration and catheterization can be performed from onset. At our hospital, two stroke doctors are on duty 24 hours a day, 365 days a year, and 11 catheterization specialists are on duty almost every day. I'm here.

It is said that for every 5 minutes it takes for a blocked blood vessel to reopen, one in 100 people will lose their independence, and global recommendations recommend that catheter treatment be started within 60 minutes of the patient's arrival at the hospital. At our hospital, with the cooperation of the Stroke Center and Emergency Department, more than half of patients receive catheter treatment within about 50 minutes (2023 results) after arriving at the hospital, and we are proud of our system that allows patients to receive the fastest treatment possible regardless of where they are transported from Kobe City.

subarachnoid hemorrhage

• Sudden onset of severe headache, unconsciousness, and vomiting.
• If rerupture occurs, the survival rate decreases, so treatment to prevent rerupture is necessary.
• Endovascular treatment and craniotomy clipping should be the best choice of treatment.
• Our hospital is equipped with a hybrid operating room that enables continuous treatment.

A subarachnoid hemorrhage is a sudden bleeding in the subarachnoid area of the skull. In many cases, the cause is due to a ruptured brain aneurysm. About 1/3 of those who develop subarachnoid hemorrhage die, about 1/3 have severe to moderate sequelae, and the remaining 1/3 return to society after treatment. Even if the patient does not die and reaches the hospital, the rate of reintegration into society is further reduced in the event of re-rupture. Treatment is required to prevent rerupture.

There are two types of treatment: endovascular treatment and craniotomy clipping. Based on the site, shape, and size of the aneurysm, it is necessary to respond flexibly to optimal treatment strategies at the site of emergency medical care. At our hospital, 10 Certified Medical Specialist by the The Japan Neurosurgical Society Society and 9 Certified Medical Specialist by the The Japanese Society for Neuroendovascular Therapy (including 4 Certified Medical Supervisor the The Japanese Society for Neuroendovascular Therapy) are working as doctor staff, almost 24 hours a day, 365 days a year. Specialists work in the hospital and can be involved in the treatment of subarachnoid hemorrhage.

Our hospital is able to use this hybrid operating room for cases of hemorrhagic stroke, allowing for uninterrupted care from diagnosis to treatment.

After surgery, postoperative management is performed together with an intensive care physician, and continuous systemic management and care are provided to prepare for cerebral vasospasm and hydrocephalus secondary to subarachnoid hemorrhage.

Although it is a serious disease with a poor prognosis, these systems have generally yielded good treatment results.

cerebral hemorrhage

• It develops with sudden loss of consciousness, headache, and paralysis, and early detection and initiation of treatment are important.
• We have established a joint Neurology treatment system (24 hours a day, Neurosurgery days a year, with multiple stroke doctor on site, capable of handling multiple cases simultaneously).
• It is important to avoid exacerbation of symptoms due to increased bleeding, and sometimes life-saving surgery may be required.

A small blood vessel in the brain ruptures, causing bleeding in the brain, which causes sudden loss of consciousness, headache, nausea, and paralysis. Once it develops, early detection and treatment at a specialized hospital are desired. In the treatment of cerebral hemorrhage, it is important to prevent an increase in bleeding, focusing on blood pressure control, and to perform early rehabilitation. You will need life-saving surgery.

Although the majority of cerebral hemorrhages are caused by high blood pressure, there may be other diseases that should never be overlooked, such as cerebral arteriovenous malformations, moyamoya disease, and brain tumors, hidden in the background. Our hospital has a hybrid operating room (an operating room that can simultaneously perform CT scans, catheter examinations, endovascular treatment, and direct surgery), and has a joint stroke medical treatment system between Neurosurgery and Neurology (24 hours a day, 365 days a year, multiple stroke doctor on-site, multiple cases can be treated at the same time) that allows for prompt examinations and identification of the cause, leading to treatment, and we are able to provide the best treatment at any time.

In addition, for eligible cases, aggressive rehabilitation is performed from the early stage after onset in the Stroke Care Unit (SCU). Severe cerebral hemorrhage often leaves aftereffects and can even be fatal. are working on treatment.

• Narrowing of the carotid artery in the neck can lead to stroke.
• Treatment without cutting using a catheter is possible, and we have more than 1000 results so far.
• Surgical treatment is also performed as necessary, and the most suitable treatment according to the patient is performed.

What is carotid artery stenosis?

Carotid stenosis is a narrowing of the carotid artery that connects the heart to the brain. It develops due to arteriosclerosis due to lifestyle-related diseases such as hypertension, and may cause cerebral infarction.

Treatment consists of surgical treatment to remove the arteriosclerotic part (carotid endarterectomy) and treatment that uses a catheter to expand the narrowed part and place a metal tube called a stent in the blood vessel (carotid artery stent). detention) is available.

In our hospital, we are actively working on carotid artery stent placement, and catheter treatment is possible for most patients. Treatment is performed jointly with the Department of Neurology, and we strive to perform treatment safely using various monitors such as transcranial Doppler (TCD).

Our clinic has experience since this treatment was introduced to Japan about 20 years ago, and we have a track record of more than 1000 treatments to date.

Since carotid artery stenting uses a contrast agent, it is generally not performed in patients with impaired renal function, but at our hospital, we also offer a method that minimizes the amount of contrast agent used. It is possible to do

• It is a bump in a blood vessel in the brain, and although many are asymptomatic, subarachnoid hemorrhage can occur if it ruptures.
• There are two types of treatment, endovascular treatment and craniotomy, and it is necessary to select the best treatment according to the patient.
• In fiscal year 2023, there were 82 treatments (14 surgeries and 68 endovascular treatments).

What is an unruptured brain aneurysm?

The pros and cons of treatment for unruptured cerebral aneurysms are considered depending on the location, size, shape, and patient condition. There are two types of treatment methods: craniotomy clipping and endovascular treatment. Our hospital has both specialists, and it is possible to select the best treatment method based on the results of a detailed examination.

We have performed approximately 2,300 cases of endovascular treatment since 2001, and are able to use almost all of the latest devices, such as coils and stents, while providing treatment that pursues safety and curability. We also use flow diverter stents to treat giant cerebral aneurysms, which were previously difficult to treat, and have achieved good treatment results.

Craniotomy clipping is performed in a state-of-the-art hybrid operating room. We are planning to reduce the burden on patients by performing angiography during surgery instead of after surgery. Nerve evoked potential monitoring (intraoperative nerve evaluation) and intraoperative ICG fluorescence angiography are performed as standard, so safer clipping surgery is possible.

• It is a disease in which the blood vessels of the dura mater, the membrane that surrounds the brain, communicates abnormally.
• Craniotomy and catheter treatment are used depending on the site, and treatment is performed.
• Our hospital is a facility that can perform treatment using liquid embolic materials (Onyx and NBCA).

A dural arteriovenous fistula is the formation of an abnormal connection (arteriovenous shunt) between an artery and a vein on the dura mater (the membrane that surrounds the brain and spinal cord) inside the skull and vertebrae, preventing the backflow of blood. It's a sickness.

Symptoms depend on the site of occurrence and the amount of blood flow, but pulsatile tinnitus, bulging eyes, bulbar conjunctival hyperemia, double vision, and paralysis if blood flow back to the brain occurs. Speech disorder, convulsions, disturbance of consciousness, cognitive symptoms, etc. may occur, and in severe cases, bleeding in the brain may occur.

We diagnose using MRI and cerebral angiography, and decide whether craniotomy or catheter therapy is appropriate. In catheter therapy, we aim to block abnormal blood vessels with metal coils or liquid embolic materials (NBCA, Onyx, etc.). Our hospital has plenty of experience in treatment with liquid embolic materials.

In addition, our hospital has a hybrid operating room, which is an operating room permanently equipped with an angiography device, so that combined treatment of surgery and catheterization can be performed, so safer and more advanced treatment is possible.

ONYX treatment case for dural arteriostatic fistula

• It is a disease in which there is an abnormal blood vessel mass (nidus) in the brain, and the artery and vein are directly anastomosed, causing subarachnoid hemorrhage, cerebral hemorrhage, and spasm.
• Treatments include craniotomy, endovascular therapy, and radiotherapy, which are combined. All treatments are available at our clinic.
• ONYX (liquid embolization material used in endovascular treatment) designated by the operator can be used in our department, and we have a top-class record of use in Japan.

Arteriovenous malformations (cerebral AVMs) are disorders in which there are direct connections between arteries and veins through abnormal blood vessel masses (nidus). Most are located on the surface of the brain, but they can occur anywhere in the brain. It is commonly discovered after bleeding or convulsions.

The annual detection rate is 1.1-1.4/100,000 people, and the frequency of rupture is about 1/10 of that due to cerebral aneurysms, but the annual bleeding rate for individual AVMs is about 2-3%. It is said to be slightly higher than that of a cerebral aneurysm.

Endovascular treatment is important as a treatment before surgical resection, significantly reducing bleeding during surgery and enabling safer surgery. Especially for the liquid embolization agent ONYX, our hospital has been an accredited facility since the time it was approved under the Pharmaceutical Affairs Law, and we are leading the treatment results in Japan. In addition, our hospital is fully equipped with a hybrid operating room dedicated to Neurosurgery, so surgery and endovascular treatment/examination can be performed at the same time, and its usefulness is also demonstrated in brain AVM treatment.

Radiation therapy is performed in cases where removal is difficult or in those who do not wish to undergo surgery, and we perform treatment in close cooperation with the Radiation Oncology at our hospital.

• The artery wall ruptures internally, causing sudden onset of pain. It may be asymptomatic and discovered incidentally on imaging studies.
• Cerebral infarction and subarachnoid hemorrhage may occur.
• Treatment includes symptomatic treatment with drugs and endovascular treatment, and an appropriate diagnosis is required.

Arteries are made up of three layers: the intima, the media, and the adventitia. Arterial dissection is when a blood vessel tears between these layers. It is often traumatic or idiopathic (the cause is not clear), and dissection of the vertebral artery and internal carotid artery is the most common. In many cases, it can be diagnosed by MRI or contrast-enhanced CT, and if a detailed examination is necessary, a cerebral angiography examination is performed.

Most of the vertebral artery dissections that are common in Japan develop with headache and posterior neck pain. Because it is asymptomatic, non-hemorrhagic cases are usually managed conservatively with only oral treatment, but some cases require surgical intervention (mainly endovascular treatment).

If surgical treatment is required immediately after onset, it is mainly treated in cases with subarachnoid hemorrhage, and is treated according to ruptured cerebral aneurysm.

Surgical treatment is required after some time has passed, in cases where cerebral infarction is repeated despite conservative treatment with antiplatelet drugs, or in cases where the aneurysm caused by arterial dissection is large or expanding. And so on, treatment according to cerebral aneurysm is performed.

Since the appropriate response differs for each case, it is necessary to visit a hospital early and receive a professional diagnosis when symptoms develop.

• It is a disease in which the large blood vessels of the brain are constricted, and the brain is nourished by the small blood vessels.
• It can cause both stroke and cerebral hemorrhage.
• We can suppress progression of symptom by vascular anastomosis.

Moyamoya disease is a disease in which the blood vessels of the brain are constricted, and the brain is fed only by a large number of well-developed thin blood vessels. It is called moyamoya disease because new blood vessels are formed to supplement blood flow to the brain. Insufficient blood flow to the brain can lead to cerebral infarction, or weak blood vessels can rupture and cause cerebral hemorrhage. It can occur in childhood as well as in adulthood. Discovered in Japan, it is a common disease among Japanese people and is designated as an intractable disease by the Ministry of Health, Labor and ministry of Health, Labor and Welfare notation. The cause is unknown, but about 10% of cases are familial, and recently, related genetic abnormalities have also been identified.

Diagnosis is made by MRI, etc., but cerebral angiography (catheterization) is effective for understanding the detailed cerebral blood vessels and blood flow. In addition, it is possible to perform all necessary tests to evaluate the state of moyamoya disease, such as head CT and cerebral perfusion scintigraphy (SPECT), so that an appropriate treatment policy can be established.

In order to prevent recurrence, bypass surgery (surgery to connect the blood vessels of the scalp to the blood vessels of the brain) may be necessary, but the content of treatment differs depending on the degree of cerebral infarction or cerebral hemorrhage, and drug treatment and rehabilitation should be given priority. in some cases. At our hospital, we cooperate with the Department of Neurology, Department of Anesthesiology, Department of Rehabilitation, etc., and strive to improve symptoms by providing appropriate treatment, postoperative management, and rehabilitation for each patient.

• It is a disease in which blood vessels press cranial nerves (trigeminal nerve, facial nerve), causing severe pain and spasms in the face, respectively.
• In many cases, the effect of medical treatment is poor, and surgery is performed to release the pressure on the nerve.
• In order to prevent complications such as hearing loss, our hospital conducts various intraoperative monitoring in all cases.

Trigeminal neuralgia is a disease that causes severe facial pain or spasm mainly due to blood vessels compressing the trigeminal nerve, which controls facial sensation, and facial spasm, which mainly controls the facial movement.

As symptomatic treatment, medications such as antiepileptic drugs are used for trigeminal neuralgia, and Botox injections are used for facial spasms.

In cases where drug treatment is difficult, surgery is performed. This surgery involves detaching the blood vessels causing the condition from the nerve and using Teflon or similar material to relieve pressure. Hearing loss is a concern as a possible complication of surgery. At our hospital, we perform intraoperative hearing monitoring (ABR) on all cases, and there has been almost no loss of hearing in our surgeries to date. In addition, during surgery for facial spasms, we confirm the disappearance of the facial spasms by checking for the disappearance of abnormal electrical signals caused by pressure (AMR).

What is microvascular decompression?

• Deep brain stimulation therapy improves motor symptoms in advanced Parkinson's disease.
• It improves ADL (activities of daily living) and QOL (quality of life), especially in cases where drug therapy is difficult to control.
• After deep brain stimulation therapy, the dose of antiparkinsonian drugs can be reduced.
• Deep brain stimulation therapy is effective not only for Parkinson's disease, but also for essential tremor and some generalized dystonia ^{[Note 1]}.

Deep Brain Stimulation (DBS) for patients with Parkinson's disease was covered by insurance in Japan in April 2000, and approximately 10,000 patients nationwide have undergone this surgery so far. .

Parkinson's disease is a disorder characterized by tremors, slow movements, muscle rigidity, and postural instability. The prevalence in Japan is said to be 1 per 1,000 population, and it is estimated that there are 150,000 patients nationwide. In Parkinson's disease, the number of dopamine-producing cells in the mesencephalic substantia nigra decreases, causing an imbalance in the communication circuit between the cerebral cortex and the basal ganglia. I know that. Unfortunately, no curative treatment has been established even now, and drug treatment is used to alleviate the symptoms, but the disease progresses over time and becomes severe as dopamine-producing cells are depleted. is. In such advanced stages of Parkinson's disease, DBS for the subthalamic nucleus can improve motor symptoms. ) and quality of life (QOL). Effectiveness can also be expected for Parkinson's disease patients with wearing off ^{[Note 2]} and dyskinesia ^{[Note 3]}.

I will briefly introduce the specific surgical method. After a small incision is made in the scalp and a small hole is made in the skull, electrodes are inserted deep into the brain, and the optimal stimulation placement site is determined while measuring the action potential of nerve cells. Test stimulation is performed on the site where the electrode is to be placed, and a neurological examination is performed to check the degree of improvement in Parkinson's symptoms and whether there are any side effects. Connect to the impacted stimulator.

DBS is not a treatment that a Neurosurgery can perform alone. It involves a neurologist who is familiar with Parkinson's disease, a clinical laboratory technologist who is in charge of physiological functions, a radiological technologist, an Anesthesiology, and an operating department before, during, and after surgery. It is a surgery that can be accomplished in cooperation with staff. It is possible to perform this therapy at our clinic, which is composed of multi-disciplinary professionals.

I would like to contribute to improve the QOL of Parkinson's disease patients and maintain a better life.

If you are wearing off ^{[Note 2]} or have dyskinesia ^{[Note 3]}, please consult with your doctor and visit a Neurosurgery or neurology outpatient clinic.

Note 1: Dystonia is a condition in which various involuntary movements and abnormalities in limb position and posture occur due to abnormal muscle tension. It is considered
Note 2 Wearing off is a state in which the duration of the effects of antiparkinsonian drugs is shortened and symptoms fluctuate.
Note 3 Dyskinesia is a general term for involuntary movements in which the body moves regardless of one's will. In particular, the limbs often move on their own, and they cannot stop themselves, so if it continues for a long time, they will get tired. It occurs as a side effect of antiparkinsonian drugs.

• It is a tumor formed from glial cells (glial cells) in the brain and spinal cord.
• In addition to excision surgery, we perform compound (multidisciplinary) treatment such as radiotherapy and chemotherapy.
• At the time of extraction surgery, intraoperative monitoring of nerve function and safe and sufficient extraction using a navigation system are performed.

Gliomas are said to be the most common tumors (primary brain tumors) that arise from cells in the brain and spinal cord, accounting for about 20%. It is thought to originate from glial cells (glial cells) that exist between nerve cells.

As mentioned above, because the cells that exist between nerve cells have become tumors, they have increased (infiltrated) so as to permeate the brain and spinal cord, and they may exist near cranial nerves that perform important functions. In many cases, it is difficult to cure with surgery alone.

For highly malignant gliomas, complex (multidisciplinary) treatment using radiation therapy including the perioperative area and an oral drug (or an injection drug) called temozolomide is performed after surgery to remove as much as possible while preserving the function of the cerebrospinal cord. treatment is standard.

In our department, in line with the above standard treatment, we use a preparation (5-ALA) that allows the site of the tumor to be confirmed during surgery, image support (navigation), and evaluation of brain function (monitoring). In some cases, we also use an indwelling drug (Gliadel) or a device that generates a special electric field (Novo TTF) on the head to suppress the division of tumor cells.

• A tumor that arises from the membrane that surrounds the brain called the meninges. The majority are benign tumors with 2-5% having a malignant course.
• If the brain is compressed and there are neurological symptoms, or if there is cerebral edema, treatment is considered.
• By combining preoperative embolization and monitoring, we perform safer surgery.

Meningiomas are mostly benign tumors that arise from the meninges that surround the brain. This means that it grows slowly and does not metastasize or invade. However, because the skull is a closed space, even without metastasis or infiltration, the brain may be compressed, and symptoms may occur with edema in the surrounding area. In that case, surgery is considered.

At our hospital, we use intraoperative nerve-evoked potential monitoring in combination to prevent neurological sequelae during surgery. We perform targeted tumor embolization and try to minimize bleeding associated with surgery.

• It develops with symptoms due to hormone deficiency or excess, and vision and visual field disorders.
• I am having surgery through the nose using an endoscope.
• I keep safe operation in mind while using various monitors.
• We provide preoperative and postoperative treatment in cooperation with the endocrinology department.

What is a pituitary tumor

The pituitary gland is located in the center of the brain and is an organ that secretes various hormones that regulate various functions of the body. Tumors around the pituitary gland are mainly pituitary adenoma, craniopharyngioma, and Rathke's cyst.

A pituitary adenoma is a tumor that arises from the pituitary gland itself. As it grows, it can put pressure on the optic nerve just above it, causing loss of vision and visual field. Depending on the type of tumor, some may oversecrete hormones, while others may cause symptoms due to insufficient hormones.

Some tumors can be treated with drugs, but when treatment with drugs is difficult, surgical treatment is common, and the tumor is removed through the nostril using an endoscope. During surgery, we use a vision monitor and a neuronavigation system to accurately determine the position of the tumor.

Hormone management before and after surgery is carefully performed with the cooperation of endocrinologists who are specialists in hormones. We have 3 Specialist in Endocrinology and Metabolism.

Rathke's cyst is also located around the pituitary gland and is filled with fluid. Usually, the progress is observed without treatment, but surgery is necessary when visual field impairment occurs.

Craniopharyngioma is also a tumor that develops from around the pituitary gland, but craniotomy may be necessary depending on the location and spread of the tumor.

• A schwannoma is a growth (tumor) that develops from cells surrounding nerves, and is basically benign and develops with tinnitus, hearing loss, dizziness, etc.
• Surgery and radiotherapy are available depending on the size of the tumor, and both can be performed at our hospital.
• Surgery can be safely performed under intraoperative monitoring.

The auditory nerve consists of the cochlear nerve (the nerve that controls hearing) and the vestibular nerve (the nerve that controls body balance). Most acoustic neuromas, called vestibular schwannoma, arise from the vestibular nerve. Schwannoma arises from cells called Schwann cells surrounding nerves, and may also arise from other brain nerves such as the trigeminal nerve (the nerve that controls the sensation of the face) and the facial nerve (the nerve that moves the face).

Tinnitus, hearing loss, and dizziness on the side of the tumor are often found during a brain examination. However, there are parts such as the facial nerve, brain stem, and cerebellum in the surrounding area, and if it grows further, it may lead to facial nerve paralysis, gait disturbance, and consciousness disorder. It arises from cells surrounding nerves and there are important parts of the brain in the vicinity, so it is necessary to carefully consider the treatment strategy depending on the symptoms and tumor size.

Small tumors found by chance with few or no symptoms may be followed up periodically. For slightly larger tumors (less than 3 cm) with mild symptoms, surgical removal or stereotactic radiotherapy may be considered after consultation with Radiation Oncology. If the lesion becomes larger (>3 cm) and the symptoms are severe (e.g., pressure on the brainstem), surgery may be necessary. At the time of surgery, we remove the tumor to the extent that is safe while evaluating (monitoring) the remaining (to be preserved) neurological functions (hearing, facial movements, swallowing, eye movements, etc.) intraoperatively with the cooperation of our specialized staff.

• There are bone and cartilage diseases such as spinal canal stenosis and intervertebral disc herniation, as well as spinal cord tumors and spinal cord vascular disorders.
• Surgery is done for spinal cord tumors that cause symptoms.
• For spinal cord vascular disorder, we perform catheter treatment and surgical operation according to the patient.

What is spine and spinal cord disease?

Diseases of the spinal cord include spinal canal stenosis and intervertebral disc herniation, but although the number is small, diseases such as vascular malformations and dural arteriovenous fistulas are sometimes found in the spinal cord. It presents with a variety of symptoms, such as bleeding and headache or back pain, and vein stasis. Lesions with complex structures are often seen, but treatment is performed by considering the optimal treatment policy for each individual lesion, such as endovascular treatment with a catheter or surgical treatment. In our hospital, we use a hybrid operating room, and it is possible to perform treatment using catheterization during surgery.

In addition, spinal cord tumors may be discovered with numbness in the hands. There are various types of tumors, such as schwannoma, meningioma, and ependymoma, and they are generally treated with surgery.

*This content is intended for doctor and is intended to deepen the understanding of this medical institution, and is not intended for publicity or advertising for the general public.

Nice to meet you, my name is Takeshi Ota from Kobe City Medical Center General Hospital Neurosurgery. In April 2022, he succeeded Nobuyuki Sakai as Neurosurgery Director. Our hospital advocates the "last bastion" to protect the lives and health of Kobe City people, and provides emergency medical care and advanced medical care. Our department treats almost all pathologies of cranial nerve diseases, with a focus on cerebrovascular accidents, brain tumors, and head injuries. In combination with two operating rooms and two catheterization rooms, 19 Neurosurgery doctors, including 9 cranial nerve Board Certified Surgeon, together with Neurology doctors, have established a system that enables a large number of surgical treatments and endovascular treatments at the same time 24 hours a day, 365 days a year, under the slogans "A city where you don't have to worry about stroke" and "Aiming for the latest and best Neurosurgery medical care". We are studying every day with the safety of Mr./Ms. as our top priority.
With the motto that each doctor is a dual-wielding Neurosurgery doctor who can perform two different treatment methods, surgical and endovascular treatment, we provide our patients with the best treatment methods, including internal Mr./Ms.. The following is a summary of some of the medical treatment we provide for cerebrovascular accidents, with a focus on cerebral aneurysm treatment.

Takeshi Ohta
Director Neurosurgery

To avoid overlooking subarachnoid hemorrhage

There are two types of cerebral aneurysms: ruptured cerebral aneurysms that have already caused subarachnoid hemorrhage and unruptured cerebral aneurysms that have not ruptured. Subarachnoid hemorrhage has a high fatality rate among strokes, and if it is overlooked, it is a disease that cannot be overlooked because rebleeding repeats and often leads to death.

Severe headache "like being hit on the head" and nausea and vomiting are typical symptoms of relatively mild subarachnoid hemorrhage without disturbance of consciousness. It is a highly urgent disease that can be diagnosed by head CT, so please do not hesitate to introduce us at any time. Also, although it depends on the site of the aneurysm, patients sometimes complain that they cannot raise their eyelids or see double things just before the aneurysm ruptures. .

Treatment of subarachnoid hemorrhage (ruptured brain aneurysm)

For the treatment of subarachnoid hemorrhage (ruptured cerebral aneurysm), neck clipping is a method of craniotomy to prevent blood flow into the aneurysm, and coil embolization is a platinum shape memory alloy. There is a catheter treatment (coil embolization) in which a very thin and soft coil made of is filled inside the aneurysm.
In recent years, catheter therapy has become the mainstay of treatment, but both have their own advantages and disadvantages.

A medical system that always allows the optimal treatment selection according to the patient

At our hospital, we have almost full-time dual-skilled Neurosurgery who are familiar with two different treatments and can perform both treatments, so we can provide the best treatment for each patient 24 hours a day, 365 days a year. In addition, treatment is performed in an operating room (hybrid room) dedicated to Neurosurgery equipped with the latest angiography equipment. Both craniotomy and catheter treatment can be performed immediately after diagnosis, so it is possible to minimize the movement of patients who have developed a serious disease such as subarachnoid hemorrhage, reducing the burden on patients. , can lead to a better prognosis.

Treatment results for unruptured cerebral aneurysms have improved with advances in equipment

The purpose of treatment for unruptured cerebral aneurysms is to prevent future rupture and to treat the symptoms that occur when the aneurysm grows and causes symptoms in the surrounding brain.

New equipment used in catheter treatment is constantly improving, and in a nationwide survey, catheter treatment is performed in more than half of cerebral aneurysms. In recent years, the procedure that has seen the biggest increase in the number of treatments is flow diverter stent placement. This is a treatment that blocks the aneurysm by placing a fine mesh metal tube called a flow diverter stent in the blood vessel where the aneurysm occurred, rather than inserting a coil into the aneurysm.

Although the number of hospitals that can perform this treatment is gradually increasing, our hospital started this treatment in 2011 and has accumulated a wide range of experience, and is capable of using all of the several types of flow diverter stents. Initially, it was intended for large aneurysms of 10 mm or more, but it is now approved for use on medium-sized aneurysms of 5 mm or more, and it is becoming an essential treatment option when treating unruptured cerebral aneurysms.

In addition to flow diverter stents, our hospital also performs treatments using new devices such as the W-EB, a fine mesh bag-shaped device that is placed inside the aneurysm, for bifurcation cerebral aneurysms, which have been difficult to treat with endovascular treatment until now. These devices are currently only available at a limited number of facilities nationwide.

The results of catheter treatment have progressed with advances in equipment, and our hospital is able to provide the best treatment using the latest techniques. If you have a patient who has been found to have an unruptured cerebral aneurysm and is suffering from it, please refer them to our hospital. We will provide the best treatment plan, including craniotomy and follow-up observation.

Safe and minimally invasive treatment for carotid artery stenosis

Cervical carotid artery stenosis is an arteriosclerotic stenotic lesion from the origin of the internal carotid artery located in the neck to the bifurcation of the common carotid artery. Once stenosis progresses or cerebral infarction (embolism) occurs, medical treatment alone increases the risk of subsequent cerebral infarction, requiring interventional treatment.

Interventional treatments include carotid endarterectomy (CEA), in which an incision is made in the neck to expose the artery and remove arteriosclerosis (plaque) in the artery, and catheter-based stent placement (CAS). Comparative trials of these two treatments have been conducted many times before, but recent studies show that CAS and CEA are equally safe, so less invasive CAS for patients is more than doubled in Japan. It's starting to happen.

At our hospital, more than 90% of cases have already been treated with CAS, but just like treatment for Neurosurgery aneurysms, CAS and CEA each have their advantages and disadvantages. We choose the best treatment method together. Including asymptomatic carotid artery stenosis found in brain checkup, if you think you need a professional judgment, please refer us anytime.

Please leave the highly difficult cerebral arteriovenous malformation and dural arteriovenous fistula to us.

Cerebral arteriovenous malformation is a disease that causes cerebral hemorrhage and epileptic seizures due to direct connection between arteries and veins in the brain without passing through capillaries. The annual bleeding rate is thought to be about 2%, but it is said that once bleeding occurs, the rupture rate increases for a certain period of time.
As a treatment policy, the three treatment methods of craniectomy, catheterization, and radiation therapy are combined to aim for a complete cure, or in cases with a particularly high degree of difficulty in treatment, follow-up is performed.

When aiming for a radical cure, craniotomy or radiotherapy is often performed alone, or both are combined with catheter therapy. Treatment is performed in a hybrid room that can treat Catheterization by a dual-skilled Neurosurgery who is familiar with surgery enables more effective catheterization and increases the safety of craniotomy. If you have a patient who has been pointed out to have cerebral arteriovenous malformation, which is said to be the most difficult Neurosurgery disease, please introduce us.

A dural arteriovenous fistula connects the blood vessels that nourish the dura that surrounds the brain with the venous sinuses and veins of the brain, causing tinnitus and bloodshot eyes. It is a special disease. Craniotomy and radiotherapy may be performed, but most of the treatment is catheter treatment. Based on detailed vascular diagnosis, a detailed treatment plan will be made, so please refer to our department, which has a wealth of experience.

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Our motto is to be a dual Kobe City Medical Center General Hospital skilled Neurosurgery who can perform Neurosurgery operations and endovascular treatments. With the cooperation of the Department of Neurology, the Emergency Department, and medical staff, we are actively working on thrombectomy therapy for acute cerebral infarction with blockage, and the average time from arrival to the start of treatment is less than 40 minutes, which is one of the leading achievements in Japan. has achieved We will continue to devote ourselves to realizing "a city where people who have a stroke will not be troubled", so we ask for your continued support and guidance.