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Background: Parkinson's disease (PD)-related pain or PD pain is a frequent non-motor symptom and is treated with pharmacotherapy and non-pharmacologic therapies such as deep brain stimulation (DBS) and spinal cord stimulation (SCS). The mechanism of PD pain relief by DBS is thought to involve increased pain threshold to nociceptive stimulation, whereas the mechanism of SCS has not been elucidated. Objective: PD pain relief by SCS may involve modulation of the pain thresholds in the spinal cord segments and supra-spinal actions. Therefore, we investigated the effect of SCS in patients who underwent SCS for intractable PD pain in the lower extremities by measuring pain thresholds to thermal nociceptive stimulation of the lower (leg) and upper (hand) parts of the stimulated spinal segment during SCS-off and SCS-on using quantitative sensory testing to determine the pain threshold. Methods: Seven PD patients with SCS in the lower thoracic spinal cord underwent measurements of cold sensory threshold, warm sensory threshold, cold pain threshold (CPT), and heat pain threshold (HPT). Results: In upper part of the stimulated spinal segment, CPT was significantly decreased during SCS-on compared to SCS-off (p

Background: Intravascular acute thrombectomy is recommended for acute cerebral infarction within 8 h of onset, based on several randomized controlled trials. However, standard treatment for cases outside these indications has not been established. Objective: Emergent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed within 72 h of onset for non-cardiogenic cerebral artery occlusive disease and the surgical outcomes are discussed. Methods: Retrospective review of 18 consecutive patients with non-cardiac cerebrovascular occlusive stroke who underwent emergent bypass surgery from September 2010 to August 2018. Surgical indications were determined as symptomatic ICA or MCA occlusive disease within 8–72 h after onset, and crescendo and/or progressive frequent transient ischemic attack, or impending stroke despite aggressive medical treatment with National Institutes of Health Stroke Scale (NIHSS) at 4 points or more, small cortical infarction (1/3 or less), and observed perfusion-diffusion mismatch. Results: Surgical outcome was good recovery in 2 patients, moderate disability in 8, severe disability in 6, and death in 2 patients. Favorable outcome was achieved in 55.6%, and poor outcome in 44.4%. No patient showed enlargement of the area of cerebral infarction. The value of the BRS significantly improved after surgery in favourable outcome group. No patient suffered any complication related to surgical intervention including hemorrhagic complications. Conclusions: Emergent STA-MCA bypass surgery can improve clinical outcome and reduce the risk of morbidity under strict surgical indications, so could be an option for acute stage revascularization after ineffective thrombolytic therapy for non-cardiac acute cerebrovascular stroke.

Background: Dural arteriovenous fistulas (DAVF) complicate intracranial hemorrhages that are secondary to cortical venous reflux (CVR). Clinicians usually pay attention to CVR but not to other uncommon etiologies in hemorrhagic cases. Here, we report the rare case of a ruptured pial feeder aneurysm arising from the posterior inferior cerebellar artery (PICA) that was successfully treated with endovascular surgery. Case description: An 81-year-old man was transferred to the emergency department of our hospital because of sudden onset of vertigo and vomiting. Head computed tomography showed a hyperdense area of up to 2.6 cm in the cerebellar vermis, intraventricular hemorrhage in the fourth ventricle, and subarachnoid hemorrhage in the cerebellopontine cistern. Digital subtraction angiography (DSA) showed a torcular DAVF. CVR was observed in the bilateral cerebellar veins (Borden type 3, Cognard type 4). DSA revealed a small aneurysm in the vermian branch of the left PICA feeding the DAVF. Because the aneurysm was arising from the vermian branch itself, we decided to occlude it with 12.5% N-butyl-2-cyanoacrylate. The vermian branch harboring the aneurysm was successfully obliterated. Rebleeding did not occur postoperatively. Conclusions: The CVR is a common etiology of intracranial hemorrhage caused by DAVF. However, clinicians should be aware that the pial feeder may also contribute to hemorrhagic complications. Our case illustrates the significance of the existence of the pial feeder in hemorrhagic DAVF and the potential contribution of an aneurysm arising from the pial feeder to the etiology. Care should be taken not to overlook the pial feeder on radiologic imaging, and appropriate surgical management should be performed to prevent rupture.

Central dural tenting sutures are surgical routine procedure in craniotomy which requires passing the thread through a small bone hole, which is time consuming and both physically and mentally stressful. We have developed a novel surgical device to easily perform these procedures and to reduce stress. This study evaluated the convenience, ease, and accuracy compared to conventional methods. We evaluated the time taken using the bone hole threader with an artificial bone model with 10 bone holes. The time required to pass the sutures through the bone hole was compared after 11 neurosurgeons performed using each of three methods twice: one surgeon and another assistant using the conventional method, one surgeon using the bone hole threader, and one surgeon and another assistant using the bone hole threader. These results were statistically analyzed using SPSS. Mean time reduction of 15.9 s was obtained for the bone threader use by one surgeon compared with conventional method by two operators (p = 0.03). Mean time reduction of 24 s was obtained for the bone threader use by two operators compared with one operator (p

Background: Seizure frequency after neurosurgery with craniotomy has been widely reported. Postoperative consciousness recovery may be prolonged in such cases due to seizures or factors related to the underlying pathology and/or surgical procedures. However, it remains unclear whether prophylactic administration of antiseizure drugs is effective. Recently, continuous administration of levetiracetam (LEV) was shown to effectively reduce postoperative seizure frequency. Here, we aimed to confirm the postoperative efficacy of LEV and investigate its potential to aid in consciousness level recovery followed by functional recovery. Method: This retrospective, single-center study analyzed the data of 61 patients who underwent supratentorial craniotomy and were divided into two groups: a continuous prophylactic LEV administration group (LEV group; 2000 mg/day for 14 days; 41 patients) or non-continuous prophylactic administration group (Control group; phenytoin 250 mg/day only on the operative day and postoperative day 1; 20 patients). Seizure frequency, the Glasgow coma scale (GCS), and modified Rankin scale (mRS) were evaluated and compared within and between groups. Results: Average age (years ± SD) was 64.0 ± 17.8 in the LEV and 64.3 ± 13.6 in the Control group. Preoperative seizure frequency was 9.8% in the LEV and 0% in the Control group, and postoperatively, it was 4.9% in the LEV and 25% in the Control group. While there were no preoperative differences in GCS between the groups, the postoperative GCS significantly improved in the LEV group starting on postoperative day 3 but only showed improvement in the Control group starting on postoperative day 14. Functional recovery as determined by the mRS indicated significant improvement in the LEV group on postoperative day 8, whereas the control group showed no significant recovery even on postoperative day 14. Conclusion: Continuous LEV administration after neurosurgical operation with craniotomy accelerates recovery from consciousness disturbance and could improve outcomes by allowing aggressive early neurorehabilitation.