Centers & Services

Neurological Surgery Department

What is neurological surgery?

Neurological surgery, or neurosurgery, is a medical field in which surgical treatment is performed for disease in the brain, spinal cord, peripheral nervous system and their associated organs (such as blood vessels, bone, and muscle).

Our Physicians

Chairman, Neurological Surgery Department

Isao Date, Professor
[Cerebrovascular disorder, brain tumor, Parkinson disease, trigeminal neuralgia, facial spasm and other neurosurgery in general]

Staff

Kenji Sugiu Associate Professor [Cerebrovascular and spinal vascular disorders, endovascular surgery and percutaneous vertebroplasty]
Tomotsugu Ichikawa Associate Professor [Brain tumor and neurosurgery in general]
Kazuhiko Kurozumi Senior Assistant Professor [Brain tumor and neurosurgery in general]
Takao Yasuhara Senior Assistant Professor [Spine and spinal cord surgery and neurosurgery in general]
Tomohito Hishikawa Assistant Professor [Cerebrovascular disorder and neurosurgery in general]
Masahiro Kameda Assistant Professor [Pediatric neurosurgery and neurosurgery in general]
Kentaro Fujii Assistant Professor [Brain tumor and neurosurgery in general]
Masafumi Hiramatsu Assistant Professor [Cerebrovascular disorder and neurosurgery in general]
Tatsuya Sasaki Assistant Professor [Functional Surgery]

*Specialty shown in [ ]

Weekly schedule of outpatient clinicians

The outpatient clinic is offered in the morning on Monday, Wednesday, and Friday for both first and return visits. Surgical operations are performed on Monday (afternoon only), Tuesday, and Thursday. Patients are treated by 10 neurosurgery specialists headed by the department chairman (as of April 2017).

  Monday Tuseday Wednesday Thursday Friday
Outpatient physicians Prof. Date Associate Professor Sugiu Associate Professor Ichikawa Senior Assistant Professor Kurozumi Senior Assistant Professor Yasuhara Assistant Professor Kameda Assistant Professor Fujii Assistant Professor Hiramatsu Operation day Associate Professor Sugiu Associate Professor Ichikawa Senior Assistant Professor Yasuhara Assistant Professor Hishikawa Assistant Professor Fujii Assistant Professor Sasaki Operation day Prof. Date Senior Assistant Professor Kurozumi Assistant Professor Hishikawa Assistant Professor Kameda Assistant Professor Hiramatsu Assistant Professor Sasaki
Clinical sections available by day of the week All clinical sections are available on Monday, Wednesday, and Friday.
Clinical sections available by day of the week Neurosurgery in general Brain tumor Cerebrovascular and spinal vascular disorders Endovascular surgery Spine and spinal cord surgery Pediatric neurosurgery
Trigeminal neuralgia
Facial spasm
  Clinical sections available by day of the week
Neurosurgery in general
Brain tumor Cerebrovascular and spinal vascular disorders Endovascular surgery Spine and spinal cord surgery Pediatric neurosurgery Epilepsy surgery
  Clinical sections available by day of the week Neurosurgery in general Brain tumor Cerebrovascular and spinal vascular disorders Endovascular surgery Spine and spinal cord surgery Pediatric neurosurgery Parkinson disease and involuntary movement Stereotactic surgery Trigeminal neuralgia Facial spasm Epilepsy surgery Intractable pain Spasticity and peripheral nerve surgery

Treatment policy

Surgical operations in the field of neurosurgery include emergency operations performed for stroke and head injury and for the resection of life-threatening brain tumors. Also included are those intended for the prevention of recurrence of stroke performed in the chronic phase as well as functional surgery that does not directly affect vital prognosis such as operations for facial spasms. The need for treatment and the method of treatment differ among individual patients, even those having the same diagnosis. Therefore, we provide the most suitable procedures selected from various highly advanced treatment methods available only at university hospitals.

Expertise

  • Clipping of cerebral aneurysms
  • Surgical treatment and follow-up treatment (chemotherapy and radiotherapy) for brain tumors
  • Endovascular treatment of cerebrovascular disorder using catheters (cerebral aneurysm coil embolization and carotid artery stenting)
  • Revascularization in moyamoya disease
  • Deep brain stimulation for involuntary movement in Parkinson disease, essential tremor, etc.
  • Surgery for refractory epilepsy (selective amygdalohippocampectomy, temporal lobectomy, and callosotomy)
  • Spinal cord stimulation for intractable pain
  • Microvascular decompression for facial spasm and trigeminal neuralgia
  • Neuroendoscopic surgery for hydrocephalus and pituitary adenoma
  • Microsurgery for spine and spinal cord diseases

Scope

  • Brain tumor: Benign and malignant brain tumor in general including meningioma, acoustic neurinoma, pituitary adenoma, glioma, and malignant lymphoma
  • Cerebrovascular disorder: Unruptured and ruptured cerebral aneurysm, cerebral arteriovenous malformation, dural arteriovenous malformation, intracerebral hemorrhage, moyamoya disease, cavernous hemangioma, carotid artery stenosis, and intracranial vascular occlusion
  • Spine and spinal cord diseases: Cervical spondylosis, lumbar disc herniation, spinal canal stenosis, ossification of the posterior longitudinal ligament, spinal cord tumor, spinal cord arteriovenous malformation, and vertebral compression fracture
  • Functional disease: Epilepsy, Parkinson disease, essential tremor, dystonia, Writer's cramp, limb spasticity, facial spasm, trigeminal neuralgia, central pain, and intractable pain
  • Pediatric neurological disease: Hydrocephalus, cranial dysplasia, myelomeningocele, and Chiari malformation
  • Head injury: Acute subdural hematoma, acute epidural hematoma, and chronic subdural hematoma

Description of medical care

The scope of neurosurgery covers widely various diseases including the following: cerebrovascular disorders in general including hemorrhagic disease such as cerebral aneurysm, cerebral arteriovenous malformation, and hypertensive intracerebral hemorrhage, in addition to ischemic diseases such as cerebral thrombosis and cerebral embolism; brain tumors in general including primary and metastatic; spinal cord disease such as spinal cord tumor, vascular disease, disc herniation, and cervical spondylosis; congenital malformation including pediatric hydrocephalus; functional neurological disease such as involuntary movement in Parkinson disease, etc., intractable pain, trigeminal neuralgia, and facial spasm; head injury; and epilepsy. For cerebrovascular disorder, hemorrhagic disease is diagnosed using imaging such as CT, MRI, and DSA. The focus is treated using craniotomy under a surgical microscope or by endovascular treatment to embolize the aneurysm or cerebral arteriovenous malformation from inside the vessel under local anesthesia. Ischemic disease is also treated actively with endovascular thrombolysis based on early diagnosis, endarterectomy for cervical internal carotid artery stenosis, and endovascular surgery (vasodilation and stenting) in addition to extracranial-intracranial bypass. For brain tumor treatment, brachytherapy, with which intratumoral irradiation is performed, and navigation-assisted microsurgery, by which tumors are accurately removed under computer navigation, are also performed in addition to surgery, chemotherapy, and radiotherapy. Among hospitals in Japan, we have performed the greatest number of stereotactic surgery operations for involuntary movement and intractable pain, particularly for Parkinson disease, with excellent results. We have also diagnosed and treated many cases of spine and spinal cord disease including spinal cord tumor, spinal cord arteriovenous malformation, spondylosis deformans and spinal stenosis, congenital malformation including hydrocephalus and spina bifida, and intractable epilepsy, trigeminal neuralgia, and facial spasm.

Second opinions

Increasingly, patients have visited us to obtain a second opinion for explanations of therapeutic strategies on a certain disease from more than one medical institution. Consequently, patients can choose a method and an institution that satisfy themselves. We offer explanations on therapeutic strategies as a leading university hospital to patients with unruptured cerebral aneurysm with therapeutic options of craniotomy and endovascular surgery, and those with brain tumors who might need multimodal treatment such as radiotherapy and chemotherapy in addition to surgical operation. It is recommended that patients seeking a second opinion bring radiographs, a referral letter, and other materials from your physician.

For outpatient visits

Fundamentally, the hours of outpatient visits are mornings on Monday, Wednesday, and Friday. New patients are accepted at the General Outpatient Reception before 11 o'clock (preferably before 10 o'clock or slightly earlier to the greatest extent possible) to visit the neurosurgery outpatient clinic. While return visits are basically scheduled by appointment, we accept your visit without an appointment.

Highly advanced/special medical treatments

Technology covered by health insurance programs

  • Deep brain stimulation
  • Spinal cord stimulation
  • Intrathecal baclofen therapy
  • Intracranial EEG monitoring
  • Brain tumor resection in combination with awake speech mapping
  • Navigation-assisted surgery for brain tumor and spinal disease
  • Rituxan (rituximab) maintenance therapy in lymphoma
  • Endovascular embolization of cerebral aneurysm
  • Carotid artery stenting

Technology classified as highly advanced medical treatment

  • Percutaneous osteoplasty for bone tumor lesions and fragile bone lesions associated with osteoporosis

Technology performed in clinical studies

  • Effects of continuous administration of Temodal on growing malignant glioma
  • Genetic diagnosis and prognosis prediction of glioma
  • MRI and CT/ These are effective for the evaluation of intracranial vascular lesion and tumor, carotid artery stenosis and spinal disease, etc., and are performed using an intravenous contrast agent as appropriate. We endeavor to make a diagnosis rapidly in collaboration with Okayama Ryogo Center of National Agency for Automotive Safety and Victims' Aid, and Okayama Diagnostic Imaging Center.
  • Cerebral angiography/ This test method enables the most detailed evaluation of cerebral blood vessels in which an contrast agent is injected via a catheter in an artery under local anesthesia, and is performed as an examination during hospitalization in most cases. Additionally, the cerebral blood flow test, EEG, echography, etc. are used as appropriate.

Major methods for testing and surgical treatment

Cerebral angiography (digital subtraction angiography: DSA)

DSA enables clear imaging using a small amount of a contrast agent. It is indispensable for the diagnosis of cerebrovascular disorder. This powerful method is particularly useful for the diagnosis of vascular lesions and the selection of surgical procedures for them, and can also be performed in outpatient care. Our neurosurgery specialists perform DSA in the angiography room in the IVR center. Although neuroendovascular therapy has become popular recently, the Neurological Surgery Department of Okayama University Hospital has been a pioneer of the therapy in Japan, and have experienced numerous endovascular surgery. The number of cases of endovascular therapy has been increasing dramatically. Our skilled staff provides treatment for one of the largest patient populations in Japan.

Computer-guided microsurgery (Navigation-assisted microsurgery)


Computer-guided microsurgery

Neurosurgery support instruments have developed along with recent progress in technology. One such instrument is the surgical navigation system, which indicates the accurate position of objects and enables safe surgical operation by computer input in advance of MRI and CT images taken before an operation. We introduced the SMN navigation system in 1997 and have used it since in brain surgery. This system enables us to preserve precious brain tissue, nerves and vessels, and to reduce residual brain tumors, etc. that are left unremoved. Two next-generation models (stealth navigation system) were introduced in 2003 for application to stereotactic surgery including Parkinson disease. The application range will continue growing in the future.

Proper use of craniotomy, microsurgery, and endovascular surgery

Two methods are used for surgery of cerebral aneurysm and cervical carotid artery stenosis: surgery by craniotomy and using a microscope, and endovascular surgery performed from inside the blood vessel. An important advantage of the Neurological Surgery Department of Okayama University Hospital is that we have specialists of both methods and can choose the best treatment method after discussing with the patient which one is more appropriate. Surgical clipping and coil embolization in the cerebral blood vessel are used as appropriate in cases of cerebral aneurysm, whereas carotid endarterectomy (CEA) and carotid artery stenting (CAS) are used as appropriate in the case of cervical carotid artery stenosis. This approach of the Neurological Surgery Department of Okayama University Hospital has been attracting attention and has appeared in the media including the "Medical Renaissance" column of the national edition of the Yomiuri Shimbun newspaper. See the website of the Neurological Surgery Department of Okayama University Hospital for related details.

Endovascular surgery for cerebral aneurysm and cerebral arteriovenous malformation


Figure 1. Clipping via craniotomy.

Cerebral aneurysm is a dreadful disease that leads to subarachnoid hemorrhage if it ruptures. Conventional treatment has been craniotomy to clip a bleeding aneurysm (Fig. 1). Recently, embolization (Fig. 2) to fill up the aneurysm from inside the blood vessel by endovascular surgery with a catheter has been attracting attention. This method presents an important benefit: no head incision is necessary, which causes less damage to the brain. Nevertheless, few neurosurgeons in Japan are skilled in the method because it remains a state-of-the-art method. The Neurological Surgery Department of Okayama University Hospital has been using this method for a long time, yielding prominent results in Japan. We have 2 of 56 preceptors of the Japanese Society for Neuroendovascular Therapy (as of May 1, 2003).

Description of cerebral endovascular surgery (embolization with coils)

Under general anesthesia (also possible under local anesthesia), the femoral artery is punctured with a needle, to insert a thin tube called a "guide catheter" into the blood vessel that reaches the craniocervical region. Then a very thin and flexible microcatheter is further inserted within that into the aneurysm in the brain. Platinum coils are sent sequentially from here to fill inside the aneurysm to embolize (fill up) the aneurysm, resulting in embolization of the aneurysm while preserving normal vessels in the brain (Fig. 3). After surgery, the anesthesia wears off, and hemostasis is achieved by compression at the puncture site (the site pricked with the needle). The patient rests for a while without moving the puncture site to avoid bleeding. If a large amount of antithrombotic agents described below is used, then the catheter might be left in the femoral region to prevent bleeding in the puncture site for 1-3 day(s) after surgery. In that case, although the resting period after surgery is extended, an important benefit is that the patient can achieve earlier ambulation after surgery than with craniotomy.

Stereotactic surgery


Stereotactic surgery device

Thalamotomy or pallidotomy is performed stereotactically both accurately and elaborately within error of 1 mm for involuntary movement and intractable pain. Deep brain stimulation is also performed actively. Among these, we have had the largest number of cases in Japan of surgery for Parkinson disease.

Percutaneous vertebroplasty


Spine model in which cement
is injected in the vertebral
body via a needle inserted
from behind

Percutaneous vertebroplasty is performed with the aim of relieving pain and stabilizing the vertebral body that has been deformed by tumor or osteoporosis. In this method, a metal needle is inserted from above the skin into the spine to inject a bone filler material. Substances to be filled into the bone include bone cement polymethylmethacrylate (PMMA), which has been used for a long time with well established efficacy, and calcium phosphate paste which has been used recently in clinical application. Although the pain relief mechanism has not been fully understood, it is said that nerve damage by the ingredients of bone cement and heat during solidification (in the case of PMMA) and stabilization of the vertebral body are involved. Over 20 years have passed since this method was first used in Europe. The number of patients has been increasing dramatically as the effects have become widely recognized. The method was recognized for reimbursement by the national health insurance system in 2011. Our department at present has more than one physician with accumulated experience with this method.

Spine and spinal cord surgery


Intramedullary tumor
(ependymoma)

Most people apparently believe that spine and spinal cord surgery is part of the field of orthopedic surgery. In Europe and the United States, spine and spinal cord surgery account for about a half of neurosurgery operations. Spine and spinal cord surgery operations in neurosurgery also have been growing belatedly in number in Japan, and are presumed to increase to the frequency of Europe and the United States in the near future with continuation of the aging society. We neurosurgeons always endeavor to use microscopy and magnifying optics to ensure the safety of spine and spinal cord surgery under proper light intensity and magnification. It is crucially important to use a microscope or a magnifying glass for a narrow and deep operative field to minimize the incidence of surgical complications. Moreover, surgery support using the navigation system has been applied to the field of spine and spinal cord surgery, and has become a powerful tool for procedures such as the insertion of a screw in a dangerous site (we use the stealth station). Various spine and spinal cord diseases are presented below. Complications in any of them might cause the patient severe disadvantages. It is our mission as spine and spinal cord surgeons to minimize complications to the greatest degree in our clinical practice.

Revascularization for moyamoya disease (occlusion in the circle of Willis)

For moyamoya disease, stenosis of the major arteries occurs bilaterally and progressively, whereas abnormal collateral circulation (moyamoya vessels) develops. It is more frequent in Japan than in Europe or the United States. About 0.5 patients per 100,000 people newly develop the disease annually, and about 10 new patients are found per year in Okayama Prefecture, although it is estimated that more numerous potential patients exist. Symptoms in most cases show onset during childhood at around five years of age by cerebral infarction or transient ischemic attack, and cerebral infarction or intracerebral hemorrhage by the rupture of fragile abnormal vessels in a patient’s thirties to forties. Transient ischemic attack is induced by the constriction of cerebral blood vessels resulting from the reduction of the carbon dioxide concentration in the blood vessel during hyperventilation. It is observed in typical cases as transient limb weakness and numbness when the patient eats ramen noodles or blows a whistle. Sometimes only a headache or spasm attack is observed.


Extensive indirect revascularization in children (Ribbon EDAMS)

Operation scheme of Ribbon EDAMS. (A) Skin incision line. Range of craniotomy by the Ribbon procedure is indicated by arrowheads. The superficial temporal artery is indicated by the arrow. (B) Operative field of EDAMS. The outer layer of the dura that is cut like leaves and the superficial temporal artery with its galea are attached to the surface of the brain. Then the whole craniotomy area is covered with the temporal muscle. (C) Operative field of the Ribbon procedure. Triangle flaps of the galea and the periosteum are inserted into the interhemispheric fissure on both sides of the cerebral falx and are fixed.

Various diagnostic imaging

Various diagnostic imaging methods such as normal MRI, CT, and EEG in addition to 3D-CT, functional MRI, SPECT and Xe-CT provide anatomical information, functional information (imaging of the motor area and the speech area) and physiological information (measurement of cerebral circulation and metabolism). That information is used in the comprehensive diagnosis and treatment of various diseases.

Neuroendoscopic surgery

Neuroendoscopy has been used in the support of craniotomy operations such as those for cerebral aneurysm, transnasal surgery such as for pituitary tumor, and third ventriculostomy for occlusive hydrocephalus. It has been attracting attention as a less invasive treatment.

Number of surgical operations

January-December, 2016

* Excluding total number of
brain stereotactic radiotherapy
559
Brain tumor (1) Resection 66
(2) Biopsy
・ Craniotomy
・ Stereotactic surgery
 
1
18
(3) Trans-sphenoidal surgery 31
(4) Extensive skull base tumor resection and reconstruction 1
Others 10
Cerebrovascular disorder (1) Ruptured aneurysm 1
(2) Unruptured aneurysm 28
(3) Cerebral arteriovenous malformation 1
(4) Carotid endarterectomy 1
(5) Bypass 15
(6) Hypertensive intracerebral hemorrhage
・ Craniotomy for hematoma removal
・ Stereotactic surgery
 
1
0
Others 20
Injury (1) Acute epidural hematoma 2
(2) Acute subdural hematoma 1
(3) Decompressive craniectomy 1
(4) Chronic subdural hematoman 7
Others 1
Malformation (1) Skull and brain 12
(2) Spine and spinal cord 5
Others 3
Hydrocephalus (1) Ventricular shunting 19
(2) Endoscopic surgery 0
Others 8
Spine (1) Tumor 10
(2) Arteriovenous malformation 0
(3) Degenerative disease
・ Spondylosis deformans
・ Disc herniation
・ Ossification of the posterior longitudinal ligament
 
28
2
4
(4) Syringomyelia 0
Others 2
Functional surgery (1) Epilepsy 10
(2) Involuntary movement and intractable pain
・ Stimulation
・ Destruction
 
49
3
(3) Microvascular decompression 9
Others 47
Endovascular surgery (1) Aneurysm embolization
・ Ruptured aneurysm ・ Unruptured aneurysm
 
13
51
(2) Arteriovenous malformation
・ Brain
・ Spinal cord
 
14
6
(3) Occlusive cerebrovascular disorder 27
(in which stenting was performed) 19
Others 28
Brain stereotactic radiotherapy (1) Total 0
(2) Tumor 0
(3) Cerebral arteriovenous malformation 0
(4) Functional disease 0
Others 0
Others Not applicable to all categories above 3