Dual-floor Burr Hole Technique Optimized for Modern Burr Hole Caps with an Internal Electrode Locking Mechanism.

Insertion of a deep brain stimulating electrode is a commonly performed procedure. Burr hole caps play an important role in this procedure by immobilizing this electrode; however, burr hole caps could form scalp bumps, which can create further complications. The dual-floor burr hole technique could prevent the formation of scalp bumps. This technique has previously been used with older versions of burr hole caps and has proved to be successful. In recent years, modern burr hole caps with an internal electrode locking mechanism have become the mainstay for this procedure. However, modern burr hole caps differ considerably in diameter and shape from older burr hole caps. In the present study, a dual-floor burr hole technique was performed using modern burr hole caps. To accommodate the increase in diameters and changes in the shape of modern burr hole caps, a perforator with a 30-mm diameter was used for shaving the bone, and the bone shaving depth was altered. This surgical technique was applied to 23 consecutive deep brain stimulation surgeries without complications and was thus positively optimized for modern burr hole caps.

[Driver's License and Welfare Systems for Epilepsy Patients].

Along with treatment, social life, including driving and welfare systems, are of great concern to patients with epilepsy. During treatment of epilepsy, guidance on these issues and actual treatment are two sides of the same coin, and both epileptologists and general neurosurgeons are required to have thorough knowledge of these issues. With regard to driving, Article 66 of the Road Traffic Law prohibits driving by persons who are likely to be incapable of normal driving. However, in epilepsy, legal criteria for driver's license eligibility has been established, and there are no legal problems if decisions are made in accordance with these criteria. Even if a patient has epilepsy, a driver's license will not be denied if the patient has not had a seizure that impairs consciousness or movement while awake for at least two years. Regarding social welfare, there are programs for patients with epilepsy related to medical expenses, disability certificates, and pension subsidies. It is necessary to present appropriate systems based on an understanding of a patient's disease and disability. These issues are described using actual examples.

Case report of an elderly woman with atypical imaging for primary central nervous system lymphoma who needed a brain biopsy for diagnosis.

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma, but its diagnosis is challenging in some cases. A brain biopsy is the gold standard for diagnosing PCNSL, but its invasiveness can be problematic. Thus, noninvasive imaging examinations have been developed for the pre-surgical diagnosis of PCNSL, including gadolinium-enhanced magnetic resonance imaging (MRI), 123I-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT), and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET). Here, we report the case of a 71-year-old woman with negative imaging findings for PCNSL, but who was diagnosed with PCNSL by a brain biopsy and histological analysis. Her imaging results were negative for gadolinium-enhanced cranial MRI, with low uptake in 123I-IMP SPECT and hypometabolism in 18F-FDG PET. However, a stereotactic brain biopsy from an abnormal lesion revealed that many round cells had infiltrated into the brain. Moreover, many infiltrating cells were positive for cluster of differentiation (CD)20 and CD79a, and proliferation marker protein Ki-67-positive cells accounted for nearly 80% of all cells. Based on these results, our final pathological diagnosis was PCNSL. The present case highlights the possibility of a PCNSL diagnosis even when all imaging-related examinations display negative results.

Timelined multimodal recording of EEG and driving performance using a driving simulator system during a focal impaired awareness seizure.

An epileptic seizure during the course of driving can result in a serious car accident. However, basic data on how epileptic seizures actually affect driving performance is significantly lacking. To understand the relationship, it is crucial to conduct not only behavioral but also electroencephalogram (EEG) analysis during epileptic seizures. Therefore, we developed a mobile driving simulator which makes it possible to record driving-related parameters time-lined with video-EEG. We report a case in which behavioral and EEG changes were successfully recorded during ictal periods of focal impaired awareness seizure in a patient engaged with the system. With the current lack of objective data describing how seizures impair driving performance, such an accumulation of information could improve personalized medical management, influence legal adjudication and assist in the development of driving support systems for people with epilepsy.

Data on characteristics of reported cases of unilateral posterior reversible encephalopathy syndrome (PRES).

Data presented in this article are related to our article entitled "Unilateral posterior reversible encephalopathy syndrome: A case report" [1]. Cases of Posterior Reversible Encephalopathy Syndrome (PRES) involving unilateral lesions are very rare. We searched the PubMed database using keywords such as PRES, unilateral, and asymmetric and found a small number of cases to include in our review. We summarized the characteristics of these reported cases of unilateral PRES, including our case.

Preoperative Three-Dimensional Diagnosis of Neurovascular Relationships at the Root Exit Zones During Microvascular Decompression for Hemifacial Spasm.

OBJECTIVE: Hemifacial spasm occurs when a blood vessel compresses against an area near the root exit zone of the facial nerve. Developments in diagnostic neuroimaging have allowed three-dimensional (3D) observation of artery and nerve locations, an effective aid for treatment selection. However, an accurate interpretation of the 3D data remains challenging because imaging representations of complex small vessels are drowned out by noise. We used a noise elimination method to analyze artery and nerve locations and to determine their 3D relationship. METHODS: Fifteen patients treated for hemifacial spasm were included. Images fused from 3 modalities of magnetic resonance imaging, 3D computed tomography, and angiography were used as source images. Using the images, models of the nerve and candidate vessels were created and shown in 3D to observe how the arteries were compressing the nerve and to identify the portions of the offending vessels that were closest to the nerve. These preoperative results were then compared with operative field observations during surgery. 3D models of the unaffected side were created and evaluated as controls. RESULTS: We confirmed that these models were accurate reconstructions of the source images as the tubular nerve and artery cross-sections showed good alignment onto magnetic resonance imaging axial slice images. The preoperative diagnoses of the compression sites and offending arteries all matched intraoperative findings. CONCLUSIONS: An accurate identification of the offending arteries and compression sites was possible, and this method is anticipated to offer effective means of preoperative simulation.

Non-contact measurement of facial surface vibration patterns during singing by scanning laser Doppler vibrometer.

This paper presents a method of measuring the vibration patterns on facial surfaces by using a scanning laser Doppler vibrometer (LDV). The surfaces of the face, neck, and body vibrate during phonation and, according to Titze (2001), these vibrations occur when aerodynamic energy is efficiently converted into acoustic energy at the glottis. A vocalist's vibration velocity patterns may therefore indicate his or her phonatory status or singing skills. LDVs enable laser-based non-contact measurement of the vibration velocity and displacement of a certain point on a vibrating object, and scanning LDVs permit multipoint measurements. The benefits of scanning LDVs originate from the facts that they do not affect the vibrations of measured objects and that they can rapidly measure the vibration patterns across planes. A case study is presented herein to demonstrate the method of measuring vibration velocity patterns with a scanning LDV. The objective of the experiment was to measure the vibration velocity differences between the modal and falsetto registers while three professional soprano singers sang sustained vowels at four pitch frequencies. The results suggest that there is a possibility that pitch frequency are correlated with vibration velocity. However, further investigations are necessary to clarify the relationships between vibration velocity patterns and phonation status and singing skills.

Benidipine reduces ischemia reperfusion-induced systemic oxidative stress through suppression of aldosterone production in mice.

Aldosterone is implicated in the pathogenesis of several cardiovascular diseases, including ischemia reperfusion (I/R) and myocardial infarction, and also causes oxidative stress and inflammation in cardiovascular systems. Benidipine, a long-acting T- and L-type calcium channel blocker, reduces infarct size following myocardial I/R in rabbits. Benidipine also inhibits the production of aldosterone in vitro. However, the precise mechanism of this phenomenon in vivo remains unknown. We therefore evaluated whether benedipine has a beneficial role through the regulation of oxidative stress in myocardial I/R. C57BL/6J mice were subjected to 30 min of left ascending coronary I/R. Benidipine was administered orally at 3 mg kg(-1) daily for 3 weeks without any changes in hemodynamic variables. Benidipine significantly reduced infarction size (13.4±2.5%) compared with controls (25.5±3.6%). Urinary 8-hydroxy-2' deoxyguanosine (8-OHdG), a marker of oxidative DNA damage, increased significantly after I/R. I/R induced increases in 8-OHdG were significantly lower with benidipine. Local myocardial 8-OHdG was also elevated in I/R, but this augmentation was significantly suppressed with benidipine. The plasma aldosterone concentration (PAC) significantly increased 2 days after I/R and remained elevated at least 7 days after I/R. Treatment with benidipine significantly decreased I/R-induced elevation of the PAC. I/R-induced markers of fibrosis in hearts also reduced in benidipine. These results suggest that the administration of benidipine reduces myocardial infarct size as well as systemic oxidative stress after I/R. These phenomena are partially linked to reduced plasma aldosterone levels.

S1P3-mediated cardiac fibrosis in sphingosine kinase 1 transgenic mice involves reactive oxygen species.

AIMS: Sphingosine kinase 1 (SPHK1), its product sphingosine-1-phosphate (S1P), and S1P receptor subtypes have been suggested to play protective roles for cardiomyocytes in animal models of ischaemic preconditioning and cardiac ischaemia/reperfusion injury. To get more insight into roles for SPHK1 in vivo, we have generated SPHK1-transgenic (TG) mice and analysed the cardiac phenotype. METHODS AND RESULTS: SPHK1-TG mice overexpressed SPHK1 in diverse tissues, with a nearly 20-fold increase in enzymatic activity. The TG mice grew normally with normal blood chemistry, cell counts, heart rate, and blood pressure. Unexpectedly, TG mice with high but not low expression levels of SPHK1 developed progressive myocardial degeneration and fibrosis, with upregulation of embryonic genes, elevated RhoA and Rac1 activity, stimulation of Smad3 phosphorylation, and increased levels of oxidative stress markers. Treatment of juvenile TG mice with pitavastatin, an established inhibitor of the Rho family G proteins, or deletion of S1P3, a major myocardial S1P receptor subtype that couples to Rho GTPases and transactivates Smad signalling, both inhibited cardiac fibrosis with concomitant inhibition of SPHK1-dependent Smad-3 phosphorylation. In addition, the anti-oxidant N-2-mercaptopropyonylglycine, which reduces reactive oxygen species (ROS), also inhibited cardiac fibrosis. In in vivo ischaemia/reperfusion injury, the size of myocardial infarct was 30% decreased in SPHK1-TG mice compared with wild-type mice. CONCLUSION: These results suggest that chronic activation of SPHK1-S1P signalling results in both pathological cardiac remodelling through ROS mediated by S1P3 and favourable cardioprotective effects.