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Since its establishment in 1978, the Department of Neurosurgery at the NCVC has endeavored to overcome cerebrospinal angiopathy. At present, the department upholds as its overriding mission the ability to perform microsurgery, endovascular treatment, and stereostatic radiosurgery (gamma knife radiosurgery), all at the highest levels and within the department. We combat complex cerebral disorders by combining various therapeutic modalities tailored to each patient's pathological condition.

1. Acute stroke treatment

Aspiring to serve as the premier model institution for comprehensive stroke treatment in Japan, we exert our utmost effort for the acute-phase treatment of stroke (subarachnoid hemorrhage, cerebral hemorrhage, cerebral infarction) at the Department of Neurology. With 42 beds in the general ward and 15 beds in the NCU (the intensive care unit exclusively used for neurosurgical treatment), we accept many acute stroke patients referred from various other institutions. Providing an immediate response, we can perform open surgery and endovascular treatment 24 h a day, 365 days a year, adopting treatment plans tailored for each case. To ensure the most effective stroke treatment, the presence of highest-level internists specializing in stroke is indispensable. Therefore, we have established a system that allows us to select best possible treatment modalities between both internist and surgical approaches. This system is supported by the department's continuous close collaboration with specialists in neurology and cerebrovascular internal medicine who comprise the country's best corps of stroke internists with an excellent track record of treatment achievements.

2. Preventive and chronic-phase treatment of stroke

(1) Unruptured brain aneurysm

We have successfully treated many cases of unruptured brain aneurysm using clipping and coil embolization. We maintain the most stringent criteria in determining the application of these treatment techniques. Considering the aneurysm size and location as well as the age of each patient, we recommend surgical procedures to patients only if we can fully ascertain sufficient follow-up observation.

Results of meta-analyses conducted thus far have revealed that the rate of brain aneurysm rupture is higher among the Japanese than among the Westerners. The Japan Consortium for Area Studies study has also demonstrated rupture rates that are specific to Japanese patients, facilitating the determination of specific aneurysm types that are dangerous despite their small size, albeit without absolute precision. When determining a treatment plan, we always provide our patients and their families with relevant data such as annual rupture rates and life-long cumulative incidence of rupture based on patients' life expectancy demonstrated in studies such as the one mentioned above. We supplement this information with the department's actual treatment results before finalizing each treatment plan, always in consultation with our patients and their families.
At the department, we also work on many referred cases of intractable diseases and cases with extremely poor prognosis, such as those with large intradural cerebral aneurysm. Even in cases that can hardly be handled using a simple strategy, we have managed to treat many lesions by adopting adjuvant deep cerebrovascular bypass or intracranial stenting or by opting for open surgery and endovascular treatment simultaneously performed in the hybrid operating room.

(2) AVM

Because AVM presents complexity in terms of vascular morphology and hemodynamics, cases that allow full extraction with hematoma in the acute rupture phase are rare. In this phase, various treatment approaches are implemented in many cases, with radical treatment considered in the chronic phase. Meanwhile, in young patients, even with unruptured lesions, the possibility of a highly safe radical treatment must be considered because of the long-term risk of rupture. Committed to providing microsurgery, endovascular treatment, and gamma knife radiosurgery, all at the highest levels and at one place, i.e., within the Department of Neurosurgery, we exert our utmost efforts to offer safety-assured treatments using these modalities. As a point of contact for patient referrals, we operate the Specialized Outpatient Clinic for AVM.

(3) Moyamoya disease

The Department of Neurosurgery at the NCVC is Japan's leading treatment center for Moyamoya disease. We operate the Specialized Outpatient Clinic for Moyamoya Disease to receive referred patients. To treat Moyamoya disease accompanying ischemic attacks, we conduct a detailed examination of cerebral circulation using single-photon emission computed tomography and positron emission tomography, thereby determining whether the patients are suited for a bypass surgery. While Moyamoya disease can affect people of all ages from infants to adults, direct bypass (microsurgical vascular anastomosis) is the standard treatment in all cases. For children, we supplement direct bypass with indirect bypass (brain-temporal fascia fusion). While surgery in the middle cerebral artery region is the main procedure, we also perform bypass surgery in the anterior cerebral artery or posterior cerebral artery regions in children, if deemed necessary.

Moyamoya disease requires long-term care and observation even after surgical treatment. Our postoperative patients can be assured of a close and continued follow-up on an outpatient basis.

(4) Carotid artery stenosis

Since the opening of the Department of Neurosurgery, we have treated many patients with carotid artery stenosis by performing carotid endarterectomy (CEA) or CAS. As with unruptured brain aneurysms, we maintain strict criteria for evaluating the suitability of treatment modalities. To finalize treatment plans, we examine our cases one by one in conferences that are also attended by cerebrovascular and neurological internal medicine specialists.

Following the recent progress in internal treatment, the criteria for the application of surgical revascularization have become stricter than ever before for asymptomatic carotid artery stenosis. Under such circumstances, we perform CEA and CAS for high-risk cases identified using carotid duplex ultrasonography or magnetic resonance plaque imaging. When choosing between CEA and CAS, we compare their respective associated risks in specific cases, naturally choosing the approach that is safer and more reliable for each case. If both methods are deemed highly risky for a given case, we opt for a combined treatment modality in the hybrid operating room.

(5) Dural arteriovenous fistula

Many patients with dural arteriovenous fistula are referred to us following complaints of tinnitus (ringing in the ears) or ocular injection (bloodshot eyes). Meanwhile, an increasing number of cases are detected during a complete brain checkup. We have treated many patients with this condition mainly using endovascular procedures. While endovascular treatment is less invasive, it is associated with the risk of complications and incomplete cure if the treatment strategy is not suitable. For these reasons, it is preferable to treat dural arteriovenous fistula at medical institutions staffed with specialists who are well experienced in performing endovascular treatment.

(6) Brain tumor

We are also actively treating brain tumors. It is well known that the prognosis of benign extra-axial brain tumors, such as skull base tumors, depends on a carefully designed treatment plan, including endovascular treatment, and technical expertise in microsurgery, as in the case of cerebrovascular diseases. We perform gamma knife radiosurgery on many patients referred from other medical institutions because it is a highly effective and non-invasive treatment for not only benign tumors but also metastatic malignant brain tumors. We operate the Specialized Outpatient Clinic for Gamma Knife Radiosurgery 2 days a week to accept patient referrals and conduct post-radiosurgery follow-up.

(7) Trigeminal neuralgia and hemifacial spasm

For these diseases, which result from the pressure of cerebral blood vessels on nerves, microvascular decompression is highly effective, offering fundamental cure in many cases. We actively perform this procedure by applying the techniques developed and improved through our surgical interventions for cerebrovascular diseases. We also use gamma knife radiosurgery in some cases of trigeminal neuralgia, such as elderly patients, patients to whom surgery is not indicated due to poor general condition, and refractory cases prone to postoperative recurrence.

Patient referrals and pre-treatment consultation

With 42 beds in the general ward and 15 beds in the NCU (the intensive care unit exclusively used for neurosurgical treatment), the Department of Neurosurgery accepts acute-phase patients 24 h a day. We are capable of providing a rapid medical response using modalities such as various emergency tests (including cerebral angiography), emergency craniotomy, and emergency endovascular treatment.

To ensure the most effective stroke treatment, the presence of highest-level internists specializing in stroke is indispensable. We have a system in place that allows us to select best possible treatment modalities from both internist and surgical approaches. This system is supported by the department's continuous and close collaboration with specialists in neurology and cerebrovascular internal medicine who comprise the country's best corps of stroke internists with an excellent track record of treatment achievements.

In parallel with acute medical care, we also strive to promote preventive medicine. Those wishing to consult a physician at the Department of Neurology on an outpatient basis are requested to make an appointment with the Neurosurgery Outpatient Clinic or with one of the Specialized Outpatient Clinics via the NCVC's Specialty Care Coordinating Office.
For your first consultation at the NCVC, you will be asked to bring with you a statement of medical information for submission as well as X-ray, computed tomography, magnetic resonance imaging, and/or other imaging data or documents and previous medical test results, among others.

last updated : 2021/10/01