There is limited high-level evidence guiding the surgical treatment of hypertensive intracerebral hemorrhage, leaving the decision to the clinician's discretion. To understand treatment practices, a questionnaire survey was conducted among members of the Japanese Society on Surgery for Cerebral Stroke. This survey examined stroke care systems at various institutions, stroke numbers, and treatment details of patients with hypertensive intracerebral hemorrhage from January 2021 to December 2023. We examined data from 42 facilities, compared with 10 primary stroke centers cores and 32 non-primary stroke center cores. The total number of physicians involved in stroke care (primary stroke center cores vs. non-primary stroke center cores, median interquartile range; 18 [11-26] vs. 8 [4-14], p = 0.01), stroke specialists (8 [5-12] vs. 4 [2-7], p = 0.03), and supervising stroke surgeons (2 [1-2] vs. 1 [0-2], p = 0.008) was significantly higher in the primary stroke center cores group. Overall, 36,412 patients with stroke were hospitalized: 68% had cerebral infarction, 22% cerebral hemorrhage, 8% subarachnoid hemorrhage, and 2% other strokes. The locations of hypertensive intracerebral hemorrhage varied, with the putamen (31%), thalamus (25%), and lobe (24%) being predominantly affected. Non-invasive treatment was more prevalent in non-primary stroke center cores for most hypertensive intracerebral hemorrhage types, except for putaminal and brainstem hemorrhages. Surgical interventions were more common in primary stroke center cores, with craniotomies, neuroendoscopic surgeries, and ventricular drainage being preferred for cerebellar hemorrhage (28%), caudate nucleus hemorrhage (20%), and intraventricular hemorrhage (41%). This study highlights the treatment variability of hypertensive intracerebral hemorrhage between primary stroke center and non-primary stroke center cores.

Spinal ependymomas are common intramedullary tumors that can show dynamic changes in magnetic resonance imaging findings over time. This study aimed to analyze these imaging changes and their implications for perioperative management. The retrospective study included patients diagnosed with World Health Organization grade 2 spinal ependymoma who underwent surgical resection and had at least 2 preoperative magnetic resonance imaging scans. Patients were divided into 2 groups based on the presence or absence of radiographic changes on magnetic resonance imaging. Magnetic resonance imaging analyses included non-contrast T1- and T2-weighted images, as well as gadolinium-enhanced T1-weighted images when available. Key features evaluated included intraparenchymal edema, hemosiderin deposition, syringomyelia, and cyst components. Changes in tumor size and contrast enhancement patterns were documented. Radiographic changes were identified in 4 out of 15 cases (26.7%). All cases with imaging changes exhibited hemosiderin deposition or hemorrhage, significantly higher than in cases without changes (100% vs. 18.2%, p < 0.05). No significant differences were observed in the presence of cystic components, syringomyelia, or edema between the groups. In the group with radiographic changes, the timeframe for these changes in the images ranged from 3 days to several years. Spinal ependymomas can demonstrate dynamic magnetic resonance imaging changes during the preoperative period, including both growth and reduction in tumor size. The presence of hemosiderin deposition or hemorrhage might be associated with these imaging changes. Proper timing of magnetic resonance imaging is crucial for informing surgical planning and optimizing treatment strategies for patients with spinal ependymomas.

Middle meningeal artery embolization has increasingly been used to treat chronic subdural hematoma. However, the current state of its application and outcomes in Japan remains unclear. We conducted a multicenter observational study involving facilities affiliated with the Japanese Society for Neuroendovascular Therapy to assess current practices and clarify the usefulness and safety of middle meningeal artery embolization for chronic subdural hematoma. A total of 466 patients from 40 facilities were included. The mean age of the patients was 78.0 ± 10.5 years, and bleeding risks, including antithrombotic therapy or bleeding predisposition, were present in 36.1% of patients. The most common timing for middle meningeal artery embolization was after the second burr hole surgery, accounting for 34.8% of cases. N-butyl-2-cyanoacrylate was used as the embolic material in 67% of cases. The complication rate was 5.2%, with complication-related morbidity at 0.9%. Hematomas were stable in 91.5% of cases at 30 days post-middle meningeal artery embolization. The symptomatic recurrence rate was 8.9%. Cases that underwent middle meningeal artery embolization after the second or subsequent burr hole surgeries were significantly associated with symptomatic recurrence. This study is the first nationwide survey investigating the real-world clinical practice of middle meningeal artery embolization for chronic subdural hematoma in Japan. While it included many elderly patients, recurrent cases, and those with bleeding risks, the safety and usefulness of middle meningeal artery embolization were deemed acceptable. However, symptomatic recurrence was common even in cases with middle meningeal artery embolization when performed after the second or subsequent burr hole surgeries. A further prospective study will be warranted to clarify treatment indications, optimal timing, and treatment techniques of middle meningeal artery embolization.

Shape indices such as size ratio are valuable for diagnosing aneurysm rupture status and may influence rupture risk. However, as these indices are calculated based on two-dimensional measurements, bias may arise from observation directions. To address this, we developed a novel parameter, spatial projection ratio, utilizing three-dimensional geometry. A retrospective analysis of 225 aneurysms diagnosed using three-dimensional computed tomography angiography was conducted to evaluate primary variables and spatial projection ratio.

Spatial projection ratio is determined by defining the gravity point as the neck orifice center and identifying the furthest point from it using commercial software. The distance between these points, known as spatial projection length, is measured and divided by the equivalent neck diameter to calculate spatial projection ratio. Significant differences in morphological variables for rupture status were observed by Brunner-Munzel tests.

Receiver-operating characteristic curve analysis was employed to assess diagnostic accuracy, with Spearman's rank correlation utilized to explore the potential for predicting rupture risk by correlating spatial projection ratio and size ratio. Ruptured aneurysms exhibited significantly higher primary variables and shape indices compared to unruptured ones. The area under receiver-operating characteristic curves of all shape indices surpassed that of primary variables, with spatial projection ratio demonstrating a particularly high area under receiver-operating characteristic curves of 0.791 (95% confidence interval 0.732-0.849; sensitivity, 0.770; specificity, 0.741; cut-off value, 1.047). Moreover, spatial projection ratio exhibited a significant correlation with size ratio (r = 0.575, p < 0.01).

Thus, spatial projection ratio emerges as a robust morphological parameter for evaluating rupture status and may provide insights into aneurysm rupture risks.