The Department of Neurosurgery, Tokyo Rosai Hospital

Notice of Establishment of Outpatient Consultations for Neurosurgery and Treatment

Features

Outpatient

Four neurosurgeons specializing in neurosurgery provide medical care. Part-time doctors from universities and doctors who used to work at the hospital are also available for outpatient consultations. Except Thursdays (surgery days), outpatients are seen every day, with priority given to appointments, but same-day consultations without appointments are also accepted. Neurosurgery and neurology share the same booth in the outpatient consultation room, allowing for smoother and more specialized consultations regarding brain diseases. We also treat chronic headaches and epilepsy (including carry-over from childhood). Referrals from neighboring medical institutions and emergency transport are available anytime outside of outpatient hours. You can see a doctor without a letter of referral, but if you do not have a letter of referral, you will be charged a fee for selected medical treatment at the time of your first visit. If you wish to see a doctor after hours or on holidays, please call the hospital before coming to the hospital to confirm if it is possible.

Hospitalization

Neurosurgical illnesses and injuries often require hospitalization for examination and treatment. Although each patient has a specific attending physician, all neurosurgeons examine the patient daily to determine a treatment plan and provide treatment. Nurses are also assigned to three shifts per day. Pharmacists, rehabilitation staff, medical social workers, clerks, technicians, and nursing assistants are also nearby during the hospitalization period. If you have any questions or concerns, please do not hesitate to ask the hospital staff.

Major diseases treated by neurosurgery

Stroke and cerebrovascular disease

As a regional base hospital, we focus on acute care, and neurosurgeons and neurologists treat patients with brain diseases 24 hours a day, 365 days a year. As a “hospital with strong stroke capabilities,” we are able to provide emergency treatment for all stroke patients, including thrombolytic therapy (t-PA) for cerebral infarction, catheter-based thrombus retrieval therapy, cerebral aneurysm clipping and coil embolization for subarachnoid hemorrhage, and others. We perform a large number of craniotomy surgeries and endovascular surgeries (catheterization) for cerebrovascular disorders, and select the treatment method that is less burdensome and has a good long-term outcome according to the patient’s condition. In recent years, more and more patients are wondering whether they should be treated for carotid artery stenosis, cerebral aneurysms, or cerebral arteriovenous malformations that have been detected during brain scans or other examinations. In such cases, we are always available for consultations and second opinions. Stroke (cerebrovascular disease) is the second leading cause of death worldwide, but the fourth leading cause in Japan. Although the mortality rate is decreasing with advances in medical care, stroke (cerebrovascular disease) is the second leading cause of death worldwide, but the fourth leading cause in Japan. Although the mortality rate has been decreasing with the progress of medical treatment, it is a disease that develops suddenly and leaves residual aftereffects, and often results in the need for nursing care. Blood pressure control, blood sugar control, smoking cessation, and exercise are important to prevent stroke.

Brain Tumors

Brain tumors include tumors that can be cured by surgery (meningiomas, pituitary adenomas, etc.) and tumors that require chemotherapy (drugs) or radiation therapy after surgery (gliomas, etc.). We use an intraoperative navigation system to inform the patient of the location of the lesion and a neuromonitoring device to check the function of the cranial nerves to ensure safe surgery that preserves brain function. We recommend treatments for brain tumors that cause fewer aftereffects and fewer recurrences. For tumors in critical areas of the brain, we perform awake and painless surgery while the patient is conscious. Before tumor resection, the blood vessels feeding the tumor are often occluded with an embolizing substance (tumor embolization). This reduces the amount of blood loss during surgery and partially necrotic tumor tissue, making the removal operation safer. Radiotherapy is performed using the latest radiation equipment, “True Beam”. New drugs are being used for chemotherapy for brain tumors, and the course of treatment is improving. In most cases, benign tumors with no symptoms do not require surgery, so we recommend periodic MRIs to monitor the progress of the disease. Cancer of other organs often metastasizes to the brain, and in the past, it was not often treated. In recent years, however, molecular targeted drugs and immune checkpoint inhibitors have greatly improved the course of cancer. Even in cases where the cancer has metastasized to the brain, surgical removal and radiotherapy often improve the course of the diseases

Trigeminal neuralgia and facial spasm

Trigeminal neuralgia and hemifacial spasm are conditions that severely impair quality of life due to intense facial pain and severe eye and mouth corner jerks. In many cases, a neurovascular decompression, or “keyhole surgery,” a surgical procedure performed through a very small bone hole, can cure trigeminal neuralgia and unilateral facial spasm. After treatment, patients can return to their normal lives. In this section, we would like to explain the detailed pathophysiology and treatment methods of these diseases.

Symptoms of trigeminal neuralgia

Severe pain that feels like an electric shock in the face occurs repeatedly for a relatively short period of time. The pain is usually in the cheeks and jaw, and may be triggered by eating or washing the face.

Symptoms of Hemifacial Spasm

Initially, spasms around one eyelid occur, Gradually, the cramps increase in frequency and spread to the corners of the mouth.

Causes

Most cases are caused by compression of the trigeminal nerve or facial nerve by cerebral blood vessels or tumors, especially blood vessel compression.

It is believed that aging causes the vessels to flex and meander, putting pressure on the nerves.

Treatment

Trigeminal neuralgia can be treated with carbamazepine or pregabalin. However, the effects of these medications gradually diminish, or the side effects of the medications may cause the patient to lose weight, or side effects of the medications may make it difficult to continue treatment. Block therapy is sometimes used for trigeminal neuralgia, but its effect wears off after about six months. Botox injections are also used for unilateral facial spasm, but the effect is temporary and may cause facial paralysis or muscle atrophy. The curative treatment is microvascular decompression to move the blood vessels causing the nerve compression (neurovascular decompression). The procedure is performed on the skin behind the ear, about 4 cm behind the ear, and is effective in more than 90% of patients.

The surgery is performed through a 4 cm skin incision behind the ear and through a hole about the size of a 10 yen coin.

Complications are minimal, and patients can lead an unrestricted life in the hospital ward the day after surgery.

At the Tokyo Rosai Hospital Neurosurgery Department, our first priority is minimally invasive treatment, and we strive to minimize the burden on the patient’s body and maximize the therapeutic effect. The Department of Neurosurgery at Tokyo Rosai Hospital is committed to minimally invasive treatment, making full use of endoscopes and microscopes to minimize the patient’s physical burden and maximize the effectiveness of treatment.

Director Morita is a direct disciple of the late Dr. Takanori Fukushima, who introduced this procedure to Japan, and has performed many neurovascular decompression surgeries with excellent results. Morita will supervise or actually perform this surgery at our clinic. Currently, we are combining the conventional microscope with an endoscope to provide a less invasive and more effective treatment.

If you are suffering from “facial pain” or “facial twitching,” please visit the neurosurgery outpatient clinic at Tokyo Rosai Hospital.

Please consult with the neurosurgery outpatient clinic at Tokyo Rosai Hospital.

Head injury

A hard blow to the head from a traffic accident or a fall may cause intracranial hemorrhage requiring emergency surgery. If the amount of intracranial hemorrhage is large, the hematoma can press on the brain, causing brain pressure to rise and resulting in death from brain damage. If the hemorrhage occurs inside the dura mater that surrounds the brain, it is called acute subdural hematoma, and if the hemorrhage occurs between the dura mater and the skull, it is called acute epidural hematoma. If the brain parenchyma is damaged and bleeding occurs, it is called a cerebral contusion. Emergency craniotomy is performed to remove the hematoma. Blood may also accumulate between the brain and dura mater one or two months after a minor trauma such as a head contusion or shin splint. If there is a large hematoma, a perforator is used to remove the hematoma by inserting a tube through a hole in the skull to drain the hematoma.

Headache

Headache is a common symptom, but the severity of the pain is severe and proper diagnosis and treatment are important. Migraine headaches are more common in women, with one in four women in their 30s and 40s and one in 10 high school students having migraine headaches. Although painkillers with almost the same ingredients as those prescribed in hospitals are now available at pharmacies, overmedication can lead to headaches that are difficult to treat due to excessive drug use. In addition, headaches that you may think are just headaches and deal with on your own may be caused by brain tumors or brain aneurysms. There are many types of headaches and different treatments; in 2021, for the first time in about 20 years, a new migraine medication will be available. In 2021, a new migraine medication will become available for the first time in almost 20 years.

Achievements in Medical Treatment

Number of surgeries

Disease	Surgery	2021
Cerebrovascular disease
Ruptured cerebral aneurysm (subarachnoid hemorrhage)	Clipping	5
	Coil embolization	0
Unruptured cerebral aneurysm	Clipping	1
	Coil embolization	6
Carotid artery stenosis	Carotid stenting	7
	Carotid endarterectomy	4
Acute cerebral infarction	Clot retrieval therap	11
Cerebral infarction, moyamoya disease	Extracranial endovascular anastomosis	4
Cerebral artery stenosis	Percutaneous angioplasty	4
Intracerebral hemorrhage	Hematoma removal	15
Cerebral arteriovenous malformation	Embolization	0
	Extraction	0
Dural arteriovenous fistula	Embolization	1
Brain tumor
Meningioma	Tumor resection	3
Metastatic brain tumor	Tumor resection	1
Pituitary tumor	Nasal enucleation	0
Other tumors	Tumor resection	1
	Tumor vascular embolization	1
Functional diseases
Facial spasm/trigeminal neuralgia	Neurovascular decompression	3
Hydrocephalus	Ventriculoperitoneal shunt	8
Spinal disorders
Spinal canal stenosis, cervical spondylosis, etc	Vertebroplasty	0
	Spinal cord stimulation	0
Trauma
Acute subdural/extradural hematoma, cerebral contusion	Cranial hematoma removal	6
Chronic subdural hematoma	Burr hole removal	29
Others
Cerebral infarction, etc	Internal/external decompression surgery	3
Brain abscess, subdural abscess, etc	Removal of abscess	0
Intracerebral hemorrhage	Ventricular drainage	13
Skull defect	Cranioplasty	11
	Others	1
Total		138

Staff

Name	Koichi Kato
Title	Director, Department of Neurosurgery
Education	Graduated from Sapporo Medical University in 1996 Doctor of Medicine
Medical Specialist	The Japan Neurosurgical Society The Japan Stroke Society The Japan Headache Society The Japan Society of Anti-Aging Medicine
Supervising Doctor	The Japanese Neurosurgical Society The Japanese Society for Neuroendovascular Therapy Technical Advisor of the Japanese Society for Stroke Surgery Workers’ Accident Compensation
Others	Supervising DMAT member of Japan DMAT Senior Instructor of Emargo International designated physician under Article 15 of the Act on Welfare of Persons with Physical Disabilities clinical training supervisor industrial physician

Name	Tomonobu Nakamura
Title	Neurosurgeon
Education	Graduated from Showa University in 2018

Name	Soichiro Ichikawa
Title	Neurosurgeon
Education	Graduated from Showa University in 2020

Name	Akihiro Nakamura
Title	Neurosurgeon
Education	Graduated from Showa University in 2020

December 1, 2023