To All Patients Visiting the Department of Neurosurgery

Neurosurgery is a primary medical specialty ^*1, and its scope of practice extends far beyond surgery. It encompasses the diagnosis, treatment, and pre- and post-operative management of neurological disorders. The conditions treated by neurosurgery are diverse and extensive, including cerebrovascular diseases, brain tumors, spinal and spinal cord disorders, congenital anomalies, epilepsy, head trauma, and many others. For more information, please see the page on eligible diseases.

Features of the Department of Neurosurgery at Kyoto University Hospital

The treatment that had been performed in the Department of Neurosurgery at Kyoto University Hospital in the past mainly focused on 1) diseases that were difficult to treat at other institutions (such as giant cerebral aneurysms, cerebral arteriovenous malformations, or giant brain tumors), 2) rare diseases with little treatment experience at other institutions (moyamoya disease, von Hippelrindt disease, and other cerebrospinal angioblastomas, spinal arteriovenous malformations), 3) highly difficult diseases such as brain tumors and epilepsy surgery that preserves the higher functions of the cerebrum. 3) Surgeries for brain tumors and epilepsy performed while preserving the higher functions of the cerebrum.

However, with the increase in the number of beds and surgical slots, 4) many preventive surgical treatments for asymptomatic or minor diseases (carotid artery stenosis, unruptured cerebral aneurysm, etc.) detected in brain docks, etc., are now also performed. In addition, since the opening of the Stroke Department in 2011, we are now able to treat acute stroke, subarachnoid hemorrhage, cerebral hemorrhage, and other strokes at any time. The robust manpower—comprising 26 board-certified neurosurgeons, 16 stroke specialists, and 18 endovascular neurosurgeons—makes this facility an ideal model as a regional core center for stroke care (Comprehensive Stroke Center^*2). Furthermore, in December 2015, a stroke intensive care unit with an exceptionally large floor area—unprecedented even on a national scale—was established. Since then, rehabilitation using robotic suits has been implemented from the acute phase of stroke care.

At Kyoto University Hospital, surgical equipment is maintained at a world-class level, including a hybrid operating room where both cerebral angiography and surgery can be performed simultaneously, Japan’s first intraoperative 3-tesla MRI system, and portable CT scanners. The hospital specializes in highly advanced procedures such as combined open and endovascular surgeries for complex cerebrovascular disorders, minimally invasive surgeries using neuroendoscopy, preoperative assessments utilizing various IT-based systems, and awake craniotomies with advanced intraoperative monitoring to assess neurological function in real time during brain tumor resection.

Informed Consent

When considering whether a surgical procedure should be performed, informed consent is essential. Informed consent means that the patient himself or herself has been fully informed, understands the information, chooses the treatment, and agrees to undergo the treatment, with the patient, not the physician, taking the lead role. In other words, it is not “explaining” but “receiving an explanation. The Department of Neurosurgery at Kyoto University Hospital places great importance on informed consent. Instead of giving the same set of instructions to every patient, the surgeons themselves prepare the instructions according to the patient’s medical condition, explain them as clearly as possible, and make sure the patient understands them. On the other hand, patients have diverse values and perspectives on life, and many do not want to hear all explanations that may be risky or stressful. We also ask patients at the time of admission how they would like to be informed of the name of their disease and how they would like to have their condition explained to them.

Attention

We value informed consent, but in actual medical practice, informed consent has its limitations. Even if treatment is carried out without delay, it is not always possible to achieve the expected results. This is because of the uncertainty inherent in medical care itself. In addition, for non-specialists, there is a limit to their ability to fully understand the subtleties of specialized information, no matter how much explanation they receive.

However, we will do our best to answer your questions, so if you have any questions, please do not hesitate to ask. If you have any questions, please do not hesitate to ask. Please write down the questions you want to ask your doctor. By writing down the questions you want to ask your doctor, you will be able to make up your own mind about what you want to ask him or her.

At the Department of Neurosurgery, Kyoto University Hospital, we try to accommodate our patients’ wishes as much as possible. We will do our best, but please understand that there are limits to the amount of time and human resources that can be invested by the personal efforts of our medical staff.

*1 Department of Basic Medical Fields

In Japan, 19 clinical departments—including internal medicine, surgery, and pediatrics—are recognized as basic specialty areas. Departments such as neurosurgery, orthopedic surgery, ophthalmology, otolaryngology, urology, and obstetrics & gynecology perform surgical procedures, but are also responsible for the overall diagnosis and treatment within their respective fields. For this reason, they are classified as basic specialties.

In contrast, certain clinical domains are covered by both internal medicine and surgical subspecialties. For example, cardiology and cardiovascular surgery, respiratory medicine and thoracic surgery, or gastroenterology and gastrointestinal surgery. In such cases, these departments are considered subspecialties of the broader basic specialties of internal medicine or surgery.
In the field of cardiology, for instance, cardiologists are primarily responsible for diagnosis, catheter-based interventions, and pharmacological treatments, while cardiovascular surgeons handle surgery-related care.

*2 Comprehensive Stroke Center

A Comprehensive Stroke Center refers to a medical facility that has a dedicated stroke intensive care unit and the diagnostic and treatment capabilities to respond at all times to acute-phase interventions, including intravenous thrombolysis with rt-PA, open neurosurgery, and endovascular procedures.
To meet these requirements, not only stroke specialists but also board-certified neurosurgeons capable of performing craniotomies and endovascular specialists skilled in catheter-based interventions must be available at all times.
According to large-scale data analyses, treatment at a Comprehensive Stroke Center reduces stroke-related mortality by 26% compared to treatment at non-comprehensive facilities.