Clinical Department & Center



Under the basic philosophy, “To not only improve the ability of each surgeon, but also every team, to take a leading role in Japan, and provide top-level medical care in Hokkaido,” the Department of Neurosurgery at Hokkaido University Hospital has provided medical care for all nervous system diseases, including the brain, spinal cord and peripheral nerve diseases, since the establishment of the clinical department.
At the Department of Neurosurgery, Hokkaido University Hospital, we conduct ward rounds and review cases before and after surgery to reevaluate and verify our treatment policies and surgical procedures to continuously improve the medical care we provide. To foster excellent medical professionals, we adopt a chief resident system with yanagawara-style education, whereby senior trainees take care of junior trainees. We are also involved in many clinical studies and trials to develop and provide advanced medical care.

Medical care system

At the Department of Neurosurgery, Hokkaido University Hospital, 11 full-time medical doctors and more than 10 part-time doctors and residents see approximately 10,000 outpatients and provide medical care to roughly 500 inpatients in a ward with 40 beds each year.
We perform a total of approximately 350 surgical procedures, including endovascular procedures, per year.
Our clinical department is divided into the cerebrovascular disease team (cerebral aneurysms, cerebral infarction, moyamoya disease, cerebral arteriovenous malformations, etc.), the brain tumor team (gliomas, meningiomas, acoustic tumors, hypophyseal tumors, etc.), the spinal cord/functional surgery team (cervical spondylosis, spinal cord tumor, essential tremor, Parkinson's disease, intractable epilepsy, etc.), and these varied teams all provide cutting-edge treatment.

Check-in procedure

The Department of Neurosurgery, Hokkaido University Hospital accepts new patients without a referral letter, but an appointment is necessary.
If you make an appointment by telephone yourself, please call 011-706-7733, and make a new patient appointment with one of the above clinical teams.
Reception hours are from 9:00 to 16:00. If you are currently seen at another medical institution, that medical institution can also make the appointment.
Outpatients seeking a second opinion can make an appointment for Thursday mornings.
If you are interested, please call 011-706-6037.
However, medical treatment at the second opinion clinic is not covered by health insurance.
If your case concerns a medical accident/lawsuit, it may not be possible to see you.
Special clinics are established at the Department of Neurosurgery.
The endovascular therapy clinic, where catheter treatment of cerebral aneurysms, etc. is performed, is open on Friday mornings, and the cranium clinic, where skull malformations/deformations in children are handled, is open from 1:00 p.m. to 3:00 p.m. on the first Tuesday of each month.
A special clinic for clinical PET studies of brain tumors jointly conducted with the Department of Nuclear Medicine is also open on Tuesday mornings.
Patients wishing to visit one of the special clinics are kindly requested to inform us accordingly when the appointment is made.
General outpatient consultation days are from Monday through Friday. Reception hours are from 8:30 a.m. to noon for first-visit patients and 8:30 a.m. to 11:00 a.m. for return-visit patients.  

Handled diseases by clinical team   

Cerebrovascular disease team

The vascular surgery group focuses on the treatment of unruptured cerebral aneurysms, cerebral arteriovenous malformations and moyamoya disease.  

Unruptured cerebral aneurysms
If a cerebral aneurysm is detected, we explain it in detail to the patient and then give the patient some time to think about it.
After closely examining the size, shape, position and other conditions of the aneurysm, we try to persuade the patient of the need and risk of treatment, and then discuss a treatment policy.

Cerebral aneurysm clipping
Figure 1. Cerebral aneurysm clipping (left side of the figure: anterior communicating aneurysm; right side of the figure: left internal carotid artery - posterior communicating artery aneurysm)
When treating an ordinary aneurysm, craniotomy or endovascular surgery is chosen depending on the conditions.
In case of craniotomy, surgical clipping is the basic approach.
Although “clipping” sounds easy, aneurysms come in highly varied shapes and sizes.
To achieve a radical cure by eradicating the aneurysm while preserving the normal blood vessels, we consider the shape and the number of clips as well as the direction of applying them (Figure 1).

Figure 2. Partially thrombosed giant aneurysm of the vertebral artery (indicated by the arrow in the upper left part of the figure). Part of the radial artery was harvested from the forearm, and then a bypass was created between the middle cerebral artery (upper right part of the figure) and the posterior cerebral artery (lower left of the figure) before the upper and lower parts of the aneurysm were clipped (lower right of the figure).

Figure 3. A giant aneurysm of the internal carotid artery (upper left part of the figure). External carotid artery to middle cerebral artery bypass was performed using a radial artery graft (upper right part of the figure), and intraoperative fluoroangiography was used to confirm the blood flow (lower left part of the figure) before the aneurysm was clipped (lower right part of the figure.

Some partially thrombosed giant aneurysms are too difficult to treat with ordinary clipping or catheter-based therapy.  
In such cases, a bypass is created using blood vessels of the scalp and arms for treatment (Figure 2).
To increase the accuracy and safety of surgery, intraoperative microscopic fluoroangiography and various instruments are utilized (Figure 3).
The use of a hybrid operating room combining an operating table and an X-ray angiography system supports various surgical operations (Figure 4).

Figure 4. Hybrid operating room that integrates an operating table and an X-ray angiography system

Cerebral arteriovenous malformation
Cerebral arteriovenous malformation is a disease that also leads to subarachnoid hemorrhage and intracerebral hemorrhage if it ruptures.
Although this disease occurs less frequently than aneurysms, the rate of rupture of cerebral arteriovenous malformations is much higher than that of an aneurysm.
Rupture is as unpredictable as with cerebral aneurysm. We carefully examine which to choose, surgical excision, conservative follow-up, or radiation therapy, and discuss it with each patient to decide on a policy.
In recent years, the safety and accuracy of surgery for cerebral arteriovenous malformation has improved tremendously thanks to the development of surgical tools, the progress of technology and the use of preoperative endovascular embolization. We try to separate adhesions at the boundaries carefully to assure bloodless surgery as far as possible.
However, cerebral arteriovenous malformations occur in various parts and their characteristics vary. If the lesion is adjacent to a part of the brain with a vital function, careful and detailed preoperative examination is necessary.  
We make a meticulous preoperative plan using MR-tractography, which shows the cerebral neural connections, functional MRI indicating active areas of the brain, magnetoencephalogram (MEG), etc. (Figure 5).

Figure 5. With the surgical excision of cerebral arteriovenous malformation (upper left part of the figure), preoperative MR-tractography (upper right part of the figure), functional-MRI (lower left part of the figure), MEG (lower right part of the figure), etc. are used to closely evaluate the positional relations with the functional areas of the brain.

Moyamoya disease
The first case of moyamoya disease was reported in Japan in the late 1950s. It is known that the disease frequently occurred in Japan, South Korean and other East Asian countries. In recent years, there has been a growing awareness of the disease worldwide.
The disease causes cerebral infarction and cerebral hemorrhage in children and adults alike, which can lead to paralysis, speech impediment and other aftereffects. Even if a stroke does not occur, the disease may lead to higher brain dysfunction over time. Appropriate diagnosis and treatment are essential.
Revascularization is effective to prevent a stroke as a result of moyamoya disease, but it is not always essential in all patients.  
Whether revascularization is necessary is decided in reference to the symptoms and imaging tests. However, the diagnosis itself may be difficult unless the facility has experienced staff.
Our department widely accepts patients diagnosed with moyamoya disease, including suspected cases, referred from other hospitals (from diagnosis to follow-up).
We offer comprehensive support to such patients and their families to ease their concerns as far as possible.
The Department of Neurosurgery at Hokkaido University has long focused on treatment of moyamoya disease, and is one of Japan’s top facilities with excellent results both for adult and child patients with the disease.
The policy for and approach to revascularization slightly differ depending on the facility. To effectively improve blood flow, our department has been applying a combination of direct and indirect revascularization as the basic procedure for children and adults alike for a long time, and has obtained favorable long-term results.  
Especially in case of children, whose vessels are small, a high level of skill is required for direct revascularization.
To reduce the complications peculiar to moyamoya disease, specific management is required, not only during surgery, but also before and after surgery. We make various efforts based on the latest medical imaging and research results.   
We have been engaged in clinical and basic research on the pathological condition, diagnosis and therapy of the disease, and have presented our results widely in Japan and the world (Hokkaido University Moyamoya Center:
However, there are still many uncertainties about this disease, so we cooperate with other departments of the university and are working on several studies to elucidate the pathogenesis and to develop new diagnostic techniques and therapies (see a list of the clinical studies).
As a major facility of the Ministry of Health, Labour and Welfare’s study team, we are also involved in several nationwide collaborative studies and disease policies.
We also promote clinical and research collaboration with other overseas facilities.

Medical expenses subsidy: Moyamoya disease is a specified disease designated by the Ministry of Health, Labour and Welfare, and medical expenses are subsidized if certain conditions are met.  

Association of Persons with Moyamoya Disease and Their Family : This association for patients was formed in 1983 to provide lectures by specialists, hold exchange parties for patients and their families, and issue newsletters. There are regional block associations all over Japan.

The endovascular therapy group focuses on the treatment of spinal vascular malformations (arteriovenous malformations, arteriovenous fistulas).
Spinal vascular malformation is an extremely rare disease. Some facilities have never had cases of this disease even though their specialized area is neurosurgery.
Major symptoms include numbness of a limb, paralysis and difficulty to urinate.
If not appropriately treated, the symptoms gradually develop and may cause serious aftereffects.  
Our hospital has put more energy into the treatment of this disease since more than 20 years ago. It is extremely difficult to cure this disease, and a radical cure may unfortunately not be possible.
However, treatment can delay symptom progression.   
Our hospital provides multidisciplinary therapy that combines surgical therapy, endovascular therapy and radiation therapy (assisted by the Department of Radiation Oncology at the hospital).
There are not many facilities where surgical therapy, endovascular therapy as well as radiation therapy can be performed at a single institution in Japan, so our department attracts many patients from all over Japan, regardless of our location in Hokkaido, which is far from Honshu (the main island of Japan).
If you are diagnosed with a difficult disease to cure, there may be something our hospital can do. Please feel free to ask us.

Brain tumor team

Brain tumor treatment rests on two major pillars.
One is surgical treatment, such as skull base surgery for deep tumors and transnasal endoscopy for pituitary disease, and the other is multidisciplinary therapy that combines radiation therapy and drug therapy for glioma, malignant lymphoma, germ cell tumor, pediatric brain tumor, etc.    

At our hospital, staff members who can handle difficult surgical procedures and experts in diagnostic imaging, such as CT, MRI and PET, pathological diagnosis by molecular level analysis, advanced radiation therapy including proton beams, drug therapy for children, endocrine therapy and rehabilitation, as well as the eyes, ears, nose and other related organs, cooperate with each other to provide advanced one-stop medical care unique to university hospitals.  
We also believe that the first step in treatment is to “talk” about it.
Please feel free to ask if you have a problem.

Spinal cord/functional surgery team

The spinal cord/functional surgery team handles diverse diseases, such as spine degenerative disease, Parkinson's disease and spasticity.   
Spinal diseases, our particular specialist area, are outlined here.
Traditionally, our group is actively engaged in the diagnosis and treatment of spinal cord tumors (especially spinal cord astrocytoma), arteriovenous malformations of the spinal cord and syringomyelia, and boasts Japan’s best treatment results.  
The total removal of high-grade spinal cord astrocytoma is impossible.
Accordingly, with the cooperation of the Department of Radiation Oncology at our hospital, we perform radiological spinal cord transection, whereby high-level radiation is given to the spinal cord to transect the spinal cord, to applicable cases to improve their survival rate.
For intramedullary arteriovenous malformation, which is especially difficult to cure among arteriovenous malformations of the spinal cord, our department’s cerebral endovascular therapy group works with the Department of Radiation Oncology to provide multidisciplinary therapy.
Only our department has this type of treatment system in Japan.
Finally, we have developed a method to surgical excision only of the epidural layer rather than the entire dura mater for syringomyelia to prevent spinal fluid fistula, which is a concern in case of foramen magnum decompression.  
The shunt tube for syringomyelia used for syrinx-subarachnoidal space shunting was developed by the group.  
Both operative procedures are widely performed throughout Japan, and favorable treatment results have been reported.  

Clinical study/trial list

Numerous clinical studies and trials are conducted at the Department of Neurosurgery, Hokkaido University.  
There are various clinical studies, including follow-up of patients, testing of patients and collecting of data from patients in return for providing new anticancer drugs for free.
The following are target diseases and the names of the clinical studies:

Cerebrovascular disease team

Cerebral infarction: tPA cool IVR Study
Clinical study in which saline at 15°C is infused through a catheter for 10 minutes after endovascular therapy for acute stroke to minimize brain damage

Moyamoya disease: Study of Registered Patients on the Progression of Unilateral Moyamoya Disease and Genetic Factors
Study to observe the relationships between gene mutations and progression of the disease. Blood collection is required.

Moyamoya disease: Concept of Prospective Multi-center Cohort Study on the Prognosis of Asymptomatic Moyamoya Disease
Study to observe asymptomatic patients with moyamoya disease for a long period of time. Regular visits are required.

Moyamoya disease: Cognitive Dysfunction Survey of Moyamoya
Study in which patients with moyamoya disease undergo a higher brain function test

Moyamoya disease: Multi-center Cohort Study on the Elucidation of the Clinical Condition of Moyamoya Patients Aged 60 Years and Older  
Observation study of elderly patients with moyamoya disease. Patients are requested to regularly visit the hospital and undergo an MRI.

Brain tumor team

Glioma: Study on the Effectiveness of Methionine PET for Incipient Glioma
Clinical study to evaluate the spread of glioma using methionine PET

Glioma: Differentiation between Recurrent Brain Tumor and Radiation Necrosis Using Methionine PET
Study to differentiate between recurrent brain tumor and radiation necrosis using methionine PET

Glioblastoma: Biomark
Therapy combining Temodar and bevacizumab. This is ordinary health insurance treatment.

Glioma (grade 3): JCOG1016
Patients are divided into a group using Temodar and a group using Nidran  

Glioma (grade 2): JCOG1303
The effectiveness of Temodar after radiation therapy is observed

Primary central nervous system lymphoma: JCOG1114
Therapy using methotrexate and Temodar
Temodar is provided free of charge

Updated on September 1, 2016
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