The city of Itoigawa is a remote place, with a population of as few as 50,000, where people aged 65 and older occupy 30% of its population. Most people with neurological disorders here have been treated at the Neurosurgical Department of the Itoigawa General Hospital. However, the number of surgical operations has decreased year after year. In search of the factors in the decreasing tendency, we analized the annual statistics about the hospitalized patients and this city's population in the past 11 years beginning on Nov. 1 1995. The diminution of the operation cases was correlated most positively with a decrease in the population of this city (+0.844), and most negatively with an increase in the ratio of persons aged 65 or older (-0.822). The number of operation cases was probably linked to the change in population make-up of the region. The number of operations on older patients had a tendency to decline presumably because of functionally poor prognosis. Conclusively, this study revealed that it is hard for neurosurgeons working in remote localities like this city to keep up the number of operative cases.
Cities ; Relations ; Small ; seconds ; Surgical aspects

  The diagnosis of spontaneous cerebrospinal fluid hypotension or hypovolemia (CSH) can be made with a set of characteristics of orthostatic headache and cranial MRI findings, and atypical cases without these characteristics can be diagnosed by CT-myelography or radionuclide cisternography, which visualizes the location of leakage of cerebrospinal fluid. It has been proposed in our country that the manifestation of a chronic whiplash syndrome may be similar to that of atypical spontaneous CSH and that a considerable number of patients may be relieved by epidural blood patching, an effective therapy for CSH. After that proposition, the definition of CSH became confused, although the guideline was presented in 2007 by the study group of CSH, which had agreed upon the presence of traumatic CSH including the chronic whiplash syndrome. We have made epidural blood patches in 14 patients since 2004 on the basis of the criteria comparable to that guideline. Among seven cases of spontaneous CSH, six cases showed both orthostatic headaches and typical cranial MR imaging, and in the remaining one, the location of the cerebrospinal fluid leakage was detected. Diagnosis was established in all of the cases of spontaneous CSH. Among the seven cases of traumatic CSH, none of which showed orthostatic headache or typical cranial MR imaging, two cases did not reveal any locations of leaks of cerebrospinal fluid, the one of which showed a good outcome of epidural blood patching. The criteria in that guideline seemed valid for the diagnosis of spontaneous and traumatic CSH. After epidural blood patches, improvement was shown in every case of the spontaneous CSH, and a good outcome was in three cases and partial improvement in two cases of the traumatic CSH. The patients of the traumatic SCH had much difficulty in keeping the daily life because of lassitude or fatigue. Epidural blood patching proved to be useful for them.