Hiroyoshi Akutsu

Publications (34) View all

• Article: Useful 'sliding-lock-knot' technique for suturing dural patch to prevent cerebrospinal fluid leakage after extended transsphenoidal surgery.

  Noriaki Sakamoto, Hiroyoshi Akutsu, Shingo Takano, Tetsuya Yamamoto, Akira Matsumura
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  ABSTRACT: Postoperative cerebrospinal fluid (CSF) leakage is a major problematic complication after extended transsphenoidal surgery (TSS). Watertight closure of the sellar dura with a fascial patch graft is a method of choice for preventing CSF leakage; however, suturing and knotting in a deep and narrow operative field is technically challenging and time consuming. To present a simple and effective knotting technique named the 'sliding-lock-knot' technique, in which the knot can easily be slid to the suturing point and tied automatically using only a single string, without loosening. We use a 6-0 nylon suture and Mosquito forceps. At first, after putting a stitch, a single knot is made by hand out of the nasal cavity. Then the 'sliding-lock-knot' is made using a forceps as shown in the illustration. The knot slides deep into the operative field through the nostril and it is automatically tied only by pulling a string. A 73-year-old woman presented with progressive visual deterioration. She had an intra-and suprasellar craniopharyngioma that was compressing the optic chiasm. She underwent an extended TSS, and the tumor was totally resected. The dural defect was closed with a fascial patch graft sutured on the dura using this technique, then covered with a vascularized mucoseptal flap. Neither CSF leakage nor meningitis was encountered during the postoperative period. The 'sliding-lock-knot' technique is simple and useful for dural suturing in microscopic/endoscopic extended TSS. This technique is a helpful tool for preventing CSF leakage after this challenging surgical procedure.
  Surgical neurology international. 01/2013; 4:19.
• Article: Benign spinal meningioma without dural attachment presenting delayed CSF dissemination and malignant transformation.

  Kyoji Tsuda, Hiroyoshi Akutsu, Tetsuya Yamamoto, Eiichi Ishikawa, Atsushi Saito, Kei Nakai, Shingo Takano, Akira Matsumura
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  ABSTRACT: Benign spinal meningiomas have good prognoses, with low rates of recurrence and no cerebrospinal fluid (CSF) dissemination. However, we experienced an extremely rare case of initially benign non-dura-based spinal meningioma that showed multiple CSF disseminated lesions, which progressed for 14 years. A 29-year-old woman without neurofibromatosis presented with progressing dysesthesia in her lower limbs, low back pain, and intermittent claudication. Magnetic resonance imaging (MRI) showed an intradural extramedullary mass lesion at the Th10/11 level. The patient underwent a tumor resection. Intraoperative findings indicated that the tumor had no dural attachment. Histopathological diagnosis after gross total removal was microcystic meningioma (grade I, WHO 2007). Seven years after the first operation, other lesions appeared at the levels of Th11/12, L1, and L2/3 in MRI. These tumors were slow growing and became symptomatic; thus, a second surgery was performed 14 years after the first operation. The histopathological diagnosis was atypical meningioma (grade II, WHO 2007). Benign spinal meningiomas show CSF dissemination extremely rarely, although some authors have reported non-dura-based intraspinal clear-cell meningiomas showing CSF dissemination. However, even in cases of WHO grade I, neurosurgeons should pay attention to late CSF dissemination and malignant transformation after surgical removal of non-dura-based intraspinal meningiomas.
  Brain Tumor Pathology 08/2012; · 1.19 Impact Factor
• Article: [Granular cell tumor of the neurohypophysis observed with hypoglycemic attack].

  Ryotaro Suzuki, Shingo Takano, Hiroyoshi Akutsu, Kaishi Satomi, Yukio Morishita, Akimitsu Takahashi, Masayuki Noguchi, Akira Matsumura
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  ABSTRACT: Granular cell tumor of the neurohypophysis (GCT) occurs as a solitary, small, nodular tumor and rarely grows to a sufficient size to present symptoms. The authors report a case of a 30-year-old man with GCT presenting with hypoglycemic attack. Hypoglycemic attack could be due to dysfunction of the hypothalamus and one of the important symptoms of GCT.
  No shinkei geka. Neurological surgery 08/2012; 40(8):723-8. · 0.13 Impact Factor
• Article: Combined transmastoid/middle fossa approach for intracranial extension of middle ear cholesteatoma.

  Keiji Tabuchi, Tetsuya Yamamoto, Hiroyoshi Akutsu, Kensuke Suzuki, Akira Hara
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  ABSTRACT: A retrospective review was performed of patients treated for middle ear cholesteatoma with bone defects of the skull base via a combined transmastoid/middle fossa approach at the University of Tsukuba Hospital from 2006 through 2011 to determine the safety and effectiveness of a combined transmastoid/middle fossa approach for the treatment of cholesteatoma involving the middle cranial fossa. The bone defects of the skull base were reconstructed with a galeal flap pedicled with a parietal branch of the superficial temporal artery and an autologous bone flap. The clinical and radiological data were analyzed. This series included 8 patients (6 men and 2 women) with a mean age of 46.3 years (range 10-67 years). One of the patients preoperatively exhibited meningoencephalocele of the middle fossa skull base, and in the remaining 7 patients, petrous bone involvement such as involvement of the supralabyrinthine cells was observed. The cholesteatoma lesion was totally removed and inner ear function preserved in all the patients. Cerebrospinal fluid leakage was observed in 1 patient during and after the surgery. Neither meningitis nor recurrence was observed in any patient during the follow-up periods (mean 29.4 months, range 6-64 months). The combined transmastoid/middle fossa approach allowed complete removal of cholesteatoma with middle cranial fossa involvement while preserving hearing and preventing postoperative cerebrospinal fluid leakage and meningitis.
  Neurologia medico-chirurgica 01/2012; 52(10):736-40. · 0.61 Impact Factor
• Article: Acute subdural hematoma without subarachnoid hemorrhage caused by ruptured A1-A2 junction aneurysm. Case report.

  Tomoya Takada, Tetsuya Yamamoto, Eiichi Ishikawa, Alexander Zaboronok, Yuji Kujiraoka, Hiroyoshi Akutsu, Satoshi Ihara, Kei Nakai, Akira Matsumura
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  ABSTRACT: A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission. Computed tomography (CT) revealed acute subdural hematoma (ASDH) on the right side of the cerebral convexity with bilateral extension along the tentorium cerebelli without signs of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH). Three-dimensional CT angiography and conventional cerebral angiography revealed a left A1-A2 junction aneurysm. Neck clipping of the aneurysm was performed. The aneurysm extended inferiorly, with the dome embedded in the chiasmatic cistern and tightly adhered to the arachnoid membrane. There was no evidence of hematoma in the subarachnoid space. The patient was discharged without neurological deficit. Ruptured aneurysms resulting in ASDH without SAH or ICH are very rare. Radiological investigation such as three-dimensional CT angiography should be performed to find the causative aneurysm in a patient with ASDH with a history of repeated headaches and without traumatic signs or episodes, and the appropriate treatment should be planned with expediency.
  Neurologia medico-chirurgica 01/2012; 52(6):430-4. · 0.61 Impact Factor