Yukio Horie

University of Toyama, Тояма, Toyama, Japan

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Publications (14)9.81 Total impact

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    ABSTRACT: The middle meningeal artery (MMA) is known to function as one of the important collateral routes in moyamoya disease. However, the anterior branch frequently courses within the lesser wing of the sphenoid bone and can easily be damaged during craniotomy for bypass surgery. This prospective study aimed to study the surgical anatomy of the MMA and to establish the technique to preserve it during bypass surgery for moyamoya disease. Twenty-two patients with moyamoya disease underwent STA-MCA anastomosis combined with indirect bypass on 27 sides. The anatomical relationship between the anterior branch of the MMA and lesser wing was classified into three types: the bridge, monorail, and tunnel types. During surgery, the lesser wing was carefully resected with a rongeur or high-speed diamond drill to preserve the anterior branch of the MMA. The anterior branch of the MMA was classified into the bridge type in 5 sides (18.5 %), monorail type in 10 sides (37.0 %), and tunnel type in 12 sides (44.5 %). Patient age was closely related to the anatomical findings (χ (2) test, p = 0.0168). Careful resection of the lesser wing with a rongeur could preserve bridge- and monorail-type MMAs (100 and 71.4 %, respectively). However, drilling out of the lesser wing under a surgical microscope was essential to preserve the tunnel-type MMA. Intraoperative indocyanine green videoangiography was useful to confirm patency during surgery. It is essential to understand the surgical anatomy of the MMA around the pterion in order to preserve its anterior branch during bypass surgery for moyamoya disease.
    Acta neurochirurgica. 11/2014;
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    ABSTRACT: Previously, we reported on the differentiation between patients with Alzheimer disease and normal controls using a quantitative electroencephalographic technique called neuronal activity topography (NAT). In this technique, cerebral neuronal activities are characterized by the signal intensity and coherence (sNAT and vNAT, respectively). In the present study, we examined 47 patients with vascular cognitive impairment in carotid stenosis and 52 normal controls. All subjects underwent electroencephalography in a resting state with closed eyes for 5 minutes. Electroencephalographic markers of the differential likelihood, that is, the sensitivity-versus-specificity characteristics, sLx:VCI-NLc and vLx:VCI-NLc, were assessed with neuronal activity topography and were compared between the 2 groups. sLx:VCI-NLc and vLx:VCI-NLc crossed each other at a cutoff value of the differential likelihood. Separation of the patients and controls was made with a sensitivity of 92% and 88%, as well as a false-positive rate of 8% and 12% for sLx:VCI-NLc and vLx:VCI-NLc, respectively. Using sNAT, we accurately differentiated 92% patients with vascular cognitive impairment. We recommend that sNAT, rather than vNAT, should be used in detecting vascular cognitive impaired patients.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 08/2014;
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    ABSTRACT: We describe a higher magnifying power operating microscope system to improve one method of high-quality microsurgical clipping for cerebral aneurysm in some cases. This higher magnification is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnifications (distinctiveness of 7 μm). This higher-resolution operating microscope system provides the surgeon with higher-magnified images (at the maximum of more than 30× magnifications as each working distance) in the operating field. The magnifications can be changed from low power (2.9×) to high power (62.0×) depending on the circumstances in a given procedure. We have used this operating microscope system on 11 patients with microsurgical clipping for cerebral aneurysms. Microsurgical treatment could be performed safely and precisely. All aneurysms were treated without any technical complications. We think that the use of this microscope would have potential benefits for microsurgical treatment for cerebral aneurysms because of better visualization.
    Neurologia medico-chirurgica 10/2013; · 0.49 Impact Factor
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    ABSTRACT: Supermicrosurgery has been developed and reported the anastomosis of vessels with diameters of about 0.5 mm or less. The anastomosis of vessels of about 0.5 mm or less in diameter is technically more difficult than 1.0 mm or larger. This article describes a novel practice card model for acquiring basic supermicrosurgical techniques. A practice card is composed of very small-caliber silicone tubes simulating very small-caliber vessels and a thick paper. The silicone tube external diameters are 0.3, 0.5, or 0.7 mm. The thickness of the tube wall is 0.05 mm. Microsurgeons can easily begin to practice and warm up the supermicrosurgical suturing and anastomosing techniques using this nonvital practice card under a personal desk stereomicroscope in the office and an operating microscope in the operating room. This training model is a simple system for practicing basic supermicrosurgical techniques repeatedly and for warming up before a supermicrosurgical operation. This article also describes basic training regarding its use at high magnifications. This training-based supermicrosurgical skill may become a valuable technique for microsurgeons in many specialties.
    Journal of Reconstructive Microsurgery 06/2011; 27(6):377-82. · 1.00 Impact Factor
  • Internal Medicine 01/2011; 50(5):533-4. · 0.97 Impact Factor
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    ABSTRACT: Donor artery dissection is a known cause of technical failure in microvascular anastomosis. A method for detection and direct repair of donor artery dissection before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is described using a high magnification operating microscope (maximum 50.4× magnification). Before STA-MCA anastomosis, the stump of the STA is stained using methylrosaniline chloride (pyoctaninum blue) and is observed under higher magnifications. Microsurgical suturing of the arterial dissection is performed before the anastomosis procedure under the high magnification microscope. This method was used in two patients with symptomatic hemodynamic cerebrovascular occlusive disease. Postoperative angiography revealed good patency and no complications occurred. This method may be useful for detection and direct repair of arterial dissection in small vessel walls before STA-MCA anastomosis.
    Neurologia medico-chirurgica 01/2011; 51(12):872-4. · 0.49 Impact Factor
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    ABSTRACT: We report a safe and precise technique of microvascular anastomosis at higher magnifications (30 - 50 ×) in neurosurgery and evaluate our experiences to examine the utility of this method for cerebral revascularization in various situations. A retrospective review was carried out of patients who underwent microvascular anastomosis using a high-magnified operating microscope. This method was performed in 30 patients with 35 microvascular anastomoses in various situations. This microscope has two optical systems, a standard zooming system and a newly developed high magnification system. High resolution and good depth of focus are achieved by a new lens design in the optical system, which makes the image of the object very clear at higher magnifications. In this operating microscope, the combination of a 10 × eyepiece and the 200, 250, and 300-mm objective lens enables a range of final magnifications from 2.9 × to 50.4 ×. This method enabled one to pay attention to performing atraumatic manipulations of small vessels and correct suturing, intima-to-intima, of vessel walls. Microvascular anastomoses were performed safely and precisely at higher magnifications. All anastomoses were patent. It is obvious that practical final magnifications of more than 30 × in neurosurgery would be super-magnified operative views. Microvascular anastomosis at 30 - 50 × magnifications (super-microvascular anastomosis) can help neurosurgeons to improve their skills, with good visualization, and to be safe and accurate when conducting cerebral revascularization in various situations.
    Surgical Neurology International 01/2011; 2:6. · 1.18 Impact Factor
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    ABSTRACT: A 62-year-old female complaining of sudden severe headache was referred to our stroke center in consultation. Computed tomography showed diffuse spread of thick subarachnoid hemorrhage to the basal cistern and both sylvian fissures, and digital subtraction angiography showed kissing aneurysms arising in the left lateral and occipital directions in the C(1) portion of the internal carotid artery (ICA). The anterior choroidal artery was situated between the two aneurysms, and another small branch originating from the dome of the distal aneurysm was confirmed as a duplicated middle cerebral artery (MCA). Endovascular treatment was successfully performed to spare the two vessels involved. This case of kissing aneurysms and ICA-duplicated MCA is very rare, and presents difficulties for both surgical and endovascular treatments.
    Neurologia medico-chirurgica 01/2011; 51(9):653-6. · 0.49 Impact Factor
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    ABSTRACT: We report a precise technique for EC-IC bypass surgery using a stereoscopic high-resolution microscope at magnifications of 40x and 50x. A stereoscopic operating microscope (Mitaka MM50 Surgical Microscope; Mitaka Kohoki Co, Tokyo, Japan) was used in STA-MCA anastomosis. This microscope has 2 optical systems, a standard zooming system, a newly developed high-magnification system, and 4 fixed working distances of 200, 250, 300 and 350 mm, with highest magnifications of 50.4x at 200 mm and 40.3x at 250 mm. High resolution is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnification. The magnification can be changed depending on the circumstances in a given procedure. The STA-MCA anastomoses were performed using this microscope. Very small vessels were observable, and arterial anastomosis could be performed precisely at high magnification. All anastomoses were patent on postoperative angiograms. Use of the new microscope allows visualization and manipulation of small vessels at high magnification and high resolution and may be very useful in EC-IC bypass surgery.
    Surgical Neurology 10/2009; 72(6):690-4. · 1.67 Impact Factor
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    ABSTRACT: We report a newly designed training card (Microvascular Practice Card) that is a non-animal practice tool for surgical training and practicing the skills for microvascular anastomosis techniques. The Microvascular Practice Card is a pocketbook-sized card that has silicone tubes affixed to it. On the card, 6 small-diameter, 4-cm-long tubes side by side are arranged in 4 directions with both ends secured. The tubes are available in diameters of 2.0, 1.0, 0.5, and 0.3 mm. The thickness of the tube wall is 0.05 or 0.1 mm. The card includes a record area that allows records to be written. Four directional tubes are arranged on one card, making it possible to practice various directional suturing and anastomosing. Beginners begin to practice suturing with larger diameter tubes (2.0 mm) and refine their skills using 1.0 mm diameter tubes as they get used to the practice. For vascular anastomosis, the card provides for end-to-end anastomosis, end-to-side anastomosis, and side-to-side anastomosis. Furthermore, superfine diameter tubes (0.5 and 0.3 mm) help microsurgeons to gain experience at higher magnifications. Training on this card is performed through a plastic box with a small hole using long microinstruments. Microvascular Practice Card is a new training tool for repeatedly practicing microvascular anastomosis in various situations. This non-animal practice tool would help trainees practice under safe and hygienic conditions and reduce the number of laboratory animals used during technical training.
    Surgical Neurology 05/2008; 71(5):616-20. · 1.67 Impact Factor
  • Clinical Neurophysiology - CLIN NEUROPHYSIOL. 01/2008; 119(6).
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    ABSTRACT: A case of cavernous sinus dural arteriovenous fistula (CS-DAVF) presenting intracerebral venous hemorrhage was reported. An 81-year-old woman was suffered from generalized convulsion accompanied by right conjunctival hyperemia and edema. Computed tomography scan revealed intracerebral hematoma involving right putamen and perifocal edema extraordinarily expanded to inferior part of the right frontal lobe and insular cortex. Cerebral angiography showed a CS-DAVF with retrograde leptomeningeal venous drainage (RLVD) not only to superficial middle cerebral vein but to basal vein of Rosenthal (BVR). Transvenous embolization was performed using mechanically detachable coils and free fibered platinum coils. After embolization, RLVD disappeared and conjunctival symptoms were improved. Hemorrhagic risk of this patient was discussed, based on her angiographical findings. We speculated that deep venous drainage to BVR through uncal vein, in case with poor venous collateral geometry, is one of the risk factor of cerebral hemorrhage.
    No shinkei geka. Neurological surgery 03/2005; 33(2):143-7. · 0.13 Impact Factor
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    ABSTRACT: Elongation and bending of the basilar artery are frequently observed in both normal and pathological subjects. However, their mechanism of generation remain unclear. In the present study, we measured basilar arteries in patients and normal subjects using magnetic resonance angiography (MRA) and estimated the relationships between these anatomical changes and some factors such as age, sex and vertebral artery dominance. A total of 510 subjects underwent MRA. Basilar artery length (BAL), bending length (BL), or side of bending of basilar artery was estimated on the plain images including the basilar artery in two groups with and without vertebral union. BAL was longer in males than in females (P = 0.0009) and correlated with age (P < 0.0001) in the population with vertebral union, while BL did not differ between genders and was not correlated with age in this population. Both BAL and BL were longer in subjects with vertebral artery dominance than in subjects with equivalent-sized vertebral arteries in the population with vertebral union (P < 0.0001 and P = 0.0005). No difference in the frequency of basilar artery bending was observed between males and females and no correlation was observed between the frequency of basilar artery bending and ages in subjects without vertebral artery union. A significant negative correlation between the side of bending of the basilar artery and dominant side of vertebral arteries was found for group of all patients (P < 0.0001). BAL growth may mainly depend on aging, and the presence of vertebral artery dominance may contribute to the growth of BAL while BL growth may depend on vertebral artery dominance mainly in the contralateral direction.
    Archives of Gerontology and Geriatrics 01/2004; 38(3):251-9. · 1.70 Impact Factor
  • Surgery for Cerebral Stroke 01/2001; 29(6):408-413.