Publications (57)40.52 Total impact
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Article: [An operated case of a meningioma causing acute subdural hematoma].
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ABSTRACT: We report a rare case of a meningioma causing acute hematoma. A 67-year-old woman presented with sudden headache. No evidence of trauma was seen. CT demonstrated a subdural hematoma in the convexity of the fronto-temporal lobe. Magnetic resonance imaging showed marked signal heterogeneity in the convexity of the frontal lobe. One week later, the patient underwent hematoma evacuation and tumor resection including the attached dura mater. The histological diagnosis was meningothelial meningioma. The clot was connected directly to the tumor and the origin of the subdural hematoma was identified as the meningioma. Postoperative course was uneventful, and the headache improved. Meningiomas have a relatively benign course but rarely present with hemorrhage. Surgical exploration is the effective and recommended treatment.No shinkei geka. Neurological surgery 03/2013; 41(3):235-9. · 0.13 Impact Factor -
Article: Symptomatic vasospasm in elderly patients with aneurysmal subarachnoid hemorrhage: comparison with nonelderly patients.
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ABSTRACT: Objective: To clarify the influence of age on the occurrence of symptomatic vasospasm (SVS), we retrospectively compared 34 elderly (over 70 years) and 71 nonelderly patients with aneurysmal subarachnoid hemorrhage (SAH). Methods: Between 2008 and 2010, at our hospital 105 patients (Hunt and Kosnik grades I-IV) underwent aneurysm surgery within 72 h of the insult. They were divided into four groups based on their age (younger/older than 70 years) and treatment (aneurysmal clipping or coiling). In all patients, we used the same protocol, which included the delivery of intrathecal urokinase and intravenous fasudil chloride; in patients with angiographic evidence of vasospasm, we also injected fasudil chloride intra-arterially. Results: Among the elderly patients, 4.3% of those treated by clipping and 9.1% of those treated by coiling experienced SVS; the comparative incidence in younger patients was 6.5% and 4.0%, respectively. The differences were not statistically significant (p = 0.40). The ratio of ventriculo peritoneal (VP) shunts was higher in the elderly patients (p = 0.00007). The incidence of favorable treatment outcomes was significantly lower in elderly patients (p = 0.00004). Conclusion: Under our treatment protocol, patient age did not affect the incidence of SVS. Our protocol may be effective for the prevention of SVS after aneurysmal SAH regardless of patient age.Acta neurochirurgica. Supplement 01/2013; 115:281-4. -
Article: [Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report].
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ABSTRACT: Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients. We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.No shinkei geka. Neurological surgery 11/2012; 40(11):1015-20. · 0.13 Impact Factor -
Article: Distinctive flow pattern of wall shear stress and oscillatory shear index: similarity and dissimilarity in ruptured and unruptured cerebral aneurysm blebs.
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ABSTRACT: Object The difference in the hemodynamics of wall shear stress (WSS) and oscillatory shear index (OSI) between ruptured and unruptured aneurysms is not well understood. The authors investigated the hemodynamic similarities and dissimilarities in ruptured and thin-walled unruptured aneurysm blebs. Methods Magnetic resonance imaging-based fluid dynamics analysis was used to calculate WSS and OSI, and hemodynamic and intraoperative findings were compared. The authors also compared ruptured and unruptured thin-walled blebs for the magnitude of WSS and OSI. Results Intraoperatively, 13 ruptured and 139 thin-walled unruptured aneurysm blebs were identified. Twelve of the ruptured (92.3%) and 124 of the unruptured blebs (89.2%) manifested low WSS and high OSI. The degree of WSS was significantly lower in ruptured (0.49 ± 0.12 Pa) than in unruptured (0.64 ± 0.15 Pa; p < 0.01) blebs. Conclusions Ruptured and unruptured blebs shared a distinctive pattern of low WSS and high OSI. The degree of WSS at the rupture site was significantly lower than in the unruptured thin-walled blebs.Journal of Neurosurgery 08/2012; 117(4):774-80. · 2.96 Impact Factor -
Article: [Operated case of a ruptured aneurysm arising from fenestration of the vertebral artery].
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ABSTRACT: Aneurysm arising from duplication of the vertebral artery (VA) is rare. We report a surgical case of an aneurysm of VA fenestration and provide a literature review. A 42-year-old man suffered from sudden onset of severe headache. CT image revealed subarachnoid hemorrhage predominantly in the posterior fossa. Digital subtraction angiography showed a fenestration of the right VA and the aneurysm arising from the proximal limb of the fenestration. Neck clipping of the aneurysm was performed because embolization was difficult due to the wide neck. The patient was discharged without deficits. Seven cases of an aneurysm of the VA fenestration have been reported. Five cases underwent coil embolization, and 2 underwent craniotomy, trapping, and resection. This is the first case of neck clipping of an aneurysm of the VA fenestration.No shinkei geka. Neurological surgery 03/2012; 40(3):221-7. · 0.13 Impact Factor -
Article: Fatal subarachnoid hemorrhage caused by Aspergillus arteritis without angiographic abnormalities.
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ABSTRACT: No source of bleeding is detected by angiogram in 15-20% of patients with nonaneurysmal subarachnoid hemorrhage (SAH). This negative angiographic finding might suggest a benign prognosis. We describe a case of fatal SAH caused by Aspergillus arteritis without formation of fusiform dilatation or aneurysms. A 76-year-old man with a 2-month history of progressive visual loss due to pachymeningitis around the optic nerves suffered from SAH in the bilateral sylvian fissures. Repetitive serum galactomannan assay and angiography showed no abnormality. Post mortem examination revealed marked proliferation of Aspergillus in the granulomas of the frontal base dura mater. In addition, major trunks and several branches of the bilateral middle cerebral arteries were invaded by Aspergillus hyphae, which destroyed the walls in the absence of dilatation and aneurysms. Invasive aspergillosis of the CNS often forms a mycotic aneurysm. However, four autopsy cases of nonaneurysmal SAH due to invasive aspergillosis have been reported. The present case is the second autopsy case of Aspergillus arteritis without angiographic abnormality, resulting in fatal SAH. Aggressive and continuous antifungal therapy is absolutely necessary in suspected cases of invasive aspergillosis of the CNS, even if angiography is negative and therapeutic markers of aspergillosis are normal.Neuropathology 01/2012; 32(5):566-9. · 2.02 Impact Factor -
Article: [Flow dynamics analysis in patients with a ruptured middle cerebral artery aneurysm. A case report].
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ABSTRACT: Despite advancement of diagnostic and treatment modalities, subarachnoid hemorrhage (SAH) is still an entity of neurosurgical emergency with poor outcome. Recent reports indicated that hemodynamic stress might play an important role in rupture or the growth of cerebral aneurysms, but there is no consensus about how or which hemodynamic factor contribute to this phenomenon. In this report, magnetic resonance (MR)-based flow dynamics analysis was performed for a patient with SAH and the data obtained were directly compared with intraoperative findings. This 74-year-old woman was admitted for sudden onset headache. Head computed tomography scan showed SAH on the right sylvian fissure and intracerebral hematoma on the right temporal tip. Digital subtraction angiography showed a right middle cerebral artery aneurysm, which was considered to be the ruptured one. The aneurysm had two blebs, and the bleb around the aneurysm tip was exposed to low magnitude and high oscillation of wall shear stress (WSS). On the other hand, another bleb was exposed to high magnitude and low oscillation of WSS. Next day, the patient underwent open surgery and intraoperative findings showed the aneurysm tip was the ruptured point. MR-based flow dynamics analysis might be a useful diagnostic modality for patients with SAH. Although low magnitude and high oscillation of WSS might contribute to the aneurysm rupture, further case accumulation is necessary to reach a conclusion whether or not this is so.No shinkei geka. Neurological surgery 03/2011; 39(3):281-6. · 0.13 Impact Factor -
Article: Pilocytic astrocytoma with histological malignant features without previous radiation therapy--case report.
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ABSTRACT: Pilocytic astrocytoma sometimes transforms to a malignant type, and previous radiation therapy is considered to be a key factor. We report a case of pilocytic astrocytoma with histological malignant features without previous radiation therapy. A 21-year-old man presented a sudden onset of severe headache. Neuroimaging had detected a cystic mass in the posterior fossa at the age of one year without therapeutic intervention. On admission, computed tomography depicted a brain tumor in the posterior fossa with cystic components, intratumoral hemorrhage, and upward herniation. Urgent surgery was performed, and histological examination revealed some features of pilocytic astrocytoma but also broad necrosis, high cellularity, and MIB-1 labeling index of more than 20%. The histological diagnosis was pilocytic astrocytoma with malignant features. This tumor had continued a benign clinical course for 20 years, but had eventually transformed to a malignant type. Therefore, pilocytic astrocytoma may undergo spontaneous malignant transformation during its natural clinical course.Neurologia medico-chirurgica 01/2011; 51(2):144-7. · 0.61 Impact Factor -
Article: Ruptured peripheral aneurysms in a collateral pathway associated with stenosis of a major cerebral artery: Report of two cases.
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ABSTRACT: While hemodynamic stress can result in aneurysm formation, it rarely contributes to the development of peripheral aneurysms in collateral pathways. We report two patients with ruptured distal aneurysms in a collateral pathway associated with stenosis of a major cerebral artery. A 67-year-old man presented with intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) revealed severe stenosis of the right middle cerebral artery and two aneurysms in the collateral pathway of the right anterior cerebral artery. The ruptured aneurysm was trapped and resected; histologically, it was a true saccular aneurysm. The unruptured aneurysm was clipped and the patient was discharged without additional neurological deficits. The second patient was a 73-year-old woman with subarachnoid hemorrhage. DSA revealed three arterial dilations. On the 7(th) day of hospitalization, one of the aneurysms in a posterior inferior cerebellar artery-anterior inferior cerebellar artery anastomosis that functioned as a collateral pathway in the presence of severe basilar artery stenosis was found to be enlarged. It was treated by selective aneurysmal coil embolization with parent artery preservation. Her postoperative course was uneventful and she was discharged without any neurological deficits. We document the successful treatment of two patients with ruptured aneurysms in the peripheral portion of a collateral pathway. We discuss the histology of peripheral aneurysms and present a review of the literature.Surgical neurology international. 01/2011; 2:81. -
Article: [A case of symptomatic arachnoid cyst, that had been growing for 14 years, at the posterior part of the left temporal lobe].
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ABSTRACT: The authors report a 54-year-old woman with headache in whom a cyst was detected at the posterior part of the left temporal lobe following a traffic accident in 1993. Symptoms had recently worsened and computed tomography demonstrated an enlarged cyst in 2007. Thereafter, the patient underwent cyst fenestration. Intraoperative findings showed multilocular cysts with calcification. Symptoms improved immediately. Histological findings showed that the cyst was composed of collagenous membrane and a monolayer of cells compatible with arachnoid cyst. These findings also showed calcification and we considered that growth of the arachnoid cyst had been induced by trauma. We expected an arachnoid cyst with a single cavity, but this lesion was multilocular. Retrospectively, cine magnetic resonance image (MRI) seemed to show multilocular cysts. Cine MRI might be an effective tool to determine whether a cyst is multilocular.No shinkei geka. Neurological surgery 02/2010; 38(2):157-62. · 0.13 Impact Factor -
Article: Cavernous angioma associated with arteriovenous malformation of the brain--case report.
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ABSTRACT: A 61-year-old man presented a rare case of cerebral cavernous angioma associated with cerebral arteriovenous malformation (AVM) manifesting as headache. Magnetic resonance imaging showed an AVM in the right occipital lobe and a cavernous angioma in the left middle fossa. The patient underwent left frontotemporal craniotomy with total resection of the left parasellar intra-axial tumor. One month after the first operation, he underwent right occipital craniotomy with total resection of the right occipital AVM. The histological diagnoses were cavernous angioma and AVM, respectively. Immunostaining for angiogenic growth factors and structural proteins revealed different expression patterns of alpha-smooth muscle actin in these structures. Expression of structural proteins may reflect differences in their pathogenesis.Neurologia medico-chirurgica 01/2010; 50(2):131-4. · 0.61 Impact Factor -
Article: Anterior cranial fossa dural arteriovenous fistula with bilateral cortical drainers--case report.
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ABSTRACT: A 58-year-old man presented with sudden onset of severe headache. Computed tomography demonstrated subarachnoid hemorrhage and right acute subdural hematoma. He had no neurological deficits. Cerebral angiography showed an anterior cranial fossa dural arteriovenous fistula (AVF) supplied by the bilateral ethmoidal arteries. A fistula was suggested on the right side, and the dural AVF drained into the superior sagittal sinus via the bilateral frontal cortical veins. Venous varix was observed at both drainage sites. Bifrontal craniotomy with right-side dural incision was performed and the fistula was interrupted. Postoperative angiography demonstrated a persistent fistula draining into the left cortical vein. Nineteen days later, bifrontal craniotomy with left-side dural incision was performed and the draining vein was completely coagulated with the aid of intraoperative angiography. Postoperatively, there was no detectable residual fistula. He was discharged without neurological deficits 2 weeks after surgery. The present case of anterior cranial fossa dural AVF with bilateral cortical drainers shows that drainer occlusion at two points may be needed for complete obliteration of the drainers because the fistulous connection may not be simple.Neurologia medico-chirurgica 01/2010; 50(3):217-20. · 0.61 Impact Factor -
Article: Cerebral venous thrombosis with dural arteriovenous fistulas and antiphospholipid syndrome: a case report.
Neurological Sciences 10/2009; 31(2):237-8. · 1.32 Impact Factor -
Article: Serial angiography of dynamic changes of traumatic middle meningeal arteriovenous fistula: case report.
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ABSTRACT: A 48-year-old woman suffered head trauma and presented with an acute epidural hematoma with a linear fracture of the right temporal bone across the middle meningeal groove. Initial angiography demonstrated no vascular abnormalities. Eight months later, she again suffered head trauma and computed tomography demonstrated traumatic subarachnoid hemorrhage. Right external carotid angiography revealed a middle meningeal arteriovenous fistula (AVF) which drained into the superficial sylvian veins via the sphenoparietal sinus. Serial angiography showed progressive dilation of the draining veins, but she refused surgical intervention and dropped out of our outpatient clinic. Fifteen years after the first head trauma, she presented with subarachnoid hemorrhage. Angiography demonstrated formation of venous aneurysms on the drainer of the AVF. The dilated superficial sylvian vein was removed together with the ruptured venous aneurysm. Histological examination of the drainer revealed an arterialized vein. The serial angiographic evaluations revealed dynamic changes of the traumatic middle meningeal AVF, including progressive dilation of the drainers, simplification of the drainage routes, and the formation of venous aneurysms, which presumably represents the entire natural course of traumatic middle meningeal AVF manifesting as hemorrhage. The present case of traumatic middle meningeal AVF with a deteriorating course suggests that surgical removal or embolization of the AVF is strongly indicated if follow-up angiography shows dilation of the drainers, which implies increased shunt flow.Neurologia medico-chirurgica 10/2009; 49(10):462-4. · 0.61 Impact Factor -
Article: [A case of posttraumatic forehead cavernous angioma].
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ABSTRACT: Cavernous angiomas of the bone are rare tumors. Skull cavernomas are even less frequent. Most cavernous angiomas of the bone are congenital tumors. In a review of the literature, we found only one case report of de novo generation of a skull cavernous angioma. We present a case of a 25-year-old woman who had experienced a head injury, and 7 years later exhibited a skull tumor at the exact region of the injury. We performed tumor resection and cranioplasty. Follow-up examinations revealed no recurrence or neurological defects. Pathological findings showed a cavernous angioma-like lesion with some atypical details. We finally diagnosed the lesion as a de novo cavernous angioma. Our case suggests that fine injury may result in de novo generation of bone cavernomas.No shinkei geka. Neurological surgery 09/2009; 37(9):899-904. · 0.13 Impact Factor -
Article: [A successful surgical case of a hypothalamic hamartoma with gelastic seizure: a case report].
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ABSTRACT: Gelastic seizure is a rare form of epilepsy defined as automatic bouts of laughter without mirth commonly associated with a hypothalamic hamartoma. Surgical treatment of hypothalamic hamartomas is associated with a high risk of complications because of the close vicinity of adjacent structures such as the optic tracts and mammillary bodies. This case was an 11-year-old girl who presented with gelastic seizure and complicated partial seizure. She developed gelastic seizure at a frequency of 10 bouts per day. She was found to have an elliptical mass close to the left hypothalamus. The signal intensity on magnetic resonance imaging (MRI) was consistent with hypothalamic hamartoma. The patient underwent surgical resection by a subtemporal approach. Pathological findings confirmed the diagnosis of hypothalamic hamartoma. Postoperative MRI demonstrated that the hypothalamic hamartoma was successfully resected. Twenty four months after surgery, complicated partial seizure in this patient has improved to Engel's class 1a and gelastic seizure has improved to Engel's class IIIa.No shinkei geka. Neurological surgery 09/2009; 37(8):781-5. · 0.13 Impact Factor -
Article: [Choice of intentional partial coiling for a ruptured intracranial aneurysm in the acute stage followed by clipping in the chronic stage].
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ABSTRACT: The inpact of the International Subarachnoid Aneurysm Trial (ISAT) trial publication in 2002 and major technical advances in neuroimaging, endovascular devices and techniques have resulted in increasing numbers of patients with ruptured aneurysms undergoing endovascular coiling, as first-line treatment for aneurysm occlusion. We treated six cases of ruptured aneurysms with this strategy, with choice of clipping as as additional treatment following intentional partial coiling. In this series, patients ranged in age from 36 to 74 years and included one man and five women. Three aneurysms were located in AcomA, 1 in ACA, and 2 in MCA. The reasons for the choice of this strategy were clinical and angiographical spasm in 2, high general surgical risk in 2, and other reasons in 2 cases, respectively. The mean interval between the first partial coiling and final clipping was 33 days. All cases were successfully clipped without difficulties and coil removal were performed in 3 cases for follow up examination. It is proposed that the choice of this strategy contributes to progresses in overall outcomes in cases of aneurysmal subarachnoid hemorrhage.No shinkei geka. Neurological surgery 09/2009; 37(8):757-63. · 0.13 Impact Factor -
Article: Osteochondroma of the sella turcica presenting with intratumoral hemorrhage.
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ABSTRACT: A 29-year-old man presented with a primary sellar turcica osteochondroma manifesting as intratumoral hemorrhage mimicking pituitary apoplexy. The patient suffered sudden onset of headache concomitant with vision loss in the left eye. Radiography and computed tomography detected destruction and calcification of the sellar turcica. Magnetic resonance imaging revealed a heterogeneously enhanced suprasellar mass that had elevated and compressed the optic chiasm. The preoperative diagnosis was hemorrhagic pituitary adenoma, craniopharyngioma, meningioma, or chordoma based on the signal heterogeneity of the lesion. To relieve the symptoms and make a definitive diagnosis, surgical removal via a basal interhemispheric approach was carried out. The tumor was not totally removed because of tight adhesion to the pituitary stalk, but postoperative ophthalmological examination revealed improvement of the visual disturbance. The histological diagnosis was osteochondroma based on the presence of mature chondrocytes and osteomatous tissue. Osteochondroma should be included in the differential diagnosis of tumors with acute hemorrhage in the sella turcica.Neurologia medico-chirurgica 02/2009; 49(1):37-41. · 0.61 Impact Factor -
Article: Spontaneous closure of transverse sinus dural arteriovenous fistula: case report.
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ABSTRACT: A 60-year-old man presented with transverse sinus dural arteriovenous fistula (AVF) manifesting as sudden onset of headache and nausea, which underwent spontaneous closure 5 years after the onset. Computed tomography on admission revealed small intraventricular hemorrhage in the right lateral ventricle. No intracranial vascular lesion was detected and magnetic resonance angiography was used at yearly follow up. Two years after the first admission, he suffered diplopia and cerebral angiography revealed transverse sinus dural AVF. Right pulsatile tinnitus occurred 4 years after the first admission. The symptoms suddenly disappeared 5 years after the first admission, and follow-up angiography showed disappearance of the dural AVF. The exact mechanism of the spontaneous occlusion of dural AVF remains unknown. This case of spontaneous transverse sinus dural AVF closure occurred without disruption of sinus patency, suggesting that thrombosis of the draining veins into sinuses was not involved.Neurologia medico-chirurgica 01/2009; 48(12):564-8. · 0.61 Impact Factor -
Article: Multiple isolated sinus dural arteriovenous fistulas associated with antithrombin III deficiency--case report--.
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ABSTRACT: A 55-year-old man presented with a rare case of multiple isolated sinus dural arteriovenous fistulas (AVFs) associated with antithrombin (AT) III deficiency manifesting as sudden onset of headache and gait disturbance. Increased arterial shunting flow had caused intraventricular hemorrhage after incomplete repeated transarterial embolization procedures for dural AVFs. Multiple isolated sinus dural AVFs were located in the anterior superior sagittal sinus (SSS) and transverse sinus, which were completely embolized by direct packing of the isolated sinuses via the SSS. The development of dural AVF is complicated and associated with a number of factors, such as congenital abnormality, head trauma, craniotomy, radiation, hematological abnormality, and sinus thrombosis. Hematological abnormality is a risk factor of sinus thrombosis. In the present case, the multiple isolated sinus dural AVFs might have resulted from the aggravation of multiple dural AVFs and the coagulative tendency due to AT III deficiency. Direct sinus packing should be considered if transvenous catheterization is difficult or fails.Neurologia medico-chirurgica 11/2008; 48(10):455-9. · 0.61 Impact Factor
Top co-authors
Top Journals
Institutions
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2003–2013
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Aomori Prefectural Central Hospital
Aomori-shi, Aomori-ken, Japan
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2007
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University of Toyama
- Department of Neurosurgery
Toyama-shi, Toyama-ken, Japan
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2004
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Social Insurance Chukyo Hospital
Nagoya-shi, Aichi-ken, Japan
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2002
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Toyama Medical and Pharmaceutical University
Toyama-shi, Toyama-ken, Japan
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