S Inao

Japanese Red Cross Kyoto Daiichi Hospital, Kioto, Kyōto, Japan

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Publications (85)136.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Hematoma expansion is correlated with morbidity and mortality for patients with intracerebral hemorrhage (ICH). Recent studies demonstrated that contrast extravasation on contrast-enhanced CT and small-enhancing foci, so-called spot signs, on CT angiography are associated with subsequent hematoma enlargement. Such radiological markers of ICH may have significant implications not only as a surrogate marker for hematoma expansion in medical hemostatic therapy but also as indication for surgery. In this article, a brief description of contrast extravasation and "spot sign" will be provided first. The findings of some of the important trials that shaped the current landscape of therapeutic interventions for ICH will then be reviewed. Many neurosurgeons have faced a significant dilemma since the Surgical Trial in Intracerebral Haemorrhage (STICH) trial was published. Under adverse circumstances, many neurosurgeons assume that minimally invasive surgical interventions are still likely to benefit some patients and will be more effective. Among future candidate strategies for ICH, the most promising is neuroendoscopic surgery with direct hemostatic devices, which attains direct local hemostasis at the sites of vascular rupture. It is plausible that ultra-early direct hemostatic surgery given in the emergency setting might reduce hematoma volume and rebleeding and improve outcome. Finally, a description of future avenues of minimally invasive surgery for ICH treatment and suggestions for the design of further studies using reliable predictor of hematoma expansion spot sign will be provided. Neuroendoscopic interventions are minimally invasive and are likely of benefit in hemostasis and hematoma removal. On the basis of these observations, the spot sign of ICH has sub-emergency surgical implications.
    Neurosurgical Review 12/2012; · 1.97 Impact Factor
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    ABSTRACT: Intraoperative hemorrhage is a critical issue in the endoscopic evacuation of intracerebral hemorrhage (ICH). Refined and dedicated endoscopic instruments for hemostasis are required. In this technical report, a hemostatic procedure using a monoshaft bipolar cautery is described. TECHNIQUE AND INSTRUMENTATION: The endoscope and monoshaft bipolar cautery are combined into a single-handed instrument, leaving the surgeon's other hand free to manipulate a suction cannula, and so a bimanual hemostatic device system - a combination of a monoshaft bipolar cautery and a multifunctional suction cannula - is obtained. Hemostasis was possible with the monoshaft bipolar cautery during endoscopic hematoma evacuation procedures. No intraoperative complications during hemostasis were apparent, nor were any apparent postoperative complications suggestive of inadvertent tissue damage. The present report describes the successful use of a monoshaft bipolar cautery and its application in a bimanual hemostatic device system.
    Clinical neurology and neurosurgery 04/2011; 113(8):607-11. · 1.30 Impact Factor
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    ABSTRACT: Neuroendoscopy is a promising therapeutic option for spontaneous intracerebral hemorrhage (ICH). We sought to compare the clinical outcomes between neuroendoscopic surgery and craniotomy for spontaneous ICH. We retrospectively analyzed the clinical and radiographic data of 43 patients treated with 23 neuroendoscopic procedures (endoscopy group) and 20 microsurgical procedures (craniotomy group). Rebleeding rate, surgical complications, and/or death were identified as primary clinical endpoints during the 2-month postoperative follow-up period. Evacuation rate, Glasgow Coma Scale (GCS) score at day 7, and Glasgow Outcome Scale (GOS) score were compared as well. A composite primary endpoint was observed in 5 cases (11.6%), including 1 postoperative death in the endoscopy group (4.3%) and 4 postoperative deaths in the craniotomy group (20.0%). No rebleeding was observed in the endoscopy group. The evacuation rate was significantly higher in the endoscopy group compared with the craniotomy group (99.0% vs 95.9%; P < .01). Mean GCS score at day 7 was 12 for the endoscopy group and 9.1 for the craniotomy group (P < .05). The mean change in GCS score was +4.8 for the endoscopy group and -0.1 for the craniotomy group (P < .001). Our data indicate that in patients with ICH, endoscopic surgery is safe and feasible, and may promote earlier recovery. Our results warrant a future prospective, randomized, controlled efficacy trial.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2011; 20(3):208-13.
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    ABSTRACT: Aberrant migration of a ventriculoperitoneal shunt catheter is an infrequent complication and the mechanism is unclear. We report three cases of subcutaneous migration of the distal catheter. The relationship between thick abdominal fat and catheter migration was suggested in all three cases. Abdominal radiography showed that the subcutaneous fat pad had slid down in the standing position, pulling the catheter out of the peritoneal cavity. We suggest the following mechanisms: Changing from the supine position to the standing position caused subcutaneous fat pad to slide down, the shifted fat pad pulled out the catheter from the peritoneal cavity, and anchoring prevents the catheter returning into the peritoneal cavity. Subcutaneous fat pad shift might act as a "windlass," resulting in coiling of the catheter in the subcutaneous tissue. During daily life, the peritoneal catheter was pulled out repeatedly and finally was coiled within the subcutaneous fat tissue. Placement of the catheter between the subcutaneous fat pad and the abdominal muscle wall will help to avoid this rare complication. This preventive measure is especially recommended for obese patients with a high risk of subcutaneous migration of the peritoneal catheter.
    Neurologia medico-chirurgica 01/2010; 50(1):80-2. · 0.49 Impact Factor
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    ABSTRACT: The chromosomal 1p/19q state was analyzed in 16 low-grade meningiomas and 7 atypical meningiomas using fluorescent in situ hybridization (FISH) analysis. Chromosome 1p aberrations were observed in all atypical meningiomas, but in only one low-grade meningioma. Atypical meningiomas showed 19q deletion or imbalance, suggesting chromosomal instability of 19q. A small group of low-grade meningioma showed 19q aberrations. FISH 1p/19q deletion/imbalance analysis is a sensitive method for detecting chromosome aberrations of meningiomas and provides useful information for grading of meningiomas. Patients with low-grade meningioma with chromosomal instability of 1p/19q should be followed up carefully. Assessment of the chromosomal state by FISH might be of crucial importance in the clinical management of meningiomas.
    Neurologia medico-chirurgica 01/2010; 50(1):27-32; discussion 32. · 0.49 Impact Factor
  • Neurologia Medico-chirurgica - NEUROL MED-CHIR. 01/2010; 50(1):80-82.
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    ABSTRACT: Endoscopic evacuation of intraoperative hemorrhage is proving to be increasingly useful and effective. For general agreement that endoscopic evacuation has advantages over craniotomy, secure hemostatic procedures are crucial. This technical note focuses on hemostatic procedures for managing intraoperative hemorrhage. Handling of the multifunctional suction cannula and its application for balanced irrigation-suction are fully explained in this report. Nearly complete evacuation of hematoma was achieved in all 15 cases. In 9 cases of intraoperative arterial bleeding, secure hemostatis has been accomplished. No surgical complications or rebleeding occurred. Even careful atraumatic evacuation of a hematoma can sometimes result in intraoperative hemorrhage. Repeated irrigation and point suctioning may be necessary to keep the operating field clear. A multifunctional suction cannula would be useful for maintaining irrigation and suction balance. Coagulation of a bleeding artery can be performed under clear visualization. A balanced irrigation-suction technique results in secure hemostasis.
    Neurosurgery 10/2009; 65(4):E826-7; discussion E827. · 2.53 Impact Factor
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    ABSTRACT: Endoscopic evacuation of intracerebral haematoma (ICH) has the advantage of being less invasive than craniotomy, but limited visualisation and difficulties in haemostasis are still a concern. The collapse of the haematoma cavity limits the visualisation of the surgical field. Inflation of the haematoma cavity with saline irrigation improves visualisation and facilitates accurate intra-operative orientation. A unique technique, the cavity inflation-deflation method can help in exploring the residual haematoma and accessing the bleeding points. We also developed a combined irrigation-coagulation suction tube that concentrates the capabilities of suction, irrigation and monopolar coagulation. The use of this multifunctional dedicated instrument and its application in the cavity inflation-deflation method allows for easy identification of residual haematoma and bleeding vessels. Secure haemostasis can also be accomplished under clear visualisation. No surgical complications and rebleeding occurred in any patient following the procedure. Our results show that the median haematoma evacuation rate was 99% and the surgical outcome was satisfactory. The inflation-deflation method using a combined irrigation-coagulation suction tube can facilitate optimal evacuation of ICH with secure haemostasis. Although further accumulation of patients and careful analyses are needed to be known whether this procedure improves the clinical outcomes in the patients, the preliminary results of its application have been promising.
    Acta Neurochirurgica 08/2008; 150(7):685-90; discussion 690. · 1.55 Impact Factor
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    ABSTRACT: Analysis of meningiomas supports the suggestion that loss of heterozygosity (LOH) of chromosome arm 1p plays an important role in malignancy. The aim of this study was to identify genes related to meningioma progression from the benign state to the atypical and anaplastic states by examining 1p LOH and the promoter methylation of RASSF1A and p73. The authors studied 40 surgical specimens (22 WHO Grade I, 11 Grade II, and seven Grade III) obtained in 37 patients with meningioma. The LOH at 1p36 was analyzed using microsatellite markers, and promoter methylation of p73 and RASSFIA was analyzed using methylation-specific polymerase chain reaction. No 1p LOH was detected in the Grade I tumors, whereas it was detected in more than 80% of the Grade II and III tumors. Methylation of the p73 promoter was observed in 81.8 and 71.4% of the Grade II and III tumors, respectively, but it was not observed in any of the Grade I tumors; methylation of the RASSF1A promoter was observed in 18.2, 63.6, and 42.9% of the Grade I, II, and III tumors, respectively. Interestingly, 1p LOH and p73 promoter hypermethylation were detected in the malignantly transformed tumors but not in the lower-grade primary ones. Based on the hypothesis that meningiomas cumulatively acquire genetic alterations and thus progress from the benign to the atypical and anaplastic states, genetic alterations in the methylation status of p73 or RASSF1A along with 1p LOH may result in the malignant transformation of a meningioma. This type of genetic fingerprint may play both diagnostic and therapeutic roles.
    Journal of Neurosurgery 09/2007; 107(2):398-404. · 3.15 Impact Factor
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    ABSTRACT: Moyamoya disease is categorized as either ischemic or hemorrhagic type, and the pathogenesis of this disease is unknown. In this paper, the authors report on a patient with moyamoya disease who suffered concomitant cerebral infarction and intraventricular hemorrhage (IVH). Endoscopic removal of the intraventricular hematoma and ventricular drainage were both performed. The patient did not experience further ischemic complications. Patients with moyamoya disease have intracranial hemodynamic insufficiency. Adequate control of intracranial pressure and removal of the intraventricular hematoma is important to prevent progression of cerebral infarction and hydrocephalus. To the authors' knowledge, this is the first report of concomitant cerebral infarction and IVH, or true mixed-type moyamoya disease. A possible pathogenesis of this rare condition is discussed.
    Journal of Neurosurgery 06/2007; 106(5 Suppl):388-90. · 3.15 Impact Factor
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    ABSTRACT: Glioblastoma is the most malignant and frequent of the glial tumors. A minor fraction of glioblastoma may contain areas showing oligodendroglioma-like tumor cell differentiation. Several authors have described such tumors as glioblastoma with oligodendroglial component (GBMO). GBMO may represent the ultimate level of malignancy in the oligodendroglial lineage. The oligodendroglial component and combined loss of chromosomal arm 1p and 19q in glioblastoma indicate increased survival. In our study, we analyzed 1p and 19q status in a series of 12 glioblastoma and 8 oligodendroglial tumors using fluorescence in situ hybridization (FISH) on paraffin-embedded tissues. In each case, hybridization status was classified as deletion, imbalance, polysomy, amplification, or normal pattern. Other genetic alterations such as CDKN2A (p16), RB, and EGFR were also assessed. On histological review, 2 of 12 glioblastoma (16.7%) were classified as GBMO. Chromosome 1p/19q deletion was detected in 3 of 12 glioblastomas (25%). In contrast, all 8 oligodendroglial tumors showed 1p/19q deletion. All GBMO had 19q deletion with imbalance, whereas 1 of 10 ordinary glioblastoma (10%) demonstrated 19q deletion with imbalance. All but 1 ordinary glioblastoma (90%) showed CDKN2A (p16) deletion, but no GBMO displayed this alteration. Our results indicate that GBMO may be a distinct subtype of glioblastoma harboring a characteristic molecular profile. FISH on paraffin-embedded specimens is a useful method for subclassification of glioblastoma.
    Brain Tumor Pathology 02/2007; 24(1):1-5. · 1.58 Impact Factor
  • Nosotchu 01/2007; 29(4):527-531.
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    ABSTRACT: Relationships between cortical excitability and regional cerebral blood flow (rCBF) were investigated in eight patients with chronic internal carotid artery occlusion using somatosensory evoked field recovery function (SEF-R). At interstimulus intervals (ISIs) of 120 and 160 ms, the SEF-R curve of the affected hemisphere demonstrated a significant overshoot above that of the non-affected hemisphere, suggesting cortical hyperexcitability. Furthermore, the rCBF at the hand area of the primary sensory area and the SEF-R at the ISI of 160 ms were inversely correlated. These results suggest that cortical hyperexcitability occurs at the primary sensory area in association with the severity of ischemia in the patients with chronic ICA occlusion.
    International Congress Series 01/2007; 1300:371-374.
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    ABSTRACT: The complications of therapeutic hypothermia sometimes undermine its clinical effects. In this study we investigated the efficacy and safety of therapeutic hypothermia based on analysis of 20 severe head injury cases from 6 institutions treated with therapeutic hypothermia in 1999. The twenty patients with severe head injury were enrolled prospectively based on the following indications; Glasgow Coma Scale of 7 or less on admission, age 60 or younger, and systric BP over 100 mmHg. A control group consisting of 21 patients with severe head injury met the same criteria but were treated without therapeutic hypothermia in other institutions. Clinical benefit were evaluated by a comparison of clinical result in the two groups defined according to the Glasgow Outcome Scale six months after injury. The hypothermia group was divided into two groups based on a target temperature [mild hypothermia group: 32-34 degrees C (n = 10); very mild hypothermia group: 35-36 degrees C (n = 10)]. The complication rate, clinical results and the duration of therapeutic hypothermia were analyzed between two groups. In the hypothermia group, 12 patients obtained a favorable outcome (Good Recovery or Moderate Disabled in GOS) and the mortality rate was 35%. In the control group, however only 5 patients had a favorable outcome and the mortality rate was 57%. Comparison between mild hypothermia and very mild hypothermia groups revealed no difference in clinical outcome. In the hypothermia group, severe pneumonia was seen in three patients, all in the mild hypothermia group with a hypothermic duration of over 120 hours. Mild hypothermia should be ended within 120 hours to avoid severe complication. When long-lasting therapeutic hypothermia of more than 120 hours is planned, very mild hypothermia is the treatment of choice.
    Acta neurochirurgica. Supplement 02/2005; 95:269-72.
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    ABSTRACT: The complications of therapeutic hypothermia sometimes undermine its clinical effects. In this study we investigated the efficacy and safety of therapeutic hypothermia based on analysis of 20 severe head injury cases from 6 institutions treated with therapeutic hypothermia in 1999. The twenty patients with severe head injury were enrolled prospectively based on the following indications; Glasgow Coma Scale of 7 or less on admission, age 60 or younger, and systric BP over 100 mmHg. A control group consisting of 21 patients with severe head injury met the same criteria but were treated without therapeutic hypothermia in other institutions. Clinical benefit were evaluated by a comparison of clinical result in the two groups defined according to the Glasgow Outcome Scale six months after injury. The hypothermia group was divided into two groups based on a target temperature [mild hypothermia group: 32∼34 °C (n=10); very mild hypothermia group: 35∼36°C (n=10)]. The complication rate, clinical results and the duration of therapeutic hypothermia were analyzed between two groups. In the hypothermia group, 12 patients obtained a favorable outcome (Good Recovery or Moderate Disabled in GOS) and the mortality rate was 35%. In the control group, however only 5 patients had a favorable outcome and the mortality rate was 57%. Comparison between mild hypothermia and very mild hypothermia groups revealed no difference in clinical outcome. In the hypothermia group, severe pneumonia was seen in three patients, all in the mild hypothermia group with a hypothermic duration of over 120 hours. Mild hypothermia should be ended within 120 hours to avoid severe complication. When long-lasting therapeutic hypothermia of more than 120 hours is planned, very mild hypothermia is the treatment of choice.
    12/2004: pages 269-272;
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    ABSTRACT: Although therapeutic hypothermia for patients with head injury has improved the outcome, the results in the most severe cases (GCS 3-6) have not been satisfactory so far. We induced hypothermia in head injury patients within 3 hours after the trauma, and compared the outcome of the treatment without hypothermia. Fourteen patients with GCS less than 6 were entered into this study (age range 13 to 58, mean 27.0 years). Seven of them were treated by hypothermia and 6 by the conventional method. The patients undergoing hypothermia were cooled to 34 degrees C within 3 hours after injury, kept at 32-34 degrees C for 48 hours, and then rewarmed. The outcome was evaluated at 6 months post-trauma, and the results were compared in the two groups. Therapeutic hypothermia dramatically suppressed brain swelling on CT in 3 of 7 patients. Four patients including these 3 showed a favorable outcome (good or moderate disability) and 3 died in the hypothermia group. In the conventional treatment group, only 1 patient was moderately disabled and 6 exhibited an unfavorable outcome (severely disabled, vegetative, or death). Early induction of hypothermia can improve the outcome in patients with severe head injury by reducing the severe brain swelling.
    Acta neurochirurgica. Supplement 02/2002; 81:83-4.
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    Stroke, v.33, 61-66 (2002). 01/2002;
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    ABSTRACT: In major cerebral arterial steno-occlusive diseases, there can be remarkably decreased hemodynamic reserve without marked neurological impairments. In such settings, it is not known whether the neural activity is well maintained or disturbed according to the severity of cerebral ischemia. The present study was therefore undertaken to examine the neural activity under mild cerebral ischemia resulting from major cerebral arterial occlusion. Seven patients with minor neurological impairment as well as either unilateral internal carotid artery or middle cerebral artery occlusion were studied. The severity of the cortical ischemia was assessed by measuring regional cerebral blood flow (rCBF) with positron emission tomography. The change in neural activity in the ischemic brain was then evaluated by means of somatosensory evoked magnetic field with magnetoencephalography. The rCBF in the primary sensory area and the strength of the initial component of somatosensory evoked magnetic field (N20 m) were significantly reduced (P<0.01) and the second component (P30 m) was significantly augmented (P<0.05) in the lesioned cerebral hemisphere as compared with the nonlesioned hemisphere. The asymmetry indexes for N20 m were positively correlated (r=0.78) and those for P30 m were inversely correlated (r=-0.92) with asymmetry indexes for rCBF. In patients with either unilateral internal carotid artery or middle cerebral artery occlusion and minor neural impairments, there was a reduction of afferent signal and an augmentation of the secondary response of the neurons in the primary sensory area. This showed correlation with the severity of cortical ischemia.
    Stroke 01/2002; 33(1):61-6. · 6.16 Impact Factor
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    ABSTRACT: Introduction Studies of somatosensory evoked magnetic fields (SEF) by averaging the signal of magnetoencephalography (MEG) have since revealed the homunculus structure of SI [1]: MEG is a noninvasive technique for the functional mapping of the human brain with high spatial and temporal resolution (in the order of mm and msec). This is accurate enough to estimate the location of the electrical source in the brain. The location of the face area in SI has been studied, mainly by stimulation of the lip, using electrocorticography in humans and monkeys. The location of the face area in SI has been also investigated by MEG [2,3], by positron emission tomography (PET) [4], and by functional magnetic resonance imaging (fMRI) [5] in humans. However, there have been no reports on stimulation of the ear. The objective of this study was to investigate the location of the ear area in SI. To our knowledge, this is the first systematic study of SEF following electrical stimulation of the ear [8].
    12/2001;
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    ABSTRACT: To evaluate the relation between brain displacement, clinical signs and symptoms, and local cerebral blood flow (lCBF) in patients with chronic subdural haematoma (CSDH). Forty five patients (age range 58-87 years, mean 71.9 (SD 8.4)) with unilateral CSDH were studied. Patients were categorised into three groups: I, headache (n=16); II, paresis (n=14); and III, mental change (n=15). T1 weighted MR images were obtained in all patients preoperatively. Quantitative values of maximum haematoma thickness, midline shift, and brain rotation angle were measured on axial and coronal MR images. In 21 patients, lCBF was measured by Xe enhanced CT. Values for lCBF were obtained in selected regions of interest in the frontal cortex, thalamus, and hemisphere on both the haematoma and contralateral sides. The lCBF reduction in the ipsilateral frontal cortex showed the best linear correlation with haematoma thickness (r=0.57), whereas the reduction in the ipsilateral thalamus had the most significant correlation with pineal shift (r=0.65) and third ventricle incline (r=0.67). In patients with paresis, lCBF decreased significantly on the ipsilateral side of both the frontal cortex and thalamus (p<0.05), whereas patients with mental change showed a significant reduction of lCBF on both sides of the thalamus (p<0.01) and in the ipsilateral frontal cortex (p<0.01). The lCBF reduction and clinical symptoms correlated well with local brain displacement in patients with CSDH. The lCBF in the central cerebral area including the thalamus was reduced in patients with clinical signs. The mental changes found were thought to derive from mild impairment of consciousness due to upper brain stem displacement.
    Journal of Neurology Neurosurgery & Psychiatry 12/2001; 71(6):741-6. · 4.92 Impact Factor

Publication Stats

679 Citations
136.35 Total Impact Points

Institutions

  • 2009–2012
    • Japanese Red Cross Kyoto Daiichi Hospital
      Kioto, Kyōto, Japan
  • 2007–2012
    • University Hospital Medical Information Network
      • Department of Neurosurgery
      Tokyo, Tokyo-to, Japan
  • 2005–2008
    • Nagoya Second Red Cross Hospital
      Nagoya, Aichi, Japan
  • 1994–2002
    • Nagoya University
      • Division of Neurosurgery
      Nagoya-shi, Aichi-ken, Japan
  • 2001
    • The Graduate University for Advanced Studies
      • Department of Integrative Physiology
      Miura, Kanagawa-ken, Japan
    • Japanese Red Cross
      Edo, Tōkyō, Japan
  • 2000
    • Kaunas University of Technology
      Caunas, Kauno Apskritis, Lithuania
  • 1997
    • Komaki City Hospital
      Комаки, Aichi, Japan