Suguru Inao

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

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Publications (12)16.22 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.

Publication Stats

64 Citations
16.22 Total Impact Points

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  • 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
  • 2007–2008
    • Nagoya Second Red Cross Hospital
      Nagoya, Aichi, Japan