Toshio Matsushima

Saga University, Сага Япония, Saga, Japan

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Publications (204)392.4 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Obtaining a wide surgical field is challenging in the cerebellomedullary cistern = CMC, and thus, the lateral bony wall is usually removed through lateral foramen magnum approaches. However, few studies reported methods of efficient and safe retraction of the cerebellar hemisphere, which is a medial obstacle. Objective We aimed to clarify microsurgical anatomical features of the cerebellomedullary fissure = CMF, the natural cleavage plane between the cerebellum and the medulla, and its relationship to CMC. Moreover, this study describes a surgical technique that uses the unilateral trans-CMF approach for CMC surgeries. Methods In the anatomical study, 2 formalin-fixed cadaver heads were used. In the clinical study, 3 patients with vertebral artery–posterior inferior cerebellar artery aneurysms and 3 with glossopharyngeal neuralgia were surgically treated through the unilateral trans-CMF approach combined with the transcondylar fossa approach, which is a lateral foramen magnum approach. Results CMC was present at the lateral end of CMF. CMF was closed by arachnoidal adhesion, and the cerebellar hemisphere was superiorly attached to the cerebellar peduncle. After the unilateral CMF was completely opened, the cerebellar hemisphere was easily retracted rostrodorsally. Clinically, almost completely opening the unilateral CMF markedly enabled the retraction of the biventral lobule to safely obtain a wide surgical field for vascular CMC lesions. Here we present 2 representative cases. Conclusion Combined unilateral trans-CMF/lateral foramen magnum approaches provided a wide and close surgical field in CMC, allowing easy and safe CMC surgery.
    World Neurosurgery 11/2014; · 2.42 Impact Factor
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    ABSTRACT: Object Jugular foramen tumors often extend intra- and extracranially. The gross-total removal of tumors located both intracranially and intraforaminally is technically challenging and often requires a combined skull base approach. This study presents a suprajugular extension of the retrosigmoid approach directed through the osseous roof of the jugular foramen that allows the removal of tumors located in the cerebellopontine angle with extension into the upper part of the foramen, with demonstration of an illustrative case. Methods The cerebellopontine angles and jugular foramina were examined in dry skulls and cadaveric heads to clarify the microsurgical anatomy around the jugular foramen and to define the steps of the suprajugular exposure. Results The area drilled in the suprajugular approach is inferior to the acoustic meatus, medial to the endolymphatic depression and surrounding the superior half of the glossopharyngeal dural fold. Opening this area exposed the upper part of the jugular foramen and extended the exposure along the glossopharyngeal nerve below the roof of the jugular foramen. In the illustrative case, a schwannoma originating from the glossopharyngeal nerve in the cerebellopontine angle and extending below the roof of the jugular foramen and above the jugular bulb was totally removed without any postoperative complications. Conclusions The suprajugular extension of the retrosigmoid approach will permit removal of tumors located predominantly in the cerebellopontine angle but also extending into the upper part of the jugular foramen without any additional skull base approaches.
    Journal of Neurosurgery 05/2014; · 3.15 Impact Factor
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    ABSTRACT: During surgeries in the upper cerebellopontine angle (CPA), the superior petrosal veins (SPVs) often act as obstacles; and their sectioning sometimes causes serious complications. In this study, we introduced a classification system for the SPVs wherein their tributaries were classified into four groups on the basis of their courses and draining areas. We furthermore explained the detailed anatomy of the vein of the cerebellopontine fissure, which is the largest tributary. In surgeries of petrous apex meningioma, the knowledge of the displacement pattern of the vein is very helpful for avoiding major venous complications. Therefore, we elucidated its anatomical situation in relation to the original portion of the meningioma and the natural draining point of the vein into the superior petrosal sinus (SPS) in each patient. In addition, we described the methods and techniques used to expose and manage the vein of the cerebellopontine fissure during surgery using the lateral suboccipital retrosigmoid approach. Presenting two illustrative cases, we recommend that the initial exposure of the tumor should be performed through the infratentorial lateral supracerebellar route and that the suprafloccular cistern is the best area to find the vein of the cerebellopontine fissure. We emphasized the importance of the preservation of the vein of the cerebellopontine fissure and also proposed the order for exposure of SPV tributaries during upper CPA surgery using the retrosigmoid approach.
    Neurosurgical Review 04/2014; · 1.86 Impact Factor
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    ABSTRACT: The increasing number of reports of complications after sacrificing the superior petrosal veins, the largest veins in the posterior fossa, has led to a need for an increased understanding of the anatomy of these veins and the superior petrosal sinus into which they empty. To examine the anatomy of the superior petrosal veins and their size, draining area, and tributaries, and the anatomic variations of the superior petrosal sinus. Injected cadaveric cerebellopontine angles (CPAs) and 3-D-multifusion angiography images were examined. The 4 groups of the superior petrosal veins based on their tributaries, course, and draining areas are: the petrosal, posterior mesencephalic, anterior pontomesencephalic, and tentorial groups. The largest group was the petrosal group. Its largest tributary, the vein of the cerebellopontine fissure, was usually identifiable in the suprafloccular cistern located above the flocculus on the lateral surface of the middle cerebellar peduncle. The medial or lateral segment of the superior petrosal sinus was absent in 40% of CPAs studied with venography. The superior petrosal veins and their largest tributaries, especially the vein of the cerebellopontine fissure, should be preserved if possible. Obliteration of superior petrosal sinuses in which either the lateral or medial portion is absent may result in loss of the drainage pathway of the superior petrosal veins. Preoperative assessment of the superior petrosal sinus should be considered before transpetrosal surgery in which the superior petrosal sinus may be obliterated.
    Neurosurgery 02/2014; · 3.03 Impact Factor
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    ABSTRACT: It is well known that brainstem dysfunction may be caused by vascular compression of the medulla oblongata (MO). However, only a limited number of reports have found microvascular decompression (MVD) surgery to be an effective treatment for symptomatic patients with MO dysfunction, such as essential hypertension, pyramidal tract signs, dysphagia, and respiratory failure. This report describes three patients with vertebral artery (VA) compression of MO who presented with respiratory failure and/or dysphagia. MVD surgery using the transcondylar fossa approach was effective in relieving patient symptoms. Although the pathogenic mechanisms of symptomatic VA compression of MO remain unclear, we should recognize that MVD surgery is effective for selected patients with brainstem dysfunction. The transcondylar fossa approach and the stitched sling retraction technique are appropriate in MVD surgery to relieve VA compression of MO.
    World Neurosurgery 01/2014; · 2.42 Impact Factor
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    ABSTRACT: Hemangioma of the skull is a benign solitary tumor, often found in the frontal or parietal area. A hemangioma lesion typically involves the outer table rather than the inner, but its complete removal at the diploe level is difficult. Full-thickness resection at the calvaria is often needed to ensure a free margin, but it will leave a bony defect that requires reconstruction. Although curettage and covering of the lesion with alloplastic material are a simple treatment option for hemangioma of the skull, it does not always prevent recurrence. Hence, complete resection is needed. As our technical strategies for reconstruction, we organize a split calvarial bone graft if a defect is near the frontal sinus and calcium phosphate cement if it is somewhat far from the sinus.
    The Journal of craniofacial surgery 01/2014; · 0.68 Impact Factor
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    ABSTRACT: Subfrontal schwannomas arising from the olfactory groove are rare and their origin remains uncertain because olfactory bulbs do not possess Schwann cells. We present two cases of subfrontal schwannomas treated with surgical resection. In one case, the tumor was located between the endosteal and meningeal layers of the dura mater. This rare case suggests that subfrontal schwannomas may originate from the fila olfactoria.
    Neurologia medico-chirurgica 12/2013; · 0.49 Impact Factor
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    ABSTRACT: Carefully tailoring the transclival approach to the involved parts of the upper, middle, or lower clivus requires a precise understanding of the focal relationships of the clivus. To develop an optimal classification of the upper, middle, and lower clivus and to define the extra and intracranial relationships of each clival level. Ten cadaveric heads and 10 dry skulls were dissected using the surgical microscope and endoscope. The clivus is divided into upper, middle, and lower thirds by two endocranial landmarks: the dural pori of the abducens nerves and the dural meati of the glossopharyngeal nerves. Useful surgical landmarks exposed in the transnasal approach that aid in locating the junction of the clival divisions are the lower limit of the paraclival segment of the internal carotid artery, which is located 4.9 mm above the posterior opening of the vidian canal, and the pharyngeal tubercle. The upper, middle, and lower clival approaches provide access to the anterior midline parts of the previously described upper, middle, and lower neurovascular complexes in the posterior fossa. The nasal and nasopharyngeal relationships important in expanding the transnasal approach to the borders of the clivus are reviewed. The transclival approach can be carefully tailored to expose focal lesions in the anterior part of the posterior fossa.
    Neurosurgery 09/2013; · 3.03 Impact Factor
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    ABSTRACT: To evaluate the clinical outcome and MRI findings after carotid artery stenting (CAS) without post-dilatation. Between May 2005 and April 2012, a total of 169 consecutive patients (61.4% symptomatic) underwent 176 CAS procedures performed with an embolic protection device (GuardWire, n=116; FilterWire EZ, n=60). All stents were deployed without post-dilatation. Periprocedural complications and mid-term outcomes were analyzed. The stroke rate was 2.3% within 30 days post-CAS (asymptomatic patients 2.8%; symptomatic patients 2.8%). Cerebral infarction occurred in one asymptomatic patient (2.8%) and one symptomatic patient (0.9%). Intracranial hemorrhage occurred in two symptomatic patients (1.9%). Post-CAS diffusion-weighted imaging (DWI) revealed a high-intensity area in 26 of 176 procedures (14.8%). Ipsilateral stroke after 31 days occurred in two patients (1.1%) and restenosis occurred in six (3.4%). A post-CAS comparison of the embolic protection devices revealed no difference in stroke incidence within 30 days and in DWI high-intensity area. Our CAS procedure without post-dilatation is feasible, safe and associated with a low incidence of stroke and restenosis.
    Journal of Neurointerventional Surgery 09/2013; · 2.50 Impact Factor
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    ABSTRACT: Our purpose was to identify the causal factors for the perfusion distribution obtained with ASL-MRI by comparing ASL-MRI with clinical information and other MRI findings in moyamoya disease. Seventy-one patients with moyamoya disease underwent ASL-MRI and other MRI, including fluid-attenuated inversion recovery imaging (FLAIR) and three-dimensional time-of-flight magnetic resonance angiography (MRA) on 3.0-Tesla MRI system. Cerebral blood flow (CBF) values (ASL values) for the cerebral hemispheres (142 sides) were measured on CBF maps generated by ASL-MRI. Relationships between the ASL values and the following 9 factors were assessed: sex, family history, revascularization surgery, age at MR exam, age at onset, the steno-occlusive severity on MRA (MRA score), degree of basal collaterals, degree of leptomeningeal high signal intensity seen on FLAIR, and size of ischemic or hemorrhagic cerebrovascular accident lesion (CVA score). Patients with a family history had significantly higher ASL values than those without such a history. There were significant negative correlations between ASL values and age at MR exam, MRA score, and CVA score. ASL-MRI may have cause-and-effect or mutual associations with family history, current patient age, size of CVA lesion, and intracranial arterial steno-occlusive severity in Moyamoya disease.
    European journal of radiology 09/2013; · 2.65 Impact Factor
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    ABSTRACT: The posterior condylar canals (PCCs) and posterior condylar emissary veins (PCEVs) are potential anatomical landmarks for surgical approaches through the lateral foramen magnum. We conducted computed tomography (CT) and microsurgical investigation of how PCCs and PCEVs can aid in planning and performing these approaches. We analyzed the microanatomy of PCCs and PCEVs using cadaveric specimens, dry skulls, and CT images. The recognition frequency and geometry of PCCs and PCEVs and their relationships with surrounding structures were evaluated. PCCs were identified in 36 of 50 sides in dry bones and 82 of 100 sides by CT. PCCs had a 3.5-mm mean diameter and a 6.8-mm mean canal length. We classified their courses into four types according to intracranial openings: the sigmoid sinus (SS) type, the jugular bulb (JB) type, the occipital sinus type, and the anterior condylar emissary vein type. In most cases, PCEV originated near the boundary between the SS and JB. PCCs and PCEVs can be useful anatomical landmarks to differentiate the transcondylar fossa approach from the transcondylar approach, thus preventing unnecessary injury of the atlantooccipital joint. They can also be used as landmarks when the jugular foramen (JF) and hypoglossal canal (HGC) are being exposed. The area anterior to the brain stem and the medial part of HGC can be accessed by removal of the lateral foramen magnum medial to PCC. JF and the lateral part of HGC can be accessed by removal of the skull base lateral to PCC without damaging the lateral rim of the foramen magnum.
    Neurosurgical Review 08/2013; · 1.86 Impact Factor
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    ABSTRACT: A 29-year-old woman complained of headache and nausea several hours after delivery, followed by mild disturbance of consciousness. Physical examination revealed hypertension, systemic edema, nystagmus, dysarthria, and cerebellar ataxia. Computed tomography showed low attenuation areas in the cerebellum, and MR imaging revealed vasogenic edema in the cerebellum. MR angiography and MR venography demonstrated no significant abnormalities. We diagnosed a cerebellar variant of posterior reversible encephalopathy syndrome(PRES), and treated the patient immediately with antihypertensive drug and diuretic. The symptoms dramatically improved and MR imaging ten days after admission revealed disappearance of the vasogenic edema in the cerebellum. She was discharged without any sequelae. Though a cerebellar variant of PRES is very rare, rapid diagnosis and treatment is important for good prognosis when the disease is encountered.
    No shinkei geka. Neurological surgery 08/2013; 41(8):697-702. · 0.13 Impact Factor
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    ABSTRACT: The affected artery in glossopharyngeal neuralgia (GPN) is most often the posterior inferior cerebellar artery (PICA) from the caudal side or the anterior inferior cerebellar artery (AICA) from the rostral side. This technical report describes two representative cases of GPN, one with PICA as the affected artery and the other with AICA, and demonstrates the optimal approach for each affected artery. We used 3D computer graphics (3D CG) simulation to consider the ideal transposition of the affected artery in any position and approach. Subsequently, we performed microvascular decompression (MVD) surgery based on this simulation. For PICA, we used the transcondylar fossa approach in the lateral recumbent position, very close to the prone position, with the patient's head tilted anteriorly for caudal transposition of PICA. In contrast, for AICA, we adopted a lateral suboccipital approach with opening of the lateral cerebellomedullary fissure, to visualize better the root entry zone of the glossopharyngeal nerve and to obtain a wide working space in the cerebellomedullary cistern, for rostral transposition of AICA. Both procedures were performed successfully. The best surgical approach for MVD in patients with GPN is contingent on the affected artery-PICA or AICA. 3D CG simulation provides tailored approach for MVD of the glossopharyngeal nerve, thereby ensuring optimal surgical exposure.
    Neurosurgical Review 06/2013; · 1.86 Impact Factor
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    ABSTRACT: Object The authors adopted the infrafloccular approach for microvascular decompression (MVD) surgery to treat hemifacial spasm (HFS). The inferior portion of the flocculus is retracted to observe the root exit zone of cranial nerve (CN) VII between CN IX and the flocculus. During the procedure, the rhomboid lip, a sheetlike layer of neural tissue forming the lateral recess of the fourth ventricle, is sometimes encountered. The existence of the rhomboid lip in cases of HFS was reviewed to determine the importance of the structure during MVD surgery. Methods Preoperative imaging and intraoperative observations in 34 consecutive cases of HFS treated in the period from October 2008 through September 2011 were used to assess the frequency of encountering the rhomboid lip. Results The rhomboid lip was observed during MVD surgery in 9 (26.5%) of the 34 cases but had been demonstrated on preoperative MR images in only 3 cases (8.8%). On T2-weighted images, it appeared as a high-intensity nonstructural area on the ventral side of the flocculus and continued into the fourth ventricle via the foramen of Luschka. Conclusions A large rhomboid lip presents an impediment to MVD surgery in a significant minority of patients with HFS. It is seldom observed on preoperative MR images. Proper dissection of the rhomboid lip away from the arachnoid membrane and/or the lower CNs during MVD surgery provides good visualization of the root exit zone of CN VII and reduces injury of CNs IX and X, avoiding postoperative deficits like dysphagia.
    Journal of Neurosurgery 05/2013; · 3.15 Impact Factor
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    ABSTRACT: BACKGROUND: Cognitive impairment is a frequent complication of moyamoya disease (MMD) in adults. Chronic hypoperfusion in frontal lobes can lead to subtle brain injury, resulting in cognitive dysfunctions. Apparent diffusion coefficient (ADC) in normal-appearing white matter on conventional magnetic resonance imaging correlates with cerebral hemodynamics in the frontal lobe. OBJECTIVE: The purpose of this study was to examine the relationship of ADC with executive function in patients with MMD. METHODS: Thirty-one patients (25 women and 6 men; mean age, 32.6 ± 10.4 years) were included in this study. Executive function was evaluated by the Frontal Assessment Battery (FAB) at 21.5 ± 7.5 years after disease onset. ADC was measured in the normal-appearing frontal white matter. RESULTS: ADC was statistically related to the occurrence of executive dysfunction in multivariate analysis (P = .0179). Total FAB score and ADC were negatively correlated (r(2) = .22; P = .0072; Spearman correlation coefficient, -.41; P = .024). Elevated ADC predicted executive dysfunction (area under the receiver operating characteristic curve, .73; 95% confidence interval, .55-.91; P = .029). CONCLUSIONS: The association of ADC with executive function might suggest that ADC is useful in screening for executive dysfunction during follow-up in the outpatient setting.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 04/2013; · 1.99 Impact Factor
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    ABSTRACT: We report a case of blood blister-like aneurysm(BBA)on the posterior wall of the internal carotid artery(ICA)causing subarachnoid hemorrhage(SAH). A 45-year-old man suffering from SAH(WFNS grade 5)was referred to our hospital. 3D-CT angiography showed a BBA on the posterior wall of the ICA. The aneurysm had been enlarged for a few days. Therefore we performed coil embolization. Four weeks after the operation, the aneurysm was found to have regrown. In the second operation the aneurysm was successfully treated by the ICA proximal occlusion with extracranial-intracranial bypass. Postoperative follow-up cerebral angiography detected no aneurysm. To our knowledge, BBA on the posterior wall of the ICA is rare. Radical surgery with bypass should be performed as soon as possible when the BBA is found to regrow. We discuss the clinical characteristics with a review of the literature.
    No shinkei geka. Neurological surgery 03/2013; 41(3):229-34. · 0.13 Impact Factor
  • Atsushi Ogata, Masatou Kawashima, Toshio Matsushima
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    ABSTRACT: A 48-year-old Japanese woman with Behçet's disease suffered successive rupture of thoracic aortic and cerebral aneurysms within one year. The patient underwent successful surgical treatment for both aneurysms. Histological examination of the aneurysm walls revealed lymphocyte infiltration into the adventitia with smooth muscle cell hyperplasia in the thickened intima. This is an extremely unusual presentation of Behçet's disease associated with both cerebral and aortic aneurysms.
    Neurologia medico-chirurgica 01/2013; 53(3):189-91. · 0.49 Impact Factor
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    ABSTRACT: A 39-year-old man suffering from progressive dysarthria, gait disturbance, and sensorineural deafness for 2 years was admitted to our hospital. He scored 28 points on the mini-mental state examination. He had previously undergone surgery at 24 years and 39 years of age for a cerebellar tumor (pilocytic astrocytoma). Superficial siderosis (SS) was diagnosed based on bloody cerebrospinal fluid (CSF) and the findings of T2*-weighted head MRI that revealed marginal hypointensity of the surface of the cerebellum, brainstem, and cerebral cortex. After intravenous infusion and the oral use of hemostatic drugs (carbazochrome, tranexamic acid), the CSF became watery clear and his condition improved. Hemostatic drug therapy should be considered for SS.
    Rinshō shinkeigaku = Clinical neurology. 01/2013; 53(6):470-3.
  • Masatou Kawashima, Yukinori Takase, Toshio Matsushima
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    ABSTRACT: Object The cerebellomedullary fissure (CMF) is a space between the cerebellum and the medulla oblongata, which often adhere to each other. The purpose of the present study was to demonstrate the importance of the unilateral CMF dissection for clipping vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysms. Methods Five adult cadaveric specimens were studied after colored silicone was infused into the arteries and veins. The microsurgical anatomy of the CMF and the trans-CMF approach for VA-PICA aneurysm surgery were examined in stepwise dissections. In addition, 6 patients underwent surgery for VA-PICA saccular aneurysms (2 ruptured and 4 unruptured aneurysms) via posterolateral approaches, with wide opening of the unilateral CMF to obtain good visualization and a wide working space in the lateral part of the cerebellomedullary cistern. Clinical data including neurological and radiological findings and patient outcomes were analyzed in all 6 cases. Results In all cases, the aneurysm was successfully clipped and no permanent neurological deficits remained. The wide opening of the unilateral CMF on the lesion side made it possible to retract the inferolateral part of the cerebellum easily, provided a wide operative field in the cerebellomedullary cistern, and enabled successful clip placement without difficulty. Conclusions For safe and effective VA-PICA aneurysm surgery, it is very important to dissect the CMF on the lesion side as well as to remove the lateral part of the foramen magnum. Direct clip placement is very safe and useful in cases involving VA-PICA aneurysms.
    Journal of Neurosurgery 11/2012; · 3.15 Impact Factor
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    ABSTRACT: OBJECTIVE: We report a rare case of hydrocephalus following aqueductal stenosis caused by developmental venous anomaly (DVA). METHODS: Four years after the incidental discovery of asymptomatic DVA, the 10-year-old boy presented with symptoms of hydrocephalus. Enhanced computed tomographic scans and magnetic resonance images showed supra- and infratentorial DVAs with caput medusae appearances in the right basal ganglia and cerebellum. Three dilated collector veins in the right basal ganglia, floor of the third ventricle, and floor of the fourth ventricle gathered together to drain into the great vein of Galen. Three-dimensional fusion images showed that the serpentine dilated vein from the posterior fossa coursed in the aqueduct and caused the aqueductal stenosis, which was confirmed by operative endoscopy. RESULTS: Endoscopic third ventriculostomy was performed and the hydrocephalus was relieved. CONCLUSIONS: Although aqueductal stenosis caused by DVA is rare, it is important to be considered in the differential diagnosis of hydrocephalus. Three-dimensional reconstruction and fusion images are very useful.
    Child s Nervous System 10/2012; · 1.24 Impact Factor

Publication Stats

3k Citations
392.40 Total Impact Points


  • 2008–2014
    • Saga University
      • Department of Neurosurgery
      Сага Япония, Saga, Japan
  • 2012
    • Takagi Hospital
      Ishinomachi, Miyagi, Japan
    • Saga-Ken Medical Centre Koseikan
      Kanzaki, Saga, Japan
  • 2003–2009
    • University of Florida
      • Department of Neurosurgery
      Gainesville, FL, United States
  • 1979–2006
    • Kyushu University
      • • Department of Neurosurgery
      • • Faculty of Medical Sciences
      • • Department of Neuropathology
      Fukuoka-shi, Fukuoka-ken, Japan
  • 2001
    • Fukuoka University
      • Department of Neurosurgery
      Hukuoka, Fukuoka, Japan
  • 2000
    • Hokkaido University Hospital
      Sapporo, Hokkaidō, Japan
    • Kyushu Medical Center
      Hukuoka, Fukuoka, Japan
  • 1989
    • Fukuoka Institute of Technology
      Hukuoka, Fukuoka, Japan
  • 1986
    • Kyushu Kosei Nenkin Hospital
      Kitakyūshū, Fukuoka, Japan