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Publications (4)4.61 Total impact

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    ABSTRACT: Peroneal nerve entrapment neuropathy(PEN)is generally known as a drop foot with sensory disturbance. However, some patients experience numbness and pain in the affected area without severe paresis due to PEN. We report the clinical features and our surgical results of PEN cases. We encountered 17 cases of PEN. The patients were 7 females and 10 males and their ages ranged from 30 to 78 years(average 56.1 years). In these cases, conservative therapy was unsuccessful;therefore, we performed surgical treatment for PEN. Among the 17 cases, 4 were of bilateral and 13 were of unilateral PEN. There was no severe paresis, as in drop foot;however, mild paresis(4/5, manual muscle test, MMT)was noted in 15 cases. In all cases, intermittent claudication presented, which ranged from 10 to 800m(average 150m). In 13 cases, radiological abnormality of the lumbar region was noted and 8 cases had a history of lumbar surgery(they had failed back surgery syndrome). In all the cases, we performed neurolysis of the peroneal nerve under local anesthesia;there was no surgical complication. After the surgery, symptoms improved, and the numerical rating of the lower limb improved from 8.6/10 to 0.8/10. Intermittent claudication also improved in all of the cases. We successfully treated 17 cases of PEN, which had lower limb pain without severe paresis, as in drop foot. Our results indicate that PEN should be recognized as a cause of intermittent claudication. Neurolysis for PEN under local anesthesia is less invasive and is useful for the treatment of lower limb pain.
    No shinkei geka. Neurological surgery 04/2015; 43(4):309-316. DOI:10.11477/mf.1436203012 · 0.13 Impact Factor
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    ABSTRACT: Since the introduction of carotid stenting (CAS), a combined treatment for bilateral lesions using carotid endarterectomy (CEA) and CAS has been developed. However, there has been only 1 report about CEA then CAS. Herein we describe 2 patients with bilateral severe carotid stenosis who were treated by CEA for the symptomatic side and CAS for the contralateral asymptomatic side. A 71-year-old man underwent CEA for the symptomatic side. Although the patient suffered hyperperfusion syndrome after CEA, he recovered fully after 3 weeks of rehabilitation. Two months later, CAS was performed for the asymptomatic side, and he was discharged with no deficit. A 67-year-old man underwent CEA for the symptomatic side. The patient developed no postoperative neurologic deficits except for hoarseness. Four weeks later, CAS was performed for the contralateral asymptomatic side. After the procedure, however, severe hypotension occurred, and treatment by continuous injection of catecholamine was necessary to maintain systematic blood pressure. The patient was ultimately discharged with no deficit. The combined therapy of CAS for the asymptomatic side and then CEA for the symptomatic side has been recommended by several authors. However, one of the problems of this strategy is the higher incidence of postprocedural hemodynamic complications, and hypotension after CAS may be dangerous for the symptomatic hemisphere. We suggest a combined therapy using CEA for the symptomatic side and then CAS for the asymptomatic side can be 1 beneficial treatment option for patients with bilateral carotid stenosis without coronary artery disease.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 09/2014; 23(10). DOI:10.1016/j.jstrokecerebrovasdis.2014.07.014 · 1.99 Impact Factor
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    ABSTRACT: Object Superior cluneal nerve (SCN) entrapment neuropathy is a poorly understood clinical entity that can produce low-back pain. The authors report a less-invasive surgical treatment for SCN entrapment neuropathy that can be performed with local anesthesia. Methods From November 2010 through November 2011, the authors performed surgery in 34 patients (age range 18-83 years; mean 64 years) with SCN entrapment neuropathy. The entrapment was unilateral in 13 patients and bilateral in 21. The mean postoperative follow-up period was 10 months (range 6-18 months). After the site was blocked with local anesthesia, the thoracolumbar fascia of the orifice was dissected with microscissors in a distal-to-rostral direction along the SCN to release the entrapped nerve. Results were evaluated according to Japanese Orthopaedic Association (JOA) and Roland-Morris Disability Questionnaire (RMDQ) scores. Results In all 34 patients, the SCN penetrated the orifice of the thoracolumbar fascia and could be released by dissection of the fascia. There were no intraoperative surgery-related complications. For all patients, surgery was effective; JOA and RMDQ scores indicated significant improvement (p < 0.05). Conclusions For patients with low-back pain, SCN entrapment neuropathy must be considered as a causative factor. Treatment by less-invasive surgery, with local anesthesia, yielded excellent clinical outcomes.
    Journal of neurosurgery. Spine 04/2013; 19(1). DOI:10.3171/2013.3.SPINE12420 · 2.36 Impact Factor
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    ABSTRACT: A 74-year-old male complained of lower back pain, paresthesia of the bilateral feet and urinary incontinence. Urinary incontinence manifested at rest and worsened with walking. He had a history of surgery for prostatic cancer. Lumbar magnetic resonance imaging (MRI) demonstrated lumbar canal stenosis at the L4/5 level. The investigations including a cystometrogram manifested an overactive bladder caused by lumbar canal stenosis. His clinical symptoms were unresponsive to conservative treatment and posterior decompression at the L4/5 level was performed surgically to treat lumbar canal stenosis. Postoperatively, his symptoms were relieved. Overactive bladder presenting urinary incontinence that deteriorates with walking due to lumbar canal stenosis is suspected of being caused by circulatory disturbance of the cauda equine or conus medullaris. Emergency treatment including surgery is required for urinary retention in patients with lumbar canal stenosis; however, some degree of urinary disturbance may persist even after prompt and adequate surgery. Overactive bladder such as the present case should be considered as a possible symptom of lumbar canal stenosis, and surgical treatment for lumbar canal stenosis may be considered in the 'overactive bladder' stage before urinary retention begins, if the patient does not respond to conservative treatment.
    No shinkei geka. Neurological surgery 10/2011; 39(10):983-8. · 0.13 Impact Factor