Hideyuki Ohnishi

Osaka Police Hospital, Ōsaka, Ōsaka, Japan

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Publications (70)116.79 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The long-term outcome of 39 patients with unruptured giant aneurysm (>2.5 cm) treated during the last 12 years was retrospectively reviewed. The 7 male and 32 female patients, aged 32 to 81 years, presented with symptoms related to compression of the surrounding structures by the aneurysm in 28 cases, cerebral infarction in one, and asymptomatic in 10. The locations were the internal carotid artery (ICA) in 27 cases, middle cerebral artery in three, anterior cerebral artery in one, and basilar artery in eight. Therapeutic modalities were direct clipping in 11 patients, ICA occlusion combined with extracranial-intracranial bypass in 15, and conservative treatment in 13. The follow-up period ranged from 16 to 128 months (mean 54.0 months). The mortality was 9% (1/11), 0% (0/15), and 31% (4/13), and morbidity was 18% (2/11), 20% (3/15), and 8% (1/13), respectively. Surgery reduced the mortality (from 31% to 4%) but increased the morbidity (from 8% to 19%) as compared with conservatively treated patients (p < 0.05). Giant intracranial aneurysm has a poor prognosis if left untreated, but these lesions are difficult to treat with the present management options.
    Neurologia medico-chirurgica 09/2006; 46(8):379-84; discussion 384-6. DOI:10.2176/nmc.46.379 · 0.65 Impact Factor
  • Surgery for Cerebral Stroke 01/2002; 30(6):419-423. DOI:10.2335/scs.30.419
  • Shuzo Okuno, Hideyuki Ohnishi
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    ABSTRACT: Only 3 cases of aneurysm associated with the communicating artery between both distal posterior inferior cerebellar arteries (PICAs) have been reported in the literature. We present the 4th case of such an aneurysm arising from the communicating artery itself, which is unrelated to the arterial branches. A hypertensive 68-year-old man presented with a Hunt and Hess grade 4 subarachnoid hemorrhage. Angiographic studies revealed that the ruptured aneurysm arose from the fine communicating artery itself interconnecting both distal PICA vermian branches. The right PICA was absent and its vermian territory was supplied by the left PICA through this communicating artery. At surgery, a saccular aneurysm was noted which developed at the top of the arterial loop under the nodulus of the cerebellar vermis and was trapped. The actual prevalence and clinical significance of aneurism associated with the communicating artery interconnecting both PICAs are unknown, but defective embryonal development may lead to congenital vulnerability of the vascular wall, resulting in aneurysm formation.
    Cerebrovascular Diseases 02/2001; 12(3):276-9. DOI:10.1159/000047716 · 3.70 Impact Factor
  • Shuzo Okuno, Hajime Touho, Hideyuki Ohnishi, Jun Karasawa
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    ABSTRACT: Acute subdural hematomas caused by meningiomas have been rarely encountered. Pathophysiologic mechanisms and clinical considerations in these patients have not been sufficiently explored. We addressed the possible mechanism of spontaneous hemorrhage in our case and briefly discuss the optimal treatment. This case of falx meningioma presenting as an acute subdural hematoma in a 78-year-old woman is described. On initial computed tomography (CT), an enhancing tumor of the falx appeared to be the cause of hemorrhage. Only faint contrast staining in the periphery of the tumor was seen on right external carotid arteriograms, with no evidence of other vascular supply. Extravasation of contrast material during the procedure occurred suddenly and was successfully treated by endovascular embolization using a microcatheter. The hematoma was emergently evacuated with gross total removal of the tumor. Pathologic examination confirmed a transitional meningioma with abundant hyalinized structures. Disruption of a thin-walled vessel adjacent to the tumor capsule was assumed to be the site of hemorrhage. The longstanding ischemia of the tumor was considered to have produced the deposition of hyalin in the tissue, which changed the hemodynamics within the tumor, producing vascular stress leading to rupture. The prognosis of patients with meningiomas complicated by acute subdural hematoma is generally poor, with mortality reported in approximately one-half of such patients. Surgical exploration is the most effective treatment and should be conducted before irreversible brain damage has occurred.
    Surgical Neurology 09/1999; 52(2):180-4. DOI:10.1016/S0090-3019(97)00028-1 · 1.67 Impact Factor
  • S Okuno, H Touho, H Ohnishi, J Karasawa
    Acta Neurochirurgica 02/1998; 140(6):629-30. DOI:10.1007/s007010050152 · 1.79 Impact Factor
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    ABSTRACT: The surgical management of extensive skull base neoplasms, which often extend to both the sub- and epidural spaces, is still a great challenge with considerable risk. The authors report 12 cases in which a two-stage operation was performed for such nonmalignant tumours. The series consisted of four cavernous sinus meningiomas, one sphenoid-ridge meningioma, one cerebello-pontine angle meningioma, three pituitary adenomas, two chordomas, and one fibroma. Our operative strategy involved removal of the epidural part of the tumour and extensive skull base reforming during the first stage. After approximately one month, the second stage operation was performed by removing the residual subdural parts and the affected dura, which were less vascular, with dural plasty and subsequent spinal drainage. No complications such as cerebrospinal fluid (CSF) leakage or infection were observed. During the long-term follow-up (1.4 to 4.6 years, with a mean of 2.7 years), tumour recurrence was observed in a single case. In conclusion, the major advantages of this procedure were as follows: [1] improvement of the total removal rate, [2] prevention of postoperative CSF leak and infection, [3] residual tumours were avascular, necrotic, and dwindling, and also shifted outwards resulting in less adhesions to the brain. Although it may counter the trend toward less invasive procedures, the two-staged skull base surgery warrants serious consideration as an option for the management of patients with such extensive cranial base tumours.
    Acta Neurochirurgica 02/1998; 140(9):891-8. DOI:10.1007/s007010050190 · 1.79 Impact Factor
  • S Okuno, H Touho, H Ohnishi, J Karasawa
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    ABSTRACT: Cases of cervical infarction with clearly documented evidence of the underlying aetiology and associated neuroradiological abnormalities have not been frequently reported. A rare case of cervical infarction caused by midvertebral artery occlusion due to spondylotic degeneration of the spine is described. The most probable aetiological factor affecting this disease entity, and the usefulness of magnetic resonance imaging in the detection of this rare lesion, are briefly discussed.
    Acta Neurochirurgica 02/1998; 140(9):981-5. DOI:10.1007/s007010050202 · 1.79 Impact Factor
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    ABSTRACT: Carotid rete mirabile is a physiological vascular network between the external carotid and internal carotid systems present in some vertebrate species, but rarely observed in humans. We describe a 17-year-old girl with rete mirabile who presented with subarachnoid hemorrhage. Angiography disclosed the bilateral internal carotid arteries (ICAs) ended at the cavernous portion, and abnormal arterial networks visualized via the ICAs and the external carotid arteries in the paracavernous region. The distal ICAs were visualized via the abnormal arterial networks. After 18 years of follow-up she is leading a normal life without neurological problems. Rete mirabile in humans may present with hemorrhage or ischemic symptoms, but the prognosis appears to be good.
    Neurologia medico-chirurgica 03/1997; 37(2):188-92. DOI:10.2176/nmc.37.188 · 0.65 Impact Factor
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    ABSTRACT: The clinical application of intraoperative motor-evoked potentials (MEPs) has been hampered by their sensitivity to anesthetics. Recently, to overcome anesthetic-induced depression of myogenic MEPs, multiple stimulus setups with a paired or a train of pulses for stimulation of the motor cortex were reported. However, the effects of anesthetics on MEPs induced by these stimulation techniques are unknown. Bipolar electrical stimulation of the left motor cortex was carried out in 15 rats anesthetized with thiopental while the compound muscle action potentials were recorded from the contralateral hind limb. After recording of the MEP in response to the single-shock stimulation of the motor cortex, paired pulses (double pulses) or a train of three pulses (triple pulses) with an interstimulus interval of each pulse at 0.3, 0.5, 1.0, 1.5, and 2.0 ms were applied. After control MEP recording, isoflurane was administered at a concentration of 0.25 minimum alveolar anesthetic concentration (MAC), 0.5 MAC, 0.75 MAC, and 1.0 MAC, and the effects of isoflurane on the MEPs induced by single, double, and triple pulses were evaluated. In all animals, distinct baseline MEPs were recorded. During the administration of 0.25 MAC and 0.5 MAC isoflurane, MEPs induced by stimulation with a single pulse could be recorded in 87% and 33% of animals, respectively, and MEP amplitude was significantly reduced in a dose-dependent manner. During the administration of 0.75 MAC isoflurane, MEPs after single-pulse stimulation could not be recorded in any animals. By stimulating with paired or triple pulses, the success rate of MEP recording and MEP amplitude significantly increased compared with those after single pulse before and during the administration of isoflurane. Both the success rate of MEP recording and MEP amplitude after double- and triple-pulse stimulation decreased significantly in a dose-dependent manner during the administration of isoflurane. Application of double or triple stimulation of the motor cortex increases the success rate of MEP recording and its amplitude during isoflurane anesthesia in rats. However, these responses are suppressed by isoflurane in a dose-dependent manner.
    Anesthesiology 12/1996; 85(5):1176-83. DOI:10.1097/00000542-199611000-00027 · 6.17 Impact Factor
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    ABSTRACT: After temporal craniotomy, pseudoankylosis of the mandible can cause difficult airway management during subsequent anesthesia. However, postcraniotomy changes in maximal mouth opening and the incidence of limited mouth opening have not been characterized. Ninety-two adult patients who underwent elective craniotomy were divided into three groups: Group A (n = 28) included patients who underwent parietal, occipital, or frontal craniotomy without incision of the temporalis muscles; Group B (n = 25) included patients who underwent temporal craniotomy; and Group C (n = 39) included patients who underwent frontotemporal craniotomy. Maximal mouth opening (interincisor gap) and the frequency of limited mouth opening (maximum mouth opening < or = 2.5 cm) were evaluated before operation and 3 days, 1 wk, 2 wk, 1 mo, and 3 mo after operation. The three groups did not differ with respect to age, sex, body weight, height, operative time, anesthetic time, or maximum mouth opening before operation. The postoperative reduction in maximal mouth opening was significantly greater in Group C than in Group B. In Group C, the incidence of limited mouth opening was 33.3% and 20.5% 2 wk and 1 mo after operation, respectively; however, limited mouth opening resolved within 3 mo in most patients. Supratentorial craniotomies separated by short intervals can increase the risk of limiting the mandibular opening, which may result in a difficult intubation. Careful preoperative assessment of the airway is mandatory if patients have previously undergone temporal or frontotemporal craniotomy.
    Anesthesia & Analgesia 10/1996; 83(4):731-4. DOI:10.1097/00000539-199610000-00012 · 3.42 Impact Factor
  • Hajime Touho, Jun Karasawa, Hideyuki Ohnishi, Satoshi Ueda
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    ABSTRACT: Selective angiography of the vertebral arteries has not been performed in rabbit models. We used a tracker-10 microcatheter for selective vertebral artery angiography. Five Japanese male rabbits weighing 2.0 to 2.5 kg were used. The right femoral artery was identified and an 18-gauge Teflon catheter was introduced into the iliac artery. A Tracker-10 microcatheter was introduced through the 18-gauge Teflon catheter into the right vertebral artery under fluoroscopic guidance. Selective angiograms of the right vertebral artery were obtained using a bolus injection of 0.1 mL of iopamidol in all five rabbits. Selective vertebral artery angiograms could be obtained via the transfemoral route with the use of Tracker-10, and intraarterial selective administration of vasodilators will be achieved using our technique.
    Surgical Neurology 08/1996; 46(1):84-6. DOI:10.1016/0090-3019(95)00434-3 · 1.67 Impact Factor
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    ABSTRACT: To determine preoperative predictors of blood pressure reduction following dural opening during surgical evacuation of hematoma, we retrospectively assessed preoperative variables including clinical profile, hemodynamic parameters, neurological findings, and computed tomography (CT) scan results in 56 patients with traumatic acute subdural hematoma (ASDH). Patients were divided into two groups according to the degree of changes in mean arterial pressure (MAP) in response to dural opening. Group A (n = 18) had a MAP reduction > 20%, and group B (n = 38) had a MAP change within +/- 20% of baseline values (5 min before opening the dura). Significant relationships were found between MAP reductions > 20% and Glasgow coma scale (GCS) scores, abnormalities of the mesencephalic cistern on CT scan, pupillary abnormalities, and degree of midline shift. Low GCS score, absence of the mesencephalic cistern on CT scan, and bilaterally dilated pupils were particularly strong predictors of this amount of blood pressure reduction. The clinical outcomes of patients with MAP reduction > 20% following dural opening during surgery were significantly poorer than those of patients without this amount of blood pressure reduction. Our findings suggest that blood pressure reduction following opening of the dura in patients undergoing surgical evacuation of hematoma for traumatic ASDH may be predicted by careful preoperative assessment of neurological and CT scan findings.
    Journal of Neurosurgical Anesthesiology 04/1996; 8(2):117-22. DOI:10.1097/00008506-199604000-00003 · 2.35 Impact Factor
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    ABSTRACT: We monitored myogenic motor evoked potentials (MEPS) during intracranial surgery in 21 patients anesthetized with nitrous oxide in oxygen, fentanyl, and 0.75-1.5 minimum alveolar anesthetic concentration (MAC) isoflurane (n = 11) or sevoflurane (n = 10). The exposed motor cortex was stimulated with a single or train-of-five rectangular pulses at a high frequency (500 Hz), while the compound muscle action potentials (CMAPS) were recorded from the abductor pollicis brevis muscle. Neuromuscular block was monitored by recording the CMAPs from the abductor pollicis brevis muscle in response to electrical stimulation of the median nerve at the wrist (M-response). Stimulation of the motor cortex with a single pulse elicited MEPs in none of the patients, while stimulation with a train-of-five rectangular pulses at high frequency elicited MEPs in all patients. The relationship between MEP amplitude and the level of neuromuscular block induced by vecuronium infusion was evaluated in seven patients. For comparison of the individual measurements, the MEP amplitude at a M-response amplitude of 100% was calculated by means of the individual regression curve as 100% of MEP amplitude. There was a linear correlation between percent MEP amplitude and percent M-response amplitude (r = 0.81; P < 0.01). Intraoperative monitoring of MEP could be performed at a M-response amplitude above 90 % of the baseline value in 10 patients and at a M-response amplitude of 20%-50% of the baseline value in 11 patients. During monitoring of the 21 patients, MEPs did not change in 18 patients and disappeared in two patients. In the remaining patient, MEP amplitudes were attenuated to approximately 10% of the baseline value and recovered after cessation of surgical manipulation. In the two patients in whom MEPs disappeared, motor paresis developed postoperatively. We conclude that 1) intraoperative myogenic MEP monitoring is feasible during isoflurane or sevoflurane anesthesia if stimulation is performed with a short train of rectangular pulses, and 2) that electromyographic monitoring of neuromuscular block is useful to assess intraoperative MEP changes under partial neuromuscular block.
    Anesthesia & Analgesia 04/1996; 82(3):593-9. DOI:10.1097/00000539-199603000-00029 · 3.42 Impact Factor
  • H Touho, J Karasawa, H Ohnishi
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    ABSTRACT: The results of long-term follow-up studies of cerebral perfusion and vasodilatory capacity following administration of acetazolamide after serial vascular reconstructions in 25 patients with childhood moyamoya disease are reported. Cerebral perfusion was measured with 99mTc-hexamethylpropyleneamine oxime single-photon emission CT before and after IV administration of 10 mg/kg acetazolamide, which was performed both before and after vascular reconstruction by superficial temporal artery-middle cerebral artery anastomosis and encephalomyosynangiosis (first and second operations) and/or omental transplantation to the brain (third operation). Follow-up periods ranged between 12 and 24 months (mean +/- SD, 18.5 +/- 3.2 months) after the first operation. Repetitive transient ischemic attacks disappeared completely after serial vascular reconstructions in all patients. Before the first operation, cerebral perfusion in the territory of the middle cerebral artery on the side of initial operation was 83.9 +/- 4.7% and was significantly lower than that in the contralateral side (88.3 +/- 4.9%, n = 25; P < .0001, paired t test). Vasodilatory capacity on the side of the first operation was -18.4 +/- 2.5% and that on the contralateral side -14.4 +/- 2.1%. The former value was significantly lower than the latter value (n = 25; P < .0001, paired t test). After the first operation, cerebral perfusion and vasodilatory capacity on the side of initial operation were markedly improved, to 87.8 +/- 4.5% and -14.7 +/- 2.7%, respectively (n = 25; P < .0001, both cases, paired t test). Before the second operation, cerebral perfusion and vasodilatory capacity on the side of the second operation were 76.6 +/- 4.1% and -20.1 +/- 1.9%, respectively, and significantly lower than those before the first operation (n = 25; P < .0001, both cases, paired t test). Eight patients subsequently required bifrontal omental transplantation for repetitive paraparetic transient ischemic attacks after the second operation; they had low cerebral perfusion and vasodilatory capacity bilaterally in the territories of the anterior cerebral arteries (72.4 +/- 2.7% and -18.6 +/- 1.7%, respectively). After omental transplantation, both were significantly increased, to 81.9 +/- 3.4% and -11.8 +/- 1.9%, respectively (n = 25; P < .0001, both cases, paired t test). Hemodynamic compromise existed in patients with childhood moyamoya disease and was a major cause of development of ischemic symptoms. Regions in which hemodynamic compromise was present could be determined by measuring regional cerebral perfusion and vasodilatory capacity.
    Stroke 03/1996; 27(2):282-9. DOI:10.1161/01.STR.27.2.282 · 6.02 Impact Factor
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    ABSTRACT: The feasibility and usefulness of intraoperative electromyographic monitoring of the oculomotor nerve (CN III), trochlear nerve (CN IV), and abducens nerve (CN IV) were evaluated under conditions of partial neuromuscular blockade in 21 patients undergoing skill base surgery. Intracranial electrical stimulation of each nerve was performed, and compound muscle action potentials (CMAPs) were reconded from the inferior or superior rectus muscle, the superior oblique muscle, and the lateral rectus muscle for monitoring of CN III, IV, and VI, respectively. Partial neuromuscular blockade was achieved by controlled infusion of vecuronium titrated to eliminate about 90% of the twitch response of the abductor pollicis brevis to electrical stimulation of the median nerve. A total of 30 cranial nerves were stimulated intraoperatively. Of these, 29 were successfully monitored (19 CN III, 6 CN IV, 4 CN VI). A relationship was found between intraoperative findings of cranial nerve monitoring, such as disappearance of response and increase in latency and stimulus threshold during manipulation of a lesion, and the presence of postoperative nerve deficits. We conclude that intraoperative electromyographic monitoring of ocular motor nerves is feasible during partial neuromuscular blockade, and that partial neuromuscular blockade does not affect the relationship between findings of intraoperative monitoring and postoperative nerve function.
    Skull Base 02/1996; 6(1):9-15. DOI:10.1055/s-2008-1058908
  • H Touho, H Ohnishi, J Karasawa
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    ABSTRACT: An ultra-thin-walled 4-French catheter was used for angiography and as a guiding catheter for the Tracker-18 microcatheter in patients with intracranial dural arteriovenous fistulas (AVFs), spinal dural AVFs, spinal epidural AVF, meningioma, and acute embolic occlusion of major cerebral vessels. The 4-French guiding catheter was introduced through the transfemoral or transbrachial route. The guiding catheter and the guidewire were advanced to the aortic arch and then turned over just above the aortic valves, and finally the catheter was introduced into the external carotid artery or vertebral artery when the transbrachial approach was selected. Images of the intracranial vessels and spinal dural branches obtained were excellent in all cases. The Tracker-18 could smoothly be advanced to the target artery through the 4-French catheter in all patients. Endovascular treatment with the Tracker-18 can be performed using an ultra-thin 4-French guiding catheter, and safely via the transbrachial route.
    Neurologia medico-chirurgica 11/1995; 35(10):759-64. · 0.65 Impact Factor
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    ABSTRACT: A new technique using intravascular ultrasound has been used for diagnosis of coronary artery in order to obtain intravascular echo images. In this study, an intracisternally positioned ultrasound catheter was introduced obtaining serial echo images of the first segment (MI) of the middle cerebral artery in order to detect cerebral vasospasm following subarachnoid hemorrhage (SAH). Thirteen patients were admitted to Osaka Neurological Institute with SAH due to ruptured intracranial aneurysm. All patients underwent surgical neck clipping on the day of admission. In each patient, an 8 Fr. ultrasound imaging catheter (Cardiovascular Imaging Systems, Inc. (CVIS), Sunnyvale, CA) was detained intracisternally adjacent to the M1 segment following neck clipping of the aneurysm and placement of cisternal drainage(s) in the prepontine and/or distal portion of the Sylvian fissure. In order to detain the mirro device near the M1 segment, the tip of a 2.0 cm cisternal drainage tube (SILASCON, E-3L-12, Kaneka Medix Co, Osaka, Japan) was attached to the tip of the intravascular ultrasound catheter with 3-0 silk suture. The tip was placed in the prechiasmal cistern. Angiographic evidence of delayed vasospasm was obtained for three (23.1%) of the 13 patients. In one (33.3%) of the three patients who had angiographic evidence of vasospasm (25% stenosis), decrease in the inner diameter of the M1 segment was detected on the echo images, but in the other two (66.7%), no such decrease was noted on echo images. Angiographically identified vasospasm in the latter patients was associated with only 10% stenosis. Intracisternally positioned ultrasound catheter can be used for intermittent measurement of the diameter of a target artery for detection of cerebral vasospasm after SAH.
    Surgical Neurology 11/1995; 44(4):319-25. DOI:10.1016/0090-3019(95)00158-1 · 1.67 Impact Factor
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    ABSTRACT: Superficial temporal artery (STA)-superior cerebellar artery (SCA) anastomosis, and STA-posterior cerebral artery (PCA) anastomosis are considered suitable as surgical procedures for the treatment of patients with significant stenosis or occlusion in the rostral portion of the basilar artery and patients with significant stenosis or occlusion of the posterior cerebral artery, respectively. However, several authors have reported frequent and serious complications of these surgical procedures, including temporal lobe retraction edema and hematoma. In this study, we introduce a new surgical revascularization using an occipital interhemispheric transtentorial approach for the treatment of severe stenosis of the rostral portion of the basilar artery. A 47-year-old man with hypertension noted the sudden onset of nuchal pain followed by vertigo, diplopia, drunken gait, and motor weakness on his right side. Angiography performed on the day of the onset disclosed severe stenosis of the basilar artery. The stenotic portion extended just distal to the anterior-inferior cerebellar artery (AICA) to just proximal to the SCA, and in addition, a pseudolumen was visualized just distal to the left AICA. The patient underwent right occipital artery (OA) to left PCA anastomosis with interposition of the STA using an occipital interhemispheric transtentorial approach. Marked improvement in dysarthria, diplopia, ataxia gait, and visual disturbance were noted and he was able to walk without aid 3 days after operation. A postoperative angiogram of the right OA obtained 25 days after operation demonstrated visualization of the left PCA via the anastomosed OA and STA graft. OA-PCA anastomosis with interposition of STA graft using an occipital interhemispheric transtentorial approach can be substituted for STA-SCA anastomosis and STA-PCA anastomosis for treatment of stenosis/occlusion of the rostral portion of the basilar artery.
    Surgical Neurology 10/1995; 44(3):245-9; discussion 249-50. DOI:10.1016/0090-3019(95)00052-6 · 1.67 Impact Factor
  • Anesthesiology 09/1995; 83(2):434-5. DOI:10.1097/00000542-199508000-00037 · 6.17 Impact Factor
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    ABSTRACT: We report our experience with anesthetic care for six patients with pseudoankylosis of the mandible following neurosurgical procedures, four of whom required fiberoptically guided intubation for anesthesia. We suggest that the development of operative approaches and reconstruction techniques in skull base surgery may increase the risk of difficult airway due to limitation of mouth opening.
    Journal of Neurosurgical Anesthesiology 08/1995; 7(3):183-6. DOI:10.1097/00008506-199507000-00005 · 2.35 Impact Factor

Publication Stats

662 Citations
116.79 Total Impact Points

Institutions

  • 2001
    • Osaka Police Hospital
      Ōsaka, Ōsaka, Japan
  • 1994–1998
    • Nara Medical University
      • • Department of Neurosurgery
      • • Department of Anesthesiology
      Nara, Nara, Japan
    • Osaka University
      • Division of Neurosurgery
      Suika, Ōsaka, Japan