Naoyuki Harada

Toho University, Edo, Tokyo, Japan

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Publications (38)30.37 Total impact

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    ABSTRACT: We prepared rapid prototyping models of heads with unruptured cerebral aneurysm based on image data of computed tomography angiography (CTA) using a three-dimensional (3D) printer. The objective of this study was to evaluate the anatomical reproducibility and accuracy of these models by comparison with the CTA images on a monitor. The subjects were 22 patients with unruptured cerebral aneurysm who underwent preoperative CTA. Reproducibility of the microsurgical anatomy of skull bone and arteries, the length and thickness of the main arteries, and the size of cerebral aneurysm were compared between the CTA image and rapid prototyping model. The microsurgical anatomy and arteries were favorably reproduced, apart from a few minute regions, in the rapid prototyping models. No significant difference was noted in the measured lengths of the main arteries between the CTA image and rapid prototyping model, but errors were noted in their thickness (p < 0.001). A significant difference was also noted in the longitudinal diameter of the cerebral aneurysm (p < 0.01). Regarding the CTA image as the gold standard, reproducibility of the microsurgical anatomy of skull bone and main arteries was favorable in the rapid prototyping models prepared using a 3D printer. It was concluded that these models are useful tools for neurosurgical simulation. The thickness of the main arteries and size of cerebral aneurysm should be comprehensively judged including other neuroimaging in consideration of errors.
    Full-text · Article · Jun 2015 · Neurologia medico-chirurgica
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    Preview · Article · Jan 2015 · Spinal Surgery
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    ABSTRACT: Aneurysms associated with hemangioblastoma are very rare. We encountered a patient in whom an aneurysm of the distal superior cerebellar artery, the main feeding vessel of cerebellar hemangioblastoma, ruptured and caused hemorrhage. On the basis of the computed tomography findings, the superior cerebellar artery aneurysm was identified as the source of hemorrhage, and embolization using a Guglielmi detachable coil was performed in subsequent endovascular surgery. Endovascular embolization was applied to the artery feeding the tumor at 4 weeks after admission, and the tumor was removed using an occipital transtentorial approach. A favorable therapeutic outcome may be expected when using a combination of endovascular therapy and surgical craniotomy for aneurysms associated with hemangioblastoma.
    No preview · Article · Nov 2014 · Neurosurgery Quarterly
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    ABSTRACT: Aneurysms associated with hemangioblastoma are very rare. We encountered a patient in whom an aneurysm of the distal superior cerebellar artery, the main feeding vessel of cerebellar hemangioblastoma, ruptured and caused hemorrhage. On the basis of the computed tomography findings, the superior cerebellar artery aneurysm was identified as the source of hemorrhage, and embolization using a Guglielmi detachable coil was performed in subsequent endovascular surgery. Endovascular embolization was applied to the artery feeding the tumor at 4 weeks after admission, and the tumor was removed using an occipital transtentorial approach. A favorable therapeutic outcome may be expected when using a combination of endovascular therapy and surgical craniotomy for aneurysms associated with hemangioblastoma.
    No preview · Article · Nov 2014 · Neurosurgery Quarterly
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    ABSTRACT: Background: To investigate the association between subarachnoid hemorrhage-induced delayed cerebral vasospasm (DCVS) and oxidative stress, an oxidation product, hydroperoxide, was measured in 3 specimens: peripheral arterial blood, cerebrospinal fluid (CSF), and internal jugular venous blood (IJVB). Methods: Hydroperoxide was measured using the diacron reactive oxygen metabolites (d-ROMs) test. The hydroperoxide levels were evaluated based on the rate of change in the d-ROMs test value on day 6 relative with that on day 3 (d-ROMs change rate). Results: The subjects were 20 patients. The d-ROMs change rate in IJVB was significantly higher in patients with DCVS on day 6 than in those without it (P < .01). When the patients were classified into the following 3 groups: Group A (no DCVS occurred throughout the clinical course); Group B (DCVS occurred, but no cerebral infarction [CI] was induced); and Group C (DCVS occurred and caused CI), the d-ROMs change rate in IJVB was the highest in Group C, followed by Group B then A (P < .01). The d-ROMs change rates in peripheral arterial blood and CSF were not related to the development of DCVS. Conclusions: It was concluded that the more severe DCVS occurs and is more likely to progress to CI as the IJVB hydroperoxide level rises early after the development of subarachnoid hemorrhage.
    No preview · Article · Oct 2014 · Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association
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    ABSTRACT: Intractable hiccups caused by an intracranial mass lesion are rare. We encountered surgical cases of cavernous angioma and hemangioblastoma in the medulla oblongata, which manifested with intractable hiccups. Herein, we report on 2 cases: case 1, a 30-year-old woman with a past medical history of surgery for cerebellar hemangioblastoma. The disease manifested with intractable hiccups, and a mass lesion was observed in the medulla oblongata on magnetic resonance imaging (MRI). During surgery, a vascular-rich tumor was localized near the obex of the mid-dorsal portion of the medulla oblongata. The hiccups were resolved immediately after total tumor excision, no event occurred thereafter, and the patient was discharged. The pathologic diagnosis was hemangioblastoma. Case 2, in a 22-year-old man, a lesion was observed in the dorsal portion of the medulla oblongata on computed tomography and MRI was performed to investigate the cause of intractable hiccups. During surgery, a mass lesion was present in the right dorsolateral aspect of the medulla oblongata. The hiccups resolved immediately after total excision of the lesion. No neurological deficit occurred, and the patient was discharged. The lesion was pathologically diagnosed as a cavernous angioma. In conclusion, a search for a dorsal medullary lesion using MRI is necessary when investigating intractable hiccups. To resolve intractable hiccups, the active application of surgical excision of the mass lesion is recommended.
    No preview · Article · Apr 2014 · Neurosurgery Quarterly
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    ABSTRACT: Basal encephalocele is rare in adults. Congenital and acquired cases have been reported with regard to the developmental mechanism, and the pathology has not been elucidated in detail. We encountered an adult with basal encephalocele strongly suggesting congenital development because of the presence of minor anomalies: strabismus and ocular hypertelorism. The disease manifested as persistent spontaneous cerebrospinal fluid rhinorrhea and repeated meningitis in a 66-year-old Japanese man. On computed tomography, brain tissue protruded through a part of the ethmoid bone of his right anterior skull base, and it was diagnosed as transethmoidal-type basal encephalocele. Regarding his facial form, the distance between his bilateral eyeballs was large compared to his facial width, and his canthal index (defined as inner to outer inter canthal ratio x 100) was calculated as 38.5, based on which it was judged as ocular hypertelorism. In addition, his right eyeball showed strabismus. A right frontotemporal craniotomy was performed for spontaneous cerebrospinal fluid rhinorrhea, and the defective dura mater region was patched with temporal fascia. Mild minor anomalies that require no treatment are overlooked in adults, but the presence of several anomalies increases the possibility of congenital disease. Therefore, it may be necessary to examine minor anomalies in cases of adult basal encephalocele when considering the possibility that the disease may be congenital.
    Full-text · Article · Jan 2014 · Journal of Medical Case Reports
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    ABSTRACT: Objective: To prevent posterior transpetrosal approach–induced liquorrhea, we developed a method involving the double application of abdominal adipose tissue in the subdural and epidural spaces. Materials and Methods: The method was applied to 8 patients who underwent surgery under a posterior transpetrosal approach: 4 with petroclival meningioma and 1 each with tentorial meningioma, jugular foramen neurinoma, trigeminal neurinoma, and metastatic brain tumor. The combined transpetrosal approach was used for 6 patients and the combination with the lateral suboccipital approach was used for the other 2 patients. After tumor resection, the divided dura mater of the presigmoid space was closed as follows: first, a fat mass excised from the abdominal region was divided into 2 parts, and several excisions were made in each part to flatten them. The exposed brain surface was covered with the flattened fat, and the fat margin was circumferentially inserted under the dura mater. The division was then closed by suturing the dural stumps at several sites, loading tension to some extent. Finally, the other part of the adipose tissue was spread in the epidural space in the dural-defective region for double closure inside and outside the dura mater. Results: Liquorrhea was prevented in all patients. Conclusions: It was concluded that this method is useful to prevent postoperative liquorrhea induced by a posterior transpetrosal approach.
    No preview · Article · Aug 2013 · Neurosurgery Quarterly

  • No preview · Article · Jan 2013
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    ABSTRACT: We describe the successful use of Shakuyaku-kanzo-to to treat 2 patients with intractable hiccups due to brain stem infarction. The patients had developed lateral medullary infarction and presented with dizziness, vomiting, facial paresthesia, and cerebellar deficits on the infarction side; disturbance of pain sensation and temperature sensation below the neck on the contralateral side; and Wallenberg syndrome. Patient 1 was a 55-year-old man who had a right lateral medullary infarction, followed by intractable hiccups, i.e., hiccups persisting 5 days or longer. No improvement was noted after treatment with breath holding, pharyngeal stimulation, or chlorpromazine. However, treatment with 7.5 g/day Shakuyaku-kanzo-to promptly resolved his hiccups. Patient 2 was a 47-year-old man who had a left lateral medullary infarction, followed by intractable hiccups. Treatment with chlorpromazine and metoclopramide, in combination with pharyngeal stimulation, resulted in temporary improvement, but recurrence occurred shortly thereafter, and intermittent hiccups continued. Treatment with 7.5 g/day Shakuyaku-kanzo-to improved his hiccups, which completely resolved after additional treatment with chlorpromazine. Shakuyaku-kanzo-to is an herbal medicine with limited side effects and potentially immediate action and should be considered for treatment of central hiccups.
    No preview · Article · May 2012
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    ABSTRACT: The trans-sylvian approach is one of the most frequently employed neurosurgical procedures, but it is difficult for medical students to understand the approach stereoscopically. A three-dimensional model equipped with an arachnoid membrane and sylvian vein was developed which can be repeatedly used to simulate surgery for the education of medical students and residents in the trans-sylvian approach. The model was prepared using existing models of the skull bone, brain, and cerebral artery. Polyvinylidene chloride film, commonly used as plastic wrap for food, was adopted for the arachnoid membrane, and wetted water-insoluble tissue paper for the arachnoid trabeculae. The sylvian vein was prepared by ligating woolen yarn with cotton lace thread at several sites. Students and residents performed the trans-sylvian approach under a microscope, and answered a questionnaire survey. Using this model, simulation of division of the arachnoid membrane and arachnoid trabeculae, and dissection of the sylvian vein was possible. In the questionnaire, the subjects answered 8 questions concerning understanding of the stereoscopic anatomy of the sylvian fissure, usefulness of the simulation, and interest in neurosurgical operation using the following ratings: yes, very much; yes; somewhat; not very much; or not at all. All items rated as 'yes, very much' and 'yes' accounted for more than 70% of answers. This model was useful for medical students to learn the trans-sylvian approach. In addition, repeated practice is possible using cheap materials, which is advantageous for an educational model.
    No preview · Article · Aug 2011 · Neurologia medico-chirurgica
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    ABSTRACT: We describe a case of metastatic petroclival tumor that was difficult to differentiate preoperatively from petroclival meningioma. A 65-year-old woman with initial symptoms of headache and diplopia developed left facial nerve palsy, left facial paresthesia, and subsequent rapid exacerbation of neurological deficits. Her past history included surgery at another hospital 3 years previously for cancer of the body of the uterus. Magnetic resonance imaging revealed a left petroclival tumor with homogeneous enhancement. Bone-window computed tomography showed marked destruction of the petrous bone. The tumor was removed by using a combined transpetrosal approach. The histological diagnosis was metastatic adenocarcinoma from a primary lesion in the body of the uterus. A dural metastatic tumor in the petroclival region caused rapid exacerbation of neurological deficit and marked destruction of the petrous bone, which suggests that these findings are useful in differentiating such tumors from petroclival meningioma.
    No preview · Article · May 2011
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    ABSTRACT: Punch-drunk syndrome (PDS) refers to a pathological condition in which higher brain dysfunction occurs in a delayed fashion in boxers who have suffered repeated blows to the head. However, the underlying mechanisms remain unknown. This study attempted to elucidate the mechanism of higher brain dysfunction observed following skull vibration in two experiments involving a rat model of PDS. Experiment 1 evaluated the effects of edaravone on histological changes in the rat brain tissue after skull vibration (frequency 20 Hz, amplitude 4 mm, duration 60 minutes). The amount of free radicals formed in response to skull vibration was very small, and edaravone administration reduced the number of glial fibrillary acidic protein and advanced glycation end product-positive cells. Experiment 2 examined the time course of change in learning ability following skull vibration in Tokai High Avoider rats. The learning ability of individual rats was evaluated by the Sidman-type electric shock avoidance test 5 days after the last session of skull vibration or final anesthesia and once a month for 9 consecutive months. Delayed learning disability was not observed in rats administered edaravone immediately after skull vibration. These results suggest that free radical-induced astrocyte activation and subsequent glial scar formation contribute to the occurrence of delayed learning disabilities. Edaravone administration after skull vibration suppressed glial scar formation, thereby inhibiting the occurrence of delayed learning disabilities.
    No preview · Article · Jan 2011 · Neurologia medico-chirurgica
  • T. Kuroki · M. Nemoto · N. Harada · K. Kondo · C. Miyazaki · T. Nagao · N. Sugo
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    ABSTRACT: The patient was an 8-year-old girl who suffered an injury to the pons, as well as traumatic pneumocephalus, skull base fracture, and cerebrospinal fluid (CSF) rhinorrhea due to a traffic accident. Liquorrhea stopped spontaneously 3 days after injury. Eighteen days after injury, post-traumatic hydrocephalus (PTH) was diagnosed by computed tomography (CT), and her level of consciousness improved from Japan coma scale (JCS) 10 to 3 after external ventricular drainage (EVD), followed by ventriculoperitoneal (VP) shunting. However, about 1 month after treatment for PTH, tension pneumocephalus was revealed by CT, and the shunt system was removed on the same day. A bone defect in the right cribriform plate was detected by multi-detector CT, a cyst was found in the right frontal lobe by magnetic resonance imaging (MRI), and a fistula communicating from the inside to the outside of the cranium was identified at this site. Three months after injury, the fistula was surgically closed by bilateral coronal craniotomy, and an Ommaya reservoir was inserted into the lateral ventricle. Four months after injury, VP shunting was performed, and the patient had an uneventful postoperative course. In patients with PTH accompanied by skull base fracture and liquorrhea, attention should be paid to the possible occurrence of tension pneumocephalus after VP shunting.
    No preview · Article · Jul 2010
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    ABSTRACT: We describe a patient with cerebral embolism caused by blunt cervical trauma-related dissection of the internal carotid artery (ICA). Two days after injury, right paresis and aphasia occurred. Traumatic ICA dissection was diagnosed based on findings from head magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and carotid ultrasonography. Despite anticoagulant therapy, the patient's symptoms worsened and the size of the cerebral infarct increased. A 20-minute transcranial Doppler test using a high-intensity transient signal in the left middle cerebral artery was positive. In the area supplied by the ICA, we observed aggravation of the cerebral infarction due to a drop in perfusion pressure, which threatened to exacerbate the neurological symptoms. Therefore, to avoid thrombus dislodgement, emergency embolization of the ICA was performed. There was no subsequent exacerbation of neurological symptoms. One month after the procedure, superficial temporal artery-middle cerebral artery anastomosis was performed. The patient's course was favorable. Early diagnosis of carotid occlusion due to traumatic ICA dissection is difficult because it is rare and often asymptomatic at the time of injury. We believe that carotid ultrasonography is a rapid and useful diagnostic examination.
    No preview · Article · May 2010
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    ABSTRACT: Herein, we describe 2 patients with unusually dilated Virchow-Robin spaces (VRS). Case 1 was a 40-year-old man who was referred to our hospital for suspected multiple lacunar infarctions that had been noted on a computed tomography (CT) scan of the head. Magnetic resonance imaging (MRI) revealed multiple round lesions in the white matter proximal to the bilateral lateral ventricles and highconvexity white matter. On T1-weighted, T2-weighted, and fluid-attenuated inversion recovery images, signal intensities similar to those observed in cerebrospinal fluid were noted. Cerebral blood flow was normal on single-photon emission computed tomography (SPECT). Case 2 was a 63-year-old woman who had undergone health screening, during which MRI revealed round lesions in the white matter proximal to the left lateral ventricle. The signal intensity on cerebrospinal fluid and magnetic resonance (MR) images were identical as in case 1. No abnormality was noted on magnetic resonance angiography in either patient The size of VRS varies among individuals. Although no invasive diagnostic examination or treatment is necessary for dilated VRS, differentiation from lacunar infarction based on neuroradiologic characteristics is clinically important.
    No preview · Article · Jul 2009
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    ABSTRACT: We describe a case of successful surgical treatment of medically intractable frontal lobe epilepsy due to meningioangiomatosis. A 14-year-old girl presented at another facility for treatment of generalized convulsions. On CT and MRI, an abnormal shadow was noted in the medial left frontal lobe. On the basis of these findings, angioma was diagnosed, and antiepileptic drugs were prescribed. At the age of 15 years, she sought treatment at our hospital for continuing complex partial seizures originating in the frontal lobe that were accompanied by mild disturbance of consciousness. The attacks lasted several seconds and occurred approximately monthly. A stereotactic brain biopsy was performed; however, the findings were inconclusive, and antiepileptic drug therapy was continued. At the age of 23 years, the frequency and duration of the attacks increased, and generalized convulsions began to recur. After the focus was determined by electrocorticography via chronic subdural electrodes, the lesion was excised, along with the adjacent irritable zone that had been identified by intraoperative electrocorticography. No epilepsy attack has occurred in the 6 years since the surgery.
    No preview · Article · Nov 2008
  • A. Goto · Y. Aoki · T. Kano · N. Harada · K. Kondo · K. Yokota · M. Nemoto · S. Goto · Y. Seiki · N. Sugo
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    ABSTRACT: Objective: To evaluate the usefulness of the pterion plate in preventing depression of the lateral side of the orbita after frontotemporal craniotomy. Methods: Forty patients who underwent frontotemporal craniotomy at our facility were studied: 20 received pterion plates during surgery (pterion plate group) and 20 did not (non-pterion plate group). In all patients, postoperative bone window CT was used to confirm the presence or absence of a depression (≥ 5 mm) on the lateral side of the orbita. Patient satisfaction was assessed by a questionnaire. Results: Depression of the lateral side of the orbita on postoperative bone window CT was noted in none of the subjects in the pterion plate group and in 12 (60%) of the subjects in the non-pterion plate group (p < 0.01). Patient satisfaction was higher in the pterion plate than in the non-pterion plate group (p < 0.01). Conclusion: Findings from bone window CT and the questionnaire indicate that the pterion plate is effective in preventing postoperative depression of the lateral side of the orbita during frontotemporal craniotomy.
    No preview · Article · Sep 2008
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    ABSTRACT: We describe a case of rapid spontaneous disappearance of traumatic intracerebral hematoma (t-ICH). The patient was a 43-year-old man who fell from a height of four meters and sustained a contusion of the right temporal region. On arrival at our hospital, his consciousness level was GCS 14 (E4V4M6), and leakage of bloody cerebrospinal fluid (CSF) from the right external auditory meatus was observed. Computed tomography (CT) revealed a t-ICH in the temporal lobe, continuous with an acute subdural hematoma (ASDH). Two hours after admission, the high-density t-ICH had changed to mixed density on CT images; 16 hours after admission, it had disappeared on CT images. The patient was subsequently discharged with no neurological symptoms except for right hearing impairment and right facial palsy. The course of this patient suggests that t-ICH which appear as mixed density lesions on CT images and are associated with liquorrhea may disappear rapidly and spontaneously.
    No preview · Article · Sep 2008
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    ABSTRACT: Background: We describe our experience of the limitations and accuracy of neurosurgery with a neuronavigator. Material and Methods: The subjects were 44 patients who underwent neurosurgery with the neuronavigator in our hospital over a 1-year period. Thirty-seven patients had intracranial tumors 2 had skull tumors, 2 had intraorbital tumors, 2 had posttraumatic rhinorrhea, and one had aneurysm. Based on the patient's medical records, we qualitatively evaluated the usefulness of the neuronavigator in the determination of the extent of craniotomy and in subdural procedures. In 36 of these patients, we investigated the concordance between image data and the patient's heads after registering the data in the neuronavigator. Results: In all patients, the neuronavigator was useful for determining the sites of skin incision and bone resection. During subdural procedures, it was possible to demarcate the lesion site in 36 (81.8%) of the 44 patients. In the other 8 patients (18.2%), there was a discrepancy between the visualized lesion site and the actual position of the lesion during surgery. Six of these 8 patients had intraaxial lesions (5 had tumors, 1 had an aneurysm) and the other 2 patients had intraorbital tumors. Registration accuracy was 1.43 ± 0.33 mm (mean ± standard deviation) using an image marker and 0.69 ± 0.14 mm with surface matching (p < 0.001). Conclusion: The mean deviation for the accuracy of this system was 1 mm or less when registration with image markers was combined with surface matching. The neuronavigator was useful for determining the extent of craniotomy and for demarcating the lesion site during neurosurgery. However, its accuracy during subdural procedures for intraaxial lesions was lower.
    No preview · Article · Mar 2007

Publication Stats

532 Citations
30.37 Total Impact Points

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Institutions

  • 2001-2015
    • Toho University
      • Department of Neurosurgery
      Edo, Tokyo, Japan
  • 1997
    • Universität Ulm
      • Institute of General Medicine
      Ulm, Baden-Wuerttemberg, Germany