Noboru Takahashi

Aomori Prefectural Central Hospital, Aomori, Aomori, Japan

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Publications (16)5.22 Total impact

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    ABSTRACT: Subarachnoid hemorrhage (SAH) is usually elicited by cerebrovascular disease and infrequently by brain tumors. A 64-year-old woman presented with SAH with a left petrous meningioma and an unruptured left internal carotid-posterior communicating artery (IC-PcomA) aneurysm. She suffered sudden onset of headache and nausea followed by consciousness disturbance 7 days after onset. Computed tomography (CT) revealed diffuse SAH and a tumor at the petrous portion. Angiography demonstrated a left IC-PcomA aneurysm. Under a diagnosis of a ruptured aneurysm and a coincidental meningioma, we performed neck clipping of the aneurysm. However, intraoperatively we found that the aneurysm was unruptured and we subsequently performed tumor resection. Intraoperatively we could not find the cause of SAH during resection of the meningioma. The histological diagnosis was transitional meningioma with deposition of fibrin on the surface of the tumor. The findings of initial CT and magnetic resonance imaging, and pathological results could not conclude the definitive etiology of SAH in this case.
    No preview · Article · May 2013 · Neurologia medico-chirurgica
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    ABSTRACT: A 29-year-old man presented with a primary sellar turcica osteochondroma manifesting as intratumoral hemorrhage mimicking pituitary apoplexy. The patient suffered sudden onset of headache concomitant with vision loss in the left eye. Radiography and computed tomography detected destruction and calcification of the sellar turcica. Magnetic resonance imaging revealed a heterogeneously enhanced suprasellar mass that had elevated and compressed the optic chiasm. The preoperative diagnosis was hemorrhagic pituitary adenoma, craniopharyngioma, meningioma, or chordoma based on the signal heterogeneity of the lesion. To relieve the symptoms and make a definitive diagnosis, surgical removal via a basal interhemispheric approach was carried out. The tumor was not totally removed because of tight adhesion to the pituitary stalk, but postoperative ophthalmological examination revealed improvement of the visual disturbance. The histological diagnosis was osteochondroma based on the presence of mature chondrocytes and osteomatous tissue. Osteochondroma should be included in the differential diagnosis of tumors with acute hemorrhage in the sella turcica.
    No preview · Article · Feb 2009 · Neurologia medico-chirurgica
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    ABSTRACT: A 55-year-old man presented with a rare case of multiple isolated sinus dural arteriovenous fistulas (AVFs) associated with antithrombin (AT) III deficiency manifesting as sudden onset of headache and gait disturbance. Increased arterial shunting flow had caused intraventricular hemorrhage after incomplete repeated transarterial embolization procedures for dural AVFs. Multiple isolated sinus dural AVFs were located in the anterior superior sagittal sinus (SSS) and transverse sinus, which were completely embolized by direct packing of the isolated sinuses via the SSS. The development of dural AVF is complicated and associated with a number of factors, such as congenital abnormality, head trauma, craniotomy, radiation, hematological abnormality, and sinus thrombosis. Hematological abnormality is a risk factor of sinus thrombosis. In the present case, the multiple isolated sinus dural AVFs might have resulted from the aggravation of multiple dural AVFs and the coagulative tendency due to AT III deficiency. Direct sinus packing should be considered if transvenous catheterization is difficult or fails.
    No preview · Article · Nov 2008 · Neurologia medico-chirurgica
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    ABSTRACT: A 55-year-old man presented with a rare case of multiple isolated sinus dural arteriovenous fistulas (AVFs) associated with antithrombin (AT) III deficiency manifesting as sudden onset of headache and gait disturbance. Increased arterial shunting flow had caused intraventricular hemorrhage after incomplete repeated transarterial embolization procedures for dural AVFs. Multiple isolated sinus dural AVFs were located in the anterior superior sagittal sinus (SSS) and transverse sinus, which were completely embolized by direct packing of the isolated sinuses via the SSS. The development of dural AVF is complicated and associated with a number of factors, such as congenital abnormality, head trauma, craniotomy, radiation, hematological abnormality, and sinus thrombosis. Hematological abnormality is a risk factor of sinus thrombosis. In the present case, the multiple isolated sinus dural AVFs might have resulted from the aggravation of multiple dural AVFs and the coagulative tendency due to AT III deficiency. Direct sinus packing should be considered if transvenous catheterization is difficult or fails.
    No preview · Article · Jan 2008 · Neurologia medico-chirurgica

  • No preview · Article · Jan 2006 · Surgery for Cerebral Stroke
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    ABSTRACT: A 12-year-old female suffered from intermittent headache with nausea. Neuroradiologic studies demonstrated a cystic lesion in the right trigone with content like cerebrospinal fluid. The right inferior horn was isolated and increased in size. Eodoscopic fenestration was attempted using a flexible fiberscope via the inferior horn. Postoperative magnetic resonance image revealed shrinkage of the cyst and reduced size of the right inferior horn. Intermittent headache dissapeared. Neuroendoscopic treatment is a less invasive and effective therapy for intraventricular arachnoid cyst as well that in the other intracranial lesion.
    No preview · Article · Jan 2006 · No shinkei geka. Neurological surgery
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    ABSTRACT: Homocystinuria is a congenital metabolic disorder, and has been known as life-threatening risk factor of vascular disease including ischemic stroke. We report a case of cerebral infarction due to homocystinuria. The patient was a 21-year-old woman exhibiting left hemiparesis and a previous history of ectopia lentis. Magnetic resonance imaging showed multiple fresh infarctions in the right frontal and temporal lobes, basal ganglia, corona radiata, and internal capsule. The right common carotid angiogram demonstrated complete occlusion at the origin of the right internal carotid artery. Further investigation clarified increased level of serum methionine and homocysteine and urinary homocystin due to cystathionine beta-synthase deficiency. Homocystinuria was diagnosed as the cause of cerebral infarction. The patient was treated by low methionine diet and administration of folic acid, cobalamin, and aspirin. It should be recognized that some patients with homocystinuria are missed in the neonatal screening for congenital metabolic disorders. Recent studies indicated that the homocysteinemia is one of risk factors of ischemic stroke in the general population as well as in the patients of homocystinuria. We recommend metabolic screening for homocystinuria, when treating a juvenile patient with ischemic stroke of unknown etiology.
    No preview · Article · Oct 2004 · Nō to shinkei = Brain and nerve
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    ABSTRACT: Superficial siderosis of the central nervous system (SS) is a rare clinical syndrome due to repeated intracranial hemorrhage. We report a case of SS occurring 19 years after subtotal removal of a non-functioning pituitary adenoma. The patient was a 37-year-old female, exhibiting progressive bilateral sensory neural hearing loss and cerebellar ataxia. T2 weighted magnetic resonance imaging demonstrated a rim of low intensity signal on the cerebellum, brain stem, and sylvian fissure. Immediate diagnosis based on characteristic symptoms and MRI findings is important for the prevention of irreversible progression of SS.
    No preview · Article · Oct 2004 · No shinkei geka. Neurological surgery
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    ABSTRACT: We report a case presenting with subarachnoid hemorrhage due to a ruptured aneurysm associated with unilateral moyamoya disease. The patient was a 29-year-old woman exhibiting sudden onset headache. Computed tomography revealed subarachnoid hemorrhage around the brain stem. Cerebral angiography showed a saccular aneurysm at the junction of the left P1 portion of the posterior cerebral artery and its perforator. The right internal carotid artery was occluded at the terminal portion, and the right middle cerebral artery territory was perfused anterogradely via abnormal moyamoya vessels in the basal ganglia. The aneurysm was completely embolized with preservation of the perforator. We suggest that as compared to surgical clipping by craniotomy, endovascular therapy is safe and effective for treatment of intracranial aneurysms associated with moyamoya disease.
    No preview · Article · Mar 2004 · No shinkei geka. Neurological surgery

  • No preview · Article · Jan 2004 · Surgery for Cerebral Stroke

  • No preview · Article · Jan 2004 · Nosotchu
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    ABSTRACT: We report a case of hydrocephalus due to posterior cranial fossa subdural effusion. The patient was a 4-year-old boy, presenting headache and nausea, with a medical history of viral meningitis 2 months before. Cerebrospinal fluid provided no evidence of infection, and symptoms caused by increased intracranial pressure gradually deteriorated, although glycerol infusion was effective temporarily. Computed tomography revealed marked ventriculomegaly with subdural effusion in the right posterior cranial fossa. The subarachnoid space in the posterior fossa was very tight, and the cerebellum and brain stem were compressed anteriorly. Magnetic resonance imaging demonstrated stenosis of the aqueduct and foramens of Luschka and Magendie. The cerebeller tonsil was dislocated inferiorly, indicating impending herniation, so an emergency operation was performed. Ventriculoperitoneal shunt was undertaken after implantation of an Ommaya reservoir for the posterior fossa subdural effusion. The patient's postoperative course was uneventful, and the symptoms were improved. Although hydrocephalus and subdural effusion following viral meningitis is rare, neuroimaging studies such as CT and MRI should be examined when a young child suffers from symptoms of increased intracranial pressure.
    No preview · Article · Oct 2003 · No shinkei geka. Neurological surgery
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    ABSTRACT: Intracranial dissecting aneurysms have been associated with subarachnoid hemorrhage (SAH) or cerebral ischemia. We encountered a patient presenting with simultaneous subarachnoid hemorrhage and brainstem infarction caused by a dissecting aneurysm of the vertebrobasilar artery, which was diagnosed by magnetic resonance imaging (MRI) but did not show abnormal findings on cerebral angiography. A 55-year-old man had sudden onset of headache and left abducens palsy. Computed tomography revealed a subarachnoid hemorrhage localized in the left prepontine cistern and the left cerebellomedullary fissure. Cerebral angiography showed neither a saccular aneurysm nor fusiform dilatation causing the subarachnoid hemorrhage. MRI demonstrated a small infarction in the left dorsal pons, and an intramural hematoma of the left vertebral artery and lower basilar artery. This is a rare case of a vertebrobasilar dissecting aneurysm that simultaneously caused both SAH and brain stem infarction. MRI should be performed in the acute phase of SAH of unknown origin to determine the possible coexistence of a dissecting aneurysm, as occurred in this case.
    No preview · Article · Feb 2003 · Surgical Neurology

  • No preview · Article · Jan 2003 · Surgery for Cerebral Stroke
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    ABSTRACT: We report a case presenting a brain abscess with multiple infectious aneurysms. A 59-year-old man was transferred to our hospital suffering from left hemiparesis. MRI demonstrated a huge mass in the right frontal lobe with marked brain edema in the surrounding area. Diffusion-weighted image revealed heterogenous intensity, which is not typical in cases of brain abscess. Surgical removal was planned, and preoperative angiography was performed. Angiography demonstrated aneurysms at the distal branch of both the right middle cerebral artery and the anterior cerebral artery. These aneurysms were surgically resected, and the abscess was totally removed. Postoperative course was uneventful. Left hemiparasis was resolved, and there was no ischemic lesion seen on postoperative MRI. In the treatment of brain abscess, stereotactic aspiration has recently been preferred to removal by craniotomy. We conclude that cerebral angiography might be necessary to evaluate cerebrovascular complications including infectious aneurysms, in cases presenting atypical findings in neuroimaging study.
    No preview · Article · Nov 2002 · No shinkei geka. Neurological surgery
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    ABSTRACT: We investigated the clinical features of 54 elderly patients aged over 80 years with ruptured intracranial aneurysms admitted to our hospital between May 1968 and December 2001. The changes in patient number, age, male/female ratio, site of cerebral aneurysm and preoperative Hunt & Kosnik grade were studied. The patients were divided into 2 groups (surgically treated group and conservatively treated group). Outcome was evaluated according to the Glasgow Outcome Scale, and the causes of poor results were analyzed.The number of patients calculated for 5-year periods is rising steadily, and reached 25 patients for the last 5 years (1997-2001), accounting for 46% of all. The mean age of the patients was 82.4 ± 2.5 (range 80-92 years), and 44 patients (81%) were under 84 years. The male/female ratio was 1:5. The location of 50 ruptured cerebral aneurysms (4 cases were excluded because cerebral angiography was not performed) were the internal carotid artery in 24 cases (48%), the middle cerebral artery in 12 cases (24%), the anterior communicating artery in 11 cases (22%), the anterior cerebral artery in 2 cases (4%), and the basilar artery in 1 case (2%). Their preoperative neurological grades, according to the classification of Hunt & Kosnik, were II in 11 cases (20%), III in 17 cases (31%), IV in 14 cases (26%) and V in 12 cases (22%).Of 54 cases, 26 were treated surgically: neck clipping of cerebral aneurysms was performed in 21 cases, wrapping of cerebral aneurysms in 2 cases, transarterial embolization of cerebral aneurysms in 3 cases and the remaining 28 cases were treated conservatively. The clinical outcome of the surgically treated group was GR in 4 cases (15%), MD in 5 cases (19%), SD in 6 cases (23%), VS in 2 cases (8%) and D in 9 cases (35%). The preoperative Hunt & Kosnik grades of the 4 GR cases were II in 1 case, III in 2 cases, and IV in 1 case. Cerebral infarction caused by cerebral vasospasm was revealed in 10 (38%) of 26 surgically treated cases. The preoperative Hunt & Kosnik grades of these 10 cases were II in 4 cases and III in 6 cases. The clinical outcome was MD in 1 case, SD in 1 case, VS in 1 case and D in 7 cases. Cerebral infarction caused by cerebral vasospasm during the last 5 years (1997-2001) was revealed in 3 (23%) of 13 surgically treated cases, although it was 7 (54%) of 13 cases before 1996. Twenty-two of 28 (79%) conservatively treated cases were serious (Hunt & Kosnik grade IV, V). The clinical outcome was GR in 1 case, SD in 2 cases, VS in 3 cases and D in 22 cases. Causes of death were primary brain damage in 14 cases, re-rupture in 4 cases, cerebral vasospasm in 3 cases and pneumonia in 1 case. It is necessary for determination of surgical indication to evaluate primary brain damage more strictly. And it is indispensable for improvement of operative outcome to take measures for cerebral vasospasm and general complications.
    No preview · Article · Jan 2002 · Surgery for Cerebral Stroke