Y Terai

Okayama University, Okayama, Okayama, Japan

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Publications (25)20.57 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The benefits of intravenous thrombolysis for acute ischemic stroke are still limited. To evaluate the safety and efficacy of double-lumen balloon catheter-based reperfusion therapy with or without intra-arterial thrombolysis for acute occlusion of intracranial arteries. Fifty-nine patients with acute occlusion of intracranial arteries were enrolled. A Gateway balloon catheter was used to disrupt clots or dilate atheromatous plaques in every patient. The technical details, technique-related complications, recanalization rates, and clinical outcomes were analyzed. The occlusion sites were internal carotid arteries in 17 patients, M1 segments in 32 patients, the M2 segment in 1 patient, a vertebral artery in 1 patient, and basilar arteries in 8 patients. Twenty-four patients (41%) were treated with thrombolysis first, and 20 patients (34%) were treated with percutaneous transluminal angioplasty (PTA) followed by thrombolysis. PTA alone was performed in 15 patients (25%). The mean dose of urokinase was 205 x 10 U. The extent of recanalization was complete (Thrombolysis in Myocardial Infarction [TIMI] score of 3) in 17 patients (29%), and partial (TIMI 1/2) in 28 patients (47%). Functional independence at discharge was preserved in 76%, 25%, and 7% of patients with TIMI 3, TIMI 1/2, and TIMI 0, respectively. A combination of PTA and thrombolysis resulted in a significantly higher recanalization rate than PTA only. Seven patients (12%) experienced hemorrhagic events after treatment. Severe parenchymal hemorrhage with neurologic deterioration was observed in 2 patients (4%), and vessel rupture was encountered in 1 atherosclerotic case. Mechanical angioplasty using a Gateway catheter combined with a low-dose thrombolytic agent is a safe and effective treatment for acute intracranial embolic and atherosclerotic occlusion with a low risk of hemorrhagic complications.
    No preview · Article · Sep 2010 · Neurosurgery
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    Yoshinori Terai · Ichiro Kamata · Takashi Ohmoto
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    ABSTRACT: Moyamoya disease is a progressive vascular disorder of unknown etiology. Theories of inflammatory and immunologic mechanisms have been proposed as the pathogeneses. We have designed a new method of administering N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) for experimental induction of moyamoya disease using an intravascular interventional technique combined with rod-shaped embolic materials made from lactic acid-glycolic acid copolymer. The embolic materials containing MDP were repeatedly injected into the right internal carotid artery of monkeys in the embolic group. Intravenous injections of MDP solution alone were performed in the intravenous group. Histological examination of the arteries demonstrated reduplication and lamination of the internal elastic laminae, which corresponded with findings of moyamoya disease in both groups. These histological changes occurred not only in the intracranial arteries on the embolization side, but also in the contralateral intracranial and even extracranial arteries. The changes were more prominent in the intravenous group than in the embolic group. We conclude that the systemic humoral factors induced by MDP in this study may be important in the pathogeneses of moyamoya disease. Our observations suggest that moyamoya disease is a systemic vascular disease and has an etiologic factor affecting both intracranial and extracranial arteries
    Preview · Article · Nov 2003 · Acta medica Okayama
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    Ichiro Kamata · Yoshinori Terai · Takashi Ohmoto
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    ABSTRACT: In this study, we investigated the relationship between intimal thickening of the internal carotid artery (ICA) and immunological reaction, and between occlusion of the ICA and development of basal collateral vessels in moyamoya disease. Rod-shaped lactic acid-glycolic acid copolymer (LGA-50) and N-acetylmuramyl-L-alanyl-D-isoglutamine (muramyl dipeptide: MDP), and immuno-embolic material, were injected into cats unilaterally via the common carotid artery. Histological changes of duplication of the internal elastic lamina could be seen mainly in the terminal portion of the ICA in the animals injected with rod-shaped LGA-50 containing MDP. No angiographic changes were seen in any of the animals. These findings suggest that the immunological reaction induced by MDP caused histological changes in the intima of the ICA similar to those observed in moyamoya disease. This experimental study, however, could not clarify the development of the basal collateral vessels.
    Preview · Article · Jul 2003 · Acta medica Okayama
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    ABSTRACT: The authors describe a unique presentation of Wegener granulomatosis (WG) manifesting predominantly as meningitis. Magnetic resonance imaging demonstrated diffuse meningeal enhancement, including the pia mater, in a 28-year-old man with meningitis. A diagnosis of atypical WG was based on the findings of a dural biopsy sample and an elevated cytoplasmic antineutrophil cytoplasmic antibody (cANCA) titer, although the patient did not have any of the lesions common to WG. Immunosuppressive therapy was quite effective. With treatment, the meningeal enhancement resolved and the cANCA titer normalized. Meningeal granulomatosis as the sole lesion in WG has never been reported in the literature. This atypical course of WG should be noted.
    No preview · Article · Dec 2002 · Journal of Neurosurgery
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    ABSTRACT: We present a case with brain abscess associated with entrapment of the lateral ventricle appearing more like remarkable brain edema in the temporo-occipital lobe than ventricular dilatation. A 72-year-old man suffering from headache and vomiting visited our clinic. CT and MRI showed brain abscess in the right parieto-occipital lobe, associated with ventriculitis. Lumbar puncture also revealed purulent meningitis. Both symptoms and CSF findings improved after administration of antibiotics. The improved condition continued for two months after admission, but disturbed consciousness and left hemiparesis than appeared. MRI and CT showed entrapment of the lateral ventricle and brain edema of the right temporo-occipital region without ventricular dilatation. Because brain edema was thought to be caused by transudate of the CSF through the ventricular wall, lobectomy of the right temporal lobe and opening of the temporal horn were carried out. Although left hemiparesis and disturbed consciousness and brain edema disappeared after the operation, subdural effusion appeared. Using a subdural-peritoneal shunt, the subdural effusion was prevented and disappeared. In this case, we thought Hounsfield Unit (HU) of the brain edema caused by transudate of CSF through the ventricular wall (12.6) was markedly lower than that of so-called vasogenic edema (25.1) due to active inflammation. Measurement of the HU seemed to be a useful means to differentiate the types of brain edema in this situation from that of vasogenic edema caused by brain abscess, and thus a means for selection of the appropriate treatment.
    No preview · Article · Mar 2001 · No shinkei geka. Neurological surgery
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    ABSTRACT: To date in our hospital, surgical reconstructions and percutaneous transluminal angioplasty (PTA) were carried out in 168 patients with vertebral artery (VA) stenosis at the origin. In this article, we discuss the comparison between surgical reconstructions and PTA, especially regarding long term follow up, patency and complications. PTA is a less invasive treatment for VA stenosis at the origin than surgical reconstructions. However, restenosis after PTA occurred in 20% of the patients. On the other hand, restenosis after surgical reconstructions did not emerge even in long term follow up. An embolism after PTA occurred in 2.6% of the cases. However, the embolism occurred in only the first 10 patients of our series, after that there was no embolism. We concluded that PTA was the first choice for VA stenosis at the origin, if the angiogram did not reveal any PTA difficulty. If restenosis after PTA was performed, we selected surgical reconstruction for VA stenosis at the origin.
    No preview · Article · Nov 2000 · Interventional Neuroradiology
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    ABSTRACT: Recently, the first choice of therapy for cavernous dural arteriovenous shunts (CdAVS) is transvenous embolization. Usually the approach routes for cavernous sinus are the inferior petrosal sinus (IPS), the superior ophthalmic vein (SOV) in most cases and the superior petrosal sinus (SPS) in rare case. But, it is difficult for us to treat patients in whom there are no extracranial veins through which to approach the cavernous sinus, with transvenous embolization. We presented the case in which intracranial transvenous approach to the cavernous sinus and transvenous embolization were performed and in which we achieve good results. In this article, we presented a case with Barrow's type D CdAVS and cortical venous drainage. At first, transarterial embolization was performed to decrease the amount of venous drainage for the purpose of eliminate convulsions and consciousness disturbance. However, cortical venous drainage continued. Moreover bilateral dilated SOVs normalized and bilateral IPSs were not visible, so we decided that it was impossible to carry out the transvenous embolization via extracranial veins. Transvenous embolization to the left cavernous sinus via the intracranial ophthalmic vein between the superior ophthalmic fissure and the inferior ophthalmic fissure after craniotomy was performed. Then, the transvenous embolization to the right cavernous sinus was carried out through the right superficial middle cerebral vein after craniotomy. The results were good and chemosis and bilateral abducens palsy diminished immediately. Trans-intracranial venous embolization for CdVAS is a very useful therapy when no extracranial veins exist for transvenous embolization.
    No preview · Article · Aug 2000 · No shinkei geka. Neurological surgery
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    ABSTRACT: The etiology of dural arteriovenous fistulas (DAVFs) remains controversial as is the issue of whether occlusion or stenosis of the transverse sinus and sigmoid sinus is a cause or a result of DAVFs. We report a case of DAVFs with transverse-sigmoid sinus occlusion and cortical venous reflux. In this case, the reconstruction of normal venous circulation by percutaneous transluminal angioplasty (PTA) for the occluded sinus was performed and cortical venous reflux diminished. PTA may be a useful treatment for DAVFs with occluded or stenotic sinus.
    No preview · Article · Nov 1999 · Interventional Neuroradiology

  • No preview · Article · Jul 1997 · Clinical Neurology and Neurosurgery
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    ABSTRACT: Introduction of microsurgery for cerebral aneurysms markedly improved the operative outcome. However, the microsurgically blind portion hidden behind unretractable structures such as a major artery, cranial nerves, aneurysm sack and tentorium, has remained a problem. An endoscope was applied for microsurgical operation of cerebral aneurysm to minimize the blind area under the microscope.We used a rigid form endoscope (CODMAN Gaab Neuroendoscope System with 30°, 70°and 120°angled telescope) to visualize the microsurgically blind portion in 10 patients with cerebral aneurysms. Application of endoscope was useful to reduce the risk of careless surgical injury by avoiding the extensive brain retraction in all patients. We report here on four patients. In 1 patient with high positioned basilar top aneurysm (Case 1), the aneurysm could not be visualized through pterional route, and after confirmation of the aneurysm by endoscope, neck clipping was performed through orbitozygomatic route. For bilateral internal carotid artery (IC) aneurysms (Case 2), after clipping of the left IC-posteior communicating artery (PcomA) aneurysm, the IC aneurysms on the right side could be inspected endoscopically through the prechiasmatic cistern. In another patient (Case 3), during endoscopic observation for left IC-PcomA aneurysm, IC-anterior choroidal artery aneurysm that had not been identified by angiography was detected. In the remaining patient (Case 4), an endoscope was used to confirm correct neck clipping for a vertebral artery-posterior inferior cerebellar artery aneurysm attached to the seventh and eighth cranial nerves.Though instruments of solid form endoscope entail some inconvenience for endoscopic surgery, the image is markedly clearer than that of the fiberoptic endoscope. Endoscopy seems to be useful for minimizing the surgical trauma in microsurgical operation for cerebral aneurysm.
    No preview · Article · Jan 1997 · Surgery for Cerebral Stroke
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    ABSTRACT: The authors report the treatment of seven intracranial aneurysms in six patients with direct infusion of cellulose acetate polymer solution, a new liquid thrombotic material. These aneurysms were considered inoperable because of their size or location, or because of the patient's neurological condition. This material avoids the difficulties associated with balloon occlusion, and completely fills even irregularly shaped aneurysms. Cellulose acetate polymer solution hardens in about 5 minutes and remains solid once inside the aneurysm. Because this technique is less invasive than surgery, it can be used for high-risk patients in the acute stage of subarachnoid hemorrhage. Transient motor aphasia occurred in one patient. A small residual neck, which caused rebleeding 3 months after the treatment, remained in another patient. This article describes the new material, the procedure for direct thrombosis, and preliminary clinical results.
    No preview · Article · Nov 1992 · Journal of Neurosurgery
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    ABSTRACT: Most intracranial saccular aneurysms arise from the angle between a parent vessel and an arterial branch. Saccular aneurysms without relation to any arterial branch are rare. During the last 24 years, 210 patients with intracranial internal carotid artery (ICA) aneurysms were directly operated on at our institution. We found eight saccular aneurysms arising from intracranial ICA without relation to any arterial branch. So we call them unbranched-site aneurysms of intracranial ICA, and describe their unique characteristics. Of the eight cases with unbranched-site aneurysm of intracranial ICA, three were men and five were women. The age ranged from 31 to 61 years with an average age of 48. Seven cases suffered a subarachnoid hemorrhage due to ruptured unbranched-site aneurysm, and the other case had been admitted to our department because of accompanying ruptured left internal carotid-posterior communicating aneurysm. All cases of unbranched-site aneurysm presented intraoperative and/or angiographic findings of arteriosclerosis, and five of the patients had a past history of hypertension. Of the four unbranched-site aneurysms at the C2 portion of ICA, two arose from the lateral wall, one arose from the superior wall and the other arose from the infero-lateral wall of ICA. Of the four unbranched-site aneurysms at the C1 portion of ICA, three arose from the superior wall and the other arose from the supero-medial wall of ICA. Radical operation was performed in all cases and intraoperative rupture occurred in two cases. It was suggested that arteriosclerotic change in the arterial wall, and local hemodynamic stress played important roles in the development of unbranched-site aneurysms of intracranial ICA.
    No preview · Article · Aug 1992 · No shinkei geka. Neurological surgery

  • No preview · Article · Jan 1992 · Surgery for Cerebral Stroke
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    ABSTRACT: The authors describe a technique using occluding spring emboli for direct obliteration of an unclippable large aneurysm, and carotid-cavernous fistula (CCF) which failed to be occluded by transarterial and transvenous approaches. Case 1: This 44 year-old man had a history of head trauma 30 years ago. He was admitted to our department on October 16, 1989, because of an aneurysm incidentally found by a CT scan taken for the examination of his vertigo. Angiograms revealed a large aneurysm at the C3 portion of the right internal carotid artery. A right frontal craniotomy was performed on November 2, 1989, but neck clipping of the aneurysm was impossible, because it was a pseudoaneurysm with quite a fragile neck. Subsequently, fourteen occluding spring emboli were inserted into the aneurysm through a polyethylene catheter directly into the aneurysmal dome. Postoperative angiograms showed almost complete obliteration of the aneurysm with good preservation of the parent artery. Case 2: This 26 year-old woman without a history of head trauma was admitted to our department on May 10, 1989, complaining of right conjunctival injection and exophthalmos. Angiograms revealed a spontaneous CCF which had a single orifice at the C4 portion of the right internal carotid artery and drained through the superior ophthalmic vein and inferior petrosal sinus. Initially, transarterial and transvenous approaches were tried, but the attempts were unsuccessful. Subsequently, a right frontotemporal craniotomy was performed on August 8, 1989, and 27 occluding spring emboli were placed into the cavernous sinus through a polyethylene catheter which had been inserted directly.(ABSTRACT TRUNCATED AT 250 WORDS)
    No preview · Article · Nov 1991 · No shinkei geka. Neurological surgery
  • K Yoshino · S Fujimoto · T Ito · K Mizobuchi · Y Terai
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    ABSTRACT: Primary intracranial T cell type malignant lymphoma is extremely rare. Only 8 cases are reported in the literature so far. In this paper, a case with this type of malignant lymphoma is reported. A 41-year-old man was admitted because of abnormal behavior. Enhanced CT scan demonstrated high density mass and perifocal low-density area in the right frontal lobe, the right basal ganglia and the periventricular region. Specimen biopsied from right frontal lobe was submitted for histological examination. An immunohistochemical technique using monoclonal surface markers confirmed reactivity for LCA, MT-1, OKT-4 and OKT-8, while there was no reactivity for MB-1 and OKB-2. Pathological diagnosis was diffuse medium T cell type malignant lymphoma. Postoperatively, after 60 Gy irradiation, the tumor disappeared. There is no difference on CT findings between B cell type and T cell type malignant lymphoma.
    No preview · Article · Dec 1989 · No shinkei geka. Neurological surgery
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    ABSTRACT: Three cases of vertebral artery stenosis or occlusion at the level of the atlantoaxial joint during head rotation were reported. The vertebral artery was mechanically compressed on the side of the head opposite to the direction in which the heads was turned. One case was associated with atlantoaxial dislocation due to rheumatoid arthritis. Posterior fixations of C1 - C2 or C1 - C3 using iliac bone and wire were performed in two cases, and a neck collar was applied in another case. All of the three cases have been free from vertebrobasilar insufficiency since the treatment. The pathogenesis and treatment of vertebral artery occlusion at the atlantoaxial joint are discussed.
    No preview · Article · Oct 1989 · No shinkei geka. Neurological surgery
  • S Fujimoto · Y Terai · T Itoh · M Kawauchi
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    ABSTRACT: Fourteen patients with symptoms of vertebrobasilar insufficiency caused by vertebral artery stenosis in the distal first portion underwent surgical reconstruction. They ranged in age between 42 and 73 years, with a median age of 57 years. Their symptoms included vertigo, dysarthria, syncope, hemiparesis, and homonymous quadrant anopsia. The etiologies of the stenoses involved kinking in 12 cases and mechanical compression due to cervical sympathetic nerve, osteophyte, or fibrous bands in two cases. Digital subtraction angiography revealed that stenosis was maximal at systole and minimal at diastole in six of eight cases. In two of the 14 cases, stenosis was not demonstrated in the neutral position, but stenosis of the left vertebral artery appeared when the head was rotated to the right. Surgical procedures involved 13 decompressions of the vertebral artery and one subclavian artery-vertebral artery bypass using the saphenous vein. Postoperatively, 12 cases of miosis and one of asymptomatic phrenic nerve palsy were observed, but there were no serious complications. All but two patients had complete resolution of their symptoms. Stenosis due to kinking and/or mechanical compression disappeared in all cases after decompression of the vertebral artery. The effects of arterial pulse and neck rotation on vertebral artery stenosis in the distal first portion are discussed.
    No preview · Article · May 1989 · Neurologia medico-chirurgica
  • T Itoh · Y Terai · S Fujimoto · K Hayashi

    No preview · Article · Jan 1989 · Neurologia medico-chirurgica
  • Shunichiro Fujimoto · Yoshinori Terai · Takahiko Itoh

    No preview · Article · Nov 1988 · Neurologia medico-chirurgica
  • S Fujimoto · Y Terai · T Itoh
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    ABSTRACT: A 67-year-old man was admitted for status epilepticus, right hemiparesis, repeating vertigo and vomiting. Computed tomography showed no abnormality except for slight brain atrophy. Angiogram demonstrated bilateral vertebral artery stenosis at the origin, especially on the left side, and bilateral cervical internal carotid artery stenosis associated with ulceration. Intracranially, bilateral anterior cerebral artery was filled only by right internal carotid artery. Internal carotid artery on both sides did not fill the posterior cerebral artery. From these findings, we thought that both bilateral internal carotid artery and left vertebral artery should be surgically reconstructed. On June 4, 1986, left vertebral transposition to the common carotid artery and left carotid endarterectomy using double-balloon shunt were performed. Waiting for recovery of the general condition, right carotid endarterectomy was carried out on June 27, 1986. Postoperative angiogram demonstrated disappearance of bilateral internal carotid artery stenosis, and good filling of left vertebral artery through left common carotid artery. Postoperative course was uneventful and right hemiparesis gradually improved. Vertigo and vomiting completely subsided. The method and indication of combined reconstruction for extracranial vertebral and carotid artery were discussed.
    No preview · Article · Apr 1988 · No shinkei geka. Neurological surgery