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Biomedical subjects

K Kyoshima

Publications and source records attributed to K Kyoshima.

At least 37 records · Page 2Linked to original sources
PubMed1997

Fenestrated oculomotor nerve caused by internal carotid-posterior communicating artery aneurysm: case report.

OBJECTIVE AND IMPORTANCE: The fenestrated oculomotor nerve associated with the internal carotid-posterior communicating artery aneurysm is very rare. CLINICAL PRESENTATION: A 48-year-old woman had a history of subarachnoid hemorrhage caused by a ruptured right middle cerebral artery aneurysm, which was wrapped with good postoperative course. Twenty years later, the patient suffered frontal headache with a mild oculomotor nerve paresis in the right side. Follow-up neuroimaging studies demonstrated a de novo right internal carotid-posterior communicating artery aneurysm. INTERVENTION: The aneurysm was exposed and clipped via a right pterional route. The fenestrated oculomotor nerve associated with the aneurysm was confirmed at surgery. CONCLUSION: We speculated that the fenestration was most likely caused, by the growth of the aneurysm.

Carotid Artery Diseases↗
PubMed1996

Surgical outcome for multiple intracranial aneurysms.

The surgical outcome of 221 cases with multiple intracranial aneurysms operated upon during the years 1988 to 1994 were reviewed. The patients were classified into three groups according to the locations of the aneurysms; group 1: multiple aneurysms located unilaterally in the anterior circulation only (147 cases); group 2: multiple aneurysms located bilaterally in the anterior circulation only (44 cases) and group 3: multiple aneurysms located in both anterior and posterior circulation or in the posterior circulation alone (30 cases). In 132 cases of group 1 (89.8%) all aneurysms were treated in one-stage operations. Twenty-eight patients from group 2 (63.6%) received partial treatment, where only the ruptured or the symptomatic aneurysms were treated. In 12 other cases from group 2 (27.3%) all multiple aneurysms were treated in two-stage operations. In group 3 patients, one-stage operations were performed in 18 cases (60%), while 9 patients (30%) received partial treatment only. Of the 221 multiple aneurysm cases, 162 (73.3%) presented with manifestations of subarachnoid haemorrhage (SAH). The remaining 59 multiple aneurysms cases (26.7%) presented with manifestations other than SAH (unruptured aneurysms). In the postoperative follow-up, of the 221 multiple aneurysms cases, 113 (51.1%) were free of neurological deficit (excellent), 48 cases (21.7%) were capable of leading an independent life (good), 32 cases (14.5%) were not independent and needed to be assisted (fair), and 28 patients (12.7%) died. These results were comparable to the results of patients with single aneurysms operated on during the same period. Based on our results, we recommend that whenever possible all multiple aneurysms should be treated in one-stage operations. In unruptured multiple aneurysm cases surgical management is the recommended treatment. In poor grade SAH patients or unruptured multiple aneurysms in old patients, two-stage operations or partial treatment of only the ruptured or the symptomatic aneurysms may be adopted.

Adult↗
PubMed1996

Cadaveric Hands-on Workshop Using a Three-Dimensional High-Definition Television System.

We report the introduction of a three-dimensional high-definition television system in cadaveric microneurosurgical hands-on workshops on skull base technique. The system was found to be a useful means of exact communication between the instructor and the participants and avoided congestion around the instructor's table. The instructions could be refayed to the multiple participants at one time and thus avoided repetitions. More participants could be accommodated in the workshops. The entire proceeding could be recorded three-dimensionally for later use and educational purposes.

Journal Article↗
PubMed1995

Cerebral aneurysm of the distal anterior inferior cerebellar artery: case report.

A case of an extremely rare aneurysm of the distal segment of the anterior inferior cerebellar artery (AICA) is presented. A 61-year-old woman who was admitted with subarachnoid hemorrhage associated with fourth ventricular hematoma had such an aneurysm, which was successfully clipped. The literature is reviewed.

Aneurysm, Ruptured↗
PubMed1995

Transplantation of basal forebrain cells of foetal rats into the subarachnoid space: improvement of disturbance of passive avoidance memory due to injury of nucleus basalis magnocellularis.

Basal forebrain cells of foetal rats were transplanted into the subarachnoid space of adult rats harbouring a kainic acid-induced unilateral lesion in the nucleus basalis magnocellularis. Passive avoidance response tests were performed eight weeks after the transplantation, and the results were compared with those of lesioned but non-transplanted rats and of non-lesioned control rats. Although acquisition impairments did not improve, retention impairments were significantly ameliorated in the transplanted rats. Histologically, transplanted foetal neurons survived and grew very well over the cortical surface, and exhibited facilitated neuritic elongation on acetylcholinesterase staining. Choline acetyl-transferase-immunoreactive neurons were found along the needle track as well as in the subarachnoid graft tissues. The results seem to indicate that not the re-innervation from the graft to the host cortex but the diffusional supply of neurotransmitters and/or their synthetic enzymes and neurotrophic factors were responsible for improvement of memory deficits. The subarachnoid space proved to be an adequate place for growth of transplanted neuronal and glial cells for reasons of ample supply of oxygen and nutrition and of low tissue pressure.

Animals↗
PubMed1995

Characteristics of pterional routes to basilar bifurcation aneurysm.

In an attempt to clarify the characteristics of the pterional routes to the basilar bifurcation aneurysm, 65 consecutive surgical cases were retrospectively analyzed concerning the size of the aneurysm, the height of the aneurysm neck, the length of the clip blades, and the direction of clip application. Clipping was performed through the pterional route in 59 cases consisting of 14 opticocarotid and 45 retrocarotid routes. A subtemporal approach was performed for six low-positioned aneurysms. The opticocarotid approach was undertaken because of the following situations: 1) laterally protruded and/or highly sclerotic internal carotid artery (n = 8); 2) long, redundant A1 segment (n = 3); 3) an associated aneurysm of the internal carotid artery obstructing the retrocarotid space (n = 2); and 4) a short and/or large posterior communicating artery obstructing the retrocarotid space (n = 1). The range in height of the aneurysm neck was narrower in the opticocarotid approach (1-10 mm) than in the retrocarotid approach (-7-15 mm). The direction of clip application on the axial plane was more anteriorly deviated in the opticocarotid approach (41.4 +/- 12.8 degrees from the glabella-inion line) than in the retrocarotid approach (58.8 +/- 11.1 degrees; P = 0.01). The retrocarotid route (n = 45) was further subdivided into the medial or lateral retrocarotid routes, depending on the medial or lateral side to the posterior communicating artery, respectively. The medial retrocarotid approach (n = 9) made it possible to reach relatively high-positioned aneurysms (7.0 +/- 3.9 mm) compared with the lateral retrocarotid approach (4.2 +/- 4.7 mm; n = 29).(ABSTRACT TRUNCATED AT 250 WORDS)

Basilar Artery↗
PubMed1994

New radiolucent head fixation made of engineering plastics for intraoperative CT scanning.

A newly developed head fixation for intraoperative computerized tomographic (IOCT) scanning is presented. The system is developed based on the head holder of multipurpose head frame and is made of two kinds of advanced engineering material; carbon fiber reinforced plastic for head holder and frames, polyamide-imide polymer for joints, screws, and head pin. Clinical tests including autoclaving and sterilization were performed and revealed all materials had sufficient strength for clinical use. This fixation system enables us to increase the efficacy of IOCT scanning during open-field neurosurgery.

Artifacts↗
PubMed1994

Intraoperative CT scan findings during resection of glial tumours.

Intraoperative computerized tomographic (CT) scan findings in two cases during resection of glial tumor are described. These intraoperative CT images were obtained by an exclusively developed operating CT scanner system for use in the operating room. Repeated intraoperative CT scans taken during tumor removal showed shift of the brain including central structures and displacement of the cortical subarachnoid space in both cases. With contrast medium, the edge of the surrounding brain after resection was enhanced and a round enhanced area was observed in distant white matter. The distant enhancement, which we call 'remote enhancement', probably suggests damage to the blood-brain barrier due to surgical manoeuvre.

Adult↗
PubMed1994

Subarachnoid hemorrhage due to rupture of infundibular dilation of a circumflex branch of the posterior cerebral artery: case report.

The authors describe a rare case in which an infundibular dilation at the origin of a circumflex branch of the P1 segment of the posterior cerebral artery caused subarachnoid hemorrhage. Wrapping was performed by a subtemporal approach in the delayed stage. At the time of surgery, the rupture point was found in the infundibular dilation.

Arcuate Nucleus of Hypothalamus↗
PubMed1994

Multiple clipping technique for large and giant internal carotid artery aneurysms and complications: angiographic analysis.

Experience with surgical clipping of 16 large and nine giant aneurysms of the intradural internal carotid artery (ICA) is described. Reconstruction of the parent artery with part of the aneurysmal wall was necessary in the majority of cases. Multiple clips were required for satisfactory clipping in 20 cases. Complications related to the clipping procedure comprised occlusion and stenosis of the parent carotid artery in isolated cases. Straightening of the parent carotid artery with consequent kinking of the middle cerebral artery was seen in three cases of an aneurysm with a dome directed ventrally in the proximal segment of the ICA. The factors that caused straightening of the ICA are analyzed. It was observed that an excessive change in the direction of the ICA can cause cerebral infarction.

Aged↗
PubMed1994

Digital angiotomosynthesis for preoperative evaluation of cerebral arteriovenous malformations and giant aneurysms.

PURPOSE: To evaluate the clinical utility of the digital angiotomosynthesis technique for giving additional information regarding critical anatomy of cerebrovascular lesions before surgical intervention. METHOD: Seven arteriovenous malformations and three giant aneurysms were examined with digital angiotomosynthesis; these images were compared with conventional angiograms. RESULTS: 1) Detailed recognition of three-dimensional vascular structures of the arteriovenous malformation and giant aneurysm was facilitated by the cine mode of digital angiograms and angiotomograms. 2) Reconstructed angiotomograms could show clear separation of overlapping vessels and demonstrate fine vasculature. 3) Fine feeders, which were difficult to trace on the conventional angiogram, were more easily recognized in all cases of arteriovenous malformation. 4) Small arteries passing in close proximity to the arteriovenous malformation nidus were identifiable. 5) Fine arterial branches, being obscured by big shadows of giant aneurysms on the conventional angiograms, were well identified. 6) The anatomic relationship of bone structures to the giant aneurysm was clearly shown. CONCLUSIONS: Digital angiotomosynthesis is helpful for recognizing the three-dimensional and detailed vascular anatomy of arteriovenous malformations and giant aneurysms and provides neurosurgeons with useful information for preoperative evaluation.

Adolescent↗
PubMed1993

[Transplantation of basal forebrain cells of fetal rats into the subarachnoid space: improvement of disturbance of passive avoidance memory due to injury of basal forebrain].

The memory disturbance of senile dementia of Alzheimer type has been thought to associate with marked degeneration and loss of cholinergic neurons of the basal forebrain (nucleus basalis of Meynert, NBM). Electrical or chemical destruction of the NBM causes memory deficits in rats. After unilateral lesioning of the NBM in adult rats with excitotoxic amino acid, kainic acid, basal forebrain cells of fetal rats were transplanted through a microsyringe needle, the tip of which was transcortically inserted to the subarachnoid space. Eight weeks after the transplantation, passive avoidance response test was performed, and the response was compared with those of non-transplanted lesioned rats and of non-operated control rats. Although acquisition impairment did not improve, retention impairment was significantly ameliorated in the transplanted rats. Transplanted fetal neurons survived and grew very well over the cortical surface and exhibited facilitated neuritic elongation (acetylcholinesterase staining), but the neurites penetrating the intact pia mater were not verified. Choline acetyltransferase-immunoreactive neurons were found along the needle tract as well as in the subarachnoidal graft. The innervated neurites from the needle tract were rare. The results indicate that the re-innervation from the graft to the host cortex is not necessarily indispensable for improvement of memory deficit due to injury of the NBM. We suppose that the diffusional supply of neurotransmitters and/or their synthetic enzymes and some kinds of neuronotrophic factors is more important. Moreover, we emphasize the participation of astroglias, which are simultaneously transplanted with neurons, in production of neuronotrophic factors.

Animals↗
PubMed1993

Dorsal internal carotid artery aneurysm: classification, pathogenesis, and surgical considerations.

Despite the rarity of dorsal internal carotid artery (ICA) aneurysms they still offer surgical challenge to achieve a safe successful clipping due to their peculiar projection. In the past 13 years, 24 cases of dorsal ICA aneurysm were operated upon in our hospitals. Three separate groups of such aneurysms could be identified: group 1; where the aneurysms were located most proximally at the carotid-ophthalmic region, group 3; in which the aneurysms were present most distally just proximal to the ICA bifurcation, and group 2; where the aneurysms were located in between. All cases in this surgical series will be reviewed stressing upon the classification, pathogenesis, and surgical tactics of such a rare type of aneurysm.

Adult↗
PubMed1993

Angiographic differentiation of carotid cave aneurysms from ventral paraclinoid carotid aneurysms of Nutik type.

Although it appears that carotid cave and ventral paraclinoid carotid aneurysms are different types of internal carotid artery (ICA) aneurysms, it can be difficult to differentiate the two on the basis of angiograms, because their locations are very close. The purpose of this study was to review the angiographic findings in 21 cases with carotid cave aneurysms and 7 cases with ventral paraclinoid carotid aneurysms of less than 15 mm in diameter (Nutik aneurysm) operated upon in our unit during the last 14 years, and to discuss the difference between the two groups. The results showed that in the anteroposterior view of the angiogram, all carotid cave aneurysms projected medially in semicircular, or berry shape, while only slight medial projection was noted in 3 cases with Nutik aneurysm, the remainder being superimposed on the ICA. In the lateral view of the angiogram, we found that in 6 of the 7 Nutik aneurysms there was a space between the axilla (area inside the genu of the ICA) and the anterior or anteroinferior wall of the aneurysm. This space was absent in all carotid cave aneurysms since these aneurysms projected inferoposteriorly from the genu of the ICA. It is concluded that predominant medial projection in the anteroposterior view and absence of space in the lateral view are two characteristic features of carotid cave aneurysms which can be used to differentiate them from most Nutik aneurysms.

Adult↗
PubMed1993

Remote-control vascular occluder: technical note.

We have designed a new remote-control vascular occluder for the temporary control of arterial blood flow. It is a modification of the biopsy forceps used in stereotactic surgery. The arm of the occluder is flexible and can be set so that it does not disturb the surgeon's view. The occluder is positioned with the blades open on the vessel to be occluded. This device, which is held with a self-retaining retractor connected to the head frame, enables an immediate on-off remote control of arterial occlusion by closing and releasing the blades with a closing button and releasing lever, respectively. Partial closure of the blades is also feasible. The device can be set in a narrow operating field, when proximal control of a parent artery is necessary at its segment distant from the exposed operating field. It can be used in a variety of vascular cases, including giant aneurysms and large arteriovenous malformations.

Aneurysm, Ruptured↗
PubMed1993

Histological examination of the gadolinium-enhanced dura mater around meningiomas on magnetic resonance imaging.

Magnetic resonance imaging often demonstrates gadolinium (Gd) enhancement of the dura mater around meningiomas. The Gd-enhanced dura mater was histologically investigated to detect meningioma cells. Gd enhancement of the dura mater occurred in 11 (79%) of the 14 meningiomas studied, and extended as far as 35 mm from the tumor. Histological examination revealed generation of vascular-rich loose connective tissue at the surface of the dura in all five tumors examined. Some clusters of meningothelial cells were distributed in the loose connective tissue in three of the five specimens, and one cluster was obviously neoplastic. These observations suggest that clusters of meningioma cells occur in the Gd-enhanced dura mater around meningiomas.

Adolescent↗
PubMed1993

Three-dimensional Hi-vision system for microneurosurgical documentation based on wide-vision telepresence system using one camera and one monitor.

A three-dimensional (3-D) high-definition television (Hi-Vision) system suitable for attachment to a stereoscopic operating microscope allowing 3-D medical documentation using one Hi-Vision camera and one Hi-Vision monitor is described. The system provides 3-D high-definition microneurosurgical recorded images suitable for viewing on a screen or monitor, or for printing.

Documentation↗