Cortical mapping using an MRI-linked whole head MEG system and presurgical decision making.
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Adult↗
Biomedical subjects
K Mizoi
Publications and source records attributed to K Mizoi.
Clinical and angiographic follow-up of childhood-onset moyamoya disease.
To clarify the differences between childhood-onset moyamoya disease and that with onset in adulthood, we studied the clinical course and angiographic findings of adult patients (over 20 years of age) with moyamoya disease of childhood onset (up to 15 years of age). The clinical course in 25 patients could be assessed. The follow-up period was 5-27 years. Neurological deficits were noted in 11/23 and mental disorders in 9/21. In all except one, the illness had started before the age of 7 years. Neither neurological nor mental condition changed during or after adolescence (15-20 years of age). Two patients died of intracranial hemorrhage. The disease progressed in angiographic stage until adolescence, but had stabilized or almost stabilized by the age of 20 years. This study indicates that moyamoya disease with onset in childhood carries high morbidity and mortality. The disease advances in angiographic stage between childhood and adolescence, but stabilizes or almost stabilizes between adolescence and adulthood.
Adolescent↗
Balloon angioplasty immediately after surgical clipping for symptomatic vasospasm on admission. Report of four cases.
In spite of recent advancements in the management of ruptured aneurysm, there are still controversies as to how to threat the patients in serious conditions, one of these concerning whether to operate patients admitted with symptomatic vasospasm (vasospasm on admission) and when. While early surgery may protect patient from further rupturing, it may also increase risk of worsening by inducing much more vasospasm. Four cases of severe vasospasm associated with aneurysmal subarachnoid hemorrhage (SAH) were reported. All of these cases showed symptomatic and angiographical vasospasm on their admission 3-11 days after initial attack of SAH. All cases had a preoperative clinical grading using Hunt & Kosnik of IV, and were treated by early surgery with clipping followed by percutaneous balloon angioplasty (PTA) immediately after clipping. Two cases returned to their previous occupations, while one case remained bed ridden and one died in spite of therapy. Early surgery in this series actually prevented further rupturing, but it is not clear whether PTA immediately after clipping may prevent further deterioration by progression of vasospasm. For selected cases especially those with reversible ischemia, this combined treatment may offer more favorable results than late surgery with conservative medical care. Further investigation is necessary to support the validity of this therapy.
Adult↗
How to treat incidental cerebral aneurysms: a review of 139 consecutive cases.
BACKGROUND: Together with current advances in neuroimaging techniques, the chance of incidental discovery of unruptured cerebral aneurysms has increased and the selection of their appropriate management remains controversial. To provide current data about management results of patients with incidental cerebral aneurysms, we have made a retrospective review of 139 consecutive patients treated either by surgical or conservative means. METHODS: The surgical indication for each patient was decided, carefully considering several factors respectively, including the surgical difficulty, aneurysm size, patient's age, and medical condition. RESULTS: Forty-nine patients were managed conservatively. Eight (16%) of those conservatively managed patients had intracranial hemorrhage due to aneurysm rupture during the follow-up period (mean, 4.3 years). Seven of these eight patients died from a fatal subarachnoid hemorrhage (SAH). The follow-up data showed that the mean size of aneurysms with late hemorrhage was significantly larger than that of aneurysms without subsequent rupture. It was also confirmed that none of the 26 tiny aneurysms smaller than 4 mm in diameter had ruptured. Ninety patients harboring 119 incidental aneurysms less than 25 mm in diameter underwent surgery. There was no surgical mortality or morbidity in this series. CONCLUSIONS: These excellent surgical results were presumably achieved due to the strict patient selection. In respect to the size of aneurysms, it seems to be justified to recommend surgery for patients with aneurysms larger than 5 mm in diameter.
Adult↗
Should meningiomas involving the cavernous sinus be totally resected?
BACKGROUND: The surgical strategy for meningiomas involving the cavernous sinus (CS) is still controversial because of the difficult surgical approach and the risks of injury to the cranial nerves or the internal carotid artery. We evaluated the efficacy of subtotal removal of meningiomas involving the CS following chemical embolization, preserving cranial nerve functions. METHODS: We analyzed the histology, embolization material, recurrence rate, and neurologic complications in 19 fresh cases with meningioma involving the CS, who received subtotal removal surgery and were followed over 1 year. Patients were 6 men and 13 women aged from 30 to 69 years (mean, 52.2 years) on admission. All patients received preoperative chemical embolization of the feeding arteries to reduce intraoperative bleeding. In the 11 earlier patients, we used estrogen (Est) as the embolization material, but changed to estrogen with 25% alcohol+polyvinyl acetate (Est+PVac) for the latter 8 patients. RESULTS: Fourteen patients were recurrence free after 1-16 (6.5 +/- 5.5) years. The performance status of the survivors was good. Five patients, including two cases of malignant meningioma, developed recurrence, with a mean recurrence-free period of 1.7 +/- 0.5 years. Patients who received embolization with Est showed a higher recurrence rate than Est+PVac. CONCLUSIONS: These results suggest that subtotal resection following Est+PVac embolization is a safe and effective strategy for this tumor.
Adult↗
Surgical removal of giant basal ganglia arteriovenous malformations through the extended transsylvian approach following preoperative embolization--two case reports.
A 12-year-old boy and a 22-year-old male presented with sudden onset of consciousness disturbance with right-sided hemiparesis and aphasia due to massive intracerebral hemorrhage from giant striocapsular arteriovenous malformations (AVMs). Angiography revealed giant AVMs located at the left basal ganglia in both patients. Large frontotemporal craniotomies were performed following staged embolization of the feeding arteries. Through an extended transsylvian approach, the lesions were totally excised with confirmation using intraoperative digital subtraction angiography. The patients showed a transient postoperative worsening of symptoms, but recovered to their preoperative status at discharge. Motor functions of the right upper and lower extremities were graded 4/5 in both patients. These cases demonstrate that combined use of preoperative embolization and intraoperative angiography allows some giant deep AVMs to be resected with encouraging results.
Adult↗
[Ipsilateral coexistence of AVM and meningioma: a case report].
The authors encountered a rare case of sphenoidal ridge meningioma associated with an arteriovenous malformation in the same cerebral hemisphere. A 65-year-old female was admitted to our service because of headache. X-ray computed tomography (X-CT) and magnetic resonance image (MRI) disclosed a huge mass with peripheral edema, diagnosed as a sphenoidal ridge meningioma. An associated small mass was also noted in the right parahippocampal gyrus. This was confirmed by angiography as an arteriovenous malformation (AVM). During the waiting period for surgical treatment she had fallen into coma abruptly. Emergency X-CT revealed intracerebral and intraventricular hematomas. Both lesions were resected successfully in a one stage operation. Postoperative course was uneventful. In general, AVM located in the medial temporal lobe is difficult to approach. However, in this case, the resultant large cavity obtained after removal of meningioma afforded us easy access to the AVM.
Aged↗
[Surgical decompression for massive cerebellar infarction].
The authors report 10 patients with progressive neurological deterioration due to massive cerebellar infarctions. Computerized tomography scans confirmed obstructive hydrocephalus and brain stem compression. All 10 patients (seven men, three women; mean age, 59 years) were treated by external ventricular drainage and decompressive suboccipital craniectomy. After discharge from the hospital, they were followed up (23-101 months) and their functional independence was evaluated by the Barthel Index. The condition of three patients with brain-stem infarction had deteriorated despite decompressive surgery. Two of these died during the acute stage and one because severely disabled. The remaining seven patients showed neurological improvement during the postoperative period. Four patients with preoperative Japan Coma Scale of 100 returned to their previous jobs within the follow-up period and three patients with preoperative Japan Coma Scale of 200 required some assistance in daily activities. It is suggested that decompressive surgery may be beneficial for massive cerebellar infarction. The postoperative prognosis depends mainly on the presence or absence of coexisting brain-stem infarction. It is possible that, without brain-stem infarction, patients who remained in a "dependent" state may have recovered better if they had been operated on earlier.
Aged↗
Role of embolization in the management of arteriovenous malformations.
For the best management of AVMs, it is essential to achieve complete elimination of abnormal arteriovenous shunting. Classically, it was considered that surgical resection of the nidus was the only way to achieve this objective. With the significant advancement and introduction of new technology, the quality of the treatment using embolization and radiosurgery improved so rapidly that it is difficult to introduce all of these achievements. However, we should utilize these three modalities, depending on the patient's condition and the anatomic condition of the lesion. Furthermore, it is better to use less invasive methods, including embolization and gamma knife radiosurgery, than to use a treatment that requires craniotomy. One of the major drawbacks of embolization as a primary modality of treatment is the low rate of complete radioanatomic cure. We should further advance the embolization technique because it facilitiates any treatment that follows.
Cerebral Angiography↗
Anterior cervical fixation with the titanium locking screw-plate: a preliminary report.
Anterior fixation of cervical spine with screw-plates is gaining in popularity in the management of anterior cervical spine instability. We report on our initial experience with anterior cervical fixation using the titanium locking screw-plate (TLSP). Twelve cases, including cervical trauma, cervical spondylosis, and ossification of the posterior longitudinal ligament (OPLL), underwent multilevel corpectomies or spondylectomies with iliac bone or hydroxylapatite grafting combined with the TLSP system. All 12 patients fused or stabilized with improvement of their neurologic symptoms at a mean follow-up period of 13 months. There were no complications relating to this plating system. Three illustrative cases are presented. Different from previous anterior cervical planting systems such as the Caspar plate, the TLSP system does not gain purchase on the posterior vertebral cortex. It thus reduces possible spinal cord injury during screw placement. The TLSP with interbody fusion may provide reliable stabilization of the cervical spine in a safe and effective manner.
Adult↗
Monitoring of brain tissue haemoglobin concentration and oxygen saturation using a three wavelength spectrophotometric method.
The authors report a new method of monitoring tissue oxygen saturation and haemoglobin concentration simultaneously and continuously using a three-wavelength spectrophotometry. Light emitting diodes were used as light source which made the recording probe small and flexible enough to be placed on the brain surface tightly. Stable and reliable recording of the tissue oxygen saturation and haemoglobin concentration was ascertained in the experimental studies using middle cerebral artery occlusion model of rabbit. In the clinical studies, monitoring during bypass surgery detected rapid changes of local oxygen metabolism and haemoglobin concentration in ischaemic brain. Simultaneous and continuous monitoring of tissue oxygen saturation and haemoglobin concentration enables more practical analysis of brain circulation and oxygen metabolism in experimental and clinical situations.
Adult↗
Multiple cerebral aneurysms associated with aortitis syndrome--case report.
A 48-year-old female presented with four aneurysms in the anterior half of the circle of Willis associated with aortitis syndrome. All the aneurysms were successfully clipped. In general, intracranial hemodynamic change, due to stenosis or occlusion of carotid arteries, is considered to initiate aneurysm growth in the vertebrobasilar system in this syndrome, but renal hypertension was probably involved in our patient. Careful screening for multiple aneurysms, even in the anterior circulation, should be undertaken in patients with aortitis syndrome who present with an aneurysm.
Aortitis↗
Direct clipping of basilar trunk aneurysms using temporary balloon occlusion.
In the surgical treatment of basilar trunk aneurysms, there is still considerable technical difficulty in gaining both proximal artery control and a sufficient operative field. The authors describe their experience in five patients with basilar trunk aneurysms treated using temporary balloon occlusion and intraoperative digital subtraction angiography. With the patient under general anesthesia, a heparinized angiography catheter was guided into the dominant vertebral artery by means of the Seldinger technique. A silicone balloon catheter was introduced coaxially through the angiography catheter to the basilar artery just proximal to the aneurysm. The balloon was inflated tentatively to evaluate the appropriate inflation volume, then the balloon catheter was withdrawn back into the angiography catheter to prevent thrombus formation. After exposure of the aneurysm, the occlusion balloon was advanced again and inflated temporarily within the basilar artery to prevent premature rupture and to facilitate dissection of the aneurysm. The mean duration of temporary balloon occlusion was 22 minutes. There were no patients with postoperative deficits attributable to the temporary occlusion. The results of aneurysm clip placement were confirmed by intraoperative digital subtraction angiography immediately after clipping. No patient suffered from distal embolism or other complications related to vessel catheterization. From this experience, it is concluded that this intraoperative endovascular technique can contribute to the success of surgery for complex cerebral aneurysms, particularly for basilar trunk aneurysms in which proximal vascular control is difficult.
Adult↗
[Follow-up study of malignant astrocytomas showing complete response after initial treatment].
The prognosis for patients with malignant astrocytomas is still poor. The identification of groups of patients with good prognostic factors should be helpful in selecting the treatment strategies. In general, important prognostic factors are thought to be the extent of surgical resection required, age, performance status, duration of symptoms, location, and pathological tumor grade. The purpose of this present study is to evaluate the prognosis of patients with complete response (CR), that is, complete disappearance of the tumor mass in the contrast enhancement of computerized tomography (CT) scan after initial treatment. An additional purpose is to examine the effect of factors such as pathological tumor grade, location, age of patient, and the extent of surgical resection in achievement of CR. The subjects of the study were 81 patients with supratentorial malignant astrocytomas (45 males, 36 females) treated with surgical resection and radiochemotherapy in our division since 1980, and followed up for more than 5 years. There were 57 anaplastic astrocytomas (WHO grade III) and 24 glioblastomas (WHO grade IV). The extent of surgical resection and the response to the therapy were evaluated by CT scans. The Kaplan-Meier method was used in generating survival plots. Twenty-two cases (27%) showed CR at the end of the initial treatment, and the other 59 cases (73%) showed Non CR. Fifteen cases (26%) among 57 grade III patients and 7 cases (29%) among 24 grade IV patients showed CR. Tumor locations of CR cases were exclusively superficial with the exception of one case that involved deep structure. Average age of CR cases and Non CR cases were 34.4 and 49.7, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Brain Neoplasms↗
Diphasic increase in thrombin-antithrombin III complex in blood from the internal jugular vein following severe head injury.
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Antithrombin III↗
Permissible temporary occlusion time in aneurysm surgery as evaluated by evoked potential monitoring.
To clarify the permissible time for temporary vascular occlusion during aneurysm surgery, we have undertaken a retrospective analysis of the results of intraoperative median nerve somatosensory evoked potential (SEP) monitoring in 97 patients with middle cerebral artery (MCA) (46 patients) or internal carotid artery (ICA) (51 patients) aneurysms. All patients underwent temporary vascular occlusion, lasting from 2 to 70 minutes, under the administration of a mixed solution of 20% mannitol with phenytoin and vitamin E. The mean occlusion time was 20.3 minutes for the MCA patients and 15.8 minutes for the ICA patients. The SEP disappeared during occlusion in 42 patients (30 MCA and 12 ICA). All but three eventually recovered the SEP to the baseline level after recirculation, and none of the 39 patients had postoperative sequelae. The time period from the start of occlusion until the complete loss of the SEP averaged 8.6 minutes among these 39 patients, and the occlusion time from total SEP loss until recirculation averaged 12 minutes. In the remaining 3 of the 42 patients (all 3 being ICA aneurysm patients), however, the SEP did not recover after recirculation and all 3 patients showed postoperative sequelae. In two of these three patients, vascular occlusions were performed at the multiple sites (i.e., at the ICA, MCA, anterior cerebral artery, and posterior communicating artery) and the SEP disappeared rapidly after the occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Combined endovascular and neurosurgical approach for paraclinoid internal carotid artery aneurysms.
The authors review the surgical management of nine complex paraclinoid aneurysms treated with the endovascular balloon catheter technique. With the patient under general anesthesia, the balloon catheter was guided into the feeding artery of the aneurysm by the Seldinger technique. After the aneurysm was exposed, the balloon was inflated temporarily to prevent premature rupture and to facilitate the dissection of the aneurysm. For the larger paraclinoid aneurysm, the double-lumen catheter was introduced into the cervical internal carotid artery (ICA). After temporarily trapping the aneurysm by balloon occlusion of the cervical ICA and clipping the intracranial ICA distal to the aneurysm, retrograde aspiration was performed to collapse the aneurysm. The complete collapse of the large aneurysm by this technique allows an easier dissection of the aneurysm and a safer application of suitable clips. Such a retrograde suction decompression method was used in six large aneurysms. Intraoperative digital subtraction angiography was performed in all cases after the aneurysmal clipping; in three aneurysms, repositioning the clip was required. Only one case of embolic complication was related to the vessel catheterization in this series, which was discovered during the operation. An embolectomy was performed immediately, and there were no postoperative sequelae. We conclude that the combined endovascular and neurosurgical approach, particularly for the large ICA aneurysms, which are difficult to control proximally, can be a useful method of treatment. To prevent complications related to thrombus formation, further refinement in the balloon catheter itself is still needed.
Adult↗
Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator.
The authors have evaluated the efficacy of postoperative intrathecal injections of tissue-type plasminogen activator (tPA) in preventing cerebral vasospasm in patients with a diffuse thick subarachnoid hemorrhage (SAH). The present study examined 105 patients who underwent direct surgery within 48 hours of SAH and whose computerized tomography (CT) findings were classified as Fisher CT Group 3. Patients showing diffuse thick subarachnoid blood clots on CT with greater than 75 Hounsfield units (HU) were included in the tPA therapy group and those with below 75 HU comprised the control group. The surgical method was the same in both groups, and both groups had cisternal drainage instituted. On the day following the operation, the tPA group was given an intrathecal injection of tPA (2 mg), and this was continued for several days until all of the cisterns exhibited low density on CT scans. Follow-up angiography showed that 26 cases (87%) in the tPA group had no vasospasm, three (10%) had moderate vasospasm, and one (3%) had severe vasospasm. All four patients showing spasm on angiography were asymptomatic, and there were no cases of delayed ischemic neurological deficits (DIND). In contrast, there were 11 cases (15%) with DIND in the control group. In the tPA group, there was one case of SAH caused by drainage catheter removal, one with a small epidural hematoma, and one with subgaleal fluid accumulation; all of these were treated conservatively with favorable results. Overall, there were no infectious complications related to cisternal drainage and intrathecal injection of tPA. These results indicate that multiple intrathecal injections of small doses of tPA are effective and safe in preventing vasospasm. On the basis of this experience, the authors conclude that injection of 2 mg of tPA daily for 5 days (a total of 10 mg) is effective in preventing the development of vasospasm.
Adult↗