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Biomedical subjects

N Kodama

Publications and source records attributed to N Kodama.

At least 181 records · Page 10Linked to original sources
PubMed1978

Moyamoya disease associated with aneurysm.

Five cases of moyamoya disease associated with aneurysm are reported. In three cases, the aneurysms were located at the peripheral portion of the posterior choroidal artery, and in two at the basilar artery. Based on these cases, the symptoms and mechanisms of formation of aneurysms in moyamoya disease are discussed.

Adolescent↗
PubMed1978

[Tethered cord syndrome--our three cases and the review of the literature (author's transl)].

Three cases of tethered cord syndrome are presented with reference of reported literatures. This syndrome is usually associated with spina bifida occulta and cutaneous manifestation such as subcutaneous tumor, skin dimple, hairy patch, and neavus. Presented symptoms are various progressive neurological deficits involving weakness and/or sensory disturbance of lower limbs, bowel and/or bladder dysfunction, leg and/or low back pain, and orthopedic pathological conditions such as scoliosis and/or foot deformities. Properly performed myelography is the only method of preoperative confirmation of this syndrome. As the surgical release of the tethered spinal cord is effective for these various symptoms except for foot deformity, early investigation and early surgery are recommended.

Abnormalities, Multiple↗
PubMed1978

[Surgery of anterior communicating artery aneurysm--from the experiences of 346 cases (author's transl)].

In the past 14 years, 1000 cases of aneurysms were submitted to surgical operations without using microscope. In this report 346 cases of anterior communicating artery aneurysms were studied. The operative result at discharge was as follows; 19 cases (5.5%) were dead, 27 poor, 39 fair, 64 good and 197 excellent. In the follow-up, out of 300 cases 29 were dead (16 were related to the operation), 7 were poor, 13 fair, 26 good and 226 excellent. Out of 19 dead cases during hospitalization, 14 were operated within two weeks after SAH. Ten out of 14 cases operated within two weeks died due to vasospasm and all these 10 cases were operated between five to 11 days after SAH. These results and results of ultra-early surgery on other sites of aneurysm suggested that the surgery should be avoided on the cases from third to 10th day after SAH. After the 3rd day, the operation should be decided by taking vasospasm into consideration. If the SAH attack is a mojor one accompanying loss of consciousness more than one hour, the operation should be postponed until the 14th day. If the SAH attack is a moderate one accompanying loss of consciousness within one hour, it should be postponed until the 9th or 10th day. When the SAH attack doesn't accompany loss of consciousness, the surgery can be done any time. If stiff neck is obvious, it should be performed on the 9th or 10th day. Our approach for anterior communicating artery aneurysms is a interhemispherical approach following the bifrontal craniotomy. Hypothermic anesthesia around 27 degrees C was used in order to prolong the temporary occlusion time until 1971. Since 1972, 500 approximately 800 ml of 20% mannitol was applied intravenously for preventing the infarction following the temporary occlusion under the normothermic general anesthesia. Details of the operative records of 346 cases were analyzed and our operative method, technique and technical points were discussed.

Adolescent↗
PubMed1978

[Third ventriculostomy for the hydrocephalus after subarachnoid hemorrhage (author's transl)].

Twenty-eight cases after subarachnoid hemorrhage due to ruptured intracranial aneurysms was undergone third ventriculostomies as the reason that the development of postoperative CSF disturbances was determined to be highly probable. The indication and value of third ventriculostomy was discussed considering various clinical and operative findings. Postoperatively, six of the 28 cases required ventriculoperitoneal shunt operation. Although temporary disturbances of serum electrolytes was noted in three cases, no other side effects was attributed to third ventriculostomy. During hospitalization, no fatalities occured following third ventriculostomy. The addition of third ventriculostomy to surgery for ruptured intracranial aneurysms in highly recommended, especially in cases strongly indicating the possible occurrance of postoperative CSF flow disturbances.

Cerebral Ventricles↗
PubMed1978

[On-off mechanism of shunt system due to slit ventricle (author's transl)].

We report two cases of high shunt dependency, which were first thought to be shunt independent arrested hydrocephalus. Though their shunt systems didn't seem to work, symptoms of rapid increasing intracranial pressure were observed after obstruction or replacement of shunt tube. Their ventricles looked so small like a slit on CT scan and PVG that the apex of the ventricular tube were easily obstructed by a ventricle wall. This is the reason why we misjudged them to be shunt independent arrested hydrocephalus. The cause of slit-like ventricles was overflow of CSF fluid due to the low pressure valve and the siphon effect. In general, after the shunt operation, most of the cases with thickening of cerebral mantle show the shunt dependency. Especially the cases showing rapid and marked thickening of the cerebral mantle are highly shunt dependent. Therefore, we must observe such cases carefully, in which the ventricle becomes small. Short interval follow-ups by CT scan after the shunt operation are quite necessary in order to observe the ventricle size. Easy and reliable judging method to know whether the shunt system is working or not is required to be developed.

Atrophy↗
PubMed1977

[Cerebrovascular moyamoya disease associated with basilar aneurysm (author's transl)].

Two adult cases of cerebrovascular Moyamoya disease, associated with basilar aneurysm are reported. At the follow-up study of angiogram performed 14 months later in one case, the aneurysmal shadow was slightly larger than before. In the other case, craniotomy was performed and two aneurysms were confirmed to be the saccular aneurysms arising from the basilar head and superior cerebellar artery junction, respectively. From these facts, it is suggested that these aneurysms were not pseudo-aneurysms but sacuular aneurysms. As for the pseudo-aneurysm associated with cerebrovascular Moyamoya disease, we discussed in our previous report. It has been generally through that the mechanism of the occurence of symptoms in adult patient with cerebrovascular Moyamoya disease is due to rupture of abnormal vessels in the subarachnoid space. But from our experiences, it is suggested that there should be another mechanicsm, which begins with rupture of these basilar aneurysms. In addition to that, the growing mechanisms of basilar aneurysm associated with cerebrovascular Moyamoya disease is discussed.

Adult↗
PubMed1977

[Electroencephalography of Moyamoya disease].

Attempts were made to evaluate the EEG findings in 16 children and 12 adults with Moyamoya disease. (1) The children revealed specific findings such as hemispheric posterior slow (HP slow), centrotemporal slow (CT slow) and re-build-up after the end of hyperventilation. (2) HP slow was mainly observed in EEG examined within one year after the initial onset. In children in whom EEG was performed more than three years after the onset, chronic suppressive findings were found on EEG. (3) Buildup after the end of hyperventilation was revealed in almost all the children, which we called "Re-build-up". (4) No specific findings were verified on EEG in adult Moyamoya, beside slight abnormalities.

Adolescent↗
PubMed1976

[Cerebrovascular moyamoya disease associated with aneurysm at the peripheral portion of the posterior chorioidal artery (author's transl)].

Three adult cases of cerebrovascular Moyamoya disease associated with aneurysmal shadow at the peripheral portion of the posterior choriodial artery are reported. According to the follow-up study of carotid angiograms, this aneurysmal shadow is considered to be a pseudo-aneurysm, which indicates a bleeding point in the brain tissue. It has generally been thought that the mechanism of the occurrence of the symptom in adult patient with cerebrovascular Moyamoya disease is due to rupture of vessels in the subarachnoid space on the brain surface. But from our experience, it is suggested that there should be another mechanism, beginning with rupture of vessels in the brain tissue.

Adolescent↗
PubMed1976

[Homonymous hemianopsia due to chiasmal compression by intracranial aneurysm (author's transl)].

Eight cases of homonymous hemianopsia due to chiasmal compression by intracranial aneurysms have been reported in the literatures. Two similar cases were experienced in our clinic and reported. Of the total 10 cases, 8 were giant aneurysms--over 2 cm in diameter--and 9 cases were aneurysm developing medially from the internal carotid artery. Visual disturbances in all the 10 cases were incongruous homonymous hemianopsia without macula sparing. It should be noted that the existence of aneurysm is possible, in patients with homonymous hemianopsia, even when there is no other clinical evidence of mass lesion.

Adult↗
PubMed1975

An attempt to treat cerebrovascular 'Moyamoya' disease in children.

Moyamoya formations at the base of the brain are not congenital vascular malformations but represent collateral pathways associated with chronic progressive stenosis of the carotid fork. The authors have studied 44 personal cases, 18 children under 15 years of age, and 26 adults. In children the Moyamoya vessels change through six stages: (1) carotid fork stenosis; (2) progressive carotid stenosis with initial Moyamoya collaterals and dilatations of cerebral arteries; (3) dilatation of Moyamoya collaterals and disappearance of anterior and middle cerebral arteries; (4) thinning of Moyamoya; (5) contraction of Moyamoya and disappearance of posterior cerebral arteries; (6) intracerebral vessels perfused from the external carotid and/or vertebrae. These six stages are not observed in adults. Bilateral cervical perivascular sympathectomy (PVS) was performed in 9 children and superior cervical ganglionectomy (SCG) was added unilaterally in 4 and bilaterally in 3 cases. Angiographic follow-up studies were carried out 1-7 years following surgery. Improvement was observed in most of the cases examined within the first 2 months after surgery. This was not the case in arteriograms performed more than 6 months postoperatively. It would seem that PVS and SCG can improve the progress of Moyamoya vessels but only for a short period of time. Clinical symptoms, however, seem to continue improving over a long period of time. Cerebral blood flow improved 5 weeks following surgery in a 13-year-old boy.

Adolescent↗