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Biomedical subjects

N Kodama

Publications and source records attributed to N Kodama.

At least 163 records · Page 9Linked to original sources
PubMed1980

[Surgery of orbital tumor--analysis of location and appropriate operative approaches (author's transl)].

Twenty-six cases of orbital tumor were operated on during the period from 1965 to August, 1978. Pseudotumor was most frequently encountered, accounting for 7 cases followed by optic glioma (5 cases), meningioma (4 cases), mixed tumor (3 cases), hemangioma (3 cases), etc. Orbital venography and CT scan were found to be useful for determination of their location and nature. Most of the orbital tumors were found in the central or upper half of the orbit (62%) in coronal section and retrobulbar position (85%) in sagittal section. Intracranial extension was found in 7 cases (27%), and in 4 cases of the 7, intracranial extension was not suspected even by detailed preoperative examination. This fact indicates the importance of opening the dura mater and inspecting the chiasmal region. We therefore have adopted a frontal intra- and extradural combined approach. Other advantages of this approach were also discussed.

Adolescent↗
PubMed1980

[An operated case of giant pituitary adenoma (author's transl)].

A case of giant pituitary adenoma was reported. The patient was a 47-year-old man with visual disturbance. CT scan revealed the huge tumor, about 6 cm in diameter, at the midportion over the sella turcica, extending to the frontal, temporal, posterior and hypothalamic region. Total resection of the tumor was successfully carried out and the difficult post-operative complications were overcome. In this paper we mainly discussed the operative procedure for giant pituitary region tumor, which usually involve the main cerebral arteries, i.e., A1 and A2 portion of the anterior cerebral artery (ACA), anterior communicating artery (ACOMA) and intracranial internal carotid artery (ICA). We used to expose the internal carotid artery at the neck for the temporary occlusion prior to craniotomy. Prolongation of the temporary occlusion time is achieved by intravenous administration of 800 ml-20% mannitol solution. After bifrontal craniotomy, we approach the tumor interhemispherically and expose the A2 portion of ACA. Then anterior communicating artery, A1 portion of ACA and ICA are exposed as the tumor is extirpated. Under the bifrontal craniotomy, as we separate bilateral Sylvian fissure and interhemisphere, we can get the wide operative field and we can also approach the tumor from various direction. Therefore, even the tumor is huge, it is possible to remove the tumor without brain damage, vessel and cranial nerve injury.

Adenoma↗
PubMed1980

[Transdural anastomosis in moyamoya disease--vault moyamoy (author's transl)].

Transdural anastomosis in Moyamoya disease, which we have named as "Vault Moyamoya", is reported. It seems that these vault moyamoya vessels are apt to be developed at certain fixed positions; 9 definite places in children cases 6 in adults. Main feeding arteries of each vault moyamoya are dural arteries. In addition to them, the blood flow from STA and OA is found. The incidence of vault moyamoya at each position shows similar tendency both in children and adults cases. Vault moyamoya are developed more frequently around the base of the brain near the carotid fork, where occlusion exists. Less moyamoya are formed as the position is farther from the carotid fork. In children, the incidence of vault moyamoya seems to coincide with the phases of basal moyamoya. It is not clarified yet whether the adults vault moyamoya are straightly inherited from children vault moyamoya. Blood flow from vault moyamoya to the brain cannot be ignored. When STA-MCA anastomosis is applied to moyamoya cases, we had better take the degree of development and positions of vault moyamoya into consideration, because we have to cut STA and MMA in the procedure.

Adult↗
PubMed1980

[An operated case of foramen magnum neurinoma (author's transl)].

A 36-year-old male with craniospinal type of foramen magnum neurinoma removed totally was reported. Foramen magnum neurinoma shows various clinical symptoms called foramen magnum syndrome but none of them is specific. Therefore almost all the cases in the literature have been misdiagnosed as degenerative or demyelinating diseases. The best way for correct diagnosis is to suspect the existence of the tumor. Conventional suboccipital craniectomy has been adopted to remove the tumors. But craniospinal type of this tumor usually develops in the anterior part of the foramen magnum. Therefore we approached to the tumor from aside in the lateral position. In this approach, we can avoid tissue damage of cerebellum and medulla due to retraction and can reach near the midportion of the posterior fossa. The importance of checking respiration during surgery is also emphasized, because surgical intervention is carried out around the medulla oblongata.

Adult↗
PubMed1979

Electroencephalographic findings in children with moyamoya disease.

The EEG findings in 25 children with moyamoya disease were studied. Characteristic findings such as posterior slow, centrotemporal slow (CT slow), "rebuildup" after the end of hyperventilation, and sleep spindle depression were observed. Posterior slow activity was mainly observed in the EEGs examined within a short period (mean, 10 months) after onset, CI slow activity after a longer period (mean,, 28 months), and a diffuse low-voltage pattern after these periods (mean, 56 months). Buildup after the end of hyperventilation, which we refer to as "rebuildup," was discovered in more than half of the cases.

Adolescent↗
PubMed1979

Aneurysm surgery above the eighth decade.

A series of nine patients over 70 years of age with saccular aneurysms, operated on by direct surgery, is reviewed in order to discuss aneurysm surgery in older patients. The median age of the patients was 74 years, and the median interval from haemorrhage to surgery was 18 days. Operative mortality was 11%, and morbidity was 33%. Because of arteriosclerosis round the aneurysm neck and parent artery, special considerations for surgical treatment on the older patients are required.

Age Factors↗
PubMed1979

[Surgical treatment of the middle cerebral artery aneurysm--from the experiences of 174 cases (author's transl)].

174 cases of middle cerebral artery aneurysm submitted to surgical operations without using microscope were reviewed. At operation, the head is set on the neutral and slightly chin up position, not turned to any directions. Small craniotomy, which is about half as much as the ordinary unifrontal craniotomy, is performed. The merit of our method is as follows; the M1 portion (Fisher) of the middle cerebral artery runs horizontally, so that we can keep the parent artery during the operation, and owing to the chin up position the strong retraction of the frontal lobe can be avoided. Of 174 cases, 9 were dead (mortality rate 5.2%) and 18 were poor (10.4%). Bad operative outcome is due to the obstruction of the middle cerebral artery around the aneurysmal neck. Therefore, we should always keep in mind to preserve the blood flow of the parent artery as well as that of its branches. Study was made mainly on this point of view such as the general technical process of the aneurysmal neck treatment, the treatment of the cases with severe arteriosclerosis and with large aneurysms having the blood coagula inside.

Adult↗
PubMed1979

[Surgical treatment of the internal carotid-posterior communicating artery aneurysm--from the experience of 213 cases (author's transl)].

213 cases of so-called posterior communicating artery aneurysm submitted to surgical operation without using microscope were reviewed from the technical point of view. Aneurysm project boradly to two directions, i.e. postero-inferior and lateral directions. We have treated these anuerysms with two very distinct operative approaches in order to reach the aneurysmal neck from the right angle. Frontal approach is used for the aneurysms projecting laterally. In contrast, the aneurysms projecting postero-inferior are reached laterally by mobilizing the tip of the temporal lobe. Of 213 patients, 15 died (mortality rate 7.0%) and 19 were poor (8.9%). The operative result of the cases in which the aneurysm ruptured during the exposure of the aneurysmal neck was poor. Therefore, intensive care is emphasized to avoid the aneurysm rupture during surgery. Other important technical points which affect the operative results were discussed.

Adolescent↗
PubMed1979

[Aneurysm surgery in the older patients (author's transl)].

A series of 9 patients over 70 years of age with saccular aneurysms, operated on by a direct surgery is reviewed in order to discuss the aneurysm surgery in the older patients. The median age of the patients was 74 years, and median interval from the hemorrhage to surgery was 18 days. Operative mortality was 11% and morbidity was 33%. Result of intracranial aneurysm surgery in the older patients depends on the surgical technique for the arteriosclerosis. 1. Treatment of the aneurysm neck must be abandoned when a severe arteriosclerosis exists around it. Subsequent to exposure of the whole aneurysm, a complete reinforcement of the aneurysm wall should be undertaken. 2. Especially gentle manipulation of the brain is necessary since small arteries are easily pulled out from the sclerotic artery. 3. The cerebral veins must be preserved as well as possible to avoid the venous congestion, which easily causes an intracerebral hematoma following brain retraction. 4. The frequency of pre and postoperative complications is high, but through vigorous care, they are kept under control. 5. It is best not to judge the surgical indication simply by the chronological age, but rather to consider the physical age including the laboratory findings. Therefore, other than cases of severe arteriosclerosis, the same principles for surgical indication in younger patients should be used for older patients.

Aged↗
PubMed1979

[Surgical treatment of the carotid-ophthalmic aneurysms (author's transl)].

Six cases of carotid-ophthalmic aneurysm submitted to direct operation were studied. 1. One out of six cases died postoperatively (mortality rate 16.7%). 2. Exposure of the internal carotid artery at the neck is absolutely necessary for its temporary occlusion. Temporary occlusion of the internal carotid artery at the neck makes the dissection of the aneurysmal neck easier and prevents the aneurysmal rupture during operation. 3. To cope with various complicated handlings, bifrontal carniotomy is recommended. 4. In order to make easy the dissection of the aneurysmal neck, the unroofing of the optic canal as well as the extensive removal of the tip of the anterior clinoid should be performed. 5. From our experience as well as review of the literature, the surgical result of the giant aneurysms is bad. Some new therapy is expected to be developed for the giant aneurysm of this site.

Adult↗
PubMed1979

[A case of giant choroid plexus carcinoma in a child (author's transl)].

A 1-year-and 4-month-old girl with giant choroid plesux carcinoma was reported from a viewpoint of surgical treatment. As this tumor develops in the ventricular system, rapid deterioration of the general condition due to marked intracranial hypertention is seen especially in children. Therefore, the first aid of the surgical treatment is the control of the intracranial pressure by continuous ventricular drainage in an attempt to improve the general condition of the patient. Because the tumor is very bloody, applying of the temporary clip on the feeding artery such as the anterior choroidal artery should be recommended prior to the dissection of the tumor during surgery.

Carcinoma↗
PubMed1979

[Spontaneous regression of a posterior fossa dural arteriovenous malformation (author's transl)].

A 29-year-old woman was admitted to our hospital because of dizziness, nausea and convulsive seizure. She complained of left sided tinnitus. Neurological examination revealed right homonymous hemianopsia, and systolic murmur on the left retroauricular area. Angiograms revealed a dural AVM in the left posterior fossa. Feeders of AVM were enlarged left occipital artery and middle meningeal artery. Since then she was treated only conservatively, but angiograms performed two years and one month later showed disappearance of the dural AVM. She experienced no head trauma, and no subarachnoidal hemorrhage. She has never been treated by irradiation nor contraceptives. We could find no clear mechanism for the spontaneous regression of the AVM.

Adult↗
PubMed1978

Brain tumor in newborn babies.

5 cases of brain tumor in newborn babies under 2 months are presented. 4 of them were supratentorial teratoma and originated from the midline, and 1 was a glioma at the cerebelloponitine angle. 2 cases died before surgery and 2 cases after surgery. In our 5th case a benign teratoma of 150 g was removed from the third ventricle. He was discharged and enjoyed rather good health for 2 years and 1 month before dying of recurrence of tumor. Internal hydrocephalus associated with the huge tumor was responsible for the sudden deterioration of general condition. Therefore, shunting procedures should be performed as the first aid. However, in our experiences, the conditions at admission were the critical and/or too late to be beneficial. Thus early diagnosis is absolutely necessary for surgical treatment. A summary and discussion of the data of 103 previously reported cases are included.

Brain Neoplasms↗
PubMed1978

Distribution of intracranial aneurysm.

The 1,080 cases of intracranial saccular aneurysms, which were seen at our clinic during the period from June 1961 to September 1975, were subjected to the analysis on the location of the aneurysms, age distribution and sex incidence.

Adolescent↗