Sequential Development of Putaminal Hemorrhage and Corona Radiata Infarction in the Same Lenticulostriate Arterial Territory

Putaminal hemorrhage is a common type of spontaneous cerebral hemorrhage. However, to our knowledge, there have been no reports of sequential cerebral hemorrhage and infarction in the same perforating arterial territory. Herein, we present the first reported case of the sequential development of putaminal hemorrhage and corona radiata infarction in the same lenticulostriate arterial (LSA) territory. Early intensive blood pressure lowering treatment may have aggravated ischemic damage. If a patient presents with motor weakness that cannot be explained by putaminal hemorrhage, the sequential development of corona radiata infarction in the same LSA territory should be ruled out

Outcome predictors of open embolectomy in middle cerebral artery occlusion

Objective: The purpose of this paper was to analyse the outcome of the patients with acute middle cerebral artery (MCA) occlusion treated by open embolectomy. Methods: A clinical chart review was retrospectively conducted for 30 patients who had MCA occlusion and were treated with open embolectomy. According to the Glasgow Outcome Scale, the patients' outcome at discharge is divided in two groups: favorable outcome (good recovery and moderate disability) or unfavorable outcome (severe disability, vegetative state and death). The following variables between the favorable and unfavorable outcomes were analysed: age, sex, Glasgow Coma Scale score on admission, affected side, occlusion site, occlusion time, atrial fibrillation on electrocardiogram, fibrinolysis, aphasia, hemiparesis and hemorrhagic infarction after surgery. Results: The outcomes of 30 patients were favorable in 16 patients (good recovery in nine and moderate disability in seven) and unfavorable in 14 patients (severe disability in 12, vegetative state in one and death in one). The M1 occlusion and fibrinolysis performance were more frequent in the unfavorable outcome group than in the favorable one. Logistic regression analysis with a stepwise method indicated that the only occlusion site was independently associated with the unfavorable outcome. The occlusion time >360 minutes was not the predictor of the unfavorable outcome. Discussion: The outcome of patients with MCA occlusion treated by the open embolectomy depends on the occlusion site and the fibrinolysis performance in the present study. The M1 occlusion is also the independent risk factor of the unfavorable outcome. However, the occlusion time itself has no relation to the unfavorable outcome. These results indicate that therapeutic time windows vary in individuals probably due to the collateral blood flow.ArticleNEUROLOGICAL RESEARCH. 31(9):892-894 (2009)journal articl

Urgent open embolectomy for cardioembolic cervical internal carotid artery occlusion

Acute ischemic stroke attributable to cervical internal carotid artery (ICA) occlusion is frequently associated with severe disability or death and is usually caused by atherosclerosis. By contrast, the cardioembolic cervical ICA occlusion is rare, and feasibility of urgent recanalization remains unclear. We present the first study in the literature that focuses on urgent open embolectomy for the treatment of cardioembolic cervical ICA occlusion. A retrospective review of the charts for patients undergoing open embolectomy was performed. Between April 2006 and September 2007, 640 consecutive patients with acute ischemic stroke were treated. Of them, three patients (0.47%) with the acute complete cardioembolic cervical ICA occlusion underwent urgent open embolectomy. All patients presented with profound neurological deficits and atrial fibrillation. The urgent open embolectomy achieved complete recanalization in all patients without any complications. All emboli in three patients were very large and fibrinous in histological findings. Two of three patients showed rapid improvement in neurological functions after surgical treatments. The cardioembolic occlusion of the cervical ICA is rare, but its possibility should be considered in patients with acute ischemic stroke suffering profound neurological deficits and atrial fibrillation. Urgent open embolectomy may be a treatment option to obtain successful recanalization for cardioembolic cervical ICA occlusion and is recommended because it is technically easier and similar to carotid endarterectomy.ArticleNEUROSURGICAL REVIEW. 33(3):341-348 (2010)journal articl

Correlations Among Consistency, Computed Tomography Values, and Histopathological Subtypes of Spinal Meningioma

The consistency of spinal meningiomas is important to consider when performing tumor removal surgery. This study evaluated the correlations between spinal meningioma consistency and both preoperative computed tomography (CT) values and histopathological subtypes. Fifteen consecutive patients who underwent surgical resection of spinal meningioma at our institution were identified, and preoperative CT values and the signal intensity of T2-weighted magnetic resonance images of the tumor were determined retrospectively. The consistency of the spinal meningioma was defined based on the ultrasonic surgical aspirator output during tumor debulking. Patients were assigned to 2 groups: a soft group (n=4) and a hard group (n=11). The T2 signal intensity was significantly higher in the soft group than in the hard group (p=0.001). While the CT values were considerably higher in the hard group, the difference was not significant (p=0.19). Regarding the histopathological subtypes, psammomatous meningioma exhibited significantly higher CT values than meningothelial meningioma (p=0.019); however, there was a higher frequency of hard tumors in meningothelial meningioma cases than in psammomatous meningioma cases. Although neither robust correlations between tumor consistency and CT values nor a relationship between tumor consistency and histopathological subtype has been established, these results might help with the perioperative manegement of spinal tumors

Mycotic Posterior Inferior Cerebellar Artery Aneurysm Following Meningitis after Endoscopic Endonasal Transsphenoidal Surgery : Case Report and Review of the Literature

Mycotic intracranial aneurysms (MIAs) are rare infection-mediated arterial wall destructions that result in focal vessel weakness and dilatation. They commonly involve the anterior cerebral circulation, usually following hematogenous embolization from infective cardiac vegetation, and are associated with an elevated risk of rupture. MIAs arising from a posterior inferior cerebellar artery (PICA) are uncommon, and those resulting from contiguous infections are extremely rare. Here, we present a case report and review the literature on rare MIAs involving the distal PICA segment following meningitis after endoscopic endonasal transsphenoidal surgery. A 75-year-old man presented with a 2-year history of progressive visual impairment of the left eye, for which initial cranial magnetic resonance imaging suggested optic perineuritis ; however, conservative management with high-dose steroid therapy did not improve the patient’s condition. He subsequently had biopsy, which confirmed an optic nerve sheath meningioma, for which optic nerve decompression via the endoscopic endonasal approach (EEA) and follow-up radiation therapy was done. He developed postoperative meningitis and subsequently had rupture of left PICA mycotic aneurysm (angiography done a month earlier demonstrated normal left PICA). Risk factors for meningitis were invasive cranial intervention, prolonged steroid use, and radiation therapy. Coil embolization was successfully performed ; however, the patient succumbed to irreversible herniation and infection. MIAs arising from the PICA following meningitis are rare, but complications following surgical intervention and rupture are associated with high morbidity and mortality. A high index of suspicion and early intervention before rupture may prevent poor outcomes.Article信州医学雑誌 71(6) : 415-422, (2023)journal articl

Intelligent Surgeon\u27s Arm Supporting System iArmS in Microscopic Neurosurgery Utilizing Robotic Technology

Background: Based on our previous reports, stabilizing the surgeon\u27s arm with an intraoperative armrest is linked to improved precision of microsurgical and endoscopic procedures. We developed the robotic intelligent surgeon\u27s arm supporting system iArmS, which automatically follows the surgeon\u27s arm and fixes it at an adequate position. Methods: iArmS has 3 states—free, hold, and wait—which can be carefully chosen automatically as follows: In free state, the armholder follows the surgeon\u27s arm. In hold state, iArmS supports the surgeon\u27s arm weight by fixing the armholder. In wait state, the surgeon can move his or her arm away from the armholder. Also, the surgeon can change the armrest position while looking through the microscope and can continue the microsurgical procedure while holding surgical instruments. From February 2015 to January 2017, iArmS was used in 108 microsurgeries at 3 of the authors\u27 institutions by 14 board-certified neurosurgeons, including the authors. After using iArmS, to quantify neurosurgeons\u27 satisfaction, a scaling evaluation guide based on visual analog scales was designed to be completed by contributing neurosurgeons, including authors. Results: iArmS decreased fatigue and reduced hand trembles experienced by surgeons. Continuous accurate motions of microinstruments were performed without any difficulties. There were no complications related to use of iArmS. Conclusions: iArmS allows continuous precise manipulations that provide high-quality surgical results in neurosurgical techniques. Moreover, iArmS is a useful automatic tool for holding and following the surgeon\u27s arm