Publications by authors named "Fumitaka Yoshioka"

25 Publications

  • Page 1 of 1

Elimination of the check-valve mechanism of the sacral Tarlov cyst using a rotation flap technique in a pediatric patient: technical note.

Childs Nerv Syst 2021 May 6;37(5):1741-1745. Epub 2021 Jan 6.

Department of Neurosurgery, School of Medicine, Saga University, 5-1-1 Nabeshima, Saga-shi, Saga, 849-8501, Japan.

Objective: Symptomatic Tarlov cysts in children are not sufficiently reported and treatment methods for Tarlov cysts are still controversial. The goal of this manuscript is to introduce a new variation of the surgical technique.

Methods: We performed surgery to eliminate the one-way check valve mechanism of the Tarlov cyst in a 7-year-old female who presented with urinary and fecal incontinence. A relatively large S3 nerve root cyst showed a one-way check valve on computed tomography myelography. The inlet of the check valve was enlarged with rotation flap reconstruction.

Results: Two months after surgery, the patient had established normal sphincter control. MRI performed two years later showed that the treated cyst was collapsing, and no recurrence occurred.

Conclusions: Rotation flap enlargement of the check valve inlet is a safe and efficacious option for the treatment of pediatric patients with sacral Tarlov cysts.
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http://dx.doi.org/10.1007/s00381-020-05029-zDOI Listing
May 2021

Hemorrhagic stroke associated with essential thrombocythemia: Case report and literature review.

J Stroke Cerebrovasc Dis 2020 Oct 18;29(10):105069. Epub 2020 Jul 18.

Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan. Electronic address:

Hemorrhagic stroke associated with essential thrombocythemia (ET) is very infrequent. Herein, we report a case of a 33-year-old woman with a 2-year history of ET who developed intracerebral and subarachnoid hemorrhage. Angiography demonstrated severe vessel irregularity in the bilateral cerebral arteries. Molecular genetic testing revealed a calreticulin mutation. To our knowledge, hemorrhagic stroke has been reported in only six other patients with ET, and this is the first report of hemorrhagic stroke in an ET patient with a calreticulin mutation. We review the current literature and discuss the possible underlying mechanisms.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105069DOI Listing
October 2020

Prenatal clinical manifestations in individuals with variants.

J Med Genet 2020 Jul 30. Epub 2020 Jul 30.

Department of Pediatric Neurology, Bobath Memorial Hospital, Osaka, Osaka, Japan.

Background: Variants in the type IV collagen gene () cause early-onset cerebrovascular diseases. Most individuals are diagnosed postnatally, and the prenatal features of individuals with variants remain unclear.

Methods: We examined in 218 individuals with suspected /2-related brain defects. Among those arising from variants, we focused on individuals showing prenatal abnormal ultrasound findings and validated their prenatal and postnatal clinical features in detail.

Results: Pathogenic variants were detected in 56 individuals (n=56/218, 25.7%) showing porencephaly (n=29), schizencephaly (n=12) and others (n=15). Thirty-four variants occurred de novo (n=34/56, 60.7%). Foetal information was available in 47 of 56 individuals, 32 of whom (n=32/47, 68.1%) had one or more foetal abnormalities. The median gestational age at the detection of initial prenatal abnormal features was 31 weeks of gestation. Only 14 individuals had specific prenatal findings that were strongly suggestive of features associated with variants. Foetal ventriculomegaly was the most common initial feature (n=20/32, 62.5%). Posterior fossa abnormalities, including Dandy-Walker malformation, were observed prenatally in four individuals. Regarding extrabrain features, foetal growth restriction was present in 16 individuals, including eight individuals with comorbid ventriculomegaly.

Conclusions: Prenatal observation of ventriculomegaly with comorbid foetal growth restriction should prompt a thorough ultrasound examination and gene testing should be considered when pathogenic variants are strongly suspected.
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http://dx.doi.org/10.1136/jmedgenet-2020-106896DOI Listing
July 2020

A case of pediatric moyamoya disease with severe cerebral vasospasm and delayed cerebral infarction following an intraventricular hemorrhage.

Childs Nerv Syst 2021 Feb 14;37(2):695-698. Epub 2020 Jul 14.

Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.

Reports on patients with moyamoya disease presenting cerebral ischemic complications after the onset of intraventricular hemorrhage (IVH) and/or intracerebral hemorrhage (ICH) are limited. Herein, we report a case of a 7-year-old girl with moyamoya disease with severe cerebral vasospasm and delayed cerebral infarction following an IVH. Although the case is rare, the potential for vasospasm-induced cerebral infarction should be carefully considered and thus, intensive treatment should be immediately initiated.
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http://dx.doi.org/10.1007/s00381-020-04769-2DOI Listing
February 2021

BMP4 induces asymmetric cell division in human glioma stem-like cells.

Oncol Lett 2020 Feb 20;19(2):1247-1254. Epub 2019 Dec 20.

Department of Neurosurgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan.

Glioblastoma (GBM) is a malignant tumor with a high recurrence rate and has very poor prognosis in humans. The median survival is still <2 years. Therefore, a new treatment strategy should be established. Recently, this cancer has been thought to be heterogeneous, consisting of cancer stem cells (CSCs) that are self-renewable, multipotent, and treatment resistant. So various strategies targeting glioma stem-like cells (GSCs) have been investigated. This study focused on strategies targeting GSCs through the induction of differentiation using bone morphogenetic protein 4 (BMP4). The expression of CD133, a cancer stem cell marker, under BMP4 treatment in GSCs was examined using flow cytometry, western blotting, and quantitative PCR. Immunofluorescent staining of GSCs was also performed to examine the type of cell division: asymmetric cell division (ACD) or symmetric cell division (SCD). We obtained the following results. The BMP4 treatment caused downregulation of CD133 expression. Moreover, it induced ACD in GSCs. While the ACD ratio was 23% without BMP4 treatment, it was 38% with BMP4 treatment (P=0.004). Furthermore, the tumor sphere assay demonstrated that BMP4 suppresses self-renewal ability. In conclusion, these findings may provide a new perspective on how BMP4 treatment reduces the tumorigenicity of GSCs.
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http://dx.doi.org/10.3892/ol.2019.11231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956386PMC
February 2020

Association between extracranial internal carotid artery tortuosity and thromboembolic complications during coil embolization of anterior circulation ruptured aneurysms.

Acta Neurochir (Wien) 2019 06 15;161(6):1175-1181. Epub 2019 Apr 15.

Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-shi, Saga, 849-8501, Japan.

Background: The most frequent neurological complication during coil embolization of a ruptured cerebral aneurysm is a thromboembolic event. The association between the tortuosity of the internal carotid artery (ICA) and thromboembolic events (TEEs) during coil embolization of ruptured cerebral aneurysms remains unclear. The present study aimed to investigate the association between extracranial ICA tortuosity and thromboembolic complications during coil embolization of anterior circulation ruptured aneurysms.

Methods: A cohort of 57 patients with 57 anterior circulation ruptured aneurysms who underwent endovascular embolization at a single institution was retrospectively investigated. Patients were divided into two groups, those who experienced TEEs and those who did not that were compared and analyzed based on patient baseline characteristics, procedural factors, and anatomical factors including those of aneurysms and extracranial ICA tortuosity. The anatomical factors of the aneurysms included maximum dome size, neck width, dome-to-neck ratio, and dome-to-neck aspect ratio. Extracranial ICA angles in the proximal and distal curvature were evaluated as ICA tortuosity.

Results: Three of the 57 patients were excluded because of unavailability of data regarding ICA tortuosity; 54 patients were finally evaluated. TEEs occurred in six patients with five anterior cerebral and one internal carotid aneurysms. The extracranial distal ICA angle was significantly larger in patients with TEEs than in those without. Procedural factors and anatomical factors of the aneurysms were not associated with TEEs.

Conclusions: Extracranial ICA tortuosity was significantly associated with an increased incidence of thromboembolic events during endovascular coiling of anterior circulation ruptured aneurysms.
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http://dx.doi.org/10.1007/s00701-019-03903-7DOI Listing
June 2019

Stabilization of vulnerable carotid plaques with proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab.

Acta Neurochir (Wien) 2019 03 7;161(3):597-600. Epub 2019 Feb 7.

Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-shi, Saga, 849-8501, Japan.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, a novel class of monoclonal antibodies, reduce low-density lipoprotein cholesterol levels and improve outcomes of myocardial infarction and stroke. However, the effects of PCSK9 inhibitors on carotid plaques remain unclear. We describe three patients treated with PCSK9 inhibitor alirocumab for progressive carotid stenosis despite lipid-lowering statin therapy. All three patients had vulnerable plaques on magnetic resonance (MR) plaque imaging. After alirocumab treatment initiation, no patients suffered stroke or adverse events, and the stabilization of the carotid plaques was observed on MR plaque imaging.
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http://dx.doi.org/10.1007/s00701-019-03825-4DOI Listing
March 2019

Significance of simulated conventional images on dual energy CT after endovascular treatment for ischemic stroke.

J Neurointerv Surg 2019 Sep 22;11(9):898-902. Epub 2019 Jan 22.

Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.

Background And Purpose: CT scans often reveal post-interventional cerebral hyperdensities (PCHDs) immediately after intra-arterial thrombectomy (IAT) for ischemic stroke. Dual energy CT (DE-CT) can indicate whether PCHDs are caused by hemorrhage or iodinated contrast. Hyperdense lesions, detected on DE-CT with the use of iodinated contrast, could be associated with delayed hemorrhagic transformation and poor outcome. However, the quantitative indicators in DE-CT for predicting delayed hemorrhagic transformation remain unclear. We assessed such indicators for predicting delayed hemorrhagic transformation.

Material And Methods: We retrospectively analyzed 52 consecutive acute ischemic stroke patients who underwent IAT. Simulated conventional CT (sCCT) images were obtained immediately after a DE-CT scan. Virtual, unenhanced, non-contrast (VNC) imaging was performed after reconstruction. Hounsfield units (HU) of the infarct areas observed on the sCCT were measured. The association of HU on sCCT with hemorrhage on VNC and delayed parenchymal hemorrhage (PH) was evaluated.

Results: The HU of sCCT with hemorrhage on VNC was significantly higher than without it (377.9±385 HU vs 83.5±37.9 HU; P<0.0001). The cut-off index was 80 HU, which displayed 100% sensitivity, 63.8% specificity, 22.3% positive predictive value, and 100% negative predictive value (P=0.0001, area under the curve (AUC)=0.89). The HU with delayed PH was substantially higher than without it (250.8±382.2 HU vs 93.7±64.8 HU; P=0.01). The cut-off index was 78 HU, which showed 100% sensitivity, 61% specificity, 25% positive predictive value, and 100% negative predictive value (P=0.049, AUC=0.76).

Conclusion: sCCT images on DE-CT are useful for excluding intracerebral hemorrhage and delayed PH.
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http://dx.doi.org/10.1136/neurintsurg-2018-014486DOI Listing
September 2019

Extensive spinal epidural immature teratoma in an infant: case report.

J Neurosurg Pediatr 2018 Oct 6;22(4):411-415. Epub 2018 Jul 6.

1Department of Neurosurgery, School of Medicine, Saga University, Saga.

Here, the authors present an extremely rare case of an extensive spinal epidural teratoma (SET) in an infant and provide a review of the cases in the literature. In this report, the authors focused on the clinical manifestation and management of extensive SET. A 64-day-old girl presented with severe dyspnea and paraparesis caused by a large thoracic mass. Imaging studies revealed that the mass originated from the epidural space of the thoracic spine and extended from C7 to L1. The tumor extended bilaterally through the intervertebral foramina and formed a large posterior mediastinal mass. The tumor was partially resected via laminotomy after an emergency thoracotomy. The remnant grade I immature teratoma grew rapidly. After a re-laminotomy and bilateral thoracotomy, the residual tumor stopped growing. However, the patient's paraparesis improved very little, and her scoliosis progressed gradually. Therefore, SET should be included in the differential diagnosis when an infant patient with paraparesis of the lower extremities is encountered. Timely diagnosis, aggressive treatment, and close monitoring are of critical importance to successful recovery in such patients.
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http://dx.doi.org/10.3171/2018.4.PEDS17676DOI Listing
October 2018

Possible involvement of pericytes in intraplaque hemorrhage of carotid artery stenosis.

J Neurosurg 2018 Jun 1:1-7. Epub 2018 Jun 1.

1Department of Neurosurgery, Faculty of Medicine, Saga University, Saga.

OBJECTIVEIntraplaque hemorrhage (IPH) is most often caused by the rupture of neovessels; however, the factors of intraplaque neovessel vulnerability remain unclear. In this study, the authors focused on pericytes and aimed to investigate the relationship between IPH and pericytes.METHODSThe authors retrospectively analyzed the medical records of all patients with carotid artery stenoses who had undergone carotid endarterectomy at their hospitals between August 2008 and March 2016. Patients with carotid plaques that could be evaluated histopathologically were eligible for study inclusion. Intraplaque hemorrhage was analyzed using glycophorin A staining, and patients were divided into the following 2 groups based on the extent of granular staining: high IPH (positive staining area > 10%) and low IPH (positive staining area ≤ 10%). In addition, intraplaque neovessels were immunohistochemically evaluated using antibodies to CD34 as an endothelial cell marker or antibodies to NG2 and CD146 as pericyte markers. The relationship between IPH and pathology for intraplaque neovessels was investigated.RESULTSSeventy of 126 consecutive carotid stenoses were excluded due to the lack of a specimen for histopathological evaluation; therefore, 53 patients with 56 carotid artery stenoses were eligible for study inclusion. Among the 56 stenoses, 37 lesions had high IPH and 19 had low IPH. The number of CD34-positive neovessels was equivalent between the two groups. However, the densities of NG2- and CD146-positive neovessels were significantly lower in the high IPH group than in the low IPH group (5.7 ± 0.5 vs. 17.1 ± 2.4, p < 0.0001; 6.6 ± 0.8 vs. 18.4 ± 2.5, p < 0.0001, respectively).CONCLUSIONSPlaques with high IPH are associated with fewer pericytes in the intraplaque neovessels. This finding may help in the development of novel therapeutic strategies targeting pericytes.
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http://dx.doi.org/10.3171/2018.1.JNS171942DOI Listing
June 2018

[Surgical Technique for Lumbar Spinal Extraforaminal Schwannoma].

No Shinkei Geka 2018 Jan;46(1):5-9

Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Mita Hospital.

Introduction: Spinal neurinomas are frequently observed in the cauda equina, particularly within the dura mater. However, extraforaminal schwannomas(EFS), which are neither intradural nor dumbbell type, are relatively rare; hence, different surgical procedures have been employed. Here, we report 12 cases of lumbar EFS with total resection that were safely performed.

Methods And Subjects: This study was comprised of 12 patients with lumbar EFS(excluding those with neurofibromas)who were previously treated at our hospital. Using the Wiltse paraspinal approach, we inserted the microscope until it reached the tumor surface. After confirming the tumor surface, we inserted a scalpel to make an incision in a portion of the outer capsule. Then, we confirmed that the surfaces of the outer capsule and the tumor within the capsule could be dissected. Next, a thread was attached to the outer capsule and pulled upwards so that there was enough space to perform the required procedures within the capsule. Using a CUSA®, we removed the intracapsular tumor. After its removal, the outer capsule was treated carefully to ensure that the origin nerve was not damaged.

Results: In all cases, we successfully performed a total removal of the intracapsular tumor;in the mean postoperative observation period of 8 years, no recurrence was observed. Although temporary paralysis was observed in three patients, this improved over time.

Conclusion: We report our experience with a surgical technique that ensured the safe removal of lumbar EFS. Satisfactory results were achieved, with no recurrences observed during the mean 8-year postoperative observation period.
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http://dx.doi.org/10.11477/mf.1436203666DOI Listing
January 2018

Spine and Spinal Cord Injury Associated with a Fracture in Elderly Patients with Ankylosing Spondylitis.

Neurol Med Chir (Tokyo) 2018 Mar 19;58(3):103-109. Epub 2017 Dec 19.

Department of Neurosurgery, School of Medicine, International University of Health and Welfare.

There are few cases of spinal cord injury with ankylosing spondylitis (AS). This study investigated the clinical results of a spinal cord injury with a fracture in elderly patients with AS. Nine patients who had sustained a spinal cord injury with vertebral fractures in ankylosed spines were included in this study. The mean age was 79.3 years; two were male and seven were female. The mechanism of injury, the level of vertebral fractures, clinical methods, the follow-up period, and treatment outcomes were investigated. The mechanism of injury of six cases was a fall and in the others was a slip. The levels of vertebral fractures were a cervical lesion (n = 5), a thoracic lesion (n = 3), and a lumbar lesion (n = 1). Six cases underwent a surgical procedure with posterior fusion and decompression, two cases were treated only with a brace, and one case was treated with a halo vest. The mean follow-up period was 4.3 years. The neurological deficit treatment outcomes were improved or no change in four cases each and one case had died. There was not much difference in treatment outcomes between a surgical treatment and a conservative treatment. Computed tomography imaging to evaluate the entire spine is required in all patients with AS with a possible spinal fracture. A surgical treatment and early rising and rehabilitation should be recommended for patients with fractures and AS to avoid further complications, not from the standpoint of improving the neurological status.
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http://dx.doi.org/10.2176/nmc.oa.2017-0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5929918PMC
March 2018

Curved Planar Reformation for the Evaluation of Hydromyelia in Patients With Scoliosis Associated With Spinal Dysraphism.

Spine (Phila Pa 1976) 2018 02;43(3):E177-E184

Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan.

Study Design: A retrospective cohort study.

Objective: Scoliosis and hydromyelia have frequently been observed in patients with spinal dysraphism. We investigated the applicability of curved planar reformation (CPR) for evaluating hydromyelia in patients with scoliosis associated with spinal dysraphism.

Summary Of Background Data: It is quite difficult to evaluate scoliosis and hydromyelia in patients with spinal dysraphism.

Methods: We identified 11 patients with scoliosis and a Cobb angle of >20° among 107 spinal dysraphism patients. In addition to routine T1- and T2-weighted axial and sagittal MRI, we obtained three-dimensional constructive interference in steady-state magnetic resonance imaging (MRI) as sagittal cross-section volume images. The spinal cord and hydromyelia were rendered into a single-plane, two-dimensional image using the straightened CPR technique. In cases of scoliosis with hydromyelia, the sagittal length and maximal diameters of hydromyelia and the spinal cord were measured by three examiners. Measurement errors among examiners were evaluated using standard deviation (SD) and coefficient of variation (CV).

Results: Each series of image sets provided a straightened CPR image that clearly delineated the entire length of the linearized spinal cord in a single plane. The straightened CPR image also demonstrated the accurate lengths and estimated volume of hydromyelia. Given that three of the 11 patients underwent serial MRI during this period, we were able to accurately compare volume changes. In the sagittal length of the hydromyelia, SD and CV were smaller with the straightened CPR technique than with the conventional T2 WI sagittal section in all cases, showing a statistically significant difference between both techniques (SD: P = 0.014, CV: P = 0.013). Even in the measurements, the difference in CV between both techniques was close to statistical significance.

Conclusion: The straightened CPR technique is useful for accurately identifying volume changes in hydromyelia, even in patients with severe scoliosis.

Level Of Evidence: 1.
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http://dx.doi.org/10.1097/BRS.0000000000002270DOI Listing
February 2018

[A Rare Case of Cerebellar Hemangioblastoma Causing Taste Disorder].

No Shinkei Geka 2017 Mar;45(3):219-224

Department of Neurosurgery, Faculty of Medicine, Saga University.

Taste(gustation)is one of the five senses, and comprises the types: sweet, bitter, salty, sour, and umami. Taste disorders, such as dysgeusia and parageusia, are classified into 2 types: those with peripheral origin and those with central origin. The peripheral origin-type taste disorder is caused by zinc deficiency, mouth dryness, a side effect of radiotherapy or complication of systemic diseases such as, diabetes, hepatopathy, and nephropathy. The central origin-type taste disorder is reported to be caused due to demyelinating disease, pontine hemorrhage, pontine infarction, and thalamic infarction; it is very rarely caused by a brain tumor. We surgically treated a 69-year-old man with cerebellar hemangioblastoma who had developed taste disorder. The tumor compressed the solitary nucleus, which includes the taste tract in the central nervous system. On removal of the tumor, the taste disorder gradually improved.
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http://dx.doi.org/10.11477/mf.1436203482DOI Listing
March 2017

The cochlea in skull base surgery: an anatomy study.

J Neurosurg 2016 11 29;125(5):1-11. Epub 2016 Jan 29.

4Department of Neurosurgery, University of Florida, Gainesville, Florida.

OBJECTIVE The object of this study was to examine the relationships of the cochlea as a guide for avoiding both cochlear damage with loss of hearing in middle fossa approaches and injury to adjacent structures in approaches directed through the cochlea. METHODS Twenty adult cadaveric middle fossae were examined using magnifications of ×3 to ×40. RESULTS The cochlea sits below the floor of the middle fossa in the area between and below the labyrinthine segment of the facial nerve and greater petrosal nerve (GPN) and adjacent to the lateral genu of the petrous carotid. Approximately one-third of the cochlea extends below the medial edge of the labyrinthine segment of the facial nerve, geniculate ganglion, and proximal part of the GPN. The medial part of the basal and middle turns are the parts at greatest risk in drilling the floor of the middle fossa to expose the nerves in middle fossa approaches to the internal acoustic meatus and in anterior petrosectomy approaches. Resection of the cochlea is used selectively in extending approaches through the mastoid toward the lateral edge of the clivus and front of the brainstem. CONCLUSIONS An understanding of the location and relationships of the cochlea will reduce the likelihood of cochlear damage with hearing loss in approaches directed through the middle fossa and reduce the incidence of injury to adjacent structures in approaches directed through the cochlea.
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http://dx.doi.org/10.3171/2015.8.JNS151325DOI Listing
November 2016

Outcome of microvascular decompression for hemifacial spasm associated with the vertebral artery.

Neurosurg Rev 2017 Apr 8;40(2):267-273. Epub 2016 Jun 8.

Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan.

We retrospectively compared the outcome of microvascular decompression (MVD) for hemifacial spasm (HFS) associated with the vertebral artery (VA) with that of MVD for HFS unrelated to the VA. Between April 2008 and April 2015, 22 patients with VA-associated HFS underwent MVD at our institution. The median follow-up period was 28 months (range, 12-90 months). Results were classified as excellent in 19 patients (86 %), good in one (5 %), fair in one (5 %), and poor in one (5 %). Immediate complications developed in five patients (23 %), and one of these complications (5 %) was permanent. The surgical outcome of MVD for VA-associated HFS was similar to that of MVD for HFS unrelated to the VA; however, the incidence of complications was significantly more frequent in patients whose VA compressed the more proximal portion of the facial nerve root exit zone from the caudal side at the pontomedullary sulcus. We conclude that preoperative evaluation of VA compression patterns is important to predict the difficulty of the planned MVD procedure.
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http://dx.doi.org/10.1007/s10143-016-0759-yDOI Listing
April 2017

[Anatomy of jugular foramen and hypoglossal canal].

Nihon Jibiinkoka Gakkai Kaiho 2015 Jan;118(1):14-24

Neuroscience Center, Fukuoka Sanno Hospital, Japan

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January 2015

Microsurgical anatomy of the trigeminal nerve.

Clin Anat 2014 Jan 9;27(1):61-88. Epub 2013 Dec 9.

Department of Neurosurgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea; Department of Neurosurgery, University of Florida, Gainesville, Florida.

The objective of this study is to review surgical anatomy of the trigeminal nerve. We also demonstrate some pictures involving the trigeminal nerve and its surrounding connective and neurovascular structures. Ten adult cadaveric heads were studied, using a magnification ranging from 3× to 40×, after perfusion of the arteries and veins with colored latex. The trigeminal nerve is the largest and most complex of the cranial nerves. It serves as a major conduit of sensory input from the face and provides motor innervation to the muscles of mastication. Because of its size and complexity, it is essential to have thorough knowledge of the nerve before diagnoses and treatment of the pathologic processes in the orofacial, temporomandibular, infratemporal, and pterygopalatine areas. The trigeminal nerve is encountered with imaging or surgery of the skull base surgery. Thus, a comprehensive knowledge of the anatomy of the trigeminal nerve is crucial for performing the surgical procedures without significant complication.
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http://dx.doi.org/10.1002/ca.22330DOI Listing
January 2014

Microsurgical anatomy of the infratemporal fossa.

Clin Anat 2013 May 27;26(4):455-69. Epub 2013 Jan 27.

Department of Neurosurgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.

The objective of this study is to clearly and precisely describe the topography and contents of the infratemporal fossa. Ten formalin-fixed, adult cadaveric specimens were studied. Twenty infratemporal fossa were dissected and examined using micro-operative techniques with magnifications of 3-40×. Information was obtained about the inter-relationships of the contents of the infratemporal fossa. The infratemporal fossa lies at the boundary of the head and neck, and the intracranial cavity. It is surrounded by the maxillary sinus anteriorly, the mandible laterally, the pterygoid process anteromedially, and the parapharyngeal space posteromedially. It contains the maxillary artery and its branches, the pterygoid muscles, the mandibular nerve, and the pterygoid venous plexus. The course and the anatomic variation of the maxillary artery and the branches of the mandibular nerve were demonstrated. The three-dimensional (3D) relationships between the important bony landmarks and the neurovascular bundles of the infratemporal fossa were also shown. The skull base anatomy of the infratemporal fossa is complex, requiring neurosurgeons and head and neck surgeons to have a precise knowledge of 3D details of the topography and contents of the region. A detailed 3D anatomic knowledge is mandatory to manage benign or malignant lesions involving the infratemporal fossa without significant postoperative complications.
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http://dx.doi.org/10.1002/ca.22202DOI Listing
May 2013

Obstructive hydrocephalus following aqueductal stenosis caused by supra- and infratentorial developmental venous anomaly: case report.

Childs Nerv Syst 2013 Feb 10;29(2):329-34. Epub 2012 Oct 10.

Department of Neurosurgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-shi, Saga 849-8501, Japan.

Objective: We report a rare case of hydrocephalus following aqueductal stenosis caused by developmental venous anomaly (DVA).

Methods: Four years after the incidental discovery of asymptomatic DVA, the 10-year-old boy presented with symptoms of hydrocephalus. Enhanced computed tomographic scans and magnetic resonance images showed supra- and infratentorial DVAs with caput medusae appearances in the right basal ganglia and cerebellum. Three dilated collector veins in the right basal ganglia, floor of the third ventricle, and floor of the fourth ventricle gathered together to drain into the great vein of Galen. Three-dimensional fusion images showed that the serpentine dilated vein from the posterior fossa coursed in the aqueduct and caused the aqueductal stenosis, which was confirmed by operative endoscopy.

Results: Endoscopic third ventriculostomy was performed and the hydrocephalus was relieved.

Conclusions: Although aqueductal stenosis caused by DVA is rare, it is important to be considered in the differential diagnosis of hydrocephalus. Three-dimensional reconstruction and fusion images are very useful.
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http://dx.doi.org/10.1007/s00381-012-1934-2DOI Listing
February 2013

Microsurgical anatomy of the abducens nerve.

Clin Anat 2012 Nov 14;25(8):1030-42. Epub 2012 Feb 14.

Department of Neurosurgery, Catholic University of Korea, Seoul, South Korea.

The aim of this study is to demonstrate and review the detailed microsurgical anatomy of the abducens nerve and surrounding structures along its entire course and to provide its topographic measurements. Ten cadaveric heads were examined using ×3 to ×40 magnification after the arteries and veins were injected with colored silicone. Both sides of each cadaveric head were dissected using different skull base approaches to demonstrate the entire course of the abducens nerve from the pontomedullary sulcus to the lateral rectus muscle. The anatomy of the petroclival area and the cavernous sinus through which the abducens nerve passes are complex due to the high density of critically important neural and vascular structures. The abducens nerve has angulations and fixation points along its course that put the nerve at risk in many clinical situations. From a surgical viewpoint, the petrous tubercle of the petrous apex is an intraoperative landmark to avoid damage to the abducens nerve. The abducens nerve is quite different from the other nerves. No other cranial nerve has a long intradural path with angulations and fixations such as the abducens nerve in petroclival venous confluence. A precise knowledge of the relationship between the abducens nerve and surrounding structures has allowed neurosurgeon to approach the clivus, petroclival area, cavernous sinus, and superior orbital fissure without surgical complications.
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http://dx.doi.org/10.1002/ca.22047DOI Listing
November 2012

Microsurgical anatomy of the carotid cave.

Neurosurgery 2012 Jun;70(2 Suppl Operative):300-11; discussion 311-2

Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.

Background: The carotid cave was first described more than 20 years ago, but its relationships to the dural rings defining the clinoid segment of the internal carotid artery (ICA), the carotid collar, and the adjacent osseous structures need further definition.

Objective: To further define the microanatomy of the carotid cave and its relationships to the adjacent structures.

Methods: : The cave and its relationships were examined in cadaveric specimens using 3 to 40× magnification.

Results: The cave is an intradural pouch, found in 19 of 20 paraclinoid areas, that extends below the level of the distal dural ring between the wall of the ICA and the dural collar surrounding the ICA. The distal dural ring is tightly adherent to the anterior and lateral walls of the ICA adjacent the anterior clinoid process and optic strut but not on the medial and posterior sides of the artery facing the upper part of the carotid sulcus where the carotid cave is located. The superior hypophyseal artery frequently arises in the cave. The depth and circumferential length of the cave averaged 2.4 mm (range, 1.5-5 mm) and 9.9 mm (range, 4.5-12 mm), respectively. Aneurysms arising at the level of the cave, although appearing on radiological studies to extend below the level of the upper edge of the anterior clinoid, may extend into and may be a source of subarachnoid space.

Conclusion: The surgical treatment of aneurysms arising in the cave requires an accurate understanding of the relationships of the cave to the ICA, dural rings, and carotid collar.
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http://dx.doi.org/10.1227/NEU.0b013e3182431767DOI Listing
June 2012

Meningioma manifesting as cerebral infarction.

Neurol Med Chir (Tokyo) 2010 ;50(7):585-7

Department of Neurosurgery, Saga University Faculty of Medicine, Saga, Japan.

A previously healthy 31-year-old man presented with an extremely rare case of small meningioma associated with cerebral infarction preceded by recurrent transient ischemic attacks manifesting as a 3-day history of recurrent and transient weakness of the left lower limb lasting several minutes for each episode. The symptoms became persistent and complete on the following day. Magnetic resonance imaging revealed acute cerebral infarction in the right frontal lobe and a 20 mm diameter tumor in the planum sphenoidale encasing the right anterior cerebral artery. Cerebral angiography demonstrated occlusion of the right A(2) portion. The patient underwent surgery and the tumor was gross totally removed. The histological diagnosis was meningothelial meningioma. Cases of meningioma causing cerebral infarction are very rare, but the possibility should be considered even if the tumor is small.
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http://dx.doi.org/10.2176/nmc.50.585DOI Listing
December 2010

[Case of an idiopathic dissecting aneurysm of the superficial temporal artery: a case report].

No Shinkei Geka 2010 Apr;38(4):341-5

Department of Neurosurgery, Koyanagi Memorial Hospital, 230-2 Morodomicho Morodomitsu, Saga-city, Saga 840-2195, Japan.

Aneurysms of the superficial temporal artery are usually traumatic in origin an are pseudoaneurysms. We present a rare case of an idiopathic dissecting aneurysm of the superficial temporal artery in a 40-year-old man without history of trauma. The patient had a pulsatile mass in the left temporal region. Angiography showed a fusiform dilatation at the left superficial temporal artery and both the true lumen and the false lumen were recognized. Resection of the aneurysm was performed. Postoperatively, the patients complaints disappeared completely. Histopathological examination of the specimen revealed a dissecting aneurysm. We investigated the histological findings by comparing them to angiographical findings.
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April 2010

Photophobia as the visual manifestation of chiasmal compression by unruptured anterior communicating artery aneurysm. Case report.

Neurol Med Chir (Tokyo) 2009 Apr;49(4):159-61

Department of Neurosurgery, Koyanagi Memorial Hospital, 230-2 Morodomitsu, Morodomi-cho, Saga, Japan.

A 37-year-old woman presented with photophobia without visual loss associated with chiasmal compression by an unruptured anterior communicating artery (AcomA) aneurysm. She had suffered progressive photophobia for one year. Neuroimaging indicated an AcomA aneurysm attached to the chiasm. Photophobia was resolved following clipping of the aneurysm. AcomA aneurysm should be considered in patients who experience photophobia without visual loss.
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http://dx.doi.org/10.2176/nmc.49.159DOI Listing
April 2009