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Biomedical subjects

H Touho

Publications and source records attributed to H Touho.

At least 55 records · Page 3Linked to original sources
PubMed1994

Dural arteriovenous fistula caused by sinus thrombosis--case report.

A 58-year-old male with a history of idiopathic sinus thrombosis presented with gradual onset of gait disturbance, dementia, and involuntary movement in the upper extremities. Cerebral angiography demonstrated a dural arteriovenous fistula fed by a falx cerebelli branch originating from the left vertebral artery and draining into the inferior vermian vein, the straight sinus, a cortical vein lying on the inferolateral surface of the left cerebellar hemisphere, the ipsilateral superior petrosal sinus, the sigmoid sinus, and the internal jugular vein. Endovascular embolization under fluoroscopic control resulted in complete disappearance of the involuntary movement. Sinus thrombosis may result in development of dural arteriovenous fistula which can cause life-threatening complications, so aggressive therapy should be considered.

Arteriovenous Fistula↗
PubMed1994

Vasculopathy of the anterior choroidal artery following intra-arterial chemotherapy--case report.

A 40-year-old male, treated with radiotherapy and supraophthalmic intracarotid artery (ICA) ACNU infusion for glioblastoma in the right occipital lobe, developed cerebral infarction secondary to vasculopathy manifesting as hemiparesis 3 months after a second ICA injection. The initial diagnosis was focal neurotoxicity, but angiography revealed severe vasospasm of the anterior choroidal artery. The symptoms improved gradually with therapy for the vasospasm. Angiography is required to discriminate vasospasm and focal neurotoxicity as a complication of ICA injection of antineoplastic agents.

Adult↗
PubMed1994

Pituitary adenoma invading the skull base--a strategy for skull base surgery.

A strategy for surgical management, including the approach and preoperative evaluation, of pituitary adenoma invading the skull base is described. Preoperative evaluation requires a balloon occlusion test of the internal carotid artery (ICA) to determine tolerance to occlusion. Failure to tolerate occlusion indicates administration of brain protective agents and/or a bypass procedure before tumor removal. The transsphenoidal, pterional, orbitofrontomalar, and infratemporal fossa approaches are all suitable for various tumor locations. A combined orbitofrontomalar and extended frontal approach allows removal of tumor with extensive invasion and is suitable for bypass procedures. Preoperative evaluation of ICA occlusion can prevent development of hemodynamic stroke. We treated five patients with pituitary adenoma invading the skull base, including two primary and three recurrent cases. All symptoms improved, but temporary oculomotor nerve disturbance occurred in three patients and anosmia in one. Reoperations for recurrent pituitary adenomas were effective in reversing the symptoms. No hemodynamic stroke was seen postoperatively. These tumors, except for drug-responsive cases, are indicated for skull base surgery.

Adenoma↗
PubMed1994

[Preoperative sedation for childhood moyamoya disease--clinical evaluation of rectally administered midazolam].

We evaluated the effectiveness of rectally administered midazolam for preoperative sedation in 26 cases of childhood moyamoya disease. The patients, aged 5.0 +/- 1.8 yr (mean +/- SD), received 1 mg.kg-1 of midazolam 30 min prior to induction of anesthesia. The patient's level of sedation, tolerance of anesthesia face mask, and amnesia were evaluated. In 22 of 26 patients induction via face mask was performed smoothly, and excellent anterograde amnesia was observed. Remarkable complications, including hemodynamic and/or respiratory depression, were not noted. The level of sedation was significantly related to the patient's age. Although further investigation to evaluate proper dose are needed, 1 mg.kg-1 of rectally administered midazolam is useful for childhood moyamoya disease, in which crying can worsen the neurological symptoms.

Administration, Rectal↗
PubMed1993

Cortical blood flow response to hypercapnia during anaesthesia in Moyamoya disease.

Cortical blood flow (CoBF) was measured continuously by the laser-Doppler method to evaluate the effect of hypercapnia on cortical blood flow during ten surgical procedures in ten young patients (mean +/- SD 9.3 +/- 6.4 yr) with Moyamoya disease. The CoBF was 42.8 +/- 13.4 (ml.100 g-1.min-1) during normocapnia (PaCO2 = 39.0 +/- 2.4 mmHg), and 38.7 +/- 14.4 during hypercapnia (PaCO2 = 47.1 +/- 2.5 mmHg). There was a decrease in CoBF with hypercapnia (P < 0.05) so that the normal CoBF response to hypercapnia was impaired during surgery in the patients with Moyamoya disease. He concluded that patients with Moyamoya disease have a precarious cerebral circulation and hypercapnia may be detrimental to the cortical circulation. This suggests that normocapnia is preferable to hypercapnia in patients with Moyamoya disease during anaesthesia.

Adolescent↗
PubMed1993

Anastomosis of occipital artery to anterior inferior cerebellar artery with interposition of superficial temporal artery. Case report.

A 56-year-old man with vertebrobasilar insufficiency and associated findings including quadriparesis, dysarthria, cerebellar ataxia, nystagmus, and somnolence underwent left occipital artery (OA) to anterior inferior cerebellar artery (AICA) anastomosis with interposition of a superficial temporal artery (STA) graft. This procedure was chosen because cerebral angiograms demonstrated occlusion of the right vertebral artery (V3) and severe stenosis of the V4 segment of the left vertebral artery, with perfusion of the territory of the left posterior inferior cerebellar artery via the ipsilateral AICA, and because dissection of the OA is a relatively difficult and time-consuming procedure. Dissection of the STA, on the other hand, is much easier. Preoperative measurements of local cerebral blood flow in the vertebrobasilar circulation before and after intravenous administration of acetazolamide (500 mg) were obtained, and demonstrated low flow and hemodynamic compromise in the posterior circulation. The patient's hemodynamic and neurological status improved following surgery. In this report, we present a new and simplified method of OA-AICA anastomosis with interposition of STA graft.

Anastomosis, Surgical↗
PubMed1993

Surgical reconstruction of failed indirect anastomosis in childhood Moyamoya disease.

Thirty-one patients with moyamoya disease, who had been treated for encephaloduroarteriosynangiosis (EDAS), encephalomyosynangiosis (EMS) or EMS with encephaloarteriosynangiosis (EAS) in other hospitals, were admitted to Osaka Neurological Institute from January 1985 to September 1991. Twenty-seven of 57 sides treated by indirect anastomosis showed good filling of the middle cerebral artery (MCA) territory via the anastomosis, whereas 16 and 14 showed fair and poor collaterals via the anastomosis, respectively. Twenty-eight cerebral hemispheres treated by indirect anastomosis underwent further surgery and received superficial temporal artery-MCA anastomosis with or without EMS for still-existent recurrent transient ischemic attacks or completed stroke even after the indirect anastomosis. One patient still had recurrent transient ischemic attacks with quadriparesis after bilateral encephaloduroarteriosynangiosis, which had produced no effective collaterals in the MCA territory; the patient then underwent omental transplantation to the bilateral anterior cerebral artery and MCA territories, resulting in the cessation of the transient ischemic attacks. Clinical improvement after superficial temporal artery-MCA anastomosis with or without EMS was noted in all patients, except on one side, where a completed stroke had resulted in fixed neurological deficits. We do not know the reasons for the uncertainty of the development of collaterals via the indirect anastomosis, but there are many patients who still need direct reconstruction of the indirect anastomosis.

Adolescent↗
PubMed1993

Long-term follow-up study of "epileptic type" moyamoya disease in children.

Twenty-three patients with epileptic type moyamoya disease are reviewed among 200 moyamoya disease patients. Ten boys and 13 girls aged 5 months to 12 years were followed over 6 months to 17.3 years. Six had generalized seizure and 17 had focal seizure. Operations were performed within 1 year in eight patients, within 1-3 years in five, and more than 3 years after onset in 10. Nineteen patients improved and suffered no seizure without receiving antiepileptic drugs, but four patients developed true epilepsy and three of these suffered cerebral infarction. Multivariate analyses showed that toddlers aged less than 1 year and mild or severe abnormal computed tomographic (CT) findings correlated with a bad outcome. This study showed that epileptic type moyamoya disease has the same clinical features as transient ischemic attack or infarction type. Age under 1 year and CT abnormalities indicate a poor prognosis and necessity for early reconstructive surgery.

Child↗
PubMed1993

Cerebral revascularization using omental transplantation for childhood moyamoya disease.

Between January, 1986, and October, 1990, 30 children with moyamoya disease, aged from 2 to 17 years, underwent omental transplantation to either the anterior or the posterior cerebral artery territory. The mean follow-up period was 3.8 years, ranging from 1.6 to 6.4 years. Seventeen patients had symptoms of monoparesis, paraparesis, and/or urinary incontinence and were treated using unilateral or bilateral omental transplantation to the anterior cerebral artery territory. Eleven patients had visual symptoms and were treated with unilateral or bilateral omental transplantation to the posterior cerebral artery territory. Two patients had symptoms associated with both the anterior and the posterior cerebral arteries, and were treated with dual omental transplantations. All 19 patients treated with omental transplantation to the anterior cerebral artery and 11 (84.6%) of the 13 treated with omental transplantation to the posterior cerebral artery showed improvement in their neurological state. Patients with more collateral vessels via the omentum had more rapid and complete improvement in their neurological state. Patients with severe preoperative neurological deficits associated with the posterior cerebral artery had persistence of their symptoms.

Adolescent↗
PubMed1993

[Spike discharge detected by intra-arterial electroencephalography from intra-arterial guide wire in temporal lobe epilepsy].

The implantation of electrodes for intracranial electroencephalography (EEG) recording as presurgical evaluation of patients with intractable epilepsy is at present most important for planning epilepsy surgery. This method is most effective in temporal lobe epilepsy. We carried out intracranial EEG by means of insulated micro guide wire for endovascular surgery in two temporal lobe epilepsy cases, and spike discharges could be detected in lesional medial temporal lobe. Case 1 is a 29 year-old-male suffered from intractable complex partial seizure (CPS) for 18 years. He was diagnosed as left temporal lobe epilepsy and performed removal of amygdala, hippocampus, parahippocampal gyrus and fusiform gyrus. Case 2 is a 16 year-old-lady suffered from drug resistant CPS for 4 years. Under the diagnosis of right temporal lobe epilepsy, temporal lobectomy was performed. As the presurgical evaluation, under the implantation of subdural strip electrode in both cases, we carried intra-arterial EEG after angiography. Seeker Lite-10 guide wire was insulated with Tracker-10 unibody infusion catheter at sphenoidal portion of middle cerebral artery, and frequent interictal spike discharge was detected in lesional medial temporal lobes by two methods simultaneously.

Adolescent↗
PubMed1993

[Multiple subpial transection after lesionectomy in an intractable epilepsy case].

A Sixty-one-year-old man was admitted to our hospital because of generalized convulsion. He had suffered from intractable epilepsy for 26 years. CT and MRI showed the right frontal cavernous angioma. On operation, intraoperative electrocorticography was performed after lesionectomy including surrounding glial scar and hemosiderin laden tissue. It showed epileptiform potentials in neighbor gyrus of the lesion. Because the removed sphere would be so broad, and we performed multiple subpial transection (MST). After MST, depression of background electrical activity and disappearance of spike discharge are seen. One and half year after operation, seizure was controlled by only phenobarbital administration.

Brain Neoplasms↗
PubMed1993

[Surgical excision of a cavernous angioma of the cerebral peduncle by orbito-fronto-malar approach].

A case with cavernous angioma at the left cerebral peduncle was cured surgically. A 36-year-old male was admitted with complaints of right facial palsy, right motor disturbance and cheiro-oral syndrome. CT revealed a round high-density mass in the left cerebral peduncle and thalamus. Angiography showed no abnormality. MRI showed a round high-intensity mass on T1-and T2-weighted image in the left thalamus, which meant hematoma at a subacute stage and mixed-intensity core in the left cerebral peduncle, which was cavernous angioma. Symptoms disappeared, and high-density also disappeared gradually, but rebleeding occurred. Because of this, an operation was performed by the orbitofrontmalar approach. Hematoma and angioma were removed under ABR and SEP monitor, which showed no abnormality during the operation. Histological examination of the surgical specimen revealed that the abnormal vessels were cavernous angioma. The postoperative course was uneventful without cosmetic problems.

Adult↗
PubMed1993

[Clinical application of calculation software of the four rules of arithmetic on computed tomography].

Calculation program software of the four rules of arithmetic in computed tomography (CT) has been introduced for clinical purposes since 1990. Evaluation of hemodynamic reserve and cerebral autoregulation can be calculated using this software in ischemic cerebrovascular diseases and delayed cerebral vasospasm after ruptured intracranial aneurysms. Eight hemodynamic maps can be entered and calculation based on the four rules of arithmetic can be performed between them and shown visually. For example, delta CBF [CBF after administration of acetazolamide (B)-CBF before its administration(A)] and % CBF [(B - A)/A x 100] maps are useful in evaluation of the capacity of hemodynamic reserve in ischemic cerebrovascular diseases. And delta CBF [CBF before induced hypertension using intravenous dopamine administration (B)-CBF during induced hypertension (A)] and % CBF [(B - A)/A x 100] also can be used in evaluation of cerebral autoregulation and decision concerning indication of the need for induced hypertension during the period of delayed cerebral vasospasm after subarachnoid hemorrhage.

Brain↗
PubMed1993

[Surgical excision of a huge olfactory groove meningioma by extensive transfrontal approach].

A case with a huge olfactory groove meningioma was cured surgically by extensive transfrontal approach. A 46-year-old female was admitted with complains of left visual disturbance. CT revealed a large high-density mass in the base of the frontal fossa which was enhanced homogenously. Hyperostosis was seen in the planum sphenoidale. MRI showed a relatively low intensity with a peritumoral low-intensity rim on T1WI and high intensity on T2WI. The brain stem had shifted dorsally. Rich feeding to the lesion from the ethmoidal artery was seen on angiography. An operation was performed using an extensive transfrontal approach. After bifrontal craniotomy, orbitofrontal osteotomy was performed. This approach enabled us to minimize frontal lobe retraction, to interrupt the blood supply to the tumor early, and to remove the tumor completely from the frontal base and to present invasion of the sinuses. The postoperative course was uneventful without cosmetic problems.

Brain Neoplasms↗
PubMed1992

Superselective embolization of spinal arteriovenous malformations using the Tracker catheter.

Eighteen patients with spinal arteriovenous malformations had been treated with conventional embolization, surgical removal, feeder ligation, and/or feeder coagulation between February 1985 and March 1990. The lesions included six glomus, four juvenile, three extramedullary, and five dural arteriovenous malformations or fistulas. Embolic therapy was conducted in 14 patients by introducing the tip of a catheter into the segmental arteries and injecting polyvinyl alcohol strips (500-1000 microns) (conventional embolization). Follow-up spinal angiography disclosed recanalization in 10 patients (71.4%) and the appearance of new feeding arteries in five patients (35.7%). We introduced the Tracker vascular access system in April 1990. Eight patients (four glomus, one juvenile, and three dural arteriovenous malformations) were treated with the minicatheter and Ivalon particles (150-350 microns). Five patients showed neurological improvement immediately after treatment. The other three patients had severe paraparesis before treatment and did not show any improvement. One patient with a glomus-type arteriovenous malformation showed transient neurological deterioration just after embolization with the Tracker-10 to occlude a lesion fed by the posterior spinal artery, because the Ivalon particles migrated into the anterior spinal artery via the anterior spinal canal artery. In one patient with a juvenile arteriovenous malformation, the Tracker-18 catheter perforated the radiculomedullary artery originating from the right vertebral artery, and subarachnoid hemorrhage occurred. However, the Tracker-10 could later successfully occlude the arteriovenous malformation. The rates of recanalization and appearance of the new feeding vessels were 4/8 (50.0%) and 2/8 (25%), respectively.

Adult↗
PubMed1992

Evaluation of therapeutically induced hypertension in patients with delayed cerebral vasospasm by xenon-enhanced computed tomography.

Serial cerebral blood flow (CBF) measurements were made with stable xenon-enhanced computed tomography in 20 patients with angiographically confirmed ruptured intracranial aneurysms, before and during induced hypertension with continuous infusion of dopamine. All patients showed angiographic vasospasm during their course. Twelve patients without symptomatic vasospasm (Group 1) had the lowest hemispheric CBF on the craniotomy side of 31.6 +/- 6.8 ml/100 gm/min on days 4-9 (control value, 40.1 +/- 2.0 ml/100 gm/min), while the other eight patients with symptomatic vasospasm (Group 2) had the lowest hemispheric CBF on the craniotomy side of 25.0 +/- 7.6 ml/100 gm/min on days 10-14. The critical hemispheric CBF inducing neurological deficits was about 20 ml/100 gm/min in Group 2. Dysautoregulation was usually present in Groups 1 and 2, but therapeutically induced hypertension could reverse the delayed neurological deficits, if begun early at the stage of delayed vasospasm.

Adult↗