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Kazutoshi Hida

Publications and source records attributed to Kazutoshi Hida.

18 recordsLinked to original sources
PubMed2003

Pierre-Robin syndrome associated with Chiari type I malformation.

CASE REPORT: Pierre-Robin syndrome (PRS) is a rare congenital malformation that shows severe micrognathia and cleft soft palate. A 15-year-old boy who was admitted with occipital headache and gait disturbance was diagnosed with PRS. Radiological evaluation revealed severe herniation of the cerebellar tonsil and multiple craniovertebral osseous anomalies. We carried out foramen magnum decompression (FMD) with duroplasty. Postoperative MRI showed the cerebellar tonsil was freed from strangulation. RESULT AND CONCLUSION: This patient presented with the common finding between PRS and Chiari type I on the embryological aspect by illustrating pathophysiology of the Chiari I malformation. To our knowledge, this is the first reported case of PRS associated with Chiari malformation type I.

Adolescent↗
PubMed2003

Feasibility of insertion/implantation of 2.0-mm-diameter gold internal fiducial markers for precise setup and real-time tumor tracking in radiotherapy.

PURPOSE: To examine the feasibility and reliability of insertion of internal fiducial markers into various organs for precise setup and real-time tumor tracking in radiotherapy (RT). MATERIALS AND METHODS: Equipment and techniques for the insertion of 2.0-mm-diameter gold markers into or near the tumor were developed for spinal/paraspinal lesions, prostate tumors, and liver and lung tumors. Three markers were used to adjust the center of the mass of the target volume to the planned position in spinal/paraspinal lesions and prostate tumors (the three-marker method). The feasibility of the marker insertion and the stability of the position of markers were tested using stopping rules in the clinical protocol (i.e., the procedure was abandoned if 2 of 3 or 3 of 6 patients experienced marker dropping or migration). After the evaluation of the feasibility, the stability of the marker positions was monitored in those patients who entered the dose-escalation study. RESULTS: Each of the following was shown to be feasible: bronchoscopic insertion for the peripheral lung; image-guided transcutaneous insertion for the liver; cystoscopic and image-guided percutaneous insertion for the prostate; and surgical implantation for spinal/paraspinal lesions. Transcutaneous insertion of markers for spinal/paraspinal lesions and bronchoscopic insertion for central lung lesions were abandoned. Overall, marker implantation was successful and was used for real-time tumor tracking in RT in 90 (90%) of 100 lesions. No serious complications related to the marker insertion were noted for any of the 100 lesions. Using three markers surgically implanted into the vertebral bone, the mean +/- standard deviation in distance among the three markers was within 0.2 +/- 0.6 mm (range -1.4 to 0.8) through the treatment period of 30 days. The distance between the three markers gradually decreased during RT in five of six prostate cancers, consistent with a mean rate of volume regression of 9.3% (range 0.015-13%) in 10 days. CONCLUSIONS: Internal 2.0-mm-diameter gold markers can be safely inserted into various organs for real-time tumor tracking in RT using the prescribed equipment and techniques. The three-marker method has been shown to be a useful technique for precise setup for spinal/paraspinal lesions and prostate tumors.

Adenocarcinoma↗
PubMed2003

Spinal subdural hematoma: a sequela of a ruptured intracranial aneurysm?

BACKGROUND: A case of spinal subdural hematoma (SSDH) following subarachnoid hemorrhage (SAH) because of a ruptured internal carotid aneurysm is described. Such a case has never been reported. CASE DESCRIPTION: A 52-year-old woman underwent a craniotomy for a ruptured internal carotid aneurysm. A computed tomography scan showed that SAH existed predominantly in the posterior fossa and subdural hematoma beneath the cerebellar tentorium. Intrathecal administration of urokinase, IV administration of fasudil hydrochloride, and continuous cerebrospinal fluid (CSF) evacuation via cisternal drainage were performed as prophylactic treatments for vasospasm. On the sixth postoperative day, the patient complained of severe lower back and buttock pain. Magnetic resonance imaging showed a subdural hematoma in the lumbosacral region. Although the mass effect was extensive, the patient showed no neurologic symptoms other than the sciatica. She was treated conservatively. The hematoma dissolved gradually and had diminished completely 15 weeks later. Her pain gradually subsided, and she was discharged 7 weeks later without any neurologic deficit. CONCLUSION: Although the exact mechanism of SSDH in this case is unclear, we speculate that this SSDH was a hematoma that migrated from the intracranial subdural space. Low CSF pressure because of continuous drainage and intrathecal thrombolytic therapy may have played an important role in the migration of the hematoma through the spinal canal. It is important to recognize the SSDH as a possible complication of the SAH accompanied with intracranial subdural hematoma.

Aneurysm, Ruptured↗
PubMed2003

Role of the bcl-2 gene after contusive spinal cord injury in mice.

OBJECTIVE: Apoptosis is indicated to have an important role in the secondary injury mechanisms of acute spinal cord injury (SCI). The proto-oncogene bcl-2 has been demonstrated to prevent apoptotic cell death in a wide variety of cell types. This study examined the recovery of behavioral function and histopathological variables after controlled-impact SCI in human bcl-2 transgenic (TG) mice and control mice. METHODS: Six bcl-2 TG mice and five control mice were subjected to controlled-impact SCI of moderate severity at T10, with the use of a pneumatic impact device (0.25-mm-deep deformation; impact velocity, 2 m/s). Functional deficits were evaluated at times up to 28 days after SCI, with assessments of hindlimb reflexes and coordinated motor function. The extents of the lesions were histopathologically analyzed and quantified with morphometric measurements. RESULTS: Both control and bcl-2 TG mice exhibited profound deficits immediately after injury, with subsequent gradual symptomatic recovery. The mean functional scores for the control mice were lower than those for the bcl-2 TG mice, although the Mann-Whitney U test revealed no significant differences. The mean lesion volume for the bcl-2 TG mice (mean +/- standard deviation, 2.9 +/- 1.1 x 10(-2) mm(3)) was significantly lower than that for the control mice (5.1 +/- 0.8 x 10(-2) mm(3); unpaired t test, P = 0.0101). Immunohistological analysis of the spinal cords from the bcl-2 TG mice revealed marked expression of Bcl-2 at the injury site and in adjacent regions. CONCLUSION: Our results suggest that overexpression of the bcl-2 gene may play a protective role in neuropathological sequelae after SCI.

Animals↗
PubMed2003

Multiple vertebral metastases from malignant cardiac pheochromocytoma--case report.

A 27-year-old male presented with a very rare metastasis to the vertebral body from a cardiac pheochromocytoma manifesting as a pathological fracture of the C-4 vertebral body that occurred while playing golf. The patient was initially treated with hard collar fixation. Gallium scintigraphy demonstrated multiple hot spots in the mediastinum, the frontal bone, the vertebral column, and the rib. Magnetic resonance imaging of the chest delineated a cardiac tumor. The patient underwent biopsies of the cardiac and the frontal bone lesions. The diagnosis was malignant cardiac pheochromocytoma with multiple bone metastases. Initial irradiation of the cardiac and the vertebral lesions was followed by surgical intervention to the cervical spine to prevent aggravation of the kyphotic deformity and spinal cord compression. Preoperative embolization of the feeding arteries was followed by C-4 corpectomy, iliac bone grafting, and anterior titanium plating fixation. The patient was discharged and returned to work. However, 20 months later, he died of a metastatic brain lesion with systemic tumor progression.

Adult↗
PubMed2003

Spinal cord edema: unusual magnetic resonance imaging findings in cervical spondylosis.

OBJECT: Spinal cord edema is a rare radiological finding in chronic degenerative disorders of the spine. Between 1997 and 2001, the authors treated six patients with cervical spondylotic myelopathy in whom postoperative spinal cord edema was demonstrated. The authors describe the radiological and clinical features of this unusual condition. METHODS: The six patients were all men, and ranged in age from 44 to 72 years. All patients presented with mild quadriparesis and underwent laminoplasty or anterior fusion. Preoperative magnetic resonance (MR) imaging revealed marked spinal cord compression with intramedullary hyperintensity on T2-weighted sequences and spinal cord enhancement at the compression level after administration of Gd. After surgery, spinal cord edema was observed in all patients; the spinal cord appeared swollen on the postoperative MR images. Preoperative and postoperative Gd-enhanced MR imaging demonstrated clear enhancement of the white matter at the compressed segment Neurologically, five of six patients experienced good improvement of symptoms; however, the spinal cord edema as documented on follow-up MR imaging persisted for several months after surgery. CONCLUSIONS: The radiological characterization of spinal cord edema was based on the reversible white matter lesion most likely caused by disturbed local venous circulation induced by chronic spinal cord compression. Such unusual MR findings in cervical spondylotic myelopathy should be differentiated from intramedullary spinal cord tumors, demyelinating disorders, or inflammatory processes.

Adult↗
PubMed2003

Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.

OBJECT: Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. METHODS: Candidates for this study were patients who experienced symptoms due to an intramedullary AVM but were ineligible for embolization or surgery. Of 21 patients with spinal AVMs, 10 cases in a 10-year period met this criterion. Angiography and contrast-enhanced computerized tomography scanning were used for treatment planning in all cases. Fractionated radiotherapy was performed using a linear accelerator, extracranial immobilization system, and frequent orthogonal linacographic verification. The starting radiation dose was 32 Gy in two, 36 Gy in three, and 40 Gy in two patients, in a regimen involving 1.8 to 2-Gy daily fractions; this was recently changed to a hypofractionation schedule of 30 Gy (in eight sessions) in one and 20 Gy (in four sessions) in two patients. RESULTS: The follow-up period ranged from 26 to 124 months (median of 49 months). There were no hemorrhages nor any adverse reactions attributable to irradiation. Of the seven patients who consented to undergo follow-up angiography, the nidus size decreased in five, but complete obliteration did not occur in any patient. CONCLUSIONS: Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.

Adolescent↗
PubMed2003

[Surgical treatment of retroperitoneal presacral large schwannoma by the anterior transabdominal approach: two cases reports].

Retroperitoneal schwannomas are relatively rare. However, when the tumors occur, they can be large and difficult to diagnose at an early stage because of their vague symptoms. Although surgery is the only treatment, the choice of surgical approach depends upon pathological type, the degree of sacral destruction, and intrapelvic extension. If a large component is present presacrally, an anterior transabdominal approach should be chosen to gain control of the tumor bleeding. We report two cases of large schwannoma in the retroperitoneal presacral space that was removed by the anterior transabdominal approach. We performed an intracapsular piecemeal resection with preservation of the tumor capsule, and were able to remove the tumor gross totally without any postoperative deficit. For this reason, we think that retroperitoneal presacral larger schwannoma should be removed leaving the capsule intact and using the anterior transabdominal approach to prevent injury of the adjacent structures.

Adult↗
PubMed2002

Calculation of rotational setup error using the real-time tracking radiation therapy (RTRT) system and its application to the treatment of spinal schwannoma.

PURPOSE: The efficacy of a prototypic fluoroscopic real-time tracking radiation therapy (RTRT) system using three gold markers (2 mm in diameter) for estimating translational error, rotational setup error, and the dose to normal structures was tested in 5 patients with spinal schwannoma and a phantom. METHODS AND MATERIALS: Translational error was calculated by comparing the actual position of the marker closest to the tumor to its planned position, and the rotational setup error was calculated using the three markers around the target. Theoretically, the actual coordinates can be adjusted to the planning coordinates by sequential rotation of gamma degrees around the z axis, beta degrees around the y axis, and alpha degrees around the x axis, in this order. We measured the accuracy of the rotational calculation using a phantom. Five patients with spinal schwannoma located at a minimum of 1-5 mm from the spinal cord were treated with RTRT. Three markers were inserted percutaneously into the paravertebral deep muscle in 3 patients and surgically into two consecutive vertebral bones in two other patients. RESULTS: In the phantom study, the discrepancies between the actual and calculated rotational error were -0.1 +/- 0.5 degrees. The random error of rotation was 5.9, 4.6, and 3.1 degrees for alpha, beta, and gamma, respectively. The systematic error was 7.1, 6.6, and 3.0 degrees for alpha, beta, and gamma, respectively. The mean rotational setup error (0.2 +/- 2.2, -1.3 +/- 2.9, and -1.3 +/- 1.7 degrees for alpha, beta, and gamma, respectively) in 2 patients for whom surgical marker implantation was used was significantly smaller than that in 3 patients for whom percutaneous insertion was used (6.0 +/- 8.2, 2.7 +/- 5.9, and -2.1 +/- 4.6 degrees for alpha, beta, and gamma). Random translational setup error was significantly reduced by the RTRT setup (p < 0.0001). Systematic setup error was significantly reduced by the RTRT setup only in patients who received surgical implantation of the marker (p < 0.0001). The maximum dose to the spinal cord was estimated to be 40.6-50.3 Gy after consideration of the rotational setup error, vs. a planned maximum dose of 22.4-51.6 Gy. CONCLUSION: The RTRT system employing three internal fiducial markers is useful to reduce translational setup error and to estimate the dose to the normal structures in consideration of the rotational setup error. Surgical implantation of the marker to the vertebral bone was shown to be sufficiently rigid for the calculation of the rotational setup error. Fractionated radiotherapy for spinal schwannoma using the RTRT system may well be an alternative or supplement to surgical treatment.

Adolescent↗
PubMed2002

A case of pediatric thoracic SCIWORA following minor trauma.

CASE REPORT: A case of spinal cord injury without radiological abnormality (SCIWORA) at the thoracic level is reported. A 14-year-old girl fell backwards from a low chair and hit her back on the floor. It left her bent forward markedly. After taking a nap, she found herself unable to walk. Neurological examination revealed flaccid paraparesis, hypalgesia below the L-1 level, and bladder and bowel dysfunction. MR imaging revealed marked edema in the thoracic spinal cord. RESULTS AND CONCLUSION: The patient was treated conservatively and showed gradual improvement in her symptoms, finally becoming independently ambulant. The spinal cord edema was less pronounced on the follow-up MR imaging. The clinical course and findings of MR imaging in this case demonstrated mid-thoracic SCIWORA caused by hyperflexion of the thoracic spine.

Adolescent↗
PubMed2002

Graded contusion model of the mouse spinal cord using a pneumatic impact device.

OBJECTIVE: This study examined the effects of varying magnitudes of controlled spinal cord impact to the mouse spinal cord on neurological and histopathological variables to obtain a mouse model of spinal cord injury (SCI). METHODS: A laminectomy of the T10 vertebra was performed on anesthetized C57BL/6 mice. A pneumatic pressure-driven impact was performed on the spinal cord through the dura mater. Experimental groups were subdivided according to the energy of impact (0.25-mm-deep deformations): Group 1 (n = 5), impact velocity at 1 m/s; Group 2 (n = 5), impact velocity at 2 m/s; and Group 3 (n = 5), impact velocity at 3 m/s. Functional deficits over time were evaluated up to 28 days after SCI by testing hindlimb reflex and coordinated motor function. The extent of the lesions was analyzed histopathologically and quantified by a morphometric measurement. RESULTS: Mice of all groups exhibited profound functional deficits immediately after injury and subsequent gradual symptomatic recovery. The degrees of recovery were precisely correlated with the magnitudes of impact. The extent of resultant cord lesions was highly reproducible among animals, with little variance: means +/- standard deviation, 0.86 +/- 0.06/100 mm3 in Group 1; 2.4 +/- 0.28/100 mm3 in Group 2; and 11.0 +/- 1.0/100 mm3 in Group 3. CONCLUSION: Our results indicate that this model provides constant functional and histopathological lesions according to impact energy. This new mouse model of SCI opens a new avenue for studies investigating roles and/or effects of specific genes in the recovery process of SCI.

Animals↗
PubMed2002

Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord.

OBJECT: In this report, the authors describe five consecutive patients with cervical perimedullary arteriovenous fistulas (AVFs) that were successfully treated using a corpectomy performed via an anterior approach. METHODS: Five patients with cervical perimedullary AVF underwent corpectomy via an anterior approach. There were four women and one man who ranged in age from 34 to 62 years (median 55 years). Four patients presented with subarachnoid hemorrhage and one with intramedullary hemorrhage. All five AVFs were located on the anterior surface of the cervical spinal cord and fed by the anterior spinal artery. All patients underwent an anterior approach with 1.5- or two-level corpectomy, opening of the dura mater, and coagulation of the fistula. After dural closure, an iliac bone graft was inserted. Four patients were treated by surgery alone and one patient by embolization and surgery. Postoperative angiography revealed complete disappearance of the AVF in all patients. Neurological status improved in two cases and stabilized in the other three. There were no surgery-related complications. CONCLUSIONS: Safe and effective interruption of cervical AVFs can be accomplished by an anterior-approach corpectomy.

Adult↗
PubMed2002

[Achondroplasia with respiratory disturbance: case report].

Achondroplasia often accompanies stenosis of both the foramen magnum and the upper cervical spinal canal. Most infants die as a result of respiratory disturbance, including upper airway obstruction, chest deformity, and compression of the cervicomedullary junction. Especially, young patients under 4 years old sometimes suffered sudden death. Therefore, we think it is necessary to perform preventive surgery when the patient's cervicomedullary junction is compressed markedly even if the symptom is mild. The patient is a 2-year-old girl. She has experienced mild respiratory disturbance since she was born. MRI showed the foramen magnum was narrowed and there was high signal intensity in her cervicomedullary junction. We performed foramen magnum decompression. After the surgery, her respiratory function improved and MRI disclosed her foramen magnum was well decompressed.

Achondroplasia↗
PubMed2002

[Intramedullary spinal cord metastasis: two case reports and literature review].

Intramedullary spinal cord metastasis was thought to be rare, but the advent of MR imaging and treatment for malignancy have revealed that it is more frequent than we previously thought. We report two cases of intramedullary spinal cord metastasis from lung and rectal colon carcinoma. Their symptoms were aggravated rapidly. We performed surgical treatment in both cases; one was grosstotal and the other was subtotal resection. After the operation, symptoms improved mildly in one patient and worsened in the other patient. Both died 3 months after surgery, because of respiratory disturbance due to brain stem compression and lung metastasis. In conclusion, MRI is highly useful for making a diagnosis of intramedullary spinal metastatic tumors. However, it is still difficult to treat such a patient by surgery alone. Further postoperative adjuvant therapy will be necessary to improve the prognosis of such patients.

Aged↗
PubMed2002

[Associated meningioma and neurofibroma at the same cervical level without clinical signs of neurofibromatosis: case report].

A 59-year-old woman presented with a history of progressive clumsiness and numbness in both hands. MRI suggested a solid mass extending, from the intradural extramedullary, extradurally at the left C1/2 level. However, intraoperative findings revealed the both the intradural tumor and the extradural tumor existed separately. Histopathological findings revealed coincident meningioma (intradural) and neurofibroma (extradural). These lesions were not associated with neurofibromatosis, and the patient did not have other tumors in either the brain or at other levels of the spine. The occurrence of different types of spinal tumors without clinical signs of neurofibromatosis is very rare. Only five cases have been reported in the literature. To our knowledge, this is the first case of occurrence of different types of spinal tumors at the same level.

Cervical Vertebrae↗
PubMed2002

[Giant, invasive sacral schwannoma extending to the 4th lumbar spine].

In this report, we describe a case with giant sacral schwannoma, which invasively extended to the 4th lumbar spine and to the surrounding sacral and iliac bone. A 26-year-old female was admitted to our hospital because of numbness and transient weakness of the right leg, and dysuria. Radiological examinations revealed that a giant sacral tumor, associated with multiple cystic formations, had invasively extended to the 4th lumbar spine, sacrum, and iliac bone. She underwent partial removal of the tumor, followed by irradiation. Pathological diagnosis was schwannoma. Subsequently, she underwent a second operation because of tumor regrowth 15 months later, and the tumor was totally removed. Numbness of the right leg resolved after surgery. No tumor recurrence has been noted during 5-year follow-up period. Previously, only 5 cases have been reported of invasive sacral schwannoma extending to the lumbar spine. Our experience in this rare case strongly suggests that aggressive resection should be aimed to improve long-term outcome.

Adult↗
PubMed2002

[Surgical approach for non-neoplastic intramedullary lesions].

There are many non-neoplastic intramedullary lesions that mimic intramedullary neoplasm. They are consisted of demyelination, granulomatous disease, infections, radiation myelopathy, vascular lesions, and syringomyelia. In this report, the authors described its differential diagnosis in clinical and neuroradiological findings. Furthermore, we mentioned its surgical approach for several non-neoplastic lesions. Syringomyelia and spinal AV fistula are both good candidate of surgical treatments. We would like to stress that good cooperation between neurologist, neuroradiologist, and neurosurgeon is important to differentiate non-neoplastic lesions and surgical biopsy is final procedure to confirm their pathology.

Humans↗