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Biomedical subjects

Kiyotaka Fujii

Publications and source records attributed to Kiyotaka Fujii.

At least 19 recordsLinked to original sources
PubMed2006

Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter - especially for geriatric patients.

BACKGROUND: Endovascular surgery is being increasingly used as an alternative to craniotomy clipping surgery, especially for aged patients and complicated cases. However, tortuous atherosclerotic arteries sometimes interfere with advancement of catheters so that direct puncture may be necessary. Short guiding catheters for use with this approach have been newly developed, as discussed in this article. METHODS: One hundred twenty three anterior circulation aneurysms in 121 patients were consecutively treated by endovascular coil embolization, of which 42 (34%) were older than 70 years. RESULTS: With 21 aneurysms, coil embolization via the transfemoral approach failed, but all could be successfully treated with the direct puncture approach with minor complications such as 1 transient ischemic attack and 1 nonsymptomatic minor leakage. In the aged patients, the direct puncture approach with short guiding catheter resulted in complete obliteration of aneurysms in 20 (71%) of 28 with follow-up angiography. CONCLUSION: Direct puncture using newly developed short guiding catheters is an alternative to femoral approaches for patients with anterior circulation aneurysm with tortuous arteries and obvious atherosclerotic change at bifurcations of the common carotid artery.

Adult↗
PubMed2006

Age dependence of fusion of primary occipital sutures: a radiographic study.

PURPOSE: When linear lucency is present in the occipital bone on radiographs throughout childhood, differential diagnosis becomes important because some primary sutures are similar to fractures. The authors here chronicled the normal development of ossification centers, sutures, and synchondroses in the chondrocranium by radiographic examination. METHODS: One hundred and twenty-seven children, aged from newborns to 6 years and without any skull base deformities, were referred to for radiographs of Towne's projection. RESULTS: In the occipital bone at birth, three primary sutures could be identified. At the age of 0-3 years, occipital and innominate sutures started to fuse, this being complete by 4 years, whereas mendosal sutures persisted until 6 years of age, after which no primary sutures could be seen. CONCLUSION: The complex process of skull base development features a step-wise process sutural closure for which radiographic standards allow differential diagnosis from fractures with judgment of the timing.

Aging↗
PubMed2006

Usefulness of transcervical approach for surgical treatment of hypoglossal schwannoma with paraspinal extension: case report.

BACKGROUND: Usefulness of transcervical approach to hypoglossal schwannoma with paraspinal extension is described herein. CASE DESCRIPTION: A 54-year-old woman presented with gradually worsening left hypoglossal nerve palsy. The findings were of a tumor lying in the left hypoglossal canal and paraspinal region and were consistent with hypoglossal schwannoma. Subtotal intracapsular removal of the tumor was performed via transcervical approach. The symptoms improved, and no additional symptoms were noted. CONCLUSION: The transcervical approach and intracapsular removal of the tumor under electrophysiological monitoring provided for successful minimally invasive surgery in this case of hypoglossal schwannoma.

Cervical Vertebrae↗
PubMed2006

Surgical approaches to the atrium of the lateral ventricle: microsurgical anatomy.

BACKGROUND: Managing lesions situated in the atrium of the lateral ventricle remains a challenging neurosurgical problem. The purposes of this study were to examine the microsurgical anatomy of the atrium of the lateral ventricle and the optic radiation and to define the differences in the exposure obtained by various surgical approaches. METHODS: Fifteen adult cadaveric specimens were studied using magnification x3 to x40 after perfusion of the arteries and veins with colored silicone. The microsurgical anatomy of the atrium of the lateral ventricle was examined. The relationship between the optic radiation and the atrium was studied using the white matter fiber dissection technique. Surgical approaches to the atrium of the lateral ventricle were examined in stepwise dissection. RESULTS: The medial and inferior walls of the atrium were free from optic radiation fibers. Surgical approaches to the atrium of the lateral ventricle are divided into 3 routes: (1) anterior approach: transsylvian approach, (2) posterior approaches: posterior transcortical, posterior transcallosal, occipital, and supracerebellar transtentorial approaches, and (3) lateral approaches: transtemporal and subtemporal approaches. CONCLUSION: Knowledge of the microsurgical anatomy of the atrium of the lateral ventricle and surrounding vital structures and the choice of an appropriate surgical approach will help surgeons perform safe and minimally invasive surgery.

Adult↗
PubMed2006

Technetium-99m ethyl cysteinate dimer dynamic and static single photon emission computed tomography in crossed cerebellar diaschisis.

A 69-year-old man with a past history of right middle cerebral artery (MCA) occlusion had cerebral single photon emission computed tomography (SPECT) with technetium-99m ethyl cysteinate dimer (Tc-99m ECD). Dynamic SPECT in the super-early phase revealed normal uptake in the left cerebellum and hypoactivity in the right MCA territory. Conventional static SPECT revealed decreased cerebral blood flow in the right MCA territory and the left cerebellum, indicating crossed cerebellar diaschisis. Our SPECT studies revealed decreased retention of Tc-99m ECD in the cerebellum manifested as crossed cerebellar diaschisis.

Aged↗
PubMed2006

Expression of autocrine motility factor mRNA is a poor prognostic factor in high-grade astrocytoma.

It has been reported that tumor infiltration is correlated with the expression of autocrine motility factor (AMF) and its receptor 78 kDa glycoprotein (gp78). The purpose of the present study was to detect AMF and gp78 mRNA expression levels and their localization in high-grade astrocytomas (glioblastoma and anaplastic astrocytoma) and to determine whether AMF and gp78 are important prognostic factors. A total of 32 formalin-fixed and paraffin-embedded glioblastomas and 23 formalin-fixed and paraffin-embedded anaplastic astrocytomas was used. The expressions of AMF and gp78 mRNA were detected using the highly sensitive in situ hybridization method. The expression of AMF mRNA was detected in 27 of 32 glioblastomas (84.4%) and 11 of 23 anaplastic astrocytomas (47.8%). The positivity of AMF mRNA was significantly higher in glioblastomas than in anaplastic astrocytomas (P = 0.0094), but gp78 mRNA was detected in most cases and no statistical significance was observed. The overall survival of patients with AMF expression was significantly shorter than patients without AMF expression (P = 0.0175). In anaplastic astrocytomas, the overall survival of patients with AMF expression was also significantly shorter than in patients without AMF expression (P = 0.0058). This study demonstrated that AMF is a poor prognostic factor in high-grade astrocytomas.

Adult↗
PubMed2006

Anatomic dissection and classic three-dimensional documentation: a unit of education for neurosurgical anatomy revisited.

OBJECTIVE AND IMPORTANCE: Despite development of computer-assisted neurosurgical navigation, learning by dissecting anatomic specimens is still important. CLINICAL PRESENTATION: We describe the processes from preparation of specimens for cranial dissection to documentation of three-dimensional (3-D) stereoscopic pictures, particularly focusing on the latter, which has been initiated in the Microneuroanatomy Laboratory, Department of Neurological Surgery, University of Florida. INTERVENTION: Preparation consists of irrigation of the major vessels and injection of colored silicone. The 3-D documentation, obtaining two pictures corresponding to each eye's view, is obtained by the shoot-shift-shoot method using a single camera mounted on a slide bar. The key of this method is correct shifting of the camera without alignment error to get exact 3-D effects. Observation of 3-D image can be made with free viewing, a 3-D viewer, or projection. Tips concerning all of the processes involved are described. CONCLUSION: The presented method of dissection and obtaining 3-D images is beneficial for accomplishing studies of anatomy and for providing teaching method.

Dissection↗
PubMed2006

Risk of damage to the endolymphatic sac and duct during removal of the posterior meatal wall: an anatomic study.

OBJECTIVE: With removal of the posterior meatal wall for intrameatal acoustic neurinoma, preservation of the structures adjacent to the internal acoustic meatus is important. The authors performed an anatomic study to clarify the risk of damage to the endolymphatic sac and endolymphatic duct during this maneuver. METHODS: Twenty-seven sides of adult temporal bone were examined. Distances measured were between the posterior meatal lip and the upper limit of the endolymphatic ledge, at the upper extent of the endolymphatic sac, and between a reference line extending from the inferior margin of the internal acoustic meatus posteriorly (parallel to the petrous ridge), simulating the inferior margin of the drilling, and the upper limit of the endolymphatic ledge. Whether the latter was located on or above the line was also recorded. After posterior meatal wall drilling, the distance between the posterior meatal lip and the vestibular aqueduct surrounding the endolymphatic duct and the depth of the structure from the surface were assessed. RESULTS: The shortest distances between the posterior meatal lip and the endolymphatic ledge and between the posterior meatal lip and the vestibular aqueduct were 6.80 mm and 4.68 mm, respectively. The upper limit of the endolymphatic ledge was present on or above the reference line in approximately half of the specimens. CONCLUSION: During surgical maneuvers to remove the posterior meatal wall, the occasional close proximity of the endolymphatic sac and endolymphatic duct to the internal acoustic meatus should be kept in mind. Preoperative radiological evaluation of anatomic relationships is mandatory when preservation of hearing is the aim.

Endolymphatic Duct↗
PubMed2006

Alteration of the pressure setting of a Codman-Hakim programmable valve by a television.

A 7-year-old girl presented in semicomatose condition. She had received a ventriculoperitoneal shunt using a Codman-Hakim programmable valve. Head computed tomography demonstrated hydrocephalus and head radiography showed that the pressure setting of the shunt valve had changed to 60 mmH(2)O from 40 mmH(2)O. The pressure setting was returned to 40 mmH(2)O, and she was discharged because her clinical symptoms and hydrocephalus improved. One month later, she lost consciousness again and was transported to our hospital. Hydrocephalus and shunt valve pressure of 50 mmH(2)O were noted, and the pressure setting was returned to 40 mmH(2)O again. She was discharged without complications. We suspected that the valve pressure was caused by close contact with a television, because the patient tended to touch a television with her head during play. The valve pressure did not change after the television was placed on a high stand out of reach. We should recognize that there are many sources of weak magnetic fields that may influence a programmable valve in everyday life.

Child↗
PubMed2006

Histological features of intracranial germinomas not disappearing immediately after radiotherapy.

The histological features of germinomas were investigated to differentiate tumors which completely disappear immediately after irradiation and those that persist. Eighteen previously untreated patients underwent germinoma biopsy and irradiation or combined irradiation and chemotherapy. Four tumors were located only in the pineal gland, eight in the suprasellar region, two in multiple locations, one in the basal ganglia, and three in other regions. Histologically, the germinomas could be divided into type A found in 13 cases which consisted mainly of large neoplastic cells and small lymphocytes, the so-called two-cell pattern, and type B found in five cases which consisted predominantly of fibrous tissue and granulomatous reaction containing occasional neoplastic cells. Follow-up computed tomography or magnetic resonance imaging showed the enhanced mass lesion disappeared in all cases of type A germinomas within 1 month after treatment, but persisted in all cases of type B germinomas for at least 1 month. Type B tumors required up to 12 months to show complete radiographic resolution. Persistent germinomas consisted predominantly of fibrous tissue and granulomatous reaction containing occasional neoplastic cells.

Adolescent↗
PubMed2006

Neuroendoscopic appearance of an intraventricular cavernous angioma blocking the foramen of monro - case report.

A 47-year-old woman presented with unilateral ventricular enlargement detected by magnetic resonance imaging during a medical checkup. Neuroendoscopic exploration identified a multilocular lesion in which dark red fluid formed a niveau near the right side of the foramen of Monro. The diagnosis was intraventricular cavernous angioma. Restricted flow of cerebrospinal fluid at the foramen of Monro was observed. Xanthochromia, which seemed to be due to previous bleeding, was observed at the fornix. When the neuroendoscope touched the angioma, the wall collapsed and bled. Endoscopic removal of the angioma was abandoned, and craniotomy and resection of the angioma were performed. No new neurological anomalies were observed after surgery. Preoperative diagnosis of intraventricular cavernous angioma is difficult based on neuroimaging. Neuroendoscopy is effective for diagnosis and the decision-making process regarding treatment.

Cerebral Arteries↗
PubMed2006

Subcutaneous pneumocele associated with ventriculoperitoneal shunt migration into the mechanically occluded colon - case report.

A 62-year-old man presented with shunt failure manifesting as consciousness disturbance 4 years after placement of a ventriculoperitoneal shunt for subarachnoid hemorrhage. Physical examination found subcutaneous pneumocele around the peritoneal catheter extending from the abdomen to the neck. He had undergone pelvic radiation therapy for bladder cancer 2 years before. The peritoneal catheter was removed from the cervical region, and external ventricular drainage and a descending colon stoma for ileus release were positioned. The cerebrospinal fluid was clear and yielded no cultures. No inflammatory changes were seen. He developed carcinomatous peritonitis and died 4 months later. Retrograde colon gas reflux due to catheter perforation into the colon occluded by metastatic sigmoid cancer was probably the cause. Fragility of the wall of colon associated with the prior abdominal radiation therapy might have been a contributing factor. Subcutaneous pneumocele around the peritoneal catheter, i.e. pneumocele within the fibrous sheath surrounding the catheter, is a differential diagnosis to cerebrospinal fluid collection in patients with subcutaneous swelling around the catheter.

Carcinoma↗
PubMed2006

Pituitary apoplexy manifesting as diffuse subarachnoid hemorrhage.

A 46-year-old woman presented with hemorrhage from a non-functioning pituitary adenoma manifesting as sudden onset of severe headache. Computed tomography demonstrated diffuse subarachnoid hemorrhage (SAH) and a suprasellar mass with intratumoral hematoma. The patient underwent transnasal transsphenoidal removal of the pituitary adenoma. This type of SAH with intratumoral hematoma simulates rupture of an anterior cerebral artery aneurysm.

Adenoma↗
PubMed2006

Possibility of using laser spectroscopy for the intraoperative detection of nonfluorescing brain tumors and the boundaries of brain tumor infiltrates. Technical note.

The response of nonfluorescing infiltrating tumors that had been exposed to 5-aminolevulinic acid and irradiated using a laser at a wavelength of 405 nm was analyzed intraoperatively using spectroscopy. Histological analyses demonstrated that neoplastic cells were present in the tissue region that displayed a peak at 636 nm, whereas no neoplastic cells were present in the region that exhibited only the excitation light peak. The authors conclude that the intraoperative use of laser spectroscopy can allow the diagnosis of infiltrating tumor and the detection of boundaries of the infiltrate when standard fluorescence techniques fail.

Adult↗
PubMed2006

Stereotactic radiosurgery as adjuvant treatment for residual solitary fibrous tumor. Case report.

This 50-year-old woman presented with headache and visual disturbance. Neuroimaging results demonstrated a well-demarcated tumor attached to the falx cerebri near the transverse sinus, and the lesion was subtotally removed. Based on histological and immunohistochemical evaluation, a solitary fibrous tumor (SFT) was diagnosed. During the next 32 months, the size of the residual tumor increased slightly at the transverse sinus. Stereotactic radiosurgery (SRS) was performed as an adjuvant treatment. Over the course of the next 4 years the tumor decreased in size. The authors suggest that SRS constitutes good adjuvant treatment for regrowing residual SFTs not amenable to reoperation.

Brain Neoplasms↗
PubMed2006

Endovascular surgery for very small ruptured intracranial aneurysms. Technical note.

Application of endovascular surgery for very small aneurysms is controversial because of technical difficulties and high complication rates. The aim in the present study was to assess treatment results in a series of such lesions at one institution. Since 1997, endovascular surgery has been advocated for very small ruptured aneurysms (< 3 mm in maximum diameter) that fulfill the criterion of a fundus/neck ratio greater than 1.5. Twenty-one patients were treated, for whom the World Federation of Neurosurgical Societies classification before treatment was Grade I in 10, Grade II in two, Grade III in two, Grade IV in five, and Grade V in two. The aneurysm location was the internal carotid artery in four, the anterior communicating artery in 11, the middle cerebral artery in one, and the vertebrobasilar system in five. In all patients, endovascular surgery was performed using Guglielmi detachable coils after induction of general anesthesia. Initially, the presumed volume of the lesions was calculated for each aneurysm. Thereafter, the appropriate coil length was decided according to the volume embolization ratio, as 30 to 40%. In all attempts to obliterate aneurysms a single coil was used. All aneurysms were completely obliterated as confirmed by postembolization angiography, without procedure-related complications. During the follow-up period only one patient needed additional coil embolization for a growing aneurysm. Final outcomes were good recovery in 15 patients, moderate disability in five, and severe disability in one. Appropriate selection of patients and coils, and use of sophisticated techniques allow a good outcome for patients with very small aneurysms.

Adult↗
PubMed2006

Regression of an atlantoaxial degenerative articular cyst associated with subluxation during conservative treatment. Case report and review of the literature.

The presence of an atlantoaxial degenerative articular cyst is rare; when present this lesion extends posteriorly to the dens, causing cervicomedullary compressive myelopathy. The authors describe a symptomatic case of this lesion associated with atlantoaxial subluxation in a 76-year-old man. The patient's neurological symptoms resolved and corresponded to a reduction in the size of the cyst. After 8 months of continued conservative treatment, in which the patient wore a Philadelphia collar, the cyst spontaneously regressed. Subsequently, a C1-2 posterior fusion was performed to treat the atlantoaxial subluxation.

Aged↗