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Mamoru Taneda

Publications and source records attributed to Mamoru Taneda.

8 recordsLinked to original sources
PubMed2006

[Surgical treatment for cerebrospinal fluid rhinorrhea from plaum sphenoidale].

A transcranial approach is frequently employed for the closure of cerebrospinal fluid (CSF) rhinorrhea, occurring after skullbase surgery or associated with anterior skull base fracture. However, the site of CSF rhinorrhea is usually most distant from the site of craniotomy and, because securing of an adequate operative field is difficult, elimination of this type of CSF rhinorrhea tends to be insufficient. We have attempted to reconstruct the anatomical structures with an extended transsphenoidal approach for a case with CSF rhinorrhea from the planum sphenoidale, and have succeeded in achieving a more physiological and reliable elimination of CSF rhinorrhea. This technique is presented, with a representative example.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2005

Successful long-term deep brain stimulation for hemichorea-hemiballism in a patient with diabetes. Case report.

The authors report a case of hemichorea-hemiballism (HC-HB) that was successfully treated using deep brain stimulation (DBS). A 65-year-old right-handed man exhibited a sudden onset of right HC-HB without a diabetic coma. At admission T1-weighted magnetic resonance (MR) images revealed a high-intensity signal in the left striatum, contralateral to the patient's involuntary movements. The HC-HB continued for 5 months after onset of the condition despite medical treatment and a decreased intensity of the signal on T1-weighted MR images. The patient underwent placement of a quadripolar DBS electrode in the left thalamus, including the left ventral oralis (VO) anterior and posterior nuclei (the VO complex). Postoperatively, the right-sided HC-HB disappeared rapidly during electrical stimulation and there were no neurological deficits. The authors demonstrate that DBS can be an effective treatment for medically refractory HC-HB. This is the first case of HC-HB that has been successfully treated with DBS.

Aged↗
PubMed2005

[Three-dimensional atlas of subthalamic nucleus and its adjacent structures].

The deep brain stimulation (DBS) is an effective treatment modality of the functional neurosurgery for disorders such as Parkinson's disease, essential tremor and generalized dystonia. Recently, the targets of DBS for treatment of Parkinson's disease are the thalamus, the Globus pallidus and subthalamic nucleus (STN). The STN-DBS induces improvements in axial motor fluctuation and the on-off phenomenon. The important problem for STN-DBS is that DBS is inserted properly into the STN for good results. The STN is a small body in the deep brain structures. We cannot understand the STN clearly because of its small size and complex shape. The topographical information of deep brain structures has been essential for accurate stereotactic placement of the stimulating electrode of DBS. The target of a deep brain structure is based on the Schaltenbrand and Wahren atlas (S-W atlas). The S-W atlas consists of two-dimensional images such as a coronal section. For this reason, it is difficult to understand localization and the shape of deep brain structures spatially, especially of the subthalamic nucleus on S-W atlas. The three-dimensional image is a useful tool for diagnosis and preoperative planning, because it can easily give neurosurgeons the vivid spatial image of complex structures. We studied a practical use of a three-dimensional atlas of deep brain structures in functional neurosurgery. We devised a three-dimensional atlas to see an image at a free angle on a personal computer. It provided us with more useful information about structures than ones by two-dimentional images. Three-dimensional atlas also helped us make a decision for placement of the deep brain electrode and appropriate electrophysiological recording.

Brain Mapping↗
PubMed2004

Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery.

OBJECTIVE: The most common postoperative complication of the transsphenoidal approach is cerebrospinal fluid (CSF) rhinorrhea. If the dura is widely opened beyond the sellar floor and massive intraoperative CSF leakage is encountered, then the conventional packing method, in which the sella turcica is filled with pieces of fat or muscle, demonstrates a relatively high incidence of CSF rhinorrhea. For more reliable prevention of postoperative CSF leakage, we developed a method for watertight closure of large dural defects. METHODS: For 34 consecutive patients with suprasellar tumors, we performed tumor resection via an extended transsphenoidal approach, in which the surgical window in the sellar floor was extended to the planum sphenoidale to expose the suprasellar cistern. The patients were retrospectively divided into three groups according to the dural defect closure technique used. Group I consisted of the first two patients, whose large dural openings were closed with a conventional fat-packing method. Group II consisted of the next 10 patients, whose large dural defects were patched with fascia and sutured with 5-0 nylon, in a watertight manner. Group III consisted of the last 22 patients, who underwent watertight dural closure with a new knot-tying technique and a double-layer patch graft, which generously covered the dural defect of the cranial base with subdural placement. In Group III, intracranial CSF compressed the patch graft against the cranial base and sealed the gap between the patch graft and the cranial base in a watertight manner. The double-layer patch graft was composed of autologous fascial membrane and a commercially available, expanded polytetrafluoroethylene dural substitute. RESULTS: Postoperative CSF leakage was noted for 50% of the patients in Group I, 30% of the patients in Group II, and 9% of the patients in Group III. The time required for dural closure for Group III was approximately 50% shorter than that required for Group II (45.9 +/- 12.4 min versus 93.5 +/- 19.1 min, P < 0.001). CONCLUSION: The subdural double-layer patch graft technique is simple and reliable for the prevention of CSF rhinorrhea after transsphenoidal surgery associated with a widely opened dura.

Adolescent↗
PubMed2004

Development of hybrid integrated endoscope-holder system for endoscopic microneurosurgery.

OBJECTIVE: Endoscopic techniques in the field of neurosurgery are under development. To perform sophisticated bimanual procedures in the delicate surgical fields of neurosurgery, rigid endoscope fixation devices with accurate locking and a safe releasing system are required. Here, we report the development of a new hybrid integrated endoscope-holder system. INSTRUMENTATION: The basic concepts of the holding device were as follows: 1) it should combine both video system and holding device; 2) it should have easy maneuverability and accurate fixation and be equipped with a safe releasing mechanism; and 3) it should be able to be used universally either in a primary or an assisting endoscopic procedure. A negatively actuated air-locking system and a bayonet-shaped endoscope were newly developed. Clinical trials of 25 patients were performed, and each prototype was tested and modified until the functional requirements were fulfilled. The final version was tested for accuracy and security in fixation and releasing mechanism. RESULTS: Eight problems were encountered in the clinical trials and improved. Accuracy in fixation of the final version was superior to the most advanced endoscope-holder on the market. No dangerous events were observed during repetitive insertion, fixation, and release in the simulated deep surgical field in the cadaveric skull. No apparent complications were noted in the clinical application. CONCLUSION: We have developed a highly reliable, accurately fixable, and easily maneuverable hybrid endoscope-holder system. To achieve a safer, more accurate, and less invasive surgery in the current socioeconomic demands, commercial manufacturers and surgeons in multiple centers need to combine their efforts to create useful techniques.

Adult↗
PubMed2003

Efficacy of moderate hypothermia in patients with severe head injury and intracranial hypertension refractory to mild hypothermia.

OBJECT: This study was performed to determine whether moderate hypothermia (31 degrees C) improves clinical outcome in severely head injured patients whose intracranial hypertension cannot be controlled using mild hypothermia (34 degrees C). METHODS: Twenty-two consecutive severely head injured patients who fulfilled the following criteria were included in this study: an intracranial pressure (ICP) that remained higher than 40 mm Hg despite the use of mild hypothermia combined with conventional therapies; and a Glasgow Coma Scale score of 8 or less on admission. After the failure of mild hypothermia in combination with conventional therapies; patients were exposed to moderate hypothermia as quickly as possible. As brain temperature was reduced from 34 to 31 degrees C, the volume of intravenous fluid infusion was increased significantly from 1.9 +/- 0.9 to 2.6 +/- 1.2 mg/kg/hr (p < 0.01), and the dose of dopamine infusion increased significantly from 4.3 +/- 3.1 to 8.2 +/- 4.4 microg/kg/min (p < 0.01). Nevertheless, mean arterial blood pressure and heart rate decreased significantly from 97.1 +/- 13.1 to 85.1 +/- 10.5 mm Hg (p < 0.01) and from 92.2 +/- 13.8 to 72.2 +/- 14.3 beats/minute at (p < 0.01) at 34 and 31 degrees C, respectively. Arterial base excess was significantly aggravated from -3.3 +/- 4 at 34 degrees C to -5.6 +/- 5.4 mEq/L (at 31 degrees C; p < 0.05). Likewise, serum potassium concentration, white blood cell counts, and platelet counts at 31 degrees C decreased significantly compared with those at 34 degrees C (p < 0.01). In 19 (86%) of 22 patients, elevation of ICP could not be prevented using moderate hypothermia. In the remaining three patients. ICP was maintained below 40 mm Hg by inducing moderate hypothermia; however, these three patients died of multiple organ failure. These results clearly indicate that moderate hypothermia induces complications more severe than those induced by mild hypothermia without improving outcomes. CONCLUSIONS: The authors concluded that moderate hypothermia is not effective in improving clinical outcomes in severely head injured patients whose ICP remains higher than 40 mm Hg after treatment with mild hypothermia combined with conventional therapies.

Adolescent↗
PubMed2003

[A case report of tuberculous meningitis: limits of detection using polymerase chain reaction (PCR) and treatments].

A 40-year-old man with intractable meningitis was transferred to our hospital 6 weeks after onset. On admission, he showed consciousness disturbance, meningeal signs and right oculomotor nerve palsy. MRI demonstrated prominent cisternal enhancement and hydrocephalus. We suspected tuberculous meningitis as the diagnosis, and treated with antituberculotics, though he died of midbrain infarction day 11 of the treatment. Before and during the admission, bacterial cultures, PCR, smear examination of cerebrospinal fluid(CSF) were repeated. But no evidence of tuberculosis was obtained. Cultures of the brainstem fragments detected mycobacterium, which was finally confirmed by a PCR method after his death. PCR provides a rapid and reliable diagnosis of tuberculous meningitis, although there is a potential for false-negative. Thus the clinical, radiological and CSF findings should be stressed. Corticosteroids treatment should be considered in cases with ischemic lesions.

Adrenal Cortex Hormones↗