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T Tsurutani

Publications and source records attributed to T Tsurutani.

At least 19 recordsLinked to original sources
PubMed1997

P2 aneurysm approached via the temporal horn: technical case report.

OBJECTIVE AND IMPORTANCE: We report the use of a transcortical transventricular approach to a P2 aneurysm, which was located near the choroidal fissure, protruded into the temporal horn, and was considered to be too difficult to approach by the conventional subtemporal route. CLINICAL PRESENTATION: An 81-year-old woman suddenly developed severe headache with vomiting and subsequently lost consciousness. Computed tomographic scans revealed a diffuse intraventricular hemorrhage and subarachnoid hemorrhage. Cerebral angiography disclosed a saccular aneurysm in the right P2 segment. INTERVENTION: On the 16th day after admission, successful neck clipping was easily performed through the temporal horn via the inferior temporal gyrus. The postoperative course was uneventful. CONCLUSION: This special approach may be preferable in such cases, because it protects the brain from the detrimental effects of strong temporal retraction and provides a wider working space.

Aged↗
PubMed1997

[Natural course of non-operative cases of acute subdural hematoma: sequential computed tomographic study in the acute and subacute stages].

We have studied 20 non-operative cases of traumatic acute subdural hematoma in the acute and subacute stages by sequential computed tomography (CT). 20 patients were divided into three groups as is shown below; 8 patients with rapid complete resolution within 24 hours (rapid resolution group), 10 patients with slow resolution beyond 24 hours, mainly in the subacute stage (slow resolution group), and 2 patients worsening clinically due to the increase of subdural fluid collection in the subacute stage (subacute worsening group, what is called, "subacute subdural hematoma"). In the rapid resolution group, CT showed mixed density thin subdural hematoma in 6 patients; delayed subdural effusion in 3 patients; cerebral contusion in 2 patients; and diffuse brain swelling in 2 patients. We reviewed 8 of our cases and 13 reported cases. As a result, we consider that the main pathological mechanisms of rapid resolution types were, in the elderly, the washout of the hematoma by the leakage of cerebrospinal fluid (CSF) and, in the young, the compression of the hematoma by brain swelling. In the subacute worsening group, CT showed, in the acute stage, mixed density thick subdural hematoma with brain atrophy and no intraaxial lesions and, in the subacute stage, the increase of low density subdural fluid collection with marked mass effect. We reviewed 2 of our cases and 19 reported cases. As a result, we related the increase of subdural fluid collection in the subacute stage with the CSF leakage into the subdural space due to the tearing of arachnoid membrane. However, massive CSF leakage into the subdural space, producing marked mass effect, may be joined by other factors such as osmotic pressure gradient or oozing from the outer membrane of the hematoma.

Accidents, Traffic↗
PubMed1996

CT findings of extravasation of contrast medium from a ruptured aneurysm during cerebral angiography--a case report and six others from the literature.

We present a case of ruptured aneurysm in which extravasation of contrast medium was suspected during cerebral angiography and confirmed by computed tomography. In cases of ruptured aneurysm, post-angiographic computed tomography before operation (measurement of the Hounsfield unit numbers and grading by them) is necessary for establishing the diagnosis of extravasation of contrast medium and for grasping its degree and extent.

Aneurysm, Ruptured↗
PubMed1996

[Subacute subdural hematoma: report of 3 cases].

Three surgical cases of subacute subdural hematomas are reported considering the pathophysiology. All patients had head traumas and complained the worsenings of the headaches 7-14 days after the head traumas. Serial computed tomography scan (CT) revealed the expansions of the subdural hematomas with the change of the density from high to mixed. The surgical findings of the hematomas showed blood clots and liquid covered with thin membranes. Morinaga et al. suggested the etiology of the subacute subdural hematoma that the influx of cerebrospinal fluid (CSF) to the hematoma cavity through the teared arachnoid. Our macroscopic findings of the hematomas which had the CSFlike liquid supported this estimation. We suggest that subacute subdural hematoma should be differed from chronic subdural hematoma because it may have the proper mechanisms of the development. Mild acute subdural hematomas should be observed carefully because they may develop to be subacute subdural hematomas between 1 and 3 weeks after the onset.

Aged↗
PubMed1995

Brain temperature before and after brain death.

Although there has been renewed interest in human brain temperature, very little information is available on the association between brain temperature and cerebral perfusion pressure. In this study, we measured brain, tympanic, and rectal temperatures, arterial blood pressure and intracranial pressure in a case of massive hemorrhage deteriorating to brain death, and showed for the first time that when cerebral perfusion pressure began to decrease markedly brain temperature fell rapidly. Rectal and tympanic temperatures were higher than brain temperatures during the period of very low cerebral perfusion pressure. Circadian change in temperature (high at day, low at night) was preserved during the period of brain death.

Body Temperature Regulation↗
PubMed1995

[Symptomatic Rathke's cleft cyst presenting with hyponatremia: a case report].

A case of symptomatic Rathke's cleft cyst, showing symptoms due to hyponatremia, is reported. The patient was a 68-year-old woman with complaints of vomiting, diarrhea and somnolence. She had severe hyponatremia (109 mEq/l). Magnetic resonance image showed a cystic mass in the intra- and suprasellar region. A right fronto-temporal craniotomy was performed and the cyst was partially resected through the pterional approach. The cyst compressed the chiasma and anterior hypothalamus upward. In the cyst, there was xanthomatous fluid and hematoma. On histopathological examination, the cyst epithelium was diagnosed as Rathke's cleft cyst with craniopharyngioma component. These findings suggested that rapid compression to the anterior hypothalamus by intracystic hemorrhage caused hyponatremia.

Aged↗
PubMed1994

Pyramidal tract Wallerian degeneration and correlated symptoms in stroke.

In order to reveal the precise degree of injury in the pyramidal tract after stroke, we studied 35 patients with motor deficit associated with cerebrovascular disease of the internal capsule using the T2-weighted coronal image along the 'pyramidal line'. According to the severity of the motor deficit, the patients were divided into three groups. The Wallerian index was calculated as: (area of Wallerian degeneration in the pons divided by area of the ipsilateral half of the pons) x 100. There were significant differences between the three groups. It is concluded that the area of Wallerian degeneration is related to the severity of motor deficit.

Adult↗
PubMed1994

Distal posterior cerebral artery aneurysms--three case reports.

One case of an aneurysm in the P3 segment and two cases of aneurysms in the P4 segment of the posterior cerebral artery are described. The P3 aneurysm in a 60-year-old female and a P4 aneurysm in a 63-year-old male were clipped or coated via the occipital interhemispheric approach. The other P4 aneurysm in a 73-year-old female was clipped via a hematoma cavity. The occipital interhemispheric approach should be selected for small or large P3 aneurysms and for P4 aneurysms associated with slack brain, as brain retraction is minimal and the approach to the aneurysm is straightforward.

Aged↗
PubMed1994

[Shunting operation with the medos programmable valve shunt system].

We reviewed 13 patients with hydrocephalus of varied etiology and two patients with arachnoid cyst who underwent shunting operations using Medos programmable valve shunt system. This shunt system allows 18 pressure settings, ranging from 30 to 200mmH2O in 10mmH2O differentials, percutaneously. Following the shunting operation, the size of the ventricle or arachnoid cyst was reduced in all cases and the clinical symptoms improved in 14 cases. The valve pressure was reset during the postoperative course in all cases. In five cases, resetting was performed because of management of complications. In the others, it was performed to find the most appropriate valve pressure for each patient. Complications were subdural effusion (2 cases), chronic subdural hematoma (2 cases) and slit ventricle syndrome (1 case). Subdural effusion and slit ventricle syndrome were improved easily by resetting the valve pressure, but both cases of chronic subdural hematoma finally required surgical treatment. Artifacts in MR imaging and movement of the valve pressure by MR imaging were small and created no clinical problem. In cases 1 and 2, clinical symptoms and CT finding were improved by a change of 30mmH2O. In case 2, hydrocephalus with slight subdural effusion followed a good course with frequent change of the valve pressure. Accordingly, we consider the Medos system to be useful for a more thorough treatment of hydrocephalus and arachnoid cyst after shunting operations.

Adolescent↗
PubMed1993

Ultrasound imaging for stereotactic evacuation of hypertension-associated intracerebral hematomas with aqua-stream and aspiration.

Stereotactic aqua-stream and aspiration (SASA) has been used for the evacuation of intracerebral hematomas. The authors have introduced ultrasound imaging (US) to monitor the evacuations of the hematoma during the surgical procedure. Hematomas were reproduced in an agar hematoma model which showed that if air collected in the hematoma cavity, it produced a strong artifact, and the hematoma could not be monitored. In the clinical trial, hematomas were visualized, and the surgical procedures were monitored in real time. The needle of the SASA and the air that collected in the hematoma cavity produced only weak artifacts, and the SASA water jet showed as a hyperechoic region on US, so that the procedure could be monitored in real time. In all cases, the average amount of evacuated hematoma exceeded 92%, as calculated from the preoperative and postoperative computed tomography images. The level of consciousness improved from a preoperative level of 1-20 (Japan Coma Scale) to 0-3 postoperatively. The addition of US monitoring to computed tomography guided stereotactic evacuation of hematomas with SASA enabled hypertension-associated intracranial hematomas to be evacuated more safely and more completely than has been achieved hitherto.

Agar↗
PubMed1991

[Quantification of wallerian degeneration of the pyramidal tract in the capsular region by magnetic resonance imaging].

Using magnetic resonance imaging, we studied 23 patients with motor deficit associated with cerebrovascular disease of the internal capsule. According to the severity of the motor deficits, 23 patients were divided into three groups (severe group...9, moderately severe group...8, mild group...6). A coronal T2-weighted image was obtained along a straight line between the front edge of the medulla and the deepest point of the interpeduncular cistern in a midsagittal T1-weighted image. It was revealed that wallerian degeneration extended continuously from part of the internal capsule down to the pons or medulla or the decussation in all patients. The area of wallerian degeneration in the pons and the area of half the pons were calculated from the coronal T2-weighted image. Moreover, the wallerian index was calculated as: (area of wallerian degeneration in pons divided by area of half the pons) X 100. Values of the wallerian index +/- SD were 26.4 +/- 5.1 in the severe group, 19.2 +/- 5.6 in the moderately severe group, and 10.0 +/- 5.4 in the mild group. There were significant differences among the three groups. We concluded that the area of wallerian degeneration was related to the severity of motor deficits.

Adult↗
PubMed1979

Projection of scrotal thermal afferents to the preoptic and hypothalamic neurons in rats.

Effects of thermal stimulation (18--41.5 degrees C) of the scrotum were observed on neurons in the preoptic area and hypothalamus (POHY) in anesthetized rats. Changes in firing rate of POHY neurons occurred, with three exceptions, within the scrotal temperature range of 30--41 degrees C. There was no dynamic response and little or no sign of rapid adaptation. Out of 46 warm-sensitive neurons, 34 increased and 9 decreased in firing rate with a rise in scrotal temperature. Out of 26 cold-sensitive neurons, 19 were excited and 4 were suppressed by scrotal cooling. The 3 exceptions were excited by scrotal cooling. The 3 exceptions were excited by scrotal warming above 36 degrees C, and were also excited by cooling below 30 degrees C. Out of 54 thermally-insensitive neurons, 16 were excited by scrotal warming 7 by cooling and 2 by warming and cooling. The scrotal temperature change needed to produce full change in POHY neuronal activity varied from less than 1 degree C to 7 degrees C, and was usually less than 4 degrees C. Thermal stimulation of either half of the scrotum had identical influence on the same POHY neuron.

Animals↗
PubMedDate not supplied

Transient hydrocephalus due to movement of a clot plugging the aqueduct.

A rare case of transient hydrocephalus is reported. A 64-year-old woman presented with headache. Computerized tomography (CT) scan revealed hydrocephalus with tiny blood clots in the left foramen of Monro and in the aqueduct. Six hours after the onset, the signs and symptoms disappeared spontaneously. The second CT showed improvement of the hydrocephalus with migration of the clot into the i.v. ventricle. Aqueductal trapping and releasing of the clot formed by bleeding from the choroid plexus located in the left foramen of Monro was suspected for the origin of the transient hydrocephalus.

Cerebral Aqueduct↗