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Biomedical subjects

Takaomi Taira

Publications and source records attributed to Takaomi Taira.

16 recordsLinked to original sources
PubMed2006

New radiofrequency coil integrated with a stereotactic frame for intraoperative MRI-controlled stereotactically guided brain surgery.

Mislocalization errors caused by MR image distortions or brain shift are one of the main causes of complications after stereotactically guided neurosurgical procedures. A special device, which could ameliorate such effects and provide intraoperative acquisition of MR images of sufficient diagnostic accuracy, was developed. It is composed of a radiofrequency receiver coil integrated with a modified Komai stereotactic frame and a Sugita four-pin head holder. Clinical testing revealed that the use of the device during stereotactically guided procedures under the control of low magnetic field strength (0.3 T) intraoperative MRI ameliorates the effects of brain shift, and permits to obtain informative tissue samples and to perform aggressive removal of the lesion without any damage of the eloquent cerebral structures. The possibility of an easy shift from a stereotactically guided to a routine microneurosurgical procedure represents an additional benefit of the developed device.

Adolescent↗
PubMed2005

Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome.

OBJECT: Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. METHODS: Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. CONCLUSIONS: An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

Aged↗
PubMed2004

[Adult type tethered cord syndrome with chronic attackwise pain in the bilateral feet].

The authors report a case of chronic attackwise pain in the bilateral feet for five years due to tethered cord syndrome. Despite extensive examinations, this condition had been overlooked. The patient is a 21-year-old man. He had suffered attackwise pain resembling sticking a thumbtack in the soles of his feet, since he was 16 years old. The pain appeared several times a day and continued for 30 seconds to 30 minutes for 5 years. Physical examination revealed hammer toes and high-arched feet. The fingers and knee joints showed hyperextension. The neurological findings showed weakness of toe extension, hyporeflexia of deep tendon reflexes in the leg. Mild hypesthesia was seen in the bilateral soles. Myelography showed sacral dural ectasia. Magnetic resonance images showed dorsal displacement of the conus medullaris, the filum terminale and the cauda equina. A computed tomographic scan after myelography also showed a dorsally located thick filum terminale (the diameter is 2 mm). Surgery disclosed thick and tight filum terminale directly under the dura mater. Its flexibility was diminished. Abnormal lesions such as lipoma, spinal dysraphysm, diastematomyelia, myelomeningocele were not observed. After the untethering operation, the pain attacks decreased dramatically. The condition of the present case is adult onset tethered cord Group 2 described by Yamada. When unusual pain is manifested, we always have to keep this syndrome in mind.

Adult↗
PubMed2003

Phrenic nerve stimulation for diaphragm pacing with a spinal cord stimulator: technical note.

BACKGROUND: Diaphragm pacing with electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. The device, however, is not readily available, at least in Japan. We used the spinal cord stimulator for pain control for phrenic nerve stimulation. The purpose of this study is to evaluate the efficacy and feasibility of phrenic pacing with the compromise method. METHODS: We implanted a stimulator for spinal cord stimulation (Itrel 3 or X-trel, Medtronic, MN) in 4 patients with chronic hypoventilation because of brainstem dysfunction of various origins. The stimulation electrode was placed along the right phrenic nerve in the neck, and the device was implanted in the anterior chest. We used the cyclic mode, and set the parameters at 1 second ramp up, 2 seconds on, 3 seconds off. The pulse width and the frequency were set at 150 microsec and 21 Hz, respectively. The amplitude of the output was adjusted to obtain sufficient tidal volume and to maintain PaCO(2) at around 40 mm Hg. RESULTS: During the follow-up period from 6 to 19 months (mean 8.3 months), stable and sufficient ventilation were observed in all patients without complications. One patient with sleep apnea syndrome used the device only at night and became free from a respirator. Three patients who were completely respirator-dependent became ambulatory during the daytime. CONCLUSION: Though longer follow-up is necessary, diaphragm pacing by stimulation of the phrenic nerve with the spinal cord stimulator is feasible for a treatment of central hypoventilation syndrome.

Brain Stem↗
PubMed2003

Selective peripheral denervation of the levator scapulae muscle for laterocollic cervical dystonia.

Laterocollis, as a symptom of idiopathic cervical dystonia may be due to abnormal contraction of the levator scapulae muscle (LSM). The purpose of this study is to define the effects of selective peripheral denervation of LSM in patients with laterocollic cervical dystonia.The clinical records of 10 patients who underwent LSM denervation for laterocollic torticollis were reviewed. Preoperatively, all patients showed sustained lateral tilt of the head and elevation of the shoulder. Abnormal contraction of LSM was observed and the muscle was denervated surgically in the posterior cervical triangle. The mean age at operation was 38.4 years (range, 20-58 years) and the mean duration of the symptom ranged from 14 to 80 months (mean, 41months). The postoperative follow up ranged from 6 to 72 months (mean, 29.4months). The cervical dystonia rating score of Tsui was 10.8 on average before the operation, and the postoperative follow up score was 1.3. According to the changes of the rating score, success rates, including excellent and good results, were 40% and 60%, respectively. Five patients (50%) postoperatively showed transient dysaesthesia in the neck. There was no disturbance of shoulder elevation or arm raising. When abnormal contraction of LSM is responsible for laterocollis in patients with cervical dystonia, selective peripheral denervation of this muscle is a safe and effective procedure for alleviation of the symptom.

Adult↗
PubMed2003

Role of pituitary radiosurgery for the management of intractable pain and potential future applications.

RATIONALE: Two or three decades ago, cancer pain was treated by surgical/chemical hypophysectomy. In one report, the control of central pain (thalamic pain syndrome) was also approached with chemical hypophysectomy. Although in most of the patients these treatments resulted in a decrease in severe pain, concomitantly severe adverse effects (panhypopituitarism, diabetes insipidus and visual dysfunction) occurred in most patients. This historical evidence prompted us to perform Gamma Knife surgery (GKS) for this kind of intractable severe pain using a high irradiation dose to the pituitary stalk/gland. In the majority of patients, marked pain relief was achieved, surprisingly without any of the complications mentioned above. MATERIALS AND METHODS: A prospective multicenter study was conducted to evaluate the efficacy and safety in patients treated in Prague, Hong Kong and Tokyo. Indications of this treatment were: (1) failure of other effective treatment approaches prior to GKS, (2) good general patient condition (Karnofsky performance status >40%), (3) response to morphine for pain control (cancer pain), and (4) no previous radiotherapy of brain metastases (GKS/conventional radiotherapy). Eight patients with severe cancer pain due to bone metastasis and 12 patients with post-stroke thalamic pain syndrome were treated with GKS. The target was the border between the pituitary stalk and gland. Maximum dose was 160 Gy for cancer pain and 140 Gy for central pain. Follow-up included 6 patients (>1 month) with cancer pain and 8 patients (> 6 months) with thalamic pain syndrome. RESULTS: All patients (6/6) with cancer pain experienced significant pain reduction, and 87.5% (7/8) of the patients with thalamic pain had initially significant pain reduction. In some patients, pain reduction was delayed for several hours. Pain relief was noted within 7 days (median 2 days). No recurrence was observed in the patients with cancer pain. However, in 71.4% (5/7) of the patients with thalamic pain syndrome, disease recurred during the 6-month follow-up. Up to now, other complications have not been observed. CONCLUSION: Our clinical study protocol is only preliminary. Further clinical results on the management of thalamic pain are required to develop this treatment protocol. However, efficacy and safety have been shown in all our cases. In our opinion, this treatment has a potential to control severe pain, and GKS will play an important role in the management of intractable pain.

Bone Neoplasms↗
PubMed2003

Subtemporal amygdalohippocampectomy prevents verbal memory impairment in the language-dominant hemisphere.

BACKGROUND: In this report, we show the operative and neuropsychological results for 20 patients with medically intractable nonlesional temporal lobe epilepsy treated surgically by subtemporal amygdalohippocampectomy whose mean postoperative follow-up period was more than 6 years. METHODS: Pre- and postoperative Wechsler Adult Intelligence Scale-Revised (WAIS/-R) scores, including verbal intelligence quotient (VIQ), performance IQ (PIQ) and full-scale IQ (FIQ) scores, were determined in the 19 adults. The revised Wechsler Intelligent Scale for Children was used in a 9-year-old boy. The verbal paired associates learning test was performed pre- and postoperatively in 15 patients. These data were compared pre- and postoperatively in 10 patients in whom the language-dominant hemisphere side was operated on, and in 5 patients in whom the language-non-dominant side was operated on. RESULTS: Seizure control was achieved in 80% of patients, with improvement into Engel categories I and II without definite permanent complications except for postoperative memory impairment in one patient. VIQ improved after 2 years, and PIQ and FIQ improved after both 2 months and 2 years postoperatively. CONCLUSION: There was no significant decline in the postoperative verbal memory scores in those patients whose medial temporal structure of the language-dominant side had been removed.

Adolescent↗
PubMed2003

Stereotactic ventrooralis thalamotomy for task-specific focal hand dystonia (writer's cramp).

BACKGROUND: Writer's cramp is a type of focal dystonia due to dysfunction of the pallido-thalamo-cortical circuit. The symptom is refractory to most conservative treatment, though botulinum toxin injection is generally used for symptomatic relief. As a surgical treatment of dystonia, we performed stereotactic nucleus ventrooralis (Vo) thalamotomy for dystonic cramp of the hand. METHODS: Twelve patients (5 men, 3 women; age 26-40 years, mean 32.1 years) with medically intractable task-specific focal dystonia of the hand underwent Vo thalamotomy. The stereotactic target was chosen at the junction of the anterior and posterior Vo nuclei. RESULTS: The mean duration of the symptom ranged from 3 to 6 years (mean 4.5 years.) All patients had complained of difficulty in writing. Seven patients were professionals, such as a comic artist, guitarist and barber, and, because of the dystonic symptoms occurring during their work, they had stopped pursuing their profession. All patients showed immediate postoperative disappearance of dystonic symptoms, and the effect was sustained during the follow-up period (3-33 months, mean 13.1 months), except in one case. Two patients showed partial recurrence of the symptom and underwent second thalamotomy 5 months after the initial surgery with satisfactory results. The score on the writer's cramp rating scale decreased significantly (p < 0.001) after Vo thalamotomy. There were no permanent operative complications. There was no mortality or permanent morbidity. CONCLUSION: Although a longer follow-up is needed, stereotactic Vo thalamotomy is a useful and safe therapeutic option for writer's cramp.

Adult↗
PubMed2003

A novel denervation procedure for idiopathic cervical dystonia.

BACKGROUND: For idiopathic cervical dystonia, the treatment of choice is botulinum toxin injection or surgical denervation. There are two major procedures of surgical denervation: intradural ventral rhizotomy and extradural peripheral neurotomy (Bertrand procedure). The Bertrand procedure is always accompanied by popstoperative sensory loss in the C2 region. METHODS: The authors have modified these procedures to minimize the complications. Our method is unilateral intradural ventral rhizotomy of C1 and C2, extradural denervation of the C3-C6 posterior rami and contralateral peripheral sectioning of the branches of the accessory nerve to the sternocleidomastoid muscle. Forty-four patients underwent this modified operation ('Taira's' method: group A) and the results were compared with those in a matched control group of 38 patients who underwent the traditional Bertrand's procedure (Bertrand's method: group B). RESULTS: Three patients in group A showed a sensory deficit in the C2 area, while all of the patients in group B had C2 sensory disturbance. Pre- and postoperative rating scores did not differ between the two groups. The intraoperative blood loss was significantly smaller in group A. CONCLUSION: Compared with the traditional Bertrand's operation, our procedure carries a much lower incidence of complications and a significant decrease of intraoperative blood loss.

Female↗
PubMed2003

Disappearance of self-mutilating behavior in a patient with lesch-nyhan syndrome after bilateral chronic stimulation of the globus pallidus internus. Case report.

Lesch-Nyhan syndrome (LNS) is an X-linked hereditary disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase. Patients with this syndrome are characterized by hyperuricemia, self-mutilation, developmental retardation, and movement disorders such as spasticity and dystonia. The authors performed bilateral chronic stimulation of the globus pallidus internus for control of dystonic movements in a 19-year-old man with LNS. His self-mutilating behavior unexpectedly disappeared after chronic stimulation. This is the first case of LNS that has been successfully treated with deep brain stimulation. The findings indicate that neurobehavioral features of this syndrome are either mediated in the basal ganglia pathways or secondary to the dystonia.

Adult↗
PubMed2003

[Diaphragm pacing with a spinal cord stimulator].

BACKGROUND: Diaphragm pacing with electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. The device, however, is not readily available in Japan. For pain control, we applied the spinal cord stimulator to bring about phrenic nerve stimulation. The purpose of this study is to evaluate the efficacy and feasibility of phrenic pacing using the compromise method. METHOD AND PATIENTS: We implanted a spinal cord stimulator in five patients with chronic central hypoventilation. The stimulation electrode was placed along the phrenic nerve in the neck, and the device was implanted in the anterior chest. We used the cyclic mode, and set the parameters at 1 second ramp up, 2 second on, 3 second off. The pulse width and the frequency were set at 150 mu sec and 21 Hz respectively. The amplitude was adjusted to obtain sufficient tidal volume and to maintain PaCO2 at around 40 mmHg. RESULT: During the follow-up period from 3 to 34 months (mean 23), stable and sufficient ventilation was observed in all patients without complications. CONCLUSION: Though longer follow-up is necessary, diaphragm pacing with the spinal cord stimulator is feasible as a treatment for central hypoventilation syndrome.

Adult↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed2002

A new denervation procedure for idiopathic cervical dystonia.

OBJECT: The Bertrand selective peripheral denervation for cervical dystonia (CD) has been well described, and its effectiveness and safety are established. It is, however, always accompanied by postoperative sensory loss in the C-2 region. Intraoperative bleeding from epidural venous plexuses may also be problematic. The authors developed a new denervation procedure with which to avoid such complications and compared the surgery-related results with those of the traditional Bertrand operation. METHODS: The new procedure consists of intradural rhizotomy of the anterior C-1 and C-2 nerve roots, extradural peripheral ramisectomy from C-3 to C-6, and selective section of peripheral branches of the accessory nerve to the sternocleidomastoid muscle. This procedure was performed in 30 patients (Group A). The results of this procedure were compared with those obtained in a matched group of 31 patients in the authors' series who underwent Bertrand denervation (Group B). Changes of CD rating score at 6-month follow up did not differ between the two groups. In one patient in Group A a C-2 sensory deficit was found, whereas C-2 sensory deficits were demonstrated in all the patients in Group B. No patients in Group A and four patients in Group B experienced occipital neuralgia. The operative time was significantly shorter in Group A. The mean intraoperative blood loss was 115 +/- 30 ml (+/- standard deviation) in Group A and 233 +/- 65 ml in Group B (p < 0.005). CONCLUSIONS: Although symptomatic improvement is the same after the Bertrand operation, the authors' new procedure for CD was associated with a lower incidence of complications and significant decrease of intraoperative blood loss.

Accessory Nerve↗