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Yuji Matsumaru

Publications and source records attributed to Yuji Matsumaru.

15 recordsLinked to original sources
PubMed2006

Predictors of angiographic changes in neck remnants of ruptured cerebral aneurysms treated with Guglielmi detachable coils.

The angiographic changes in neck remnants of ruptured cerebral aneurysms treated with Guglielmi detachable coils (GDCs) were evaluated in the acute stage to analyze the important radiological and clinical factors. The clinical and radiological data of 37 patients with a residual neck of a ruptured cerebral aneurysm treated with GDC were reviewed. The angiographic changes on follow-up angiography were classified into three groups: recanalization of the neck remnant, progressive thrombosis, and unchanged. The effects of the clinical and angiographic findings, such as patient age, follow-up period, type of aneurysm (terminal type or side wall type), dome diameter, neck size, dome/neck ratio, obliteration rate, and volume embolization ratio were investigated. Recanalization of the neck remnant was observed in 18 of 37 cases, progressive thrombosis in nine, and unchanged in 10. The type of aneurysm, dome diameter, neck size, and volume embolization ratio were correlated with changes in the neck remnant. The aneurysm dome diameter and type of aneurysm were independent predictive factors for the recanalization of neck remnants on follow-up angiography. Dome diameter of less than 4.5 mm and volume embolization ratio of more than 31% in side wall aneurysms were likely to lead to progressive thrombosis.

Adult↗
PubMed2004

Management of unruptured cerebral aneurysms in patients with polycystic kidney disease.

BACKGROUND: Autosomal dominant polycystic kidney disease (PKD) is a hereditary disorder characterized by bilateral multiple renal cysts and early onset chronic renal failure. PKD patients tend to suffer their subarachnoid hemorrhage at a younger age. Unruptured aneurysms in PKD patients are not always innocuous, and proactive treatment has been indicated for these lesions. However, the management of PKD patients undergoing unruptured cerebral aneurysm surgery has been documented on only a few occasions. The purpose of this study was to better define the management of unruptured cerebral aneurysms in patients with PKD. METHODS: We present a retrospective review of the management of unruptured cerebral aneurysms in 16 patients with PKD. Eight patients were maintained through chronic hemodialysis whereas the remaining 8 patients did not require hemodialysis, at the time of treatment of their cerebral aneurysms. The mean follow-up period was 24 months. RESULTS: In the nonhemodialysis patients prophylactic hemodialysis was routinely performed after cerebral angiography to prevent deterioration of the pre-existing renal dysfunction. Microsurgical clipping of the aneurysm was performed in 15 patients (7 nonhemodialysis and 8 hemodialysis patients) and intravascular coil embolization was performed in 1 nonhemodialysis patient. One nonhemodialysis patient who underwent microsurgical clipping required a temporary hemodialysis after surgery, but the patient was not shifted to chronic hemodialysis. No patients developed postprocedural complications, and each showed an excellent recovery. CONCLUSION: PKD patients with unruptured cerebral aneurysms can be safely treated with an appropriate treatment strategy including the use of prophylactic hemodialysis.

Adult↗
PubMed2003

Small unruptured cerebral aneurysms presenting with oculomotor nerve palsy.

OBJECTIVE: Symptomatic unruptured aneurysms have been considered at relatively high risk for future rupture, and the majority of aneurysms that cause symptoms of mass effect are large. Unruptured aneurysms smaller than 1 cm in diameter sometimes cause neurological symptoms, but their clinical aspects remain obscure. In this article, we review our experience with small unruptured aneurysms presenting with oculomotor nerve palsy. METHODS: Sixteen patients with unruptured aneurysms smaller than 1 cm presenting with oculomotor nerve palsy were included in this study. The patients' clinical profiles were reviewed, and factors affecting the recovery of oculomotor function were determined. RESULTS: The mean size of the aneurysms was 5.8 +/- 1.4 mm. Eleven patients (68.8%) had preceding retrobulbar pain. Fifteen patients underwent successful microsurgical clipping or intravascular embolization, but one patient died of aneurysm rupture before surgery. Seven patients (43.8%) had a complete recovery of oculomotor function, six (37.5%) had an incomplete recovery, and two (12.5%) remained unchanged after treatment. The mean interval between the onset of oculomotor nerve palsy and treatment was 4.7 +/- 3.3 days in patients with complete recovery, 24.2 +/- 15.5 days in patients with incomplete recovery, and 41.0 +/- 12.7 days in unchanged patients. Early surgery resulted in more complete recovery of neural function (P < 0.01). CONCLUSION: Unruptured aneurysms smaller than 1 cm can cause neurological symptoms of mass effect. We recommend timely surgery, preferably within 5 days, to avoid not only aneurysm rupture but also functional disability even in patients with unruptured aneurysms smaller than 1 cm.

Adult↗
PubMed2003

Head and neck extension-fixation with a head frame for exposure of the distal internal carotid artery in carotid endarterectomy--technical note.

Adequate exposure of the distal internal carotid artery (ICA) for carotid endarterectomy may be difficult to achieve because of the position of the mandible and associated soft tissues. A simple yet effective use of a head frame is described to gain several centimeters of exposure of the distal ICA. The patient's head and neck are fixed in an extension position using a radiolucent head frame. Nasotracheal intubation and secure taping of the chin are also employed to keep the mouth closed and to prevent the mandible from spontaneously hanging down. The head frame tightly fixes the patient's neck, so the mandible does not disturb the surgical field throughout the operation. This simple method maximizes exposure of the distal ICA. The radiolucent head frame also enables intraoperative angiography to confirm the patency of the ICA and the absence of flap formation. This simple technique is useful for exposing the distal ICA.

Carotid Stenosis↗
PubMed2003

Intraoperative angiographic assessment of graft patency during extracranial-intracranial bypass procedures.

The use of intraoperative angiography to monitor graft patency was retrospectively reviewed in extracranial-intracranial bypass procedures. Forty-two patients underwent 43 extracranial-intracranial bypass procedures with the use of intraoperative angiography. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed in 41 patients (42 procedures) with ischemic cerebrovascular diseases, and vertebral artery-MCA bypass using radial artery graft for intentional ligation of the common carotid artery in one patient with nasopharyngeal carcinoma. Intraoperative angiography provided high-quality subtraction images in every case. There were no complications due to angiography. Graft occlusion was observed intraoperatively in three cases, but an additional procedure reopened the occluded graft in all three cases. Graft patency rate was 100% after surgery. Outcome was excellent in 40 patients and good in one patient who underwent STA-MCA bypass. Intraoperative angiography provides useful information regarding graft patency during bypass surgery. Intraoperative assessment prior to wound closure allows for the recognition and correction of technical failure and decreases the risk of postoperative complications.

Adult↗
PubMed2003

Significance of a small bulge on the basilar artery in patients with perimesencephalic nonaneurysmal subarachnoid hemorrhage. Report of two cases.

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (SAH) is a distinct type of hemorrhage with a characteristic bleeding pattern and an excellent clinical outcome. The cause of this benign form of SAH remains unknown. The authors report on two cases of perimesencephalic nonaneurysmal SAH in which a small bulge on the basilar artery (BA) was demonstrated on three-dimensional rotational angiography studies. Based on data from these cases, one may infer that the lesion on the BA is responsible for the SAH. The possible pathogenesis is discussed.

Basilar Artery↗
PubMed2002

Ruptured aneurysm of the ophthalmic artery trunk demonstrated by three-dimensional rotational angiography: case report.

OBJECTIVE AND IMPORTANCE: Aneurysms arising from the ophthalmic artery are extremely rare, compared with carotid-ophthalmic aneurysms arising from the wall of the internal carotid artery. We present a very unusual type of aneurysm arising from the ophthalmic artery itself. CLINICAL PRESENTATION: A 54-year-old man presented with a sudden onset of headache and was transferred to a local hospital. Computed tomography demonstrated subarachnoid hemorrhage around the left anterior clinoid process, but digital subtraction angiography failed to localize the source of the hemorrhage. The patient was referred to our hospital for further evaluation and treatment. Conventional cerebral angiography did not reveal the source of the hemorrhage, but three-dimensional rotational angiography clearly demonstrated an aneurysm arising from the ophthalmic artery trunk, apart from the internal carotid artery. INTERVENTION: The patient underwent microsurgical clipping of the aneurysm via a left pterional craniotomy. The aneurysm originated from the bifurcation of the ophthalmic artery and a perforating artery to the optic nerve. The aneurysm was successfully obliterated, and the postoperative course was uneventful. CONCLUSION: This report is the first to describe a case of a ruptured aneurysm arising from the ophthalmic artery trunk. We discuss the clinical significance of an aneurysm at this site, as well as the role of three-dimensional rotational angiography in determining the source of subarachnoid hemorrhage.

Aneurysm↗
PubMed2002

Intraoperative angiography evaluation of the microsurgical clipping of unruptured cerebral aneurysms.

Intraoperative angiography evaluation of the clippings of cerebral aneurysms was investigated in a series of 38 consecutive patients with unruptured cerebral aneurysms to determine any favorable impact on the outcome. Unexpected findings including major arterial occlusion or residual aneurysm were identified. Specific variables such as the size and site of aneurysm were analyzed to determine the impact on clinical outcome and the incidence of clip modification. There were 11 large and 27 small aneurysms in this series. Mortality and permanent morbidity after microsurgical clipping were 0.0% and 2.6%, respectively. Unexpected angiographic findings necessitating clip repositioning consisted of residual aneurysm in two cases and distal branch occlusion or parent vessel stenosis in four. The need for clip modification was significantly higher for large than for small aneurysms (p = 0.007), and the rate of clip adjustment increased with increasing aneurysm size (p = 0.008). Intraoperative assessment prior to wound closure allows for the recognition and correction of defects and decreases the risk of postoperative complications. Intraoperative angiography may become important in the microsurgical clipping of unruptured cerebral aneurysms, especially large aneurysms.

Aged↗
PubMed2001

Current and future therapies for ischemic cerebrovascular disease. II. Surgery and new treatments on the horizon.

Stroke is the third leading cause of death in the adult population. Numerous neuroprotective agents and procedures have been developed and a new wave of therapies is now on the horizon with the potential to minimize ischemic brain damage. On the other hand, surgical treatment has also played an important role in the treatment of stroke. This article highlights recent advances in stroke treatment, including surgical and neurointerventional radiological procedures, as well as potential new therapies. (c) 2001 Prous Science. All rights reserved.

Journal Article↗