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1.  A case of angiographically occult, distal small anterior inferior cerebellar artery aneurysm 
A small aneurysm at an unusual location, such as a distal anterior inferior cerebellar artery (AICA) aneurysm, may conceal as a computed tomography angiography (CTA) and digital subtraction angiography (DSA)-occult aneurysm.
Case Description:
We herein present the case of a patient suffering from a subarachnoid hemorrhage (SAH) with two aneurysms in which the AICA aneurysm was negative by CTA and DSA. CTA demonstrated a right anterior choroidal artery aneurysm, which was revealed to be an unruptured aneurysm after surgical exploration. A small distal AICA aneurysm was detected by 3D rotational angiography (3DRA). The patient fully recovered except for left-side hearing loss four months after the second operation.
We recommend a meticulous diagnosis by 3DRA in patients with SAH in which the distribution is not coincident with a typical aneurysmal location.
PMCID: PMC4462615  PMID: 26110079
Distal anterior inferior cerebellar aneurysm; diagnosis; subarachnoid hemorrhage; 3D rotational angiography; 3D computed tomography angiography
2.  Zigzag Skin Incision Effectively Camouflages the Scar and Alopecia for Moyamoya Disease: Technical Note 
Neurologia Medico-Chirurgica  2015;55(3):210-213.
Moyamoya disease is commonly diagnosed in children, and requires various vascular reconstruction to improve symptoms. Therefore, scar widening and hair loss after craniotomy, which sometimes occurs in this disease, are serious problems for patients. A variety of plastic surgical techniques in scalp have been reported to minimize the scar widening and hair loss. However, any neurosurgical reports describing this purpose have never been published for moyamoya disease. The objective of this study was to investigate whether these plastic surgical techniques could be applied to bypass surgery without any compromise of vascular reconstruction for moyamoya disease. We performed direct and indirect vascular reconstruction in six hemispheres of moyamoya disease patients not only in the middle cerebral artery territory but also in the anterior cerebral artery territory. The scalp incision was designed not parallel to the hair stream, and the bevelled incision was conducted not to jeopardize the hair follicles. The scar and hair loss were effectively camouflaged throughout the postoperative period in all cases. This study demonstrates that our design of scalp incision achieve effective vascular reconstruction and obscure the scar and hair loss.
PMCID: PMC4533337  PMID: 25739436
moyamoya disease; scar widening; hair loss; extracranial-intracranial bypass; zigzag incision
3.  Novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue for complete resection 
An outstanding issue regarding the surgical treatment of cyst-type metastatic brain tumors is the incomplete resection of cyst walls. Herein we propose a novel surgical technique that can overcome this issue. During a surgical procedure for cystic tumors, autologous fibrin glue is to be injected into the tumor cysts, which solidifies the cyst lumens and cyst walls en bloc with reducing the tumor size. As a result, tumor masses and cyst walls can be removed completely in an en bloc fashion in all cases.
The illustrative case presented in this report is a patient with metastatic brain tumors in the frontal lobe. When we reached the tumor wall surgically, we first suctioned out the cyst content and subsequently injected autologous fibrin glue into the cyst lumen. The autologous fibrin glue solidified the tumor en bloc, and we resected the tumor mass and the cyst walls in an en bloc fashion.
We have applied this technique to four cases with cyst-type metastatic brain tumors. This approach made it possible to perform ideal en bloc resection in all cases. There were no adverse events due to the autologous fibrin glue.
We developed a novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue, which allows en bloc resection of tumor masses and cyst walls quite safely using inexpensive materials. Given these advantages, it appears a promising surgical strategy for cyst-type metastatic brain tumors.
PMCID: PMC4123252  PMID: 25101195
Autologous fibrin glue; brain metastasis; cystic brain tumor
4.  Neural decoding of single vowels during covert articulation using electrocorticography 
The human brain has important abilities for manipulating phonemes, the basic building blocks of speech; these abilities represent phonological processing. Previous studies have shown change in the activation levels of broad cortical areas such as the premotor cortex, the inferior frontal gyrus, and the superior temporal gyrus during phonological processing. However, whether these areas actually convey signals to representations related to individual phonemes remains unclear. This study focused on single vowels and investigated cortical areas important for representing single vowels using electrocorticography (ECoG) during covert articulation. To identify such cortical areas, we used a neural decoding approach in which machine learning models identify vowels. A decoding model was trained on the ECoG signals from individual electrodes placed on the subjects' cortices. We then statistically evaluated whether each decoding model showed accurate identification of vowels, and we found cortical areas such as the premotor cortex and the superior temporal gyrus. These cortical areas were consistent with previous findings. On the other hand, no electrodes over Broca's area showed significant decoding accuracies. This was inconsistent with findings from a previous study showing that vowels within the phonemic sequence of words can be decoded using ECoG signals from Broca's area. Our results therefore suggest that Broca's area is involved in the processing of vowels within phonemic sequences, but not in the processing of single vowels.
PMCID: PMC3945950  PMID: 24639642
covert articulation; single vowel; neural decoding; electrocorticography (ECoG); functional mapping
5.  Which is the Most Appropriate Disconnection Surgery for Refractory Epilepsy in Childhood? 
Neurologia Medico-Chirurgica  2013;53(11):814-820.
Children with unilobar or multilobar pathology issuing in refractory epilepsy are potential candidates for surgical treatment. Extensive surgery results in good seizure control, but it also increases the risk of neurological deficits as well as motor and mental problems. We reviewed the cases of 19 children with refractory epilepsy treated surgically at Osaka University Hospital. Four of the 19 patients underwent temporal disconnection, 2 underwent occipital lobectomy, 4 underwent temporoparietooccipital disconnection, 6 underwent functional hemispherotomy, and 3 underwent corpus callosotomy. A good surgical outcome, i.e., Engel’s class I or II, was achieved in 12 (63%) of the 19 patients. Excellent surgical outcomes and satisfactory motor and mental development were achieved in 4 patients who underwent temporoparietooccipital disconnection. The outcomes of functional hemispherectomy were also satisfactory. The outcomes of temporal disconnection and corpus callosotomy were poor in comparison to outcomes of the other procedures. We believe that better surgical outcomes would have been achieved with temporoparietooccipital disconnection in some cases treated by temporal disconnection or occipital resection. Adequate extensive surgical procedures should be considered for refractory childhood epilepsy arising from unilobar or multilobar pathology.
PMCID: PMC4508717  PMID: 24140769
refractory epilepsy; childhood; disconnection surgery; unilobar; multilobar
6.  Computed Three-Dimensional Atlas of Subthalamic Nucleus and Its Adjacent Structures for Deep Brain Stimulation in Parkinson's Disease 
ISRN Neurology  2012;2012:592678.
Background. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the standard surgical treatments for advanced Parkinson's disease. However, it has been difficult to accurately localize the stimulated contact area of the electrode in the subthalamic nucleus and its adjacent structures using a two-dimensional atlas. The goal of this study is to verify the real and detailed localization of stimulated contact of the DBS electrode therapeutically inserted into the STN and its adjacent structures using a novel computed three-dimensional atlas built by a personal computer. Method. A three-dimensional atlas of the STN and its adjacent structures (3D-Subthalamus atlas) was elaborated on the basis of sagittal slices from the Schaltenbrand and Wahren stereotactic atlas on a personal computer utilizing a commercial software. The electrode inserted into the STN and its adjacent structures was superimposed on our 3D-Subthalamus atlas based on intraoperative third ventriculography in 11 cases. Findings. Accurate localization of the DBS electrode was identified using the 3D-Subthalamus atlas, and its clinical efficacy of the electrode stimulation was investigated in all 11 cases. Conclusion. This study demonstrates that the 3D-Subthalamus atlas is a useful tool for understanding the morphology of deep brain structures and for the precise anatomical position findings of the stimulated contact of a DBS electrode. The clinical analysis using the 3D atlas supports the contention that the stimulation of structures adjacent to the STN, particularly the zona incerta or the field of Forel H, is as effective as the stimulation of the STN itself for the treatment of advanced Parkinson's disease.
PMCID: PMC3265216  PMID: 22389840
7.  Microsurgical Maneuvers under Side-Viewing Endoscope in the Treatment of Skull Base Lesions 
Skull Base  2011;21(2):115-122.
The objective of the present study is to elucidate the feasibility of surgical maneuvers under the side-viewing endoscope during skull base tumor removal. The study focused on 51 patients who underwent tumor removal with the assistance of a side-viewing endoscope. The side-viewing endoscope enabled visualization and removal of residual tumors obscured by the skull base bone, cranial nerves, and other vital structures after a microscopic procedure. If the surgical field is surrounded by the dura or skull base tissue, not only curettage of a tumor but also semisharp dissection and bipolar coagulation are shown to be feasible. In the subarachnoid space, however, the primary feasible surgical maneuver was suctioning of the tumor. The extent of skull base resection could be reduced in 25 cases and additional tumor removal became possible in 47 cases. Application of the side-viewing endoscope enabled removal of the tumor compartment, the exposure of which has conventionally required an extensive skull base resection. This technique is a promising option for the treatment of skull base tumors.
PMCID: PMC3312587  PMID: 22451812
Side-viewing endoscope; skull base tumor; microsurgical maneuver; malleable instrument
8.  Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases 
Advances in Orthopedics  2011;2011:516382.
We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.
PMCID: PMC3170783  PMID: 21991415

Results 1-8 (8)