Browsing by Autor "Hajime Touho"

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Appearance of Ischemic Symptoms of the Left Parietal Lobe following Compression of the Right STA after Left STA-MCA Anastomosis in a Moyamoya Disease Patient
(The Japanese Congress of Neurological Surgeons, 2002) Hajime Touho
The author describes a case of a 13 -year -01d female moyamoya disease patient who had undergone a left super cial temporal artery ( STA) -middle cerebral artery ( MCA )anastomosis and an encephalo -myo --synangio - sis ( EMS ) The patient experienced repetitive transient ischemic attacks associated with motor weakness and sensory disturbance of the left upper extremity and dysarthria Preoperative angiograms of the right common carotid aery showed that a part of the left parietal lobe was angiographically filled via the parietal branch of the right STA Preoperatively it was compressed manually whether ischemia in the left parietal lobe was apparent or not Acalculia finger agnosia and right -1eft disorientation appeared 5 minutes later with the beginning of the com - pression The patient underwent encephalo -arterio -synangiosis using a onta branch of the right STA and EMS The postoperative course was unevent 1 The patient was discharged 15 days after the second operation
Intradural/subarachnoid Osteoma presented with Sudden-onset Headache followed by Intermittent Headache : A Case Report
(The Japanese Congress of Neurological Surgeons, 2011) Hajime Touho; Daiji Ogawa; Toshihiko Kuroiwa
硬膜および頭蓋骨内板と付着をもたないクモ膜下骨腫はまれであり,現在までに6例の症例報告のみである.ほとんどの主訴が頭痛であった.今回,突然の頭痛で発症しその後間欠的頭痛を呈したクモ膜下骨腫を経験したので,文献的考察も含めて報告する.
Measurement of Cerebral Vessel Flow Velocity during Direct Anastomosis for the Treatment of Moyamoya Disease with Severe Brain Atrophy : A Case Report
(The Japanese Congress of Neurological Surgeons, 2003) Hajime Touho; Tsutomu Iseda
目的:脳萎縮を伴う小児モヤモヤ病では,脳酸素消費量が著明に低下しており,直接吻合術を施行する際,脳表動静脈の区別が困難な場合がある.今回,術中ドップラー流速測定が有用であった症例を経験したので報告する.症例:1歳9ヵ月のモヤモヤ病男児で,急速に脳萎縮が進行し,経過中,同側の硬膜下血腫を合併した症例に,suoerficial temporal artery-middle cerebral artery anastomosis を施行した.術野の脳表動静脈はいずれも外観上は赤く識別が困難であったため,術中ドップラーを使用した.静脈と考えられる血管では流速が測定できず記録できなかったが,動脈枝と考えられた血管では動脈波が確認できたため,これに浅側頭動脈を直接吻合した.結論:著明な脳萎縮を伴う小児モヤモヤ病に対する直接吻合術中,脳表の動静脈の識別が困難な際は,ドップラーを用いた術中流速測定が有用である可能性が示唆された.
Preparating Scalp Arteries for Childhood Moyamoya Disease Surgery using Subcutaneous Injections of Physiological Saline(SURGICAL TECHNIQUES and PERIOPERATIVE MANAGEMENT)
(The Japanese Congress of Neurological Surgeons, 2008) Hajime Touho; Nobuko Yanagawa; Toshihiko Kuroiwa
小児もやもや病手術時,頭皮動脈剥離部の皮膚壊死を防止する目的で2007年1月7日〜同年10月20日までの16歳以下のもやもや病手術患者22名を対象とした.22名患者に計29回の手術を施行した.皮膚が比較的厚い7歳女児の1例を除いて21例28目で,手術中,翻転した皮弁内側から頭皮動脈の両側へ約10 mlの生理的食塩水を注入し,頭皮動脈を真皮から浮き上がらせた後剥離した.その後,バイパス術は型どおり施行した.21例28回の手術全例で,手術後頭皮動脈剥離部皮膚壊死は生じなかった.本法を施行しなかった1例で剥離部に直径3mmの皮膚壊死を生じた.本法は無害で臨床上有用な方法と考えられた.
Preservation of Middle Meningeal Arteries during Epidural Hemostatic Procedure in Surgical Treatment of Moyamoya Disease : Technical Note(SURGICAL TECHNIQUE AND PERIOPERATIVE MANAGEMENT)
(The Japanese Congress of Neurological Surgeons, 2002) Hajime Touho
もやもや病で中大脳動脈領域の虚血に対する外科的手術に際して,脳への側副路を形成している,あるいは将来側副路を形成する可能性のある中硬膜動脈を温存する基本的手技について検討を加えた.硬膜表面の出血は,主に骨弁を通して中硬膜動脈およびその分枝へ流入する側副路の断端からの出血であり,特に中硬膜動脈本幹およびその分枝からの出血は,その断端はほとんど中硬膜動脈側へ残っていたため,顕微鏡下にこれを吸引管で吸引して,その断端のみを電気凝固することで止血できた.以上の顕微鏡下の止血操作で,中硬膜動脈からの側副路を温存することが可能であった.
Surgical Planning for Direct Anastomosis on a Childhood Moyamoya Disease Patient with No Visualization of a Proximal Portion of the STA: A Case Report
(Japanese Society on Surgery for Cerebral Stroke, 2014) Hajime Touho
Surgical revascularization including direct/indirect anastomosis is needed in childhood moyamoya disease. In the present study, I report a moyamoya disease patient on which direct anastomosis could be performed in spite of no visualization of a proximal portion of a superficial temporal artery (STA). An 11-year-old boy was admitted to our clinic on June 27, 2012, for repetitive headache and transient ischemic attacks (TIAs) associated with dysarthria, sensory disturbance and monoparesis of his right arm, and monoparesis of his left leg. He had had repetitive TIAs associated with right hemiparesis and a surgical procedure on the right brain at another hospital because the proximal portion of left STA was not visualized on preoperatively performed cerebral angiography. The scalp artery was separated from the distal portion of the left STA to a branch of the ipsilateral occipital artery, and the end of the distal STA could be directly anastomosed to a branch of the middle cerebral artery. Direct anastomosis may be successfully performed by precise inspection of obtained cerebral angiograms and careful preparement of the donor artery even in a situation without visualization of a proximal portion of the STA.
Surgical Technique for Direct Anastomosis to a Fine Recipient Artery with a Diameter of 0.3 mm or Less in Moyamoya Disease
(Japanese Society on Surgery for Cerebral Stroke, 2016) Hajime Touho; Taichiro Toho
In our institution, 346 operations on 175 moyamoya disease patients aged less than 16 years, and 188 operations on 121 moyamoya disease patients aged 16 years and over have been performed between March 1, 2001 and December 31, 2013. Direct anastomosis was used in 173 operations in the former group and 122 operations in the latter. Five procedures, all in the former group, which had a recipient artery of diameter 0.3 mm or less, were performed with direct anastomosis. Under such conditions, direct anastomosis is possible, and we discuss its strategy here.Fishmouth opening of a fine recipient should be performed by a single incision technique and should be as small as possible.The tip of the microneedle should be moved to the inner surface of the arterial wall at the time when the surface of the brain is situated at the highest level, and it should pass the arterial wall when the surface of the brain moves downward. Finally, definite fixation and fine movement of a microneedle is mandatory for its passing of a recipient's arterial wall.