Taisuke Otsuki

Retrograde Adriamycin Sensory Ganglionectomy: Novel Approach for the Treatment of Intractable Pain

Selective sensory ganglionectomy by means of retrograde suicide transport of adriamycin was performed on 3 patients with neuropathic pain in the areas of the trigeminal and intercostal nerves, producing significant pain relief, particularly from hyperalgesic pain. Adriamycin ganglionectomy is considered as a less invasive and highly selective pain treatment, which may possibly become an alternative for surgical ganglionectomy or rhizotomy.

CT-Guided Stereotactic Aspiration of Intracerebral Hematoma – Result of a Hematoma-Lysis Method Using Urokinase

CT-guided stereotactic aspiration was performed in the CT room on 97 patients with hypertensive intracerebral hematomas, using a standard ventricular cannula. Residual hematomas were liquefied by urokinase and aspirated through the drainage tube. Major and minor rebleeding were seen in 7 cases. Two out of the 4 major rebleeding cases were followed by craniotomy, while the other cases were treated conservatively. More than 80% of the hematomas were aspirated in 68 cases, 50-70% in 19 cases and 30-40% in 6 cases. Operation in the CT room and hematoma lysis with urokinase is very useful for the aspiration of intracerebral hematomas.

Evaluation of the analgesic effects of capsaicin using a new rat model for tonic pain.

An animal model for tonic pain has been produced by means of injecting monosodium urate crystals into a knee joint of rat hind paws in order to evaluate the analgesic effects of various drugs and analgesic methods and to elucidate the physiology of tonic pain. This model allows for stable and long-term behavioural changes due to tonic pain followed by complete recovery without tissue damages. It is advantageous in allowing for objective and quantitative evaluation of the effects of analgesics and should prove useful in research on pain and the development of pain therapy techniques. Using this model, the analgesic effects of capsaicin was evaluated when administered to the neonatal rat or locally to peripheral nerves. In both cases, significant analgesic effects were obtained.

Spontaneous intracerebral hemorrhage and liver dysfunction.

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated gamma-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage.

Cavernoma-related epilepsy: Review and recommendations for management - Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies

Cerebral cavernous malformations (CCMs) are well‐defined, mostly singular lesions present in 0.4–0.9% of the population. Epileptic seizures are the most frequent symptom in patients with CCMs and have a great impact on social function and quality of life. However, patients with CCM‐related epilepsy (CRE) who undergo surgical resection achieve postoperative seizure freedom in only about 75% of cases. This is frequently because insufficient efforts are made to adequately define and resect the epileptogenic zone. The Surgical Task Force of the Commission on Therapeutics of the International League Against Epilepsy (ILAE) and invited experts reviewed the pertinent literature on CRE. Definitions of definitive and probable CRE are suggested, and recommendations regarding the diagnostic evaluation and etiology‐specific management of patients with CRE are made. Prospective trials are needed to determine when and how surgery should be done and to define the relations of the hemosiderin rim to the epileptogenic zone.

Altered Distribution of KCC2 in Cortical Dysplasia in Patients with Intractable Epilepsy

Summary:  Purpose: To examine the distribution of KCC2, a neuron‐specific K+–Cl− cotransporter, in human cortical dysplasia (CD).

Stereotactic guiding tube for open-system endoscopy: a new approach for the stereotactic endoscopic resection of intra-axial brain tumors.

Stereotactic endoscopic resection of intra-axial brain tumors using a newly developed endoscopic system consisting of a stereotactic guiding tube and a fine endoscope is reported. The stereotactically inserted guiding tube acts in the place of brain retractors to expose deep-seated pathological lesions, which are then visualized by means of a fine endoscope. The lesions may then be treated by various microsurgical techniques such as laser vaporization. Fifteen intra-axial lesions were operated on by this method using a guiding tube of 8 mm in outer diameter without significant complications. Seven small lesions measuring 3 to 26 mm in maximal diameter were resected totally. Eight large lesions, including two highly vascularized tumors, were examined by biopsy and resected partially through a burr hole with complete hemostasis under direct vision. This system is particularly useful for removing small intra-axial tumors in deep or eloquent areas difficult to resect using ordinary surgical techniques. It will also be applicable for other stereotactic operations that require accuracy and minimum invasiveness with complete hemostasis under direct visualization.

Complex behavioral automatism arising from insular cortex

We describe two cases of complex partial seizures with ictal violent movements arising from the insular cortex. The first patient, a 14-year-old girl, presented with hyperkinetic behavior such as rolling, thrashing, and pedaling, and the second case, a 38-year-old woman, had been suffering from frequent daytime hyperkinetic seizures characterized by bizarre vocalization, jumping, and violent bimanual movements. Both patients showed a slight high signal change in the right posterior ventral insular cortex in fluid-attenuated inversion recovery (FLAIR) studies involving magnetic resonance imaging, and extensive subdural electroencephalographic monitoring revealed EEG seizure onset from the temporal lobe. The posterior ventral insular and lateral temporal cortices were resected, resulting in complete seizure freedom in both cases. The histological diagnoses were focal cortical dysplasia in the first case and gliosis in the second case. There may exist a group of patients with complex partial seizures with ictal violent automatism that can be ameliorated by the resection of epileptogenic lesions in the insular cortex. Careful inspection of the insular cortex is necessary to diagnose this type of epileptic seizure.

Deep Brain Stimulation for Tourette Syndrome: A Prospective Pilot Study in Japan

Objective:  Refractory Tourette syndrome (TS) disturbs the social life of patients. Deep brain stimulation (DBS) has recently been applied to relieve severe tics. We report a prospective open‐labeled case series of DBS for TS as a pilot study.

Clinical planning support system-CliPSS

Clinical planning support system (CliPSS), which is software developed to support neurosurgical planning and to enable a surgeon to generate 3-D computed images interactively and simulate sterotactic surgery on them, is discussed. The basic functions of CliPSS, involving section display, editing, extraction, and rendering, are reviewed. A method of thinning the volume of polygonal data for a surface-rendered image, which improves CliPPSs performance and interactivity, is presented.<<ETX>>