Prof. Kenichiro KIKUTAJapan
Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui
2021/4/1 to present | Vice president of University of Fukui Hospital, Assistant to the president, Fukui University |
2009/4 to present | Professor and Chairman, Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui |
2008/4/1 - 2009/3/31 | Associate Professor, Department of Neurosurgery, Kyoto University Graduate School of Medicine |
2000/10 - 2008/3/31 | Assistant Professor, Department of Neurosurgery, Kyoto University Graduate School of Medicine |
1998/4/1 - 2000/9/30 | Staff surgeon, Kurashiki Central Hospital |
1992/6/1 - 1994/9/30 | Resident, Japanese Red Cross Otsu Hospita |
1991/6/1 - 1992/1/15 | Resident, Kyoto University Hospital |
AVM. moyamoya disease, aneurysm, keyhole surgery, bypass, vestibular schwannoma, skull base meningioma, microvascular decompression
Indication and techniques in keyhole clipping for anterior circulation aneurysms
1109 08:00-08:10
Cerebrovascular/304A
Purpose: To investigate the most significant factors for the preservation of the global neurocognitive status and frontal executive functions in the surgical clipping of unruptured anterior circulation aneurysms, specifically in keyhole and conventional clipping procedures. Methods: The prospective study that started on April 2016. After exclusion posterior circulation aneurysms, anterior communicating aneurysms treated by interhemispheric approach, giant aneurysms, and paraclinoid aneurysms, 23 patients who were enrolled before May 2017 were treated by conventional clipping, and 18 patients who were enrolled after June 2017 were treated by keyhole clipping. Two patients were excluded from each group due to missing data. Finally, 21 and 16 patients in each group were analyzed, respectively. Three-tesla magnetic resonance imaging was performed before and after surgery to detect the presence of perioperative cerebral infarctions and brain edema. The Mini-Mental State Examination, Frontal Assessment Battery, and Self-Rating Depression Scale scores were obtained before and 1 month after surgery. Results: Logistic regression analyses indicated that anterior communicating and internal carotid artery aneurysms were the most significant factors for poor outcomes and that keyhole clipping for these two types of aneurysms were the most significant factor for the preservation of patient global neurocognitive status. Keyhole clipping was also the most significant factor for the preservation of frontal executive functions in patients. Conclusions: Keyhole clipping may be more favorable than conventional clipping for the preservation of the global neurocognitive status and frontal executive functions. Moreover, it may be the most effective factor for preservation of global neurocognitive status when it is indicated for anterior communicating or internal carotid artery aneurysms.
Surgical set-up and effect of bypass surgery for moyamoya disease using exoscope
1109 08:20-08:30
Cerebrovascular/304A
Abstract
Introduction: This study aimed to examine the result of initial experience of superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD) with 4K3D exoscope "Orbeye" comparing to that with microscope.
Materials and methods: Of 179 consecutive bypass surgeries in 89 MMD patients at the University of Fukui Hospital between 2009 and 2023, 133 anastomoses in 66 patients were enrolled in this retrospective cohort clinical trial. 89 anastomose in 49 patients underwent with microscope (MS) (M:F=17:32, mean age 34.2+19.7 years) and 34 anastomoses in 17 patients underwent with 4K3D exoscope "Oebeye" (M:F=6:11, mean age 44.4+17.0 years) (OE. Olympus Corporation. Tokyo, Japan). Anastomostic time, occurrence of troubles during surgery, patency rate, and occurrence of perioperative complications were compared between the two groups by using chi square test and Mann Whitney-U test.
Results: There was no significant difference in clinical character of the patient except for the age.
As for the clump time of the recipient artery, the clump time per one suture was significantly shorter in MS group than that of OE group (MS:OE=4.1+0.2 minutes :4.6+0.5 minutes, p=0.012) but the number of sutures in MS group was significantly larger than that of OE group (MS:OE=9.9+0.2 sutures:9.1+0.3 sutures, p=0.017). Accordingly, there was no significant difference in the total clump time between the two groups (MS:OE=40+2.2 minutes:41+3.6 minutes, p=0.2994) .The frequency of re-anastomosis was significantly more common in OE group than in MS group (MS:OE=3.4%:17.7%, p=0.5407) but There was no significant difference in the final patency rate by indocyanine green video-angiography (MS:OE=92%:88%, p=0.4979). As for the perioperative complication, there was no significant difference in the occurrence of postoperative symptomatic stroke (MS:OE=10.4%:5.6%, p=1.0000), of hyperperfucion syndrome (MS:OE=10.4%:5.6%, p=1.0000), and of would infection (MS:OE=8.3%:11.1%, p=0.6608).
Conclusion: In spite of taking some mote time in suturing and higher rate of re-anastomosis, initial results of STA-MCA anastomosis for MMD with "Orbeye" seemed feasible.