Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 50, Issue 7
Displaying 1-21 of 21 articles from this issue
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Original Articles
  • Cilostazol May Suppress Restenosis and New Contralateral Carotid Artery Stenosis After Carotid Endarterectomy
    Tetsuyuki YOSHIMOTO, Shin FUJIMOTO, Mutsuko MURAKI, Rina KOBAYASHI, Ta ...
    Article type: Original Article
    2010 Volume 50 Issue 7 Pages 525-529
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.525
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    Carotid artery restenosis is a serious complication following carotid endarterectomy (CEA), so preventative management of the risk factors is important. The present study investigated the potential of cilostazol, a mediator of vascular stabilization as well as inhibitor of platelet aggregation, to suppress restenosis on the ipsilateral carotid artery and new plaque development on the contralateral carotid artery. Eighty-two patients treated by CEA were divided into two groups according to the postoperative antiplatelet aggregation drugs into the cilostazol and other groups. Patients were periodically examined for recurrence of the plaque on the ipsilateral side, development of plaque on the contralateral side, and the bilateral intermedia thicknesses measured by ultrasonographic examination for up to 6 years. Restenosis and development of the contralateral plaque were not detected in any patients in the cilostazol group, whereas such changes were found in seven patients in the other group. Cilostazol might be effective to inhibit the growth mechanism of plaque.
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  • Problems With Diagnosis by Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Patients With Acute Aneurysmal Subarachnoid Hemorrhage
    Masami SHIMODA, Kaori HOSHIKAWA, Hideki SHIRAMIZU, Shinri ODA, Mitsuno ...
    Article type: Original Article
    2010 Volume 50 Issue 7 Pages 530-537
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.530
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    The diagnostic efficacy of fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging and computed tomography (CT) for acute subarachnoid hemorrhage (SAH) were compared and the problems with diagnosis were investigated in 81 patients with aneurysmal SAH within 24 hours after onset who underwent FLAIR imaging and CT on admission. The number of hematomas in the cisterns and ventricles were evaluated by clot scores. In addition, the frequency of undetected hematomas was calculated for the cisterns and ventricles. Clot scores were significantly higher for FLAIR imaging than for CT in the lateral sylvian, quadrigeminal, and convexity cisterns. On the other hand, clot scores were significantly higher for CT than for FLAIR imaging in the interhemispheric and medial sylvian cisterns. The overall frequency of undetected SAH was 2% for FLAIR imaging and 14% for CT. With the exception of the interhemispheric and medial sylvian cisterns, the frequency of undetected SAH was higher for CT than for FLAIR imaging. In this study, FLAIR imaging was more sensitive than CT for the detection of acute SAH within 24 hours after onset. However, the diagnostic efficacy of FLAIR imaging was reduced in comparatively tight cisterns.
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  • Effects and Complications of Stereotactic Aspiration for Spontaneous Intracerebral Hemorrhage
    Daisuke UMEBAYASHI, Ayako MANDAI, Yasuhiko OSAKA, Yoshikazu NAKAHARA, ...
    Article type: Original Article
    2010 Volume 50 Issue 7 Pages 538-544
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.538
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    Stereotactic aspiration of intracerebral hemorrhage (ICH) improves the general condition of patients, promotes improvement of consciousness, and decreases the incidence of pneumonia, but may induce rebleeding. The present study investigated the effects of stereotactic aspiration and factors that inhibit rebleeding in 70 consecutive patients who underwent stereotactic aspiration for ICH. Consciousness was significantly improved after surgery. Of patients who underwent surgery on day 0 or 1, 5 patients developed pneumonia and 29 patients did not. Of patients who underwent surgery on day 2 or later, 14 patients developed pneumonia and 22 patients did not. Early surgery within 2 days significantly reduced the rate of aspiration pneumonia. Patients with rebleeding tended to have liver dysfunction and hemorrhagic tendency. Early stereotactic aspiration of ICH facilitates better patient management than conservative treatment in patients with moderate consciousness disturbance. Patients with liver dysfunction and hemorrhagic tendency should be identified.
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  • Bystander Killing Effect of Tymidine Kinase Gene-Transduced Adult Bone Marrow Stromal Cells With Ganciclovir on Malignant Glioma Cells
    Kentaro MORI, Junko IWATA, Masahiro MIYAZAKI, Hideo OSADA, Yuichi TANG ...
    Article type: Original Article
    2010 Volume 50 Issue 7 Pages 545-553
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.545
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    Transduction of the suicide gene of Herpes simplex virus thymidine kinase (Hsv-tk) into glioma cells or neural stem cells combined with pro-drug ganciclovir (GCV) treatment has been effective to treat experimental glioma in the rat through the bystander effect. Bone marrow stromal cells (MSCs) in the adult bone marrow have tropism for brain tumors and act as tumor stromal cells. Whether adult MSCs expressing Hsv-tk can also act as effector cells of the bystander killing effect on murine glioma cells was investigated. In vitro study of co-culture between 9L/LacZ (9L) glioma cells and Hsv-tk-transduced MSCs (MSCs/tk(+)) followed by GCV administration in the culture medium resulted in apparent nuclear morphological changes in the 9L glioma cells surrounding the MSCs/tk(+). 9L glioma cell survival in the presence of MSCs/tk(+) and GCV treatment was quantitatively measured and showed significant decrease of 9L glioma cell proliferation with higher MSCs/tk(+) ratio and GCV concentration. Intracerebral co-inoculation experiments in Fisher rats used 9L glioma cells and either MSCs/tk(+) or Hsv-tk-non-transduced MSCs (MSCs/tk(−)) followed by intraperitoneal injection of GCV (100 mg/kg, daily for 7 days). The animals co-inoculated with 9L glioma cells and MSCs/tk(+) showed significant retardation of tumor growth and prolongation of survival time compared with the animals with 9L glioma cells and MSCs/tk(−). Quantitative findings were established of the novel effects of adult MSCs/tk(+) as effector cells of the bystander killing effect on glioma cells.
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  • Neuropsychological Improvement in Patients With Cervical Spondylotic Myelopathy After Posterior Decompression Surgery
    Minoru HOSHIMARU
    Article type: Original Article
    2010 Volume 50 Issue 7 Pages 554-559
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.554
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    Patients with cervical spondylotic myelopathy sometimes complain of cognitive dysfunction, which may be coincidence. However, cognitive dysfunction may be related to disorders of the cervical spine and/or spinal cord. This study investigated cognitive dysfunction in patients with cervical spinal disorders. A total of 79 patients with cervical spondylotic myelopathy (40 women and 39 men, mean age 61.2 years) underwent cervical laminoplasty between January 2006 and July 2007. Ten of these 79 patients (7 women and 3 men, mean age 65.2 years) complained of moderate to severe memory disturbances. These 10 patients underwent neuroimaging studies and a battery of neuropsychological tests consisting of the mini-mental state examination, Kohs Block Design Test, Miyake Memory Test, Benton Visual Retention Test (BVRT), and “kana-hiroi” test before and 3 months after surgery. Brain magnetic resonance imaging showed no organic brain lesions in the 10 patients, but single photon emission computed tomography demonstrated reduced regional cerebral blood flow in the posterior cortical areas in eight patients before surgery. Neuropsychological test scores showed statistically significant improvement after surgery in the Kohs Block Design Test and the BVRT, which measure visuospatial perception and reflect the function of the parietal and/or occipital lobes (p < 0.05). The practice effect may have contributed to the neuropsychological improvements, but this study suggests that cervical spinal disorders may affect cognitive functions and that surgical treatment can ameliorate such effects.
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  • Comparative Analysis of Spinal Hemangioblastomas in Sporadic Disease and Von Hippel-Lindau Syndrome
    Keisuke TAKAI, Makoto TANIGUCHI, Hiroshi TAKAHASHI, Masaaki USUI, Nobu ...
    Article type: Original Article
    2010 Volume 50 Issue 7 Pages 560-567
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.560
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    The clinical differences were evaluated in spinal hemangioblastoma between patients with sporadic disease and patients with von Hippel-Lindau (VHL) syndrome. The distribution of hemangioblastomas in the central nervous system was investigated in 56 patients treated between 1988 and 2008 at the University of Tokyo Hospital. The characteristics of spinal hemangioblastomas were compared in 35 patients including 17 with sporadic disease and 18 with VHL syndrome treated between 1988 and 2008 at our hospital and three affiliated institutions. Spinal hemangioblastomas were much more prevalent in patients with VHL syndrome (88.2%) than in patients with sporadic disease (20.5%, p < 0.001). Spinal hemangioblastomas associated with VHL syndrome were diagnosed a decade earlier (p = 0.007) and were associated with less severe neurological symptoms than sporadic lesions (p = 0.004). Most patients with sporadic disease had a single lesion at the cervical or thoracic level, whereas patients with VHL syndrome had multiple lesions at all spinal levels (p = 0.04). Patients with sporadic disease exhibited significant improvement in postoperative neurological status (p = 0.02), whereas patients with VHL syndrome had no change in status (p = 1.00). Number of removed lesions (p = 0.03) and lower spinal cord lesions (p = 0.05) were associated with poor surgical outcome. Tumor recurrence was correlated with partial removal of lesions (p = 0.05). One third of patients with VHL syndrome developed new lesions every 2 years. The major finding of this study is that the incidence of spinal hemangioblastoma, distributed through all spinal levels, may be as high as 88% in patients with VHL syndrome, which is much greater than previously reported.
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Case Reports
  • Fusiform Aneurysm Associated With Fenestration of the Posterior Communicating Artery
    —Case Report—
    Shiro BABA, Yuutaka FUKUDA, Shingo MIZOTA, Kentaro HAYASHI, Kazuhiko S ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 568-570
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.568
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    A 62-year-old male presented with a rare case of fenestration of the supraclinoid segment of the internal carotid artery (ICA) at the origin of the posterior communicating artery (PCoA). The patient had a fusiform aneurysm at the proximal branch of the PCoA, which was successfully clipped, sparing the anterograde blood flow. The double origin and fenestration of the PCoA branching off at the C2 segment of the left ICA suggested that this anomalous fenestration might have developed as the origin of the PCoA rather than the supraclinoid ICA during the early embryonal stage.
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  • Compression of the Medulla Oblongata and Acute Respiratory Failure Caused by Rupture of a Thrombosed Large Aneurysm of the Anterior Inferior Cerebellar Artery
    —Case Report—
    Hirofumi OYAMA, Akira KITO, Hideki MAKI, Kenichi HATTORI, Kuniaki TANA ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 571-573
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.571
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    A 65-year-old female presented with an extremely rare case of a ruptured thrombosed large aneurysm of the anterior inferior cerebellar artery (AICA) in which a local hematoma compressed the medulla oblongata and caused acute respiratory failure. She first presented with dizziness, general fatigue, and nausea 2 months before admission. She was hospitalized for intense general fatigue, nausea, and occipitalgia. Computed tomography and T1-weighted magnetic resonance imaging showed a heterogeneous lesion around the right cerebello-medullary cistern. Angiography revealed a fusiform aneurysm of the right AICA. Asphyxia occurred 4 days after admission and the patient underwent an emergency operation. No subarachnoid hematoma was present, but a hematoma around the ruptured portion markedly compressed the medulla oblongata. The medulla oblongata was adequately decompressed after subtotal removal of the aneurysm. The patient's respiratory status and consciousness level recovered after the operation.
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  • Simultaneous Occurrence of Subarachnoid Hemorrhage and Cerebral Infarction Caused by Anterior Cerebral Artery Dissection Treated by Endovascular Trapping
    —Case Report—
    Tomoo INOUE, Miki FUJIMURA, Yasushi MATSUMOTO, Ryushi KONDO, Takashi I ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 574-577
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.574
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    A 48-year-old man presented with a rare dissection of the anterior cerebral artery (ACA) causing simultaneous subarachnoid hemorrhage (SAH) and cerebral infarction manifesting as sudden onset of headache and left hemiparesis. Computed tomography and magnetic resonance imaging showed SAH localized in the interhemispheric fissure and cerebral infarction in the territory of the right ACA. Digital subtraction angiography (DSA) demonstrated segmental narrowing and dilatation at the right A1 and A2 portions of the ACA, leading to a diagnosis of ACA dissection. Fourteen days after the onset, DSA confirmed the enlarged fusiform dilatation of the right A2 portion with distal narrowing, suggesting the risk of rerupture of the dissection. Endovascular obliteration of the aneurysm with parent artery occlusion was performed without anastomosis on day 16. The aneurysm was catheterized and obliterated with detachable coils. Postoperative DSA revealed complete obliteration of the dissection and parent artery. The patient was doing well without recurrence of the dissection 8 months after the intervention. The simultaneous occurrence of SAH and cerebral infarction in patients with ACA dissection is extremely rare, and the optimal treatment has not yet been established. Endovascular treatment is safe and effective for the treatment of ACA dissection.
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  • Ruptured Pseudoaneurysm of the Petrous Internal Carotid Artery Caused by Chronic Otitis Media
    —Case Report—
    Hirofumi OYAMA, Kenichi HATTORI, Shigeaki TANAHASHI, Akira KITO, Hidek ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 578-580
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.578
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    A 60-year-old man presented with a rare case of pseudoaneurysm in the petrous internal carotid artery (ICA) caused by chronic otitis media manifesting as right otorrhagia after the earpick procedure. Computed tomography showed the destroyed petrous bone; the ICA and the aneurysm, which were exposed to the right middle ear; and a massive hematoma in the right middle ear. Right carotid angiography revealed a pseudoaneurysm arising from the ICA coursing through the middle ear. Two weeks later, the right ICA was trapped after external carotid artery-middle cerebral artery bypass surgery using a vein graft. A biopsy specimen was obtained from the middle ear and the histological diagnosis was inflammatory disease. Pseudoaneurysm often causes sudden massive aural bleeding. The appropriate management strategy may be exclusion of the pseudoaneurysm with revascularization to avoid leaving foreign material in the infected middle ear.
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  • Unusual Delayed Hydrocephalus After Bare Platinum Coil Embolization of an Unruptured Aneurysm
    —Case Report—
    Kouichi MISAKI, Naoyuki UCHIYAMA, Masanao MOHRI, Yuichi HIROTA, Yutaka ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 581-585
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.581
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    A 69-year-old woman developed hydrocephalus after the embolization of an incidentally detected unruptured large internal carotid artery aneurysm with bare platinum coils. Endovascular embolization resulted in near-total aneurysm occlusion. She complained of mild headache 18 hours after the procedure and magnetic resonance (MR) imaging performed on the 6th post-treatment day revealed wall enhancement and perianeurysmal brain edema. Follow-up MR imaging showed recanalization of the aneurysm and gradual ventricular enlargement. She presented with typical symptoms of hydrocephalus including disorientation, gait disturbance, and urine incontinence at 7 months post-embolization. We removed 30 ml of cerebrospinal fluid by lumbar tap, which improved her condition without symptom recurrence for 2 months. She did not require shunt placement. Post-interventional hydrocephalus is known in patients with unruptured aneurysms embolized with bioactive second-generation coils. This case shows that hydrocephalus can occur after aneurysm embolization with bare platinum coils without intracranial hemorrhage.
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  • Meningioma Manifesting as Cerebral Infarction
    —Case Report—
    Jun MASUOKA, Fumitaka YOSHIOKA, Hidehiko OHGUSHI, Masatou KAWASHIMA, T ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 585-587
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.585
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    A previously healthy 31-year-old man presented with an extremely rare case of small meningioma associated with cerebral infarction preceded by recurrent transient ischemic attacks manifesting as a 3-day history of recurrent and transient weakness of the left lower limb lasting several minutes for each episode. The symptoms became persistent and complete on the following day. Magnetic resonance imaging revealed acute cerebral infarction in the right frontal lobe and a 20 mm diameter tumor in the planum sphenoidale encasing the right anterior cerebral artery. Cerebral angiography demonstrated occlusion of the right A2 portion. The patient underwent surgery and the tumor was gross totally removed. The histological diagnosis was meningothelial meningioma. Cases of meningioma causing cerebral infarction are very rare, but the possibility should be considered even if the tumor is small.
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  • Germinoma With Syncytiotrophoblastic Giant Cells Arising in the Corpus Callosum
    —Case Report—
    Hajime YONEZAWA, Yoshinari SHINSATO, Soichi OBARA, Tatsuki OYOSHI, Hir ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 588-591
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.588
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    A previously healthy 31-year-old Japanese man presented with a very rare germinoma of the corpus callosum without other intracranial lesions manifesting as transitory speech disturbance. Magnetic resonance (MR) imaging revealed a heterogeneously enhanced mass in the corpus callosum extending into the cavity of the septum pellucidum. A tumor specimen obtained by stereotactic biopsy revealed a two-cell pattern germinoma containing human chorionic gonadotropin (HCG)-β-positive giant cells. The cerebrospinal fluid and serum levels of HCG and HCG-β subunit were measurable. The diagnosis was germinoma with syncytiotrophoblastic giant cells. Three cycles of chemotherapy consisting of ifosfamide, cisplatin, and etoposide, followed by radiation therapy achieved complete remission, and 5 cycles of chemotherapy with carboplatin and etoposide were added. MR imaging performed 40 months after the diagnosis showed a cicatricial cyst in the body of the corpus callosum, the original tumor site. All 11 previously reported cases of germinoma in the corpus callosum were associated with synchronous or metachronous intracranial lesions. These patients tended to be older than patients with general intracranial germinoma. Germinoma should be included in the differential diagnosis of corpus callosum tumors, especially in young adult males.
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  • Primary Intramedullary Spinal Cord Germinoma
    —Case Report—
    Yusuke KINOSHITA, Keiichi AKATSUKA, Minoru OHTAKE, Hideki KAMITANI, Ta ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 592-594
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.592
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    A 21-year-old woman presented with an intramedullary spinal cord germinoma and a history of gait disturbance and elimination disorder. Magnetic resonance (MR) imaging demonstrated two isolated lesions, one located within the medulla between T9 and T11, and another at the cauda equina (L2 to L3 levels). After partial reduction of the intramedullary mass, histological findings revealed that the tumor was typical germinoma. Further MR imaging revealed no evidence of intracranial germinoma. Combined chemotherapy (carboplatin and etoposide) and whole spine radiation were performed. Follow-up MR imaging showed that the enhanced mass at the L2-L3 levels had disappeared. No recurrence of the tumor has been detected 3 years after the operation, and no dissemination into the cranial area was detected. Cisplatin and etoposide chemotherapy combined with radiotherapy is recommended for primary spinal germinoma, and is effective for inhibition of both tumor dissemination and recurrence.
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  • Primary Diffuse Large B-Cell Lymphomas of the Temporoparietal Dura Mater and Scalp Without Intervening Skull Bone Invasion
    —Case Report—
    Hidenobu OCHIAI, Hirokazu KAWANO, Ryo MIYAOKA, Noriaki KAWANO, Yoshiya ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 595-598
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.595
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    A 72-year-old man presented with an extremely rare case of primary diffuse large B-cell lymphomas (DLBCLs) of the dura and scalp existing independently without intervening cranial vault invasion. The patient presented with an indolent mass lesion at the left temporal parietal scalp. Magnetic resonance imaging and computed tomography revealed a solid homogeneously enhanced mass in the left temporoparietal scalp, and an extra-axial intracranial mass that existed just below the scalp without intervening skull invasion. The patient underwent gross total resection of these lesions via a left frontotemporoparietal craniotomy. Histological examination of the masses revealed DLBCLs. The patient received whole-brain radiation therapy, and subsequent chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone. He was discharged without neurological deficit. The present case of DLBCLs in the scalp and dura without intervening skull bone invasion indicates that malignant lymphoma should be considered in the differential diagnosis of scalp and dural tumors without intervening skull bone invasion.
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  • Malignant Transformation of Craniopharyngioma Associated With Moyamoya Syndrome
    —Case Report—
    Kenta UJIFUKU, Takayuki MATSUO, Tomonori TAKESHITA, Yukishige HAYASHI, ...
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 599-603
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.599
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    A 32-year-old man presented with malignant craniopharyngioma associated with moyamoya syndrome manifesting as right visual disturbance. Magnetic resonance (MR) imaging revealed a parasellar mass lesion diagnosed as adamantinomatous craniopharyngioma. He underwent three surgical procedures and repeated courses of radiotherapy, and was able to resume his daily life. MR imaging demonstrated tumor regrowth and bilateral occlusions of the internal carotid arteries (ICAs) with basal moyamoya phenomenon, which might have been induced by irradiation and/or tumor compression, 10 years after the initial manifestations. Sufficient debulking was safely achieved via the transsphenoidal route and histological examination revealed squamous cell carcinoma, indicating malignant transformation of craniopharyngioma. The tumor relapsed after only one month, so transsphenoidal tumor debulking was tried again. However, the postoperative course was unfavorable because of intraoperative bleeding from the right ICA. Malignant transformation of craniopharyngioma may be included in moyamoya syndrome. The treatment strategy should be carefully considered in such a complicated situation.
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  • Motor Cortex Stimulation for Intractable Neuropathic Facial Pain Related to Multiple Sclerosis
    —Case Report—
    Takafumi TANEI, Yasukazu KAJITA, Toshihiko WAKABAYASHI
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 604-607
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.604
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    A 33-year-old man presented with ongoing severe right facial pain and sensory disturbances caused by multiple sclerosis (MS). Neuroimaging demonstrated demyelinating lesions in the right dorsal pons and medulla oblongata. The pain was refractory to carbamazepine at 800 mg/day, gabapentin at 1800 mg/day, morphine at 30 mg/day, amitriptyline at 60 mg/day, and diazepam at 4 mg/day, along with twice-monthly ketamine (60 mg) drip infusions. The patient underwent motor cortex stimulation (MCS), resulting in >60% pain relief, reduction in the required doses of pain medications, and discontinuation of ketamine administration. MCS is effective for MS-related neuropathic facial pain.
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  • Allergic Reaction Following Arachnoid Plasty With a Fibrin Sealant
    —Case Report—
    Ryuzaburo KANAZAWA, Shun SATO, Naotaka IWAMOTO, Akira TERAMOTO
    Article type: Case Report
    2010 Volume 50 Issue 7 Pages 608-610
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.608
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    A 65-year-old woman underwent surgical treatment of an unruptured aneurysm in the left middle cerebral artery. Surgical craniotomy using arachnoid plasty with a fibrin sealant was completed without incident, but abrupt neurological deterioration occurred on the 9th postoperative day. Antibiotic treatment was given, but the symptoms did not resolve. Neuroimaging and physical findings indicated allergic reaction rather than infectious process. Therefore, systemic steroids were administered that resulted in dramatic resolution of symptoms. Nine months later, lymphocyte stimulation test of materials used in arachnoid plasty revealed positive response to a component of the combination pair in fibrin glue. The fibrin sealant placement method is a widely accepted and familiar technique, but surgeons should anticipate possible allergic reactions such as those observed in the present case.
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Technical Notes
  • Depth-Adjustable Fixation of External Ventricular Drains to Counteract Obstruction in Tight Ventricles
    —Technical Note—
    Satoru SHIMIZU, Hiroyuki HAGIWARA, Kenji NAKAYAMA, Isao YAMAMOTO, Kiyo ...
    Article type: Technical Note
    2010 Volume 50 Issue 7 Pages 611-613
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.611
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    Tightness of the lateral ventricle may result in mechanical obstruction of an external ventricular drain (EVD). We propose a modified EVD fixation method that allows retraction of the EVD to reopen the drainage. We used this technique in patients requiring long-term EVD placement in the frontal horn who were expected to develop tightening of the ventricle. We placed a catheter fixation device consisting of a dialysis catheter with a catheter-holding wing and a fixture spring. The wing is placed on the EVD just distal to its exit and tied down, and the fixture spring is attached to the wing to secure the EVD. If EVD obstruction associated with tightening of the ventricle was suspected, we removed the spring and retracted the EVD to the depth required for cerebrospinal fluid drainage, then replaced the spring. Retraction by 5-12 mm (mean 8.7 mm) resulted in opening of 8 of the 10 obstructed EVD devices. We encountered no major procedure-related complications. This modified EVD fixation method facilitates depth adjustments for reopening the obstructed drain.
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  • Preventive Stitching for Migration of a Peritoneal Catheter Into the Abdominal Wall After Ventriculoperitoneal Shunting
    —Technical Note—
    Kuniaki NAKAHARA, Satoru SHIMIZU, Hidehiro OKA, Satoshi UTSUKI, Kiyota ...
    Article type: Technical Note
    2010 Volume 50 Issue 7 Pages 614-615
    Published: 2010
    Released on J-STAGE: July 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.614
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    Migration of the distal end of a ventriculoperitoneal shunt into the abdominal wall (epi-peritoneal layer) is a complication which is especially likely in obese patients with high intra-abdominal pressure and wide dead space around the catheter remaining after laparotomy. A preventive abdominal stitching method for this complication was developed consisting of sutures beside the catheter penetrating the peritoneum, posterior and anterior sheath of rectus abdominis muscle, and subcutaneous fat. This method was applied to more than 20 patients who underwent ventriculoperitoneal shunting. No patient experienced shunt migration. The technique is easy and safe to perform, avoids leaving a dead space around the peritoneal catheter, and prevents catheter migration.
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Editorial Committee
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