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Article type: Cover
2004 Volume 13 Issue 8 Pages
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Article type: Cover
2004 Volume 13 Issue 8 Pages
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Article type: Index
2004 Volume 13 Issue 8 Pages
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Article type: Appendix
2004 Volume 13 Issue 8 Pages
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Jun A Takahashi, Masato Hojo, Tomofumi Nishikawa, Hisae Mori, Asao Hir ...
Article type: Article
2004 Volume 13 Issue 8 Pages
565-571
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Object : Pituitary dysfunction associated with Rathke cleft cyst is not necessarily related to the size of the lesion. We hypothesized that any other factors could affect decreased pituitary function in cases with Rathke cleft cyst. Methods and Results : We studied 27 cases of Rathke cleft cyst we surgically treated between 1983 and 2002. The diameter of Rathke cleft cyst, which was calculated from MR images, was not significantly correlated to pituitary dysfunction. HE section of 6 surgical cases with panhypopituitarism demonstrated remarkable destruction of the acinar structures of the anterior pituitary lobe adjacent to each Rathke cleft cyst, which included lymphocyte and macrophage infiltration, decreased collagen tissue and calcification. In contrast, HE findings of 4 surgical cases and 4 autopsy cases with normal pituitary function showed that intact acinar structures surrounded Rathke cleft cyst. Conclusion : There is the possibility that pituitary dysfunction in cases of Rathke cleft cyst is caused by an inflammatory reaction, which may be induced by cyst contents leaking into the surrounding pituitary tissue.
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Atsushi Katsumata, Kenji Sugiu, Wataru Sasahara, Kyoichi Watanabe, Ayu ...
Article type: Article
2004 Volume 13 Issue 8 Pages
572-577
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Currently, temporary balloon test occlusion (BTO) of the internal carotid artery (ICA) has become a well accepted procedure in the preoperative evaluation of patients with large aneurysm or tumor involving the neck or skull base in whom arterial sacrifice or prolonged temporary occlusion is considered. In this paper we review our experience with 119 cases of BTO and evaluate the associated techniques and complications. BTO of the ICA was accomplished endovascularly using triple-lumen balloon catheter. After ICA occlusion using the balloon, the patient's neurological status was assessed and monitored continuously throughout 30 minutes. When the patient showed neurological changes, BTO was immediately stopped. Complication related to this procedure occurred in 5 (4.2%) patients. Two (1.7%) patients had symptomatic and three (2.5%) had asymptomatic complications. One (0.8%) of these was a permanent neurological deficit due to ICA dissection caused by the balloon catheter. The other (0.8%) was embolic M2 occlusion resulted in transient neurological deficit. There were no death related this procedure. BTO of the ICA can be performed with an acceptable low complication rate, however, it should be performed by the experienced hand and under strict indication.
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Kazuyoshi Uchida, Yoshio Taguchi, Yohtaro Sakakibara, Masaaki Okada, A ...
Article type: Article
2004 Volume 13 Issue 8 Pages
578-582
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A case of intracystic hematoma in a posterior fossa arachnoid cyst in a young man following a severe head injury was reported. An otherwise healthy 34-year-old man was admitted in a comatose state following a head injury suffered in a traffic accident while riding a motorcycle. A computed tomography scan on admission showed a small hemorrhage in the left anterior thalamus, subarachnoid hemorrhage in the interpeduncular cistern, moderate brain swelling, and a high density area in a cystic cavity posterior to the cisterna magna. The patient's head injury was treated conservatively under continuous monitoring of the intracranial pressure. Magnetic resonance images taken two weeks after the onset revealed several T2 high intensity signals in the deep white matter and the corpus callosum as well, suggesting a diffuse axonal injury. The posterior fossa cyst having intracavitary hemorrhage was diagnosed as an arachnoid cyst associated with intracystic hemorrhage. He regained his consciousness gradually and showed loss of motor function in the right extremities. Fortunately he could walk without any aid after a rehabilitation program. Arachnoid cysts may associate with various types of intracranial hematoma such as subdural, intracystic, and rarely, epidural hematomas following head injuries, even mild. Although arachnoid cysts in the posterior fossa are occasionally encountered incidentally, all hemorrhagic complications but one reportedly occurred in the supratentorial cranial cavity. Considering the mechanisms of traumatic brain injury, more severe traumatic force may be necessary to cause hemorrhagic complications in arachnoid cysts of the posterior fossa.
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Article type: Appendix
2004 Volume 13 Issue 8 Pages
582-
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Ichiro Nakahara, Yoshihiko Watanabe, Toshio Higashi, Yasushi Iwamuro, ...
Article type: Article
2004 Volume 13 Issue 8 Pages
583-587
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A case of a 76-year-old man with severe stenosis of the left carotid artery was reported. He was admitted forcarotid stenting for the lesion because of symptomatic thromboembolic infarction suffered one and a half monthsbefore admission. He underwent carotid stenting uneventfully with satisfactory dilatation of the stenotic carotidartery. On the following day, he presented ischemic skin purpura lesions and acute renal failure followed by severeliver dysfunction and soft tissue destruction, which was diagnosed as resulting from an atheroembolism caused bythe catheterization maneuver. In spite of intensive care including hemodilution and LDL serum exchange therapy,he expired on the third day due to multiorgan dysfunction and acute cardiopulmonary failure. Atheroemblism wasconsidered as a rare but serious complication in carotid stenting that has been introduced rapidly in the field of neurovascular intervention.
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Jin Momoji, Hiroshi Shimabukuro
Article type: Article
2004 Volume 13 Issue 8 Pages
588-592
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We experienced two difficult cases of coil retrieval during aneurysm embolization using Guglielmi detachable coils. In the first case, one coil was caught by the other coil and a microcatheter at the tip of it. When a microcatheter which has a hard shaft is put into a tightly packed coil mesh and the coil is pushed forcefully, it may return into the microcatheter again and capture another one. In the second case, a knot in the coil was formed during embolization while using the remodeling technique. When the tip of the coil crosses the next loop and is trapped between the balloon and the blood vessel wall, a knot may form if it is pulled in that situation. In intracranial aneurysm embolization, detachment of the first coil or manipulation near the neck of the aneurysm in the last stage of embolization are very important. Therefore, the risk of trouble with the coil at those times, possibly leading to a fatal complication, is very high. We hope that safer treatment will be carried out by through knowledge of such rare cases.
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Junichi Shimada, Nobuaki Takeda, Hiroshi Kawaguchi, Shu Hirai
Article type: Article
2004 Volume 13 Issue 8 Pages
593-598
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A case of intraosseous meningioma of the parietal bone in a 69-year-old female is described. Intraosseousmeningiomas are very rare,, She was admitted to our hospital with a hard, painless growing mass in the left parietalregion. Neurological examination and laboratory data revealed no abnormalities except for recent memory disturbance. However, a plain craniogram showed a 3 × 4 cm osteolytic lesion in the left parietal bone. CT scan demonstrated a multilocular intraosseous mass. Gd-enhanced MRI showed heterogenous enhancement of the masslesion and thickened dura mater adjacent to the tumor (dural tail sign). Selective external carotid angiogram showed tumor stain in the thinned skull fed by middle meningeal and superficial temporal arteries. After embolization of the middle meningeal artery, the tumor was removed en bloc with the surrounding normal bone. Macro-scopically complete tumor resection (Simpson's grade 1) was carried out. The patient had an uneventful recoveryand remains well without recurrence at 1/2 years follow-up. Histological examination of the specimen revealedmeningothelial (WHO2000) meningioma. Tumor cells infiltrated through the adjacent dura mater. No mitosis was identified.
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Kentaro Horiguchi, Eiichi Kobayashi, Shigeki Kobayashi, Shinji Hirai, ...
Article type: Article
2004 Volume 13 Issue 8 Pages
599-604
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We report on a rare case of recurrent traumatic carotid-cavernous fistula (TCCF) after complete embolizationwith a detachable balloon at intervals of six months. A 15-year-old male patient was injured in a car accident andcomplained of diplopia and tinnitus. At an outside hospital, right carotid angiogram revealed TCCF, fed by the rightcarotid artery, and draining into a lot of ways. It was treated completely with a detachable balloon at the other hospital. Six months later the fistula recurred with a predominantly cortical reflux and with a reduction of drainingveins. We perfomed two intravascular treatments. First, we tried transarterial occlusion of the fistula with somedetachable balloons, but failed. Secondly, the internal carotid artery trapping with microcoils was performed. Postoperatively, the patient was free of symptom except for slight sixth nerve palsy. Two months after the trapping MRA indicated no recurrence of the fistula.
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Yasutaka Kuzu, Kuniaki Ogawawara, Yasufumi Kikuchi, Akira Ogawa
Article type: Article
2004 Volume 13 Issue 8 Pages
605-607
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A 54-year-old man presented with an unusual case of splitting and penetration of the optic nerve by a cerebral aneurysm. He suffered sudden onset of headache. Computed tomography showed subarachnoid hemorrhage. Cerebral angiography revealed aneurysms on the right middle cerebral artery, right internal carotid artery-posterior communicating artery bifurcation, and anterior communicating artery. Right frontotemporal craniotomy revealed the right middle cerebral artery aneurysm was covered with hematoma and presumably ruptured, and the unruptured right internal carotid artery-posterior communicating artery bifurcation aneurysm. Both aneurysms were clipped. The unruptured anterior communicating artery aneurysm was then revealed to have penetrated the left optic nerve. This aneurysm was clipped without detachment from the optic nerve. Postoperatively, visual field testing demonstrated enlarged Mariotte's blind spots in both eyes and lower medial quadrant hemianopsia in the left eye. No visual field deficit had been detected 3 years previously. The left quadrant hemianopsia had probably been present preoperatively, since no optic nerve damage occurred during the operation. The anterior communicating artery aneurysm had probably grown slowly and eventually penetrated the optic nerve, resulting in the visual field deficit.
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Ichiro Kawahara, Makio Kaminogo, Yukishige Hayashi, Tomohiro Okunaga, ...
Article type: Article
2004 Volume 13 Issue 8 Pages
608-613
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We report a case of metastatic seeding glioblastoma in a 67-year-old female patient, which has progressed from gemistocytic astrocytoma along the trajectory of a Stereotactic brain biopsy. Generally, Stereotactic biopsy is thought to be safe, easy and accurate for the histological comfirmation of brain tumors and it carries a low risk of complication. Common complications include intracranial hemorrhage, brain swelling, and infection. But a rare complication of tumor seeding following biopsy can occur. However, tumor seeding as a result of biopsy has beenreported or discussed in only a few publications. The seeding of tumor cells along the trajectory of the biopsy mayoccur to some extent during every biopsy. This has been reported to occur in animal models. However, seededtumor cells usually do not grow into a clinically significant bulk of tumor. The growth of seeded tumor cells proba-bly depends on the cytokinetic characteristics of the cells, the number of tumor cells, cell adhesiveness, cell growthpotential, the fertility of the host, and the degree of malignancy. The more malignant the tumor type, the higher therisk of tumor seeding. These factors should keep in mind to help avoid these complications and device strategies to minimize tumorseeding.
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Article type: Appendix
2004 Volume 13 Issue 8 Pages
614-616
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2004 Volume 13 Issue 8 Pages
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2004 Volume 13 Issue 8 Pages
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2004 Volume 13 Issue 8 Pages
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Article type: Bibliography
2004 Volume 13 Issue 8 Pages
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2004 Volume 13 Issue 8 Pages
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2004 Volume 13 Issue 8 Pages
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Article type: Cover
2004 Volume 13 Issue 8 Pages
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