Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 4, Issue 2
Displaying 1-31 of 31 articles from this issue
  • Article type: Cover
    1995 Volume 4 Issue 2 Pages Cover4-
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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  • Article type: Cover
    1995 Volume 4 Issue 2 Pages Cover5-
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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  • Article type: Index
    1995 Volume 4 Issue 2 Pages 83-
    Published: March 20, 1995
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages App3-
    Published: March 20, 1995
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  • Ulrich Batzdorf
    Article type: Article
    1995 Volume 4 Issue 2 Pages 85-91
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    Cervical spondylosis frequently is associated with alterations in cervical spine curvature deviating from the normal lordotic curve. Since the aim of surgery for cervical spondylotic myelopathy is to eliminate contact between osteophytic spurs or bone and the spinal cord, consideration of the type of abnormal spine curvature is of paramount importance. Laminectomy will result in decompression only when the lordotic curve is preserved, while a straightened or kyphotic spine can best be decompressed by an anterior approach. Laminectomy offers the advantage of not eliminating motion segments, and a combination of posterior and anterior procedures may offer some patients surgical therapy which limits the number of segments fused, yet decompresses the spinal cord adequately.
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  • Junya Hanakita
    Article type: Article
    1995 Volume 4 Issue 2 Pages 92-97
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    This manuscript describes the surgical approaches for treating thoracic ossification of the posterior longitudinal ligament (OPLL) and thoracic soft disc hernia. Although the incidence of thoracic OPLL and soft disc hernia is extremely rare, these disorders could result in a severe myelopathy. A conventional laminectomy cannot be used due to the kiphotic angulation of the thoracic spine. Further, an anterior approach, which is often used for the cervical lesions, cannot be easily applied at the thoracic level. Because of these limitations, several alternative surgical approaches have been advocated for thoracic ventral lesions such as OPLL and soft disc hernia. The author describes three representative surgical approaches: an anterior approach with sternal splitting, a transthoracic anterolateral approach, and a posterolateral approach. Based on the author's experience, the important points, such as the strategies and complication that can arise when using these surgical approaches are described in detail.
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages 97-
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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  • Satoru Kadoya
    Article type: Article
    1995 Volume 4 Issue 2 Pages 98-103
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    Described are the basic concepts of diagnosing and surgically treating lumbar spondylosis, a degenerative disease particularly invo1ving the facet joints of the lumbosacral spine. This results in stenotic lesions of the central and nerve root canals that impinge on the cauda equina and lumbosacral roots. The hypertrophied inferior articular facets constrict the central portion of the vertebral canal (central spinal stenosis) and the degenerated thickened yellow ligament usually enhances this stenosis. Intermittent claudication is a typical clinical syndrome. The lumbosacral roots run through the nerve root canal and their entrapment can occur and cause stenosis at two locations : most commonly in a narrow lateral recess, i. e., a lateral or subarticular recess stenosis, and, less frequently, in an exit zone of the nerve root canal between the pedicle and the superior articular process, i. e., a lateral stenosis. Computed tomography (CT) with myelography is a most reliable method to diagnose lumbar spondylosis, since this provides precise in formation about both the anatomical and pathological status of a bony and/or a soft tissue involvement, and a lateral stenosis associated with herniation of a distant lateral disc cannot be diagnosed unless CT-myelography is used. Magnetic resonance imaging (MRI) provides three-dimensional images of neural tissue entrapment and information on intervertebral disc degeneration. Decompressive treatment can be classified into three basic surgical procedures. A decompressive laminectomy is the choice for central spinal stenosis, whereas a medial facetectomy is used for a lateral recess stenosis (subarticular recess stenosis) and a facetectomy for a lateral stenosis. Since patients often show many clinical signs and symptoms of a cauda equina and/or radicular compression, all three operative procedures are usually variously combined. In view of possible postoperative instability, we do a bilateral partial laminectomy for treating central spinal stenosis', which is a limited interlaminar decompressive procedure that does not require removal of the spinous process, and the supra- and inter-spinous ligament, and posterolateral fusion is usually performed for cases given a facetectomy. Our long postoperative follow-up results have shown a 90% recovery from intermittent claudication and an 89% success rate in relieving leg pain, respectively.
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  • Tsunemaro Koyama, Hironori Fujisawa
    Article type: Article
    1995 Volume 4 Issue 2 Pages 104-110
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    Among many clinical issues concerned with lumbar disc herniation, the authors discuss the pitfalls of diagnosing and surgically treating lumbar disc herniation in this article. Lumbar disc herniation is among the most common lumbar diseases, and is manifested by low back pain, leg pain, and other sensory and motor disturbance ; however, there are many other lumbar diseases that manifest similar symptoms, so that to obtain good surgical results it is necessary to clinically distinguish lumbar disc herniation from these other similar diseases. Diagnosing lumbar disc herniation has become easier since the introduction of magnetic resonance (MR) imaging ; however, improper use of this imaging method has led to abuses, such as oversurgery and misdiagnosis of the disease. MR imaging for diagnostic purposes should only be pursued after the patient is fully and appropriately examined neurologically and neuroradiologically. The only absolute indication for surgically treating lumbar disc herniation are cases manifesting the acute cauda equina syndrome that are associated with bladder dysfunctioning. For such cases, a microsurgical disectomy is a good operative procedure. The author describes methods for this surgical procedure.
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  • christopher G Paramore, Volker K.H. Sonntag
    Article type: Article
    1995 Volume 4 Issue 2 Pages 111-120
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    The use of spinal instrumentation has increased tremendously In the last ten years. Despite this explosion in technology, the goal of operation for instability remains a solid bony fusion, and the ultimate impact of new types of instrumentation on fusion outcome remains to be seen. Future gains in surgical fusion rates may depend as much on biological advances as on improvements in instrumentation. Autogenous bone remains the graft material of choice, but much work is underway in improving the quality of banked bone and even providing bone substitutes. A number of growth factors and bone matrix components are being considered for local application to graft beds. Finally, proper patient selection is becoming easier as more factors which affect the success of fusion operations are being elucidated. Recent advances in cervical spine instrumentation Include novel methods of atlantoaxial arthrodesis such as screw fixation of the odontoid and the Cl-C2 facet joints. Plate and screw systems have found wide applicability in both the anterior and posterior cervical spine, from Tl to the occiput. In the thoracolumbar spine, the advent of pedicle screw fixation and universal instrumentation systems have made it much easier to address the difficult problems of deformity, instability, and neural compromise resulting from a wide range of etiologies including idiopathic scoliosis, metabolic and degenerative diseases, and trauma. Improved instrumentation offers the promise of better surgical fusion rates. However, basic surgical tenets such as careful patient selection and meticulous surgical technique must be adhered to if successful outcomes are to be obtained.
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  • Hideharu Karasawa, Hiromichi Naito, Ken Sugiyama, Junji Ueno, Hiroshi ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 121-127
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    The authors have investigated 8 cases of a traumatic subacute subdural hematoma by the following methods : computed tomography (CT), magnetic resonance imaging (MRI), the results of surgery, and the histological findings. Within a few days after each head injury, CT showed a highly dense subdural hematoma, but the volume of the hematoma then decreased in 3 to 7 days. However, CT at 7 to 14 days demonstrated a low or isodense area and enlargement of subdural hematoma. MRI findings showed that most of the subacute subdural hematomas visualized as an area of high intensity with only a small portion showing a low intensity, and that the shape of the hematomas over the cortical surface were irregular. For repair, 6 of the cases underwent a craniotomy and two received a burr hole evacuation in 7 to 27 days. The contents of these subdural hematomas consisted of clots and liquid. There was all outer neomembrane on the outer surface of each of the hematomas, but none had an inner membrane. In 3 cases, on removal of the subdural hematoma, blood was seen spurting from a tiny cortical artery rent, and in 5 cases, localized subarachnoid hemorrhage was found around the cortical arteries. These findings appear to indicate that the cortical arteries are a bleeding source of head traumas. In one subdural hematoma, MRI revealed that the cerebral cortex had attached to the dura mater within the hematoma in the shape of a tent (the "tenting"sign) , and the subsequent surgical and histological finding showed that a cortical artery had adhered to the outer neomembrane, and that there was a defect in the arachnoid membrane at the point of adhesion. Thus, this"tenting"sign can be considered a diagnostic sign that the cerebral cortex has adhered to the dura mater or to the outer neomembrane. In another case, a small tear ill the arachnoid membrane was found near localized subarachnoid hemorrhage. In 4 cases the results of the histological examination showed that the outer neomembrane consisted of fibrous connective tissue and many dilated capillaries, and in 3 cases new petechial hemorrhages around the capillaries were noted. Based on these findings, the mechanisms that cause a subacute subdural hematoma to develop may occur as follows : 1) On sustaining a mild head injury, an acute subdural hematoma may arise from a cortical artery rupture. Then, from 3 to 7 days later, the hematoma decreases in volume. Next, a neomembrane of granulous tissue forms between the hematoma and the dura mater, and, 2) An influx of cerebrospinal fluid enters the subdural space, and during the subacute stage, a transcapillary shift of blood plasma through dilated capillaries and petechial hemorrhaging in the neomembrane may cause the enlargement of the hematoma.
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  • Yasushi Kurokawa, Kohsaku Watanabe, Seisho Abiko, Tomomi Okamura, Tats ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 128-132
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    Described is a method for preserving decompressed bone flaps in 80% ethanol. Such bone flaps have been used in cranioplasty to repair 17 cases that received a decompressive craniotomy after surgery for a subarachnoid hemorrhage or a spontaneous intracerebral hematoma because these cases manifested high intracranial pressure (ICP). A11 of the decompressed bone flaps were first washed in saline and preserved in 80% ethanol from 19 to 117 days before use. Of 17 bone flaps so prepared, 15 were used for cranioplasty and no postoperative infectious complications occurred. Both histopathological and radiological studies of the flaps after each cranioplasty confirmed that the flaps preserved by this method were suitable.
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  • Kaoru Sakatani, Shigefumi Morimoto, Masafumi Otaki, Kazuo Hashi
    Article type: Article
    1995 Volume 4 Issue 2 Pages 133-137
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    We measured the local heat generation induced by electrical coagulation with bipolar diathermy forceps using thermography, and evaluated the effects of different irrigation materials on the local temperature. The heat spreads like concentric circles to the tissue surrounding the tips of the bipolar diathermy forceps. The maximum temperature generally increased with bipolar output power; however, it varied depending on the moisture of local tissue and the contact area between the tip and tissue. With irrigation of saline, the increased tissue temperature induced by electrical coagulation at low output power decreased to normal temperature. However, irrigation of saline spreads the heat to surrounding area when tissue was coagulated at moderate to high output power, due to boiling of saline, an ionic solution, induced by current passage. On the contrary, isotonic mannitol, a nonionic solution, cooled the increased temperature to normal temperature at any Output power.
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  • Satoshi Iwabichi, Noboru Ogata, Katsuya Goto, Akihiko Takechi
    Article type: Article
    1995 Volume 4 Issue 2 Pages 138-144
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    The authors have evaluated the cerebral blood flow (CBF) using single photon emission computed tomography (SPECT) during balloon occlusion of the internal carotid artery (ICA) as a preembolization test for permanent carotid ligation. Seventeen patients were studied. These Included 8 cases with aneurysm, 5 cases with direct carotid cavernous fistula (DCCF), 2 cases with arteriovenous fistula (AVF), I case with carotid basal plexus fistula and I case of parasellar tumor. The SPECT study during the balloon occlusion test was performed using technetium-99m hexamethyl-propyleneamine oxime (^<99m>Tc-HMPAO) intravenous injection method. The results showed that the SPECT study during the balloon occlusion test was a secure and useful examination, but it was necessary to be aware of the following : (1) As there were some cases whose blood pressure was unstable after the permanent carotid ligation, it was necessary to inject ^<99m>TC-HMPAO under induced hypotension. (2) In cases with DCCF, the steal phenomenon through the fistula is enhanced under proximal ICA occlusion. Therefore administration of ^<99m>TC-HMPAO should be done under complete occlusion of the fistula together with ICA. (3) For patients with preexisting reduction of regional CBF, a quantative analysis was required.
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  • Keisuke Yamada, Susumu Miyamoto, Izumi Nagata, Haruhiko Kikuchi, Masat ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 145-150
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    The hemodynamic reserve has been assessed in 14 patients with moyamoya disease by means of a 1-hexamethyl-propyleneamine oxide (HM-PAO) single photon emission computed tomography (SPECT) and an acetazolamide challenge prior to undergoing revascularization Surgery. Following acetazolamide loading, focal decreases in the regional cerebral blood flow (r-CBF) were noted in 5 of 9 tested children under 16 years of age (reverse steal phenomenon). As for the other 4 tested children, the reverse steal phenomenon did not occur, although their vasodilatory response was disturbed. Manifestation of the reverse steal phenomenon suggests that there may be risks associated with hypercapnic management during general anesthesia.
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  • Takeo Tanishima, Norio Yoshimasu, Masahiro Ogai
    Article type: Article
    1995 Volume 4 Issue 2 Pages 151-156
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    The results of an expansive laminoplasty with a unilateral opening have been evaluated in 25 patients with cervical spondylotic myelopathy caused by a narrowed canal and/or multisegmental spondylosis. At one year postoperatively, drilled and hinged laminae showed sufficient bony consolidation for stabilizing the posterior spinal structure in all patients. However, in 3 patients the laminae were inadvertently separated from the lateral mass of the vertebrae during their hinging and had dislocated into the spinal column. Even so, this dislocation had no adverse effect on the patients' neurological conditions and six months after the laminoplasty, a spontaneous reduction was noted with a definite bony fusion. Further, at six months postoperatively, a slightly kyphotic deformity occurred in 2 patients, but no further deformity developed in these patients and the spinal column remained unchanged and no neurological dysfunctions that could be ascribed to this deformity were manifested. In 20 patients the neurological conditions exhibited an improvement, whereas in 4 patients no change was seen, although all 4 patients had shown atrophy of the spinal cord. Finally, I patient developed a C5 nerve dysfunction, which was presumably caused by the tethering of the posteriorly shifted cord following decompression. Based on these findings, it thus was concluded that an expansive laminoplasty with a unilateral opening is a safe and reliable procedure for cases manifesting a cervical spondylotic myelopathy due to a narrowed canal and/ or multisegmental spondylosis.
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  • Masahiro Kurisaka, Koreaki Mori
    Article type: Article
    1995 Volume 4 Issue 2 Pages 157-162
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    Using a immunohistochemical technique, the sites of the copper and zinc-superoxide dismutase (Cu, Zn-SOD) expression has been examined in acoustic schwannomas. These acoustic schwannomas included three cases associated with Recklinghausen disease (R-AS) and seven cases without von Recklinghausen disease (N-AS). Histologically, two out of four R-AS schwannomas were Antoni's type A, one was Antoni's type B, and one was a mixed type. The N-AS cases demonstrated four Antoni's type A schwannomas, two that were a mixed type, and one Antoni's type B schwannoma. The Cu, Zn-SOD expression was localized diffusely in the cytoplasms of the tumor cells of both the Antoni's type A and type B schwannomas. Occasionally, immunoreactive Cu, Zn-SOD products were revealed in the cytoplasms of the endothelial cells, the neutrophils, the macrophages, and the cell membranes of the erythrocytes. The percentage of the Cu, Zn-SOD content in the tumor cells ranged from 31〜63% in the R-AS cases, and from 43〜58% in the N-AS cases, and from 37〜66% in the Antoni's type A schwannomas of the R-AS cases, and 31% in the type B schwannomas. The Antoni's type A schwannomas of the N-AS cases showed a Cu, Zn-SOD positivity that ranged from 47〜60%, whereas the type B schwannomas showed a positivity that ranged from 43〜58%. Thus, no significant difference was noted in the SOD content among the Antoni's type A, type B, and mixed type schwannomas. However, a tendency towards a higher SOD content was recognized in Antoni's type A rather than in type B schwannomas.
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  • Katsuji Shima, Tsuyoshi Kawasaki, Akira Shimizu, Hiroshi Takiguchi, Hi ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 163-169
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    The authors present three cases of an ophthalmic artery occlusion after a pterional craniotomy, one case resulting in sudden blindness and two cases in which vision was preserved. The male patient who developed blindness was admitted because of a subarachnoid hemorrhage. Selective internal carotid angiography revealed aneurysms at the right A3 bifurcation and at the M1 bifurcation, but the ophthalmic artery was not found. The patient underwent a two-stage operation. For the first stage, using an interhemispheric approach, the A3 aneurysm was successfully clipped with no neurological deficit. For the second stage, a pterional approach was used and the M1 aneurysm was clipped. Postoperatively, however, the right eye lost all vision and manifested a cherry-red-spot fundus, and it is suspected that the blindness may have been caused by postoperative occlusion of the ophthalmic artery arising from the middle meningeal artery. In the other two cases, selective internal carotid angiography revealed aneurysms, and based on selective external carotid angiography, the ophthalmic artery appeared to originate from the branch of the middle meningeal artery. These two patients underwent pterional craniotomy with careful removal of sphenoid ridge, so as to avoid injurying the orbital ramus of the middle meningeal artery, and the aneurysms were successfully clipped. When a pterional craniotomy is performed for patients in whom the ophthalmic artery is being primarily supplied from the branch of the external carotid artery, the authors urge that careful attention be paid to all aspects of the surgery.
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  • Toshiki Mori, Masahito Fujimoto, Hiroshi Shin, Takehiko Sakakibara, Ts ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 170-173
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    This paper reports a case of posterior fossa epidural hematoma in a 21 month old girl. She was dropped accidentally by her mother and hit her head on the ground. Then she vomited several times and she was immediately admitted to our hospital while still unconscious. A plain X-ray film of the skull showed a linear fracture across the transverse sinus. A CT scan demonstrated a slightly high density area with a small isodensity area in the right posterior fossa. The next CT scan performed 60 minutes after the first examination revealed an lenticular epidural hematoma appearing as a high density area. Evacuation of the hematoma was performed, and the child was discharged without neurological deficit 11 days after admission. Acute epidural hematoma of the posterior fossa is very rare in children younger than two years of age. It is difficult to make a correct diagnosis only by clinical symptoms. Hence, a CT scan should be performed for all patients, including small infant, with occipital head injury. It should also be noted that at the first examination, the fresh hematoma may appear as a low or mixed density area. When early diagnosis and timely treatment are achieved, the prognosis becomes excellent in cases without cerebral injury.
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  • Kenji Imagawa, Akio Kuwayama, Akira Asai, Tatsuo Takahashi, Kazuyoshi ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 174-179
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    We report a patient having an angiosarcoma of the skull, and Factor VIII related antigen was demonstrable in the tumor. The patient was a 62-year-old male who complained of a growing mass of the skull with pain. The plain skull film revealed the multiple osteolytic lesions. The tumor was filled with hematoma, and showed the typical histologic features as angiosarcoma, and Factor VIII related antigen staining was positive. Bone scintigraphy with Tc-99m-MDP showed hot areas in the left frontal, parietal and occipital skull. Also, there were moderately or markedly hot areas in the left maxilla, left mandible, sternal angle, left 4th rib, and the 3rd to 7th cervical, the 11th thoracic and the 5th lumbar vertebra. He was treated by excision of the left frontal and parietooccipital tumors, followed by irradiation therapy and anticancer chemotherapy. In addition, the adoptive immunotherapy by recombinant interleukin-2 (rIL-2, CELEUK^<(R)> , TAKEDA Pharma. Co.) was performed. After the IL-2 therapy, the biological activities of lymphokine activated killer (LAK) cells and natural killer (NK) cells in serum increased, but the tumors were not reduced. Although the adoptive immunotherapy of IL-2 for angiosarcoma was not so effective in our case, immunotherapy seems to require combined chemotherapy or radiation after excision.
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  • Tsutomu Kawaguchi, Hiroaki Yokoyama, Masaru Inoue, Akio Ichikura, Masa ...
    Article type: Article
    1995 Volume 4 Issue 2 Pages 180-184
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    This report describes a rare case of pineocytoma with neuronal differentiation in a 68-year-old woman and discusses the clinical, radiographic, and pathological findings in this and other reported cases. T1-weighted magnetic resonance (MR) imaging revealed a hypointence round tumor in the pineal region and the mass was brightly enhanced after the administration of gadolinium. The lesion was hyperintence on T2-weighted MR images with hypointensity spots. The tumor was successfully removed using an occipital trans-tentorial approach and the postoperative course was uneventful. Histologically, the tumor was composed of isomorphous small cells round to oval-shaped nuclei separated by fibrovascular stroma (lobulated pattern) with rosette-like structures (pineocytomatous rosette). In addition, cells which had large nuclei with prominent nucleoli and Nissl substance within an abundant cytoplasm were observed, Suggesting the neuronal differentiation. Ultrastructually, dense-core vesicles and synapse-1ike structures were easily detected. The histological diagnosis was pineocytoma with neuronal differentiation. Their clinicopathological features and neuroradiological findings of this rare tumor are discussed.
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  • Yukio Takamura, Masayuki Takeda, Shigeki Kashiwabara, Hiroshi Takayama
    Article type: Article
    1995 Volume 4 Issue 2 Pages 185-188
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    We report a case of widespread and recurrent subcutaneous cerebrospinal fluid (CSF) retention in a 20-year -old female after a left frontotemporal craniotomy to remove a left frontal arteriovenous malformation (AVM). Examination found that a massive amount of cerebrospinal fluid was leaking into the subcutaneous space, distending it whenever she bowed her head; she also suffered from repeated headaches especially in the head-up position as a result of her low CSF pressure. The patient had manifested intracerebral hemorrhage clue to the frontal AVM at l0 years of age, and had undergone surgery to remove the hematoma. The total removal of the AVM had been performed 13 months prior to her present hospitalization. Her postoperative course had been uneventful, except for widespread subcutaneous CSF retention. Thus, a L-P shunt was inserted 2 months postoperatively, however, the subcutaneous CSF retention persisted unchanged. A S-P shunt that was added also did not change the patient's condition. On her second admission to hospital, a CT scan revealed an area of low density in the left frontal lobe that connected with the anterior horn of the left lateral ventricle. Thus, a frontotemporal craniotomy was performed through the previous operative wound. The brain surface was found to be covered by a thin neomembrane, and a small fistula was found sited between the subcutaneous space and the frontal horn of the left lateral ventricle. This fistula was found to be acting as a one-way valve for CSF from the ventricle to enter the subcutaneous space. Therefore by enlarging this fistula and adding a V-P shunt, the subcutaneous CSF retention disappeared.
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  • Akira Yamaura, Junichi Ono, Motoo Kubota
    Article type: Article
    1995 Volume 4 Issue 2 Pages 189-192
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    Analysed herein are data with regard to 80 cases of nontraumatic intracranial arterial dissections collected from 32 hospitals in Japan for the year of 1992. These cases were compared with the data of 188 Japanese cases previously reported in literature and no significant differences were found between the two groups. The profile of a nontraumatic intracranial arterial dissection in Japan has been found to be as enumerated below. 1. Age: The mean age was 48 years, with a highest incidence peak occurring in subjects in their 40s. Patients with a carotid lesion were younger and patients with a subarachnoid hemorrhage (SAH) were older. 2. Gender: Males dominated. The male/female ratio was 2.3 : 1. 3. Location: Ninety percent of the lesions had a vertebrobasilar (VB) distribution. 4. Clinical picture: In 60% of these cases, the SAH was the major event. Among the VB lesions, SAH was more common. 5. Angiography: The most common finding was the pearl and string sign. 6. Operation: In approximately 60% of the cases, the most common surgical procedure used was a proximal ligation of the parent artery. 7. Outcome: Seventy-six percent of the cases had a good recovery. The mortality rate was 16%.
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  • Takashi Tsuruno, Yoshimi Matsuoka, Akira Hakuba
    Article type: Article
    1995 Volume 4 Issue 2 Pages 193-195
    Published: March 20, 1995
    Released on J-STAGE: June 02, 2017
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    After a wide dissection of the arachnoid membrane and aspiration of the cerebrospinal fluid, the brain may sometimes collapse, thereby leading to the postoperative formation of a large subdural space. Further, when a significant subdural fluid collection appears, surgery may be necessary. To remedy such problems, the authors present a new surgical technique using a collagen seat and fibrin glue that allows for the expansion of the collapsed brain and closure of the communication between the subarachnoid space and subdural space. The authors have found this simple technique useful for the prevention of a postoperative subdural fluid collection.
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages 196-
    Published: March 20, 1995
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages 197-
    Published: March 20, 1995
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages 198-
    Published: March 20, 1995
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages 199-200
    Published: March 20, 1995
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages App4-
    Published: March 20, 1995
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  • Article type: Appendix
    1995 Volume 4 Issue 2 Pages 203-
    Published: March 20, 1995
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  • Article type: Cover
    1995 Volume 4 Issue 2 Pages Cover6-
    Published: March 20, 1995
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