Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 7, Issue 7
Displaying 1-22 of 22 articles from this issue
  • Article type: Cover
    1998 Volume 7 Issue 7 Pages Cover28-
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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  • Article type: Cover
    1998 Volume 7 Issue 7 Pages Cover29-
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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  • Article type: Index
    1998 Volume 7 Issue 7 Pages Toc1-
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages App1-
    Published: July 20, 1998
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  • Hiromichi INO, Takashi SHIMIZU, Yukiya KOMINAMI
    Article type: Article
    1998 Volume 7 Issue 7 Pages 415-420
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    Brain retraction is a necessary and important proceduse for skull base surgery, but excessive and prolonged pressure during the operation can cause serious postoperative complications. In fact, because it is almost imposible to gauge the retracting pressure during an operation, a practical means by which to measure it is essential. In response to this need, the authors have invented a pressure receiver called a "pressure receiver of air packed type"to measure retracting pressure. This air packed pressure receiver is inexpensive, easy to make, and easily fits onto almost all types of retractors. Facilitating its use during sensitive manipulation is its use of air as a medium to indicate pressure. Because it uses air instead of water, no calibration or readjustment subsequent to each movement of the retractor is needed. Furthermore, we developed a calibration test especially for the pressure receiver, which has proven its accuracy. The polyester of the pressure receiver is 0.035mm thich, and when injected with air the inflated pressure receiver still measures only 1mm, so as not to impede surgical procedures. Finally practical unobtrusive and precise measurement of retracting pressure under clinical conditions is possible.
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  • Gaku SEKI, Tohru HOSHIDA, Kazuo GODA, Hiroshi HASHIMOTO, Hiroyuki NAKA ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 421-428
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    We comparatively assessed detection of epileptogenic areas on preoperative evaluation in 33 patients with intractable partial epilepsy using scalp interictal and ictal electroencephalography (EEG), magnetic resonance imaging (MRI), and interictal single photon emission computed tomography (SPECT). There are 22 temporal and 11 extratemporal lobe epilpsies. All or almost of their seizures have stopped after resective surgery for more than 12 months follow-up period, averaged 43 months. MRI studies demonstrated 21 organic lesions, 11 mesial temporal sclerosis and one patient showed normal brain tissue. Scalp EEG could correctly identify the focus in 14 of 33 cases (42%), interictal SPECT in 18 of 26 (69%), MRI in 29 of 33 (88%), interictal scalp EEG-video monitoring in 17 of 24 (71%), and ictal scalp EEG-video monitoring in 15 of 22 (68%). Although neuroimaging studies, especially MRI, are useful to detect not only localization of epileptic lesions but also epileptogenic focus, for example, mesial temporal sclerosis, the exact localization of epileptogenic areas could be done by comprehensive evaluation including ictal scalp EEG-video monitoring.
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  • Satoshi NAKAJIMA, Yuichi SENGOKU, Tadaharu FUKUDA, Masamichi HASUE, Jo ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 429-432
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    With the use of an experimental device, we have evaluated the sealing effect of fibrin glue with regard to cerebrospinal fluid (CSF) leakage from dura mater repaired with expanded polytetrafluoroethylene (ePTFE) surgical membrane. Three methods for application of fibrin glue were studied : an external spray method, an internal spray method, and a combination internal-external (sandwich) method. The burst pressure for one-step increase in pressure was 43.3 cm H_2O when the external spray method was used, and 61.0 cm H_2O when the sandwich method was used. The burst pressure for stepwise increases in pressure was 20 cm H_2O when the external spray method was used, and 30 cm H_2O when the sandwich method was used. CSF leakage from dura mater repaired with ePTFE surgical membrane is more frequent and the sealing effect of fibrin glue is less effective when compared with cadaveric dural grafts. In conclusion, the sandwich method is effective in preventing CSF leakage under conditions similar to those of an increase in postoperative intracranial pressure.
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  • Yoshio TAGUCHI, Yasuji MIYAKITA, Motoshi MATSUZAWA, Yohtaro SAKAKIBARA ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 433-439
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    A new magnetic resonance imaging (MRI) Trauma Study was commenced in April, 1995, so that any pathological changes of traumatic brain injuries could be indentified. In our study, fluid attenuated inversion recovery (FLAIR) images, and multishot echo planar imaging T2^*-weighted images (EPI T2^*-WI) were used in addition to conventional T1-weighted images, T2-weighted images and T2-weighted sagittal images. In this series we focused our attention on small parenchymatous lesion of a mild or moderate form of diffuse brain injury. These injuries are shown as high intensity areas on T2-weighted images (T2-high intensity lesions) but are not visualized in CT images. This series consisted of 29 patients who were diagnosed with diffuse brain injury and whose CT scans showed a Diffuse Injury I or II, according to the CT classification of Marshall et al. With Gennarelli's clinical classification, most of the patients were described as mild or moderate diffuse brain injury. Nineteen patients were studied in an acute or subacute stage. In all but 3 patients, small T2-high intensity lesions were found in the brain parenchyma. Susceptibility artifacts were displayed by an EPT T2^*-WI in 56% of the brain stem lesions, 69% of the corpus callosum lesions, and 91% of the supratentorial lesions. Elderly patients were excluded because of the possibility of age-related lesions. In the follow-up study brain edema was suggested because the lesions tended to be absent within 3 months in T2-weighted images and FLAIR. Susceptibility artifacts remained unchanged. In 10 patients examined during a chronic stage, susceptibility artifacts could be identified in most of the lesions initially shown as T2-high intensity lesions. Small hemorrhages in patients with Diffuse Injury II were shown with variable intensities on the conventional T1- and T2-weighted images, but were visualized with low intensity in an EPI T2^*-WI. In diffuse brain injuries, small T2-high intensity lesions have been considered to be brain edema or ischemic insults. Our data however, suggested that microhemorrhages associated with brain edema were present in most of the supratentorial lesions, and in more than a half of the lesions in the corpus callosum and the brain stem. These findings appear similar to contusions, which are defined as traumatic bruises of the neural parenchyma. The use of MRI has increased our understanding of in vivo pathological changes in mild or moderate forms of diffuse brain injury.
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  • Tatsuhiko Kubo, Yoshito Sakata, Takamasa Yamazaki, Go Endo, Mikiro Mat ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 440-444
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    A 61-year-old woman underwent right frontotemporal craniotomy for a right unruptured ophthalmic aneurysm. The aneurysm was obliterated with a clip with no troubles either during surgery or the anesthetic course. Postoperatively, the patient awoke fully from anesthesia and no neurological abnormality was noticed. However, the following day, her movement was ataxic and CT scan demonstrated diffuse swelling of the right hemisphere and subpial hemorrhagic infarction caused by venous congestion on diffuse cerebellum. Angiograms obtained on the ninth postoperative day showed disappearance of the aneurysm and no other vascular abnormalities including venous circulation of the posterior fossa were observed. Although the patient was discharged home without neurological deficit, swelling of the right cerebral hemisphere on CT scans had been existed for next two years. Although the mechanisms of venous congestion on the cerebellum remain unclear, we belive that postoperative cerebrospinal fluid overdrange may play an important role and disturbed venous circulation of the righthemisphere may acceletrate this process.
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  • Shigetaka ANEGAWA, Takashi HAYASHI, Ryuichiro TORIGOE, Hiroaki HIGASHI ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 445-449
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    Inflammatory pseudotumor of the orbit (IPO), also labeled nonspecific orbital inflammation, is the third most common cause of unilateral exophthalmos in adults. Affected individuals usually experience the abrupt onset of painful proptosis with chemosis, eyelid, edema, and limitation of gaze. This paper reports a case of IPO, which represented unusually long clinical course. A 40-year-old man was seen in our clinic because of the deteriorating left expophthalmos for 6 years. CT scan revealed an intraorbital mass with exophthalmos. MRI also demonstrated a dumbbell shaped mass in the orbital apex. To differentiate neoplastic lesions, open biopsy was performed via the left fronto temporal craniotomy. Histological examination showed the evidence of IPO-lymphocytic infiltration. He satisfactory responded to oral corticosteroid treatment. Eleven months after the treatment, he showed no exophthalmos.
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  • Keiji ADACHI, Kazutaka OHYAMA, Yoshiaki KADOTA, Sumio ISHIMARU, Minoru ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 450-454
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    We report a case of dysembryoplastic neuroepithelial tumor (DNT) in a 12-year-old girl who had experienced generalized convulsions. A multinodular cystic mass was located at the postcentral gyrus. During a 5-year period of MRI observation, the tumor had enlarged slowly. Histological examination of the specimen revealed that the tumor was composed of microcystic components with alveolar pattern and consisted of oligodendrocyte-like-cells, astrocytes, and neurons ; however, there was no evidence of malignant transformation. These facts suggest that the DNTs in the rolandic area should be considered as a possible diagnosis when the tumor shows slow but definite growth.
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  • Shinichi OKABE, Takuji KOHNO, Yoichi NONOGAKI, Yoichi HARADA, Kiyoshi ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 455-459
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    We are reporting a surgical case of an unruptured fusiform aneurysm located on the A2 segment of the left anterior cerebral artery. The patient is a 49-year-old female who presented with nuchal pain. The presence of an anterior communicating artery (AcoA) aneurysm was suspected after analysis with MRI and MRA investigation. The left carotid angiogram revealed a 1 cm saccular aneurysm located on the AcoA portion of the artery. However, the 3D-CTA showed the presence of a left A2 segment fusiform aneurysm near the AcoA. The patient was operated on via left pterional approach. Two angled fenestrated clips were applied to the aneurysm so as to reconstruct the A2 segment. The postoperative course was uneventful, and the aneurysm was not visible in a subsequent angiogram. Thus, 3D-CTA has been shown to be useful in identifying an extremely rare case of an A2 segment fusiform aneurysm.
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  • Yoshihiko NISHIJIMA, Naohiro TSUYUGUCHI, Kenji OHATA, Yoshimi MATSUOKA ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 460-462
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    Precise placement of a ventricular catheter is important to prevent shunt dysfunction. A new and simple method for shunt placement using a neuroendoscope with a small diameter (1.2mm) has been described. This might be an optimum and simple method for placement of a ventricular catheter.
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  • Toshihiko NAKASHIMA, Masahiro FURUICHI, Jouji KOKUZAWA, Haruki YAMAKAW ...
    Article type: Article
    1998 Volume 7 Issue 7 Pages 463-465
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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    A case of subarachnoid hemorrhage (SAH) resulting from a dissecting aneurysm of the internal carotid artery is reported. A 51-year-old woman suffering from a sudden loss of consciousness was admitted to our hospital in a stuporous state. Computed tomography revealed a diffuse SAH at the basal cistern. Cerebral angiography detected no aneurysm other than a small protuberance at the orgin of the A2 segment of the left anterior cerebral artery. However, on left frontotemporal carniotomy, the arterial wall of the origin of the A2 segment appeared normal and, unexpectedly, a fusiform enlargement with a subadventitial hematoma was observed at the C1-C2 segment of the right internal carotid artery. On the basis of the angiogram and operative view, a dissecting internal carotid artery aneurysm was suggested as the cause of the SAH. The enlarged portion of the carotid artery was wrapped with cotton sheet and the postperative course was uneventful until the patient developed a comaproducing SAH 16 days after surgery. Cerebral angiography at this time revealed aneuysmal dilation, suggesting the formation of a pseudolumen, at the C1-C2 segment of the right internal carotid artery. After conservative therapy for the subsequent 16 days, the dissecting aneurysm was successfully terated by proximal occlusion of the right internal carotid artery with a detachable balloon. Although dissection of the internal carotid artery resulting in arterial stenosis or occlusion has been regarded as a cause of inchemic stroke in youth, only four cases of a dissecting internal carotid aneurysm producing SAH have been previously described.
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 466-
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 467-
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 468-
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 468-
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 469-472
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 473-
    Published: July 20, 1998
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  • Article type: Appendix
    1998 Volume 7 Issue 7 Pages 474-
    Published: July 20, 1998
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  • Article type: Cover
    1998 Volume 7 Issue 7 Pages Cover30-
    Published: July 20, 1998
    Released on J-STAGE: June 02, 2017
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