Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 9 , Issue 1
Showing 1-24 articles out of 24 articles from the selected issue
  • Type: Cover
    2000 Volume 9 Issue 1 Pages Cover1-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Cover
    2000 Volume 9 Issue 1 Pages Cover2-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Index
    2000 Volume 9 Issue 1 Pages 1-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 2-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Masami Shimoda, Shinri Oda, Jiro Tominaga, Mamoru Kittaka, Akira Kumas ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 3-9
    Published: January 20, 2000
    Released: June 02, 2017
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    To evaluate therapeutic strategies for patients with aneurysmal subarachnoid hemorrhage (SAH) who rebleed in the early stage (within 72 hours of initial SAH), we performed early surgery within 6 hours after onset of rebleeding in these patients and retrospectively investigated clinical results by multiple logistic regression analysis to determine prognostic factors and define indications for emergent craniotomy in SAH patients with early rebleeding. Overall, only 18% of patients with rebleeding at various intervals (18/100) had favorable outcomes, and mortality was 68%. Among 35 patients, who underwent obliteration of the aneurysmal neck within 6 hours following occurrence of rebleeding in the first 3 days, favorable outcomes occurred in 14 (40%), while 15 died (43%). By multivariate analysis, variables significantly associated with favorable outcome in SAH patients who underwent immediate craniotomy after acute-phase rebleeding included absence of a packed intraventricular clot on CT scan after rebleeding ; a World Federation of Neurological Surgeons (WFNS) grade of I to III before rebleeding ; and an unimpaired light reflex after rebleeding. We found that the outcome in SAH patients with rebleeding is not always dismal, and that aggressive management including prompt surgical obliteration of the aneurysm can benefit many patients if they are selected carefully according to their clinical condition before and after rebleeding.
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  • Hiroshi Kuba, Toshio Matsushima, Koichiro Matsukado, Yoshihiro Natori, ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 10-15
    Published: January 20, 2000
    Released: June 02, 2017
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    Intracranial epidermoid tumors show various patterns of extension in the cisterns. Especially, cerebellopontine angle (CPA) epidermoid tumors spread to the cerebellum and the brain stem. We classified epidermoid tumors in the posterior cranial fossa according to their location and extension into the cerebello-brain stem fissures, and analyzed a total of 22 patients with epidermoid tumors in the posterior cranial fossa treated during the past 15 years with regard to our classification and surgical approach. In 14 of the patients (63.6%), tumors were confined in the cerebellopontine and prepontine cisterns, all of which were subtotally removed using a lateral suboccipital approach. Tumors spread from the CPA to the cerebellomedullary fissure and the cerebellopontine fissure, or to the cerebellomesencephalic fissure and the cerebellopontine fissure in 2 of the patients respectively, both of which resulted in a partial removal using the lateral suboccipital approach. In 3 of the patients (13.6%), tumors extended from the CPA to the middle cranial fossa, all of which were subtotally removed using the pterional approach. With the lateral suboccipital approach, subtotal removal is possible in most of the CPA epidremoid tumors. However, with some CPA epidermoid tumors, such as those with the cerebello-brain stem fissure extensions, subtotal removal of the tumor with the lateral suboccipital approach is difficult. Other surgical approaches, such as the far lateral approach or the posterior transpetrosal approach, are necessary for tumors with these extension. Therefore it is important to select the most appropriate approach according to the tumors location and extension, in the surgery of epidermoid tumors in the posterior cranial fossa.
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  • Masahiro Kawanishi, Hiroshi Kajikawa, Kunio Yamamura, Akira Sugie, Eii ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 16-19
    Published: January 20, 2000
    Released: June 02, 2017
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    We reported a case that developed an intracerebral hemorrhage after superficial temporal artery-middle cerebral artery (STA-MCA) bypass for internal carotid artery (ICA) occlusion. A 61-year-old female exhibited repeated transient episodes of left motor weakness despite the best medical treatment. Angiography demonstrated complete occlusion of the right cervical ICA and 75% stenosis of the left intracranial ICA. Neither CT (computed tomography) nor MRI (magnetic resonance imaging) demonstrated any abnormal findings of the brain parenchyma. SPECT (single photon emission computed tomography) showed moderate reduction of the cerebral perfusion reserve capacity in the right ICA territory. STA-MCA bypass was performed to prevent ischemic attack due to hemodynamic insufficiency. Although no problems were observed concerning the intraoperative procedures or the control of blood pressure, postoperative CT showed an asymptomatic intracerebral hemorrhage in the right temporal lobe. While the cause of the intracerebral hemorrhage in this case was not determined, STA-MCA bypass is recommended more than 8 weeks after the last stroke under strict control of the blood pressure to prevent postoperative intracerebral hemorrhage.
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  • Kouji Fujita, Yutaka Naka, Yasuhiko Nishimura, yoshinari Nakamura, Nao ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 20-24
    Published: January 20, 2000
    Released: June 02, 2017
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    Neuroblastoma presenting after the infantile is rare. Ordinarily the skull tumor is initially found as the scalp mass before the intracranial symptoms. We report a young adolescent case of secondary skull neuroblastoma presenting with the intracranial hypertension before forming the scalp mass. A 15-year-old boy was admitted complaining of headache and diplopia. On admission, he had bilateral abducens nerve palsies and papilledema. CT scans and MR images showed the multiple epidural and subperiosteal masses with the contrast enhancement. Cerebral angiograms revealed the occipital epidural mass compressing the superior sagittal sinus. After admission, these multiple masses were enlarged progressively and his neurological symptoms got worse. The largest tumor on the right parietal region were removed. They developed out of the bone into the epidural and subperiosteal spaces but not infiltrating over the adjacent sutural edge, periosteum and dura mater. The histological diagnosis was neuroblastoma. Later a small primary focus was revealed in the retroperitoneum. The skull tumor involving the multiple epidural spaces, compressing the brain substance and the venous sinus, can initially produce the clinical evidence of the intracranial hypertension before forming the scalp mass. Neuroblastoma should be considered as multiple skull tumors in adolescence.
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  • Hideki Sakai, Nobuyuki Sakai, Naoki Hayashi, Toshio Higashi, Joji Koku ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 25-29
    Published: January 20, 2000
    Released: June 02, 2017
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    A 74-year-old male presented mild left hemiparesis due to multiple lacunar infarctions associated with bilateral carotid stenosis (left ; 80%, right ; 90%). After admission to our hospital he exhibited crescendo transient ischemic attacks and developed disorientation. MR diffusion-weighted imaging (DWI) before surgical treatment showed recent multiple embolisms in bilateral cerebral and right cerebellar hemispheres. Emergent stenting for the carotid stenosis was performed using a Palmaz stent. DWI the day after carotid stenting demonstrated cerebral embolisms that newly occurred just before and during the intervention, distinguishing recent ischemic lesions from previous ones. It was difficult to discriminate between acute embolisms and subacute ischemic lesions by CT and/or conventional MRI studies. Since no additional ischemic lesions were observed by DWI 8 and 16 days following the intervention, carotid stenting was considered effective to prevent cerebral embolisms that arose from the senotic lesion. Thus, DWI in the peri-operative period is useful to evaluate the benefits and ischemic complications of carotid stenting.
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  • Masayuki Sasoh, Takaaki Beppu, Tsukasa Wada, Yuki Yoshida, Kazuyuki Mi ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 30-34
    Published: January 20, 2000
    Released: June 02, 2017
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    The patient was a 25-year-old female who only had a sudden headache. The CT and MR images suggested a hematoma due to a rupture of cavernous angioma in the right caudate nucleus. The MR images with gadolinium and angiography demonstrated an abnormal vein in the vicinity of the hematoma, suggesting a venous malformation. A surgical treatment was carried out using the transcallosal approach. Intraoperatively, we found numerous capillary vessels existed between the hematoma and extending vein, suggested a venous malformation, surrounding the hematoma. The capillary vessels were severed, and then the hematoma was completely removal, but the extending vein retained. Postoperatively, there was no neurological or physical deficit. A thorough investigation of the hematoma led to a histological diagnosis a cavernous angioma. The pathological condition in this case was identified as a mixed cerebrovascular malformation, which consisted of venous malformation and cavernous angioma. In this paper, we reviewed clinical features of 21 mixed cerebrovascular malformation cases including the present case.
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 34-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Atsushi Fujita, Masahiro Asada, Minoru Saitoh, Hidemi Nakamura, Mitsug ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 35-43
    Published: January 20, 2000
    Released: June 02, 2017
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    We present a case of a malignant meningioma associated with a middle cerebral artery aneurysm. Although there have been some reports regarding meningiomas associated with cerebral aneurysms, few have described malignant meningiomas with cerebral aneurysms. We review 55 reported cases and discuss the management of these coexisting lesions. A 51-year-old woman presented with several months history of headache and slowly progressive right-sided hemiparesis. She was admitted to our hospital because of the disturbance of consciousness and right-sided hemiparesis. Radiological examinations showed a giant mass at the right middle fossa and an ipsilateral middle cerebral artery aneurysm. Both lesions were successfully treated simultaneously by a single craniotomy. The patient was discharged without neurological deficits except for left oculomotor palsy. We reviewed a total 56 cases of meningiomas associated with cerebral aneurysms. The patients ages ranged from 7 to 75 years with a mean of 50.5 years, while the male to female ratio was 16:40. In 78.6% of these cases, initial symptoms were attributed to tumors. The incidence of the olfactory groove (17.9%) meningiomas with cerebral aneurysms was significantly higher than that of meningiomas without aneurysms. Most of the tumors were located at the skull base, and very rarely at the posterior fossa (48.2%, 7.1%, respectively). The significantly higher incidence of cerebral aneurysms was in the internal carotid artery (35.7%). The incidence of multiple lesions was relatively high in both meningiomas and cerebral aneurysms ; however, rare cases showed the coexistence of multiple meningiomas and cerebral aneurysms. Histological review indicated that the most common tumor was meningotheliomatous meningioma (32.3%), while malignant meningioma was very rare (6.5%). Postoperative rupture or rebleeding of cerebral aneurysms are noted in 4 of 16 untreated cerebral aneurysms. Because of the high incidence of aneurysmal rupture from untreated aneurysms, simultaneous surgical treatment of these lesions, if possible, is recommended.
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 43-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Shigeki Imaizumi, Kenji Owada, Takehide Onuma, Hideyuki Kamii, Takehik ...
    Type: Article
    2000 Volume 9 Issue 1 Pages 44-47
    Published: January 20, 2000
    Released: June 02, 2017
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    Hydroxyapatite ceramics (HAC) have not caused any foreign body reactions in clinical cases due to its high affinity to bone. A 45-year-old male underwent surgery for parietooccipital parasagittal meningioma. After total removal, LYODURA^[○!R] (10×12cm) was used as a substitutive dura mater, and bone cement CEMEX^<TM> was used instead of the removed bone flap since they had been invaded by a tumor. Subcutaneal effusion appeared 4 months later. HAC-made bone-plate (10×8cm) was set after removal of the CEMEX^<TM> bone-plate. Nevertheless, distinctive epidural-subcutaneal effusion reappeared 1 month later. The 3rd operation was performed to remove the HAC bone-plate after 2 more months. Clear effusion (120ml) was pooling. No leakage of cerebrospinal fluid throught substitutive dura was seen. The effusion was thought to be derived from foreign body reaction because there was no sugar in the constituent. When a skull defect is wide, previous use of bone cement may produce fluid collection even in HAC applied cases.
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  • Ryuta Saito, Kiyotaka Sato, Masato Kato, Takashi Yoshimoto
    Type: Article
    2000 Volume 9 Issue 1 Pages 48-51
    Published: January 20, 2000
    Released: June 02, 2017
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    Lactate is known to accumulate when systemic circulation is insufficient. We assessed the state of systemic circulation from this point of view in 154 neurosurgical cases. Among these cases 54 subjects had ruptured aneurysms, and 100 had other conditions. After the induction of general anesthesia, blood lactate levels were assessed from arterial blood. In some cases, jugular blood was also sampled simultaneously. There was no difference between lactate in arterial and in jugular blood. Arterial lactate levels tended to be higher in cases with ruptured aneurysms (2.5±1.5mmol/l ; mean±S.D.) and with intracerebral hemorrhage (2.0±1.2mmol/l). Arterial lactate in patients with ruptured aneurysms was statistically higher than that in cases with unruptured aneurysms (p<0.05), brain tumor (p<0.05), and spinal diseases (p<0.01). The arterial lactate in cases of emergent operation (2.3±1.4mmol/l) was higher than that of scheduled operation (1.3±0.6mmol/l)(p<0.01). In cases of subarachnoid hemorrhage, arterial lactate was higher in cases operated on within 24 hours (2.9±1.4mmol/l) than cases operated on later (2.2±1.1mmol/l), although the difference was not statistically significant (p=0.05). No correlation was found between arterial lactate levels and Hunt & Kosnik grade (rs=0.228). These results suggest that in neurosurgically emergent patients, especially those with ruptured aneurysm, there will be some unbalance between systemic oxygen supply and demand.
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 52-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 53-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 54-55
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 56-57
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 58-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 59-62
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 63-
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 1 Pages 64-65
    Published: January 20, 2000
    Released: June 02, 2017
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  • Type: Cover
    2000 Volume 9 Issue 1 Pages Cover3-
    Published: January 20, 2000
    Released: June 02, 2017
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