Japanese Journal of Neurosurgery
Online ISSN : 2187-3100
Print ISSN : 0917-950X
ISSN-L : 0917-950X
Volume 9 , Issue 2
Showing 1-23 articles out of 23 articles from the selected issue
  • Type: Cover
    2000 Volume 9 Issue 2 Pages Cover13-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Cover
    2000 Volume 9 Issue 2 Pages Cover14-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Index
    2000 Volume 9 Issue 2 Pages 67-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 68-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Nobuya Okami, Hiroshi Ujiie, Hiroto Kawasaki, Takakazu Kawamata, Tomok ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 69-74
    Published: February 20, 2000
    Released: June 02, 2017
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    Monitoring and management of intracranial pressure(ICP)are essential to modern neurosugery. ICP monitoring is beneficial in guiding the use of potentially harmful treatments such as mannitol, hyperventilation, barbiturate coma, and hypothermia. Many investigators have reported on the accuracy and reliability of ICP monitoring in the detection of cerebral herniation in the initial stage. The authors used an ICP monitoring system to detect postoperative hemorrhages in 85 patients with cerebrovascular diseases, including subarachnoid hemorrhage(SAH), intracranial hemorrhage(ICH), and arteriovenous malformation(AVM). Within 24 hours after surgery, the average ICP of 83 patients gradually rose and was lower than 10.7±8.2mmHg. In 2 patients who had postoperative bleeding ICP sharply increased by more than 30 mmHg. The first case was a 45-year-old male with a massive intracerebral hematoma(80×65mm in diameter)due to a ruptured aneurysm(Hunt & Kosnik grade V). The patient underwent removal of the hematoma without angiography and clipping of the aneurysm was immediately carried out. Although ICP monitoring demonstrated less than 5mmHg 6 hours following the operation, ICP rapidly soon thereafter exceeded 30mmHg. An emergency CT scan revealed postoperative hemorrhage. The second case was a 33-year-old male with a huge AVM in the left occipital lobe. On the way to the intensive care unit after surgical removal of AVM, ICP was 25mmHg. Then postoperative hemorrhage was veified on emergency CT scans. The present study demonstrates that a rapid increase of ICP by more than 25mmHg in the early stages after surgery indicates postoperative hemorrhage. We concluded that continuous ICP monitoring after surgery is a reliable method to salvage the patient before a critical condition due to postoperative hemorrhage occurs.
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 74-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Hirohiko Arimoto, Takahito Miyazawa, Toshiki Shirotani, Hiroshi Katoh, ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 75-80
    Published: February 20, 2000
    Released: June 02, 2017
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    Interval changes in the diameter of cerebral arteries were studied in 9 cases of Moyamoya disease(4 children, 5 adults)by means of retrospective quantitative measurement of cerebral angiographical films. The initial clinical symptoms were hemorrhage in 3 cases and ischemia in 6 cases. The index of angiographic changes was obtained as follows. The diameters of the anterior cerebral artery(A1), middle cerebral artery(M1), maxillary artery(Max), and superficial temporal artery(STA)were divided by that of the ipsilateral internal carotid artery(ICA). The indices were compared between child-onset cases(COC)and adult-onset cases(AOC), and between ischemic-onset cases(IOC)and hemorrhagic-onset cases(HOC). In the non-operated sides, the diameter indices of the A1 and M1 decreased progressively in IOC, but did not decrease remarkably in HOC. There was no significant difference between COC and AOC. The diameter indices of the STA and Max were decreased in ischemic AOC, but not in ischemic COC. Thus, quantitative analysis using angiography distinctly reveals the natural progression of Moyamoya disease. In the operated sides, the diameter index of the M1 decreased progressively in both COC and AOC, while those of the STA and Max increased remarkably only in COC regardless of ischemic and hemorrhagic onset. This finding demonstrated that indirect revascularization is more effective in COC than in AOC. Consequently, it is useful to take advantage of past angiographical films by quantitavely estimating them during the follow-up of Moyamoya disease and by comparing findings with those of follow-up MRI and MRA.
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  • Masahiro Kawanishi, Hiroshi Kajikawa, Kunio Yamamura, Akira Sugie, Eii ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 81-85
    Published: February 20, 2000
    Released: June 02, 2017
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    A case of penetrating brain injury by a nail-gun at the site of the occipital midline region is reported. A 57-year-old male was urgently transported to our hospital due to a penetrating head injury due to a nail-gun accident. On admission the nail-head was seen at the occipital midline region. The patient was conscious and alert and he showed no focal neurological signs. Plain craniography, CT and 3 dimensional-CT revealed that the nail penetrated the skull at the sagittal suture in the occipital midline. Cerebeal angiography did not show any particular findings strongly suggesting an injured superior sagittal sinus. As the possibility of injuries to this sinus could not be ruled out the nail was carefully extracted by craniotomy. The prognosis of penetrating brain injury by nail is mainly dependent on major vascular injury, infection and traumatic aneurysm, so meticulous preoperative examination and surgical exploration prior to the removal of the nail are mandatory.
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 85-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Atsushi Fujita, Masahiro Asada, Minoru Saitoh, Hidemi Nakamura, Hirofu ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 86-91
    Published: February 20, 2000
    Released: June 02, 2017
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    Because the congenital arteriovenous malformation(AVM)of the scalp is rare, the treatment of this lesion has still been controversial. Although a few examples of interventional embolization with various embolic materials for this lesion have been reported, the surgical excision has been the most popular for curative treatment. During surgery, an aggressive excision of the malformation from the adjacent scalp causes the wall of wound to heal, but it can also result in skin necrosis and bleeding into the scalp. The devascularization of the wound can cause these complications postoperatively. We present a case of congenital AVM of the scalp treated with rotation scalp flap without these complications. The patient was a 14-year-old boy with a pulsatile scalp mass at the right parietal region. He had no history of trauma. Radiological examination showed an AVM of the scalp fed by the right superficial temporal artery, the posterior auricular artery and the occipital artery. Surgical resection of the malformation and reconstructive closure of the scalp defect, using rotation flap, were performed. The postoperative course was uneventful and the patient was discharged without skin necrosis or cicatricial alopecia. The goal of the treatment for this lesion is the total excision of malformations without any deforming scar. If the AVM of the scalp is not very large, we recommend the en bloc resection of the scalp with the AVM and closure of the scalp defect by using rotation flap, as the best method of treatment.
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  • Taku Shigeno, Masamichi Atsuchi, Jun-ichi Tanaka, Kazuhiko Ishii, Sato ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 92-100
    Published: February 20, 2000
    Released: June 02, 2017
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    A key principle for safe and reliable surgery is to provide ample working space as if operating in a shallow basin. Even for deep seated aneurysms located in a previously thought difficult positions, safe surgery is possible by carefully looking at all of the structures around the aneurysm. For this purpose, use of the skull base technique is essential. We present surgery of either high-positioned or large basilar top aneurysms, employing the so-called extradural temporopolar approach. By freeing the C2-C3 portion of the internal carotid artery, basically via the extracavernous route, full mobilization of the internal carotid artery was obtained. The aneurysm neck was approached easily ; either medial or lateral to the carotid artery. Because the posterior communicating artery was located very distal in this approach, severance of the artery was not necessary. Following a step-by-step strategy, this technique can be performed by surgeons without advanced neurosurgical skills. This extracural temporopolar approach was also useful for an internal carotid aneurysm at the carotid ring. By contrast, in a case of a basilar artery-superior cerebellar artery aneurysm operated via conventional pterional approach, manipulation through the narrow space between the internal carotid artery and oculomotor nerve caused a tear in the internal carotid artery due to direct retraction. The extradural temporopolar approach if employed in this case would not have caused such disaster. Details of these cases are discussed.
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  • Yoshinori Terai, Noboru Kusaka, Minoru Nakagawa, Kimihiro Yoshino, Shu ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 101-109
    Published: February 20, 2000
    Released: June 02, 2017
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    Recently, the embolization of cerebral aneurysms using Guglielmi detachable coils(GDCs)has become the choice of treatment not only for aneurysms presenting a high surgical risk but also for furgically clippable aneurysms. Therefore, thrombo-embolic complications associated with embolization should be greatly reduced, however, few reports concerning the optimal anticoagulation therapy during and after the procedure have been made. We experienced a case of unruptured intracavernous internal carotid artrery(ICA)aneurysm demonstrating carotid cavernous fistula(CCF)on follow-up angiography after embolization with GDCs. A 64-year-old woman was admitted to our hospital for embolization of an incidentally found intracavernous ICA aneurysm. Embolization was performed with four GDCs and over 90% of the aneurysm was embolized under systemic heparinization without any complications. During and after the procedure activated clotting time(ACT)was maintained at a level 1.4 to 2.5 times the initial level. A day after embolization, ACT was maintained at a level 1.5 times longer than the initial level, however, activated partial thromboplastin time was excessively longer than the baseline. Follow-up angiography was performed the day after the initial procedure. The residual dome and neck of the aneurysm was still opacified with contrast material and arteriovenous shunt from the dome to the cavernous sinus was seen. This shunt was low-flow and asymptomatic, however, it seemed direct CCF. Accordingly, the anticoagulation therapy was discontinued. The patient was still asymptomatic and follow-up angiography was performed 11 days after the initial embolization. Minimum residual lumen was ween, however, the arteriovenous shunt had disappered. Re-embolization using additional four GDCs was performed six months after the initial procedure because of coil compaction. Mild systemic heparinization during embolization and low dose heparin therapy after the procedure yielded no complizations. In conclusion, our case suggests that excessive anticoagulation therapy may be hazardous even for GDC embolization of unruptured aneurysms. Appropriate anticoagulation therapy for various conditions should be further investigated.
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  • Yasushi Takabatake, Yoshie Okada, Eiichi Uno, Kouichi Wakamatsu, Takur ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 110-114
    Published: February 20, 2000
    Released: June 02, 2017
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    A case of thyroid papillary carcinoma initially appearing as the multiple brain metastases was reported. A 53-year-old male suffered from drowsiness and left homonymous hemianopsia. Physical examination revealed swelling of the neck lymph nodes. A brain computerized tomographic scan revealed an isodensity mass with marked brain edema in the right parietal lobe. The margin of the mass was enhanced by contrast medium. Magnetic resonance imaging showed a ring enhanced mass with subacute hematoma surrounded by brain edema. Two small tumors were also seen in both the left and right frontal lobes. A total resection was done. The tumor was reddish in color with subacute hematoma and the margin was clear. Histopathological diagnosis was metastatic papillary carcinoma from the thyroid gland. After a total resection of the thyroid gland and dissection of the neck lymph nodes, he was discharged without any neurological deficits. Brain metastases from thyroid carcinoma are rare, especially, in papillary carcinoma. Moreover, the case of a thyroid papillary carcinoma initially appearing as a brain metastasis is extremely rare. Only 3 cases have been reported.
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  • Kazuki Hosoi, Hiroshi Tomita, Norihiko Tamaki
    Type: Article
    2000 Volume 9 Issue 2 Pages 115-119
    Published: February 20, 2000
    Released: June 02, 2017
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    A 35-year-old woman was admitted to our hospital with headache, numbness of her left side arm and left side hemiparesis. CT scans showed a low density area in the right frontoparietal region and a swelling of the optic chiasm. A contrast enhanced MRI showed right subdural and chiasmatic mass lesions. Removal of the right subdural lesion was performed to obtain biopsy specimens and reduce the mass. The biopsy specimen revealed neurosarcoidosis. The mass lesion was reduced in size with administration of a corticosteroid. Sarcoid granuloma infiltrates vessels. Cerebral infarction, however, secondary to subdural neurosarcoidosis is rare. Contrast enhanced MRI is useful in evaluating neurosarcoidosis located to subdural space or basal cisterns.
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  • Hideyuki Yoshizumi, Sen Yamagata, Yasunobu Goto, Ken-ichiro Kikuta, Ya ...
    Type: Article
    2000 Volume 9 Issue 2 Pages 120-124
    Published: February 20, 2000
    Released: June 02, 2017
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    We report a case, where, during a routine follow-up, an epidermoid tumor was found to have undergone a malignant transformation. A 70-year-old male developed double vision in March, 1995. A CT scan showed a small, iso-dense mass with a small high-density spot in the right prepontine cistern. Two years later, a follow-up CT scan revealed an inhomogeneously enhancing mass in the right cerebello-pontine angle. A histological diagnosis of this enhancing mass was malignant epidermoid. This case suggests that it is possible for an epidermoid to transform into a malignant carcinoma. Rediological characteristics of this epidermoid tumor are presented and discussed.
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 125-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 126-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 127-128
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 129-130
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 131-134
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 135-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Appendix
    2000 Volume 9 Issue 2 Pages 136-
    Published: February 20, 2000
    Released: June 02, 2017
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  • Type: Cover
    2000 Volume 9 Issue 2 Pages Cover15-
    Published: February 20, 2000
    Released: June 02, 2017
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