Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 17pt2, Issue 4
Displaying 1-10 of 10 articles from this issue
  • —2 Acute Epidural Hematoma—
    1977 Volume 17pt2 Issue 4 Pages 279-286
    Published: 1977
    Released on J-STAGE: December 28, 2006
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    1977 Volume 17pt2 Issue 4 Pages 287-293
    Published: 1977
    Released on J-STAGE: December 28, 2006
    Normal anatomy of the anterior cerebral vein is briefly described. In angiography the anterior cerebral vein indicates the position of the lamina terminalis just above the optic chiasm. In cases of intrasellar masses with suprasellar extension the anterior cerebral vein is elevated and indicates the superior margin of the tumor. In highly vascular frontal tumor the anterior cerebral vein is hypertrophic and serves as a drainer of the tumor. In choroid plexus papilloma of the third ventricle the anterior cerebral vein is depressed and anteriorly displaced. This indicates dilatation of the third ventricle. Usefulness of the anterior cerebral vein in diagnosing suprasellar extension of intrasellar masses is stressed.
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    1977 Volume 17pt2 Issue 4 Pages 295-303
    Published: 1977
    Released on J-STAGE: December 28, 2006
    The patterns of symptoms exhibited by a total of 48 cases of basal meningiomas were studied. The cases included 21 male and 27 female patients. The youngest subject was a boy of 11 and the oldest was a 72 year-old man. Distribution of tumor site were 7 in the olfactory groove, 12 in the suprasellar region, 18 in the sphenoid ridge, 3 in the base of the middle fossa, 8 in the posterior fossa, the last including only those that had attachment at the skull base. Operative grades I, II, III, IV and V (according to Simpson's grading) were applied to 1, 13, 15, 17 and 2 cases respectively. Histological findings of the resected tumors were 39 meningothelial, 6 fibrous and 3 angioblastic. Recurrence was observed in 16 cases out of 48 (33.3%). The site of 16 recurrences were 1 olfactory groove, 4 suprasellar region, 6 sphenoid ridge, 2 base of the middle fossa and 3 posterior fossa. The preoperative and post-operative symptom patterns were comparatively studied from the aspects of clinical symptoms, neuroradiological findings and operative findings.
    The tumors were classified into three types according to its growth pattern. A type: mainly in the intracranial cavity, B type: mainly in the skull, and C type: the mixture of the two. All of the seven cases of tumor in the olfactory groove belonged to the A type. A single recurrent case belonging to this group, however, was found to be the B type in a second operation. The twelve suprasellar tumors were first classified as eleven A types and one C type. All of the four recurrences from this group belonged to the A type at the time of the first operation. At the time of recurrence, however, they were distinguished as three A types and one C type. The eighteen sphenoid ridge tumors were first classified as nine A types, one B type and eight C types. The six recurrences were one A type, two B types and three C types at time of the first operation, but later found to be one A type, one B type and four C types. The three tumors at the base of the middle fossa were equaly distributed among the A, B and C types at the first operation, however, the two recurrences were one each of B type and C type. The eight posterior fossa tumors were first classified as two A types, two B types and four C types at the first operation. All the three recurrences belonged to the C type but on a closer look the intracranial proliferation was greater compared to the penetration into the bone tissue.
    The clinical symptoms can be summarized as follows. Multiple cranial nerve lesions and growth of intraosseous tissue were more frequent in the sphenoid ridge meningiomas, while recurrence as intracranial mass indicating increased CSF pressure was more frequent more in the posterior fossa. Nasal liquorrhae was observed in two of the recurrences of which one was in the olfactory groove. For the latter, nasal liquorrhae was the initial symptom of recurrence. Visual disturbance was mostly indicated in tumors in the suprasellar resion and the sphenoid ridge, and the post-operative exacerbation was rapid in the recurrent cases.
    Follow-up results of the 48 basal meningiomas in the postoperative periods of 8 months to 14 years were: 4 excellent (8.3%), 12 good (25.1%), 7 fair (14.5%), 6 poor (12.5%), 13 deaths (27.1%) and lost 6 (12.5%), The 16 recurrences were 3 good, 7 fair and poor inclusive, and 6 deaths.
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    1977 Volume 17pt2 Issue 4 Pages 305-312
    Published: 1977
    Released on J-STAGE: December 28, 2006
    Intraventricular septations complicating meningitis, ventriculitis and brain abscess in infants and children remain extremely difficult therapeutic problem. Successful treatment in the intraventricular septations have been scarcely described in previous papers.
    Six cases of the intraventricular septations, which we have experienced for the past 8 years, are reviewed. Ventriculoperitoneal shunts were performed in all cases. In cases 1, 2 and 3, a solitary septum was demonstrated in the right temporal horn, enclosing a fluid-filled cavity that resembled a mass. This isolated cyst was fenestrated to another CSF cavity. In cases 4, 5 and 6, multiple septations were disclosed in both lateral ventricles. Multiple septums were opened in cases 4 and 5. Case 6 died the second day after bilateral shunting procedures. Four of the five survivors have serious neurological deficits.
    It makes difficult the treatment that these post-inflammatory septations compartmentalize the ventricular system, and interfere with attempted shunting procedures. Therefore, in the treatment of intraventricular septations, the opening of multiple septums or the fenestration of an isolated cavity to another CSF cavity should be performed with the combination of shunting procedures. In our series, the case with a single septum in the ventricular system, in comparison with multiple septums, was easily treated and had a good result. These intraventricular septations should be suspected with the presence of the increased intracranial pressure, the deformity of head or focal neurological signs, in spite of the treatment of post-meningitic hydrocephalus. The early diagnosis by angiogram or ventriculogram leads a proper treatment and a good result.
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    1977 Volume 17pt2 Issue 4 Pages 313-326
    Published: 1977
    Released on J-STAGE: December 28, 2006
    1. Basilar artery vasospasm was induced in cats by mechanical stimulation and application of fresh arterial blood, lysed platelets in saline and blood-CSF mixture incubated at 37°C for 5 to 10 days. Following the observation of sequential changes of the caliber, the basilar arteries were fixed and extirpated, and distributions and conditions of the nerves in the vessel wall were electron-microscopically studied.
    2. In the group with fresh arterial blood and lysed platelets in saline, the severity of induced vaso-constriction was light and the duration was short. Mechanical stimulation induced very short-term vaso-constriction. On the other hand, mixture incubated for 5 to 10 days induced severe and prolonged vaso-constriction.
    3. In the investigation of nerve endings, small cored vesicles were transformed, decreased and disappeared gradually in the course of time after the development of vasospasm induced with mixture incubated for 5 to 10 days, but these changes were not observed in the group with fresh arterial blood, laysed platelets in saline and mechanical stimulation.
    4. In the group with mixture incubated for 5 to 10 days, the relationship between the degree of vasospasm and the nerve distribution was investigated. In the portion with severe vasospasm, the nerve distribution was very rich in the most inner area of the adventitia, within 10 μ from the outer edge of the media. On the contrary, in the same area of the arterial segment with slight vasospasm the nerves were extremely scanty, and they were seen only in the more outer area of the adventitia. This relation was clear in the animals with segmental vasospasm.
    5. Basilar artery vasospasm were induced by the blood-CSF mixture incubated for 7 days on the 7th days after the bilateral superior cervical ganglionectomy and perivascular sympathectomy of the cervical carotid arteries. Vasospasm was not suppressed completely but the severity of constriction was definitely lighter and the duration was shorter than the cases without sympathectomy.
    6. These findings show that the nerves especially the adrenergic axon in the most inner area of the adventitia may play an important role on the genesis of late vasospasm, and this difference of the nerve distribution may participate in the individual difference in frequency or severity of vasospasm. On the other hand, function of adrenergic nerve is not so important on the genesis of early vasospasm.
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  • —Follow-up Study—
    1977 Volume 17pt2 Issue 4 Pages 327-333
    Published: 1977
    Released on J-STAGE: December 28, 2006
    Follow-up study of 50 cases with directly operated anterior communicating aneurysm was made, ranging from 6 months to 5 years and 6 months. Forty six cases were alive and the condition of all these cases was evaluated through questionnaires, and 42 cases of them were examined utilizing the WAIS and Y-G test.
    Four patients out of 46 cases showed decreased ADL and they needed help in their daily activity. About 60% of the cases have resumed full activity of previous occupation, although 68% of the 46 cases have complained of slight headache, forgetfullness and worries about their illness being never cured. The number of cases with the above complaints decreased markedly 2 years after surgery was performed.
    Verbal IQrecovered sooner than Performance IQobtained on WAIS, and the profile of recovery showed quite a resemblance in the repeated WAIS. Comparing pre and post-operative cases in short term the cause of the poor IQ at present study was considered due to subarachnoid hemorrhage itself rather than to surgical intervention.
    Poor preoperative condition, such as grade III, IV, of Hunt and Hess, showed delay in recovery. There was no definite evidence of disturbing IQrecovery by angiospasm, ventricular dilatation, direction of aneurysm etc., as far as preoperative grade I, and II groups were concerned.
    The ultimate evaluation of the patient in regard to social adaptability from IQ test required a 2 year period.
    Symptoms of so called normal pressure hydrocephalus due to subarachnoid hemorrhage showed sometimes remarkable recovery of the mental state after shunt operation, but in other cases, shunt procedure failed to show persistent effect and several patients showed good IQ in the follow-up study, although the shunt device lost patency in early stage of follow-up.
    Y-G test showed interesting fact that the cases of poor IQ, especially poor Performance IQ, assumed types of passive adaptability.
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    1977 Volume 17pt2 Issue 4 Pages 335-341
    Published: 1977
    Released on J-STAGE: December 28, 2006
    Many reports about psychiatric symptoms in cases with anterior communicating aneurysm were published, but there were few reports describing the correlation between postoperative appearance of psychiatric symptoms and surgical techniques, and those describing long-term follow-up results.
    We examined psychiatric symptoms in consecutive 95 patients with ruptured anterior communicating aneurysm before and after the operation. Thirty-eight out of 95 cases were operated on using microsurgical techniques.
    Before the operation, psychiatric changes were observed in 56 cases (59%) and those symptoms were mild in 30 cases, moderate in 10 cases and severe in 16 cases. A high frequency of moderate and severe changes was found in cases which had multiple bleeding episodes, those which had shown prolonged disturbance of consciousness, and those which had various neurological deficits after SAH.
    After the surgery, psychiatric symptoms were observed in 67 cases (71%), including 4 deaths after the operation and those changes were mild in 26 cases, moderate in 14 cases and severe in 22 cases. In the apperance of deteriorated psychiatric symptoms after the surgery, there was statistically significant difference (p<0.02) between macroscopical group (24 out of 57 cases) and microscopical group (7 out of 38 cases). In macroscopical group, a high frequency of psychiatric morbidity rate was found in cases with upward projection of aneurysm.
    In 87 cases, long-term follow-up (3 months to 9 years) were carried out and 11 deaths were found during foolow-up period. Psychiatric symptoms were observed in 26 cases out of 76 cases (34%) and those changes were mild in 14 cases, moderate in 7 cases and severe in 5 cases. There were 62 cases out of 76 cases (82%) returned to their former social life. There was obvious positive correlation between psychiatric symptoms after surgery and those at long-term follow-up.
    Vasospasm and injury of anterior cerebral arteries and fine perforating arteries at SAH and during the operation were considered responsible in producing psychiatric symptoms in cases with anterior communicating aneurysm. Microsurgical techniques were necessary to prevent those changes during operation.
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  • —Clinical Review of Cases Admitted within 24 hours after the Attack and Postmortem Study of the Acute Death—
    1977 Volume 17pt2 Issue 4 Pages 343-349
    Published: 1977
    Released on J-STAGE: December 28, 2006
    During the past three years, we admitted 326 cases of cerebro-vascular disease which included 109 cases of intracranial hematoma and 67 cases of ruptured intracranial aneurysm. Of those aneurysm cases, 36 cases were admitted in acute stage or within 24 hours after the attack. On admission, 27 cases of them showed severe disturbance of consciousness with the grade of 4 or 5. 12 cases died in acute stage and 11 cases of them were autopsied. On postmortem examination all of them showed severe primary cerebral damage and massive subarachnoid or intracerebral hemorrhage. The extension of subarachnoid and intracerebral hematoma depended upon the location of the aneurysm and the direction of its dome. Among 11 autopsy cases 8 cases had massive subarachnoid hematoma and 8 cases had intracerebral hematoma. 6 cases of them had associated ventricular perforation.
    Though it was difficult to clarify the mechanism of the acute death, the following conditions seemed to be contributing; massive subarachnoid hematoma in basal cistern surrounded the brain stem and constricted it. The basal artery was streched and separated from the brain stem. Ventricular perforation often caused early tentorial herniation and developed secondary midbrain hemorrhage.
    There would be still considerable cases in which if they were admitted in the early stage after the attack and had the hematoma removed, they could be rescued with satisfactory function. In our series of acute cases, one third of them was succeeded to return to the social life.
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    1977 Volume 17pt2 Issue 4 Pages 351-360
    Published: 1977
    Released on J-STAGE: December 28, 2006
    Since 1972 authors have carried out direct operations on 16 cases of the basilar artery aneurysms and on 8 cases of the vertebral artery aneurysms. 22 cases (92%) could work and lead normal family lives postoperatively. There were two postoperative deaths. They were operated upon on the 4th and 5th day respectively after subarachnoid hemorrhage. In 5 cases of the basilar artery aneurysm the operations were carried out by the subtemporal approach and in 11 subsequent cases: the transsylvian approach were chosen. Generally the transsylvian approach had more advantages than the subtemporal approach in our experiences. Injury in the temporal lobe and the oculomotor nerve occured at less degree by the transsylvian approach. While the postoperative transient oculomotor nerve palsy occured in all cases of the subtemporal approach for the aneurysms of the basilar artery bifurcation, no such palsy was found in any case of the transsylvian approach even at the night of the surgery. The important maneuvours and some useful instruments for the surgery in the region were discussed.
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  • —Part II—
    1977 Volume 17pt2 Issue 4 Pages 361-369
    Published: 1977
    Released on J-STAGE: December 28, 2006
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