Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 18pt2, Issue 11
Displaying 1-10 of 10 articles from this issue
    1978 Volume 18pt2 Issue 11 Pages 795-802
    Published: 1978
    Released on J-STAGE: December 28, 2006
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    1978 Volume 18pt2 Issue 11 Pages 803-811
    Published: 1978
    Released on J-STAGE: December 28, 2006
    Meningiomas are known for their propensity to hemorrhage during surgery. When massive hemorrhaging occurs, exision of the tumor occasionally becomes difficult or incomplete. For this reason, it appeared to us that preoperative gelfoam embolization of the feeding vessels of meningiomas should facilitate surgery by abolishing or diminishing the risk of hemorrhage.
    The authors have undertaken embolization of 6 intracranial meningiomas which possessed predominant or exclusive external carotid vascularization. The cases included 2 male and 4 female patients. The age of the youngest was 42, and the oldest 64 yrs. The distribution of tumor sites was as follows: 2 in the convexity, 2 in the parasagittal region, 1 in the middle cranial fossa, and 1 in the tentoriurn. Histological examinations of the resected tumors revealed 5 to be meningothelial and 1 angioblastic.
    Cerebral catheterization by the retrograde transfemoral route was performed. The embolization in all 6 cases was effected with gelfoam, cut into fine strips.
    The delay between embolization and craniotomy varied between 1 day and 7 days, with a mean of 5.5 days.
    The results of embolization were evaluated on the basis of operative findings and the postoperative sequelae. In 2 cases (the 2 convexity meningiomas), the surgery (bone flap, section of the dural attachment and excision of the meningioma itself) was bloodless. In one of these convexity meningiomas, histological examinations of surgical specimens revealed fragments of gelfoam in the fine vessels within the capsule as well as the tumor tissue. In 2 cases (1 tentorial and 1 parasagittal), the surgery was minimally hemorrhagic, considering the volume and site of the tumor. In 1 case (the middle cranial fossa meningioma), preoperative embolization of the external carotid branches appeared to have a little effect. In this case, hemostasis of the dural attachment at the base of the middle cranial fossa was extremely difficult to maintain. This patient died 4 days after the operation.
    Complications related to the embolization were seen in 2 cases with transient pain in the temporal scalp region, and in 1 case with ischemic scalp complications.
    The findings of repeated CT scan after the embolization were useful for detecting possible changes within the tumor tissue itself.
    When performed as an integral part of the preoperative angiographic evaluation in case of meningiomas, careful embolization of the feeding vessels causes little increase in danger to the patient, while it clearly facilitates surgery by reducing the high risk of hemorrhage during the operative procedure.
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    1978 Volume 18pt2 Issue 11 Pages 813-820
    Published: 1978
    Released on J-STAGE: December 28, 2006
    It is said that cerebral angiospasm following rupture of cerebral aneurysm affects very seriously the prognosis whether or not surgical radical operation is performed. Of patients with ruptured aneurysm who died without undergoing surgical radical operation, we performed light microscopic, histopathological studies in 8 patients in whom the cause of death was cerebral ischemia due to cerebral angiospasm.
    The results were outlined as follows:
    1. Findings of infarction were observed in the cerebrum in all of the cases and were classified into 3 types; mild changes localized both in the gray and white matters, localized but intensive infarction in the gray matter, extensive infarction observed with stronger changes in the white matter than in the gray matter.
    2. Changes in the thalamus, hypothalamus, and basal ganglia were mild.
    3. No ischemic changes were observed in the brain stem, except for secondary hemorrhage due to tentorial herniation in the midbrain and upper pons.
    4. Changes of the intima and smooth muscle of the media were observed only in 2 cases.
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    1978 Volume 18pt2 Issue 11 Pages 821-829
    Published: 1978
    Released on J-STAGE: December 28, 2006
    The purpose of this report is to analyze the difference in occurence of massive gastrointestinal bleeding caused by severe brain damage between 125 cases treated preventively by antacid buffer (Maalox®) therapy and 387 cases without antacid treatment.
    The antacid buffer therapy consists of complete neutralization of gastric acid with antacid buffer (Maalox®). Maalox® is infused intermittently through the gastric tube and gastric juice was aspirated through the tube to maintain the pH of the aspirate at 7.0 during one week after the onset of the original disease. Among 125 patients, 43 cases were of traumatic intracerebral hematoma, 38 cases of ruptured aneurysm, and 44 cases of hypertensive intracerebral hematoma.
    In the group treated by antacid therapy only three cases developed the uncontrolable massive gastrointestinal bleeding; one of them had the bleeding following shock caused by severe infection, and in other 2 cases the pH of gastric juce could not be kept nutralized in spite of antacid buffer therapy. In 97 per cent of the group treated by antacid buffer therapy, massive gastrointestinal bleeding was prevented.
    On the other hand, 47 cases (12.1 %) out of 387 cases without antacid buffer therapy had massive gastric bleeding and died. In hypertensive intracerebral hematoma, 24.6% of them died because of massive gastric bleeding, and 12.8% of the cases of ruptured aneurysm and 8.2% of severe head injury had untreatable gastric bleeding within one week from the onset of original disease.
    For the prevention of massive gastrointestinal bleeding caused by severe brain damage following hypertensive cerebral hematoma, ruptured aneurysm and severe head injury, the antacid buffer therapy is effective reducing the occurence rate to less than 3 per cent. This result also suggests that the presence of gastric hydrochloric acid plays an important role in the development and perpetuation of gastrointestinal bleeding.
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    1978 Volume 18pt2 Issue 11 Pages 831-837
    Published: 1978
    Released on J-STAGE: December 28, 2006
    Histochemical examinations of the cerebral cortex of rats were performed using the Falck-Hillarp method, to observe an enzymatic blood-brain barrier mechanism of intracerebral capillary endothelium and a repairmechanism of damaged blood-brain barrier with glucocorticoids.
    After depletion of the endogenous monoamines with a large dose of reserpine, dopamine and trypan blue were given intraperitoneally to the three groups of rats; control group, cold injury group, and cold injury group treated with dexamethazone.
    In the control group, dopamine and trypan blue remained in the capillary lumen and had no penetration into the cerebral parenchyma.
    In the cold injury group, dopamine and trypan blue penetrated into cerebral parenchyma freely through the endothelium in the edematous regions. Dopamine was uptaken into neurons and astrocytes, and trypan blue penetrated into neuropil in the edematous regions.
    In the cold injury group treated with dexamethazone, dopamine was uptaken into the capillary endothelium in the edematous regions. Trypan blue was not found in the capillary endothelium.
    From these findings, it is concluded that the capillary endothelium loses an enzymatic barrier mechanism by the cold injury, but that dexamethazone restores the protective function of the capillary endothelium to dopaminepenetration into the cerebral parenchyma. It is suggested that dexamethazone activates an enzymatic reaction in the endothelium or produces a structural repair of the endothelial basement menbranes and astrocytic feet.
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    1978 Volume 18pt2 Issue 11 Pages 839-850
    Published: 1978
    Released on J-STAGE: December 28, 2006
    Computerized Tomography (CT) has acquired a preeminent position in the neuroradiological diagnosis and already played an important role in the neurosurgical practice. The interpretation of CT scans is commonly based on the CT images of cathode ray tube. However, CT essentially provides us the informations in digital form and stores them on the disc and/or the magnetic tape.
    The authors have attempted to analyse the data stored on the magnetic tape of EMI scanner (Model 1000) with another computer system (FACOM 230/45S) under three different programs, that is, histogram, profile and isometric display. The objects of analysis were data acquired from the contrast studies in histologically verified cases of intracranial tumors involving 61 cases of cerebral neoplasm and 9 cases of the other mass lesion. The results were as follows :
    1) When change of pre and post-contrast attenuation values were within 1.0±0.3 of EMI-number, the difference can be regarded as non-significant.
    2) Most of preferential tumors in the cerebral hemisphere, the cerebello-pontine angle and the parasellar region, have possessed characteristic attenuation values and revealed certain enhancement effects.
    3) The histographic and the isometric displays have expressed characteristic patterns of the tumor types particularly in the cases of malignant astrocytoma, meningioma, pituitary adenoma, and hemangioblastoma.
    4) To evaluate homogeneity of the tumor tissue, the authors have proposed an index for the convenience on the analysis of histogram. It has been able to discriminate the solid tumors from the cystic tumors and/or the necrotizing tissues by analyzing these indices.
    5) From the analysis of the profile display, different patterns of ring-like enhancement were recognized between the cases of malignant astrocytoma and metastatic carcinoma, and the cases of cerebral abscess and resolving hematoma. So it was supposed that different mechanism should exist in the mechanism of ringlike image formation in different diseases.
    From the above-described results, computer-assisted analysis of the EMI-number, in combination with the CRT images, could be greatfully contributory to differential diagnosis of the cerebral tumors in vivo. Moreover, it will be expected that these analytical methods could participate in further developments for the preoperative diagnosis of brain tumor in such a form of automatic diagnosis.
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    1978 Volume 18pt2 Issue 11 Pages 851-856
    Published: 1978
    Released on J-STAGE: December 28, 2006
    Three cases of bilateral basal ganglia calcification following radiation therapy for brain tumors were presented. In all of them the calcification was not seen on plain skull X-rays but only on CT scan. Case 1 was a 14 year-old boy who had a course of irradiation 5, 000 rads to the brain and 3, 300 rads to the spinal axis for cerebellar medulloblastoma at the age of 2 years. Case 2 was a 18 year-old girl who had a course of irradiation 5, 990 rads locally for craniopharyngioma at the age of 7 years. Case 3 was a 14 year-old girl who had a course of irradiation 5, 600 rads locally for suprasellar germinoma at the age of 9 years. The common features of these cases were: 1) radiation therapy was given for brain tumors in childhood, 2) more than 5 years had elapsed before calcification was seen, and 3) calcification was observed only on CT.
    Review of the literature revealed that 7 cases of similar calcification were previously reported. Slight disturbance of calcium metabolism was noted in both of our two cases who were examined in detail. It was suggested that subtle disturbance of calcium metabolism secondary to irradiation to the hypothalamus or directly to the parathyroid might play an important role in the pathogenesis of this disorder. It was expected that similar cases would increase keeping step with further improvement of CT machinery.
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  • —A Case Report—
    1978 Volume 18pt2 Issue 11 Pages 857-862
    Published: 1978
    Released on J-STAGE: December 28, 2006
    The authors report a case of intracerebral cavernous hemangioma diagnosed by cranial CT. A woman, aged 27, had suffered from Jacksonian epilepsy since 20 year of age. The seizure involved only the left hand at first but gradually deteriorated to general convulsion with unconsciousness and postictal left hemiparesis in the last two years.
    Neurological examination on admission revealed left fascial palsy, left hemiparesis and left paresthesia with increased left tendon reflex.
    Lumbar puncture shows clear CSF and normal pressure. Skull radiograms and brain scintigram revealed no abnormality. Right carotid angiograms revealed the avascular area and the stretched ascending branches of the middle cerebral artery in the parietal region. Surgery disclosed the subcortical demarcated dark red tumor, 3 cm in size, accompanied with hematoma. The tumor had no remarkable feeding arteries and draining veins. Histology comfirmed a cavernous hemangioma with thrombosis in multiple vascular spaces. Her postoperative course was uneventful.
    The authors discussed on the radiological findings of the intracerebral cavernous hemangioma especially those of angiography and CT scanning with a review of literatures.
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  • —Its Diagnosis and Treatment—
    1978 Volume 18pt2 Issue 11 Pages 863-871
    Published: 1978
    Released on J-STAGE: December 28, 2006
    Seven surgical cases of cavernous hemangioma (cavernoma) of the CNS was analysed. Of these cases, one was intracerebral (intraventricular), three extracerebral in the middle fossa, one intraspinal intramedullary (C4-6), and two intraspinal extradural (T4-6, T5-6). The age of the patient on admission ranged from 9 to 62 years, mostly over 40 years. The duration of the symptoms before admission ranged from 1.5 months to 11 years. Sudden onset of the illness suggesting a hemorrhage in or around the tumor was found in 2 cases. The signs and symptoms in all patients were divided into three groups, namely, those of increased intracranial pressure, of local compression, and of hemorrhage.
    The plain X-ray films revealed abnormalities in all but an intraspinal extradural case. RI scan was done in 2 intracranial cases showing a positive uptake in both cases. CT scan was done in a case of the middle fossa and revealed a slightly high density area which was markedly enhanced with contrast media.
    Angiography was done in all intracranial cases and in a cervical intramedullary case. The commonest finding in the intracranial cavernomas was an avascular mass lesion with or without faint tumor stain. However, in a case of the middle fossa the avascular mass on conventional angiography turned to a vascular mass on angiography with more contrast media (15 ml) and longer injection time (4 sec.). We called this method prolonged (or slow) injection angiography. Small venous poolings at the site of tumor were noted in an intracerebral case by conventional angiography. Neuroradiologic diagnosis of cavernoma of the CNS would be attained by the findings, 1. localized hot area in RI scan, 2. high density area with definite contrast enhancement in CT scan, 3. avascular or hypovascular mass lesion with no or poor visualization of feeding arteries in conventional angiography, 4. presence of venous poolings at the site of tumor, and 5. visualization of fine neovascularity or tumor stain in prolonged injection angiography.
    Removal of the tumor was total in an intracerebral case and intraspinal extradural cases, but was partial in cases of the middle fossa and an intraspinal intramedullary case. It was stressed that correct preoperative diagnosis would be very important because total removal was at all impossible and would therefore not have been indicated in some cases.
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  • —Part 3 Tumors Developing Mainly Lateral to the Third Ventricle (2)—
    1978 Volume 18pt2 Issue 11 Pages 873-884
    Published: 1978
    Released on J-STAGE: December 28, 2006
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