Neurologia medico-chirurgica

Headache

KOICHI KITAMURA, TAKASHI MIYAZAKI

1979 Volume 19 Issue 2 Pages 133-140
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.133

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Treatment of Spontaneous Carotid-cavernous Fistula

SHUNICHI YONEDA, MASAYUKI MATSUDA, HIROSHI GOTO, HAJIME HANDA

1979 Volume 19 Issue 2 Pages 141-147
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.141

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The so called “spontaneous” carotid-cavernous fistulae are mostly dural shunts between the meningeal branches of internal or external carotid arteries and dural veins in the vicinity of cavernous sinus. The spontaneous external carotid-cavernous fistula could be treated by ligation or embolization of branches of external carotid artery. On the other hand, the direct closure of internal carotid-cavernous fistula is quite a challenge to neurosurgeons.
Here is a report of a technique for direct closing of a spontaneous internal carotid-cavernous fistula which does not impair internal carotid blood flow. Exposure of cavernous sinus wall is achieved by means of a frontotemporal craniotomy. Operative angiography is performed in order to establish the topographical relationship of internal carotid artery, Parkinson's triangle of the cavernous sinus and fistula. Fine copper on copper compound wire is threaded transdurally into the lumen of the sinus. A direct current (0.2 mA to 2 mA) is applied to the copper wire for 1 to 2 minutes. The closure of fistula is verified by operative angiograms. Our experiences of the three cases suggest that electrothrombosis is an ideal treatment of spontaneous internal carotid-cavernous fistula.

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A Clinical Study of Intracranial AVMs with Reference to Their Enlargement and Regression

—A Follow-up Study with Angiography and CT Scan—

SACHITOSHI KUWAHARA, TAKESHI SHIMA, SUSUMU ISHIKAWA, TOHRU UOZUMI, MAS ...

1979 Volume 19 Issue 2 Pages 149-161
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.149

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From March 1960 to April 1975, 31 cases with arteriovenous malformation were treated without radical operation due to various reasons. Of these cases, it was possible to carry out follow-up study by cerebral angiography in 15 for a maximum of 15 years, with the mean period being 6.6 years.
Four of the 15 received radiation therapy and 3 had exploratory craniotomy only, while the remaining were treated medically.
The ages when angiographic changes were first noted ranged from 22 to 49, with the mean being 35.5 years. Twelve of the 15 cases were males.
The initial symptom most frequently noted was subarachnoid hemorrhage in 10 cases, followed by convulsion in 4, and 1 with hemiparesis and speech disturbance due to intracerebral hematoma.
At the time of the second angiography 7 cases were asymptomatic, and all the other 8 cases with hemiparesis, hemianopsea or aphasia were able to make their own living.
The size of AVM increased in 5(33.3%), decreased in 2(13.3%), totally regressed in 2(13.3%) and unchanged in 6(40%). 4 cases of the 5 with increase in size affected the parietal and temporal regions, where it was considered by some authors increase in size readily occurs.
The main feeders in the 6 cases in whom the size of AVM remained unchanged were arteries incapable of providing a large amount of blood, such as the thalamoperforating artery, anterior choroidal artery and branch of the posterior cerebral artery, with the exception of 1 case in whom the feeder was the middle cerebral artery. No changes could be observed on the feeders or drainers per se of these cases.
Total regression was noted in 2 cases, in one of whom it was so-called spontaneous total regression and in the other it occurred after radiation therapy.
It is difficult to grasp the detailed morphology of AVM even with newly developed computed tomography scanner, but the apparatus is useful in observing the changes in AVM and its surrounding tissues, and thus is necessary for follow-up studies.

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Visualization of Intracranial Aneurysm with Aid of Computerized Tomography

SHOICHI SANADA, AKIRA MIYASHITA, HIROAKI SEKINO, TOSHIAKI ABE, TSUTOMU ...

1979 Volume 19 Issue 2 Pages 163-172
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.163

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The authors reported 8 cases of intracranial aneurysms in which CT had on important role in the diagnostic process.
In 2 cases with subarachnoid hemorrhage (SAH), the first angiographic studies showed no aneurysm, but the use of CT revealed aneurysm itself and hemorrhage. By repeated angiography, aneurysm was found.
In other 2 cases with SAH, episodes of the symptom were atypical, and the diagnosis was obscure, but CT again revealed the aneurysm itself.
The other 4 cases had no episodes of SAH. With CT, three of them were found incidentally to have aneurysms, and the last case with the chiasmal syndrome already present, was found to have a huge aneurysm of the internal carotid artery of which shape and size were incompletely revealed in the angiogram. As for these non-ruptured aneurysms CT was considered helpful for preventive treatment.
On the basis of our experiences with these 8 cases, the following were considered necessary for detecting the aneurysm by CT.
1) Improvement of enhancement method, namely, the volume of contrast medium and the timing of scanning after injection of contrast medium.
2) Choice of the plane including the circle of Willis and immobilization of the head of the patient during scanning.
3) Differentiation from irrelevant images.
Concerning the last, some beneficial results might be obtained by using the subtraction method.

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Intracranial Surgery and Postoperative Management of Patients with Ruptured Aneurysm in Acute and Subacute Stage

—Basal Cisternal Drainage and Lumbar Subarachnoid Drainage—

JINICHI SATO, OSAMU SATO, HIROSHI KAMITANI, ITARU KANAZAWA, TAKASHI KO ...

1979 Volume 19 Issue 2 Pages 173-179
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.173

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Eighteen patients with ruptured aneurysm operated on with microsurgical techniques within 2 weeks after the last subarachnoid hemorrhage(SAH) were analyzed with regards to the surgical treatment and postoperative management.
There were 10 female and 8 male patients. The patients age ranged from 35 to 66 years with a mean age of 49 years.
After the clipping of the aneurysmal neck, we made an effort to incise the membrane of Lilliquist in order to improve the CSF circulation around the ring of Willis. Following these procedures, continuous basal cisternal drainage(BCD) and/or continuous lumbar subarachnoid drainage(LSD) were performed on every cases.
The duration of BCD and/or LSD methods ranged from 4 to 19 days with an average of 10 days. The drained volume of CSF per day ranged from 40.6 to 285.6 ml with a mean volume of 146.4(±66.8)ml.
There were 14 excellent(77.8%) and 2 fair results. The overall mortality was 5.6%(1 patient) and the cause of the death was pseudomonas meningitis.
Probable merits of BCD or LSD method are as follows :
1. It may restore the CSF circulation to normal or physiological state.
2. It clears the CSF of blood around the ring of Willis following SAH.
3. It prevents and cures the postoperative vasospasm which may occur.
4. It may minimize the change in the subarachnoid space after SAH.
This method has the possibility of postoperative meningitis as a complication, but it was not serious with an exception of a patient. The incidence of meningitis increased when the BCD and/or LSD methods was continued for more than a week.

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Clinical Evaluation in Measuring Astroprotein in Cerebrospinal Fluid in Patients with Head Injuries

AKIRA MATSUMOTO

1979 Volume 19 Issue 2 Pages 181-185
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.181

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Mori et al. (1970) found an astrocyte-specific cerebroprotein and designated it as astroprotein. They also established the radioimmunoassay method for measuring astroprotein in CSF and reported that this technique might be applicable as a screening test for glioma. At the same time there is an possibility that astroprotein in CSF may increase following cerebral tissue damage, because fibrillary astrocytes which contain astroprotein also exist in normal brain tissue. The purpose of the present study is to detect astroprotein in CSF by radioimmunoassay, attempting to clarify the diagnostic value of astroprotein for cerebral tissue damages. The CSF samples from 100 patients with head injuries as well as other non-tumor diseases had been examined and the following results were obtained:
1) Astroprotein in CSF from the patients without organic cerebral tissue damages (such as cervical spondylosis, Meniere's disease, neurosis and so on) and with cerebral concussion was found generally under 30 ng/ml.
2) Remarkably high amounts of astroprotein were detected in patients with cerebral contusion, cerebral hemorrhage and acute subdural hematoma.
3) Serial measurement of astroprotein in CSF showed it reached to the maximum value within several hours after cerebral tissue damages and then gradually decreased to the control value within 7 ?? 14 days.
From these results, it might be concluded that measurement of astroprotein in CSF is clinically valuable not only for making the diagnosis of the cerebral tissue damages, but also for evaluating the grade of brain tissue injuries and prognosis.

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Ten Cases of Trigeminal Neurinoma

SHINRO KOMATSU, YOSHIHARU SAKURAI, TERUAKI MORI, JIRO SUZUKI

1979 Volume 19 Issue 2 Pages 187-193
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.187

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Symptomatologic and radiographic features of ten cases of trigeminal neurinoma were analysed and compared with those which were reported in the literature.
Patients often had symptoms of several years duration before they were diagnosed, and in many cases the tumor had grown up too large to make the total removal of tumor impossible. Therefore, it is apparent that early diagnosis is indispensable for the successful treatment of trigeminal neurinoma. We must always be careful in order not to miss a presence of trigeminal neurinoma.

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Multiple Extramedullary Plasmacytoma Manifesting Increased Intracranial Pressure Signs

—A Case Report—

TAKAOMI UEMURA, KEIKI UNEOKA

1979 Volume 19 Issue 2 Pages 195-202
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.195

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Multiple extramedullary plasmacytoma is a very rare tumor. Its incidence is about 0.74% of all plasma cell tumors. A case of multiple extramedullary plasmacytoma, manifesting intracranial hypertension signs, was presented. The patient was a 53-year-old man and was admitted because of the seizure in bilateral lower extremities, right fronto-temporo-parietal(FTP) swelling and bilateral neck masses. The patient was in confused status upon admission and the neurological examination revealed negative findings except for the bilateral disc margin blurring.
Laboratory examinations were within normal limits except for mild anemia. Skull films showed a huge radiolucent area on the right FTP region. Cerebral angiography disclosed tumor stain and mass effect at the FTP area with marked displacement of the middle and anterior cerebral arteries.
At surgery a reddish-gray huge nodular mass, attached to the transverse sinus, sigmoid sinus and tentorium, extending into infratentorial and subtemporal regions and eroding the pyramid bone, was found and resected.
Microscopic pathology of this tumor revealed a typical plasmacytoma with “cartwheel” chromatin pattern.
Postoperative course was relatively well. However, he died from acute renal failure on 35th postoperative day.
A short review was provided concerning diagnosis, treatment and prognosis of plasmacytoma. It was emphasized that the negative pressure continuous ventricular drainage(CVD) was effective for controlling the cerebrospinal fluid leak from the wound.

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A Case of Pituitary Adenoma with Extensive Calcification

TADASHI NISHIYAMA, KAZUHIKO MORITA, TADAHISA KURIMOTO, KUNIYUKI SOMEDA ...

1979 Volume 19 Issue 2 Pages 203-207
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.203

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We have reported an unusual case of pituitary adenoma with extensive calcification from the base of the skull to the right middle fossa. The patient was 28 years old male who was admitted to our department of neurosurgery on September 6, 1976 with the chief complaint of generalized convulsion. Neurological examination on admission revealed irregular bitemporal hemianopsia. There was no sparseness of body hair.
Plain skull films showed extensive suprasellar calcification extending into the right middle fossa. The sella turcica and the sphenoid sinus was completely destroyed and was replaced with a huge calcified mass. Hormonal study revealed a slight hypopituitarism.
On September 30, right frontotemporal craniotomy was performed. Grayish calcified tumor was found originating from the temporal base. It was covered with a thin capsule, easy to bleed and contained many small calcium freckles. Frozen section was reported as squamous cell carcinoma, and extensive tumor removal was abandoned. Postoperatively Cobalt therapy was given. However, paraffin sections showed no malignancy and pituitary adenoma or meningioma was suspected. After a course of irradiation, the second operation was carried out on December 2nd and this calcified tumor was subtotally removed.
Postoperative hormonal studies disclosed prominently high level of the serum prolactin. Light microscopic finding of the specimen taken at the second operation was regarded as chromophobe adenoma, with predominant tendency to degeneration and calcification. Electron microscopically, tumor cells had dilated rough endoplasmic reticulum and sparse secreting granules compatible with prolactin-secreting adenoma cells.

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Neuroradiological Diagnosis of Third and Para-third Ventricular Tumors

—Part 4 Tumors Developing in the Posterior Portion of the Third Ventricle—

JUSUKE ITO

1979 Volume 19 Issue 2 Pages 209-218
Published: 1979
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.19.209

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