Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 19, Issue 9
Displaying 1-10 of 10 articles from this issue
  • NORIO NAKAMURA
    1979 Volume 19 Issue 9 Pages 853-862
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Pathological knowledge of brain trauma is a fundamental necessity for all neurosurgeons in the treatment of brain injury patients. Gross and microscopical characteristics of cortical as well as centrencephalic injuries are commented on and several clinical problems such as the following are discussed from the pathological viewpoint.
    1) Dense scar formation in cases of penetrating head injury as an epileptogenic focus.
    2) Reliability and pitfalls of CT in diagnosing brain contusion.
    3) Technical keystone in the operation of acute subdural hematoma.
    4) Significance of urgent management of patients suffering brain injury to prevent secondary irreversible brain damage.
    5) Other complications.
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  • —Natural History of 104 Cases of Intracranial Aneurysms—
    SHOJI ISHIMORI, KINYA OSHIDA, HIROSHI SANKAWA
    1979 Volume 19 Issue 9 Pages 863-871
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Among 104 cases of intracranial aneurysms, 64 were operated under hypervolemic hypotension (HVH) and Trimethaphan induced hypotensive anesthesia. Of the remaining 40 cases, 14 were operated under normotensive anesthesia, 12 were treated by common carotid clamp, and 14 were found not compatible to surgical treatment because of recurrent bleeding, vasospasm and other serious complications.
    The advantages and surgical results of HVH, including morbidity, mortality, and complications are discussed and compared with several other reports of induced hypotensive anesthesia. The benefits of the HVH are as follows :
    1) Cerebral metabolism is maintained within normal range during the prolonged induced hypotension by hypervolemic perfusion.
    2) The dissection and clipping of aneurysm are considerably easier and premature rupture occurring during surgical manipulation of the aneurysm can be handled without difficulty.
    3) The hypervolemic hypotension may diminish the danger of postoperative cerebral swelling and edema, and improve the prognosis and long-term survival of the intracranial aneurysm patients.
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  • TATSUO HAYASHI, HIROKO SAKO, TOSHIRO UNO, EISEI LEE, Koji KUSUNO, MASA ...
    1979 Volume 19 Issue 9 Pages 873-880
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The effect of cerebral perfusion pressure on the brain tissue after cerebral arterial occlusion was investigated. The cerebral perfusion pressure was changed by lowering the mean arterial blood pressure (MABP) by an exsanguination. Mongrel dogs were used as the experimental animal and they were divided into three groups (Group A, B and C). Group A had normal MABP, Group B 60 mmHg, and Group C 40 mmHg, respectively. Measurements of middle cerebral arterial blood pressure (MCAP), EEG and cerebral blood flow (CBF), and cerebral perfusion with carbon black solution (carbon perfusion) were performed on each group prior to, following occlusion of the right middle cerebral artery (MCA), and after de-occlusion.
    Group A: MCAP was 98 mmHg when MABP was 128 mmHg. MCAP fell to 28 mmHg immediately following occlusion of MCA, however, 74% spontaneous recovery of MCAP was accomplished at 1 hour after occlusion. No ischemic change was recognized on EEG and carbon perfusion which were performed after occlusion of MCA.
    Group B: MCAP was 50 mmHg when MABP was 60 mmHg. MCAP fell to 20-25 mmHg following MCA occlusion without recovery thereafter. EEG change appeared, continued and cerebral ischemia was recognized by carbon perfusion on the cerebral tissue of occluded side.
    Group C: MCAP was 33 mmHg when MABP was 40 mmHg. MCAP fell to 5-10 mmHg following MCA occlusion without recovery. More severe EEG changes and cerebral ischemia than Group B were observed in the cerebral tissue on the occluded side. Group A had enough cerebral perfusion pressure to maintain the collateral circulation following MCA occlusion. On the contrary, Groups B and C did not have enough cerebral perfusion pressure to maintain the collateral circulation following MCA occlusion. Therefore, ischemic change appeared in the brain on the affected side after the occlusion of MCA. In another experiment, the reversibility of cerebral ischemia was investigated by the same method. It was found that irreversible damage on the occluded cerebral tissue might be caused by one hour occlusion of MCA under 60 mmHg of MABP. We think that low cerebral perfusion pressure may be responsible for the cerebral ischemia following main cerebral arterial occlusion.
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  • TOSHITERU OHNISHI, TOSHIKI YOSHIMINE, TORU HAYAKAWA, KIYOO KAMIKAWA
    1979 Volume 19 Issue 9 Pages 881-888
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    “Medilaser-S Model MEL-442” is a CO2 laser surgical unit manufactured by Mochida Pharmaceutical Co. Ltd.. The maximum output power is 60 W at the handpiece of the surgical arm. Scalp incision, dural incision and corticotomy were performed by laser surgery and the results of laser surgery were compared with those of conventional neurosurgical techniques in the same materials. Blood loss during scalp incision was reduced by laser surgery. However, wound healing of the scalp was delayed with slightly extended scar formation. Laser surgery was not necessary for dural incision. At corticotomy by laser surgery, the large vessels had to be clipped or coagulated electrically when it was hard to cut them by laser alone. It was concluded that no need of laser surgery was recognized for craniotomy and corticotomy.
    Coagulation and vaporization by laser irradiation to the brain tumors resulted in reduction of blood loss during surgery and time saving of the procedures. When the tumors were large and the vessels were abundant in the tissue, the laser surgical unit proved to be a powerful surgical asset. Six cases of meningiomas, 4 cases of glioblastomas and 7 cases of metastatic brain tumors were successfully removed by the aid of the laser surgical unit. Three cases of arteriovenous malformations in the brain were also treated by laser. Defocused beam irradiation caused coagulation of the nidus of AVM, but the large vessels were not coagulated. Coagulation of the nidus helped surgeons to clip the feeders and the drainers without any trouble. Combination of the surgical microscope and the laser surgical unit was useful for transsphenoidal operation of a pituitary tumor.
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  • KEIJI SHIMIZU, YUKITAKA USHIO, TORU HAYAKAWA, NORIO ARITA, HEITARO MOG ...
    1979 Volume 19 Issue 9 Pages 889-894
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Using an experimental model of meningeal carcinomatosis in rats, studies of how the blood-CSF barrier was affected by tumor growth in the subarachnoid space were conducted. The state of the blood-CSF barrier was estimated by drug delivery to the tumor.
    Cyclophosphamide which crosses the blood-brain barrier poorly and 1-(4-amino-2-methyl-5-pyrimidinyl)-methy 1-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) which crosses it easily had an equivalent cytostatic effect on the subcutaneously transplanted Walker 256 carcinosarcoma in SD rats at a dose of 30 mg/kg and 15 mg/kg, respectively.
    SD rats inoculated intracisternally with 1×104 Walker 256 carcinosarcoma cells were treated by either a single i. v. dose of cyclophosphamide 30 mg/kg or ACNU 15 mg/kg at 1, 2, 4 or 5 days after tumor inoculation. Effects of these two types of agents were compared by the survival time of animals. At 1 day after tumor inoculation, intravenously administered cyclophosphamide failed to prevent tumor growth in the subarachnoid space and survival time of tumor-bearing animals was prolonged only 10 to 14% compared to control. On the other hand, ACNU was effective and produced a maximum increased survival time of 180%. At 2 days after inoculation both cyclophosphamide and ACNU were effective and increased median survival time by 109% and 127%, respectively. At 4 days after inoculation, cyclophosphamide increased survival time 90% and ACNU 240%. At 5 days, cyclophosphamide increased survival time 52% and ACNU 74%.
    The results indicated that the subarachnoid tumor growth in its early stage was protected from the water-soluble chemotherapeutic agent by the intact blood-CSF barrier. In the advanced stage of tumor growth, the barrier was mostly circumvented, however there were still some areas where infiltrating neoplastic cells were protected by the intact barrier.
    These findings suggest that systemic chemotherapy of metastatic tumors of the central nervous system should include an agent which crosses the blood-brain (CSF) barrier, although the first choice is an agent to which the original tumor is most sensitive.
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  • —On the Residual Pituitary Gland and “Capsule” of the Adenoma—
    AKIRA TERAMOTO, KEIJI SANO, R. YOSHIYUKI OSAMURA, KEIICHI WATANABE
    1979 Volume 19 Issue 9 Pages 895-902
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    In order to investigate the anatomical and functional relationships between pituitary adenomas, residual pituitary glands and pituitary capsule, 24 surgical specimens and 26 autopsy materials (8 acromegalies, I 1 PRL producing adenomas, 9 non-functioning adenomas, 22 subclinical microadenomas) were studied by the peroxidase-labeled antibody method for the localization of various pituitary hormones.
    Usually well-delineated interface was found between adenoma and gland, while superficial invasions of tumor cells were observed locally in a few cases. On the other hand, when smaller than 2 mm in diameter, the adenoma had somewhat irregular boundaries, containing a few anterior pituitary cells in its parenchyma.
    Even in the advanced cases with suprasellar extension, several compressed normal layers with intact immunoreactivity were often found between tumor and diaphragma sellae. A small amount of invasion was seen in some pituitary capsule to which the adenoma was directly related.
    Neither hyperplasia nor pathological cell populations were detected in the residual gland of all of the adenoma examined. Irrespective of tumor functions, cell proportions of the residual glands were as follows: GH≈PRL>ACTH>TSH, FSH.
    From the above findings, the assessment of operative procedures and the patterns of tumor growth are also discussed.
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  • SHOJI TSUCHIMOTO, AKIRA MATSUMOTO, HIDEYUKI KUYAMA, TOSHIO EGUCHI, AKI ...
    1979 Volume 19 Issue 9 Pages 903-908
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Astroprotein has been measured by radioimmunoassay and it is known to increase remarkably in the cerebrospinal fluid and tumorous cystic fluid of patients with gliomas. For this reason, it was strongly suggested that the measurement of astroprotein in CSF might be helpful as a screening test for glioma detection. However, astroprotein was detected not only in astrocytoma cells, but also in fibrillary astrocytes in the normal brain. Therefore, astroprotein in CSF might be expected to have high value if fibrillary astrocytes in the normal brain were damaged.
    Astroprotein levels of CSF in severe head injuries, complicated cerebral contusions, traumatic subarachnoid hemorrhages and acute subdural hematomas were also detected to be significantly high. On the other hand, in mild head traumas, complicated cerebral concussions, epidural hematomas and chronic subdural hematomas, astroprotein levels were in normal ranges. Therefore, astroprotein levels in CSF might indicate the degree of severity of damage to the brain parenchyma. The purpose of this study is to investigate the correlations between astroprotein levels and the severity of head injury.
    Changes in CSF astroprotein titer were studied after experimental brain injury. Standard cold lesions of different severities were produced in dogs by the application of dry ice on the dura. 2 % Evans blue was given to examine the extent of the lesion and the dogs were sacrificed 24 hours after injury. In cases in which the lesion was limited to the cortex, astroprotein was detected to be below 30ng/ml during 24 hours of observation. In contrast, in cases in which the lesion had extended to the white matter, astroprotein titers exceeded 200 ng/ml 24 hours after the injury. It was confirmed that the degree of astroprotein release into the cerebrospinal fluid increased in parallel to the severity of brain damage.
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  • YOSHIMI MATSUOKA, KAZUO HASHI, ATSUSHI KAWARAZAKI, NAOSUMI OHKAWA
    1979 Volume 19 Issue 9 Pages 909-915
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A method for quantitative measurement of CSF flow through the ventriculo-peritoneal shunt is described. A Pudenz type shunt reservoir was punctured with a 26 gauge needle and a 0.03 ml of 99mTcO4- was injected, then the radioactivity over the reservoir was counted continuously for 10 minutes. An in vitro experiment using a calibrated infusion pump showed a single exponential washout curve when the flow rate was between 0.667 ml/min and 0.0278 ml/min. The flow rate through the shunt (q) could then be estimated using the formula:
    q = V·log 2/T½
    where V is the volume of the reservoir and T½ is a clearance half-time. In this experiment the volume of the reservoir was assumed to be 0.375 ml and the maximum error for estimation of flow rate was 25%. The measurement was performed 74 times for 55 patients. In 18 measurements performed on patients diagnosed to have malfunction of the shunt system, the washout curve showed a flat pattern except for two occasions where the flow rates were 0.011 ml/min and 0.0 16 ml/min. In 39 cases in which the shunt system was considered to be functioning adequately, the mean flow rate through the shunt was 0.14±0.115m1/min. The flow rate was significantly lower when the opening pressure of the slit valve at the peritoneal tube was higher or the anti-siphon system was installed. In 8 cases with obstructive hydrocephalus due to posterior fossa tumor, the mean flow rate was 0.186±0.108 ml, which was higher than the value in 10 cases after subarachnoid hemorrhage of 0.115±0.058 ml/min. In cases after subarachnoid hemorrhage there was a tendency that the flow rate through the shunt gradually decreased as time elapsed. The flow rate was significantly influenced by positional change during the study unless the anti-siphon system was installed. Two representative cases with simultaneous measurement of intracranial pressure are presented. In conclusion, this technique for quantitative measurement of flow rate through the shunt not only provides access as to the adequacy of the shunt for the patient, but also may contribute to the study of dynamic mechanism of the third circulation.
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  • —A Successfully Treated Case—
    TOMOKAZU GOYA, KAZUO KINOSHITA, KEIKICHI MIHARA, YOSHIBUMI TAKEHARA
    1979 Volume 19 Issue 9 Pages 917-924
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A case of aneurysm of vein of Galen in a 5½-month-old male baby is presented. The baby was born on February 16, 1978 and had apparently been well until age of 3 months, when he was suddenly seized with right hemiconvulsion. Positive findings on admission on Aug. 2, 1978 were setting-sun phenomenon, bulging of the anterior fontanel, equivocal weakness of the left lower limb, and bruit synchronous with pulsation on the scalp. The bruit was blowing, high-pitched and most prominent at the parieto-occipital region. CT scan disclosed an isodensity mass in the posterior part of the 3rd ventricle and symmetrical dilatation of the lateral ventricles. Cerebral angiography disclosed an enormously large aneurysm at the vein of Galen. Feeding arteries were the elongated and enlarged dural branch of the superior cerebellar artery on the right and bilateral medial posterior choroidal arteries. Draining veins were formed by huge straight sinus, basal vein, and dilated cortical veins.
    A right ventriculo-peritoneal shunt was placed for obstructive hydrocephalus prior to direct approach to the aneurysm. On August 25 and September 14, 1978, left temporal craniotomies were done. The clippings and divisions of the feeding arteries to the vein of Galen aneurysm were performed via subtemporal approach. The aneurysm completely disappeared on the postoperative angiography and an avascular mass was present between both posterior cerebral arteries. On clipping of a major feeder during general anesthesia, systemic blood pressure and central venous pressure suddenly elevated and bradycardia developed and lasted for 45 minutes. After recovery from anesthesia, atrial fibrillation suddenly developed. Suitable digitalization and preserving the hypovolemic state were successful to make the regular heart rhythm return. Variability of heart rate continued for about 24 hours thereafter.
    Postoperative CT scan and angiogram revealed bilateral subdural effusion. Repeated puncture and aspiration of the subdural fluid collection were performed but the fluid collection did not disappear. Postoperative PEG showed the patency of Sylvian aqueduct and no filling to the convexity subarachnoid space. Treatment of this subdural fluid collection still remains unsolved.
    This case is the third surgical case of aneurysm of vein of Galen to appear in the Japanese literature.
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  • Part V Clinical Significance of the Hearing Test
    TAKASHI FUKAYA, ATSUSHI KOMATSUZAKI
    1979 Volume 19 Issue 9 Pages 925-927
    Published: 1979
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
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