Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 21, Issue 5
Displaying 1-11 of 11 articles from this issue
  • KAZUO MORI
    1981 Volume 21 Issue 5 Pages 447-455
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
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  • SHIGEJIRO MATSUMURA, SHINTARO MORI, TOHRU UOZUMI
    1981 Volume 21 Issue 5 Pages 457-465
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Effects of transsphenoidal surgery on decompression of the optic nerve and chiasm were evaluated in sixteen cases of pituitary adenomas with visual disturbances.
    After transsphenoidal surgery, visual acuity was normalized in 34.6%, improved in 53.8%, unchanged in 7.7% and worse in 3.8%. Complete recovery of the visual field was achieved in 26.9%, widening of peripheral isoptors occurred in 46.2%, and it remained unchanged in 23.1% and became worse in 3.8%.
    Transsphenoidal surgery for pituitary adenomas is effective and has relatively few complications.
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  • —II Evaluation of Surgical Treatment—
    OSAMU SATO, HIROMI TSUCHITA, YOHICHI NAKAGAKI, JUNSUKE TSURUTA, SUMIYO ...
    1981 Volume 21 Issue 5 Pages 467-475
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The authors evaluated results of surgical treatment for 12 cases of prolactin-secreting pituitary microadenomas with respect to the effect on the endocrinological status and compared these results with those for 10 cases of macroadenomas.
    The cases of microadenomas were all female; 10 cases with amenorrhea and galactorrhea, a case with oligomenorrhea and galactorrhea and a case with only amenorrhea. Both microadenomas and macroadenomas were operated on through the transsphenoidal route. Microadenomas were considered to have been removed completely but macroadenomas were not always removed completely because of their larger size.
    The relation between operative findings of microadenomas and basal serum PRL levels was analysed. Two elastic and firm adenomas showed elevated serum PRL levels (p<0.001) exceeding 400 ng/ml and two eosinophilic and two mixed adenomas showed higher serum PRL levels than the chromophobes (p<0.01). Adenomas with serum PRL levels around or over 200 ng/ml were all peripheral types. Localization within the sella turcica or size of the tumors had little relation to serum PRL levels.
    In microadenomas, serum PRL levels fell to the normal level in nine cases (75.0%) within a month after the operation. Three cases with normal PRL levels, however, gradually returned to elevated levels in the follow-up after a month. Conversely, no drop to the normal level was observed in cases of macroadenomas.
    Surgical impacts on HGH, TSH, LH, FSH and ACTH reserves were examined. Only four out of 18 cases (22.2%) among the microadenomas and macroadenomas had impaired hormonal reserves after transsphenoidal surgery which was considered to be a safe procedure.
    Regular menses were restored in nine out of 12 cases (75.0%) of microadenomas after a mean interval of a month and a half after the operation. Six cases showed ovulatory menses. One case experienced normal delivery and two cases became pregnant among the six patients. Galactorrhea disappeared in nine out of 11 cases (81.8%) of microadenomas after a mean interval of 2 months and a half after the operation and another case showed a remarkable decrease in lactation. However, none of the seven cases of macroadenomas showed restored menses, only one out of six cases had cessation of lactation and another two cases showed a decrease in lactation after the operation.
    Transsphenoidal removal of prolactin-secreting microadenomas was a safe and satisfactory treatment of choice.
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  • —Experience with Three Cases—
    TORU HAYAKAWA, KIYOO KAMIKAWA, TOSHITERU OHNISHI, TOSHIKI YOSHIMINE
    1981 Volume 21 Issue 5 Pages 477-484
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    An operative approach to aneurysms located at the lower half of the basilar artery or the vertebro-basilar junction is difficult. The transoral transclival approach, developed by Sano et al., seems to be reasonable, but it has been used in only a few cases. The most serious problem with this approach lies in high incidence of postoperative complications involving formation of a CSF fistula communicating with the nasopharyngeal cavity and the consequent meningitis.
    This approach was used in three cases of basilar artery-anterior inferior cerebellar artery aneurysms. Aneurysmal neck clipping was carried out in all three cases. The first patient, on whom an emergency operation was performed in a critical condition immediately after the re-rupture of a basilar aneurysm, died 4 days after the operation without signs of recovery. In the second case, CSF fistula formation and the consequent fungal meningitis took place in the postoperative course, but the patient was discharged without any neurological deficit. The result of the third patient was satisfactory and no complication occurred postoperatively.
    Based on this experience, the importance of complete closure of the nasopharyngeal mucosa and usefulness of long-term nasopharyngeal packing and of continuous spinal drainage were described.
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  • —Forecast of Chronic Subdural Hematoma—
    YOSHIO TAKAHASHI, HIROYUKI SATO, YOSHITOSHI INOUE, SATOSHI TAKEDA, SYU ...
    1981 Volume 21 Issue 5 Pages 485-490
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    CT examinations were performed in 621 cases of minor head injury within 3 days, and 26 cases (4%) exhibited hygroma-like CT findings. These 26 cases were divided into two patterns : Type A (12 cases) and Type B (14 cases). Type A showed smooth thin hygroma-like low density area beneath the skull with compression of the cerebral surface and cerebral sulci. Type B showed an irregular thin hygroma-like low density area beneath the skull with recognized cerebral sulci. Many of these cases changed into chronic subdural hematomas, i.e. Twelve cases (100%) of Type A and three cases (21%) of Type B changed into chronic subdural hematomas. It is highly possible to forecast the subsequent occurrence of the chronic subdural hematomas soon after a head injury.
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  • NORIO NAKAMURA, TAKENORI OGAWA, TAKUO HASHIMOTO, KENJI YUKI, SHIGERU K ...
    1981 Volume 21 Issue 5 Pages 491-500
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Spontaneous resolution of the encapsulated chronic subdural hematoma has been observed not rarely in clinical practise. The authors had investigated eight such cases in detail in 1967, and the tentative criteria for the resolving hematoma had been proposed.
    Further eight cases were presented in this paper which accounted to seven percent of 121 cases of chronic subdural hematoma encountered between 1968 and 1978. Two cases of bilateral hematomas, two cases of apoplectic type and two cases of biconvex hematomas on CAG were included in the eight. These observations meant that the resolving subdural hematoma was not a different clinical entity from conventional chronic ones.
    The resolving hematoma appeared as preservation of low density area or area of decreasing density from mixed to low in successive CT scans in a course of resolution.
    It was proposed that in case of the resolving type increased fibrinolytic activity of the hematoma capsule and of the fluid became prematurely diminished due to unknown initiation and that spontaneous resolution took place without surgery.
    The previous criteria were commented based on discussion on the natural history of chronic subdural hematoma, outline of which was graphically illustrated.
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  • TOSHIO TSUDA, SHIN UEDA, KEIZO MATSUMOTO
    1981 Volume 21 Issue 5 Pages 501-509
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Twenty-one cases of arachnoid cysts were experienced in the last 5 years. Craniotomy and extirpation of the arachnoid cysts were performed on 20 cases.
    Clinical features and histological findings of these cases were investigated. Ages of these patients ranged from 7 months to 70 years. Twelve cases (57%) were under the age of 20 years and the other nine cases (43%) were over 20 years old. The cysts were located in the middle fossa in 12 cases, in the frontal lobe in five cases, in the posterior fossa in three cases and in the left-sided hemisphere in one case. Symptoms were generally rather mild.
    Among the 12 cases of middle fossa arachnoid cysts, only six cases showed bony changes such as elevation of the sphenoid wing in plain skull films and of the 11 cases which underwent angiographic studies, only five cases showed poor visualization of the superficial middle cerebral veins on the affected side. Arachnoid cysts were readily diagnosed by CT examination as watery low density areas with a clear-cut margin which showed no enhancement by intravenous injection of contrast media.
    Metrizamide-CT and RI-cisternography were utilized in nine cases. Eight cases showed non-communicative cysts surrounded by metrizamide acummulation in the adjacent arachnoid space.
    Histological examinations of the cystic membrane were performed in eight cases by taking specimens from the covering part as well as from the bottom where the membrane adhered to the cortical surface. Seven out of eight cases showed duplicated normal arachnoid membrane. This finding indicated that the cysts could be regarded as “intraarachnoid cysts”, as pointed out by Starkman.
    Normal arachnoid membrane was examined histologically by taking specimens from lobectomized cortex as well as autopsied brain for comparison with the cystic membrane.
    These examinations revealed an interesting arachnoidal structure which might be termed “micro-intraarachnoid cysts” in certain instances. The etiology of the primary arachnoid cyst has been considered as congenital or developmental in nature. Starkman advocated that the structure of the intraarachnoid cyst itself indicated congenital malformation of the arachnoid membrane.
    However, this series included so many unexpected adult cases and also a case of posttraumatic arachnoid cyst in one identical twin. Therefore, one course of pathogenesis of the arachnoid cysts, can be postulated as a “microintraarachnoid cyst” existing in normal people starting to grow and becoming a large arachnoid cyst, triggered by some enlarging forces in head traumas or other unknown factors.
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  • —Experimental Study—
    HIROBUMI SEKI, KEIJI KOSHU, HIKARU OHISHI, TAKASHI YOSHIMOTO, JIRO SUZ ...
    1981 Volume 21 Issue 5 Pages 511-515
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Using a “thalamic infarction model in the dog”, it was previously found that hemorrhagic infarction can be produced by 6 ?? 12 hour occlusion of blood flow, followed by recirculation. In the current study, regional cerebral blood flow (rCBF) and CT scan characteristics of this model were investigated.
    By means of vascular occlusion, rCBF was reduced roughly to 15 ml/100 gr/min and maintained at that level throughout the period of occlusion. Due to recirculation, transient hyperemia was produced, followed by a decrease in blood flow to below the level found prior to occlusion after several hours. Autopsied sections revealed hemorrhagic infarctions clearly present in the thalamus.
    Plain CT scans showed low density areas in the right thalamus one hour after recirculation and mild high density areas were seen after intravenous administration of contrast medium. After 2 hours, the high density areas became more marked. Hemorrhagic infarction was clearly found in these models.
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  • —Its Preparation and Histological Findings—
    TETSUO KANNO, TARO NAKAMURA, TOMOJI SUGIMOTO
    1981 Volume 21 Issue 5 Pages 517-520
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A new model of experimental hydrocephalus was prepared by innoculation of KS-1 cells into the cerebrum of C57 Black mice. KS-1 cells which originated from a human glioblastoma multiforme were first established in 1969 by the authors. The cells have undergone 150 passages.
    Doses of 0.03 ml of KS-1 cell solution (106 cells/ml) were innoculated in the right temporal lobes of 63 ten day-old C57 Black mice. Two to four weeks after the innoculation, hydrocephalus developed. Incidence of hydrocephalus was 17 mice or 27%. In histological studies, no obstruction was observed in the CSF system. The lining of the ependymal cells was stretched and interrupted. In the subependymal tissue, spongy formation and gliosis were observed. The subarachnoidal space was widened to some extent and contained some hemorrhaging.
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  • —A Case Report—
    KAZUHISA FUJISAWA, NOBUYUKI SUZUKI, MASAAKI HOSHINO, TAROH NAKAMURA, K ...
    1981 Volume 21 Issue 5 Pages 521-524
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Congenital dermal sinus is a rare disease, and is usually found in the occipital or the lumbosacral portion. The authors experienced a very rare case of congenital dermal sinus in the nose complicated with a brain abscess.
    The patient, a two-year-old boy, was admitted with a high fever and vomiting. Neurological examinations on admission revealed a somnolent status of consciousness, stiff neck and swelling of the anterior fontanel. In addition to these signs, a dimple with hairs was found on the nose. A CT-scan showed a large ring-shaped enhanced mass in the right frontal lobe. Under the diagnosis of a brain abscess, removal of the abscess was performed. It was observed during the operation that the abscess had developed from the intracranial portion of the dermal sinus in the nose. Five months later, the patient died. No autopsy was performed.
    The frequency of this disease, and the possibility of causal genesis were discussed.
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  • (2) Neuropathology for CT Diagnosis—Brain Tumors (Part 3)—
    TAKAYOSHI MATSUI
    1981 Volume 21 Issue 5 Pages 525-532
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
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