Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 21, Issue 9
Displaying 1-11 of 11 articles from this issue
  • YOSHINOBU IWASAKI, TERUFUMI ITO, TOYOHIKO ISU, MITSUO TSURU
    1981 Volume 21 Issue 9 Pages 917-921
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Treatment of acute spinal cord injury has not been definitely established.
    The purpose of this study was to investigate the effect of the combined treatment of mannitol administration followed by myelotomy on experimental spinal cord injury.
    Adult dogs were traumatized at the T10 level by means of Allen's method. 500gm-cm contused dogs resulted in complete paraplegia one month after trauma.
    Dogs given mannitol one and four hours after trauma could stand or raise their hips, but none could walk or run. The dogs treated by myelotomy four hours after trauma showed similar results as ones given mannitol. The dogs treated by a combination of early mannitol administration and myelotomy four hours after trauma could all walk or stand. This result was almost the same as the effect of myelotomy one hour after trauma which was previously reported by the authors.
    It is suggested that spinal autodestruction following cord contusion starts early after trauma, and that mannitol is able to suppress this early irreversible spinal damage.
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  • —I. Dynamic Brain Scintigraphy before and after Bypass Surgery—
    JUN KARASAWA, HARUHIKO KIKUCHI, YOSHIHIRO KURIYAMA, TOHRU SAWADA, TSUN ...
    1981 Volume 21 Issue 9 Pages 923-930
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Cerebral hemodynamics were studied in 38 children with “Moyamoya” disease. About 10mCi of Tc-99m was injected into the anterior cubital vein as a bolus, and serial brain scintigrams in one second intervals were obtained with a gamma scintilation camera (Ohio-nuclear Σ410s) and processed on an on-line radioisotope processing system including microcomputers (DEC PDP 11/34, 11/60).
    The characteristic images of serial brain scintigraphy were obtained in preoperative cases: early accumulation of radioisotope activities in the base of the skull, corresponding to the basal “Moyamoya” vessels, and the poor filling in the territories of the anterior (ACA) and middle cerebral arteries (MCA), indicating disturbance of the cerebral circulation. After bypass surgery, early accumulation of RI activities in the base of the skull diminished and evidence of improved cerebral circulation in the territories of the middle cerebral artery was obtained, but poor filling in the territories of the anterior cerebral artery persisted, measurements of local mode of transit time (MOTT) were made by our modified method which was originally reported by Oldendorf. Regions of interest were bilaterally settled both in the areas of basal “Moyamoya” vessels and in the territories of MCA in the anterior view image. The mean values of MOTT in the MCA territories were significantly longer than in the basal “Moyamoya” (10.8±2.7 sec, 7.7±2.1 sec, N=17, respectively). After surgery, shortening of MOTT in the MCA territory was observed (5.8± 1.3 sec, N=17).
    Positive static brain scintigrams were observed in only two cases. One patient was the case of cerebral infarction 14 days after the onset, the other patient showed a transient positive area in the region of the frontal lobe without neurological deficit, which was thought to be hyperpermeability of unknown origin. Findings of static brain scintigraphy of “Moyamoya” disease only indicated the results of damage of the blood-brain barrier.
    From this evidence, it was concluded that dynamic studies using Tc-99m and a scinti-camera were useful not only in the diagnosis of “Moyamoya” disease, but also in the study of the pathophysiology of brain circulation.
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  • ZENTARO ITO
    1981 Volume 21 Issue 9 Pages 931-939
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The author developed a new technique of intracranial interarterial anastomosis between distal anterior cerebral arteries (ACA).
    In 1974, a case was encountered where clipping of the aneurysmal neck was difficult because the left A2 arose from the big dome of an anterior communicating artery (Aco) aneurysm.
    Before clipping of the aneurysmal neck, the left A2 was cut off and anastomosed to the right A2 as an end-to-side anastomosis. By this method, a new flow route to a left peripheral ACA territory was obtained via the right A2, just as in the case of “artificial azygos anterior cerebral artery”.
    Thereafter, this operative technique was modified to an easier procedure. In this report, the operative technique, its indication and its operative results are described in detail.
    Bifrontal craniotomy followed by the interhemispheric approach should be performed. The anastomotic techniques were theoretically divided into four types as follows; 1) A2 A, end-to-side or 2) side-to-side anastomosis at the origin of distal ACA. 3) A3-A3 end-to-side or 4) side-to-side anastomosis at the knee portion of ACA.
    Among them, A2-A2, anastomosis is relatively difficult with respect to in the suturing technique because the operating field is very narrow and deep. However, A3-A3 anastomosis is easy for microsuturing because the operating field is situated superficially. By A3-A3 end-to-side anastomosis, reflow will be obtained to the proximal and to the peripheral vessels from the anastomotic part.
    Inter-ACA anastomosis was applied to two cases with Aco-aneurysms and three cases with spontaneous occlusion of one sided ACA. In postoperative angiography, only I case with ACA occlusion, in which this technique was used 5 months after occlusion of a vessel, lacked patency. The operative indication is proposed as follows; 1) in cases with occlusion of one ACA—especially A1 occlusion combined with hypoplasia of the Aco or A2-A3 occlusion—, and 2) in cases with a big or giant Aco-aneurysm, which causes occlusion of an A1 or A2.
    By this new technique, it becomes relatively easy to operate on cases with a big or giant Aco-aneurysm, where the direct surgical approach has, until now, been considered as difficult.
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  • TAKEHIDE ONUMA, NAMIO KODAMA, JIRO SUZUKI
    1981 Volume 21 Issue 9 Pages 941-944
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Thirty four cases of bilateral hematoma (14%) out of 248 cases of acute traumatic intracranial hematoma are reported with regards to clinical analysis and therapeutic problems.
    Operative results of the bilateral hematomas were the worst among various intracranial hematomas because of severe preoperative conditions and bilateral brain damage. Bilateral hematomas had no specific clinical features in comparison with unilateral hematomas. It was difficult to diagnose them by symptoms alone.
    The validity of Nelson and Freimanis method of differential diagnosis between unilateral hematoma and bilateral hematoma based on the shift of anterior cerebral artery during unilateral cerebral angiography was checked. Fifteen cases out of 25 cases of bilateral hematoma angiographically showed over 51 % shifts of the anterior cerebral artery. This was quite different from the report by Nelson and Freimanis.
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  • —With Special Reference to the Possibility of Secondary Stenosis—
    YUH TANAKA, SHIGETOSHI NAKAMURA, HIROSHI YAMADA, MASATAKA TAJIMA, NAOK ...
    1981 Volume 21 Issue 9 Pages 945-953
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    In recent years several reports have noted that aqueduct stenosis may result from compression to the midbrain caused by enlarged lateral ventricles. The purpose of this report is to discuss the possibility of this “secondary” aqueduct stenosis.
    Ninety patients with infantile hydrocephalus aged one week to four years were studied and classified radiologically into three groups: (A) 17 cases of hydrocephalus with aqueduct stenosis; (B) 25 cases of communicating hydrocephalus; and (C) 48 cases of hydrocephalus with Arnold-Chiari malformation.
    In group (A) all of the patients were examined by ventriculography using water-soluble contrast media such as Conray, Dimer-X or metrizamide. Based on the ventriculographic appearance, the forms of the aqueduct stenosis were divided into two types; one showed uniformly narrowed lumen of the aqueduct and the other funnel-shaped stenosis of the aqueduct. Pneumoencephalography or metrizamide CT-cisternography was performed in eight cases of this group and they demonstrated apparent opacification of the ambient cistern except for one case. From these observations, it was concluded that the aqueduct stenosis could not be regarded from the morphological point of view as the product of compression to the midbrain. The fact that the ambient cistern was clearly visualized by radiological studies and considered to be patent may be an objection to the possibility of “secondary” aqueduct stenosis because the ambient cistern should be obstructed if the aqueduct is occluded by lateral compression of enlarged lateral ventricles.
    In group(B) ventriculography or pneumoencephalography revealed that the lumen of the aqueduct was unusually large in many of the patients and the width of the aqueduct was closely related with the degree of the hydrocephalus. Therefore, the aqueduct was not considered to be gradually narrowed in the course of progressive hydrocephalus.
    In group (C) the aqueduct in ventriculography showed a characteristic figure that was supposed to be pathognomonic of the Arnold-Chiari malformation. The aqueduct was rather distended in its caudal end in the lateral view of the ventriculogram but the lumen of the aqueduct was extremely narrowed in the AP view. CT-cisternography was performed in six cases of this group and gave clear opacification of the ambient cistern. The specific appearance of the aqueduct and patency of the ambient cistern in this group may indicate that the aqueduct stenosis seen in the Arnold-Chiari malformation is one of the developmental anomalies of this malformation, not the product of hydrocephalic forces.
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  • —Part 3. The Morphology and Endocrinological Cure of Functioning Adenomas—
    SHIZUO OI, IVAN S. CIRIC, WILLIAM D. KERR, FRANK W. GUTHRIE, E. DENNIS ...
    1981 Volume 21 Issue 9 Pages 955-960
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    Sixty-three pituitary functioning adenomas were analyzed with respect to correlation between the preoperative morphological/endocrinological potentials of the tumor and the postoperative surgical endocrinological'cure rates. There were 38 prolactin, 18 growth hormone and seven ACTH secreting adenomas.
    In 38 prolactin secreting adenomas, 16 were microadenomas. A trial of selective total adenomectomy completely preserving the normal pituitary gland was performed in eight cases. The endocrinological cure rate (50%) and the abscence of galactorrhea (50%) were not satisfactory. Attempted complete adenomectomy with a partial hypophysectomy resecting some normal surrounding tissue improved the cure rates to 87%. Large tumors with sella destruction or tumors with a very high preoperative serum prolactin (not always correlated) had poor endocrinological cure rates. The endocrinological cure rate was 30% in the prolactin secreting adenomas with grade III and IV sella turcica (Hardy & Vezina classification). This rate was 40% in the prolactinomas with high preoperative endocrinological potentials (over 500 ng/ml), while it was 80% in the tumors with preoperative serum prolactin of less than 100 ng/ml.
    Similar results were obtained in the analysis of growth hormone secreting adenomas. The necessity of postoperative hormonal replacement increased in the larger tumors, 30% in Grades I and II and 50% in Grades III and IV. The hormoral cure rate was 80% in tumors with a preoperative growth hormone level of less than 100 ng/ml and 38% in those with over 100 ng/ml.
    The majority of ACTH secreting tumors were microadenomas and had excellent cure rates, 86% in seven cases.
    This study strongly suggests that the preoperative morphological/endocrinological potentials are the major factors affecting the postoperative surgical endocrinological cure rates in functioning adenomas. The authors emphasize that the transsphenoidal resection of the pituitary adenomas should be performed while the tumors have low morphological/endocrinological potentials to obtain excellent surgical results.
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  • TAKAHIRO NAITO, MOTOTSUGU MAEGAWA, TETSUYA MORIMOTO, TOSHISUKE SAKAKI, ...
    1981 Volume 21 Issue 9 Pages 961-968
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    The authors' experience is based on 84 patients with chronic subdural hematomas verified by surgery. Analysis of CT findings of the chronic subdural hematoma led to a classification of four different types: low, iso-, mixed and high density. The mixed density type was classified into two subdivisions: Type I characterized by the sharp border between two compartments and Type II characterized by high density around the hematoma capsule.
    There was a tendency in the high density type group for the clinical course from onset to be the most rapid, the mass effect for the brain the strongest and the period from onset to surgical intervention the shortest. They were slower, weaker and longer in order of the mixed, iso and low density types.
    As a result of analysis of hematoma content, there was no correlation among Ca ion concentration, total protein volume and types of hematoma, but there were some significant correlations among hemoglobin, hematocrit and types of hematoma.
    Hemoglobin and hematocrit were highest in hematoma content of the high density type and were lower in the order of the high density part of the mixed density type, isodensity type and low density type. However, the hematoma content in the low density type showed the highest value of LDH.
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  • KAZUO MIZOI, MICHIHARU NISHIJIMA, TAKEHIDE ONUMA
    1981 Volume 21 Issue 9 Pages 969-972
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A 29-year-old man fell down the stairs and suffered impact in the left temporo-parietal region. On the following day, although he was stuporous, motor disturbances and anisocoria were not observed, and both pupils normally reacted to light. Carotid angiography showed an avascular area in the left temporal area. Four days after the head injury he showed a generalized tonic-clonic convulsion. He became semicomatose with dilatation of bilateral pupils and decerebrate rigidity of all extremities. An immediate craniotomy was carried out and 100g. of epidural hematoma was removed. He became fully conscious 6 days after the operation, and he complained of blindness.
    A CT scan performed 15 days after the operation revealed low density areas occupying the bilateral lateral geniculate bodies and the visual corteces, and these areas were enhanced by contrast medium. These lesions were diagnosed as infarction caused by compression of the posterior cerebral arteries resulting from tentorial herniation.
    This is the first case reported in the literature.
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  • FUMOTO NAKAJIMA, SHINSA PAK, YASUHIRO CHIBA, TAKEO KUWABARA, SABURO YA ...
    1981 Volume 21 Issue 9 Pages 973-978
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A case of primary cerebral neuroblastoma was reported with respect to the clinical course and pathological findings. The patient, a three-year-old girl, suffered from headache and vomiting. Carotid angiography and CT scan showed a large tumor in the right parieto-occipital lobe expanding to the right lateral ventricle and crossing the midline to the opposite side. A total resection of the tumor was performed, and Linac therapy with a tumor dose of 5, 100 rads and chemoimmunotherapy (Me-CCNU, vincristine, OK-432) were given. Repeated CT scan showed recurrence of the tumor three months after surgery, and further irradiation therapy (tumor dose of 4, 500 rads) was given. She continued to deteriorate with multiple pulmonary metastases, and died eleven months after the initial symptoms and nine months after the surgery.
    Histologically the tumor cells were small, uniform and spherical, were arranged in delicate fibrillary stroma, and occasionally formed Homer-Wright rosettes. Electron microscopy showed neuronal processes with growth cones and rosettes with distinct lumina. The luminar surfaces were covered with a smooth plasma membrane lacking any surface differentiation and the lateral surface of these cells had many cell junctions, reminiscent of a primitive neural tube.
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  • SEISHO ABIKO, TETSUJI ORITA
    1981 Volume 21 Issue 9 Pages 979-984
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
    A Six-year-old boy was admitted to National Shimonoseki Hospital with headache, vomiting and consciousness disturbance. Skull plain film showed thinning and outer bulging of the left temporal bone. Markedly enhanced large masses were found in bilateral temporal bases by CT scan. A V-P shunt was performed on the next day for alleviation of increased intracranial pressure. Cerebral angiography disclosed bilateral temporal tumors which were nourished by the external carotid arteries. Two months later removal of the infected shunt system and partial resection of the left-sided tumor arising from temporal base were performed. A large tumor, 8 cm in greatest diameter was found in the middle fossa. Resected tumor weighed 1 10 g. It was thought that this tumor was derived from the dura of the base of the middle fossa. Microscopically the tumor was composed of spindle-shaped fibroblasts, foam cells and giant cells. It was diagnosed histologically as fibrous xanthoma. After surgery the patient had temporary respiratory failure. Differentiation between this tumor and meningioma was discussed.
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  • (2) Neuropathology for CT Diagnosis—Brain Tumors (Part 6)— edulloblastoma, Ependymoma, Choroid Plexus Papilloma
    TAKAYOSHI MATSUI
    1981 Volume 21 Issue 9 Pages 985-990
    Published: 1981
    Released on J-STAGE: November 10, 2006
    JOURNAL FREE ACCESS
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