Neurologia medico-chirurgica

Holography of Neuroradiograms

Holography of Spinal Tomograms

Saburo WATANABE, Kinjiro IWATA, Masane SUZUKI

1982 Volume 22 Issue 6 Pages 407-411
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.407

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Since 1975, the authors have introduced the new technology of holography for three-dimensional evaluation of neuroradiograms. In this study we holographed conventional tomograms, axial transverse tomograms, and CT scans of a dry cervical vertebralcolumn. The axis of the spinal canal must be as vertical as possible to the tomographic plane in order to observe deeply inside the spinal canal. The hologram was the most clear when 8-10 sheets of tomographic film with a distance of 3-5 mm between each tomogram were recorded. The hologram from CT scans were more stereoscopic and clear than other types of holograms or the sagittally reconstructed CT. Clinically, the authors produced spinal multi-layered tomogram holograms of CT scans for two cases of cervical spondylosis, one of lumbar disc herniation, three of ossification of posterior longitudinal ligament and one of lipoma of the upper cervical region.

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Normal Pressure Hydrocephalus (Part I)

Pre- and Post-operative r-CBF

Tadaki KUSUNOKI, Shigeru KOSE, Norihiko TAMAKI, Satoshi MATSUMOTO, Hid ...

1982 Volume 22 Issue 6 Pages 412-416
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.412

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Pre- and post-operative r-CBF was examined with the ¹³³Xe inhalation method in 11 patients of normal pressure hydrocephalus (NPH). In the effective shunt group consisting of 8 patients, the preoperative mean hemispheric CBF was slightly lower than normal, while depression of the r-CBF in the frontal and parietal lobes was considerable. However, in the non-effective shunt group consisting of 3 patients, the preoperative mean hemispheric CBF was significantly lower than normal, and the r-CBF in the frontal, parietal and temporal lobes was consistantly low. In the effective shunt group, about a 10% increase in the postoperative mean hemispheric CBF was noticed and the increased r-CBF was more prominent in the frontal and parietal lobes. However, the postoperative CBF did not increase in the noneffective shunt group. Improvement of symptoms did not always parallel the postoperatively increased mean hemispheric CBF.
The possibility of predicting shunt effectiveness from the features of preoperative r-CBF study in NPH, the mechanism of the postoperative change in CBF, and the necessity of pathogenetic diagnosis of NPH for the evaluation of pre and post-operative CBF study were discussed.

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Xenon-enhanced Cranial Computed Tomography (Part I)

Experimental Study

Hideo HIRATSUKA, Shin TSURUOKA, Hitoshi TABATA, Seiji MONMA, Tohru FUK ...

1982 Volume 22 Issue 6 Pages 417-420
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.417

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Xenon-enhanced computed tomography (CT) was done in monkeys to study the enhancement effect and clearance rate of xenon in the normal and the embolized brain. The embolization was performed by using barium-impregnated silicone spheres blown through the internal carotid artery which were detectable by CT. The normal brain was enhanced symmetrically, first in the gray matter, then in the white matter, while the infarcted brain showed significantly diminished enhancement. By obtaining serial CT scans for 10 minutes, the clearance rate of xenon and the cerebral blood flow were calcurated. Xenon-enhanced CT may be used for clinical study of regional cerebral blood flow.

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Posterior Fossa Meningioma with Special Reference to False Localizing Sign

Shinji NAGAHIRO, Yasuhiko MATSUKADO, Shozaburo UEMURA

1982 Volume 22 Issue 6 Pages 421-428
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.421

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Twenty-one cases of meningiomas of the posterior fossa were reported.
They were located in the cerebellopontine angle (9 cases), over the cerebellar convexity (7 cases), and in the tentorial attachment (5 cases). Of the 21 patients, 18 were female. The most common subjective symptoms were headache (95%) and unsteady gait (81%). Loss of hearing and tinnitus were the initial symptoms in 4 of 9 patients with the cerebellopontine angle meningiomas. Papilledema was present in 15 patients. Cerebellar signs, although observed in all cases, were not prominent in those patients with the cerebellar convexity or tentorial meningiomas. Except in the cases of cerebellopontine angle meningiomas, cranial nerve involvement was not a consistent finding. False localizing signs (FLS) of the cranial nerves were present in 6 (29%) of 21 cases of posterior fossa meningiomas including 4 (44%) of 9 patients with cerebellopontine angle meningiomas, whereas only 7 (16%) of 45 patients with acoustic neurinomas showed FLS. CT scan, performed in 15 patients, was the most useful examination in the diagnosis of this meningioma. In precontrast CT, the tumor frequently appeared iso or high dense. Calcifications were located in the tumor in 4 patients. Contrast CT revealed huge tumors in all of the cases and homogenous enhancement was seen in 13 patients (87%). Tumor stains in angiograms were demonstrated in 12 (57%) of 21 patients. Operative treatments were performed in all cases; total removal-12 (including 2 cases with second stage operation); subtotal removal-4; partial removal-5. Total removal was not easy except in cases of cerebellar convexity meningioma. There were 4 hospital deaths after the first operation. Follow-up revealed only three cases in good condition in the cerebellopontine angle meningiomas group, good results were obtained in the cerebellar convexity and the tentorial meningiomas groups.
The mechanism of the development of false localizing signs was discussed with a review of the literature.

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Acute Subdural Hematoma in Chronic Stage Compared with Chronic Subdural Hematoma

Tetsumori YAMASHIMA, Shinjiro YAMAMOTO, Haruhide ITO

1982 Volume 22 Issue 6 Pages 429-436
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.429

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Among 126 cases of chronic subdural hematoma, 6 cases (4.8%) were diagnosed as acute subdural hematoma in chronic stage. They were 3 males and 3 femals whose age ranged from 46 to 79 years (average 62.8 years).
All of them received major trauma to the head, but surgical treatment was not necessary until a mean period of 22.7 days, ranging from 17 to 30 days. Acute subdural hematoma in its chronic stage has subdural granulation tissue similar to that of the outer membrane of chronic subdural hematoma. This membrane was formed in the dural surface of the hematoma and was partially liquefied near the arachnoidal surface, but none of them had a macroscopically well-formed inner membrane. The subdural granulation tissue was of irregular thickness ranging from 1-2 mm, and was tightly adhered to the hematoma. Histologically, the granulation tissue consisted mainly of old fibrous connective tissue, having less capillaries than the outer membrane, and with scant blood components and few inflammatory cells. Pigments such as hemosiderin or hematoidin, and macrophages laden with these pigments accumulated in the granulation tissue, while new hemorrhagic foci were rare around the capillaries. The border layer between the subdural granulation tissue and the hematoma was generally irregular and not clearly discriminated, where many fibroblasts with mitotic figures and the macrophages irregularly accumulated.
Thus, acute subdural hematoma in chronic stage differed from chronic subdural hematoma, both in its clinical and pathological aspects. The results suggest that the existence of an inner membrane plays an important role in defining the chronicity of subdural hematomas. It is advisable to investigate not only the clinical course, but also the existence of an inner membrane and the histology of the subdural granulation tissue in order to differentiate acute subdural hematoma in chronic stage from chronic subdural hematoma.

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Development of New Aneurysm and Enlargement of Small Aneurysm

Report of Seven Cases

Hideaki NUKUI, Takao NAGAYA, Osamu MIYAGI, Jun-pei TAMADA, Masami KANE ...

1982 Volume 22 Issue 6 Pages 437-445
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.437

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The authors reported 7 cases that showed development of new aneurysms or enlargement of small aneurysms originally less than 3 mm in diameter. New aneurysms of the anterior communicating artery and the right pericallosal artery were found in one case. In this patient with a 5 year history of hypertension, cerebral angiography performed 8 years before following a head trauma had revealed marked arteriosclerosis and a hypoplasia of A₁, but no aneurysm. Development of an aneurysm from a dilatation at the origin of the right embryonal posterior cerebral artery was found 3 years after the clipping of an aneurysm of the left internal carotid artery in the other case. In 3 cases, a small unruptured aneurysm all originally less than 3 mm in diameter previously noted in conjunction with a ruptured aneurysm were found to have enlarged 3 to 13 years after the clipping of the ruptured aneurysm. In these 3 cases, anomalies of the circle of Willis, such as hypoplasia of unilateral A₁, infundibular dilatation at the origin of the posterior communicating artery and the embryonal posterior cerebral artery were revealed. Arteriosclerosis and hypertension were noted in 2 cases. In 2 cases, a small ruptured aneurysm, which had not been recognized at the first subarachnoid hemorrhage, was noted to have enlarged 5 and 10 years after the first bleeding.
Changes of the arterial wall due to hypertension, arteriosclerosis, etc., and hemodynamic stress caused by anomalies of the circle of Willis seemed to be responsible for the new development of aneurysm and the enlargement of aneurysm. A small aneurysm less than 3 mm in diameter, including an unruptured aneurysm that is found in association with the ruptured aneurysm, have a high incidence of progressive enlargement and rupture. Therefore, even a small aneurysm should be diagnosed and treated precisely.

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Diagnosis and Treatment of Brain Metastasis of Lung Cancer in CT Era

Correlation to Histological Types

Tatsuya KOBAYASHI, Yoshihisa KIDA, Jun YOSHIDA, Naoki SHIBUYA, Itaru I ...

1982 Volume 22 Issue 6 Pages 446-452
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.446

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This paper studied the biological nature of brain metastasis of lung cancer correlated with their histological types and CT findings, and investigated the prognostic factors in treating these cases. Fortytwo cases were treated since 1977. The histological types were: 17 cases of adenocarcinoma; 9 of squamous cell cancer; 7 of small cell; 6 of large cell; and 3 of unclassified lung cancer.
The overall incidence of single metastatic lesions were more frequent than multiple lesions (23: 19). However, multiple lesions were common in squamous cell and large cell cancers, while single lesions were more common in adenocarcinoma and small cell cancer at their early stages. Rather characteristic CT findings were found for each histological type; when such parameters were taken into consideration e.g., size, shape, multiplicity mode of enhancement in the metastatic lesion, and the grade of peritumoral edema and brain shift. The 39 surgical cases were treated with irradiation and/or systemic chemotherapy. Overall mean survival time was 6 months after treatment and the 1 and 2 year survival rates were 20.5% and 7.6%, respectively. Mean survival time was 16.3 months in cases with total removal of metastasis followed by whole brain irradiation, and was 20.5 months in cases treated with total removal, postoperative irradiation, plus scheduled chemotherapy (ACNU and FT-207). From analysis of the 8 longest surviving cases, the most favorable outcome was for cases of adenocarcinoma with single brain metastasis, in cases receiving multidisciplinary therapies, and when the primary lesions were controlled. In conclusion, early diagnosis by CT scan and specified, multidisciplinary treatments based on the histological type are advised for a more favorable prognosis for cases of metastatic brain tumor arising from lung cancer.

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Cystic Prolactin Secreting Tumor

A Light Microscopic, Ultrastructual, and Immunocytochemical Study

Masahiro KURISAKA, Gary S. PEARL, Yoshio TAKEI, George T. TINDALL

1982 Volume 22 Issue 6 Pages 453-460
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.453

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Two cases of pituitary adenoma associated with large cyst formation were described. Ultrastructurally, the cyst lining cells resembled those of Rathke's cleft, whereas the adenoma cells were of the prolactin-secreting type as confirmed by immunocytochemical examinations. In addition, an apparent transition between the cyst lining cells and the adenoma cells was identified. These findings suggest that these cases represent an extremely rare form of adenohypophyseal tumor which has been termed “transitional cell tumor” by Kepes.

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Stereotactic Evacuation of Intracerebral Hematomas

Eiji DOI, Hiroshi MORIWAKI, Norihiko KOMAI, Munehisa IWAMOTO

1982 Volume 22 Issue 6 Pages 461-467
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.461

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A new treatment was performed for hypertensive intracerebral hemorrhage. The procedure, indication, timing, and result of the treatment were discussed.
Stereotactic evacuation of hematomas was performed on twelve patients; six cases were thalamic hemorrhage and six were putaminal hemorrhage. None of these patients, showed severe disturbance of conseiousness. Timing of the operation ranged from seven to thirty-seven days after the ictus (subacute stage). Although most of the hematoma was usually aspirated, the remaining hematoma was liquefied by Urokinase and was drained out through a silicon tube over three to four days. Decreased mass effect and diminished high density area were confirmed on CT scans 24 hours after surgery, and all of the patients had good functional outcomes. Rebleeding due to the ill effect of Urokinase was not encountered.

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An Arteriovenous Malformation Associated with Three Aneurysms; Case Report

Concerning Priority in Surgical Procedure

Eiichiro KAMAZUKA, Tetsuro CHISHIKI, Kazuaki SUGIURA

1982 Volume 22 Issue 6 Pages 468-472
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.468

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The association of an arteriovenous malformation (AVM) with an intracranial aneurysm has been reported repeatedly, and its association with multiple aneurysms has also been reported sporadically. The authors described such a case, in which surgical intervention prompted the rupture of an aneurysm. The patient, a 47-year-old businessman, suddenly lost consciousness on his way to his office. He was admitted the next day with clinical findings of severe neck stiffness, loss of memory, and right hemiparesis. Cerebral angiography demonstrated 3 aneurysms and 1 AVM. Left frontal craniotomy was performed. During resection of the AVM, massive arterial hemorrhage from a middle cerebral aneurysm occurred, which necessitated clipping of the aneurysm before removal of the AVM. Postoperative angiography showed the disappearance of the AVM and of the middle cerebral aneurysm. The patient was discharged with moderate disability (Glasgow Outcome Scale).
Associated AVM and aneurysm should both be treated surgically, preferably in one operative stage. The aneurysm should be treated first, if it is the source of hemorrhage. It should be treated first, if it lies proximally to the AVM, even if the source of hemorrhage is unclear or the source is the AVM. The AVM should be removed in advance of the aneurysm only when both lesions are situated in different arterial regions and the AVM is the source of hemorrhage.

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Primary Fibrosarcoma of the Skull

Case Report

Kiyoshige FUJIMOTO, Shiro WAGA, Toukichi TAKEUCHI

1982 Volume 22 Issue 6 Pages 473-477
Published: 1982
Released on J-STAGE: November 10, 2006

DOIhttps://doi.org/10.2176/nmc.22.473

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A case of primary fibrosarcoma of the calvarium is presented. A 51-year-old female was admitted because of a progressively enlarging mass in the left parietooccipital region. Radiograms of the skull revealed a radiolucent area with an osteosclerotic margin in the left parietooccipital region. CT scan showed an ovoid mass with osteolysis, extending both intracranially and extracranially. The tumor was slightly enhanced after infusion of contrast material. Under the diagnosis of a primary skull tumor, en bloc resection was performed. Histological diagnosis was fibrosarcoma. The postoperative course was uneventful. She was discharged without neurological deficits after completion of chemo- and radiotherapy. She was readmitted two months after discharge because of frequent coughing and hemoptysis. The patient died of pulmonary metastases 4 months after diagnosis.
Primary fibrosarcoma of the calvarium is very rare. The literature suggests that definite surgical treatment should be done before distant metastases occur.

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