Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 25, Issue 11
Displaying 1-12 of 12 articles from this issue
  • Hiroaki ISHIZAKA
    1985 Volume 25 Issue 11 Pages 873-880
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The dura mater was obtained from fresh cadavers at autopsy in a series of 52 specimens from 31 males and 21 females, ranging in age from 31 to 80 years. By dissecting the superior wall of dural venous sinuses, the courses and connections of all the major venous channels were examined. The configuration of the torcular herophili was divided into 11 types and four variations. The most frequent type was ScRc (29%), in which four major venous sinuses (that is the superior sagittal sinus, rectal sinus, and two transverse sinuses) joined at the same place. When the transverse or sigmoid sinus is obstructed at the time of surgery, there is a potential risk of developing brain edema. From that aspect, the variety and complexity of the torcular herophili configuration were divided into three groups. It was thought that the “freely communicating” type (63%), in which these channels possess open and unobstructed communication, had the least likelihood of brain edema, but that the “partially communicating” type (13%) and “non-communicating” type (23%) are more dangerous. Especially, the SrRr or SIRI type with complete atresia of the transverse sinus would certainly cause a marked congestion of the venous return. Light and electron microscopic observations clearly demonstrated the presence of smooth muscle cell layers in the subendothelial connective tissues. They varied in each sinus, but in the transverse and sigmoid sinuses, cell layers were thicker than in others. In 16 instances of the 52 specimens (31%), trabeculae were disclosed in and around the torcular herophili. The significance of smooth muscle cells and trabeculae is uncertain, but it is speculated that they regulate the venous blood flow to some extent by contractions and relaxations.
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  • Ultrastructural Localization of Na+, K+-adenosinetriphosphatase by Immunocytochemical Technique
    Toshio MASUZAWA, Toshiko OHTA, Fumiaki SATO
    1985 Volume 25 Issue 11 Pages 881-885
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The peroxidase-antiperoxidase (PAP) method was employed to determine the ultrastructural localization of Na+, K+-adenosinetriphosphatase (ATPase) in normal adult canine choroidal epithelium.
    The α- and β-subunits of Na+, K+-ATPase were prepared from Na+, K+-ATPase holoenzyme, which was purified from canine renal outer medulla. Rabbit antisera to both subunits were then produced. The intense immunoreactive electron-dense products were confined along the apical plasmalemma, including that of microvilli of choroidal epithelial cells. This finding is compatible with that of the authors' previous report by light microscopic immunohistochemistry.
    It can be inferred that the apical border of the epithelium is a very important site for cerebrospinal fluid secretion.
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  • Light and Electron Microscopical Studies In Vitro
    Masanori KABUTO, Toshihiko KUBOTA, Minoru HAYASHI, Shinjiro YAMAMOTO
    1985 Volume 25 Issue 11 Pages 886-893
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The effect of bromocriptine on the morphological features of a clonal strain derived from human pituitary adenoma [18-54, SF cells (SF cells)] was studied. Bromocriptine was added to serum-free medium at concentrations of 1 and 10 μg/ml. After 24 hours, 3 days, and 7 days of cultivation, each cell was observed under both phase-contrast microscopy and transmission electron microscopy. Immunocytochemical staining for prolactin (PRL) was also made.
    The phase-contrast microscopic study disclosed that untreated SF cells had angular or polygonal shapes. Ultrastructurally they were characterized by the presence of numerous free ribosomes, many mitochondria, well developed rough endoplasmic reticuli (RER) and Golgi complex, and especially by the lack of secretory granules in the cell. Immunoreactive products for PRL were observed throughout the cytoplasm. These cells showed little change after the administration of 1 μg/ml of bromocriptine all through the study. On the other hand, the cisternal spaces of the RER were dilated to varying degrees, and many vacuoles originating from the RER cisternae were observed in the cytoplasm 3 days after the administration of 10 μg/ml of bromocriptine. Mitochondria were decreased in number and size, and the electron density of their matrix was increased at this stage. Seven days after the administration of 10 μg/ml of bromocriptine, electron microscopy disclosed the following; pyknosis of nuclei, atrophy or swelling of mitochondria, increased cytoplasmic electron density, and severe degeneration in a large number of cells. No degenerative changes were observed in fetal mouse glial cells when 10 μg/ml of bromocriptine was administered (control group).
    The results suggest that bromocriptine has a cytocidal effect on SF cells and that this effect is a dose- and time-related phenomenon.
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  • Tsuneki KONISHI, Kouzo MORITAKE, Hideyuki SUWA, Mikio TAKAYA, Tatsuhit ...
    1985 Volume 25 Issue 11 Pages 894-899
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The effect of the intracranial use of an ultrasonic surgical aspirator with an electric striction transducer on the common carotid artery and nervous tissues was studied in anesthetized adult cats.
    Experiments were performed without suction to investigate the effect of ultrasonic emulsification alone. The intensity of the ultrasonic vibration was fixed at 60% of the maximal vibration (240 μm). Saline was irrigated over the tip of ultrasonic aspirator at a flow rate of 5 ml/min. The temperature rise produced by ultrasonic vibration was studied by use of a thermistor buried in the brain parenchyma of animals 2 mm from the ultrasonic vibratory tip. No rise above the physiological range could be observed.
    The effect of ultrasonic vibrations on the nervous system was studied using trigeminal evoked potentials (TEP) to monitor nerve function. An ultrasonic vibratory probe was applied to the cerebral cortex, brainstem and semilunar ganglion of trigeminal nerve. No significant changes on TEP occurred during or after application of ultrasonic vibration on any occasion. The common carotid artery and cerebral cortex exposed to ultrasonic vibrations were studied histologically. The changes were localized only in the superficial layer at the site of ultrasonic application.
    These experimental results suggest that damage to the nervous tissue and major vessels by ultrasonic vibrations can be prevented by keeping the intensity of vibration to less than 60% and avoiding continuous use of ultrasonic vibrations.
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  • Shigeki KAMEYAMA, Yoshiho HONDA, Kenichi TANIMURA, Yasuhiro KAWASE
    1985 Volume 25 Issue 11 Pages 900-906
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Old patients need a non-invasive screening test instead of conventional angiography for diagnosis of cerebrovascular diseases (CVD). The availability of radioisotope (RI) angiography as a screening test was studied on ischemic cerebral diseases, and compared with computed tomography findings or conventional angiographic findings.
    RI angiography was performed with a bolus injection of 20 mCi 99mTcO4- via a cephalic vein using a scintillation camera and an on-line computer system. One hundred images were obtained during 50 seconds.
    RI angiography was found useful for detecting occluded major arteries and perfusion through collateral circulations in acute stage of the ischemic CVD. Sequential examinations of RI angiography were performed without complications even in old patients. Recanalization of the major arteries was also detected without the help of conventional angiography. Occlusion of an internal carotid artery with no cross circulation indicated a poor prognosis, whereas good collateral circulation such as the presence of the flip-flop sign indicated a good recovery. A patent extracranial-intracranial (EC-IC) bypass after an operation and a patent internal carotid artery after a carotid endarterectomy were well detected. Increased perfusion of the distal middle cerebral arteries from the EC-IC bypass was revealed. The intracranial non-filling phenomenon in patients with brain death was also well detected.
    RI angiography is suitable for screening of ischemic cerebral diseases, especially in old patients, reconstructive vascular surgery, and brain death.
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  • Hiroki OHKUMA, Kunihiko EBINA, Takashi IWABUCHI
    1985 Volume 25 Issue 11 Pages 907-914
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    It is still debatable, whether the infundibular dilatation of the posterior communicating artery (ID) is preaneurysmal or not. Since there have been reports of aneurysms having developed clinically from ID, a proper follow-up or therapy procedures must be considered. In order to know what kind of cases must be followed up and operated on, incidence of ID was investigated on angiograms of 260 patients with cerebral aneurysms over the past 9 years. A statistical analysis of incidence and morphology of ID was performed. The results were as follows: 1) ID was seen in 67 out of 398 carotid angiograms (17%). This is about twice as much as in similar past studies on general neurological cases. 2) In patients with an internal carotid-posterior communicating artery aneurysm, the incidence of ID was much higher (P<0.05), and the ratio of round and large ID's was high (P<0.05). 3) Small ID's were mainly triangular in shape and large ID's chiefly round (P<0.01). 4) In young patients the ratio of large ID's was high (P<0.05). 5) In patients with a past history of hypertension, the ratio of large ID's was high (P<0.05). 6) In cases which had a well-developed posterior communicating artery, the ratio of round and large ID's was high (P<0.01). 7) In cases with a wide angle between the internal carotid artery and posterior communicating artery, the ratio of round and large ID's was high (P<0.05). Follow-up and therapy are indicated in cases with the above factors.
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  • Kazuo YAMADA, Toru HAYAKAWA, Shoji BITOH, Yuzuru OKU, Hiroshi TAKIMOTO ...
    1985 Volume 25 Issue 11 Pages 915-922
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    The surgical approach for 41 cases of carotid-ophthalmic aneurysm is reviewed. These are divided into 4 types according to Kothandaram et al. and Thurél et al.; namely, the subchiasmal type (25 cases), suprachiasmal type (4 cases), parachiasmal type (1 case), and global type (11 cases).
    Subchiasmal type aneurysms were mainly treated through the ipsilateral pterional approach removing the anterior clinoid process. However, 8 of the cases did not receive neck clipping for the following reasons: 1) The neck was not visible (4 cases), 2) a part of the aneurysmal dome was located in the cavernous sinus (3 cases), or 3) the neck was not separated from the ophthalmic artery (1 case). The contralateral pterional approach (6 cases) or interhemispheric approach (1 case) was useful in the aneurysm directing medially or posteromedially because the anterior clinoid process need not be removed. Suprachiasmal and parachiasmal type aneurysms were treated through the ipsilateral pterional approach. All 5 aneurysms were clipped successfully, though the anterior clinoid process had to be removed in 4 out of 5 cases. Global type aneurysms were treated by direct attack (4 cases), proximal arterial ligation alone (3 cases), or proximal arterial ligation with extracranial-intracranial (EC-IC) arterial bypass (4 cases). Although direct neck clipping or trapping is ideal for the treatment of global type aneurysms, this procedure was often impossible and proximal arterial ligation with EC-IC bypass was a useful alternative for this type of carotidophthalmic aneurysm.
    The surgical approach for carotid-ophthalmic aneurysm should be varied according to the type of aneurysm, position of the neck, and direction of the dome. Those must be clarified prior to surgery by reviewing angiograms and applying high-resolution computed tomography.
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  • Report of Three Cases
    Yusuke ISHIWATA, Takao SHIOZAWA, Teruo ICHIKAWA, Yasuhiro KOJIMA, Yosh ...
    1985 Volume 25 Issue 11 Pages 923-927
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Three cases of cerebrospinal fluid (CSF) leakage were successfully treated by percutaneous lumboperitoneal (L-P) shunting. Case 1 showed rhinorrhea secondary to a head injury. Case 2 had CSF leakage through the operative wound due to status post intraspinal dural tearing, and Case 3 had CSF leakage through a necrotic wound secondary to brain radiotherapy. The important points for the postoperative management of the patient are as follows: 1) posture of the patient, 2) frequent skull X-rays, 3) removal of shunt system when intracranial low pressure syndrome occurs, and 4) removal of shunt system approximately 3 weeks after operation when hydrocephalus is not present. No serious complications or recurrence were observed in the 3 cases.
    Thirty-one cases of CSF leakage managed by percutaneous L-P shunt were reviewed. Twentynine cases were successfully treated. The remaining 2 cases failed to improve. No serious complications were observed in any of the cases. Percutaneous L-P shunt appears to be an effective method for the management of CSF leakage.
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  • Autopsy Study
    Satoshi NAKASU, Asao HIRANO, Toshiro SHIMURA
    1985 Volume 25 Issue 11 Pages 928-932
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    Incidental meningiomas are not rare at autopsy. The incidence of meningiomas at autopsy is reported to be between 1 to 2%.
    The authors reviewed 10, 033 autopsy cases of the central nervous system at Montefiore Medical Center from 1950 to 1982, and found 272 cases of intracranial meningiomas (2.7%). Most of these meningiomas were incidental cases (231 cases or 2.3%). They increased with age and reached the highest percentage at the age of more than 80 years. Females showed a three times greater frequency than males. The incidental meningiomas were usually small in size, less than 1 cm in 59% of the cases. However, the frequency of the larger sizes increased with age, presumably because brain atrophy prevents them from becoming symptomatic, even if they grow relatively larger. Multiple meningiomas were found in 8.2% of the incidental cases. None of these cases had the stigmata of neurofibromatosis. They were thus the so-called “true multiple meningiomas.” They were also most frequent at the age of more than 80 years.
    These results indicate that large numbers of meningiomas remain asymptomatic in spite of their growth, and they increase with age.
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  • With Special Reference to the Histogenesis —Case Report—
    Shinji NAGAHIRO, Yasuhiko MATSUKADO, Shozaburo UEMURA, Yosuke MIHARA, ...
    1985 Volume 25 Issue 11 Pages 933-938
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A case of an epithelial cyst of the fourth ventricle is reported. A 10-month-old girl was admitted because of inactivity, developmental retardation, and enlarged head. On admission she was inactive and the head circumference measured 48.5 cm with tense fontanel and dilatation of scalp veins. Neurological examination showed a slight hyperreflexia in both lower limbs. Computerized tomography scan disclosed a large round low density area in the region of the fourth ventricle and marked dilatation of the third and lateral ventricles. Suboccipital craniectomy was performed and a 4 cm diameter cyst within the fourth ventricle was totally removed. The cyst contained watery clear fluid. On light microscopic examination, the cyst wall was composed of a single layer of columnar or cuboidal epithelial cells and thick collagenous connective tissue. Electronmicroscopic study revealed that the epithelial cells rested on a basement membrane separating them from the underlying collagenous tissue. Cilia and microvilli without coating material were occasionally present on the surface of the cells.
    The literature is reviewed and the origin of the cyst is discussed. The authors suggest that the cyst originated from the developing choroid plexus.
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  • Case Report
    Naokatsu SAEKI, Chiaki ITO, Naoki ISHIGE, Nobuo OKA
    1985 Volume 25 Issue 11 Pages 939-944
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    This is a case report of traumatic brain stem contusion. The pathogenesis was considered to be due to direct injury by tentorial margin. A 20-year-old male was involved in an automobile accident and was transferred in an unconscious state. The Glasgow Coma Scale score on admission was 8. Computed tomography (CT) scan showed a linear high-dense lesion at the left dorso-lateral midbrain without other significant intracranial lesions. He was treated conservatively. He regained consciousness several hours later, but drowsiness persisted for 3 weeks. He initially presented the left one-and-half syndrome and the right hemiparesis, which improved after a month. Follow-up CT scans showed a contusional lesion at the level of the ponto-mesencephalic junction which resolved in 3 weeks. The neurological deficits 6 months after the accident were right hemihypesthesia, left cerebellar sign, and right trochlear nerve palsy. He could not return to his previous occupation due to the persisting ataxia.
    The mechanism of this injury was supposed to be due to a direct injury by the tentorium cerebelli for the following reasons. The location of injury coincides with the level of the tentorium cerebelli. The injury started at the brain stem surface. The tentorial margin was closely located, to the brain stem in this case. Similar CT findings were reported in shear injuries, in which the prognosis was graver and follow-up CT scans showed diffuse brain atrophy. Therefore, the importance of differentiating between two mechanisms at the acute stage is emphasized.
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  • Case Report
    Hiroaki SEKINO, Yasuo KATOH, Toshinori KANKI, Norio NAKAMURA
    1985 Volume 25 Issue 11 Pages 945-951
    Published: November 15, 1985
    Released on J-STAGE: September 21, 2006
    JOURNAL FREE ACCESS
    A rare case of iatrogenic traumatic intracranial aneurysm which was found on the internal carotid artery 8 months after clipping of the basilar artery aneurysm is reported. A 25-year-old male was admitted with left hemiplegia and conjugate deviation toward the right. Computed tomography and repeat angiographies showed obstruction of the right middle cerebral artery and a fusiform aneurysm of the right internal carotid artery. The clip previously applied on the basilar artery aneurysm appeared touching the fusiform aneurysm. Development of the newly recognized fusiform aneurysm was considered to be due to a chronic pulsatile force on the internal carotid artery.
    Only 29 cases, including the authors', of iatrogenic traumatic aneurysms have so far been reported in the literature. The main cause was arterial injury during the first operation. It is emphasized that postoperative angiography is necessary in cases of an injury of the cerebral artery during operation. However, it is very difficult to find an aneurysm such as the one described here.
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