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In Vivo Dialysis coupled with High-performance Liquid Chromatography with Electrochemical Detection
Teruaki KAWANO, Hitoshi MIYAKE, Keisuke TSUTSUMI, Kazuo MORI
1988 Volume 28 Issue 3 Pages
217-222
Published: 1988
Released on J-STAGE: September 21, 2006
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Dialysis tubing with a 0.2-mm diameter was implanted into the caudate nucleus of spontaneously hypertensive rats. Continuous perfusion with Ringer's solution at a flow rate of 10 μ
l/min was then initiated. During incomplete cerebral ischemia induced by bilateral common carotid artery occlusion, the perfusate was collected every 20 minutes and analyzed for the content of monoamines and their metabolites. The extracellular content of dopamine was abruptly increased about 4 to 6 minutes after ischemic insult, reached a maximum after about 20 to 40 minutes, and then decreased over 120 minutes. During the same period, 3, 4-dihydroxyphenyl acetic acid and 5-hydroxyindole acetic acid were significantly decreased, and 5-hydroxytryptamine was not detected during the ischemic period. The results suggest that the ischemia induced a large increase in extracellular dopamine within the caudate nucleus and that leakage occurred due to the energy failure of cell membranes. This process may be one causal factor in the neuronal damage observed after ischemia.
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Satoshi KUWABARA, Seiichi ANDOH, Junji UNO, Shigeo MATSUMOTO, Susumu I ...
1988 Volume 28 Issue 3 Pages
223-229
Published: 1988
Released on J-STAGE: September 21, 2006
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A new, canine model of brainstem infarction has been developed. The authors describe the production of this model as well as the neurological symptoms, changes invital signs, and extent of infarction observed. Twenty-four mongrel dogs were anesthetized with sodium pentobarbital. After removal of the right zygomatic arch, a small temporal craniectomy was performed. The perforating arteries arising from the bilateral posterior cerebral arteries as far as their junctions with the posterior communicating arteries were occluded by means of a subtemporal approach to the region of the interpeduncular cistern. The animals were divided into three groups. In the acute group (n=6), the brain was perfused with microcarbon or microbarium immediately after occlusion of the perforators. In the chronic group (n=14), the animals were examined daily for neurological alterations and changes in vital signs for 7 to 10 days after the procedure. The remaining 4 animals were controls and underwent a sham procedure. Sagittal and/or serial coronal sections of the fixed brains of all animals were prepared for examination of the extent of defective perfusion or infarction. All of the sham-operated animals survived without any neurological deficit and showed no evidence of pathological lesions. In the acute group, the area not perfused with microcarbon or microbarium was the rostral brainstem, which corresponded to the extent of infarction observed in the chronic animals. Thirteen of the 14 chronic animals survived for more than 1 week, while exhibiting such clinical symptoms as disturbance of consciousness, tetraparesis, oculomotor paralysis, respiratory abnormalities, bradycardia, and arrhythmia. Gross pathological study of the brain sections revealed well defined infarctions, which were consistently located in the posterior thalamus, subthalamus, midbrain, and upper pons in all 14 chronic animals. The lesions were butterflyshaped in the paramedian portion of the thalamus and wedge-shaped at the midbrain and upper pons levels. The clinical features and extent of infarction observed in this model closely resemble those of rostral brainstem infarction in human stroke. Therefore, this model may be useful in the study of the pathophysiology of brainstem ischemia.
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Tetsuji ORITA
1988 Volume 28 Issue 3 Pages
230-235
Published: 1988
Released on J-STAGE: September 21, 2006
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Sequential changes in the microvascular architecture of rat brains following local freezing injury were studied by scanning electron microscopy involving the cerebrovascular casting method. Repair of the microvascular architecture was initiated on day 3 after injury. Hematogenous cells and reactive astrocytes within the edematous zone participated in the regenerative process. The microvascular architecture was reconstructed from the edge of the lesion toward the brain surface. On the other hand, in small parts of the brain surface subjected to severe, focal freezing, the microvascular architecture was newly formed and resembled that of fetal and newborn rat cortices. Within 7 days after injury, the microvascular architecture was completely repaired.
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Yukihiko UEDA, Takashi MATSUMOTO, Hajime NAGAI, Takaaki NAKAMURA
1988 Volume 28 Issue 3 Pages
236-240
Published: 1988
Released on J-STAGE: September 21, 2006
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Although there have been numerous clinical and experimental studies of the etiology and clinical features of chronic subdural hematoma, certain details remain obscure. For instance, it is unknown whether the neomembranes (outer membranes) are peculiar to chronic subdural hematomas or whether they are caused by a general inflammatory reaction. The pathological features of these neomembranes were studied in relation to the clinical presentation in 46 patients with chronic subdural hematoma who underwent surgery at Nagoya City University. There were 34 males and 12 females, and their ages ranged from 26 to 84 years. Since attention has recently been focused on eosinophilic infiltration in the outer membranes, the patients were divided into two groups according to whether eosinophilic infiltration was extensive (Group A) or negligible (Group B). There was no significant sex difference between the groups; 47% of the males and 42% of the females were in Group A. There were no significant correlations between the extent of eosinophilic infiltration and either age or the interval from trauma to surgery. Intramembranous hemorrhage was observed more frequently in Group B. It was not possible to differentiate the two groups by computed tomography (CT) alone, as the preoperative hematoma densities were similarly distributed between them on CT scans. There was no correlation between the preoperative maximal thickness of the hematoma cavity and the extent of eosinophilic infiltration. The serum eosinophil counts were normal in all patients evaluated. Patients who showed no clinical improvement following surgery and/or required a second operation all belonged to Group B.
Some authors claim that eosinophils participate in the absorption of hematomas and the formation of granulation tissue, while others assert that eosinophilic infiltration can cause rebleeding. In the present study there was a higher incidence of intramembranous hemorrhage and a less favorable response to surgery in Group B than in Group A, which suggests that eosinophilic infiltration plays a key role in the formation of granulation tissue and the prevention of rebleeding.
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Takashi UEDA, Kazuo KINOSHITA, Katsushi WATANABE, Hiroaki HOSHI, Seish ...
1988 Volume 28 Issue 3 Pages
241-247
Published: 1988
Released on J-STAGE: September 21, 2006
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Continuous sequential single photon emission computed tomography (dynamic SPECT) with N-isopropyl-p-[
123I]iodoamphetamine (IMP) was performed in 17 patients with cerebrovascular diseases (three with transient ischemic attack, four with cerebral infarction, two with ruptured aneurysms, two with arteriovenous malformations (AVM), one with an unruptured giant aneurysm, and five with moyamoya disease). Dynamic SPECT scans were obtained with a circulardetector array emission CT instrument at a fixed level parallel to the orbitomeatal plane. The scans were taken over a 20-minute period, at 2-minute intervals, immediately after intravenous injection of IMP. Time courses of activity ratio of the affected/non-affected areas were calculated. Accumulation of IMP in ischemic areas was consistently suppressed to approximately 70 to 80% that in the non-affected areas. IMP accumulation in infarcted regions was less than 40 to 50% that in non-affected areas. In the regions of AVM and giant aneurysm, accumulation of IMP was rapid and relatively high, but its removal was prompt. Dynamic IMP SPECT appears useful in the assessment of cerebral perfusion and may have numerous applications in neurosurgery.
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Reconstruction for Vertebral Artery Stenosis at its Origin
Shunichiro FUJIMOTO, Yoshinori TERAI, Takahiko ITOH, Kazushi KINUGASA, ...
1988 Volume 28 Issue 3 Pages
248-253
Published: 1988
Released on J-STAGE: September 21, 2006
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Ten males and one female with symptoms of vertebrobasilar insufficiency associated with vertebral artery stenosis at its origin were surgically treated by reconstruction. Their ages ranged from 46 to 67 years (mean, 59 years). Their symptoms included vertigo, dysarthria, dysphagia, syncope, motor and/or sensory disturbance, and cerebellar ataxia. Six had multiple stenotic lesions. Surgical procedures consisted of eight vertebral artery transpositions to the common carotid artery, two subclavian artery-vertebral artery bypasses with saphenous vein grafting, and one vertebral arterythyrocervical trunk anastomosis. Postoperative angiography showed all reconstructions to be patent. All but three patients had complete resolution of their symptoms, and no neurological deficits occurred as a result of interruption of cerebral flow. Miosis limited to the affected side was observed in nine cases. As has been noted in previous reports concerning arterial reconstruction, vertebral artery to common carotid artery transposition is a safe and relatively easy procedure.
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With Special Reference to Somatomedin-C Level
Michihiko OSAWA, Shigeaki KOBAYASHI, Toshiki TAKEMAE, Fukuo NAKAGAWA
1988 Volume 28 Issue 3 Pages
254-258
Published: 1988
Released on J-STAGE: September 21, 2006
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Fourteen patients with acromegaly who had undergone transsphenoidal surgery were followed for 1 to 7 years (average, 4.3 years). Pre- and postoperative growth hormone (GH) levels, changes in the GH response to thyrotropin releasing hormone (TRH) tolerance testing, and the correlation between clinical improvement and postoperative GH and somatomedin-C levels were studied. Clinical improvement was assessed by scoring of the pre and postoperative symptoms. A significant correlation was found between the postoperative GH and somatomedin-C levels (p<0.01). All patients with postoperative somatomedin-C levels of less than 2 IU/m
l, including one of the three patients whose postoperative GH levels were between 5 and 10 ng/m
l, showed clinical improvement. Normal responses to TRH testing were rare and were poorly correlated with clinical improvement. These results suggest that somatomedin-C is more useful than GH in predicting clinical improvement following surgery for acromegaly.
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Kenichi KITAOKA, Hiroshi ABE, Yoku NAKAGAWA, Masaharu SATOH, Terufumi ...
1988 Volume 28 Issue 3 Pages
259-264
Published: 1988
Released on J-STAGE: September 21, 2006
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Twenty-four cases of surgery for solitary brain metastasis from lung cancer were clinically evaluated. After total or subtotal removal of the single metastasis, 87.5% of the patients had neurological improvement. However, in 43% of these 21 patients the improvement lasted no longer than 2 months. Also, one third of all patients lived for less than 5 months after surgery. The 2 patients who underwent intracranial surgery plus chemotherapy and radiation therapy for brain metastasis and also received radiation therapy plus chemotherapy or radical surgery plus chemotherapy for primary lung cancer survived somewhat longer. In 29% of the patients, death was caused mainly by regrowth of metastatic brain tumors shortly after intracranial surgery. In most of these cases the tumors were very large and cystic; thus, removal of both the cyst capsule and the solid portion may be a means of prolonging survival. Patients who also had metastases to bone and/or other organs had a poor outcome following intracranial surgery. This indicates that intracranial surgery for patients with extensive metastases is contraindicated.
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Report of Three Cases
Shigeki MATSUMURA, Hidehiko TAKAMATSU, Sumito SATO, Seiji ARA
1988 Volume 28 Issue 3 Pages
265-270
Published: 1988
Released on J-STAGE: September 21, 2006
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Interferon-β (IFN-β) is considered remarkably nontoxic compared with other anticancer drugs. Central nervous system toxicity, in particular, is very rare, only three cases having been reported (seizure in one case and deterioration of consciousness in two cases). In this study, human fibroblast interferon (Hu IFN-β with a specific activity of 2.0 × 10
8 IU/mg protein) was administered to three patients who were marginally functioning with malignant brain tumors (two glioblastoma multiforme and one grade 2 astrocytoma with intracerebral seeding) by intraventricular and/or intratumoral injection. Deterioration of the highest integrative functions, such as spontaneity, interaction with the environment, and orientation to time, place, person, and situation were then observed. Drowsiness and deterioration of consciousness were observed in two cases. One patient, to whom IFN-β was administered through an Ommaya's reservoir into a left parietal tumor cavity, developed complete sensory aphasia. The mechanisms of these central nervous system reactions to IFN-β are unclear. Deterioration of high integrative functions and consciousness disturbance are considered to reflect global suppression of cerebral function by IFN-β access to the subarachnoid space or ventricular system. Sensory aphasia is regarded as a result of direct, local suppression of cerebral function. It is suggested that IFN-β-induced central nervous system toxicity tends to occur in patients whose cerebral function is tenuous. The possibility of central nervous system toxicity should be kept in mind when IFN-β is administered locally.
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Toyohiko ISU, Hiroshi ABE, Yoshinobu IWASAKI, Minoru AKINO
1988 Volume 28 Issue 3 Pages
271-277
Published: 1988
Released on J-STAGE: September 21, 2006
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Chiari malformations are often associated with congenital anomalies. The authors evaluated several surgical procedures for Chiari malformations associated with basilar impression and/or syringomyelia. Twenty patients with Chiari malformations with and without congenital anomalies were treated by various surgical procedures. Associated anomalies were atlantoaxial dislocation in one, basilar impression in eight, and syringomyelia in 11. There were 11 males and nine females, ranging in age from 6 to 63 years. Nine patients were treated by foramen magnum decompression (suboccipital craniectomy and upper cervical laminectomy), one by foramen magnum decompression combined with terminal syringostomy, one by anterior decompression via the transoral approach, and nine by syringosubarachnoid shunting. The period of follow-up ranged from 5 months to 21 years (mean, 7 years). Seventeen of the 20 patients showed neurological improvement, one was unchanged, and two deteriorated. One of the patients who deteriorated had undergone syringosubarachnoid shunting, and the shunt malfunctioned because of arachnoiditis. A patient with basilar impression died of respiratory failure after suboccipital craniectomy and upper cervical laminectomy.
On the basis of their results, the authors recommend posterior decompression for patients with Chiari malformations alone. If a foramen magnum lesion is responsible for the neurological manifestations and the clivoaxial angle is narrow in Chiari malformations associated with basilar impression and/or syringomyelia, anterior decompression with fusion should be performed. If the clivoaxial angle is within normal limits, the authors perform posterior decompression. Syringosubarachnoid shunting appears effective in patients in whom syringomyelia is the main cause of neurological symptoms.
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Clinical, Neuroradiological, and Surgical Features
Hajime ARAI, Kiyoshi SATO, Akira UTO, Katsumi YAGUCHI, Atsushi ISHIZAW ...
1988 Volume 28 Issue 3 Pages
278-287
Published: 1988
Released on J-STAGE: September 21, 2006
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The authors studied 19 cases of posterior fossa cysts —14 of retrocerebellar cyst, three of unilateral cerebellar hemispheric cyst, and two of cerebellopontine angle cyst— all of which were presumptively diagnosed by means of axial computed tomography (CT) There were 15 children and four adults, ranging in age from 2.5 months to 65 years. Thirteen were male and six female. The patients underwent various neuroradiological tests, including sagittal reconstruction CT, radioisotope (RI) and/or CT cisternography, and angiography, as appropriate. Seventeen patients were treated surgically by excision of the outer wall of the cyst, followed in 15 cases by cystoperitoneal shunting. Retrospective classification of the 19 cases yielded seven communicating or non-communicating intra-arachnoid cysts, two Blake's pouch cysts, one Dandy-Walker cyst, two Dandy-Walker variants, one glioependymal cyst, one enlarged cisterna magna with communicating hydrocephalus, one fourth ventricular diverticulum, and four cases of large cisterna magna. In 10 of the 17 operated cases, the cyst disappeared, the cerebellum expanded, and the clinical symptoms abated.
Four major findings were obtained in this study. First, posterior fossa intra-arachnoid cysts were encountered more frequently than expected and were found to be surgically treatable. Second, although fourth ventricular cysts were categorized as Dandy-Walker cyst, Dandy-Walker variant, and Blake's pouch cyst in this study, the neuroradiological distinctions between these three types are uncertain. Third, the surgical findings did not always corresponded to the preoperative classification. Finally, in cases with the following neuroradiological findings, surgery appears to be indicated: 1) occipital bossing or petrosal scalloping with distortion or obliteration of cerebrospinal fluid (CSF) cisterns of the posterior fossa; 2) compression and deformity of the brain surrounding the cyst; 3) RI and/or CT-cisternographic findings suggestive of disturbance of intracystic CSF circulation; and 4) a non-communicating cyst.
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Case Report
Shigeru MUNEMOTO, Shuso ISHIGURO, Akira KIMURA, Masahiro KITABAYASHI, ...
1988 Volume 28 Issue 3 Pages
288-292
Published: 1988
Released on J-STAGE: September 21, 2006
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A 59-year-old woman complained of headaches and vomiting. On admission, neurological examination revealed bilateral choked disc and tendon hyper-reflexia. Lumbar puncture showed a high opening cerebrospinal fluid (CSF) pressure (195 mmH
2O) ; however, protein and sugar levels were normal. The CSF was clear and watery. Computed tomography showed that the bilateral white matter was of low density and the ventricles were compressed bilaterally. Intracranial pressure (ICP), measured continuously by means of a ventricular tube, ranged from 20 to 40 mmHg. The ICP record showed typical A waves and, when an A wave was observed, the patient simultaneously lost consciousness. From these data, the diagnosis of benign intracranial hypertension was established. Intravenous glycerol administration during ICP recording produced only a temporary decrease in ICP. Ventricular external drainage, however, was continuously effective. After a ventriculoperitoneal shunt had been emplaced, the patient recovered. In this case, continuous ICP recording was very useful in both the diagnosis of benign intracranial hypertension and evaluation of its treatment. Shunting is an effective treatment for this disease.
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Case Repoet
Yoshimi TANAKA, Akira IKEDA, Shinya YAMADA, Isao YAMAMOTO, Osamu SATO, ...
1988 Volume 28 Issue 3 Pages
293-297
Published: 1988
Released on J-STAGE: September 21, 2006
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A 41-year-old woman had had slowly progressive loss of vision and exophthalmos of the left eye from the age of 35 years. Multiple café-au-lait spots and subcutaneous neurofibromatous masses were noted. Plain skull X-rays revealed a defect of the posterior wall of the left orbit and bulging of the left frontotemporal bone. There was also a small bony defect in the occipital bone adjacent to the left lambdoid suture. Computed tomography (CT) disclosed a marked deformity of the left middle cranial fossa and a bony defect in the posterior wall of the left orbit. Three-dimensional CT was extremely useful in the planning of the surgical repair. The posterior orbital wall defect, which was approached through a left frontotemporal craniotomy, was covered with a resin plate, and the exophthalmos was corrected under direct vision. The bulging frontotemporal bone was resected and replaced by a resin plate. Postoperatively, the exophthalmos was markedly reduced and the patient regained light perception in the left eye.
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Case Report
Shigeki KAMEYAMA, Ryuichi TANAKA, Norio TAKEDA, Kentaro SEKIGUCHI, Sat ...
1988 Volume 28 Issue 3 Pages
298-302
Published: 1988
Released on J-STAGE: September 21, 2006
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A 40-year-old male was hospitalized for recent onset of focal epilepsy. Computed tomography revealed a large, convexity mass in the left hemisphere, which was diagnosed as a meningioma and was deemed the cause of the focal seizures. In addition, there was a small area of ring-like enhancement in the right occipital lobe. The occipital lesion, histologically diagnosed as anaplastic glioma, progressively enlarged and eventually caused the patient's death. The presence of multiple, diverse primary brain tumors is infrequent in patients without phakomatosis. Although meningioma may possibly be induced by another, adjacent tumor or by cranial irradiation, in this case the coexistence of the two tumors is thought to have been incidental because both glioma and meningioma have a high incidence and because they were separate.
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Case Report
Masabumi NAGASHIMA, Toyohiko ISU, Yoshinobu IWASAKI, Keikichi MIYAMACH ...
1988 Volume 28 Issue 3 Pages
303-308
Published: 1988
Released on J-STAGE: September 21, 2006
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Subependymoma is usually intraventricular; only three cases of spinal cord subependymoma have been reported. The authors encountered a 57-year-old female with a cervical intramedullary subependymoma. The patient had been well until 1967, when she noted numbness in the left arm. Over the next 17 years, weakness of the left leg, numbness of both legs, and gait disturbance slowly progressed. Neurological examination on admission revealed tetraparesis, which was particularly severe on the left side, hyporeflexia of both triceps, hyper-reflexia of both legs, bilateral sensory disturbance below the C5 level, and spastic gait. Myelography and post-myelography computed tomography (CT) showed cord swelling from C5 to Th2 and intramedullary reflux of contrast medium. Contrast-enhanced CT showed marked intramedullary enhancement adjacent to a lowdensity area. Laminectomy was performed and the tumor, which was sharply demarcated and protruding into the cystic cavity, was totally removed. Pathological examination disclosed that it was a typical subependymoma. The postoperative course was uneventful and the symptoms abated. In this as in the three cases previously reported, the tumor was located in the cervical cord of a middleaged patient with a long history of clinical symptoms. The authors emphasize that subependymoma is a benign tumor occasionally found in the spinal cord and that it can be totally removed because of its sharp demarcation from normal tissue.
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