Neurologia medico-chirurgica

Amino Acid Study of Cerebral Gliomas Using Positron Emission Tomography

—Analysis of (¹¹C-methyl)-L-methionine Uptake Index—

Katsuyoshi MINEURA, Toshio SASAJIMA, Yoshitaka SUDA, Masayoshi KOWADA, ...

1990 Volume 30 Issue 13 Pages 997-1002
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.997

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Sixteen patients with gliomas (7 low grade, 9 high grade) were examined using positron emission tomography (PET) with intravenous administration of 22.2 MBq/kg (0.6 mCi/kg) of (¹¹C-methyl)-L-methionine (C-11 Met). The tracer uptake in regions of interest was calculated on PET images taken 45 minutes after injection; the uptake index was represented as a percentage of the total count in the arterial blood summed over 45 minutes. C-11 Met uptake indices in the tumors ranged from 0.020 to 0.041% with a mean of 0.032% for the low-grade gliomas and from 0.013 to 0.044% with a mean of 0.036% for the high-grade gliomas. These indices significantly increased as compared with those in the contralateral gray matter (0.008-0.032% with a mean of 0.023%; p < 0.01 vs. low-grade gliomas, p < 0.001 vs. high-grade gliomas). In the low-grade gliomas, C-11 Met PET images clearly depicted the existence and even the extent of the tumors, although x-ray computed tomography (CT) did not always distinguish tumoral lesions. In the high-grade gliomas, the areas of tracer accumulation regionally extended to peritumoral low density on CT scans, where malignant tumor cell infiltration was proved by operative and follow-up CT findings. C-11 Met may be a useful radiopharmaceutical for differential diagnosis of gliomas, and the accuracy of tumor localization will give us a better rationale in therapeutic strategies for surgery and radiation therapy of gliomas.

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Hemodynamic Evaluation in Patients with Superficial Temporal Artery-Middle Cerebral Artery Anastomosis

—Stable Xenon CT-CBF Study and Acetazolamide—

Hajime TOUHO, Jun KARASAWA, Hisashi SHISHIDO, Toshitaka MORISAKO, Keis ...

1990 Volume 30 Issue 13 Pages 1003-1010
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1003

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Sixteen patients with minor completed stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The acetazolamide-activated regional cerebral blood flow (rCBF) was measured 20 minutes after the injection using inhalation of stable xenon and computed tomographic scanning (Xe^S CT-CBF study) pre- and postoperatively. Eleven patients (Group 1) showed immediate improvement in neurological state within a few days of the operation, while five (Group 2) showed no improvements. Preoperative rCBF in the ischemic areas without infarction was 30.8 ± 3.0 ml/100 gm/min in Group 1 and 53.0 ± 5.2 ml/100 gm/min in Group 2. Preoperative vasodilatory capacity with acetazolamide in Group 1 was 5.7 ± 8.6 and significantly increased to 19.8 ± 4.9 after surgery. In Group 2, pre- and postoperative vasodilatory capacity was 12.7 ± 3.1 and 14.9 ± 2.9, respectively, and there was no significant change. These results suggested that minor stroke patients with moderate decrease of affected side rCBF (less than 40 ml/ 100 gm/min) and with hemodynamic impairment may have the surgical indication for STA-MCA anastomosis.

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Contrast Medium Extravasation During Cerebral Angiography for Ruptured Intracranial Aneurysm

—Clinical Analysis of 26 Cases—

Takeshi SAMPEI, Nobuyuki YASUI, Makoto MIZUNO, Shigeyoshi NAKAJIMA, Ta ...

1990 Volume 30 Issue 13 Pages 1011-1015
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1011

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Since 1976, the authors performed angiography on 837 patients with ruptured intracranial aneurysm, among which extravasation (EV) of contrast medium occurred in 26. Eleven patients underwent radical surgery within 3 hours after the EV, and four recovered well. The other 15 patients were conservatively treated, and all died. A large quantity of EV occurred when consciousness was severely disturbed and angiography was performed within 3 hours of the last attack. Most EV resulted in poor outcome. However, some patients with mildly disturbed consciousness before angiography, even with severe temporary disturbance of consciousness after the EV, recovered well after emergency radical surgery.

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Familial Pituitary Adenoma

—Report of Four Cases from Two Unrelated Families—

Hiroshi YUASA, Sumitaka TOKITO, Hiroyuki NAKAGAKI, Katsutoshi KITAMURA

1990 Volume 30 Issue 13 Pages 1016-1019
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1016

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The authors report four cases of familial pituitary adenomas from two unrelated families. No clinical or biochemical evidence of multiple endocrine neoplasia, type I (MEN-I) was demonstrated. Detailed study of the family trees disclosed no other family members affected by MEN-I. Familial occurrence of pituitary adenomas unassociated with MEN-I is rare.

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New Method of MVD Using a Vascular Tape for Neurovascular Compression Involving the Vertebrobasilar Artery

—Report of Two Cases—

Susumu SUZUKI, Hiromi TSUCHITA, Yasutaka KUROKAWA, Koichi KITAMI, Tsut ...

1990 Volume 30 Issue 13 Pages 1020-1023
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1020

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In the treatment of hemifacial spasm and trigeminal neuralgia by microvascular decompression (MVD), lack of improvement or recurrence may occur because of the difficulties in positioning prostheses and the involvement of the large vertebrobasilar arteries, even with use of fenestrated aneurysm clips or adhesives. We have developed a new method of MVD, in which a vascular tape is anchored to the dura mater to transpose the responsible large artery. This method achieved successful results in our two patients with nerve compression involving the vertebrobasilar arteries.

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Successful Reconstruction of Completely Obstructed Right CCA in Takayasu's Disease: Usefulness of Rapid Sequence Scanning Method

—Case Report—

Tetsuro KAWAGUCHI, Shigekiyo FUJITA, Akihiro IJICHI, Yoshiteru SHOSE, ...

1990 Volume 30 Issue 13 Pages 1024-1028
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1024

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The authors describe a case of Takayasu's disease accompanied by complete occlusion of the bilateral subclavian, left vertebral (VA), and right common carotid arteries (CCA) and by severe stenosis of the right VA and left CCA. The patency of the right external and internal carotid arteries was demonstrated preoperatively by rapid sequence computed tomographic scanning. The right CCA was successfully reconstructed with an aorta-CCA bifurcation bypass. Simultaneously, the stenotic left CCA was also reconstructed with an aorta-CCA bypass using a Y-shaped woven Dacron graft.

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Giant Congenital Capillary Hemangioma of Pericranium

—Case Report—

Yoshio TOKUDA, Tohru UOZUMI, Katsuaki SAKODA, Kenji YAMADA, Masami YAM ...

1990 Volume 30 Issue 13 Pages 1029-1033
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1029

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The authors report a newborn male infant with a giant congenital capillary hemangioma of the pericranium. An elastic mass, measuring 6.5 × 6.9 × 3.9 cm, was located in the parieto-occipital region. Neurological examination revealed no abnormality. Angiographically, the tumor was fed symmetrically by the bilateral superficial temporal, occipital, and middle meningeal arteries. At surgery, the encapsulated tumor appeared to have arisen from the periosteum and was removed completely. Histological diagnosis was capillary hemangioma. Capillary hemangioma is a common benign tumor in infancy and usually present as a strawberry mark or port-wine stain. However, when the tumors seat relatively deeply as in the present case, they produce little or no discoloration in the overlying skin. Angiography is then useful to differentiate capillary hemangioma from other lesions and to choose an appropriate treatment.

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Ceruminoma with Intracranial Invasion

—Case Report—

Ryoichi SAITO, Kohei KODAKI, Ryuzo SHIOBARA, Shigeo TOYA, Jin KANZAKI

1990 Volume 30 Issue 13 Pages 1034-1037
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1034

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Ceruminous gland tumors (ceruminomas), which usually involve the external auditory canal, are rare. A case of ceruminoma invading the temporal bone and histologically proven to be papillary adenoma is presented. The tumor recurred and invaded intracranially after subtotal removal and was finally diagnosed as adenocarcinoma. The importance of early diagnosis and radical treatment is stressed.

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Multiple Intracranial Metastases Following Malignant Evolution in Recurrent Pleomorphic Adenoma of the Lacrimal Gland

—Case Report—

Toshiki YAMASAKI, Haruhiko KIKUCHI, Hirohiko YAMABE, Junkoh YAMASHITA

1990 Volume 30 Issue 13 Pages 1038-1042
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1038

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A 54-year-old female presented with multiple intracranial metastases following malignant transformation in the third recurrence of pleomorphic adenoma of the left lacrimal gland, 25 years after the first surgical treatment. The preoperative computed tomography and magnetic resonance imaging demonstrated direct invasion of the orbital tumor into subdural and epidural spaces in the ipsilateral frontotemporal region and also an intracerebral metastasis in the ipsilateral parietal lobe. Histological examination of the surgical specimen revealed features of poorly differentiated adenocarcinoma, suggesting carcinomatous changes. The relevant literature is reviewed.

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Eosinophilic Granuloma of the Skull in Identical Twins

—Case Report—

Satoshi KUWABARA, Masaru TAKAHASHI

1990 Volume 30 Issue 13 Pages 1043-1046
Published: 1990
Released on J-STAGE: September 05, 2006

DOIhttps://doi.org/10.2176/nmc.30.1043

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This is the first reported occurrence of identical twins with eosinophilic granuloma of the skull. These cases provide strong additional support that eosinophilic granuloma and Hand Schüller-Christian disease are variants of the same basic disease process.

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