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30 巻, 12 号
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Eiji MORIYAMA1990 年 30 巻 12 号 p. 923-929
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーHyperthermia is becoming a potent therapeutic method for malignant brain tumors, either alone or in combination with radiation therapy. The heat response of organized tissues includes other factors besides the inherent cellular thermosensitivity, that is, tissue pH, PaO2, and nutrient supply, all of which are largely influenced by the tissue blood flow. In this study, the regional cerebral blood flow (rCBF) changes in 15 Japanese normal monkey brains during interstitial microwave hyperthermia were investigated by the hydrogen clearance method. Under general anesthesia and controlled respiration, a parieto-occipital craniectomy, 4 × 4 cm, was performed. A microwave antenna was inserted into the brain to a depth of 2.0 cm, and the brain tissue was heated with 2450 MHz microwave irradiation. The intracerebral temperatures and rCBF were measured in the white matter 1 cm from the brain surface. During hyperthermia, the rCBF linearly increased at a rate of 10% per 1°C temperature rise. Heating at 42°C for 180 minutes resulted in a constant increase in rCBF. The perfusion rate returned to the control levels after the termination of heating. Above 45°C, the rCBF transiently increased and then started to decline during heating. No consistent results were obtained with heating at 43°C. These results show that normal monkey brain tissues respond to hyperthermia by an rCBF increase as long as the threshold values of tissue temperature (43°C) and exposure time (40-60 minutes) are not exceeded. Excessive heating may lead to irreversible damages to normal tissue and vasculature.抄録全体を表示PDF形式でダウンロード (446K) -
—First Cases in Japan—Susumu NAKATANI, Yasuo NII, Yoshitaka IKEJIRI, Hirotaka TANABE, Heitar ...1990 年 30 巻 12 号 p. 930-939
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーCorpus callosotomy is a well established procedure for the treatment of intractable epilepsy. However, this is the first clinical report of surgical division of the corpus callosum in Japan. Four patients with refractory seizures suffering from Lennox-Gastaut syndrome underwent anterior partial corpus callosotomy. Their seizures consisted of absences, tonic, atonic, tonic-clonic attacks and were characterized by frequent falls. Electroencephalograms showed paroxysms of bilateral synchrony of slow spike and wave complexes. Postoperative follow-up during 12-27 months showed that partial callosotomy reduced the frequency and severity of seizures in all the patients, although they still require antiepileptic medication. This procedure was effective even in patients with mixed cerebral dominance and also in a patient with low intelligence quotient. Postoperatively, disconnection syndrome developed in three patients, which was transient in one and lasting in two.抄録全体を表示PDF形式でダウンロード (721K) -
—Report of Three Cases—Nobuo OKA, Kazuyo KAMIYAMA, Jun-ichi NAKADA, Shunro ENDO, Akira TAKAKU1990 年 30 巻 12 号 p. 940-944
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーWe report three cases of arteriovenous malformation (AVM) of the medial temporal lobe and the surgical approaches used. The AVM was fed by the anterior choroidal artery (AChA) in two cases (Cases 1 and 2) and by the posterior cerebral artery in one (Case 3). The trans-Sylvian approach was first used for cerebrospinal fluid aspiration to retract the brain in all cases, and for confirming the feeding arteries to prevent premature bleeding from the AVM in Cases 1 and 2. In Case 1, a corticotomy was then made in the fusiform gyrus via the subtemporal approach to avoid the development of speech disturbance and visual field defects, while in Cases 2 and 3, a cortical incision was made in the middle temporal gyrus because visual field defects were preoperatively present. Cases 1 and 2 achieved good recoveries, but Case 3 suffered postoperative speech disturbance and died of rebleeding from a recurrent AVM fed by the AChA 22 months after the operation. This AVM was not demonstrated on the postoperative angiograms. We emphasize the usefulness of the combination of transSylvian and subtemporal approaches for this lesion, because the feeding arteries are easily identified and retraction of the temporal lobe is alleviated. A corticotomy in the fusiform gyrus is also recommended to avoid the development of not only visual field defects but also aphasia.抄録全体を表示PDF形式でダウンロード (456K) -
—Case Report—Tomohisa OKADA, Yoshihisa KIDA, Takehisa KINOMOTO, Tsuyoshi SAKURAI, T ...1990 年 30 巻 12 号 p. 945-948
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーThe authors report a case of moyamoya disease accompanied by arteriovenous malformation (AVM). Angiography demonstrated typical moyamoya vessels on the right and early changes of moyamoya disease on the left. A small AVM in the left frontal lobe supplied by a distal branch of the middle cerebral artery (MCA) was also revealed. The AVM was surgically resected simultaneously with contralateral encephaloaponeurotic synangiosis for the moyamoya vessels. One month after surgery, left MCA occlusion at the origin occurred probably due to hemodynamic changes after the resection of the AVM.抄録全体を表示PDF形式でダウンロード (323K) -
—Case Report—Kazuhiro YAMANAKA, Kazuyuki NOGUCHI, Koji HAYASAKI, Yoshimi MATSUOKA1990 年 30 巻 12 号 p. 949-955
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーA case of persistent primitive hypoglossal artery (PPHA) associated with arteriovenous malformation (AVM) is reported. A 46-year-old male suddenly developed severe headache followed by transient unconsciousness and was admitted to our hospital 2 hours later. A computed tomographic scan showed subarachnoid hemorrhage. Angiograms revealed an AVM in the left cerebellar hemisphere and an ipsilateral PPHA. The AVM was completely removed and he was discharged 1 month after surgery without neurological deficit.
Only three cases of PPHA associated with intracranial AVM have been reported in the literature. One patient died of rebleeding from the AVM before surgery, and another was conservatively treated because the AVM was too large for resection. The remaining one was surgically treated only by ligation of the feeding arteries. Ours is the first case treated by total removal of the AVM. Since these four cases, including ours, account for 3.0% of 134 cases of PPHA reported, PPHA associated with AVM is considered rare.抄録全体を表示PDF形式でダウンロード (564K) -
—Case Report—Keiji MURATA, Akimasa NISHIO, Misao NISHIKAWA, Yoshimitsu OHINATA, Mas ...1990 年 30 巻 12 号 p. 956-959
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーThe authors report a case of subarachnoid hemorrhage and spinal root injury caused by an acupuncture needle buried in the posterior neck about 30 years before onset. A 33-year-old female presented with sudden onset of severe occipital headaches. Plain x-ray films of the cervical spine revealed a fine gold needle, about 1.5 cm in length, between the C1 and C2 vertebrae. The needle was piercing the spinal nerve root through the dural vein, and was removed. Postoperatively, the pain exacerbated by neck movement disappeared.抄録全体を表示PDF形式でダウンロード (226K) -
—Case Report—Kazuhiko NAGATANI, Shiro WAGA, Juhji TAKEUCHI, Yoshihiro TAKEBE, Katsu ...1990 年 30 巻 12 号 p. 960-965
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーA 58-year-old female was admitted to our hospital with nausea, vomiting, and gait disturbance of 1 year duration. Postcontrast computed tomographic scans demonstrated enhanced lesions in the left cerebellopontine angle (CPA), the retrosellar region, the right parasellar region, and the left parietooccipital convexity. The left parieto-occipital tumor was totally removed in the first operation and the left CPA tumor was partially removed in the second. The histological diagnosis of both tumors was xanthogranuloma. She also had cutaneous lesions (subcutaneous nodules without tenderness) and an ureteral stenosis possibly due to the retroperitoneal involvement. A skin biopsy demonstrated infiltration of xanthoma cells and foamy cells in the dermis. A gallium scintigram demonstrated an abnormal uptake in the thoracic cavity, liver, and bones. From these findings, systemic Weber-Christian disease was diagnosed. Another unique aspect was that the serum IgE levels were increased during postoperative hospitalization. This suggests that abnormal immunological conditions are related to this disease and that intracranial xanthogranulomas are a manifestation of systemic Weber-Christian disease.抄録全体を表示PDF形式でダウンロード (630K) -
—Case Report—Tetsuro IRIKURA, Tatsuhiro JOHKI, Hideaki TANAKA, Masato NAKAJIMA, Mas ...1990 年 30 巻 12 号 p. 966-971
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーA rare case of intramedullary holocord astrocytoma extending from the medulla oblongata to the conus medullaris is reported. A 27-year-old male who had been suffering from nuchalgia for a few years was admitted to our department because of lumbago and gait disturbance. Neurological examination revealed sensory disturbances in various locations, weakness of the right lower extremity, mild swallowing disturbance, and bowel and bladder difficulties. Magnetic resonance (MR) images and myelograms showed a long cystic lesion extending from the medulla oblongata to the thoracolumbar spinal cord. Gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA)-enhanced images detected a solid tumor located at the Th6-7 level. Two syrinx-subarachnoid shunts were placed at the upper cervical and Th12 levels. The solid neoplasm at the Th7 level was partially resected and histologically diagnosed as astrocytoma. Differentiation between cystic lesions and solid masses in the spinal cord is difficult. The usefulness of Gd-DTPA-enhanced MR imaging in the diagnosis of holocord tumor and the pathogenesis of secondary syringomyelia are discussed.抄録全体を表示PDF形式でダウンロード (465K) -
—Case Report—Yasuhiro KOJIMA, Nobumasa TANAKA, Nobumasa KUWANA1990 年 30 巻 12 号 p. 972-976
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーMassive hemorrhage within an intracranial neurinoma occurs rarely. The authors describe a 62-year-old female with intratumoral bleeding which led to the discovery of an acoustic neurinoma. She developed a gait disturbance after a minor head injury. A computed tomographic scan obtained 2 months later demonstrated multiple high-density areas in the anterior portion of the left cerebellopontine angle. Preoperative diagnosis was acoustic neurinoma. The tumor had multiple cysts which contained a mixture of xanthochromic fluid and old, brownish hematomas, and was successfully removed. The intratumoral hemorrhage is thought to have resulted from traumatic rupture of the dilated vessels, although the trauma was slight. This is the first reported case of an acoustic neurinoma discovered through treatment for intratumoral hemorrhage occurring after a minor head injury.抄録全体を表示PDF形式でダウンロード (545K) -
—Case Report—Kunihiko WATANABE, Susumu WAKAI, Masakatsu NAGAI, Hiroaki MURAMATSU1990 年 30 巻 12 号 p. 977-979
発行日: 1990年
公開日: 2006/09/05
ジャーナル フリーThe authors report a case of epidermoid tumor attached to the dura of the frontal convexity and extending into the cerebral parenchyma, with unusual computed tomographic (CT) and magnetic resonance (MR) findings. The tumor appeared as a mixed density intracerebral mass containing dense calcifications on the precontrast CT scan, and the capsule was intensely enhanced on the postcontrast scan. It appeared as a mixed intensity lesion on both the T1 and T2-weighted MR images.抄録全体を表示PDF形式でダウンロード (300K)
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