Neurologia medico-chirurgica

Surgical Approaches to Foramen Magnum Meningioma

—Report of Three Cases—

Takeshi KONDOH, Norihiko TAMAKI, Katsushi TAOMOTO, Muneaki YASUDA, Sat ...

1990 Volume 30 Issue 3 Pages 163-168
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.163

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Although foramen magnum meningiomas are usually removable, their location poses considerable surgical risk. The authors present three cases of foramen magnum meningioma. The first involved a ventral type tumor extending to the second cervical body. Following bilateral mandibulotomy, surgery was performed via the anterior transoral approach and the tumor was totally removed. Nine days postoperatively, she developed meningitis, which was successfully treated with antibiotics. The second patient's tumor was dorsal type and was deeply embedded in the lateral part of the vermis. The tumor was totally removed via the midline suboccipital approach and she recovered uneventfully, with only slight upper-extremity paresthesia. In the third case, the tumor was ventral type and situated mainly in the clivus. Craniotomy was performed by the bilateral suboccipital approach and extended nearly to the jugular tubercle. The tumor, which severely displaced the lower cranial and upper cervical nerves, was totally removed. The postoperative course was lengthy and complicated. Artificial ventilation was required for 2 months, and difficulty in swallowing persisted during long-term follow-up. As illustrated by the second case, dorsal and lateral type foramen magnum meningiomas can usually be removed via the lateral suboccipital approach. In the case of ventral type tumors, the anterior transoral approach entails the risk of infection, as occurred in the first case. The authors conclude that the lateral suboccipital approach is preferable; craniotomy extending to the jugular tubercle lowers the risk of brainstem damage.

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Meningioma Associated with Subdural Hematoma

—Case Repor—

Shuji NIIKAWA, Masahiro KAWAGUCHI, Shingo SUGIMOTO, Tatsuaki HATTORI, ...

1990 Volume 30 Issue 3 Pages 169-172
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.169

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The case of a 49-year-old female with a left parietal convexity meningioma associated with an acute subdural hematoma is described. She was admitted because of sudden onset of severe headache accompanied by nausea and vomiting. She was also confused, and 6 hours after admission she developed lethargy, right hemiplegia, and left mydriasis with no pupillary reaction to light. Computed tomography disclosed a round, extra-axial mass in the left parietal region; it was heterogeneously enhanced. Emergency craniotomy, performed after carotid angiography, revealed a tumor with a massive underlying subdural hematoma. The histological diagnosis was meningotheliomatous meningioma, and there were many meningothelial cells within the hematoma.

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Long-term Results in a Case of Meningioma Treated by Embolization Alone

—Case Report—

Tetsuo KOIKE, Osamu SASAKI, Ryuichi TANAKA, Hiroyuki ARAI

1990 Volume 30 Issue 3 Pages 173-177
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.173

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A 73-year-old female, unable to walk without a cane, was hospitalized for evaluation of left sensorimotor disturbance. Computed tomographic (CT) scans revealed a large parasagittal mass, which was markedly and homogeneously enhanced by contrast material. Bilateral external carotid angiograms showed that the middle meningeal arteries supplied the tumor. Both CT and angiographic findings suggested a right frontal parasagittal meningioma. Catheter embolization with Ivalon® (polyvinyl alcohol foam) particles was carried out prior to the planned surgery for the purpose of decreasing intraoperative hemorrhage from the tumor. However, her clinical symptoms began to improve 9 days after the embolization procedure, and surgery was decided against because of her advanced age and symptomatic improvement. Ten months after embolization, she was able to walk unassisted and CT scans showed a 60% reduction of the pre-embolization tumor size. Four years after embolization, she remained nearly asymptomatic despite some regrowth of the tumor.

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Central Neurocytoma

—Case Report—

Takashi TAMIYA, Tomohisa FURUTA, Shoji ASARI, Akira NISHIMOTO

1990 Volume 30 Issue 3 Pages 178-183
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.178

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The authors present a case of central neurocytoma in a 34-year-old female who had experienced intermittent headaches over a 10-year period. On computed tomographic (CT) scans and magnetic resonance images, the tumor appeared as a large, calcified mass occupying both lateral ventricles. A right parieto-occipital craniotomy was performed and the tumor was totally removed. While the light microscopic findings suggested a diagnosis of oligodendroglioma, electron microscopic examination demonstrated clear vesicles, microtubules, and synaptic structures within the abundant cytoplasmic processes of the tumor cells. Immunohistochemical examination showed the tumor cells to be strongly positive for neuron-specific enolase, sparsely positive for S-100 protein, and negative for glial fibrillary acidic protein. The final histological diagnosis was central neurocytoma. The postoperative course was uneventful and no further treatment was administered. She has no neurological deficits and CT has shown no evidence of recurrence during the 2 years since her surgery.
Central neurocytoma is a rare tumor arising in the lateral ventricle, and the diagnosis is mainly based on electron microscopic findings. Since central neurocytoma appears to have a good prognosis following total removal alone, it is very important to distinguish between this and other ventricular tumors.

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Infantile Myofibromatosis with a Solitary Lesion in the Skull

—Case Report—

Toshihiko KUROIWA, Tomio OHTA, Shuji KAZUKI, Ryusuke OGAWA, Hitoshi KO ...

1990 Volume 30 Issue 3 Pages 184-187
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.184

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The term “infantile myofibromatosis” was coined in 1981 to describe a rare type of soft-tissue tumor in infants. Solitary lesions are usual, but extremely rare in the skull. An infantile case involving a lesion in the left parietal bone is described. The patient was a 6-month-old girl admitted with a mass measuring 2 × 2 cm in the left parietal region. Skull x-rays showed an osteolytic lesion with a sclerotic margin in the parietal bone. Computed tomographic (CT) scans revealed a low-density mass with homogeneous enhancement. The tumor adhered to the dura and had destroyed the left parietal bone. Histological examination disclosed spindle-shaped cells arranged in short bundles and abundant vasculature. Phosphotungstic acid hematoxylin staining revealed longitudinal fibrils resembling myofibroblasts. This is the first report in which CT findings are described in a case of infantile myofibromatosis with a solitary lesion occurring in the skull.

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Brain Metastasis from Transitional Cell Carcinoma of the Bladder

—Case Report—

Shinichiro WAKISAKA, Satoshi MIYAHARA, Akitsugu NONAKA, Naoki ASAMI, K ...

1990 Volume 30 Issue 3 Pages 188-190
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.188

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A rare case of brain metastasis from a transitional cell carcinoma (TCC) of the bladder is presented. A 66-year-old female underwent total removal of a bladder carcinoma and postoperative radiation therapy and chemotherapy. Right hemiparesis and seizures developed about 16 months later, and a solitary brain metastasis was discovered in the left Rolandic area. The tumor was totally removed and microscopic examination showed it to be TCC.

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Type 2 Proatlantal Artery Associated with a Ruptured Aneurysm

—Case Report—

Kikuo KUROSE, Hiroshige KISHI, Yoshihiko NISHIJIMA

1990 Volume 30 Issue 3 Pages 191-193
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.191

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A rare case of a type 2 proatlantal artery discovered following the rupture of a cerebral aneurysm in a 74-year-old female is reported. The aneurysm was clipped and the hematoma removed, but she died of severe vasospasm 9 days after surgery. The anomalous artery was thought to have been unrelated to rupture of the aneurysm.

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Neurosyphilis Manifesting as a Focal Mass Lesion: Computed Tomographic and Magnetic Resonance Imaging Features

—Case Report—

Masanori ITO, Kiyoshi SATO, Hiroshi TADA, Yutaka KURU

1990 Volume 30 Issue 3 Pages 194-197
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.194

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The computed tomographic (CT) and magnetic resonance (MR) imaging findings in a middle-aged male with cerebral syphilis are described. He presented with convulsive seizures and focal neurological deficits. A CT scan revealed a slightly enhanced, low-density mass in the left parieto-occipital region. MR imaging showed low intensity on T₁-weighted images and high intensity on T₂-weighted images. He was initially diagnosed as having a low-grade glioma. However, intraoperative histological examination of a small surgical specimen revealed no tumor cells but heavy infiltration of inflammatory cells in the menihges and cerebral parenchyma. Immunostaining for Treponema organisms by the peroxidase-antiperoxidase method was positive. Although the clinical and radiological findings are nonspecific, neurosyphilis should be considered in any patient in whom a nonspecific mass lesion is demonstrated by CT and MR imaging.

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Invagination of a Shunt Valve: An Unusual Complication

—Case Report—

Masafumi YOSHIDA, Yuhki OHSHIMA, Shinken KURAMOTO

1990 Volume 30 Issue 3 Pages 198-200
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.198

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The authors present an unusual case of ventriculoperitoneal shunt failure due to invagination of a valve in the proximal portion of the silicone casing of the shunt system. The shunt had been in place for 5 years and the 57-year-old male patient had incurred no head injury during that period. The valve failure was discovered during evaluation of his gradual deterioration, which culminated in his functional incapacitation. Nine such cases have been reported in the literature. This complication is specifically associated with the Holter and Hakim valves and seems to a primary mechanical failure attributable to the structure of these two valves.

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Digitally Controlled Neurosurgical Operating Table

—Technical Note—

Hiroshi OKUDERA, Shigeaki KOBAYASHI, Kei KANEMARU, Kenichiro SUGITA

1990 Volume 30 Issue 3 Pages 201-203
Published: 1990
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.30.201

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The authors describe a new, digitally controlled operating table for neurosurgery. The apparatus includes a digitally controlled motor for manipulating the table and a rotary encoder with a central processing unit, which calculates and displays the table's position. The table can be operated with any type of digitalized computer system and its position is monitored by the encoder unit in real time.

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