Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 31, Issue 13
Displaying 1-37 of 37 articles from this issue
  • Vascular Endothelial Cell Growth Factor in Human Omentum
    Toshio IMAIZUMI, Kazuo HASHI
    1991 Volume 31 Issue 13 Pages 839-845
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Omentum tissue has potent angiogenic activity, so transplantation is often effective in treatment of moyamoya disease. Omentum was homogenized and fractionated to investigate the presence of an endothelial cell growth factor. The effectiveness of extracts was measured by the growth activity of bovine aortic endothelial cell incubated for 6 days with various omentum extracts. The lipid fraction had no growth promoting activity. However, the water soluble extracts were active. The activity could be increased by ammonium sulfate precipitation (60-80% saturation). Gel permeation chromatography of the ammonium sulfate fraction showed that the endothelial growth factor had an apparent molecular weight of 96, 000. Heparin affinity chromatography revealed poor heparin affinity. The activity was stable at pH 3.5 and pH 9.5, but inactivated by heating at 70°C for 10 minutes or 100°C for 2 minutes. These properties clearly distinguish the omentum-derived growth factor (OmDGF) from the heparin binding growth factor. OmDGF is probably distinct from other vascular endothelial cell growth factors.
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  • Yuji SAITO, Takuhiro HOTTA, Takashi MIKAMI, Kaoru KURISU, Keiichi KAWA ...
    1991 Volume 31 Issue 13 Pages 846-852
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     One of the most serious problems in cancer chemotherapy is the acquired drug resistance of tumor cells. In order to investigate the mechanism of acquired resistance to 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU), nine resistant cells were isolated from rat gliosarcoma 9L cells and characterized. ACNU-resistant cells were easily isolated after a single treatment even with low-dose ACNU (5 μg/ml) . However, in spite of repeatedly high-pressure dose of ACNU, more than 30 fold increase to parental 9L cell resistance was not achieved. At this time, further increase in selection pressure resulted in cell death. The resistant ratios of these resistant cells were stable in the absence of ACNU for more than 1 year. Luria and Delbruck's fluctuation test indicated that the appearance of ACNU-resistant cells occurred spontaneously at a rate of (4.40-8.02) × 10-7/cell/generation. In karyotypic analysis, the mode was higher in the resistant cells than in 9L cells, but a homogeneously staining region or double minute chromosome, which was considered to be a result of gene amplification, was not observed. In growth kinetics, all the resistant cells except R1 and R12 cells had higher saturation density and plating efficacy than parental 9L cells. These findings seemed to be due to cellular modification associated with ACNU resistance.
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  • Masanori KUWAHARA
    1991 Volume 31 Issue 13 Pages 853-858
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     The relationship between the thermosensitivity of cultured brain tumor cells and cytoskeleton was studied. C6 rat glioma cell line (C6 cells) and U-373-MG human glioblastoma cell line (MG cells) were used in monolayer culture. Survival rates at various temperatures were calculated by colony forming assay 10 days after heat treatment. Actin filaments, the main components of microfilaments, were observed by the 7-chloro-4-nitrobenzo-2-oxadiazole phallacidin staining and indirect immunofluorescence staining methods. Alpha-tubulins, the main components of microtubules, were also stained with an indirect immunofluorescence staining method. The morphological changes were investigated by scanning electron microscopy (SEM). Both the C6 cells and the MG cells showed moderate thermosensitivity on the survival curves. Actin filaments were revealed at stress fibers and the ruffles of the leading edge on both cell lines. Stress fibers were well developed in MG cells but were only minor in C6 cells. After heat treatment ruffles and stress fibers were disrupted. However, alpha-tubulins were not affected by heat treatment. SEM showed Swiss-cheese like change of cell surfaces due to many pores with disruption of ruffles and stress fibers after heat treatment. These results suggest that the cytoskeleton, especially microfilaments, may be damaged by hyperthermia.
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  • Katsuzo KUNISHIO, Tetsuya SHIRAISHI, Nobuya MISHIMA, Nobuhiko MATSUMI, ...
    1991 Volume 31 Issue 13 Pages 859-866
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     An immunohistochemical study of glial fibrillary acidic protein (GFAP), S-100 protein, cytokeratin (CKER), epithelial membrane antigen (EMA), and transthyretin (TTR) was carried out on 11 cases of choroid plexus papilloma (CPP) and 19 of ependymoma, using the peroxidase antiperoxidase technique. Among the 11 cases of CPP, all 11 were positive for CKER, EMA, and TTR, 10 for S-100 protein, and five for GFAP. Most of the GFAP-positive papilloma cells were simultaneously positive for CKER. However, these GFAP-positive cells were negative for TTR. Among the 19 cases of ependymoma, 16 were positive for GFAP, 17 for S-100 protein, three for CKER, eight for EMA, but none for TTR. Some GFAP-positive cells were also stained for CKER. However, TTR was not found in any of the ependymal cells. These findings suggested that CPP cells which show ependymal or glial differentiation lost the ability to synthesize TTR which is known to be synthesized in the epithelial cells of the choroid plexus. The more GFAP-positive cells present in a CPP, fewer TTR-positive cells are present. Though CPPs are usually easily distinguishable from ependymomas, occasional doubt arises concerning the differential diagnosis between CPP and papillary ependymoma. TTR can be a very useful diagnostic marker of CPP.
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  • Takashi IWABUCHI
    1991 Volume 31 Issue 13 Pages 867-875
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     The effect of perfluorodecalin and perfluorotripropylamine, Fluosol DA-20% (FDA-20%), on the ischemic brain after hypertensive intracerebral hemorrhage (ICH) was evaluated and the mechanism investigated. Regional cerebral blood flow (rCBF), and cerebral metabolic ratios of oxygen (CMRO2) and glucose (CMRGlu) were measured before and after infusion of FDA-20%. The rCBF was estimated by single photon emission computed tomography using the 133Xe inhalation method, and CMRO2 and CMRGlu were determined by calculating arteriovenous difference between the femoral artery and the jugular bulb. The results showed: 1) The mean cerebral blood flow (mCBF) in both affected and non-affected hemispheres significantly increased by 10-20% over the control during 3 hours and 6-12 hours after infusion of 500 ml and 1000 ml FDA-20%, respectively. 2) Administration of 500 ml FDA-20% caused a maximal increase of 15% in CMRO2 and 24% in CMRGlu, and 1000 ml FDA-20% administration caused a maximal increase of 30% in CMRO2 and 75% in CMRGlu. 3) There was no significant change in mean blood pressure, arterial partial pressure of carbon dioxide and oxygen, or hematocrit before and after FDA-20% infusion. The results indicate that FDA-20% improved rCBF and brain metabolism in the ischemic brain of hypertensive ICH. FDA-20% may operate as an excellent oxygen carrier, and stimulate the brain metabolism directly.
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  • Seisho ABIKO, Tetsuo YAMASHITA, Yujiro SHIROYAMA, Hideo AOKI
    1991 Volume 31 Issue 13 Pages 876-880
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     In 14 normal volunteers and 22 consecutive patients with subarachnoid hemorrhage (SAH) due to a ruptured cerebral aneurysm, ionized calcium (Ca2+) concentrations in whole blood were measured using an automatic calcium analyzer. The values were corrected against pH 7.4. The relationships between the Ca2+ concentration and the following aspects were studied: neurological grading by Hunt and Kosnik, grade of SAH on computed tomography scan by Fisher's definition, and the presence of vasospasm. Clinical vasospasm was recognized in eight cases. The averaged Ca2+ value of the control group was 1.23±0.02 mmol/l. In patients with a poor neurological grade or severe SAH, the Ca2+ level was apt to be lower than that of the control group. In patients with vasospasm, the values of Ca2+ were significantly decreased, especially between 8 and 14 days after SAH, compared with those patients without vasospasm and the control group (p< 0.05). These results indicate that measurement of Ca2+ concentration in whole blood may give a useful clue to treatment of vasospasm by calcium antagonist and that it may also provide a possible indicator as to the time of vasospasm in patients with severe SAH. However, it is very difficult to conclude whether decreased level of Ca2+ in patients with vasospasm is caused by the vasospasm itself.
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  • Hiroyuki YOKOTA, Shouzo NAKAZAWA, Toshirou SHIMURA, Akio KIMURA, Yasuh ...
    1991 Volume 31 Issue 13 Pages 881-886
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Hypothalamic and pituitary hormone levels were measured in 56 patients meeting the criteria of brain death proposed by the Japanese Ministry of Welfare. Pituitary hormone releasing tests were carried out in 39 patients. In addition, cerebral angiography and transcranial Doppler (TCD) were performed in 13 and six patients, respectively, just after hormone measurements. Serum hypothalamic and pituitary hormone levels were inconsistently high based on the half life time in the presumed absence of cerebral blood flow shown by angiography. The responses to releasing hormones were normal in 16 patients. TCD detected cerebral blood flow in the middle cerebral artery or ophthalmic artery in three patients who showed non-filling on angiography. Postmortem microscopic examination of the hypothalamus and anterior pituitary lobe revealed normal structure and cells intermingled with lytic changes and necrosis. This series suggests that some part of the hypothalamus and hypophysis may still be alive after brain death, although the function of these regions may be clinically insignificant.
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  • Taizou HIROHATA, Ushio SASAKI, Tohru UOZUMI, Masahiro OHTA, Shinya SHI ...
    1991 Volume 31 Issue 13 Pages 887-891
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Recurrence of hypertensive intracerebral hemorrhage confirmed by computed tomography scan has rarely been reported. The authors have experienced nine cases of recurrent hemorrhage among 494 cases of hypertensive intracerebral hemorrhage. Recurrence rate was 1.8%. There were eight males and one female with an average age of 60.5 years. Six cases had their first and second attacks in ganglionic regions. Among them, three cases had the second attack in the ipsilateral side, and the other three cases had the second attack in the contralateral side. Two cases had the first attack in the thalamic and the second in the cerebellar regions. One case had the first attack in the pontine and the second in the putaminal regions. Intervals between the first and second attacks were within 6 months for ipsilateral ganglionic attacks and over 4 years for contralateral ganglionic attacks. In all cases systemic blood pressure was normalized or well controlled by antihypertensive agents after the first attack. The mechanism of rebleeding has not been clarified.
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  • Masahito NEMOTO, Nobuyuki YASUI, Akifumi SUZUKI, Ichiro SAYAMA
    1991 Volume 31 Issue 13 Pages 892-898
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A series of 105 patients presenting with multiple aneurysms and subarachnoid hemorrhage (SAH) were operated on for ruptured and unruptured aneurysms between 1976 and 1984. Clinical factors other than the severity of SAH affecting the outcomes included: 1) Misdiagnosis of the location of a ruptured aneurysm among multiple aneurysms resulted in poor outcomes because of multiple surgical approaches or rebleeding during the acute period. 2) Combinations of aneurysmal locations requiring multiple surgical approaches, such as interhemispheric and transsylvian, during the acute stage caused worse outcomes than with multi-stage surgeries. If an unruptured aneurysm could not be reached during the initial exposure, multi-stage surgery was safe if the ruptured aneurysm had been clipped during the acute period. 3) Complications occurring during unruptured aneurysm surgery. The patient's age, the location and size of the unruptured aneurysms were significant factors in the clinical prognosis. Surgery for unruptured aneurysm caused 1.8% morbidity in patients between 28 and 55 years, but 18.0% morbidity in patients over 56 years of age. Surgery for internal carotid artery aneurysms resulted in 14.8% overall morbidity. Surgery for middle cerebral and anterior cerebral artery aneurysms caused below 5% morbidity. Postoperative morbidity in patients with aneurysms less than 5 mm in diameter was 1.3%, and with aneurysms measuring 10 mm or more, 20%. The optimum treatment for multiple aneurysms with SAH should be based on all factors of the patient's condition, including the unruptured aneurysms.
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  • Kazuhiro HIRANO, Ryoji ISHII, Yasuo SUZUKI, Masahisa KIKUOKA, Hiroshi ...
    1991 Volume 31 Issue 13 Pages 899-904
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Cerebrovascular disease is a lethal complication for patients with renal failure because of the hemostatic disturbance and equivocality about management of the central nervous system. Appropriate management of the renal failure in neurosurgical patients was considered on the basis of experience. Hemodialysis (HD), which is the most common dialysis method, has a serious disadvantage: the elevation of intracranial pressure during dialysis due to the “disequilibrium syndrome.” It is important to stabilize the serum osmolarity during dialysis in order to prevent the disequilibrium syndrome. From this point of view, continuous ambulatory peritoneal dialysis (CAPD) has great advantages; serum osmolarity is not rapidly changed and no anticoagulants are required during dialysis. CAPD is recommended as the first method of choice in neurosurgical management of renal failure patients. However, if a patient has to be maintained with HD because of a history of laparotomy or peritonitis, it is essential to keep the serum osmolarity as stable as possible using the extracorporeal ultrafiltration method, hypernatremic HD, bicarbonate HD, and intravenous administration of glycerol.
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  • Tatsuhiro MAEDA, Masahiro NAKADAI, Yuji ASOH, Haruhisa YOKOYAMA, Motoh ...
    1991 Volume 31 Issue 13 Pages 905-911
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Some gliomas are not noticeably enhanced on initial computed tomography (CT) scans. Such low-density non-enhancing gliomas have a relatively long period between onset and surgery ranging from 5 to 25 months. The mechanism causing the low density over a certain period of time in the sequential CT findings was retrospectively investigated. Characteristic histological findings associated with such low-density areas were microcystic formation, necrosis, intratumoral edema, infiltrative growth, and absence of capillary proliferation. Proliferation of capillary vessels is characteristic of CT enhancement.
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  • Report of Two Cases
    Kenji KIKUCHI, Katsuyoshi MINEURA, Tetsuya SAKAMOTO, Masayoshi KOWADA, ...
    1991 Volume 31 Issue 13 Pages 912-918
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Two midline oligodendrogliomas in young males were successfully totally removed after preoperative irradiation. A 33-year-old male with right lower extremity weakness had a large hypervascular mass occupying the left lateral ventricle. Even after 31 Gy whole-brain irradiation, massive bleeding occurred at surgery and resulted in only partial removal. The residual tumor markedly regressed with disappearance of abnormal vascularity after subsequent local boost irradiation. At the second operation, the tumor was totally removed. A 32-year-old male with progressive headache had a hypervascular mass with gross calcification in the right lateral ventricle. The tumor was partially resected due to its abundant vascularity and blood loss. After 60 Gy local irradiation, the tumor was moderately shrunk with a significant reduction in vascularity. At the second operation, the tumor was totally removed. Preoperative irradiation as an adjunct to surgery may increase the resectability of highly vascular tumors such as midline oligodendrogliomas.
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  • Yuji NIKAIDO, Takahide SHIMOMURA, Hidehiro HIRABAYASHI, Shozaburo UTSU ...
    1991 Volume 31 Issue 13 Pages 919-926
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Multimodality evoked potentials (EPs) or three types of EPs — auditory brainstem response (ABR), somatosensory evoked potential (SEP), and visual evoked potential (VEP) — were recorded in 51 cases of traumatic intracranial hemorrhage within 3 days after injury. In order to assess these EPs, five EP grades were constructed, from normal, Grade I, to highly abnormal, Grade V. Furthermore, an EP pattern classification was devised to integrate the respective EP grades. Namely, PA, consisting of all three EPs within Grades I-III; PB, composed of one type of EP or both ABR and VEP at Grades IV and V; Pc, consisting of both SEP and VEP at Grades IV and V; PD, comprising both ABR and SEP at Grades IV and V; and PE, covering all three EPs at Grades IV and V. PA signifies “no severe damage, ” PB, “localized damage, ” PC, “severe cerebral damage, ” PD, “severe brainstem damage, ” and PE, “severe diffuse damage.” The results when compared with computed tomography (CT) findings were as follows: 1) The size of hematoma correlated with the SEP grade in 16 cases of acute epidural hematoma; a hematoma diameter of 17.5 mm was the threshold value at which SEP abnormalities developed. Eleven patients who underwent surgical removal of the hematoma showed “no severe damage, ” and the outcome was good. 2) In 13 cases of acute subdural hematoma, six cases revealed “severe cerebral damage” or “severe diffuse damage.” In such cases, the degree of damage was not related to the hematoma size, and the outcome was very poor. 3) In 13 cases of a solitary contusional hemorrhage, only one case revealed “severe diffuse damage” and subsequently died. 4) The CT findings were not in agreement with the EP data in nine cases of diffuse axonal injury, but the degree of EP abnormality correlated with the outcome. All three patients with “severe diffuse damage” died. The determination of the actual state of brain damage by morphological diagnosis with CT alone may be incomplete, and the pathological state can be precisely determined by functional evaluation simultaneously using three types of EPs.
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  • Masayuki BAN, Masahito AGAWA, Tsuneharu FUKAMI
    1991 Volume 31 Issue 13 Pages 927-930
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     105 patients over a 5-year period underwent emergency evacuation of traumatic intracranial hematomas. Seven (6.7%) developed delayed contralateral extracerebral hematomas (5 epidural and 2 subdural hematomas). These hematomas were insignificant or not present on initial computed tomography (CT) scan, but repeat CT scan after craniotomy showed sizable hemorrhage. In one patient, neurological deterioration heralded the delayed onset. In one case, intraoperative ultrasound imaging disclosed an epidural hematoma. Ultrasound examination is recommended in cases with a skull fracture contralateral to the initial hemorrhage.
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  • Report of Three Cases
    Mitsuru NUNOMURA, Yoshinobu IWASAKI, Toyohiko ISU, Minoru AKINO, Hiros ...
    1991 Volume 31 Issue 13 Pages 931-935
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Three cases of post-traumatic syringomyelia are presented and the mechanism of syrinx formation is discussed. Two cases were examined radiologically. Computed tomography and magnetic resonance images (MRI) showed an expansive syrinx with adhesive arachnoiditis in the thoracic levels below the injury site and a localized syrinx on the posterolateral gray matter in the cervical levels above the injury site. These syrinxes existed below the C2 level and had no communication with the fourth ventricle. The other was an autopsy case. Postmortem examination revealed that a syrinx existed from C2 to Th6 and had no communication with the fourth ventricle or the central canal. It is concluded that small traumatic cavities in the gray matter evolve to an extensive syrinx by cerebrospinal fluid (CSF) entering via the posterior root entry zone, and adhesive arachnoiditis is an important factor in increasing the CSF which is entering. MRI was useful for the diagnosis.
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  • Junya HANAKITA, Hideyuki SUWA, Shinji NAGAYASU, Shogo NISHI, Fumihito ...
    1991 Volume 31 Issue 13 Pages 936-942
    Published: 1991
    Released on J-STAGE: July 19, 2006
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     Thoracic lesions present several clinical problems, particularly in their diagnosis and treatment, compared with cervical or lumbar lesions. Since 1983, 18 cases of thoracic space lesions, excluding spinal tumors or trauma have been experienced: nine cases of ossification of yellow ligament (OYL), five of ossification of posterior longitudinal ligament (OPLL), and four of disc hernia (DH). In these 18 patients, problems of clinical manifestations, neuroradiological examination, and surgical approaches are analyzed and discussed. As clinical manifestations, there was a preponderant occurrence in males in the OYL group, while in the OPLL group all the patients were females. OYL and DH occurred at lower thoracic levels. Thirteen of the 18 patients showed combined lesions either in the cervical or in the lumbar regions, such as cervical OPLL, cervical spondylosis, lumbar DH, and lumbar canal stenosis. In the neuroradiological examinations diagnosis of the upper thoracic lesions was difficult. Computed tomography (CT) scan with intrathecal metrizamide injection seemed essential for examination of ossified thoracic lesions. However, because CT imaging of the entire spine is impractical, efficient use of this examination requires previous localization of the offending vertebral level from either the neurological findings or other neuroradiological examinations such as myelography. Magnetic resonance imaging seemed most useful for ruling out the thoracic compressing lesions. As for surgical approaches, posterior decompression was effective for OYL and the anterior approach was useful for OPLL and DH. In patients with “tandem lesions, ” neurological and neuroradiological findings played an important role in deciding the responsible site.
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  • Osamu HIRAI, Hiroyasu YAMAKAWA, Michio NISHIKAWA, Shu WATANABE, Yoshim ...
    1991 Volume 31 Issue 13 Pages 943-947
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Fifty-one cases with subdural hygroma experienced in the past 20 years were retrospectively reviewed. Eight patients showed definite ventricular dilation differing from simple restoration of the ventricles following disappearance of the cavity. The mean age was 72.4 years. Six patients presented with mental change as the initial symptom. On the initial computed tomography (CT), 75% of the cases had bilateral lesions, all were low density, and 88% were crescent shaped. Trepanation performed on six patients yielded watery clear or xanthochromic fluid. Nine to 61 days (mean 4 weeks) after admission, definite ventricular dilation was observed. Cisternography performed in four patients was all abnormal, although cerebrospinal fluid (CSF) pressure was within normal range. Cerebral blood flow images using 123I-iodoamphetamine and single photon emission CT in four patients revealed periventricular low uptake which was disproportionately large compared with the ventricular span on CT. A ventriculoperitoneal shunt was placed in four patients. The final outcome, however, was poor irrespective of treatment. These findings indicate that an impairment of the CSF circulation was not the sole cause of the ventricular dilation. Low CSF pressure and the disproportionately large periventricular low perfusion, compared with the ventricular span on CT scan, suggest a pre-existing periventricular parenchymal damage, which had been subsequently compromised by the presence of subdural mass lesion. Therefore, attention should be paid in aged patients with bilateral low dense, crescent-shaped subdural hygroma, presenting with mental change, for the risk of subsequent ventricular dilation which may affect the functional outcome.
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  • Report of a Case with Multiple Cerebrovascular Occlusive Disease
    Yoshifumi HIRATA, Yasuhiko MATSUKADO, Yoshiki SAITO, Mutsumasa TAKAHAS ...
    1991 Volume 31 Issue 13 Pages 948-952
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 53-year-old male complained of frequent left motor-sensory transient ischemic attack for 4 months. On admission, he demonstrated mild right hemiparesis, dysarthria, and right hemisensory disturbance of all modalities. Cerebral angiography demonstrated complete occlusion of the left internal carotid artery just above the origin of the ophthalmic artery and a stenotic lesion at the horizontal segment of the right middle cerebral artery. Renal angiography showed severe stenosis of the right renal artery. Systolic blood pressure was over 200 mmHg and marked circadian variation of blood pressure was noted. Serum renin was 4.0 ng/ml/hr. Four months after superficial temporal artery-middle cerebral artery anastomosis, left carotid angiography showed good patency of the bypass and the ischemic symptoms completely disappeared. Single photon emission computed tomography (SPECT) showed increased cerebral blood flow (CBF), especially in the left hemisphere after surgery. Six months after the bypass surgery, he complained of mild right hemiparesis again. Shortly after percutaneous transluminal angioplasty (PTA) for renal arterial stenosis, his hemiparesis was improved and the systolic blood pressure stabilized to 150-170 mmHg. SPECT showed the CBF had also recovered in both hemispheres. The improvement in ischemic symptoms and increased CBF after PTA were probably related to stabilization of the systemic blood pressure or inhibition of serum renin-angiotensin.
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  • Case Report
    Jun MIYAGI, Minoru SHIGEMORI, Yasuo SUGITA, Nobuaki NISHIO, Katsuhiko ...
    1991 Volume 31 Issue 13 Pages 953-956
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 24-year-old female who had had several attacks of complex partial seizures was admitted after minor head trauma. There was no neurological deficit on admission, but a large oval calcification was incidentally found in the left temporal region on the plain skull film. Computed tomography scan and carotid angiography revealed a giant thrombosed aneurysm which arose from the M2 portion of the left middle cerebral artery. Focal spike discharges were found on the left temporal region on conventional electroencephalography. Left frontotemporal craniotomy and opening of the left sylvian fissure disclosed a giant aneurysm at the M2 portion of the left middle cerebral artery. The neck of the aneurysm was buried in the dome of the aneurysm and the parent artery was curved at an acute angle at the site of the neck. The aneurysm was excised and end-to-end anastomosis of the main stem of the M2 portion was successfully performed. Postoperative course was uneventful and the patient became completely free from seizures. The surgical technique and the possible mechanism of complex partial seizure in this patient are described.
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  • Case Report
    Takeo ABUMIYA, Hiroyasu KAMIYAMA, Nobumitsu KOBAYASHI, Shouji MABUCHI, ...
    1991 Volume 31 Issue 13 Pages 957-960
    Published: 1991
    Released on J-STAGE: July 19, 2006
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     A 41-year-old female suffered transient ischemic attack. Cerebral angiography revealed occlusion of the left internal carotid artery at the cervical portion and collateral pathways consisting of transpial anastomosis and parenchymal anastomosis from the posterior circulation. Five years later, the second angiography was carried out. Left carotid angiography revealed appearance of transdural anastomosis from the middle meningeal artery and the anterior ethmoidal artery. Right carotid angiography revealed severe stenosis at the carotid fork with moyamoya vessels. Bilateral encephalomyo-arterio-synangiosis was performed for revascularization. Postoperative bilateral carotid angiograms revealed good neovascularization on both sides. In typical moyamoya disease, occlusive change of the carotid fork with moyamoya vessels appeared symmetrically and simultaneously on both sides. Although this case is not a typical moyamoya disease, its pathogenesis is quite similar to that of moyamoya disease.
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  • Case Report
    Tetsuyuki YOSHIMOTO, Terufumi ITOU, Shugo TAKIKAWA, Naruyoshi HORIUCHI
    1991 Volume 31 Issue 13 Pages 961-965
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Recently attention has been drawn to postoperative cerebral hyperperfusion after carotid endarterectomy (CEA) associated with a preoperative state of impaired cerebral hemodynamics. Rarely postoperative neurological deficits are caused by cerebral edema due to hyperperfusion. The patient was a 65-year-old male with dysarthria and right hemiparesis. Because of the presence of severe stenosis of the left carotid artery, CEA was performed. On the 6th postoperative day, he developed severe right hemiparesis and aphasia due to cerebral edema in the subcortical region of the left cerebral hemisphere. Left carotid angiography showed normal circulation without evidence of the carotid stenosis. Later the cerebral edema and the neurological deficits gradually disappeared.
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  • Case Report
    Akira HODOZUKA, Kazuhiro SAKO, Yukichi YONEMASU, Nozomi SUZUKI, Tsutom ...
    1991 Volume 31 Issue 13 Pages 966-971
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 55-year-old male was hospitalized with severe headache. On admission, neurological examination revealed no abnormal findings. Plain computed tomography (CT) showed a slightly high-density area in the medial surface of the right parietal lobe. A marked enhancement in the same region was noted in enhanced CT. Cerebral angiography showed an arteriovenous malformation (AVM) in the medial surface of the right parietal lobe and two aneurysms on the right pericallosal artery which fed the AVM. In addition, a saccular aneurysm was noted at the anterior communicating artery. It was not possible to treat the AVM, two aneurysms nearby the AVM, and the unruptured anterior communicating artery aneurysm simultaneously with a single craniotomy. It was therefore decided to perform surgery for the AVM and two aneurysms nearby the AVM prior to clipping of the anterior communicating artery aneurysm. Total excision of the AVM and two aneurysms nearby the AVM was performed. Cerebral angiography performed 18 days after surgery revealed no AVM and also reduction in size was noted of the anterior communicating artery aneurysm. Three months later, repeated cerebral angiography showed disappearance of the aneurysm. This was further confirmed 15 months after surgery by angiography. From the literature, 117 cases of coexistence of AVM and aneurysms of the brain were collected and classified into three types according to their anatomical and hemodynamic correlation. It is suggested that hemodynamic stress, due to increased blood flow caused by the AVM, played a major role in the development of the aneurysm. Therefore, a conservative attitude toward operation on an aneurysm on the feeding system of the AVM may be justified, provided both vascular lesions cannot be treated with a single craniotomy.
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  • Case Report
    Junya HANAKITA, Hideyuki SUWA, Shogo NISHI, Fumihito OHTA, Hiroshi SAK ...
    1991 Volume 31 Issue 13 Pages 972-977
    Published: 1991
    Released on J-STAGE: July 19, 2006
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     A 52-year-old male was admitted because of right hemiparesis. Computed tomography scan showed a low-density area in the basal ganglia on the left side. Left carotid angiography showed an aneurysm of the extracranial internal carotid artery at the level of the C1-C2 vertebral body. Right carotid angiography also showed an aneurysm of the extracranial internal carotid artery. Because there were neither steno-occlusive changes in the intracranial vessels nor abnormality in the heart, the right hemiparesis seemed to be due to embolism from the extracranial aneurysm. Aneurysmectomy and end-to-end anastomosis of the left internal carotid artery were performed. Extracranial carotid aneurysms are rare conditions. In surgery on these aneurysms, ischemic changes of the brain during arterial clump must be detected and treated. Hypothermia, induced hypertension, and/or internal shunting have been used during arterial clump. The pathogenesis, symptoms, prognosis, and surgical treatments of these aneurysms are discussed.
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  • Case Report
    Atsushi SASAKI, Yoshishige NAGASEKI, Toshiyuki KAKIZAWA, Hideo SASAKI, ...
    1991 Volume 31 Issue 13 Pages 978-981
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 48-year-old female suffered from severe headache, vomiting, and disturbance of consciousness. On admission, she was somnolent with mild paresis of the left leg. Precontrast computed tomography (CT) scans showed a high-density area in the left sylvian fissure and the posterior horn of the left lateral ventricle. Angiographically, a right middle cerebral artery aneurysm and a basilar artery aneurysm were recognized. Furthermore, on the venous phase of bilateral carotid angiograms, superior sagittal sinus (SSS) thrombosis was recognized. Subarachnoid hemorrhage (SAH) was probably induced by rupture of a dilated vein associated with SSS thrombosis, because high-density area on CT scan and location of the aneurysms were different. The patient was initially treated conservatively. Two months later, craniotomy was performed which did not disclose any trace of hemorrhage around the aneurysms and aneurysms themselves. Postoperatively, acute brain swelling and generalized convulsion were induced. The patient became ambulatory 5 months after surgery. In SAH cases, the venous phase should be examined at least in one side of the carotid arteries. In such a SAH case induced by venous thrombosis complicated by aneurysms it is very difficult to decide the timing of surgery for aneurysms.
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  • Case Report
    Shunichi KIHARA, Hisao KOGA, Kazuo TABUCHI
    1991 Volume 31 Issue 13 Pages 982-985
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     The patient was involved in a traffic accident at the age of 1 and the left parieto-occipital scalp was contused without skull fracture. At the age of 5, an extracranial scalp mass was first noticed just beneath the multiple scalp scars. Angiography through the mass revealed that the extracranial mass cavity was connected to the superior sagittal sinus through the emissary veins. The mass located in the subgaleal, epiperiosteal space was totally resected and the connection with the intracranial sinus was closed with bone wax. Histologically, there were many capillaries and some large blood cavities with only one layered endothelium and connective tissue. Therefore, the mass was diagnosed as sinus pericranii and considered to be secondary to previous head trauma because: 1) The patient had a history of head trauma with considerably severe scalp injuries. 2) The extracranial blood sinus was located exactly beneath the traumatic scar. 3) There was no neoplastic tissue histologically. 4) No scalp mass was noticed before the traffic accident. 5) There was an elapsed time between the trauma and the growth of the mass. 6) No scalp nevus such as port-wine stain existed.
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  • —Case Report—
    Atsushi SUGAWARA, Kazuo EBINA, Tomohisa HIRANO, Hiroshi OHI, Soichi YO ...
    1991 Volume 31 Issue 13 Pages 986-990
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 15-year-old female was hospitalized for the treatment of systemic lupus erythematosus complicated with nephritis. She improved with administration of steroid hormones and an immunosuppressant, plasma exchange, and dialysis. However, a lung abscess developed 6 months after admission, and multiple brain abscesses appeared 2 months after the onset of the lung abscess. The lung abscess faded with oral administration of fluocytosine and intravenous administration of miconazole, but the brain abscesses enlarged. Intrathecal administration of miconazole was not effective. Therefore, the abscess in the right frontal lobe was surgically removed and an Ommaya's reservoir was placed in the anterior horn of the right lateral ventricle. Aspergillus was identified in the removed abscess. Subsequently, miconazole was administered intraventricularly through the Ommaya's reservoir 10 mg daily for 1 month. The abscesses in the left parietal lobe gradually diminished. One year later, she complained of right hypesthesia again. Computed tomography scan revealed enlargement of the abscess. Miconazole was administered intravenously and intraventricularly for 1 month. Second craniotomy was performed 16 months after the first surgery and the abscess was completely removed. She was discharged with mild hypesthesia of the right leg. It is concluded that intraventricular administration of miconazole through an Ommaya's reservoir is an effective therapy for central nervous system aspergillosis.
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  • Case Report
    Ken KAMIYA, Nobuko YAMASHITA, Hajime NAGAI, Ikuo MIZAWA
    1991 Volume 31 Issue 13 Pages 991-994
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Intracranial tuberculoma is a relatively rare tumor in developed countries. A 41-year-old Japanese male with a personal history of pulmonary tuberculosis at the age of 20 was referred because of continuous headache. Computed tomography scan revealed multilocular ring-like enhancement in the right deep temporal region with massive brain edema. Angiography showed an avascular mass with narrowing of the carotid bifurcation. The preoperative diagnosis was glioblastoma. This mass was successfully removed and the histological diagnosis was tuberculoma. This case suggested that tuberculoma is still one of the differential diagnoses of an enhanced mass lesion even without any active extracranial tuberculous lesion.
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  • Case Report
    Shouko KOYANAGI, Tetsuya SHIRAISHI, Kiyotaka UETA, Kazuo TABUCHI
    1991 Volume 31 Issue 13 Pages 995-998
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Fenestration of cerebral vessels is congenital and usually of no clinical significance. A 58-year-old female presented with left trigeminal neuralgia associated with double fenestrations of the vertebrobasilar artery. Vertebral angiography showed bilateral fenestrations in the intracranial segment. The left fenestrated artery originated at the distal portion of the vertebral artery and terminated at the middle portion of the basilar artery, compressing the left Vth cranial nerve root. The neuralgia improved after microvascular decompression. Fenestration of cerebral vessels is usually single. Five of eight reported cases with double fenestrations had bilateral extracranial fenestrations at the atlantoaxial portion of the vertebral artery. Bilateral fenestrations of the vertebrobasilar artery with trigeminal neuralgia have not been previously reported.
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  • Case Report
    Koji IIHARA, Junya HANAKITA, Hideyuki SUWA, Kiyoshi NISHIHARA, Hiroshi ...
    1991 Volume 31 Issue 13 Pages 999-1002
    Published: 1991
    Released on J-STAGE: July 19, 2006
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     A 46-year-old female was admitted complaining of progressive, severe girdle pain consistent with the left Th3 dermatome. Neurological examination on admission revealed dysesthesia and radiating pain in the left Th3 territory. Plain X-rays and tomograms of the thoracic spine revealed a beak-like bony excrescence arising from the lamina and projecting moderately to the Th3/4 intervertebral foramen, suggesting ossification of the thoracic ligamentum flavum (OYL). Myelography showed the dural sac compressed from laterally just below the left Th3 pedicle, which suggested that the Th3 nerve root was compressed by the OYL. After Th3 nerve root decompression through hemilaminectomy and foraminotomy, the girdle pain disappeared. OYL is known to cause thoracic radiculomyelopathy, but presentation with intercostal neuralgia only is very rare. The authors review the literature and stress the importance of myelography for diagnosis.
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  • Case Report
    Yoshiteru SHOSE, Hidekazu NOGAKI, Shuji KAMIKAWA
    1991 Volume 31 Issue 13 Pages 1003-1007
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 39-year-old male was admitted because of slowly progressive disturbance of consciousness, diplopia, and ataxia after laparotomy. Ventriculoperitoneal shunting and removal of an arteriovenous malformation had been performed previously. Neurological examination on admission revealed drowsiness, rotatory nystagmus, Parinaud's sign, and truncal ataxia. Computed tomography scan revealed extraordinary dilatation of the fourth ventricle compared with other dilated ventricles, and old low-density areas in the cerebellar hemispheres. After an external ventricular drainage (EVD) was inserted, all the ventricles decreased in size and the symptoms disappeared. The authors confirmed the patency of the aqueductal canal. One week later, the EVD was replaced by a ventriculoperitoneal shunt. A disproportionately large, communicating fourth ventricle (DLCFV) should be differentiated from an isolated fourth ventricle, which consists of marked enlargement of the fourth ventricle with obstruction of both the inlet and outlet of the fourth ventricle. The authors propose the importance of the fragility to pressure of the brain parenchyma and cerebellar hemispheres around the fourth ventricle as the mechanism of producing DLCFV.
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  • Case Report
    Yasuhisa YOSHIDA, Hidekazu NOGAKI, Yoshiteru SHOSE
    1991 Volume 31 Issue 13 Pages 1008-1011
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 72-year-old hypertensive male was hospitalized with progressive gait disturbance (small step gait), urinary incontinence, and dementia. Computed tomography (CT) showed ventriculomegaly with periventricular lucency. T2-weighted magnetic resonance imaging revealed wide periventricular high-signal intensity and small infarctions in the basal ganglia. CT cisternography demonstrated ventricular stasis and convexity stasis of the contrast medium. Continuous intracranial pressure monitoring showed increased B wave percentage, low pressure volume index, and high outflow resistance. These findings indicated the coexistence of normal pressure hydrocephalus. After ventriculoperitoneal shunting, gait disturbance was greatly improved and urinary incontinence disappeared. The development of Binswanger's disease may be partially due to disturbed cerebrospinal fluid (CSF) dynamics. The possible pathophysiology of CSF dynamics in relation to Binswanger's disease is discussed. Detailed investigations of CSF dynamics are important in patients with Binswanger's disease, especially in the early stage.
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  • Case Report
    Tsugio SAIBARA, Tsuneyo HASHIMOTO, Masanori TAKAHASHI, Shuji HORIE, Ts ...
    1991 Volume 31 Issue 13 Pages 1012-1017
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     An 18-year-old male was admitted with headache, nausea, and vomiting. Computed tomography (CT) revealed an enhanced tumor of the pineal region and hydrocephalus. The tumor was partially resected via a parieto-occipital craniectomy. The histological diagnosis was germinoma. No serum tumor markers such as alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) were detectable. A ventriculo-peritoneal (V-P) shunt was emplaced and radiation therapy (whole brain 59 Gy) given. The tumor and the hydrocephalus regressed completely and he returned to work. Six years later, he experienced constipation and general fatigue. CT and echotomography of the abdomen showed a large peritoneal tumor and ascites. Laboratory investigation demonstrated serum levels of AFP 7640 ng/ml and HCG 150 IU/l, and high ascitic levels of AFP 12, 890 ng/ml and HCG 1030 IU/l. AFP and HCG levels regressed after combined chemotherapy. However, he died due to leukopenia and pneumonia. Autopsy found no metastasis of tumor cells to the central nervous system. The peritoneal cavity contained hemorrhagic fluid and a large tumor 4100 g in weight. The tip of the V-P shunt tube was in front of the tumor. No neoplasm was found in the testis, retroperitoneal cavity, thymus, and other organs. The microscopic appearance of the peritoneal tumor was different to the first pineal tumor. The neoplasm was confirmed as a mixed germ cell tumor with teratoma components and suspected to be a metastasis of the pineal tumor through the V-P shunt system.
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  • Case Report
    Tsutomu KATO, Toshimitsu AIDA, Hiroshi ABE, Akemi WAKISAKA, Takashi YO ...
    1991 Volume 31 Issue 13 Pages 1018-1022
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Occurrence of embryonal kidney tumors in patients with primitive neuroectodermal tumors, socalled central nervous system-renal neoplasia has been reported. An infant who presented with masses in the right lateral ventricle and the cerebellar vermis is reported. Histological examination showed primitive neuroectodermal tumors. Further investigation revealed tumors in the bilateral kidneys, which were removed subtotally and pathologically shown to be Wilms' tumors. The patient was then treated with anticancer drugs and irradiation. However, he developed lung metastases from the renal tumors and expired. At autopsy, a small tumor was found in the inferior horn of the left lateral ventricle. Histological finding showed a primitive neuroectodermal tumor. Also, bilateral large masses of recurrent Wilms' tumors, multiple metastases to the lungs and peritoneal dissemination were found. There is no evidence that this association is based on the selective neoplastic transformation of embryonal cells of similar histogenetic or cytogenetic origin. Several reports demonstrate the presence of embryonal cells in the nervous tissue which could imply a neuroepithelial origin for Wilms' tumors.
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  • Case Report
    Yoshihiro YAMAMOTO, Takehisa TSUJI, Masakazu SUGA, Norio SUNAMI, Yuji ...
    1991 Volume 31 Issue 13 Pages 1023-1029
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     A 65-year-old male was admitted with memory and gait disturbance. A computed tomography (CT) scan showed bilateral, diffuse, low-density areas with two round, slightly enhanced masses. T1-weighted magnetic resonance image revealed a low-intensity area in the left paraventricular region, which converted to increased signal intensity, extending to the right paraventricular region through the splenium, on T2-weighted images. The tumor was diagnosed as glioblastoma multiforme after needle biopsy and treated by irradiation and chemotherapy. Seven months after admission, a CT scan revealed subependymal infiltration of the tumor with spotty calcification. He died of respiratory complications 11 months after the onset of symptoms. The autopsy showed brain swelling with flattened gyri. Horizontal sections of the brain showed diffuse enlargement of the white matter and basal ganglia with scattered hemorrhage and necrosis. Microscopically, the lesion was far more extensive and diffuse than was suspected from gross examination. Wide glial tumor cell infiltration was observed in the cerebral hemispheres, basal ganglia, brainstem, cerebellum, and even the cervical spinal cord with minimum destruction of the pre-existing architecture. Calcification was found around the thrombosed vessels and necrotic lesions. The clinical diagnosis and histological features of gliomatosis cerebri are discussed with reference to reported cases.
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  • Case Report
    Eiji KURIHARA, Hidekazu NOGAKI, Yoshiteru SHOSE
    1991 Volume 31 Issue 13 Pages 1030-1034
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     An 82-year-old female was admitted with slowly progressive aphasia and right hemiparesis, accompanied by a hard, 5 × 5 cm subcutaneous swelling in the left frontotemporal region. Plain X-ray film showed a well-circumscribed round radiolucency in the left pterional region. Computed tomography (CT) scans showed an intraosseous mass lesion, homogeneously enhanced postcontrast, extending to the intracranial cavity. Bone CT demonstrated a concave appearance and partial destruction of the inner table, strongly suggesting an intradiploic origin of the tumor. Left carotid angiography revealed the mass supplied by the middle meningeal artery. Left frontotemporal craniectomy demonstrated that the inner surface of the skull was destroyed, and the dura was compressed but not invaded. Histological examination found meningotheliomatous meningioma with many psammoma bodies.
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  • Case Report
    Seiji SAITOH, Hiroshi SUZUI, Hikaru MIZOBUCHI, Yoshihiko KAMIMURA, Mas ...
    1991 Volume 31 Issue 13 Pages 1035-1039
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Ossifying fibroma is relatively common in the maxilla, but rare in the cranial vault. A 10-year-old girl was referred for painful swelling of the left temporal region. On admission, she presented no abnormal physical and neurological findings except for the painful swelling. Plain skull X-ray films showed a radiolucent lesion of the left temporal bone about 4 cm in diameter, with a hyperostotic area of the parietal side. Computed tomography scan using bone window level also showed an abnormal density lesion in the same site. Curettage of this tumor was performed from a cosmetic point of view and at the family's petition. Histological examination showed vascular fibrous tissue in which lamellar bone was surrounded by osteoblasts.
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  • Case Report
    Takeshi JIMBO, Koji TSUBOI, Yukio IWAMURA, Michio KANEKO, Kunio NAKAGA ...
    1991 Volume 31 Issue 13 Pages 1040-1044
    Published: 1991
    Released on J-STAGE: July 19, 2006
    JOURNAL FREE ACCESS
     Amplification of L-myc oncogene was noticed in a malignant meningioma originating from the right sphenoidal wing of a 54-year-old female. The patient underwent three surgical resections plus radiotherapy over a period of 11 years and then the growth rate of the tumor became much greater with a severely invasive appearance. Using Southern blot hybridization, L-myc amplification was examined on the specimen resected at the fourth operation. As a result, approximately five-fold amplification was confirmed, which has not been previously reported except for that in a small cell carcinoma of the lung. This result may suggest that L-myc amplification is responsible to some extent for the malignant transformation in this meningioma.
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