Neurologia medico-chirurgica

Study of Regional Cerebral Blood Flow in Experimental Head Injury: Changes Following Cerebral Contusion and During Spreading Depression

Yoshinori OZAWA, Takao NAKAMURA, Kenro SUNAMI, Motoo KUBOTA, Chiaki IT ...

1991 Volume 31 Issue 11 Pages 685-690
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.685

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Changes in regional cerebral blood flow (rCBF) following fluid-percussion brain injury (cerebral contusion) were studied in rats using the autoradiographic method. The direct current potential was monitored to identify spreading depression (SD). The rCBF was measured during SD and 2, 4, and 24 hours after injury. rCBF was almost nil in the contused area and decreased considerably in the cortices of the injured side for 4 hours after insult, then recovered by 24 hours. Focal relative rCBF increase occurred in the parietal cortex during SD, and was probably hyperperfusion due to SD. However, the rCBF did not increase over the sham-operated control. The injury probably caused hypoperfusion within 4 hours of insult and abolished the vascular response to SD.

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Direct Calorimetry Using Swan-Ganz Catheter for Evaluation of General Metabolic Expenditure in Acute Cerebrovascular Disease

—Comparison Between Direct Fick Method and Indirect Calorimetry Technique—

Hajime TOUHO, Jun KARASAWA, Hisashi SHISHIDO, Keisuke YAMADA, Keiji SH ...

1991 Volume 31 Issue 11 Pages 691-694
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.691

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Oxygen consumption calculated by the direct Fick method using a Swan-Ganz catheter (D-VO₂) and indirect calorimetry using a metabolic computer (ID-VO₂), carbon dioxide production calculated by the latter method, and respiratory quotient were determined pre and postoperatively in 12 patients with acute hypertensive intracerebral hemorrhage and eight patients with acute ruptured intracranial aneurysm. The mean D-VO₂ value was slightly lower than the mean ID-VO₂ value, but had a significantly positive correlation. The regression curve was very close to the line of identity. The total metabolic expenditure can be calculated from D-VO₂ and daily urinary nitrogen excretion. Direct calorimetry using a Swan-Ganz catheter is a simple method to evaluate metabolic expenditure in acute hemorrhagic cardiovascular disease.

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Pharmacokinetic Study of Selective Continuous Internal Carotid CDDP Infusion in Malignant Brain Tumors

Yoshikatsu SEIKI, Iekado SHIBATA, Hideo TERAO, Motoshige KUDO, Tetsuya ...

1991 Volume 31 Issue 11 Pages 695-701
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.695

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Cis-diamminedichloroplatinum (CDDP) was administered by selective continuous internal carotid infusion to nine patients with malignant brain tumors, including five glioblastomas, one mixed glioma, and three metastatic tumors. CDDP was infused through a catheter in the internal carotid artery at 100 mg/hr in all cases, except one glioblastoma case in which the lower rate of 10 mg/hr was used. The results of CDDP concentration measurements were: 1) CDDP in the blood peaked at termination of CDDP infusion and then decreased slowly, 2) CDDP infiltrated intratumoral cysts and accumulated there, 3) CDDP in the cerebrospinal fluid peaked 6-18 hours after infusion, and 4) the tumor/plasma CDDP ratio varied from 2 to 8. The size of tumors decreased moderately in three of the nine cases, but no complete response was achieved. The histological changes due to CDDP were observed in the tumor tissue and were absent in the normal brain parenchyma.

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Intraoperative Radiation Therapy for Malignant Glioma

Noboru SAKAI, Hiromu YAMADA, Takashi ANDOH, Toshifumi HIRATA, Yasuaki ...

1991 Volume 31 Issue 11 Pages 702-707
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.702

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Intraoperative radiation therapy (IORT) was used as part of the initial therapy for malignant glioma in 32 of 73 patients with histologically verified anaplastic astrocytoma (grade III astrocytoma) and glioblastoma multiforme. The initial treatment for all cases was subtotal or total tumor resection combined with external irradiation and chemotherapy. IORT was performed 1 week after tumor resection, with doses of 10-50 Gy (mean 26.7 Gy) in one session. Fourteen of 32 cases had IORT two times because of tumor recurrence. The IORT patients had survival rates at 24 and 36 months after initial treatment of 57.1 and 33.5% (median survival 26.2 months). The other 41 patients had 23.6 and 13.1 % survivals (median survival 20.7 months), which were significantly lower (p < 0.01). Tumor recurrence within the original lesion site was suspected because of clinical condition, computed tomography, and magnetic resonance imaging studies in 65.6% of the IORT group (21 cases) 12 months after initial treatment. Twenty cases of death in the IORT group, including five autopsy cases, demonstrated regional tumor recurrence with a high incidence of intraventricular tumor invasion. The authors consider IORT is beneficial for selected malignant glioma patients, including tumor recurrence, because of prolonged survival.

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Effects of Encephalo-duro-arterio-synangiosis on Childhood Moyamoya Patients

—Swift Disappearance of Ischemic Attacks and Maintenance of Mental Capacity—

Yoshiharu MATSUSHIMA, Masaru AOYAGI, Yoshihiko KOUMO, Yoshio TAKASATO, ...

1991 Volume 31 Issue 11 Pages 708-714
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.708

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The effect of encephalo-duro-arterio-synangiosis (EDAS) upon chronic cerebrovascular ischemia in 65 pediatric moyamoya patients was evaluated by the postoperative interval before complete disappearance of ischemic attacks and changes in pre- and postoperative intelligence (IQ) or development quotients (DQ). The ischemic attacks disappeared after a mean period of 239 days, in three-fourths of patients within a year and in about one-fourth within the second year. This was very fast compared with the natural course of the disease. There was no significant difference in DQ/IQ before and after the operation. The mentally normal (IQ/DQ ≥ 86) population in the postoperative patients was greater than in the natural course of the disease, although fewer in the preoperative group. This shows that EDAS delayed or prevented the deterioration in mental capacity usually present but often overlooked in the natural course of pediatric moyamoya disease.

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Foramen Magnum Decompression for Syringomyelia Associated with Basilar Impression and Chiari I Malformation

—Report of Three Cases—

Kanehisa KOHNO, Saburo SAKAKI, Hisashi NAKAMURA, Masaharu SAKOH, Sadan ...

1991 Volume 31 Issue 11 Pages 715-719
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.715

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Anterior or posterior decompression of the foramen magnum was performed in three patients with syringomyelia associated with basilar impression and Chiari I malformation. The operative results were evaluated using the pre- and postoperative magnetic resonance (MR) images. Two patients with combined anterior and posterior cervicomedullary compression due to basilar impression and tonsillar descent received suboccipital craniectomy, upper cervical laminectomy, and dural plasty without any intradural manipulations via the posterior approach. One patient with prominent anterior cervicomedullary compression due to basilar impression and a sharp clivoaxial angle was operated on by the transoral anterior approach. Postoperatively, all patients showed a sustained shrinkage of the syrinx and rounding of the flattened cerebellar tonsils. Two patients showed upward movement of the herniated tonsils. All patients had improved symptoms during 2-4 years follow-up. Treatment of syringomyelia associated with basilar impression and Chiari I malformation requires more efficient decompressive procedures at the foramen magnum based on neurological and MR findings.

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Coexistence of Intracranial and Spinal Meningiomas

—Report of Two Cases—

Seiji KANNUKI, Tetsuro SOGA, Hideki HONDO, Keizo MATSUMOTO, Kouichiro ...

1991 Volume 31 Issue 11 Pages 720-724
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.720

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The authors report two rare cases of multiple meningiomas in both the intracranial and spinal regions. A 64-year-old female presented with a right sphenoidal ridge meningioma and a cervical extramedullary meningioma. Tumor histology was transitional and vacuolated types, respectively. The tumors were removed successfully in two stages, craniotomy then laminectomy 3 months later. A 62-year-old female presented with a right sphenoidal ridge meningioma (meningotheliomatous type) which was totally removed. An extramedullary spinal meningioma became symptomatic 33 months later, which was also removed totally. The meningiomas in the first case had different subtypes, but immunohistochemical characteristics including microcyst formation were similar. The second case had meningiomas of the same subtype with similar characteristics, but different fibrous septum development. Multiple meningiomas, even in different compartments of the central nervous system, may have common characteristics.

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Subarachnoid Dissemination of Pineal Germinoma 9 Years After Radiation Therapy without Local Relapse

—Case Report—

Kazuhiko TOKORO, Yasuhiro CHIBA, Shizuo MURASE, Saburo YAGISHITA, Yosh ...

1991 Volume 31 Issue 11 Pages 725-728
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.725

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A 22-year-old female developed intracranial and spinal subarachnoid metastases 9 years after radiation therapy for a pineal germinoma. Computed tomographic scans showed no evidence of local recurrence. Cerebrospinal axis irradiation achieved total remission. Delayed subarachnoid dissemination may be caused by germinoma cells remaining dormant in the subarachnoid space, outside the radiation field.

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Intracranial and Spinal Germinomas Occurring Four Years After Spinal Cord Germinoma

—Case Report—

Shiro NAGASAWA, Haruhiko KIKUCHI, Junkoh YAMASHITA, Kameyoshi MITSUNO

1991 Volume 31 Issue 11 Pages 729-731
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.729

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Intracranial and thoracic tumors developed in a 31-year-old male 4 years after irradiation therapy for a cervical tumor. He received irradiation for the pineal, suprasellar, and thoracic tumors. All tumors disappeared by neuroradiological imaging after treatment. The previous and present tumors were probably germinomas, possibly with multifocal origins.

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Subependymoma of the Lateral Ventricle

—Case Report—

Masaaki HASHIMOTO, Hidenobu TANAKA, Keiji OGURO, Toshio MASUZAWA

1991 Volume 31 Issue 11 Pages 732-735
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.732

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A 56-year-old male presented with mild gait disturbance and short-term memory disturbance. Computed tomographic scans revealed an isodense mass with a large cyst in the left lateral ventricle, extending to the right. The tumor was removed totally via the left frontal transcortical approach. Light microscope examination found clusters of isomorphic cells separated by a dense fibrillar matrix. No ependymal rosettes or blepharoplasts were found. Some cluster cells had positive immunoperoxidase staining for glial fibrillary acidic protein and S-100 protein. Electron microscope observation found tumor cells with gap junctions and zonula adherens resembling the junctional complexes of normal ependymal cells, many microvilli and cilia, and long processes containing abundant glial fibrils. Such “transitional cells” may be important in establishing the origin of subependymoma.

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Pituitary Prolactinoma Associated with Polycystic Ovary

—Case Report—

Satoshi KURODA, Yasuhiro YONEKAWA, Teruaki KAWANO

1991 Volume 31 Issue 11 Pages 736-739
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.736

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A 25-year-old female presented with pituitary prolactinoma associated with polycystic ovarian disease and amenorrhea. After trans-sphenoidal adenomectomy, the serum prolactin level returned to normal. Postoperative ultrasonography revealed resolution of the polycystic ovary. Regular menses recommenced 2 months after surgery. Our experience suggests that pituitary prolactinoma may be a cause of polycystic ovarian disease.

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Fenestration of the Intracranial Internal Carotid Artery

—Case Report—

Shouji TAKANO, Motoyoshi SAITOH, Yoshio MIYASAKA, Kenzoh YADA, Hiroshi ...

1991 Volume 31 Issue 11 Pages 740-742
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.740

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A rare case of fenestration of the intracranial internal carotid artery (ICA) was identified by angiography in a 51-year-old female with suspected subarachnoid hemorrhage. Only two similar cases have been reported previously. Fenestration tends to develop on the right side and near the bifurcation of the ophthalmic artery. Congenital factors at the 4 mm embryonic stage may be involved in the fenestration of the intracranial ICA.

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Anticoagulant-related Intracerebral Hemorrhage in Patients with Prosthetic Heart Valves

—Report of Two Cases—

Nobuhisa NAGANO, Hitoshi TABATA, Kunio HASHIMOTO

1991 Volume 31 Issue 11 Pages 743-745
Published: 1991
Released on J-STAGE: July 19, 2006

DOIhttps://doi.org/10.2176/nmc.31.743

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Two cases of intracerebral hemorrhage in patients with prosthetic heart valves receiving anticoagulant therapy without preceding embolic cerebral infarction are reported. Phytonadione and fresh frozen plasma were immediately given, and the intracerebral hematoma evacuated successfully. In one case, intractable bleeding occurred perioperatively until the thrombotest value reached 40% or more. This patient later developed fatal massive multiple intracerebral hemorrhages.

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