Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 31, Issue 2
Displaying 1-9 of 9 articles from this issue
  • —Development of a New Three-dimensional Radiodiagnostic Device and Evaluation in Neurosurgical Clinics—
    Michinori OTTOMO, Norihiko BASUGI, Hajime HANDA, Takashi TANIGUCHI, Ta ...
    1991 Volume 31 Issue 2 Pages 69-76
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The rotatostereoradiographic device uses an x-ray tube coupled with an image intensifier rotating through a 180° arc in 2.25 seconds. The rapidly rotating x-ray tube allows 180°-arc angiograms to be obtained with a single injection of contrast medium. Subtracted fluoroscopic angiograms can be viewed immediately after injection of the contrast medium with digital recording. These three-dimensional images are displayed on side-by-side monitors stereoscopically.
     The mortality and morbidity of subarachnoid hemorrhage can only be greatly reduced by surgical treatment of unruptured aneurysms and arteriovenous malformations detected by a wide survey of subarachnoid hemorrhage. Such a wide survey would be possible utilizing intra-arterial digital subtraction angiography via the ascending aorta and this new three-dimensional radiodiagnostic method. A fluoroscopic device must be used to allow easier manipulation of the catheter from the axillary or brachial artery.
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  • Hajime TOUHO, Jun KARASAWA, Hisashi SHISHIDO, Keisuke YAMADA, Keiji SH ...
    1991 Volume 31 Issue 2 Pages 77-81
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A noninvasive, simplified method using inhalation of stable xenon (Xes) and computed tomographic (CT) scanning to estimate regional cerebral blood flow (rCBF) and regional partition coefficient (rλ) is described. Twenty-four patients with cerebrovascular occlusive disease and six volunteer controls inhaled 30% Xes and 70% oxygen for 180 seconds and exhaled for 144 seconds during serial CT scanning without denitrogenation. The end-tidal Xes concentration was continuously monitored with a thermoconductivity analyzer to determine the build-up range (A value) and build-up rate constant (K value) for arteries with the curve fitting method. The time-CT number (Hounsfield unit) curve for cerebral tissue during the Xes washin and washout phases was used to calculate rλ, and rCBF using least squares curve fitting analysis. The resultant rλ and rCBF map demonstrated a reliable distribution between the gray and white matter, and infarcted areas. rCBF was high in gray matter, low in white matter, and much lower in infarcted areas than in white matter. rλ was high in white matter, low in gray matter, and much lower in infarcted areas. Xes CT-CBF studies with very short inhalation of 180 seconds is a clinically useful method for evaluation of rCBF in patients with cerebrovascular diseases.
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  • Kazuko KAMIYA, Tetsuji INAGAWA, Mitsuo YAMAMOTO, Shuji MONDEN
    1991 Volume 31 Issue 2 Pages 82-86
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Subdural hematoma (SDH) was observed in 15 of 484 cases of aneurysmal subarachnoid hemorrhage (SAH). There were four males and 11 females, with ages ranging from 39 to 75 years. The clinical grades (Hunt and Hess) on admission were II in three cases, III in two, IV in four, and V in six. The ruptured aneurysms were located in the middle cerebral artery (MCA) in six cases, anterior communicating artery in three, internal carotid artery in two, and distal anterior cerebral artery (ACA) in two, with two cases unconfirmed. A high proportion of aneurysms occurred in the MCA and distal ACA. Aneurysmal neck clipping and removal of SDH were performed in the acute stage of seven cases, without intraoperative rerupture. The outcomes 1 year after SAH of the seven patients undergoing surgery were good recovery in five, but in two, vegetative state due to preoperative rerupture or medical complications. All eight patients without surgical intervention died. A good prognosis for patients with ruptured intracranial aneurysms accompanied by SDH can be expected with direct surgical intervention in the acute stage, even if the clinical grade on admission is poor.
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  • —Case Report—
    Shizuo OI, Seishiro URUI, Seiji HAMANO, Satoshi MATSUMOTO
    1991 Volume 31 Issue 2 Pages 87-91
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Cosmetic cranio-orbital reconstructive surgery was carried out on a 22-year-old male, the longest surviving case of cloverleaf skull syndrome reported. He previously underwent classical linear suturectomy for synostotic sutures and temporal cranioplasty. Fortunately, hydrocephalus became arrested so did not require continuous cerebrospinal fluid drainage through shunt tube. His intelligence quotient was in the 40s. The present problem was mainly of cosmetic cranio-orbital corrections of shallow orbits with resultant exophthalmos, frontal dysgenesis, and marked temporal bossings. Bilateral orbital advance, lateral canthal/pterional reshaping, frontal remodeling, and temporal reduction cranioplasty were performed. The postoperative outcome was satisfactory. The cloverleaf skull deformity is etiologically and pathologically heterogeneous, so radical surgical reconstructive procedures should be planned and designed individually.
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  • —Report of Two Cases—
    Chikashi MARUKI, Takeyoshi SHIMOJI, Hiroshi KIJIMA, Michio MATSUMOTO, ...
    1991 Volume 31 Issue 2 Pages 92-95
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    The authors report two cases of symptomatic Rathke's cleft cyst. Cytological examination of the cyst contents identified clusters of ciliated epithelial cells. Rathke's cleft cyst is normally defined by mucoid fluid in the cyst cavity and cyst wall biopsy. However, intraoperative cytology was found useful in diagnosis and deciding operative strategy.
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  • —Case Report—
    Minoru SHIGEMORI, Takayuki TOKUNAGA, Jun MIYAGI, Gihachiro EGUCHI, Shi ...
    1991 Volume 31 Issue 2 Pages 96-99
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A rare case of coexistent Burkitt-type lymphoma and meningioma associated with an unruptured cerebral aneurysm is presented. A 49-year-old male complaining of headache and right hemiparesis was admitted to our hospital. Neuroradiological examination revealed a multinodular mass in the left frontal convexity and an unruptured cerebral aneurysm at the M1 portion of the left middle cerebral artery. He underwent an operation for tumor removal and aneurysm clipping. Histological examination revealed the tumor to be a typical meningotheliomatous meningioma without malignancy. However, a second operation was necessary for another tumor invading into the left frontal lobe, which proved to be a Burkitt-type lymphoma. The second tumor may have been resulted from irritative effect of the first tumor, but the aneurysm was considered purely coincidental.
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  • —Case Report—
    Junki ITOH, Kazuo USUI
    1991 Volume 31 Issue 2 Pages 100-103
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A rare case of cavernous angioma located in the fourth ventricular floor occurred in a 44-year-old female complaining of occipital headache, vomiting, diplopia, and dysarthria. Computed tomographic scans demonstrated a high-density area in the fourth ventricle and slight hydrocephalus. Magnetic resonance (MR) imaging showed a mixed intensity mass on T2-weighted images and high or isointensity regions on T1-weighted images. The tumor was totally removed and histologically diagnosed as cavernous angioma. Postoperatively, ataxic gait, nausea, and vomiting disappeared gradually. MR imaging was useful to accurately evaluate the anatomic relationship between the lesion and the brainstem.
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  • —Case Report—
    Ichiro SUNADA, Shigeru YAMAMOTO, Yoshimi MATSUOKA, Shuro NISHIMURA
    1991 Volume 31 Issue 2 Pages 104-108
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    Persistent primitive hypoglossal artery, an anastomosis between the carotid artery and the vertebrobasilar system, is found in about 0.05% of cerebral angiograms. Though usually asymptomatic, it may occasionally cause ischemic disease. A 62-year-old male presented with left hemiparesis. Right carotid angiograms demonstrated a primitive hypoglossal artery originating from the internal carotid artery at the 2nd cervical spine. This artery supplied almost all blood to the basilar artery system. A marked stenosis extended from the origin of the internal carotid artery to the primitive hypoglossal artery. An endarterectomy of the internal carotid and primitive hypoglossal arteries was performed using a special internal shunt 46 days after the onset. Sudden arterial bleeding from the incised part of the internal carotid artery occurred 12 days after the operation. The carotid artery was resutured. The rupture of the carotid artery appeared to be caused by an infection of Pseudomonas aeruginosa, which was detected by culture of the chronic ear discharge. Rupture of the vessel wall due to infection is an important complication after endarterectomy. This is the second reported endarterectomy of the primitive hypoglossal artery.
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  • —Case Report—
    Yoshiaki KIM, Akira TANAKA, Masato KIMURA, Shinya YOSHINAGA, Masamichi ...
    1991 Volume 31 Issue 2 Pages 109-112
    Published: 1991
    Released on J-STAGE: September 05, 2006
    JOURNAL FREE ACCESS
    A 64-year-old female was admitted with a 6-year history of right hemifacial spasm. Neurological examination and precontrast computed tomographic (CT) scanning showed no abnormality. Vertebral angiography disclosed, however, a small arteriovenous malformation (AVM) in the right cerebellopontine angle. A postcontrast CT scan demonstrated a high-density area in the right cerebellomedullary junction which appeared as a flow-void signal on magnetic resonance images. A right retromastoid craniectomy was performed to separate an enlarged and tortuous loop of the right anterior inferior cerebellar artery from the right facial nerve using a Teflon-felt sheet. The AVM was not excised. Postoperatively, she was completely free of hemifacial spasm.
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