Neurologia medico-chirurgica

Radical Removal of Craniopharyngioma: A Long-term Follow-up

Nobuyuki KAWANO, Takashi OHWADA, Kenzoh YADA

1993 Volume 33 Issue 8 Pages 543-546
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.543

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Radical removal of craniopharyngiomas was attempted as the primary treatment in 12 adult and six child patients. No postoperative radiotherapy was given to patients undergoing total removal, while those undergoing subtotal removal received 50-60 Gy. Overall evaluation showed 15 cases of total removal and three of subtotal removal. One patient died of septicemia 2 months postoperatively and another developed a recurrent tumor which was removed totally at a second operation. The mean follow-up period was 7 years. The quality of life was “excellent” in 10 patients, “good” in five, and “fair” in two. Visual losses were minimized and endocrinological disturbances treated medically. These satisfactory results indicate that radical surgical removal is the first choice for treatment of craniopharyngioma irrespective of the age of patients.

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Subclinical Carpal Tunnel Syndrome in Acromegaly

Shigeki KAMEYAMA, Ryuichi TANAKA, Akira HASEGAWA, Tetsuro TAMURA, Mizu ...

1993 Volume 33 Issue 8 Pages 547-551
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.547

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Median nerve conduction was studied in 16 acromegalic patients with asymptomatic carpal tunnel syndrome (CTS) to examine the incidence of subclinical CTS. Thirteen patients (81%) and 23 hands (72%) demonstrated subclinical CTS, 10 bilaterally and three unilaterally in the dominant hand. The incidence reflects the greater sensitivity of the inching method for detecting focal conduction abnormalities. Two of three patients without subclinical CTS showed normal plasma somatomedinC concentration despite growth hormone hypersecretion. Following adenomectomy, nerve conduction normalized in only six hands (26%). The postoperative persistence of the conduction delay implies that irreversible narrowing of the carpal tunnel rather than reversible soft tissue edema is the principal cause of CTS associated with acromegaly.

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Acute Subdural Hematoma

—Prediction of Outcome with a Linear Discriminant Function—

Kiyoyuki YANAKA, Takao KAMEZAKI, Takashi YAMADA, Shingo TAKANO, Kotoo ...

1993 Volume 33 Issue 8 Pages 552-558
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.552

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We devised a linear discriminant function to predict the outcome for patients with acute subdural hematoma (ASDH) based on a consecutive series of 170 ASDH cases with mild to severe head injury [Glasgow Coma Scale (GCS) 3-15]. Functional recovery was achieved in 50.0% of patients and the mortality was 36.5%. The relationship between initial clinical and radiological signs and the outcome 3 months after admission was studied retrospectively by Mann-Whitney''s U-test and Pearson''s chisquared test. Fourteen factors (GCS, pupillary response, motor paresis, age, hematoma volume and thickness, midline shift, association with cerebral contusion and subarachnoid hemorrhage, obliteration of the basal, ambient, or quadrigeminal cistern on computed tomography, fibrin-fibrinogen degradation product level, and intracranial pressure) were found to correlate significantly (p < 0.01) with outcome. Linear discriminant functions were formulated by multivariate analysis to investigate the relationship between these factors and recovery or poor prognosis. The following formula was obtained:
Z = -0.110 + 0.013 (Age) - 0.108 (GCS) + 0.397 (Eye) + 0.003 (Shift) + 0.268 (Ambient).
Functional recovery could be predicted by a negative Z value, with an accuracy of 90.59%. This simple discriminant function is useful for predicting the outcome of ASDH.

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Asymptomatic Calcified Chronic Subdural Hematoma —Report of Three Cases—

Mitsunobu IDE, Minoru JIMBO, Masaaki YAMAMOTO, Yutaka UMEBARA, Shinji ...

1993 Volume 33 Issue 8 Pages 559-563
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.559

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Three adults with asymptomatic calcified chronic subdural hematoma are described. Plain skull x-ray films following head trauma disclosed calcified chronic subdural hematomas and computed tomography (CT) revealed large, frontoparietal, calcified hematomas in all cases. A 49-year-old male received hematoma removal because of his lower age and CT evidence of cerebral compression. An 83-year-old male was not operated on and remained asymptomatic. The third patient died of traumarelated injuries. In the non-elderly, surgery for asymptomatic calcified chronic subdural hematoma with significant cerebral compression should be considered for relief of cerebral compression and prevention of possible future brain damage.

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Large Dorsal Internal Carotid Artery Aneurysm —Report of Two Cases—

Ahmed DIRAZ, Shigeaki KOBAYASHI, Hirohiko GIBO, Michihiko OHSAWA

1993 Volume 33 Issue 8 Pages 564-567
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.564

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Two patients with unusually large dorsal internal carotid artery aneurysms manifesting as subarachnoid hemorrhage are described. Surgery in both cases resulted in intraoperative rupture of the sac. The outcome was poor in the first patient and excellent in the second. The importance of wide exposure of the proximal and distal vasculature to the aneurysm, subpial dissection of the frontal and temporal lobes not to injure the fragile aneurysmal dome, and parallel clipping was emphasized for this rare type of aneurysm.

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Dystrophic Axonal Formation (Spheroid Body) in Central Neurocytoma —Case Report—

Ahmed DIRAZ, Mitsuhiro TADA, Yutaka SAWAMURA, Jun-ichi MURATA, Toshimi ...

1993 Volume 33 Issue 8 Pages 568-571
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.568

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A 30-year-old female presented with a central neurocytoma manifesting as positional headache. Magnetic resonance imaging showed a large calcified mass in the right lateral ventricle. The tumor was completely removed surgically. Light microscopy showed a linear arrangement of well-defined cells (beaded-string pattern) containing small round nuclei with abundant perikarya. A perinuclear halo reminiscent of oligodendroglioma was prominent in some cell groups. The tumor was entirely amitotic and free of atypia. Large, plump spheroid bodies lacking nuclei but containing coarse brown pigments were present among the tumor cells. The tumor cells were immunoreactive to neuron-specific enolase and synaptophysin but not glial fibrillary acidic protein or neurofilament. The ultrastructure of the tumor cells included abundant spheroid bodies containing secretory granules around neurons, indicating a dystrophic or aborted process of neuronal differentiation rather than a completelydifferentiated central neurocytoma.

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Endoscopic Observation of the Syrinx in Chiari Malformation —Case Report—

Shiro NAGASAWA, Tomio OHTA, Toshinobu ONOMURA, Yoshiki MIYAJI

1993 Volume 33 Issue 8 Pages 572-574
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.572

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The cervical syrinx cavity in a 27-year-old male with Chiari 1 malformation was inspected with a flexible small-caliber endoscope during syringosubarachnoid shunting. A cleft was observed in the midline on the ventral wall of the cavity, from which blood vessels emerged and ran along the wall. Several strands accompanying the blood vessels passed from one wall to another. The endoscope was also used to evaluate whether any obstacles to the passage of a shunt tube were present in the subarachnoid space. Endoscopic observation of the syrinx cavity is helpful in performing the shunt operation.

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Dilated Fourth Ventricle in Arnold-Chiari Malformation Type II: Isolated Fourth Ventricle as Sequelae of Shunt? —Case Report—

Shigetaka ANEGAWA, Takashi HAYASHI, Ryuichiro TORIGOE, Tetsuzo OGASAWA ...

1993 Volume 33 Issue 8 Pages 575-578
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.575

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A female infant with Arnold-Chiari malformation type II developed cystic dilatation of the fourth ventricle at age 15 months. She received shunt emplacement into the dilated fourth ventricle to restore communication to the subarachnoid space and achieved improved symptoms and decreased ventricular size. Such dilatation is a typical feature of this malformation, and the isolation of the fourth ventricle is supposed to result from the cerebrospinal fluid shunting procedure. In this patient, the cause appeared to be external compression of the aqueduct by the beaking deformity of the mesencephalic spur, a characteristic of Arnold-Chiari malformation type II.

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Subarachnoid Hemorrhage Presenting an “Abnormal Movement” —Case Report—

Kazuhiro HONGO, Masahiko MIZUNO, Susumu OIKAWA, Fusakazu OYA, Shigeaki ...

1993 Volume 33 Issue 8 Pages 579-581
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.579

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A 61-year-old male presented with subarachnoid hemorrhage manifesting an abnormal movement as the initial symptom. The movement was rhythmic with phases: tongue protrusion with eyes wide open, and tongue retraction with eyes closed, lasting for about 10 minutes. Neuroradiological methods identified a small aneurysm as the origin of the hemorrhage. The movement never after recurred clipping the aneurysm and clot drainage. Transient increase in the intracranial pressure was thought to be the cause.

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Clinical Experience with Expanded Polytetrafluoroethylene Sheet Used as an Artificial Dura Mater

Sen YAMAGATA, Kazuo GOTO, Yoshifumi ODA, Haruhiko KIKUCHI

1993 Volume 33 Issue 8 Pages 582-585
Published: 1993
Released on J-STAGE: June 20, 2006

DOIhttps://doi.org/10.2176/nmc.33.582

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Dural repair using chemically treated cadaveric dura mater often results in atrophic and fragile change of the substitute as well as adhesion between the dura mater and brain surface at reoperation. Creutzfeldt-Jakob disease has occurred after repair using cadaveric dura mater. Expanded polytetrafluoroethylene (EPTFE) surgical sheet was used for dural repair in 34 patients. Suturing of EPTFE was easy and the incidence of cerebrospinal fluid accumulation in the epidural space was the same as when cadaveric dura mater was used. Six patients underwent reoperation, 1-15 months after the first operation. At reoperation the EPTFE sheet showed no change except for becoming transparent, and the strength was well preserved. A very thin layer of granulation tissue was formed between the EPTFE sheet and brain surface, but the EPTFE sheet was easily detached from the brain surface without adhesion even 15 months after the first operation. Our results suggest that the EPTFE sheet can be used safely and effectively as an artificial dura mater.

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