Neurologia medico-chirurgica

Immunohistochemical Analysis of Tumor-infiltrating Lymphocytes and Adhesion Molecules (ICAM-1, NCAM) in Human Gliomas

Ryuya YAMANAKA, Ryuichi TANAKA, Takafumi SAITO

1994 Volume 34 Issue 9 Pages 583-587
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.583

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The presence of tumor-infiltrating lymphocytes (TILs) and the expression of adhesion molecules were examined in 12 glioma tissues. Most TILs were T lymphocytes, and both cytotoxic/suppressor and helper/inducer T lymphocyte phenotypes were found. Neural cell adhesion molecule was intensely expressed in 11 gliomas, and intercellular adhesion molecule-1 (ICAM-1) in seven. Many TILs were found only in gliomas expressing ICAM-1, but there was no relationship with clinical course in the patients.

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Differentiation of Malignant Glioma and Metastatic Brain Tumor by Thallium-201 Single Photon Emission Computed Tomography

Yasuhiro KOJIMA, Nobumasa KUWANA, Masato NOJI, Junichi TOSA

1994 Volume 34 Issue 9 Pages 588-592
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.588

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The use of superdelayed thallium-201 single photon emission computed tomography (²⁰¹Tl SPECT) for differentiating malignant gliomas from cerebral metastases was investigated in 23 patients (7 with meningioma, 6 with glioma, 7 with cerebral metastasis, 1 with each of neurinoma, abscess, and necrosis). 4 mCi of ²⁰¹Tl was injected intravenously, and gamma camera scans were performed after 10 minutes and 4, 24, 72, and 96 hours (superdelayed scan). The mean thallium index of meningiomas was significantly higher than those of gliomas and cerebral metastases after 10 minutes, while the mean thallium indices of meningiomas and gl.iomas were significantly higher than those of cerebral metastases after 96 hours. The combination of early and superdelayed ²⁰¹Tl SPECT may be useful in differentiating malignant gliomas from cerebral metastases.

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Delayed Cerebral Ischemia Manifesting as Peduncular Hallucinosis after Aneurysmal Subarachnoid Hemorrhage —Three Case Reports—

Koh YANO, Tatsuya KURODA, Yusuke TANABE, Hiromu YAMADA

1994 Volume 34 Issue 9 Pages 593-596
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.593

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Three cases of peduncular hallucinosis occurred in patients with aneurysmal subarachnoid hemorrhage. All patients underwent early clipping of the ruptured aneurysms of the anterior circulation. Several days after onset of subarachnoid hemorrhage, the patients complained of vivid visual hallucinations associated with abnormal sleep-waking rhythms, suggesting a diagnosis of peduncular hallucinosis. The hallucinations disappeared with administration of an increased dose of dobutamine. These findings indicated that peduncular hallucinosis might be a manifestation of delayed cerebral ischemia after subarachnoid hemorrhage. No other possible cause of neurological deficits such as hydrocephalus, cerebral infarcts, or metabolic encephalopathies was identified. Damage to the ascending reticular activating system has been implicated in the pathogenesis of peduncular hallucinosis. Cerebral vasospasm in the perforating arteries of the ascending reticular activating system was probably the cause of the hallucinosis in our patients.

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Selection and Combination of Techniques for Treating Spontaneous Carotid-cavernous Sinus Fistulas

Kazushi KINUGASA, Kouji TOKUNAGA, Ichiro KAMATA, Shinya MANDAI, Kenji ...

1994 Volume 34 Issue 9 Pages 597-606
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.597

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Twenty-eight patients with spontaneous carotid-cavernous sinus fistulas (CCFs) were treated using a variety of techniques. Three of four patients with direct CCFs underwent intravascular embolization with a detachable balloon. Embolization with polyvinyl alcohol particles through an external carotid endoarterial route was used in six patients with indirect CCFs, and with ethylene-vinyl alcohol copolymer solution in two. Patients undergoing these conventional treatments, including embolization of the meningeal branches of the external carotid artery, had less satisfactory outcomes. The transvenous approach using minicoils through the inferior petrosal sinus was successful in eight patients. One patient treated using the transvenous approach using copper wire through the ophthalmic vein had worsening of visual acuity and field. Unsuccessful transvenous embolization in four patients required direct surgical exposure and embolization with spring coils. Spontaneous cures occurred in four patients. Direct CCFs with high flow rates were best treated with the detachable balloon or coil technique through a internal carotid endoarterial route. Indirect CCFs were best treated with the minicoil through the inferior petrosal sinus. If these techniques fail, direct surgical exposure allows placement of coils into the cavernous sinus.

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Early Changes in Volume and Non-enhanced Volume of Acoustic Neurinoma after Stereotactic Gamma-radiosurgery

Hirofumi OYAMA, Tatsuya KOBAYASHI, Yoshihisa KIDA, Takayuki TANAKA, Yo ...

1994 Volume 34 Issue 9 Pages 607-611
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.607

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The effectiveness of stereotactic gamma-radiosurgery for treating acoustic neurinoma was evaluated by measuring the volumes of the tumor, non-enhanced tumor, and cerebellar edema in 13 patients with acoustic neurinoma who were followed up for 9 to 15 months (median 12.7 mos) after treatment. The tumor volume and non-enhanced volume tended to reach a maximum after 6 months, and cerebellar edema volume after 9 months, then decreased gradually thereafter. Hearing loss tended to increase gradually, but involvement of the facial nerve was transient.

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Cerebellar Concussion —Three Case Reports—

Hiroshi FUMEYA, Hiroshi HIDESHIMA

1994 Volume 34 Issue 9 Pages 612-615
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.612

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Three patients with transient cerebellar dysfunction following head injury are described. Acute cerebellar signs, such as ataxia, nystagmus, and dysarthria, occurred just after trauma and resolved gradually, disappearing in every patient. Cerebrospinal fluid and computed tomography examinations were normal but magnetic resonance imaging and single photon emission computed tomography revealed cerebellar lesions. These findings distinguish cerebellar concussion from cerebellar contusion and suggest that the synergistic effect of trauma and ischemia may be the pathophysiological basis of this unusual syndrome.

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Subarachnoidal Abscess Associated with Bacterial Meningitis in Infants —Two Case Reports—

Shigeru NISHIZAWA, Hiroshi RYU, Tetsuo YOKOYAMA, Ichiro SHIMOYAMA, Kat ...

1994 Volume 34 Issue 9 Pages 616-619
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.616

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Two infants, an 11-month-old boy and a 7-month-old girl, presented with subarachnoidal abscess associated with severe bacterial meningitis refractory to intensive managements with antibiotics. Computed tomography (CT) revealed bifrontal extracerebral low-density areas and remarkably enhanced surfaces of the bilateral frontal lobes postcontrast. Surgical exploration disclosed thick pus accumulation in the subarachnoid space which required curettage. The boy developed appropriately for his age, but the girl showed severe psychomotor retardation because of additional complications such as subdural fluid collection and hydrocephalus associated with the subarachnoidal abscess. Appropriate early neurosurgical management of subarachnoidal abscess is essential for satisfactory psychomotor development. Postcontrast CT should be performed to detect the subarachnoidal abscess as early as possible, and extensive craniotomy to remove the subarachnoidal pus accumulation performed to preserve psychomotor development.

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Vasculopathy of the Anterior Choroidal Artery Following Intra-arterial Chemotherapy —Case Report—

Hiroyuki NAKASE, Hideyuki OHNISHI, Hajime TOUHO, Tamio ITOH, Jun KARAS ...

1994 Volume 34 Issue 9 Pages 620-623
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.620

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A 40-year-old male, treated with radiotherapy and supraophthalmic intracarotid artery (ICA) ACNU infusion for glioblastoma in the right occipital lobe, developed cerebral infarction secondary to vasculopathy manifesting as hemiparesis 3 months after a second ICA injection. The initial diagnosis was focal neurotoxicity, but angiography revealed severe vasospasm of the anterior choroidal artery. The symptoms improved gradually with therapy for the vasospasm. Angiography is required to discriminate vasospasm and focal neurotoxicity as a complication of ICA injection of antineoplastic agents.

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Posterolateral Extradural Approach for Lateral Thoracic Meningocele —Case Report—

Yukihiko SONODA, Teiji TOMINAGA, Keiji KOSHU, Akira OGAWA, Takashi YOS ...

1994 Volume 34 Issue 9 Pages 624-627
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.624

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A 26-year-old female presented with a lateral thoracic meningocele associated with neurofibromatosis. The development of the thoracic meningocele was documented on serial chest roentgenograms. Magnetic resonance imaging and three-dimensional bone computed tomography scans were particularly useful to identify organic changes in the surrounding structures and the osseous orifice of the dural sac, respectively. The large thoracic meningocele was successfully treated through the posterolateral extradural approach in combination with resection of the adjacent ribs and cerebrospinal fluid drainage from the dural sac.

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Primary Ewing''s Sarcoma of the Skull Base with Intracerebral Extension —Case Report—

Toshichi NAKANE, Yoshio HASHIZUME, Eiji TACHIBANA, Nobuhiko MIZUTANI, ...

1994 Volume 34 Issue 9 Pages 628-630
Published: 1994
Released on J-STAGE: May 22, 2006

DOIhttps://doi.org/10.2176/nmc.34.628

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A 32-year-old female presented with an uncommon primary Ewing''s sarcoma of the skull involving the middle cranial fossa with an extremely unusual extension into the cerebral parenchyma. She was treated with surgical excision, irradiation, and chemotherapy. Two years after surgery she demonstrated no evidence of local recurrence or distant metastasis. Ewing''s sarcoma of the skull may achieve a better survival rate under adequate management than this lesion in other sites.

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