Neurologia medico-chirurgica

Arteriovenous Malformations of the Corpus Callosum —Radioanatomic Study and Effectiveness of Intranidus Emboli.zation—

Luc PICARD, Shigeru MIYACHI, Marc BRAUN, Serge BRACARD, Antoine PER, J ...

1996 Volume 36 Issue 12 Pages 851-859
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.851

JOURNAL FREE ACCESS

Show abstractHide abstract

Forty-three patients with arteriovenous malformations (AVMs) of the corpus callosum treated by embolization were reviewed. The following clinical and radioanatomic characteristics were found: 84% (36 patients) presented with intracranial hemorrhage, 43% (20 nidi) of the lesions were located in the posterior half of the corpus callosum, multiple nidi were more frequent (21%) than expected, 27 nidi (59%) were fed by branches of both the anterior and posterior cerebral arteries, AVMs mainly drained into the internal cerebral vein and/or interhemispheric superficial veins, and 19 (41%) had both draining pathways, 10 patients (23%) had impaired drainage through the straight sinus due to dysplasia. Staged embolization was performed in 245 feeders. Curative occlusion (more than 95%) was obtained in 17 patients (40%) and considerable occlusion (more than 75%) in 33 patients (77%). Large and giant, diffuse-type, and multifocal AVMs were difficult to completely embolize. Complications associated with embolization occurred in six patients, mostly during the first 5 years. Only two patients had a permanent deficit related to a complication. Overall morbidity and mortality were 7% and 2%, respectively. Nine patients were referred for stereotactic radiosurgery, three of whom were completely cured and five patients have not been assessed. Most AVMs in the corpus callosum are supplied by multi-axial feeders, so multi-target intranidus embolization is very important to prevent the development of other feeders secondary to the hemodynamic shift. Combined therapy using maximum embolization and subsequent radiosurgery may be the most effective method to treat AVMs in the corpus callosum.

View full abstract

Download PDF (790K)
Intracranial Aneurysms Associated with Moyamoya Disease

Ljubisa BOROTA, Slobodan MARINKOVIC, Radoslav BAJIC, Miroslav KOVACEVI ...

1996 Volume 36 Issue 12 Pages 860-864
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.860

JOURNAL FREE ACCESS

Show abstractHide abstract

The authors examined 31 patients with moyamoya disease in Yugoslavia. Among them four intracranial aneurysms were disclosed, two in males and two others in females. The aneurysms, which were present in adult patients only, were diagnosed angiographically. Three of four patients died several days or weeks after onset of hemorrhage. The aneurysms were located within the basal abnormal vascular network, on a distal branch of the posterior cerebral artery, on the top of the basilar artery, and on the posterior branch of the middle meningeal artery. The moyamoya disease on the side of the individual aneurysms was most often stage III or IV.

View full abstract

Download PDF (463K)
Elevated Plasma Basic Fibroblast Growth Factor in Brain Tumor Patients

Masanori KURIMOTO, Shunro ENDO, Yutaka HIRASHIMA, Michiharu NISHIJIMA, ...

1996 Volume 36 Issue 12 Pages 865-869
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.865

JOURNAL FREE ACCESS

Show abstractHide abstract

We attempted to determine whether the plasma concentration of basic fibroblast growth factor (bFGF) was elevated in brain tumor patients. The plasma concentration of bFGF was measured in 55 brain tumor patients and 17 normal subjects by enzyme immunoassay. Upper limit of plasma bFGF in the normal subjects was 1.6 pg/ml. Elevated plasma bFGF levels were observed in 28 patients including 13 of 17 glioma patients, eight of 19 benign tumor patients, and seven of 19 malignant tumor patients. Twelve of 14 malignant glioma patients had elevated plasma bFGF levels. There was a good correlation (r = 0.42, p < 0.05) between the elevated plasma bFGF level and the tumor volume. Further studies are needed to determine whether the plasma bFGF level is a clinically useful diagnostic and prognostic marker for patients with brain tumors.

View full abstract

Download PDF (316K)
Long-term Evaluation of Radiation-induced Brain Damage by Serial Magnetic Resonance Imaging

Tsutomu KATO, Yutaka SAWAMURA, Mitsuhiro TADA, Hiroshi ABE, Hiroki SHI ...

1996 Volume 36 Issue 12 Pages 870-876
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.870

JOURNAL FREE ACCESS

Show abstractHide abstract

The long-term changes during late delayed radiation-induced brain damage were investigated by serial magnetic resonance (MR) imaging of eight patients over a mean follow-up period of 45 months after irradiation. The radiation damage appeared as an enhanced lesion on T₁-weighted MR images with gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) at 3 to 30 months after radiotherapy (mean 12.8 months). In all patients, an abnormal high signal intensity area on T₂-weighted imaging preceded the enhanced lesion. The volume and number of enhanced lesions continued to increase for 3 to 23 months (mean 10.3 months). The high signal intensity area on T₂-weighted imaging simultaneously expanded. The lesions were subsequently stabilized, and in four long-term survivors, the Gd-DTPA-enhanced lesions then decreased in size, the intervals from onset to regression were 12, 13, 17, and 35 months (mean 19.3 months), respectively. However, two patients showed a relapse of the enhanced lesion with latent periods of 8 and 9 months, respectively. Finally, the radiation-damaged brain became atrophic including the high signal intensity area on T₂-weighted images. Late delayed radiation-induced brain damage continues to progress for over a year and then regresses, but thereafter a relapse may occur.

View full abstract

Download PDF (740K)
Cerebrospinal Fluid Rhinorrhea Secondary to Small Tumor Invasion into the Superior Sagittal Sinus —Case Report—

Kimito TANAKA, Shiro WAGA, Tadashi KOJIMA, Hiroshi SAKAIDA

1996 Volume 36 Issue 12 Pages 877-879
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.877

JOURNAL FREE ACCESS

Show abstractHide abstract

A 53-year-old male presented with non-traumatic cerebrospinal fluid rhinorrhea due to obstructive extension of a small parasagittal meningioma. Radical excision of the tumor was curative. The rhinorrhea apparently developed due to increased intracranial pressure associated with primary empty sella.

View full abstract

Download PDF (288K)
Brainstem Schwannoma —Case Report—

Michiharu TANABE, Hajime MIYATA, Hisayo OKAMOTO, Takashi WATANABE, Tom ...

1996 Volume 36 Issue 12 Pages 880-883
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.880

JOURNAL FREE ACCESS

Show abstractHide abstract

A 68-year-old female presented with rare brainstem schwannoma manifesting as right hemiparesis, diplopia, and dysphagia. Neuroimaging revealed a lesion in the pons and cerebral peduncle, which was supposed to be a highly malignant glioma. The mass was approached via a single-flap orbitozygomatic craniotomy through an anteromedial pericavernous approach. Intraoperative frozen-section specimens indicated glioma, but the tumor was distinct from the surrounding parenchyma, and could be removed successfully. A tumor capsule was found and also removed. Postoperative histological, immunohistochemical, and ultrastructural examinations confirmed the diagnosis of benign schwannoma. Most schwannomas, even in the brainstem, are benign and complete removal may be curative.

View full abstract

Download PDF (478K)
Hemifacial Spasm due to Compression of the Facial Nerve by Vertebral Artery-Posterior Inferior Cerebellar Artery Aneurysm and Elongated Vertebral Artery —Case Report—

Shusuke MORIUCHI, Hidemitsu NAKAGAWA, Masanobu YAMADA, Tsuyoshi KADOTA

1996 Volume 36 Issue 12 Pages 884-887
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.884

JOURNAL FREE ACCESS

Show abstractHide abstract

A 62-year-old female presented with rapid aggravation of long-standing facial spasm occurring within a few months. Neuroimaging and angiography demonstrated compression of the root exit zone (REZ) of the facial nerve by an ipsilateral saccular aneurysm at the left vertebral artery (VA)-posterior inferior cerebellar artery bifurcation, in addition to the elongated VA. Neck clipping of the aneurysm and decompression of the REZ from the elongated VA and clipped aneurysm resulted in complete disappearance of the facial spasm. The aneurysm had very thin walls and was apparently about to rupture. Aggravation of long-standing hemifacial spasm may be a warning sign for rapid growth and rupture of a causative aneurysm.

View full abstract

Download PDF (301K)
Intramedullary Spinal Cord Meningioma —Case Report—

Shusuke MORIUCHI, Hidemitsu NAKAGAWA, Masanobu YAMADA, Tsuyoshi KADOTA

1996 Volume 36 Issue 12 Pages 888-892
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.888

JOURNAL FREE ACCESS

Show abstractHide abstract

A 54-year-old female presented with a spinal intramedullary meningioma manifesting as extremely slow development of dysesthesia in the extremities. Sagittal T₁-weighted magnetic resonance imaging showed fusiform enlargement of the cervical spinal cord with an area of low-signal intensity suggestive of syringomyelia extending bidirectionally up to the medulla oblongata and downward from the homogeneously enhanced intramedullary space-occupying lesion. The tumor was confirmed to be intramedullary mass with no dural attachment, and was totally removed en bloc. Histological examination showed transitional type of meningioma. The tumor specimen was positive for epithelial membrane antigen, and included glial fibrillary acidic protein-positive fibers, which were thought to be surrounding neural tissues trapped by the nodularity of the tumor in the growing process.

View full abstract

Download PDF (430K)
Vein of Galen Aneurysmal Malformation in a Neonate Treated by Endovascular Surgery —Case Report—

Masaki KOMIYAMA, Misao NISHIKAWA, Toshihiro YASUI, Shouhei KITANO, Hir ...

1996 Volume 36 Issue 12 Pages 893-900
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.893

JOURNAL FREE ACCESS

Show abstractHide abstract

A male neonate with vein of Galen aneurysmal malformation developed fetal heart failure after a gestation period of 37 weeks. Labor was induced, but a cesarean section had to be performed because of fetal distress. His Apgar scores were 2/8 at birth. The boy required controlled ventilation due to generalized seizure and cyanosis. Neuroimaging revealed vein of Galen aneurysmal malformation with enormous arteriovenous shunt flows. Transarterial embolization was performed on days 4 and 6 to reduce the progressive high-output congestive heart failure. Three large feeders were occluded with interlocking detachable coils, markedly reducing the shunt flow. Although heart failure improved markedly, he died of pulmonary hemorrhage on day 12. Endovascular surgery can improve the prognosis of heart failure in the neonatal period less invasively than other treatment modalities, and may help to minimize ischemic brain damage and thus increase the possibility of normal brain maturation.

View full abstract

Download PDF (922K)
Arachnoid-Trabeculae Tenting as a Self-retaining Retractor in Resecting Ventrally Located Spinal Meningioma —Technical Note—

Yuzo YAMAKAWA, Hidenobu OCHIAI, Tokuro IKEDA

1996 Volume 36 Issue 12 Pages 901-902
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.901

JOURNAL FREE ACCESS

Show abstractHide abstract

Tenting of the arachnoid with intact trabeculae to facilitate and maintain rotation of the cord during the resection of ventrally or ventrolaterally located spinal meningiomas is proposed. The arachnoidtrabeculae tenting acts as a self-retaining retractor, and prevents overlapping of the cord onto the tumor due to gravity.

View full abstract

Download PDF (146K)

Register with J-STAGE for free!