Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 36, Issue 1
Displaying 1-10 of 10 articles from this issue
  • Takeshi KAWASE, Ryuzo SHIOBARA, Takayuki OHIRA, Shigeo TOYA
    1996 Volume 36 Issue 1 Pages 1-6
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Thirty-six cases of petroclival meningiomas with clearly defined anatomical features were selected to analyze the site of tumor attachment and the displacement of the trigeminal nerve. The tumors were classified into four categories according to the origin and extension of the tumor: clival origin medial to the trigeminal nerve (upper clivus type), clival origin with dumbbell extension to the cavernous sinus (cavernous sinus type), tentorial origin over the trigeminal nerve (tentorium type), and petrous apex origin lateral to the trigeminal nerve (petrous apex type). Patients with tumors in each category had characteristic neurological symptoms. Patients with the upper clivus type had oculomotor nerve paresis as a single symptom, if suprasellar tumor extension was present. Patients with the cavernous sinus type commonly presented with abducens nerve paresis caused by epidural tumor invasion around Dorello''s canal. Dumbbell tumor extension along the venous drainage of the cavernous sinus was a significant problem for surgical removal in this type. Half of the patients with the tentorium type had a characteristic symptom of trigeminal neuralgia caused by retrograde tumor invasion into Meckel''s cave from its orifice, but the cavernous sinus was not involved. The main complaint of patients with the petrous apex type was hearing disturbance, but no epidural or parasellar extension was present. Clinical symptoms and magnetic resonance imaging provide important information about the origin and extension patterns of these tumors, especially the presence or absence of tumor extension into the cavernous sinus. Abducens nerve paresis or trigeminal neuralgia suggests tumor invasion into the cavernous sinus or Meckel''s cave, respectively.
    Download PDF (535K)
  • Takayuki TANAKA, Tatsuya KOBAYASHI, Yoshihisa KIDA
    1996 Volume 36 Issue 1 Pages 7-10
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The effect of gamma knife radiosurgery for cranial base meningiomas was analyzed using magnetic resonance (MR) imaging in 33 patients followed up for a mean 26.5 months. There were 10 male and 23 female patients aged from 38 to 87 years (mean 54.5 yrs). Twenty-three patients had already had more than one open surgery before radiosurgery. The mean tumor volume was 16.8 cm3. The mean maximum dose was 29 Gy and the mean marginal dose was 15.1 Gy. Four patients were treated by two-stage treatment at 1 to 4-month intervals. Follow-up MR imaging revealed a decrease in tumor size in 10 patients, a small low intensity area in the tumor center in three, increase in tumor size in two, and no change in 18. After radiosurgery one patient had marked edema on MR imaging and showed cognitive deficits, and another three patients had neurological deterioration. All other patients were unchanged or improved. Growth control of cranial base meningiomas without severe neurological deficits can be achieved by radiosurgery.
    Download PDF (467K)
  • Mamoru TOMIDA, Masaaki MURAKI, Hisaya HIRAMATSU, Katsuyuki TSUKAMOTO, ...
    1996 Volume 36 Issue 1 Pages 11-14
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 62-year-old male presented with glioblastoma multiforme in the left frontal lobe manifesting as motor aphasia, subsequent to a malignant lymphoma in the right orbit. He underwent subtotal removal of the right orbital mass presenting as right exophthalmos which was shown by histological examination to be non-Hodgkin''s lymphoma. He received 30 Gy Lineac irradiation to the right orbit. His postoperative course was satisfactory. Magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) 7 months later demonstrated a small spotty enhanced lesion in the left frontal lobe. He developed motor aphasia 1 year after irradiation. MR imaging disclosed an enhanced mass in the left frontal lobe, which was totally removed. Histological examination revealed glioblastoma multiforme. Patients with malignant lymphoma may develop a subsequent second malignant tumor. MR imaging with Gd-DTPA is quite useful for early detection of a second brain tumor.
    Download PDF (371K)
  • Mitsutoshi NAKAMURA, Kiyoshi TAKEMURA, Junichi IIDA, Shigeru TSUNODA
    1996 Volume 36 Issue 1 Pages 15-18
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 19-year-old male underwent an emergent operation for a massive brain tumor in the right cerebral basal ganglia. However, brain herniation had already developed and he subsequently died. Histological examination showed the tumor consisted of immature epithelial arrangements and glandular structures, considered as immature teratoma containing choriocarcinomatous components. Such an immature teratoma arising in the cerebral basal ganglia in an adult is very rare.
    Download PDF (378K)
  • Nobuaki ISHII, Yutaka SAWAMURA, Takeshi AOKI, Kazuo NAGASHIMA, Takeshi ...
    1996 Volume 36 Issue 1 Pages 19-22
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 19-year-old female presented with an unusual intracranial extracerebral neuroblastoma originating from the dura mater. The tumor was located in the right frontal convexity, and had adhered neither to the underlining arachnoid membrane nor the cerebral cortex. The tumor feeders were meningeal arteries. Light microscopy showed the tumor consisted of small compact cells, forming numerous Homer-Wright rosettes. Immunohistochemical examination and electron micrography confirmed the diagnosis of neuroblastoma. Intracranial extracerebral neuroblastoma is extremely rare, especially originating from the dura mater. This neuroblastoma probably originated from heterotopic neuroglial nest cells in the meninges.
    Download PDF (475K)
  • Mitsuhiro TADA, Yutaka SAWAMURA, Hiroshi ABE, Fumio ITOH, Hisatoshi SA ...
    1996 Volume 36 Issue 1 Pages 23-25
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 14-year-old girl presented with a diffuse venous hemangioma of the right temporalis muscle. The muscle had become swollen, thinning the underlying zygomatic and temporal bones. Magnetic resonance (MR) imaging demonstrated a diffuse isointense area containing high intensity foci on the T1-weighted images, and a serpiginous high intensity pattern on the T2-weighted images. A biopsy specimen revealed irregularly dilated veins in the fibrous stroma of the muscle. Diffuse abnormal signals on MR images may be a pathognomonic feature of intramuscular venous hemangiomas.
    Download PDF (312K)
  • Katsuyoshi SHIMIZU, Fumito YAMADA, Sakae FUKUDA, Shigeo TOYA
    1996 Volume 36 Issue 1 Pages 26-30
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 63-year-old male presented with a cerebral arteriovenous malformation in the dominant motor area which subsequently disappeared spontaneously. He had suffered from epileptic attacks in his right extremities for 2 years before he first presented aged 53 years. He was treated with anticonvulsants and was followed up. Bleeding from the cerebral arteriovenous malformation occurred when he was 61 years old. Two years later, angiography revealed the complete disappearance of the cerebral arteriovenous malformation. Such spontaneous disappearance is rare, and the patient should be followed up as the nidus may reappear later.
    Download PDF (384K)
  • Noriyuki YAMAGUCHI, Hiromichi MIYAZAKI, Naomi ISHIYAMA, Shigeo TOYA
    1996 Volume 36 Issue 1 Pages 31-35
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 41-year-old male presented with vertigo, nausea, and vomiting suggesting a space-occupying lesion of the posterior fossa. Computed tomography (CT) and left vertebral angiography revealed a large distal posterior inferior cerebellar artery (PICA) aneurysm. Operation revealed the fusiform aneurysm was partially embedded in the medulla, preventing neck clipping or trapping of the aneurysm. Therefore, proximal ligation of the PICA was performed. The symptoms caused by the mass effect improved, and the aneurysm was not visualized by CT or angiography.
    Ligation of the PICA proximal to the choroidal point is not necessarily safe. In our case, ligation was distal to the tonsillomedullary segment from which the perforating arteries mainly arose, so the postoperative course was good without new neurological deficits. Proximal ligation is an effective treatment for distal PICA aneurysms manifesting as mass effect if other interventions are not possible.
    Download PDF (426K)
  • Narihito YAMAGUCHI, Kiyonobu IKEDA, Jun ISHISE, Junkoh YAMASHITA
    1996 Volume 36 Issue 1 Pages 36-39
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 6-year-old boy presented with traumatic atlanto-occipital dislocation due to a traffic accident. Lateral spinal tomography showed anterior misalignment of the craniocervical junction. Magnetic resonance imaging demonstrated associated cervicomedullary injury. He underwent an occipital-cervical fusion with implantation of a spinal cord electrical stimulation unit. His consciousness level improved, but he remained quadriplegic and dependent on a respirator 2 years after the injury.
    Download PDF (334K)
  • Motoshi SAWADA, Makoto IWAMURA, Toshifumi HIRATA, Noboru SAKAI
    1996 Volume 36 Issue 1 Pages 40-44
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 53-year-old male developed fever, nuchalgia, shoulder pain, and sore throat after a partial sigmoidectomy. He suffered sudden onset of quadriplegia about 5 days later. Magnetic resonance (MR) imaging indicated the characteristic appearance of C5-6 intervertebral disc herniation. However, anterior discectomy showed that he had cervical discitis associated with spinal epidural abscess. Continuous pus drainage from the abscess and vigorous antibiotic therapy were undertaken after surgery. He improved and could walk with assistance. MR imaging with gadolinium can be useful in diagnosing pyogenic spinal infection (epidural abscess, osteomyelitis, and discitis), but care should be taken in MR image interpretation since spinal epidural abscess associated with discitis may mimic disc herniation. Axial MR images are important to distinguish this rare disease from other cervical disorders.
    Download PDF (344K)
feedback
Top