Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 36, Issue 6
Displaying 1-10 of 10 articles from this issue
  • Takahiko EGUCHI, Toshiaki TAOKA, Yuji NIKAIDO, Kazuaki SHIOMI, Takatos ...
    1996 Volume 36 Issue 6 Pages 353-357
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Cine-magnetic resonance (MR) imaging examinations were performed in 10 patients with middle cranial fossa arachnoid cysts to evaluate communication between the cysts and the normal cerebrospinal fluid (CSF) space. Eight of 10 patients were evaluated by time of flight cine-MR imaging, and two by phase contrast cine-MR imaging. Two patients underwent membranectomy of the cysts, and were evaluated both pre and postoperatively. Computed tomography cisternography was used to confirm communication between the cysts and the surrounding cisterns. Pulsatile fluid motion within the cysts was present in all patients. However, marked fluid motion and jet flow between the cysts and the surrounding cisterns were only observed in communicating cysts. In the two patients who underwent membranectomy, postoperative examination found greater fluid motion and jet flow not previously present. Cine-MR imaging demonstration of marked pulsatile fluid motion accompanied by jet flow suggests that a cyst communicates with the normal CSF space.
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  • Masaaki YAMAMOTO, Mitsunobu IDE, Yutaka UMEBARA, Shinji HAGIWARA, Mino ...
    1996 Volume 36 Issue 6 Pages 358-363
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The postradiosurgical volume changes were compared with preradiosurgical growth fractions defined as the tumor doubling time and/or MIB-1 staining index in 14 patients who underwent gamma knife radiosurgery for treatment of various brain tumors. The mean preradiosurgical observation period using neuroimaging techniques was 750 days (range 80-2967 days), and the mean follow-up period after radiosurgery was 664 days (range 328-1100 days). There were four neurinomas, three meningiomas, two craniopharyngiomas, two gliomas, one hemangioblastoma, one pituitary tumor, and one intracranially infiltrative lacrimal gland tumor. The mean patient age at the time of radiosurgery was 52 years (range 8-81 yrs). There were eight males and six females. Following gamma knife radiosurgery, the mean tumor half time was estimated to be 789 days (range 124-2101 days), and the volume reduction against the preradiosurgical tumor volume ranged from 6.3% to 76.1%. This study demonstrates that gamma knife radiosurgery can control tumor growth despite the lack of a correlation with preradiosurgical tumor growth or staining indices for MIB-1. Analyses of this type are essential to show that an “unchanged tumor volume” as demonstrated by postradiosurgery follow-up neuroimaging can be regarded as showing successful radiosurgery.
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  • Keisuke UEKI, Masao MATSUTANI, Osamu NAKAMURA, Yoshiaki TANAKA
    1996 Volume 36 Issue 6 Pages 364-369
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The benefit and risk of whole brain radiation therapy (WBRT) compared to locally limited radiation therapy was assessed in 61 patients with solitary brain metastases from non-small cell lung cancer without an unresectable active primary lesion or systemic dissemination in the other organs. Twentythree patients received local irradiation (Group A), and 38 patients received whole brain irradiation with or without local irradiation (Group B). The survival was significantly better in Group A than in Group B (p < 0.05), with median survivals of 83.1 and 30.7 weeks, respectively. One-year local recurrence rates were 7% in Group A and 21% in Group B, but the difference was not statistically significant. The 1-year distant recurrence rate was similar at 18%. Radiation-induced dementia occurred in two patients in Group A (8.7%) and seven in Group B (18.4%), but was not statistically significant (p = 0.30). There is no obvious benefit and possible disadvantages of WBRT compared to local irradiation for the population of patients investigated in this study. Intraoperative radiation therapy or stereotactic radiosurgery without WBRT should be considered in the patients with solitary brain metastases.
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  • Masaaki YAMAMOTO, Minoru JIMBO, Mitsunobu IDE, Noriko TANAKA, Yutaka U ...
    1996 Volume 36 Issue 6 Pages 370-376
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The efficacy of a new protocol consisting of a prophylactic antibiotic regimen of peri and postoperative intravenous administration of flomoxef and irrigation of the operative field with saline containing gentamicin was assessed by comparing infection rates in two consecutive series of patients who underwent neurosurgical procedures. Group A received postoperative flomoxef administration, with saline containing no antibiotics for irrigation, from July 1988 to December 1989. Group B received the new protocol from January 1990 to December 1991. For further evaluation, this protocol was continued in most patients who underwent surgery from January 1992 through December 1993 (Group C). Only adult or adolescent patients who underwent clean neurosurgical procedures were included. The number of patients and procedures in each group were: 76 patients (97 procedures) in Group A, 103 (133) in Group B, and 107 (137) in Group C. There were no significant differences between Groups A and B in age, sex, clinical category, coexistent disease, clinical outcome, surgical procedures, general anesthesia, emergency operation, steroid administration, and the timing (season), duration, and frequency of surgery. Meningitis developed in three patients and subcutaneous infection in one in Group A. None of the patients in Group B experienced postoperative infection. This difference in infection rates (4.1% vs. 0%) was statistically significant (p = 0.0305). Furthermore, no postoperative infections developed in the Group C patients. The most appropriate interval for multiple dose administration was determined by analyzing intraoperative time-related changes in the serum flomoxef concentration during surgery in 21 recent patients. Serum flomoxef concentrations fell below therapeutic levels (3.0μg/ml) by the 6th post-administration hour in 70% of patients. We conclude that this antibiotic regimen significantly reduces the postoperative infection rate following neurosurgical procedures. Multiple dose administration of flomoxef is recommended when the duration of surgery is 6 hours or more.
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  • Keigo MATSUMOTO, Takashi HOURI, Tarumi YAMAKI, Satoshi UEDA
    1996 Volume 36 Issue 6 Pages 377-379
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    An 8-year-old boy, who fell downstairs and struck his head, and a 62-year-old female, who hit her head in the automobile accident, presented with unusual traumatic acute subdural hematoma localized on the superior surface of the tentorium cerebelli. Magnetic resonance imaging was useful for determination of the anatomical location of the hematoma, and confirmation of absence of significant parenchymal contusion. Injury of the variant bridging vein possibly caused subdural hematoma over the tentorium.
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  • Yuji TOMONO, Sadayuki TAKEUCHI, Tadao NOSE
    1996 Volume 36 Issue 6 Pages 380-383
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 66-year-old female presented with a large organized hematoma within an acoustic neurinoma. She had suffered from diminished hearing for 20 years and had headache 1 week before presentation. Computed tomography demonstrated an inhomogeneously high density cerebellopontine angle mass, and magnetic resonance imaging showed a mass with heterogeneous intensity and gadoliniumdiethylenetriaminepenta-acetic acid enhancement of only the peripheral surface of the mass and the inner parts of the internal auditory meatus. At operation the majority of the mass was soft and featureless with a firm capsule, and a yellowish soft tumor was removed from the perimeatal area. Histological examination showed the mass was an acoustic neurinoma with a large organized hematoma. Extensive hemorrhage from an abnormal vascularity in the tumor had repeated followed by granulomatous organization.
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  • Satoshi KOBAYASHI, Akiyoshi OTSUKA, Tadao TSUNODA, Hiroshi K. INOUE
    1996 Volume 36 Issue 6 Pages 384-387
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 46-year-old female presented with an intracranial hypoglossal neurinoma manifesting only as spasticity in the lower extremities without hypoglossal nerve paresis. Magnetic resonance imaging greatly aided in the early detection of the tumor with this atypical presentation. Unilateral suboccipital craniotomy with resection of the occipital condyle allowed us to approach the tumor in front of the medulla from an inferolateral direction and to remove it successfully. We emphasize the need to pack dead space with fatty tissue to prevent cerebrospinal fluid leakage.
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  • Masayuki MATSUDA, Takuya NAKAZAWA, Hirohiko KIZUKI, Kenichi MATSUMURA, ...
    1996 Volume 36 Issue 6 Pages 388-392
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 55-year-old female presented with a rare solitary plasmacytoma restricted to the skull vault without systemic myelomatosis. She had a 9-month history of a slowly growing soft mass in the right temporal region. Neuroradiological examination revealed a skull defect and an extradural tumor. The whole layer of the skull was destroyed by the tumor, but the dura was not involved. The tumor was totally removed, and postoperative radiotherapy was given. Follow-up examination after 2 years showed she was free from local recurrence or evidence of systemic involvement. Complete surgical resection with adjuvant radiation therapy is the treatment of choice. Although the prognosis is good, regular lifelong examinations for myelomatosis are required.
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  • Atul GOEL, Rajan BHAYANI, Anand P. DESAI, Naina GOEL
    1996 Volume 36 Issue 6 Pages 393-395
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 37-year-old female presented with a rare case of intradural, extraaxial Blastomyces dermatitidis granuloma involving a large part of the skull base. She had the principal complaint of worsening vision, but was otherwise healthy. The lesion mimicked an en-plaque meningioma on radiological examination and in gross appearance during surgery. This is a very unusual presentation for a blastomycosis granuloma.
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  • Totaro TAKEUCHI, Eishi KASAHARA, Mitsuyoshi IWASAKI
    1996 Volume 36 Issue 6 Pages 396-399
    Published: 1996
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A cystplastic cyst-subarachnoid shunt procedure using a ventricular catheter of Denver type shunt system was performed in seven patients with non-communicating middle cranial fossa arachnoid cyst. The operation technique consists of: linear incision of the outer membrane of arachnoid cyst and intrusion into the cyst; followed by a 5 mm incision of both the inner membrane of the arachnoid cyst and the arachnoid membrane; insertion of a 2-3 cm length of the ventricular catheter, cut as required with silk thread bound around the midpoint of the tube, into the subarachnoid space; fixation of the tube to the arachnoid membrane by a silk thread with Weck clips; and finally suturing of the outer membrane of arachnoid cyst by a nylon thread. During the follow-up period of 3 months to 3 years after the operation, the symptoms were relieved in all patients, and no recurrence or complication was observed.
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