Neurologia medico-chirurgica

Ultrastructure of Collagen Fibers in the Outer Membrane of Recurrent Chronic Subdural Hematoma

Yoshihiko TAKAHASHI, Akira OHKURA, Fumihide YOSHIMURA, Satoshi OCHIAI, ...

1996 Volume 36 Issue 9 Pages 627-631
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.627

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The three-dimensional structure of the collagen fibers in the outer membrane of recurrent chronic subdural hematoma was studied by scanning electron microscopy (SEM). Specimens obtained at surgery were treated with NaOH at room temperature to digest away all cellular components and expose the collagen fibers. SEM observation of the dural side of the outer membrane showed the collagen fibers were woven into a compact feltwork with a dense arrangement. The fiber bundles had a honeycomb structure framed by the collagen fibers. Observation of the hematoma side found the collagen bundles had a sparse wavy appearance. The arrangement of the collagen fibers on the dural side is different from that on the hematoma side. The thick outer membrane may be formed by granulation resulting from inflammatory reaction. Collagen fibrillar networks are not fragile, and may reinforce the outer membrane of the recurrent hematoma.

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Combined Irradiation and Chemotherapy Using Ifosfamide, Cisplatin, and Etoposide for Children with Medulloblastoma/Posterior Fossa Primitive Neuroectodermal Tumor —Results of a Pilot Study—

Yutaka SAWAMURA, Jun IKEDA, Nobuaki ISHII, Tsutomu KATO, Mitsuhiro TAD ...

1996 Volume 36 Issue 9 Pages 632-638
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.632

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Ten children with newly diagnosed medulloblastoma/primitive neuroectodermal tumor of the posterior fossa were treated with total surgical resection, radiation therapy, and ICE chemotherapy regimen with ifosfamide (900 mg/m², days 1-5), cisplatin (20 mg/m², days 1-5), and etoposide (60 Mg/M², days 1-5) every 4 weeks for eight cycles. Four children under 2 years old were at first treated with eight cycles of ICE chemotherapy, and then irradiated. The ICE regimen was well tolerated by all children, with no irreversible adverse effects. However, dose reductions during the eight cycles were inevitable mainly due to myelosuppression. Complete remissions were achieved in eight of 10 patients at 1 month after completion of the treatment. One child showed recurrence 21 months after complete remission. The disease-free survival rate was 70% with a mean observation period of 24 months after surgery. The ICE regimen is a useful treatment modality for children with medulloblastoma. Further study is warranted to clarify long-term outcome in a number of patients.

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Paraclinoid Carotid Artery Aneurysms with the Dome Eroding the Anterior Clinoid Process: Preoperative Depiction of Topography and Surgical Tactics —Two Case Reports—

Shiro NAGASAWA, Ryuhsuke OGAWA, Yoshio SUYAMA, Tomio OHTA

1996 Volume 36 Issue 9 Pages 639-643
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.639

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A 70-year-old male and a 55-year-old female presented with unruptured aneurysms in the clinoid segment of the carotid artery. Intraoperative rupture during removal of the anterior clinoid process resulted in unintended carotid artery occlusion in the former patient, causing hemispherical infarction and death. However, the aneurysm was successfully clipped due to preoperative recognition of the aneurysmal dome in the clinoid process in the latter. Magnetic resonance angiography and three-dimensional computed tomography angiography source images provide detailed visualization of the topographic anatomy around the paraclinoid aneurysms and are helpful for definite surgical planning.

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Pathological Laughter as a Presenting Symptom of Trigeminal Neurinoma —Case Report—

Mohinish G. BHATJIWALE, Atul GOEL, Ketan DESAI

1996 Volume 36 Issue 9 Pages 644-646
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.644

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A 26-year-old male presented with a trigeminal neurinoma manifesting as pathological laughter. After resection of the large tumor, the symptom disappeared completely. Pathological laughter sometimes precedes other manifestations of tumors around the brainstem and may be a useful localizing sign.

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Bilateral Chronic Subdural Hematomas Associated with Intracranial Hypotension —Case Report—

Hiroshi NAKAJIMA, Tatsuo SAKAI, Nobuhiko AOKI, Kintomo TAKAKURA

1996 Volume 36 Issue 9 Pages 647-649
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.647

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A 56-year-old female presented with chronic subdural hematoma due to spontaneous (primary) intracranial hypotension (SIH). She was admitted in a deep coma. Computed tomography showed bilateral chronic subdural hematomas with tight basal cisterns. Percutaneous aspiration of the chronic subdural hematoma with the twist drill revealed negative pressure. The neurological symptoms rapidly improved postoperatively, but the chronic subdural hematoma recurred three times, requiring further aspiration procedures. Patients with SIH may develop subdural hematoma requiring surgical treatment.

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Cerebral Venous Sinus Thrombosis Associated with Systemic Multiple Hemangiomas Manifesting as Chronic Subdural Hematoma —Case Report—

Yukio TAKAMURA, Shigefumi MORIMOTO, Teiji UEDE, Toshiaki YAMAKI, Yoshi ...

1996 Volume 36 Issue 9 Pages 650-653
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.650

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A 35-year-old male was admitted with headache, nausea, and vomiting persisting for 2 days. Computed tomography (CT) revealed a left chronic subdural hematoma. Cerebral angiography demonstrated cerebral venous sinus thrombosis (CYST). He had presented with a subcutaneous mass involving the neck at age 2 years, which was shown to be a cavernous angioma, and thereafter shown signs of consumptive coagulopathy with systemic multiple hemangiomas. Burr hole aspiration of the hematoma was performed. Seventy-two hours later, he developed clouding of consciousness and right hemiparesis. CT revealed a fresh hematoma in the operated subdural cavity and hemorrhagic diathesis manifested. A frontotemporoparietal large craniotomy was performed to remove the hematoma. Extensive electrocauterization was required. He had a satisfactory postoperative course. Collateral venous pathways, resulting from the CYST due to systemic multiple hemangiomas, may have caused hemodynamic stress in the bridging veins which subsequently induced chronic subdural hematoma.

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Cerebral Cysticercosis Manifesting as Hydrocephalus —Case Report—

Yoshihisa OKA, Keiji FUKUI, Daisuke SHODA, Tomohiro ABE, Yoshiaki KUMO ...

1996 Volume 36 Issue 9 Pages 654-658
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.654

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A 70-year-old female presented with gait disturbance and dementia. Cerebrospinal fluid examination revealed mild aseptic meningitis. Magnetic resonance images showed multiple cystic lesions and mural nodules in some of the cysts in the cerebral parenchyma. Metrizamide computed tomography clearly demonstrated multiple intracisternal cysts. Some cysts were surgically excised and a ventriculoperitoneal shunt was implaced. Postoperatively, her gait disturbance and dementia disappeared. Histological examination revealed cysticercosis with viable larva. Ten months after the initial surgery, she presented with right hemiparesis due to enlargement of the remaining cysts in the left frontal lobe. These cysts were removed. Postoperative neurological examination showed slight right hemiparesis. We recommend ventriculoperitoneal shunting for hydrocephalus due to cisternal cysticercosis and praziquantel administration for parenchymal lesions.

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Thoracic Laminoplasty Using Spinous Processes —Technical Note—

Atul GOEL, Milind DEOGAONKAR

1996 Volume 36 Issue 9 Pages 659-661
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.659

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A simple method of thoracic laminoplasty using spinous processes is described. The procedure involves reshaping the spinous processes which have been removed during laminectomy and suturing these back into position to provide a cover for the dura. The procedure was carried out in five patients with good results. Laminoplasty using spinous processes appears to be a simple and safe alternative, using otherwise discarded tissue and requiring no sophisticated instrumentation, prosthetic material, or technically complex maneuvers.

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Cholesterol Granuloma of the Petrous Apex: Establishment of a Drainage Route into the Superior Tympanic Cavity —Technical Note—

Hiroyuki KAMIGUCHI, Takeshi KAWASE, Shigeo TOYA, Yasuhiro INOUE

1996 Volume 36 Issue 9 Pages 662-665
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.662

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A 40-year-old male presented with a cholesterol granuloma of the petrous apex manifesting as progressive hearing loss and tinnitus. The lesion was treated via an extradural middle cranial fossa approach employing a new procedure to establish a drainage pathway into the superior tympanic cavity which preserved his hearing. The pathway was formed by a groove 5 mm wide and deep in the anterolateral aspect of the petrous bone, crossing the major petrosal nerve and carotid artery, running around the cochlea, crossing the tensor tympanic muscle, and entering the superior tympanic cavity above the orifice of the eustachian tube. This procedure is easy to perform without special techniques.

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Hemifacial Dismasking Flap for Anterior Skull Base Tumor —Technical Note—

Shigeo KYUTOKU, Katsuhiro KAWAKAMI, Hiroyuki TSUJI, Yasuo HOSODA, Yuta ...

1996 Volume 36 Issue 9 Pages 666-670
Published: 1996
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.36.666

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A new approach to malignant tumor in the anterior skull base using a hemifacial dismasking flap is described. A bicoronal incision is extended unilaterally down to the neck, degloving the craniofacial tissue to widely expose the skeleton underneath, allowing easy resection of an extensive tumor without postoperative scarring of the face. This method has been used successfully on five patients.

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