Neurologia medico-chirurgica

Surgical Management of Craniopharyngiomas: A Review

Madjid SAMII, Marcos TATAGIBA

1997 Volume 37 Issue 2 Pages 141-149
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.141

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Craniopharyngiomas are uncommon benign intracranial tumors that still represent a task in management. Controversy exists concerning the treatment of choice for these tumors. Radical surgery, subtotal resection combined with radiotherapy, or primary irradiation are the frequent treatment modalities. Although an increasing number of reports have appeared stressing the role of primary radiation for these tumors, radical surgery still represents the treatment of choice in most cases, since craniopharyngioma is a benign tumor and many affected patients are at a young age. In this article the authors review different aspects of pathology, clinical presentation, radiology, and management of the craniopharyngiomas. Common surgical approaches are described and both preoperative and postoperative management are outlined.

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Infrequent Mutation of Waf1/p21 Gene, a CDK Inhibitor Gene, in Brain Tumors

Itaru TSUMANUMA, Ryuichi TANAKA, Satoshi ABE, Takashi KAWASAKI, Kazuo ...

1997 Volume 37 Issue 2 Pages 150-157
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.150

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Possible mutations of the Waf1/p21 gene, a cyclin-dependent kinase (CDK) inhibitor gene, were investigated in biopsy specimens of 28 brain tumors using polymerase chain reaction (PCR)-single strand conformation polymorphism and nucleotide sequence analysis. There were 15 astrocytic tumors, six medulloblastomas, five pineal parenchymal tumors, and two neuroblastomas. A mutation was detected in exon 2, which comprises 90% of the cording region including the CDK inhibitory domain, in only two samples. A missense mutation was detected at codon 33 in rare PCR clones from an astrocytic tumor and a silent mutation was detected at codon 35 in a medulloblastoma. Therefore, mutation of the Waf1/ p21 gene is infrequent in these brain tumors. Examination of deoxyribonucleic acid (DNA) from normal subjects and paired DNA of brain tumor patients observed a polymorphism at codon 31, which encodes either Ser (AGC) or Arg (AGA).

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Tumor Cell Counting Using an Image Analysis Program for MIB-1 Immunohistochemistry

Mitsunobu IDE, Minoru JIMBO, Masaaki YAMAMOTO, Osami KUBO

1997 Volume 37 Issue 2 Pages 158-162
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.158

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A cell counting method for MIB-1 immunohistochemistry, using an image analysis program, NIH Image, on a personal computer, has advantages over manual cell counting by microscopy. MIB-1 slides were photographed at a magnification of × 50 on 24 × 36 mm color films and the photographs were then enlarged to adequate size for observation. The MIB-1-positive cells, on the enlargements, were marked with a white pen, and negative cells with a black pen. Subsequently, the image of an enlargement was converted into data that can be processed by the program using a flatbed image scanner. Threshold levels were adjusted according to the respective white and black markings, and the program automatically counted the number of MIB-1-positive and negative tumor cells. Our method has the following significant advantages: Once cells had been marked and the image converted into the NIH Image data, the cell count process was completed within a few minutes; in contrast to manual microscopic cell counting, count overlapping or cells missed by the observer are eliminated; overlapping nuclei could be separated by the marking procedure; our method required no elaborate and costly image analysis system. The present method may be recommended to researchers undertaking cell kinetic studies utilizing immunohistochemical methods.

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Distribution of Intraarterially Administered Papaverine in Endovascular Treatment of Delayed Cerebral Vasospasm

Hajime TOUHO, Norihiko FURUOKA, Jun KARASAWA

1997 Volume 37 Issue 2 Pages 163-172
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.163

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The distribution of selectively administered papaverine was determined in nine patients with delayed cerebral vasospasm in the territories of the anterior (ACA) and/or middle cerebral arteries (MCA) secondary to aneurysmal subarachnoid hemorrhage by simultaneous infusion with technetium-99m-hexamethyl-propyleneamine oxime (^99mTc-HMPAO). Four of the nine patients had a ruptured anterior communicating artery aneurysm, four had an internal carotid artery aneurysm, and the remaining one had a MCA aneurysm. Trapping of anterior communicating artery was carried out in one case and clipping of aneurysms in other eight cases. Neurological deterioration with hemiparesis, paraparesis, and/or somnolence appeared between postsurgical Days 8 and 13 due to delayed cerebral vasospasm in all patients. Intraarterial infusion of 40 mg of papaverine containing 37 MBq of ^99mTc-HMPAO was performed from the C₁ segment in seven of the nine patients and from the C₄ segment in the other two patients. ^99mTc-HMPAO was distributed in the territories of the ACA and MCA in the two patients who were treated with intraarterial infusion of papaverine from the C₄ segment, but was distributed only to the territory of the ACA in four patients who were treated with intraarterial infusion of papaverine from the C₁ segment at 1 ml/min. In contrast, ^99mTc-HMPAO was distributed in the territories of the ACA and MCA in the three patients who were treated with papaverine from the C₁ segment at 2 ml/min, although most ^99mTc-HMPAO was distributed in the territory of the ACA. Vasospasm of the ACA can be treated by intraarterial infusion of papaverine from the C₁ segment at 1 ml/min when selective catheterization to the ACA is difficult to perform.

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Bone Window Computed Tomography for Detection of Dural Defect Associated with Cervical Ossified Posterior Longitudinal Ligament

Kazutoshi HIDA, Yoshinobu IWASAKI, Izumi KOYANAGI, Hiroshi ABE

1997 Volume 37 Issue 2 Pages 173-176
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.173

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Anterior decompression of a cervical ossified posterior longitudinal ligament (OPLL) which involves the dura mater occasionally results in a postoperative cerebrospinal fluid fistula. Bone window computed tomography (CT) was carried out to detect dural defects in 21 patients with cervical OPLL. Twelve of 21 patients had double-layer OPLL, and nine had single-layer OPLL. Dural defects were present in 10 of the 12 patients with double-layer OPLL compared with only one of the nine patients with single-layer OPLL. In addition, greater stenosis of the spinal canal by the OPLL was also associated with dural defect. Preoperative bone window CT can indicate likely locations of dural defect in patients with OPLL.

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Interhemispheric Chronic Subdural Hematoma —Case Report—

Manabu MINAMI, Junya HANAKITA, Hideyuki SUWA, Hiroshi SUZUI, Kohji FUJ ...

1997 Volume 37 Issue 2 Pages 177-180
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.177

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A 74-year-old male presented with right hemiparesis greater in the lower than the upper extremity. He had no apparent head trauma. He had been treated with anticoagulants for cerebral and myocardiac infarction. Computed tomography (CT) and magnetic resonance imaging demonstrated an unusual combination of subdural hematomas in the interhemispheric space on the left, and the left temporoparietal and right frontotemporooccipital regions. The left convexity hematoma was irrigated through a single burr hole. Postoperatively, the size of the left convexity hematoma was diminished and the left interhemispheric subdural hematoma disappeared. However, his consciousness deteriorated, and a second irrigation of the recurrent left convexity hematoma was performed 7 days after the first surgery. CT obtained 3 days after the second operation showed a right interhemispheric subdural hematoma, which diminished spontaneously. The convexity hematoma on the left reaccumulated, and was treated by shunting. His neurological status did not improve, and he died from myocardial infarction 39 days later. Irrigation of convexity hematoma may be effective to treat an associated ipsilateral interhemispheric subdural hematoma.

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Internal Carotid-Posterior Communicating Artery Aneurysm Manifesting as an Unusual Ocular Motor Paresis after Minor Head Trauma —Case Report—

Yong Choo PARK-MATSUMOTO, Toshiaki TAZAWA

1997 Volume 37 Issue 2 Pages 181-183
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.181

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A 75-year-old female fell down in the road and hit her head. Two days later her right eye abduction was slightly limited on right lateral gaze. Cerebral angiography revealed an ipsilateral internal carotidposterior communicating artery aneurysm. Craniotomy found the aneurysm had compressed the oculomotor nerve and was successfully clipped. The ocular motor paresis completely resolved after the operation. Therefore, the ocular motor paresis was possibly due to the aneurysmal compression to the oculomotor nerve. The oculomotor nerve stretched over the aneurysm was probably vulnerable to sudden mechanical stress, and aberrant innervation of the oculomotor nerve might be responsible for this unusual ocular motor paresis. Minor head trauma might precipitate ocular motor paresis in patients harboring an otherwise occult mass lesion at the skull base.

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Ventricular Hemorrhage at an Early Stage of Moyamoya Disease —Case Report—

Kensuke KAWAI, Koji NARITA, Hitoshi NAKAYAMA, Akira TAMURA

1997 Volume 37 Issue 2 Pages 184-187
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.184

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A 19-year-old male presented with intraventricular hemorrhage manifesting as sudden onset of headache. Angiography showed mild stenotic changes in the distal internal carotid artery and proximal anterior cerebral artery only on the right. The anterior choroidal artery and lenticulostriate arteries appeared dilated, and an aneurysm-like shadow was seen in the distal right anterior choroidal artery. He was discharged without treatment. Eighteen months later, he presented with a second intraventricular hemorrhage manifesting as sudden occipitalgia, vomiting, and nausea. He had hyperreflexia of the left extremities and paresthesia of the left upper extremity. Angiography showed marked progression of the vascular abnormalities bilaterally. Moyamoya vessels were also present. He received bilateral encephalo-duro-arterio-myo-synangiosis with good results. Moyamoya disease may cause hemorrhage even at an early stage.

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Rete Mirabile in Humans —Case Report—

Jun KARASAWA, Hajime TOUHO, Hideyuki OHNISHI, Masahiko KAWAGUCHI

1997 Volume 37 Issue 2 Pages 188-192
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.188

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Carotid rete mirabile is a physiological vascular network between the external carotid and internal carotid systems present in some vertebrate species, but rarely observed in humans. We describe a 17-year-old girl with rete mirabile who presented with subarachnoid hemorrhage. Angiography disclosed the bilateral internal carotid arteries (ICAs) ended at the cavernous portion, and abnormal arterial networks visualized via the ICAs and the external carotid arteries in the paracavernous region. The distal ICAs were visualized via the abnormal arterial networks. After 18 years of follow-up she is leading a normal life without neurological problems. Rete mirabile in humans may present with hemorrhage or ischemic symptoms, but the prognosis appears to be good.

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Vertebral Artery Dissection Not Detected by Initial Angiography —Case Report—

Yasushi KUROKAWA, Seisho ABIKO, Tomomi OKAMURA, Norio IKEDA, Kohsaku W ...

1997 Volume 37 Issue 2 Pages 193-196
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.193

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A 57-year-old male presented with subarachnoid hemorrhage caused by vertebral artery dissection. The first cerebral angiogram on the day of ictus found minimal caliber change with lower contrast density at the V₄ segment, but repeat angiography showed typical segmental narrowing of the artery on the 14th day. Repeat angiography with magnetic resonance imaging in the subacute stage would be useful to identify the cause of “angiogram-negative” subarachnoid hemorrhage.

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Abducens Nerve Neurinoma —Case Report—

Kazuyoshi ICHIMI, Jun YOSHIDA, Suguru INAO, Toshihiko WAKABAYASHI

1997 Volume 37 Issue 2 Pages 197-200
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.197

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A 61-year-old female presented with an abducens nerve neurinoma manifesting as diplopia and facial numbness. The tumor was totally removed, and the exact origin was confirmed intraoperatively. Neuroradiological imaging and clinical history are frequently insufficient to obtain an accurate preoperative diagnosis of intracranial neurinoma.

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Neurotoxicity Testing of a New Bioactive Bone Cement

Nozomu MURAI, Yoshifumi ODA, Izumi NAGATA, Jun A. TAKAHASHI, Masatsune ...

1997 Volume 37 Issue 2 Pages 201-204
Published: 1997
Released on J-STAGE: April 10, 2006

DOIhttps://doi.org/10.2176/nmc.37.201

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Bioactive bone cement (BABC) is a novel artificial bone cement. It has some noteworthy characteristics that are applicable to neurological surgery. The toxicity of BABC to the nervous system was tested by implanting BABC and polymethylmethacrylate (PMMA) cement as a control at the parietal and the suboccipital regions of the skull in beagles. The auditory brainstem response (ABR) was tested before and after implantation. Sections of the cerebral cortex and the acoustic nerve were examined at 3 and 6 months after implantation. No abnormal ABR was found in any animals. Histological examination of the cerebral cortex and acoustic nerve demonstrated slight gliosis in both the BABC and PMMA cement groups, but no other abnormalities.

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