Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 37, Issue 5
Displaying 1-10 of 10 articles from this issue
  • Mitsuru HONDA, Hideo TERAO
    1997 Volume 37 Issue 5 Pages 373-379
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A canine model of cerebral vasospasm using noncellular blood material (fibrin glue) was designed to investigate the effect of cerebrospinal fluid obstruction. The arachnoid membrane covering the cerebral arteries in the basal cistern was dissected and fibrin glue was applied to the adventitial surface of the arteries in three groups of animals. In Group 1, the arachnoid membrane was extensively dissected and fibrin glue was widely applied to the cerebral arteries. In Group 2, the dissection and coating was less extensive. Group 3 was a control group in which the arachnoid membrane was dissected but fibrin glue was not applied. Cerebral angiography 1 week later clearly demonstrated vasospasm in all six dogs in Group 1 and in four of six dogs in Group 2. Vasospasm did not occur in Group 3. The dogs were sacrificed and the arteries in the basal cistern were removed. Histological investigation showed typical findings of vasospasm and inertness of fibrin glue to the tissue. Cerebral vasospasm can be induced by a noncellular material from the blood densely applied to the arterial surface suggesting that obstruction of cerebrospinal fluid circulation around the artery may be important in the development of cerebral vasospasm.
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  • Hiroyasu YAMAKAWA, Noboru SAKAI, Katsunobu TAKENAKA, Shin-ichi YOSHIMU ...
    1997 Volume 37 Issue 5 Pages 380-386
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The clinical features of recurrent subarachnoid hemorrhage (SAH) after neck clipping surgery were investigated in a series of 1436 consecutive patients treated between 1980 and 1994, and seven patients treated prior to 1980. Recurrent SAH occurred within 1 month in seven patients and between 1.5 and 20 years in 20 patients (mean interval 9.2 years) from the first surgery. The patients were aged from 31 to 76 years (mean 49.8 years) at the first SAH. There were 19 females and eight males. Recurrent SAH occurred at the same site as the prior aneurysms in 12 cases, at an infundibular dilatation in three cases, de novo aneurysms in nine cases, untreated multiple aneurysms in two cases, and unknown in one case. The main causes for early recurrent SAH were incomplete clipping or untreated multiple aneurysms, whereas late recurrent SAH was due to de novo aneurysms, untreated multiple aneurysms, or regrowth aneurysm at the prior site. The outcomes of late recurrent SAH were good in eight cases, moderate disability in two, severe disability in three, and dead in seven, whereas most cases of early recurrent SAH resulted in poor outcome. Immediate postoperative angiography is desirable in cases with incomplete clipping, because early recurrent SAH resulted in poor outcomes. De novo or regrowth aneurysms caused late recurrent SAH, so follow-up angiography is strongly recommended for young patients, even if complete clipping was achieved.
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  • Kazuhiro SAKO, Hirofumi NAKAI, Akira HASHIZUME, Shizuka AIZAWA, Nozomi ...
    1997 Volume 37 Issue 5 Pages 387-391
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Aneurysms at the horizontal segment of the middle cerebral artery or anterior cerebral artery are relatively rare. The characteristics of 13 cases were analyzed retrospectively. Six of the 13 cases had multiple aneurysms, nine had aneurysmal rupture, and three of these nine were complicated by intracerebral hematoma. Neck clipping of the aneurysm was performed in 11 cases and four developed a new cerebral infarction in the territory of the perforating arteries. Overall mortality and morbidity was 15% and 38%, respectively. The outcome for patients with aneurysms at these sites was evidently poorer than for those with aneurysms at other sites.
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  • Toshihiko WAKABAYASHI, Jun YOSHIDA, Toru TAKAOKA, Takashi SADAMOTO, Ma ...
    1997 Volume 37 Issue 5 Pages 392-398
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Expression of tenascin, an extracellular matrix glycoprotein, was measured in glioma cell lines using a newly established enzyme immunoassay. Secreted tenascin was found at concentrations greater than 800 ng/ml in eight of 14 glioma, three small cell lung carcinoma, two melanoma, and one sarcoma cell lines. The remaining six glioma and other carcinoma cell lines, and cell lines originating from normal tissues demonstrated low levels or no secretion into the supernatant. The glioma cell line, U-251-MG nu/nu, which had almost 100% transplantability in nude mice, had the highest expression level of tenascin among the glioma cell lines examined. Even low secretor glioma cell lines released high concentrations of tenascin, detectable by assaying the NP-40 solubilized cell lysates. Flow cytometric analysis revealed that tenascin was located on both the cell surface and primarily in the cytoplasm of glioma cells. When the glioma cell lines were exposed to tumor necrosis factor-α (TNF-α), levels of secreted tenascin increased between 36% and 380%, whereas transforming growth factor-β induced only minimal changes. These results suggest that glioma cell lines may be classified according to the degree of tenascin secretion/expression: high secretor type, low secretor type, and non-expressing type. The increase in tenascin secretion by TNF-α suggests that the expression of tenascin in glioma growth and development may be mediated through a cytokine network.
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  • Tetsuyoshi HORIUCHI, Yuichiro TANAKA, Shigeaki KOBAYASHI, Takashi UNOK ...
    1997 Volume 37 Issue 5 Pages 399-402
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 75-year-old male with left abducens nerve paresis presented with an ectopic pituitary adenoma invading the posterior wall of the sphenoid sinus. The sphenoidal mass grew rapidly for 6 months with left ophthalmoplegia and was partially removed via the transsphenoidal approach. The histological examination showed a benign pituitary adenoma, but the MIB-1 proliferating cell index was 6.8%, reflecting the clinically malignant behavior. The symptom gradually improved without tumor regrowth over 1.5 years after conventional irradiation.
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  • Ken-ichi ISHIZAKI, Go DAITA, Yukichi YONEMASU, Masayuki KUNIMOTO, Naoy ...
    1997 Volume 37 Issue 5 Pages 403-406
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 61-year-old male presented with a hypervascular variant of dysplastic gangliocytoma (LhermitteDuclos disease) manifesting as gait disorder. Computed tomography and magnetic resonance imaging both showed enhancement of the tumor after injection of contrast medium. Angiography demonstrated a tumor stain. Histological examination showed a double-layered structure comprising an outer layer of myelinated axons and an inner layer of dysplastic granular cells, and numerous dilated thin-walled blood vessels. Partial resection of the tumor resulted in resolution of the neurological deficit.
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  • Yoshinori KUBOTA, Tatsuya UEDA, Yasuo KAGAWA, Noboru SAKAI, Akira HARA
    1997 Volume 37 Issue 5 Pages 407-410
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 63-year-old female presented with an unusual case of microcystic meningioma manifesting as a 4year history of unsteady gait, dysarthria, and hearing loss. Computed tomography disclosed a large hypodense mass in the right cerebellopontine angle, clivus, and middle fossa, with slight contrast enhancement. T1-weighted magnetic resonance images demonstrated the lesion as a hypointense mass, which was little enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Right carotid angiography revealed blood supply from the external carotid artery, but no tumor staining. The extracerebral tumor was subtotally removed. The histological diagnosis was microcystic meningioma. Light microscopy revealed abundant microcysts throughout the tumor tissue, and electron microscopy disclosed that the microcysts were mostly located in the extracellular spaces and only a few in the cytoplasm. Microcystic meningioma without enhancement is rare and should be differentiated from low-grade astrocytoma, epidermoid, or other non-enhanced tumor.
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  • Masaaki YAMAMOTO, Takeo FUKUSHIMA, Seisaburo SAKAMOTO, Hitoshi TSUGU, ...
    1997 Volume 37 Issue 5 Pages 411-415
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Three patients presented with cerebellar hemispheric astrocytic tumors which showed an exophytic growth pattern. The neuroimaging appearances of these cases mimicked a cerebellopontine angle tumor in two cases, and a posterior fossa extra-axial tumor in the other, which arose from the left cerebellar hemisphere with exophytic extension into the left crural and quadrigeminal cisterns and compressed the midbrain directly. All patients underwent surgical resection, and two patients also received adjuvant radiation therapy and chemotherapy. Intraoperative findings confirmed that the tumors had intramedullary origins from the cerebellar hemisphere, and extended exophytically into the subarachnoid space forming an extra-axial mass lesion. The histological diagnoses were mixed malignant oligo-astrocytoma (grade III), astrocytoma (grade II), and glioblastoma (grade IV). Cerebellar gliomas with exophytic growth to the cerebellopontine angle cistern should be considered in the differential diagnosis of cerebellopontine angle tumors.
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  • Takaaki BEPPU, Yuki YOSHIDA, Tsukasa WADA, Hiroshi ARAI, Michiyasu SUZ ...
    1997 Volume 37 Issue 5 Pages 416-421
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 66-year-old male presented with cerebellovestibular symptoms and hypesthesia of the V2 area of his face. Neuroimaging only detected a cerebellopontine angle (CPA) meningioma. The CPA meningioma was removed using the lateral suboccipital approach, which exposed small neurinomas arising from the trochlear and abducens nerves. Both neurinomas were removed intracapsularly. Postoperatively hypesthesia resolved, but other symptoms were unchanged. A karyotypic analysis of chromosome 22 and estrogen receptor analysis suggested absence of neurofibromatosis II, but the cause(s) of the genesis of multiple diverse tumors was not determined. This extremely rare combination of neurinomas and meningioma was probably incidental, as there are no reports of any case with a combination of the trochlear and the abducens nerve neurinomas, much less one accompanied by a meningioma.
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  • Toshiaki YAMAKI, Tadashi NONAKA, Kohsuke AKIYAMA, Sumiyoshi TANABE, Ka ...
    1997 Volume 37 Issue 5 Pages 422-425
    Published: 1997
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 68-year-old male presented with an anaplastic astrocytoma deep in the sensorimotor cortex manifesting as acute pure motor hemiparesis suggestive of a vascular mechanism rather than tumor mass effect. Perfusion-weighted magnetic resonance (MR) imaging showed a significant decrease of blood flow in the sensorimotor area, where fluid-attenuated inversion recovery imaging demonstrated a prominently edematous area. Angiography also suggested ischemia with poor visualization of the precentral and central arteries. Diffusion-weighted MR imaging failed to identify the edema as cytotoxic or vasogenic due to technical problems. Brain tumors may manifest through impairment of peritumoral blood supply, which can be clarified by recent MR methods.
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