Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 38, Issue 11
Displaying 1-17 of 17 articles from this issue
  • Kentaro MORI, Keiji ADACHI, Kajin CHO, Sumio ISHIMARU, Minoru MAEDA
    1998 Volume 38 Issue 11 Pages 697-703
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Dynamic biologic modeling was used to calculate the transfer rate constant for gadoliniumdiethylenetriaminepenta-acetic acid (Gd-DTPA) and capillary permeability in the outer membrane of chronic subdural hematomas and effusions. Following intravenous Gd-DTPA injection, Gd concentrations in the subdural fluid and in timed arterial blood samples were measured by ion-coupled plasma emission spectrometry in 53 chronic subdural hematomas and 18 chronic subdural effusions. The capillary surface area in outer membrane was assessed morphometrically. Transfer rate constants for subdural hematomas and subdural effusions were 12.4 ± 1.0 and 20.6 ± 1.7 (× 10-4)min-1, respectively. Capillary permeabilities for subdural hematomas and subdural effusions were 16 ± 1.2 and 19 ± 3.7 ml⋅min-1(mm2/mm3)-1, respectively. The capillary surface areas for subdural hematomas and subdural effusions were 48 ± 3 and 77 ± 10 mm2/mm3, respectively. The high degree of infiltration of Gd into subdural effusions reflects the high capillary surface area in the outer membrane rather than greater permeability of individual capillaries. The value of transfer rate constant was correlated inversely with the duration of the chronic subdural fluid collection. Immature outer membrane has a high transfer rate constant which allows extravasation of plasma components into the subdural space, resulting in increasing volume of the subdural effusion. Delayed magnetic resonance imaging following Gd administration may be clinically useful for estimating the age of chronic subdural fluid accumulations.
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  • Makio KAMINOGO, Masahiro YONEKURA, Masanari ONIZUKA, Akio YASUNAGA, Sh ...
    1998 Volume 38 Issue 11 Pages 704-709
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The preventive effect of the serine protease inhibitor FUT-175 (nafamostat mesilate), a potent inhibitor of the complement system, against vasospasm was evaluated in 34 high risk patients with thick and diffuse subarachnoid hemorrhage (SAH) demonstrated by computed tomography corresponding to Fisher group 3. All patients underwent surgery within 96 hours following SAH and received the thromboxane A2 synthetase inhibitor, OKY-046, as part of standard care. FUT-175 (40-160 mg/day) was administered during the initial 4 days following surgery. 455 patients treated without FUT-175 in the Nagasaki SAH Data Bank (non-FUT group) formed the control group. FUT-175 significantly decreased the incidence of symptomatic vasospasm in patients with severe neurological grade (Hunt and Hess grade 3, p < 0.02; Hunt and Hess grade 4, p < 0.02). The incidence of favorable outcome was 76.5% in the FUT group and 60.4% in the non-FUT group, but not statistically different. However, when patients of Hunt and Hess grade 5 were excluded, the FUT group had a significantly improved outcome (p < 0.05). This study suggests that FUT-175 has an additive effect to OKY-046 in preventing vasospasm in high risk patients with severe SAH.
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  • Toru FUKUHARA, Colleen M. DOUVILLE, J. Paul ELIOTT, David W. NEWELL, H ...
    1998 Volume 38 Issue 11 Pages 710-717
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The relationship between intracranial pressure (ICP) and the development of vasospasm after subarachnoid hemorrhage caused by the rupture of an intracranial aneurysm was investigated. Eleven patients were divided into high (6 cases) and low (5 cases) ICP groups based on ICP data obtained during the perioperative period by continuous ICP monitoring. Transcranial Doppler ultrasonography was performed every 24 hours for 7 days and the severity, distribution, and duration of vasospasm were assessed. The high ICP group tended to have severe, prolonged, and diffuse vasospasm compared with the low ICP group. However, only duration of vasospasm was statistically different. The relationship between cerebral perfusion pressure (CPP) and the development of vasospasm was also examined. CPP had a less significant effect than ICP although similar tendencies for high ICP and low CPP were observed. High ICP worsens vasospasm and treatment for decreasing ICP with perioperative ICP monitoring has potential for avoiding the development of vasospasm.
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  • Nedal HEJAZI, Paul-Yash THAPER, Werner HASSLER
    1998 Volume 38 Issue 11 Pages 718-724
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Nontraumatic spinal epidural hematoma (NSEH) is a rare but potentially serious spinal disease, which progresses inexorably to a catastrophic neurological situation if left untreated. Nine patients (5 males and 4 females, mean age 59.8 years) with NSEH were admitted to our hospital between 1987 and 1997. Clinical data, imaging, and operative results of these patients were analyzed retrospectively. Multilaminectomy was performed to decompress the affected levels. Postoperative neurological evaluation revealed functional improvement in five patients and no significant change in four patients. The most important factors influencing postoperative recovery were the preoperative neurological condition of the patient and the interval from onset of deficit until the operation. Magnetic resonance imaging allows non-invasive and specific diagnosis of NSEH, except in the first 24 hours. Computed tomography myelography with sagittal reconstructions provides specific diagnosis in this period. Combination of these diagnostic imaging modalities allows early diagnosis. Surgical decompression within 24 hours of complete sensorimotor deficit or within 48 hours of incomplete sensorimotor deficit will achieve the optimum outcome.
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  • Waro TAKI, Nobuyuki SAKAI, Ichiro NAKAHARA, Naohiro OSAKA, Takaaki KOS ...
    1998 Volume 38 Issue 11 Pages 725-729
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 43-year-old male presented with a cerebral aneurysm manifesting as right facial paresthesia, without neurological deficit. Angiography revealed a large aneurysm (22 mm) of the left internal carotid artery. Intravascular treatment using placement of a detachable coil was attempted, but the coil did not stay in the aneurysmal cavity and the procedure was abandoned. The patient did not tolerate the transient balloon occlusion test of the left internal carotid artery. Therefore, the aneurysm was clipped through an open craniotomy with profound hypothermia (20°C) with cardiac arrrest (24 minutes). The aneurysmal dome was collapsed, allowing easy dissection of the posterior communicating artery. The closed chest method was used during the extracorporeal cardiopulmonary bypass. Postoperative angiography revealed complete neck clipping with preservation of carotid blood flow. The patient recovered well and resumed his employment. Circulatory arrest with hypothermia provides several benefits for the surgical treatment of large and giant aneurysms.
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  • Hisato IKEDA, Hitoshi IZUMIYAMA, Nobuo HIROTA, Takumi ABE, Kiyoshi MAT ...
    1998 Volume 38 Issue 11 Pages 730-732
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 49-year-old female presented with a case of de novo aneurysm which was documented angiographically 10 years after the initial aneurysm rupture. The de novo aneurysm arose as a blister-like aneurysm from a previously normal location 7 years after the first ictus. The de novo aneurysm progressed to a saccular aneurysm and ruptured after another 3 years. We recommend late angiography in high-risk patients to prevent repeat ictus.
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  • Yuichi HIROSE, Masachika SAGOH, Takuro HAYASHI, Hideki MURAKAMI
    1998 Volume 38 Issue 11 Pages 733-737
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 64-year-old female presented with hemangiopericytoma arising from a dural fascia graft placed after a previous operation for the total removal of a benign meningioma. The patient also had multiple pulmonary metastases identified as hemangiopericytoma. The tumor resected at the first operation was benign based on all grading systems for meningiomas. We considered that the tumor was a kind of scar tumor. The hemangiopericytoma probably developed from a scar tumor at the graft. We emphasize the importance of long-term follow-up for patients who have undergone surgery for benign tumors.
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  • Hideki KANAI, Kazuo YAMADA
    1998 Volume 38 Issue 11 Pages 738-742
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 73-year-old male was admitted with right-sided motor weakness and presented with a rare association of incidental venous malformation in the right frontal lobe and a glioblastoma in the left frontal lobe. Computed tomography and magnetic resonance imaging failed to demonstrate typical appearance of venous malformation and showed atypical findings surrounding the suspected vascular lesion. Angiography was needed to obtain the diagnosis of venous malformation. The patient underwent subtotal resection of the glioblastoma and received radiation therapy. The venous malformation was followed up conservatively because it was asymptomatic. Correct diagnosis of coexisting venous malformation is important for the treatment of an associated brain tumor, especially when both lesions are closely located.
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  • Shunsuke KAWAMOTO, Kazuya NAGATA, Yubuhito MOCHIZUKI, Takayuki HARA, T ...
    1998 Volume 38 Issue 11 Pages 743-745
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    A 63-year-old male with a preexisting chronic subdural hematoma presented with progressive confusion and left hemiparesis as well as high fever. Subdural empyema was strongly suspected. At surgery, the empyema was encapsulated by definite inner and outer membranes. Cultures isolated from the subdural fluid and from an abscess of his left thigh yielded methicillin-resistant Staphylococcus aureus. A pulsed-field gel electrophoresis showed these two strains were genetically identical. Hematogenous infection of a preexisting subdural hematoma is an extremely rare cause of subdural empyema.
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  • Masamitsu ABE, Kazuo TABUCHI, Masaaki GOTO, Akira UCHINO
    1998 Volume 38 Issue 11 Pages 746-751
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Plastic skull models of seven individual patients were fabricated by stereolithography from threedimensional data based on computed tomography bone images. Skull models were utilized for neurosurgical planning and simulation in the seven patients with cranial base lesions that were difficult to remove. Surgical approaches and areas of craniotomy were evaluated using the fabricated skull models. In preoperative simulations, hand-made models of the tumors, major vessels and nerves were placed in the skull models. Step-by-step simulation of surgical procedures was performed using actual surgical tools. The advantages of using skull models to plan and simulate cranial base surgery include a better understanding of anatomic relationships, preoperative evaluation of the proposed procedure, increased understanding by the patient and family, and improved educational experiences for residents and other medical staff. The disadvantages of using skull models include the time and cost of making the models. The skull models provide a more realistic tool that is easier to handle than computer-graphic images. Surgical simulation using models facilitates difficult cranial base surgery and may help reduce surgical complications.
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  • Kazuo HASHI
    1998 Volume 38 Issue 11 Pages 755
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
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  • —A New Therapeutic Modality for the 21st Century—
    Toru ITAKURA, Ekini NAKAI, Naoyuki NAKAO, Kunio NAKAI
    1998 Volume 38 Issue 11 Pages 756-762
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
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  • Toshihiko WAKABAYASHI, Masaaki MIZUNO, Jun YOSHIDA
    1998 Volume 38 Issue 11 Pages 763-771
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Recently, remarkable advances have been achieved in molecular and genetic researches of different kinds of general diseases, as well as in basic and clinical studies using gene therapy for central nervous system diseases. For brain tumors, clinical trials have been already started in more than 10 clinical protocols and more than 100 patients with malignant brain tumors. Nevertheless, there are still major issues that remain to be resolved for achieving better clinical results, such as delivery system of genetic material, regulatory methods of the intracellular expression of the transgene, antitumor efficacy, and tumor selectivity. In this paper, molecular genetic studies and the current state of gene therapy for neurological diseases, especially brain tumors, are described, and the future direction of this fascinating approach is discussed.
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  • Yoshito IKADA
    1998 Volume 38 Issue 11 Pages 772-779
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    Biomedical engineering is increasingly becoming very important also in neurosurgery. This article describes some examples of neurosurgical applications of biomaterials which play a central role in biomedical engineering. Since a large number of biomaterials are currently used in neurosurgery, only the biomaterials that have been developed in our laboratories in collaboration with neurosurgeons are briefly presented here.
    The biomaterials developed include devices used for interventional neurosurgery and bioabsorbable scaffolds for regeneration of dura mater and skull bone. We developed an immediately electrically detachable coil using a poly(vinyl alcohol) junction between the coil and the delivery wire. This is the first detachable coil developed in Japan and is currently under clinical trial. In addition to the coil used for interventional neurosurgery, the development of an embolic liquid is presented. As an alternative to allografts such as Lyodura, we developed a dural substitute from synthetic bioabsorbable polymers which are completely free from potential risk of latent virus infection. Finally, our experience in tissue engineering for skull bone regeneration using growth factors coupled with polymeric carriers is presented to demonstrate the promise of tissue engineering in the future.
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  • Steven D. CHANG, Martin MURPHY, Paul GEIS, David P. MARTIN, Steven L. ...
    1998 Volume 38 Issue 11 Pages 780-783
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    The Cyberknife is an image-guided “frameless” dedicated radiosurgical device. This instrument has several distinct advantages over frame-based systems, including improved patient comfort, increased treatment degrees of freedom, and the potential to target extracranial lesions. Clinical results thus far with respect to the treatment of malignant intracranial tumors has been promising. Additionally, the Cyberknife will likely revolutionize the application of radiosurgery to extracranial sites. A description of the components, treatment planning, and clinical results of the Cyberknife will be reviewed.
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  • Yasunobu HANDA, Ryo YAGI, Nozomu HOSHIMIYA
    1998 Volume 38 Issue 11 Pages 784-788
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
    This paper describes restoration of motor function in patients with paralyzed extremities due to upper motor neuron disorders by functional electrical stimulation (FES). Percutaneously indwelling intramuscular electrodes were implanted into the muscles of the paralyzed upper and lower extremities to be controlled by FES. Stimulation patterns for extremity FES were created from electromyography (EMG) during motion in healthy subjects. By using a percutaneous FES system, all of the joint movement in the extremities could be controlled as long as severe lower motor neuron damage did not exist. In the paralyzed upper extremity, motor function of not only the hand but also the wrist, elbow, and shoulder could be restored with well-coordinated manner by EMG-based stimulation data and utilized for vocational tasks in the hemiplegic and quadriplegic patients. Continuous bias stimulation to the paralyzed muscle in combination with volitional contraction of its antagonistic muscles provided the patient with more volitional and natural control of the upper extremity. Restoration of locomotive movement in the paraplegics at around T-8 level was also achieved by FES under the usage of a walker.
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  • Jun YOSHIDA
    1998 Volume 38 Issue 11 Pages 789
    Published: 1998
    Released on J-STAGE: April 10, 2006
    JOURNAL FREE ACCESS
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