Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 38, Issue 3
Displaying 1-8 of 8 articles from this issue
  • Kyoji SAKAI, Kazuko IWAHASHI, Kinya TERADA, Yuji GOHDA, Masaru SAKURAI ...
    1998 Volume 38 Issue 3 Pages 131-136
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    Acute ischemic stroke involving the entire vascular distribution of a carotid or middle cerebral artery can cause massive cerebral edema. This study evaluated external decompression for the treatment of massive stroke and analyzed possible prognostic factors. Twenty-four patients with acute massive cerebral infarction, which had progressed to tentorial herniation and impending death, underwent external decompression after medical therapy failed to achieve an effective response. The neurological outcome 2 months after surgery using the Glasgow Outcome Scale was severe disability in 14 patients, vegetative state in two, and death in eight. The overall mortality was 33%. Various characteristics (age, sex, etiology, side of hemispheric infarction, pupillary asymmetry, Japan Coma Scale, distribution of infarction, hemorrhagic infarction, midline shift, tentorial herniation) were evaluated to determine the factors associated with high mortality after surgical intervention. There was no statistically significant relationship between any variable and mortality. Mortality was especially high in the patients with preoperative consciousness level of 200, anterior, middle, and posterior cerebral artery territory infarction, and stage III of tentorial herniation. Postoperatively, all patients with severe disability returned to a clear level of consciousness. Six patients with dominant hemisphere stroke had some measure of communicative skills in spite of aphasia. External decompression is a life-saving treatment for patients with massive cerebral infarction and can provide a reasonable quality of life even for those with dominant hemisphere strokes. Decompressive surgery should be considered and performed as soon as possible if computed tomography demonstrates signs of descending tentorial herniation.
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  • Shingo KAWAMURA, Nobuyuki YASUI
    1998 Volume 38 Issue 3 Pages 137-142
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    The effects of dobutamine on the diameters of rat pial vessels were investigated in vivo using a closed cranial window technique. Dobutamine (10-7-10-3 M) was dissolved in artificial cerebrospinal fluid (CSF). Arterioles (17-78 μm in diameter) and venules (20-97 μm in diameter) were observed through the cranial window over the left parietal cortex. Superfusion of the brain surface with only artificial CSF had no effect on vessel diameter. Dobutamine, even at a high concentration of 10-4 M, did not induce significant diameter changes in the pial vessels, compared with control animals. The arterioles showed marked dilatation (+73%) during superfusion with 10-3 M dobutamine (p < 0.01 vs. control). The venules were also dilated (+12%), although the increased diameter was not statistically different from controls. Therefore, dobutamine did not induce a dose-dependent dilation. The results strongly suggest that dobutamine at clinical dosages does not have a direct vasomotor effect on brain microvessels.
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  • Ken UDA, Katsuya GOTO, Noboru OGATA, Naoto IZUMI, Shinji NAGATA, Haruo ...
    1998 Volume 38 Issue 3 Pages 143-154
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    This study investigated the problems in treating ruptured aneurysms using Guglielmi detachable coils (GDCs) in the acute stage and evaluated the long-term efficacy in a series of 25 patients with 29 aneurysms. Eight patients with ruptured aneurysm treated within 2 weeks of the onset of subarachnoid hemorrhage (SAH) suffered no mortality or morbidity related to the procedure. Five patients achieved good outcomes despite severe SAH and returned to their previous lives. Three patients had poor clinical outcomes, two related to vasospasm and one related to pulmonary complication. More than 9 months follow-up was completed in 14 patients with 16 aneurysms. All six small aneurysms with small necks were completely obliterated and no recanalization was seen, and two of the eight large or giant aneurysms were completely obliterated. Recanalization was seen in four large or giant aneurysms and one small aneurysm due to coil compaction within 13 months. One patient died of rupture of a large aneurysm 18 months after complete obliteration of the aneurysm. Embolization using GDCs in the acute stage after SAH can prevent rerupture of cerebral aneurysms. However, recanalization due to coil compaction was the major problem in the chronic stage. Intensive follow-up and additional embolization, if necessary, is important.
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  • junichi MIZUNO, Hiroshi NAKAGAWA
    1998 Volume 38 Issue 3 Pages 155-160
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    Fifteen patients with Meyerding I spondylolisthesis causing disabling lumbago underwent threaded fusion cage implantation at the unstable segments. Low back pain and intermittent claudication subsided in all patients postoperatively. The preoperative Japan Orthopaedic Association score was 11.5 on average, and improved to 23.5 after surgery. Five patients achieved significant resolution of preoperative symptoms, six improved reasonably, and four required less medication. There was no failure of fixation. No patient required supplemental fixation such as pedicle screws to achieve stable fusion. One patient had an inflammatory course but re-surgery was not necessary. The threaded fusion cage is an effective and promising device for the relief of low back pain when used to promote fusion of the lumbar spine in patients with low-grade spondylolisthesis.
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  • Masaki KOMIYAMA, Toshihiro YASUI, Toru IZUMI
    1998 Volume 38 Issue 3 Pages 161-164
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    Two patients presented with unusually dilated Virchow-Robin spaces appearing as cystic lesions of varying size with signal intensity identical to the cerebrospinal fluid on all magnetic resonance pulse sequences. However, fluid-attenuated inversion-recovery (FLAIR) images disclosed small, high intensity foci adjacent to these cystic lesions in one patient. These high intensity foci on FLAIR images may represent chronic ischemic change, which produces the gradual dilation of the Virchow-Robin spaces.
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  • Yasushi MIZUMAKI, Shunro ENDO, Kazumasa YAMATANI, Akira TAKAKU, Eiji T ...
    1998 Volume 38 Issue 3 Pages 165-167
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A 54-year-old male presented with pure left hypoglossal nerve paresis. Angiography and magnetic resonance (MR) imaging showed the characteristic findings of left internal carotid artery (ICA) dissection. He received aspirin and his symptoms gradually disappeared. Repeat angiography and MR imaging showed that the lesion had completely disappeared. This case supports the hypothesis that hypoglossal nerve paresis is due to nerve stretching and compression by intramural hematoma of the dissected ipsilateral ICA, and severe tortuosity of the ICA may be a related phenomenon.
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  • Eiichiro HONDA, Hironori FUJISAWA, Tunemaro KOYAMA, Yuki OSHIMA, Yasuo ...
    1998 Volume 38 Issue 3 Pages 168-172
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    A 49-year-old male presented with a symptomatic thoracic intradural arachnoid cyst triggered by seat belt trauma, which appeared within 3 weeks following a traffic accident. The initial symptom was a dull back pain induced immediately after the accident. Three and half months later, magnetic resonance (MR) imaging diagnosed the cystic nature of the lesion consistent with a low intensity on T1-weighted image which extended dorsally between the T-4 and T-6 levels. One month later, MR imaging showed that this cystic mass had enlarged in the anteroposterior direction associated with developing clinical symptoms. The final diagnosis of arachnoid cyst was made based on surgical findings and histological examinations. The spinal arachnoid cyst was probably a congenital arachnoid cyst or diverticula originating from the septum posticum which became enlarged due to sudden increase of intra-abdominal pressure caused by the fastened seat belt during the accident.
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  • Takashi TSUZUKI, Hiroyuki YANAI, Chikashige KUKITA, Hirotsugu SAMEJIMA ...
    1998 Volume 38 Issue 3 Pages 173-174
    Published: 1998
    Released on J-STAGE: March 30, 2006
    JOURNAL FREE ACCESS
    An irrigation system which can easily be applied to the conventional high-speed air drill was developed to allow simultaneous irrigation during micro-drilling. The irrigation system is constructed with a tube of 0.8 mm outer diameter and supporting rings. Irrigation is entirely coordinated with drilling by a single foot switch. The tube of the system ejects normal saline intermittently toward the cutter bar tip. Use of this system in skull base surgery showed that effective irrigation and a clean operative field was achieved even in a narrow space under the operating microscope, saline is ejected exactly on the point of drilling and over-heating does not occur so that heat-related damage to the local nerves and blood vessels is avoided. The system can easily be applied to any type of high-speed air drill by using supporting rings of the correct size. This irrigation system is particularly useful in microneurosurgery using the high-speed air drill.
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