Neurologia medico-chirurgica

Intra-arterial Papaverine Treatment for Cerebral Vasospasm: Our Experience and Review of the Literature

Yuji NUMAGUCHI, Gregg H. ZOARSKI

1998 Volume 38 Issue 4 Pages 189-195
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.189

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We described the techniques and efficacy of intra-arterial papaverine hydrochloride infusion (IA-PAP) for symptomatic vasospasm due to aneurysmal subarachnoid hemorrhage based on our experience and review of the literature. Angiographic improvement occurred almost always, but only 50% of patients who presented with acute symptoms showed remarkable clinical improvement after the first, second, or third IA-PAP. Recurrent vasospasm after IA-PAP frequently occurred and this seems to be an apparent source of controversy regarding its efficacy. Review of the literature indicates that IA-PAP may be most effective in combination with percutaneous transluminal angioplasty. Further controlled studies should be conducted regarding papaverine''s true efficacy including most effective papaverine concentration and rate of infusion, maximum total dose, site of infusion, timing of treatment, and selection of patients.

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Proliferative Potential and Apoptosis in Rat Glioma Cell Lines after Hyperthermia

Rong-Yao Liu, Kengo MATSUMOTO, Katsuzo KUNISHIO, Shinichiro MIZUMATSU, ...

1998 Volume 38 Issue 4 Pages 196-202
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.196

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The proliferative potential of cultured rat glioma cells (C6 and 9L) was evaluated after hyperthermia using immunohistochemical staining with bromodeoxyuridine (BrdU) and Ki-67 monoclonal antibodies. Apoptosis was assessed by in situ end-labeling of deoxyribonucleic acid breaks. Both BrdU and Ki-67 labeling indexes decreased with increasing hyperthermia time. The decrease of the Ki-67 labeling index was not as great as that of the BrdU labeling index. The number of apoptotic cells increased with time after hyperthermia. These results indicate that the antitumor effect of hyperthermia may reflect the induction of apoptosis in the cells within the cell cycle, and the resultant reduction of the proliferative potential of surviving cells, especially in the S phase.

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Combined Brachytherapy and External Beam Radiotherapy in Normal Monkey Brains —Experimental Radiation Necrosis Evaluated by Sequential Magnetic Resonance Imaging—

Eiji TADA, Kengo MATSUMOTO, Kimihisa KINOSHITA, Nobuo TAMESA, Yasuhiko ...

1998 Volume 38 Issue 4 Pages 203-212
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.203

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Radiation-induced brain damage was evaluated using sequential magnetic resonance (MR) imaging in monkeys more than 1 year after either brachytherapy or combined brachytherapy and external beam radiotherapy (EBRT). MR images were obtained 1 week, 1 month, 3 months, and subsequently every 3 months after brachytherapy, and the volume of the lesions was measured. In all four monkeys receiving only brachytherapy and three of the four animals receiving combined brachytherapy and EBRT, MR imaging revealed only transient extensive edema 1 week after treatment and ring enhancement, which was maximal 3 months after treatment, surrounding the implantation site. In one of the four animals undergoing combined brachytherapy and EBRT, MR images obtained 9 months after treatment showed an irregularly extending enhanced lesion with edema. MR images obtained 15 months after brachytherapy in this monkey showed the lesion extended into the contralateral hemisphere through the corpus callosum. Necropsy revealed severe radiation necrosis. This animal developed a very similar MR imaging presentation to that often encountered in human brains after combined brachytherapy and EBRT.

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Surgical Indications for and Limitations of Staged Transsphenoidal Surgery for Large Pituitary Tumors

Shigeru NISHIZAWA, Tetsuo YOKOYAMA, Seiji OHTA, Kenichi UEMURA

1998 Volume 38 Issue 4 Pages 213-220
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.213

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Surgical indications and limitations of transsphenoidal surgery and intentionally staged transsphenoidal surgery for large pituitary tumors were investigated by retrospective analysis of the surgical and neuroradiological findings of 22 patients with large tumor and suprasellar extension. Twelve patients underwent intentionally staged transsphenoidal surgery, and 10 underwent combined transsphenoidal and transcranial surgeries. Successful removal by intentionally staged surgery required descent of the suprasellar part following the first transsphenoidal surgery. Analysis showed that a smooth suprasellar extension and/or soft tumor are indications for intentionally staged transsphenoidal surgery even in patients with small sella. However, lobulated suprasellar extension, fibrous and firm tumor without descent, and small sella with normal pituitary gland located at the bottom of the sella are contraindications for staged transsphenoidal surgery. The first transsphenoidal surgery is always indicated to achieve histological confirmation and decompression of optic nerves. Transcranial surgery should be attempted instead of repeated transsphenoidal surgeries when the residual tumor does not descend following the first transsphenoidal surgery.

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Visual Recovery Following Immediate Decompression of Traumatic Retrobulbar Hemorrhage via Transcranial Approach —Case Report—

Kenichi AMAGASAKI, Reizo TSUJI, Yoshishige NAGASEKI

1998 Volume 38 Issue 4 Pages 221-224
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.221

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A 17-year-old boy presented with retrobulbar hemorrhage manifesting as right proptosis, periorbital swelling, and blindness after suffering a midfacial trauma. Immediate decompression by removal of the retrobulbar hemorrhage via the transcranial approach was performed. The proptosis was resolved and visual acuity and eye movement were restored. Retrobulbar hemorrhage is a serious injury which may lead to blindness. However, recovery from blindness can be achieved with adequate management including neurosurgical decompression in the early stage.

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Cerebellar Hemorrhage Associated with Moyamoya Disease —Case Report—

Hiroshi ISE, Hitoshi TOKUNAGA, Masamichi AIZAWA, Hiroaki SAWAURA

1998 Volume 38 Issue 4 Pages 225-228
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.225

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A 60-year-old female was admitted with complaints of severe headache, nausea, and vomiting. Computed tomography demonstrated a right cerebellar hematoma, which was surgically removed. Bilateral carotid angiography showed occlusions of the anterior and middle cerebral arteries, and abnormal vascular networks. Vertebral angiography showed a well-developed posterior pericallosal artery. Left encephalo-duro-arterio-synangiosis was performed. No cerebral vascular incident has been observed for 32 months.

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Intraosseous Meningioma with a Dural Defect —Case Report—

Hiroshi KUDO, Sakan MAEDA, Takeshi TAKAMOTO, Norihiko TAMAKI

1998 Volume 38 Issue 4 Pages 229-231
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.229

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A 56-year-old female presented with a rare intraosseous meningioma associated with an unusual dural defect caused by invasion of the tumor. The underlying dura mater is normal or thickened in most cases of intraosseous meningiomas. Most intraosseous meningiomas are benign histologically, but they should be extirpated before invasion into the subdural space occurs.

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Primary Malignant Lymphoma of the Brain in Childhood —Case Report—

Yutaka KAI, Jun-ichi KURATSU, Yukitaka USHIO

1998 Volume 38 Issue 4 Pages 232-237
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.232

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A 5-year-old boy presented with a 1-year history of frontal headache and nausea. Neurological examination showed left abducens nerve palsy, left facial nerve palsy, Bruns'' nystagmus, and wide-based gait. Neuroimaging demonstrated a lesion with moderate linear enhancement in the left cerebellar hemisphere. He underwent stereotactic needle biopsy. The histological diagnosis was well-differentiated small lymphocytic type of malignant lymphoma. Following the biopsy, the patient underwent radiotherapy (whole brain 30 Gy, local 20 Gy). He has been in good condition for more than 5 years. The long-term survival is attributable to the absence of aggressiveness and the good response to radiation of this subtype of malignant lymphoma.

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Intracranial Pressure Monitoring Using a Newly Developed Transducer-tipped Ventricular Drainage Catheter —Technical Note—

Keiichiro KASAI, Hirotsugu SAMEJIMA, Morikazu UEDA, Yukio USHIKUBO, Hi ...

1998 Volume 38 Issue 4 Pages 238-240
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.238

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A transducer-tipped ventricular drainage catheter (TVDC) was developed to allow continuous measurement of intracranial pressure (ICP) without interrupting cerebrospinal fluid (CSF) drainage. The 8.5 Fr catheter with a double lumen has 16 side holes for CSF drainage and a small silicone strain-gauge transeducer on the side of the catheter tip to measure the ICP directly. The transducer is composed of a 2 × 1 mm² silicone plate. Calibration must be performed before insertion. The calibrated catheter is inserted into the ventricles, usually via the anterior horn of the lateral ventricles to the foramen of Monro. Recalibration is not necessary even if the patient''s head is tilted. The TVDC was applied to patients in whom ICP was suspected to be high and in whom the ventricles were large enough for tapping. The ICP wave form and values measured by the TVDC and the manometer method were equivalent. The drift phenomenon did not occur throughout the entire measurement period. The TVDC is very useful for both controlling and monitoring ICP.

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