Neurologia medico-chirurgica

Change in Ca²⁺ Sensitivity of Cerebrovascular Smooth Muscle in Experimental Chronic Cerebral Vasospasm

Yuichi TANAKA, Toshio MASUZAWA, Mitsuru SAITO, Takeshi YAMADA, Kiyoshi ...

1998 Volume 38 Issue 8 Pages 459-463
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.459

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The mechanism of chronic cerebral vasospasm was investigated by examining the relation between cytosolic Ca²⁺ level ([Ca²⁺]_i) and muscle contraction in vascular smooth muscle after experimental vasospasm produced by the two-hemorrhage method in the canine basilar artery. [Ca²⁺]_i and tension were recorded simultaneously with a fluorimeter using the arterial strips with a Ca²⁺ indicator, fura-2. High K⁺ concentration (72.4 mM) and U-46619 (thromboxane A₂ analogue, 10^-8 M) were used as stimulants. The increase in contractile tension per [Ca²⁺]_i, per unit cross-sectional area was calculated, and compared for the vasospasm and the control groups. The increase in [Ca²⁺]_i in the vasospasm group was smaller than that in the control group, so the increase in tension per [Ca²⁺]_i per unit sectional area was larger in the vasospasm group. This value was much larger for the contraction induced by U-46619 than that induced by high K⁺ concentration in both groups. These results suggest that there is an increase in the basal Ca²⁺ sensitivity of the contractile elements in vasospastic vessels. In addition, the U46619-induced increase in Ca²⁺ sensitivity seemed to be augmented in the vasospasm group.

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Cerebral Revascularization Using Muscle Free Flap for Ischemic Cerebrovascular Disease in Adult Patients

Nobutaka YOSHIOKA, Shinsuke TOMINAGA

1998 Volume 38 Issue 8 Pages 464-468
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.464

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The efficacy of encephalo-myo-synangiosis (EMS) using muscle free flap was evaluated for the treatment of ischemic cerebrovascular disease in adult patients. Three patients with adult moyamoya disease and three patients with atherosclerotic ischemic cerebrovascular disease were treated. EMS used four latissimus dorsi muscles and two serratus anterior muscles. Postoperative selective angiography showed collateral circulation from the transferred muscle to the brain in four of the six patients. The other two patients showed patent nutrient artery of the transferred muscle flap. Cerebral blood flow study disclosed postoperative improvement of perfusion reserve capacity in all sides. One patient suffered a perioperative stroke by hemoconcentration due to poor control of diabetes mellitus. The mean follow-up period was 23 months. EMS using muscle free flap is a possible procedure in selected patients with impaired cerebral perfusion reserve capacity due to multiple stenosis or occlusion of cerebral arteries including moyamoya disease or who require cerebral blood flow augmentation in the anterior and/or posterior cerebral artery territories due to internal carotid artery occlusion.

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Growth Inhibition of Experimental Glioma by Human Interferon-β Superinduced by Cationic Liposomes Entrapping Polyinosilic:Polycytidilic Acid

Narcisa BUCUR, Masaaki MIZUNO, Toshihiko WAKABAYASHI, Jun YOSHIDA

1998 Volume 38 Issue 8 Pages 469-474
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.469

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Intracellular production of human interferon-β (HuIFN-β) was enhanced in three glioma cell lines (U251-MG, U251-SP, and U251-NN) using modified superinduction with cationic liposomes containing polyinosilic:polycytidilic acid (polyI:polyC), initially given with cycloheximide, to decrease the toxicity due to polyI:polyC. Modified superinduction had a significantly (p < 0.02-0.0001) greater inhibitory effect on all three glioma cell lines, and less toxicity than superinduction. A pilot trial in experimental gliomas implanted into nude mice was also performed. Superinduction including intratumoral injection of cationic liposomes containing polyI:polyC resulted in growth inhibition of U251-NN tumors and eradication of U251-SP tumors. Weight gain in mice was not inhibited by modified superinduction. Cationic liposomes decreased drug toxicity, and may help to target tumor cells in the modified superinduction of endogenous HuIFN-β production.

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Speech Arrest Caused by Meningioma —Two Case Reports—

Akihiko SHIINO, Masayuki MATSUDA, Jyoji HANDA

1998 Volume 38 Issue 8 Pages 475-477
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.475

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Parasagittal or falx meningioma occasionally causes paroxysmal speech disturbance. A 22-year-old and a 46-year-old female harboring meningiomas suffered recurrent episodes of supplementary motor seizures. Magnetic resonance imaging showed the meningioma compressing the left supplementary motor area. Seizures did not recur after total removal of the tumors.

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Multiple Dural Arteriovenous Fistulas

Satoshi USHIKOSHI, Yoichi KIKUCHI, Kiyohiro HOUKIN, Hisatoshi SAITO, H ...

1998 Volume 38 Issue 8 Pages 478-484
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.478

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Four patients with multiple intracranial dural arteriovenous fistulas (DAVFs) at separate sites were treated by endovascular techniques (transarterial and/or transvenous embolization), surgery (excision or isolation), radiotherapy, or combinations, according to the pathophysiological condition. All lesions in two patients were obliterated completely without neurological deficit. There were residual fistulas after the treatment in two patients, but these were low-grade lesions without retrograde cortical venous drainage, and marked clinical improvement was obtained. Planning of treatment strategies for multiple DAVFs requires careful analysis of the venous drainage from the affected sinuses and cerebral hemodynamics.

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Anterior Communicating Artery Aneurysm Associated with Tuberculum Sellae Meningioma —Case Report—

Vinko V. DOLENC, Rado PREGELJ, Samo SLOKAN, Miha SKRBEC

1998 Volume 38 Issue 8 Pages 485-488
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.485

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A 50-year-old male presented with a very unusual case of a calcified anterior communicating artery (AComA) aneurysm associated with a tuberculum sellae meningioma. Until 10 years previously, the patient had been a professional soccer player for 15 years. He noticed a slight decrease in visual acuity in the right eye 7 years before. The patient was in the care of an oculist throughout this period. Two months before admission, a significant and rapid decrease of vision in the right eye occurred. Computed tomography and magnetic resonance imaging showed a round-shaped, partially calcified tumorous lesion. Four-vessel angiography revealed a large AComA aneurysm. During surgery, a tuberculum sellae meningioma was found in combination with an AComA aneurysm with a completely calcified wall. The meningioma was resected totally. The AComA aneurysm with a calcified wall could not be clipped or resected and was left alone. His visual deficit improved postoperatively.

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Intramedullary Hemangioblastoma of the Medulla Oblongata —Two Case Reports and Review of the Literature—

Takeo FUKUSHIMA, Seisaburo SAKAMOTO, Mitsutoshi IWAASA, Shuji HAYASHI, ...

1998 Volume 38 Issue 8 Pages 489-498
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.489

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We determined the treatment modality of hemangioblastoma of the brain stem on the bases of our two cases and 31 cases searching from the literature since 1960 which were treated surgically. Hemangioblastomas of the brain stem were categorized according to one of three locations: hemangioblastoma of the fourth ventricle attached to the floor of the ventricle (Type A), hemangioblastoma of the fourth ventricle partially embedded in the floor of the ventricle (Type E), and intramedullary hemangioblastoma of the medulla oblongata (Type I); and were evaluated their clinical features including the operative mortality and morbidity of each location. In our two cases of Type I hemangioblastoma, Case 1, removed partically, died due to sleep apnea and Case 2 lead to normal school life after hemangioblastomas were removed radically. In our review of the 33 surgically-treated cases, radical excision was carried out in 29 cases (87.9%). The mortality was 24.2% overall; that of Type A was 25%, Type E was 28.6%, and Type I was 14.3%. In terms of postoperative mortality, the location of the hemangioblastoma was irrelevant and radical excision was much better than partial removal. Hemangioblastomas of the brain stem could be removed radically by meticulous dissection of the tumor on distinct cleavage, even in cases of intramedullary location. Microsurgical dissection of medullary hemangioblastomas with low morbidity is feasible and prudent postoperative care is mandatory to reduce the operative mortality and morbidity.

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Giant Pyocele in the Anterior Intracranial Fossa —Case Report—

Toshiyuki NAKAYAMA, Kentaro MORI, Minoru MAEDA

1998 Volume 38 Issue 8 Pages 499-502
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.499

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A 43-year-old male presented with headache localized in the right forehead. Computed tomography and magnetic resonance imaging demonstrated a cystic mass in the frontal sinus, with a huge extension into the anterior cranial fossa. The mass was removed by transcranial surgery. The cyst contained pus. Histological examination of the cyst wall revealed mucocele (pyocele). Pyocele with huge intracranial extension is rare and requires combined neurosurgery and otolaryngology for optimum treatment.

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Two-staged Resection of a Left Frontal Astrocytoma Involving the Operculum and Insula Using Intraoperative Neurophysiological Monitoring —Case Report—

Toshihiro KUMABE, Nobukazu NAKASATO, Kyoko SUZUKI, Kiyotaka SATO, Yuki ...

1998 Volume 38 Issue 8 Pages 503-507
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.503

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A 29-year-old right-handed male with a 12-year education presented with a 2-month history of generalized epileptic activity. Neuroradiological imaging demonstrated a large lesion in the left frontal lobe involving the insulooperculum and in the temporal tip. Neurological and neuropsychological examination revealed no abnormality. Two-staged total resection of a left frontal large astrocytoma involving the insulooperculum was achieved, with preservation of the speech and motor functions. The prefrontal area was resected en bloc under general anesthesia. To avoid vascular damage including the lenticulostriate arteries, the sylvian and the interhemispheric fissures were thoroughly opened. The tumor was apparently located in the anatomical Broca''s area. Eighteen days later, the residual tumor was totally resected with no language deficit after identifying the motor-speech cortex, which was displaced from the usual location, by direct cortical stimulation under local anesthesia. The medially extended insular tumor was then resected stepwise with frequent neurological monitoring with the patient awake. Surgery for intraaxial insuloopercular lesions in the dominant hemisphere carries a high risk of speech and motor deficit. This staged operation enables maximum tumor resection of dominant-side large frontal gliomas involving the insuloopercular region, with preservation of both motor and speech functions.

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Primitive Neuroectodermal Tumor in the Spinal Epidural Space —Case Report—

Takuya AKAI, Hideaki IIZUKA, Satoru KADOYA, Takayuki NOJIMA, Miyuki KO ...

1998 Volume 38 Issue 8 Pages 508-511
Published: 1998
Released on J-STAGE: March 30, 2006

DOIhttps://doi.org/10.2176/nmc.38.508

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A 4-year-old boy presented with a rare case of an epidural tumor causing compression of the thoracic spinal cord manifesting as rapid worsening of gait disturbance. The tumor was grossly totally resected, and radiotherapy and chemotherapy were subsequently administered. The histological diagnosis was primitive neuroectodermal tumor. He has been free of recurrence for more than 6 years. Early tumor resection followed by chemotherapy and irradiation is recommended for patients with primitive neuroectodermal tumor and unstable symptoms.

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