Neurologia medico-chirurgica

Treatment of Intradural Paraclinoidal Aneurysms

Nobuhiko MIYAZAWA, Hideaki NUKUI, Shigeru MITSUKA, Tsutomu HOSAKA, Tos ...

1999 Volume 39 Issue 11 Pages 727-734
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.727

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Intradural paraclinoidal aneurysm still presents conceptual confusion and technical surgical problems. The clinical features of 68 consecutive patients with paraclinoidal aneurysms were analyzed. The pterional approach was used in all patients. Subarachnoid hemorrhage (SAH) occurred in 37 patients from the paraclinoidal aneurysm and in 10 patients from another associated aneurysm. Thirty-four of the 37 ruptured paraclinoidal aneurysms were clipped, two blister-like aneurysms required trapping, and one blister-like aneurysm was coated. Thirteen of the 31 unruptured paraclinoidal aneurysms, consisting of 10 with ruptured associated aneurysm, four symptomatic, and 17 incidental, were clipped and 18 were coated. Favorable outcomes were obtained in 38 of 47 patients with SAH and 17 of 21 patients without SAH. Nine unfavorable outcomes in SAH patients were caused by primary brain damage (5), vasospasm (2), cerebral infarction after trapping (1), and pneumonia (1). All four unfavorable outcomes in non-SAH patients were due to surgical procedures for giant aneurysms or associated basilar artery aneurysm. Removal of the anterior clinoid process was performed to secure the proximal neck in 15 patients with large or giant aneurysms. Multiple clips with or without fenestrated clips were required in all giant aneurysms, and exposure of the cervical internal carotid artery (ICA) in 17 giant or large aneurysms. Fenestrated clips were also useful for one small aneurysm projecting posteriorly. A favorable outcome was achieved in 17 of 19 patients undergoing coating. Coating without clipping might be better for some blister-like ICA aneurysms, even if ruptured. Paraclinoidal aneurysms can be clipped with favorable results using these techniques except for giant aneurysms and associated basilar artery aneurysm.

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Sudden Death in a Rat Subarachnoid Hemorrhage Model

Weiguo ZHAO, Hiroshi UJIIE, Yoshinori TAMANO, Keiko AKIMOTO, Tomokatsu ...

1999 Volume 39 Issue 11 Pages 735-743
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.735

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The pathogenesis of sudden death during subarachnoid hemorrhage (SAH) still remains to be elucidated. A new rat common carotid artery-prechiasmal extracorporeal shunt model was designed to study the effect of different severities of SAH on intracranial pressure (ICP), regional cerebral blood flow (rCBF), and mortality. Different severities of SAH were induced by controlling the bleeding period (from 30 to 90 sec) and number of bleedings (one or three times). SAH caused a dramatic increase in ICP and immediate depression of rCBF, which recovered slowly to a certain extent. ICP increased sharply within the first 30 seconds and reached a plateau concomitant with nearly zero rCBF, which suggested the occurrence of cerebral circulation arrest. Bleeding of more than 60 seconds and increased ICP over 80 mmHg were directly correlated with the mortality. Respiratory arrest was the first sign of death, immediately followed by cardiac depression resulting in sudden death. This model combines arterial bleeding with systemic blood pressure and controlled bleeding time to simulate the acute period of SAH.

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Neuroimaging of a Wooden Foreign Body Retained for 5 Months in the Temporalis Muscle Following Penetrating Trauma with a Chopstick —Case Report—

Hidenobu OCHIAI, Yuzo YAMAKAWA, Tsuyoshi FUKUSHIMA, Hiroki YAMADA

1999 Volume 39 Issue 11 Pages 744-747
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.744

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A 48-year-old female was stabbed by her husband with a chopstick made of wood in the left temporal region during a quarrel. She suffered laceration of the left temporal scalp. At initial examination, she concealed the assault with a chopstick. Radiography showed no abnormality, so the wound was sutured. One month after the injury, a painless subcutaneous mass appeared in the left temporal region which grew rapidly for 3 months. She was then admitted to our department. Computed tomography (CT) on admission showed a hyperdense area at the center of the mass. This area was hypointense on both T₁ and T₂-weighted magnetic resonance (MR) images. Temporalis muscle tumor with accompanying central necrosis, old hematoma, and inflammatory granuloma was considered. The mass was totally resected for cosmetic purposes and was found to be wooden foreign body granuloma. High density on CT and hypointensity on both T₁ and T₂-weighted MR images are characteristic of a chronically retained wooden foreign body in the living body and are useful for detecting wooden foreign bodies in the chronic granulomatous phase.

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Persistent Primitive Trigeminal Artery Imaged by Three-dimensional Computed Tomography Angiography —Two Case Reports—

Yasuhiro SUZUKI, Norihiko KUNII, Kiyoshi MATSUMOTO

1999 Volume 39 Issue 11 Pages 748-751
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.748

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Three-dimensional computed tomography (3D CT) angiography was used to investigate two cases of persistent primitive arteries. 3D CT angiography and 3D CT demonstrated a persistent primitive trigeminal artery variant penetrating the lateral edge of the posterior clinoid process and running to the posterior medial side, and a persistent primitive trigeminal artery perforating the canal of the posterior clinoid process and the petrosal bone junction. 3D CT angiography can delineate these persistent primitive arteries and the anatomy relative to the bone structure simultaneously, so is very useful to identify the arterial line where the canal is penetrated.

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Acute Subdural Hematoma Due to Near-Drowning —Case Report—

Hidekatsu MIZUSHIMA, Kazuo HANAKAWA, Nobusuke KOBAYASHI, Yoshiharu SAW ...

1999 Volume 39 Issue 11 Pages 752-755
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.752

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A 46-year-old male was transferred to our hospital after near-drowning when swimming. Examination found no subcutaneous hematoma or abrasion on his head. Cardiopulmonary resuscitation was started immediately. Emergent computed tomography (CT) revealed no abnormalities. The next day, his consciousness level improved and repeat CT suggested an acute spontaneous subdural hematoma in the parieto-occipital region. The acute subdural hematoma was evacuated. The source of bleeding was probably an abnormally large vein located in the center of the hematoma. The patient was discharged without neurological deficit. Repeat CT is needed even if there were no abnormality on initial CT after drowning.

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Isolated Metastases of Adenocarcinoma in the Bilateral Internal Auditory Meatuses Mimicking Neurofibromatosis Type 2 —Case Report—

Iwao YAMAKAMI, Hiromichi OISHI, Yasuo IWADATE, Akira YAMAURA

1999 Volume 39 Issue 11 Pages 756-751
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.756

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A 56-year-old male with a history of lung cancer presented with isolated metastases of adenocarcinoma in the bilateral internal auditory meatuses (IAMs), mimicking the bilateral acoustic schwannomas of neurofibromatosis type 2, and manifesting as rapidly worsening tinnitus and bilateral hearing loss. Magnetic resonance imaging showed small tumors in both IAMs with no sign of leptomeningeal metastasis. The preoperative diagnosis was neurofibromatosis type 2. Both tumors were removed and the histological diagnoses were adenocarcinoma. Neuroimaging differentiation of a solitary metastatic IAM tumor from a benign tumor is difficult, although rapidly progressive eighth cranial nerve dysfunction suggests a malignant process. Metastases should be considered as a rare diagnostic possibility in a patient with small tumors in both IAMs.

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Calcifying Pseudotumor of the Neural Axis —Case Report—

Hitoshi TSUGU, Takeo FUKUSHIMA, Yoshiaki TAKENO

1999 Volume 39 Issue 11 Pages 762-765
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.762

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A 22-year-old female presented with a calcifying pseudotumor of the neural axis manifesting as generalized convulsive seizure twice within 1 year. Computed tomography revealed a small, calcified mass lesion located in the right parietal lobe adjacent to the skull. The tumor was composed of an extensively calcified mass with accompanying peripheral epithelioid cells and focal mature bone structure, consistent with the diagnosis of a calcifying pseudotumor of the neural axis. Following complete excision of the tumor, the patient has been free from seizures for 8 years.

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Dandy-Walker Syndrome Successfully Treated With Cystoperitoneal Shunting —Case Report—

Tadao MIYAMORI, Takashi OKABE, Takeshi HASEGAWA, Kenji TAKINAMI, Tetsu ...

1999 Volume 39 Issue 11 Pages 766-768
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.766

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A neonate presented with Dandy-Walker syndrome manifesting as a large posterior cranial fossa cyst, aplasia of the lower cerebellar vermis, and elevation of the confluence of the sinuses but without hydrocephalus. A cystoperitoneal shunt was placed at one month after birth. The cyst diminished in size, and marked development of the cerebellar hemispheres and descent of the confluence of sinuses were observed, but not vermis development. The primary pathology of Dandy-Walker syndrome is posterior cranial fossa cyst formation due to passage obstruction in the fourth ventricle exit area and aplasia of the lower cerebellar vermis. The first choice of treatment in patients with Dandy-Walker syndrome in whom the cerebral aqueduct is open is cystoperitoneal shunt surgery, regardless of the presence or absence of hydrocephalus.

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Dorsally Sequestrated Thoracic Disc Herniation —Case Report—

Asuka MORIZANE, Junya HANAKITA, Hideyuki SUWA, Noboru OHSHITA, Kazuo G ...

1999 Volume 39 Issue 11 Pages 769-772
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.769

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A 53-year-old male presented with a rare dorsally sequestrated thoracic disc herniation manifesting as acute low back pain and weakness. He had no history of trauma. Magnetic resonance (MR) imaging demonstrated a mass at T10-11 intervertebral level connected with the T-10 disc. Axial MR imaging showed the mass had surrounded and compressed the dural sac from the lateral and dorsal sites. MR imaging with gadolinium-diethylenetriaminepenta-acetic acid showed slight rim enhancement of the lesion. Computed tomography detected no abnormal calcification. The diagnosis was thoracic disc herniation. Laminectomy resulted in rapid and satisfactory recovery. The histological diagnosis was thoracic disc herniation. MR imaging was very effective for the diagnosis based on the connection between the mass and the disc space. The differential diagnosis includes metastatic epidural tumor, epidural hematoma, and epidural abscess.

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Telemedicine in Neurosurgery Using International Digital Telephone Services Between Japan and Malaysia —Technical Note—

Kiyohiro HOUKIN, Shunichi FUKUHARA, Benedict M. SELLADURAI, Adnan ABD ...

1999 Volume 39 Issue 11 Pages 773-778
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.773

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A new image transmission and teleconference system using international digital telephone services was established between Japan and Malaysia. This new system consists of an ordinary personal computer, image scanner, and terminal adapter for digital telephone lines. The quality of images transferred using this system was high enough for diagnosis and discussion except for images such as radiographs requiring huge data transfer. Transmission of one image took approximately 20 seconds. The cost performance was almost equal to the conventional mailing system. The most remarkable advantage of this new system is the high quality of transferred images, the cost and time performance, and security of the medical information. New communication systems using international digital networks including the internet may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery.

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