Neurologia medico-chirurgica

Clinical Use of Scents for Carotid Artery Disease

Constantine C. PHATOUROS, Randall T. HIGASHIDA, Adel M. MALEK, Philip ...

1999 Volume 39 Issue 12 Pages 809-827
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.809

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Over the last 5 years, the clinical use of intravascular stents for treatment of carotid artery pathology has become more prevalent and the spectrum of potential indications has widened. Endovascular stenting is providing an alternative to surgical endarterectomy for treatment of cervical carotid artery atherosclerotic disease. This has prompted a North American, randomized, controlled clinical trial directly comparing these two therapies. In this article we review the major surgical endarterectomy trials that currently provide the scientific rationale for revascularization of carotid artery occlusive disease, critically evaluate the evidence supporting the application of endovascular stenting procedures for the treatment of occlusive and nonocclusive disease of the extracranial and intracranial carotid artery, consider the current clinical indications for use of stents in the carotid artery, and discuss current equipment, technique, and potential procedure-related complications.

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Postoperative Anticonvulsant Prophylaxis for Patients Treated for Cerebral Aneurysms

Toshiaki HAYASHI, Hiromu HADEISHI, Shingo KAWAMURA, Yutaka NONOYAMA, A ...

1999 Volume 39 Issue 12 Pages 828-834
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.828

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The incidences of postoperative seizures and side effects were evaluated in 193 patients with cerebral aneurysm who received anticonvulsant prophylaxis and underwent 224 craniotomies for cerebral aneurysms between 1993 and 1995. The patients were 73 males and 120 females aged between 31 and 80 years. One hundred and sixteen patients had ruptured cerebral aneurysms and 108 had unruptured aneurysms. Phenytoin followed by valproic acid were administered. Early postoperative seizures occurred in five patients (4 with ruptured and 1 with unruptured aneurysms) within 14 days after surgery. Late postoperative seizures occurred in four different patients with ruptured aneurysms more than 14 days after surgery. The presence of cortical lesions detected by cerebral computed tomography and occurrence of symptomatic vasospasm were correlated with the occurrence of early postoperative seizure (p < 0.05). Three of the four patients with late postoperative seizure had cortical lesions and two were receiving continued medication. Side effects that warranted discontinuation of therapy were seen in the follow-up period in 12.9% of patients. Anticonvulsant prophylaxis is not recommended due to the higher incidence of side effects than seizure, except in patients in poor clinical condition for the purpose of brain protection. Otherwise, anticonvulsant medication should be initiated at the time of the initial seizure attack.

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Anterior Approach for Dumbbell Type Cervical Neurinoma

Yoshinobu IWASAKI, Kazutoshi HIDA, Izumi KOYANAGI, Tetsuyuki YOSHIMOTO ...

1999 Volume 39 Issue 12 Pages 835-840
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.835

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A one-stage anterior approach was performed in four patients for total removal of dumbbell type neurinoma at the cervical level. In each case, the neurinoma compressed the spinal cord in the cervical canal, developed anteriorly through the intervertebral foramen, and compressed the vertebral artery. A conventional cervical anterior approach at the tumor site was performed, followed by confirmation of the tumor located outside the spinal canal. After identification of the vertebral artery, corpectomy was carried out and the extradural component of the tumor was resected. In cases with a portion of the tumor located also within the dura mater, the dura mater was opened for removal of the intradural tumor. We found the anterior approach to be effective for the total removal of some kinds of cervical dumbbell type neurinomas.

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Prediction of Effectiveness of Shunting in Patients with Normal Pressure Hydrocephalus by Cerebral Blood Flow Measurement and Computed Tomography Cisternography

Chia-Cheng CHANG, Nobumasa KUWANA, Susumu ITO, Tadashi IKEGAMI

1999 Volume 39 Issue 12 Pages 841-846
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.841

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Measurement of cerebral blood flow (CBF) and computed tomography (CT) cisternography were performed in 37 patients with a tentative diagnosis of normal pressure hydrocephalus (NPH) to predict their surgical outcome. The mean CBF of the whole brain was measured quantitatively by single photon emission computed tomography with technetium-99m-hexamethylpropylene amine oxime before surgery. The results of CT cisternography were classified into four patterns: type I, no ventricular stasis at 24 hours; type II, no ventricular stasis with delayed clearance of cerebral blush; type III, persistent ventricular stasis with prominent cerebral blush; type IV, persistent ventricular stasis with diminished cerebral blush and/or asymmetrical filling of the sylvian fissures. The mean CBF was significantly lower than that of age-matched controls (p < 0.005). Patients with a favorable outcome had a significantly higher mean CBF than patients with an unfavorable outcome (p < 0.005). Patients with the type I pattern did not respond to shunting. Some patients with type II and III patterns responded to shunting but improvement was unsatisfactory. Patients with type IV pattern responded well to shunting, and those with a mean CBF of 35 ml/100 g/min or over achieved a favorable outcome. The combination of CBF measurement and CT cisternography can improve the prediction of surgical outcome in patients with suspected NPH.

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Cavernous Angioma of the Internal Acoustic Meatus —Case Report—

Tsutomu SASAKI, Tomio SASAKI, Kouichiro OKAMOTO, Tsuyoshi ISHIDA, Taka ...

1999 Volume 39 Issue 12 Pages 847-851
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.847

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A 39-year-old female presented with an intrameatal cavernous angioma manifesting as hearing loss and tinnitus in the right ear which progressed over 8 months. Magnetic resonance (MR) images revealed an intrameatal lesion as ultra-high intensity, nearly as bright as cerebrospinal fluid, on the T₂-weighted images, and isointensity on the T₁-weighted images. Computed tomography (CT) showed the mass accompanied by stippled patterns of calcification. The patient underwent surgery under a diagnosis of calcified acoustic neurinoma. Histological studies were compatible with cavernous angioma. Intrameatal cavernous angioma is a rare disease which requires differential diagnosis from the more common neurinoma or meningioma in this location. Intrameatal lesion with ultra-high intensity on T₂-weighted MR imaging and stippled patterns of calcification on CT is more likely to be cavernous angioma than acoustic neurinoma. These neuroimaging features are important information in deciding the treatment strategy.

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Postpartum Dissecting Aneurysm of the Superior Cerebellar Artery —Case Report—

Kiyonobu IKEDA, Katsuo SHOIN, Hiroki TAGUCHI, Jun YAMANO, Ryouichi KAW ...

1999 Volume 39 Issue 12 Pages 852-857
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.852

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A 37-year-old female with toxemia of pregnancy suffered sudden headache and loss of consciousness on the day following a cesarean delivery. Computed tomography revealed subarachnoid hemorrhage (SAH). Vertebral angiography revealed a fusiform dilatation near the origin of the right superior cerebellar artery (SCA) with distal luminal narrowing. She underwent surgery within 24 hours of the ictus. A SAH clot was carefully removed from the prepontine cistern, and subadventitial discoloration was seen in the wall of the right SCA just distal to the aneurysmal protuberance (rupture site). The dissecting aneurysm was treated with body clipping by directly clipping the rupture site and with additional wrapping of the proximal SCA, including the aneurysmal protuberance and discolored site. The postoperative clinical course was uneventful. Postoperative angiography revealed complete obliteration of the aneurysm and patency of the SCA. Therapeutic intervention should be considered for patients with ruptured dissecting aneurysm who present with recurrent SAH.

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Aneurysms Arising from the Cortical Segment of the Superior Cerebellar Artery —Two Case Reports—

Mitsuo SATO, Namio KODAMA, Tatsuya SASAKI, Zenichiro WATANABE

1999 Volume 39 Issue 12 Pages 858-862
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.858

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Two unusual cases of partially thrombosed or fusiform type aneurysm on the cortical segment of the superior cerebellar artery (SCA) with subarachnoid hemorrhage are described. A 71-year-old female had a partially thrombosed, multi-lobular aneurysm located at the marginal branch of the SCA. This aneurysm was successfully clipped and wrapped via a subtemporal transtentorial approach in the acute stage. A 52-year-old female had an atherosclerotic fusiform aneurysm located at the distal portion of the hemispheric branch of the SCA. This aneurysm was successfully trapped using an infratentorial supracerebellar approach in the acute stage. Both patients were discharged without neurological deficits. The subtemporal transtentorial or lateral suboccipital approach for the proximal cortical segment, and the infratentorial supracerebellar approach for the distal cortical segment of the SCA are recommended for surgical treatment of these aneurysms.

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Ruptured Vertebral Artery-Posterior Inferior Cerebellar Artery Aneurysm Associated with Facial Nerve Paresis Successfully Treated with Interlocking Detachable Coils —Case Report—

Ryu KUROKAWA, Ryoichi SAITO, Yoshiki NAKAMURA, Hiroshi KAGAMI, Kiyoshi ...

1999 Volume 39 Issue 12 Pages 863-866
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.863

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An 81-year-old female presented with severe headache. Computed tomography revealed subarachnoid hemorrhage. She developed right facial nerve paresis on the next day. Angiography revealed a right vertebral artery-posterior inferior cerebellar artery aneurysm. The aneurysm was successfully occluded with interlocking detachable coils (IDCs) on the 7th day. Magnetic resonance (MR) imaging 1 month after IDC placement showed partially thrombosed aneurysm near the internal acoustic meatus. Ten months after the ictus, MR imaging revealed marked resolution of the intra-aneurysmal thrombus and reduction of the aneurysm size. Her facial nerve function gradually recovered during this period. Her facial nerve paresis was probably caused by acute stretching of the facial nerve by the ruptured aneurysm that was in direct contact with the nerve. Intra-aneurysmal thrombosis using coils can reduce aneurysm size and alleviate cranial nerve symptoms.

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Bow Hunter''s Stroke Associated with an Aberrant Course of the Vertebral Artery —Case Report—

Satoru SHIMIZU, Masaru YAMADA, Hiroshi TAKAGI, Kiyotaka FUJII, Shinich ...

1999 Volume 39 Issue 12 Pages 867-869
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.867

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A 53-year-old male presented with repeated vertebrobasilar insufficiency on turning the head to the left. Angiography revealed severe stenosis of the dominant right vertebral artery at the atlantoaxial level in this position. Decompression surgery for the affected vertebral artery at the transverse foramen of the atlas was planned. However, surgery revealed an aberrant course of the artery, turning at the orifice of the transverse foramen of the atlas and perforating the dura at the occipitoatlantal level after passing through the bony canal of the atlas. Therefore, decompression was performed at the bony canal, which was the contributing site, and the symptoms improved. Bow hunter''s stroke may be caused by atlantoaxial arterial anomalies, so accurate preoperative evaluation of the region is necessary to avoid anatomical confusion at surgery.

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Sellar Chondroma —Case Report—

Aya AOKI, Kentaro MORI, Atsushi TAJIMA, Minoru MAEDA

1999 Volume 39 Issue 12 Pages 870-874
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.870

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A 12-year-old boy presented with right visual disturbance. Skull radiography and computed tomography (CT) showed an irregular deformity of the sella turcica, hypertrophic change of the dorsum sellae, and an inhomogeneously calcified mass in the sella turcica. Magnetic resonance (MR) imaging demonstrated the mass lesion filled the hypophyseal fossa, and extended to the dorsum sellae, right cavernous sinus, and right suprasellar region. The Dolenc pterional combined epidural and subdural approach was carried out. The histological diagnosis was chondroma. Sellar chondroma requires relief of the compression to the chiasm or optic nerve as soon as possible, so partial resection can still be beneficial. However, follow-up MR imaging or CT, visual examination, and control of pituitary dysfunction are required after the operation.

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Neurenteric Cyst of the Craniocervical Junction —Case Report—

Kazuhiro ABE, Kazutaka OYAMA, Kentaro MORI, Sumio ISHIMARU, Masanobu E ...

1999 Volume 39 Issue 12 Pages 875-880
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.875

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A 60-year-old female presented with occipital headache and limitation of neck movement. Neurological examination showed weakness of the right sternocleidomastoid muscle. Magnetic resonance imaging revealed a cystic lesion at the craniocervical junction and posterior compression of the brain stem. The lesion was totally removed through the transcondylar approach. The histological diagnosis was neurenteric cyst. The transcondylar approach provides a direct operative view of the clivus and anterior craniovertebral junction.

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