Neurologia medico-chirurgica

Prognostic Factors for Supratentorial Low Grade Astrocytomas in Adults

Satoshi IWABUCHI, Samir BISHARA, Peter HERBISON, Albert ERASMUS, Hirot ...

1999 Volume 39 Issue 4 Pages 273-281
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.273

JOURNAL FREE ACCESS

Show abstractHide abstract

The principal prognostic factors and effect on survival were retrospectively evaluated in 56 adult patients with supratentorial low grade astrocytomas treated between 1967 and 1993. Fifteen factors were evaluated with uni- and multivariate analysis to investigate their importance in predicting the length of survival. The median patient age at presentation was 42 years and the median survival was 5.0 years. The following characteristics were associated with improved patient survival by univariate analysis (p < 0.01): Age group, preoperative Karnofsky scale, and extent of surgery. Age group and Karnofsky scale were significant by multivariate analysis, but not the extent of surgery. Thus the usefulness of cytoreductive surgery in the management remains unclear, but the extent of surgery is determined by the characteristics of the tumor and the potential of the patient. Since 93% of our patients received postoperative radiotherapy, the effect of adjuvant irradiation could not be determined.

View full abstract

Download PDF (625K)
Magnetic Resonance Cisternography Using the Fast Spin Echo Method for the Evaluation of Vestibular Schwannoma

Shigeru NISHIZAWA, Tetsuo YOKOYAMA, Kenichi UEMURA

1999 Volume 39 Issue 4 Pages 282-287
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.282

JOURNAL FREE ACCESS

Show abstractHide abstract

Neuroimaging of vestibular schwannoma was performed with the fat-suppression spoiled gradient recalled acquisition in the steady state (SPGR) method and magnetic resonance (MR) cisternography, which is a fast spin echo method using a long echo train length, for the preoperative evaluation of the lateral extension of the tumor in the internal auditory canal, and the anatomical identification of the posterior semicircular canal and the nerves in the canal distal to the tumor. The SPGR method overestimated the lateral extension in eight cases, probably because of enhancement of the nerves adjacent to the tumor in the canal. The posterior semicircular canal could not be clearly identified, and the cranial nerves in the canal were shown only as a nerve bundle. In contrast, MR cisternography showed clear images of the lateral extension of the tumor and the facial and cochlear nerves adjacent to the tumor in the internal auditory canal. The anatomical location of the posterior semicircular canal was also clearly shown. These preoperative findings are very useful to plan the extent to which the internal auditory canal can be opened, and for intraoperative identification of the nerves in the canal. MR cisternography is less invasive since no contrast material or radiation is required, as with thin-slice high-resolution computed tomography (CT). MR cisternography should replace high-resolution CT for the preoperative neuroradiological evaluation of vestibular schwannoma.

View full abstract

Download PDF (555K)
Stereotactic Radiosurgery for Cavernous Sinus Cavernous Hemangioma —Case Report—

Yoshiyasu IWAI, Kazuhiro YAMANAKA, Hideki NAKAJIMA, Toshihiro YASUI

1999 Volume 39 Issue 4 Pages 288-290
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.288

JOURNAL FREE ACCESS

Show abstractHide abstract

A 40-year-old female presented with cavernous sinus cavernous hemangioma manifesting as left abducens and trigeminal nerve pareses. Magnetic resonance imaging revealed a left cavernous sinus tumor. The tumor was partially removed. Histological examination of the specimen confirmed cavernous hemangioma. Radiosurgery was performed using the gamma knife. The tumor markedly decreased in size after radiosurgery and morbidity was avoided. Cavernous sinus cavernous hemangiomas may be difficult to treat surgically due to intraoperative bleeding and cranial nerve injury. Stereotactic radiosurgery can be used either as an adjunct treatment to craniotomy, or as the primary treatment for small cavernous sinus cavernous hemangioma.

View full abstract

Download PDF (262K)
Angiographically Occult Dural Arteriovenous Malfomlation in the Anterior Cranial Fossa —Case Repoct—

Tatsuaki HATTORI, Hiroshi KOBAYASHI, Satoru INOUE, Noboru SAKAI

1999 Volume 39 Issue 4 Pages 291-293
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.291

JOURNAL FREE ACCESS

Show abstractHide abstract

A 62-year-old male presented with a dural arteriovenous malformation located in anterior cranial fossa manifesting as acute right frontal intracerebral and subdural hematomas. Cerebral angiography showed only mass sign, but surgical exploration disclosed the dural arteriovenous malformation in the anterior cranial fossa. Anterior cranial fossa dural arteriovenous malformation should be considered if computed tomography reveals intracranial bleeding involving the frontal base, even if cerebral angiography does not demonstrate vascular anomalies.

View full abstract

Download PDF (370K)
Moyamoya Disease Showing Atypical Angiographic Findings —Two Case Reports—

Hiroharu KATAOKA, Susumu MIYAMOTO, Izumi NAGATA, Taketo HATANO, Hideyu ...

1999 Volume 39 Issue 4 Pages 294-298
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.294

JOURNAL FREE ACCESS

Show abstractHide abstract

A 7-year-old boy and a 10-year-old girl presented with moyamoya disease showing atypical angiographic findings. In these cases, the internal carotid artery (ICA) had a tapering occlusion just distal to the origin of the ophthalmic artery, whereas the top of the ICA was not occluded and was retrogradely supplied through the posterior communicating artery from the posterior circulation. Surgical treatment resolved the symptoms in both patients. Moyamoya disease may include a number of variant types not showing all the characteristic angiographic findings of moyamoya disease.

View full abstract

Download PDF (486K)
Lumbar Spinal Subdural Hematoma Following Craniotomy —Case Report—

Satoru SHIMIZU, Shigekuni TACHIBANA, Hiroshi MAEZAWA, Kiyotaka FUJII, ...

1999 Volume 39 Issue 4 Pages 299-301
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.299

JOURNAL FREE ACCESS

Show abstractHide abstract

A 52-year-old female complained of lumbago and weakness in the lower extremities 6 days after craniotomy for clipping an aneurysm. Neurological examination revealed symptoms consistent with lumbosacral cauda equina compression. The symptoms affecting the lower extremities spontaneously disappeared within 3 days. Magnetic resonance (MR) imaging 10 days after the operation demonstrated a lumbar spinal subdural hematoma (SSH). She had no risk factor for bleeding at this site, the symptoms appeared after she began to walk, and MR imaging suggested the SSH was subacute. Therefore, the SSH was probably due to downward movement of blood from the cranial subdural space under the influence of gravity. SSH as a complication of cranial surgery is rare, but should be considered if a patient develops symptoms consistent with a lumbar SSH after craniotomy.

View full abstract

Download PDF (225K)
Massive Subependymal Hemorrhage Caused by an Occult Vascular Malformation—Two Case Reports—

Hitoshi KOBATA, Akinori KONDO, Koichi IWASAKI, Itaro HATTORI

1999 Volume 39 Issue 4 Pages 302-307
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.302

JOURNAL FREE ACCESS

Show abstractHide abstract

Two patients presented with massive subependymal hemorrhage caused by vascular anomalies occult to angiography, computed tomography (CT) scanning, and magnetic resonance (MR) imaging. A 47-year-old male initially presented with a headache and became comatose 3 weeks later. CT and MR imaging demonstrated a massive hematoma in the right caudate head projecting into the lateral ventricle. A 60-year-old male sustained heaviness of his left extremities 8 days prior to admission and his condition gradually deteriorated. Neuroimaging revealed a right thalamic hematoma adjacent to the lateral ventricle. Cerebral angiography, CT, and MR imaging failed to detect any vascular anomaly. The hematomas increased in size gradually and were surgically explored. The histological diagnosis was arteriovenous malformation for the first case and cavernous angioma for the second case that had ruptured repeatedly. These cases were unique in the unusual location in the subependyma, and diagnostic neuroimaging modalities could not disclose the vascular anomalies, and the hematomas enlarged progressively to become critically symptomatic. Surgical intervention is mandatory for mass reduction and correct diagnosis of such lesions, with favorable outcome as long as the surgery is not delayed until too late.

View full abstract

Download PDF (672K)
Paraganglioma in the Frontal Skull Base —Case Report—

Toshihiro YAMAUCHI, Motoo KUBOTA, Naokatsu SAEKI, Naoto AIHARA, Yasuo ...

1999 Volume 39 Issue 4 Pages 308-312
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.308

JOURNAL FREE ACCESS

Show abstractHide abstract

A 56-year-old female presented with a paraganglioma in the left anterior cranial fossa who manifesting as persistent headache. Computed tomography and magnetic resonance imaging showed a solid, enhanced tumor with a cystic component located medially. The tumor was attached to the left frontal base and the sphenoid ridge. Angiography demonstrated a hypervascular tumor fed mainly by the left middle meningeal artery at the left sphenoid ridge. The preoperative diagnosis was meningioma of the left frontal base. The tumor was totally resected via a left frontotemporal craniotomy. Histological examination revealed the characteristic cellular arrangement of paraganglioma generally designated as the “Zellbaren pattern” on light microscopy. Only 10 patients with supratentorial paraganglioma have been reported, seven located in the parasellar area. The origin of the present tumor may have been the paraganglionic cells which strayed along the middle meningeal artery at differentiation.

View full abstract

Download PDF (534K)
Migration of the Abdominal Catheter of a Ventriculoperitoneal Shunt into the Scrotum —Case Report—

M. Faik ÖZVEREN, Ahmet KAZEZ, Hasan ÇETIN, Ibrahim M. ZIYA ...

1999 Volume 39 Issue 4 Pages 313-315
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.313

JOURNAL FREE ACCESS

Show abstractHide abstract

A 3-day-old male neonate presented with migration of the ventriculoperitoneal (VP) shunt tip through the patent processus vaginalis resulting in scrotal hydrocele. The association of myelomeningocele with hydrocephalus may have been a predisposing factor in this rare complication. Development of scrotal swelling or hydrocele in a child with VP shunt should be recognized as a possible shunt complication.

View full abstract

Download PDF (237K)
Mesh-and-Glue Technique to Prevent Leakage of Cerebrospinal Fluid After Implantation of Expanded Polytetrafluoroethylene Dura Substitute. —Technical Note—

Kazuya NAGATA, Shunsuke KAWAMOTO, Jun SASHIDA, Tadashi ABE, Akitake MU ...

1999 Volume 39 Issue 4 Pages 316-319
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.316

JOURNAL FREE ACCESS

Show abstractHide abstract

Expanded polytetrafluoroethylene (ePTFE) can be used as a dura substitute but is associated with leakage of cerebrospinal fluid (CSF) through the suture line. Fibrin glue alone may not prevent this problem. This new method for sealing the suture line in ePTFE membrane uses an absorbable polyglycoic acid mesh soaked with fibrinogen fluid placed on the suture line. Thrombin fluid is then slowly applied to the wet mesh, forming a large fibrin membrane reinforced by the mesh over the suture line. Only one of 33 patients in whom this technique was used had CSF leakage, whereas 12 of 59 patients in whom a dural defect was closed with ePTFE alone showed postoperative subcutaneous CSF collection (p < 0.05). Our clinical experiences clearly show the efficacy of the mesh-and-glue technique to prevent CSF leakage after artificial dural substitution. Mesh and glue can provide an adequate repair for small dural defect. The mesh-and-glue technique may also be used for arachnoid sealing in spinal surgery.

View full abstract

Download PDF (274K)

Register with J-STAGE for free!