Neurologia medico-chirurgica

Proliferative Potential of Malignant Glioma Cells Before and After Interstitial Brachytherapy

Katsuzo KUNISHIO, Kengo MATSUMOTO, Hisato HIGASHI, Hisashi ADACHI, Tak ...

1999 Volume 39 Issue 5 Pages 341-349
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.341

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The viability of tumor cells in radionecrotic tissue after interstitial brachytherapy (BRTX) was evaluated using immunohistochemical markers of proliferative potential in primary and recurrent tumors. Tumor specimens from 30 patients with malignant gliomas (14 anaplastic astrocytomas, 16 glioblastomas) taken before and after BRTX were examined using MIB-1 monoclonal antibody. Histological examination of specimens obtained by craniotomy or stereotactic biopsy after BRTX revealed tumor recurrence in 18 patients and radionecrosis in 12 patients including two with pure radionecrosis and 10 with a mixture of both tumor and radionecrosis. The MIB-1 index of the tumors with radionecrosis was 7.6 ± 5.5%, and that of the primary tumors was 17.0 ± 11.2%, showing a significant difference (p < 0.05). There was no significant difference between the MIB-1 index of the primary tumors with local recurrence after BRTX and the primary tumors which underwent radionecrosis. Although morphologically viable tumor cells were found in the radionecrotic tissue, BRTX causes a reduction in the proliferative potential of these tumor cells.

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Long-term Results of Ventrolateral Thalamotomy for Patients with Parkinson''s Disease

Eiji MORIYAMA, Hiroichi BECK, Toshihiko MIYAMOTO

1999 Volume 39 Issue 5 Pages 350-357
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.350

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This study evaluated the long-term outcome for 53 patients with idiopathic Parkinson''s disease treated by stereotactic thalamotomy between 1977 and 1996 at our institute. Significant reduction of tremor and rigidity of the contralateral extremities persisted throughout the follow-up period (mean 8.8 years) in 44 patients who underwent unilateral thalamotomy. These effects resulted in postoperative improvement of activity of daily life (ADL) with reduced dosage of levodopa. The effect of surgery on akinesia was limited and postoperative progression of akinesia was related to the postoperative deterioration of ADL. Multivariate analysis disclosed that the preoperative akinesia score was the critical factor for poor outcome. Nine patients underwent bilateral thalamotomies at a mean interval of 56 months. Five patients were obviously benefited from the second thalamotomy. The only perioperative complication was large intracerebral hematoma at the lesion site in one patient. This study confirmed the reliable and persistent effect of thalamotomy. Patients with Parkinson''s disease whose disability is mainly caused by tremor and/or rigidity will be benefited from this procedure. Second thalamotomy, contralateral to the initial side, may be indicated if the ADL deteriorates due to the progression of the symptoms on the non-treated side. Patients disabled by advanced akinesia are not good candidates for thalamotomy.

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Avulsion Fracture of the Anterior Half of the Foramen Magnum Involving the Bilateral Occipital Condyles and the Inferior Clivus —Case Report—

Michiharu TANABE, Takashi WATANABE, Satoshi MATSUMOTO, Hisayo OKAMOTO, ...

1999 Volume 39 Issue 5 Pages 358-361
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.358

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A 38-year-old male presented with an avulsion fracture of the anterior half of the foramen magnum due to a traffic accident. He had palsy of the bilateral VI, left IX, and left X cranial nerves, weakness of his left upper extremity, and crossed sensory loss. He was treated conservatively and placed in a halo brace for 16 weeks. After immobilization, swallowing, hoarseness, and left upper extremity weakness improved. Hyperextension with a rotatory component probably resulted in strain in the tectorial membrane and alar ligaments, resulting in avulsion fracture at the sites of attachment, the bilateral occipital condyles and the inferior portion of the clivus. Conservative treatment is probably optimum even for this unusual and severe type of occipital condyle fracture.

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Variant Arteriovenous Fistula o f the Superior Sagittal Sinus —Case Report—

Gerhard BAVINZSKI, Andreas SCHOEGGL, Andreas GRUBER, Monika KILLER

1999 Volume 39 Issue 5 Pages 362-366
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.362

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A 57-year-old male presented with a rare variant of dural arteriovenous fistula, located in the wall of an unobstructed superior sagittal sinus. Drainage occurred through a cortical vein no longer connected to its parent sinus, which filled up a cluster of transmedullary running veins, one of which was the presumed site of hemorrhage. Arterial blood was supplied via the external carotid artery branches. This type of fistula seriously increases the risk of hemorrhage in the patient and therefore requires complete obliteration. Attempts to embolize the fistula failed. The draining vein was isolated and coagulated resulting in permanent occlusion of the fistula. The fistula probably developed through a process of thrombophlebitis and revascularization via arterioles of the vein rather than previous occlusion of the sinus.

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Bilateral Chronic Subdural Hematomas Resulting in Unilateral Oculomotor Nerve Paresis and Brain Stem Symptoms After Operation —Case Report—

Kazuo OKUCHI, Masayuki FUJIOKA, Yuji MAEDA, Tadashi KAGOSHIMA, Toshisu ...

1999 Volume 39 Issue 5 Pages 367-371
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.367

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An 85-year-old male presented with bilateral chronic subdural hematomas (CSDHs) resulting in unilateral oculomotor nerve paresis and brainstem symptoms immediately after removal of both hematomas in a single operation. Initial computed tomography on admission demonstrated marked thick bilateral hematomas buckling the brain parenchyma with a minimal midline shift. Almost simultaneous removal of the hematomas was performed with the left side was decompressed first with a time difference of at most 2 minutes. However, the patient developed right oculomotor nerve paresis, left hemiparesis, and consciousness disturbance after the operation. The relatively marked increase in pressure on the right side may have caused transient unilateral brain stem compression and herniation of unilateral medial temporal lobe during the short time between the right and left procedures. Another factor was the vulnerability of the oculomotor nerve resulting from posterior replacement of the brain stem and stretching of the oculomotor nerves as seen on sagittal magnetic resonance (MR) images. Axial MR images obtained at the same time demonstrated medial deflection of the distal oculomotor nerve after crossing the posterior cerebral artery, which indicates previous transient compression of the nerve and the brain stem. Gradual and symmetrical decompression without time lag is recommended for the treatment of huge bilateral CSDHs.

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Persistent Primitive Hypoglossal Artery Associated with Cerebral Aneurysm and Cervical Internal Carotid Artery Stenosis —Case Report—

Takashi HATAYAMA, Kanji YAMANE, Takeshi SHIMA, Yoshikazu OKADA, Masahi ...

1999 Volume 39 Issue 5 Pages 372-375
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.372

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A 71-year-old female had vertigo attacks once or twice a day secondary to vertebrobasilar insufficiency. Left carotid angiography revealed persistent primitive hypoglossal artery (PPHA) associated with a large internal carotid artery (ICA) aneurysm and severe stenosis of the ICA. The bilateral vertebral arteries were hypoplastic. The basilar artery was opacified via the PPHA but not via vertebral arteries. Clipping of the aneurysm was performed first because the risk of rupture of the aneurysm was not negligible. One month after clipping, carotid endarterectomy using a T-shaped shunt system was successfully performed. The postoperative course was uneventful and the vertebrobasilar ischemic attacks did not recur. Left carotid angiography demonstrated complete obliteration of the aneurysm and disappearance of the carotid artery stenosis. Low ICA flow (70 ml/min) and low stump pressure of the PPHA (25 mmHg) strongly suggested low perfusion of the posterior circulation. Carotid endarterectomy may be essential for augmentation of the posterior circulation in patients with PPHA associated with ICA stenosis.

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Progressive Myelopathy Caused by Dural Arteriovenous Fistula at the Craniocervical Junction —Case Report—

Shinzo YOSHIDA, Yoshifumi ODA, Yasuto KAWAKAMI, Shinichi SATO

1999 Volume 39 Issue 5 Pages 376-379
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.376

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A 68-year-old male presented an unusual dural arteriovenous fistula (AVF) located at the craniocervical junction. Magnetic resonance imaging revealed dilated perimedullary veins around the spinal cord at C-1 and C-2 levels, as well as high intensity signals in the spinal cord on T2-weighted images. Vertebral angiography identified an AVF at the point where the right vertebral artery penetrates the dura. The fistula was a single and direct communication between the vertebral artery and the spinal vein. Surgical interruption of the fistula at its venous side resulted in prompt improvement of both motor and sensory signs and symptoms.

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Ehlers-Danlos Syndrome Associated with Multiple Spinal Meningeal Cysts —Case Report—

Mitsuo ISONO, Shigeaki HORI, Yohei KONISHI, Hidetomo KINJO, Kenji KAKI ...

1999 Volume 39 Issue 5 Pages 380-383
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.380

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A 40-year-old female with Ehlers-Danlos syndrome was admitted because of a large pelvic mass. Radiological examination revealed multiple spinal meningeal cysts. The first operation through a laminectomy revealed that the cysts originated from dilated dural sleeves containing nerve roots. Packing of dilated sleeves was inadequate. Finally the cysts were oversewed through a laparotomy. The cysts were reduced, but the postoperative course was complicated by poor wound healing and diffuse muscle atrophy. Ehlers-Danlos syndrome associated with spinal cysts may be best treated by endoscopic surgery.

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Galea-Cranium Suture Method for Prevention of the Subcutaneous Fluid Collection —Technical Note—

Tsutomu KATO, Yutaka SAWAMURA, Hiroshi ABE

1999 Volume 39 Issue 5 Pages 384-386
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.384

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A simple method is described for preventing cerebrospinal fluid (CSF) from collecting in the subcutaneous space following a supratentorial osteoplastic craniotomy. A few pairs of oblique holes through which suture materials may pass are made by drilling in the surface cortex of the bone flap. The galea aponeurotica is sutured to the bone flap by means of these holes. These galea-cranium sutures reduce the subgaleal free space in which pooling of CSF or hematoma may occur.

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The Suture Applicator for Replacing a Bone Flap —Technical Note—

Soichiro KONDO, Akira KOBAYASHI, Hirokazu NAGATA

1999 Volume 39 Issue 5 Pages 387-390
Published: 1999
Released on J-STAGE: March 27, 2006

DOIhttps://doi.org/10.2176/nmc.39.387

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A new instrument was developed for passing and holding sutures during the replacement of a bone flap. The new device is a simple straight aluminum shaft, 6 cm in length and 0.7 mm in diameter with a groove on both ends for holding the suture. The shaft can be easily bent with the fingers to attain the desired curve and more suitable manipulation. Passing the shaft through the straight hole in the cranium or the cranial flap was very easy and convenient. No dural damage occurred during 80 procedures using this shaft. No needle holder or forceps for temporary clipping sutures were necessary, which reduced the operative time and mental and physical burden on the operator and the nurses. The mean time per hole with our instrument (45.8 ± 9.2 sec) was significantly shorter compared to conventional methods with a circular needle, needle holder, and many forceps for temporary clamping of sutures (65.6 ± 13.2 sec).

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