Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 40, Issue 12
Displaying 1-10 of 10 articles from this issue
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Original Articles
  • Balloon-assisted Coil Placement in Wide-necked Cerebral Aneurysms: Preliminary Clinical Experience
    Keiko IRIE, Masahiko KAWANISHI, Seigo NAGAO
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 12 Pages 603-609
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.603
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    Endovascular treatment of wide-necked cerebral aneurysms with Guglielmi detachable coils (GDCs) has been limited due to coil protrusion into the artery. Seven patients with wide-necked cerebral aneurysms were treated with GDCs with temporary balloon inflation for mechanical protection during coil placement. Transarterial embolization of the aneurysm with GDCs had failed due to coil protrusion into the parent artery. The use of simultaneous temporary balloon protection achieved more dense intra-aneurysmal coil packing, especially in the neck, without compromising the parent artery.
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  • New Grading System to Predict Resectability of Anterior Clinoid Meningiomas
    Atul GOEL, Sanjay GUPTA, Ketan DESAI
    2000 Volume 40 Issue 12 Pages 610-617
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.610
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    Sixty patients with anterior clinoid meningiomas (mean age 48 years) were surgically treated. There was a slight female predominance. Headache and visual impairment were the commonest clinical symptoms at presentation. The patients were classified on the basis of extent of the visual impairment, size of the tumor, and the tumor relationship with the internal carotid artery. A grading system was designed using the total scores in these classifications on the scale of 2-10. The classifications and the grading system were assessed for planning of the operative strategy, anticipating the extent of resectability, possible difficulties in dissecting the carotid artery and optic nerve during the operation, and prognosis. Total resection was achieved in 42 cases (scores 4-8), subtotal resection in 17 cases (scores 7-10), and only partial resection in one case (score 10). Vision improved in 14 cases. Three patients died following surgery. Mean follow up was 26 months. There was one recurrence. Fifty-four patients are leading independent and active lives.
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  • In Vivo Gene Transfer into the Periventricular Region by Electroporation
    Takeshi KONDOH, Yasuhiko MOTOOKA, Abesh Kumar BHATTACHARJEE, Takashi K ...
    2000 Volume 40 Issue 12 Pages 618-623
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.618
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    Gene transfer by electroporation was attempted in the normal rat brain. The reporter gene pEGFP-C1 (25 μg/5 μl) was injected into the striatum of young adult rats and various square electrical impulses were applied using a pair of electrodes implanted in the striatum. The brains were removed and sliced after 5 days. Histological examination revealed that the high energy impulses caused extensive tissue damage whereas lower energy impulses (200-400 mJ) resulted in the transfection of more than 300 cells per brain, which were widely distributed in the subependymal region of the lateral ventricle and extended long processes into the striatum.
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Case Reports
  • Dissecting Aneurysm of the Anterior Cerebral Artery Requiring Surgical Treatment
    —Case Report—
    Yukihiro WAKABAYASHI, Toshihisa NAKANO, Mitsuo ISONO, Tsuyoshi SHIMOMU ...
    2000 Volume 40 Issue 12 Pages 624-627
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.624
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    A 45-year-old male presented with spontaneous dissecting aneurysm in the anterior cerebral artery manifesting as headache persisting for several days and speech disturbance. Neurological and laboratory examinations showed no abnormalities. Magnetic resonance imaging revealed infarction in the right cingulate gyrus. Angiography revealed occlusion of the right A2. Repeat angiography 8 months later showed a saccular aneurysm had developed. The interhemispheric approach exposed the aneurysm at the junction between the right frontopolar artery and the pericallosal artery. The aneurysm was fusiform due to the right A2 dissection. The aneurysm was trapped and resected. One month after the operation, the patient was discharged without neurological deficits. Cases of dissecting aneurysms in the anterior cerebral artery with ischemic onset are usually treated conservatively. Cases requiring surgery include those due to trauma, growing aneurysms, giant aneurysms, and uncontrolled hypertension. Some dissecting aneurysms of the distal anterior cerebral artery require only resection without bypass surgery.
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  • Dissecting Aneurysm of the Vertebral Artery Causing Subarachnoid Hemorrhage After Non-hemorrhagic Infarction
    —Case Report—
    Masanori TSUTSUMI, Teruaki KAWANO, Tsutomu KAWAGUCHI, Yoshirou KANEKO, ...
    2000 Volume 40 Issue 12 Pages 628-631
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.628
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    A 45-year-old male presented with lateral medullary infarction. Cerebral angiography showed dissecting aneurysm as pearl and string sign in the right vertebral artery (VA). Conservative treatment was administered with antiplatelet agent. However, subarachnoid hemorrhage occurred 2 days after admission, inducing coma. Intraaneurysmal embolization and proximal occlusion of the right VA by intravascular surgery resulted in only mild neurological deficits. Conservative treatment including strict control of blood pressure is the first choice of treatment. Antiplatelet therapy and anticoagulant therapy should not be administered. Patients must be followed up by serial angiography and surgery considered if signs of aneurysmal progression are seen.
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  • Direct Clipping of a Large Basilar Trunk Aneurysm Via the Posterior Petrosal (Extended Retrolabyrinthine Presigmoid) Approach
    —Case Report—
    Yasushi MOTOYAMA, Hideyuki OHNISHI, Naoki KOSHIMAE, Yukihide KANEMOTO, ...
    2000 Volume 40 Issue 12 Pages 632-636
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.632
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    A 53-year-old female presented with an unruptured, large basilar trunk aneurysm manifesting only as headache with no neurological deficits, including absence of cranial nerve dysfunction. Cerebral angiography disclosed a large aneurysm with a wide neck arising from the midbasilar artery. We treated the aneurysm surgically via the posterior petrosal approach. Five angled clips were applied sequentially to the aneurysm and the basilar artery was successfully reconstructed. Electrophysiological monitoring was continued during the operation and showed no changes. Following the operation, the patient suffered from transient right abducens nerve palsy, which persisted for 3 months. Postoperative angiography showed that the aneurysm was obliterated, and the patency of the basilar artery was preserved.
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  • Endovascular Treatment for a Ruptured Persistent Trigeminal Artery Variant Aneurysm on the Distal Portion
    —Case Report—
    Kenichiro HANABUSA, Kenichi MURAO, Atsunori MORIKAWA, Waro TAKI, Shiro ...
    2000 Volume 40 Issue 12 Pages 637-640
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.637
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    A 71-year-old female presented with a rare case of ruptured aneurysm on the distal persistent trigeminal artery (PTA) variant trunk. The endovascular approach was used to successfully occlude the proximal PTA variant, as direct catheter approach to the PTA variant aneurysm on the distal portion was prevented by the tortuous course of the vessel. She was discharged without neurological deficit.
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  • Local Intraarterial Fibrinolytic Therapy for Embolic Stroke Associated With Vascular Anomalies
    —Two Case Reports—
    Takahisa FUSE, Yuji NIWA, Shigenori HARADA
    2000 Volume 40 Issue 12 Pages 641-644
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.641
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    Two cases of embolic stroke associated with vascular anomalies were treated by intraarterial fibrinolytic therapy. A 78-year-old male had embolic stroke associated with fenestration of the middle cerebral artery (MCA). The embolus lodged in the terminal portion of the right internal carotid artery (ICA) and in the M2 portion of the right MCA. The fenestration was not detected before local fibrinolytic therapy, but was identified by postinterventional angiography. An 82-year-old female had a left-sided persistent primitive trigeminal artery (PPTA), and the embolus lodged in the terminal portion of the left ICA. Left internal carotid angiography also showed rich collateral circulation via the abundant leptomeningeal anastomosis. The PPTA involved the left ICA, so the anomalous anatomy had to be considered in performing local thrombolysis. However, the rich collateral circulation allowed recanalization of the occluded ICA without inducing bleeding. Dissolution of persistently adherent emboli must be performed with great care because of the possibility of such rare vascular anomalies.
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  • Superior Sagittal Sinus and Cerebral Cortical Venous Thrombosis Caused by Congenital Protein C Deficiency
    —Case Report—
    Seikou KUWAHARA, Tomoki ABE, Shigetoshi UGA, Koreaki MORI
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 12 Pages 645-649
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.645
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    A 47-year-old male receiving anticoagulant therapy for thrombophlebitis in the left leg for several years presented with mild left hemiparesis and ipsilateral hypesthesia. The cause of the thrombophlebitis was still unknown. Magnetic resonance (MR) imaging showed subacute thrombosis of both the superior sagittal sinus (SSS) and a cortical vein in the right cerebral hemisphere. Fluid attenuation inversion recovery axial MR imaging demonstrated these lesions more obviously than conventional T2-weighted axial MR imaging. Right carotid angiography showed a partial SSS filling defect and occlusion of the cortical vein with collateral circulation. Coagulation studies revealed decreases in both protein C activity and antigen levels with normal levels of blood coagulation factors II, VII, IX, and X and protein S activity and antigen. The patient’s mother had normal levels of both protein C activity and antigen, but his father had decreased levels. The diagnosis was SSS and cerebral cortical venous thrombosis caused by congenital protein C deficiency. The patient was treated conservatively, and his clinical course was uneventful. His neurological dysfunctions recovered within approximately 3 weeks after the onset. Ten months later, right carotid angiography showed recanalization of the SSS and partial filling of the cortical vein. Anticoagulant therapy has been continued, and no cerebral venous thrombosis has recurred during the 1.5 years after the onset.
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  • Solitary Fibrous Tumor Arising From the Falx Cerebri
    —Case Report—
    Satoru SHIMIZU, Hidehiro OKA, Nobuyuki KAWANO, Satoshi UTSUKI, Sachio ...
    2000 Volume 40 Issue 12 Pages 650-654
    Published: 2000
    Released on J-STAGE: September 02, 2005
    DOIhttps://doi.org/10.2176/nmc.40.650
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    A 50-year-old female was admitted with headache and visual disturbance. Neuroimaging demonstrated a well-demarcated large tumor attached to the falx cerebri. The tumor was totally removed by surgery. Histological examination showed that the tumor consisted of spindle cells with no pattern in the collagenous background. Staghorn-like blood vessels were common. Immunohistochemical study showed the tumor cells were strongly positive for CD34 and vimentin, but negative for epithelial membrane antigen. The diagnosis was solitary fibrous tumor arising from the falx cerebri. Solitary fibrous tumor is rare within the cranial cavity, and can be distinguished from meningioma and hemangiopericytoma by the histological, ultrastructural, and immunohistochemical findings.
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