Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 40, Issue 8
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Toshihiro KUMABE, Nobukazu NAKASATO, Takashi INOUE, Takashi YOSHIMOTO
    2000 Volume 40 Issue 8 Pages 393-403
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    Useful landmarks on magnetic resonance (MR) images were identified for preoperative prediction of the relationship of a tumor to the primary sensory cortex of the thumb. Functional MR (fMR) imaging and magnetoencephalography were used to retrospectively localize the hand-digit sensorimotor area in four patients who underwent tumor resection around the central sulcus with intraoperative neurophysiological mapping. fMR imaging revealed the hand-digit motor cortex in the so-called “precentral knob” inside the characteristic inverted-omega on axial MR images. Equivalent current dipoles of the N20m response in somatosensory evoked fields (SEFs) of the thumb, median nerve, and ulnar nerve stimuli were localized at the lateral portion of the inverted omega-shape from the lateral to medial directions. The SEF-based thumb sensory cortex was verified by intraoperative functional mapping with a neuronavigation system. The hand-digit somatosensory cortices were localized at the lateral shoulder of the inverted-omega, in the lateral anterior inferior position to the hand-digit motor cortices in the precentral knob. Axial MR imaging can provide useful preoperative planning information for the surgical treatment of tumors within or adjacent to the motor-somatosensory cortex.
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  • Toshiyuki SUGINO, Yasuhiro MATSUSAKA, Yutaka MITSUHASHI, Keiji MURATA, ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 404-407
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    Seven patients, six females and one male aged 26 to 39 years old, presented with headache in the upright posture, which was completely relieved in the recumbent posture. Radioisotope cisternography with technetium-99m-human serum albumin detected cerebrospinal fluid (CSF) leakage at the cervicothoracic level in six patients, and at the high cervical level in one patient. The diagnosis was intracranial hypotension due to spontaneous CSF leakage. Complete bed rest for more than 2 weeks resulted in complete resolution of the headache in all patients, and follow-up cisternography showed no leakage. Radioisotope cisternography is useful for the diagnosis of spontaneous CSF leakage, and complete bed rest for more than 2 weeks may be the best method of treatment.
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Case Reports
  • —Case Report—
    Shigeru NISHIZAWA, Tetsuo YOKOYAMA, Kenji SUGIYAMA, Naoki YOKOTA
    2000 Volume 40 Issue 8 Pages 408-412
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 43-year-old hypertensive male developed a pseudoaneurysm at the site of a superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, causing massive intracerebral hemorrhage 5 years after the operation. He first experienced repeated transient ischemic attacks, and cerebral angiography disclosed complete occlusion in the cervical portion of the left internal carotid artery. STA-MCA anastomosis was performed, and the ischemic attacks stopped. Postoperative angiography confirmed patency of the anastomosis and good filling of the cortical branches of the left MCA. Five years after surgery, the patient suffered sudden onset of generalized convulsions and consciousness disturbance. Computed tomography disclosed a massive intracerebral hemorrhage in the left frontoparietal region, and angiography revealed an aneurysmal dilatation at the site of the anastomosis that was not seen before. Emergency evacuation of the hematoma and clipping of the aneurysmal dilatation were performed. The patient recovered well and became ambulatory. Histological examination of the surgical specimen showed collagen tissue, indicating a pseudoaneurysm. Patients who undergo STA-MCA anastomosis, especially hypertensive patients, should be followed up by repeated magnetic resonance angiography to confirm the patency of the anastomosis and cerebral perfusion, and to detect the formation of pseudoaneurysms at the anastomosis site, which can cause fatal bleeding.
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  • —Case Report—
    Kazuhiro OHTAKARA, Toshio MATSUBARA, Tadashi KOJIMA, Waro TAKI, Shiro ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 413-418
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    An 80-year-old female presented with non-traumatic cerebrospinal fluid (CSF) rhinorrhea due to untreated prolactinoma, with simultaneous development of bilateral leg pains and gait disturbance due to lumbar canal stenosis. Neuroimaging showed an intrasellar mass extending into the sphenoid sinus, right cavernous sinus, and suprasellar cistern. Computed tomography cisternography clearly showed the CSF pathway through the tumor. Subtotal removal of the tumor and reconstruction of the sellar floor via a transsphenoidal approach resulted in resolution of the CSF rhinorrhea. Both the invasive features and/or spontaneous shrinkage of the tumor might have created the abnormal CSF pathway. The clinical manifestation of lumbar canal stenosis might be triggered by such profound CSF leakage.
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  • —Case Report—
    Takuro HAYASHI, Yoshiaki KUROSHIMA, Kazunari YOSHIDA, Takeshi KAWASE, ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 419-422
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 28-year-old male presented with a primary osteosarcoma of the sphenoid bone with extensive periosteal extension manifesting as severe headache and right exophthalmos. Computed tomography (CT) and magnetic resonance imaging revealed an anterior middle cranial fossa tumor extending into both the orbit and the extracranial space. However, roentgenography and CT with bone windows showed no marked osteolytic changes of the sphenoid bone. Total removal of the tumor was performed via the orbitozygomatic approach. Surgery revealed that the tumor had extended periosteally without macroscopic bone destruction, but no obvious abnormalities of the skull. The histological diagnosis was osteosarcoma. The patient was treated with chemotherapy and radiation therapy, but died of tumor recurrence 10 months after the surgery.
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  • —Case Report—
    Tatsuki OYOSHI, Masaki NAKAYAMA, Hirofumi HIRANO, Shinji SHIMOKAWA, Ju ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 423-426
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 24-year-old male presented with a rare intracranial dural metastasis from a mediastinal germ cell tumor infiltrating the superior vena cava, pericardium, ascending aorta, and lung. Routine chest radiography incidentally revealed the abnormal mediastinum, which was partially resected after median sternotomy, followed by radiotherapy. One year after the radiotherapy, magnetic resonance imaging revealed a right parasagittal tumor mimicking a meningioma. Partial tumor removal was performed. Two cycles of chemotherapy with carboplatin and etoposide were then performed, and the residual tumor almost completely disappeared. The histological diagnosis of both the mediastinal and intracranial tumors was pure seminoma. Sections of metastatic tumor revealed several thick fibrous septa and numerous epithelioid granulomas infiltrated by plasma cells, intermingled between the clusters of tumor cells. Follow up of patients apparently in remission from mediastinal seminoma without evidence of advanced or recurrent disease at other sites is recommended.
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  • —Case Report—
    Eiji TACHIBANA, Kiyoshi SAITO, Toshihiko WAKABAYASHI, Tetsuro NAGASAKA ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 427-431
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 21-year-old female with a 5-year history of prolactinoma was referred to our hospital because of cerebrospinal fluid leakage and meningitis immediately following a third transsphenoidal operation for a rapidly growing tumor. Histological examination of the tumor removed at the second transsphenoidal operation found atypical epithelial and sarcomatous components. Administration of bromocriptine, radiotherapy, and chemotherapy were initiated. Emergent craniotomy was required for rapid regrowth of the tumor. Histological examination found predominant sarcomatous components. Tumor growth was difficult to control. The patient died of subarachnoid hemorrhage due to rupture of a pseudoaneurysm involving the C1 portion of the right internal carotid artery. Pituitary adenoma rarely shows malignant transformation. In this case, prolactinoma underwent malignant change to sarcoma. Development of the pseudoaneurysm may have resulted from surgical manipulation, radiotherapy, or tumor invasion.
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  • —Case Report—
    Hiroshi NAWASHIRO, Shinji NAGAKAWA, Hideo OSADA, Hiroshi KATOH, Akira ...
    2000 Volume 40 Issue 8 Pages 432-434
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 58-year-old female presented with a rare case of intracranial solitary fibrous tumor (SFT) manifesting as progressive ataxic gait and hearing loss on the left persisting for 6 months with recent symptoms of increased intracranial pressure. Computed tomography demonstrated a large isodense irregular-shaped mass in the left posterior cranial fossa. T2-weighted magnetic resonance imaging showed two components appearing as very low intensity and high intensity. Extreme-lateral suboccipital craniotomy was performed. Gross total resection was achieved except for some dural attachment in the jugular foramen. All symptoms and signs subsided after surgery. Histological, immunohistochemical, and electron microscopic examinations led to a diagnosis of SFT. The strongly hypointense areas on the T2-weighted images were hypocellular region characterized by disorganized spindle cells and thick bands of collagen. The hyperintense areas on the T2-weighted images were hypercellular region mimicking hemangiopericytoma. Strong immunoreactivity for CD34 was also helpful in the diagnosis. Electron microscopy revealed absence of pinocytic vesicles and dense laminae which are characteristic of hemangiopericytoma. The magnetic resonance imaging appearance of SFT seems to be pathognomonic.
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  • —Case Report—
    Satoshi TSUTSUMI, Akihiko WACHI, Akira UTO, Junpei KOIKE, Hajime ARAI, ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 435-438
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    A 2-year-old boy presented with a rare sacral arachnoid cyst manifesting as gait disturbance. Neuroimaging revealed an intradural cyst in the sacral nerve root sheath associated with spina bifida occulta and a lipoma at the same level. At surgery, the conus medullaris was situated at the L-1 level and not tethered. The highly pressurized arachnoid cyst had exposed the dural sheath of the left S-2 nerve root and compressed the adjacent nerves. An S-2 nerve root pierced through the cyst. There was no communication between the cyst and spinal arachnoid space. We thought the one-way valve mechanism had contributed to the cyst enlargement and the nerve compression. Radical resection of the cyst was not attempted. A cyst-subarachnoid shunt was placed to release the intracystic pressure. Postoperatively, his gait disturbance improved and no deterioration occurred during the 4-year follow up. Both tethered cord syndrome and sacral arachnoid cyst in the nerve root sheath should be considered in pediatric progressive gait disturbance. Cyst-subarachnoid shunt is an alternative method to cyst resection or fenestration to achieve neurological improvement.
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  • —Three Case Reports—
    Kazunori ARITA, Kaoru KURISU, Koji IIDA, Ryosuke HANAYA, Kazuhiko SUGI ...
    Article type: Others
    Subject area: Others
    2000 Volume 40 Issue 8 Pages 439-445
    Published: 2000
    Released on J-STAGE: September 02, 2005
    JOURNAL OPEN ACCESS
    The surgical treatment modality for intractable epilepsy with cavernous angioma in the dominant hemisphere is still unclear. Three patients with medically intractable seizures associated with cavernous angioma in the dominant hemispheric temporal lobe underwent tailored resection based on magnetic resonance (MR) imaging, single photon emission computed tomography (SPECT), electroencephalography monitoring (from scalp and sphenoidal electrodes), and neuropsychologic assessment. Epileptogenic zones were located in the area surrounding the angioma in all patients and mesial temporal dysfunction in two patients. The adjacent cortex and gliotic tissues containing hemosiderin were resected, in conjunction with either total or partial resection of the nidus. Intraoperative electrocorticography (ECoG) was then performed. Additional resection of the mesial temporal structures or multiple subpial transection was performed as indicated by the ECoG findings. All three patients have been seizure free and showed no language or cognitive deterioration for 30, 18, and 14 postoperative months, respectively, while receiving tapered antiepileptic medication. Tailored resection based on electrophysiological data, MR imaging, SPECT, and intraoperative ECoG is effective for the treatment of medically intractable seizure associated with cavernous angioma in the temporal lobe of the dominant hemisphere.
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