Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 41, Issue 12
Displaying 1-11 of 11 articles from this issue
Review Article
  • Mario ZUCCARELLO
    2001 Volume 41 Issue 12 Pages 571-575
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    The increased sensitivity of neuroimaging techniques has enabled the more frequent diagnosis of unruptured aneurysms. Because the most devastating complication of an unruptured aneurysm is subarachnoid hemorrhage, it has been considered desirable to treat these aneurysms before they rupture. However, the optimal treatment strategy for patients with unruptured aneurysms remains controversial. The management decision requires knowledge of the natural history and an accurate assessment of the risks related to various treatment options. On December 10, 1998 the New England Journal of Medicine published an article by the International Study of Unruptured Intracranial Aneurysms Investigators. The study retrospectively assessed the natural history of unruptured aneurysms in 1449 patients; in addition, treatment-related mortality and morbidity were examined in a prospective cohort of 1172 patients. The major finding was that the rate of rupture for aneurysms smaller than 10 mm in diameter in patients with no history of subarachnoid hemorrhage was 0.05% per year, and that the mortality and morbidity associated with surgery greatly exceeded the risk of rupture in such patients. This report has generated tremendous controversy in the treatment of unruptured aneurysms and has influenced our decision making. The results of this study are critically analyzed and potential flaws presented. To develop recommendations for treatment, the literature was reviewed. The conclusion of this search is that there is insufficient evidence to recommend a standard of management. Therapeutic guidelines are provided, particularly for patients with small incidental aneurysms and no history of subarachnoid hemorrhage.
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Original Articles
  • Hidenobu OCHIAI, Yuzo YAMAKAWA
    2001 Volume 41 Issue 12 Pages 576-581
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    Continuous drainage of lumbar cerebrospinal fluid (CSF) was analyzed for the preoperative management of patients with aneurysmal subarachnoid hemorrhage (SAH) in 50 consecutive cases of surgically treated aneurysmal SAH. Patients were divided into a lumbar drainage group, in whom continuous lumbar CSF drainage was established for preoperative management, and a non-lumbar drainage group. Rebleeding from the aneurysm during the insertion of the lumbar drainage tube and during continuous lumbar drainage, effect on the control of the systolic blood pressure, and effect on the sedation of the patient were examined. Continuous lumbar CSF drainage significantly decreased the systolic blood pressure. Seven of 17 patients in the non-lumbar drainage group had systolic blood pressure uncontrollable to below 150 mmHg even when a large amount of nicardipine was used, whereas only two of 33 patients had the same problem in the lumbar drainage group. Sedation was better in the patients in the lumbar drainage group with a smaller amount of analgesics. The rebleeding rate was 11.7% among patients in the non-lumbar drainage group, and 9.09% among patients in the lumbar drainage group. No rebleeding occurred during insertion of the lumbar drainage catheter. Continuous lumbar CSF drainage improved control of systolic pressure and sedation, and is a useful method of preoperative management for patients with aneurysmal SAH.
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  • Kenji MAEDA, Sachiko MATSUHASHI, Kazuo TABUCHI, Takeshi WATANABE, Toyo ...
    2001 Volume 41 Issue 12 Pages 582-589
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    NELL1 and NELL2 encode cysteine-rich amino acid sequences including six epidermal growth factor-like motifs, which contain signal peptides at the N-terminals. The deduced amino acid sequences of both genes are 55% identical and their cysteine stretch structures are conserved. NELL1 is expressed in the brain and kidney, whereas NELL2 is expressed specifically in the brain. The cell lineage expressing NELLs in the nervous system was investigated in established cell lines and central nervous system tumor tissues obtained from patients by Northern blot and reverse transcriptase-polymerase chain reaction analyses. NELL1 and NELL2 were predominantly expressed in neuroblastoma cell lines and little expressed in glioblastoma cell lines. NELL1 and NELL2 were also expressed in central neurocytoma, medulloblastoma, and some astrocytic tumors. Immunohistochemical analysis revealed that NELL2 protein was localized in the cytoplasm of neurons. These results suggest that NELL2 is predominantly expressed in the neuronal cell lineage in the human nervous system. NELL1 is expressed mainly in tumors in the neuronal cell lineage.
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  • Katsuhiko AKIYAMA, Ryuichi TANAKA, Mitsuya SATO, Norio TAKEDA
    2001 Volume 41 Issue 12 Pages 590-598
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    Cognitive dysfunction and histological changes in the brain were investigated following irradiation in 20 Fischer 344 rats aged 6 months treated with whole brain irradiation (WBR) (25 Gy/single dose), and compared with the same number of sham-irradiated rats as controls. Performance of the Morris water maze task and the passive avoidance task were examined one year after WBR. Finally, histological and immunohistochemical examinations using antibodies to myelin basic protein (MBP), glial fibrillary acidic protein (GFAP), and neurofilament (NF) were performed of the rat brains. The irradiated rats continued to gain weight 7 months after WBR whereas the control rats stopped gaining weight. Cognitive functions in both the water maze task and the passive avoidance task were lower in the irradiated rats than in the control rats. Brain damage consisting of demyelination only or with necrosis was found mainly in the body of the corpus callosum and the parietal white matter near the corpus callosum in the irradiated rats. Immunohistochemical examination of the brains without necrosis found MBP-positive fibers were markedly decreased in the affected areas by irradiation; NF-positive fibers were moderately decreased and irregularly dispersed in various shapes in the affected areas; and GFAP-positive fibers were increased, with gliosis in those areas. These findings are similar to those in clinically accelerated brain aging in conditions such as Alzheimer's disease, Binswanger's disease, and multiple sclerosis.
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Case Reports
  • —Case Report—
    Satoru SHIMIZU, Katsumi IRIKURA, Yoshio MIYASAKA, Takahiro MOCHIZUKI, ...
    2001 Volume 41 Issue 12 Pages 599-602
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 50-year-old man was treated with stereotactic gamma knife radiosurgery for an incidentally detected small callosal arteriovenous malformation (AVM) with stenosis of the main draining pathway. He suffered two episodes of intraventricular hemorrhage at 4 and 14 weeks after the radiosurgery. Radiological studies demonstrated that the anterior portion of the draining system including a varix, which had been irradiated, was thrombosed before the obliteration of arteriovenous shunts. Stereotactic radiosurgery is an accepted treatment for selected small and medium AVMs, but this procedure may increase the risk of bleeding. Early occlusion of a part of the draining pathway after stereotactic radiosurgery might have induced AVM rupture. An impaired venous outlet, either consisting of one draining vein or with stenosis, present before treatment may be develop thrombosis in response to high-dose irradiation.
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  • —Case Report—
    Jung-Yong AHN, Seong-Oh KWON, Jin-Yang JOO
    2001 Volume 41 Issue 12 Pages 603-606
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 50-year-old male presented with an extremely rare dorsal wall aneurysm of the internal carotid artery manifesting as intracerebral hemorrhage. Computed tomography demonstrated intracerebral hemorrhage on the frontal base. Magnetic resonance imaging clearly showed the hemorrhage was related to an aneurysm of the internal carotid artery. Cerebral angiography disclosed an elongated aneurysm of the dorsal wall of the internal carotid artery. The aneurysm was packed as fully as possible with Guglielmi detachable coils to achieve complete obliteration. The patient was discharged without neurological deficits. Dorsal internal carotid artery aneurysms have a high risk of premature rupture due to their unusual shape and position, adhesion to the brain tissue, and fragile neck. Direct clipping requires careful brain retraction, necessary exposure of the aneurysm, and gentle neck manipulation. Endovascular treatment is an alternative method for obliteration of the aneurysmal sac.
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  • —Case Report—
    Shinji FUKUI, Hiroshi KATOH, Hiroshi NAWASHIRO, Hidetoshi OOIGAWA, Tat ...
    2001 Volume 41 Issue 12 Pages 607-610
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 15-year-old girl presented with an extremely rare anomalous origin of the internal carotid artery (ICA) from the common carotid artery, associated with an arteriovenous malformation in the brain and aberrant course of the ICA in the temporal bone. These anomalies, which were found on the same side, may be due to a maldevelopment of the vascular network including the aortic arches.
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  • —Case Report—
    Hitoshi KOBATA, Hideo TANAKA, Yuichi TADA, Kentaro NISHIHARA, Akira FU ...
    2001 Volume 41 Issue 12 Pages 611-614
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 77-year-old woman suddenly lost consciousness and presented with right hemiparesis. Computed tomography showed a large subcortical hematoma in her left frontal lobe associated with subarachnoid hemorrhage. The first impression was hemorrhage due to a ruptured aneurysm of the middle cerebral or the internal carotid artery on the left. Left internal carotid angiography showed no aneurysm or vascular anomaly, but back flow of contrast medium into the external carotid artery disclosed two saccular aneurysms arising from the anterior branch of the left middle meningeal artery (MMA). Emergent surgical intervention confirmed that the hematoma was due to ruptured MMA aneurysm. Nontraumatic MMA aneurysm should be recognized as a possible causative lesion of intracranial hemorrhage despite the extremely low incidence. External carotid angiography should be performed in patients with intracranial hemorrhage in whom no vascular cause can be detected in the internal carotid system.
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  • —Case Report—
    Trimurti NADKARNI, Atul GOEL, Ketan DESAI, Purnima AIYER, Asha SHENOY
    2001 Volume 41 Issue 12 Pages 615-619
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 19-year-old male patient presented with a midline facial, nose, and forehead hard and bony swelling associated with hypertelorism. Neuroimaging revealed a massive tumor involving the anterior cranial fossa floor, which had occupied and enlarged all paranasal air sinuses, and displaced the orbits outwards and the frontal lobes of the brain superiorly. A basal transcranial route was used for radical resection of the massive and vascular tumor. Histological examination confirmed an aneurysmal bone cyst. Such tumors only rarely involve the cranial bones or paranasal air sinuses.
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  • —Case Report—
    Cahide TOPSAKAL, Fatih Serhat EROL, Ibrahim OZERCAN, Ayse MURAT, Bilgi ...
    2001 Volume 41 Issue 12 Pages 620-625
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 35-year-old woman presented with a solitary neurofibroma in an unusual presacral location without neurofibromatosis manifesting as bilateral chronic sciatica for 2 years. She was initially considered as having a giant right ovarian mass, but was referred with a prediagnosis of solitary giant sacral nerve sheath tumor. The initial differential diagnosis was based on neuroimaging. A right-sided J incision with the extraperitoneal approach provided good exposure and handling of the tumor bed. Almost total excision without neurological deficit was possible. The histological diagnosis was neurofibroma. Benign retroperitoneal neural sheath tumors in patients without von Recklinghausen's disease are quite rare. Intrapelvic tumors are often diagnosed at a later stage. Neuroimaging is very helpful to delineate this unusual site and the extent of tumor development, and to determine the appropriate surgical intervention. A clear understanding of retroperitoneal anatomy is essential for safe removal of such tumors. Complete resection is preferred to prevent local recurrence and malignant transformation. Although root section is inevitable, neurological deficit is unlikely.
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  • —Case Report—
    Toru FUKUHARA, Mark G. LUCIANO, Jing Z. LIU, Guang H. YUE
    2001 Volume 41 Issue 12 Pages 626-630
    Published: 2001
    Released on J-STAGE: June 28, 2005
    JOURNAL OPEN ACCESS
    A 70-year-old man with hydrocephalus was examined with functional magnetic resonance (fMR) imaging before and after ventriculoperitoneal shunting. Preoperatively, activation by right hand exercise revealed only a slight signal increase in the peri-rolandic area. However, 3 months after ventriculoperitoneal shunting, a significant signal increase was observed. fMR imaging may detect activity-related improvement of cerebral blood flow responses in patients with hydrocephalus after surgical treatment.
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