Neurologia medico-chirurgica

Original Articles

Efficacy of Navigation in Skull Base Surgery Using Composite Computer Graphics of Magnetic Resonance and Computed Tomography Images

Nakamasa HAYASHI, Masanori KURIMOTO, Yutaka HIRASHIMA, Hiroaki IKEDA, ...

2001 Volume 41 Issue 7 Pages 335-339
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.335

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The efficacy of a neurosurgical navigation system using three-dimensional composite computer graphics (CGs) of magnetic resonance (MR) and computed tomography (CT) images was evaluated in skull base surgery. Three-point transformation was used for integration of MR and CT images. MR and CT image data were obtained with three skin markers placed on the patient's scalp. Volume-rendering manipulations of the data produced three-dimensional CGs of the scalp, brain, and lesions from the MR images, and the scalp and skull from the CT. Composite CGs of the scalp, skull, brain, and lesion were created by registering the three markers on the three-dimensional rendered scalp images obtained from MR imaging and CT in the system. This system was used for 14 patients with skull base lesions. Three-point transformation using three-dimensional CGs was easily performed for multimodal registration. Simulation of surgical procedures on composite CGs aided in comprehension of the skull base anatomy and selection of the optimal approaches. Intraoperative navigation aided in determination of actual spatial position in the skull base and the optimal trajectory to the tumor during surgical procedures.

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Lumbar Disc Herniation in Patients Up to 25 Years of Age

Terttu Aulikki PIETILÄ, Ruediger STENDEL, Theodoros KOMBOS, Josef ...

2001 Volume 41 Issue 7 Pages 340-344
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.340

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Retrospective analysis of 165 patients (105 males, 60 females) with a mean age of 21.2 years (range 14 to 25 years) of 6933 surgically treated patients from January 1987 to May 1999 focused on age and sex distribution, body mass, familial predisposition, trauma, histology, and clinical course. The incidence of herniated lumbar discs was 2.3% in patients aged up to 25 years. A valid family history was obtained in 121 patients and a positive history was found in 82 of these patients (67.8%). The patients had a higher body mass index compared to a group of individuals with a similar age structure. Radiography demonstrated bony changes in 124 patients (75.2%), primarily attributable to postural deformities such as scoliosis. The condition of the bony structures seems to be more important than the condition of the disc tissue in the occurrence of this disease in young patients.

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Case Reports

Transorbital Penetrating Injury by a Chopstick

—Case Report—

Takeshi MATSUYAMA, Kazuo OKUCHI, Keiji NOGAMI, Mitiaki HATA, Yoshinori ...

2001 Volume 41 Issue 7 Pages 345-348
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.345

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A one-year-old boy presented with orbitocranial penetrating injury by a chopstick. Neurological examination did not reveal abnormal findings. Skull radiography did not reveal any sign of fracture and there were no abnormal findings. Initially, computed tomography (CT) of the head did not reveal any intracranial lesions. However, bone window CT showed a well-defined low-density abnormality measuring 2.5 cm in length in the right orbit and parasellar region. Magnetic resonance imaging clearly revealed a low-intensity structure extending from the orbit to the prepontine area. Surgical exploration was emergently performed and the wooden fragment was removed. The postoperative course was uneventful. Transorbital penetrating injury by a wooden foreign body is relatively rare. The wound may be superficial and trivial. Major neurological deficit does not usually manifest immediately, so the penetrating injury may be overlooked. If the foreign body is retained in the orbit and cranium, severe infectious complications may occur later.

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Cavernous Angioma of the Corpus Callosum Mimicking an Astrocytic Tumor

—Case Report—

Shunichi HARADA, Maki NIIMI, Kenichi MURAKAMI, Tsuneo NAKAMURA

2001 Volume 41 Issue 7 Pages 349-351
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.349

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A 49-year-old female presented with a mass at the genu of corpus callosum manifesting as vertiginous sensation persisting for a couple of months. The preoperative diagnosis based on neuroimaging was astrocytic tumor, probably an oligodendroglioma. The mass was totally excised through a left interhemispheric approach without postoperative neurological deficits. Histological examination of the mass revealed only vascular components with tiny hemorrhage, compatible with cavernous angioma. Cavernous angioma at the genu of corpus callosum is very rare, and definitive diagnosis can be achieved only through surgery. Surgical intervention should be considered before starting radiotherapy without histological confirmation.

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Hearing Restoration From Deafness After Resection of a Large Cerebellopontine Angle Meningioma

—Case Report—

Toshiro KATSUTA, Tooru INOUE, Ken UDA, Akinori MASUDA

2001 Volume 41 Issue 7 Pages 352-355
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.352

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A 61-year-old man presented with a large cerebellopontine angle meningioma manifesting as a 1-year history of deafness on the right side, in whom hearing was restored from the deaf state immediately after tumor resection. Neuroimaging demonstrated a large mass in the right cerebellopontine angle, originating at the region adjacent to the jugular foramen. Audiometry showed his hearing was off-scale (>105 dB) on the right. The tumor was successfully removed through the retrosigmoid approach, and the integrity of the 7th and 8th cranial nerves was maintained. The patient regained hearing on the day after the operation, which continued to improve until near-normal. The 8th cranial nerve function may recover dramatically after removal of non-acoustic tumors, even if preoperative hearing loss is profound. To maximize the opportunity to regain hearing, approaches which devastate cochlear function should be avoided and more meticulous manipulation during tumor removal is needed.

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Mature Teratoma Arising From the Sella

—Case Report—

Dattatraya MUZUMDAR, Atul GOEL, Ketan DESAI, Asha SHENOY

2001 Volume 41 Issue 7 Pages 356-359
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.356

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A 26-year-old, short statured, obese male presented with a mature teratoma located entirely within the dural confines of the sella manifesting as headaches and progressive loss of vision. He had panhypopituitarism. Magnetic resonance imaging showed a large sellar-suprasellar but entirely infradiaphragmatic tumor of varying consistency. The tumor was resected through a trans-sphenoidal route. The tumor had elevated the diaphragma sellae to a significant extent but did not pass through. Histological examination confirmed a mature teratoma.

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Solitary Metastasis From Occult Follicular Carcinoma of the Thyroid Mimicking Trigeminal Neurinoma

—Case Report—

Rajneesh KACHHARA, Suresh NAIR, Vishnupuri Venkatraman RADHAKRISHNAN, ...

2001 Volume 41 Issue 7 Pages 360-363
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.360

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A 50-year-old woman presented with an extremely uncommon case of solitary metastasis from follicular carcinoma of the thyroid, which presented clinically as trigeminal neurinoma. Neuroimaging detected a tumor in the right petrous apex, which was removed surgically. Histological examination showed metastatic follicular carcinoma of the thyroid. However, no primary tumor was detected by various investigations. The tumor recurred twice, and was treated surgically both times. The patient finally agreed to adjuvant therapy for the suspected primary. Radiotherapy was performed followed by complete thyroidectomy. Examination of the gross specimen found the tumor nodule. Clinically significant metastasis can arise from histologically benign and silent follicular thyroid neoplasms.

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Reversible Posterior Leukoencephalopathy Syndrome in a Patient With Hypertensive Encephalopathy

—Case Report—

Kensaku YOSHIDA, Takuji YAMAMOTO, Kentaro MORI, Minoru MAEDA

2001 Volume 41 Issue 7 Pages 364-369
Published: 2001
Released on J-STAGE: June 30, 2005

DOIhttps://doi.org/10.2176/nmc.41.364

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A 58-year-old male presented with reversible posterior leukoencephalopathy syndrome (RPLS) manifesting as headache, papilledema, and renal hypertension. T₂-weighted magnetic resonance (MR) imaging showed hyperintensity lesions in the medulla, pons, bilateral thalami, and bilateral deep white matter of the parieto-occipital lobes. The pons was swollen. Diffusion-weighted MR imaging did not show increased intensity in these lesions. The lesions disappeared with improvement of clinical symptoms after treatment for hypertension. These findings suggested the lesions were vasogenic edema and the diagnosis was RPLS. T₂-weighted and diffusion-weighted MR imaging are useful modalities to differentiate RPLS from other central nervous system abnormalities such as infarction, multiple sclerosis, and central pontine myelinolysis. The clinical and neuroradiological findings of RPLS can be reversed by timely initiation of treatment for the causative factor.

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