Neurologia medico-chirurgica

Original Articles

Transluminal Imaging With Perspective Volume Rendering of Computed Tomographic Angiography for the Delineation of Cerebral Aneurysms

Toru SATOH

2001 Volume 41 Issue 9 Pages 425-430
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.425

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Transluminal imaging with perspective volume rendering of computed tomographic angiography was used to investigate three patients with unruptured cerebral aneurysms. Selective changes in the opacity chart of computed tomography values, based on a spiked peak curve, represented the contour of the vessel and aneurysmal walls as a series of rings, and allowed a transluminal view from outside or inside the vessel lumen through the spaces between the rings. This imaging technique provided direct visualization of the underlying structures and an extensive perspective view of the cerebral aneurysms, including the parent arteries and surrounding bony structures, through the overlying vessel and aneurysmal walls. Transluminal imaging may be a useful method for the extra- and intraluminal diagnosis of a cerebral aneurysm, and for simulation of the interventional and surgical procedures considered for cerebral aneurysms.

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Asymptomatic Brain Tumor Detected at Brain Check-up

Masanari ONIZUKA, Kazuhiko SUYAMA, Akira SHIBAYAMA, Tsuyoshi HIURA, No ...

2001 Volume 41 Issue 9 Pages 431-435
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.431

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Brain check-up was performed in 4000 healthy subjects who underwent medical and radiological examinations for possible brain diseases in our hospital from April 1996 to March 2000. Magnetic resonance imaging revealed 11 brain tumors which consisted of six meningiomas, three pituitary adenomas, one astrocytoma, and one epidermoid cyst. The detection rate of incidental brain tumor in our hospital was 0.3%. Nine patients underwent surgery, with one case of morbidity due to postoperative transient oculomotor nerve paresis. The widespread use of brain check-up may increasingly detect asymptomatic brain tumors. Surgical indications for such lesions remain unclear, and the strategy for treatment should be determined with consideration of the patient's wishes.

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Case Reports

Spontaneous Thrombosis of Intracavernous Internal Carotid Artery Aneurysm and Parent Artery Occlusion in Patients With Positive Balloon Test Occlusion

—Two Case Reports—

Ryu KUROKAWA, Yoshiaki KUROSHIMA, Kazunari YOSHIDA, Takeshi KAWASE

2001 Volume 41 Issue 9 Pages 436-441
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.436

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Two patients with giant intracavernous internal carotid artery (ICA) aneurysms were intolerant to balloon test occlusion of the ICA, and later developed spontaneous thrombosis of the aneurysm and the parent ICA without ischemic sequelae. Case 1: A 60-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. An unsuccessful extracranial-to-intracranial bypass graft operation was complicated by transient postoperative ophthalmoplegia. The patient did not tolerate balloon test occlusion of the right ICA after attempted bypass surgery, and was treated conservatively. The patient presented with acute onset of headache 3 years later. Case 2: A 50-year-old female with a giant right intracavernous ICA aneurysm presented with right abducens nerve paresis. The patient was managed conservatively after a positive balloon test occlusion of the right ICA. The patient suffered transient hypopituitarism and acute onset of headache 2 years later. Spontaneous thrombosis of the aneurysms and occlusion of the parent ICA were found in both patients. Neither had major hemispheric infarcts, but the first patient had asymptomatic infarcts, which were presumed to be thromboembolic in nature. Patients with intracavernous ICA aneurysms who have positive balloon test occlusions appear to develop tolerance to spontaneous and gradual occlusion of the ICA without significant sequelae. However, these patients have an increased risk of developing embolic infarctions. The role for anticoagulation and repeat hemodynamic tests remains unclear.

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Endarterectomy for Narrowing of the External Carotid Artery in a Patient Who Underwent Extracranial-Intracranial Bypass for Occlusion of the Internal Carotid Artery

—Case Report—

Shigetaka ANEGAWA, Seiji SHIGEKAWA, Takashi HAYASHI, Yoshihiko FURUKAW ...

2001 Volume 41 Issue 9 Pages 442-445
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.442

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A 56-year-old man had undergone extracranial-intracranial (EC-IC) bypass surgery for occlusion of the right internal carotid artery. Six years later, he complained of transient episodes of numbness in the left arm, occurring periodically over the previous 3 months. Neuroimaging showed the right external carotid artery was severely narrowed and cerebral blood flow (CBF) was diffusely low. Endarterectomy of the right external carotid artery was performed. Postoperative CBF was markedly improved, suggesting that EC-IC bypass became effective again by endarterectomy of a parent artery.

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Primitive Trigeminal Artery Variant Aneurysm Treated With Guglielmi Detachable Coils

—Case Report—

Akimasa NISHIO, Yoshihiko NISHIJIMA, Masaki KOMIYAMA, Mitsuhiro HARA

2001 Volume 41 Issue 9 Pages 446-449
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.446

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A 69-year-old woman had suffered from diplopia on right lateral gaze for the last 4 months due to right abducens nerve paresis. Right carotid angiography showed a cavernous internal carotid artery (ICA) aneurysm of 17 × 16 × 14 mm size and a primitive trigeminal artery (PTA) variant supplying the territory of the posterior inferior cerebellar artery. Intraluminal occlusion of the aneurysm was performed with 15 Guglielmi detachable coils. The flow of the PTA variant and the ICA was preserved. Right abducens nerve paresis improved partially. PTA variant is a primitive artery originating from the cavernous ICA supplying the cerebellum without opacification of the basilar artery. Only four of the 67 cases of PTA variant were associated with an aneurysm of the PTA variant. The possibility of this rare association should be considered when treating cavernous portion aneurysm because of the risk of cerebellar ischemia.

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Cerebral Ischemic Complications Following Intracranial Bleeding in Patients With Moyamoya Disease

—Three Case Reports—

Toru IWAMA, Yoshinori KOTANI, Hiroyasu YAMAKAWA, Izumi NAGATA, Nobuo H ...

2001 Volume 41 Issue 9 Pages 450-453
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.450

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Three patients with bleeding-type moyamoya disease suffered ischemic complications following their first episode of intracranial bleeding. The patients presented with intraventricular hemorrhage and suffered cerebral infarction on the 14th, 16th, and 11th days after the ictus, respectively. The clinical records revealed no obvious hypotension before progression to infarction and suggested that dehydration accelerated by the administration of hyperosmotic drugs was a contributing factor to the infarction. Two patients underwent superficial temporal artery-middle cerebral artery anastomoses in the chronic stages and have never experienced further ischemic complications. The other patient died despite receiving intensive care. Hemodynamic reserve may be severely impaired in patients with bleeding-type moyamoya disease. Adequate control of hydration is important to prevent cerebral infarction after intracranial bleeding in patients with moyamoya disease.

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Basilar Artery Vasculitis Secondary to Sphenoid Sinusitis

—Case Report—

Takatoshi SORIMACHI, Kenichi KAMADA, Tsunenori OZAWA, Shigekazu TAKEUC ...

2001 Volume 41 Issue 9 Pages 454-457
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.454

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A 35-year-old male presented with basilar artery vasculitis secondary to sphenoid sinusitis manifesting as rapidly deteriorating symptoms including consciousness disturbance and right hemiparesis. Computed tomography (CT) on admission showed sphenoid sinusitis without intracranial lesion. Emergency angiography demonstrated basilar artery stenosis. The neurological deterioration was considered to be caused by ischemia of the perforating arteries branching from the stenotic portion of the basilar artery. The patient was treated with urokinase infusion through a microcatheter just proximal to the stenosis 3 hours after the onset of the symptoms. His consciousness level and right hemiparesis markedly improved immediately after the procedure. Magnetic resonance (MR) imaging on day 5 revealed that extension of the sphenoid sinusitis into the prepontine cistern had formed an abscess which was attached to the clivus. The basilar artery was embedded in the abscess at the angiographic stenosis. Cerebrospinal fluid (CSF) analysis showed white blood cell count of 601/mm³ with 82% neutrophils, 89.2 mg/dl protein, and 31 mg/dl glucose. No causative organism in the CSF could be identified by smear or culture. Early MR imaging and CSF examination are recommended when patients present with both ischemic symptoms involving the basilar artery and opacification of the sphenoid sinus on CT to identify basilar artery vasculitis secondary to sphenoid sinusitis.

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Transcondylar Fossa Approach to Treat Ventral Foramen Magnum Meningioma

—Case Report—

Yuichi TANGE, Akira UTO, Akihiko WACHI, Junpei KOIKE

2001 Volume 41 Issue 9 Pages 458-462
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.458

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A 41-year-old female presented with a meningioma of the craniocervical junction manifesting as tetraparesis and vesicourethral dysfunction. Neuroradiological examinations showed a homogeneous enhanced mass lesion extending from the foramen magnum to the upper aspect of the second vertebral body. The tumor was totally removed via the transcondylar fossa approach, which is one type of the lateral approach. She was discharged without neurological deficits. The transcondylar approach is often utilized for lesions that occupy the ventral portion around the foramen magnum. The transcondylar fossa approach, a variation of the transcondylar approach, is a refined technique which obtains a closely similar surgical working field. Use of the transcondylar fossa approach remains controversial when treating patients with little brain stem dislocation, a small condylar fossa, and a protruding occipital condyle, but the approach can easily be converted to the transcondylar approach. The transcondylar fossa approach could become a standard method to access the craniocervical junction.

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Interhemispheric Cyst Causing Leg Monoparesis in the Elderly

—Case Report—

Toshiaki HAYASHI, Michiharu NISHIJIMA, Kunihiko UMEZAWA, Miki FUJIMURA ...

2001 Volume 41 Issue 9 Pages 463-465
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.463

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A 64-year-old female presented with a rare case of interhemispheric cerebral cyst manifesting as progressive monoparesis in the right lower extremity for 2 years. Surgical excision of the cyst wall was performed and communication to the subdural space was created. Postoperatively, the cyst was greatly reduced in size, and the neurological signs and symptoms were markedly improved. Interhemispheric cyst often presents with motor disturbances such as hemiparesis or paraparesis. These symptoms tend to progress slowly and sometimes years are required for a proper diagnosis. Interhemispheric cyst can also cause slowly progressive monoparesis in the lower extremity.

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Technical Note

Modified Draping to Avoid Fluid Leakage in Cranial Surgery

—Technical Note—

Satoru SHIMIZU, Takahiro MOCHIZUKI, Kenji NAKAYAMA, Kiyotaka FUJII

2001 Volume 41 Issue 9 Pages 466-468
Published: 2001
Released on J-STAGE: June 29, 2005

DOIhttps://doi.org/10.2176/nmc.41.466

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Contamination under draping due to leakage of fluid from the surgical field should be avoided to maintain cleanness. A modified draping method was developed using standard draping materials but with an irrigation pouch applied directly to the scalp. The present method prevents fluid leakage along the scalp, increases surgeon comfort, and reduces postoperative room cleaning.

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