Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 42, Issue 11
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Iwao YAMAKAMI, Yoshio UCHINO, Eiichi KOBAYASHI, Naokatsu SAEKI, Akira ...
    2002 Volume 42 Issue 11 Pages 465-471
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    The prognostic significance of the variety of changes in the internal auditory meatus (IAM) caused by vestibular schwannoma was retrospectively analyzed in 69 consecutive patients with vestibular schwannoma. Preoperative bone-window computed tomography was used to classify IAM changes into extensive destruction (17%), widening (46%), and normal IAM (36%). Extensive destruction (47 ± 19 years) and widening (48 ± 13) occurred in significantly younger patients than normal IAM (59 ± 9). Preoperative hearing was significantly more severely disturbed in patients with extensive destruction than in those with widening or normal IAM. IAM change was significantly related to the tumor consistency, as normal IAM was more common in patients with cystic tumor than in those with solid tumor. Postoperative hearing and facial function were worse in patients with severe IAM change, although the relationship between the IAM change and the surgical result was not significant. One patient with extensive destruction developed postoperative cerebrospinal fluid (CSF) leakage through the air cells around the IAM, and needed surgical repair. Severe IAM change occurs with solid tumor and causes severely disturbed preoperative hearing in younger patients, which reflects the tumor aggressiveness. Severe IAM change increases the technical difficulty of tumor removal and the risk of postoperative CSF leakage, and is associated with a poorer prognosis for patients with vestibular schwannoma.
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  • Elio Arnaldo MARIN SANABRIA, Kazumasa EHARA, Norihiko TAMAKI
    2002 Volume 42 Issue 11 Pages 472-480
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    The surgical treatment of patients with foramen magnum meningioma remains challenging. This study evaluated the outcome of this tumor according to the evolution of surgical approaches during the last 29 years. A retrospective analysis of medical records, operative notes, and neuroimages of 492 meningioma cases from 1972 to 2001 identified seven cases of foramen magnum meningioma (1.4%). All patients showed various neurological symptoms corresponding with foramen magnum syndrome. The tumor locations were anterior in five cases and posterior in two. Surgical removal was performed through a transoral approach in one patient, the suboccipital approach in three, and the transcondylar approach in two. Total removal was achieved in all patients, except for one who refused any surgical treatment. The major complications were tetraparesis and lower cranial nerve paresis for tumors in anterior locations, and minor complications for posterior locations. One patient died of atelectasis and pneumonia after a long hospitalization. The transcondylar approach is recommended for anterior locations, and the standard suboccipital approach for posterior locations.
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  • Kensuke KAWAI, Hiroyuki SHIMIZU, Taketoshi MAEHARA, Hideki MURAKAMI
    2002 Volume 42 Issue 11 Pages 481-490
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    The outcome of long-term vagus nerve stimulation (VNS) was evaluated in 13 Japanese patients with intractable epilepsy, all followed up for more than 4 years (48-91 months, median 56 months). VNS achieved a long-lasting and cumulative seizure-control effect in nine of 13 patients. The mean reduction of seizure frequency in the 1st to 4th year was 28%, 47%, 54%, and 63%, respectively. The percentage of patients with >60% seizure reduction in the 1st to 4th year was 15%, 46%, 54%, and 69%, respectively. One patient did not respond to the treatment at all. No patient became completely free from seizure or free from medication, but the number and/or dosage of antiepileptic drugs was reduced in five patients. Ten patients underwent exchange of the generator and continued treatment, and two patients underwent removal of the generator because of the unsatisfactory result. VNS controlled more disabling seizures earlier and more efficiently than less disabling seizures in seven patients. The cumulative reduction of seizures was partly associated with changes in the device setting toward increased stimulation. These effects were similar in patients with or without previous resective surgery. Long-term VNS therapy achieved a favorable outcome in a significant proportion of patients with intractable epilepsy.
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Case Reports
  • —Case Report—
    Atsushi FUKUNAGA, Masanao TABUSE, Heiji NARITAKA, Tsuneo NAKAMURA, Tak ...
    2002 Volume 42 Issue 11 Pages 491-495
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    A 49-year-old man presented with nontraumatic bilateral intracranial vertebral artery dissections without subarachnoid hemorrhage manifesting as Wallenberg's syndrome on the right. Magnetic resonance imaging revealed an infarct in the right dorsolateral aspect of the medulla oblongata. Antiplatelet therapy was administered. Vertebral angiography performed on the 9th hospital day (Day 9) revealed pearl and string sign in the right vertebral artery and narrowing of the left vertebral artery. Second angiography performed on Day 25 showed no change, but third angiography performed on Day 74 revealed spontaneous resolution of the bilateral vertebral artery dissections. Magnetic resonance angiography performed on Day 250 showed no evidence of dissection. However, magnetic resonance imaging revealed a small infarct in the splenium of the corpus callosum. Spontaneous resolution of stenotic dissections of the bilateral vertebral arteries is extremely unusual. Serial cerebral angiography and magnetic resonance angiography are very important for monitoring the time course of changes in patients with vertebral artery dissections.
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  • —Four Case Reports—
    Kenichi AMAGASAKI, Takashi HIGA, Nobuyasu TAKEUCHI, Toshiyuki KAKIZAWA ...
    2002 Volume 42 Issue 11 Pages 496-500
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    Late recurrence of subarachnoid hemorrhage (SAH) due to regrowth of aneurysm after neck clipping surgery occurred in four patients. Two patients underwent surgical treatment, and two patients received endovascular treatment. Endovascular treatment was successful in one case, but emergent surgery was necessary for the other case because of possible pseudoaneurysm formation. Postoperative course of all patients was excellent. Late recurrence of SAH can occur even after complete clipping, and further treatment should be considered.
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  • —Case Report—
    Ketan DESAI, Trimurti NADKARNI, Mohinish BHATJIWALE, Atul GOEL
    2002 Volume 42 Issue 11 Pages 501-503
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    A 38-year-old female presented with headaches, fever, and malaise. Computed tomography showed an intraventricular peripheral ring-enhanced lesion with central necrosis. The lesion was totally excised. Histological examination revealed a tuberculoma. The patient was treated with antituberculous chemotherapy. The patient was asymptomatic at 9 months. Ventricular involvement in neurotuberculosis is rare, but should be considered in the presence of other indicators of tuberculous infection.
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  • —Case Report—
    Osamu HAMASAKI, Toshinori NAKAHARA, Shigeyuki SAKAMOTO, Munenori KUTSU ...
    2002 Volume 42 Issue 11 Pages 504-509
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    A 59-year-old man presented with a rare intracranial meningeal melanocytoma in the left cerebellopontine angle. The patient underwent partial surgical excision and radiosurgery for successful control of the tumor. Meningeal melanocytoma is an essentially benign melanotic tumor, derived from the melanocytes of the leptomeninges, and may occur anywhere in the cranial and spinal meninges. Preoperative differential diagnosis of intracranial meningeal melanocytoma from malignant melanoma is difficult based on magnetic resonance imaging. Ultrastructural findings are essential to establish the diagnosis. The prognosis of this tumor is not always favorable with occasional local recurrence. Total resection is the best treatment, but gamma knife radiosurgery is effective for the residual tumor following partial resection.
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  • —Case Report—
    Junichi YOSHIMURA, Kiyoshi ONDA, Ryuichi TANAKA, Hitoshi TAKAHASHI
    2002 Volume 42 Issue 11 Pages 510-515
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    A 38-year-old man presented with a giant cell reparative granuloma (GCRG) of the left temporal bone. Computed tomography showed a osteolytic middle cranial mass lesion. Magnetic resonance (MR) imaging showed the lesion as low intensity with heterogeneous enhancement by gadolinium on the T1-weighted images, and extremely low intensity on the T2-weighted images. Angiography showed the lesion as highly vascular and fed by branches of the left external carotid artery. After preoperative embolization, gross total removal of the tumor was performed. The postoperative course was uneventful and no evidence of recurrence has been found for more than 4 years. Histological examination revealed GCRG with multinucleated giant cells in the fibrous background, abundant collagen bundles, hemosiderin deposits, and trabeculae of reactive bone. Some of the mononuclear stromal cells and almost all of the giant cells were positive for CD68, suggesting histiocytic differentiation. These histological features reflect the marked decrease in signal intensity on T2-weighted MR images.
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  • —Case Report—
    Eiichi ISHIKAWA, Koji TSUBOI, Kojiro ONIZAWA, Akira HARA, Jun KUSAKARI ...
    2002 Volume 42 Issue 11 Pages 516-520
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    A 24-year-old man presented with a rare chondroblastoma of the temporal base manifesting as local pain accompanied by difficulty in opening the mouth. Gross total removal was achieved at initial surgery, but the tumor demonstrated rapid and destructive regrowth from a very small residual volume without definite histological malignant transformation. Growth activity estimated by MIB-1 staining increased spontaneously from 2.5% at the initial operation to 18.7% at recurrence. Further extensive radical tumor removal by surgeons from multiple disciplines was performed. The patient has been free of recurrence for 3 years without radiotherapy. Chondroblastoma of the temporal bone is widely accepted as a benign tumor and regrowth after gross total removal is very rare. However, some cases of chondroblastoma have potentially high mitotic activity.
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  • —Two Case Reports—
    Takuro HAYASHI, Kazunari YOSHIDA, Kenji HIRAGA, Makoto KATAYAMA, Takes ...
    2002 Volume 42 Issue 11 Pages 521-525
    Published: 2002
    Released on J-STAGE: June 12, 2005
    JOURNAL OPEN ACCESS
    Two patients with vagal schwannoma manifesting as deafness with no lower cranial nerve paresis were treated surgically. A 42-year-old male underwent partial resection of the tumor, which was tightly adhered to the cranial nerves, to prevent lower cranial nerve paresis. A 29-year-old female underwent total removal of the tumor without complications. The patients recovered useful audition with no postoperative deficit.
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