巻号一覧
42 巻, 5 号
選択された号の論文の10件中1～10を表示しています
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Original Articles
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Intraoperative Angiography Evaluation of the Microsurgical Clipping of Unruptured Cerebral AneurysmsKiyoyuki YANAKA, Hiroyuki ASAKAWA, Shozo NOGUCHI, Yuji MATSUMARU, Akio ...2002 年 42 巻 5 号 p. 193-201
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスIntraoperative angiography evaluation of the clippings of cerebral aneurysms was investigated in a series of 38 consecutive patients with unruptured cerebral aneurysms to determine any favorable impact on the outcome. Unexpected findings including major arterial occlusion or residual aneurysm were identified. Specific variables such as the size and site of aneurysm were analyzed to determine the impact on clinical outcome and the incidence of clip modification. There were 11 large and 27 small aneurysms in this series. Mortality and permanent morbidity after microsurgical clipping were 0.0% and 2.6%, respectively. Unexpected angiographic findings necessitating clip repositioning consisted of residual aneurysm in two cases and distal branch occlusion or parent vessel stenosis in four. The need for clip modification was significantly higher for large than for small aneurysms (p = 0.007), and the rate of clip adjustment increased with increasing aneurysm size (p = 0.008). Intraoperative assessment prior to wound closure allows for the recognition and correction of defects and decreases the risk of postoperative complications. Intraoperative angiography may become important in the microsurgical clipping of unruptured cerebral aneurysms, especially large aneurysms.
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Hirofumi NAGANUMA, Eiji SATOH, Hideaki NUKUI2002 年 42 巻 5 号 p. 202-213
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスPituitary adenomas are usually soft, but 5-13.5% are fibrous adenomas which are difficult to remove. Magnetic resonance (MR) imaging and operative findings were evaluated in eight patients (12.1%) with fibrous pituitary adenoma among 66 patients. Tumor specimens were examined histologically and immunohistochemically for collagen content and subtypes. Seven patients had clinically inactive non-functioning pituitary adenomas and one patient growth hormone-secreting adenoma. All patients underwent transsphenoidal surgery. Four cases were giant adenomas with suprasellar extension of more than 2 cm. T1- and T2-weighted MR imaging showed the tumors as nearly isointense to the surrounding brain, except in one case where the tumor was high intense on T2-weighted MR imaging. All tumors required piecemeal resection using a micro-dissector and tumor forceps. Four tumors of maximum size more than 3 cm needed a second operation. The interface between the thinned normal pituitary gland and fibrous adenoma was intended to identify at the anterior-superior portion in recent four cases, which was helpful to remove the tumors and preserve pituitary functions. Histological examination revealed prominent deposition of collagen in the perivascular area. The percentage of collagen content in fibrous adenomas was more than 5% and significantly higher than that in soft adenomas and normal pituitary glands. Immunohistochemical examination showed positive staining for collagen types I and III in the fibrous adenomas, but only for type V collagen in the normal pituitary glands. Large fibrous adenomas can be resected by transsphenoidal surgery which may require two-stage operations. Identification of the interface between the normal pituitary gland and adenoma is helpful to remove fibrous adenomas and to preserve pituitary functions. We propose that firm adenomas containing more than 5% collagen are “fibrous” adenomas.
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Case Reports
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—Case Report—Takeshi MATSUYAMA, Kazuo OKUCHI, Kazuobu NORIMOTO, Tohru UEYAMA2002 年 42 巻 5 号 p. 214-216
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスA 39-year-old woman presented with a rare dissecting aneurysm of the proximal anterior inferior cerebellar artery (AICA). She presented with sudden onset of headache and vomiting, and subsequently became comatose with acute respiratory distress syndrome. Computed tomography showed subarachnoid hemorrhage and ventricular dilation. Left vertebral angiography identified a fusiform aneurysm at the proximal portion of the left AICA. The patient underwent endovascular treatment using Guglielmi detachable coils. The aneurysm was completely embolized. Computed tomography detected no infarcted areas in the regions supplied by the AICA. She was discharged without neurological deficits.
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—Case Report—Akimasa NISHIO, Kenji OHATA, Kazuyuki TSUCHIDA, Naohiro TSUYUGUCHI, Mi ...2002 年 42 巻 5 号 p. 217-220
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスA 57-year-old woman presented with a dural arteriovenous fistula (AVF) involving the superior sagittal sinus (SSS) based upon serial radiological examinations. Her chief complaints were headache and vomiting. Cerebral angiography and magnetic resonance (MR) venography revealed the sinus thrombosis involving the SSS, the bilateral transverse sinuses (TSs), and the right sigmoid sinus. Her symptoms disappeared after anticoagulant therapy. Follow-up MR venography revealed almost complete recanalization of the occluded sinuses, followed by restenosis of the SSS and the left TS and occlusion of the right TS without symptoms. She developed transient right hemiparesis 13 months after the initial on- set. Cerebral angiography revealed a dural AVF involving the SSS with cortical reflux into the left frontoparietal region. The dural AVF was occluded by transarterial and transvenous embolization. Her symptom disappeared during the follow-up period.
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—Case Report—Tsutomu KAWAGUCHI, Teruaki KAWANO, Yoshirou KANEKO, Takao OOASA, Hides ...2002 年 42 巻 5 号 p. 221-223
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスA 44-year-old man presented with traumatic injuries of the bilateral middle meningeal arteries after a traffic accident. Neurological examination found left visual impairement due to left optic nerve injury. Computed tomography demonstrated a small amount of left epidural hemorrhage and bilateral skull fractures. Left external carotid angiography revealed a pseudoaneurysm of the left middle meningeal artery at the sphenoid ridge. Right external carotid angiography demonstrated a dural arteriovenous fistula fed by the right middle meningeal artery colocated with the right frontal convexity fracture. Transarterial embolization of the left middle meningeal artery pseudoaneurysm with four fibered platinum coils and transarterial embolization of the right dural arteriovenous fistula with poly(2-hydroxyethyl methacrylate-co-methyl methacrylate) were performed, resulting in complete obliteration of both lesions. Angiographic cure was obtained and the postoperative course was uneventful.
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—Case Report—Keizo YAMAMOTO, Kazumichi YAMADA, Tadashi NAKAHARA, Akira ISHIHARA, Sh ...2002 年 42 巻 5 号 p. 224-227
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスA 48-year-old female presented with a subependymal giant cell astrocytoma (SEGA) without tuberous sclerosis manifesting as memory and mental disturbance. Magnetic resonance imaging showed a huge mass which was well-demarcated and extended from the anterior horn of the right lateral ventricle to the septal area on the right side. Surgery was performed with partial removal of the tumor. The histological diagnosis was typical SEGA. One year postoperatively, follow-up magnetic resonance imaging revealed marked regrowth of the tumor. Total resection of the tumor was performed. Microscopic and immunohistochemical studies could not identify the cause of the rapid regrowth. SEGA can regrow rapidly after partial removal of the tumor.
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—Case Report—Yasushi MOTOYAMA, Hiroyuki HASHIMOTO, Yasuhito ISHIDA, Jun-Ichi IIDA2002 年 42 巻 5 号 p. 228-231
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスAn 83-year-old man presented with gait disturbance, dementia, and urinary incontinence that had progressed over 2 months. Computed tomography (CT) of the brain revealed hydrocephalus due to a well-demarcated, round hyperdense mass in the third ventricle, which was not enhanced by contrast agent. Ten days after the initial evaluation, CT revealed that the cyst in the third ventricle had disappeared. Magnetic resonance imaging revealed spontaneous rupture of the lesion and remnants of cyst wall anchored to the anterior roof of the third ventricle. Thereafter, the symptoms of hydrocephalus subsided. However, 6 months later the patient's condition gradually deteriorated and the ventricles dilated without any evidence of tumor regrowth. Surgical intervention was not performed as the family of the patient withheld consent. The natural history of colloid cysts of the third ventricle remains unclear. Spontaneous rupture of a presumed colloid cyst of the third ventricle should be considered when planning treatment.
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—Case Report—Toru MATSUI, Kohichi IWAMURO, Tosiroh ISHIKAWA, Takao ASANO, Shinji IT ...2002 年 42 巻 5 号 p. 232-236
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスA 41-year-old man presented with a large mass bulging over the suprazygomatic temporal region. Neuroradiological examination showed that the huge extra-axial mass with osteolytic character originated from the upper surface of the petrous bone. Preoperative obliteration of the feeding arteries with superselective intravascular embolization was helpful for the total removal of the tumor. Histological examination revealed that the tumor consisted of massive fibrohistiocytic proliferation with numerous heavily hemosiderin-laden macrophages and numerous multinucleated giant cells. The most probable diagnosis was giant cell reparative granuloma. Therefore, no postoperative irradiation or other adjuvant therapy was given.
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—Case Report—Takeshi MATSUYAMA, Kazuo OKUCHI, Kazuo GODA2002 年 42 巻 5 号 p. 237-241
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスA 47-year-old right-handed female became aware of proximal ache and muscle weakness in the right shoulder and elbow in 1997. Atrophy of the right biceps muscle was recognized and the right deltoid, triceps, supraspinatus, and infraspinatus muscles were weak. The Morley test and elevated arm stress test were positive. Neurolysis of the brachial plexus and anterior scalenectomy were performed via a right supraclavicular approach. An abnormal fibromuscular band was identified passing between the upper and middle trunks and constricting the middle trunk. Another scalene muscle anomaly was found passing between the C-5 and C-6 nerve roots and connecting the anterior and middle scalene muscles. These muscles were resected, and thorough neurolysis was performed around all nerves and the trunks. Postoperatively, all symptoms completely resolved and the patient was discharged 5 days after surgery. Thoracic outlet syndrome (TOS) manifests as symptoms of lower cervical nerve involvements with hypesthesia and paresthesia. However, upper plexus TOS manifests as symptoms due to the involvement of the C-5 to C-7 nerve roots, and is relatively rare. Transaxillary first rib resection is performed as the primary operation for TOS, but supraclavicular scalenectomy is effective for upper plexus TOS.
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NMC Essay Club
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Kyu Chang LEE2002 年 42 巻 5 号 p. 242-243
発行日: 2002年
公開日: 2005/06/18
ジャーナル オープンアクセスPDF形式でダウンロード (257K)
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