Neurologia medico-chirurgica

Review Article

Review of Spinal Epidural Cavernous Hemangioma

Norio AOYAGI, Kuniaki KOJIMA, Hirohiko KASAI

2003 Volume 43 Issue 10 Pages 471-476
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.471

JOURNAL OPEN ACCESS

Show abstractHide abstract

The characteristics of spinal epidural cavernous hemangioma without primary origin in the vertebral bone were evaluated in 54 patients including our new case. The 36 male and 18 female patients were aged 5 to 78 years (mean 47 years). Most lesions were in the thoracic spine (80%) and on the dorsal side of the spinal cord (93%). The clinical course was mostly slowly progressive, with myelopathy in 33% at onset and 83% at admission. The lesion appeared isointense to the spinal cord on T₁-weighted imaging, and isointense or slightly hypointense to the cerebrospinal fluid on T₂-weighted imaging. Lesion without hemorrhage showed prominent homogeneous enhancement after administration of gadolinium-diethylenetriaminepenta-acetic acid because of the sinusoidal channel structure. Heterogeneous enhancement was caused by hematoma and/or post-hemorrhagic degeneration. The differential diagnosis of this disease includes metastatic tumor, Ewing's sarcoma, chordoma, eosinophilic granuloma, sarcoidosis, lipoma, hypertrophy of the posterior longitudinal ligament or the ligamentum flavum, meningioma, and neurinoma. The relationships between clinical course and surgery or outcome suggest that early diagnosis and total removal of the lesion before massive lesional bleeding occurs are necessary for a good outcome.

View full abstract

Download PDF (244K)

Original Article

Gamma Knife Surgery for the Treatment of Spontaneous Dural Carotid-Cavernous Fistulas

Masanari ONIZUKA, Katsuharu MORI, Nobuaki TAKAHASHI, Ichiro KAWAHARA, ...

2003 Volume 43 Issue 10 Pages 477-483
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.477

JOURNAL OPEN ACCESS

Show abstractHide abstract

Endovascular treatment for a spontaneous dural carotid-cavernous fistula (CCF) is an established treatment, but stereotactic radiosurgery might provide a less-invasive alternative in selected cases. Four women aged 67 to 79 years (mean 72.0 years) with spontaneous dural CCFs presented with chemosis or bruit. Angiography revealed arteriovenous fistulas in the cavernous portion. Three cases were Barrow type D and one was type B converted from type D. Stereotactic gamma knife surgery was performed with a marginal dose of 13-15 Gy and a maximum dose of 26-30 Gy with a volume from 824 to 1755 mm³. The target point of radiosurgery for type D CCFs was the compartment of the cavernous sinus supplied by multiple feeders from the external carotid artery. All patients responded favorably to the treatment, with improvement of symptoms beginning after 1 to 3 months. Angiography confirmed the complete disappearance of the CCFs in all patients. There were no recurrences, and the follow-up period was 14 to 32 months (mean 24 months). No significant side effects were observed. Stereotactic radiosurgery is a useful method to treat CCFs and is indicated for elderly patients, low-flow CCFs, and cases in which endovascular treatment has failed.

View full abstract

Download PDF (327K)

Case Reports

Unilateral Oculomotor Nerve Paresis Associated With Anterior Communicating Artery Aneurysm Rupture

—Two Case Reports—

Toyotaka AIBA, Masafumi FUKUDA

2003 Volume 43 Issue 10 Pages 484-487
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.484

JOURNAL OPEN ACCESS

Show abstractHide abstract

Two cases of complete unilateral oculomotor nerve palsy occurred after subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm. A 61-year-old female suffered left oculomotor nerve paresis after mild SAH. This paresis was probably related to pre-existing oculomotor nerve stretching caused by abnormal positioning of the posterior cerebral and superior cerebellar arteries in the premesencephalic cistern. A 70-year-old female suffered right oculomotor nerve paresis after severe SAH. Elevated intracranial pressure might have caused this paresis, but the reason for the unilateral occurrence was undetermined. Both patients were treated by clipping of the aneurysm, and the signs of oculomotor nerve paresis gradually resolved. A pattern of pupil-sparing paresis was observed during the early recovery stage in both patients.

View full abstract

Download PDF (196K)
Percutaneous Transluminal Angioplasty and Stent Placement for Subclavian Steal Syndrome With Concomitant Anterograde Flow in the Left Internal Mammary Artery Graft for Coronary Artery Bypass

—Case Report—

Akimasa NISHIO, Toshihiro TAKAMI, Tsutomu ICHINOSE, Seiya MASAMURA, Mi ...

2003 Volume 43 Issue 10 Pages 488-492
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.488

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 63-year-old man presented with subclavian steal syndrome associated with left internal mammary artery (IMA) bypass graft to a coronary artery. He was admitted with a history of oppressive sensation in the chest, dizziness, and light headedness on exertion for 2 weeks in March 2002. He had undergone myocardial revascularization consisting of a left IMA-to-left anterior descending coronary artery graft in April 1988. His blood pressure was 140/70 mmHg in the right arm and 80/64 mmHg in the left arm. Aortic arch arteriography revealed complete occlusion of the left subclavian artery proximal to the left IMA takeoff and subclavian steal with anterograde flow of the left IMA. Percutaneous angioplasty and stent placement with protection of the left IMA bypass graft using a balloon catheter was successfully performed without complication by cerebral or myocardial ischemia. Complete recanalization of the occluded left subclavian artery and anterograde flow of the left vertebral artery were achieved. His symptoms disappeared and blood pressure in the left arm recovered. This variant of coronary subclavian steal might require protection of the left IMA during angioplasty and stent placement.

View full abstract

Download PDF (189K)
Distant Metastasis of Dermatofibrosarcoma Protuberans of the Scalp

—Case Report—

Yuji UEMATSU, Junya FUKAI, Manabu TAMURA, Yoshihiro OWAI, Shinji OBAYA ...

2003 Volume 43 Issue 10 Pages 493-496
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.493

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 49-year-old man presented with a rare dermatofibrosarcoma protuberans (DFSP) of the scalp associated with local recurrence and distant metastasis to the lung and abdomen. An elastic-hard small mass on the right occipital scalp was initially treated by simple resection in another clinic. Ten years later, recurrent tumor was associated with infiltration to the calvarium, and resection was performed again also in another clinic. Approximately 1.5 years later, the patient was transferred to our clinic because of recurrence with intracranial involvement. Repeated relapses and metastasis to the lung were recognized despite surgery, chemotherapy, and local radiation. Eventually, the patient died of distant metastasis to the abdomen 17 years after the initial diagnosis. Scalp DFSP is very uncommon but is an aggressive scalp tumor, so initial wide local resection and local radiation therapy after surgery are important to prevent local recurrence and distant metastasis.

View full abstract

Download PDF (237K)
Locked-in Syndrome Due to Metastatic Pontomedullary Tumor

—Case Report—

Servet INCI, Tuncalp ÖZGEN

2003 Volume 43 Issue 10 Pages 497-500
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.497

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 21-year-old man presented with an extremely rare case of locked-in syndrome caused by a metastatic brainstem tumor manifesting as quadriplegia, lower cranial nerve pareses, and irregular respiration. Cranial magnetic resonance imaging revealed a large pontomedullary tumor. An emergency operation was performed via a posterior fossa approach and the tumor was grossly totally removed. The histological diagnosis was malignant melanoma. The clinical status of the patient remained unchanged and he died on postoperative day 34 of diffuse bronchopneumonia. Locked-in syndrome is characterized by quadriplegia, lower cranial nerve paralysis, and mutism but with maintenance of consciousness, as well as vertical eye movements and eyelid blinking. This case suggests that locked-in syndrome should be considered in any patient seemingly comatose or stuporous, this syndrome may be due to a pontomedullary tumor, and malignant melanoma metastasis should be considered in the differential diagnosis of patients who present with brainstem tumor.

View full abstract

Download PDF (209K)
Schwannoma of the Spinal Accessory Nerve

—Case Report—

Shizuo HATASHITA, Takashi MITSUHASHI, Akihiro KUROSU, Hideo UENO

2003 Volume 43 Issue 10 Pages 501-504
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.501

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 60-year-old woman presented with a rare schwannoma arising from a spinal accessory nerve at the C1-2 levels manifesting as cervico-occipital pain. The tumor was removed by surgery with the involved segment of the nerve. She had no postoperative neurological deficit. Histological examination confirmed the diagnosis of schwannoma. Surgical removal is recommended for such cases.

View full abstract

Download PDF (121K)
Recurrent Meningitis Associated With Complete Currarino Triad in an Adult

—Case Report—

Yasushi HAGA, Hiroyuki CHO, Souji SHINODA, Toshio MASUZAWA

2003 Volume 43 Issue 10 Pages 505-508
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.505

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 58-year-old woman presented with Currarino triad manifesting as recurrent meningitis. Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality, and an anorectal malformation, which is caused by dorsal-ventral patterning defects during embryonic development. She had a history of treatment for anal stenosis in her childhood. Radiographic examinations demonstrated the characteristic findings of Currarino triad and a complicated mass lesion. The diagnosis was recurrent meningitis related to the anterior sacral meningocele. Neck ligation of the meningocele was performed via a posterior transsacral approach after treatment with antibiotics. At surgery, an epidermoid cyst was observed inside the meningocele. The cyst content was aspirated. She suffered no further episodes of meningitis. The meningitis was probably part of the clinical course of Currarino triad. Radiography of the sacrum and magnetic resonance imaging are recommended for patients with meningitis of unknown origin. The early diagnosis and treatment of this condition are important.

View full abstract

Download PDF (207K)

Technical Notes

Intraoperative Angiographic Assessment of Graft Patency During Extracranial-Intracranial Bypass Procedures

Kiyoyuki YANAKA, Keishi FUJITA, Shozo NOGUCHI, Yuji MATSUMARU, Hiroyuk ...

2003 Volume 43 Issue 10 Pages 509-513
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.509

JOURNAL OPEN ACCESS

Show abstractHide abstract

The use of intraoperative angiography to monitor graft patency was retrospectively reviewed in extracranial-intracranial bypass procedures. Forty-two patients underwent 43 extracranial-intracranial bypass procedures with the use of intraoperative angiography. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed in 41 patients (42 procedures) with ischemic cerebrovascular diseases, and vertebral artery-MCA bypass using radial artery graft for intentional ligation of the common carotid artery in one patient with nasopharyngeal carcinoma. Intraoperative angiography provided high-quality subtraction images in every case. There were no complications due to angiography. Graft occlusion was observed intraoperatively in three cases, but an additional procedure reopened the occluded graft in all three cases. Graft patency rate was 100% after surgery. Outcome was excellent in 40 patients and good in one patient who underwent STA-MCA bypass. Intraoperative angiography provides useful information regarding graft patency during bypass surgery. Intraoperative assessment prior to wound closure allows for the recognition and correction of technical failure and decreases the risk of postoperative complications.

View full abstract

Download PDF (142K)
Combined Laminoplasty With Posterior Lateral Mass Plate for Unstable Spondylotic Cervical Canal Stenosis

—Technical Note—

Akira MATSUMURA, Kiyoyuki YANAKA, Hiroyoshi AKUTSU, Shouzou NOGUCHI, T ...

2003 Volume 43 Issue 10 Pages 514-519
Published: 2003
Released on J-STAGE: April 26, 2005

DOIhttps://doi.org/10.2176/nmc.43.514

JOURNAL OPEN ACCESS

Show abstractHide abstract

A technique of combined expanding laminoplasty using longitudinal interspinous iliac bone graft with posterior lateral mass plate is described for the treatment of cervical canal stenosis associated with spinal instability. A 52-year-old male and a 76-year-old female presented with cervical myelopathy. Imaging studies demonstrated spondylotic cervical canal stenosis associated with spinal instability. Posterior stabilization with lateral mass plate by the Axis Fixation System was performed after expanding laminoplasty using interspinous iliac bone graft. The symptoms improved and instability and malalignment (in the female patient) also improved after surgery. This combined surgical technique allows decompression of the spinal cord, immediate internal fixation by plate fixation, and subsequent long-term stabilization by interspinous bony fusion. This technique is indicated in selected patients with multiple segment spondylotic cervical canal stenosis associated with instability and/or malalignment of the spinal column for which simultaneous decompression and stabilization are required.

View full abstract

Download PDF (279K)

Register with J-STAGE for free!