Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 43, Issue 3
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Norio AOYAGI, Nobuhiko TAKEMURA, Kintomo TAKAKURA, Hajime KOBAYASHI
    2003 Volume 43 Issue 3 Pages 105-111
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    A method of induction of moderate hyperthermia with a plate heater and a direct current energy source was investigated in the VX-2 rabbit sarcoma model. The theoretical distribution of temperature in the rabbit brain was calculated under various heating conditions. The calculated temperatures coincided well with the temperatures of moderate hyperthermia measured by a thermocouple to a depth of 7 mm under the heater. Moderate hyperthermia was induced in the VX-2 sarcoma. Hyperthermia at 40°C for 20 minutes caused no changes in the lesion. Hyperthermia at 45°C for 20 minutes destroyed the lesion partially to a maximum depth of 3 mm. Hyperthermia at 50°C for 20 minutes caused greater destruction, but also caused edema in the lesion and the surrounding normal brain. Hyperthermia at 55°C for 20 minutes caused severe damage in both the lesion and the surrounding normal brain. Comparison of the actual destruction by hyperthermia and the theoretical temperature distribution indicated that hyperthermia at 43°C for 20 minutes was effective against brain tumor, and destruction reached at least 3 mm from the heater.
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  • Atul GOEL, Dattatraya MUZUMDAR, Pravin SHARMA
    2003 Volume 43 Issue 3 Pages 112-119
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    The clinical, radiological, and surgical issues concerning cavernous hemangiomas located within the dural confines of the cavernous sinus were analyzed on the basis of experience with 13 cases. The feasibility of radical resection by an entirely extradural approach using a basal temporal surgical route to this relatively rare and formidable surgical problem was investigated. Thirteen patients, four males and nine females, with cavernous hemangioma involving the cavernous sinus were treated from 1992 to 2001. The patients were aged from 15 to 55 years. Headaches and deficits of the cranial nerves coursing through the cavernous sinus were the principal symptoms at presentation. Vision was affected in four patients. The radiological features in all patients were similar with a characteristic pattern of extension and encasement of internal carotid artery. The maximum size of the tumor was 28 to 73 mm (mean 44 mm). An entirely extradural route using the basal temporal approach was used successfully in seven cases. Total resection was achieved in 12 patients and partial resection was achieved in one patient. The follow up ranged from 8 months to 9 years (mean 45 months). The outcome of extraocular movements was poor in our series, possibly due to the massive sizes of the tumors encountered. There was no recurrence or growth of the residual tumor and all patients were leading active lives.
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  • Setsuko NAKAGAWA, Takashi HAYASHI, Shigetaka ANEGAWA, Susumu NAKASHIMA ...
    2003 Volume 43 Issue 3 Pages 120-124
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    Dural reconstruction is a significant problem in many cases of decompressive craniotomy and dural defect. Expanded polytetrafluoroethylene (ePTFE) sheet have been used as a dura mater substitute for duraplasty. The outcomes of 83 consecutive patients at our institution were reviewed who underwent external decompression and closure with the ePTFE sheet between August 1995 and December 2000. Eight cases of infection occurred. Seven patients had infection with subdural empyema after cranioplasty with autologous bone. Three patients improved after removal of only the infected bone. One patient improved after removal of the infected bone and ePTFE sheet. One patient experienced wound infection after the original operation. Four patients subsequently developed local and severe inflammation with skin erythema until the ePTFE sheet was removed. Four patients had severe recurrent infections which required subsequent therapy such as vascularized free rectus abdominis muscle flap transfer. Duraplasty with ePTFE sheet might promote infection and poor circulation in the skin flap. The ePTFE sheet should be removed at an early stage in a patient with infection.
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Case Reports
  • —Case Report—
    Kunihide IMAI
    2003 Volume 43 Issue 3 Pages 125-129
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    An 83-year-old female presented with signs of intracranial herniation due to subdural hematoma (SDH) which resolved rapidly and spontaneously. This patient showed bilateral decerebrate postures due to left SDH on admission. Since she had serious neurological symptoms and critical systemic conditions caused by an asthma attack, conservative treatment including osmotherapy and mechanical ventilation was performed instead of surgical intervention. Her signs of intracranial herniation resolved only 6 hours after admission. Although the SDH did not diminish rapidly, she showed excellent neurological improvement even with conservative treatment only. Characteristic serial changes on computed tomography corresponding to the neurological improvements were seen. She was discharged with slight right hemiparesis and slight dementia that were present prior to this admission. The rapid resolution of signs of intracranial herniation was attributable to the spontaneous diminution of SDH. The diminution or disappearance of hematomas probably depended on the redistribution of cerebrospinal fluid into the hematoma in the present case.
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  • —Case Report—
    Mamoru MURAKAMI, Kiyohito KAKITA, Youhei HOSOKAWA
    2003 Volume 43 Issue 3 Pages 130-133
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    A 75-year-old man suffered acute subdural hematoma shortly after trivial head trauma. Thirteen hours after a trivial brow to the occipital region, caused by contact with a mat, he suddenly deteriorated to the level of a Glasgow Coma Scale score of 6. Computed tomography demonstrated an acute subdural hematoma on the left and angiography revealed an aneurysm of the distal middle cerebral artery. An emergent craniotomy disclosed no skull fracture and exposed a thick subdural hematoma with no brain contusions. After evacuation of the hematoma, an aneurysm was found on the distal portion of posterior temporal artery, which was compatible with the angiographical findings. The neck of aneurysm was so fragile that neck clipping could not be successfully performed. Therefore, the aneurysm was extirpated, and the bleeding site coagulated with oxidized cellulose reinforcement. Histological examination of the aneurysm indicated a pseudoaneurysm during the early phase of clot formation. The acute subdural hematoma resulted from rupture of this pseudoaneurysm which was formed shortly after the minor head trauma. Rupture of a pseudoaneurysm caused by trivial trauma might be one of the origins for so-called acute “spontaneous” subdural hematoma.
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  • —Case Report—
    Shinya OSHIRO, Hirokazu OHNISHI, Mika OHTA, Hirohito TSUCHIMOCHI
    2003 Volume 43 Issue 3 Pages 134-137
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    A 5-year-old boy was struck by a pickup truck, and admitted with Glasgow Coma Scale score of 14. Initial computed tomography (CT) showed no evidence of intracerebral lesions except for a skull fracture. Repeat CT 5 hours later showed hyperdense middle cerebral artery (MCA) sign, but he did not show any focal signs. Eighteen hours after the accident, he developed left hemiparesis. CT revealed a fresh infarction in the right MCA territory, associated with definite hyperdense MCA sign. He was immediately transferred to our hospital for further evaluation. Emergent angiography revealed a rat tail-shaped occlusion of the right internal carotid artery at the C-3 level. Cross-filling of the right MCA territory was insufficient for collateral circulation. He was treated conservatively because of the significant risk of hemorrhagic change from the established infarction. His hemiparesis improved gradually, and he was discharged on foot. Hyperdense MCA sign in a child is an important clinical sign for the early detection of cerebral ischemia after blunt carotid injury, before any focal signs appear.
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  • —Case Report—
    Soichi OYA, Kazuo TSUTSUMI, Keisuke UEKI
    2003 Volume 43 Issue 3 Pages 138-141
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    A 78-year-old Japanese woman presented with adult-onset moyamoya disease manifesting as repetitive ischemic attacks over a period of 26 years. Initial ischemic attack occurred at age 52 years. Neurological status deteriorated, associated with worsening in angiographical and single photon emission computed tomography findings over the last 10 years. She suffered frequent transient attacks of aphasia and right hemiparesis. Superficial temporal-middle cerebral artery anastomosis was performed. Postoperative angiography and single photon emission computed tomography revealed a marked increase in cerebral blood flow and symptoms showed considerable improvement. Direct revascularization may be the treatment of choice even for aged patients with moyamoya disease.
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  • —Case Report—
    Masaki KOMIYAMA, Toshie MORIKAWA, Yasuhiro MATSUSAKA, Toshihiro YASUI, ...
    2003 Volume 43 Issue 3 Pages 142-145
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    A 69-year-old woman developed acute angle-closure glaucoma 2 weeks after successful transvenous coil embolization of a traumatic carotid-cavernous sinus fistula. The angle-closure glaucoma was precipitated by oculomotor palsy caused by transvenous coil packing of the cavernous sinus. Emergency iridotomy resulted in normalization of the intraocular pressure and restoration of vision. Acute angle-closure glaucoma may develop in association with an oculomotor palsy caused by any etiology, including neurointervention.
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  • —Case Report—
    Koushou FUJIKAWA, Yoshihiro KAWAHARA, Hirofumi HIRANO, Shunichi YOKOYA ...
    2003 Volume 43 Issue 3 Pages 146-149
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    A 28-year-old man presented with progressive mental deterioration. Thirteen years earlier he had undergone radiation therapy for a pineal germinoma. Neuroimaging showed a homogeneously enhanced mass lesion along the ventricular wall. The cerebrospinal fluid (CSF) level of human chorionic gonadotropin (HCG) was high. Endoscopic biopsy revealed that the tumor was a two-cell pattern germinoma. The diagnosis was germinoma with syncytiotrophoblastic giant cells (STGC). He first received three cycles of chemotherapy with carboplatin and etoposide and then two cycles with ifosfamide, cisplatin, and etoposide. Subsequently, the tumor size decreased markedly and the CSF level of HCG returned to normal. However, he died 22 months after the recurrence. Histological verification and measurement of tumor markers are necessary for the optimum treatment of germ cell tumors. Adequate initial chemotherapy and long-term follow up are essential for patients with germinoma with STGC.
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  • —Two Case Reports—
    Toshio TAKAHASHI, Kanae KUDO, Satoshi ITO, Shigeharu SUZUKI
    2003 Volume 43 Issue 3 Pages 150-152
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    Two cases of spontaneous rupture of cystic craniopharyngioma without chemical meningitis are described. A 70-year-old woman complained of headache and visual field disturbance in July 1993. The tumor was extirpated in November 1993 and again in December 1996. After regular periodic follow-up evaluation, she was hospitalized for reoperation because of expansion of the cyst on magnetic resonance (MR) imaging in November 1998. However, preoperative MR imaging taken 8 weeks later revealed spontaneous reduction of the cyst. A 69-year-old woman noticed deteriorating vision and bitemporal hemianopsia in November 1998. The tumor was removed in December 1998, and 50.4 Gy postoperative radiotherapy was administered. MR imaging in May 2000 demonstrated an enlargement of the cyst, so she was hospitalized again for operation. However, preoperative MR imaging taken 7 weeks later showed spontaneous reduction of the cyst. Neither of the cases of cyst rupture were accompanied by symptoms of chemical meningitis. The signal intensity of the tumors on T1-weighted MR imaging declined after cyst reduction. Thereafter, the cysts increased in size again at 7 months and 5 months. Regular follow-up on MR imaging is necessary, since the cyst size can increase rapidly, even after spontaneous rupture.
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Technical Note
  • —Technical Note—
    Ryo TAKEUCHI, Yoshiharu YONEKURA, Shigenori KATAYAMA, Naoya TAKEDA, Ka ...
    2003 Volume 43 Issue 3 Pages 153-162
    Published: 2003
    Released on J-STAGE: May 29, 2005
    JOURNAL OPEN ACCESS
    The previously reported three-dimensional stereotaxic region of interest (ROI) template (3DSRT-t) for the analysis of anatomically standardized technetium-99m-L,L-ethyl cysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT) images was modified for use in a fully automated regional cerebral blood flow (rCBF) quantification software, 3DSRT, incorporating an anatomical standardization engine transplanted from statistical parametric mapping 99 and ROIs for quantification based on 3DSRT-t. Three-dimensional T2-weighted magnetic resonance images of 10 patients with localized infarcted areas were compared with the ROI contour of 3DSRT, and the positions of the central sulcus in the primary sensorimotor area were also estimated. All positions of the 20 lesions were in strict accordance with the ROI delineation of 3DSRT. The central sulcus was identified on at least one side of 210 paired ROIs and in the middle of 192 (91.4%) of these 210 paired ROIs among the 273 paired ROIs of the primary sensorimotor area. The central sulcus was recognized in the middle of more than 71.4% of the ROIs in which the central sulcus was identifiable in the respective 28 slices of the primary sensorimotor area. Fully automated accurate ROI delineation on anatomically standardized images is possible with 3DSRT, which enables objective quantification of rCBF and vascular reserve in only a few minutes using 99mTc-ECD SPECT images obtained by the RVR method.
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