Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 43, Issue 6
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Surgical Treatment of Intracranial Epidermoid Tumors
    Ziya AKAR, Necmettin TANRIOVER, Saffet TUZGEN, Ali M. KAFADAR, Cengiz ...
    2003 Volume 43 Issue 6 Pages 275-281
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.275
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    Intracranial epidermoid tumors are rare, potentially curable, benign lesions that are sometimes associated with perioperative complications, and tend to recur if not completely removed. Histologically benign epidermoid tumors may also develop into highly malignant tumors. This study evaluated on 28 cases of intracranial epidermoid tumor treated over a 13-year period by radical resection with microneurosurgical techniques. The majority of patients underwent computed tomography and/or magnetic resonance imaging within the first 24 hours postoperatively to confirm the results of surgery. Radical surgical resection was achieved in 21 of the 28 cases, and there was no operative mortality. The most common postoperative complication was transient paresis of various cranial nerves. During a mean follow up of 6 years, only one tumor became malignant. Radical surgical resection should be the goal in treating these benign lesions, but if not possible, every effort should be made to minimize the amount of tumor tissue that remains.
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  • Topographical Relationships Between the Brainstem Auditory and Somatosensory Evoked Potentials and the Location of Lesions in Posterior Fossa Stroke
    Yoshikatsu SHIMBO, Masahiro SAKATA, Makoto HAYANO, Syuichi MORI
    2003 Volume 43 Issue 6 Pages 282-292
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.282
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    The topographical relationships between the location of brainstem lesions detected by magnetic resonance imaging and abnormality of brainstem auditory evoked potentials (BAEPs) and short-latency somatosensory evoked potentials (SSEPs) were studied in 57 patients with stroke in the posterior fossa. Abnormal BAEPs or SSEPs were associated with lesions involving the pontine tegmentum, and abnormal BAEPs also with lesions at the cerebellar peduncle. Absence of the V wave in BAEPs and N20 in SSEPs was associated with a localized overlapping area in the pontine tegmentum contralateral to stimulation. The overlapping area associated with loss of N20 coincided with the location of the medial lemniscus. Lesions widely involving the pontine tegmentum caused the disappearance of multiple waves in the BAEPs and SSEPs. Patients who entered prolonged coma or died had total loss of the III, IV, and V waves, bilateral absence to the contralateral response in BAEPs, or loss of N18 in SSEPs. The loss of N18 in SSEPs had a statistically significant correlation with bad outcome, which suggests the superiority of SSEPs for predicting the outcome of stroke and indicates the involvement of some system excluding the medial lemniscus in the generation of N18.
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Case Reports
  • Cerebral Aneurysm Regrowth and Coil Unraveling After Incomplete Guglielmi Detachable Coil Embolization: Serial Angiographical and Histological Findings
    —Case Report—
    Kentaro MORI, Yasuaki NAKAO, Naoaki HORINAKA, Ryo WADA, Akira HIRANO, ...
    2003 Volume 43 Issue 6 Pages 293-297
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.293
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    A 69-year-old woman suffered subarachnoid hemorrhage due to rupture of an aneurysm at the tip of the basilar artery. The aneurysm was treated by endovascular treatment using Guglielmi detachable coils but the aneurysm dome could not be completely packed. Serial angiography at 10 and 18 months after embolization showed progressive regrowth of the aneurysm with loosening and unraveling of the packed coils. The patient died accidentally after head injury and autopsy was performed. Examination of the aneurysm showed further regrowth and “relative coil compaction” of the coil mass. Histological examination of the resected aneurysm showed no endothelialized membrane in the orifice and only minimal organized thrombus in the body of the aneurysm.
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  • Ruptured Vertebral Artery Dissecting Aneurysm Associated With Parent Artery Occlusion
    —Case Report—
    Kyoji SAKAI, Masahiro KAMEDA, Takaho TANIMOTO, Kaoru TERASAKA, Hiroshi ...
    2003 Volume 43 Issue 6 Pages 298-300
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.298
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    A 63-year-old hypertensive man presented with vertebral artery (VA) dissection manifesting as subarachnoid hemorrhage located mainly in the posterior fossa. Left vertebral angiography on the day of hemorrhage showed complete occlusion of the left VA. Right vertebral angiography showed retrograde filling of the distal portion of the left VA and the left posterior inferior cerebellar artery, and a “double lumen”-like finding in the left VA. He was managed conservatively. Follow-up angiography on Day 29 showed spontaneous recanalization of the occlusive lesion and an almost normal arterial configuration. T2-weighted magnetic resonance (MR) imaging on Day 45 revealed multiple infarctions in the brainstem. T1-weighted MR imaging showed a high intensity area, suggestive of intramural hematoma, in the left VA. He was transferred to another hospital in a persistent vegetative state.
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  • Aneurysm of the Distal Posterior Inferior Cerebellar Artery Originating from the Extracranial and Extradural Vertebral Artery
    —Case Report—
    Yoshinori TAMANO, Tomonori KOBAYASHI, Shinji HAGIWARA, Noriko TANAKA, ...
    2003 Volume 43 Issue 6 Pages 301-303
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.301
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    A 42-year-old woman presented with a ruptured aneurysm of the distal posterior inferior cerebellar artery (PICA), which had a rare extracranial and extradural origin. Medial suboccipital craniectomy and C-1 laminectomy were performed. The aneurysm had adhered to the right cerebellar tonsil, but was successfully clipped without difficulty. Intraoperatively, the PICA origin was recognized in the extracranial and extradural space between the dorsal roots of the C-1 and C-2 nerves. The origin of the PICA from the vertebral artery (VA) may occur at any portion of the VA from the site of penetration of the dura to the vertebrobasilar junction, but an extradural origin is uncommon. A ruptured aneurysm of the PICA branching from the VA at a site proximal to the vertebrobasilar junction and below the foramen magnum may be overlooked by three-vessel angiography if the contrast medium cannot reflux to the contralateral PICA origin.
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  • Microsurgically Critical Anomaly of the Anterior Communicating Artery Complex During the Pterional Approach to a Ruptured Aneurysm: Double Fenestration of the Proximal A2 Segments
    —Case Report—
    Jun NAMIKI, Youichi DOUMOTO
    2003 Volume 43 Issue 6 Pages 304-307
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.304
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    A 50-year-old man presented with a ruptured aneurysm of the anterior communicating artery (ACoA) complex anomaly with the neck of the aneurysm located in the upper ACoA. The right pterional approach was performed 2 days after admission. Retraction of the frontal lobe exposed the lower half of the ACoA complex consisting of the origins of the bilateral A2 segments, and the apparent neck of the aneurysm was clipped. However, further exposure of the bilateral A2 segments revealed double fenestration of the proximal A2 segments, a subtype of duplication of the ACoA accompanied by a bridging artery between the upper and lower ACoA. The limited visualization of this ACoA complex anomaly with an aneurysm had led to the proximal origin of the bridging artery being mistaken for the neck of the aneurysm. Such double fenestration of the proximal A2 segments is a microsurgically critical anomaly of the ACoA complex, because the bridging artery mimics the neck of an aneurysm when visualized by the pterional approach.
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  • Dural Arteriovenous Fistula Associated With Meningioma: Spontaneous Disappearance After Tumor Removal
    —Case Report—
    Jung Yong AHN, Byung-Hee LEE, Yong Jae CHO, Jin Yang JOO, Kyu Sung LEE
    2003 Volume 43 Issue 6 Pages 308-311
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.308
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    A 45-year-old woman presented with a non-dominant transverse-sigmoid sinus dural arteriovenous fistula (AVF) associated with convexity meningioma on the same side. The dural AVF disappeared spontaneously after surgical removal of the meningioma, even though there was no manipulation of the dural AVF. Dural AVFs are usually acquired lesions, and may develop after trauma, surgery, and dural sinus thrombosis. Dural AVFs of the acquired origins are rarely associated with brain tumor. Dural AVFs associated with a tumor may develop even in the absence of sinus occlusion.
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  • Recurrent Intrasellar Arachnoid Cyst
    —Case Report—
    Mamoru MURAKAMI, Hirotaka OKUMURA, Kiyohito KAKITA
    2003 Volume 43 Issue 6 Pages 312-315
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.312
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    A 48-year-old man presented with complaints of decreased visual acuity persisting for 6 weeks in December 1997. Neurological examination demonstrated defects in the superior bitemporal visual field and bilateral optic atrophy. Computed tomography and magnetic resonance (MR) imaging showed an intrasellar cystic lesion. The cyst wall was excised via a transsphenoidal approach. The diagnosis was intrasellar arachnoid cyst. The sellar floor was reconstructed after packing fat in the sellar turcica. The visual complaint improved, but he was lost to follow up. Four years later, he was re-admitted complaining of decreased visual acuity. Superior bilateral field defects were found. MR imaging revealed recurrence of the intrasellar arachnoid cyst. The cyst wall was excised through a craniotomy. The visual acuity and the visual field defects gradually improved. Intrasellar arachnoid cyst may recur after transsphenoidal surgery, so long-term follow up is necessary after excision of the intrasellar cyst wall.
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  • Pineal Xanthogranuloma
    —Case Report—
    Hideo TAKESHIMA, Maki MURAYAMA, Osamu MIYANOHARA, Yo-ichi NAKAZATO, Ju ...
    2003 Volume 43 Issue 6 Pages 316-319
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.316
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    A 64-year-old man presented a large pineal cystic lesion manifesting as headache and exhibiting unusual neuroradiological findings. Magnetic resonance imaging showed a cystic lesion appearing as hyperintense on both T1- and T2-weighted images, and a nodular lesion which was hypointense on T1- and mixed intensity on T2-weighted images. The cystic mass was removed via a right occipital transtentorial approach. Histological examination disclosed that the inner surface of the cystic part consisted of bi-layered epithelial lining, portions of which had changed to stratified squamous epithelium. The solid part showed the characteristics of xanthogranuloma such as cholesterol clefts, hemosiderin-laden macrophages, and foreign body giant cells.
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Technical Note
  • Expanded Polytetrafluoroethylene Membrane for Prevention of Adhesions in Patients Undergoing External Decompression and Subsequent Cranioplasty
    —Technical Note—
    Tetsuro KAWAGUCHI, Kohkichi HOSODA, Yuji SHIBATA, Junji KOYAMA
    2003 Volume 43 Issue 6 Pages 320-324
    Published: 2003
    Released on J-STAGE: May 17, 2005
    DOIhttps://doi.org/10.2176/nmc.43.320
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    Cranioplasty performed after external decompression for brain swelling may be difficult because of the development of adhesions between the temporal muscle and the dura. Membranes composed of expanded polytetrafluoroethylene (ePTFE) were inserted at external decompression to prevent such adhesions. The ePTFE membranes were placed suturelessly between the temporal muscle and the dura, covering the proximal portion of the temporal muscle at the sphenoidal ridge and the dural suture line. In addition, part of the membrane was placed directly below the skin incision to allow easy visualization at subsequent cranioplasty in 10 patients. Cranioplasty was performed 38 to 126 days (mean 63.9 days) after external decompression. No adhesions were observed, either between the ePTFE membranes and the dura, or between the membranes and the temporal muscle. No temporal muscle and dural injuries occurred during cranioplasty, and no patient showed signs of infection. Mean operating time was 71.0 minutes and mean blood loss was 75.2 ml. Sutureless insertion of ePTFE membranes at external decompression increases the ease and safety of subsequent cranioplasty, decreases operating time and blood loss, and avoids injury to the temporal muscle and dura.
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