Neurologia medico-chirurgica

Original Articles

Branches of the Anterior Cerebral Artery Near the Anterior Communicating Artery Complex: an Anatomic Study and Surgical Perspective

Emel AVCI, Damirez FOSSETT, Mehmet ASLAN, Ayhan ATTAR, Nihat EGEMEN

2003 Volume 43 Issue 7 Pages 329-333
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.329

JOURNAL OPEN ACCESS

Show abstractHide abstract

The anatomy of the branches of the anterior cerebral artery (ACA) near the anterior communicating artery (ACoA) complex were investigated to minimize neurovascular morbidity caused by surgical procedures performed in this region. Thirty-one cadaver brains were perfused with colored silicone, fixed, and studied under the operating microscope. The recurrent artery of Heubner (RAH), orbitofrontal artery (OFA), and frontopolar artery (FPA) were identified as the branches of the ACA arising near the ACoA complex. The OFA and FPA were identified in all hemispheres. Forty-nine (64%) of a total of 77 RAHs arose from the A₂ segment. The OFA always arose from the A₂ segment, was consistently the smallest branch, and coursed to the gyrus rectus, olfactory tract, and olfactory bulb. The mean distance between the ACoA and the OFA was 5.96 mm. The FPA arose from the A₂ segment in 95% of the specimens, and coursed to the medial subfrontal region. The mean distance between the ACoA and the FPA was 14.6 mm. The RAH, OFA, and the FPA are three branches that arise from the ACA near the ACoA complex. These vessels have similar diameters, but can be distinguished by the final destination. Distinguishing these vessels is important since the consequences of injury or occlusion of the FPA and OFA are significantly less than of the RAH.

View full abstract

Download PDF (381K)
Computed Tomography Evaluation of Air Cells in the Petrous Bone

—Relationship With Postoperative Cerebrospinal Fluid Rhinorrhea—

Iwao YAMAKAMI, Yoshio UCHINO, Eiichi KOBAYASHI, Akira YAMAURA

2003 Volume 43 Issue 7 Pages 334-339
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.334

JOURNAL OPEN ACCESS

Show abstractHide abstract

The anatomy of air cells in the petrous bone was investigated using thin-slice bone-window computed tomography (CT) of 168 petrous bones in 84 patients. Air cells in the petrous bone were classified into mastoid and petrous cells. Petrous cells were subdivided into perilabyrinthine and apical cells. Perilabyrinthine cells comprised supralabyrinthine and infralabyrinthine cells. Supralabyrinthine cells were subdivided into posterosuperior, posteromedial, and subarcuate cells. The mastoid was classified as eburnated (11%) or pneumatized (89%) by the extent of the mastoid cells. The mastoid cells were classified into presinusoidal (14%), sinusoidal (44%), and postsinusoidal (42%) according to the relationship with the sigmoid sulcus. The extent of the mastoid cells was significantly correlated with the pneumatization of the petrous apex, i.e. the apical cells (p < 0.01). CT precisely depicted the complex anatomy of the air cells in the petrous bone. Cerebrospinal fluid (CSF) rhinorrhea is the most common complication after skull base surgery for cerebellopontine angle tumors. Air cells in the petrous bone provide the route for CSF rhinorrhea. Therefore, CT assessment of the air cells is useful for preventing this complication.

View full abstract

Download PDF (237K)

Case Reports

Duplex Doppler Ultrasonography of Subclavian Steal Syndrome

—Three Case Reports—

Yasuhiro SUZUKI, Masateru NAKAJIMA, Hisato IKEDA, Takumi ABE

2003 Volume 43 Issue 7 Pages 340-344
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.340

JOURNAL OPEN ACCESS

Show abstractHide abstract

Three cases of subclavian steal syndrome were detected by duplex Doppler ultrasonography. Ultrasonography demonstrated retrograde flow with to-and-fro pattern in the right vertebral artery in two cases, and reflux with diastolic flow deceleration in one case. Interventional treatment with stenting was successfully performed in two cases and conservative treatment was given in one case. Ultrasonography is an effective noninvasive method for the evaluation of the vertebral artery, and should become a routine part of cerebrovascular examinations.

View full abstract

Download PDF (267K)
Distal Anterior Inferior Cerebellar Artery Aneurysm Occult on Magnetic Resonance Angiography One Month Prior to Rupture

—Case Report—

Takeshi KONDOH, Eiji KURIHARA, Eiji KOHMURA

2003 Volume 43 Issue 7 Pages 345-348
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.345

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 77-year-old man suffered subarachnoid hemorrhage due to a ruptured aneurysm of the distal anterior inferior cerebellar artery (AICA). He had a history of hearing disturbance in the left ear for more than 3 years. Computed tomography on three separate occasions had found no abnormalities. One month before the hemorrhage, he came to our outpatient service complaining of vertigo. Magnetic resonance (MR) imaging and MR angiography detected no abnormality. Conventional angiography demonstrated an aneurysm of 8 mm diameter in the distal AICA region after the hemorrhage. Filling and wash out of the aneurysm sac by contrast medium was markedly delayed, which suggested that MR imaging had failed to detect the flow void because of the slow blood flow in the dome. The aneurysm was clipped successfully. He was discharged with mild dysarthria on the 33rd postoperative day. MR angiography has limitations in detecting unruptured aneurysms and there is certainly a high risk group of false negatives, including aneurysms located in the distal region of the main trunk.

View full abstract

Download PDF (177K)
Reversible Non-thrombotic Occlusion of the Superior Sagittal Sinus Caused by Metastatic Malignant Lymphoma

—Case Report—

Kenichi MATSUMOTO, Masaru OHTA, Iwao TAKESHITA

2003 Volume 43 Issue 7 Pages 349-351
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.349

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 57-year-old female presented with intracranial hypertension secondary to non-thrombotic superior sagittal sinus occlusion manifesting as acute onset of headache, vomiting, and disorientation. She had a history of intrapelvic malignant lymphoma. Neuroimaging and tumor biopsy revealed that both the superior sagittal sinus and the straight sinus were occluded by metastatic deposits of malignant lymphoma. Her clinical symptoms were remarkably improved by irradiation and chemotherapy, and the affected sinuses were angiographically recanalized.

View full abstract

Download PDF (216K)
Multiple Vertebral Metastases from Malignant Cardiac Pheochromocytoma

—Case Report—

Satoshi YAMAGUCHI, Kazutoshi HIDA, Nishio NAKAMURA, Toshitaka SEKI, Yo ...

2003 Volume 43 Issue 7 Pages 352-355
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.352

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 27-year-old male presented with a very rare metastasis to the vertebral body from a cardiac pheochromocytoma manifesting as a pathological fracture of the C-4 vertebral body that occurred while playing golf. The patient was initially treated with hard collar fixation. Gallium scintigraphy demonstrated multiple hot spots in the mediastinum, the frontal bone, the vertebral column, and the rib. Magnetic resonance imaging of the chest delineated a cardiac tumor. The patient underwent biopsies of the cardiac and the frontal bone lesions. The diagnosis was malignant cardiac pheochromocytoma with multiple bone metastases. Initial irradiation of the cardiac and the vertebral lesions was followed by surgical intervention to the cervical spine to prevent aggravation of the kyphotic deformity and spinal cord compression. Preoperative embolization of the feeding arteries was followed by C-4 corpectomy, iliac bone grafting, and anterior titanium plating fixation. The patient was discharged and returned to work. However, 20 months later, he died of a metastatic brain lesion with systemic tumor progression.

View full abstract

Download PDF (188K)
Growth Hormone-Secreting Pituitary Adenoma Associated With Primary Moyamoya Disease

—Case Report—

Kazutaka UCHIDA, Yoshiki ARAKAWA, Kenji OHYAMA, Manabu SIRAKAWA, Rie T ...

2003 Volume 43 Issue 7 Pages 356-359
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.356

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 40-year-old female presented with growth hormone (GH)-secreting pituitary adenoma associated with primary moyamoya disease manifesting as amenorrhea, acromegaly, and transient ischemic attack. Magnetic resonance (MR) imaging revealed a tumor mass extending from the sella turcica to the suprasellar cistern, and MR angiography demonstrated stenoses in the bilateral internal carotid arteries with basal moyamoya vessels. Her blood GH and insulin-like growth factor (IGF-1) levels were elevated to 78.94 and 923.0 ng/ml, respectively. The patient underwent removal of the pituitary adenoma because her ischemic symptoms disappeared after oral aspirin medication. Subtotal resection resulted in persistence of the high blood GH and IGF-1 levels. Postoperative MR angiography showed progression of the stenoses in the bilateral internal carotid arteries. Excess systemic GH and IGF-1 may participate in the progression of vascular disease and so could have caused the deterioration of the moyamoya disease.

View full abstract

Download PDF (215K)
Intraventricular Rupture of Nocardia Brain Abscess

—Case Report—

Shinya OSHIRO, Hirokazu OHNISHI, Mika OHTA, Hirohito TSUCHIMOCHI

2003 Volume 43 Issue 7 Pages 360-363
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.360

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 71-year-old male presented with left hemiparesis and confused conversation. Computed tomography showed a mass lesion with rim enhancement in the right parietal lobe. He developed meningeal irritation the day after admission. Emergent fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging revealed a clear hyperintense component in the right lateral ventricle and niveau formation inside the intracerebral lesion, indicating intraventricular rupture of the brain abscess. The patient underwent aspiration of the abscess and ventricular drainage with antibiotic administration. Nocardia asteroides was isolated from the aspirated pus, so systemic and direct administration of effective antibiotics was subsequently commenced. These procedures resulted in gradual improvement of his clinical course, and he left our hospital. Several days after discharge, he developed acute pan-peritonitis due to malignant lymphoma. He appeared to be progressively deteriorating after an exploratory laparotomy, and died on the 17th day after the laparotomy. Intraventricular rupture of nocardia brain abscess can be successfully treated after early definitive diagnosis with FLAIR MR imaging.

View full abstract

Download PDF (251K)
Idiopathic Spinal Cord Herniation Associated With Calcified Thoracic Disc Extrusion

—Case Report—

Takao SAGIUCHI, Hideo IIDA, Shigekuni TACHIBANA, Satoshi UTSUKI, Ryusu ...

2003 Volume 43 Issue 7 Pages 364-368
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.364

JOURNAL OPEN ACCESS

Show abstractHide abstract

A 48-year-old man presented with idiopathic spinal cord herniation associated with calcified thoracic disc extrusion at the T7-8 intervertebral level, manifesting as Brown-Séquard syndrome at the thoracic level persisting for 20 years. Preoperative magnetic resonance imaging and computed tomography myelography revealed ventral displacement of the spinal cord and extrusion of a calcified disc at the T7-8 intervertebral level. At surgery, the spinal cord herniation at this level was released from the dura mater and carefully returned to the dural sac. An extruded calcified thoracic disc was found just below the dural defect at the same level. The development of idiopathic spinal cord herniation is associated closely with a defect in the ventral dura mater of unknown etiology. In our case, the etiology of the ventral dural defect was probably associated with the calcified thoracic disc extrusion.

View full abstract

Download PDF (186K)

Technical Note

Traumatic Carotid-Cavernous Fistula Identified by Three-dimensional Digital Subtraction Angiography

—Technical Note—

Fujimaro ISHIDA, Tadashi KOJIMA, Kenji KAWAGUCHI, Tamotsu HOSHINO, Ken ...

2003 Volume 43 Issue 7 Pages 369-373
Published: 2003
Released on J-STAGE: May 16, 2005

DOIhttps://doi.org/10.2176/nmc.43.369

JOURNAL OPEN ACCESS

Show abstractHide abstract

Conventional digital subtraction angiography (DSA) identified a right carotid-cavernous fistula (CCF). Three-dimensional DSA (3D-DSA) was used to evaluate the CCF before treatment. The 3D-DSA images showed the anatomical relationship of the parent artery and the veins, which was difficult to understand on conventional DSA. The endoscopic image revealed the fistula and cavernous sinus. The direction and location of the fistula could be confirmed. However, the size of the fistula significantly varied depending on the adjustment of the window thresholds, so the balloon size could not be selected based on the images. Catheterization and subsequent embolization of the cavernous sinus with a detachable balloon via the femoral artery was successfully accomplished by referring to the 3D-DSA images.

View full abstract

Download PDF (219K)

Erratum

Erratum

Article type: Errata
2003 Volume 43 Issue 7 Pages e1
Published: 2003
Released on J-STAGE: May 19, 2005

JOURNAL OPEN ACCESS

Show abstractHide abstract

To the Readership: The author has been informed that the following reference was incorrectly reported. Wrong:10) Oka K, Rhoton AL Jr, Barry M, Rodoriguez R: Obstruction of superior sagittal sinus caused by parasagittal meningiomas: the role of collateral venous pathways. J Neurosurg 81: 520-524, 1994
Right:10) Oka K, Go Y, Kimura H, Tomonaga M: Obstruction of the superior sagittal sinus caused by parasagittal meningiomas: the role of collateral venous pathways. J Neurosurg 81: 520-524, 1994

View full abstract

Download PDF (434K)

Register with J-STAGE for free!