Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 43, Issue 8
Displaying 1-10 of 10 articles from this issue
Original Article
  • Junichi YOSHIMURA, Kiyoshi ONDA, Ryuichi TANAKA, Hitoshi TAKAHASHI
    2003 Volume 43 Issue 8 Pages 375-382
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    Diffuse type brainstem glioma is one of the most malignant types of brain tumors and the prognosis is extremely poor. The proliferative potential of these tumors is presumed to be very high, but there is little information about the cell kinetics of brainstem glioma because surgical resection is rarely performed. The histological grade, tumor spread, growth potential, and prognosis were evaluated in 40 autopsy cases of diffuse type brainstem glioma. To quantify the growth potentials of individual tumors, the proliferating cell indices of Ki-67 (MIB-1) and proliferating cell nuclear antigen (PCNA) monoclonal antibodies were measured. Mean MIB-1 and PCNA proliferating cell indices were 20.4% (24 cases) and 37.0% (28 cases), respectively, in 34 glioblastomas. The median survival time was 40 weeks in 22 treated patients. The mean PCNA proliferating cell index was 10.8% in four of five anaplastic astrocytomas and the median survival time in four treated patients was 91 weeks. The MIB-1 and PCNA proliferating cell indices of one astrocytoma were 2.9% and 20.3%, respectively, and the survival time was 56 weeks. The overall median survival time was 32 weeks. There was a significant difference in PCNA proliferating cell indices between glioblastomas and anaplastic astrocytomas (p < 0.05) and there was a significant difference in survival time between glioblastomas (40 weeks) and anaplastic astrocytomas plus astrocytoma (74 weeks) among the treated patients (p < 0.05). Supratentorial extension was more frequent in glioblastomas than in anaplastic astrocytomas (p < 0.05). Our results suggest that the majority of diffuse type brainstem gliomas are glioblastoma and the proliferative potential is probably as high as that of adult supratentorial glioblastoma. Supratentorial extension and dissemination are relatively frequent in the advanced stage. Anaplastic astrocytoma or astrocytoma is rarer and less infiltrative and proliferative, and carries a slightly better prognosis than glioblastoma.
    Download PDF (379K)
Case Reports
  • —Case Report—
    Shunji ASAMOTO, Dieter-Karsten BÖKER, Marcus LÜCKE
    2003 Volume 43 Issue 8 Pages 383-385
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 46-year-old white man complained of swelling in the left orbital region. The only significant event in his medical history was minor trauma which occurred during ice hockey 15 years previously. On admission, the only clinical finding was left-sided exophthalmos. Computed tomography and magnetic resonance imaging revealed a left intraorbital cystic mass lesion. The cystic mass was completely removed through a left subfrontal extradural approach. There was no anatomical contact with the paranasal sinuses and the orbital walls were intact. The cystic mass was isolated in the orbital cavity. Histological examination confirmed the diagnosis of mucocele. Generally, the cause of mucocele is chronic sinusitis, but we suspect that the old minor trauma was the most likely cause in the present case.
    Download PDF (181K)
  • —Two Case Reports—
    Masanori TSUTSUMI, Kiyoshi KAZEKAWA, Akira TANAKA, Hiroshi AIKAWA, Yas ...
    2003 Volume 43 Issue 8 Pages 386-390
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    Two patients with extracranial internal carotid artery (ICA) stenosis and tandem stenosis of the ipsilateral intracranial ICA were treated simultaneously by angioplasty with stenting. A 68-year-old man who presented with neovascular glaucoma had 90% stenosis of the right cervical ICA and 80% stenosis of the ipsilateral petrous ICA. A 74-year-old man who suffered from transient ischemic attack had 75% stenosis of the left cervical ICA and 90% stenosis of the ipsilateral cavernous ICA. Hemodynamic compromise was confirmed in both patients. Tandem stenting of both extracranial and intracranial ICA stenoses was performed simultaneously in both patients without complications. Poststenting angiography demonstrated excellent dilation of both lesions and normalization of cerebral perfusion. Simultaneous tandem stenting for extracranial ICA stenosis with intracranial tandem stenosis is less invasive than open surgery in high-risk patients with hemodynamic compromise, especially if the major lesion responsible for cerebral hypoperfusion is difficult to determine.
    Download PDF (240K)
  • —Case Report—
    Nobuo TAKENAKA, Tomoyuki IMANISHI, Hikaru SASAKI, Kenji SHIMAZAKI, Hit ...
    2003 Volume 43 Issue 8 Pages 391-395
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 39-year-old man presented with multiple intracranial cavernous malformations manifesting as intractable seizures persisting for more than 20 years. He underwent gamma knife radiosurgery (GKRS) for right frontal and left temporal cavernous malformations. He began to suffer from progressive left hemiparesis and inattention 2 years 5 months after the GKRS. Magnetic resonance imaging showed abnormal ring enhancement and extensive brain edema around the right frontal lesion. Conservative therapies such as external decompression, low-dose barbiturates, and mild hypothermia had no effect on his clinical status. Stereotactic biopsy of the ring-enhanced area demonstrated gliosis. Signs of cerebral herniation appeared, so we performed partial resection of the right frontal lobe. His symptoms recovered immediately. Subsequent hyperbaric oxygen (HBO) therapy significantly improved the extensive brain edema. Delayed radiation necrosis associated with potentially fatal brain edema may occur after GKRS for cavernous malformations. Internal decompression and subsequent HBO therapy were very effective for the treatment of these lesions.
    Download PDF (350K)
  • —Case Report—
    Naoko FUJIMURA, Toshi ABE, Masaru HIROHATA, Hitoshi MORIMITSU, Takashi ...
    2003 Volume 43 Issue 8 Pages 396-398
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 50-year-old man presented with subarachnoid hemorrhage from a ruptured cerebral aneurysm arising from a left posterior inferior cerebellar artery (PICA)-anterior inferior cerebellar artery anastomotic artery manifesting as severe headache, obtundation, and quadriplegia. Conventional and three-dimensional digital subtraction angiography showed that the anastomotic complex was present bilaterally and both vertebral arteries terminated at the origin of the PICA. The identification of this anomalous vascular network allowed coil embolization of the broad-based aneurysm with occlusion of the parent artery. The patient had residual moderate disturbance of consciousness and quadriplegia before transfer for rehabilitation.
    Download PDF (154K)
  • —Case Report—
    Nobuhiro HATA, Tooru INOUE, Toshiro KATSUTA, Toru IWAKI
    2003 Volume 43 Issue 8 Pages 399-403
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 24-year-old woman presented with a rare adrenocorticotropic hormone (ACTH)-positive pituitary adenoma in the cavernous sinus, manifesting as sudden onset of oculomotor nerve paresis. Neuroimaging revealed a tumor in the cavernous sinus bulging into the subdural space. There was no continuity between the tumor and the pituitary gland in the sella turcica. Gross total removal of the tumor was performed through the orbitozygomatic approach followed by stereotactic radiosurgery. The oculomotor nerve paresis was resolved. Histological examination revealed an adenoma positive for ACTH. Ectopic pituitary adenoma occurs mostly in the sphenoid sinus or the suprasellar region. This extremely rare case of ectopic macroadenoma in the cavernous sinus manifested as oculomotor nerve paresis without signs of Cushing's syndrome.
    Download PDF (312K)
  • —Case Report—
    Yosuke NISHIMUTA, Masaki NIIRO, Takashi KAMEZAWA, Koichi ISHIMARU, Shu ...
    2003 Volume 43 Issue 8 Pages 404-408
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 7-year-old boy presented with acute onset of left hemiparesis and headache, followed by disturbance of consciousness. Neuroimaging studies showed pontine hemorrhage. Surgery was performed to remove a massive hematoma. Histological examination of the wall revealed anaplastic astrocytoma. Postoperative radiation therapy and several types of chemotherapy were administered. However, the tumor recurred and he died 9 months after onset. Hemorrhagic onset of pontine glioma is rare and carries an extremely poor prognosis.
    Download PDF (312K)
  • —Case Report—
    Ibrahim M. ZIYAL, Serdar AYDIN, Servet INCI, Altan SAHIN, Tunça ...
    2003 Volume 43 Issue 8 Pages 409-412
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 47-year-old female with diabetic nephropathy presented with acute onset of severe back pain and progressive weakness in both lower extremities. Neuroimaging revealed a spinal epidural hematoma extending from the T-3 vertebra to the sacrum. Removal of all or every other lamina on levels with epidural hematoma and emergent evacuation of the hematoma were planned. T-9 and T-10 laminectomies were performed, but excessive bleeding during the operation prompted us to abandon the procedure. Plasma and desmopressin administration controlled the bleeding from the drain 8 hours after the operation. Follow-up neuroimaging one month later revealed total resolution of the hematoma with improved neurological status. Acute spinal epidural hematomas extending over more than 15 segments are extremely rare and the surgical treatment is still challenging. Coexisting hemorrhagic diathesis creates more problems. Conservative treatment may be the best option.
    Download PDF (263K)
  • —Case Report—
    Abhijit RAUT, Dattatraya MUZUMDAR, Ranjeet NARLAWAR, Arpit NAGAR, Nade ...
    2003 Volume 43 Issue 8 Pages 413-415
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A 26-year-old woman currently treated for systemic lupus erythematosus with steroid therapy presented with sudden onset of right hemiplegia. Computed tomography of the brain showed a large frontoparietal ring-enhanced lesion with perifocal edema. Stereotactic aspiration of the lesion revealed Cladosporium bantianum. The size of the abscess did not reduce in spite of optimum antifungal treatment. The abscess was subsequently excised through a frontoparietal craniotomy. At follow up after 24 months, there was no recurrence of the abscess. Cerebral Cladosporium bantianum infection is usually refractory to antifungal agents and the prognosis is very poor. This patient had the longest survival period in a case of Cladosporium brain abscess so far reported.
    Download PDF (169K)
Technical Note
  • —Technical Note—
    Yuichiro TANAKA, Kazuhiro HONGO, Tsuyoshi TADA, Yukinari KAKIZAWA, Shi ...
    2003 Volume 43 Issue 8 Pages 416-418
    Published: 2003
    Released on J-STAGE: May 11, 2005
    JOURNAL OPEN ACCESS
    A new method was developed to avoid the risk of injury to the cranial nerves and vessels during intradural bone resection at the paraclinoid region and porus acusticus. The semicircular dural flap is pulled out with a thread over the anterior clinoid process or the porus acusticus. The flap is extended over the underlying structures with a tapered spatula to create adequate space for drilling the bone. The site for drilling was adequately exposed and bone was drilled away smoothly without damaging the underlying vessels and nerves in 10 patients with paraclinoid aneurysms and in seven patients with vestibular schwannomas. This “protective dural flap” method provides wide exposure for drilling, protects the underlying structures, and allows quick inspection during bone resection.
    Download PDF (147K)
feedback
Top