Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
44 巻, 1 号
選択された号の論文の10件中1~10を表示しています
Original Articles
  • Tomoaki OMORI, Yutaka HIRASHIMA, Nobuo OKA, Shigenori TAKEDA, Yoshiki ...
    2004 年 44 巻 1 号 p. 1-5
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    The relationships between temperature indices and clinical condition on admission or improvement after ventriculoperitoneal (VP) shunting were evaluated in patients with subarachnoid hemorrhage (SAH). Brain temperatures were measured at intervals of 1 cm from the brain surface to the lateral ventricle at shunt operation. Rectal temperature was also measured. The difference between intraventricular and rectal temperatures was correlated with age (p = 0.0486), Glasgow Coma Scale (p = 0.0129), Hunt and Hess grade (p = 0.0101), and improvement score after VP shunting (p = 0.0104). Measurement of brain temperature may predict the outcome of VP shunting in patients with SAH.
  • Kazuya FUTAMI, Mitsutoshi NAKADA, Masayuki IWATO, Daisuke KITA, Tadao ...
    2004 年 44 巻 1 号 p. 6-13
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A novel method for the simulation of the clipping position for cerebral aneurysms based on three-dimensional computed tomography (3D CT) angiography was evaluated. Rotating the regional 3D CT angiography images including the aneurysm provided the virtual intraoperative views of 36 cerebral aneurysms that were eligible for clipping through a pterional approach with a perpendicularly applied straight clip. The cut-along-trace function of the 3D CT workstation was used to simulate the clipping position. The presence or absence of aneurysm remnants was preoperatively evaluated by observing the clipping simulation image. Intraoperative endoscopy and postoperative cerebral angiography were routinely performed to confirm the completeness of obliterations. Nineteen of 21 aneurysms for which complete obliteration was preoperatively expected were confirmed to have no aneurysm remnant. Nine of 15 aneurysms which were expected to have aneurysm remnant were confirmed to persist. The clipping simulation images could correctly predict aneurysm remnant after the initial clipping with a sensitivity of 90.5% and specificity of 60%. The present simulation method can predict aneurysm remnants and improve the likelihood of complete obliteration by clipping.
  • Yalcin KIRICI, M. Kemal IRMAK
    2004 年 44 巻 1 号 p. 14-19
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    The posterior interosseous nerve arises from the deep branch of the radial nerve, and compression by adjacent structures results in posterior interosseous nerve syndrome. Sixty upper limbs from 30 Turkish subjects (18 males and 12 females) were dissected to reveal the course of the posterior interosseous nerve and to examine possible compression sites at the proximal and distal edges of the supinator muscle, and the exit of the nerve from the extensor carpi radialis brevis muscle. Posterior interosseous nerve syndrome is most probably caused by the tendinous part of the supinator muscle at the proximal edge.
Case Reports
  • —Case Report—
    Toshiyuki AMANO, Takanori INAMURA, Koichiro MATSUKADO, Shunichi YOSHIK ...
    2004 年 44 巻 1 号 p. 20-23
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A 42-year-old woman presented with very rare cases of ruptured saccular aneurysm of a dolichoectatic internal carotid artery (ICA) associated with agenesis of the contralateral ICA manifesting as sudden onset of severe headache and nausea without neurological deficits. Angiography and three-dimensional computed tomography demonstrated intraventricular hemorrhage with slight subarachnoid hemorrhage and dolichoectasia of the right ICA with agenesis of the contralateral ICA, as well as a saccular aneurysm of the ectatic right ICA. The aneurysm neck was clipped successfully. The patient remained ambulatory with no neurological deficits at discharge 15 days after the surgery. The saccular aneurysm in our case was formed in the dolichoectatic ICA, presumably due to both abnormal hemodynamics and abnormal arterial wall.
  • —Case Report—
    Jun LI, Masayuki EZURA, Akira TAKAHASHI, Takashi YOSHIMOTO
    2004 年 44 巻 1 号 p. 24-28
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A 73-year-old man presented with a rare transverse sinus dural arteriovenous fistula (dAVF) with venous reflux to the brainstem and medulla manifesting as brainstem and spinal cord edema mimicking brainstem infarction. Complete occlusion of the fistula was achieved by transvenous embolization, resulting in angiographic cure of the fistula and progressive improvement of the symptoms. Intracranial dAVFs with perimedullary venous drainage, type V according to the Cognard classification, are rare lesions with distinctive clinical, radiological, and therapeutic aspects. This case demonstrates that the symptoms of dAVF with perimedullary venous reflux are variable, so dAVF should be considered in patients with clinical and radiological findings suggestive of congestion in the brainstem and spinal cord. Dysfunction of the medulla and spinal cord caused by venous hypertension is the most probable cause of the neurological symptoms in such cases. Interventional therapy can lead to angiographic cure and resolution of the symptoms.
  • —Case Report—
    Naoko SANNO, Shinkichi HAYASHI, Toshiro SHIMURA, Shotaro MAEDA, Akira ...
    2004 年 44 巻 1 号 p. 29-32
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A 56-year-old woman presented with an intracranial osteosarcoma at the site of previous radiosurgery, manifesting as sudden onset of headache and left hemiparesis with aphasia. She had a previous history of stereotactic radiosurgery for an intracranial tumor under a diagnosis of falx meningioma. Computed tomography showed intratumoral and peritumoral hemorrhage at the right parietofrontal region. Gross total resection of the tumor with hematoma was performed. The histological diagnosis was osteosarcoma. Sarcomatous change is a rare complication of radiotherapy. This case illustrates that osteosarcoma may develop years after radiosurgery for benign brain neoplasm.
  • —Case Report—
    Kenji YAGI, Teruyoshi KAGEJI, Shinji NAGAHIRO, Hidehisa HORIGUCHI
    2004 年 44 巻 1 号 p. 33-37
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A 16-year-old woman presented with a non-germinomatous germ cell tumor in the neurohypophysis manifesting as progressive visual disturbance, amenorrhea, hydrodipsia, and polyuria. Her serum α-fetoprotein and human chorionic gonadotropin levels were elevated. She experienced sudden, rapid visual deterioration and underwent emergency partial tumor removal to decompress the optic nerves. Her vision subsequently improved. Histological examination of the surgical specimens confirmed immature teratoma. She received chemotherapy (ifosphamide 900 mg/m2, cisplatin 20 mg/m2, etoposide 60 mg/m2) for 5 consecutive days. Although the tumor marker levels decreased remarkably, her vision again declined rapidly due to enlargement of the tumor after the first course of chemotherapy. A second radical operation resulted in vision improvement. The tumor specimen showed only mature teratoma elements. This phenomenon, called the growing teratoma syndrome, is very rare in intracranial non-germinomatous germ cell tumors.
  • —Case Report—
    Ryo UEDA, Ryoichi SAITO, Takashi HORIGUCHI, Yoshiki NAKAMURA, Kiyoshi ...
    2004 年 44 巻 1 号 p. 38-42
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A 36-year-old man presented with a tumor in the anterior skull base manifesting as headache and visual disturbance. Neurofibromatosis type 1 (NF-1) was identified in early childhood in the patient, and also in his father. Subtotal excision of the tumor was performed, leaving the portion extending outside of the cranium. The histological diagnosis was malignant peripheral nerve sheath tumor. Local radiotherapy was instituted postoperatively. Facial paralysis and dysphagia appeared 7 months after the first operation. Magnetic resonance imaging revealed new lesions in the lateral ventricle and around the brainstem. These tumors were also subtotally excised, but the patient died 10 months after the first operation. The tumor very likely originated from the meningeal branch of the trigeminal nerve. Treatment of such tumors developing inside the cranium should include the widest resection possible, followed by irradiation of the entire neuraxis including the spinal cord to inhibit dissemination through the cerebrospinal fluid. Treatment should be started as quickly as possible if the tumor is associated with NF-1, because of the poor prognosis associated with this condition.
  • —Two Case Reports—
    Shiro YAMASHITA, Yoshihito MATSUMOTO, Katsuzo KUNISHIO, Seigo NAGAO
    2004 年 44 巻 1 号 p. 43-46
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    Two cases of craniopharyngioma with intratumoral hemorrhage are reported. A 22-year-old male was admitted with meningitis. Lumbar tapping was performed twice. He subsequently developed reduced visual acuity and field deterioration due to intratumoral hemorrhage from an intra- and suprasellar tumor. He underwent emergency craniotomy and total extirpation of the tumor. A 29-year-old female underwent partial extirpation of an intra- and suprasellar cystic tumor via transsphenoidal surgery. Two months after the first operation, she suffered intratumoral hemorrhage necessitating emergency surgery and subsequent gamma-knife therapy. The histological diagnosis was craniopharyngioma in both cases. Hemorrhage is extremely rare in craniopharyngiomas and difficult to discriminate from that in pituitary adenoma, but both diseases require decompression by clot extirpation.
  • —Case Report—
    Takakazu YOKOYAMA, Atsuo YOSHINO, Yoichi KATAYAMA, Takao WATANABE, Yoj ...
    2004 年 44 巻 1 号 p. 47-52
    発行日: 2004年
    公開日: 2005/03/09
    ジャーナル オープンアクセス
    A 63-year-old man presented with rapidly progressive visual field deficit and hypopituitarism including diabetes insipidus, 8 years after treatment for a renal cell carcinoma. Neuroimaging studies revealed a dumbbell-shaped pituitary mass that had destroyed the sellar floor and abutted against the optic apparatus. Fractionated stereotactic radiotherapy (SRT), employing computer-image integration techniques and a frame that could be relocated to facilitate a fractionated dosing scheme, was carried out under a plan for reducing the treatment risk to the optic apparatus. Three months later, the patient exhibited marked improvement in the visual field deficit and visual acuity concomitant with a reduction in tumor volume. Magnetic resonance imaging of the sellar region confirmed striking shrinkage of the metastasis. His neurological status remained stable at 12 months after the SRT with no complications. Fractionated SRT appears to be effective for preserving or improving the residual vision in patients with visual loss secondary to metastatic tumor of the pituitary gland, and may result in a longer and better quality of life.
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