Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 44, Issue 11
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Hiroyuki KINOUCHI, Kuniaki OGASAWARA, Hiroaki SHIMIZU, Kazuo MIZOI, Ta ...
    2004 Volume 44 Issue 11 Pages 569-577
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    The efficacy of intraoperative cisternal irrigation using tissue-type plasminogen activator (tPA) combined with continuous cisternal drainage was assessed for the prevention of symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Seventy consecutive patients underwent direct surgery for aneurysm clipping within 48 hours of SAH and had computed tomography (CT) findings classified as Fisher group III or IV with densities of more than 65 Hounsfield units (HU). Fibrinolysis of the cisternal clots was performed during surgery using 1.6 mg tPA in 55 cases or 3.2 mg tPA in 15 cases. If postoperative CT within 24 hours of surgery showed areas with density more than 65 HU, additional tPA (0.8 mg/day) was administered into the cisternal catheter until the high density areas disappeared. The cisternal drainage catheters were left in place until day 14. Additional tPA injection was necessary in four of the 55 patients receiving 1.6 mg tPA. Symptomatic vasospasm occurred in three patients (4.3%) and two patients had low density areas on CT. Permanent deficit (hemiparesis) due to cerebral vasospasm remained in only one patient. Intraoperative cisternal irrigation with tPA combined with cisternal drainage is safe and effective for the prevention of symptomatic vasospasm following SAH.
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  • Tomonori TAMAKI, Takayuki KITAMURA, Yoji NODE, Akira TERAMOTO
    2004 Volume 44 Issue 11 Pages 578-583
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    Patients with spontaneous cerebellar hemorrhage are usually treated by large suboccipital craniectomy for hematoma evacuation or by computed tomography-guided stereotactic aspiration of the hematoma. The present study evaluated the outcome and complications in 25 patients with spontaneous cerebellar hemorrhage treated by paramedian suboccipital mini-craniectomy and 21 patients treated by large suboccipital craniectomy. There were no significant differences between the two groups with respect to age, clinical grade, hematoma volume, hematoma location, hydrocephalus, and mean interval from admission to operation. There was also no significant difference in postoperative outcome between the two groups. However, patients treated by paramedian suboccipital mini-craniectomy were less likely to require blood transfusion, had a shorter operating time, and had less postoperative liquorrhea compared with those undergoing extensive suboccipital craniectomy. Paramedian suboccipital mini-craniectomy is a simple and effective method for hematoma evacuation that causes fewer complications.
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Case Reports
  • —Case Report—
    Tetsuryu MITSUYAMA, Mitsunobu IDE, Hirotsune KAWAMURA
    2004 Volume 44 Issue 11 Pages 584-586
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    A 50-year-old woman presented with a rare case of contrecoup epidural hematoma (EDH) associated with coup EDH. She was hit by a car while riding a bicycle, and struck the left parietal region of her head on the ground. She was dazed for a few minutes. On admission, she complained of nausea but exhibited no neurological deficits. Skull radiography revealed a linear fracture of the left temporal bone. Computed tomography (CT) demonstrated acute EDH in the right frontal region due to contrecoup injury, and thin EDH in the left temporal region due to coup injury. She vomited repeatedly after admission. She became lethargic and exhibited right hemiparesis. CT, taken 2 hours later, revealed enlargement of the left coup EDH, but no enlargement of the right contrecoup EDH. An emergent evacuation of the enlarged coup EDH was performed. Immediately after the operation, she became alert and the right hemiparesis subsided. The contrecoup EDH was conservatively treated, in the absence of enlargement. She was discharged 12 days after the injury without neurological deficits.
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  • —Case Report—
    Toshihiro YASUI, Masaki KOMIYAMA, Yoshiyasu IWAI, Kazuhiro YAMANAKA, Y ...
    2004 Volume 44 Issue 11 Pages 587-590
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    A 40-year-old man suffered chronic progressive symptoms of brainstem compression after undergoing endosaccular coil placement in a ruptured large basilar bifurcation aneurysm. Radiographical examinations showed coil compaction and regrowth of the aneurysmal mass with perifocal mesencephalic edema. The symptoms did not resolve even after additional clip occlusion of the upper basilar artery and the patient died of rerupture. At present, direct surgical clipping using a skull base technique with or without hypothermic circulatory arrest or upper basilar artery occlusion with or without bypass surgery may be a better choice as an initial treatment for giant or large basilar bifurcation aneurysm with a wide neck.
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  • —Case Report—
    Hiroki SANO, Yutaka HAYASHI, Mitsuhiro HASEGAWA, Junkoh YAMASHITA
    2004 Volume 44 Issue 11 Pages 591-594
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    A 44-year-old man presented with a rare subfrontal schwannoma with headache. He had undergone radiation therapy for a pineal lesion 30 years previously, but the histology was not verified. On admission, neurological examination revealed no focal deficits including hyposmia. Computed tomography demonstrated a mass measuring 5 × 3 cm in the right anterior cranial fossa. Magnetic resonance imaging revealed a heterogeneously enhanced mass with multiple cysts. The tumor, which was clearly separable from the surrounding normal brain, was totally resected through a right frontal craniotomy. There was no adhesion between the tumor and the olfactory groove or cribriform plate. The frontal base dura was suspected to be the tumor attachment. The patient was discharged without hyposmia. Histological examination revealed a typical pattern of schwannoma consisting of Antoni type A and type B. Immunohistochemical staining was positive for S-100 protein but negative for epithelial membrane antigen. Subfrontal schwannoma not associated with the olfactory groove or cribriform plate is extremely rare. The operative findings and absence of hyposmia suggest that the meningeal branch of the trigeminal nerve was the origin of the tumor. However, the possibility of radiation-induced reactive Schwann cells cannot be excluded.
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  • —Case Report—
    Masanori HASHIMOTO, Akira YOKOTA, Eiichirou URASAKI, Hajime IMADA, Har ...
    2004 Volume 44 Issue 11 Pages 595-599
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    A 44-year-old man presented with an endolymphatic sac tumor (ELST) associated with von Hippel-Lindau disease, which required four surgical procedures within 10 years. The earlier two surgeries resulted in only partial removal of the tumor because of vigorous intraoperative bleeding. Stereotactic radiation therapy was performed twice. The intraoperative bleeding was easy to control in the third operation, and ultimately the tumor was totally extirpated in the fourth operation. Histological examination of the tumor specimen harvested in the final surgery showed that the tumor cells had clearly decreased in number, and the interstitial tissue had become fibrous with organization of the tumor vessels, compared with the tumor specimen from the first surgery. Preoperative radiotherapy may be effective to reduce the devastating intraoperative bleeding of ELST.
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  • —Case Report—
    Takuya AKAI, Shunsuke SHIRAGA, Hideaki IIZUKA, Miyuki KISHIBE, Shigehi ...
    2004 Volume 44 Issue 11 Pages 600-602
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    A 70-year-old woman presented with meningioma with metastasis to the skin incision. Neuroimaging demonstrated a tumor of the falx extending to the frontal bone. The tumor was grossly totally resected through a coronal skin incision. The histological diagnosis was meningotheliomatous meningioma. The tumor recurred in the ethmoid sinus 2 years later, and was resected through the transfacial approach. One year later, the tumor recurred in the ethmoid sinus and orbit, and was resected through the transcranial approach. Six months later, she noticed an isolated small mass under the skin incision, distant from a further recurrence of the tumor. Both tumors were resected. The histological diagnosis was atypical meningioma. Resection of atypical meningioma carries the risk of iatrogenic metastasis. Surgeons should wash out the operative field carefully and change surgical tools frequently.
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  • —Two Case Reports—
    Atul GOEL, Umesh PHALKE, Francesco CACCIOLA, Dattatraya MUZUMDAR
    2004 Volume 44 Issue 11 Pages 603-606
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    Two relatively elderly male patients (61 and 78 years) suffered moderately severe trauma to the head 1 and 3 years, respectively, prior to presentation with progressive quadriparesis and neck pain. Investigations revealed retroodontoid ligamentous hypertrophy and subtle mobile atlantoaxial dislocation. Following atlantoaxial fixation, both patients showed remarkable and sustained neurological improvement. These cases provide further evidence that retroodontoid ligamentous hypertrophic mass lesion could be secondary to instability of the atlantoaxial region.
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  • —Case Report—
    Hidenori ENDO, Toshiyuki TAKAHASHI, Hiroaki SHIMIZU, Teiji TOMINAGA
    2004 Volume 44 Issue 11 Pages 607-610
    Published: 2004
    Released on J-STAGE: February 04, 2005
    JOURNAL OPEN ACCESS
    A 54-year-old woman presented with a very rare association of spinal intradural arachnoid cyst and spinal epidural hematoma manifesting as paraparesis subsequent to severe back pain. Magnetic resonance (MR) imaging disclosed a ventral epidural hematoma extending from the T-4 to T-6 levels and compressing the spinal cord ventrally. Emergent surgical evacuation of the epidural hematoma was carried out 22 hours after the onset. MR imaging obtained 2 days after surgery showed enlargement of the dorsal subarachnoid space at the T-3 to T-8 levels. The patient could walk independently within 6 months after discharge, but paraparesis recurred 3 years after surgery. MR imaging showed formation of an intradural arachnoid cyst, which compressed the spinal cord dorsally. She underwent arachnoid cystectomy, and recovered ambulation postoperatively. This case of intradural arachnoid cyst of the thoracic spine which appeared after surgical removal of an epidural hematoma at the same spinal level indicates some association between the epidural hematoma and the arachnoid cyst.
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Technical Note
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