Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 44, Issue 4
Displaying 1-16 of 16 articles from this issue
Original Articles
  • Nobuyuki YASUI, Hiromi NISHIMURA
    2004 Volume 44 Issue 4 Pages 155-163
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    The medical records of 312 patients who underwent surgical intervention for unruptured intracranial aneurysm by the same neurosurgeon between April 1979 and December 2000 were analyzed retrospectively to clarify the complexities of this treatment. Patients were divided into Groups I (earlier) to IV (later) according to the date of surgery. Outcome was evaluated as no change after surgery, transient postoperative deterioration (TD), or permanent deterioration (PD). Operative period, background disease, age, aneurysm location and size, postoperative results, and affecting factors were investigated. The overall rate of PD was 5%, including one death (0.3%), and the overall rate of TD was 11%. Cases of middle cerebral artery aneurysm and small aneurysm with diameters less than 10 mm in all locations showed favorable outcomes. There were no significant differences in operative results and period except the lower incidence of TD in Group IV. Surgical outcome was significantly correlated with aneurysm size. Vertebrobasilar artery aneurysm was associated with worse operative results. Most of the causes of PD were related to operative procedures, mainly perforator injury and general complications. Unruptured aneurysm can be treated safely, especially in cases of middle cerebral artery aneurysm and small aneurysm of less than 10 mm diameter in all locations. Larger aneurysms and vertebrobasilar artery aneurysm should be treated by experienced neurosurgeons.
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  • Masaru HONDA, Keisuke TSUTSUMI, Hiroaki YOKOYAMA, Masahiro YONEKURA, I ...
    2004 Volume 44 Issue 4 Pages 164-169
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A series of 10 cases of posterior cerebral artery (PCA) aneurysms were retrospectively reviewed. There were five men and five women aged 38 to 68 years (mean 57.5 years). Seven patients presented with subarachnoid hemorrhage. Two aneurysms were found incidentally during clinical examination for stroke. One aneurysm was associated with moyamoya disease. All aneurysms were saccular. The aneurysms arose from the P1 segment in three patients, the P1/P2 junction in three patients, the P2 segment in three patients, and the P3 segment in one patient. Two patients died before operation and one patient refused surgery. Aneurysmal clipping was performed for seven patients. All aneurysms except the P2 and the P3 aneurysms were treated via the pterional approach. Four patients had excellent outcome, but one patient with a P3 aneurysm developed homonymous hemianopsia due to thrombosis of the parent vessel and another patient with a P2 aneurysm had moderate disability from the initial insult. Coil embolization has been indicated as the first choice of therapy, but PCA aneurysms are good candidates for direct clipping.
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  • Takamitsu YAMAMOTO, Yoichi KATAYAMA, Takafumi NAGAOKA, Kazutaka KOBAYA ...
    2004 Volume 44 Issue 4 Pages 170-182
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    The corticospinal motor evoked potential was investigated as a monitoring index of motor function to perform maximal resection of brain tumors located around the motor cortex in 37 patients with glioma. Tumor resections were performed under general anesthesia with muscle relaxant and completely controlled ventilation. No special arrangements for anesthesia were required. Direct cortical stimulation revealed that if one electrode was placed on the posterior half of the precentral gyrus, the D-wave could be recorded even when using an electrode separation of 10 mm, and the amplitude was larger with anodic rather than cathodic stimulation. Monitoring of the D-wave enabled the function of the corticospinal tract to be evaluated selectively. Postoperative persistent motor disturbance remained in six patients who had a decrease of over 30% in amplitude of the D-wave during tumor resection. A decrease of less than 30% may indicate postoperative preservation of motor function, including transient motor disturbance with subsequent complete recovery. Intraoperative monitoring of the D-wave is suitable for open cranial surgery with general anesthesia, can detect the primary motor cortex, and allow maximal resection of brain tumors located around the motor cortex.
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Case Reports
  • —Case Report—
    Reiko KAGAWA, Yoshikazu OKADA, Kouzo MORITAKE, Mutsuyo TAKAMURA
    2004 Volume 44 Issue 4 Pages 183-186
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A 21-year-old woman presented with moyamoya disease manifesting as speech disturbance and right quadrant hemianopsia on October 22, 1994. Magnetic resonance (MR) angiography showed occlusion of the left internal carotid artery (ICA) with the normal right ICA. The diagnosis was “unilateral” moyamoya disease by conventional angiography. Follow-up MR angiography revealed further occlusive changes of the right middle cerebral artery (MCA) trunk on July 30, 1995, which progressed to occlusion of the MCA on March 25, 1997. Conventional angiography confirmed occlusion of the right terminal ICA to MCA with basal moyamoya vessels. The diagnosis was “bilateral” moyamoya disease. She was successfully treated by bilateral superficial temporal artery-MCA anastomosis. Follow-up MR angiography should be performed in relatively young patients with “unilateral” moyamoya disease to detect any progression to bilateral moyamoya disease.
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  • —Case Report—
    Yoji YAMASHITA, Toshihiro KUMABE, Hiroyuki SHIMIZU, Masayuki EZURA, Te ...
    2004 Volume 44 Issue 4 Pages 187-190
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A 40-year-old man demonstrated spontaneous regression of a malignant glioma following vasospasm caused by subarachnoid hemorrhage due to rupture of an intracranial aneurysm. The patient had been treated under a diagnosis of malignant glioma for 5 years. He presented with a ruptured aneurysm manifesting as subarachnoid hemorrhage. Single photon emission computed tomography with N-isopropyl-p-123I-iodoamphetamine and diffusion-weighted magnetic resonance (MR) imaging revealed severe flow reduction due to vasospasm in the bilateral temporoparietal cortical regions, including the tumor. MR imaging performed 5 months later showed marked tumor regression. The present case suggests that treatment targeting angiogenesis of malignant gliomas may be effective as a part of multimodality treatment.
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  • —Case Report—
    Mamoru MURAKAMI, Tetsuya TSUKAHARA, Taketo HATANO, Takuya NAKAKUKI, Ei ...
    2004 Volume 44 Issue 4 Pages 191-194
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A 30-year-old man presented with a 2-year history of intermittent headache. No neurological deficit was detected. Computed tomography (CT) and magnetic resonance imaging showed a tumor with a diameter of 2.5 cm in the left anterior skull base associated with bone scalloping on three-dimensional CT. Angiography showed a hypovascular tumor. Craniotomy demonstrated a tumor in the region of the left olfactory groove attached to the anterior part of the cribriform plate. The histological diagnosis was schwannoma. Schwannoma arising from near the olfactory groove is rare, with only 13 other cases reported. The precise origin of these tumors is not well understood, but the tumor in this case probably arose from the fila olfactoria, because the olfactory bulb was involved in the tumor, whereas the olfactory tract remained intact.
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  • —Two Case Reports—
    Hirofumi NAGANUMA, Satoshi SAKATSUME, Masao SUGITA, Eiji SATOH, Takayu ...
    2004 Volume 44 Issue 4 Pages 195-200
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    Two cases of solitary plasmacytomas of the skull are presented, and some biological aspects of the tumor examined. A 75-year-old woman presented with a tumor in the right parietal region. The serum level of immunoglobulin G (IgG) was high and a urine test for Bence Jones protein was negative. A reddish vascular mass was totally removed at surgery. The serum level of IgG was within normal limits after the operation. Postoperative radiotherapy was not performed. A 58-year-old woman presented with a tumor in the occipital region. Serum levels of Igs were within normal limits. A urine test for Bence Jones protein was positive for Ig kappa chain. Bone marrow aspiration revealed no evidence of systemic myelomatosis. The tumor mass was totally removed at surgery and she received local radiation therapy (total 50 Gy). Three months after the surgery, Bence Jones protein (kappa chain) was detected in both the urine and serum and bone scintigraphy showed a weak hot spot in the iliac bone, suggesting development to multiple myeloma. Immunohistochemical studies showed that most tumor cells were positive for vascular endothelial growth factor and syndecan-1, and some tumor cells were strongly positive for basic fibroblast growth factor in both cases. The Ki-67 staining indices were 11.3% and 15.6%. Tumor tissues were negative for p53. These results suggest that solitary plasmacytoma of the skull expresses the angiogenic factors, vascular endothelial growth factor, and basic fibroblast growth factor, in accordance with the high vascularity of the tumors, and syndecan-1 may be an immunohistochemical marker of solitary plasmacytoma of the skull.
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  • —Two Case Reports—
    Kamil Melih AKAY, Önder ÖNGÜRÜ, Sait SIRIN, Bü ...
    2004 Volume 44 Issue 4 Pages 201-204
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    Two young adult males presented with paranasal sinus osteoma associated with mucocele. A 20-year-old man presented with headache and seizure, and another 20-year-old man presented with headache, frontal deformity, and visual disturbances. Both patients underwent surgery and satisfactory results were obtained. Isolated paranasal sinus osteomas are benign and slow-growing tumors, but may become more aggressive in association with mucoceles. The higher aggressiveness of the lesions may be due to the presence of the mucocele. Calcification and ossification of the mucocele probably contributes to the unexpected enlargement of the osteoma.
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  • —Case Report—
    Hideo HAMADA, Nakamasa HAYASHI, Masanori KURIMOTO, Kimiko UMEMURA, Yut ...
    2004 Volume 44 Issue 4 Pages 205-208
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A 60-year-old female presented with gait disturbance, urinary incontinence, and recent memory disturbance. Computed tomography and magnetic resonance imaging revealed a partially calcified mass lesion without enhancement in the left caudate head and mild ventriculomegaly. She underwent endoscopic tumor biopsy. The histological diagnosis was astrocytoma grade 2. After the endoscopic procedure she presented with prolonged consciousness disturbance caused by tension pneumocephalus. Tension pneumocephalus is one of the potential complications of neuroendoscopic procedures.
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  • —Case Report—
    Tetsuya MASADA, Kazuhiro TAKAYAMA, Katsuzo KUNISHIO, Seigo NAGAO
    2004 Volume 44 Issue 4 Pages 209-212
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A 53-year-old man presented with malignant lymphoma manifesting as disturbances of walking and standing. Magnetic resonance (MR) imaging showed multifocal bifrontal lesions which were enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Positron emission tomography (PET) with [18F]fluorodeoxyglucose showed high uptake of tracer in the lesion. The PET-MR coregistered image was used to determine the biopsy target. After right frontal craniotomy, a sterilized probe controlled by a neuronavigation system was directly passed into the tumor, and a guide tube was inserted along the same track. After dura opening, a small corticotomy was performed along the guide tube track and the tumor was biopsied. Histological examination revealed malignant lymphoma. The stereotactically inserted tube-guided brain biopsy was less invasive and provided an accurate diagnosis. The PET-MR coregistered image was helpful for determining the most active lesion of the brain tumor.
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EBM of Neurosurgical Disease in Japan
  • —Interim Report—
    Masahiro YONEKURA
    2004 Volume 44 Issue 4 Pages 213-214
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    A prospective study (SUAVe Study, Japan) is in progress at 13 national hospitals to determine the surgical indications for small unruptured intracranial aneurysm. These hospitals are observing the natural history of small unruptured aneurysms (under 5 mm diameter) without surgical treatment. Since October 2000, 455 aneurysms (393 patients) with 75 aneurysms excluded by film judgment committees have been registered, of which 380 aneurysms (329 cases) have been followed up for a mean of 13.8 months (5 aneurysms for 36 months, 68 for 24 months, 164 for 12 months, and 64 for 6 months). Four aneurysms have already ruptured (3 multiple and 1 single). The annual rupture rate was 0.8% (95% confidence interval 0.2-3%). Another 18 aneurysms have enlarged including seven aneurysms treated for enlargement over 2 mm in size. Considering this finding, the annual rupture rate might rise slightly. The important factors for rupture and enlargement were multiplicity of aneurysm, female, patient aged over 70 years old, and location of aneurysm (anterior communicating artery, basilar artery). The growth rate may be faster in multiple aneurysms than in single aneurysms.
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  • Shunro ENDO, Naoya KUWAYAMA, Yutaka HIRASHIMA, JCAS members
    2004 Volume 44 Issue 4 Pages 215-217
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    The recent randomized trials, North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Asymptomatic Carotid Atherosclerosis Study, have demonstrated the effectiveness of carotid endarterectomy to reduce the incidence of cerebral infarction in patients with symptomatic and asymptomatic high-grade carotid artery stenosis. However, no studies on Japanese patients have been done until now, and recent progress in endovascular stent treatment has been made. The present prospective, multicenter (not randomized) trial, the Japan Carotid Atherosclerosis Study, has started to analyze present practice and propose treatment guidelines for Japanese patients. Here, the protocol and early results of 565 patients registered until the end of January 2004 are presented.
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  • —The Japan Adult Moyamoya Trial Group—
    Susumu MIYAMOTO, The Japan Adult Moyamoya Trial Group
    2004 Volume 44 Issue 4 Pages 218-219
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    This article summarizes the study design and organization of a multicenter, prospective randomized trial of extracranial-intracranial (EC-IC) bypass for treating adult patients with moyamoya disease who suffered episodes of intracranial bleeding. The Japan Adult Moyamoya Trial will determine whether the combination of EC-IC bypass with risk factor modifications affects the prognosis and the incidence of recurrent bleeding attacks. Direct bypass such as superficial temporal artery-middle cerebral artery anastomosis is essential and indirect bypass procedures alone such as encephalo-duro-arterio-synangiosis or encephalo-myo-synangiosis are not dealt with in this trial. Power calculations are based on an assumption of α=0.05 with an annual event rate of 8% significant morbidity and mortality per year in the non-surgical group and 4% in the surgical group. The study has an 80% rate of accuracy for detection of a 20% difference between the two groups in events in a 5-year follow up.
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  • —Activities of the Japan Clinical Oncology Group-Brain Tumor Study Group—
    Soichiro SHIBUI
    2004 Volume 44 Issue 4 Pages 220-221
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    The Japan Clinical Oncology Group (JCOG)-Brain Tumor Study Group was organized with the support of the Health and Labour Sciences Research Grants of the Ministry of Health, Labour and Welfare. The group is now preparing a multi-institutional randomized controlled phase II/III study of chemoradiotherapy using ACNU versus procarbazine and ACNU for astrocytoma grades 3 and 4. The overall survival and response rates will be compared between the patients treated with ACNU and those treated with ACNU plus procarbazine. This study, under the surveillance of the JCOG, aims to set a standard protocol for treating patients with malignant glioma. Moreover, the study will establish a proper methodology for performing randomized studies in the field of neuro-oncology.
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  • Masatsune ISHIKAWA
    2004 Volume 44 Issue 4 Pages 222-223
    Published: 2004
    Released on J-STAGE: February 28, 2005
    JOURNAL OPEN ACCESS
    Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by gait disturbance, dementia, and/or urinary incontinence without causative disorders, and ventricular enlargement due to disturbance of the cerebrospinal fluid (CSF) circulation. The number of patients with iNPH will increase with the aging of the population in Japan. However, iNPH is often difficult to differentiate from other senile disorders such as lumbar canal stenosis, parkinsonism, and so on. Clinical guidelines for iNPH are required to improve understanding and provide for patients’ quality of life and social care. These guidelines propose three levels of iNPH: possible, probable, and definite. Possible iNPH includes one or more of the classical triad and ventricular dilation in middle aged and elderly patients with closing of the CSF space at high convexity on magnetic resonance imaging. Probable iNPH shows improvement of the symptoms after CSF removal in patients with possible iNPH. Definite iNPH shows clinical improvement after CSF shunt operation. The CSF tap test is a major diagnostic measure because of the simplicity and less invasiveness. Use of the programmable valve is recommended to decrease CSF overdrainage. These guidelines are helpful for the diagnosis and treatment of iNPH.
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Erratum
  • Article type: Erratum
    2004 Volume 44 Issue 4 Pages e1
    Published: 2004
    Released on J-STAGE: March 03, 2005
    JOURNAL OPEN ACCESS
    To the Readership: Due to an error by the author, the following were transposed.
    1) The images of Fig. 1 B and C must be exchanged.
    2) Accordingly, the captions must also be changed. Wrong:Axial T1-weighted magnetic resonance (MR) images with gadolinium-diethylenetriaminepenta-acetic acid. (A) MR image at the first manifestation of the disease, showing the heterogeneously enhanced tumor in the right parahippocampal gyrus. (B) Follow-up MR image 4 years after radiotherapy, showing tumor progression. (C) Fluid-attenuated inversion recovery MR image 5 months after the ictus of subarachnoid hemorrhage, showing tumor regression. (D) Follow-up MR image one month before death, showing regrowth of the tumor.
    Right:Axial T1-weighted magnetic resonance (MR) images with gadolinium-diethylenetriaminepenta-acetic acid. (A) MR image at the first manifestation of the disease, showing the heterogeneously enhanced tumor in the right parahippocampal gyrus. (B) Follow-up MR image 4 years after radiotherapy, showing tumor progression. (C) MR image 5 months after the ictus of subarachnoid hemorrhage, showing tumor regression. (D) Fluid-attenuated inversion recovery MR image one month before death, showing regrowth of the tumor.
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