Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 44, Issue 6
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Takashiro OHYAMA, Takuji NISHIDE, Hiroo IWATA, Hideki SATO, Mitsuaki T ...
    2004 Volume 44 Issue 6 Pages 279-287
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    Platinum microcoils coated with immobilized recombinant human vascular endothelial growth factor (rhVEGF) were prepared and the effectiveness for the embolization of aneurysms was investigated using a rat model. Platinum coils were prepared by successive deposition of cationic polyethyleneimine and anionic heparin, and VEGF was immobilized through affinity interaction with heparin. Unmodified, heparin-coated, or rhVEGF-immobilized platinum coil segments were inserted into the ligated external carotid arteries at the bifurcation of the common carotid artery (CCA) of adult female rats. The bifurcation segments of the CCA were harvested 2 weeks after the coil placement. rhVEGF-immobilized coils showed significantly greater endothelial formation at the aneurysm orifice and cell infiltration in the aneurysm body compared with the unmodified and heparin-coated coils. The percentage of sac occlusion was significantly greater in the rhVEGF-immobilized group (77.53 ± 27.58%) than in the heparin-coated group (44.81 ± 38.30%) and unmodified group (34.99 ± 28.15%). Scanning electron microscopy showed a tendency for more fibrotic and cellular collections on the coil surface and more tissue mass filling in the coil lumen in the rhVEGF-immobilized group. Platinum microcoils coated with immobilized rhVEGF may be effective for the obliteration of aneurysms.
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  • Mete ERTURK, Gulgun KAYALIOGLU, Mehmet Asim OZER, Tomris OZGUR
    2004 Volume 44 Issue 6 Pages 288-293
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    The transcallosal-interforniceal approach is the most appropriate approach to localize and totally remove space-occupying lesions around the anterior third ventricle region such as craniopharyngiomas and gliomas. This study examined the microsurgical anatomy of the normal anterior third ventricle region in 81 adult cadaver hemispheres. The central sulcus was identified and surface landmarks determined as the points 5 cm (P5) and 7 cm anterior to the central sulcus (P7). The distances between P5 and P7 and the upper margin of the interventricular foramen, which delineate the surgical corridor chosen to avoid disturbance of important neural structures, were 46.26-60.96 (54.09 ± 3.35) mm and 48.00-62.00 (54.94 ± 3.09) mm, respectively. The distances between the upper margin of the hemisphere and the cingulate sulcus, especially important for avoiding damage to the cingulate gyrus and other mesiolimbic structures, were 13.54-30.00 (21.28 ± 3.89) mm and 12.22-29.52 (21.12 ± 3.90) mm at the level of P5 and P7. The distances between the upper margin of the hemisphere and the callosal cistern containing the pericallosal artery were 28.34-40.50 (33.94 ± 2.84) mm and 28.16-40.26 (33.50 ± 2.61) mm, respectively. Normative morphometric data of the structures involved in the surgical procedure are necessary for planning and performance of the transcallosal-interforniceal approaches. This study of a large series of specimens shows that these measurements have large individual variations.
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Case Reports
  • —Case Report—
    Takashi MARUYAMA, Keisuke ISHII, Mitsuo ISONO, Tatsuya ABE, Minoru FUJ ...
    2004 Volume 44 Issue 6 Pages 294-297
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A 63-year-old man presented with sudden severe headache. Computed tomography (CT) demonstrated subarachnoid hemorrhage. Cerebral angiography demonstrated an aneurysm of the anterior communicating artery. Left frontotemporal craniotomy and neck clipping of the aneurysm via the pterional approach were performed. CT obtained 18 hours after surgery revealed cerebellar hemorrhage, and magnetic resonance (MR) imaging 17 days postoperatively demonstrated that the hemorrhage was located within the folia. Neurological examination after surgery revealed slight dysarthria after drainage of cerebrospinal fluid (CSF) but no other neurological deficits. Follow-up CT and MR imaging showed characteristic findings of postoperative cerebellar hemorrhage clearly different from those of hypertension. The cerebellar hemorrhage was probably secondary to overdrainage of CSF. He was discharged without deficits.
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  • —Case Report—
    Taku SATO, Tatsuya SASAKI, Masato MATSUMOTO, Kyouichi SUZUKI, Mitsuo S ...
    2004 Volume 44 Issue 6 Pages 298-301
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A 52-year-old man suddenly experienced headache and vomiting. Computed tomography demonstrated a small area of hemorrhage in the right cerebellar hemisphere. Angiography revealed a thalamic arteriovenous malformation (AVM) fed by the bilateral medial posterior choroidal arteries and left marginal tentorial artery, and drained into the confluence via the cerebellar veins without flow into the supratentorial venous system. The draining veins included two varices, one of which, in the right cerebellar hemisphere, was thought to be the source of bleeding. The AVM nidus was removed via the right occipital transtentorial approach. A portion of a drainer adhered to the surface of the great vein of Galen but without opening into the galenic system and all drainers from this thalamic AVM flowed into the infratentorial cerebellar venous system.
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  • —Four Case Reports—
    Sedat ÇAGLI, Nezih OKTAR, Tayfun DALBASTI, Sertaç ISLEKE ...
    2004 Volume 44 Issue 6 Pages 302-310
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    Four rare cases of intracranial intravascular papillary endothelial hyperplasia (IPEH) manifesting as cranial nerve disturbances occurred in 16-, 18-, 24-, and 28-year-old females. Magnetic resonance imaging showed all lesions as isointense with strong enhancement on T1-weighted images, and as hyperintense on T2-weighted images. All lesions were removed via craniotomies. Histological examination found vascular structures and papillary spaces lined with endothelial cells showing immunoreactivity for CD31. Complete removal was curative in two cases, whereas incomplete removal resulted in cure in one case and residual deficits in one case. Iatrogenic deficits should be avoided in IPEH treatment by surgery. Differentiation from neoplasm such as angiosarcoma depends on histological characteristics.
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  • —Case Report—
    Satoshi NISHIMURA, Yoshikazu KYUMA, Aki KAMIJO, Atsuo MARUTA
    2004 Volume 44 Issue 6 Pages 311-316
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A 30-year-old female presented with a rare case of isolated recurrence of granulocytic sarcoma manifesting as extra- and intracranial masses 16 months after successful treatment of acute myeloblastic leukemia (M-2). She presented with a swelling located on her forehead that had appeared just after hitting her forehead, and never diminished in size. The mass was elastic hard and not freely mobile. Computed tomography and magnetic resonance imaging demonstrated enhanced masses in the right frontal extra- and intracranial region with no bone destruction. There was no evidence of relapse in the bone marrow. Needle aspiration biopsy of the subscalpal mass was performed. Fluorescence in situ hybridization revealed AML1/MTG8 fusion gene associated with t(8; 21). Two courses of systemic chemotherapy with high-dose cytarabine and total neural axis irradiation resulted in complete remission.
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  • —Case Report—
    Shigeo OHBA, Ryu KUROKAWA, Kazunari YOSHIDA, Takeshi KAWASE
    2004 Volume 44 Issue 6 Pages 317-320
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A 27-year-old female presented with gait disturbance and left facial paresthesia. She had a history of breast and lung masses not yet identified. Magnetic resonance (MR) imaging revealed a tumor suggesting a petroclival meningioma. Her symptoms worsened rapidly. MR imaging showed enlargement of the tumor. Subtotal removal of the tumor was performed. Histological examination revealed metastatic adenocarcinoma. Examination of the other masses confirmed adenocarcinoma originating from lung carcinoma. Dural metastases can be difficult to preoperatively differentiate from meningioma clinically or radiographically. MR spectroscopy and laboratory examinations such as cytologic and serologic studies are valuable for differential diagnosis. The final diagnosis of the tumor depends on the histological findings. However, careful monitoring of the patient's course is very important to detect rapid growth of metastases.
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  • —Case Report—
    Mitsunobu IDE, Masaaki YAMAMOTO, Shinji HAGIWARA, Noriko TANAKA, Hirot ...
    2004 Volume 44 Issue 6 Pages 321-325
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A 24-year-old woman underwent craniotomy for falx meningioma (5 cm in diameter) on October 24, 1995. The deepest part of the tumor was located in the anterior horn of the lateral ventricle, which was not resected. The histology was clear cell meningioma (CCM), aggressive in nature. The MIB-1 labeling index was high (11%). She underwent gamma knife (GK) radiosurgery for the residual tumor with an irradiation dose of 16 Gy at the tumor periphery on May 24, 1996. The postradiosurgical course was uneventful. The residual intraventricular tumor gradually decreased in size, but the peripheral portion gradually grew into the diencephalic region. The patient remained in good condition for 5 years until September 2001, when she exhibited memory disturbance and lethargy. Magnetic resonance imaging demonstrated a large tumor (4.5 cm in diameter) in the diencephalon, compressing the optic nerves and fornix. The calculated tumor doubling time was 120 days. A second craniotomy was performed on October 9, 2001. The tumor was totally resected through the anterior transcallosal approach. The histology and the MIB-1 labeling index of the tissue from the second operation did not differ markedly from those of the first operation. Neither tumor recurrence nor metastasis has been observed to date. GK radiosurgery contributed to control of the residual intraventricular tumor, but the peripheral portion of the tumor, which received a relatively low radiation dose (16 Gy), grew rapidly. This suggests that a marginal dose of 16 Gy may not be sufficient for control of CCM.
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  • —Case Report—
    Joji INAMASU, Yoshiki NAKAMURA, Maaya ORII, Ryoichi SAITO, Yoshiaki KU ...
    2004 Volume 44 Issue 6 Pages 326-330
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A 41-year-old man presented with progressive worsening of postural headache. Computed tomography (CT) showed bilateral subdural hematomas without prior history of trauma. The diagnosis was spontaneous intracranial hypotension (SIH). Conservative treatment with oral steroids failed to prevent gradual deterioration of the patient's consciousness. CT myelography revealed massive cerebrospinal fluid (CSF) leakage between the C-1 and C-2 levels. The leak was repaired surgically via a laminectomy. A cyst, thought to be a meningeal cyst, was discovered adjacent to the right C-2 nerve root, and CSF was seen seeping out from around the cyst after a Valsalva maneuver. The presumed dural defect of the cyst was sealed by packing with muscle fragments and fibrin glue. The symptoms disappeared soon after surgery. He was discharged 1 month after surgery without deficits. Most SIH cases are benign and can be managed conservatively, or by the epidural blood patch method. Surgery is more invasive than the epidural blood patch method, but should be performed in patients with a high cervical lesion and massive CSF leakage.
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Technical Note
  • —Technical Note—
    Mitsunori MATSUMAE, Hideki ATSUMI, Masaki SHINODA, Minako YAMAMOTO, Yo ...
    2004 Volume 44 Issue 6 Pages 331-334
    Published: 2004
    Released on J-STAGE: February 15, 2005
    JOURNAL OPEN ACCESS
    A basket dilation technique has been developed for fenestration of ventricular or cystic walls, using a basket type widely used in the urological field to collect renal or ureteric stones. This technique allows deep-seated structures to be visualized directly through the expanded basket during dilation and the thinnest part of ventricular wall to easily be pierced, cut, and dilated. Fine control can be exerted over expansion pressure through the hand piece directly connected to the basket tip. In addition, the basket can be rotated to cut the floating tissue that must be removed around the stoma. This basket dilation technique is safer than the balloon inflation technique currently used because it allows visualization of deep-seated structures that cannot be seen through the balloon, and should therefore prove useful in third ventriculostomy, plasty of the sylvian aqueduct, and fenestration of intracranial cystic lesions.
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