Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 44, Issue 8
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Yoshiki ARAKAWA, Ken-ichiro KIKUTA, Masato HOJO, Yasunobu GOTO, Sen YA ...
    2004 Volume 44 Issue 8 Pages 393-401
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    The preventative effect of cisternal irrigation with milrinone against vasospasm was evaluated in 12 patients with subarachnoid hemorrhage (SAH) of World Federation of Neurosurgical Societies grade IV or V treated between September 1999 and September 2000. All aneurysms were clipped or embolized within 72 hours of the onset of SAH. Inlet and outlet tubes were placed in either the supratentorial cisternal space, lateral ventricle, or spinal subarachnoid space. Lactated Ringer solution containing urokinase (120 IU/ml), ascorbic acid (3.5 mg/ml), and milrinone (3.6 μg/ml) was continuously infused at 30 ml/hr for as long as 2 weeks. Angiographical vasospasm was detected in only two of the 11 patients who received milrinone irrigation and underwent postoperative angiography. Vasospasm may have resulted from irrigation obstruction associated with pneumocephalus in one patient and clot in the sylvian fissure in the other patient. The outcome of the milrinone irrigation therapy was significantly better than that of the conventional therapy. This study suggests that cisternal irrigation with milrinone is safe and effective, and reduces the occurrence of vasospasm in patients with poor grade aneurysmal SAH.
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  • Satoshi UTSUKI, Hidehiro OKA, Yuichi SATO, Benio TSUTIYA, Kouji KONDO, ...
    2004 Volume 44 Issue 8 Pages 402-407
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    Cadherins are cell-surface glycoproteins that mediate Ca2+-dependent, homophilic cell-cell adhesion. The classical cadherins, E- and N-cadherins, bind to beta-catenin, the lining protein. Dysfunctional expression of these factors seems to be related to tumor invasion and metastasis. This study examined the relationship between changes in E- and N-cadherins, and catenin expression, and biological behavior in medulloblastomas and atypical teratoid/rhabdoid tumors. Specimens of 13 medulloblastomas and two atypical teratoma/rhabdoid tumors were collected and stained immunohistochemically to detect E- and N-cadherins, and beta-catenin. None of the medulloblastomas were immunoreactive for E-cadherin, but both atypical teratoma/rhabdoid tumors were immunoreactive for E-cadherin at the cell-cell borders where epithelial differentiation occurred. In contrast, N-cadherin and beta-catenin were present at the cell-cell borders in 12 of the 13 medulloblastomas and both atypical teratoma/rhabdoid tumors. Nuclear beta-catenin staining was not present in the medulloblastomas or atypical teratoma/rhabdoid tumors. There was no significant difference in the Ki-67 staining index between patients with medulloblastomas showing high and low immunoreactivity for N-cadherin and beta-catenin. Moreover, immunoreactivity for N-cadherin and beta-catenin increased with dissemination in the medulloblastomas. Low immunoreactivity in medulloblastomas tended to be associated with a better prognosis. These results suggest that expression of E-cadherin is useful for the differential diagnosis of atypical teratoma/rhabdoid tumor and medulloblastoma, and the expression of N-cadherin or beta-catenin may be related to the biological behavior of medulloblastomas.
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  • Yukiko NAKAHARA, Hisao KOGA, Kenji MAEDA, Masashi TAKAGI, Kazuo TABUCH ...
    2004 Volume 44 Issue 8 Pages 408-415
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    Cystic mass lesions in the suprasellar cistern are often associated with neurological deficits, cognitive disorders, and endocrinological impairments. Many surgical approaches are available to treat these mass lesions, but are technically difficult and cannot remove the lesion completely without risking damage to neurological and endocrinological functions due to the proximity to the surrounding structures.
    Neuroendoscopic transventricular surgery was performed using a ventricular fiberscope for three patients with craniopharyngiomas and two patients with Rathke cleft cysts, with gamma knife radiosurgery for craniopharyngiomas. The endoscopic transventricular approach is safe and minimally invasive for congenital benign suprasellar cystic lesions, especially arachnoid cysts.
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Case Reports
  • —Case Report—
    Jun SHINODA, Yasuhiko AJIMI, Motoyuki YAMADA, Satoshi ONOZUKA
    2004 Volume 44 Issue 8 Pages 416-419
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A 62-year-old woman suffered transient cortical blindness during coil embolization for a saccular aneurysm in the posterior circulation, with cerebral angiography using non-ionic contrast material. Just before completion of the procedure, the patient showed abrupt onset of restlessness and blindness. At this point 150 ml of contrast material had been injected into the left vertebral artery. Immediate computed tomography showed persistence of contrast medium in the bilateral occipital lobes and part of the left frontal lobe. Repeat angiography showed no evidence of embolism. Single photon emission computed tomography obtained the next day showed decreased perfusion in the bilateral occipital lobes. Magnetic resonance imaging on the third day showed multiple lesions in the bilateral occipital lobes. Her vision was restored gradually. Transient cortical blindness may be associated with osmotic disruption of the blood-brain barrier in the bilateral occipital lobes. Endovascular neurosurgeons must be aware of this rare complication.
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  • —Case Report—
    Takashi TAKASE, Hideki TANABE, Akinori KONDO, Naosuke NONOGUCHI, Kazuy ...
    2004 Volume 44 Issue 8 Pages 420-423
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A 62-year-old man presented with a very rare cerebral aneurysm arising from the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography showed a saccular aneurysm at the curved mid-section of the trunk of the left PPTA of the adult type. The patient underwent surgery via the left subtemporal approach, and the aneurysm was successfully eliminated by clipping without sequelae. Aneurysm formation at this point was probably due to hemodynamic stress. The perforating arteries from the PPTA may be important in supply of the hindbrain, so PPTA patency should be preserved if possible.
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  • —Case Report—
    Shigeki ONO, Tomotsugu ICHIKAWA, Yasuhiro ONO, Isao DATE
    2004 Volume 44 Issue 8 Pages 424-428
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A 6-year-old boy presented with a large supratentorial ependymoma with massive calcification and central cyst formation manifesting as generalized convulsion and right hemiparesis. Computed tomography and magnetic resonance imaging showed a large, poorly enhanced, left frontal mass with massive calcification and a central cyst. Angiography revealed no extracranial blood supply to the tumor, which was supplied by branches of the left middle cerebral artery. The patient underwent total resection of the tumor, which was located in the parenchyma with no dural attachment. The tumor was clearly demarcated and dissected subpially from the surrounding brain parenchyma. The surgical findings suggested no relationship with the lateral ventricular system. Histological examination of the tumor demonstrated perivascular pseudorosette formation and mitosis with massive calcification, and immunocytochemical reactivity for glial fibrillary acidic protein and epithelial membrane antigen, but not synaptophysin. These findings were compatible with ependymoma, World Health Organization grade 2. Postoperative magnetic resonance imaging clearly showed that the tumor was located in the intradural, intraaxial space with no relationship to the ventricles.
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  • —Case Report—
    Takeshi KONDOH, Akitsugu MORISHITA, Ayman ABOUELFETOUH, Kazuki YAMAMOT ...
    2004 Volume 44 Issue 8 Pages 429-434
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A 33-year-old male presented with syncopal attacks. He had a history of slowly progressive deterioration of visual acuity in both eyes. His visual deterioration began in the left eye at age 12 years and in the right eye at age 20 years. His left eye was completely blind by age 33 years. He had received no prior treatment for these visual disturbances. Magnetic resonance (MR) imaging on admission showed a large tumor with inhomogeneous intensity occupying the bilateral optic canals and orbital cavities, with extension to parasellar region. Arachnoid cysts were found in the left middle fossa and supracerebellar space, which had caused herniation of the cerebellar tonsils to the foramen magnum. Open biopsy and histology verified that the tumor was pilocytic astrocytoma. Arachnoid cysts associated with the hydrocephalus were treated with a ventriculoperitoneal shunt. Seven years after surgery, visual acuity of the right eye had improved although the left eye remained blind. Follow-up MR imaging demonstrated marked reduction in size of the ventricles and arachnoid cysts, but the tumor size did not change. This case illustrates the benign nature of low-grade glioma in this region in spite of the large size and long history. Deterioration of visual acuity may be reversible in some cases of opticochiasmal astrocytoma. In our case, the improvement in visual acuity probably resulted from growth arrest of the tumor and improvement in the dynamics of cerebrospinal fluid flow.
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  • —Case Report—
    Hideo HAMADA, Nakamasa HAYASHI, Masanori KURIMOTO, Kimiko UMEMURA, Yut ...
    2004 Volume 44 Issue 8 Pages 435-437
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A 48-year-old woman presented with a unique case of isolated third and fourth ventricles associated with neurosarcoidosis, manifesting as upward gaze palsy. She had a past history of surgery for intracranial sarcoid granuloma 10 years previously and placement of a ventriculoperitoneal shunt 3 years later. Magnetic resonance imaging revealed isolated third and fourth ventricles. Endoscopic plasty of the right foramen of Monro, fenestration of the septum pellucidum, and revision of the ventriculoperitoneal shunt were performed. Postoperatively the size of the third and fourth ventricles was reduced, and the upward gaze palsy resolved. Endoscopic treatment is less invasive and effective for the treatment of multiple septum formation in the ventricular system.
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  • —Two Case Reports—
    Krishnamurthy SRIDHAR, Balasubramaniam RAMAMURTHI, Madubhushi Chakrava ...
    2004 Volume 44 Issue 8 Pages 438-441
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A 19-year-old male presented with raised intracranial pressure and a peripherally enhanced multinodular lesion with a large subjacent cyst in the right medial frontal lobe. Surgery revealed a solid tuberculoma and an underlying cyst lined with normal brain tissue. A 22-year-old male with a history of tuberculous meningitis and hydrocephalus presented with an exophytic brain stem and a left temporal tuberculoma, which were excised in two stages. The temporal tuberculoma had a peripherally located cyst that was lined with tuberculous tissue. Intracranial tuberculomas are an important part of the differential diagnosis where tuberculosis is endemic and in immunocompromised patients. Cystic tuberculomas are uncommon. The cysts may be centrally or peripherally intralesional, or either subdural and extralesional, or occur between the lesion and the brain. The type of cyst is important to recognize preoperatively, so that adequate precautions can be taken during the excision of these lesions.
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Technical Note
  • —Technical Note—
    Hiroji MIYAKE, Masao TSUJI, Naoyuki HIRAMOTO, Tohru UKITA, Takehisa OH ...
    2004 Volume 44 Issue 8 Pages 442-445
    Published: 2004
    Released on J-STAGE: February 08, 2005
    JOURNAL OPEN ACCESS
    A new irrigation sucker (Delta Irrigation Sucker®) was designed for microneurosurgery. The Delta Irrigation Sucker® has a unique trigonal pyramid-shape thumb piece, providing a very stable grip. Irrigation is achieved easily by pushing a small button just behind the pressure-regulating pore. Stable hold of the sucker and easy handling of the irrigation button enable irrigation without unsteadiness of the sucker. The Delta Irrigation Sucker® is available in six sizes, with diameters from 1.5 mm to 4.0 mm at 0.5 mm intervals. Irrigation force is provided by a pressure bag, and a normal sterile transfusion set can be used as the irrigation circuit. The Delta Irrigation Sucker® was used in 20 cases of clipping for ruptured cerebral aneurysm, five cases of tumor resection, and three cases of anterior clinoidectomy and opening of the internal auditory meatus. Subarachnoid clot was easily removed and the bleeding points were easily confirmed. Irrigation, controlled by natural finger movement, did not cause unsteadiness of the sucker.
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