Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 44, Issue 9
Displaying 1-10 of 10 articles from this issue
Original Articles
  • Akiyo SADATO, Tetsu SATOW, Akira ISHII, Tsuyoshi OHTA, Nobuo HASHIMOTO
    2004 Volume 44 Issue 9 Pages 447-455
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    Percutaneous balloon angioplasty for subclavian stenosis achieves satisfactory procedural success rates except for total occlusion. Seven lesions in six consecutive patients who underwent stenting for subclavian total occlusion were reviewed to evaluate the feasibility and efficacy of endovascular stenting. Six lesions were treated using Palmaz stents, and one with the combination of a Palmaz and a SMART stent. Procedural success (residual stenosis < 30%) was achieved for all lesions. The only neurological complication was an embolism in a branch of the posterior cerebral artery, which resulted in homonymous hemianopsia. Follow-up angiography over 6 months after the stenting for five lesions found one in-stent re-occlusion and one ostial restenosis due to elastic recoil. No patient had any new or recurrent symptoms except for recurrent upper limb ischemia due to the case of in-stent re-occlusion during the clinical follow-up period of 1 to 52 months (mean 16.6 months). This complication was resolved by a second treatment. Our limited experience suggests that stenting can redilate even cases of angiographical total occlusion of the proximal segment of the subclavian artery.
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  • Akio SOEDA, Nobuyuki SAKAI, Hideki SAKAI, Koji IIHARA, Izumi NAGATA
    2004 Volume 44 Issue 9 Pages 456-466
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.
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  • Kuri SASAKI, Hiroshi UJIIE, Takashi HIGA, Tomokatsu HORI, Noriko SHINY ...
    2004 Volume 44 Issue 9 Pages 467-474
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    The concentrations and application methods of elastase in the rabbit aneurysm model were optimized to control the initiation of aneurysms and to cause rupture in a stepwise, controlled fashion. The common carotid artery of male Japanese albino rabbits was exposed. No aneurysm was generated if the adventitia was not dissected. After gentle removal of the adventitia, a two-fold dilution series of elastase was applied to the lesion and observed over a period of 2 hours. Various stages of aneurysmal lesions, from spindle-shaped enlargement to rupture, were produced in proportion to the elastase concentration. Application of elastase stock solution (5 U/mg of type I porcine pancreatic elastase) resulted in rupture within 30 minutes in all six animals. Elastase 1:2 solutions caused oozing in all animals, but subsequent rupture in only three of six animals. Histological examination found serious destruction of the internal elastic lamina and media, with expansion of the very thin wall. Elastase 1:4 to 1:16 solutions caused spindle-like distention of the entire artery and the development of tortuosity at the lesion. Elastase 1:32 or weaker solutions caused only localized dilatations. Overall, the destruction of the tunica media became less severe with decreased elastase concentration. Furthermore, the bursting pressure of the aneurysms decreased with increasing elastase concentrations. In particular, aneurysms produced by the elastase 1:2 solution ruptured at less than 150 mmHg, whereas aneurysms induced by the elastase 1:4 or weaker solutions did not rupture within the physiological range of blood pressure. The present aneurysm model requires shorter preparation time and enables accurate control of aneurysm development and rupture.
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Case Reports
  • —Case Report—
    Tomosato YAMAZAKI, Kiyoyuki YANAKA, Kazuya UEMURA, Atsuro TSUKADA
    2004 Volume 44 Issue 9 Pages 475-478
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    A 32-year-old man developed an extremely rare subdural hematoma after syringosubarachnoid shunting for syringomyelia. He presented with a 4-year history of neck pain and spastic paraparesis resulting from T-7 and T-8 vertebral body fracture suffered in a traffic accident at age 22 years. Magnetic resonance imaging revealed syringomyelia between the craniocervical junction and the T-10 level. The symptoms were slowly progressive, and a syringosubarachnoid shunting was performed. His spasticity improved after surgery, but he developed orthostatic headache 7 days after surgery. Magnetic resonance imaging of the brain demonstrated a thin subdural hematoma over the right cerebral convexity. The subdural hematoma resolved spontaneously within a week with conservative treatment. Vigorous cerebrospinal fluid outflow observed during surgery presumably lowered the pressure in the syrinx cavity, leading to significant but transient intracranial hypotension and consequently the formation of subdural hematoma.
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  • —Case Report—
    Hiroyoshi AKUTSU, Shozo NOGUCHI, Takashi TSUNODA, Mamoru SASAKI, Akira ...
    2004 Volume 44 Issue 9 Pages 479-483
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    A 29-year-old man presented with lethargy, headache, high fever, and visual disturbance. Neurological examination showed mydriatic pupil, ptosis, diminished light reflex, and ophthalmoplegia on the left. Magnetic resonance (MR) imaging showed the typical findings of pituitary apoplexy, and cerebral angiography disclosed mild narrowing of the A1 segment of the left anterior cerebral artery (ACA). Transsphenoidal tumor resection was performed. Transient severe right hemiparesis occurred directly after the operation. Computed tomography demonstrated cerebral infarction in the territory of the left Heubner's and medial lenticulostriate arteries. Pituitary apoplexy followed by cerebral infarction is very rare. Vasospasm of the perforating arteries of the ACA probably caused the cerebral infarction. Subarachnoid blood or vasoactive agents released from the tumor were the most likely cause of the vasospasm. MR imaging findings of contrast enhancement around the vessels may indicate reactive processes around the vessels.
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  • —Case Report—
    Ketan DESAI, Trimurti NADKARNI, Sudhir FATTEPURKAR, Atul GOEL, Asha SH ...
    2004 Volume 44 Issue 9 Pages 484-488
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    A 40-year-old male presented with hemangiopericytoma in the lateral ventricle manifesting as headaches persisting for 6 months associated with vomiting and visual obscurations for one month. Computed tomography and magnetic resonance imaging of the brain showed a large tumor in the trigone of the right lateral ventricle. The highly vascular tumor was completely excised. The histological diagnosis was hemangiopericytoma. Hemangiopericytoma is rarely located in the lateral ventricle and is difficult to differentiate from meningioma by neuroimaging methods.
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  • —Case Report—
    Kazuhide ADACHI, Kazunari YOSHIDA, Hideyuki TOMITA, Maki NIIMI, Takesh ...
    2004 Volume 44 Issue 9 Pages 489-492
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    A 25-year-old male presented with an intracranial tuberculoma mimicking falx meningioma manifesting as right lower monoparesis. The patient had a past history of pulmonary tuberculosis, cured by antituberculous therapy. Computed tomography and magnetic resonance (MR) imaging showed a lesion mimicking a falx meningioma. Surgery achieved subtotal resection. Histological and biochemical examinations revealed the surgical specimen was tuberculoma. He was treated with antituberculous therapy, and his gait disturbance disappeared. Follow-up MR imaging showed no regrowth.
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  • —Case Report—
    Kenichiro ONO, Hirohiko ARIMOTO, Kojiro WADA, Takashi TAKAHARA, Toshik ...
    2004 Volume 44 Issue 9 Pages 493-496
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    A 73-year-old male presented with diffuse mixed B cell lymphoma with involvement of the central nervous system (CNS) and testis manifesting as mild disorientation and aphasia. A left frontal cerebral mass and a right testicular tumor were found, and both lesions were surgically resected. Histological examination revealed diffuse mixed B cell type malignant lymphoma in the CNS and testis. The patient received irradiation to the head, and his initial symptoms improved. Pelvic computed tomography revealed enlargement of the contralateral testis and prostate. Needle biopsy confirmed lymphoma. The patient died 5 months after the initial diagnosis of septic shock. Autopsy examination revealed lymphoma cell invasion of the lung, bone marrow, prostate gland, and thalamus, but without involvement of the systemic lymph nodes. In a patient with an intracranial lymphoma, it is important to determine if the lesion is primary or metastatic and to plan medical treatment including systemic chemotherapy as soon as possible. Improvement of the prognosis of systemic non-Hodgkin's lymphoma with CNS involvement requires the detection and effective treatment of systemic lesions as well as the control of the CNS lesions.
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  • —Case Report—
    Rezzan ERGUVAN-ÖNAL, Çagatay ÖNAL, Ali GÜRLEK, A ...
    2004 Volume 44 Issue 9 Pages 497-501
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    A 45-year-old woman presented with an extremely rare metastatic fibrosarcoma of the brain manifesting as persistent headache. She had undergone surgery for a fibrosarcoma of the soft tissue of the thigh 2 months earlier. She had a history of previous surgery and radiotherapy for this tumor. She was somnolent with papilledema and left hemiparesis. Magnetic resonance imaging of the brain revealed a right frontal lesion with mass effect and heterogeneous enhancement. Computed tomography and scintigraphy showed multiple metastatic lesions of the lung. Right frontal craniotomy was performed for gross total removal of the yellowish-white tumor. Histological examination showed signs of epithelioid transformation based on positive staining for epithelial membrane antigen compared to the primary tumor. Postoperatively the patient was alert and the left hemiparesis improved. She refused radiotherapy or chemotherapy. Follow-up computed tomography showed multiple intracranial metastases. She died 5 months after the surgery.
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Technical Note
  • —Technical Note—
    Cengiz ÇOKLUK, Kirk W. JOBE, Alparslan SENEL, Ömer IYIGUN, ...
    2004 Volume 44 Issue 9 Pages 502-506
    Published: 2004
    Released on J-STAGE: February 06, 2005
    JOURNAL OPEN ACCESS
    The present study investigated the benefits of intraoperative ultrasonographic guidance during the surgical repair of congenital cystic spinal dysraphic lesions. Twenty-one children with cystic spinal dysraphism who underwent surgical repair were examined by real-time ultrasonography during the surgical intervention. Five children had meningoceles, six had myelomeningoceles, four had open neural plaques, three had lipomyelomeningoceles, and three had diastematomyelia. Visualization of the cystic compartments, identification of the neural structures, and identification and localization of the associated lesions were all reliably achieved in all cases. Intraoperative ultrasonographic guidance could determine the type of lesion and the associated lipomas, ectopic tissues, dermoid and epidermoid cysts, and doubling of the spinal cord, and locate diastematomyelic spurs, bands, and adhesions. Components filled with cerebrospinal fluid appeared as anechoic areas, and lipomas as hyperechoic. Intraoperative ultrasonographic guidance allowed the surgeon to correlate the complex anatomy identified on preoperative computed tomography and magnetic resonance imaging to the surgical site during the operation. Better orientation to the defect allows appropriate repair of the lesion with optimal preservation of neural tissues.
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