Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 45, Issue 8
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Yasuhiro SUZUKI, Masateru NAKAJIMA, Hisato IKEDA, Takumi ABE
    2005 Volume 45 Issue 8 Pages 387-394
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    The venous variations of the galenic system were evaluated using three-dimensional computed tomography angiography (3D-CTA) to assess the influence on the occipital transtentorial approach in 150 patients who underwent 3D-CTA as a routine screening examination for cerebrovascular diseases. The variations of the vein of Galen with its tributaries, the tentorial sinus, and the veins around the tentorium were evaluated in multiple intensity projections and stereoscopic images. The angle between the vein of Galen and the straight sinus was 67.1 ± 31.9° (mean ± SD). Observation of the pineal body from the direction of the approach tended to extend to the quadrigeminal bodies in acute angle cases, and to the third ventricle in obtuse angle cases. Bilateral internal cerebral veins (ICVs) joined in the anterior portion were associated with a long vein of Galen, or in the posterior portion with a short vein of Galen. The distance between the bilateral ICVs was 4.66 ± 2.28 mm (mean ± SD), and the shape of the space could be classified as spindle, parallel, hairpin, and round types. The basal vein could be classified into well-developed, hypoplastic, hardly recognized, and mimicking two basal veins because the tributary did not join but ran parallel to the basal vein. The drainage pathways lead to the anterior or posterior portion of the vein of Galen, the ICV, the tentorial sinus, and the superior petrosal sinus. The various types of the tentorial sinus and primitive tentorial sinus which might be sacrificed during section of the tentorium were confirmed. The inferior cerebral vein draining to the tentorial sinus could be seen. 3D-CTA could also demonstrate the presence, the course, and the drainage points of the internal occipital vein, the precentral cerebellar vein, the posterior pericallosal vein, and so on. 3D-CTA is useful to evaluate the variations of the venous system and the relationship with the tumor, and for preoperative simulation and intraoperative navigation of the occipital transtentorial approach.
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  • Hideki MATSUURA, Takashi INOUE, Kuniaki OGASAWARA, Makoto SASAKI, Hiro ...
    2005 Volume 45 Issue 8 Pages 395-399
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    Magnetic resonance (MR) imaging is an important diagnostic tool for neurosurgical diseases but susceptibility artifacts caused by biomaterial instrumentation frequently causes difficulty in visualizing postoperative changes. The susceptibility artifacts caused by neurosurgical biomaterials were compared quantitatively by 0.5, 1.5, and 3.0 Tesla MR imaging. MR imaging of uniform size and shape of pieces ceramic (zirconia), pure titanium, titanium alloy, and cobalt-based alloy was performed at 0.5, 1.5, and 3.0 Tesla. A linear region of interest was defined across the center of the biomaterial in the transverse direction, and the susceptibility artifact diameter was calculated. Susceptibility artifacts developed around all biomaterials at all magnetic field strengths. The artifact diameters caused by pure titanium, titanium alloy, and cobalt-based alloy increased in the order of 0.5, 1.5, to 3.0 Tesla magnetic fields. The artifact diameter of ceramic was not influenced by magnetic field strength, and was the smallest of all biomaterials at all magnetic field strengths. The artifacts caused by biomaterials except ceramic increase with the magnetic field strength. Ceramic instrumentation will minimize artifacts in all magnetic fields.
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Case Reports
  • —Case Report—
    Hidehiko ENDO, Yasunari OTAWARA, Kuniaki OGASAWARA, Akira OGAWA, Shin- ...
    2005 Volume 45 Issue 8 Pages 400-403
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 47-year-old man presented with a ruptured vertebral artery dissecting aneurysm manifesting as subarachnoid hemorrhage followed by acute occlusion and early recanalization of the affected artery. Cerebral angiography 2 hours after the onset of the symptom showed pearl-and-string sign in the right vertebral artery. Serial angiography showed that the affected artery was occluded at 12 hours but was recanalized on the 4th day. The dissecting aneurysm was resected with side-to-side anastomosis between the bilateral posterior inferior cerebellar arteries. Postoperative cerebral angiography demonstrated disappearance of the lesion and patency of the right posterior inferior cerebellar artery via the anastomosis. Histological examination of the lesion showed hematoma between the media and adventitia, disrupting the internal elastica and intima. Acute occlusion and early recanalization of the affected artery may occur in ruptured vertebral artery dissecting aneurysms. Serial neurological and neuroradiological examinations are essential to decide the timing and method of treatment.
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  • —Case Report—
    Kuniaki NAKAHARA, Hideo IIDA, Tetsuo MITOMI, Shigeyuki OHSAWA, Satoshi ...
    2005 Volume 45 Issue 8 Pages 404-406
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 30-year-old woman presented with headache which occurred when standing up from a recumbent position. Magnetic resonance (MR) imaging of the brain revealed slightly diffuse enhancement of the dura mater and two ventral extradural spinal flow voids in the supine position. Radionuclide cisternography identified cerebrospinal fluid leakage localized below the cervical level. Vertebral angiography demonstrated two dilated ventral extradural veins. The patient was treated by conservative therapy and improved with rest. The unusual clinical presentation with dilation of two epidural veins indicates the diagnostic value of MR imaging in cases of spontaneous intracranial hypotension.
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  • —Case Report—
    Takeshi MIYAZAKI, Toshiki YAMASAKI, Kouzo MORITAKE, Yoshifumi MATSUMOT ...
    2005 Volume 45 Issue 8 Pages 407-410
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 72-year-old female complained of acute pain on left eye movement followed by progressive exophthalmos. Neuroimaging revealed a large well-demarcated lesion consisting of solid and cystic parts, as well as bone destruction and hemorrhage, within the left orbital cavity. The preoperative diagnosis was pleomorphic adenoma with or without malignant transformation, or cavernous angioma. En bloc excision including adjacent tissues was planned to resolve the progressive symptoms and to obtain a histological diagnosis. The transcranial route was chosen since tumor invasion to the cranial base was possible. The histological diagnosis was pleomorphic adenoma. Pathological and preoperative radiological examinations indicated that repeated intratumoral hemorrhage had caused the orbital bone destruction and acute orbital pain. Neoplasms should be differentiated from a wide spectrum of other possible pathologies. Accurate clinical diagnosis of neoplasm in the orbital cavity is important for correct therapeutic management. Malignancy is generally suspected if painful and progressive signs and symptoms are associated with an orbital mass lesion. The present case suggests that pleomorphic adenoma should also be considered in the differential diagnosis. The therapeutic strategy for lacrimal gland tumors remains controversial, so a flexible management approach is required.
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  • —Case Report—
    Keisuke MARUYAMA, Akio MORITA, Junji SHIBAHARA, Yoichi NAKAZATO, Takaa ...
    2005 Volume 45 Issue 8 Pages 411-414
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 7-year-old boy presented with headache, visual disturbance, and psychomotor seizures persisting for 7 months. He had mild hemiparesis and homonymous hemianopia on the left. Neuroimaging showed bilateral temporal lobe masses with calcification and cysts. The right temporal mass was subtotally resected. The histological diagnosis was pilocytic astrocytoma with ependymal differentiation and a MIB-1 staining index of up to 8.0%. Postoperatively his hemiparesis and psychomotor seizures disappeared. Adjuvant chemotherapy consisting of carboplatin and vincristine was given followed by radiotherapy. Neuroimaging showed that the bilateral tumors had disappeared and showed no recurrence for 29 months after the diagnosis. Pilocytic astrocytoma usually presents as a solitary mass in the cerebellum or optic pathway with low proliferative activity, but should be included in the differential diagnosis of multifocal tumors arising in the bilateral temporal lobes. Ependymal differentiation with extremely high proliferative activity might be related to this unusual clinical presentation. Intensive treatment is recommended for patients with such specific neuroimaging and histological features.
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  • —Case Report—
    Hiroki NISHIBAYASHI, Yuji UEMATSU, Tomoaki TERADA, Toru ITAKURA
    2005 Volume 45 Issue 8 Pages 415-417
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 20-year-old man presented with diplopia. Neurological examination revealed mild skew deviation and upbeat nystagmus. Computed tomography showed a clover-shaped isodense mass in the pineal region with homogeneous enhancement. The lesion was isointense on both T1- and T2-weighted magnetic resonance (MR) imaging with homogeneous enhancement by gadolinium-diethylenetriaminepenta-acetic acid. Cerebral angiography showed no tumor staining. Serum and cerebrospinal fluid were negative for β-human chorionic gonadotropin, α-fetoprotein, and placental alkaline phosphatase. Open biopsy was performed using a right occipital transtentorial approach. Histological examination revealed a tumor consisting of clusters of germinoma cells, but with prominent infiltration of lymphocytes, plasma cells, and macrophages, and proliferation of small vessels. The histological diagnosis was germinoma with granulomatous reaction. MR imaging showed complete disappearance of the tumor after chemoradiotherapy. Neurosurgeons should be aware of this rare tumor to avoid misdiagnosis as granulomatous inflammation.
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  • —Case Report—
    He LIU, Toshiaki YAMAKI, Shin-ichi OKA, Izumi KOYANAGI, Kiyohiro HOUKI ...
    2005 Volume 45 Issue 8 Pages 418-422
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 54-year-old man, with a past history of renal cell carcinoma, presented with bitemporal visual field defect, hyponatremia, and diabetes insipidus. Endocrinological examination revealed panhypopituitarism. Computed tomography and magnetic resonance imaging showed an intrasellar mass with suprasellar extension. The initial radiological impression was pituitary adenoma. The tumor was decompressed via the transsphenoidal route. Histological examination revealed metastatic renal cell carcinoma. The clinical characteristics of metastatic pituitary carcinoma appear to be panhypopituitarism, and neuroimaging findings of strong enhancement of the tumor and bony destruction without marked sellar enlargement.
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  • —Case Report—
    Takashi SADATOMO, Kiyoshi YUKI, Keisuke MIGITA, Eiji TANIGUCHI, Yasuno ...
    2005 Volume 45 Issue 8 Pages 423-427
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    A 77-year-old man presented with a metastatic brain tumor 15 years after nephrectomy for a renal cell carcinoma. Neurological examination showed recent memory disturbance and slight right hemiparesis. Magnetic resonance imaging revealed a round well-demarcated mass extending from the left thalamus to the left trigone of the lateral ventricle. Preoperative angiography showed tumor staining. Surgery was performed by opening the inferior temporal sulcus. Only biopsy could be performed because of extensive bleeding from the tumor. Histological examination identified metastatic renal cell carcinoma. Gamma knife surgery was performed which resulted in resolution of his hemiparesis. Metastatic renal cell carcinoma should be considered even if nephrectomy was performed 10 or more years before presentation.
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Technical Note
  • —Technical Note—
    Shigeki KUBO, Hiroshi HASEGAWA, Toshihiko INUI, Shinsuke TOMINAGA, Tos ...
    2005 Volume 45 Issue 8 Pages 428-432
    Published: 2005
    Released on J-STAGE: August 25, 2005
    JOURNAL OPEN ACCESS
    Silicone plates sutured together to form blocks were used for extradural elevation of the sella floor in two patients who underwent chiasmapexy for visual disturbance associated with empty sella syndrome. A 36-year-old woman had been treated for prolactinoma for about 19 years with bromocriptine and then presented with left visual disturbance. A 79-year-old man presented with right blurred vision of unknown cause other than empty sella. The sella turcica was accessed via the endonasal transsphenoidal approach under endoscopic guidance. The bony sellar floor was opened with a drill. Two or three pieces of 1-mm-thick silicone plate were sutured to make a block. Two or three blocks were inserted into the epidural space to elevate the sellar contents. Visual symptoms improved in both patients. Silicone is biocompatible and not absorbable. Silicone plates are elastic and easy to handle during insertion, but firm enough to support the sella. The elevation can be adjusted by changing the number of plates in the block. The endonasal endoscopic approach is minimally invasive and particularly suitable for transsphenoidal extradural chiasmapexy for empty sella syndrome.
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