Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 45, Issue 9
Displaying 1-15 of 15 articles from this issue
Review Article
  • Joji INAMASU, Daniel H. KIM, Arnett KLUGH
    2005 Volume 45 Issue 9 Pages 439-447
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    The surgical treatment of craniocervical junction (CCJ) instability has recently undergone significant development and change. Posterior instrumentation surgery has been the mainstay of treatment of CCJ instability, and is the focus of this review. For the treatment of atlantoaxial instability, C1-2 transarticular screw fixation has shown good stability, and has been regarded as the “gold standard” procedure. Because of potentially hazardous complications including vertebral artery injury, however, C-1 lateral mass-C-2 pedicle screw fixation is gaining popularity. For treatment of atlantooccipital instability, occipitocervical fixation using screw constructs (combined with either rods or plates) has shown more stability than sublaminar wiring techniques, and has been utilized more frequently. Both innovation in material engineering and in vitro biomechanical studies have contributed significantly to the development of more rigid internal fixation devices, and as a result, many patients who would have been treated conservatively with external orthosis are treated nowadays with instrumentation surgery, resulting in earlier ambulation, shortened hospital stay, and earlier recovery into social activities. New surgical techniques and instruments, however, need to stand the test of time to see whether they are free from long-term adverse events. The rapid turnover of new surgical techniques and hardware has made it difficult for less experienced surgeons to keep up with the latest developments. Conventional techniques can be safer and less technically demanding than newer techniques for those who are not familiar with them.
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Original Articles
  • —Survey of 1225 Sites in Japan—
    Kiyohiro HOUKIN, Tadashi NONAKA, Shinnichi OKA, Izumi KOYANAGI
    2005 Volume 45 Issue 9 Pages 448-453
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    Social demand for the disclosure of medical information is increasing, especially the treatment for unruptured intracranial aneurysms. This study investigated to what extent information on the treatment for unruptured intracranial aneurysms is disclosed on websites in Japan. We surveyed 1225 institutions authorized by The Japan Neurosurgical Society. The following factors were analyzed: percentage of institutions with websites, disclosure of number of surgeries, and disclosure of outcome of treatment for ruptured and unruptured intracranial aneurysms. Of the 1225 institutions surveyed, 1097 (89.6%) had their own websites. The total number of websites was 1262 since some institutions have several homepages in different websites. The annual number of surgeries was shown in 274 of the 1225 institutions (22.4%). The outcome of treatment for ruptured intracranial aneurysms was disclosed in 104 of the 1225 institutions (8.5%). The outcome of treatment for unruptured intracranial aneurysms was shown in only 32 of the 1225 institutions (2.6%). Disclosure of outcome of treatment for unruptured intracranial aneurysms on websites is not common. To improve disclosure of the outcome on websites, guidelines should be established.
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  • Yukitaka USHIO, Masato KOCHI, Jun-ichiro HAMADA, Yutaka KAI, Hideo NAK ...
    2005 Volume 45 Issue 9 Pages 454-461
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    The relationship between the extent of tumor resection and the progression-free survival, overall survival, and quality of life was evaluated retrospectively in 105 consecutive adult patients with supratentorial hemispheric glioblastoma not primarily involving the basal ganglia, thalamus, or hypothalamus. All patients underwent multidisciplinary treatment including tumor removal and postoperative adjuvant therapy in prospective randomized trials designed to test several chemotherapy regimens. Magnetic resonance imaging with contrast medium was used to determine the extent of tumor resection. Gross total resection (GTR) was performed in 35 patients (33%), partial resection (PR) in 57 (54%), and biopsy in 13 (12%). Univariate and multivariate analysis was performed to assess the prognostic relevance of the extent of resection. The Karnofsky performance status (KPS) improved from 78% to 83% in the GTR group. The difference was not statistically significant. There was no significant change in the PR (from 70% to 72%) and the biopsy groups (from 64% to 62%). Progression- free survival was significantly longer in the GTR group (median survival time [MST] 10.3 months) than in the PR (MST 5.2 months) and the biopsy groups (MST 3.6 months). The overall survival was significantly longer in the GTR group (MST 20 months) than in the PR (MST 14.2 months) and the biopsy groups (MST 8.3 months). The difference in survival between the PR and the biopsy groups was not statistically significant. GTR prolongs the survival of patients with glioblastoma compared to PR or biopsy.
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Case Reports
  • —Case Report—
    Shin-Hyuk KANG, Yong-Gu CHUNG, Hoon-Kap LEE
    2005 Volume 45 Issue 9 Pages 462-463
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    A 34-year-old man presented with an acute epidural hematoma that resolved within 24 hours after a fall. On admission, neurological examination found no abnormalities. Computed tomography (CT) indicated a linear fracture in the occiput. Four hours after the injury, the patient’s condition worsened and repeat CT showed a bilateral epidural hematoma in the posterior fossa extending over the bilateral transverse sinuses and severe brain swelling. The patient’s family refused surgery. Conservative management with pentothal was performed in the intensive care unit. Follow-up CT 21 hours after the initial injury showed complete resolution of the hematoma and an increase in the CT density of the pericranial soft tissue near the hematoma. The pressure gradient between the subgaleal and epidural space may have been important in the rapid disappearance of this epidural hematoma.
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  • —Five Case Reports—
    Seikou KUWAHARA, Masaaki FUKUOKA, Yoko KOAN, Hirohisa MIYAKE, Yuko ONO ...
    2005 Volume 45 Issue 9 Pages 464-469
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    Five cases of traumatic subdural hematomas in the subacute stage (from 7 to 20 days after head injury) were treated in one male and four females, aged from 63 to 82 years, with evacuation via craniotomy in three and aspiration via burr hole surgery in two. All hematomas were evaluated by T1-, T2-, and diffusion-weighted magnetic resonance imaging, and measurement of the apparent diffusion coefficient (ADC). Diffusion-weighted imaging showed the hematoma as a crescent high intensity area with a low intensity rim close to the brain surface (two-layered structure) in four cases and as high intensity with low intensity components in one case. The high intensity areas under the dura mater on diffusion-weighted imaging appeared as homogeneous high intensity on T1- and T2-weighted imaging in four cases, and inhomogeneous high intensity on T1- and isointensity on T2-weighted imaging in one case. The mean ADC value of the high intensity areas was 0.58 ± 0.23 (mean ± standard deviation) × 10-3 mm2/sec. The operative findings revealed the high intensity areas as solid clots. The low intensity areas on diffusion-weighted imaging appeared as homogeneous high intensity in four cases and inhomogeneous isointensity with high intensity components in one case on T1- and T2-weighted imaging. The mean ADC value of the low intensity areas was 2.03 ± 0.27 × 10-3 mm2/sec. The operative findings revealed the low intensity areas as mixtures of resolved clot and cerebrospinal fluid. Diffusion-weighted imaging showed the characteristic two-layered structure in traumatic subdural hematomas in the subacute stage, and analysis of the ADC values was useful for differentiating solid from liquid hematoma and for selection of the surgical procedure.
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  • —Case Report—
    Mikinobu TAKEUCHI, Naoya KUWAYAMA, Michiya KUBO, Kimiko UMEMURA, Yutak ...
    2005 Volume 45 Issue 9 Pages 470-471
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    A 68-year-old man presented with occlusion of the internal carotid artery (ICA) manifesting as a 6-month history of progressive sensory and motor disturbance of the left lower limb. Angiography clearly demonstrated a collateral arterial network between the ICA and external carotid artery (ECA) through the vidian artery, a small branch of both the ICA and ECA. The vidian artery may form an unusual but important ECA-ICA collateral pathway in patients with occlusive lesion of the ICA.
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  • —Case Report—
    Masayasu KATO, Yasuhiko KAKU, Ayumi OKUMURA, Toru IWAMA, Noboru SAKAI
    2005 Volume 45 Issue 9 Pages 472-475
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    A 71-year-old man presented with right hemiparesis and aphasia due to cerebral infarction in the frontal lobe. Computed tomography (CT) revealed a high-density mass, 12 mm in diameter, in the stem of the left sylvian fissure. Carotid angiography demonstrated occlusion of the left ascending frontal artery complex and retention of contrast medium at the bifurcation of the left middle cerebral artery (MCA). The diagnosis was cerebral infarction caused by occlusion of the ascending frontal artery complex resulting from thrombosed left MCA aneurysm. The patient was managed conservatively and his neurological symptoms gradually improved. One month later, he lapsed into a coma. CT revealed subarachnoid hemorrhage. Carotid angiography showed a large left MCA aneurysm with branch occlusion of the left ascending frontal artery complex. A left frontotemporal craniotomy was performed. The MCA aneurysm was opened and the intramural thrombi removed, and finally neck clipping was performed. The patient made a good postoperative recovery.
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  • —Case Report—
    Naoyuki ISOBE, Shuichi OKI, Masayuki SUMIDA, Yukari KANOU, Shinya NABI ...
    2005 Volume 45 Issue 9 Pages 476-479
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    An 11-year-old boy developed occlusion of the left internal carotid artery (ICA) following surgical correction of atypical coarctation of the aorta. The patient was admitted to our hospital after presenting with severe hypertension secondary to abdominal aortic hypoplasia and renal artery stenosis. Reconstruction of the abdominal aorta with bypass grafting was performed without complication. However, in the postoperative period, the patient experienced recurrent transient ischemic attacks manifesting as paresthesia of the right upper limbs, dysarthria, and right-sided weakness. Cerebral angiography revealed occlusion of the C2 portion of the left ICA and decreased resting cerebral blood flow in the left hemisphere. Extracranial-intracranial arterial bypass was performed, and the patient suffered no further adverse neurological events. Coarctation of the aorta is an uncommon congenital condition that may result in cerebral ischemic disease. The cerebrovascular circulation should be evaluated, even in patients without a pre-existing history of cerebral ischemic symptoms.
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  • —Case Report—
    Jun-Hong MIN, Shin-Hyuk KANG, Jang-Bo LEE, Yong-Gu CHUNG, Hoon-Kap LEE
    2005 Volume 45 Issue 9 Pages 480-483
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    A 56-year-old man presented with a meningioma associated with hyperostotic bone containing little tumor cell infiltration. The patient presented with a growing mass on his right forehead and exophthalmos. Computed tomography (CT) taken 4 years previously revealed only hyperostosis without intracranial lesion. Repeat CT revealed an enhanced intracranial mass with overlying diffuse hyperostosis extending extracranially. The tumor and affected bone were widely removed. Histological examination confirmed rhabdoid meningioma in the intracranial and extracranial lesion. However, most of the hyperostotic bone showed no tumor cell infiltration. The cause of hyperostosis associated with meningioma is unclear, but tumor invasion is the generally accepted cause. In this case, hyperostosis occurred without tumor cell infiltration so another mechanism was probably involved. The extracranial extension occurred despite the disproportionately small tumor without global tumor cell infiltration of the bone or bony erosion.
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  • —Case Report—
    Yutaka HIRASHIMA, Hiroaki IKEDA, Takashi ASAHI, Takashi SHIBATA, Kyo N ...
    2005 Volume 45 Issue 9 Pages 484-486
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    A 50-year-old man had undergone right nucleus ventrointermedius (Vim) thalamotomy 1 year previously, resulting in the disappearance of left hand tremor. However, he presented with right distal and proximal tremor including the axial trunk, neck, and head. Deep brain stimulation (DBS) of the left Vim for these symptoms was unsuccessful. Attempts were made to stimulate the left Vim, nucleus ventralis lateralis, and subthalamic nucleus (STN), but no significant improvement was obtained after repeat surgery. However, subsequent improvement of the symptoms including proximal tremor was very marked even without DBS stimulation. Brain magnetic resonance imaging demonstrated lesion and edema in the posteromedial area of the STN. Mechanical injury of the area caused by the surgical procedures may have contributed to the improvement in his persistent symptoms.
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Technical Note
Erratum
  • 2005 Volume 45 Issue 9 Pages 493
    Published: 2005
    Released on J-STAGE: September 26, 2005
    JOURNAL OPEN ACCESS
    To the Readership: The first author has been informed that two coauthors' names were incorrectly reported in the above-mentioned article. Wrong:Kuniaki NAKAHARA, Hideo IIDA, Tetsuo MITOMI*, Shigeyuki OHSAWA, Satoshi UTSUKI**, Satoru SIMIZU**, and Kiyotaka FUJII**
    Right:Kuniaki NAKAHARA, Hideo IIDA, Tetsuo MITOMI*, Shigeyuki OSAWA, Satoshi UTSUKI**, Satoru SHIMIZU**, and Kiyotaka FUJII**
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