Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 1
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Predictors of Angiographic Changes in Neck Remnants of Ruptured Cerebral Aneurysms Treated With Guglielmi Detachable Coils
    Tomosato YAMAZAKI, Makoto SONOBE, Yasunobu NAKAI, Kyoichi SUGITA, Yuji ...
    2006 Volume 46 Issue 1 Pages 1-10
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.1
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    The angiographic changes in neck remnants of ruptured cerebral aneurysms treated with Guglielmi detachable coils (GDCs) were evaluated in the acute stage to analyze the important radiological and clinical factors. The clinical and radiological data of 37 patients with a residual neck of a ruptured cerebral aneurysm treated with GDC were reviewed. The angiographic changes on follow-up angiography were classified into three groups: recanalization of the neck remnant, progressive thrombosis, and unchanged. The effects of the clinical and angiographic findings, such as patient age, follow-up period, type of aneurysm (terminal type or side wall type), dome diameter, neck size, dome/neck ratio, obliteration rate, and volume embolization ratio were investigated. Recanalization of the neck remnant was observed in 18 of 37 cases, progressive thrombosis in nine, and unchanged in 10. The type of aneurysm, dome diameter, neck size, and volume embolization ratio were correlated with changes in the neck remnant. The aneurysm dome diameter and type of aneurysm were independent predictive factors for the recanalization of neck remnants on follow-up angiography. Dome diameter of less than 4.5 mm and volume embolization ratio of more than 31% in side wall aneurysms were likely to lead to progressive thrombosis
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  • Clinical Study of Cerebrospinal Fluid Dynamics Using 111In-DTPA SPECT in Patients With Subarachnoid Hemorrhage
    Ken KAZUMATA, Hiroyasu KAMIYAMA, Tatsuya ISHIKAWA, Kenichi MAKINO, Tos ...
    2006 Volume 46 Issue 1 Pages 11-18
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.11
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    The ventricle-to-background ratio and clearance rate constant measured by indium-111 diethylenetriaminepenta-acetic acid single photon emission computed tomography (111In-DTPA SPECT) were evaluated for predicting hydrocephalus in 16 patients at 2 to 3 weeks after onset of subarachnoid hemorrhage. The activity in the lateral ventricles, basal cistern, and hemispheric convexities was measured at 6, 24, and 48 hours after lumbar injection of radionuclide. In the follow-up study, eight patients developed hydrocephalus, and required ventriculoperitoneal shunting. Radioactivity measured in the hemispheric convexity did not reach peak activity within 48 hours. The clearance rate measured by applying the mono-exponential equation failed to show delayed clearance of radionuclide in hydrocephalus. The ratio between the ventricle and basal cistern measured at 6 hours postinjection was the best predictor of hydrocephalus (F(1, 30) = 42.84, p < 0.0001). These results suggest that a single 111In-DTPA SPECT scan may be sufficient to identify patients at risk of developing hydrocephalus.
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  • Interstitial Hyperthermia With Intra-arterial Injection of Adriamycin for Malignant Glioma
    Takeo UZUKA, Hideaki TAKAHASHI, Ryuichi TANAKA
    2006 Volume 46 Issue 1 Pages 19-23
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.19
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    A new method for treating malignant glioma by concurrent intra-arterial injection of adriamycin during thermotherapy was performed in seven patients with malignant glioma, four males and three females, with five cases of glioblastoma and two of anaplastic oligodendroglioma. Adriamycin was intra-arterially injected at a dose of 20 mg via the common carotid artery during thermotherapy. The heating procedure was repeated three times combined with chemotherapy in one therapy course, and a total of nine therapy courses were performed in the seven patients. All patients tolerated the protocol well. Based on post-therapy computed tomography, five of the therapy courses achieved partial response, one course resulted in disease progression, and the remaining three courses showed no change. The median time to progression was 3.4 months and the overall median length of survival following stereotactic biopsy was 13.2 months. Facial flushing was observed during eight therapy courses, and extensive alopecia in six therapy courses. Intracystic concentrations of adriamycin were determined in three patients, and marked increases were observed. Intra-arterial injection chemotherapy during hyperthermia is a promising therapeutic method for treatment of malignant glioma with few adverse effects.
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Case Reports
  • Covered Stent Treatment for Traumatic Cervical Carotid Artery Aneurysms
    —Two Case Reports—
    Jun DEGUCHI, Makoto YAMADA, Hitoshi KOBATA, Toshihiko KUROIWA
    2006 Volume 46 Issue 1 Pages 24-28
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.24
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    A 37-year-old man and a 23-year-old man with cervical carotid artery aneurysms were treated with covered stents. The covered stent was constructed from a Palmaz stent covered with an expanded polytetrafluoroethylene graft. Angiography showed the aneurysms had disappeared immediately after the procedure. Patency of the covered stents was confirmed at 18 and 34 months after intervention by three-dimensional computed tomography angiography. The covered stent allows relatively noninvasive reconstruction of the parent artery that immediately brings about complete thrombosis of the aneurysm. However, delivering the covered stent to the carotid artery may be difficult.
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  • Kissing Aneurysms at the Junction of the Internal Carotid Artery and the Ipsilateral Duplicate Anterior Choroidal Arteries
    —Case Report—
    Takatoshi SORIMACHI, Yukihiko FUJII, Takeo NASHIMOTO, Kenichi MORITA
    2006 Volume 46 Issue 1 Pages 29-31
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.29
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    A 45-year-old woman presented with kissing aneurysms located at the junctions of the internal carotid artery and the duplicate anterior choroidal arteries manifesting as acute subarachnoid hemorrhage. The aneurysms were clipped during temporary occlusion of the internal carotid artery. Surgery for kissing aneurysms requires special consideration including analysis of the anatomical relationship before clipping, control of premature rupture during clipping, and preservation of the patency of the two anterior choroidal arteries after clipping.
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  • De Novo Vertebral Artery Dissecting Aneurysm After Contralateral Vertebral Artery Occlusion
    —Two Case Reports—
    Yoshiro INUI, Yoshitsugu OIWA, Tomoaki TERADA, Kazuo NAKAKITA, Ichiro ...
    2006 Volume 46 Issue 1 Pages 32-36
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.32
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    Two patients developed de novo vertebral artery dissecting aneurysm after contralateral vertebral artery occlusion. A 36-year-old man presented with brainstem ischemia and was treated non-surgically. Subsequent angiography showed spontaneous vertebral artery occlusion at the site of dissection. A 45-year-old man developed subarachnoid hemorrhage due to vertebral artery dissecting aneurysm. He underwent endovascular occlusion of the vertebral artery proximal to the dissecting aneurysm. These patients developed de novo dissecting aneurysm on the contralateral vertebral artery at 13 months and 11 days after unilateral vertebral artery occlusion, respectively. These cases strongly suggest that changes in hemodynamic stress due to unilateral vertebral artery occlusion are related to de novo dissecting aneurysm on the contralateral side. The risk of de novo dissecting aneurysm may be increased by proximal occlusion or trapping of dissecting aneurysm of the contralateral vertebral artery.
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  • Chordoid Meningioma
    —Case Report—
    Takashi MITSUHASHI, Shinsuke ONO, Tadashi INOHARA, Takashi OTOMO, Aya ...
    2006 Volume 46 Issue 1 Pages 37-40
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.37
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    A 69-year-old female presented with a de novo lesion detected incidentally. Computed tomography demonstrated an isodense mass in the left parietal convexity with peritumoral edema, with homogeneous enhancement by contrast medium. Magnetic resonance imaging showed the left parietal convexity tumor as isointense on T1-weighted imaging and homogeneously hyperintense on T2-weighted imaging, with homogeneous enhancement and dural tail sign after intravenous administration of gadolinium-diethylenetriaminepenta-acetic acid. The tumor was totally removed. The histological diagnosis was chordoid meningioma. Combined immunohistochemical staining was helpful to differentiate chordoid meningioma from other chordoid neoplasm.
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  • Neurocytoma Manifesting as Intraventricular Hemorrhage
    —Case Report—
    Hiroki NISHIBAYASHI, Yuji UEMATSU, Tomoaki TERADA, Toru ITAKURA
    2006 Volume 46 Issue 1 Pages 41-45
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.41
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    A 43-year-old man presented with a neurocytoma manifesting as severe headache and disturbance of consciousness. Computed tomography revealed intraventricular hemorrhage, and a small mass lesion with calcification on the wall of the left lateral ventricle. The lesion appeared as mixed intensity regions on both T1- and T2-weighted magnetic resonance imaging, and heterogeneous enhancement with gadolinium-diethylenetriaminepenta-acetic acid. Angiography showed the pooling sign near the calcification in the late venous phase. Neurologically, amnestic syndrome was demonstrated in the subacute phase. Gross total removal of the lesion was performed through a transcallosal approach. His transient memory disturbance resolved. The histological diagnosis was neurocytoma. Intraventricular hemorrhage is rare as the initial presentation of neurocytoma. Surgery should avoid fornix injury and the risk of permanent memory disturbance.
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  • Safe Removal of Glioblastoma Near the Angular Gyrus by Awake Surgery Preserving Calculation Ability
    —Case Report—
    Masanori KURIMOTO, Takashi ASAHI, Takashi SHIBATA, Chiaki TAKAHASHI, S ...
    2006 Volume 46 Issue 1 Pages 46-50
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.46
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    A 67-year-old patient presented with progressive agraphia, alexia, and impaired ability to calculate persisting for 4 weeks. He showed preserved ability to do single-digit addition and subtraction. Magnetic resonance imaging demonstrated a tumor in the left parietal lobe. A malignant glioma was suspected, and awake craniotomy was performed to remove the tumor with functional cortical mapping to determine the cortices involved in calculation and language. His calculation ability was mapped on the angular gyrus, and partial resection of the tumor was achieved without deterioration of that ability. The histological diagnosis was glioblastoma multiforme. The patient’s calculation ability improved dramatically after the operation.
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  • Radiation-Induced Osteosarcoma 16 Years After Surgery and Radiation for Glioma
    —Case Report—
    Takayuki WATANABE, Takahisa FUSE, Masanari UMEZU, Mitsuharu YAMAMOTO, ...
    2006 Volume 46 Issue 1 Pages 51-54
    Published: 2006
    Released on J-STAGE: January 25, 2006
    DOIhttps://doi.org/10.2176/nmc.46.51
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    A 35-year-old man developed osteosarcoma of the left parietal and occipital bones 16 years after radiotherapy for glioma in the right occipital lobe. Radiotherapy of the primary neoplasm used 50 Gy administered to a localized field through two lateral ports. The secondary neoplasm arose contralateral to the primary lesion but within the irradiated field. The tumor had a multilocular cyst with considerable intracranial extension, and symptoms of elevated intracranial pressure were prominent early in the course. After a short-lived initial remission following surgical intervention and chemotherapy, the patient deteriorated because of tumor recurrence and died 18 months after the diagnosis. Radiation-induced osteosarcoma is a well-known but rare complication of radiotherapy for brain neoplasms with a poor prognosis.
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Editorial Committee
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