Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 46, Issue 3
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Nestin Expression in Vascular Malformations: A Novel Marker for Proliferative Endothelium
    Tatsuya SHIMIZU, Ken-ichi SUGAWARA, Masahiko TOSAKA, Hideaki IMAI, Kat ...
    2006 Volume 46 Issue 3 Pages 111-117
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.111
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    Cavernous angiomas (CAs) and arteriovenous malformations (AVMs) sometimes show growth or de novo appearance. Proliferative capacity of the endothelium is evident in such malformations. Intermediate filament nestin is a newly identified marker for proliferative endothelium, which was originally detected in the neuroepithelial stem cells of the embryonal central nervous system. Immunohistochemical analysis of nestin was evaluated as a marker for proliferative capacity of endothelial cells by comparison with proliferating cell nuclear antigen (PCNA). Sixteen of 27 CAs and 13 of 20 AVMs were positive for nestin. Likewise, 12 of 27 CAs and 10 of 20 AVMs were positive for PCNA. Nestin staining was stronger in the typical malformative vessels of CAs than in AVMs, in both the endothelial cells and the interstitial cells. Newly formed endothelial cells expressed nestin strongly in the reactive tissues including organizing or encapsulated hematomas. These results suggest that neovascularization occurs in the process of repeated bleeding and remodeling of hematomas.
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  • Skull Base Chordomas: Management and Results
    Carsten STÜER, Johannes SCHRAMM, Carlo SCHALLER
    2006 Volume 46 Issue 3 Pages 118-125
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.118
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    Growth patterns of skull base chordomas are related to important neurovascular structures. Local invasiveness results in “clinically malignant” behavior. A high rate of transient neurological deficits occurs following radical surgery. At our institution, the principle of radical removal is not followed at any price. This study compared the results of our management with recent series. Eleven patients, five females and six males aged 24-65 years (mean 41 years), underwent removal of skull base chordoma with size one <3 cm, five 3-5 cm, and five >5 cm. Mostly, standard operative approaches were chosen. All patients underwent postoperative radiotherapy. Resection was subtotal/partial in seven patients and total in four with no mortality. Neurological deterioration occurred due to transient cranial nerve deficits in six patients. Temporary surgical morbidity (including cranial nerve deficits) was observed in seven patients. Median Karnofsky performance status score improved compared to preoperative (80), early postoperative (70), and latest assessment (90) (median 36 months). Five patients underwent reoperation due to tumor recurrence after 4-48 months (mean 24 months). Most patients undergoing removal of skull base chordomas suffer from transient neurological deficits which are mainly nonsignificant as the patients return to preoperative functional status. The apparently high rate of incomplete tumor resection (64%) reflects the infiltrative behavior and relationship with neurovascular structures. The operative strategy should not be excessively aggressive at any price, but rather take into account the options of radiotherapy and observation of residual tumor.
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  • Spontaneous Resolution of Diabetes Insipidus After Pituitary Stalk Sectioning During Surgery for Large Craniopharyngioma
    —Endocrinological Evaluation and Clinical Implications for Surgical Strategy—
    Shigeru NISHIZAWA, Seiji OHTA, Yutaka OKI
    2006 Volume 46 Issue 3 Pages 126-135
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.126
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    The mechanism of spontaneous resolution of diabetes insipidus (DI) was investigated after surgery for large craniopharyngioma. Twenty-two adult patients (mean age 48.9 years old), who underwent surgery via the anterior interhemispheric trans-lamina terminalis approach, were divided into three groups: Group I, the entire pituitary stalk was preserved (n = 2); Group II, the stalk was dissected distally from the tumor but ultimately sacrificed (n = 9); Group III, the stalk was not identified and was sacrificed (n = 11). All patients were discharged without neurological deficits 1 month after surgery. Four patients underwent gamma-knife treatment for residual tumor or recurrence. Postoperative endocrinological functions were normal in Group I, and no replacement therapy was required. Hormonal replacement for pan-hypopituitarism and DI was necessary in Groups II and III (mean follow-up period 5.9 years). DI resolved at 2.7 ± 1.3 years after surgery in four patients in Group II, and a hypertonic saline infusion test revealed production of small amounts of intrinsic antidiuretic hormone (ADH). Urine osmolarity was high in the morning, and a significant increase in urinary osmolarity was noted after Pitressin injection. These results indicate induction of hypersensitivity of the distal renal tubules to small amounts of intrinsic ADH, resulting in decreased urinary output. Recovery from DI can be expected, despite permanent impairment of anterior pituitary function, if the pituitary stalk is dissected as distally as possible.
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Case Reports
  • Evaluation of Interhemispheric Time Difference by Magnetoencephalography Before and After Total Callosotomy
    —Two Case Reports—
    Kamran Ali SALAYEV, Nobukazu NAKASATO, Mamiko ISHITOBI, Hiroshi SHAMOT ...
    2006 Volume 46 Issue 3 Pages 136-142
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.136
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    Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (<20 msec). In Case 1 before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.
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  • Persistent Primitive Trigeminal Artery Aneurysm Associated With Cerebellar Hemangioblastoma
    —Case Report—
    Yasuo MURAI, Shiro KOBAYASHI, Kojiro TATEYAMA, Akira TERAMOTO
    2006 Volume 46 Issue 3 Pages 143-146
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.143
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    A 72-year-old man presented with a cerebellar vermian tumor manifesting as headaches and vertigo. Angiography disclosed a vascular tumor fed by the superior cerebellar artery and an aneurysm of a primitive trigeminal artery. The patient underwent right occipital craniotomy to remove the highly vascular tumor via an occipital transtentorial approach. Association of a cerebral aneurysm with a hemangioblastoma has been reported previously in only five cases. Only three aneurysms were located on the feeding artery. The aneurysm in this case was not on the feeding artery. Simple coincidence might account for this case.
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  • Atypical Meningioma With Large Cyst
    —Case Report—
    Nobuo SENBOKUYA, Takayuki ASAHARA, Mikito UCHIDA, Tsutomu YAGISHITA, H ...
    2006 Volume 46 Issue 3 Pages 147-151
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.147
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    A 29-year-old male presented with loss of consciousness and generalized seizure, followed by right hemiparesis and speech disturbance. Computed tomography and magnetic resonance imaging showed a solid, enhanced tumor with a cyst in the left frontal area with surrounding edema and mild mass effect. The cyst wall was also enhanced. The preoperative diagnosis was cystic falx meningioma. The tumor was totally resected, but most of the cyst wall adhered tightly to the surrounding brain and could not be removed. Histological examination revealed atypical meningioma and tumor cells in the cyst wall. The patient received local radiotherapy to the residual cyst wall with a total dose of 50 Gy.
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  • Pituicytoma
    —Two Case Reports—
    Yoko NAKASU, Satoshi NAKASU, Akira SAITO, Satoshi HORIGUCHI, Toru KAME ...
    2006 Volume 46 Issue 3 Pages 152-156
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.152
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    Pituicytoma is a rare tumor in the sellar or suprasellar region with distinct histological characteristics of glial neoplasm. A 42-year-old woman presented with a history of amenorrhea and vertigo, and a 62-year-old woman presented with mild headache. Both patients had mild hyperprolactinemia and one had mild anterior pituitary dysfunction. They underwent transcranial partial resection of a suprasellar tumor. The tumors were characterized by storiform pattern of elongated cells immunoreactive for S-100 protein and glial fibrillary acidic protein. Ultrastructural study showed abundant cytoplasmic intermediate filaments and tumor/blood vessel basal lamina, but no desmosomes between tumor cells. The residual tumors showed no changes in size without adjuvant therapy at 56 and 18 months after surgery. Pituicytoma is a glial neoplasm of adults with low proliferative activity. Patients often present with visual symptoms or anterior pituitary dysfunction. Symptoms and signs of neurohypophysis are rare. Neuroimaging reveals an intra- or suprasellar mass with non-specific features. The prognosis and role of adjuvant therapy remain unclear for this discrete noninfiltrative glioma.
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  • Lumbar Spinal Extradural Angiolipomas
    —Two Case Reports—
    Seref DOGAN, Erhan ARSLAN, Soner SAHIN, Kaya AKSOY, Sibel AKER
    2006 Volume 46 Issue 3 Pages 157-160
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.157
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    Spinal extradural angiolipomas are benign tumors mostly localized in the thoracic region. A 50-year-old woman and a 36-year-old man presented with rare lumbar spinal angiolipoma manifesting as low back pain but without neurological signs. Magnetic resonance imaging showed lumbar extradural tumors at the L4-5 and L1-2 levels, respectively. Each patient underwent complete surgical resection of the epidural tumors. Histological examination revealed characteristics of angiolipomas in both tumors. The symptoms of both patients improved postoperatively and no recurrence of the tumors was found 1 year after surgery.
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  • Stevens-Johnson Syndrome Associated With Intravenous Acetazolamide Administration for Evaluation of Cerebrovascular Reactivity
    —Case Report—
    Kuniaki OGASAWARA, Nobuhiko TOMITSUKA, Masakazu KOBAYASHI, Nobukazu KO ...
    2006 Volume 46 Issue 3 Pages 161-163
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.161
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    A 62-year-old man with left middle cerebral artery stenosis manifesting as transient ischemic attack underwent evaluation of regional cerebrovascular reactivity to acetazolamide using single photon emission computed tomography. Three days after intravenous administration of acetazolamide, erythematous eruptions of various sizes appeared on his back and spread over almost his entire body. Subsequently, painful ulcerations developed on his lips, and oral and nasal mucosa, and the conjunctiva became hyperemic, indicating Stevens-Johnson syndrome. The results of the lymphocyte transformation test were positive to only acetazolamide. Stevens-Johnson syndrome, also known as erythema multiforme major, can be life-threatening, and may be induced by intravenous administration of acetazolamide.
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  • Surgical Removal of a Live Worm by Stereotactic Targeting in Cerebral Sparganosis
    —Case Report—
    Misato NOBAYASHI, Hidehiro HIRABAYASHI, Toshisuke SAKAKI, Fumihiko NIS ...
    2006 Volume 46 Issue 3 Pages 164-167
    Published: 2006
    Released on J-STAGE: March 24, 2006
    DOIhttps://doi.org/10.2176/nmc.46.164
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    A 64-year-old man presented with generalized tonic clonic convulsion followed by weakness of the right lower extremity. He had a medical history of hypertension, hyperlipidemia, and right cerebellar infarction. Computed tomography (CT) showed a small high density nodule with an enhanced perifocal low density area in the left occipital lobe. T1-weighted magnetic resonance (MR) imaging showed a ring-shaped and partial string-like nodule with enhancement by gadolinium. T2-weighted MR imaging showed the white matter of the left occipital lobe as high intensity. CT and MR imaging seemed to indicate metastatic brain tumors, although cortical atrophy and ventricular dilation were recognized. Left parietal craniotomy was performed under stereotactic targeting to obtain a definitive diagnosis. During manipulation at the center of the targeted lesion, a white, tape-like body was found and recognized to be a live worm. Serological testing revealed strong immunopositivity against Spirometra mansoni. The infection route in the present case was probably through eating raw chicken meat. Cerebral sparganosis is extremely rare but should be considered in the differential diagnosis of metastatic brain tumors, especially in endemic areas.
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Editorial Committee
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