Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 46, Issue 9
Displaying 1-11 of 11 articles from this issue
Original Articles
  • —Results of a Randomized Trial of Fasudil Hydrochloride Versus Nimodipine—
    Jizong ZHAO, Dingbiao ZHOU, Jing GUO, Zyuan REN, Liangfu ZHOU, Shuo WA ...
    2006 Volume 46 Issue 9 Pages 421-428
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    The efficacy and safety of fasudil hydrochloride, a novel protein kinase inhibitor, were evaluated for the treatment of cerebral vasospasm and associated cerebral ischemic symptoms in patients with ruptured cerebral aneurysm. This randomized open trial with nimodipine as the control included 72 patients who underwent subarachnoid hemorrhage surgery for ruptured cerebral aneurysm of Hunt and Hess grades I to IV. For 14 days following surgery, patients were administered either 30 mg of fasudil hydrochloride by intravenous injection over a period of 30 minutes three times a day or 1 mg/hr of nimodipine by continuous intravenous infusion. Fasudil hydrochloride and nimodipine both showed inhibitory effects on cerebral vasospasm. The incidence of symptomatic vasospasm was five of 33 patients in the fasudil group and nine of 32 patients in the nimodipine group. Good recovery evaluated by the Glasgow Outcome Scale was achieved by 23 of 33 patients in the fasudil group and 19 of 34 patients in the nimodipine group. Both drugs significantly improved consciousness levels and neurological deficits such as aphasia. However, fasudil hydrochloride improved motor disturbance more than nimodipine. Adverse reactions occurred in 13 of 37 patients receiving fasudil hydrochloride and 15 of 35 patients receiving nimodipine. There were no serious adverse events in the fasudil group. The results of this clinical trial indicate that fasudil hydrochloride is a safe and efficient agent for suppressing cerebral vasospasm after subarachnoid hemorrhage surgery for ruptured cerebral aneurysm.
    Download PDF (130K)
  • Satoshi UTSUKI, Hidehiro OKA, Yoshinori TANIZAKI, Koji KONDO, Nobuyuki ...
    2006 Volume 46 Issue 9 Pages 429-433
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    The histological features of germinomas were investigated to differentiate tumors which completely disappear immediately after irradiation and those that persist. Eighteen previously untreated patients underwent germinoma biopsy and irradiation or combined irradiation and chemotherapy. Four tumors were located only in the pineal gland, eight in the suprasellar region, two in multiple locations, one in the basal ganglia, and three in other regions. Histologically, the germinomas could be divided into type A found in 13 cases which consisted mainly of large neoplastic cells and small lymphocytes, the so-called two-cell pattern, and type B found in five cases which consisted predominantly of fibrous tissue and granulomatous reaction containing occasional neoplastic cells. Follow-up computed tomography or magnetic resonance imaging showed the enhanced mass lesion disappeared in all cases of type A germinomas within 1 month after treatment, but persisted in all cases of type B germinomas for at least 1 month. Type B tumors required up to 12 months to show complete radiographic resolution. Persistent germinomas consisted predominantly of fibrous tissue and granulomatous reaction containing occasional neoplastic cells.
    Download PDF (599K)
Case Reports
  • —Case Report—
    Ayumi NARISAWA, Hiroaki SHIMIZU, Mika WATANABE, Teiji TOMINAGA
    2006 Volume 46 Issue 9 Pages 434-437
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    A 61-year-old male presented with left hand motor weakness associated with cerebral infarction in the right frontal lobe. Right common carotid angiography demonstrated a 66% stenosis and carotid duplex scan demonstrated intermediate echogenic plaque, indicating typical carotid plaque. Carotid endarterectomy was performed 22 weeks after the ischemic onset. During exposure of the carotid artery, a soft and yellowish mass (5 × 5 mm) was observed in the lateral wall of the carotid bulbus, which was not covered with adventitia but with thin connective tissue. The mass was removed en-bloc with a small part of the surrounding arterial wall combined with ordinary endarterectomy. The artery was closed with a collagen-impregnated polyester patch graft (Hemashield patchTM) to maintain adequate arterial lumen. Histological examination of the removed plaque confirmed that atheroma had protruded from the intima through the media as well as the adventitia and formed an extra-arterial mass. Such a case requires great care to dissect the carotid artery to prevent premature disintegration of the atheroma.
    Download PDF (585K)
  • —Case Report—
    Cem DINC, Ahmet Celal IPLIKCIOGLU, Kerem BIKMAZ, Serkan KOSDERE, Y&uum ...
    2006 Volume 46 Issue 9 Pages 438-440
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    A 52-year-old woman presented with bilateral distal anterior cerebral artery (ACA) mirror aneurysms, in addition to two right middle cerebral artery (MCA) aneurysms. The left distal ACA and right MCA aneurysms were clipped through right interhemispheric and right pterional craniotomies. The right distal ACA aneurysm was thrombosed. Distal ACA aneurysms tend to be multiple, but mirror aneurysms are rare, especially in the absence of congenital vascular anomaly. Single stage unilateral craniotomy is recommended for surgical treatment.
    Download PDF (301K)
  • —Two Case Reports—
    Shinji NAGATA, Takato MORIOKA, Yoshihiro NATORI, Tomio SASAKI
    2006 Volume 46 Issue 9 Pages 441-445
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    Two patients with giant occipital arteriovenous malformation (AVM) underwent microsurgical treatment among 294 patients with intracranial AVM treated between 1981 and 2004. The patients were aged 52 and 65 years and showed common symptoms consisting of long-term frequent migraine-like headaches with visual aura and recent homonymous hemianopia. Common neuroimaging findings were abundant dural feeders plus feeders from the posterior, middle, and anterior cerebral arteries, and deep drainers to the galenic system. Both patients underwent preoperative staged embolization and total microsurgical removal of the nidus with a neuronavigation system. Both patients returned to ordinary life without the need for assistance. These findings emphasize that giant occipital AVM, even if unruptured, is surgically treatable with acceptable morbidity.
    Download PDF (859K)
  • —Case Report—
    Yukinori AKIYAMA, Jun IKEDA, Yukihiro IBAYASHI, Tadashi NONAKA, Yasufu ...
    2006 Volume 46 Issue 9 Pages 446-449
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    A 38-year-old man presented with a dysplastic cerebellar gangliocytoma associated with a paraspinal arteriovenous fistula (AVF) at the upper cervical portion. Neuroimaging examination indicated the diagnosis of Lhermitte-Duclos disease. The patient was treated by embolization of the AVF followed by partial resection of the cerebellar tumor. Genetic examination showed a mutation of the phosphatase and tensin homolog deleted on chromosome ten (PTEN) gene. Histological examination confirmed the diagnosis. Lhermitte-Duclos disease is a rare dysplastic gangliocytoma manifesting as a slowly growing mass in the cerebellum and is usually asymptomatic. This case of Lhermitte-Duclos disease associated with paraspinal AVF and mutation of the PTEN gene suggests a relationship between Lhermitte-Duclos disease and Cowden disease.
    Download PDF (530K)
  • —Case Report—
    Masatomo KAJI, Hideo TAKESHIMA, Yoichi NAKAZATO, Jun-ichi KURATSU
    2006 Volume 46 Issue 9 Pages 450-454
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    A 17-year-old male presented with morning headache and double vision. Neuroimaging revealed a lobulated enhanced mass lesion with a blurred margin and remarkable peritumoral edema, and high uptake of methionine. The gray, soft, well-circumscribed mass was grossly totally resected. Histological examination showed the tumor cells were well differentiated with the perivascular pseudorosette pattern with broad, non-tapering processes radiating towards a central vessel without anaplastic features such as necrosis and endothelial proliferation. The histological diagnosis was low-grade astroblastoma. Follow-up magnetic resonance imaging demonstrated local recurrence 5 months later. Second surgery was followed by adjuvant radiotherapy and combination chemotherapy. Histological examination disclosed wide invasion by tumor cells into the subpial and perivascular space of the surrounding brain tissue. Follow-up magnetic resonance imaging demonstrated further recurrence around the tumor cavity. Surgical removal followed by six courses of combination chemotherapy (ifosfamide, cisplatin, and etoposide) resulted in complete remission of the tumor. Although gross total resection of astroblastoma usually results in long-term survival, some of these yet unfamiliar tumors may develop a more malignant character.
    Download PDF (1003K)
  • —Case Report—
    Mustafa Aziz HATIBOGLU, A. Celal IPLIKCIOGLU, Deniz OZCAN
    2006 Volume 46 Issue 9 Pages 455-458
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    A 28-year-old woman presented with a rare primary epidural hemangioma without adjacent vertebral involvement manifesting as progressive paraparesis. Magnetic resonance imaging of the thoracic spine showed an epidural lesion at T4-5 space appearing as isointense on T1-weighted images with enhancement by contrast medium and hyperintense on T2-weighted images. The lesion was totally removed microsurgically. Histological examination revealed cavernous hemangioma. She made a complete recovery from her symptoms and has remained asymptomatic for 9 years.
    Download PDF (359K)
  • —Case Report—
    Florian ROSER, Rainer RITZ, Florian H. EBNER, Dirk FREUDENSTEIN, Marco ...
    2006 Volume 46 Issue 9 Pages 459-461
    Published: 2006
    Released on J-STAGE: September 25, 2006
    JOURNAL OPEN ACCESS
    A 37-year-old female presented with a history of lumbar intraspinal glass fragments due to an accident in childhood. The patient developed progressive right convexity thoracolumbar scoliosis during puberty. Twenty-eight years after the accident, horizontalization of this deformity was performed by dorsal stabilization. Postoperatively the patient complained of acute L-5 radiculopathy. Radiological examination detected multiple glass fragments intra- and extradurally around the L3-4 levels with compression of the dural sac. Microsurgical removal of the extra- and intradural glass fragments led to complete relief of the radicular pain. Foreign bodies can become symptomatic due to changes in the status of the spine, especially during growth in young patients.
    Download PDF (325K)
Technical Note
Editorial Committee
feedback
Top