Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 47, Issue 3
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Naoyuki HATTORI, Yoichi KATAYAMA, Takumi ABE, The Japan Neurosurgical ...
    2007 Volume 47 Issue 3 Pages 95-101
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    The present study analyzed the impact of case volume on outcome after cerebral aneurysm clipping at all 382 core neurosurgical training centers certified by the Japan Neurosurgical Society. A survey requested information on all clipping surgeries for cerebral aneurysms performed during 2003. Among these centers, 369 (96.6%) responded to our request and data satisfactory for analysis were obtained for 11,974 patients. Clinical condition was graded on admission according to the classification of the World Federation of Neurosurgical Societies. Outcomes were evaluated at discharge using the modified Rankin scale. Case volume at centers was divided into three groups based on the number of clippings (<30, 30-50, ≥50) performed in 2003. Totals of 7,578 (63.3%) and 4,396 (36.7%) patients underwent clipping for ruptured and unruptured aneurysms, respectively. The mortality rate was 9.6% for patients with ruptured aneurysms, and 0.2% for patients with unruptured aneurysms. No significant correlation was detected between case volume and outcome for either ruptured (Spearman’s correlation coefficient = 0.034, p = 0.483) or unruptured aneurysms (Spearman’s correlation coefficient = 0.029, p = 0.562). Furthermore, no relationships between case volume and outcome were identified for ruptured aneurysms in each neurological grade or unruptured aneurysms (Kruskal-Wallis test).
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  • Gulgun KAYALIOGLU, Mete ERTURK, Tuncay VAROL, Enis CEZAYIRLI
    2007 Volume 47 Issue 3 Pages 102-108
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    Anatomical measurements of the cervical pedicle in a large series of human cervical vertebrae from 48 individuals were obtained to reduce the incidence and severity of complications caused by transpedicular screw placement. The greatest pedicle length was at C-3 and the greatest pedicle width was at C-6. Pedicle width and lateral mass thickness gradually increased from C-3 to C-6. Pedicle height and interpedicular distance increased from C-3 to C-5, and decreased slightly at C-6. The lateral mass-pedicle length was greatest at C-4. The present study found right-left differences for the pedicle-spinous process distance at C-6 (p < 0.05). Pedicle width and height were smaller than those reported in earlier studies, especially at C-3 and C-4, whereas the increasing pedicle widths at C-5 and C-6 were appropriate for pedicle screw fixation.
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  • —A Prospective Study—
    Ahmet ÇOLAK, Murat KUTLAY, Zekai PEKKAFALI, Mehmet SARAÇ ...
    2007 Volume 47 Issue 3 Pages 109-115
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.
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Case Reports
  • —Case Report—
    Mamoru MURAKAMI, Tetsuya TSUKAHARA, Hiroyasu ISHIKURA, Taketo HATANO, ...
    2007 Volume 47 Issue 3 Pages 116-120
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    A 19-year-old female was admitted to our hospital after severe head injury in a traffic accident. On admission, she had no spontaneous respiration, but did have heart beat with a blood pressure of 100/60 mmHg. Neurological examination demonstrated that the Glasgow Coma Scale score was 3 and her pupils were fixed and dilated. Computed tomography (CT) showed diffuse brain swelling with disappearance of the perimesencephalic cistern. Chest CT showed bilateral lung contusions. Mild hypothermia with a target temperature of 33°C was immediately induced, and was continued for 28 days to control the persistent increase in intracranial pressure (ICP). Subsequently, she recovered, and 20 months after admission, could speak and walk with slight hemiparesis on the left. Prolonged mild hypothermia may be effective to control persistent increase in ICP due to diffuse brain swelling.
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  • —Case Report—
    Masakazu KOBAYASHI, Kuniaki OGASAWARA, Takashi INOUE, Hideo SAITO, Nob ...
    2007 Volume 47 Issue 3 Pages 121-125
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    A 68-year-old man with left cervical internal carotid artery stenosis suffered crescendo transient ischemic attacks caused by mobile thrombus detected by carotid echography and secondary impairment of cerebral hemodynamic reserve demonstrated by positron emission tomography. Urgent carotid endarterectomy (CEA) was performed following pretreatment with edaravone and early clamping of the carotid arteries without intraluminal shunting. The postoperative course was uneventful, and postoperative magnetic resonance imaging and single-photon emission computed tomography revealed no new cerebral ischemic lesions and no findings of cerebral hyperperfusion, respectively. The risks associated with CEA are higher for patients with evolving stroke or crescendo transient ischemic attacks than that for patients with stable disease. This case demonstrates that urgent endarterectomy for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombi and hemodynamic cerebral ischemia can be successfully performed following pretreatment with edaravone and early clamping of the carotid arteries.
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  • —Two Case Reports—
    Shun-ichi NAGATA, Kiyoshi KAZEKAWA, Hiroshi AIKAWA, Reizo KANEMARU, Ko ...
    2007 Volume 47 Issue 3 Pages 126-127
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    Two patients with atherosclerotic ischemic cerebrovascular disease presented with transdural anastomoses. A 74-year-old woman had a cerebral infarct, and a 76-year-old man had dementia. Patients with atherosclerotic ischemic cerebrovascular disease may have developed transdural anastomoses, so care must be taken not to damage these functions during revascularization surgery.
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  • —Case Report—
    Ercan ÖZER, Orhan KALEMCI, Kemal YÜCESOY, Serafettin CANDA
    2007 Volume 47 Issue 3 Pages 128-131
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    A 15-year-old boy presented with an extremely rare optochiasmatic cavernous angioma. He was admitted to a special hospital with the complaint of blurred vision persisting for 1 month. Magnetic resonance imaging and biopsy of the lesion were inconclusive. He was admitted to our neurosurgical clinic after worsening of the visual symptoms 9 months later. Repeat magnetic resonance imaging showed optochiasmatic cavernous angioma which had doubled in size. The lesion was removed completely without any problem. Postoperatively his visual complaints remained stable, but had improved after 1 year. Optochiasmatic cavernous malformation should be treated by surgical excision, whereas biopsy is useless and may result in enlargement.
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  • —Case Report—
    Junichi MIYAMOTO, Kazunori TATSUZAWA, Hiroyasu SASAJIMA, Katsuyoshi MI ...
    2007 Volume 47 Issue 3 Pages 132-135
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    A 67-year-old female presented with a rare metastatic skull tumor from cholangiocarcinoma (CCC) manifesting as a progressive painful subcutaneous tumor. Computed tomography and magnetic resonance (MR) imaging revealed an osteolytic tumor attached to the sigmoid sinus and mastoid sinus. Mass reduction of the tumor was performed and radiotherapy applied to the postoperative cavity. The symptoms resolved following the surgical intervention. The skull metastasis from CCC appeared as heterogeneous intensity on MR imaging reflecting the honeycomb structure. Surgery should be considered to relieve symptoms and improve the patient’s quality of life, if there is a low risk of morbidity or mortality. The present case indicates another metastatic pathway through the vertebral plexus in the clinical course of CCC.
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  • —Case Report—
    Tomofumi NISHIKAWA, Jun A. TAKAHASHI, Akira SHIMATSU, Nobuo HASHIMOTO
    2007 Volume 47 Issue 3 Pages 136-139
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    A 62-year-old woman presented with general malaise persisting for 2 months and narrowing of her visual field. T1-weighted magnetic resonance (MR) imaging showed swelling of the pituitary gland and stalk, and a homogeneous isointense intra- and suprasellar mass enhanced by gadolinium. During outpatient follow up, her condition deteriorated rapidly and she developed diabetes insipidus and panhypopituitarism. T1-weighted MR imaging demonstrated shrinkage of the lesion and disappearance of the central hypointense area indicating the cyst cavity, especially in the pituitary stalk. She underwent surgical exploration via the transsphenoidal approach under a provisional diagnosis of lymphocytic hypophysitis. Histological examination revealed ciliated columnar cells and squamous metaplasia on the inner surface of the cyst wall, with many foamy cells, infiltration by many lymphoid cells and some eosinophils, and fibrosis in the adenohypophysitis and inflammatory hypophysitis in the anterior and posterior pituitary gland. The present neuroimaging findings of cyst shrinkage associated with rapid clinical deterioration strongly support the suggestion that rupture of Rathke’s cleft cyst causes inflammatory hypophysitis.
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  • —Case Report—
    Mayu TAKAHASHI, Armando PAZ PAREDES, Didier SCAVARDA, Gabriel LENA
    2007 Volume 47 Issue 3 Pages 140-144
    Published: 2007
    Released on J-STAGE: March 23, 2007
    JOURNAL OPEN ACCESS
    A 10-year-old girl presented with a brainstem epidermoid cyst manifesting as dysphagia and post-prandial vomiting. Magnetic resonance imaging disclosed a cystic mass in the brainstem with associated hydrocephalus. She was treated under a presumptive diagnosis of abscess until the definitive histological diagnosis was established at the fourth admission. In spite of four interventions, she remained in good condition with minimal cranial nerve pareses. Subtotal removal of the epidermoid cyst in the brainstem results in recurrence within a relatively short period, especially in children. Total resection of the tumor is the optimum treatment. The differential diagnosis includes abscess, cystic glioma, and neurenteric cyst.
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