Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 47, Issue 6
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Mikhail F. CHERNOV, Pavel I. IVANOV
    2007 Volume 47 Issue 6 Pages 243-249
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    Outcome of urgent reoperation for major regional complication after removal of intracranial tumor was evaluated retrospectively in 100 consecutive patients treated since 1983. Urgent reoperation was performed from 3 to 240 hours (mean 74 hours) after primary surgery for 32 meningiomas, 23 pituitary adenomas, 22 gliomas, 13 vestibular schwannomas, and 10 other intracranial neoplasms. Mean Glasgow Coma Scale (GCS) score before reoperation was 8. Brain edema was the most frequent operative finding at reoperation (31 patients), followed by extradural hematoma (25) and brain ischemia (24). Removal of various types of intracranial hematomas was the most common surgical procedure at reoperation (47 cases). Final outcome was considered favorable in 54 patients, who were discharged without major neurological deficit, and unfavorable in 46, with severe disability or vegetative state in four and death in 42. Multivariate analysis showed statistically significant association with the outcome for histological type of the tumor (p < 0.0001), clinical state at admission (p < 0.001), GCS score before urgent reoperation (p = 0.001), time interval between primary surgery and urgent reoperation (p < 0.01), and patient age (p < 0.05). Therefore, the outcome after urgent reoperation due to major regional complications after removal of intracranial tumor is determined mainly by the clinical condition of the patient and characteristics of the tumor, and less influenced by the type of complication.
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  • Tohru TERAO, Hiroshi TAKAHASHI, Makoto TANIGUCHI, Katsuhisa IDE, Muneh ...
    2007 Volume 47 Issue 6 Pages 250-257
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    Retrospective analysis of 10 cases of resection of symptomatic lumbar juxtafacet cysts in nine patients (mean age 65.4 years) investigated the relationship between surgical method and progression of spinal spondylolisthesis or cyst recurrence. Patient characteristics, surgical methods, and postoperative course were reviewed. The most common preoperative symptom, painful radiculopathy, occurred in all cases, followed by motor weakness in five, sensory loss in four, and intermittent claudication in four. All patients underwent bilateral total (n = 6) or partial laminectomy (n = 4), with minimal (n = 3) or no (n = 7) facetectomy. Cysts were gross totally resected in eight cases and partially resected in two. Concomitant fixation was not performed. Painful radiculopathy, motor weakness, and sensory disturbance all resolved, resulting in good or excellent outcome in all patients. Postoperative symptomatic spondylolisthesis had not been noted at mean 52.1 months postoperatively. However, new juxtafacet cysts were later detected on the contralateral side to the initial lesion in two patients. Surgical removal of juxtafacet cysts is recommended for immediate symptomatic relief. Concomitant spinal fixation to prevent progression of spinal spondylolisthesis or cyst recurrence depends on cyst size, involvement of surrounding structures, degree of preoperative spondylolisthesis, and facet joint destruction.
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Case Reports
  • —Case Report—
    Akihiro KUROSU, Katsumi SUZUKAWA, Masashi AMO, Naoaki HORINAKA, Hajime ...
    2007 Volume 47 Issue 6 Pages 258-260
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    A 37-year-old man presented with perimesencephalic non-aneurysmal subarachnoid hemorrhage associated with cavernous sinus thrombosis. Anticoagulant therapy was administered to treat the cavernous sinus thrombosis, but provoked severe intracranial hemorrhage, severely disabling the patient. Perimesencephalic non-aneurysmal subarachnoid hemorrhage is a benign clinical entity with generally good prognosis, but the association with cavernous sinus thrombosis requires careful investigation prior to treatment.
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  • —Two Case Reports—
    Kentaro HAYASHI, Hideaki TAKAHATA, Naoki KITAGAWA
    2007 Volume 47 Issue 6 Pages 261-264
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    A 68-year-old woman and a 42-year-old woman presented with subarachnoid hemorrhage due to rupture of cerebral aneurysm. Both patients were treated with endovascular coil embolization. Thromboembolic complications occurred during the procedure and local thrombolysis was performed for recanalization. One patient developed massive rebleeding immediately after the procedure and the other suffered minor hemorrhage adjacent to the embolized aneurysm 2 days later. Local thrombolysis during treatment of ruptured aneurysm by coil embolization carries a significant risk of rebleeding. Prevention of thromboembolic complication by adequate heparinization is important.
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  • —Case Report—
    Satoshi TSUTSUMI, Takuma HIGO, Akihide KONDO, Yusuke ABE, Yukimasa YAS ...
    2007 Volume 47 Issue 6 Pages 265-268
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    A 75-year-old male suffered sudden onset of retroorbital pain, visual loss, periorbital ecchymosis, and double vision without preceding trauma, paranasal sinus surgery, or infectious signs. Neuroophthalmological inspection also revealed marked restriction of the extraocular movements, visual defect, and exophthalmos on the affected side. Neuroimaging showed an irregular-shaped retrobulbar mass centered in the inferolateral aspect and partially protruding between the inferior and lateral rectus muscles without enhancement by contrast medium. High dose steroid therapy provided little improvement in the visual symptoms. Needle aspiration biopsy revealed only fluid hematoma. Surgical exploration via the lateral wall of the orbit resulted in escape of chocolate-colored, liquefied hematoma during dissection between the inferior and lateral rectus muscles. No obvious vascular lesion was recognized. A small purplish elastic soft mass with irregular contours was recognized adherent to the inferior rectus muscle within the capsule of the hematoma. The mass was subtotally resected. The histological diagnosis was inflammatory pseudotumor with hemorrhagic change. No component of vascular malformation was found. Visual function and extraocular movement improved postoperatively and neuroimaging showed no abnormal structures in the affected orbit. Pseudotumor may bleed and form a retrobulbar hematoma which carries the risk of visual loss.
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  • —Case Report—
    Kohsuke TERANISHI, Takuji YAMAMOTO, Yasuaki NAKAO, Hideo OSADA, Ryo WA ...
    2007 Volume 47 Issue 6 Pages 269-272
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    A 61-year-old male presented with a recurrent solitary fibrous tumor (SFT) arising from the falx cerebri with intraventricular extension manifesting as nausea and vomiting. Magnetic resonance imaging showed the heterogeneously enhanced tumor in the falx, which extended to the bilateral lateral ventricles and the third ventricle. Total tumor removal was performed via the bifrontal interhemispheric approach. Histological examination showed mostly spindle cells with rich intercellular fibers. Immunohistochemical examination showed strong staining for CD34 in the cytoplasm but no staining for epithelial membrane antigen. Reexamination of the two previous tumor specimens, previously identified as fibrous meningioma, found SFT. The differential diagnosis of SFT in the central nervous system from fibrous meningioma and hemangiopericytoma requires immunohistochemistry and electron microscopy.
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  • —Case Report—
    Kimihiko YOKOSUKA, Ryoji ISHII, Yasuo SUZUKI, Kazuhiro HIRANO, Norihir ...
    2007 Volume 47 Issue 6 Pages 273-277
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    A 21-year-old man presented with extraneural metastases to the peritoneum, pleura, bone marrow, lymph nodes, and other organs from a pulvinar high grade glioma. He had undergone a shunt operation and three tumor removals during a 6-year period. He also received radiotherapy and adjuvant chemotherapy with 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride and interferon-beta. Two and a half years after the last surgery, extraneural metastasis to the peritoneal cavity was discovered. He died 13 months after the occurrence of extraneural metastases and 10 years after the initial diagnosis. Autopsy revealed tumor masses in the peritoneum, pleura, bone marrow, lymph nodes, and other organs, but no recurrent tumor of the primary lesion or metastases to other areas in the central nervous system. Systemic metastases from primary intracranial tumors are rare, but are likely to become more frequent as the prognosis of patients with brain tumors improves and the duration of survival lengthens.
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  • —Case Report—
    Naoshi HAGIHARA, Shuji SAKATA
    2007 Volume 47 Issue 6 Pages 278-281
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    A 13-year-old boy presented with syringomyelia associated with disproportionately large communicating fourth ventricle (DLCFV) manifesting as symptoms attributable to hydrocephalus and characteristic posterior fossa symptoms. Magnetic resonance imaging demonstrated remarkable dilation of the fourth ventricle and syringomyelia. Ventriculoperitoneal shunting completely resolved all symptoms as well as the ventricular and spinal cord abnormalities. Pre- and postoperative cine magnetic resonance imaging revealed the change of cerebrospinal fluid flow signal in the area of the foramen magnum. We concluded that the syringomyelia could be described as enlargement of the central canal with DLCFV.
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Technical Notes
  • —Technical Note—
    Hiroshi KASHIMURA, Kuniaki OGASAWARA, Yoshitaka KUBO, Akira OGAWA
    2007 Volume 47 Issue 6 Pages 282-284
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    Neck clipping for internal carotid-posterior communicating artery (IC-PC) aneurysms using standard straight, angled, or curved clip may result in remnant aneurysm neck. We describe complete neck clipping of IC-PC aneurysms using a bayonet-shaped clip. The bayonet-shaped clip is applied perpendicular to the long axis of the internal carotid artery (ICA), and the blades of the clip are inserted between the aneurysm neck and the ICA. Using the clip applicator, the clip is gradually rotated counterclockwise or clockwise for left or right ICA aneurysm, respectively, so that the distal and shank portions of the clip blade are located at the aneurysm neck in the posterior communicating artery (Pcom) and ICA, respectively. As a result, the distal flexure of the clip blade fits the junction of the ICA and Pcom. This technique was used in four patients with ruptured ICA aneurysms and five patients with unruptured ICA aneurysms. Postoperative cerebral angiography demonstrated no residual aneurysm neck and preservation of the Pcom in all patients. This technique is useful for cases of IC-PC aneurysm involving the origin of the Pcom.
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  • —Technical Note—
    Masanori TSUTSUMI, Kiyoshi KAZEKAWA, Masanari ONIZUKA, Tomonobu KODAMA ...
    2007 Volume 47 Issue 6 Pages 285-288
    Published: 2007
    Released on J-STAGE: June 25, 2007
    JOURNAL OPEN ACCESS
    Carotid artery stenting for carotid bifurcation stenosis usually uses the transfemoral approach. However, in patients with proximal common carotid artery (CCA) stenosis, the guiding catheter is difficult to introduce into the narrow origin of the CCA without risking cerebral embolization before activation of the protection device. A technique of cerebral protection by internal carotid artery (ICA) clamping with or without simultaneous external carotid artery (ECA) clamping was used to treat patients with proximal CCA stenosis by the retrograde direct carotid approach. The carotid bifurcation was surgically exposed and retrograde catheterization was performed to approach the stenosis. The ICA was clamped during angioplasty and stenting to avoid cerebral embolization. The ECA was clamped simultaneously if any extracranial-intracranial anastomosis was present. None of five patients treated with this technique experienced ischemic complications attributable to this technique.
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