Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 47, Issue 8
Displaying 1-11 of 11 articles from this issue
Original Articles
  • Yoshinobu SEO, Tamio ITO, Takehiko SASAKI, Jyoji NAKAGAWARA, Hirohiko ...
    2007 Volume 47 Issue 8 Pages 335-340
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    The anatomical relationship between the arcuate eminence (AE) and the superior semicircular canal (SSC) was examined by computed tomography (CT) in 52 petrous bones of 26 patients. After acquiring volume data by multidetector CT, 1-mm thick oblique bone window images perpendicular to the SSC were obtained from the axial images. The distances between the AE and the SSC, and the SSC and the superior surface of the petrous bone were measured. The AE corresponded exactly with the SSC in only 2/52 petrous bones, and corresponded well in 7/52. The AE was lateral to the SSC in 25/52 cases, medial to the SSC in 6/52 cases, intersected in 3/52 cases, and was indiscernible in 9/52 cases. The distance between the SSC and the petrous surface was 0 mm in 45/52 petrous bones, 1 mm in 5/52, 2 mm in 1/52, and 3 mm in 1/52. The SSC typically does not correspond exactly with the AE, and is generally located just under the surface of the petrous bone. Planning of the middle cranial fossa approach requires location of the SSC by CT.
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  • Dai ISHII, Atsushi NATSUME, Toshihiko WAKABAYASHI, Hisashi HATANO, Yos ...
    2007 Volume 47 Issue 8 Pages 341-350
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    Promoter methylation of the deoxyribonucleic acid (DNA) repair gene, O6-methylguanine-DNA methyltransferase (MGMT), is associated with improved outcome of patients with glioblastoma multiforme and anaplastic astrocytoma treated with temozolomide (TMZ). Molecular genetic analysis of loss of heterozygosity (LOH) of 1p, 19q, or 10q, p53 mutation, and MGMT promoter methylation was performed in 44 assessable tumor specimens obtained from 46 patients with recurrent malignant gliomas, including 21 with glioblastoma multiforme, 17 with anaplastic astrocytoma, and eight with anaplastic oligoastrocytoma, which have heterogeneous features and variable histological diagnosis, to assess the correlation with the response to TMZ. LOHs of 1p and 19q, and MGMT promoter methylation showed positive correlations with the clinical response to TMZ therapy (p < 0.005, 0.05, and 0.05, respectively; Fisher’s exact test). In addition, LOH of 1p and MGMT promoter methylation were associated with longer progression-free survival (p < 0.05 and 0.05, respectively; Cox regression analysis). LOH of 1p in the heterogeneous population of malignant gliomas may be one of the important factors besides MGMT methylation that predict better outcome in patients treated with TMZ.
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Case Reports
  • —Case Report—
    Yoshinori AOKI, Masaaki NEMOTO, Kyosuke YOKOTA, Toshiyuki KANO, Shouzo ...
    2007 Volume 47 Issue 8 Pages 351-355
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 42-year-old man presented with a ruptured fusiform aneurysm of the proximal anterior cerebral artery (A1 segment) manifesting as sudden onset of severe headache. Brain computed tomography revealed subarachnoid hemorrhage in the basal cisterns, and left carotid angiography demonstrated a fusiform aneurysm of the left A1 segment. He underwent surgery via the left pterional approach. The left A1 segment exhibited a fusiform configuration. Adequate development of the anterior communicating artery was confirmed. Trapping of the aneurysm was performed. The aneurysm was associated with atherosclerotic changes. The postoperative course was uneventful, and the patient was discharged without neurological deficits 1 month after surgery. Fusiform aneurysm of the A1 segment is quite rare, and tends to bleed, so must be treated. The atherosclerotic origin indicates long-term follow up to identify subsequent lesions.
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  • —Case Report—
    Seong Jun LEE, Jung Yong AHN
    2007 Volume 47 Issue 8 Pages 356-359
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 55-year-old woman presented with moyamoya disease manifesting as recurrent transient ischemic attacks despite taking aspirin and antihypertensive agent. Angiography showed the characteristic angiographic appearance with bilateral internal carotid artery occlusion and abnormal collateral vessels. Left external carotid angiography demonstrated moderate stenosis of the proximal external carotid artery (ECA). A self-expandable stent was successfully placed in the left ECA to improve ipsilateral cerebral perfusion. The patient had an uneventful outcome after a 1-year follow up. Involvement of the proximal ECA is very unusual in moyamoya disease, and might result from hemodynamic stress or degenerative atherosclerosis. Revascularization procedures for stenoses of proximal ECA may improve cerebral perfusion in patients with moyamoya disease.
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  • —Case Report—
    Michele LANOTTE, Rosa PEREZ, Riccardo BOCCALETTI, Isabella CASTELLANO, ...
    2007 Volume 47 Issue 8 Pages 360-363
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 49-year-old woman presented with a rare atypical growth pattern of meningioma without evidence of dural attachment manifesting as chronic headache associated with transient paresthesia and left motor disorders. On admission, neurological examination showed no abnormalities. Magnetic resonance (MR) imaging revealed a right temporo-parieto-occipital lesion, which appeared to involve the subdural space and filling the cortical sulci. The lesion caused peritumoral white matter edema. The tumor appeared hypointense on T1-weighted and hyperintense on T2-weighted MR images, with homogeneous enhancement after contrast administration. A biopsy of the lesion was performed. Histological examination indicated that the lesion was a meningioma. Intraparenchymal meningiomas should be considered in the differential diagnosis of intraaxial lesions in patients of any age.
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  • —Case Report—
    Daiya ISHIGAKI, Hiroshi ARAI, Masayuki SASOH, Kuniaki OGASAWARA, Noriy ...
    2007 Volume 47 Issue 8 Pages 364-366
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 14-year-old boy presented with a very rare meningioma in the posterior cranial fossa without dural attachment. Magnetic resonance imaging revealed a 3-cm, well-circumscribed, heterogeneously enhanced, round mass without dural tail sign in the right side of the posterior fossa. Right vertebral angiography revealed very faint tumor staining supplied by the right posterior inferior cerebellar artery. Total removal of the tumor was performed. Intraoperatively, the mass exhibited no attachment to the dura mater, cerebellar parenchyma, or choroid plexus, but was firmly attached to the arachnoid tissue near the foramen of Luschka. Histological and immunohistochemical studies established the diagnosis of meningothelial meningioma (World Health Organization grade I).
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  • —Case Report—
    Toshitaka INUI, Tetsuya MORIMOTO, Naoki KOSHIMAE, Kiyoshi NAGATA, Shut ...
    2007 Volume 47 Issue 8 Pages 367-370
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 49-year-old female presented with a rare giant schwannoma arising from the dura mater of the middle fossa manifesting as loss of left visual acuity. Magnetic resonance imaging revealed a heterogeneously enhanced giant mass in the left middle fossa. Surgery via the transsylvian approach confirmed the origin of the tumor between the left internal carotid artery and the trigeminal nerve in the lateral wall of the cavernous sinus. Elongated abducens nerve was confirmed, but no tumor adhesion to the abducens nerve was found. The tumor was closely attached to the dura mater of the middle fossa and the lateral wall of the cavernous sinus. The histological diagnosis was schwannoma. Both left oculomotor and abducens nerve pareses occurred immediately after the operation but gradually resolved over 3 months. The operative findings indicated that this schwannoma may have arisen from the meningeal branch of the trigeminal nerve in the dura mater of the middle fossa.
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  • —Case Report—
    Satoshi TSUTSUMI, Takuma HIGO, Akihide KONDO, Yusuke ABE, Yukimasa YAS ...
    2007 Volume 47 Issue 8 Pages 371-374
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 23-year-old female presented with chronic occipitalgia without signs of increased intracranial pressure followed by worsening headache and slight gait unsteadiness. Cerebral magnetic resonance (MR) imaging showed no corresponding lesions. Cervical MR imaging revealed a cervical intramedullary tumor. Intraoperatively the subpial tumor was found to stretch the 3rd-5th dorsal nerve roots posteriorly, which was thought to cause the intolerable headache. Total tumor resection was achieved without requiring myelotomy using electrophysiological monitoring with somatosensory and motor evoked potentials. Histological examination identified diffuse astrocytoma. Postoperatively the headache had completely resolved. Cervical astrocytoma of subpial location is a very rare cause of headache in adults. The subpial location enables surgical extirpation because minimal or no myelotomy is needed.
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  • —Case Report—
    Tetsuhiro HIGASHIDA, Takashi KAWASAKI, Katsumi SAKATA, Yutaka TANABE, ...
    2007 Volume 47 Issue 8 Pages 375-378
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    A 27-year-old man presented with a very rare spinal epidural mass associated with recurrence of acute lymphocytic leukemia (ALL) manifesting as acute progressive neurological deficits. The patient presented with shoulder pain and ambulatory difficulties 3 years after remission of ALL treated by bone marrow transplantation. Magnetic resonance imaging revealed an epidural mass extending from C-7 to T-3, which compressed the cord and extended to the intervertebral foramen along the roots. After decompression surgery, the symptoms dramatically improved. Histological examination showed clusters of immature lymphocytes consistent with recurrence of leukemia, so chemotherapy and radiation therapy were carried out. At 1 year after the operation, no local mass expansion or systemic progression of leukemia had occurred. Leukemic mass must be considered in the differential diagnosis of spinal epidural mass, even in patients with ALL.
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Technical Note
  • —Technical Note—
    Satoru SHIMIZU, Hiroyuki KOIZUMI, Mari KURITA, Satoshi UTSUKI, Hidehir ...
    2007 Volume 47 Issue 8 Pages 379-381
    Published: 2007
    Released on J-STAGE: August 23, 2007
    JOURNAL OPEN ACCESS
    Application of sutures between expanded polytetrafluoroethylene (ePTFE) dural substitutes and the dura mater is often frustrating in posterior fossa surgery because of the difficulty in holding the elastic graft in a deep and narrow field. To resolve this problem, we have developed a boat-shaped graft made from a triangular ePTFE sheet by pinching each angle using a suture. Formation of standing edges of the sheet facilitates holding of the flaps for secure and more rapid suturing than the conventional approach using a flat sheet.
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