Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 48, Issue 6
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Safety and Efficacy of Fasudil Monotherapy and Fasudil-Ozagrel Combination Therapy in Patients With Subarachnoid Hemorrhage: Sub-analysis of the Post-marketing Surveillance Study
    Yoshio SUZUKI, Masato SHIBUYA, Shin-ichi SATOH, Hirotoshi SUGIYAMA, Mi ...
    2008 Volume 48 Issue 6 Pages 241-248
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.241
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    Sub-analysis of the fasudil post-marketing surveillance study compared the safety and efficacy of fasudil plus ozagrel to fasudil only. A total of 3690 patients received fasudil and 1138 received fasudil plus ozagrel between 1995 and 2000. The occurrence of adverse events, occurrence of low density areas associated with vasospasm on computed tomography, absence of symptomatic vasospasm, and poor clinical outcomes associated with vasospasm were compared between the fasudil and fasudil plus ozagrel groups. The pharmacokinetics of fasudil were assessed in 5 patients with subarachnoid hemorrhage. The drug interaction between fasudil and ozagrel was pharmacologically investigated in vitro and in vivo. The occurrence of adverse events and clinical outcomes were similar between the two groups. The occurrences of symptomatic vasospasm and low density areas were lower in the fasudil group than in the fasudil plus ozagrel group. The average trough value (8-hour value) of the fasudil active metabolite, hydroxyfasudil, was 50 nM. Fasudil showed no pharmacological interaction with ozagrel. The combination of fasudil plus ozagrel was well tolerated, but did not result in better efficacy than fasudil only.
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  • Shortening of Wallstent RP During Carotid Artery Stenting Requires Appropriate Stent Placement
    Hiroshi AIKAWA, Shun-ichi NAGATA, Masanari ONIZUKA, Masanori TSUTSUMI, ...
    2008 Volume 48 Issue 6 Pages 249-253
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.249
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    Changes in the location and length of the Wallstent RP during carotid artery stenting (CAS) were evaluated using intraoperative videos of 28 patients with carotid artery stenosis who underwent CAS with a 10/20 mm Wallstent RP to determine the appropriate stent placement. The stent was deployed after its midpoint was positioned over a virtual center line, the perpendicular line which crossed the most stenotic point of the lesion on the road mapping image. The length of the stenotic lesion, the changes in the locations of the distal and proximal ends of the stent, and the changes in stent length were examined. The distal end of the stent moved a maximum of 6.1 mm toward the proximal side to a point 19.9 mm from the virtual center line. The proximal end moved a maximum of 11.3 mm toward the distal side to a point 14.7 mm from the virtual center line. The stent length ranged from 37.7 to 44.5 mm (mean 41.2 mm). The 10/20 mm Wallstent RP placed by our technique covers the entire lesion with no less than 5.7 mm of margin over the segment distal to the lesion in patients with stenotic segments shorter than 29.4 mm.
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Case Reports
  • Unusual Location of Anterior Communicating Artery Aneurysm Located on the Planum Sphenoidale Due to Long A1 Segments
    —Case Report—
    Masatou KAWASHIMA, Masataka ENDO, Takao KITAHARA, Kazui SOMA, Kiyotaka ...
    2008 Volume 48 Issue 6 Pages 254-256
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.254
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    A 51-year-old woman presented with a rare variation in the location of the anterior communicating artery (AComA) complex associated with aneurysm manifesting as sudden onset of headache. Computed tomography (CT) revealed widespread subarachnoid hemorrhage with intracerebral hematoma and intraventricular hemorrhage. Three-dimensional (3D)-CT angiography revealed an aneurysm located at the AComA complex on the planum sphenoidale. Surgical clipping of the aneurysm through the right pterional approach was performed without complication. AComA aneurysm located on the planum sphenoidale is extremely rare, but should be recognized in the planning of surgery in the AComA region. 3D-CT angiography is very useful for understanding the relationships between aneurysms and the surrounding structures.
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  • Symptomatic Inferior Cavernous Sinus Artery Aneurysm Associated With Cerebral Arteriovenous Malformation
    —Case Report—
    Masanori TSUTSUMI, Hiroshi AIKAWA, Tomonobu KODAMA, Minoru IKO, Kouhei ...
    2008 Volume 48 Issue 6 Pages 257-258
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.257
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    A 50-year-old man presented with a symptomatic aneurysm arising from the right inferior cavernous sinus artery (ICSA) associated with a cerebral arteriovenous malformation (AVM) manifesting as a 3-month history of progressive right abducens nerve palsy. Cerebral angiography demonstrated a high-flow AVM and a saccular aneurysm arising from the right ICSA acting as a meningeal feeder. The symptom was thought to be attributable to aneurysmal mass effect rather than the AVM. The aneurysm was successfully treated with endovascular embolization and the symptom improved gradually. Hemodynamic stress in the ICSA may have resulted in the development of the aneurysm of the ICSA. Meningeal artery aneurysm presenting with cranial nerve palsy is extremely uncommon. The present case illustrates the need for detailed evaluation of the external carotid artery and internal carotid artery vasculature in patients with cerebral AVMs.
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  • Posterior Inferior Cerebellar Artery Aneurysm Associated With Persistent Primitive Hypoglossal Artery
    —Case Report—
    Masahito KOBAYASHI, Kazunori AKAJI, Yoshio TANIZAKI, Ban MIHARA, Takay ...
    2008 Volume 48 Issue 6 Pages 259-261
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.259
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    A 49-year-old woman presented with subarachnoid hemorrhage (SAH) from an aneurysm associated with a persistent primitive hypoglossal artery (PPHA) manifesting as sudden onset of headache, but without neurological deficits. Conventional computed tomography (CT) of her head showed no abnormality but lumbar tap indicated SAH. Three-dimensional (3D)-CT angiography showed a PPHA originating from the internal carotid artery and an aneurysm of the posterior inferior cerebellar artery at the junction with the remnant hypoplastic vertebral artery. 3D-CT angiography was essentially useful for presurgical planning to determine the extent of craniotomy and the space for possible temporary clipping, and confirmed the diagnosis of aneurysmal SAH. The aneurysm was clipped and she returned to her job 4 weeks later. Cerebral angiography is the golden standard technique to diagnose PPHA, but 3D-CT angiography can be recommended for presurgical evaluation, especially in patients with complex and anomalous anatomical structures.
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  • Intracranial Epidermoid Tumor After Subcutaneous Lipoma Excision
    —Case Report—
    Koichi KATO, Takashi HIGA, Hiroshi UJIIE, Mikhail CHERNOV, Osami KUBO, ...
    2008 Volume 48 Issue 6 Pages 262-265
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.262
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    A 66-year-old man presented with complaints of numbness for the past 5 years and progressive motor weakness of the right leg for the previous 2 months. Magnetic resonance imaging revealed large intra- and extracranial tumors in the frontoparietal region. Physical examination suggested the extracranial lesion was a subcutaneous lipoma, which had been partially resected 60 years before, connected to the intracranial lesion via a defect of the skull. Gross total removal of the tumors was performed. Histological examination showed the intracranial lesion was epidermoid tumor, and connected to the extracranial lipoma by a lipoma bridge. The symptoms improved remarkably following surgery. This case of intracranial epidermoid tumor associated with intra-extracranial lipoma indicates that implantation of skin tissue in childhood carries the risk of epidermoid tumor even after several decades. Neuroimaging screening is recommended to detect the development of any intracranial components.
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  • Synovial Chondromatosis of the Temporomandibular Joint With Intracranial Extension
    —Case Report—
    Naoki YOKOTA, Chikanori INENAGA, Tsutomu TOKUYAMA, Shigeru NISHIZAWA, ...
    2008 Volume 48 Issue 6 Pages 266-270
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.266
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    A 52-year-old man presented with an extremely rare case of synovial chondromatosis in the temporomandibular joint (TMJ) with extension into the middle cranial fossa manifesting as swelling and exacerbation of pain. He had a long history of right TMJ disorders. Computed tomography and magnetic resonance imaging showed a mass in the right TMJ with extension into the intracranial part through the destroyed temporal skull base. The preoperative diagnosis was chondrosarcoma or osteosarcoma. The patient underwent surgery via combined trans-zygomatic temporal skull base and pre-auricular approaches and the mass was totally removed. Histological examination found an enormous number of closely packed loose bodies of various sizes, consisting of hyaline chondrocytes. The histological diagnosis was synovial chondromatosis. This rare lesion is difficult to discriminate from chondrosarcoma, so total removal is essential for correct diagnosis and cure.
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  • Giant Plexiform Neurofibroma and Suboccipital Meningocele Manifesting as Segmental Neurofibromatosis
    —Case Report—
    Masanori KURIMOTO, Yasushi MIZUMAKI, Osamu FUKUDA, Nakamasa HAYASHI, N ...
    2008 Volume 48 Issue 6 Pages 271-274
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.271
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    A 34-year-old woman presented with segmental neurofibromatosis manifesting as a soft lump with a large café-au-lait macule on her occipital region and neck. Magnetic resonance imaging showed a thick skin tumor in the occipital region and posterior neck, and a suboccipital meningocele which seemed to have no association with her symptoms. Biopsy lead to a histological diagnosis of giant plexiform neurofibroma. During biopsy, massive local bleeding occurred and hemostasis was achieved by electrocautery and meticulous suture ligation. The postoperative course was uneventful and observation was continued for both the giant plexiform neurofibroma and the meningocele.
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  • Idiopathic Calvarial Thinning
    —Case Report—
    Satoshi TSUTSUMI, Yukimasa YASUMOTO, Masanori ITO
    2008 Volume 48 Issue 6 Pages 275-278
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.275
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    An 82-year-old diabetic female had been aware of gradually enlarging, painless scalp depressions in the bilateral parietal regions for more than 6 years. She had no history of head injury, or inflammatory or malignant disease. Her family history was unremarkable for hereditary bone disease. She had diabetes mellitus which had been well controlled with orally administered drugs. Blood examination showed normal renal and liver functions with normal serum calcium, magnesium, and phosphorus concentrations, in addition to normal parathyroid hormone and calcitonin levels. Neuroimaging including skull radiography, head computed tomography, and magnetic resonance imaging demonstrated symmetric thinning in the bilateral parietal bones attributed to loss of diploe and thinning of the outer table. The inner table was intact without associated soft tissue mass or vascular lesions. Technetium-99m methylene diphosphate systemic bone scintigraphy showed mild hypoaccumulation in the affected calvarium on the left. No other pathological findings were found by systemic examination. She underwent open biopsy for histological verification which revealed homogeneous membranous bone tissue with regressed diploe, absence of osteoblasts, absence of osteoclastic appearance, and absence of findings of underlying malignancy. There was no markedly fibrovascular connective tissue typical of Gorham-Stout disease. Calvarial thinning in the present case may have been caused by an undetermined complex mechanism.
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Technical Note
  • Importance of Fixation Angle in Posterior Instrumented Occipitocervical Fusion
    —Technical Note—
    Toshihiro TAKAMI, Tsutomu ICHINOSE, Kenichi ISHIBASHI, Takeo GOTO, Nao ...
    2008 Volume 48 Issue 6 Pages 279-282
    Published: 2008
    Released on J-STAGE: June 24, 2008
    DOIhttps://doi.org/10.2176/nmc.48.279
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    Occipitocervical fusion with the head in a functionally neutral position is critically important. Various methods have been proposed for measuring the angle of the craniovertebral junction based on lateral radiography. We describe a simple and reliable measurement of fixation angle during occipitocervical fusion using the line parallel to the bony palate and the posterior longitudinal line of the C2 vertebra. The normal range of the angle of the craniovertebral junction was measured in 30 normal healthy volunteers, 15 males and 15 females aged from 17 to 77 years (mean 45.1 years), without symptoms of neck pain or limitations of neck movement. The angle ranged from 85 to 118 degrees. The mean angle was 97.1 degrees in males and 102.6 degrees in females, with overall mean ± standard deviation of 99.9 ± 8.1 degrees. Careful adjustment of the angle of the craniovertebral junction can help to avoid postoperative complications such as dysphagia, dyspnea, and subaxial subluxation.
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Editorial Committee
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