巻号一覧
48 巻, 8 号
選択された号の論文の11件中1～11を表示しています
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Original Articles
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Tatsuya OHTONARI, Kenichi KAKINUMA, Tomohiro KITO, Isamu EZUKA, Tsutom ...2008 年 48 巻 8 号 p. 331-336
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスDiffusion-weighted and perfusion-weighted magnetic resonance (MR) imaging were investigated as a method to detect diffusion-perfusion mismatch in the early stages of vasospasm in 17 patients with acute subarachnoid hemorrhage after aneurysm clipping. Single photon emission computed tomography (SPECT) with N-isopropyl-p-[123I]iodoamphetamine was also performed. Diffusion-perfusion mismatch was clearly identified in the 3 patients who manifested clinical deterioration. Perfusion-weighted imaging showed increased mean transit time, normal cerebral blood flow, and increased or normal cerebral blood volume. SPECT revealed no earlier signs of vasospasm. Diffusion-perfusion mismatch was clearly demonstrated in the early stages of vasospasm, so may be useful for early identification of ischemia in vasospasm and initiating appropriate treatment.
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Fumiyuki MOMMA, Teruo NAKAZAWA, Masaharu AMAGASA2008 年 48 巻 8 号 p. 337-342
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスAntero-lateral partial vertebrectomy (ALPV) was used for decompression in 91 patients with multilevel cervical disorders. The high-speed drill was used to excise about 1/3 of the vertebral body for relief of anterior compression of the cord and nerve roots under the operating microscope. The key point was opening of the medial wall of the foramen of transverse process at the beginning of the ALPV, allowing the determination of the lateral borders of the ALPVs. To repair and regenerate the vertebral body, a beta-tricalcium phosphate (β-TCP) block was trimmed into a cuneiform shape and implanted into the sites of the ALPV excluding the upper and lowermost vertebral bodies. Postoperative computed tomography confirmed that β-TCP was gradually replaced by newly formed bone from the surface towards the center of the block, and that the affected vertebral body was remodeled by 6 to 12 months after the implantation of β-TCP. The cortical bone borders on the bone marrow at the site of the regeneration. The pedicles on the side of the ALPVs were rebuilt during regeneration of the affected vertebrae. Thus, the vertebral foramen of the cervical spine was widened in the anterior direction at the levels of the ALPVs, resulting in restoration of the physiological size of the cervical cord. The cervical curvature remained unchanged and a certain degree of cervical mobility (mean 86%) was preserved in this series.
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Case Reports
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—Case Report—Youichi YANAGAWA, Shin-ichiro IWAMOTO, Kouichirou NISHI2008 年 48 巻 8 号 p. 343-346
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスA 77-year-old male pedestrian was hit by a car. On admission, he had disturbance of consciousness and left hemiplegia. Computed tomography (CT) indicated only left frontal subcutaneous hematoma and minor hemorrhage in the left frontal lobe, suggesting axonal injury. CT on hospital day 2 revealed a low density area in the right paramedian pons, but CT angiography showed no dissection or occlusion of the vertebrobasilar artery. The diagnosis was pontine infarction resulting from shearing force injury to the paramedian branch of the basilar artery. He was transferred to another hospital for rehabilitation without improvement of symptoms on hospital day 51. Paramedian pontine infarction tends to occur in patients with risk factors for arteriosclerosis, including hypertension, diabetes mellitus, hyperlipidemia, or smoking. The present elderly patient had hypertension and hyperlipidemia, so arteriosclerosis in the paramedian branch may have contributed to his susceptibility to such injury.
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—Case Report—Taek-Hyun KWON, Hoon JOY, Youn-Kwan PARK, Hung-Seob CHUNG2008 年 48 巻 8 号 p. 347-350
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスAn 11-year-old girl presented with a very rare traumatic retroclival epidural hematoma manifesting as bilateral abducens nerve palsy, deviation of the uvula to the left, and weakened movement of tongue, which developed after a motor vehicle accident. The patient was treated conservatively and showed good outcome. Retroclival hematoma is a mainly pediatric entity usually associated with ligamentous injury at the craniocervical junction, and can be treated conservatively with good outcome.
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—Case Report—Satoshi TSUTSUMI, Yukimasa YASUMOTO, Masanori ITO2008 年 48 巻 8 号 p. 351-354
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスA 3-year-old girl presented with osmotic demyelination syndrome after undergoing uneventful neuroendoscopic cystostomy for a growing cystic suprasellar craniopharyngioma following microscopic subtotal resection 1 year previously. Endocrinopathy had well been controlled by hormone replacement therapy and administration of 1-amino-8-d-arginine-vasopressin with serum sodium concentration within the normal range. She presented generalized seizure and fever on postoperative day 7, with hyponatremia beginning on postoperative day 4 and deteriorating despite frequent correction. The serum sodium concentration began to fluctuate on the same day, in the range 111-164 mEq/l, which lasted for 2 weeks, refractory for intense management. Her body temperature also fluctuated between hypo- and hyperthermia not correlated with serum inflammatory markers. Her conscious disturbance progressively deteriorated with spastic paraparesis. T2-weighted magnetic resonance (MR) imaging taken on postoperative day 19 revealed hyperintense areas in the pons, external capsule, bilateral thalami, and basal nuclei, which had not been recognized before, suggesting osmotic demyelination syndrome causing central pontine and extrapontine myelinolysis. MR imaging taken on postoperative days 230 and 360 showed some diminished lesions but others persisted and resulted in a cavity. The patient’s depressed conscious level did not improve. Suprasellar craniopharyngioma with long-standing hypothalamic dysfunction may be associated with severe osmotic demyelination syndrome even after less invasive surgery, so serum sodium derangement after surgery should be promptly corrected even if only subtle signs are present.
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—Case Report—Rei YAMAGUCHI, Hideaki KOHGA, Minori KUROSAKI, Masaru TAMURA, Soukichi ...2008 年 48 巻 8 号 p. 355-358
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスA previously healthy 22-year-old man presented with thoracic outlet syndrome manifesting as Raynaud’s phenomenon in the left hand and embolic occlusion of the basilar artery. Three-dimensional computed tomography angiography showed that the left subclavian artery was occluded as it passed over the abnormal first rib. Retrograde propagation of the thrombus from the site of arterial occlusion and/or reflux of embolic material was suspected. Medical therapy was started. The patient underwent resection of the anomalous rib. Postoperative angiography demonstrated that the subclavian artery was recanalized with almost normal distal flow. The basilar artery was also recanalized. Thoracic outlet syndrome due to a first rib anomaly may cause stroke.
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—Case Report—Kentaro KUDO, Satoshi TSUTSUMI, Yasuo SUGA, Hidehiro OKURA, Yusuke ABE ...2008 年 48 巻 8 号 p. 359-362
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスAn 85-year-old female presented with a 3-month history of worsening hyperlacrimation and blurred vision following blunt head injury. Her past medical history was unremarkable. Her blood examination identified no abnormal findings. Neuroophthalmological inspection revealed extraocular movement disorder and mild exophthalmos on the affected side. Her visual acuity was not disturbed. Neuroimaging showed a cystic mass located extraconally in the superolateral compartment of the anterior orbit, without enhancement by contrast medium. Surgical exploration resulted in escape of chocolate-colored, liquefied hematoma during dissection. No vascular lesion was found. A grayish-white cyst wall was found adhering strongly to the lateral and superior rectus muscles. The lacrimal gland was not identified. The mass was totally resected. Histological examination indicated dermoid cyst with inflammatory interstitial hemorrhage. No component of vascular malformation or atypia was found. Hyperlacrimation and extraocular movement improved postoperatively. We thought that the previous blunt head injury might have induced intratumoral hemorrhage in the preexisting dermoid cyst and that the escaped contents caused inflammatory irritation, resulting in the hyperlacrimation. Dermoid cyst may show atypical presentation with intratumoral hemorrhage and should always be included in the differential diagnosis of orbital tumor.
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—Case Report—Aiki MARUSHIMA, Kazuya UEMURA, Naoaki SATO, Toru MARUNO, Akira MATSUMU ...2008 年 48 巻 8 号 p. 363-366
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスA 25-year-old man presented with left lumboischialgia refractory to medical treatment. Neurological examination revealed L5 and S1 radiculopathy which rapidly worsened over a short period. Magnetic resonance imaging demonstrated disk bulging with a discal cyst at the L4-5 intervertebral space and disk herniation at the L5-S1 intervertebral space. Computed tomography showed osteolytic change of the L5 vertebral body adjacent to the cyst. Resection of the cyst and removal of the herniated disk were performed following fenestration of the L4-5 and L5-S1 interlaminar spaces. Bloody serous fluid followed by clear serous fluid was recognized during the aspiration and partial resection of the cyst at the L4-5 level. Histological examination demonstrated a cyst wall consisting of fibrous connective tissue without a single-layer lining of cells, and fibrin deposits. The patient’s symptoms disappeared immediately after the operation. This osteolytic lumbar discal cyst possibly occurred subsequent to hemorrhage from the epidural venous plexus following intervertebral disk injury, hematoma encapsulation by connective fibrous tissue, and cyst wall formation in reaction to the disk injury and hemorrhage. The cyst may have enlarged due to the inflow of the serous fluid from the water-containing degenerated disk.
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—Case Report—Takeshi AOYAMA, Kazutoshi HIDA, Minoru AKINO, Shunsuke YANO, Hisatoshi ...2008 年 48 巻 8 号 p. 367-371
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスA 33-year-old man presented with a rare case of lumbar epidural venous varix causing radiculopathy manifesting as sciatica exacerbated during bowel movements. The left straight-leg raising test was positive and patellar tendon reflex was lost. Lumbar magnetic resonance imaging showed a mass lesion in the epidural space at the L4 level just anterior to the dural sac on the left, appearing as hypointense on T1- and hyperintense on T2-weighted images, with ring-like enhancement with gadopentetate dimeglumine. He underwent surgery under a preoperative diagnosis of cystic nerve sheath tumor. After left hemilaminectomy, intraoperative ultrasonography showed a low echoic mass lesion ventral to the L4 nerve root. The mass was dark blue with a smooth wall. Tearing of the wall resulted in continuous bleeding. After removal of the lesion, we confirmed that the dura of the nerve root was intact. Histological examination of the surgical specimen confirmed venous tissue. The postoperative course was excellent. Lumbar epidural varix is difficult to diagnose preoperatively. Lumbar epidural varix should be considered if the lesion is smaller on preoperative than intraoperative imaging, or disap- pears with bleeding cessation, as this may avoid unnecessary widening of the operative field. The correct preoperative diagnosis remains difficult, so we recommend surgical removal and histological confirmation.
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Technical Note
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—Technical Note—Tomoyoshi SHIGEMATSU, Shingo TOYOTA, Yasunori FUJIMOTO, Hiroshi YAMAMO ...2008 年 48 巻 8 号 p. 372-375
発行日: 2008年
公開日: 2008/08/22
ジャーナル オープンアクセスA novel technique was developed to detect coil migration to the stent interior using mask images of rotational angiography. Stent-assisted coil embolization under x-ray fluoroscopy control was simulated with a hand-made vessel model. The stent interior was observed with a rigid endoscope during coil embolization. After insertion of the coil, mask images using rotational angiography were acquired and multi-planar reformation (MPR) images were reconstructed on a workstation. The stent interior could be observed during coil embolization. Longitudinal MPR images showed the positional relationships between the stent, coil, and tip of the microcatheter. This technique was successfully employed in a patient to detect displacement of the tip of the microcatheter inside the stent. This technique is useful for monitoring stent-assisted coil embolization of an ultra-wide necked aneurysm, but requires extra time and increased radiation exposure, so we recommend use only if coil migration is strongly suspected.
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Editorial Committee
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2008 年 48 巻 8 号 p. EC15-EC16
発行日: 2008年
公開日: 2013/03/25
ジャーナル オープンアクセスPDF形式でダウンロード (52K)
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