Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 48, Issue 9
Displaying 1-12 of 12 articles from this issue
Original Articles
  • Kazutoshi HIDA, Shunsuke YANO, Izumi KOYANAGI, Minoru AKINO, Toshitaka ...
    2008 Volume 48 Issue 9 Pages 377-382
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    The incidence of cervical spondylosis in the elderly is increasing with the higher proportion of elderly individuals among the Japanese population. The present study retrospectively analyzed the clinical and radiological features of this clinical entity in 107 patients with cervical spondylosis aged 70 years or older surgically treated between 1995 and 2005. The patients were divided into Group 1 (n = 60) aged between 70 and 74 years, and Group 2 (n = 47) 75 years or older. Patients with localized compression within 2 levels responsible for the neurological symptoms underwent anterior fusion, and patients with a narrow spinal canal were treated by laminoplasty. The pre- and postoperative neurological status (Neurosurgical Cervical Spine Scale) and postoperative complications were compared. More patients in Group 2 required laminoplasty but most patients underwent single-level anterior fusion. There was no statistically significant difference in the surgical results. Group 2 had a much higher ratio of anterior fusion at the C3-4 level. Many of the aged patients had multiple risk factors. Surgical decompression for cervical spondylosis is beneficial even in elderly patients. Single-level anterior fusion to treat the lesion most responsible for the symptoms is the least invasive choice. Elderly patients tend to present with multiple risk factors so require careful perioperative management.
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  • Dong Yeob LEE, Sang-Ho LEE
    2008 Volume 48 Issue 9 Pages 383-389
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    Percutaneous endoscopic lumbar discectomy (PELD) is one of the surgical options for soft lumbar disk herniation, but the learning curve is perceived to be steep. The first 51 PELD cases performed for single-level intracanalicular lumbar disk herniation causing radiculopathy by the same surgeon were prospectively studied. The patients were divided into 3 groups of 17 patients, and the PELD learning curve was assessed by evaluating operating time, failure rate, complication rate, and 1-year reherniation rate. One-year clinical success rate was assessed by telephone interviews. The herniated disk was successfully removed by PELD in 47 patients. Four patients required subsequent open discectomy due to PELD failure. There were 2 minor complications. One year after surgery, clinical success was achieved in 42 of the 47 patients in whom PELD was initially successful, and reherniation developed in 5 patients. A significant reduction in operating time was observed after 17 patients had been treated (p = 0.0004). No significant differences were observed in terms of either failure rate or complication rate between the 3 groups. No significant differences were observed in terms of either the clinical success rate or the reherniation rate at 1 year after surgery. The PELD learning curve seems to be stable and acceptable with proper pre-PELD training.
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Case Reports
  • —Case Report—
    Koji KAMIJO, Toru MATSUI
    2008 Volume 48 Issue 9 Pages 390-393
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A 31-year-old woman with moyamoya disease presented with choreiform movements persisting for 4.5 years. Magnetic resonance imaging showed a fine vascular plexus in the base of the brain but no parenchymal brain damage. Cerebral angiography revealed intracranial vascular abnormalities compatible with moyamoya disease. Single photon emission computed tomography with N-isopropyl-p-123I-iodoamphetamine showed definite reduction of the regional cerebral blood flow (rCBF) in the bilateral striata and frontotemporoparietal cortex. rCBF study with acetazolamide administration indicated marked decrease of rCBF reserve in those regions. She underwent indirect bypass surgery (encephalo-duro-arterio-myo-synangiosis) under a diagnosis of moyamoya disease. The choreic involuntary movements disappeared shortly after surgery. Postoperative angiography showed neovascularization in the extracranial to intracranial direction, associated with dramatic increase in rCBF in the involved regions.
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  • —Case Report—
    Atsushi SAITO, Yasuhiro SUZUKI, Yuichi FURUNO, Hironaga KAMIYAMA, Shin ...
    2008 Volume 48 Issue 9 Pages 394-396
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A 49-year-old man presented with a brainstem cavernous angioma associated with hemophilia manifesting as gradual progression of neurological deficits over a period of 2 weeks. Computed tomography revealed a hematoma and perifocal edema on the left side of the pons, and T2-weighted magnetic resonance imaging revealed a hemosiderin rim around the lesion with venous malformation. The neurological deficits deteriorated despite conservative treatment, so surgery was performed 2 weeks after admission, after supplementary therapy of factor IX. The hematoma and anomalous vascular component were entirely removed without intractable bleeding. The postoperative course was uneventful and his neurological symptoms improved. The histological diagnosis was cavernous angioma. Six months after onset, he was doing well. Surgery can be effective for the treatment of hemorrhagic cavernous angioma associated with hemophilia after initiation of supplementary therapy with coagulation factor.
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  • —Case Report—
    Hiroaki MOTEGI, Satoshi KURODA, Nobuaki ISHII, Hidefumi AOYAMA, Satosh ...
    2008 Volume 48 Issue 9 Pages 397-400
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A 47-year-old male underwent stereotactic radiosurgery (25 Gy) for a cerebral arteriovenous malformation located in the right caudate nucleus, using a linear accelerator. Complete obliteration of nidus was confirmed 20 months after radiosurgery. However, a hypointense mass on T2-weighted magnetic resonance imaging developed in the area adjacent to the nidus after approximately 80 months. The mass gradually increased in size and induced severe perifocal edema over 2 years. The mass was successfully excised. Histological examination revealed that the mass consisted of dilated sinusoid vessels attached to the hematoma capsule, and the hematoma included clots in various stages of organization encapsulated by dense collagenous tissue. The histological diagnosis was cavernoma. De novo formation of cavernoma is well known to occur after radiation surgery for intracranial tumor, especially in pediatric patients, but is rare in adults. Based on the radiological and histological findings in the present case, the radiation-induced cavernoma underwent repeated bleedings resulting in chronic encapsulated expanding hematoma.
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  • —Case Report—
    Yuuta KAMOSHIMA, Yutaka SAWAMURA, Masaaki HOKARI, Yoshinobu IWASAKI, H ...
    2008 Volume 48 Issue 9 Pages 401-404
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A 28-year-old man presented with a rare craniocervical paraganglioma with multiple pulmonary metastases manifesting as hearing disturbance, hoarseness, and dysphagia in February 2003. Magnetic resonance imaging depicted a large jugular foramen tumor extending to the deep cervical region. Chest computed tomography revealed numerous small pulmonary nodules. The jugular tumor was totally resected immediately after preoperative embolization. Histological examination revealed paraganglioma. Localized irradiation (54 Gy) and two courses of combination chemotherapy consisting of paclitaxel (80 mg/m2) and gemcitabine (1000 mg/m2) were given. The patient remained well during follow up for 48 months and the number of pulmonary metastases did not increase. Local control of primary craniocervical paraganglioma by palliative surgical resection may be effective for control of metastatic lesions.
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  • —Case Report—
    Satoshi TSUTSUMI, Akihide KONDO, Yukimasa YASUMOTO, Masanori ITO
    2008 Volume 48 Issue 9 Pages 405-408
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A female neonate was the first child of a 30-year-old mother, with unremarkable medical history. Prenatal ultrasonography performed at 36 weeks of gestation suggested intracranial mass lesion. The baby was delivered by cesarean section at 41 weeks of gestation because of bradycardia and asphyxia. The birth weight, height, and head circumference were within the normal ranges with soft fontanels. Congenital anomaly was not observed with normal neurological findings. She was referred to our department at age 5 months. Physical examination revealed normal developmental milestones and intact endocrinological function without macrocephaly. Cerebral magnetic resonance (MR) imaging revealed a unilocular huge cyst appearing as homogeneously hypointense on T1- and hyperintense on T2-weighted images, and extending into the basal, suprasellar, ambient, quadrigeminal, interpeduncular, prepontine, right cerebellopontine angle, and premedullary cisterns. The pituitary stalk was markedly stretched and displaced ventrally, and the brainstem was displaced dorsally by the cyst. No other brain anomalies, dysgenesis of the corpus callosum, or ventriculomegaly were recognized. Neuroendoscopic cystocisternostomy was performed to form a communication between the cyst cavity and premedullary cistern. Pressurized watery fluid was released on puncturing the cyst wall which consisted of transparent membrane. Surveillance MR imaging at 2 and 9 months after the surgery revealed remarkable regression without regrowth of the cyst. She remained in good condition and showed normal development during the follow up for 1 year 9 months. Less invasive prophylactic surgery using the neuroendoscope may be beneficial for carefully selected cases of asymptomatic neonatal arachnoid cysts.
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  • —Case Report—
    Toru SASAMORI, Kazutoshi HIDA, Shunsuke YANO, Takeshi ASANO, Yoshinobu ...
    2008 Volume 48 Issue 9 Pages 409-413
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A 9-month-old boy was transferred to our institute after suffering sudden seizure and loss of consciousness followed by cardiopulmonary arrest. Neurological examination on admission revealed deep coma and tetraparesis. Brain computed tomography revealed diffuse intracranial subarachnoid hemorrhage (SAH), whereas brain magnetic resonance (MR) angiography showed no intracranial abnormalities. MR imaging of the spine demonstrated a remarkable flow void extending from C3 to T1. Digital subtraction angiography revealed a perimedullary arteriovenous fistula (AVF) fed by the left thyrocervical trunk, associated with a varix and a dilated perimedullary vein. He had hypoxic encephalopathy due to transient cardiopulmonary arrest, and remained in the intensive care unit for 2 months. Thereafter, he was transferred to the pediatric ward, where his general condition improved, and after 7 months underwent embolization of the AVF to prevent further SAH. The perimedullary AVF was successfully interrupted by transarterial embolization with n-butyl-2-cyanoacrylate and platinum coils, and no additional neurological deficits developed. Post-embolization MR imaging showed loss of the flow void. The favorable outcome demonstrates the importance of spinal cord imaging in infants with SAH without other intracranial abnormalities to detect the presence of perimedullary AVF. Perimedullary AVFs in children are often associated with huge fistulas and varices, so are good candidates for endovascular surgery.
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  • —Case Report—
    Naohisa MIYAKOSHI, Michio HONGO, Yuji KASUKAWA, Shigeru ANDO, Yoichi S ...
    2008 Volume 48 Issue 9 Pages 414-417
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A 54-year-old man presented with an extremely rare case of intervertebral disk herniation with hematoma in the thoracic spine, manifesting as acute progressive numbness and muscle weakness in the bilateral lower extremities. He had been treated with anticoagulants. Magnetic resonance imaging of the thoracic spine showed intervertebral disk herniation and severe compression of the spinal cord at T9-10, appearing as hyperintense on T1- and hypointense on T2-weighted imaging suggestive of concomitant hematoma. His symptoms completely resolved after resection of the brownish herniated disk material. Old hemorrhage was also aspirated from the intervertebral disk space. Hemosiderin deposition was found in the cartilaginous tissue of the resected disk. Intervertebral disk herniation with hematoma is extremely rare, but may occur in patients with bleeding diathesis.
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Technical Note
  • —Technical Note—
    Hiroshi KASHIMURA, Kuniaki OGASAWARA, Hiroshi ARAI, Takaaki BEPPU, Tak ...
    2008 Volume 48 Issue 9 Pages 418-422
    Published: 2008
    Released on J-STAGE: September 24, 2008
    JOURNAL OPEN ACCESS
    A fusion technique for magnetic resonance (MR) angiography and MR imaging was developed to help assess the peritumoral angioarchitecture during surgical planning for meningioma. Three-dimensional time-of-flight (3D-TOF) and 3D-spoiled gradient recalled (SPGR) datasets were obtained from 10 patients with intracranial meningioma, and fused using newly developed volume registration and visualization software. Maximum intensity projection (MIP) images from 3D-TOF MR angiography and axial SPGR MR imaging were displayed at the same time on the monitor. Selecting a vessel on the real-time MIP image indicated the corresponding points on the axial image automatically. Fusion images showed displacement of the anterior cerebral or middle cerebral artery in 7 patients and encasement of the anterior cerebral arteries in 1 patient, with no relationship between the main arterial trunk and tumor in 2 patients. Fusion of MR angiography and MR imaging can clarify relationships between the intracranial vasculature and meningioma, and may be helpful for surgical planning for meningioma.
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