巻号一覧
49 巻, 10 号
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Rapid Communication
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Yukihiro WAKABAYASHI, Keisuke ISHII, Tatsuya ABE, Tohru KAMIDA, Minoru ...2009 年 49 巻 10 号 p. 447-448
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスPDF形式でダウンロード (141K)
Original Articles
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Toru FUKUHARA, Tomohisa SHIMIZU, Yoichiro NAMBA2009 年 49 巻 10 号 p. 449-455
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスEndoscopic third ventriculostomy (ETV) has not been recognized as a surgical option for hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH), since hydrocephalus following aneurysmal SAH is considered to result from the communicating component. However, obstructions in the ventricular system may exist, so ETV could help resolve the condition. The present study evaluated the efficacy of ETV for hydrocephalus appearing within one month after aneurysmal SAH. This prospective study evaluated a total of 118 patients admitted to our hospital with aneurysmal SAH. Nine of 66 surgically treated patients suffered hydrocephalus within one month after aneurysmal SAH and 8 underwent ETV. Seven of these 8 patients showed no further ventricular enlargement or deterioration in consciousness, and required no external cerebrospinal fluid (CSF) drainage at least temporarily, and could commence early physical rehabilitation. Four patients also experienced cognitive improvements after ETV, but none made a full cognitive recovery. Ventriculoperitoneal (VP) shunt was implanted for one patient who did not respond to ETV, and the necessity of VP shunt was evaluated including the CSF removal test for the other patients, due to residual cognitive impairment even after initiating the rehabilitation. Five of the 8 patients eventually had VP shunts implanted, and 3 patients, including two patients who improved cognitively after ETV, had further cognitive improvements. ETV for hydrocephalus following aneurysmal SAH is likely to help manage intracranial pressure. ETV may improve cognitive impairment in some patients, but whether the maximum resolution is obtained only with ETV remains uncertain. VP shunt implantation should be the main treatment for hydrocephalus after aneurysmal SAH, but ETV can be employed as a temporary intervention in certain conditions, such as during the waiting period for the clearance of aneurysmal SAH.
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Hiroshi IGAKI, Keisuke MARUYAMA, Tomoyuki KOGA, Naoya MURAKAMI, Masao ...2009 年 49 巻 10 号 p. 456-461
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスStereotactic radiosurgery is now a treatment option for meningiomas, especially for high-risk patients such as those with skull base lesions. The clinical outcomes were retrospectively analyzed of stereotactic radiosurgery using the Leksell Gamma Knife® performed for 98 patients with 106 skull base meningiomas at the University of Tokyo Hospital between June 1990 and April 2006 and followed up for more than a year. After a median follow-up period of 53.2 months (range 12.2-204.4 months), local tumor control rates were 86.9% and 78.9% at 5 years and 10 years, respectively. Tumors with volume of 4 cm3 or smaller (97.5% vs. 76.1% at 5 years, p = 0.001) and tumors completely included within the isodose line of 14 Gy or more (97.5% vs. 67.2% at 5 years, p = 0.0006) had higher local control rates. Postoperative residual tumors treated by stereotactic radiosurgery were controlled in all 25 cases. Cranial nerve deficits were improved, stable, and deteriorated in 12, 64, and 3 patients, respectively, after stereotactic radiosurgery. Stereotactic radiosurgery was effective treatment method for local control of skull base meningiomas, especially for small or postoperative residual tumors. Correct combination of microsurgery and radiosurgery leads to excellent local control.
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Case Reports
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—Case Report—Hiroyuki SAKATA, Shinjitsu NISHIMURA, Masaki MINO, Emiko HORI, Tomoaki ...2009 年 49 巻 10 号 p. 462-464
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 48-year-old woman suffered head trauma and presented with an acute epidural hematoma with a linear fracture of the right temporal bone across the middle meningeal groove. Initial angiography demonstrated no vascular abnormalities. Eight months later, she again suffered head trauma and computed tomography demonstrated traumatic subarachnoid hemorrhage. Right external carotid angiography revealed a middle meningeal arteriovenous fistula (AVF) which drained into the superficial sylvian veins via the sphenoparietal sinus. Serial angiography showed progressive dilation of the draining veins, but she refused surgical intervention and dropped out of our outpatient clinic. Fifteen years after the first head trauma, she presented with subarachnoid hemorrhage. Angiography demonstrated formation of venous aneurysms on the drainer of the AVF. The dilated superficial sylvian vein was removed together with the ruptured venous aneurysm. Histological examination of the drainer revealed an arterialized vein. The serial angiographic evaluations revealed dynamic changes of the traumatic middle meningeal AVF, including progressive dilation of the drainers, simplification of the drainage routes, and the formation of venous aneurysms, which presumably represents the entire natural course of traumatic middle meningeal AVF manifesting as hemorrhage. The present case of traumatic middle meningeal AVF with a deteriorating course suggests that surgical removal or embolization of the AVF is strongly indicated if follow-up angiography shows dilation of the drainers, which implies increased shunt flow.
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—Case Report—Toshikazu KIMURA, Masaaki SHOJIMA, Tomoyuki KOIZUMI, Syunsuke FUKAYA, ...2009 年 49 巻 10 号 p. 465-467
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスAn 85-year-old woman presented with a dural arteriovenous fistula of the superior petrosal sinus manifesting as venous infarction of the cerebellum. Magnetic resonance imaging and angiography revealed right cerebellar swelling, venous engorgement, and an arteriovenous fistula in the superior petrosal sinus. Our initial attempt to obliterate the lesion through a transvenous endovascular approach failed, so we successfully treated the fistula via surgical interruption of the superior petrosal vein through a small suboccipital craniotomy. Careful examination of the pattern of venous drainage is important to determine surgical indications. This case indicates that minimally invasive open surgery can be effective even in an elderly patient.
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—Case Report—Makoto KATSUNO, Takayuki MIZUNARI, Shiro KOBAYASHI, Hiroshi TAKAHASHI, ...2009 年 49 巻 10 号 p. 468-470
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスThe development of vertebral artery (VA) dissecting aneurysm after trapping of the contralateral VA is rare, and rupture of angiographically occult VA dissecting aneurysms immediately after trapping is even less common. A 39-year-old man suffered subarachnoid hemorrhage caused by rupture of a left VA dissecting aneurysm. The VA was trapped and the left occipital artery anastomosed to the posterior inferior cerebellar artery. Postoperatively, he suddenly developed apnea and died of rupture of a right VA dissecting aneurysm. Histological examination of the bilateral VAs and the basilar artery disclosed a hematoma between the media and the adventitia. This case further confirms the need for careful preoperative imaging study of the dissection and all segments of the dissected vessel in patients requiring trapping of a VA dissecting aneurysm, as well as preservation of VA anterograde flow.
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—Case Report—Mehmet Faik OZVEREN, Yasushi MATSUMOTO, Ryushi KONDO, Akira TAKAHASHI2009 年 49 巻 10 号 p. 471-473
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 36-year-old male patient with Behcet's disease consulted our hospital for treatment of an unruptured intracranial aneurysm. He was neurologically intact. He had undergone surgery for an aneurysm of the superior mesenteric artery 2 years ago and had been followed up because of the aneurysm of the left radial artery for 1 year. He had been receiving steroid treatment for 4 years. Three-dimensional computed tomography angiography identified an aneurysm of the left intracranial internal carotid artery. The lesion was treated by coil embolization. He was discharged without complications. Intracranial aneurysm formation is extremely rare in patients with Behcet's disease. The presence of extracranial aneurysms indicates screening for intracranial aneurysms. The present case shows that coil embolization can be used to treat unruptured intracranial aneurysm in patients with Behcet's disease.
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—Case Report—Kosei IJIRI, Kazutoshi HIDA, Shunsuke YANO, Yoshinobu IWASAKI2009 年 49 巻 10 号 p. 474-477
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 41-year-old woman presented with a rare cervical intramedullary cavernous angioma manifesting as acute paralysis in her left upper extremity. Magnetic resonance imaging revealed hematomyelia. Laminectomy (C2-C7) was performed, followed by posterior midline myelotomy and removal of the intramedullary hematoma and the tumor. She showed marked improvement after the surgery. However, 3 years and 10 months later the patient showed slight intramedullary bleeding located ventrally at the same level. Anterior approach with corpectomy was performed. Complete removal of the tumor was attained and salvage surgery was performed. Postoperative stabilization was achieved with excellent clinical outcome. The anterior approach is useful method as a salvage surgery for ventrally located cavernous angioma.
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—Two Case Reports—Kenichiro ONO, Junichi HATADA, Kenzo MINAMIMURA, Ichiyo OHARA, Kojiro ...2009 年 49 巻 10 号 p. 478-481
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスTwo patients underwent uneventful total removal of convexity or trigone meningioma, but subsequently edema enlarged causing symptoms 3-4 weeks later. Gradual improvement was obtained by steroid administration in 1 patient and re-craniotomy in 1 patient. The histological findings in Case 1 were not confirmed, but inflammatory reaction against residual microfibrillar collagen hemostat (MCH) may have developed. The specimen from around the cyst in Case 2 showed moderate staining for vascular endothelial growth factor (VEGF). VEGF secreted by the tumor might have resulted in spread of inflammation due to MCH in the brain parenchyma. Furthermore, inflammatory reactions may have obstructed or formed a one-way communication in the inferior horn and residual cavity, resulting in malabsorption of cerebrospinal fluid. Postoperative edema with the timing in these cases is difficult to anticipate. However, the risk of this phenomenon can probably be minimized by ensuring that MCH is removed as effectively as possible after use, or by refraining from use in the brain parenchyma and by taking care to connect the residual cavity to the ventricular system, particularly if the tumor contacts a cerebral ventricle.
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—Case Report—Tsutomu ICHINOSE, Takeo GOTO, Hisashi MOTOMURA, Yuzo TERAKAWA, Kenji O ...2009 年 49 巻 10 号 p. 481-483
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 66-year-old man presented with an extremely rare primary frontal sinus squamous cell carcinoma who was successfully treated by the extreme radical extended frontobasal approach. The tumor was resected en bloc with a clear margin and the large defect of the frontal region was reconstructed using a rectus abdominis myocutaneous flap. The tumor was well controlled without adjuvant therapy, and no recurrence or metastasis had occurred 2 years after the operation. Frontal sinus malignancy can be resected by the extreme radical extended frontobasal approach. The rectus abdominis myocutaneous flap is useful for the large defect of the skin and frontal base.
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—Case Report—Mayu TAKAHASHI, Junkoh YAMAMOTO, Yuichi AOYAMA, Yositeru SOEJIMA, Dais ...2009 年 49 巻 10 号 p. 484-487
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 12-month-old girl presented with a rare atypical choroid plexus papilloma manifesting as conscious disturbance and vomiting. Magnetic resonance (MR) imaging revealed a well-delineated 5 × 6-cm lobulate mass in the right lateral ventricle. Only partial removal of the tumor was performed because of excessive intraoperative hemorrhage at the first surgery. The histological diagnosis was atypical choroid plexus papilloma. To control the intraoperative hemorrhage, embolization of the feeding artery was performed before the second surgery, and the tumor was macroscopically totally removed. MR imaging disclosed a small residual tumor which showed relatively rapid growth. The patient underwent the third removal 5 months after the second surgery. Two months later, MR imaging showed a cystic lesion with a small nodule adjacent to the midbrain, indicating dissemination of the tumor. The lesion was successfully treated with chemotherapy. Atypical choroid plexus papilloma was recently defined in the classification of the World Health Organization, so clinical data based on these criteria are lacking to establish the therapeutic strategy. Total resection of atypical choroid plexus papilloma is the most reliable treatment at present. However, postoperative chemotherapy should be considered for recurrence or dissemination.
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—Case Report—So TOKUNAGA, Takato MORIOKA, Kimiaki HASHIGUCHI, Kazuhiro SAMURA, Fumi ...2009 年 49 巻 10 号 p. 487-490
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA female baby was born at 37 weeks and 6 days gestation by vaginal delivery with omphalocele, exstrophy of the cloaca, and imperforate anus, indicating the presence of OEIS complex, a rare combination of defects consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal deformity (S), associated with lumbosacral lipoma. The most common associated spinal deformity is terminal myelocystocele, and spinal lipoma is rare. Constructive interference in steady-state magnetic resonance imaging clearly revealed double lipomas, a dorsal-type lipoma, located dorsal to the low-lying conus medullaris, and a filar-type lipoma, revealed by a thickened and fatty filum terminale. After recovery from abdominogenital repairs, debulking of the dorsal-type lipoma and untethering of the spinal cord by sectioning of the filar-type lipoma were performed at the age of 14 months. Neurosurgical treatment for occult spinal dysraphism should be undertaken after recovery from the initial series of major abdominogenital procedures.
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—Case Report—Kuniaki NAKAHARA, Satoru SHIMIZU, Hidehiro OKA, Satoshi UTSUKI, Hideo ...2009 年 49 巻 10 号 p. 490-492
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 64-year-old obese woman underwent ventriculoperitoneal shunting for hydrocephalus associated with subarachnoid hemorrhage. On the 10th postoperative day, the distal end of the peritoneal catheter migrated into the abdominal wall and she developed a cyst filled with cerebrospinal fluid around the migrated catheter. The distal end of the catheter was surgically repositioned. We attribute the migration to increased intra-abdominal pressure due to obesity, the use of a low friction hydrogel-processed peritoneal catheter, and the presence of a large dead space around the catheter. The laparotomy must be closed meticulously to prevent this type of migration.
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—Case Report—Takashi MORISHITA, Takao WATANABE, Takashi OHTA, Masamichi FUKUSHIMA, ...2009 年 49 巻 10 号 p. 492-494
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 63-year-old man presented with an unusual supracallosal epidermoid cyst with repetitive hemorrhages that initially manifested as severe headache in 2003. Physical examination found no neurological deficit. Computed tomography demonstrated a homogeneously high density mass lesion measuring 3 × 3 cm in the supracallosal area, and the clinical diagnosis was cavernous malformation. No change occurred in neurological findings except for headache, but the lesion underwent hemorrhages several times over a 4-year period and increased in size to 4 × 5 cm. Surgery revealed a pearly cyst filled with old blood and debris. Histological examination disclosed keratinizing, stratified squamous epithelium without hair follicles or sebaceous glands, consistent with the diagnosis of epidermoid cyst. Surgery was successfully performed without complications such as akinetic mutism, motor weakness, or chemical meningitis. The present case suggests that epidermoid cyst should be considered in the differential diagnosis of suspected cavernous malformation in any location.
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—Case Report—Atsushi SAITO, Takayuki SUGAWARA, Ryu WATANABE, Yousuke AKAMATSU, Shig ...2009 年 49 巻 10 号 p. 495-498
発行日: 2009年
公開日: 2009/10/25
ジャーナル オープンアクセスA 71-year-old man presented with vestibular schwannoma manifesting as hearing disturbance and truncal ataxia 16 years after removal of a cerebellopontine angle (CPA) epidermoid cyst, and located adjacent to the remnant lesion. The patient first presented with a 6-month history of right trigeminal neuralgia. Neuroimaging demonstrated a right CPA lesion, suggestive of an epidermoid cyst. Right lateral suboccipital craniotomy was performed and the histological diagnosis was epidermoid cyst. A small lesion remained, but the symptoms were relieved. Sixteen years later, the patient presented with right auditory disturbance, vertigo, and truncal ataxia. Magnetic resonance imaging revealed a multiple cystic mass adjacent to the remnant epidermoid cyst in the right CPA. The lesion was removed and the histological diagnosis was vestibular schwannoma associated with the epidermoid cyst. The irritative effect of the remnant epidermoid cyst or surgical procedures may have caused the vestibular schwannoma, but no evidence of the evolution of the different types of tumors was found.
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Editorial Committee
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2009 年 49 巻 10 号 p. EC19-EC20
発行日: 2009年
公開日: 2013/03/08
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