Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 49, Issue 11
Displaying 1-16 of 16 articles from this issue
Original Articles
  • Kazuya NISHIOKA, Shinji IMAE, Mari KITAYAMA, Jun-ichiro MIKI, Toshika ...
    2009 Volume 49 Issue 11 Pages 501-506
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    Vertebroplasty with hydroxyapatite blocks through a modified percutaneous approach was used to treat 30 patients with vertebral body fractures in 32 vertebral bodies between February 2003 and March 2007. The mean follow-up period was 16.6 months. The pain associated with this procedure, effects on adjacent vertebral bodies, and other complications were evaluated. The rate of recollapse after vertebroplasty was examined in 26 patients with 26 vertebral bodies treated and followed up for more than 3 months. Mean time of operation was 57 minutes and mean number of blocks used per vertebral body was 104. The mean visual analogue scale score was 7.0 preoperatively and 1.6 postoperatively. The mean decline in postoperative vertebral body height was 13%. New vertebral body fractures occurred postoperatively in 3 vertebral bodies in 2 patients. Leakage of blocks outside the vertebral body occurred in 2 patients during the operation, and after the operation in one patient, and the hydroxyapatite plug broke postoperatively in one patient. Hydroxyapatite blocks yielded good pain relief comparable to bone cement, with no serious complications such as a pulmonary embolism or leakage into the spinal canal, and are effective for percutaneous vertebroplasty.
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  • Takafumi TANEI, Yasukazu KAJITA, Takashi NIHASHI, Yoshiki KANEOKE, Shi ...
    2009 Volume 49 Issue 11 Pages 507-513
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    Changes in regional cerebral blood flow (rCBF) induced by unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) were investigated in 7 consecutive patients with Parkinson's disease, 4 men and 3 women (mean age 62.3 ± 8.1 years), who underwent rCBF measurement by N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography at rest before and after unilateral STN DBS preoperatively in the on-drug condition, and postoperatively in the on-drug and on-stimulation condition. Statistical parametric mapping was used to identify significant changes in rCBF from the preoperative to the postoperative conditions. rCBF was increased in the bilateral cingulate cortices and bilateral cerebellar hemispheres. rCBF was decreased in the bilateral medial frontal cortices and left superior temporal cortex. Unilateral STN DBS produced rCBF changes in the bilateral cingulate cortices, cerebellar hemispheres, and medial frontal cortices. These findings indicate that unilateral STN DBS affects rCBF in both hemispheres.
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Case Reports
  • —Case Report—
    Hideyuki ISHIHARA, Nobuyuki SAKAI, Terumasa KUROIWA, Takeharu KUNIEDA, ...
    2009 Volume 49 Issue 11 Pages 514-517
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 56-year-old woman with adult idiopathic thrombocytopenic purpura (ITP) diagnosed 17 years previously presented with a fusiform aneurysm manifesting as chronic headache. She had suffered no major hemorrhagic complications, although her platelet counts were between 3.0 × 109/l and 50.0 × 109/l. Magnetic resonance angiography identified a fusiform aneurysm of the right vertebral artery. Endovascular trapping after high-dose gammaglobulin with steroid therapy was performed. The patient received antiplatelet therapy to prevent thromboembolic events. The parent artery and aneurysm were completely occluded with no hemorrhagic complications. Endovascular treatment is considered safe in patients with ITP, although careful periprocedural management of platelet count is required.
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  • —Case Report—
    Tsuyoshi OHTA, Hidetsugu MAEKAWA, Kenji KASUNO, Tatsuo TSUKAMOTO, Eri ...
    2009 Volume 49 Issue 11 Pages 517-519
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 70-year-old woman with a history of end-stage renal disease secondary to anti-neutrophil cytoplasmic autoantibody-associated vasculitis had been receiving hemodialysis for 5 years. The patient underwent attempted right internal jugular vein cannulation for temporary hemodialysis catheter placement. Pulsating mass developed in the neck and angiography revealed a subclavian artery pseudoaneurysm 4 days later. The pseudoaneurysm disappeared spontaneously during the interval between the diagnosis and the planned surgical procedure. Such delayed onset and spontaneous resolution of subclavian artery pseudoaneurysm is uncommon. Close observation may be optimal if delayed onset of pseudoaneurysm occurs after small needle puncture with cessation of antiplatelet/anticoagulant administration.
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  • —Case Report—
    Sakiko SUZUKI, Hiroshi WANIFUCHI, Takashi SHIMIZU, Osami KUBO
    2009 Volume 49 Issue 11 Pages 520-523
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 31-year-old female presented with a particularly rare hemangiopericytoma (HPC) in the right lateral ventricle manifesting as a 6-month history of visual disturbance and headache. Left hemianopsia and choked disc were identified by an ophthalmologist who referred her to us. Magnetic resonance imaging demonstrated a 5-cm homogeneously enhanced mass in the trigone of the right lateral ventricle. The tumor was totally removed by two stage surgery. The histological findings were consistent with HPC. HPC is very important to differentiate from meningioma and solitary fibrous tumors because HPC is more aggressive. The histological and immunochemical findings are important for the differential diagnosis. The present case showed no local recurrence or metastasis without radiation therapy for 4 years, indicating that radiation therapy is not absolutely imperative for patients with intraventricular HPC showing low MIB-1 staining index after total removal.
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  • —Case Report—
    Rosario CALTABIANO, Giuseppe PARISI, Vincenzo ALBANESE, Salvatore LANZ ...
    2009 Volume 49 Issue 11 Pages 523-527
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 71-year-old woman presented with a rare case of malignant fibrous histiocytoma (MFH) associated with recurrent meningothelial meningioma. The neuroimaging findings were consistent with a diagnosis of recurrent meningioma. Surgical removal was performed. Histological and immunohistochemical examinations detected meningothelial and MFH tumor components. The MFH component showed diffuse 3+ staining for epidermal growth factor receptor protein, predominantly located on the cell membrane and to a lesser extent within the cytoplasm. However, a fluorescein isothiocyanate analysis detected no amplification of epidermal growth factor receptor gene.
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  • —Case Report—
    Hitoshi TSUGU, Shinya OSHIRO, Yushi UENO, Hiroshi ABE, Fuminari KOMATS ...
    2009 Volume 49 Issue 11 Pages 528-531
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 13-year-old girl presented with an exceedingly rare case of primary yolk sac tumor located within the lateral ventricle, manifesting as headache, nausea, and diplopia. Magnetic resonance imaging revealed a 4-cm-diameter solid enhanced mass within the left inferior horn of the lateral ventricle. The tumor was removed subtotally via left middle temporal corticotomy. The histological and immunohistochemical diagnosis was pure yolk sac tumor. The serum alpha-fetoprotein (AFP) level was elevated at 1957.2 ng/ml and the serum beta-human chorionic gonadotropin level was 4 mIU/ml after surgery. The patient underwent radiotherapy (whole brain, 30 Gy; tumor bed, 21 Gy; whole spinal axis, 30 Gy) and chemotherapy (ifosfamide, cisplatin, etoposide). After three treatment cycles, the serum AFP level had decreased to 4.5 ng/ml. However, the tumor recurred with cerebrospinal fluid dissemination after nine cycles of chemotherapy. She died 18 months after surgery. The possibility of germ cell tumor should be considered in pediatric patients with brain tumors occurring outside the pineal or suprasellar region.
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  • —Case Report—
    Takashi SASAYAMA, Katsu MIZUKAWA, Yoshio SAKAGAMI, Takashi MIZOWAKI, K ...
    2009 Volume 49 Issue 11 Pages 532-535
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 54-year-old man with Klinefelter syndrome presented with glioblastoma multiforme manifesting as a 2-week history of motor weakness of the bilateral extremities. Magnetic resonance imaging showed multiple heterogeneously enhanced tumors in the bilateral frontal lobes. Angiography showed no tumor stain or arteriovenous shunt. The tumor was partially removed through a right craniotomy. The histological diagnosis was glioblastoma. Immunohistochemical examination showed no O6-methylguanine-deoxyribonucleic acid methyltransferase protein expression. Postoperative local radiotherapy (60 Gy/30 fractions) combined with temozolomide (75 mg/m2 × 42 days) and interferon-beta (3,000,000 U, 3 times/week) was performed. The patient's clinical status rapidly deteriorated during chemoradiotherapy, and he died of tumor progression 3.5 months after the surgery. Postmortem examination revealed widespread glioblastoma infiltrating the basal ganglia and thalamus. Klinefelter syndrome is associated with increased cancer predisposition, especially for male breast cancer and germ cell tumors, but glioma is extremely rare. The abnormal genetic constitution of this patient may have been directly responsible for the poor outcome.
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  • —Case Report—
    Tatsuya OHTONARI, Nobuharu NISHIHARA, Taisei OTA, Shinzo OTA, Tsunemar ...
    2009 Volume 49 Issue 11 Pages 536-538
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 29-year-old man presented with an intramedullary schwannoma of the conus medullaris manifesting as an 8-month history of mild bladder dysfunction, sexual impotence, and paresthesia in the buttocks. Subtotal removal of the lesion was achieved, as part of the tumor showed dense adhesion to the rostral neural tissue, with only postoperative transient deterioration of bladder dysfunction. Intramedullary schwannoma, especially involving the conus medullaris and the proximal spinal cord, is relatively rare and the pathogenesis and pathophysiology are unclear. Complete resection is often advised to avoid recurrence, but tumor adhesion to neural tissue sometimes renders complete resection difficult, and may create the risk of unacceptable operative morbidity. The present case shows that transient neurological deterioration may occur even with just subtotal removal, leaving the adherent part. Therefore, recognition of the particular features and the strategy for treatment in intramedullary schwannoma of the conus medullaris is essential for making appropriate decisions on the degree of removal.
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  • —Case Report—
    Shigeharu FUKAO, Junya HANAKITA, Yoshihiro KITAHAMA, Naoto ANDO, Manab ...
    2009 Volume 49 Issue 11 Pages 539-541
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T1- and T2-weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.
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  • —Case Report—
    Kraiyot KIATSOONTORN, Toshihiro TAKAMI, Tsutomu ICHINOSE, Isao CHOKYU, ...
    2009 Volume 49 Issue 11 Pages 542-545
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 25-year-old male patient presented with an extremely rare primary spinal peripheral primitive neuroectodermal tumor (pPNET) manifesting as acutely progressive paraparesis and back pain. Neuroimaging and intraoperative examination showed that the tumor was confined to the epidural space of the thoracic spine. The patient was treated successfully by gross total resection of the tumor followed by chemotherapy and local radiotherapy. The present case illustrates the unexpected occurrence and important differential diagnosis of primary epidural pPNET of the thoracic spine in young patients presenting with progressive paraparesis and back pain.
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  • —Case Report—
    Masamitsu NISHIHARA, Takashi SASAYAMA, Takeshi KONDOH, Kazuhiro TANAKA ...
    2009 Volume 49 Issue 11 Pages 546-548
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 49-year-old man was admitted suffering from headache persisting for a month. He had a history of primary spinal intramedullary malignant melanoma at the T6 level 18 years previously, which had remained stable for 18 years. Magnetic resonance imaging revealed central nervous system (CNS) dissemination of malignant melanoma. Whole brain radiation therapy (30 Gy), local radiation therapy (15 Gy), and routine intrathecal injection of interferon beta were performed. The progression of CNS dissemination of malignant melanoma was controlled without neurological deterioration for 38 months. The prognosis for primary CNS malignant melanomas better than that for cutaneous melanoma. However, the clinical course is still unknown, and CNS dissemination is regarded fatal. The unusually long survival in the present case indicates the effectiveness of the combined radiotherapy and interferon therapy.
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  • —Case Report—
    Yasuo NISHIJIMA, Miki FUJIMURA, Ken-ichi NAGAMATSU, Misaki KOHAMA, Tei ...
    2009 Volume 49 Issue 11 Pages 549-552
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    A 24-year-old man, who had an asymptomatic septum pellucidum cyst incidentally found one year previously, presented with severe headache and right abducens nerve palsy caused by expansion of the midline cyst. Preoperative magnetic resonance (MR) imaging revealed obstructive hydrocephalus due to the enlarged midline cyst. Neuroendoscopic fenestration of the septum pellucidum cyst was successfully performed via a right frontal approach using a high-resolution flexible neuroendoscopic system without complication. Communication between the cyst cavity and bilateral lateral ventricles was constructed via a single trajectory. The entire inner cyst wall could be inspected from the cyst cavity by manipulating the flexible neuroendoscopic system, which excluded the presence of neoplasm. His symptoms were completely relieved after surgery, and postoperative MR imaging showed significant improvement of hydrocephalus and shrinkage of the midline cyst. Septum pellucidum cavum vergae cyst may expand and become symptomatic, so fenestration using a flexible neuroendoscope system may be the optimal method for constructing communication to the bilateral lateral ventricles with minimal invasion.
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Technical Notes
  • —Technical Note—
    Tatsuya ISHIKAWA, Tatsushi MUTOH, Naoki NAKAYAMA, Hiroshi YASUDA, Miki ...
    2009 Volume 49 Issue 11 Pages 553-558
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    Blood blister-like aneurysms are dangerous aneurysms with fragile walls arising from the supraclinoid internal carotid artery (ICA). Primary treatment of these aneurysms in the acute stage is challenging, due to the substantial risk of periprocedural bleeding. We describe a series of 4 patients who presented with ruptured blister-like aneurysm of the ICA and were treated with completion of extracranial-intracranial high-flow bypass followed by inspection and trapping of the aneurysm. All patients were treated in the acute stage, within 48 hours of bleeding. External carotid artery to proximal middle cerebral artery bypass with interposed radial artery (RA) graft was established followed by approach to the lesion and trapping of the parent vessels. The aneurysms in 3 patients ruptured during dissection of the lesion from the surrounding structures, but bleeding was easily controlled. RA grafts were patent in all patients and no postoperative symptomatic ischemic or hemorrhagic complications were encountered, resulting in excellent outcomes with modified Rankin scale scores of 0 at follow up after 3 months. Our present strategy for surgical treatment of blister-like aneurysms completely avoided the risk of devastating intraoperative hemorrhage, offering a most cautious strategy associated with minimal risk of intraoperative massive bleeding.
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  • —Technical Note—
    Kosumo NODA, Rokuya TANIKAWA, Toshihide SUGIMURA, Kazutsune KAWASAKI, ...
    2009 Volume 49 Issue 11 Pages 559-562
    Published: 2009
    Released on J-STAGE: November 25, 2009
    JOURNAL OPEN ACCESS
    LactoSorb® fixation plates are made of a bioabsorbable polymer (82% poly-L-lactic acid and 18% polyglycolic acid), and the strength is not inferior to titanium plates. LactoSorb® has been used in the fields of pediatric neurosurgery and facial plastic surgery. Cranial fixation in craniotomy is mostly performed using titanium plates and clamps, but there are issues with esthetics and artifacts on postoperative radiographic images. Absorbable plates solve these problems, but are slightly thicker and more expensive. Here, we describe a technique to solve these disadvantages by inserting absorbable plates into the diploe. The present method was employed in 46 patients, and esthetically favorable results were obtained without intraoperative and postoperative complications. Absorbable plates may replace titanium plates as the main device for cranial fixation. The present method is particularly useful for cranial fixation in adults with a thin scalp.
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