Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 49, Issue 3
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • New Predictor for Intraaneurysmal Embolization Using Guglielmi Detachable Coils
    Yasushi MATSUMOTO, Masayuki EZURA, Ryushi KONDO, Naoto KIMURA, Akira T ...
    2009 Volume 49 Issue 3 Pages 100-103
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.100
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    Aneurysm volume/virtual column volume (AV/CV) ratio, calculated from measurements derived from reconstructed images based on rotational three-dimensional digital subtraction angiography (3D-DSA), was investigated as a predictor of the success of intraaneurysmal embolization in 20 unruptured wide-necked internal carotid artery aneurysms treated by Guglielmi detachable coils. AV and neck area were automatically calculated with a workstation. CV was defined as the product of height and neck area of the aneurysm. The percentage of aneurysm occlusion at the end of the procedure was evaluated by volume embolization ratio (VER). Successful intraaneurysmal embolization (VER ≥20%) was achieved in 10 of 11 aneurysms with AV/CV ratios of more than 1.0, whereas failed embolization (VER = 0%) was observed in 3 of 4 aneurysms with AV/CV ratios of less than 0.8. The AV/CV ratio is a possible predictor of embolization success, which can be easily calculated using 3D-DSA.
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  • Effect of Anthropometric Features on the Severity of Lumbar Disk Herniation
    Dong Yeob LEE, Sang-Ho LEE
    2009 Volume 49 Issue 3 Pages 104-107
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.104
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    Normal standing body height, body weight, and body mass index were measured in 256 patients with severe lumbar disk herniation who underwent surgery and compared with those of matched controls with mild lumbar disk herniation who showed improvement of symptoms after conservative treatment. Statistical analysis was performed using the paired sample t test and analysis of covariance test. Body weight and body mass index were significantly higher in women with severe lumbar disk herniation than in those with mild lumbar disk herniation (p = 0.01 and p = 0.01, respectively), but not in men. Standing body height showed no significant difference between patients with severe and mild lumbar disk herniations in both sex groups. Differences in body weight and body mass index may be key factors distinguishing the development of severe lumbar disk herniation from that of mild lumbar disk herniation in women.
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Case Reports
  • Cervical Epidural Arteriovenous Fistula With Radiculopathy Mimicking Cervical Spondylosis
    —Case Report—
    Masahito KAWABORI, Kazutoshi HIDA, Shunsuke YANO, Takeshi ASANO, Yoshi ...
    2009 Volume 49 Issue 3 Pages 108-113
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.108
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    A 65-year-old woman presented with a rare case of cervical epidural arteriovenous fistula (AVF) manifesting as radiculopathy of the right upper extremity that mimicked cervical spondylosis. She had a 2-month history of gradually progressive right-hand motor weakness and sensory disturbance. The initial diagnosis was cervical disk herniation. However, computed tomography with contrast medium showed abnormal enhancement at the right C5-6 and C6-7 intervertebral foramina. Magnetic resonance (MR) imaging with gadolinium disclosed an enhanced abnormal epidural mass at the dorsal surface of the dural tube between the C5 and C6 vertebrae. T2-weighted MR imaging showed a slight flow void on the dorsal and ventral surfaces of the spinal cord between C3 and T4. Digital subtraction angiography disclosed cervical epidural and dural AVFs fed by the C5 and C6 radicular arteries. The diagnosis was concomitant epidural and dural AVFs. The dilated internal vertebral venous plexus attributable to epidural AVF was considered to be responsible for the radiculopathy. Transarterial embolization using n-butylcyanoacrylate achieved complete occlusion of the lesions. Her symptoms improved immediately and MR imaging and angiography performed 10 days postembolization showed reduction of both the epidural and dural AVFs.
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  • Hemorrhagic Infarction Originating From Vertebral Artery Stenosis Caused by an Osteophyte at the C5 Superior Articular Process
    —Case Report—
    Satoru TAKEUCHI, Tsutomu KAWAGUCHI, Mitsuru NAKATANI, Toyohiko ISU
    2009 Volume 49 Issue 3 Pages 114-116
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.114
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    A 62-year-old man presented with right upper homonymous quadrihemianopsia. Magnetic resonance imaging showed hemorrhagic infarctions in the bilateral occipital lobes and infarction in the left cerebellar hemisphere. Digital subtraction angiography and three-dimensional computed tomography angiography revealed right vertebral artery (VA) stenosis caused by an osteophyte at the C5 superior articular process. The VA stenosis was aggravated by neck extension. The brain infarctions were attributed to embolism from the right VA stenosis. Unroofing of the anterior root of the right C4 transverse foramen, removal of the osteophyte at the superior articular process of C5, and anterior fusion at C4-5 were performed. His postoperative course was uneventful.
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  • Remote Cerebellar Hemorrhage Following Thoracic Spinal Surgery
    —Case Report—
    Yoichi MOROFUJI, Keishi TSUNODA, Tomonori TAKESHITA, Kentaro HAYASHI, ...
    2009 Volume 49 Issue 3 Pages 117-119
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.117
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    A 51-year-old man underwent surgery for ossification of the ligamentum flavum at the T9-T10 levels. Intraoperatively, the dura was opened unintentionally and a subcutaneous suction drain was placed. The patient complained of severe headache and nausea postoperatively. Brain computed tomography obtained 3 days after the surgery demonstrated remote cerebellar hemorrhage and hydrocephalus. Suboccipital decompression, C1 laminectomy, and ventriculostomy were performed and his symptoms subsided 2 months later. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur after any type of spinal surgery resulting in dural tear or intradural manipulation. Early diagnosis is particularly important for the treatment of remote cerebellar hemorrhage following spinal surgery.
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  • Reversible Clinical and Magnetic Resonance Imaging of Central Pontine Myelinolysis Following Surgery for Craniopharyngioma: Serial Magnetic Resonance Imaging Studies
    —Case Report—
    Ichiro KAWAHARA, Yoshiharu TOKUNAGA, Shunsuke ISHIZAKA, Nobuhiro YAGI
    2009 Volume 49 Issue 3 Pages 120-123
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.120
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    An 18-year-old girl presented with central pontine myelinolysis (CPM) following surgery for craniopharyngioma. Postoperatively, the patient developed diabetes insipidus with remarkable fluctuation of serum sodium level, suffered a seizure, and developed mental state changes and quadriparesis. Magnetic resonance (MR) imaging obtained soon after the development of the symptoms showed no significant abnormalities. MR imaging obtained 2 months later demonstrated typical trident or bat-like signal abnormalities in the center of the pons, compatible with CPM. Serial MR imaging obtained at 7 and 10 months showed the lesion had decreased in size or almost completely resolved and the patient almost completely recovered. CPM is well known, but neurosurgeons should consider the possibility following surgery for craniopharyngioma.
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  • Xanthogranuloma in the Suprasellar Region
    —Case Report—
    Sei SUGATA, Hirofumi HIRANO, Kazutaka YATSUSHIRO, Shunji YUNOUE, Katsu ...
    2009 Volume 49 Issue 3 Pages 124-127
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.124
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    A 26-year-old man presented with a xanthogranuloma located exclusively in the suprasellar region manifesting as general fatigue, bitemporal hemianopsia, and polyuria. Endocrinological examination disclosed severe hypopituitarism. Magnetic resonance imaging demonstrated a clearly defined suprasellar mass that was heterogeneously enhanced after gadolinium administration and was markedly hypointense on T2-weighted images. The tumor was subtotally removed under a preoperative diagnosis of craniopharyngioma. Histological examination found fibrous tissue with abundant cholesterol clefts, multinucleated giant cells, and hemosiderin deposits, but no epithelial cells. Xanthogranulomas of the sellar region are reported to be predominantly located in the sella turcica, but should be included in the differential diagnosis even in cases of suprasellar mass lesions.
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  • Primary Intramedullary Spinal Cord Germinoma: Diagnostic Challenge and Treatment Strategy
    —Two Case Reports—
    Toru YAMAGATA, Toshihiro TAKAMI, Naohiro TSUYUGUCHI, Takeo GOTO, Kenic ...
    2009 Volume 49 Issue 3 Pages 128-133
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.128
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    Two patients presented with primary intramedullary spinal cord germinoma (PISCG). Neither diagnosis was correct at initial evaluation, and both underwent surgical verification of the tumor. Based on the histological diagnosis, both patients were treated successfully by combination of chemotherapy and radiotherapy. These cases illustrate the unexpected occurrence of PISCG and treatment strategy.
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  • Delayed Recurrent Arachnoid Cyst of the Occipital Convexity in an Elderly Woman
    —Case Report—
    Masanori SUZUKI, Tomonori TAMAKI, Shigeki TODA, Masato TSUCHIYA, Kazun ...
    2009 Volume 49 Issue 3 Pages 134-137
    Published: 2009
    Released on J-STAGE: March 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.134
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    A 62-year-old woman presented with a symptomatic arachnoid cyst of the right occipital convexity manifesting as visual disturbances and headache. She underwent craniotomy with membranectomy and fenestration to the subarachnoid space. Postoperatively, her complaints disappeared and brain magnetic resonance (MR) imaging showed cyst shrinkage. During the first 1 year after surgery, she made a good recovery without clinical symptoms or cyst enlargement. However, she complained of visual disturbances after 6 years. Brain MR imaging revealed cyst enlargement and Goldmann perimetry detected left lower quadrantanopia. The diagnosis was recurrent arachnoid cyst. A second surgical procedure was performed including membranectomy for histological examination of the cyst membrane, and an Ommaya reservoir was inserted into the cyst cavity to prevent further cyst enlargement. The histological findings were compatible with arachnoid cyst, similar to the results seen at the first surgery. She was discharged 3 weeks after the second operation with no complications, and follow up continues as an outpatient. Patients with symptomatic arachnoid cysts typically have good progress after surgery, but the present case shows that follow up should continue for at least 6 years after surgery, even if cyst volume reduction was initially favorable.
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Editorial Committee
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