Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 49, Issue 7
Displaying 1-11 of 11 articles from this issue
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Original Articles
  • Postoperative Quality of Life Outcome and Employment in Patients Undergoing Resection of Epileptogenic Lesions Detected by Magnetic Resonance Imaging
    Kouzo MORITAKE, Nobuhiro MIKUNI, Yasuhiko AKIYAMA, Hidemasa NAGAI, Nob ...
    2009 Volume 49 Issue 7 Pages 281-286
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.281
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    The long-term postoperative improvement of quality of life (QOL) and employment were investigated in patients undergoing resection of epileptogenic lesions detected by magnetic resonance (MR) imaging to identify the associated preoperative factors. Thirty of 47 patients who underwent lesionectomy between 1987-2001 replied to questionnaires. Patients with extratemporal resection outnumbered those with temporal lobe resection. The mean follow-up period was 12.4 ± 3.7 years. An arbitrary score for quantitatively assessing QOL was assigned. The mean increases in QOL score points were significantly higher in the late childhood onset group than those in the early childhood onset group, and were also significantly higher in the temporal resection group and extratemporal resection of non-dysplastic cortical pathology group than in the extratemporal resection of dysplastic cortical pathology group. Postoperative QOL improvement and occupational status of patients depended on the completeness of seizure control. Resection of lesions detected by MR imaging in patients with intractable epilepsy resulted in effective long-term QOL improvement and postoperative occupational status. Favorable outcome was related mainly to the pathology of the epileptogenic lesions, whether the lesion site was temporal or extratemporal, and the completeness of seizure control.
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  • Endovascular Treatment With Bare Platinum Coils for Middle Cerebral Artery Aneurysms
    Hidenori OISHI, Kensaku YOSHIDA, Takashi SHIMIZU, Munetaka YAMAMOTO, N ...
    2009 Volume 49 Issue 7 Pages 287-293
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.287
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    Middle cerebral artery (MCA) aneurysms often have unfavorable anatomical characteristics preventing successful endovascular occlusion. We reviewed the outcomes of our series of endosaccular embolization of MCA aneurysms using bare platinum coils, angiographic images, and medical records. Immediate and follow-up angiographic results were categorized as complete occlusion, residual neck, and residual flow. Follow-up angiographic changes were categorized as unchanged, minor or major recurrence, and progressive thrombosis. Between December 2001 and August 2007, 112 patients with 113 MCA aneurysms underwent endovascular treatment, of whom 60 presented with subarachnoid hemorrhage (SAH) due to MCA aneurysm rupture. Immediate angiographic outcomes for 103 aneurysms revealed complete occlusion in 64, residual neck in 21, residual flow in 18, and failed embolization in 10. Follow-up angiography of 70 aneurysms demonstrated 41 unchanged, 10 minor recurrences, 12 major recurrences, 7 progressive thromboses, and no bleeding of coil embolized aneurysms. Outcomes of 58 SAH patients treated endovascularly revealed 45 good recovery and moderate disability, 10 severe disability or persistent vegetative state, and 3 deaths. Forty-four of the 45 patients with unruptured aneurysms treated endovascularly had no changes in their neurological status. One of 5 patients with complications had permanent morbidity. For patients with MCA aneurysms suitable for endovascular surgery, bare platinum coil embolization can be performed with acceptable low morbidity and mortality rates, with a lower risk of postprocedural aneurysmal bleeding.
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  • Cerebral Ischemia Promotes Rich Pseudopalisading Necrosis in the Rat C6 Glioblastoma Model
    Mahabub H. MAMUN, Hideki KAMITANI, Yusuke KINOSHITA, Sadaharu TABUCHI, ...
    2009 Volume 49 Issue 7 Pages 294-299
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.294
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    The effect of hypoxia on glioma growth including pathological changes was investigated in an experimental model of brain ischemia in the rat C6 glioma model. C6 glioma cells were inoculated into the subcortex of adult Wistar rats. Focal cerebral ischemia near the implanted glioma area was induced by permanent middle cerebral artery occlusion (PMCAO). Ten days later, the rats were sacrificed to compare tumor volume of C6 glioma without PMCAO (control group) versus C6 glioma with PMCAO (hypoxia group). The histological features were also observed. The mean tumor volume in the hypoxia group was significantly larger than that in the control group. The most prominent histological finding in the hypoxia group was abundant formation of pseudopalisading around the necrotic areas. Immunohistological examinations showed intensive staining for vascular endothelial growth factor and hypoxia-inducible factor in these pseudopalisading cells. These findings suggest that cerebral ischemia positively modulates glioma mass growth by the formation of pseudopalisading necrosis, a characteristic histological finding of glioblastoma.
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Case Reports
  • Emergent Surgical Repair for Penetrating Injury of the Cervical Carotid Artery Associated With Shock
    —Case Report—
    Yoshie HARA, Haruo YAMASHITA, Kohei OHTA, Syuichi KOZAWA, Masahiko NAK ...
    2009 Volume 49 Issue 7 Pages 300-302
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.300
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    A 41-year-old male presented with penetrating carotid artery injury after being stabbed in the left neck with a knife. He had profuse bleeding from the wound and was in hemorrhagic shock. No neuroimaging evaluation was possible, so emergent surgery was begun with continuous manual compression of the left neck. Graft reconstruction of the injured carotid artery was performed. He recovered well without neurological deficits. Urgent hemostasis is required for patients with penetrating carotid artery injury presenting with shock. Surgical reconstruction of the carotid artery with a vascular graft is a safe option.
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  • Persistent Primitive Olfactory Artery Aneurysm
    —Case Report—
    Tetsuya YAMAMOTO, Kensuke SUZUKI, Tomosato YAMAZAKI, Wataro TSURUTA, T ...
    2009 Volume 49 Issue 7 Pages 303-305
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.303
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    A hypertensive 69-year-old man presented with an incidentally discovered non-ruptured aneurysm of the persistent primitive olfactory artery (POA). The POA originates at the terminal portion of the internal carotid artery, runs along the olfactory tract anteriorly toward the crista galli, and forms an acute angle with the distal anterior cerebral artery. The aneurysm was located at this characteristic acute angle. The persistent POA aneurysm associated with an anterior communicating artery aneurysm with wide neck was successfully treated by clipping surgery.
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  • Spinal Cerebrospinal Fluid Leakage After Motor Vehicle Accident
    —Two Case Reports—
    Eiji MORIYAMA, Hiroaki TERADA, Shinichi ISHIKAWA
    2009 Volume 49 Issue 7 Pages 306-309
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.306
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    Two patients presented with spinal cerebrospinal fluid (CSF) leakage manifesting as chronic disabling headache and other symptoms after motor vehicle accidents. Combined radioisotope cisternography and computed tomography myelography confirmed the presence of the spinal leaks in the lumbar spine. Radioisotope cisternography has limited spatial resolution, so there is persistent and probably unfair mistrust in its reliability. The present 2 cases confirmed the diagnosis and support the causal relationship between motor vehicle accidents and spinal CSF leakage.
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  • Chronic Cervicothoracic Spinal Subdural Hematoma
    —Case Report—
    Batuk DIYORA, Alok SHARMA, Ravikrishna MAMIDANNA, Laxmi KAMAT
    2009 Volume 49 Issue 7 Pages 310-312
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.310
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    A 33-year-old female presented with an extremely rare case of chronic spinal subdural hematoma in the cervicothoracic region manifesting as sudden onset of flaccid paraplegia and urinary retention. She was receiving warfarin medication for an episode of superior sagittal sinus thrombosis 2 years earlier. Two months previously, she had undergone a minilaparotomy under general anesthesia following unsuccessful spinal anesthesia. Magnetic resonance imaging showed a large cervicothoracic extramedullary mass causing cord compression. However, laminectomy for excision of mass revealed a purely subdural hematoma. Her neurological deficits were partially resolved after removal of subdural hematoma.
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  • Spontaneous Regression of a Spinal Extradural Arteriovenous Fistula After Delivery by Cesarean Section
    —Case Report—
    Manabu KINOSHITA, Akio ASAI, Shoko KOMEDA, Kunikazu YOSHIMURA, Junichi ...
    2009 Volume 49 Issue 7 Pages 313-315
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.313
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    A 23-year-old Japanese woman presented with a newly developed spinal extradural arteriovenous fistula (AVF) during pregnancy. She had been followed up for a suspected spinal cavernous angioma and became unable to walk during the 29th week of her pregnancy. Magnetic resonance (MR) imaging showed a spinal extradural AVF at the T3 to T4 levels compressing the spinal cord. After delivery by cesarean section, her neurological symptoms gradually began to resolve, and she was able to resume walking without assistance. MR imaging confirmed spontaneous regression of the AVF. This case suggests that exacerbated neurological symptoms and AVF growth triggered by pregnancy can improve after delivery without interventional treatment. Careful follow up of neurological findings is required to prevent unnecessary interventional procedures in pregnant women with spinal AVF.
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  • Lumbar Congestive Myelopathy Mimicking Neoplasia Without Concurrent Vascular Malformation
    —Case Report—
    Satoshi TSUTSUMI, Yusuke ABE, Yukimasa YASUMOTO, Masanori ITO
    2009 Volume 49 Issue 7 Pages 316-319
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.316
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    A 78-year-old male presented with congestive myelopathy manifesting as progressive gait disturbance following conservative therapy for lumbar spinal canal stenosis, with suspected spinal cord tumor in the conus medullaris. His past medical history was unremarkable and he was not aware of any traumatic injury in the back or infectious disease. On admission, he had clumsy hand, moderate paraparesis, significant sensory disturbance below the L5 level, and severe vesicorectal dysfunction. The deep tendon reflex was promoted in the upper extremities, but poorly induced in the lower extremities. Blood examination found no abnormalities including values of tumor markers. Cerebral, cervical, and thoracic magnetic resonance (MR) imaging revealed no contributory pathology without spondylotic change at the C3-C6 levels. Lumbar MR imaging showed fusiform swelling of the cord from the T10 to T12-L1 levels, with rimlike enhancement at the T12-L1 levels by gadolinium. The patient underwent surgery. Intraoperatively, the dorsal surface of the affected cord was pale, not swollen, and sparsely vascularized without tortuous vessels. Midline myelotomy caused escape of creamy material that was identified as necrotic neural tissue. A collapsed vessel, located on the surface of the cord, was histologically identified as a thrombosed vein. The histological findings were compatible with spinal infarction caused by congestive myelopathy. Whole craniospinal and iliac angiography performed postoperatively failed to reveal any dural and paraspinal vascular malformation. His paraparesis, sensory disturbance, and vesicorectal dysfunction improved significantly after surgery. Congestive myelopathy may be caused by various angiographically occult etiologies other than dural arteriovenous fistula.
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Technical Case Report
  • New Pull-through Technique Using the Superficial Temporal Artery for Transbrachial Carotid Artery Stenting
    —Technical Case Report—
    Yutaka MITSUHASHI, Akimasa NISHIO, Taichiro KAWAKAMI, Kazunori SHIBAMO ...
    2009 Volume 49 Issue 7 Pages 320-324
    Published: 2009
    Released on J-STAGE: July 25, 2009
    DOIhttps://doi.org/10.2176/nmc.49.320
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    Carotid artery stenting (CAS) is an effective and less invasive alternative to carotid endarterectomy for internal carotid artery (ICA) stenosis, but the guiding catheter is often technically difficult to introduce into the common carotid artery (CCA) in patients with concomitant atherosclerotic disease in the peripheral vessels or aorta. A new pull-through technique between the superficial temporal artery (STA) and the brachial artery was used to deliver the guiding catheter into the CCA safely and steadily. An 83-year-old male presented with repeated transient left hemiparesis caused by severe stenosis of the origin of the right ICA. He also had severe systemic atherosclerotic disease with occlusion of the bilateral femoral arteries. The innominate artery branched at an acute angle from the aorta. Therefore, catheterization of the right CCA seemed to be impossible using a conventional approach. The guidewire introduced from the right STA was lassoed by a loop snare wire and pulled out of the left brachial artery, forming the pull-through system. The guiding catheter could be introduced into the CCA from the left brachial artery over this guidewire. Subsequently, successful stent placement was performed under the distal protection. This new technique may facilitate safe and stable CAS even in patients with a severely tortuous access route due to concomitant atherosclerotic disease.
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Editorial Committee
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