Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Search
Advanced search
OR
Browse
Search
Volume 50, Issue 10
Displaying 1-21 of 21 articles from this issue
Show all abstracts
    • |<
    • <
    • 1
    • >
    • >|
Original Articles
  • Effectiveness of Brain Hypothermia Treatment in Patients With Severe Subarachnoid Hemorrhage — Comparisons at a Single Facility
    Ryogo ANEI, Hideki SAKAI, Koji IIHARA, Izumi NAGATA
    Article type: Original Article
    2010 Volume 50 Issue 10 Pages 879-883
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.879
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    The effectiveness of hypothermia treatment for severe subarachnoid hemorrhage (SAH) was evaluated at the same facility under the same director. A total of 187 patients with SAH, 67 admitted before the introduction of hypothermia treatment in May 1999 (early cases) and 120 treated thereafter (late cases), were transported to the National Cardiovascular Center and treated in the acute phase between November 1997 and September 2001. Brain hypothermia treatment was performed in 19 patients of the 120 late cases, 10 males and 9 females aged 33-72 years (mean 57. 6 years), treated by direct surgery in 15 and endovascular surgery in 4. The indications for hypothermia treatment were age of 75 years or younger, SAH due to rupture of a cerebral aneurysm, Japan Coma Scale score of 100 or higher, and initiation of treatment within 24 hours after the onset. The body core temperature was sustained at 34°C for 48 hours, rewarming was performed over 48 hours, and normothermia was maintained thereafter. The outcome, evaluated according to the modified Rankin scale (m-RS) on transfer to another hospital or after 3 months, was m-RS 3 in 1 patient, m-RS 4 in 4, m-RS 5 in 3, and death in 11. Before the introduction of hypothermia treatment (early period), 16 patients showed the indications for the treatment, and their outcomes were m-RS 3 in 2, m-RS 4 in 3, m-RS 5 in 2, and death in 9. Cerebral vasospasm was important as a prognostic factor, markedly deteriorating the outcome. Hyperthermia after therapeutic hypothermia induced brain swelling and markedly affecting the outcome. Brain hypothermia treatment did not improve the outcome of severe SAH compared with the period before its introduction. The emphasis in treating severe SAH should be placed on the maintenance of normothermia to prevent brain swelling and elimination of factors that may induce cerebral vasospasm, rather than interventional hypothermia for aggressive brain protection.
    View full abstract
    Download PDF (178K)
  • Poor-Grade Ruptured Middle Cerebral Artery Aneurysm With Intracerebral Hematoma: Bleeding Characteristics and Management
    Ken KAZUMATA, Hiroyasu KAMIYAMA, Yuka YOKOYAMA, Katsuyuki ASAOKA, Shun ...
    Article type: Original Article
    2010 Volume 50 Issue 10 Pages 884-892
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.884
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Poor-grade ruptured middle cerebral artery aneurysm is frequently associated with intraparenchymal hemorrhage, which is associated with high morbidity rates. We analyzed the clinical presentations and surgical strategies of 23 cases of ruptured middle cerebral artery aneurysm. Hematomas were divided into three types: temporal hematoma (7 patients), sylvian hematoma (10 patients), and frontal hematoma (6 patients). In 13 of 23 patients, preoperative brainstem symptoms suggested impeding uncal herniation. Surgical procedures included external decompression in 11 patients, simple lateral temporal lobectomy in 5, and selective uncectomy in 9. Three patients died. Favorable outcome defined as upper half of severely disabled or better in the extended Glasgow Outcome Scale was achieved in 13 patients. Patients with frontal hematomas presented with both uncal herniation and brainstem signs preoperatively, but this subgroup showed unexpectedly good recovery. Patients with sylvian hematomas had relatively poor outcomes. The present series suggests that aggressive decompression and evacuation of hematoma in the acute stage may prevent significant postoperative brain swelling, and will not compromise the treatment of vasospasm.
    View full abstract
    Download PDF (518K)
  • Comparing Accuracy of Cerebral Aneurysm Size Measurements From Three Routine Investigations: Computed Tomography, Magnetic Resonance Imaging, and Digital Subtraction Angiography
    Hiroyuki TAKAO, Yuichi MURAYAMA, Toshihiro ISHIBASHI, Takayuki SAGUCHI ...
    Article type: Original Article
    2010 Volume 50 Issue 10 Pages 893-899
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.893
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Modern imaging technologies, such as computed tomography (CT) angiography, magnetic resonance (MR) angiography, and digital subtraction (DS) angiography are widely used for pretreatment evaluation of cerebral aneurysms, but the relative accuracies of these modalities are unclear. This study compared the measurements of aneurysm neck and dome height and width on CT angiography, time-of-flight (TOF)-MR angiography, and DS angiography using a three-dimensional workstation. An elastic model of a side-wall aneurysm was connected to an artificial heart pulsatile circuit system. The aneurysm model was prepared using a silicone membrane of 0.6-mm thickness under normal physiological circulation parameters. Using this aneurysm model, three-dimensional TOF-MR angiography, contrast-enhanced CT angiography, and DS angiography were performed. Source images were post-processed on a dedicated workstation to calculate the aneurysm size. DS angiography measurements were found to be the most accurate. In contrast, aneurysm neck sizes measured on CT angiography were significantly wider than actual values (p < 0.05) and aneurysm heights measured using TOF-MR angiography were significantly lower than actual values (p < 0.01). In this in-vitro model, at least one aneurysm dimension measured with CT angiography and with TOF-MR angiography differed significantly from actual values. Aneurysm neck width markedly affects therapeutic planning, as a wide neck requires craniotomy or endovascular treatment using an adjunctive device, so inaccuracies should be considered when aneurysm treatment is planned using modern methods of visualization.
    View full abstract
    Download PDF (394K)
  • Spray-Irrigation System Attached to High-Speed Drills for Simultaneous Prevention of Local Heating and Preservation of a Clear Operative Field in Spinal Surgery
    Manabu SASAKI, Shayne MORRIS, Tetsu GOTO, Koichi IWATSUKI, Toshiki YOS ...
    Article type: Original Article
    2010 Volume 50 Issue 10 Pages 900-904
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.900
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Heat generation due to drilling during spinal surgery is potentially hazardous to nerves. Saline irrigation is often performed to prevent such local heating, but sometimes floods and obscures the operative field. We have developed a spray-irrigation system for attachment to high-speed drills, which sprays saline solution with an air-jet in the direction of the surface cut by the drill. We anticipated that this air jet would create a clearer operative view by displacing excess fluid, and would also provide an added cooling effect greater than that of irrigation with saline. This study was designed to evaluate these predicted effects of the spray-irrigation system compared to conventional irrigation. A thermography study was performed to confirm the cooling effect of the spray-irrigation system. A plaster board coated with adhesives was drilled at 100,000 rpm along a 10-cm line for a duration of 20 seconds. Thermograms were recorded every minute, without cooling, with irrigation, and with the spray-irrigation system. To examine the operative views, continuous drilling for a period of seconds was performed with conventional irrigation and with the spray-irrigation system. Local heating was inhibited by the spray-irrigation system to 14-30% of that with irrigation. A clear operative field was maintained during continuous drilling using the spray-irrigation system through the air-jet action of the system. The spray-irrigation system can simultaneously provide effective cooling and a clear operative field during surgical manipulations with high-speed drills.
    View full abstract
    Download PDF (444K)
  • Surgical Experience of Gas-Containing Disk Herniation
    Kyung-Chul CHOI, Jin-Sung KIM, Sang-Ho LEE
    Article type: Original Article
    2010 Volume 50 Issue 10 Pages 905-909
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.905
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Disk herniation with gas or gas-containing disk herniation (GCDH) is rare, although epidural gas is associated with the vacuum phenomenon. The clinical, radiologic, and surgical findings were retrospectively analyzed of 18 patients with GCDH. The demographic, clinical, and radiologic findings including computed tomography and magnetic resonance imaging, as well as operative methods were examined. The mean age was 64.4 years (range 51-84 years). All patients presented with acute radiculopathy or exacerbation of chronic pain associated with GCDH of the lumbar spine. All lumbar GCDHs were related to the vacuum phenomenon. Ruptured disks predominantly compressed the nerve root with gas in 17 cases, except in one with only compressed nerve root by gas without disk herniation. All patients had confirmed GCDH at surgery. All patients underwent removal of GCDH and five with another level of spinal stenosis or disk herniation underwent selective decompression. The six patients with instability underwent fusion. Visual analogue scale score of radicular pain was improved from 7.4 ± 0.9 before surgery to 3.2 ± 0.7 at the 3-month follow-up examination. No recurrence occurred after surgery. GCDH can occur as a space-occupying lesion in epidural space as well as a cause of radiculopathy. GCDH may indicate the source of clinical symptoms in the degenerative spine, especially combined with spinal stenosis or multiple spinal disk herniations.
    View full abstract
    Download PDF (226K)
Case Reports
  • Long-Term Follow Up of Antegrade Recanalization of Vertebral Artery Dissecting Aneurysm After Internal Trapping
    —Case Report—
    Atsuhiro KOJIMA, Shunichi OKUI, Satoshi ONOZUKA
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 910-913
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.910
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 34-year-old female presented with subarachnoid hemorrhage caused by the rupture of a right vertebral artery (VA) dissecting aneurysm. The affected site, including the aneurysm and parent artery, was successfully occluded with detachable coils. Follow-up angiography performed 28 days after the endovascular treatment revealed recanalization of the parent artery. We decided to treat the patient conservatively without further intervention because the aneurysm had been completely occluded. Magnetic resonance imaging showed a normal VA configuration with a minor irregularity of the affected wall at 6 years after onset. Rebleeding tends to occur during the acute stage because spontaneous healing of the dissecting vascular wall typically occurs within one month after onset. Our case suggests that additional intervention is unnecessary during the chronic stage once the aneurysm has been occluded and no further signs of the development of VA dissection are found.
    View full abstract
    Download PDF (253K)
  • Internal Trapping of a Ruptured Vertebral Artery Dissecting Aneurysm Followed by Recanalization of the Trapped Vertebral Artery Without Aneurysm Recurrence
    —Case Report—
    Shinobu ARAKI, Keiko ODA, Takashi FUJITA, Masahisa KAWAKAMI
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 914-917
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.914
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 61-year-old man presented with a ruptured vertebral artery dissecting aneurysm manifesting as severe headache, which was treated by internal trapping, and later resulted in recanalization of the affected vertebral artery without aneurysm recurrence. Computed tomography revealed subarachnoid hemorrhage caused by a dissecting right vertebral artery aneurysm located just distal to the origin of the posterior inferior cerebellar artery. The patient underwent uneventful internal trapping. However, recanalization of the affected vertebral artery with stenosis was found on the 22nd postoperative day, apparently caused by insufficient thrombosis related to the short trapping length. No aneurysm recurrence or ischemic events were detected, so the patient was observed carefully. After 4 months, right vertebral angiography revealed that the vertebral artery was normal with no stenosis or aneurysm. Restoration of the vertebral artery without complication probably occurred by complete thrombosis of the aneurysm followed by reconstruction of the injured arterial wall. We adopted a conservative approach in this case, but additional embolization and/or stenting should be considered if high risk of rebleeding is suggested by angiographic findings, although the management of recanalization remains controversial.
    View full abstract
    Download PDF (274K)
  • Giant Internal Carotid Artery Aneurysm Manifesting as Difficulty in Swallowing
    —Case Report—
    Kenichiro HANABUSA, Yutaka NONOYAMA, Waro TAKI
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 917-920
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.917
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 66-year-old man presented with a rare case of a giant aneurysm of the internal carotid artery manifesting as difficulty in swallowing, resulting in severe malnutrition. Initial examination found a pulsating mass protruding from the posterior wall of the pharynx in the oral cavity. The patient had left hemiplegia caused by cerebral infarction one year previously. The patient underwent surgical therapy consisting of superficial temporal artery-middle cerebral artery bypass and trapping of the internal carotid artery. The pulsation of the oral mass vanished just after surgery and his difficulty in swallowing gradually improved. The patient was discharged with no new neurological deficits. The previous cerebral infarction was probably caused by an embolus from this giant aneurysm.
    View full abstract
    Download PDF (285K)
  • Carotid Artery Stenting in a Patient With Internal Carotid Artery Stenosis and Ipsilateral Persistent Primitive Hypoglossal Artery Presenting With Transient Ischemia of the Vertebrobasilar System
    —Case Report—
    Kouhei NII, Hiroshi AIKAWA, Masanori TSUTSUMI, Masanari ONIZUKA, Hiroy ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 921-924
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.921
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 62-year-old man experienced transient episodes of vertigo associated with left upper extremity weakness. Cerebral angiography showed 75% right internal carotid artery (ICA) stenosis and divergence of a persistent primitive hypoglossal artery (PPHA) distal to the stenosis. The area of stenosis was at a high position and he had a past medical history of congestive heart failure, which contraindicated carotid endarterectomy (CEA). Therefore, carotid artery stenting (CAS) was performed with single distal balloon protection. The stenotic area was restored and he was discharged without suffering recurrent attacks. CAS may be an effective alternative treatment to CEA to prevent further ischemic attacks in the posterior circulation in patients with PPHA. CAS using simple embolic protection devices is possible if the distance between the distal end of the ICA stenosis and the origin of the PPHA is sufficiently long.
    View full abstract
    Download PDF (183K)
  • Rapid Reduction of Acute Subdural Hematoma and Redistribution of Hematoma
    —Case Report—
    Arata WATANABE, Tomohiro OMATA, Hiroyuki KINOUCHI
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 924-927
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.924
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    An 88-year-old woman presented with acute subdural hematoma (ASDH) which showed rapid resolution on computed tomography (CT) and magnetic resonance (MR) imaging. She was transferred to our hospital after falling out of bed. On admission, she was comatose with Japan Coma Scale score of 200 and Glasgow Coma Scale score of E1V1M2. Brain CT showed a thick left frontotemporal ASDH. Conservative treatment consisted of 200 ml of glycerol administered intravenously twice a day, and maintenance in the approximately 20 degree head-up position to reduce intracranial pressure. Three days later, her consciousness recovered to Japan Coma Scale score of 30 and Glasgow Coma Scale score of E2V4M5. CT showed obvious reduction of the hematoma without brain or scalp swelling. Spinal MR imaging detected no redistribution of hematoma to the spine. The present case illustrates that rapid spontaneous reduction of ASDH may occur by redistribution of hematoma, mainly to the supratentorial subdural space because of brain atrophy.
    View full abstract
    Download PDF (360K)
  • Acute Epidural Hematoma in a Patient With Glanzmann's Thrombasthenia
    —Case Report—
    Hitoshi YAMAHATA, Kazuho HIRAHARA, Tetsuzo TOMOSUGI, Masahiko YAMADA, ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 928-930
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.928
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 7-year-old girl with Glanzmann's thrombasthenia (GT) fell and hit her head against a table. Within 2 hours she began to vomit and became drowsy. On admission to our hospital her Glasgow Coma Scale score was 13. Computed tomography (CT) on admission showed acute epidural hematoma in the left posterior fossa. We administered platelets, performed emergent lateral suboccipital craniotomy, and totally removed the epidural hematoma. Postoperative CT showed no evidence of hematoma or re-bleeding. She was discharged without neurological deficits 14 days after the operation. GT is a platelet aggregation disorder due to a functional loss of platelet membrane glycoprotein IIb/IIIa. The present patient with GT underwent successful emergency craniotomy after platelet transfusion.
    View full abstract
    Download PDF (200K)
  • Choroid Plexus Papilloma Presenting With Cerebrospinal Fluid Rhinorrhea and Otorrhea
    —Case Report—
    Yusuke KINOSHITA, Brian WASITA, Keiichi AKATSUKA, Atsushi KAMBE, Masam ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 930-933
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.930
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 52-year-old woman presented with right rhinorrhea and right otorrhea manifesting as aural fullness for 2 years caused by a choroid plexus papilloma in the right cerebellomedullary cistern. Computed tomography and magnetic resonance imaging revealed a well defined lobulated mass at the foramen of Luschka, which extended towards the right cerebellomedullary cistern with slight dilation of the ventricular systems. The tumor was totally resected via a right lateral suboccipital approach. Histological examination revealed a choroid plexus papilloma. Postoperative course was uneventful, just after the operation rhinorrhea ceased completely, and hearing of the right ear dramatically improved. Choroid plexus papillomas rarely cause cerebrospinal fluid (CSF) rhinorrhea. Total removal of the tumor resulted in the cessation of CSF leaks.
    View full abstract
    Download PDF (299K)
  • Subependymoma With Prominent Rosenthal Fiber Formation
    —Case Report—
    Tadahiro OHMURA, Hitoshi TSUGU, Mitsutoshi IWAASA, Hidetsuna UTSUNOMIY ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 933-935
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.933
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 62-year-old woman presented with a rare case of subependymoma associated with prominent Rosenthal fibers located in the left lateral ventricle manifesting as right hemiparesis and mild motor aphasia. The tumor was well demarcated and consisted of clusters of round nuclei embedded in an abundant gliofibrillary matrix with some microcysts and prominent Rosenthal fibers. Immunohistochemically, the tumor stained positively for glial fibrillary acidic protein and negatively for synaptophysin. This case of subependymoma containing Rosenthal fiber formation is very unusual.
    View full abstract
    Download PDF (349K)
  • Intracranial Epidermoid Tumor With Changes in Signal Intensity on Magnetic Resonance Imaging Because of Non-hemorrhagic Pathology
    —Case Report—
    Jun MUTO, Kazunari YOSHIDA, Suketaka MOMOSHIMA, Michitake KAZUNO, Taka ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 936-938
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.936
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 61-year-old woman presented an intracranial epidermoid tumor manifesting as dizziness and right facial hypesthesia. Magnetic resonance (MR) imaging revealed a well-defined lobulated mass in the right cerebellopontine angle as nearly isointense to the cerebrospinal fluid (CSF) on both T1- and T2-weighted images but inhomogeneously hyperintense on fluid-attenuated inversion recovery images. MR imaging performed 1 year later revealed that the tumor had significantly enlarged, and now appeared hyperintense to the CSF on T1- and T2-weighted images. The lesion was confirmed at surgery to be an epidermoid tumor filled with xanthochromic fluid. Histological examination found no evidence of hemorrhage in the resected tumor, so the changes in the MR imaging signal intensity were attributed to changes in the protein concentration of the intratumoral fluid, accumulation of debris, or some other non-hemorrhagic process.
    View full abstract
    Download PDF (322K)
  • Pilomyxoid Astrocytoma of the Cervical Spinal Cord Successfully Treated With Chemotherapy
    —Case Report—
    Kazuhito MATSUZAKI, Teruyoshi KAGEJI, Hiroyoshi WATANABE, Takanori HIR ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 939-942
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.939
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 15-month-old girl presented with a spinal pilomyxoid astrocytoma manifesting as a 3-month history of dysphagia. Magnetic resonance imaging showed an intramedullary mass of the cervical spinal cord at C1-C6 with syringobulbia. She underwent partial removal of the tumor and received postoperative chemotherapy with cisplatin and etoposide. The tumor completely responded to the treatment and has not relapsed for 64 months. Pilomyxoid astrocytoma frequently occurs in the opticohypothalamic regions but is rare in the spine. The present case suggests that surgery followed by chemotherapy with cisplatin and etoposide may be an effective therapeutic option for pilomyxoid astrocytoma of the cervical spinal cord.
    View full abstract
    Download PDF (282K)
  • Myelopathy Due to Multilevel Cervical Canal Stenosis With Forestier Disease
    —Case Report—
    Shinichiro KOIZUMI, Mitsuo YAMAGUCHI-OKADA, Hiroki NAMBA
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 942-945
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.942
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 56-year-old woman presented with multilevel myelopathy associated with Forestier disease (FD). The patient was hospitalized for dysphagia, bilateral shoulder pain, and progressive gait disturbance. The diagnosis was confirmed by radiography and magnetic resonance imaging which demonstrated coalescent anterior osteophyte formation extending from C2 to C7 with atlanto-axial dislocation and persistence of mobility at C3-4, and a hyperintense area in the spinal cord at the C1 and C3-4 levels on T2-weighted images. Dynamic radiography showed no instability at the C1 and C3-4 levels. Decompressive laminectomy of the atlas, dome-like laminectomy, and facet fusion at C3-4 were performed, resulting in symptomatic improvement. Myelopathy is very rare in patients with FD and is due to mechanical stress at the level where mobility persists. Strategic intervention should be considered based on evaluation of mobile levels and stenotic lesions.
    View full abstract
    Download PDF (171K)
  • Migration of a Distal Ventriculoperitoneal Shunt Catheter Into the Internal Jugular Vein and Heart Through the External Jugular Vein
    —Case Report—
    Tomoaki KANO, Shuhei KUROSAKI, Susumu IWASA, Hirochiyo WADA
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 945-948
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.945
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 6-year-old boy had undergone ventriculoperitoneal (VP) shunt for acute hydrocephalus because of a brain tumor at the age of 11 months, and presented with vomiting and somnolence after the shunt malfunctioned 6 days after VP shunt reconstruction, during which the right external jugular vein was injured during the tunneling process and the peritoneal catheter was not fixed to the peritoneum with a purse string suture. Radiography revealed an abnormal route of the peritoneal catheter, suggesting that the distal VP shunt catheter had migrated into venous vasculature through the right external jugular vein. Computed tomography revealed that the peritoneal catheter had migrated into the internal jugular vein and the right atrium. At surgery, the peritoneal catheter was exposed through a small incision on the subclavicular region, was easily extracted from the internal jugular vein and the heart as there was no coiling or adhesion of the distal catheter to the vascular tissues, and was repositioned into the peritoneum with weak fixing between the subcutaneous tissues of the right subclavicular region and the right abdominal rectus muscle fascia as a temporary emergency measure. Peritoneal shunt migration into the internal jugular vein and the heart through the external jugular vein can be lethal because of pulmonary infarction or arrhythmia, and must be detected as soon as possible. Periodic follow-up radiography should be scheduled after VP shunt placement, even in the absence of symptoms.
    View full abstract
    Download PDF (175K)
  • Endoscopic Management of a Traumatic Meningo-encephalocele Through a Planum Sphenoidale Defect
    —Case Report—
    Fuminari KOMATSU, Mika KOMATSU, Tadahiro OHMURA, Hitoshi TSUGU, Shinya ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 949-952
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.949
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 37-year-old man involved in a motor vehicle accident was admitted to our hospital with disturbed consciousness. Computed tomography (CT) showed an acute, right-sided epidural hematoma and pneumocephalus. Emergency evacuation of the acute epidural hematoma was carried out, and his condition gradually recovered. However, cerebrospinal fluid (CSF) rhinorrhea continued despite conservative treatment. Three-dimensional reconstructed CT revealed a bone defect, which was approximately 20 mm in size, in the planum sphenoidale and tuberculum sellae, and magnetic resonance imaging demonstrated a traumatic meningo-encephalocele through the defect, with CSF collection in the sphenoid sinus. Endoscopic endonasal transsphenoidal surgery was performed. The 9-mm diameter dural defect was clearly visualized in the sphenoid sinus and was reconstructed with a combination of suturing and overlay with abdominal fascia, and absorbable polyglycolic acid felt. The CSF leakage from a traumatic meningo-encephalocele through the planum sphenoidale was successfully repaired by endoscopic endonasal surgery. Thorough preoperative evaluation of the feasibilities of the endoscopic and transcranial approaches should be based on the preoperative identification of the fistula, the bone defect, and vital structures.
    View full abstract
    Download PDF (395K)
  • Small Onodi Cell Mucocele Causing Chronic Optic Neuropathy
    —Case Report—
    Hitoshi FUKUDA, Ryu FUKUMITSU, Mitsushige ANDOH, Takayuki SUZUKI, Nori ...
    Article type: Case Report
    2010 Volume 50 Issue 10 Pages 953-955
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.953
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 45-year-old woman presented with a rare case of small isolated Onodi cell mucocele manifesting as unilateral chronic optic neuropathy. The patient complained of gradual visual disturbance of her left eye with no other neurological abnormalities. Neuroimaging examinations showed a small cystic lesion located in the left posterior ethmoid extending into the anterior clinoid process. Surgery via the pterional epidural approach revealed a cystic lesion containing mucinous fluid isolated in the anterior clinoid process. Total removal of the lesion combined with unroofing of the left optic canal resulted in relief of the patient's symptom. Histological examination showed the lesion was a mucocele. Based on the radiological and surgical findings together with the histological examination, the final diagnosis was Onodi cell mucocele. Such small Onodi cell mucocele can cause optic neuropathy but is extremely unusual.
    View full abstract
    Download PDF (280K)
Technical Note
  • Superficial Temporal Artery to Middle Cerebral Artery Double Bypass Via a Small Craniotomy
    —Technical Note—
    Shinichi YOSHIMURA, Yusuke EGASHIRA, Yukiko ENOMOTO, Kiyofumi YAMADA, ...
    Article type: Technical Note
    2010 Volume 50 Issue 10 Pages 956-959
    Published: 2010
    Released on J-STAGE: October 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.956
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Frontotemporal craniotomy is usually necessary to perform superficial temporal artery (STA)-middle cerebral artery (MCA) double bypass for cerebrovascular occlusive disease. This report describes a less invasive technique of double bypass through a small craniotomy with minimum skin incision. Thirty-four consecutive patients underwent an elective STA-MCA double bypass via a small craniotomy from January 2006 to October 2009. The parietal and frontal branches of the STA were divided through a minimum linear or y-shaped skin incision, and these branches were anastomosed to the supra- and infrasylvian portions of the MCA. No periprocedural complication such as subdural hematoma or cutaneous necrosis occurred. Postoperative cerebral angiography within 6 months showed that the bypasses were patent in all 34 patients. Double STA-MCA bypass via a small craniotomy might be less invasive, especially for patients at high risk for postoperative hemorrhagic complication or cutaneous necrosis.
    View full abstract
    Download PDF (320K)
Editorial Committee
    • |<
    • <
    • 1
    • >
    • >|
feedback
 Top