Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 50, Issue 12
Displaying 1-21 of 21 articles from this issue
Original Articles
  • Joji INAMASU, Masashi NAKATSUKASA, Takumi KURAMAE, Yuh NAKAGAWA, Sator ...
    Article type: Original Article
    2010 Volume 50 Issue 12 Pages 1051-1055
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    Ground-level fall is the most common cause of traumatic intracranial hemorrhage (TICH) in the elderly. Many studies on geriatric TICH have regarded patients aged ≥65 years as a single group, but substantial heterogeneity is likely to exist within this population. Eighty-two elderly patients with fall-related TICH treated in our institution during a 6-year period were stratified into 3 age groups (65-74, 75-84, and ≥85 years), and intergroup differences in the demographics and outcomes at discharge were evaluated. The influence of the use of anti-platelet/anti-coagulant (AP/AC) agent on outcomes was also investigated. Comparison of demographic variables demonstrated significant differences in the frequency of preinjury alcohol consumption and use of AP/AC agents between the 3 groups, indicating that the causes or triggers of fall might be substantially different between the 65-74 years group and the other two groups combined. The frequency of unfavorable outcomes increased with age, and the increase was statistically significant. The 82 patients were divided into two subgroups depending on the use of AP/AC agents. The outcomes of the ≥85 years group taking AP/AC agents were particularly poor compared with those of the ≥85 years group not using AP/AC agents. Advancing age may be associated with unfavorable outcomes in elderly patients with fall-related TICH, and patients aged ≥85 years taking AP/AC have the greatest risk of unfavorable outcomes. Physicians must consider the risk/benefit analysis before prescribing AP/AC agents to patients aged ≥85 years.
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  • Takami HIYAMA, Toshihide TANAKA, Shinichi ENDO, Kazumasa KOMINE, Tadas ...
    Article type: Original Article
    2010 Volume 50 Issue 12 Pages 1056-1061
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    Carotid plaque with hemorrhage leads to cerebral embolism and ischemic stroke. Plaque angiogenesis and angiogenetic factors such as vascular endothelial growth factor (VEGF) are critical in the progression of atherosclerotic carotid plaque and intraplaque hemorrhage. The correlation between plaque angiogenesis and presence of clinical symptoms was studied in 41 specimens obtained during carotid endarterectomy from 20 symptomatic and 21 asymptomatic patients treated for carotid artery stenosis. Histological findings using hematoxylin-eosin and immunohistochemical staining against von Willebrand factor and VEGF were examined. Intraplaque hemorrhage, calcification, necrosis, and invasion of foam cells were frequently observed in the carotid plaques from symptomatic patients compared with asymptomatic patients. Higher microvessel density was found in the carotid plaques with necrosis and invasion of foam cells compared with plaques without necrosis and/or foam cell invasion, and higher expression of VEGF was found from symptomatic patients compared with asymptomatic patents. These results suggest that plaque angiogenesis and higher level of VEGF expression may enhance the progression of ischemic symptoms in patients with carotid artery stenosis. Invasive macrophages in the plaque of symptomatic patients increase levels of VEGF and might enhance plaque angiogenesis and atherosclerosis progression.
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  • Takao WATANABE, Kazunari YACHI, Takashi OHTA, Takao FUKUSHIMA, Atsuo Y ...
    Article type: Original Article
    2010 Volume 50 Issue 12 Pages 1062-1069
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    Zygote arrest 1 (ZAR1) is a novel maternal-effect gene which is extremely important during the oocyte-to-embryo transition. Comprehensive methylation analysis of tumor-specific differentially methylated regions in human malignant melanoma has recently led to the identification of non-promoter hypermethylation of the ZAR1 gene that had never been previously linked to aberrant methylation. Strikingly, ZAR1 hypermethylation was frequently observed in melanomas but was absent in benign nevi, and ZAR1 expression was found to be up-regulated in methylated tumors. The present study searched for non-promoter ZAR1 hypermethylation in 90 primary human brain tumor samples, normal brain tissue from one autopsy case, and 7 glioma cell lines, employing Sequenom MassARRAY, in which bisulfite-treated fragments are quantitatively detected using time-of-flight mass spectroscopy. ZAR1 transcript expression levels were also evaluated by quantitative real-time reverse transcription-polymerase chain reaction in the 7 glioma cell lines. Hypermethylation of ZAR1 was frequently found in diffuse astrocytomas (7/7, 100%), anaplastic astrocytomas (16/17, 94%), glioblastomas (27/29, 93%), oligodendrogliomas (3/3, 100%), anaplastic oligodendrogliomas (3/3, 100%), and pituitary adenomas (9/10, 90%), but not in pilocytic astrocytomas (0/3). Other tumor types showed infrequent ZAR1 hypermethylation: 1 (17%) of 6 vestibular schwannomas and 4 (33%) of 12 meningothelial meningiomas. The normal brain tissue revealed no evidence of ZAR1 methylation. All 7 glioma cell lines displayed aberrant hypermethylation of ZAR1, but none had detectable ZAR1 transcript. Our findings indicate that non-promoter hypermethylation of ZAR1 is extremely frequent in diffuse gliomas and pituitary adenomas, but methylation-related aberrant ZAR1 expression is far less likely to be related to glioma tumorigenesis.
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  • Omur KASIMCAN, Hulagu KAPTAN
    Article type: Original Article
    2010 Volume 50 Issue 12 Pages 1070-1073
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    The efficacy of gabapentin monotherapy was investigated against both acute or chronic radicular pain caused by lumbar disk hernia (LDH) or lumbar spinal stenosis (LSS). Seventy-eight patients with radicular pain, 10 males and 68 females aged 23 to 76 years (mean 49.4 years), caused by LSS in 45 patients or LDH in 33 patients were treated with oral administration of gabapentin and were followed up for 3 months. The evaluation included neurological examination, Odom's criteria, visual analog pain scale (VAS), and walking distance. Gabapentin treatment resulted in decreased VAS scores in both groups. Odom's criteria scores had improved to excellent or good in 36 patients with LSS and 28 patients with LDH. Furthermore, walking distance was significantly longer at the 3rd month of the treatment protocol. Eight patients discontinued gabapentin therapy because of the side effects. Gabapentin could be an option in the conservative management of acute or chronic radicular pain.
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  • Sang-Ho LEE, Han Sug KANG, Gun CHOI, Byoung Joon KONG, Yong AHN, Jin-S ...
    Article type: Original Article
    2010 Volume 50 Issue 12 Pages 1074-1078
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    The ‘foraminoplastic’ ventral epidural approach and its advantages in the treatment of extruded disk herniation at the L5-S1 level are described. Percutaneous endoscopic lumbar discectomy is a minimally invasive procedure applicable to various types of lumbar disk herniation, but the L5-S1 disk space is still challenging to access due to anatomic limitations such as high iliac crest or severely narrowed foramen. The ‘foraminoplastic’ ventral epidural approach was performed in 25 patients with herniated disk radiculopathy at L5-S1 from March 2003 to May 2004. Their mean age was 39.2 years (range 20-67 years) and the mean follow-up duration was 32.5 months (range 28-42 months). During the procedure, ‘foraminoplasty’ was performed by undercutting the hypertrophic superior facet with the endoscopic bone cutter under C-arm guidance. The clinical result was assessed according to the visual analogue scale (VAS) and Oswestry disability index (ODI). Preoperative mean VAS score of 7.4 for leg pain fell to 1.6 postoperatively and mean preoperative ODI of 55.5% improved to 16.9% postoperatively, both showing significant improvements (p < 0.001). Mean hospital stay was 14.2 hours. Twenty-two patients had the favorable outcomes. Two patients required conversion to open microdiscectomy due to incomplete decompression and recurrent disk herniation. The ‘foraminoplastic’ approach is a safe and efficient surgical option for L5-S1 disk herniation even in patients with high iliac crest and narrow foramen.
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Case Reports
  • —Two Case Reports—
    Hideyuki ARITA, Shuichi IZUMOTO, Manabu KINOSHITA, Yoshiko OKITA, Naoy ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1079-1083
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    Posttransplant lymphoproliferative disorder (PTLD) is one of the life-threatening complications of organ transplantation. PTLD sometimes involves the central nervous system (CNS), but the clinical characteristics are not well recognized. A total of 631 patients received kidney transplantation at Osaka University Hospital between March 1965 and December 2008. Two of the 631 patients (0.32%) developed CNS PTLD. A 40-year-old Japanese woman suffered onset of CNS PTLD 5 years after renal transplantation. After diagnosis based on histological examination by open biopsy, she obtained remission with dose increase of steroid and dose reduction of mycophenolate mofetil. She experienced relapse 20 months after first remission. She underwent second biopsy and the diagnosis was recurrent CNS PTLD. Further reduction of mycophenolate mofetil and increase of steroid led to second remission. The disease remained in complete remission at 60 months after first onset. A 61-year-old woman suffered onset of CNS PTLD 19 years after renal transplantation. After tumor removal, whole brain irradiation was performed. The disease remained in remission at 54 months after onset. Histological examination showed polymorphic-type PTLD in both cases. The first case of polymorphic CNS PTLD was successfully treated by modulation of immunosuppressants without radiation therapy even at recurrence. PTLD should be included in the differential diagnosis of brain tumors in recipients of solid organ transplantation, and histological subtype should be carefully identified to establish the correct treatment strategy.
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  • —Case Report—
    Hitoshi YAMAHATA, Hiroshi TOKIMURA, Masashi HIRABARU, Hirofumi HIRANO, ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1084-1087
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 75-year-old woman presented with a rare aneurysm on the distal portion (P4) of the posterior cerebral artery (PCA) causing subarachnoid hemorrhage (SAH) and manifesting as sudden onset of headache, nuchal rigidity, and nausea. Computed tomography on admission revealed thin SAH in the left parietooccipital sulcus. Cerebral angiography demonstrated a small saccular aneurysm on the cortical branch of the left PCA. The aneurysm was successfully clipped via the occipital interhemispheric approach. Distal PCA aneurysms frequently affect middle-aged persons and tend to be small, with good clinical course but may cause visual field defects. Direct aneurysm clipping is recommended for patients without visual defect from the onset. Parent artery occlusion by the endovascular technique should be considered for patients with visual loss caused by the initial hemorrhage.
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  • —Case Report—
    Hidenori ENDO, Miki FUJIMURA, Takashi INOUE, Hiroaki SHIMIZU, Teiji TO ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1088-1091
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 69-year-old woman was admitted to our hospital because of fluctuating dysarthria during the past 2 months. Magnetic resonance imaging revealed old cerebral infarction of the left cerebral hemisphere with acute subarachnoid hemorrhage in the left sylvian fissure. Cerebral angiography showed a large saccular aneurysm, 14 mm in diameter, at the bifurcation of the left middle cerebral artery (MCA) in association with moyamoya vasculopathy with atherosclerosis, including steno-occlusive changes at the bilateral terminal internal carotid arteries and abnormal net-like vessels at the base of the brain. She underwent microsurgical neck clipping of the large aneurysm followed by superficial temporal artery-MCA anastomosis without complication. Intraoperative findings showed no evidence of aneurysm rupture, suggesting that the subarachnoid hemorrhage was due to the intrinsic pathology of moyamoya vasculopathy. The postoperative course was uneventful, and the patient was discharged without neurological deficit. Association of moyamoya syndrome with large MCA aneurysm is extremely rare, and formation of large aneurysm at the vascular territory of an occluded vessel is apparently unique.
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  • —Case Report—
    Takehiro UDA, Keiji MURATA, Masakazu SAKAGUCHI, Keishi YAMAGATA, Kenji ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1091-1094
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 67-year-old man was admitted for evaluation of left homonymous hemianopsia. Carotid ultrasonography showed that the right common carotid artery (CCA) was occluded up to just proximal to the carotid bifurcation, and the patent external carotid artery showed retrograde flow to the patent internal carotid artery via the carotid bifurcation. The Doppler waveform pattern of the external carotid artery showed high end-diastolic flow velocity and low pulsatility index. The diagnosis was Riles type 1A CCA occlusion. Digital subtraction angiography and iodine-123 N-isopropyl-p-iodoamphetamine single photon emission computed tomography were performed to confirm the collateral circulation and adequate intracranial hemodynamic sufficiency. Nonsurgical treatment with antiplatelet therapy was performed for the CCA occlusion. No stroke events have occurred within the 2-year follow-up period.
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  • —Case Report—
    Morio NAGAHATA, Hiroko SEINO, Shinya KAKEHATA, Kohei MORIMOTO, Takahir ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1095-1098
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 42-year-old male patient presented with an anterior cerebral artery (ACA) dissection manifesting as sudden onset of severe headache. Initial computed tomography revealed faint subarachnoid hemorrhage in the frontal region. Initial angiography showed tapering stenosis at the A2 segment of right ACA. The patient was admitted to our hospital and treated conservatively. Magnetic resonance (MR) imaging and angiography did not detect intramural hematoma, intimal flap, or double lumen at the stenotic right A2 segment. The ACA dissection was difficult to confirm based on the findings on day 0. ACA dissection was confirmed by improvement of the right ACA stenosis on follow-up angiography on day 14. On the other hand, MR cisternography revealed a fusiform dilatation of the vascular outer contour at the right A2 on day 0, which had resolved on day 14. Cerebral angiography and MR cisternography similarly suggested asymptomatic contralateral (left) A2 dissection on day 14. Fusiform dilatation of the vascular outer contour at the affected segment on MR cisternography may be indicative of arterial dissection in the acute phase.
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  • —Case Report—
    Takeshi HAMAMURA, Takato MORIOKA, Tetsuro SAYAMA, Nobutaka MUKAE, Shuj ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1099-1104
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 77-year-old man developed cerebral hyperperfusion syndrome with temporal deterioration of consciousness and worsening of left hemiparesis on the 6th postoperative day following superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for right M1 occlusion. Electroencephalography (EEG) revealed frequent ictal discharges in the right hemisphere, although convulsive seizures were not apparent. Administration of anticonvulsants was performed based on the diagnosis of non-convulsive status epilepticus (NCSE). Complete recovery from hyperperfusion syndrome was achieved with rapid improvement of EEG findings. The present case demonstrates the pathophysiological mechanism of hyperperfusion syndrome associated with NCSE after STA-MCA anastomosis.
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  • —Case Report—
    Shigeto HAYASHI, Naoya TAKEDA, Eiji KOMURA
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1105-1107
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 30-year-old woman suffered cerebellar hemorrhage during the delivery of her first child. She had undergone surgical removal of a symptomatic cerebellar hemangioblastoma 6 years previously. Neuroradiological examinations indicated recurrent hemangioblastoma, confirmed by histological examination of the surgical specimen. She was discharged with no neurological deficit. Hemangioblastomas are benign tumors that are curable with surgical removal, but can grow during pregnancy. Women of reproductive age who have been treated for hemangioblastoma need careful long-term follow up, even if they show no signs of lesion recurrence.
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  • —Case Report—
    Satoshi TSUTSUMI, Yusuke ABE, Yukimasa YASUMOTO, Masanori ITO
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1108-1112
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 16-year-old female, with unremarkable medical and family history, presented with a huge dural-based mass in the right frontotemporal fossae, manifesting as headache. The patient underwent subtotal tumor resection. Intraoperative findings revealed focal erosion in the temporal fossa dura mater and skull adjacent to the lesion. Most of the tumor was located extraaxially, but a part of the tumor had invaded the temporal lobe, and had tightly adhered to the middle cerebral artery and its perforating vessels. Histological examination revealed cellular pleomorphism with mitotic activity, focal necrosis, but lacking endothelial proliferation, consistent with anaplastic pleomorphic xanthoastrocytoma (PXA) with component of anaplastic astrocytoma. Postoperatively, the patient underwent local irradiation and temozolomide administration, but the tumor relapsed 13 months later. Second tumor resection was performed followed by gamma knife radiosurgery, but the residual tumor progressively grew, extending into the contralateral hemisphere, and formed an enormous mass in the left frontal lobe at 17 months. Magnetic resonance imaging performed at 18 months revealed extracranial infiltration of the frontal tumor, through the cribriform plate, with enormous extension into the paranasal sinuses, nasal cavity, and orbit during the next month. The patient died at 20 months after the initial surgery. PXA with anaplastic appearance may have a component of anaplastic astrocytoma with more aggressive behavior.
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  • —Case Report—
    Weiting GU, Hanbing SHANG, Xiaolong JIN, Jing XIE, Weiguo ZHAO
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1112-1115
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 23-year-old Chinese male patient presented with an extremely rare case of spinal teratoma with neuronal and glial tissue components manifesting as lower back pain and radiating pain to the leg. Subtotal excision of the tumor was conducted. Histological examination revealed a mature teratoma with neuronal and glial tissue components. Initial presentation of spinal teratoma in adulthood is rare. Teratomas show a wide array of organoid tissue differentiation, but neuronal tissue component is uncommon.
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  • —Case Report—
    Junichi MIYAMOTO, Kazunori TATSUZAWA, Hiroyasu SASAJIMA, Katsuyoshi MI ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1116-1118
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 1-year 9-month-old girl presented with achondroplasia. Serial magnetic resonance (MR) imaging demonstrated mild compression of the medulla oblongata by the occipital bone, macrocrania, and progressive hydrocephalus. Cerebrospinal fluid (CSF) flow study using MR imaging clearly demonstrated CSF flow disturbance at the cervicospinal junction. Foramen magnum decompression was performed for her hydrocephalus and compressed medulla. Postoperative CSF flow study demonstrated improvement of CSF flow at the craniocervical junction. The patient has remained in a stable condition for 7 months postoperatively. Achondroplasia represents hydrocephalus or medullary compression caused by narrowed foramen magnum, which can result in sudden death in some infants. Surgical indications and methods for hydrocephalus combined with achondroplasia remain controversial because the natural history of the hydrocephalus has remained unclear. CSF flow study using MR imaging can provide useful information regarding the surgical indication and methods for the treatment of hydrocephalus combined with achondroplasia.
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  • —Three Case Reports—
    Satoru OSUKA, Hironori IMAI, Eiichi ISHIKAWA, Akira MATSUSHITA, Tetsuy ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1118-1122
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome with a very particular clinical course. Three patients with MERS were evaluated by various sequences of magnetic resonance imaging with diffusion tensor imaging. Initial diffusion-weighted imaging showed reduction in the apparent diffusion coefficient values in the lesions, which completely resolved with the elimination of symptoms. However, diffusion anisotropy of the lesions showed no remarkable abnormalities in the early or delayed phases. These results may indicate that white matter architecture is preserved in both early and delayed phases in MERS.
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  • —Case Report—
    Daisuke KITA, Yasuhiko HAYASHI, Masashi KINOSHITA, Kazunori OHAMA, Jun ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1122-1125
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 5-year-old male presented with scrotal migration of the catheter from a ventriculoperitoneal shunt manifesting as left scrotal swelling 4 months after implantation. Surgical obliteration of the patent peritoneal processus vaginalis that forms a corridor from the peritoneum to the scrotum was performed to avoid shunt malfunction. Review of the 26 reported cases including the present case revealed that most patients were up to 18 months old. Our patient was the oldest. Migration tended to occur within 6 months after implantation (mean 3.8 months, median 1.0 month). Involvement of the right side of the scrotum was prevalent (23 of 26 cases). Patent processus vaginalis and small peritoneal cavity probably contribute to scrotal catheter migration.
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  • —Case Report—
    Hirofumi MORIHARA, Kiichiro ZENKE, Daisuke SHODA, Satoshi FUJIWARA, Sa ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1126-1128
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 25-year-old man presented with an intraorbital encephalocele manifesting as progressive left pulsatile exophthalmos. He had a history of frontal lobe contusion from a motorbike accident 10 years before the onset of the symptom. Computed tomography and magnetic resonance imaging revealed an oval-shaped defect in the left orbital roof with an underlying intracranial cystic lesion, herniated into the orbit. Intraoperative findings included disruption of the dura mater around the bony defect. The loculated arachnoid membrane and protruding brain tissue were excised with primary dural closure and reconstructive cranioplasty with a titanium mesh. The postoperative course was uneventful, and the pulsatile proptosis disappeared immediately after the procedure. Intracranial cyst may be important in the development of progressive pulsatile exophthalmos and intraorbital encephalocele.
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  • —Case Report—
    Hong Joo MOON, Joo Han KIM, Jong-Hyun KIM, Taek-Hyun KWON, Hung-Seob C ...
    Article type: Case Report
    2010 Volume 50 Issue 12 Pages 1129-1131
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    A 74-year-old man presented with a cervical juxtafacet cyst on the right side of C5-6 and prominent myelopathy. He had been treated with anterior cervical discectomy and fusion at C4-5 as well as anterior foraminotomy of the right C5-6 lesion 20 months previously. The patient underwent complete surgical excision of the lesion. The patient recovered uneventfully, and the myelopathy resolved. Reexamination of the images revealed that we failed to investigate a suspicious minimal cervical juxtafacet cyst on the initial preoperative images and that the degree of subluxation at C5-6 on flexion radiography had increased postoperatively. Therefore, the surgeon should be aware that juxtafacet cyst can be progressive in planning of cervical spinal surgery which can cause or aggravate instability in the presence of an incidental, suspicious juxtafacet cyst on preoperative imaging at the same level, even if the lesion is very small and subclinical.
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Technical Note
  • —Technical Note—
    Satoshi TANI, Futoshi SUETSUA, Junichi MIZUNO, Hisaaki UCHIKADO, Hiroy ...
    Article type: Technical Note
    2010 Volume 50 Issue 12 Pages 1132-1136
    Published: 2010
    Released on J-STAGE: December 25, 2010
    JOURNAL OPEN ACCESS
    Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty.
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