Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 50, Issue 4
Displaying 1-21 of 21 articles from this issue
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Original Articles
  • Intraprocedural Changes in Angiographic Cerebral Circulation Time Predict Cerebral Blood Flow After Carotid Artery Stenting
    Hiroshi AIKAWA, Kiyoshi KAZEKAWA, Masanori TSUTSUMI, Masanari ONIZUKA, ...
    2010 Volume 50 Issue 4 Pages 269-274
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.269
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    Changes in the cerebral blood flow (CBF) are important for planning postoperative care in patients treated by carotid artery stenting (CAS). The relationship between intraprocedural changes in the angiographic cerebral circulation time (CCT) and perioperative CBF changes were retrospectively studied in 49 CAS procedures performed in 46 patients with carotid artery stenosis. The CCT, defined as the interval between the timing of maximal opacification at the terminal portion of the internal carotid artery and at the cortical vein, was determined by referring to time-density curves of data obtained from routine intraprocedural digital subtraction angiography. The intraoperative change in CCT (ΔCCT) was calculated for each of the 49 procedures. CBF studies, using dynamic perfusion computed tomography, were performed 10-2 days before and 2-4 days after CAS. Perioperative changes in the ratio of the CBF in the territory of the middle cerebral artery on the affected side to CBF on the contralateral side (%CBF) were calculated by subtracting pre- from postoperative %CBF (Δ%CBF) and the correlation between ΔCCT and Δ%CBF was evaluated. Mean CCT was shortened by 1.1 seconds from 5.3 to 4.2 seconds after CAS. Mean %CBF increased by 11.9% from 91.8% to 103.7% after the procedure. ΔCCT and Δ%CBF showed a significant positive correlation (r = 0.61, p = 0.008). Intraprocedural changes in angiographic CCT are predictive of postoperative CBF in patients with CAS.
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  • Interventional Neuroradiological Techniques for the Treatment of Aneurysms of the Supra-aortic Extracranial Arteries
    Mahmoud M. TAHA, Ichiro NAKAHARA, Toshio HIGASHI, Yasushi IWAMURO, Yos ...
    2010 Volume 50 Issue 4 Pages 275-280
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.275
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    Aneurysms in the supra-aortic extracranial arteries are rare in neurovascular pathology. Conventional surgery is effective but technically demanding and successful endovascular repair is reported. We treated 5 patients with supra-aortic extracranial artery aneurysms at our hospital (mean age 53.8 years). There were 2 aneurysms of the common carotid artery, 1 of the extracranial internal carotid artery, 1 of the subclavian artery, and 1 located at the innominate artery. Four patients were symptomatic. The lesion was the result of trauma in 3 patients. The procedure was conducted using bare stent placement and coil embolization of the aneurysm in 2 patients, covered stent in 2 patients, and bare stent only in 1 patient. No periprocedural complications occurred. Follow-up angiography revealed asymptomatic stent thrombosis in a patient treated using a covered stent, but the remaining 4 patients showed successful treatment of the aneurysms with the parent arteries remaining patent. Follow-up clinical assessment ranged between 30 and 81 months. The patient with stent thrombosis died of unrelated pathology; the remaining patients did not experience aneurysm recurrence, hemorrhage, or distal thromboembolism.
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  • Comparison of Large Intrasylvian and Subpial Hematomas Caused by Rupture of Middle Cerebral Artery Aneurysm
    Atsushi SAITO, Yousuke AKAMATSU, Shigeki MIKAWA, Takayuki SUGAWARA, Hi ...
    2010 Volume 50 Issue 4 Pages 281-285
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.281
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    The clinical characteristics of intrasylvian and subpial hematomas caused by rupture of middle cerebral artery (MCA) aneurysm were examined in 86 patients admitted to our department with subarachnoid hemorrhage (SAH) caused by ruptured MCA aneurysms. A retrospective study of 26 patients with a large hematoma associated with SAH treated surgically within 48 hours evaluated clinical grade at admission, secondary development of cerebral swelling, ratio of hematoma removal, and incidence of symptomatic vasospasm. Clinical grade on admission, age, and sex showed no significant differences. Ratio of cerebral swelling against the initial hematoma volume (p = 0.005), and incidence of symptomatic vasospasm (p = 0.041) were significantly lower, and the ratio of hematoma was significantly higher (p = 0.01) in the subpial hematoma group. Removal of hematoma was more difficult and symptomatic vasospasm was more frequent in the intrasylvian hematoma group. The clinical features of subpial and intrasylvian hematomas caused by rupture of MCA aneurysm should be considered for the better management of associated SAH.
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  • Insulo-opercular Gliomas: Four Different Natural Progression Patterns and Implications for Surgical Indications
    Ryuta SAITO, Toshihiro KUMABE, Masayuki KANAMORI, Yukihiko SONODA, Tei ...
    2010 Volume 50 Issue 4 Pages 286-290
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.286
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    The insular cortex is circumscribed with three limiting sulci, so progression patterns of insulo-opercular gliomas can be categorized into tumor progression limited to the insular cortex, tumor progression via the anterior limiting sulcus, tumor progression via the inferior limiting sulcus, and tumor progression via the superior limiting sulcus. Recent improvements in clinical accessibility and imaging devices have identified more patients harboring small tumors in the insulo-opercular regions. Therefore, the natural progression patterns of insulo-opercular gliomas and the implications for surgical indications are important. Among 36 patients who suffered glioma at insulo-opercular regions and underwent radical resection at our institute between February 2002 and August 2008, cases that showed four different development patterns were retrospectively reviewed. In our series of patients, 7 patients were followed up for more than 100 days after detection of the diseases until surgery. Among these patients, there existed cases that represent four different progression patterns of insulo-opercular gliomas. Surgical complications associated with insulo-opercular gliomas often result from damage to surrounding structures, especially the perforating arteries. Resection of tumors invading medially to the putamen can result in damage to the lenticulostriate arteries, and resection higher than the superior limiting sulcus can result in injury to the long insular arteries. Consequently, the surgical indications for insulo-opercular gliomas should be limited to small tumors within the insular cortex or progressing via the anterior or inferior limiting sulcus. Tumors that progress via the superior limiting sulcus carry a high risk of injuring the long insular arteries.
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  • Evaluation of Intraoperative Brain Shift Using an Ultrasound-Linked Navigation System for Brain Tumor Surgery
    Shiro OHUE, Yoshiaki KUMON, Shigeyuki NAGATO, Shohei KOHNO, Hironobu H ...
    2010 Volume 50 Issue 4 Pages 291-300
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.291
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    Image-guided neurosurgery using navigation systems is an essential tool to increase accuracy in brain tumor surgery. However, brain shift during surgery has remained problematic. The present study evaluated the utility of a new ultrasound (US)-linked navigation system for brain tumor surgery in 64 patients with intracranial tumors. The navigation system consisted of a StealthStationTM navigation system, a SonoNavTM system, and a standard US scanner. This system determines the orientation of the US images and reformats the images from preoperative computed tomography (CT) or magnetic resonance (MR) imaging to match the US images. The system was used intraoperatively to measure brain shift several times, using the results to guide tumor resection. US-linked navigation provided information regarding brain shift, and extent of tumor resection during surgery. Evaluation of brain shift was easily achieved in all patients, without using intraoperative CT or MR imaging. Accurate information regarding the true anatomical configuration of the patient could be obtained in all phases of the operation. Magnitude of brain shift increased progressively from pre- to post-resection and depended on the type of cranial structure. Integration of the US scanner with the navigation system allowed comparisons between the intraoperative US and preoperative images, thus improving interpretation of US images. The system also improved the rate of tumor resection by facilitating the detection of remnant tumor tissue. This US-linked navigation system provides information on brain shift, and improves the accuracy and utility of image-guided surgery.
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  • Simple Landmark for Preservation of the Cochlea During Maximum Drilling of the Petrous Apex Through the Anterior Transpetrosal Approach
    Yoshinobu SEO, Takehiko SASAKI, Hirohiko NAKAMURA
    2010 Volume 50 Issue 4 Pages 301-305
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.301
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    The cochlea is one of the most important organs to preserve during skull base surgery. However, no definite landmark for the cochlea has been identified during maximum drilling of the petrous apex such as anterior transpetrosal approach. The relationship between the cochlea and the petrous portion of the internal carotid artery (ICA) was assessed with computed tomography (CT) in 70 petrous bones of 35 patients, 16 males and 19 females aged 12-85 years (mean 48.6 years). After accumulation of volume data with multidetector CT, axial bone window images of 1-mm thickness were obtained to identify the cochlea and the horizontal petrous portion of the ICA. The distance was measured between the extended line of the posteromedial side of the horizontal petrous portion of the ICA and the basal turn of the cochlea. If the cochlea was located posteromedial to the ICA, the distance was expressed as a positive number, but if anterolateral, as a negative number. The mean distance was 0.6 mm (range −4.9 to 3.9 mm) and had no significant correlation with sex or age. The cochlea varies in location compared with the horizontal petrous portion of the ICA. Measurement of the depth and distance between the extended line of the posteromedial side of the horizontal intrapetrous ICA and the cochlea before surgery will save time, increase safety, and maximize bone evacuation during drilling of the petrous apex.
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Case Reports
  • Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm
    —Two Case Reports—
    Toshiya SUGINO, Masafumi OHTAKI, Masahiko WANIBUCHI, Sonen KIN, Kiyohi ...
    2010 Volume 50 Issue 4 Pages 306-309
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.306
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    A 68-year-old woman presented with severe headache 9 days after undergoing successful clipping of a right middle cerebral artery aneurysm. Postoperative imaging revealed increased perfusion and diffuse edema in the right frontotemporal cortex. A 57-year-old woman exhibited perseveration soon after undergoing successful clipping of an anterior communicating artery aneurysm. Postoperative imaging studies revealed increased perfusion and diffuse edema in the left frontal and insular cortex. The symptoms and diffuse edema gradually resolved in both patients. These two cases of hyperperfusion syndrome occurred in a series of 190 patients treated by clipping of unruptured cerebral aneurysms. Hyperperfusion syndrome is a rare complication following aneurysm surgery, especially surgery for unruptured cerebral aneurysms without temporary clipping.
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  • De Novo Formation and Rupture of an Intracranial Aneurysm 10 Months After Normal Findings on Conventional Magnetic Resonance Angiography in a Patient With No History of Intracranial Lesions
    —Case Report—
    Toshiyuki OKAZAKI, Toru NISHI, Shigeo YAMASHIRO, Kazunari KOGA, Shinji ...
    2010 Volume 50 Issue 4 Pages 309-312
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.309
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    A 40-year-old male smoker presented with a ruptured saccular aneurysm that formed de novo 10 months after normal magnetic resonance (MR) angiography findings. Computed tomography of the head at the second admission showed subarachnoid hemorrhage in the interhemispheric fissure and anterior basal cistern. MR and conventional cerebral angiography revealed an aneurysm arising from the anterior communicating artery (AcomA). MR angiography performed 10 months earlier, when he experienced transient loss of consciousness, revealed no anomalies at the AcomA. Intraoperatively, the de novo aneurysm was found to be a typical saccular aneurysm with a fragile wall.
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  • Vertebral Artery Dissecting Aneurysm With Cushing's Syndrome
    —Case Report—
    Masayasu KATO, Yoshitaka TANAKA, Tatsuya KURODA, Toshihiko NAKASHIMA, ...
    2010 Volume 50 Issue 4 Pages 313-315
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.313
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    A 45-year-old woman presented with subarachnoid hemorrhage of World Federation of Neurosurgical Societies grade IV. Cerebral angiography showed a dissecting aneurysm of the right vertebral artery (VA). Internal trapping of the right VA with coils was performed. The postoperative course was uneventful, but she continued to demonstrate moon facies and experience amenorrhea. Computed tomography demonstrated an adrenal tumor. Laparoscopic adrenalectomy was performed under a diagnosis of Cushing's syndrome caused by an adrenal tumor. Overproduction of cortisol caused by Cushing's syndrome may be related to the development of cerebral aneurysm.
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  • Asymptomatic Moyamoya Disease Subsequently Manifesting as Transient Ischemic Attack, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage in a Short Period
    —Case Report—
    Miki FUJIMURA, Shunji MUGIKURA, Hiroaki SHIMIZU, Teiji TOMINAGA
    2010 Volume 50 Issue 4 Pages 316-319
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.316
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    A 59-year-old man, who had incidentally been found to have asymptomatic moyamoya disease 4 months previously, suffered transient ischemic attack (TIA) in the left extremities. Three weeks later, he again suffered TIA, and neuroimaging examination revealed fresh subarachnoid hemorrhage in the interhemispheric cistern as well as an asymptomatic thalamic hemorrhage in the contralateral hemisphere, which was not evident at the first onset of TIA. Digital subtraction angiography confirmed the diagnosis of moyamoya disease, and single-photon emission computed tomography demonstrated significant hemodynamic compromise in the right hemisphere. He underwent superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis without complication one month later. The TIA completely disappeared after surgery, and no further cerebrovascular event occurred during the follow-up period of 2 years. Asymptomatic moyamoya disease may manifest with a dynamic course, so careful follow up is necessary. Simultaneous manifestation of ischemic attack, subarachnoid hemorrhage, and intracerebral hemorrhage in a short period in the present case may indicate the underlying mechanism of the cerebrovascular events in this rare entity.
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  • Cerebral Vasospasms After Intraventricular Hemorrhage From an Arteriovenous Malformation
    —Case Report—
    Shoji YOKOBORI, Akihiro WATANABE, Ryuta NAKAE, Hidetaka ONDA, Akira FU ...
    2010 Volume 50 Issue 4 Pages 320-323
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.320
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    A 33-year-old female presented with a rare case of severe vasospasm following the rupture of an arteriovenous malformation (AVM) without subarachnoid hemorrhage. Initial computed tomography (CT) revealed a subcutaneous hematoma and cast formation of intraventricular clots without the deposition of subarachnoid blood in any basal cistern. Cerebral angiography revealed a small AVM located in the right parietal lobe without aneurysmal formations. Repeat CT demonstrated no evidence of subarachnoid clots expected with the presence of intraventricular clots and she was transferred to a general ward. She suffered sudden onset of motor aphasia and disturbance of consciousness on Day 17 after the hemorrhage. Magnetic resonance imaging indicated diffuse cortical infarction and subsequent magnetic resonance angiography revealed severe narrowing of the bilateral internal carotid arteries. Three-dimensional CT angiography on the same day indicated similar findings. She was transferred back to the intensive care unit for critical treatment. However, she suffered persistent mild right hemiparesis and motor aphasia. The characteristic features of vasospasm after intraventricular hemorrhage from AVMs are delayed onset, acute deterioration of consciousness, female predominance, and localization to the bilateral internal carotid arteries. Treatment of patients with AVM rupture should consider the risk of severe vasospasm, even if there is no subarachnoid clot.
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  • De Novo Formation of Orbital Cavernous Malformation 9 Years After Surgical Management of Dural Arteriovenous Fistula in the Anterior Middle Fossa
    —Case Report—
    Shunsuke OMODAKA, Miki FUJIMURA, Toshiki ENDO, Takashi INOUE, Hiroaki ...
    2010 Volume 50 Issue 4 Pages 324-327
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.324
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    A 30-year-old man presented with recurrent dural arteriovenous fistula (dAVF) associated with de novo orbital cavernous malformation (CM), manifesting as progressive left visual disturbance. He had undergone transarterial embolization and subsequent surgical management for a left anterior middle fossa dAVF 9 years previously. External carotid angiography showed recurrence of the dAVF. Magnetic resonance imaging revealed a well delineated intraorbital mass lesion with hypointense signal rim by T2-weighted imaging, adjacent to the shunting point of the recurrent dAVF. Transcranial subtotal removal of the intraorbital mass lesion through the orbitopterional approach revealed continuity between the mass lesion and the draining vein of the recurrent dAVF. The histological diagnosis was CM. His symptom was relieved postoperatively, and no regrowth was seen during the follow-up period of one year. The coexistence of recurrent dAVF with newly formed orbital CM is extremely rare, but may indicate the underlying mechanism of the formation of CMs and recurrent dAVF.
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  • Supratentorial High Convexity Intradural Extramedullary Cavernous Angioma
    —Case Report—
    Yohtaro SAKAKIBARA, Takashi MATSUMORI, Yoshio TAGUCHI, Hirotaka KOIZUM ...
    2010 Volume 50 Issue 4 Pages 328-329
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.328
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    A 59-year-old man presented with a 2-month history of numbness in the lower left side of the face and upper left extremity. Axial T1-weighted magnetic resonance imaging showed a wedge-shaped mass measuring 3 × 2.5 cm in the right frontoparietal high convexity area that was heterogeneously enhanced after administration of gadolinium-diethylenetriaminepenta-acetic acid. Right frontoparietal craniotomy was performed and a bluish soft mass was found under the arachnoid membrane. The mass could be dissected free from the arachnoid membrane and the brain surface. Histological examination revealed the typical findings of cavernous angioma. Cavernous angioma should be considered in the differential diagnosis of supratentorial high convexity intradural extramedullary tumor, especially appearing as a heterogeneously enhanced mass adjacent to the brain parenchyma causing mass effect.
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  • Cavernous Sinus Cavernous Hemangioma Largely Extending Into the Sella Turcica and Mimicking Pituitary Adenoma
    —Case Report—
    Satoshi HORI, Nakamasa HAYASHI, Kazuhiro NOMOTO, Hikari SATO, Tomohide ...
    2010 Volume 50 Issue 4 Pages 330-332
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.330
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    A 77-year-old female presented with a rare cavernous sinus cavernous hemangioma with extension to the sella turcica, neuroradiologically mimicking nonfunctioning pituitary macroadenoma. The lesion was partially removed via transsphenoidal surgery, and the histological diagnosis was cavernous hemangioma. After stereotactic radiosurgery using a cyber knife, the lesion decreased in size. Stereotactic radiosurgery may be a good option for cavernous sinus cavernous hemangioma with high risk of surgical bleeding.
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  • Coexistence of Cranial and Spinal Subdural Hematomas
    —Case Report—
    Naoshi HAGIHARA, Toshi ABE, Kazuyuki KOJIMA, Mitsuo WATANABE, Kazuo TA ...
    2010 Volume 50 Issue 4 Pages 333-335
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.333
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    A 47-year-old man presented with chronic cranial subdural hematomas (SDHs) associated with spinal SDH manifesting as onset of severe lumbago revealed in the follow up for bilateral subdural effusions after trauma. Left chronic cranial SDH was first identified. Two months after evacuation of the left chronic cranial SDH, he complained of severe lumbago. Magnetic resonance imaging detected spinal SDH, prior to the diagnosis and treatment of right chronic cranial SDH. The present case of concomitant occurrence of cranial and spinal SDHs suggests that the possibility of spinal SDH should be investigated with magnetic resonance imaging in patients with chronic cranial SDH.
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  • Cerebral Vasculitis Associated With Amyloid Angiopathy
    —Case Report—
    Masaki MORISHIGE, Tatsuya ABE, Tohru KAMIDA, Takamitsu HIKAWA, Minoru ...
    2010 Volume 50 Issue 4 Pages 336-338
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.336
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    A 78-year-old female presented with coexisting primary angiitis of the central nervous system (CNS) and cerebral amyloid angiopathy (CAA) manifesting as motor aphasia caused by a left frontal lobe lesion. Magnetic resonance imaging revealed an enhanced lesion with moderate surrounding edema.Technetium-99m propylene amine oxime single-photon emission computed tomography showed decreased cerebral blood flow (CBF) in the lesions, and high serum soluble-interleukin-2 level was detected, suggesting intravascular lymphoma of the CNS. Cerebral biopsy revealed CAA with secondary florid vasculitic appearance. The CBF and neurological symptoms, such as aphasia and dementia, recovered following steroid treatment. Cerebral vasculitis associated with CAA should be included in the differential diagnosis of an unusually enhanced lesion, because timely diagnosis and aggressive treatment are critical to successful recovery in such elderly patients.
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  • Transient Asystole During Surgery for Posterior Fossa Meningioma Caused by Activation of the Trigeminocardiac Reflex
    —Three Case Reports—
    Kenichi USAMI, Kyousuke KAMADA, Naoto KUNII, Hiroko TSUJIHARA, Yoshits ...
    2010 Volume 50 Issue 4 Pages 339-342
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.339
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    Three patients undergoing surgery for cerebello-pontine angle meningioma suffered transient episodes of asystole. All patients exhibited return to the previous heart rate with cessation of surgical manipulations and administration of anticholinergic agents. These reactions were apparently elicited by activation of the trigeminocardiac reflex (TCR) by direct stimulation of the trigeminal nerve or branches in the dura mater or cerebellar tentorium. Remifentanil was used in all three cases as an anesthetic agent, so may be a cause of the TCR. The possibility of activation of the TCR should be considered during surgical manipulation around the trigeminal nerve or the distribution of the trigeminal nerve branches. Transient bradycardia, hypotension, or asystole can occur regardless of whether there is pressure on the brainstem during posterior fossa meningioma surgery.
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  • Temporal Gliosarcoma With Extraneural Metastasis
    —Case Report—
    Daisuke MAEDA, Takahito MIYAZAWA, Terushige TOYOOKA, Katsuji SHIMA
    2010 Volume 50 Issue 4 Pages 343-345
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.343
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    A 51-year-old woman presented with a rare case of temporal gliosarcoma manifesting as a 2-month history of headache that rapidly penetrated the middle fossa floor postoperatively and metastasized to the lung. The tumor included an anteroinferior component consisting of a sarcomatous lesion adjacent to the middle fossa floor, and a posterosuperior component consisting of a gliomatous lesion. The MIB-1 index of the sarcomatous component was 47.5%, and that of the gliomatous component was 36.5%. In addition to the highly proliferative nature of the sarcomatous component, the craniotomy with partial excision of the dura mater might have accelerated the tumor penetration through the temporal base and the hematogenous metastasis to the lung.
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  • Cervical Myelopathy Caused by Atlas Osteochondroma and Pseudoarthrosis Between the Osteochondroma and Lamina of the Axis
    —Case Report—
    Naohisa MIYAKOSHI, Michio HONGO, Yuji KASUKAWA, Yoichi SHIMADA
    2010 Volume 50 Issue 4 Pages 346-349
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.346
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    A 58-year-old man presented with a 6-month history of progressive cervical myelopathy. Magnetic resonance imaging and computed tomography of the cervical spine revealed a bone tumor arising from the posterior arch of the atlas and osteophytes at a pseudoarthrosis between the tumor and the lamina of the axis, resulting in marked spinal cord compression. The patient's symptoms resolved after en bloc resection of the tumor and removal of the osteophytes. The histological diagnosis was osteochondroma. The primary cause of myelopathy in the present case was osteochondroma arising from the posterior arch of the atlas, but the osteophyte formations appearing at the pseudoarthrosis between the atlas osteochondroma and the lamina of the axis might also have contributed to the symptoms, which appeared when the patient was in his late 50s.
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  • Malignant Transformation of an Intracranial Large Epidermoid Cyst With Leptomeningeal Carcinomatosis
    —Case Report—
    Tomoaki KANO, Hayato IKOTA, Satoshi KOBAYASHI, Susumu IWASA, Shuhei KU ...
    2010 Volume 50 Issue 4 Pages 349-353
    Published: 2010
    Released on J-STAGE: April 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.349
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    A 64-year-old female presented with rapid onset of left ophthalmoplegia and truncal ataxia, after experiencing diplopia due to left abducens nerve palsy for a year. She had undergone surgery twice for left trigeminal neuralgia caused by a large intracranial epidermoid cyst at the age of 48 and 52 years. The intracranial epidermoid cyst grew and became predominantly enhanced by contrast medium on computed tomography (CT) and T1-weighted magnetic resonance (MR) imaging, which had not been observed earlier. The tumor was partially removed and the histological diagnosis was squamous cell carcinoma (SCC). Radiation therapy was administered, but she presented with paraplegia of the bilateral lower extremities and anesthesia due to spinal multiple metastases of SCC one year later. Radiation therapy was administered for the spinal lesions, but she died of multiple metastases to the cerebellum and medulla oblongata with hydrocephalus 2 years after the third surgery. Transformation of intracranial epidermoid cysts to SCC appears as predominant enhancement on CT or T1-weighted MR imaging with rapid deterioration of neurological features. All reported cases of malignant transformation of intracranial epithelial cysts to SCC with leptomeningeal carcinomatosis have occurred in intracranial epidermoid cysts.
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