Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 50, Issue 5
Displaying 1-21 of 21 articles from this issue
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Original Articles
  • Epileptic Focus Stimulation and Seizure Control in the Rat Model of Kainic Acid-Induced Limbic Seizures
    Tomoyuki URINO, Kiyotaka HASHIZUME, Michiyo MAEHARA, Kouichi KATO, Yos ...
    2010 Volume 50 Issue 5 Pages 355-360
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.355
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    The inhibitory effects of deep brain stimulation (DBS) were investigated in a rat model of kainic acid (KA)-induced limbic status epilepticus. Wistar rats were injected with 1.0 μg KA into the left amygdala after stereotactic implantation of a guide cannula and electrodes. Bipolar rectangular pulses of 0.1 msec duration and 0.1-0.3 mA amplitude were applied intermittently to the left amygdala (10 Hz or 130 Hz), left ventral hippocampus (10 Hz), and left dorsomedial thalamus (130 Hz). Seizure frequency was evaluated by video electroencephalography monitoring and compared to control animals that did not receive DBS. All rats developed limbic status epilepticus 60-90 minutes after KA injection. Seizure frequency was significantly reduced by 10 Hz stimulation of the amygdala and by 130 Hz stimulation of the dorsomedial thalamus. No significant effects were observed with other types of stimulation. Seizure behaviors or duration of seizure were not changed significantly by DBS treatment. DBS of an epileptic focus may attenuate KA-induced limbic seizures, depending on the stimulation sites and parameters.
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  • Effect of Recombinant Human Erythropoietin on Serum S100B Protein and Interleukin-6 Levels After Traumatic Brain Injury in the Rat
    Xiao-xing BIAN, Xue-song YUAN, Chuan-ping QI
    2010 Volume 50 Issue 5 Pages 361-366
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.361
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    Erythropoietin (EPO) has a neuroprotective effect in the animal model of ischemia/hypoxia, but the mechanisms underlying the EPO effect in traumatic brain injury (TBI) are not well understood. This study examined the potential neuroprotective mechanisms of recombinant human EPO (rhEPO) in rats after TBI. Sixty healthy adult male Sprague-Dawley rats were randomly divided into 5 groups: 1000 U/kg rhEPO-treated, 3000 U/kg rhEPO-treated, 5000 U/kg rhEPO-treated, citicoline, and normal saline (control) groups. The TBI model was based on the modified Feeney's free falling model. Serum samples were collected at 6 hours, 24 hours, 3 days, 5 days, and 7 days after trauma. The serum S100B protein and interleukin-6 (IL-6) levels were measured after treatment in each group with double antibody sandwich enzyme-linked immunosorbent assay. Both serum S100B protein and IL-6 levels were significantly lower in 3000 U/kg rhEPO-treated and 5000 U/kg rhEPO-treated groups (p < 0.001). The decrease in serum S100B protein level was correlated with the dosage of rhEPO. Medium doses of rhEPO achieved the optimum decreases in the serum IL-6 level. Therefore, inhibition of the composition and secretion of S100B protein and IL-6 levels by EPO might be one of the mechanisms involved in decreasing inflammatory reaction in the brain, and may be responsible for the neuroprotective effect after TBI.
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  • Efficacy and Safety of Key Hole Craniotomy for the Evacuation of Spontaneous Cerebellar Hemorrhage
    Hiroshi TOKIMURA, Kenichiro TAJITSU, Ayumi TANIGUCHI, Hitoshi YAMAHATA ...
    2010 Volume 50 Issue 5 Pages 367-372
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.367
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    The efficacy and safety of cerebellar hemorrhage evacuation by key hole craniotomy and the importance of thorough evacuation and irrigation of the hematoma in the fourth ventricle to resolve obstructive hydrocephalus were assessed in 23 patients with spontaneous cerebellar hemorrhage (SCH) greater than 3 cm or with brainstem compression and hydrocephalus. A 5-cm elongated S-shaped scalp incision was made, and a 3-cm key hole craniotomy was performed over a cerebellar convexity area. The hematoma was immediately evacuated through a small corticotomy. The hematoma in the fourth ventricle was gently removed through the hematoma cavity, followed by thorough saline irrigation to release obstructive hydrocephalus. Patients classified retrospectively into favorable and poor outcome groups using the Glasgow Outcome Scale (GOS) scores of 4-5 vs. 1-3 showed significant differences with respect to the preoperative Glasgow Coma Scale, hematoma size and volume, and brainstem compression. Only 2 of the 23 patients required ventricular drainage and no postoperative complications were recorded. Patients treated by experienced and inexperienced surgeons showed no significant differences in the hematoma evacuation rate, postoperative GOS, and interval from skin incision to start of hematoma evacuation. Our simplified method of key hole craniotomy to treat SCH was less invasive but easy to perform, as even inexperienced neurosurgeons could obtain good surgical results. Thorough cleaning of the fourth ventricle minimized the necessity for ventricular drainage.
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  • Consequences of Preoperative Evaluation of Patterns of Drainage of the Cavernous Sinus in Patients Treated Using the Anterior Transpetrosal Approach
    Nakamasa HAYASHI, Hikari SATO, Yoshifumi TSUBOI, Shoichi NAGAI, Naoya ...
    2010 Volume 50 Issue 5 Pages 373-377
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.373
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    Extradural procedures in an anterior transpetrosal approach (ATPA) may interrupt the route of drainage from the superficial middle cerebral veins (SMCVs) and the cavernous sinus (CS) to the pterygoid venous plexus at the temporal skull base. Patterns of drainage of the SMCV and the CS and the results of surgery were examined in 12 patients with petroclival lesions treated using the ATPA between 2000 and 2008. The angiographic patterns of drainage of the SMCV were examined in 22 sides of the 12 patients. The SMCV drained into the sphenoparietal sinus in 12 sides, the sphenobasal veins in 4 sides, and the cortical veins in 6 sides. The patterns of drainage of the CS were examined on 12 sides in which the SMCV drained into the sphenoparietal sinus. The CS drained into the inferior petrosal sinus (IPS) in 7 sides and equally into the pterygoid plexus and IPS in 3 sides. The CS drained mainly into the pterygoid plexus in 2 sides of 2 patients, who both suffered temporal lobe swelling postoperatively. The pattern of venous drainage of the CS must be considered in planning surgical approaches to petroclival lesions. In patients with a well-developed pterygoid plexus, surgical interruption of this drainage route may be a cause of injury of the temporal lobe.
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  • Clinical Features of Unilateral Moyamoya Disease
    Kentaro HAYASHI, Kazuhiko SUYAMA, Izumi NAGATA
    2010 Volume 50 Issue 5 Pages 378-385
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.378
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    Moyamoya disease is characterized by progressive occlusion of the internal carotid artery or its terminal branches, associated with formation of extensive collateral vessels (moyamoya vessels) at the base of the brain. Whether unilateral moyamoya disease, confirmed by typical angiographic evidence of moyamoya disease unilaterally and normal or equivocal findings contralaterally, is an early form of definite (bilateral) moyamoya disease remains controversial. The present study investigated the incidence and clinical features of unilateral moyamoya disease in a series of patients treated for moyamoya disease. Fifty-two patients were diagnosed with definite moyamoya disease and nine patients with unilateral moyamoya disease. Sex, age, signs at onset, neuroimaging findings, treatment, course of the disease, and family history of unilateral moyamoya disease were reviewed. Among the nine patients with unilateral moyamoya disease, there were twice as many females as males, and mean age at onset was 39.0 years. The clinical presentation was ischemic in three patients, bleeding in one, and asymptomatic in five. Two had familial moyamoya disease. Progression to bilateral lesions is known to occur in pediatric patients and patients with stenotic changes of the contralateral internal carotid artery bifurcation. Some unilateral cases are caused by the same genetic defects as definite cases, and others seem to be an unusual form of stenoocclusive process of cerebral arteries. Surgical treatment on the symptomatic side followed by close observation for bilateral involvement is recommended.
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Case Reports
  • Consciousness Recovery Induced by Intrathecal Baclofen Administration After Subarachnoid Hemorrhage
    —Two Case Reports—
    Hirofumi OYAMA, Akira KITO, Hideki MAKI, Kenichi HATTORI, Kuniaki TANA ...
    2010 Volume 50 Issue 5 Pages 386-390
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.386
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    Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 μg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. However, the patient could eat food and wash her face with minimal assistance at 3 months after the implantation, and could stand up in the parallel bars with assistance and speak several words at 8 months. Case 2 was in a completely bedridden state at 10 months after onset and could neither drink water nor follow instructions. However, the patient became oriented and could eat by herself within 3 to 4 weeks of implantation. She could walk with a cane and use the stairs with minimal assistance at 2 and 3 months after implantation. The patient could speak fluently within 6 months of implantation. Flatulence and dysuria happened during the screening test, but these symptoms were not repeated after implantation of a pump-catheter-system and continuous intrathecal baclofen infusion. Continuous intrathecal baclofen infusion caused both improvement in muscle tone and spasms and consciousness recovery from the vegetative state. This therapy is a strong candidate treatment for patients with spasticity and consciousness disturbance.
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  • Rapid Spontaneous Resolution of Neurological Signs and Cerebral Herniation Caused by Intracerebral Hemorrhage
    —Case Report—
    Hitoshi YAMAHATA, Masashi HIRABARU, Kazunori ARITA
    2010 Volume 50 Issue 5 Pages 390-392
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.390
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    A 47-year-old man presented with sudden consciousness disturbance and left hemiplegia caused by intracerebral hemorrhage. Initial computed tomography (CT) showed a massive subcortical right temporoparietal lobe hematoma and signs of impending uncal herniation. However, he became alert and his hemiplegia improved considerably in the course of 2 hours, so conservative treatment was preferred over surgical intervention. Follow-up CT acquired on the next day revealed dramatic diminution of the intracerebral hemorrhage. Small intracerebral hemorrhages occasionally produce transient symptoms with or without disappearance of the hematoma, but the present patient had a large hematoma that decreased in size within a short time with rapid improvement of the symptoms attributed to the hematoma. The mechanism underlying the diminution of the hematoma may be related to redistribution by cerebrospinal fluid flow.
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  • Takotsubo Cardiomyopathy Induced by Dobutamine Infusion During Hypertensive Therapy for Symptomatic Vasospasm After Subarachnoid Hemorrhage
    —Case Report—
    Ryuta SAITO, Toshie TAKAHASHI, Nobuo NOSHITA, Ayumi NARISAWA, Ken NEGI ...
    2010 Volume 50 Issue 5 Pages 393-395
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.393
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    A 65-year-old female with subarachnoid hemorrhage (SAH) developed takotsubo cardiomyopathy induced by dobutamine infusion for vasospasm 9 days after onset of SAH. She underwent neck clipping of the ruptured cerebral aneurysm on day 1. Course after surgery was uneventful, but she developed motor aphasia on day 9. Hypertensive therapy was carried out under the diagnosis of symptomatic vasospasm. Half an hour after initiation of dobutamine infusion at 6 μg/kg/min, sudden symptoms of takotsubo cardiomyopathy developed. Fortunately, her symptoms recovered in a few days with supportive therapy without any consequences. Takotsubo cardiomyopathy is one pattern of cardiac dysfunction occasionally encountered after SAH. Possible mechanisms of this disorder include epicardial catecholamine cardiotoxicity. Therefore, generally, cardiac function is worst at the early stage of SAH, when sympathetic activity is highest, and recovers thereafter. Dobutamine infusion seems to have triggered the takotsubo cardiomyopathy in the present patient even 9 days after onset of SAH. Inotropic agents including dobutamine are often used during the course of SAH, and since takotsubo cardiomyopathy can occur in patients with SAH, this complication must be considered.
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  • Endovascular Treatment for Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm
    —Case Report—
    Daizo ISHII, Akihiko TAKECHI, Katsuhiro SHINAGAWA, Takashi SOGABE
    2010 Volume 50 Issue 5 Pages 396-399
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.396
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    A 73-year-old woman presented with subarachnoid hemorrhage caused by a ruptured left distal anterior inferior cerebellar artery (AICA) aneurysm. Computed tomography showed a thin subarachnoid hemorrhage in the ambient cistern, and digital subtraction angiography revealed an aneurysm arising from the lateral branch of the left AICA, which was separate from the meatal loop. Endovascular treatment was performed to achieve parent artery occlusion using two Guglielmi detachable coils. Postoperatively, the patient had no complications except for left hearing disturbance, and she was independent in daily life. Endovascular parent artery occlusion for distal AICA aneurysm, especially distal from the meatal loop, can avoid sacrificing the internal auditory artery if the lateral branch of the AICA could be occluded more distally from the meatal loop. Sufficient collateral circulation prevents major infarction, and this strategy may be the first-line treatment choice.
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  • Spontaneous Epidural Hematoma Secondary to Sphenoid Sinusitis
    —Case Report—
    Yoshinobu TAKAHASHI, Naoya HASHIMOTO, Akihiko HINO
    2010 Volume 50 Issue 5 Pages 399-401
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.399
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    Epidural hematoma is typically caused by direct head trauma. Spontaneous epidural hematoma can be caused by infections of adjacent regions, vascular malformations of the dura mater, and disorders of blood coagulation. A 10-year-old girl with no history of head injury presented with complaints of headache and fever. On arrival at our hospital, her Glasgow Coma Scale score was 13 and neurological examination revealed right oculomotor palsy and left hemiparesis. Computed tomography (CT) showed an epidural hematoma in the right temporal base. Preoperative angiography identified no specific vascular lesions. Removal of the hematoma was undertaken immediately. Retrospective evaluation of the preoperative CT revealed sphenoid sinusitis and a bone defect between the temporal base and the sphenoid sinus. The epidural hematoma was probably caused by the spread of inflammation from the sphenoid sinus. Sphenoid sinusitis is one of the possible causes of acute epidural hematoma, especially if no traumatic episodes or risk factors can be identified.
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  • Concomitant Cranial and Lumbar Subdural Hematomas
    —Case Report—
    Kyongsong KIM, Makoto KATSUNO, Toyohiko ISU, Masahiro MISHINA, Daizo Y ...
    2010 Volume 50 Issue 5 Pages 402-404
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.402
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    A 24-year-old woman presented with concomitant spinal and bilateral intracranial subdural hematomas (SDHs) after hitting her head and lower back in a fall while snowboarding. She developed lower back pain and posture headache. Magnetic resonance imaging revealed bilateral intracranial SDHs and spinal SDH. Her symptoms improved and all hematomas resolved gradually without treatment, and completely disappeared by 5 months after the accident. Simultaneous intracranial SDH and spinal SDH have been reported in only 18 patients, including ours, of whom 6 had suffered trauma. The mechanism of concomitant SDHs has not been clarified, but migration of the hematoma from the intracranial to spinal sites may be an important mechanism. In our patient, low cerebrospinal fluid pressure syndrome and double trauma may also have been involved.
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  • Three-Dimensional Digital Subtraction Angiography for Endovascular Treatment of Direct Carotid-Cavernous Fistula
    —Case Report—
    Shinya KOHYAMA, Shoichiro ISHIHARA, Fumitaka YAMANE, Ryuzaburo KANAZAW ...
    2010 Volume 50 Issue 5 Pages 404-406
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.404
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    A 63-year-old woman with a direct carotid-cavernous fistula (CCF), manifesting as sudden onset of severe headache and pulsatile tinnitus suffered during coronary angiography, was successfully treated with transarterial embolization based on the anatomical information obtained from volume-rendered three-dimensional digital subtraction angiography (3D DSA) images. 3D DSA is useful for understanding the configuration of such fistulas accurately and devising a therapeutic strategy for the endovascular treatment of direct CCFs.
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  • Synchronous Multifocal Osteosarcoma Involving the Skull Presenting With Intracranial Hemorrhage
    —Case Report—
    Hikari SATO, Nakamasa HAYASHI, Hiromichi YAMAMOTO, Shoichi NAGAI, Kazu ...
    2010 Volume 50 Issue 5 Pages 407-409
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.407
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    A 40-year-old man presented with a rare case of synchronous multifocal osteosarcoma involving the skull associated with intracerebral hemorrhage, manifesting as sudden headache and left homonymous hemianopia. Computed tomography revealed a skull tumor in the right occipital bone and intracerebral hemorrhage in the right occipital lobe. Gross total resection of the skull tumor with hematoma was performed. The histological diagnosis was osteosarcoma. The tumor cells had invaded into the surrounding brain parenchyma, resulting in intracerebral hemorrhage.
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  • Preoperative Chemotherapy for Infiltrative Low-Grade Oligoastrocytoma: a Useful Strategy to Maximize Surgical Resection
    —Case Report—
    Giannantonio SPENA, Diego GARBOSSA, Laura BARLETTA, Chiara PREVOST, Pi ...
    2010 Volume 50 Issue 5 Pages 410-413
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.410
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    A 38-year-old woman presented with a large infiltrative left frontal low-grade glioma manifesting as partial seizures of the left arm and lower limb. First line chemotherapy with temozolomide reduced infiltration and volume, allowing subtotal surgical resection. The patient suffered postoperative supplementary motor area syndrome with right hemiparesis and mutism that resolved completely after approximately one month. She was able to return to her full-time job after 4 months. The residual tumor was stable, and the frequency of seizures had lessened dramatically at the last follow-up examination at 18 months. The present case demonstrates that this new therapeutic approach of chemotherapy followed by surgery can offer safer and more radical surgical resection, improving the quality of life of the patient.
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  • Glioblastoma Detected at the Initial Stage in its Developmental Process
    —Case Report—
    Hirofumi OYAMA, Yusuke ANDO, Shinichirou AOKI, Akira KITO, Hideki MAKI ...
    2010 Volume 50 Issue 5 Pages 414-417
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.414
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    A 73-year-old male presented with a glioblastoma that was detected at the initial stage in the developmental process. He suffered cerebral infarction. Follow-up magnetic resonance (MR) imaging showed no abnormality. Ten months later, he had transient right hemiparesis. Diffusion-weighted and fluid-attenuated inversion recovery (FLAIR) MR imaging showed a hyperintense area in the left frontal lobe. The diagnosis was cerebral infarction and antiplatelet drug treatment was begun. The patient's right hemiparesis subsided. Ten days later, right hemiparesis reappeared. Diffusion-weighted and FLAIR MR imaging showed an enlarged hyperintense area in the left frontal lobe. Three weeks after the onset of right hemiparesis, MR imaging revealed an irregular ring-enhanced mass lesion that had further increased in size. The diagnosis was brain abscess and antibiotic treatment was initiated. However, the lesion did not respond and had further enlarged 5 weeks after the onset of right hemiparesis. The lesion was partially removed and the histological diagnosis was glioblastoma with Ki-67 labeling index of 26%. After surgical treatment, the patient received irradiation of 60 Gy and chemotherapy with temozolomide. Follow-up MR imaging showed regrowth of the tumor and aggravation of edema. The rapid progression of the tumor ultimately resulted in the patient's death 12 months after the onset of right hemiparesis. Diffusion-weighted imaging is a good method for the early detection of glioblastoma.
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  • Solitary Metastatic Cauda Equina Tumor From Breast Cancer
    —Case Report—
    Kiyoshi ITO, Takahiro MIYAHARA, Tetsuya GOTO, Tetsuyoshi HORIUCHI, Kei ...
    2010 Volume 50 Issue 5 Pages 417-420
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.417
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    A 45-year-old woman presented with a rare case of metastatic cauda equina tumor from breast cancer without spinal column or brain metastasis. She had undergone resection of breast cancer 4 years previously. She presented with a 2-month history of severe low back pain. Magnetic resonance imaging showed a well-enhanced intradural extramedullary mass at the L1 level without other intradural lesions. At surgery, the tumor was partially removed to preserve the nerve root function under electrophysiological monitoring. The histological diagnosis was adenocarcinoma. The tumor was located in the subarachnoid space, suggesting hematogenous metastasis from the breast cancer. Postoperatively the pain subsided and no neurological deficit occurred. She underwent adjuvant therapy and rehabilitation. Cauda equina tumors may be relatively progressive regardless of imaging findings and clinical symptoms, so preoperative systemic investigation should be conducted, considering the possibility of metastatic tumor. A comprehensive therapeutic strategy involving adjuvant therapy after surgery is important to establish, considering the preservation of postoperative nerve function.
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  • Skull Base Metastasis From Follicular Thyroid Carcinoma
    —Two Case Reports—
    Akira MATSUNO, Hideki KATAKAMI, Ryo OKAZAKI, So YAMADA, Mitsuyoshi SAS ...
    2010 Volume 50 Issue 5 Pages 421-425
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.421
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    A 58-year-old woman and a 71-year-old woman presented with extremely rare skull base metastases from follicular thyroid carcinoma (FTC). Surgical removal and external radiotherapy were performed followed by iodine-131 (131I) brachytherapy and thyroid hormone administration. The metastatic tumors in the skull base were well controlled. Treatment for skull base metastasis from FTC includes surgical debulking of the metastatic lesion, as well as complete resection of the thyroid gland, followed by internal irradiation with 131I, external irradiation, and administration of thyroid hormone to prevent tumor growth by suppression of endogenous thyroid-stimulating hormone. Skull base metastases may be the initial clinical presentation of FTC, with silent primary sites. The possibility of skull base metastasis from FTC should be considered in patients with clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction.
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  • Myelomeningocele Associated With Split Cord Malformation Type I
    —Three Case Reports—
    Tetsuhiro HIGASHIDA, Mari SASANO, Hironobu SATO, Ken'ichi SEKIDO, Susu ...
    2010 Volume 50 Issue 5 Pages 426-430
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.426
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    Three neonates presented with split cord malformation (SCM) associated with myelomeningocele (MMC), complicated with various coexisting anomalies. All patients were female and classified as SCM type I. All patients had a syrinx located rostral to the SCM. One patient had hydrocephalus and Chiari malformation causing serious respiratory problems. Two patients had partial hypertrichosis located close to the MMC, suggesting association with SCM. One patient had sacral hypoplasty and right kidney agenesis, suggesting that some embryologic errors may affect not only neural but also mesodermal development. All patients underwent surgical treatment for SCM after detailed evaluation and management of concomitant anomalies, and developed no new neurological deficits. Delayed surgery is an alternative treatment strategy for SCM in patients with both SCM and MMC with similar complications.
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  • Apparently Asymptomatic Arachnoid Cyst: Postoperative Improvement of Subtle Neuropsychological Impediment
    —Case Report—
    Wakoto MATSUDA, Hiroyoshi AKUTSU, Shinya MIYAMOTO, Shozo NOGUCHI, Taka ...
    2010 Volume 50 Issue 5 Pages 430-433
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.430
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    A 13-year-old right-handed boy sustained minor head trauma in a traffic accident. Computed tomography of the head showed no injuries, but revealed an arachnoid cyst in the left middle fossa. Single photon emission computed tomography revealed relatively decreased cerebral blood flow (CBF) in the left frontal and temporal lobes compared with the contralateral regions. The Wechsler Intelligence Scale for Children-Revised (WISC-R) test showed full scale intelligence quotient (IQ) was normal, but also a discrepancy between verbal IQ and performance IQ. Cyst-peritoneal shunting was performed. Postoperatively, laterality of the CBF in the frontal and temporal lobes was resolved and the verbal IQ/performance IQ discrepancy was normalized. In this case, although the WISC-R score was apparently within normal limits, latent regional ischemia induced by compression due to the arachnoid cyst may have caused neuropsychological dysfunction. CBF study and neuropsychological evaluation by the WISC-R may be useful for selecting patients with apparently asymptomatic arachnoid cysts for surgery.
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Technical Note
  • Middle Fossa Approach to a Temporosphenoidal Encephalocele
    —Technical Note—
    Jae Eun KWON, Ealmaan KIM
    2010 Volume 50 Issue 5 Pages 434-438
    Published: 2010
    Released on J-STAGE: May 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.434
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    Temporosphenoidal encephalocele (TSE) is a rare entity caused by herniation of the anteromedial temporal lobe into the sphenoid sinus (SS) through a middle fossa (MF) defect. A 45-year-old woman presented with a spontaneous TSE manifesting as a 4-year history of recurrent cerebrospinal fluid rhinorrhea and meningitis. Coronal computed tomography showed a skull defect in the superior wall of the right lateral recess of the SS. This homogeneous intrasphenoidal lesion appeared hypointense on T1-weighted magnetic resonance (MR) imaging and hyperintense on T2-weighted MR imaging. The patient underwent a frontotemporal craniotomy and extradural MF exploration. The encephalocele was amputated and the temporal base dura primarily sutured and reinforced with fat graft. The MF hole was plugged with temporalis fascia and a calvarial graft layered over the bone defect. Histological examination confirmed meningoencephalocele. Rhinorrhea resolved and the patient remained asymptomatic. Resection of an anteromedial TSE and closure of the craniodural defect in the MF floor via a less invasive extradural skull base approach is effective.
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