Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 50, Issue 8
Displaying 1-22 of 22 articles from this issue
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Original Articles
  • Decreasing Expression of the Interleukin-13 Receptor IL-13Rα2 in Treated Recurrent Malignant Gliomas
    Oliver BOZINOV, Jens-Martin KALK, Niklaus KRAYENBÜHL, Christoph M ...
    Article type: Original Article
    2010 Volume 50 Issue 8 Pages 617-621
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.617
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    The IL-13Rα2 gene encodes for a 65 kDa protein that forms one of the subunits of the interleukin-13 (IL-13) receptor. This gene is highly expressed in various types of human tumors including malignant gliomas. The expression level of IL-13Rα2 was examined in a total of 45 tissue samples of anaplastic astrocytomas (AAs) World Health Organization (WHO) grade III, glioblastomas (GBMs) WHO grade IV, and first-recurrent glioblastomas (frGBMs) after treatment with radiation and chemotherapy. IL-13Rα2 expression was detected by semiquantitative reverse transcription real-time polymerase chain reaction (PCR) using ABITM PRISM 7700 and Qiagen QuantiTect® SYBR Green PCR kits. The expression level of IL-13Rα2 (15 fold) was significantly reduced in frGBMs compared to the primary GBMs (p = 0.014), and significantly reduced by more than 15 fold (p = 0.003) in all untreated malignant astrocytomas (AAs and GBMs) compared with treated frGBMs. Expression of IL-13Rα2 seems to be lower in frGBMs compared to GBMs. The promising antitumor effect of IL-13 cytotoxin could be greatly reduced in frGBM or only achievable with higher amounts of cytotoxin, due to the significantly lower expression of the cytotoxin's target structure.
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  • Intravenous Methylprednisolone Reduces the Risk of Propofol-Induced Adverse Effects During Wada Testing
    Nobuhiro MIKUNI, Youhei YOKOYAMA, Atsuhito MATSUMOTO, Takayuki KIKUCHI ...
    Article type: Original Article
    2010 Volume 50 Issue 8 Pages 622-626
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.622
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    The adverse effects and risks associated with intracarotid propofol injection during Wada testing were retrospectively compared in two groups of patients with (n = 75) and without (n = 58) intravenous methylprednisolone administered before intracarotid propofol injection. The incidences of all adverse effects were decreased in the methylprednisolone group. In particular, severe adverse effects such as increased muscle tone with twitching and rhythmic movements or tonic posture, which could adversely affect Wada test results, were seen in one patient in the methylprednisolone group and seven patients in the control group, indicating 92% risk reduction. This study suggests that Wada testing using intravenous methylprednisolone administration prior to propofol injection is a safe approach to the preoperative evaluation of brain tumors, epilepsy, and arteriovenous malformations.
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  • Novel Brain Model for Training of Deep Microvascular Anastomosis
    Tatsuya ISHIKAWA, Nobuyuki YASUI, Hidenori ONO
    Article type: Original Article
    2010 Volume 50 Issue 8 Pages 627-629
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.627
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    Models of the brain and skull were developed using a selective laser sintering method for training in the procedures of deep microvascular anastomosis. Model A has an artificial skull with two craniotomies, providing fronto-temporal-subtemporal and suboccipital windows. The brain in Model A is soft and elastic, and consists of the brainstem and a hemispheric part with a detailed surface. Rehearsals or training for anastomosis to the insular part of the middle cerebral artery, superior cerebellar artery, posterior cerebral artery, and posterior inferior cerebellar artery can be performed through the craniotomies. Model B has an artificial skull with a bifrontal craniotomy and an artificial brain consisting of the bilateral frontal lobes with an interhemispheric fissure and corpus callosum. Rehearsals or training for anastomosis of the callosal segment of the anterior cerebral artery can be practiced through this craniotomy. These realistic models will help to develop skills for deep vascular anastomosis, which remains a challenging neurosurgical procedure, even for experienced neurosurgeons.
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  • Benefits of Clipping Surgery Based on Three-Dimensional Computed Tomography Angiography
    Mutsumi NAGAI, Eiju WATANABE
    Article type: Original Article
    2010 Volume 50 Issue 8 Pages 630-637
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.630
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    The recent development of three-dimensional computed tomography (3D-CT) angiography with multi detector row CT (MDCT) improves cerebral artery imaging due to faster scanning at thinner collimation over a large scanning volume. Aneurysm clipping was performed using only 3D-CT angiography created by MDCT with 16 detector arrays (16-MDCT angiography), in place of digital subtraction angiography (DSA) to evaluate the suitability of 16-MDCT angiography for preoperative examination before aneurysm clipping, and identify the essential points when making 3D images. Thirty-two patients with subarachnoid hemorrhage (SAH) identified by initial CT or with non-ruptured aneurysm were entered in this study. Twenty-six SAH patients underwent 3D-CT angiography, and aneurysms were treated by clipping (n = 25) or coil embolization (n = 4). One patient with no aneurysm depicted by 3D-CT angiography underwent conventional DSA twice subsequently. The sensitivity of 16-MDCT angiography to depict aneurysms in patients with SAH, and time between admission and entering the operating room were evaluated, and compared with those under the former protocol using DSA. The sensitivity of 16-MDCT angiography for aneurysm detection was 100%. Shapes of all aneurysms depicted by 3D-CT angiography were validated intra-operatively. The mean operation waiting time was 2.8 hours, with the shortest time being 1.5 hours. Re-bleeding occurred in one of the 20 patients. We conclude that shorter preoperative waiting time decreased the incidence of premature re-bleeding, resulting in better outcomes. We highly recommend that the surgeon sets the threshold value, and rotates the 3D image to establish better surgical orientation.
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  • Low Peripheral Lymphocyte Count Before Focal Radiotherapy Plus Concomitant Temozolomide Predicts Severe Lymphopenia During Malignant Glioma Treatment
    Eiichi ISHIKAWA, Tetsuya YAMAMOTO, Noriaki SAKAMOTO, Kei NAKAI, Hiroyo ...
    Article type: Original Article
    2010 Volume 50 Issue 8 Pages 638-644
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.638
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    Malignant glioma patients treated with the golden standard therapy, focal radiotherapy plus concomitant daily temozolomide (radiotherapy/TMZ), often suffer severe lymphopenia. The frequency of severe lymphopenia and its predictors were analyzed by assessing adverse effects including decrease in white blood cell counts, lymphocyte counts, and neutrocyte counts according to the Common Toxicity Criteria version 3.0 (CTC) in 28 consecutive patients with pathologically verified malignant gliomas treated with radiotherapy/TMZ. Eighty-two percent of the patients suffered one or more adverse effects; lymphopenia (68%) was the most frequent adverse effect, with 32% of patients suffering CTC grade 4 lymphopenia. CTC grade 4 lymphopenia was associated with the incidence of other CTC grade 3 or 4 adverse effects and discontinuance of TMZ. Minimal lymphocyte counts during radiotherapy/TMZ and lymphocyte counts before radiotherapy/TMZ showed close linear correlation by linear regression analysis (p < 0.0001, R2 = 0.569), and the most important predictor for CTC grade 4 lymphopenia was lymphocyte count before radiotherapy/TMZ less than 1200/μl by multivariate analysis (p < 0.0321, Exp = 13.2). Lymphocyte counts before radiotherapy/TMZ of less than 1200/μl predict severe lymphopenia during radiotherapy/TMZ.
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  • Two-Level Anterior Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: A Minimum 3-Year Follow-up Study
    Dong Yeob LEE, Sang-Ho LEE, Dae Hyeon MAENG
    Article type: Original Article
    2010 Volume 50 Issue 8 Pages 645-650
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.645
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    The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two-level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.1°, 39.2°, and 32.6° to 32.9°, 44.5°, and 36.6°, respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery.
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Case Reports
  • Reversible Magnetic Resonance Imaging Changes Associated With Hypoglycemia
    —Case Report—
    Shiro YAMASHITA, Kenya KAWAKITA, Naohisa HOSOMI, Takayuki NAYA, Hiroyu ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 651-654
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.651
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    A 63-year-old man was found with confusion and right limb monoparesis. He was taken to the emergency center under suspicion of stroke. Head computed tomography and magnetic resonance (MR) imaging and MR angiography were immediately conducted, which revealed no abnormality, but diffusion-weighted imaging showed increased intensity areas in the splenium of the corpus callosum and the left posterior limb of the internal capsule with decreased apparent diffusion coefficient (ADC) in the same areas. Immediately after the head scan, blood sugar level was measured, which revealed hypoglycemia (23 mg/dl). He quickly became lucid after intravenous administration of 20 ml of 50% glucose solution, and the paresis disappeared. Follow-up brain MR imaging was conducted 3 days later, but no clearly abnormal findings were seen on T2-weighted, fluid-attenuated inversion recovery, diffusion-weighted, or ADC images. Reports of reversible high intensity area in the splenium of the corpus callosum on diffusion-weighted imaging due to transient hypoglycemia are rare. Hemiparesis is one of the manifestations of hypoglycemia, so verifying the blood sugar level is important. Since MR imaging can be conducted easily now, we may need to consider the imaging findings in the differential diagnosis of hypoglycemia.
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  • Vertebral Artery Dissecting Aneurysm Treated by Proximal Occlusion and Posterior Inferior Cerebellar Artery Reconstruction With Fenestrated Clips
    —Case Report—
    Yuhui LI, Tetsuyoshi HORIUCHI, Fukuo NAKAGAWA, Kazuhiro HONGO
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 655-658
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.655
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    A 57-year-old man presented with subarachnoid hemorrhage caused by a dissecting aneurysm of the vertebral artery close to the origin of the posterior inferior cerebellar artery (PICA). The aneurysm was treated successfully with two fenestrated clips preserving the efferent artery with anterograde blood flow without PICA anastomosis. The postoperative course was uneventful. Postoperative angiography indicated disappearance of the aneurysm and anterograde blood flow of the PICA.
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  • Recurrence of Subarachnoid Hemorrhage Due to the Rupture of Cerebral Aneurysms in a Patient With Sjögren's Syndrome
    —Case Report—
    Kentaro HAYASHI, Yoichi MOROFUJI, Kazuhiko SUYAMA, Izumi NAGATA
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 658-661
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.658
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    A 52-year-old woman with Sjögren's syndrome presented with multiple cerebral aneurysms, which resulted in recurrent subarachnoid hemorrhage (SAH) manifesting as severe headache. Computed tomography (CT) showed SAH. Cerebral angiography revealed aneurysms of the anterior communicating artery and the left middle cerebral artery. The necks of the aneurysms were successfully clipped. Postoperative course was uneventful and she was discharged without neurological deficit. Thirteen years later, she suddenly lost consciousness and was brought to our hospital. CT demonstrated recurrence of SAH. Cerebral angiography revealed cerebral aneurysms of the right internal carotid artery and the right middle cerebral artery. The clipped aneurysms were stable. The internal carotid artery aneurysm was successfully treated with endovascular coil embolization. However, she regained no neurological function and died. Patients with Sjögren's syndrome may develop cerebral aneurysm complicated with SAH.
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  • Delayed Parenchymal Hemorrhage Following Successful Embolization of Brainstem Arteriovenous Malformation
    —Case Report—
    Yusuke MORIHIRO, Kei HARADA, Shoichi KATO, Hideyuki ISHIHARA, Satoshi ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 661-664
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.661
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    A 64-year-old man presented with subarachnoid hemorrhage from a small brainstem arteriovenous malformation (AVM). Cerebral angiography showed a small AVM in the lateral midbrain, which was fed by a basilar perforating artery, and drained into the right transverse pontine vein and superior petrous vein. Endovascular embolization in the acute stage was selected to occlude the arteriovenous shunt and provide additional intensive treatment for cerebral spasm with lower risk of rebleeding. The AVM was occluded by embolization using n-butyl cyanoacrylate. Intraparenchymal hemorrhage in the ipsilateral pons was detected 1 month after treatment. The causes of the hemorrhage remain unclear.
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  • Cushing's Disease Associated With Unruptured Large Internal Carotid Artery Aneurysm
    —Case Report—
    Yasuo NISHIJIMA, Yoshikazu OGAWA, Kenichi SATO, Yasushi MATSUMOTO, Tei ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 665-668
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.665
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    A 40-year-old woman with Cushing's disease presented with hypertensive cerebral hemorrhage. Neuroimaging detected an unruptured large intracavernous aneurysm, which projected beyond the midline, and thin crescent-shaped adenoma along the aneurysm wall. The aneurysm was treated with endovascular tight packing with coils. Transsphenoidal adenomectomy was then safely performed. The signs of Cushing's disease were resolved, and she was discharged without deficits. The first line therapy for Cushing's disease is transsphenoidal adenomectomy. However, the therapeutic strategy and optimal timing of treatment are unclear for Cushing's disease with large intracavernous aneurysm. The present case shows that transsphenoidal surgery was safely possible with minimal invasiveness after embolization of the intracavernous aneurysm.
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  • Familial Moyamoya Disease Associated With Graves' Disease in a Mother and Daughter
    —Two Case Reports—
    Hiroshi TOKIMURA, Kenichiro TAJITSU, Hiroshi TAKASHIMA, Takahisa HIRAY ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 668-674
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.668
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    A mother and daughter presented with a rare combination of moyamoya disease and Graves' disease. A 19-year-old woman experienced numbness in her right hand due to cerebral infarction during therapy for Graves' disease. Cerebral angiography demonstrated stenoses of the bilateral internal carotid arteries and net-like abnormal collateral vessels indicative of moyamoya disease. Her 52-year-old mother with a history of Graves' disease presented with left hemiparesis due to intracerebral hemorrhage; she recovered after hematoma evacuation. Postoperative angiography demonstrated stenoses of the bilateral internal carotid arteries and net-like abnormal collateral vessels indicative of moyamoya disease. Another otherwise healthy daughter manifested slight stenosis of the left internal carotid artery. After cerebral revascularization surgery the patients were able to return to their normal daily lives. These familial cases of moyamoya disease and Graves' disease indicate hereditary involvement in both diseases.
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  • Symptomatic T2 Vertebral Hemangioma in a Pregnant Woman Treated by One Stage Combination Surgery; Posterior Stabilization and Anterior Subtotal Tumor Resection
    —Case Report—
    Munehisa SHINOZAKI, Akio MORITA, Koji KAMIJO, Atsushi SEICHI, Nobuhito ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 674-677
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.674
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    A 27-year-old woman presented with vertebral hemangioma manifesting as sudden onset of paraplegia, and bladder and bowel dysfunction during pregnancy. Magnetic resonance imaging revealed a mass lesion that had infiltrated into the entire T2 vertebral body and expanded to the vertebral canal. Laminectomy from T1 to T3 and biopsy of the lesion were performed. Biopsy confirmed the diagnosis of vertebral hemangioma, but laminectomy resulted in no neurological changes. The patient was transferred to our hospital, where radical treatment comprising embolization of the feeding arteries, posterior stabilization of the vertebrae, and anterior excision of the tumor was performed. Symptoms resolved gradually but steadily, and she made a full recovery by 18 months postoperatively. Radical operation might be extremely effective for extradural vertebral hemangioma, even in the delayed phase or in the presence of severe neurological deficit.
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  • Infantile Cervical Intramedullary Cavernous Angioma Manifesting as Hematomyelia
    —Case Report—
    Yasuyuki MIYOSHI, Takao YASUHARA, Masako OMORI, Isao DATE
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 677-682
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.677
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    A 2-month-old infant presented with a cervical intramedullary spinal cord cavernous angioma manifesting as left hemiparesis caused by hematomyelia. Osteoplastic laminotomy of the cervical spine was carried out with subsequent microsurgical excision of the intramedullary spinal cord cavernous angioma. Magnetic resonance imaging revealed no residual tumor. At 25 months after the surgery, she presented no neurological deficit without recurrence and cervical deformity. This case of infantile intramedullary spinal cord cavernous angioma presenting with cervical hematomyelia shows osteoplastic laminotomy of the cervical spine might be helpful to prevent consequent cervical deformity in pediatric cases.
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  • Solitary Intraosseous Neurofibroma of the Frontal Bone
    —Case Report—
    Rei YAMAGUCHI, Takaaki YOSHIDA, Yoichi NAKAZATO, Yuhei YOSHIMOTO
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 683-686
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.683
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    A 54-year-old female presented with a very rare intraosseous neurofibroma of the frontal bone manifesting as forehead bulging. Skull radiography showed a radiolucent round lesion. Magnetic resonance imaging showed a mass lesion expanding from the frontal bone diploic layer to the epidural space. Fluorodeoxyglucose positron emission tomography and thallium-201 single photon emission computed tomography findings indicated tumor malignancy. The tumor was resected, and the histological diagnosis was benign intraosseous neurofibroma. Intraosseous neurofibroma usually occurs in the mandible. The origin of the present case may have been a peripheral nerve in the diploic vascular tissue.
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  • Two Meningiomas With Different Histological Grades in the Same Patient
    —Case Report—
    Hakan EMMEZ, Aydemir KALE, Mehmet TÖNGE, Asli ÇAKIR, Necde ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 686-688
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.686
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    A 56-year-old female presented with two intracranial meningiomas with different grades manifesting as speech disorder for one week. Neurological and radiological evaluations showed two distinct tumors suggestive of multicentric meningiomas. Surgical resection of both masses was performed in the same procedure. Histological examination found both meningothelial and atypical meningiomas. Concurrency of meningiomas with different grades in same patient is extremely rare. The present case emphasizes the need for follow up of all patients with meningioma even if the neuroimaging features indicate benign character.
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  • Brain Metastasis of Undifferentiated Sarcoma and Response to Temozolomide Treatment
    —Case Report—
    Hirotomo TANAKA, Takashi SASAYAMA, Masamitsu NISHIHARA, Atsushi ARAI, ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 689-693
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.689
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    A 33-year-old woman presented with rare brain metastases from undifferentiated high-grade sarcoma manifesting as headache and vomiting. Magnetic resonance (MR) imaging demonstrated multiple tumors in the brain, subcutaneous soft tissue, and mediastinum. The patient underwent surgery, followed by chemotherapy and radiotherapy. The histological diagnosis was undifferentiated high-grade sarcoma. Radiotherapy was effective, but the brain tumors recurred 6 months later. The patient underwent high-dose methotrexate therapy, but showed no response. Promoter hypermethylation in the O6-methylguanine-deoxyribonucleic acid methyltransferase (MGMT) genes was detected and MGMT protein expression was negative in the recurrent tumor, so temozolomide (TMZ) salvage chemotherapy was given, and follow-up MR imaging showed tumor reduction. This case suggests that TMZ may be effective for brain metastasis of undifferentiated sarcoma without MGMT protein expression.
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  • Langerhans Cell Histiocytosis of the Petrous Bone With Sudden Sensorineural Hearing Loss
    —Case Report—
    Hideaki SUZUKI, Shigeru NISHIZAWA, Nobusuke HOHCHI, Tetsuro WAKASUGI, ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 693-697
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.693
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    A 56-year-old woman with Langerhans cell histiocytosis of the petrous bone presented with sudden onset of sensorineural hearing loss and vertigo without other neurological impairment, mimicking idiopathic sudden sensorineural hearing loss. Differential diagnosis was difficult until neuroimaging demonstrated a lesion of the petrous bone. The patient eventually underwent removal of the lesion via the transpetrosal approach, and received postoperative chemotherapy consisting of vinblastine, methotrexate, 6-mercaptopurine, and prednisolone. Although her hearing did not recover, complete remission was achieved, and the patient is currently free from disease. Physicians need to be aware that patients with sudden onset of hearing loss may have an unexpected and hidden disease which requires neuroimaging and histological examinations for definitive diagnosis and appropriate treatment.
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  • Arachnoidplasty for Traumatic Subdural Hygroma Associated With Arachnoid Cyst in the Middle Fossa
    —Case Report—
    Yuzuru HASEGAWA, Toshihide TANAKA, Naoki KATO, Shougo KAKU, Takao ARAI ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 698-701
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.698
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    A 5-year old boy presented with an arachnoid cyst in the middle cranial fossa with mild midline shift manifesting as headache and loss of activity. Computed tomography (CT) showed subdural hygroma. Burr-hole drainage was carried out and symptoms were improved postoperatively. However, recollection of subdural hygroma was found on follow-up CT 3 weeks after subdural drainage. He underwent craniotomy, and tearing of the outer wall of the arachnoid cyst was observed. The ruptured cyst wall was tightly closed by arachnoidplasty to prevent cerebrospinal fluid leakage. Arachnoidplasty was effective for traumatic subdural hygroma with arachnoid cyst for reconstruction.
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  • Epidermoid Cyst in Meckel's Cave With Unusual Computed Tomography and Magnetic Resonance Imaging Findings
    —Case Report—
    Atsushi ARAI, Takashi SASAYAMA, Junji KOYAMA, Atsushi FUJITA, Kohkichi ...
    Article type: Case Report
    2010 Volume 50 Issue 8 Pages 701-704
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.701
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    A 27-year-old woman presented with headache and occasional numbness over her right face. Computed tomography revealed a hypodense mass in the middle cranial fossa and another adjacent hyperdense mass in the posterior fossa with erosion of the right petrous apex. Magnetic resonance imaging revealed the lesion in the middle cranial fossa as iso- to hypointense on T1-weighted and hyperintense on T2-weighted imaging, with peripheral enhancement after gadolinium administration, and the adjacent lesion in the posterior fossa as hyperintense on T1-weighted and hypointense on T2-weighted imaging. During surgery, these lesions mimicking two adjacent distinct tumors were revealed to connect through Meckel's cave. The hypodense lesion in the middle cranial fossa consisted of pearly-like solid contents, and the hyperdense lesion in the posterior cranial fossa consisted of viscid dark-green materials. The tumors were gross totally resected with endoscopic assistance. Histological examination confirmed that the tumor was an epidermoid cyst. The present case cyst indicates that although the diffusion-weighted imaging sequence is useful for detection of intracranial epidermoid cysts, epidermoid cysts including viscous materials with unusual radiological findings could complicate the preoperative diagnosis.
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  • Supplementary Comment on “Neuropsychological Improvement in Patients With Cervical Spondylotic Myelopathy After Posterior Decompression Surgery”
    Alessandro DUCATI, Marc P. SINDOU
    2010 Volume 50 Issue 8 Pages 705
    Published: 2010
    Released on J-STAGE: August 25, 2010
    DOIhttps://doi.org/10.2176/nmc.50.705
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