Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Search
Advanced search
OR
Browse
Search
Volume 51, Issue 10
Displaying 1-16 of 16 articles from this issue
Show all abstracts
    • |<
    • <
    • 1
    • >
    • >|
Original Articles
  • Efficacy and Safety of Fasudil in Patients With Subarachnoid Hemorrhage: Final Results of a Randomized Trial of Fasudil Versus Nimodipine
    Jizong ZHAO, Dingbiao ZHOU, Jing GUO, Zuyuan REN, Liangfu ZHOU, Shuo W ...
    Article type: Original Article
    2011 Volume 51 Issue 10 Pages 679-683
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.679
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Fasudil is believed to be at least equally effective as nimodipine for the prevention of cerebral vasospasm and subsequent ischemic injury in patients undergoing surgery for subarachnoid hemorrhage (SAH). We report the final results of a randomized, open trial to compare the efficacy and safety of fasudil with nimodipine. A total of 63 patients undergoing surgery for SAH received fasudil and 66 received nimodipine between 1998 and 2004. Symptomatic vasospasm, low density areas on computed tomography (CT), clinical outcomes, and adverse events were all recorded, and the results were compared between the fasudil and nimodipine groups. Absence of symptomatic vasospasm, occurrence of low density areas associated with vasospasm on CT, and occurrence of adverse events were similar between the two groups. The clinical outcomes were more favorable in the fasudil group than in the nimodipine group (p = 0.040). The proportion of patients with good clinical outcome was 74.5% (41/55) in the fasudil group and 61.7% (37/60) in the nimodipine group. There were no serious adverse events reported in the fasudil group. The present results suggest that fasudil is equally or more effective than nimodipine for the prevention of cerebral vasospasm and subsequent ischemic injury in patients undergoing surgery for SAH.
    View full abstract
    Download PDF (123K)
  • Combined Microsurgical and Endoscopic Removal of Extensive Suprasellar and Prepontine Epidermoid Tumors
    Tadashi WATANABE, Eiji ITO, Taku SATO, Masahiro ICHIKAWA, Keiko ODA, H ...
    Article type: Original Article
    2011 Volume 51 Issue 10 Pages 684-688
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.684
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Epidermoids tend to grow around and adhere to critical neurovascular structures, but total or maximal tumor removal is recommended to reduce the risk of recurrence. We describe our method of combined microscopic and endoscopic resection for extensive epidermoid tumors. Thirteen patients with epidermoid tumors located in the suprasellar, prepontine, or surrounding cisterns underwent microsurgical resection with a rigid endoscope and a high definition camera system. An anterior petrosal and/or a pterional approach was selected in 6 patients and a lateral suboccipital approach in 7 patients. An endoscope was used with the operating microscope to remove 6 tumors through the anterior petrosal and/or pterional approaches in 5 cases and the lateral suboccipital approach in 1 case. An endoscope was used to confirm microscopic removal in 5 patients. Total removal was achieved in 5 patients and subtotal removal in 8 patients. We recommend the combined microsurgical and endoscopic approaches to achieve maximal resection of extensive suprasellar and prepontine epidermoids.
    View full abstract
    Download PDF (647K)
  • Xanthogranuloma of the Sellar Region of Children: Series of Five Cases and Literature Review
    Yuuta KAMOSHIMA, Yutaka SAWAMURA, Hiroaki MOTEGI, Kanako KUBOTA, Kiyoh ...
    Article type: Original Article
    2011 Volume 51 Issue 10 Pages 689-693
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.689
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Five Japanese children presented with rare xanthogranuloma located in the sellar region between 2000 and 2010 at the Department of Neurosurgery, Hokkaido University Hospital. Endocrinological examination disclosed central diabetes in four patients. Preoperative magnetic resonance (MR) imaging and computed tomography (CT) demonstrated clearly defined intra- or suprasellar masses appearing as isointense or hyperintense on T1-weighted MR imaging with no calcification on CT. The tumor was totally removed under preoperative diagnosis of craniopharyngioma in all cases. Histological examination found fibrous tissue with abundant cholesterol clefts and hemosiderin deposits, but no or only tiny amounts of epithelial cells in each case. Therefore, the histological diagnoses were xanthogranuloma of the sellar region, not adamantinomatous craniopharyngioma. Postoperatively, no patient recovered from endocrinological deficits, whereas visual disturbances were improved immediately after operation. Currently, whether xanthogranuloma is distinct from adamantinomatous craniopharyngioma remains unclear. Only a few clinical reports of xanthogranuloma of the sellar region have been reported in pediatric patients. Our series shows that xanthogranuloma should be included in the differential diagnosis of pediatric tumor of the sellar region.
    View full abstract
    Download PDF (1519K)
  • Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor
    Kyoji TSUDA, Eiichi ISHIKAWA, Alexander ZABORONOK, Kei NAKAI, Tetsuya ...
    Article type: Original Article
    2011 Volume 51 Issue 10 Pages 694-700
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.694
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    To evaluate the efficacy of intraparenchymal brain tumor biopsy using endoscopy and a navigation system (navigation-guided endoscopic biopsy) as a diagnostic tool, a case series of intraparenchymal tumor biopsies was reviewed. Navigation-guided endoscopic biopsy was applied in 9 cases, stereotactic needle biopsy in 16 cases, and open biopsy with or without navigation system in 34 cases. In all biopsy cases, 84.7% of biopsy points were sampled accurately, and 93.2% of diagnoses by biopsy were correct. Comparison of each type of biopsy showed that the resected volumes in navigation-guided endoscopic biopsy and open biopsy tended to be larger than those in stereotactic biopsy, and the mean operation time for the open biopsy procedure was the longest. To define the most applicable device or examination method to increase sampling accuracy, various factors were analyzed in 59 procedures. Navigation-guided endoscopic biopsy was the most accurate of the three types of biopsy, although the statistical difference was not significant. Older patients, histological diagnosis of high-grade glioma or malignant lymphoma, positive photodynamic diagnosis, and positive intraoperative pathology were significant factors in improving the sampling accuracy. Navigation-guided endoscopic biopsy could provide a larger sample volume within a relatively short operation time. The biopsy can be easily combined with both photodynamic diagnosis and intraoperative pathology, significantly improving the histological diagnostic yield.
    View full abstract
    Download PDF (334K)
  • Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation
    Jae Taek HONG, Tomoyuki TAKIGAWA, Keizo SUGISAKI, Alejandro A. Espinoz ...
    Article type: Original Article
    2011 Volume 51 Issue 10 Pages 701-706
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.701
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. Thirteen recently frozen cadaveric specimens were used. The occipital condyle anatomy and the hypoglossal canal dimension were measured using reconstructed computed tomography images. Insertion torque and pullout strength were evaluated to compare the midline occipital keel screw, C0-C1 transarticular screw, C1 lateral mass screw, and direct occipital condyle screw. The dimensions of the occipital condyle allow use of a 3.5 or 4.0-mm diameter screw. Mean pullout strength was 1619.6 N for the midline occipital keel screw, 870.7 N for the C0-C1 transarticular screw, 707.0 N for the C1 lateral mass screw, and 431.7 N for the direct occipital condyle screw. Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients.
    View full abstract
    Download PDF (243K)
Case Reports
  • Traumatic Longitudinal Clival Fracture in a Child
    —Case Report—
    Hajime ONO, Masashi UCHIDA, Yuichiro TANAKA, Katsuyuki TANAKA, Takuo H ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 707-710
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.707
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 7-year-old boy presented with a longitudinal clival fracture following a traffic accident. The boy presented only with temporary unconsciousness despite suffering a fracture of the clivus. Fractures of the clivus are often caused by severe head trauma, and the mortality rate is high due to coexisting injury of the adjacent vessels, brain stem, and lower cranial nerves. Review of the radiological and clinical findings of longitudinal clival fractures found that all reported pediatric patients with longitudinal clival fracture, including the present case, suffered an occipital impact, whereas the majority of longitudinal clival fractures in adults occur following frontal or axial impact.
    View full abstract
    Download PDF (295K)
  • Mobile Schwannoma of the Cauda Equina Incarcerated Following Caudal Migration After Trauma
    —Case Report—
    Manabu SASAKI, Masanori AOKI, Toshiki YOSHIMINE
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 710-712
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.710
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 56-year-old man presented with a very rare case of mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma, manifesting as attack of severe back pain and bilateral sciatica which developed just after a fall. Magnetic resonance imaging demonstrated a large intradural tumor at the L4-5 level with redundant nerve roots below that. Two days before the surgery, his pain unexpectedly lessened without additional treatment. Computed tomography showed that the tumor had migrated cranially and was now located at the L3-4 level. These findings suggest that the severe symptoms were caused by incarceration of a mobile tumor at the L4-5 level following the trauma. The tumor was successfully removed using minimally invasive procedures with guidance provided by the intraoperative myelography. The patient was relieved from pain postoperatively. The histological diagnosis was schwannoma. This case suggests that intraoperative myelography is a useful method for guiding the removal of mobile tumors.
    View full abstract
    Download PDF (247K)
  • Spontaneous Superficial Temporal Artery Pseudoaneurysm in Elderly Women
    —Three Case Reports—
    Kouhei NII, Masanori TSUTSUMI, Hiroshi AIKAWA, Masanari ONIZUKA, Kimiy ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 713-715
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.713
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    Three women older than 75 years presented with spontaneous superficial temporal artery (STA) pseudoaneurysms manifesting as a pulsatile mass in the preauricular region. None of the patients had a history of trauma. Histological examination of the surgically removed masses identified pseudoaneurysms based on the presence of connective tissue and adventitia. Spontaneous STA pseudoaneurysms are extremely rare. We suggest that all 3 aneurysms were associated with latent dissection and external force exerted by the frames of glasses.
    View full abstract
    Download PDF (2564K)
  • Endovascular Coil Embolization of a Ruptured Distal Anterior Choroidal Artery Aneurysm Associated With Ipsilateral Middle Cerebral Artery Occlusion
    —Case Report—
    Ayumi NISHIDA, Koji TOKUNAGA, Tomohito HISHIKAWA, Kenji SUGIU, Isao DA ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 716-719
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.716
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    An 84-year-old woman with a history of hypertension and a brain infarction presented with a rare distal anterior choroidal artery (AChoA) aneurysm not associated with moyamoya disease manifesting as sudden onset of headache caused by intraventricular hemorrhage. Digital subtraction angiography revealed a peripheral aneurysm in the left AChoA located distal to the plexal point and steno-occlusive changes of the proximal left middle cerebral artery (MCA) and the left posterior cerebral artery (PCA). Collateral arterial channels to the left MCA and left PCA territories were observed along the left AChoA. No neuroimaging findings were compatible with moyamoya disease. Since the aneurysm did not shrink at 2 months after the onset, endovascular treatment was indicated. Under local anesthesia, a microcatheter was placed into the AChoA proximal to the aneurysm with the aid of a 0.008-inch microguidewire. After a provocation test, three detachable platinum coils were delivered into the aneurysm and the parent artery. Complete obliteration of the aneurysm was achieved without additional neurological sequelae. Successful treatment of a ruptured distal AChoA aneurysm associated with atherosclerotic changes of the intracranial arteries was achieved using a meticulous endovascular technique.
    View full abstract
    Download PDF (428K)
  • Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography May Predict the Outcome in Patients With Asymptomatic Mild Stenosis of Internal Carotid Artery
    —Case Report—
    Hiroaki MOTEGI, Satoshi KURODA, Naoki NAKAYAMA, Kenji HIRATA, Tohru SH ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 720-723
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.720
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 47-year-old male presented with asymptomatic mild (45%) internal carotid artery (ICA) stenosis associated with familial hypercholesterolemia. Fluorine-18-fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) showed that the carotid plaque had high uptake of [18F]FDG on the initial scan. He was treated with antiplatelet agent, but subsequently developed retinal artery occlusion on the ipsilateral side. The patient safely underwent carotid endarterectomy (CEA). Histological examination revealed that the plaque was rich in lipids and activated macrophages. Previous large randomized clinical trials have clarified that CEA is an effective therapeutic option to reduce the risk for subsequent ischemic stroke in patients with severe (more than 70%) ICA stenosis. The case strongly suggests that [18F]FDG PET may be a useful modality to identify inflamed and/or vulnerable carotid plaque and may be useful to predict the risk for subsequent ischemic stroke even in patients with mild to moderate ICA stenosis (less than 70%).
    View full abstract
    Download PDF (3705K)
  • “Kissing” Brainstem Cavernous Angiomas Removed Using a Trans-Fourth Ventricular Floor Approach
    —Case Report—
    Takahiro MURATA, Tetsuyoshi HORIUCHI, Yoshiki HANAOKA, Hisashi MURAOKA ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 724-727
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.724
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 39-year-old woman presented with a rare case of “kissing” brainstem cavernomas formed by separate lesions enlarging with simultaneous recurrent hemorrhages, which was successfully treated by staged resection using a trans-fourth ventricular floor approach. She had a familial history of cerebral cavernous angioma, and presented with a history of four episodes of sudden neurological deterioration. Magnetic resonance (MR) imaging obtained at each neurological event demonstrated two distinct brainstem cavernomas located in the pontine tegmentum and ventral part of the lower pons, both of which enlarged stepwise caused by simultaneous recurrent hemorrhages. Both cavernomas contacted and formed “kissing” lesions. She underwent midline suboccipital craniotomy in the prone position. The cavernoma in the pontine tegmentum was resected through a trans-fourth ventricular floor approach. Although “kissing” formation appeared on preoperative MR imaging, parenchyma was identified at the bottom of the removal cavity of the dorsal lesion, and resection was terminated. MR imaging following the first surgery revealed complete resection of the pontine tegmentum cavernoma and the ventral pontine cavernoma, which was located adjacent to the bottom of the removal cavity and aligned in same direction along the fourth ventricular floor approach. At 10 days after first surgery, she underwent the same procedure with the aid of neuronavigation to resect the ventral pontine cavernoma through the former removal cavity. This approach through the previous removal route, particularly for resection of “kissing” lesions which are difficult to access in the brainstem, is a technically feasible microsurgical procedure.
    View full abstract
    Download PDF (209K)
  • Reactivation of Hepatitis B Virus After Glioblastoma Treatment With Temozolomide
    —Case Report—
    Makoto OHNO, Yoshitaka NARITA, Yasuji MIYAKITA, Hideki UENO, Takamasa ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 728-731
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.728
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 61-year-old man with glioblastoma and positive for hepatitis B surface antigen (HBsAg) developed acute hepatitis due to hepatitis B virus (HBV) reactivation after concomitant postoperative treatment with temozolomide (75 mg/m2/day) and radiation therapy (60 Gy in 30 fractions). Corticosteroids were not used during chemo-radiation therapy, and grade 4 lymphocytopenia was observed. The levels of liver function tests (LFTs), including levels of aspartate aminotransferase and alanine aminotransferase, increased 5 weeks after the completion of chemo-radiation therapy, and reached the maximum levels of 1,549 IU/l (normal 13 to 33 IU/l) and 1,653 IU/l (normal 8 to 42 IU/l), respectively, after 2 weeks. At this point, serum HBV-deoxyribonucleic acid (DNA) level had increased to 630-fold over the baseline, and therapy with the antivirus agent entecavir (0.5 mg daily) was started. Over the next 2 weeks, the levels of LFTs and HBV-DNA improved. The present and previous cases suggest that grade 3/4 lymphocytopenia or grade 2 lymphocytopenia with corticosteroid use might have a significant effect on HBV reactivation. To avoid this complication, HBsAg-positive patients with glioblastoma should consult a hepatologist for initiating antivirus therapy before temozolomide treatment.
    View full abstract
    Download PDF (310K)
  • Spinal Hemangioblastoma of Cauda Equina Origin Not Associated With Von Hippel-Lindau Syndrome
    —Case Report—
    Noritsugu KUNIHIRO, Toshihiro TAKAMI, Toru YAMAGATA, Naohiro TSUYUGUCH ...
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 732-735
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.732
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 50-year-old male presented with a rare case of hemangioblastoma of cauda equina origin, without clinical signs of von Hippel-Lindau syndrome, manifesting as pain radiating from the back to the left thigh. Magnetic resonance imaging before surgery revealed an intradural spinal tumor at the L3-L4 levels with serpentine flow voids of tortuous and convoluted vessels, which appeared to be continuous with the left L5 nerve root. Surgical removal of the tumor was successfully accomplished via the posterior unilateral approach, and the histological diagnosis was hemangioblastoma. Clinical symptoms resolved dramatically after surgery, although the patient developed mild dysesthesia of the left L5 area early after surgery which was gradually improved late after surgery.
    View full abstract
    Download PDF (2214K)
  • Parasitic Rachipagus Conjoined Twins With Spina Bifida, Diplomyelia, Scoliosis, Tethered Cord Syndrome, and Ventricular Septal Defect
    —Case Report—
    Jiayong ZHANG, Hongzhou DUAN, Yang ZHANG, Zhiqiang YI, Shengde BAO
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 736-739
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.736
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 17-year-old girl presented with a rare case of parasitic rachipagus conjoined twins associated with spina bifida, diplomyelia, scoliosis, tethered cord syndrome, and ventricular septal defect. Physical examination found a well developed breast and an apophysis on the back of the patient, and neuroimaging demonstrated scoliosis, spina bifida from T8 to L5, butterfly-shaped vertebra of T6, abnormal bone behind T7, diplomyelia, and tethered cord. Successful surgical excision of the parasitic mass was performed. Histological examination discovered uterine tube, Muller's duct, bone, cartilage, and nerve tissue besides the mammary gland. Rachipagus conjoined twins are extremely rare, but should be considered if well developed abnormal tissue is found in the dorsal midline of the spine. However, the possibility of malformations in other organs in the autosite should be considered. Careful preoperative examination and refined microsurgery may provide good outcome for the patient.
    View full abstract
    Download PDF (291K)
  • Rathke's Cleft Cyst With Xanthogranulomatous Change
    —Case Report—
    Yoshiteru MIYAJIMA, Hidehiro OKA, Satoshi UTSUKI, Kiyotaka FUJII
    Article type: Case Report
    2011 Volume 51 Issue 10 Pages 740-742
    Published: 2011
    Released on J-STAGE: October 25, 2011
    DOIhttps://doi.org/10.2176/nmc.51.740
    JOURNAL OPEN ACCESS
    Show abstractHide abstract
    A 58-year-old man presented with a rare case of Rathke's cleft cyst (RCC) manifesting as headache and visual disturbance. Goldman's perimeter showed he had bitemporal hemianopia. Magnetic resonance imaging revealed a solid intrasellar lesion. He underwent surgery via a right pterional approach. The lesion was red, solid, and fibrous. Histological examination revealed a few columnar epithelial cells with poor cilia in a xanthogranulomatous lesion. Only 13 cases of RCC with granulomatous change have been diagnosed by pathological examination, including 4 xanthogranulomatous cases. Xanthogranuloma of the sellar region is relatively rare. The etiology is still unknown. We speculate that xanthogranulomas of the sellar region may be caused by reaction to the presence of RCC.
    View full abstract
    Download PDF (220K)
Editorial Committee
    • |<
    • <
    • 1
    • >
    • >|
feedback
 Top