巻号一覧
51 巻, 12 号
選択された号の論文の16件中1～16を表示しています
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Original Articles
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Koichi ITO, Yutaka KAI, Akio HYODO, Shogo ISHIUCHI原稿種別: Original Article
2011 年 51 巻 12 号 p. 813-818
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスPercutaneous transluminal angioplasty (PTA) and stent placement are effective in patients with stenosis of the cavernous or petrous portion of the internal carotid artery (ICA), but the long-term outcomes remain unclear. The present study evaluated long-term outcomes in 54 patients treated by PTA or stent placement for stenotic lesions involving more than 50% of the cavernous or petrous portion of the ICA with ischemic symptoms or without ischemic symptoms if cerebral blood flow on single photon emission computed tomography images was decreased by 20% compared with the contralateral side. Follow-up magnetic resonance, three-dimensional computed tomography, and conventional angiography were performed. Patient condition in the follow-up period was investigated using telephone interviews or questionnaires. PTA was used to treat 13 lesions and stent placement for 41 lesions. Permanent and transient complications occurred in 2 and 5 patients, respectively. The morbidity rate was 13% (7 of 54 patients). The follow-up period ranged from 3 to 80 months (mean 29.9 months), and restenosis and occlusion were recognized in 4 patients (7.4%). Five patients died (2 of malignancy and 3 of myocardial infarction) during the follow-up period. PTA and stent placement are safe and effective in patients with stenosis of the cavernous or petrous portion of the ICA, and result in low long-term rates of restenosis.
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Keishi FUJITA, Yoji KOMATSU, Naoaki SATO, Osamu HIGUCHI, Yuji KUJIRAOK ...原稿種別: Original Article
2011 年 51 巻 12 号 p. 819-824
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスProgressive stroke is a serious problem due to the associated morbidity and mortality. Aspirin is recommended for acute ischemic stroke, but does not reduce the frequency of stroke progression. No standard treatment has been approved for the prevention of stroke progression. Cilostazol, which reduces platelet aggregation about 3 hours after single administration, does not increase the frequency of bleeding events when compared with aspirin or a placebo. Moreover, the combination of 100 mg aspirin and 200 mg cilostazol does not increase the frequency of bleeding events compared with only 100 mg aspirin, and thus is expected to prevent stroke progression with a high degree of safety. The present study investigated the safety of this combination of two drugs administered at the above concentrations in 54 patients with acute ischemic stroke within 48 hours of stroke onset. Modified National Institutes of Health Stroke Scale (NIHSS) measurements were performed at baseline and again on day 4 to 7. Progressive stroke was defined as an increase greater than or equal to 1 point on NIHSS. Patient scores on the modified Rankin Scale (mRS) were evaluated at baseline and 3 months after enrollment. Stroke progression occurred in 11.1% of the patients. The percentages of patients with mRS score from 0 to 2 were 42.6% and 75% at baseline and 3 months, respectively. No symptomatic intracranial hemorrhage or major extracranial hemorrhage occurred. These results suggest that administration of aspirin and cilostazol is safe for acute ischemic stroke.
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Hirofumi OYAMA, Akira KITO, Hideki MAKI, Kenichi HATTORI, Tomoyuki NOD ...原稿種別: Original Article
2011 年 51 巻 12 号 p. 825-828
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスThe characteristics of 90 cases of acute subdural hematoma were analyzed in 25 patients taking medication related to bleeding tendency, the bleeding tendency group, and 65 patients without such medication, the control group. Acute subdural hematoma was significantly associated with over-turning or without accident in the bleeding tendency group (92%) compared with the control group (56.9%). The time from trauma to admission was significantly longer in the bleeding tendency group (32.7 hours) compared with the control group (9.7 hours). The mean Glasgow Coma Scale score on admission was 13.0 points in the bleeding tendency group and was significantly better than 10.9 points in the control group. The international normalized ratio of prothrombin time on admission was 3.59 in the patients treated with warfarin. All patients taking warfarin received reversal agents and this value decreased significantly to 1.38. In the bleeding tendency group, hematoma size increased in 20% after the operation, almost the same as in the control group (25%). Although good recovery tended to be observed less frequently in the bleeding tendency group than in the control group, the mean age of the bleeding tendency group was significantly higher than that of the control group, so the prognosis might be affected by this age-related factor. Cautious diagnosis, follow-up imaging, and strict management are mandatory in patients with bleeding tendency.
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Toshiyuki TAKAHASHI, Junya HANAKITA, Manabu MINAMI, Yoshihiro KITAHAMA ...原稿種別: Original Article
2011 年 51 巻 12 号 p. 829-835
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスTransforaminal lumbar interbody fusion (TLIF) procedure is widely used, but the surgical indications for TLIF in elderly patients remain controversial because of potential risks such as inferior bone quality and higher rate of postoperative complications. Clinical efficacy and operative risk of TLIF in elderly patients are unclear. This study investigated the clinical effect and safety of TLIF for lumbar degenerative spondylolisthesis with radiculopathy or neurogenic claudication in patients aged 70 years or older. The clinical records were retrospectively reviewed of 35 consecutive patients aged 70-86 years (mean 74.8 years) who underwent one or two-level TLIF. The preoperative diagnosis included degenerative spondylolisthesis with segmental instability. Clinical outcomes were assessed by the Japanese Orthopaedic Association score, visual analogue scale, Oswestry Disability Index. Radiological fusion rate was also investigated. Clinical and radiological results were compared with those of 43 younger patients. Clinical outcome measures were significantly improved after operation in the elderly patients, but improvement rates were significantly lower than those of younger patients. Fusion rate was similar in both groups. Overall postoperative complications were increased in aged patients, although the prevalence of complications directly related to surgical technique was not significantly increased. Postoperative complications not related to the surgical procedure were factors affecting poor results. TLIF is acceptable for achieving clinical recovery and lumbar fusion with high radiographic fusion success even in elderly patients, although clinical benefits were limited compared with those of younger patients. Postoperative morbidity was mainly related to general or non-operative site complications.
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Case Reports
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—Case Report—Shinya SONOBE, Miki FUJIMURA, Hidenori ENDO, Takashi INOUE, Hiroaki SH ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 836-838
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 61-year-old woman presented with aneurysmal subarachnoid hemorrhage (SAH) associated with multiple remote intracerebral hemorrhages (ICHs). She had undergone microsurgical neck clipping for ruptured right middle cerebral artery aneurysm and ventriculo-peritoneal shunting 16 years previously. Computed tomography revealed SAH predominantly in the basal cistern and ambient cistern, in association with multiple ICHs in the bilateral tegmentum of the brain stem and right caudate nucleus. Digital subtraction angiography revealed an aneurysm at the P1 segment of the left posterior cerebral artery. The ruptured aneurysm was microsurgically clipped via a left subtemporal approach without complications. Simultaneous occurrence of aneurysmal SAH and multiple remote ICHs is rare. The spatial pattern of the ICHs in the present case is apparently unique.
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—Case Report—Kazuhito MATSUZAKI, Masaaki UNO, Toshitaka FUJIHARA, Takeshi MIYAMOTO, ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 839-842
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 48-year-old man presented with an extremely rare aneurysm arising from an accessory anterior cerebral artery (ACA) manifesting as sudden onset of headache lasting for 5 days. Neurological examination on admission revealed no abnormalities. Computed tomography showed subarachnoid hemorrhage of the interhemispheric fissure and intraparenchymal hematoma of the left cingulate gyrus. Magnetic resonance and cerebral angiography revealed a saccular aneurysm of the distal portion of the accessory ACA classified as the bihemispheric type. Neck clipping of the aneurysm was performed via an interhemispheric approach 17 days after symptom onset. The patient made a good postoperative recovery without neurological deficit. Distal accessory ACA aneurysms tend to arise from the first bifurcation and supply parietal branches. The aneurysms tend to occur on the bihemispheric type of distal accessory ACA. Hemodynamic stress may contribute to formation or development of these aneurysms.
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—Case Report—Hiroshi YOKOTA, Shinya SUGIURA, Yuki IDA, Hiroo ITOH原稿種別: Case Report
2011 年 51 巻 12 号 p. 842-846
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 90-year-old woman presented with aneurysmal subarachnoid hemorrhage (SAH) corresponding to Hunt and Hess grade II. Acute congestive heart failure and pulmonary edema developed following uneventful surgical clipping. Serial electrocardiography and echocardiography led to a diagnosis of neurogenic stress cardiomyopathy (NSC), also known as tako-tsubo cardiomyopathy. The outcome was favorable after supportive therapy with respiratory management and diuretic administration. Neurosurgeons treating SAH must take into account the various general treatment strategy options on a case by case basis after prompt recognition of NSC.
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—Case Report—Hiroyuki TOI, Shunji MATSUBARA, Shigeru WATANABE, Takenori YAMASHITA, ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 846-849
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 60-year-old man presented with paraspinal arteriovenous fistula (AVF) manifesting as subarachnoid hemorrhage (SAH) and acute progressive myelopathy. The patient presented with sudden onset of low back pain and paraparesis. Spinal magnetic resonance imaging revealed a vascular malformation on the lumbar spinal canal. Three-dimensional computed tomography angiography demonstrated a paraspinal AVF in the sacral ventral pelvis. The clinical symptoms were progressing rapidly, so transarterial embolization and surgical drainage ligation were performed. Paraspinal AVF may present with SAH and cause acute progressive myelopathy. Prompt examination and treatment are necessary.
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—Case Report—Mineko MURAKAMI, Takeshi UNO, Hiroshi NAKAGUCHI, Shoko M. YAMADA, Kats ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 850-854
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 52-year-old man presented with a rare case of isolated recurrence of myeloid sarcoma (MS) manifesting as rapidly growing intracranial and temporal bone masses 5 years after complete remission (CR) of acute myeloid leukemia (AML) (M2 in the French-American-British classification). Magnetic resonance imaging and computed tomography of the head revealed enhanced mass lesions on the superior aspect of the right petrous bone and within the right mastoid air cells, extending into the right middle ear cavity without bone destruction. Peripheral blood testing found no evidence of relapse. As the right temporal bone mass showed significant growth into the right temporal lobe over one month and diagnostic tissue was not available, he was admitted to our department for biopsy. On admission, blood testing showed relapse of AML and tumoral hemorrhage in the right temporal lobe. Emergent evacuation of the hematoma and biopsy of the right temporal lobe tumor was performed, resulting in a diagnosis of MS. Chromosomal analysis of the peripheral blood identified t(8;21)(q22;q22) abnormality. Before initiation of anti-AML chemotherapy, tumoral bleeding occurred again and he died 12 days after the operation of brain herniation. Autopsy revealed leukemia cell infiltrations in the perivascular region of the peritumoral brain parenchyma associated with hemorrhage, indicating vascular damage caused by leukemic cell infiltration from MS induced cerebral hemorrhage. Although relapse after 5 years of CR is uncommon in patients with AML, the possibility of MS recurrence must be considered.
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—Case Report—Kohei CHIDA, Hirotsugu YUKAWA, Tomohiko MASE, Hideo ENDO, Kuniaki OGAS ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 854-856
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 4-month-old girl fell off a table onto the floor. Computed tomography performed 4 hours after the trauma showed a left parietal epidural hematoma (EDH) with an omega-shaped fracture line in the left parietal region. The EDH was enlarged after another 4 hours. However, the EDH showed drainage into the subgaleal space through the skull fracture 2 days after the trauma and was almost completely discharged into the subgaleal space by 5 days after trauma. Both the EDH and the subgaleal hematoma had resolved completely by 12 days after the trauma. No symptoms or signs were observed during the course. This case suggests that EDH can drain slowly and spontaneously into the subgaleal space through a skull fracture in an infant.
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—Case Report—Yoshiaki SAKAMOTO, Hideo NAKAJIMA, Ikkei TAMADA, Kazuo KISHI, Takeshi ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 857-860
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 10-year-old girl presented with facial asymmetry associated with bulging of the right fronto-orbital region with no symptoms. Computed tomography demonstrated enlargement of the right zygomatic, frontal, ethmoid, and sphenoid bones. Abnormal proliferation of the bone had obliterated the sphenoid, right frontal sinus, and right ethmoid sinuses. These radiological findings suggested right optic nerve compression due to fibrous dysplasia. Right optic canal decompression was performed. In preparation for recurrence, the resulting bone defect in the right orbital roof was reconstructed using the outer table of the split lesion bone. The removed frontal bone was divided into intact and lesioned parts, and the intact part was returned. The lesioned part was split and the outer table graft used to reconstruct the frontal region. A temporal musculopericranial flap was used to form a barrier between the opened ethmoid sinus and cranial cavity. A protrusion appeared on the left forehead 10 years later, and was shaved to improve the aesthetic appearance. The patient was followed up for a total of 23 years. The use of dysplastic bone involves the risk of recurrence, but the period of recurrence is delayed and the progression stops after adolescence, so the second operation involved only shaving for aesthetic appearance. This procedure is one of the treatments of choice because of easy reconstruction, easy revision, and good results.
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—Case Report—Toshikazu KIMURA, Kazuo TSUTSUMI, Akio MORITA原稿種別: Case Report
2011 年 51 巻 12 号 p. 861-862
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 57-year-old man presented with recurrent parasagittal anaplastic meningioma of frontoparietal region. The tumor was extensively removed, and the dura was repaired with Gore-Tex surgical membrane. After the operation, subcutaneous cerebrospinal fluid (CSF) collection was observed in the fronto-parietal area and a lumboperitoneal shunt was placed. Four weeks after the shunt procedure, he complained of right scrotal swelling and recurrence of the CSF collection. Radiography revealed the coiled catheter in the scrotum. The catheter was surgically removed through a small incision in the skin of the scrotum under local anesthesia. Lumboperitoneal shunt is a simple and useful procedure to control CSF pressure, but catheter migration has been reported in infants and children. Shunt catheter can migrate into the scrotum even in an adult, as the vaginal process, through which the catheter seemed to have entered the scrotum, is patent in 5% of the adult population. In these cases, direct removal through a small incision is appropriate to remove the catheter.
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—Case Report—Kiyoshi ITO, Tetsuro AOYAMA, Takashi KIUCHI, Maki OKADA, Kohei KANAYA, ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 863-866
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 14-year-old girl who presented with an endodermal cyst manifesting as severe neck and shoulder pain along with vesicorectal disturbances. Cervical magnetic resonance imaging showed a slightly enhanced intradural cyst at the C6-7 level in the ventral side of the spinal canal, with significant dorsal shortening and thinning of the spinal cord. Anterior corpectomy was chosen because of the dorsal effacement of the spinal cord. The cyst wall was subtotally removed to avoid damage to the normal spinal cord. After cyst removal, the iliac bone and an anterior cervical plate were used for anterior fusion. Postoperatively, her pain subsided without neurological deficits. The histological diagnosis was endodermal cyst. The cyst did not recur during a follow-up period of 18 months. Endodermal cysts are rare congenital lesions of the spine lined by endodermal epithelium. The natural history of this lesion is unclear, and the surgical strategy for the approach route and the extent of removal of the cyst wall remain controversial. We suggest that the anterior approach may allow a safer and more effective surgical route for the treatment of ventrally located endodermal cyst compared to the posterior approach.
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—Case Report—Hiroaki MATSUMOTO, Shigeo MATSUMOTO, Takanori MIKI, Yuki MIYAJI, Hiroa ...原稿種別: Case Report
2011 年 51 巻 12 号 p. 867-871
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスA 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.
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Technical Note
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—Technical Note—Nobuhisa MATSUMURA, Takashi SHIBATA, Hironaga KAMIYAMA, Takahiro TOMIT ...原稿種別: Technical Note
2011 年 51 巻 12 号 p. 872-874
発行日: 2011年
公開日: 2011/12/25
ジャーナル オープンアクセスDonor artery dissection is a known cause of technical failure in microvascular anastomosis. A method for detection and direct repair of donor artery dissection before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is described using a high magnification operating microscope (maximum 50.4× magnification). Before STA-MCA anastomosis, the stump of the STA is stained using methylrosaniline chloride (pyoctaninum blue) and is observed under higher magnifications. Microsurgical suturing of the arterial dissection is performed before the anastomosis procedure under the high magnification microscope. This method was used in two patients with symptomatic hemodynamic cerebrovascular occlusive disease. Postoperative angiography revealed good patency and no complications occurred. This method may be useful for detection and direct repair of arterial dissection in small vessel walls before STA-MCA anastomosis.
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Editorial Committee
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2011 年 51 巻 12 号 p. EC23-EC24
発行日: 2011年
公開日: 2013/02/20
ジャーナル オープンアクセスPDF形式でダウンロード (54K)
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