巻号一覧
51 巻, 4 号
選択された号の論文の16件中1～16を表示しています
- |<
- <
- 1
- >
- >|
Original Articles
-
Shoji YOKOBORI, Akihiro WATANABE, Gaku MATSUMOTO, Hidetaka ONDA, Tomoh ...原稿種別: Original Article
2011 年 51 巻 4 号 p. 265-271
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスAge may be an independent predictor of outcomes in traumatic brain injury (TBI), but the causes of the poor outcomes in elderly patients remain unclear. To clarify the differences between elderly and young patients with TBI, brain metabolism parameters were monitored with the microdialysis method in 30 patients with severe TBI (Glasgow Coma Scale scores 3-8). The microdialysis probe was inserted in the penumbra area of the brain and extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate were measured hourly for the initial 168 hours (7 days) after operation. The lactate/pyruvate ratio, which is considered to be a good indicator of neuronal ischemia, was also calculated. The patients were divided into the elderly group aged 65 years or older and the young group aged less than 65 years, and the biochemical markers were compared daily between these two groups. The value of extracellular glucose concentration was significantly lower in the elderly group than in the young group, and continued until the 7th day after injury. Moreover, the lactate/pyruvate ratio peaked on the 5th day after injury in the elderly group, later than in the young group. We concluded that neural vulnerability persisted longer in elderly patients than in young patients with TBI, and this should be considered to prevent the occurrence of additional secondary brain injury.
抄録全体を表示PDF形式でダウンロード (236K) -
Kuniaki NAKAHARA, Satoru SHIMIZU, Takao KITAHARA, Hidehiro OKA, Satosh ...原稿種別: Original Article
2011 年 51 巻 4 号 p. 272-274
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスComputed tomography (CT) is now widely used as the only screening method for fractures in patients with head injury. However, clear depiction of a fracture requires a discontinuity in the skull, so linear fractures parallel to the CT slice may not be visualized. We retrospectively evaluated 302 patients with minor head injuries aged from 0 to 91 years, who had undergone routine skull radiography (anteroposterior and lateral views) and head CT to study these types of fracture and discuss the risk of nondetection. Three patients had linear fractures (0.99%) that were invisible on bone window axial CT but detected on skull radiography, which all ran parallel to the scan slice. Two patients developed acute epidural hematoma or traumatic subarachnoid hemorrhage. Evaluation of head injury by only axial CT may miss such fractures and result in sequelae, so diagnosticians should be alert to the possible presence of this type of fracture.
抄録全体を表示PDF形式でダウンロード (249K) -
Shihomi TAKADA, Takashi INOUE, Kuniyasu NIIZUMA, Hiroaki SHIMIZU, Teij ...原稿種別: Original Article
2011 年 51 巻 4 号 p. 275-281
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスPrevious bleeding from a cerebral aneurysm indicates a higher risk of rupture. Hemosiderin may be detected during aneurysm surgery or by preoperative imaging sensitive to hemosiderin. The detection of hemosiderin deposits by T2*-weighted magnetic resonance (MR) imaging was evaluated in 49 patients with unruptured cerebral aneurysms who underwent open surgery. MR imaging was performed using 3.0 tesla MR scanner. Two sequences of T2*-weighted imaging, and proton density images were obtained. Preliminary study in patients with old subarachnoid hemorrhage provided the definitions of likely pathological findings during surgery and on T2*-weighted imaging due to previous hemorrhage. Hemosiderin deposits in the subarachnoid space were observed during surgery in 9 of the 49 patients, although no obvious rupture site was detected around the aneurysm wall. Size, presence of bleb, location, and number of aneurysms showed no significant difference between patients with and without hemosiderin deposition. Hypointense areas on T2*-weighted imaging were recognized in four patients. The mean size of the aneurysms in these patients was 9.8 mm, significantly larger than those in other patients (p = 0.029). Hemosiderin deposits were observed during surgery in sites close to the lesions on T2*-weighted imaging in two of these four patients. Hemosiderin deposits are not rare in patients with unruptured aneurysms, and preoperative T2*-weighted imaging can detect such deposits.
抄録全体を表示PDF形式でダウンロード (607K) -
Masaki WATANABE, Takahisa MORI, Keisuke IMAI, Hajime IZUMOTO原稿種別: Original Article
2011 年 51 巻 4 号 p. 282-288
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスThe efficacy of endovascular interventions based on magnetic resonance (MR) imaging for acute ischemic stroke caused by embolic carotid T occlusion was assessed. Endovascular intervention was performed in 10 of 751 consecutive acute ischemic stroke patients admitted to our institution between April 2001 and July 2003. Indications were: presentation within 6 hours of onset of cardioembolic stroke; National Institute of Health Stroke Scale (NIHSS) score ≥10 on admission; absence of extensive signal hyperintensity on diffusion-weighted imaging; and carotid T occlusion on angiography. Localized intra-arterial thrombolysis using urokinase and/or mechanical clot disruption using micro-balloon catheter were performed. Radiographic findings, ΔNIHSS defined as NIHSS on day 7 − NIHSS on admission, 3-month modified Rankin scale (mRS), 3-month mortality, and symptomatic intracranial hemorrhage (ICH) were evaluated. Partial recanalization was achieved in 5 of 10 patients, but no recanalization was obtained in 5 patients. No significant differences in 3-month mRS (0-2) or symptomatic ICH were identified between these groups. However, the partial recanalization group showed significantly better clinical outcomes (median 3-month mRS 3 vs. 6, p = 0.009) and lower mortality rate at 90 days (0% vs. 80%, p = 0.047) with significantly greater ΔNIHSS (−8 vs. +6, p = 0.009). Endovascular intervention based on MR imaging resulting in partial recanalization may reduce poor outcomes and mortality in patients with embolic carotid T occlusion. Improvement of the outcomes of such patients requires more efficient methods such as clot retrieval therapy.
抄録全体を表示PDF形式でダウンロード (216K)
Case Reports
-
—Case Report—Ryuzaburo KANAZAWA, Shoichiro ISHIHARA, Hiroaki NEKI, Mai OKAWARA, Hid ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 289-292
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 44-year-old man presented with traumatic aneurysm of the left ophthalmic artery. The first coil embolization intervention achieved relatively tight packing of the aneurysm and the parent artery. After 5 months, a second embolization procedure was required because of recurrence of the aneurysm with transition of the intraaneurysmal coil formation. No recurrence occurred after the second embolization. We thought that the first embolization might have prevented catastrophic rupture, whereas the second embolization resulted in complete obliteration of the aneurysm. No entity of the aneurysmal wall formation of the current traumatic aneurysm in the acute stage may have resulted in the recanalization of the aneurysm followed by the second intervention. The stability of the wall in the chronic stage may correlate with the complete obliteration.
抄録全体を表示PDF形式でダウンロード (245K) -
—Case Report—Fuminari KOMATSU, Naoki WAKUTA, Mika KOMATSU, Mitsutoshi IWAASA, Tooru ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 293-295
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 57-year-old female presented with a left putaminal hemorrhage, intraventricular hematoma (IVH), and acute obstructive hydrocephalus. Neuroendoscopic surgery was performed for the IVH. Three days after successful IVH removal and improvement of her consciousness, the patient lapsed into a comatose state due to hydrocephalus caused by obstruction of the mesencephalic aqueduct by a small remnant clot. The small clot was identified by constructive interference with steady state magnetic resonance imaging and was removed during a second-look operation. Even after the cerebrospinal fluid circulation improves following neuroendoscopic surgery for IVH, the patient may nevertheless develop a life-threatening condition without warning signs in the subacute phase. Awareness of this complication will lead to early diagnosis and correct management.
抄録全体を表示PDF形式でダウンロード (299K) -
—Case Report—Yasuo MURAI, Koji ADACHI, Kenta KOKETSU, Akira TERAMOTO原稿種別: Case Report
2011 年 51 巻 4 号 p. 296-298
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスThe intraoperative findings of an indocyanine green videoangiography (ICG-VAG) study of a cavernous angioma located in the optic chiasm are reported. A 23-year-old Japanese man suddenly developed visual field loss, and magnetic resonance imaging suggested the presence of a suprasellar tumor in contact with the optic chiasm. Preoperative angiography did not clearly show any tumor shadow. Right fronto-temporal craniotomy was performed, and an aggregation of blood vessels was seen on the right surface of the optic chiasm. Cavernous angioma was suspected. ICG-VAG was begun 22 seconds after the beginning of contrast agent infusion via a peripheral blood vessel. The lesion remained unstained, although the brain surface, an artery superior to the optic nerve, and veins were visualized. The cavernous angioma was resected following surface coagulation. ICG-VAG is currently being evaluated for future application in the differential diagnosis based on imaging findings, and the present case provides an important example of intraoperative ICG-VAG imaging of an unoperated cavernous angioma.
抄録全体を表示PDF形式でダウンロード (141K) -
—Case Report—Shigeo OHBA, Satoshi ONOZUKA, Takashi HORIGUCHI, Takeshi KAWASE, Kazun ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 299-301
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスPerimedullary arteriovenous fistulas (AVFs) at the craniocervical junction are uncommon, and are often fed by the anterior spinal artery, with only a few cases fed by the intradural vertebral artery (VA). A 55-year-old man presented with a case of perimedullary AVF fed by the VA at the craniocervical junction manifesting as subarachnoid hemorrhage. Left vertebral angiography demonstrated an AVF supplied by branches from the VA. Three-dimensional computed tomography angiography (3D-CTA) revealed that the feeding arteries originated from the VA at the intradural position. Two feeding arteries were coagulated and dissected, followed by coagulation of a small feeder. The draining veins became discolored and shrank. 3D-CTA performed 2 months after the operation revealed disappearance of the AVF. Open surgery was successfully performed for the almost perimedullary AVF at the craniocervical junction, and is considered to be preferable for the treatment of this disease.
抄録全体を表示PDF形式でダウンロード (213K) -
—Case Report—Tomohiro KAWAGUCHI, Yoshikazu OGAWA, Takashi INOUE, Teiji TOMINAGA原稿種別: Case Report
2011 年 51 巻 4 号 p. 302-305
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 59-year-old woman presented with bacterial meningitis causing arterial narrowing in the very late stage. She initially underwent transsphenoidal surgery for massive non-functioning pituitary adenoma resulting in gross total removal. The postoperative course was uneventful, and she was discharged 12 days after surgery. Fourteen months later, she presented with bacterial meningitis due to streptococcus. Administration of multiple antibiotics resulted in normalization of cerebrospinal fluid findings. Forty days after meningitis onset, she suddenly suffered motor weakness of the right extremities. Magnetic resonance (MR) angiography revealed multiple intracranial arterial narrowings. Despite intensive treatment, no improvement of arterial narrowing was seen, and she suffered cerebral infarction. Six months after the onset of meningitis, MR angiography still showed multiple arterial narrowings, and MR plaque imaging of the stenotic vessel disclosed thickened arterial wall. This case illustrates the complex time course of arteritis caused by severe bacterial meningitis, and the intractability to treatment.
抄録全体を表示PDF形式でダウンロード (280K) -
—Case Report—Yasuo SASAGAWA, Takuya AKAI, Shoutarou ITOU, Hideaki IIZUKA原稿種別: Case Report
2011 年 51 巻 4 号 p. 306-310
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 52-year-old man underwent resection of an oligodendroglioma in the left frontal lobe, followed by chemoradiation therapy in 1989. He presented with a de novo aneurysm arising from the feeding artery of a recurrent malignant glioma in 2009. Serial follow-up magnetic resonance imaging showed no tumor progression until 19 years after the initial diagnosis. Angiography revealed an intratumoral aneurysm of the dilated feeding artery. The recurrent tumor was resected together with the aneurysm. Histological examination revealed that the tumor was an anaplastic oligodendroglioma, and the aneurysm was encased in the tumor. Clinicians should carefully look for tumor recurrence and aneurysm formation during follow up of patients treated for malignant glioma.
抄録全体を表示PDF形式でダウンロード (405K) -
—Case Report—Satoshi HORIGUCHI, Koichi MITSUYA, Reiko WATANABE, Saburo YAGISHITA, Y ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 310-314
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 32-year-old man with familial neurofibromatosis type 1 presented with a rare case of coexisting pleomorphic xanthoastrocytoma (PXA) and moyamoya disease manifesting as progressive right hemiparesis. Magnetic resonance (MR) imaging with gadolinium showed an enhanced mass lesion in the left basal ganglia extending to the left parietal lobe. Preoperative angiography showed severe stenosis of the bilateral internal carotid arteries, and moyamoya vessels. The patient underwent open biopsy. Histological examination showed the characteristic findings of PXA. After radiation therapy and chemotherapy, MR imaging showed decreased size and enhancement of the tumor, but his clinical condition worsened with generalized convulsions and consciousness disturbance. He died 1 year and 6 months after the first presentation. Autopsy findings demonstrated necrosis in the main mass and tumor cell dissemination without anaplastic change. The rare combination of PXA and moyamoya disease in the basal ganglia limited treatment options. Injured moyamoya vessels and ischemic condition might have caused tumor progression and dissemination. Radiation therapy, in combination with moyamoya disease, induced decreased cerebral blood flow (CBF) in the left frontal lobe. Tumor dissemination, CBF decrease, and hydrocephalus led to the clinical deterioration of this patient.
抄録全体を表示PDF形式でダウンロード (406K) -
—Case Report—Kyoji TSUDA, Eiichi ISHIKAWA, Atsushi SAITO, Kaishi SATOMI, Akiko SAKA ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 315-318
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 70-year-old woman with neurofibromatosis type 1 (NF-1) presented with a primary cerebellar pilocytic astrocytoma (PA) with anaplastic features manifesting as worsening headache and ataxia. Magnetic resonance (MR) imaging on admission showed a diffusely enhanced solid mass in the left cerebellar hemisphere, although MR imaging showed no abnormalities 2 years before admission. Histological examination after gross total removal of the tumor exhibited a biphasic pattern with marked Rosenthal fibers, together with some malignant features including frequent mitoses and invasive growth pattern. The final diagnosis was PA with anaplastic features. Previous PA cases with mitotic activity and endothelial proliferation, and/or palisading necrosis have been classified as anaplastic PA (or PA with anaplastic features). In the present case, the tumor histology corresponded to this designation. The present case indicates that PAs with anaplastic features can occur in patients with NF-1.
抄録全体を表示PDF形式でダウンロード (596K) -
—Three Case Reports—Noriaki SAKAMOTO, Eiichi ISHIKAWA, Tetsuya YAMAMOTO, Kaishi SATOMI, Ke ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 319-325
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスTemozolomide (TMZ), an alkylating agent widely used for patients with glioblastoma multiforme (GBM), has the potential to enhance the acquired immune response to GBM. Here, we describe 3 cases of GBM patients treated with autologous formalin-fixed tumor vaccine (AFTV) combined with TMZ. All cases demonstrated pathological changes associated with the therapy. After a 4-week break from the standard initial treatments, 1 patient with primary GBM and 2 patients with secondary GBM received adjuvant TMZ for 5 days combined with AFTV injection and were subsequently treated with multiple cycles of adjuvant TMZ for 5 days every 28 days (AFTV/TMZ therapy). Adverse effects related to AFTV plus TMZ were very minor in all patients. Magnetic resonance imaging revealed partial response in 2 patients. CD3+CD8+ lymphocytes were frequently detected in surgical specimens and MIB-1 labeling index in 2 cases decreased after AFTV/TMZ therapy. AFTV/TMZ therapy is suitable for larger scale clinical trials.
抄録全体を表示PDF形式でダウンロード (558K) -
—Case Report—Takao YASUHARA, Tomotsugu ICHIKAWA, Yasuyuki MIYOSHI, Kazuhiko KUROZUM ...原稿種別: Case Report
2011 年 51 巻 4 号 p. 326-329
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスA 27-year-old woman presented with a case of primary medulla oblongata germinoma manifesting as sleep apnea, aspiration pneumonia, and left hemiparesis. Magnetic resonance (MR) imaging revealed a dorsal mass in the medulla oblongata with heterogeneous enhancement by gadolinium (Gd). Emergent biopsy and foramen magnum decompression with C1 laminectomy were performed because of rapid worsening of her symptoms. The histological diagnosis was germinoma. Subsequently she received chemoradiation therapy with subsequent amelioration of her neurological deficits and disappearance of enhancement on MR imaging with Gd. Primary medulla oblongata germinoma is rare and difficult to diagnose preoperatively. However, correct diagnosis and subsequent adequate chemoradiation therapy is possible by understanding the common characteristics of the disease. Germinoma should be included in the differential diagnosis of midline medullary lesion in young patients, and biopsy should be considered.
抄録全体を表示PDF形式でダウンロード (362K)
Technical Note
-
—Technical Note—Shingo TOYOTA, Nobuyuki OHARA, Fuminori IWAMOTO, Akatsuki WAKAYAMA, To ...原稿種別: Technical Note
2011 年 51 巻 4 号 p. 330-332
発行日: 2011年
公開日: 2011/04/25
ジャーナル オープンアクセスDetection of the position of the microcatheter tip is important for safe and effective coil embolization of cerebral aneurysms, but is sometimes difficult, especially in the final stage with a high density of embolized coils. We report a new technique to deduce the position of the microcatheter tip using a novel microguidewire during coil embolization of cerebral aneurysms. The novel microguidewire (ASAHI CHIKAI 10; Asahi Intecc, Nagoya, Aichi), with a radiopaque portion of 30 mm, is advanced into the microcatheter until the distal end of the radiopaque portion reaches the coil mass edge at the neck of the aneurysm. The distance between the second marker of the microcatheter and the proximal end of the radiopaque portion of the microguidewire is checked. The position of the microcatheter tip is deduced from the distance and curve of the microguidewire. Microcatheter tips can be easily detected with this technique without complications. This technique is safe, simple, and useful for deducing the position of the microcatheter tip during coil embolization of cerebral aneurysms.
抄録全体を表示PDF形式でダウンロード (150K)
Editorial Committee
-
2011 年 51 巻 4 号 p. EC7-EC8
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 (55K)
- |<
- <
- 1
- >
- >|