Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 51, Issue 5
Displaying 1-17 of 17 articles from this issue
Obituary
Original Articles
  • Hiroyasu KOIZUMI, Hirosuke FUJISAWA, Eiichi SUEHIRO, Satoshi SHIRAO, M ...
    Article type: Original Article
    2011 Volume 51 Issue 5 Pages 337-343
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    Ebselen is a mimic of glutathione peroxidase that reacts with peroxynitrite and inhibits nitric oxide (NO) synthase. Ebselen has beneficial effects on the neurological outcome of patients with stroke. In this study, the mechanisms by which ebselen can elicit neuroprotective effects against ischemic brain injury were investigated in male Wistar rats. Experimental forebrain ischemia was induced by bilateral common carotid artery occlusion with hemorrhagic hypotension. Ebselen was administered to animals in the treatment group 2 hours prior to the induction of forebrain ischemia, and placebo was administered in the control group. Cerebral blood flow (CBF) was measured by the hydrogen clearance method. Cortical extracellular levels of excitatory amino acids (EAAs) and NO were evaluated using in vivo microdialysis. Neuronal damage in the CA1 subfield of the hippocampus was assessed in brains harvested after a 24-hour period of survival. CBF did not recover to normal physiological levels after ischemic insults in either the control or treatment groups. The differences in the sequential changes in extracellular EAA and NO levels between groups were not statistically significant. There was a significantly larger mean density of intact, undamaged neurons in the CA1 subfield in the treatment group than in the control group. The neuroprotective effects of ebselen were reflected in the histological findings, without significant inhibition of glutamate release or NO synthesis during the acute phase of experimentally induced cerebral ischemia.
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  • Taketoshi MAEHARA, Kikuo OHNO
    Article type: Original Article
    2011 Volume 51 Issue 5 Pages 344-348
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    The outcomes of postoperative antiepileptic drug (AED) cessation after temporal lobe epilepsy surgery were investigated to identify the preoperative factors associated with seizure-free status without drug treatment in 40 patients who underwent resective epilepsy surgery between 2000 and 2007 for the treatment of complex partial seizures of the type typically associated with temporal lobe epilepsy. All patients were followed up for at least 3.5 years after surgery. After the numbers and types of AEDs used as preoperative and postoperative treatments were determined, the patients who obtained seizure-free outcome for at least 2 years after AED cessation were analyzed. Sex, age at surgery, age at seizure onset, time to operation, seizure frequency, operation side, invasive study, pathological types (hippocampal sclerosis or others), history of generalized convulsive seizures, and number of preoperative AEDs were analyzed as factors potentially associated with seizure-free status without drug treatment. In total, 35% of the patients who underwent temporal lobe epilepsy surgery achieved seizure-free status without drugs. The mean number AEDs fell from 2.1 preoperatively to 1.2 after the surgery. Seizures recurred in 18% of the patients after AED withdrawal. A shorter duration from seizure onset to surgery was found to be significantly related to successful withdrawal of postoperative AED treatment. Our results suggested that early surgical intervention after seizure onset is an important precondition for achieving seizure-free status without drugs after temporal lobe epilepsy surgery.
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  • Yuzo HASEGAWA, Toshihiko IUCHI, Katsunobu OSATO, Takashi KODAMA, Naoki ...
    Article type: Original Article
    2011 Volume 51 Issue 5 Pages 349-355
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    Dose escalation to the target while sparing the organs at risk near the lesion has been difficult over the last decade. However, recent radiotherapy techniques can deliver more sophisticated doses to the target. This study evaluated whether intensity modulated radiotherapy can deliver more homogeneous and conformal doses to the target than dynamic three-dimensional conformal radiotherapy while sparing organs at risk near the lesion in 13 patients with central nervous system tumors and other tumors around the central nervous system. Dynamic three-dimensional conformal radiotherapy and intensity modulated radiotherapy plans were calculated and dose distributions were compared for all patients with regard to the planning target volume and organs at risk. The plan of intensity modulated radiotherapy was significantly superior to that of dynamic three-dimensional conformal radiotherapy in target dose conformity (p = 0.0006) and organs at risk sparing (p = 0.0257). Intensity modulated radiotherapy could deliver more homogeneous and conformal doses to the target than dynamic three-dimensional conformal radiotherapy with sparing organs at risk near the lesion and may improve local control of radioresistant tumors via dose escalation.
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  • Masaaki TAKEDA, Satoshi YAMAGUCHI, Mizuki MORISHIGE, Kuniki EGUCHI, Ka ...
    Article type: Original Article
    2011 Volume 51 Issue 5 Pages 356-360
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    Prevention of postoperative neurological deficits is a major concern of spinal surgeons and has led to the introduction and current development of intraoperative neurophysiological monitoring. We have used motor evoked potentials and somatosensory evoked potentials as routine monitoring techniques and, in some cases, added optional methods such as direct stimulation of nerve roots and spinal evoked potentials. We report our experience of direct nerve root stimulation as an optional monitoring method during spinal surgeries in 7 patients with lesions affecting the proximal nerve roots aged from 1 day to 78 years (mean 23.5 years). Four patients had anomalous lesions, two had spinal nerve root schwannomas, and one had a far-lateral lumbar disc herniation. Direct stimulation was used for detection of motor nerve roots in the anomalous lesions and schwannomas, and to distinguish the nerve root from the paraspinal soft tissues in the case of a far-lateral herniated disc at the L5-S1 level. Although some patients had slight transient neurological symptoms such as motor weakness and sensory disturbance, none developed severe permanent neurological impairment. Direct stimulation allows detection of the motor nerve during spinal surgery in real time. Our limited experience suggests that the direct stimulation technique could reduce the risk of motor or vesicorectal disturbance after surgery of lesions affecting or involving the spinal nerve roots.
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Case Reports
  • —Case Report—
    Yutaka KAI, Yuki OHMORI, Masaki WATANABE, Motohiro MORIOKA, Teruyuki H ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 361-364
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 71-year-old woman presented with an aneurysm at the trunk of the persistent primitive trigeminal artery (PPTA) manifesting as subarachnoid hemorrhage. Angiography and three-dimensional computed tomography revealed a wide-necked saccular aneurysm at the trunk of the left PPTA. Coil embolization with the balloon-assist technique was successful and PPTA patency was preserved. Preoperative conventional angiography should be performed to check for cross-filling of the PPTA. This case demonstrates that an aneurysm of the trunk of the PPTA can be successfully treated by coil embolization using the balloon-assist technique.
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  • —Case Report—
    Toshinari MEGURO, Tatsuya SASAKI, Jun HARUMA, Tomoyuki TANABE, Kenichi ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 365-367
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 61-year-old woman suffered cisternal coil migration in the follow-up period after endovascular coil embolization for a ruptured cerebral aneurysm. She presented with sudden onset of headache. Computed tomography demonstrated diffuse subarachnoid hemorrhage, and cerebral angiography disclosed a left anterior choroidal artery aneurysm. The aneurysm was treated by endovascular embolization with Guglielmi detachable coils. During the embolization procedure, the microcatheter perforated the aneurysm. For direct closure of the perforation site with coils, the microcatheter was withdrawn and coils were deployed partially in the subarachnoid space and partially in the aneurysm sac. The coil mass was spread in the subarachnoid space around the aneurysm immediately after embolization. The patient was discharged with no neurological deficit. Three months later, follow-up radiography demonstrated obvious reduction in the size and compaction of the coil mass. Magnetic resonance angiography and digital subtraction angiography demonstrated stable occlusion of the aneurysm. The coil mass probably spread in the cistern around the aneurysm and was compacted by the shape memory of the coils and pulsation of the brain and vessels, as the subarachnoid clots around the aneurysm had disappeared. This case suggests that cisternal coil migration should be considered in the follow up of intracranial aneurysm treated with detachable coils.
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  • —Case Report—
    Hiroshi KAGAMI, Jun MUTO, Masashi NAKATUKASA, Joji INAMASU
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 368-370
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A previously healthy 68-year-old woman presented with a rare case of subdural empyema which developed at the site of preceding acute subdural hematoma (SDH). She was first admitted for treatment of an acute SDH after a fall. Since she was neurologically intact and the SDH volume decreased with conservative management, she was discharged 9 days after admission for follow up as an outpatient. Three days after discharge, she unexpectedly returned with worsening headache and altered mental status. Brain computed tomography (CT) showed increased SDH volume. Her condition deteriorated rapidly after presentation, with further increase in SDH volume. Copious pus in addition to the SDH was evacuated by emergency drainage, establishing the diagnosis of subdural empyema. Streptococcus pneumoniae was identified from bacterial cultures. Despite improvement in postoperative CT findings, she fell into septic shock and died 3 days after the drainage. Autopsy revealed meningitis and lobar pneumonia, and the postmortem diagnosis was invasive pneumococcal disease. Infection of acute SDH resulting in subdural empyema by S. pneumoniae is extremely rare. However, invasive pneumococcal disease is not uncommon in the elderly and tends to cause intracranial bleeding. Considering the high mortality rate of invasive pneumococcal disease and the low vaccination rate among the elderly in Japan, neurosurgeons should ask about the pneumococcal vaccination status.
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  • —Case Report—
    Hiroshi NAKAGUCHI, Katsumi HOYA, Shoko YAMADA, Mineko MURAKAMI, Akira ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 371-375
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 54-year-old man presented with a rare case of cavernous angioma located in the ventral vermis manifesting as sudden onset of vertigo, followed by cerebellar ataxia. T1-weighted magnetic resonance imaging revealed a 1.5-cm homogeneously enhanced lesion in the ventral vermis. The postpyramidal fissure was opened widely, and upward exploration through the incision enabled piecemeal removal of the lesion without deterioration of the symptoms. The histological diagnosis was cavernous hemangioma with ruptured enlarged varices. The trans-postpyramidal fissure approach allows visualization of the entire fourth ventricle and avoids damaging the cerebellar nuclei and major postoperative cerebellar dysfunction.
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  • —Case Report—
    Yukiko ENOMOTO, Shinichi YOSHIMURA, Yusuke EGASHIRA, Toru IWAMA
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 375-378
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 2-month-old girl presented with cervical hemangioma associated with Kasabach-Merritt syndrome. The patient had previously undergone systemic administration of corticosteroids (prednisolone 2 mg/kg/day) and radiotherapy (0.5 Gy × 5 times), which temporarily increased the platelet count, but the effects were short-lived and thrombocytopenia gradually worsened again despite increased dosage of prednisolone to 5 mg/kg/day. Computed tomography and magnetic resonance imaging revealed a hemangioma in the left retroauricular-cervical region with a well-enhanced, ill-defined margin and bony structure involvement. Diagnostic and therapeutic angiography were carried out through the femoral route under general anesthesia. Polyvinyl alcohol particles (250-350 μm) suspended in contrast medium were slowly injected and a fibered coil was finally placed in the proximal portion of the arterial feeder. Angiography after embolization revealed a marked reduction in the tumor stain. Platelet count rapidly increased and reached the normal range on postembolization day 7. Tumor tension decreased on the day after the procedure and tumor size gradually decreased. The patient was discharged with oral corticosteroid therapy at 6 months postembolization. Corticosteroid dose was gradually decreased and coagulation parameters were normal at 1 year postembolization.
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  • —Case Report—
    Toshihide TANAKA, Naoki KATO, Takao ARAI, Yuzuru HASEGAWA, Toshiaki AB ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 378-382
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 67-year-old right-handed woman presented with a case of hemangiopericytoma in the lateral ventricle manifesting as digit number memory disturbance, sensory aphasia, and right quadrantanopsia. Magnetic resonance imaging demonstrated a 6-cm homogeneously enhanced mass in the trigone of the left lateral ventricle. The tumor was totally removed via the left inferior temporal gyrus. The histological findings were consistent with hemangiopericytoma. Differential diagnosis of hemangiopericytoma from meningioma and solitary fibrous tumors is very important because the clinical behavior of hemangiopericytoma is very aggressive, including local recurrence or distant metastases in the central nervous system and periphery. Histological confirmation is required to make a definitive diagnosis. The present patient did not receive radiation therapy, but developed no local recurrence or metastases. Complete surgical resection and awareness of hemangiopericytoma in the lateral ventricle are very important for good clinical outcome.
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  • —Case Report—
    Takashi NAGATA, Takeo GOTO, Tsutomu ICHINOSE, Naohiro TSUYUGUCHI, Kenj ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 382-385
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 58-year-old woman presented with a rare tentorial schwannoma manifesting as a chief complaint of headache. Magnetic resonance imaging showed an infratentorial extra-axial mass lesion with both cystic and solid components and dural tail sign. The tumor was easily separated from the surrounding structures, and the origin was apparently the tentorial branch of the trigeminal nerve. Tentorial schwannoma should be considered in the differential diagnosis of mixed cystic and solid mass lesions associated with the tentorium around the ambient cistern.
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  • —Case Report—
    Yosuke KAWAHARA, Mitsutoshi NAKADA, Yutaka HAYASHI, Takuya WATANABE, A ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 386-388
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 62-year-old woman presented with an uncommon case of anaplastic meningioma manifesting as recent memory disturbance. Magnetic resonance imaging revealed a mass located in the right temporal lobe. She became unconscious because of uncal herniation and underwent urgent surgery. The tumor was completely resected, except for a lesion tightly attached to arteries. Histological examination indicated the presence of anaplastic meningioma with an extremely high MIB-1 labeling index (70%). After 43 days, the patient developed local recurrence and dissemination in the left temporal lobe. The exceptionally high MIB-1 labeling index corresponded with a short tumor doubling time (8.2 days). Whole-brain irradiation and linear accelerator surgery for disseminated lesions were performed, and the tumor growth halted. Although meningiomas rarely show malignant behavior, corresponding to World Health Organization grade III, it is necessary to consider malignant behavior when treating meningiomas.
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  • —Case Report—
    Fumio SUZUKI, Tadashi KITAGAWA, Kenji TAKAGI, Kazuhiko NOZAKI
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 389-393
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 15-year-old girl developed a rare case of subdural hygroma after foramen magnum decompression for Chiari type 1 malformation manifesting as rapid symptom deterioration around 10 days after uncomplicated operation with uneventful immediate postoperative course. Progressive enlargement of the subdural hygroma in both supra- and infratentorial spaces was followed by the development of hydrocephalus. Syringomyelia improved shortly after the first operation but then deteriorated with massive presyrinx formation. Reoperation with wide opening of the arachnoid membrane lead to a rapid resolution of the hydrocephalus and the presyrinx. The present case shows that wide opening of the arachnoid membrane is an effective therapeutic option.
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  • —Case Report—
    Shigeo ISHIGURO, Tatsuya NAGASHIMA, Kazuki YAMAMOTO, Kimio KANEKAWA, M ...
    Article type: Case Report
    2011 Volume 51 Issue 5 Pages 393-396
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    A 5-month-old boy presented with a rare case of intramedullary teratoma extending from T1 to S5 and associated with a lumbosacral lipoma. Magnetic resonance imaging showed the tumor extended over the lipoma. Since the tumor could not be clearly demarcated from the spinal cord, surgery was performed under a preoperative diagnosis of spinal glioma. The lack of demarcation made safe resection of the tumor difficult to perform, so that the tumor was only partially removed by decompressing the spinal cord. The histological diagnosis was mature teratoma. This case was likely the result of some dysembryogenetic mechanism and the tumor was not neoplastic. The long-term outcome cannot yet be determined, but no recurrence of the symptoms has been observed for 3 years. Spinal intramedullary teratoma is rare and tends to be located in the lumbosacral region. Surgical intervention is crucial and total removal may be achievable, but is likely to be partial with tight adhesion to the spinal cord, so that aggressive approaches should be avoided in such cases.
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Technical Note
  • —Technical Note—
    Yohei BAMBA, Masahiro NONAKA, Shin NAKAJIMA, Mami YAMASAKI
    Article type: Technical Note
    2011 Volume 51 Issue 5 Pages 397-402
    Published: 2011
    Released on J-STAGE: May 25, 2011
    JOURNAL OPEN ACCESS
    Surgical procedures for spinal lipoma or tethered spinal cord after myelomeningocele (MMC) repair are often difficult and complicated, because the anatomical structures can be deformed in complex and unpredictable ways. Imaging helps the surgeon understand the patient's spinal anatomy. Whereas two-dimensional images provide only limited information for surgical planning, three-dimensional (3D) reconstructed computed tomography (CT)-magnetic resonance (MR) fusion images produce clearer representations of the spinal regions. Here we describe simple and quick methods for obtaining 3D reconstructed CT-MR fusion images for preoperative planning of surgical procedures using the iPlan® cranial (BrainLAB AG, Feldkirchen, Germany) neuronavigation software. 3D CT images of the vertebral bone were combined with heavily T2-weighted MR images of the spinal cord, lipoma, cerebrospinal fluid (CSF) space, and nerve root through a process of fusion, segmentation, and reconstruction of the 3D images. We also used our procedure called “Image Overlay” to directly project the 3D reconstructed image onto the body surface using an LED projector. The final reconstructed 3D images took 10-30 minutes to obtain, and provided the surgeon with a representation of the individual pathological structures, so enabled the design of effective surgical plans, even in patients with bony deformity such as scoliosis. None of the 19 patients treated based on our 3D reconstruction method has had neurological complications, except for CSF leakage. This 3D reconstructed imaging method, combined with Image Overlay, improves the visual understanding of complicated surgical situations, and should improve surgical efficiency and outcome.
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