Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 51, Issue 6
Displaying 1-16 of 16 articles from this issue
Special Topic
  • —Annual Meeting: President's Keynote Lecture—
    Tomio SASAKI, Kimiaki HASHIGUCHI, Koji YOSHIMOTO, Akira NAKAMIZO, Masa ...
    Article type: Original Article
    2011 Volume 51 Issue 6 Pages 405-414
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    Based on the data reported in the National Institute of Science and Technology Policy 2010, Japan is ranked in fourth place in the world in terms of the numbers of the articles in the fields of clinical medicine. However, there had not been any objective data regarding the numbers of publications by neurosurgeons. As it is important for neurosurgeons to realize the extent of academic contributions by the neurosurgeons in different countries, the numbers of publications in the major journals by the members of the Japan Neurosurgical Society and those from neurosurgical institutions around the world were analyzed using both the biomedical literature database PubMed and the publication database “ISI Web of Knowledge.” Parts of the results were presented in the 69th Annual Meeting of the Japan Neurosurgical Society. As to the number of neurosurgical publications in English from the top 9 countries, the US has been consistently in first place and Japan in second. However, the number of publications from Japan has been decreasing since 2000. With regards to the “top 8 journals” such as the Lancet and the Journal of the American Medical Association, the number of first-author publications by Japanese neurosurgeons increased in the late 1980s and had been 2-9 articles per year until recently. In the “top 12 neuroscience journals” which include Stroke, Neuro-Oncology, Cancer Research, and others, Japan had been in the third next to the US and UK till 2004, but Germany surpassed Japan in 2005. In the “top 6 clinical journals” such as the Journal of Neurosurgery and Neurosurgery, the US has been consistently keeping first place and Japan second place since 1977. Searches using the key word elucidated that Japanese neurosurgeons are greatly contributing in the field of “aneurysm.” Regarding the number of publications per neurosurgeon, Canada and UK are in the forefront and Japan is down to eighth place. Japanese neurosurgeons have been contributing greatly next to the Americans to the field of clinical neurosurgery and neuroscience by publishing in English. However, the number of publications by Japanese neurosurgeons has been declining since 2000. The Japan Neurosurgical Society must come up with countermeasures to address this problem.
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Original Articles
  • Takatoshi FUJIMOTO, Yasuhito ISHIDA, Yoshitomo UCHIYAMA, Hiroyuki NAKA ...
    Article type: Original Article
    2011 Volume 51 Issue 6 Pages 415-422
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    The pre- and postoperative radiological predictive factors for the regrowth of residual benign meningiomas were investigated in 80 of 327 patients who underwent first surgery for intracranial meningioma, who met the following conditions: residual tumor observed on postoperative imaging, follow up for more than 5 years or until regrowth of the residual tumor, histological diagnosis of World Health Organization grade I, and no additional therapy performed within 1 month after surgery. These 80 patients were divided into those with no regrowth during the follow-up period (Group A, n = 54) and those with regrowth (Group B, n = 26), and the clinical characteristics and pre- and postoperative imaging findings were compared. Univariate analysis of factors influencing regrowth showed 6 factors were significant: tumor size ≥4 cm (p = 0.043), tumor volume ≥30 cm3 (p = 0.026), presence of edema (p = 0.036), unclear brain-tumor interface (p < 0.001), presence of a pial-cortical blood supply (p = 0.031), and residual tumor volume ≥3.0 cm3 (p < 0.001). Multivariate analysis showed only residual tumor volume ≥3.0 cm3 was significant (p = 0.001). Generally, the significant imaging findings on univariate analysis suggest malignant meningioma. Similar findings may be observed even in grade I cases, and residual tumors may regrow in such cases. The possibility is particularly high if the residual tumor volume exceeds 3.0 cm3, so early radiotherapy should be performed to prevent regrowth.
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  • Motoyuki IWASAKI, Minoru AKINO, Kazutoshi HIDA, Shunsuke YANO, Takeshi ...
    Article type: Original Article
    2011 Volume 51 Issue 6 Pages 423-426
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    Upper and lower lumbar disc herniation apparently have different background, symptoms, and operative results. This retrospective study reviewed the clinical records of 403 patients (409 discs) who underwent lumbar microdiscectomy performed by different surgeons at our institute between 1999 and 2009. The 290 male (72.0%) and 113 female (28.0%) patients were aged from 19 to 77 years (mean 44 years). Demographics, symptoms, and static and dynamic radiographic and magnetic resonance images obtained at the L1-2, L2-3, L3-4, L4-5, and L5-S1 intervertebral levels were analyzed. Of the 409 herniations, 3 were at L1-2, 9 at L2-3, 21 at L3-4, 166 at L4-5, and 210 at L5-S1. The mean age at herniation at L1-2 and L2-3 levels was 55.7 years. Patients with herniation of discs at L3-4 or above were significantly older than patients who suffered herniation at L4-5 or below (p < 0.0001), and the incidence of urinary disturbance was significantly higher in patients with herniation at L1-2 and L2-3 levels (p = 0.0013). The incidence of degenerative scoliosis was significantly higher in patients with herniation at L1-2 and L2-3 than in those with herniated discs at L3-4 or below (p < 0.0001). Patients with upper lumbar disc herniation were older and manifested a higher incidence of urinary disturbance. A high incidence of degenerative scoliosis was noted in the course of prolonged degenerative processes.
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Case Reports
  • —Two Case Reports—
    Jung-Hoon LEE, Jin-Uk KIM, Jee-Soo JANG, Sang-Ho LEE
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 427-430
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    Sacral fractures in elderly patients with associated lumbosacral lesions can be overlooked easily because of vague symptoms and delayed neurological insufficiency. A 70-year-old female and a 73-year-old female presented with delayed neurological insufficiency caused by transverse sacral fracture after minor trauma. Both patients had suffered from lower extremity symptoms with dysuresia and dyschezia for more than a month. Coexisting lumbosacral pathological lesions may confuse the correct diagnosis for sacral fractures. Decompressive sacral laminectomy was performed, and the patients showed relatively favorable outcomes.
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  • —Case Report—
    Toshi ABE, Naoshi HAGIHARA, Masaru HIROHATA, Yusuke UCHIYAMA, Norimits ...
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 431-433
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 50-year-old man presented with a 2-month history of dysarthria caused by a partially thrombosed vertebral artery (VA) aneurysm. Magnetic resonance imaging showed enhancement of the thickened wall and angiography detected staining. Stent-assisted coil embolization with protection of the parent artery patency was performed. The patient's clinical course was unremarkable and shrinking of the aneurysm was obtained. The stent-assisted coil embolization promoted intra-aneurysm flow disruption and stabilized the wall environment, suggesting another strategy for the treatment of partially thrombosed VA aneurysm.
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  • —Case Report—
    Takashi SHUTO, Shigeo MATSUNAGA, Jun SUENAGA
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 434-437
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 53-year-old man suffered contralateral hearing disturbance one day after acoustic neuroma surgery. Hearing function gradually recovered after steroid and hyperbaric therapy. Contralateral hearing disturbance after acoustic neuroma surgery is an extremely rare complication that can also occur after other posterior fossa surgery. The mechanism of this rare phenomenon remains unclear, but the patent cochlear aqueduct may be involved.
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  • —Case Report—
    Ryogo ANEI, Yoshimitsu HAYASHI, Satoru HIROSHIMA, Nobuyuki MITSUI, Ryo ...
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 437-441
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    An 8-month-old female presented with hydrocephalus caused by cerebrospinal fluid (CSF) overproduction due to bilateral choroid plexus enlargement, which was clinically diagnosed as diffuse villous hyperplasia of the choroid plexus, but differentiation from bilateral choroid plexus papilloma was difficult. She initially underwent ventriculoperitoneal shunt surgery, but developed marked retention of ascites. Therefore, the peritoneal end of the shunt was removed for external drainage, but excessive CSF (1,500 ml/day) was collected. Computed tomography and magnetic resonance imaging revealed marked symmetric enhancement of the choroid plexuses in the bilateral lateral ventricles. Thallium-201 chloride single-photon emission computed tomography showed pronounced uptake on both early and delayed images, and good washout. CSF examination revealed no abnormalities such as atypical cells, and a ventriculoatrial shunt was inserted, achieving good control of the hydrocephalus.
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  • —Case Report—
    Jan-Karl BURKHARDT, Ralf A. KOCKRO, Hildegard DOHMEN-SCHEUFLER, Christ ...
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 441-444
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 16-year-old boy presented with an unusual case of a supratentorial, extraaxial small round blue cell tumor of the central nervous system, which was most likely a primitive neuroectodermal tumor (PNET). Preoperative computed tomography and magnetic resonance imaging showed a large multistage hematoma in the left central region. Intraoperatively, a small, superficial tumorous lesion was found between the sagittal sinus and a large cortical vein hidden by the hematoma. The histological diagnosis was PNET. This tumor is one of the most aggressive intracerebral tumors, not only in children, so treatment strategies must be early, profound, and interdisciplinary. This case represents an important example of atypical extraaxial appearance of this lesion, which should be considered in the differential diagnosis of cortical or subcortical hemorrhage, since complete resection of this lesion is critical for the successful treatment and outcome.
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  • —Case Report—
    Naoki NITTA, Satoshi SHITARA, Kazuhiko NOZAKI
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 445-448
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 58-year-old woman presented with right supplementary motor area glioblastoma multiforme and deep venous thrombosis in her legs. The tumor was resected after temporary inferior vena cava filter placement, considering that increased thrombosis during and after the operation would cause fatal pulmonary embolism. After anticoagulation with unfractionated heparin, thrombocytopenia was aggravated, and computed tomography showed filter catheter-related thrombosis in the inferior vena cava. The diagnosis was heparin-induced thrombocytopenia, and argatroban and urokinase were administered. Thrombolysis with urokinase was completed and the temporary inferior vena cava filter catheter was removed without complication. The present case illustrates the possibility of heparin-induced thrombocytopenia associated with catheter-related thrombosis in neurosurgery.
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  • —Case Report—
    Jun MUTOU, Yuichi HIROSE, Eiji IKEDA, Kazunari YOSHIDA, Yoichi NAKAZAT ...
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 449-454
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    Rhabdoid tumor (RT) of the central nervous system is an uncommon and aggressive neoplasm that usually affects pediatric patients. Currently, these tumors are classified as malignant RT or atypical teratoid/RT. Another entity of intraparenchymal brain tumor with a rhabdoid component is the extremely rare rhabdoid glioblastoma. A 23-year-old woman presented with a malignant RT in the right thalamus. The tumor was adjacent to the right lateral ventricle and was partially resected. Histological examination revealed prominent proliferation of rhabdoid cells, which is consistent with a diagnosis of malignant RT; the typical features of glioblastoma were not observed. The tumor cells stained positively for integrase interactor-1 and glial fibrillary acidic protein. Therefore, the tumor may have originated from glial components. Genetic analysis using comparative genomic hybridization showed a deoxyribonucleic acid copy-number gain on chromosome 7 but not on chromosome 22. The tumor did not respond to chemotherapy or radiotherapy, and the patient survived for only 4 months after surgery. The present case of malignant RTs shows certain similarities with those of rhabdoid glioblastoma. Further accumulation and analysis of data, including data from genetic analyses, may lead to the identification of a new type of malignant RT.
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  • —Case Report—
    Toshiya UCHIYAMA, Keiichi SAKAI, Megumi ASANUMA, Tatsuro AOYAMA, Kazuh ...
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 455-459
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 12-year-old girl presented with complaints of headache, lethargy, photophobia, and fever. Cerebrospinal fluid examination revealed bacterial meningitis. Magnetic resonance (MR) imaging showed a cystic lesion with peripheral enhancement in the pituitary fossa. The patient underwent transnasal-transsphenoidal surgery (TSS). The diagnosis was pituitary abscess associated with Rathke's cleft cyst. Postoperatively, the patient recovered rapidly. However, recurrence of the pituitary abscess causing meningitis occurred four times and required repeated TSS. She had diabetes insipidus and received hormone replacement. This case requiring repeated emergency surgeries shows that follow-up examinations including MR imaging and pituitary endocrine evaluation are necessary because the rate of recurrence is high in patients with pituitary abscess associated with Rathke's cleft cyst.
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  • —Case Report—
    Satoshi YAMAGUCHI, Masaaki TAKEDA, Hirotaka KIHARA, Kuniki EGUCHI, Tak ...
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 460-462
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 6-month-old female presented with purulent discharge from a dimple in the right lateral buttock. A subcutaneous abscess was palpated on the right paravertebral region at the L5-S1 level. She had low-grade fever with laboratory findings of leukocytosis and elevation of C-reactive protein levels. Klebsiella and Enterococcus species were cultured from the pus. Computed tomography (CT) clearly showed a tract traversing the subcutaneous tissue and connecting to the abscess. Magnetic resonance (MR) imaging showed no abnormality in the spinal canal. The diagnosis was infected congenital dermal sinus (CDS) in the right buttock. After normalization of body temperature and laboratory findings in response to antibiotic treatment, the dermal sinus tract was surgically removed. Intraoperative findings showed that the tract gradually tapered and ended at the subcutaneous abscess space over the lumbosacral fascia. Histological examination confirmed the lesion was dermal sinus. Although laterally placed CDS in the buttocks is extremely rare with only 5 previous cases reported, lateral CDS should be included in the differential diagnosis of a dimple in the buttocks. CT as well as MR imaging should be performed to evaluate suspected lateral CDS.
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  • —Case Report—
    Yasuyuki MIYOSHI, Takao YASUHARA, Isao DATE
    Article type: Case Report
    2011 Volume 51 Issue 6 Pages 463-466
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    A 11-year-old female with Noonan syndrome presented with occipito-atlantal dislocation and upper cervical cord compression due to C1 dysplasia and basilar invagination. Computed tomography (CT) of the cervical spine showed dysplasia of the C1 posterior arch and bilateral dislocation of the occipito-atlantal joints. Dynamic lateral radiography revealed no instability at the occipito-atlantal joints. CT also demonstrated basilar invagination. The tip of the odontoid process extended above the Chamberlain line by 9 mm and the McGregor line by 10 mm. Whole spinal radiography showed no scoliosis. C1 laminectomy was performed with instrumented occipito-C2 fixation. The postoperative course was uneventful, and magnetic resonance imaging revealed sufficient decompression of the upper cervical cord at 2 months after surgery. CT demonstrated solid bony fusion between the occipital bone and C2 at 8 months after surgery. Cervical neuraxial malformations are rare in patients with Noonan syndrome.
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Technical Notes
  • —Technical Note—
    Yuzo TERAKAWA, Kenichi ISHIBASHI, Takeo GOTO, Kenji OHATA
    Article type: Technical Note
    2011 Volume 51 Issue 6 Pages 467-471
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    Three-dimensional (3-D) video recording of microsurgery is a more promising tool for presentation and education of microsurgery than conventional two-dimensional video systems, but has not been widely adopted partly because 3-D image processing of previous 3-D video systems is complicated and observers without optical devices cannot visualize the 3-D image. A new technical development for 3-D video presentation of microsurgery is described. Microsurgery is recorded with a microscope equipped with a single high-definition (HD) video camera. This 3-D video system records the right- and left-eye views of the microscope simultaneously as single HD data with the use of a 3-D camera adapter: the right- and left-eye views of the microscope are displayed separately on the right and left sides, respectively. The operation video is then edited with video editing software so that the right-eye view is displayed on the left side and left-eye view is displayed on the right side. Consequently, a 3-D video of microsurgery can be created by viewing the edited video by the cross-eyed stereogram viewing method without optical devices. The 3-D microsurgical video provides a more accurate view, especially with regard to depth, and a better understanding of microsurgical anatomy. Although several issues are yet to be addressed, this 3-D video system is a useful method of recording and presenting microsurgery for 3-D viewing with currently available equipment, without optical devices.
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  • —Technical Note—
    Kitaro YOSHIMITSU, Takashi MARUYAMA, Yoshihiro MURAGAKI, Takashi SUZUK ...
    Article type: Technical Note
    2011 Volume 51 Issue 6 Pages 472-476
    Published: 2011
    Released on J-STAGE: June 24, 2011
    JOURNAL OPEN ACCESS
    The dedicated intraoperative examination monitor for awake surgery (IEMAS) was originally developed by us to facilitate the process of brain mapping during awake craniotomy and successfully used in 186 neurosurgical procedures. This information-sharing device provides the opportunity for all members of the surgical team to visualize a wide spectrum of the integrated intraoperative information related to the condition of the patient, nuances of the surgical procedure, and details of the cortical mapping, practically without interruption of the surgical manipulations. The wide set of both anatomical and functional parameters, such as view of the patient's mimic and face movements while answering the specific questions, type of the examination test, position of the surgical instruments, parameters of the bispectral index monitor, and general view of the surgical field through the operating microscope, is presented compactly in one screen with several displays. However, the initially designed IEMAS system was occasionally affected by interruption or detachment of the connecting cables, which sometimes interfered with its effective clinical use. Therefore, a new modification of the device was developed. The specific feature is installation of wireless information transmitting technology using audio-visual transmitters and receivers for transfer of images and verbal information. The modified IEMAS system is very convenient to use in the narrow space of the operating room.
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