Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 51, Issue 8
Displaying 1-16 of 16 articles from this issue
Original Articles
  • Eiichi SUEHIRO, Hirosuke FUJISAWA, Hiroyasu KOIZUMI, Sadahiro NOMURA, ...
    Article type: Original Article
    2011 Volume 51 Issue 8 Pages 551-555
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    The differences between brain and bladder temperature (delta T), and the relationship of delta T to cerebral perfusion pressure (CPP) and jugular venous oxygen saturation (SjO2) were studied during hypothermia in 11 patients with severe traumatic brain injury, of whom 5 underwent conservative treatment for diffuse axonal injury (DAI) (DAI group) and 6 who underwent decompressive craniectomy for hematoma (SDH group). All patients underwent hypothermia treatment. Brain temperature was monitored via an intraparenchymal catheter. Bladder temperature was used as the core temperature. SjO2 was measured continuously. The outcome of all patients was evaluated at discharge using the Glasgow Outcome Scale. Delta T in the SDH group was significantly lower than that in the DAI group. No relationship was found between delta T and CPP during the investigation period. A significant correlation between delta T and SjO2 was seen in the DAI group, but not in the SDH group. Decompressive craniectomy affects the brain temperature through external environmental factors. Measurement of brain temperature may be a reliable indicator of cerebral blood flow and brain metabolism in patients with DAI and closed cranium during hypothermia. Further experience is required to test this proposal.
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  • Kouhei NII, Masanori TSUTSUMI, Hiroshi AIKAWA, Shuko HAMAGUCHI, Housei ...
    Article type: Original Article
    2011 Volume 51 Issue 8 Pages 556-560
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    The rates of hemodynamic depression (HD) and thromboembolism were compared in 95 carotid artery stenting (CAS) procedures performed in 87 patients with severe carotid artery stenosis using self-expandable braided Elgiloy stents (Wallstent) in 52 and slotted-tube Nitinol stents (Precise) in 43 procedures. The blood pressure, pulse rate, and neurological signs were recorded at short intervals during and after CAS. All patients underwent diffusion-weighted magnetic resonance imaging within 5 days after the procedure. The incidences of hypotension, bradycardia, and both were 17.9%, 3.2%, and 11.6%, respectively. The rate of postprocedural HD was 23.1% with Wallstent and 44.2% with Precise; the difference was significant (p = 0.025). No patient manifested major cardiovascular disease after CAS. Diffusion-weighted magnetic resonance imaging revealed thromboembolism after 26.9% and 34.9% of Wallstent and Precise stent placement procedures, respectively; the difference was not significant. The type of self-expandable stent placed may affect the risk of procedural HD in patients undergoing CAS. Postprocedural HD was resolved successfully by the administration of vasopressors and by withholding antihypertensive agents.
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  • Takeshi AOYAMA, Kazutoshi HIDA, Kiyohiro HOUKIN
    Article type: Original Article
    2011 Volume 51 Issue 8 Pages 561-566
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    Magnetic resonance imaging has increased the incidence of the diagnosis of intramedullary cavernous angioma. Surgical therapy tends not to be recommended for asymptomatic lesions, but symptomatic lesions that bleed recurrently should be treated. The natural course of intramedullary cavernous angioma remains unknown and arguments have been raised against the surgical treatment of symptomatic lesions. We reviewed the clinical features of 13 intramedullary cavernous angiomas in 12 patients surgically treated between 1988 and 2009. The 7 men and 5 women were aged from 14 to 60 years, the preoperative interval ranged from 0 to 161 months, and the mean number of hemorrhages in the 13 lesions was 2.5. Sixteen operations were performed to treat the 13 lesions. The surgical approach depended on the lesion location. The outcome of patients with mild to moderate preoperative symptoms (McCormick grades I-III) was significantly better than that of patients with severe symptoms (McCormick grade IV) (p < 0.05). Symptomatic intramedullary cavernous angioma tends to bleed repeatedly. The lesion should be surgically removed to avoid further deterioration due to recurrent hemorrhages. The shortest path approach should be selected based on preoperative images and complete removal should be attempted. Residual lesion may be masked by surrounding gliosis, so careful postoperative follow up is necessary.
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  • Naoyuki HARADA, Kosuke KONDO, Chikao MIYAZAKI, Jun NOMOTO, Satoru KITA ...
    Article type: Original Article
    2011 Volume 51 Issue 8 Pages 567-571
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    The trans-sylvian approach is one of the most frequently employed neurosurgical procedures, but it is difficult for medical students to understand the approach stereoscopically. A three-dimensional model equipped with an arachnoid membrane and sylvian vein was developed which can be repeatedly used to simulate surgery for the education of medical students and residents in the trans-sylvian approach. The model was prepared using existing models of the skull bone, brain, and cerebral artery. Polyvinylidene chloride film, commonly used as plastic wrap for food, was adopted for the arachnoid membrane, and wetted water-insoluble tissue paper for the arachnoid trabeculae. The sylvian vein was prepared by ligating woolen yarn with cotton lace thread at several sites. Students and residents performed the trans-sylvian approach under a microscope, and answered a questionnaire survey. Using this model, simulation of division of the arachnoid membrane and arachnoid trabeculae, and dissection of the sylvian vein was possible. In the questionnaire, the subjects answered 8 questions concerning understanding of the stereoscopic anatomy of the sylvian fissure, usefulness of the simulation, and interest in neurosurgical operation using the following ratings: yes, very much; yes; somewhat; not very much; or not at all. All items rated as ‘yes, very much’ and ‘yes’ accounted for more than 70% of answers. This model was useful for medical students to learn the trans-sylvian approach. In addition, repeated practice is possible using cheap materials, which is advantageous for an educational model.
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Case Reports
  • —Case Report—
    Kazunori YAMANAKA, Masahiro ISHIHARA, Shin NAKAJIMA, Mami YAMASAKI, To ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 572-575
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    Traumatic intracranial aneurysms are rare, usually occur as a result of traffic accidents, and are associated with high rates of morbidity and mortality. A 12-year-old boy was admitted for treatment of cerebral hemorrhage in the left frontal lobe, 3 months after a traffic accident. Angiography revealed an intracranial aneurysm of the distal part of the azygos anterior cerebral artery (ACA). The maximum size of this aneurysm was 9.5 mm. Coil embolization was successfully performed with preservation of the parent arteries. Angiography performed at the 4-year follow-up examination revealed no abnormalities. The present case showed that primary coiling may allow aneurysm occlusion along with parent vessel preservation in selected cases of traumatic intracranial aneurysm of the distal part of the azygos ACA.
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  • —Case Report—
    Junkoh YAMAMOTO, Naoto SAKAI, Tetsuo YOKOYAMA
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 575-578
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 31-year-old man presented with bilateral unruptured vertebral artery (VA) dissections. The temporal course of the dissected arteries was successively evaluated using brain surface imaging modality basi-parallel anatomical scanning (BPAS) magnetic resonance (MR) imaging in combination with the conventional modalities of MR angiography and three-dimensional computed tomography (3D-CT) angiography. Initially, BPAS-MR imaging clearly demonstrated bilateral fusiform dilatations of the arterial wall, whereas MR angiography and 3D-CT angiography showed irregular, dilated, or interrupted inner contour of the arteries. Finally, BPAS-MR imaging demonstrated resolution of both aneurysms, and MR angiography demonstrated obstruction of the left VA and normal contours of the right VA. Combination of diagnostic tools such as BPAS-MR imaging and MR angiography is useful for evaluating the exact nature of dissected arteries and determining the temporal course.
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  • —Case Report—
    Yuhui LI, Tetsuyoshi HORIUCHI, Takehiro YAKO, Shigetoshi ISHIZAKA, Kaz ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 579-581
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 39-year-old woman presented with left visual disturbance and diplopia. Magnetic resonance imaging revealed a well-enhanced tumor in the left tentorium, cavernous sinus, and suprasellar region. Angiography demonstrated an abnormal origin of the ophthalmic artery from the anterior cerebral artery. The tumor was partially removed by left frontotemporal craniotomy with orbitozygomatic osteotomy. Intraoperatively, the anomalous origin of the ophthalmic artery was confirmed. This anatomical variation is extremely rare.
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  • —Case Report—
    Tadaaki KAWANABE, Ryota TANAKA, Yohei SAKAGUCHI, Osamu AKIYAMA, Hideki ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 582-585
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 57-year-old woman suffered sudden onset of thunderclap headache after exposure to phenylpropanolamine (PPA), and subsequently developed posterior reversible encephalopathy syndrome (PRES) complicated by occipital intracranial hemorrhage (ICH) with cerebral vasoconstriction. PPA is well known to be associated with ICH and vasoconstriction, but this case illustrates the association with PRES. The danger of exposure to PPA and subsequent adverse events is quite low at present, but we must consider the possibility of exposure to medical agents in patients with repeated severe headache who have no organic disorder.
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  • —Case Report—
    Motoaki FUJIMOTO, Junji UNO, Yoshiaki IKAI, Satoshi INOHA, Yasutoshi K ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 585-587
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 27-year-old woman presented with rebleeding from an intracranial arteriovenous malformation (AVM) 6 years after radiosurgery. Cerebral angiography demonstrated venous drainage change into a single drainer and cortical reflux due to drainage occlusion into the superior sagittal sinus. During surgery, multiple small feeders thought to be occluded on preoperative angiography caused brain swelling, hindering resection of the AVM border plane. Flow changes after radiosurgery, especially impaired venous drainage, may have increased the tendency to rebleeding of the AVM. Scheduled angiography after radiosurgery is recommended, and retreatment for residual AVMs is preferable, especially if venous drainage change occurs.
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  • —Case Report—
    Shunya HANAKITA, Akira IIJIMA, Osamu ISHIKAWA, Kyousuke KAMADA, Nobuhi ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 588-591
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 62-year-old man presented with rupture of a pseudoaneurysm of the left common carotid artery (CCA) that was induced after radiation therapy and neck surgery. The initial treatment was an endovascular procedure to obliterate the aneurysm with coils, and a covered stent was placed in the parent artery. However, the patient presented with subsequent coil migration, wound infection, and left CCA stenosis. Direct surgical procedures were then performed, including resection of the pseudoaneurysm with coils and stent; replacement of the carotid artery with a saphenous vein graft; and operative wound reinforcement with a pedicle flap. Endovascular treatments may be chosen for vascular diseases after irradiation, because of the low risk of wound infection and fragility of the vessels, but the long-term outcomes of intravascular treatments are still unclear. In direct surgery, dissection of the adhesive tissue and adequate wound healing are difficult. Musculocutaneous flaps with vascular pedicles can achieve good results.
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  • —Case Report—
    Tomoji TAKIGAWA, Yuji MATSUMARU, Mikito HAYAKAWA, Kenji IKEDA, Akira M ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 592-595
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 58-year-old man presented with a very rare case of pituitary metastasis from hepatocellular carcinoma with active nasal bleeding which was treated by transarterial embolization using ethiodized oil (Lipiodol) and gelatin sponge. After treatment, nasal bleeding ceased and tumor size decreased. The prognosis for patients with pituitary metastases is very poor, so aggressive treatment is recommended to alleviate symptoms. This minimally invasive approach may be a reasonable therapeutic option for pituitary metastases.
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  • —Case Report—
    Hironori FUJISAWA, Takuro KANEKO, Yasuo TOHMA, Shinya KIDA, Yasuharu K ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 596-599
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 65-year-old male who had previously received curative treatment for a pineal tumor presented with an extremely rare case of primary central nervous system (CNS) primitive neuroectodermal tumor (PNET) of the spinal cord manifesting as progressive tetraparesis. Although the histology was not verified, highly radiosensitive tumor was suspected because of the benign clinical course for over 20 years after only radiation therapy. Magnetic resonance imaging demonstrated an intramedullary tumor extending from C5 to T1. He underwent partial resection and histological examination revealed blue tumor with undifferentiated small round cells. Immunohistochemically, c-kit was negative but CD99 was strongly and diffusely positive. Therefore, rearrangement of the Ewing sarcoma gene was examined to determine the presence of peripheral type of PNET. The results were negative and systemic workup revealed no other disease. These findings led to the diagnosis of primary intramedullary CNS PNET of the spinal cord, and suggested that the spinal cord tumor occurred independently of the prior pineal disease. The residual tumor was controlled by postoperative local radiation therapy.
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  • —Case Report—
    Hiroki SAKAMOTO, Toshihide TANAKA, Naoki KATO, Takao ARAI, Yuzuru HASE ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 600-603
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    A 70-year-old man presented with a rare case of paranasal osteoma with secondary mucocele extending intracranially, manifesting as a generalized convulsion. Computed tomography showed a large calcified tumor adjacent to the cystic mass in the left frontal lobe. He underwent left frontal craniotomy, and the cystic lesion was totally removed. Histological examination confirmed the diagnosis of osteoma and mucocele. The giant paranasal sinus osteoma prevented growth of the mucocele into orbital recess and extension into the orbital space and paranasal sinus. The mucocele disrupted the dura in the anterior cranial fossa, resulting in a giant cystic intracranial lesion. Frontal osteoplastic craniotomy was effective for exposing both lesions and plastic repair of the dural perforation to prevent cerebrospinal fluid leakage and secondary infection.
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  • —Five Case Reports in One Family—
    Satoshi KOIZUMI, Kensuke KAWAI, Shuichiro ASANO, Keisuke UEKI, Ichiro ...
    Article type: Case Report
    2011 Volume 51 Issue 8 Pages 604-610
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    Documentation of familial epilepsy is of paramount importance for identification of epilepsy-associated genes, elucidation of pathomechanisms of epilepsy, and development of treatment of epilepsy. We report a Japanese family with 5 members with lateral temporal lobe epilepsy beginning around the second decade of life. All seizures were intractable to medical treatment, and four patients underwent surgical treatment following long-term monitoring by intracranial electroencephalography with subdural electrodes, which revealed neocortical origins for the seizure. These four patients were successfully treated with surgery. The clinical features of this familial temporal lobe epilepsy seem to be different from those of previously reported types of familial temporal lobe epilepsy.
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Technical Note
  • —Technical Note—
    Hideki ATSUMI, Mitsunori MATSUMAE, Akihiro HIRAYAMA, Kenichiro SATO, H ...
    Article type: Technical Note
    2011 Volume 51 Issue 8 Pages 611-616
    Published: 2011
    Released on J-STAGE: August 25, 2011
    JOURNAL OPEN ACCESS
    Flexible endoscopes can be used in areas that are difficult to approach using rigid endoscopes. No current real-time navigation systems identify the tip of the flexible neuroendoscope. We have developed a flexible neuroendoscope mounted with a magnetic field sensor tip position-tracking system and evaluated the accuracy of this magnetic field neuronavigation system. Based on an existing flexible neuroendoscope, we created a prototype with a built-in magnetic field sensor in the tip. A magnetic field measurement device provides a magnetic field with a working volume of 500 × 500 × 500 mm in front of the device. The device consists of a flat field generator that creates a pulsed magnetic field, connected to a system control unit that interfaces with a computer. The magnetic field sensor (1.8 × 9 mm) was sealed in a site 0.9 mm from the endoscope tip. Accuracy of neuroendoscope tracking was measured using a three-dimensional coordinate-measuring machine that measures the position of objects along 3 axes, with an error of about 3 µm. The accuracy for this neuroendoscope with built-in magnetic field sensor was root mean square error of 1.2 mm and standard deviation of 0.5 mm. This magnetic field neuronavigation system enables real-time tracking of the tip of the flexible neuroendoscope. Application of this flexible neuroendoscope to intraoperative navigation appears promising, and may provide new advantages for minimally invasive endoscopic surgery.
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