Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 51, Issue 9
Displaying 1-16 of 16 articles from this issue
Original Articles
  • Joji INAMASU, Yu NAKAGAWA, Takumi KURAMAE, Masashi NAKATSUKASA, Satoru ...
    Article type: Original Article
    2011 Volume 51 Issue 9 Pages 619-623
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    Aneurysmal subarachnoid hemorrhage (SAH) is a common cause of cardiopulmonary arrest (CPA). The outcomes of SAH patients presenting with CPA are extremely poor, and long-term survivors have occasionally been reported, but the circumstances under which SAH-CPA patients achieve long-term survival are unclear. Neurosurgeons will have to determine whether a SAH-CPA patient is brain-dead or not more often after enactment of the revised Organ Transplantation Act. Prediction of survival length may be important not only to neurosurgeons, but also to the transplantation team. A retrospective study was conducted to elucidate how often brainstem function was recovered in resuscitated SAH-CPA patients and whether the recovery was associated with longer survival. Among 315 patients with non-traumatic SAH admitted to our institution during 6 years, 35 (11%) presented with CPA. Ventricular fibrillation (VF) as initial cardiac rhythm was rare, observed only in 1 patient. The survival length ranged from 1 to 15 days (mean 3.5 ± 0.7 days), and none achieved long-term survival. Return of brainstem function, represented by spontaneous respiration and/or reactive pupils, was observed in 6 patients (17%), but was only partial and transient. Cardiac arrest to return of spontaneous circulation interval tended to be shorter in patients with transient recovery of the brainstem function than in those without recovery. However, the survival length was not significantly different between the two groups. In addition to the 35 SAH-CPA patients, another 44 SAH patients lost both brainstem reflexes and spontaneous respiration within 72 hours of admission. As a result, 79 (25%) of the 315 SAH patients were considered to have sustained fatal, irreversible brain damage. Review of previous experience suggests that SAH-CPA patients may survive only if the cause of cardiac arrest is VF and not brainstem damage/respiratory arrest. Approximately one-third of resuscitated SAH-CPA patients may die within 24 hours of arrival, for whom the declaration of brain death may be difficult.
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  • Yoshiro ITO, Toshiyuki OKUMURA, Kensuke SUZUKI, Akira MATSUMURA, Koich ...
    Article type: Original Article
    2011 Volume 51 Issue 9 Pages 624-629
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    The effectiveness of proton beam (PB) radiosurgery for large lesions is greater than for other treatment modalities. At our institute, PB radiosurgery is used to treat arteriovenous malformations (AVMs). We report the outcome of PB radiosurgery for AVMs over a period of 15 years, focusing on the efficacy of PB radiosurgery combined with embolization for AVMs ≥30 mm in diameter. We retrospectively analyzed 11 patients with AVMs ≥30 mm in diameter who were treated with PB radiosurgery between June 1990 and September 2005 at the Proton Medical Research Center of the University of Tsukuba. The mean irradiation dose was 25.3 gray-equivalent, and the mean duration of clinical follow up was 134.2 months (median 138 months). Pre-radiosurgical embolization was performed in all cases. Complete obliteration was achieved in 9 of the 11 patients. One patient experienced post-radiosurgical hemorrhage, and 1 patient experienced radiation-related aggravation of clinical symptoms due to radiation necrosis. Eight patients had excellent outcomes. The multimodal therapy approach of combining pre-radiosurgical embolization and PB radiosurgery for AVMs yielded a favorable outcome for AVMs ≥30 mm in diameter. Thus, PB radiosurgery is a viable treatment option for AVMs ≥30 mm in diameter.
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  • Liang WU, Ning YAO, Daxing CHEN, Xiaofeng DENG, Yulun XU
    Article type: Original Article
    2011 Volume 51 Issue 9 Pages 630-634
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    Intramedullary spinal schwannomas are rare benign spinal cord tumors and are easily misdiagnosed because of the imaging characteristics shared with intramedullary glioma. Correct preoperative definitive diagnosis is essential for treatment and prognosis. To improve the preoperative diagnostic strategy, clinical and imaging data of seven patients with intramedullary spinal schwannoma (6 men, mean age 44 years, mean duration of illness 4.2 years) treated in our department between 2003 and 2010 were collected and retrospectively evaluated. The cervical cord was affected in five patients, followed by the thoracic cord in two. All seven cases were misdiagnosed as intramedullary glioma based on the imaging characteristics. Comparison of the clinical features of these 7 patients with those of patients with intramedullary tumors (173 ependymomas and 70 astrocytomas) admitted during the same period revealed significant differences in somatic pain and root pain as the initial symptoms between intramedullary spinal schwannomas and ependymomas (p = 0.005) and between intramedullary spinal schwannomas and astrocytomas (p = 0.019), but not between ependymomas and astrocytomas (p = 0.175). Root or somatic pain as an initial symptom is important for the preoperative diagnosis of intramedullary spinal schwannoma, especially if the imaging characteristics are not entirely specific.
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  • Koji NAKASHIMA, Takato NAKAJO, Michiari KAWAMO, Akihito KATO, Seiichir ...
    Article type: Original Article
    2011 Volume 51 Issue 9 Pages 635-638
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    Cerebrospinal fluid (CSF) shunts are frequently used to treat hydrocephalus. The use of a programmable shunt valve allows physicians to easily change the opening pressure. Since patients with adjustable CSF shunt valves may use portable game machines, the permanent magnets in these machines may alter the shunt valve programmed settings or permanently damage the device. This study investigated the risk of unintentional valve adjustment associated with the use of game machines in patients with programmable CSF shunt valves. Four adjustable valves from 4 different manufacturers, Sophysa Polaris model SPV (Polaris valve), Miethke proGAV (proGAV), Codman Hakim programmable valve (CHPV), and Strata II small valve (Strata valve), were evaluated. Magnetic field interactions were determined using the portable game machine, Nintendo DS Lite (DS). The maximum distance between the valve and the DS that affected the valve pressure setting was measured by x-ray cinematography. The Polaris valve and proGAV were immune to unintentional reprogramming by the DS. However, the settings of the CHPV and Strata valves were randomly altered by the DS. Patients with an implanted shunt valve should be made aware of the risks posed by the magnetic fields associated with portable game machines and commonly used home electronics.
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Case Reports
  • —Case Report—
    Shinya SUMIOKA, Akinori KONDO, Hideki TANABE, Soichiro YASUDA
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 639-641
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 66-year-old man presented with typical right trigeminal neuralgia. Neuroimaging showed a small arteriovenous malformation (AVM) in the right cerebellopontine angle. Suboccipital craniotomy verified that the AVM was almost completely embedded in the root entry zone of the trigeminal nerve and the nerve axis was tilted infero-posteriorly. The patient obtained complete pain relief without sequelae after surgery by transposition of the superior cerebellar artery and correction of the tilted nerve axis. The nidus of the unresected AVM was obliterated by gamma knife radiosurgery.
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  • —Case Report—
    Toshiya UCHIYAMA, Tetsuyoshi HORIUCHI, Takahiro MURATA, Kazuhiro HONGO
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 642-644
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 40-year-old Brazilian man presented with headache followed by consciousness disturbance. Computed tomography showed subarachnoid hemorrhage with right frontal hematoma. Angiography revealed a dural arteriovenous fistula (dAVF) fed by the inferolateral trunk of the internal carotid artery and draining into the superficial sylvian vein with varix formation. The shunting point was directly obliterated through a pterional approach. Postoperative angiography showed complete disappearance of the fistula. A ventriculoperitoneal shunt was needed for normal pressure hydrocephalus during his hospitalization. The modified Rankin scale at discharge was grade 2 with mild cognitive dysfunction. This case of dAVF may represent congenital dAVF.
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  • —Case Report—
    Yukihiro WAKABAYASHI, Yuzo HORI, Yayoi KONDOH, Tomoshige ASANO, Akira ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 645-648
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 36-year-old female patient was admitted to our hospital with a rare case of aneurysm at the origin of the accessory middle cerebral artery (MCA) manifesting as severe headache and vomiting. Neurological examination did not detect any abnormalities or consciousness disturbance. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Magnetic resonance angiography showed an aneurysm in the horizontal portion of the left anterior cerebral artery (A1). Digital subtraction angiography and three-dimensional digital subtraction angiography demonstrated a saccular aneurysm originating at the junction of the left A1 and accessory MCA. Another accessory MCA originated at the proximal portion of the left A2 without an aneurysm. Two accessory MCAs were found on the left. Neck clipping was performed via a left pterional approach. One month after admission, she was discharged without neurological deficits.
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  • —Case Report—
    Satoshi IIHOSHI, Kei MIYATA, Tomohiro MURAKAMI, Takahisa KANEKO, Izumi ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 649-652
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 60-year-old female presented with sudden onset of severe headache and back pain, followed by nausea. The initial head computed tomography (CT) scan revealed posterior fossa subarachnoid hemorrhage (SAH). Spinal T2-weighted magnetic resonance imaging demonstrated SAH, and a homogeneous and slightly low signal intensity mass at T11. Spinal angiography in the early arterial phase revealed a small pearl and string-like aneurysm of the proximal radiculomedullary artery on the left side at the T12 level. Forty days after the onset of SAH, CT angiography demonstrated complete occlusion of the dissecting aneurysm and the preserved anterior spinal artery. The present case of ruptured dissecting aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with SAH underwent subsequent spontaneous occlusion, indicating that the wait-and-see strategy may be justified and will provide adequate treatment.
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  • —Case Report—
    Chiaki TAKAHASHI, Michiya KUBO, Soushi OKAMOTO, Nobuhisa MATSUMURA, Yu ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 653-656
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 62-year-old female complaining of sudden severe headache was referred to our stroke center in consultation. Computed tomography showed diffuse spread of thick subarachnoid hemorrhage to the basal cistern and both sylvian fissures, and digital subtraction angiography showed kissing aneurysms arising in the left lateral and occipital directions in the C1 portion of the internal carotid artery (ICA). The anterior choroidal artery was situated between the two aneurysms, and another small branch originating from the dome of the distal aneurysm was confirmed as a duplicated middle cerebral artery (MCA). Endovascular treatment was successfully performed to spare the two vessels involved. This case of kissing aneurysms and ICA-duplicated MCA is very rare, and presents difficulties for both surgical and endovascular treatments.
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  • —Case Report—
    Shinya YAMAGUCHI, Osamu ITO, Yoshihisa MAEDA, Hideki MURATA, Naoyuki I ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 657-660
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 74-year-old man suffered sudden loss of consciousness at home. Computed tomography revealed severe subarachnoid hemorrhage and an unusual posterior cerebral artery (PCA) aneurysm with vertebrobasilar dolichoectasia (VBD). The aneurysm was located in the right hypothalamus. VBD associated with a distal lesion makes endovascular treatment difficult because of the elongation and tortuosity of the access route. However, endovascular coil embolization was successful for the present ruptured PCA aneurysm with VBD.
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  • —Case Report—
    Ken KAZUMATA, Katsuyuki ASAOKA, Yuka YOKOYAMA, Toshiya OSANAI, Taku SU ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 661-663
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 74-year-old man underwent pterional craniotomy to treat a left proximal anterior cerebral artery (ACA) aneurysm. The orifice of the aneurysm was located at the origin of the proximal segment of the ACA, and the right A1 segment of ACA was hypoplastic. After failed attempts at neck plasty with fenestrated clips, trapping and bypass were performed. Superficial temporal to left frontopolar artery bypass was performed to secure minimal blood supply. The radial artery (RA) was then harvested, and middle cerebral artery (MCA) to A1 segment of the ACA bypass was performed using the RA interposition graft. Trapping of the aneurysm was successfully achieved without ischemic event. Intracranial-intracranial bypass has been employed in the treatment of complex cerebral aneurysm in an increasing number of selected patients. The present case shows that MCA-ACA-RA interposition graft bypass is an effective procedure to provide blood supply to the ACA territory if a proximal A1 lesion requires trapping with incompetent contralateral A1.
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  • —Case Report—
    Takao YASUHARA, Yasuyuki MIYOSHI, Isao DATE
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 664-666
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 78-year-old man presented with a rare massive subarachnoid hematoma (SAH) in the cervical spine after coronary stenting for angina pectoris. Chest pain and electrocardiographic changes were resolved after administration of coronary dilator and coronary stenting, but shoulder pain persisted. At 6 hours after stenting, left hemiparesis was found with deteriorated shoulder pain. Computed tomography and magnetic resonance imaging revealed massive SAH in the cervical spine. Emergent hematoma evacuation with laminoplasty was performed because of rapid progression of the hemiparesis and pain. The hemiparesis was ameliorated after surgery. Spinal hematoma should be considered in the differential diagnosis in patients receiving anti-platelet or anti-coagulant drugs with rapid progression of pain.
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  • —Case Report—
    Kouji YAMASAKI, Tetsuaki SUGIMOTO, Munetomo FUTAMI, Takuzo MORIYAMA, H ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 667-670
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 51-year-old immunocompetent Japanese woman presented with a rare case of granulomatous amoebic encephalitis (GAE) caused by Balamuthia mandrillaris. She was brought to our hospital with epilepsy. Magnetic resonance imaging of the brain revealed a homogeneously enhanced solitary mass in the left frontal lobe. Histological diagnosis was made by a biopsy, which suggested lymphomatoid granulomatosis. After that, her neurological condition got worse. New masses were found and had spread across the whole brain. She died 2 months later of cerebral hernia. Autopsy revealed that the patient had GAE caused by Balamuthia mandrillaris. GAE is usually fatal, and is difficult to diagnose except at autopsy. Therefore, awareness of this disease is important, and earlier diagnosis and the development of a better therapeutic strategy will improve clinical outcome.
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  • —Case Report—
    Shigeo OHBA, Kazunari YOSHIDA, Ichiro SUGIYAMA, Eiji IKEDA, Takeshi KA ...
    Article type: Case Report
    2011 Volume 51 Issue 9 Pages 671-672
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A 69-year-old male presented with a rare dural cyst manifesting as numbness and pain in the limbs. Magnetic resonance imaging revealed a mass anterior to the medulla oblongata appearing as low intensity on T1-weighted and high intensity on T2-weighted imaging, with no enhancement. A cystic lesion ventral to the medulla oblongata was removed via the lateral suboccipital transcondylar approach. Histological examination showed the wall of the cyst consisted of fibrous connective tissue with a dense zone and a loose zone, similar to the structure found in the dura mater. The lesion was diagnosed as dural cyst. Dural cysts can be defined as cyst with the wall consisting of dura mater-like fibrous tissue, and attached to the dura mater. The origin of the present dural cyst was considered to be congenital.
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Technical Note
  • —Technical Note—
    Satoshi TANAKA, Takashi TASHIRO, Akira GOMI, Hiroshi UJIIE
    Article type: Technical Note
    2011 Volume 51 Issue 9 Pages 673-677
    Published: 2011
    Released on J-STAGE: September 25, 2011
    JOURNAL OPEN ACCESS
    A newly designed hydroxyapatite (HA) spacer for cervical laminoplasty is provided with a hole through which the titanium miniplate is passed. A new method of unilateral open-door laminoplasty with titanium miniscrew and miniplate through this HA spacer is described. Twenty-two patients with cervical stenotic disorders were treated by this procedure. Only the predominantly affected side of the laminae is exposed. The supraspinous and interspinous ligaments and the deep muscle layer in the contralateral side are left intact. A 4-mm wide gutter near the intervertebral joint is made and contralateral hinges are made under the deep muscle layer with minimum detachment of these muscles. The opened lamina is fixed with the titanium miniplate passed through the hole in the newly designed HA spacer. Mean operative time for the 22 operations was 193.5 minutes. Mean enlargement of the minimum spinal canal diameter was 50.9%. Neurological outcomes after 3 months were evaluated according to the Japanese Orthopaedic Association (JOA) scoring. Mean recovery rate of JOA score by Hirabayashi's method was 49.5%. Only 2 patients reported postoperative axial neck pain. Our method for unilateral open-door laminoplasty provides adequate decompression and tight fixation of laminae, and is less invasive to the posterior supporting elements of cervical spine.
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