Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 52, Issue 12
Displaying 1-19 of 19 articles from this issue
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The 70th Annual Meeting Special Topics — Part IV: Safe Treatment for High Grade Arteriovenous Malformations
  • Role of Stereotactic Radiosurgery in the Treatment of High-Grade Cerebral Arteriovenous Malformation
    Shunya HANAKITA, Tomoyuki KOGA, Masahiro SHIN, Masaaki SHOJIMA, Hirosh ...
    2012 Volume 52 Issue 12 Pages 845-851
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.845
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    Arteriovenous malformation (AVM) with a small nidus located in the cortical eloquent areas is difficult to surgically resect without neurological complication, but is a suitable target for stereotactic radiosurgery (SRS). However, lesions with large nidus volume or with deeply located nidus are difficult to safely treat, even by SRS. To explore the optimal treatment strategies for such high-grade cerebral AVM, we reviewed treatment outcomes of SRS using gamma knife surgery (GKS) for patients with high-grade AVM at our institute and in published reports. Although lesions in the thalamus and the brainstem carried higher risk of morbidity after SRS, accumulation of technical knowledge and experience about SRS and technological advances in dose planning have enabled safer treatment of AVM in these locations. Large AVM presents another challenge to SRS treatment. Multimodal treatment, including surgery and endovascular treatment, should be considered. In this setting, staged SRS using GKS or CyberKnife may achieve safer treatment of large cerebral AVM. Further progress in SRS is anticipated to enhance the treatment efficacy for high-grade cerebral AVM while reducing treatment morbidity.
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  • Surgical Treatment of Spetzler-Martin Grade III to V Cerebral Arteriovenous Malformations: 10 Years Experience in Kyoto University
    Yasushi TAKAGI, Jun C. TAKAHASHI, Kazumichi YOSHIDA, Akira ISHII, Nobu ...
    2012 Volume 52 Issue 12 Pages 852-858
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.852
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    Cerebral arteriovenous malformations (AVMs) are abnormal connections between arteries and veins leading to arteriovenous shunting with nidus formation. This study reviewed the clinical outcomes of surgical treatment for AVMs of Spetzler-Martin grades III to V in our institute. In addition, we summarized the technical aspects of surgical treatment for cerebral AVMs. Our development of the surgical modality for high-grade AVMs included intraoperative digital subtraction cerebral angiography, non-stick bipolar forceps, magnetic resonance tractography, and indocyanine green videoangiography. Excellent outcomes were obtained, but about 40% of all patients with AVMs could not receive surgical treatment. Multimodality approach including Onyx embolization may extend the surgical indications.
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  • Multimodality Treatment for Cerebral Arteriovenous Malformations
    —Complementary Role of Proton Beam Radiotherapy—
    Yasunobu NAKAI, Yoshiro ITO, Masayuki SATO, Kazuhiro NAKAMURA, Masanar ...
    2012 Volume 52 Issue 12 Pages 859-864
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.859
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    A total of 29 cerebral arteriovenous malformations (AVMs) treated at the University of Tsukuba with multimodality treatment including proton beam (PB) radiotherapy for cerebral AVMs between 2005 and 2011 were retrospectively evaluated. Eleven AVMs were classified as Spetzler-Martin grades I and II, 10 as grade III, and 8 as grades IV and V. For AVMs smaller than 2.5 cm and located on superficial and non-eloquent areas, surgical removal with/without embolization was offered as a first-line treatment. For some small AVMs located in deep or eloquent lesions, gamma knife (GK) radiosurgery was offered. Some AVMs were treated with only embolization. AVMs larger than 2.5 cm were embolized to achieve reduction in size, to enhance the safety of the surgery, and to render the AVM amenable to GK radiosurgery. For larger AVMs located in deep or eloquent areas, PB radiotherapy was offered with/without embolization. Immediately after the treatment, 24 patients exhibited no neurological worsening. Four patients had moderate disability, and 1 patient had severe disability. Three patients suffered brain damage after surgical resection, and 2 patients suffered embolization complications. However, no neurological worsening was observed after either GK radiosurgery or PB radiotherapy, but 3 patients treated by PB radiotherapy suffered delayed hemorrhage. Fractionated PB radiotherapy for cerebral AVMs seems to be useful for the treatment of large AVMs, but careful long-term follow up is required to establish the efficacy and safety.
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The 70th Annual Meeting Special Topics — Part I: Validation and Prospects for Neuromodulation (Supplemental)
  • Preoperative Regional Cerebral Blood Flow and Postoperative Clinical Improvement in Patients With Parkinson's Disease Undergoing Subthalamic Nucleus Deep Brain Stimulation
    Toshiya NAGAI, Yasukazu KAJITA, Satoshi MAESAWA, Daisuke NAKATSUBO, Ko ...
    2012 Volume 52 Issue 12 Pages 865-872
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.865
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    Preoperative regional cerebral blood flow (rCBF) was measured in 92 patients with Parkinson's disease (PD) by iodine-123 N-isopropyl-p-iodoamphetamine single-photon emission computed tomography. Quantitative mapping of rCBF was performed using the stereotactic extraction estimation method. The clinical features of the patients were assessed according to the Unified Parkinson Disease Rating Scale (UPDRS). The correlation between rCBF and improvement in the UPDRS score following surgery was examined. rCBF in the fusiform gyrus, superior and inferior parietal gyri, middle occipital gyrus, superior frontal gyrus, and middle temporal gyrus of the Talairach Daemon Level 3 was significantly correlated with UPDRS part II (off stage) and III (on stage) scores (p < 0.05). rCBF in the middle temporal gyrus (p = 0.00147), medial frontal gyrus (p = 0.00713), and cerebellum (p = 0.048) of the Talairach Daemon Level 3 was significantly greater in 47 patients with >60% improvement of UPDRS part III (off stage) score than in 37 patients with 40-60% improvement. The cutoff value of rCBF, which indicated that >40% improvement in the surgical outcome could be expected, was 38.8 ± 6.2 ml/100 g/min in the frontal lobe. This study indicated that rCBF in patients with PD might be related to their clinical features, suggesting that quantitative mapping of rCBF may be useful for predicting surgical outcome.
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Original Articles
  • Inadequate Communication Between Patients With Unruptured Cerebral Aneurysms and Neurosurgeons
    Makoto SAITO, Yoshimitsu TAKAHASHI, Yayoi YOSHIMURA, Ayako SHIMA, Akio ...
    2012 Volume 52 Issue 12 Pages 873-877
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.873
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    Communication between patients with cerebral aneurysms and consulting neurosurgeons remains unstudied in Japan. The present clinical study surveyed patients with unruptured cerebral aneurysms and their neurosurgeons after explanation of the disease and its treatment options and expected outcomes in clinic visits using a one-page written questionnaire about treatment options and decisions given to patients and their neurosurgeons. The numbers of participating patients and neurosurgeons were 42 and 9, respectively, and 42 paired patient-neurosurgeon responses were obtained. Agreement was quite low (κ = 0.17-0.31 for 6-point Likert scale and κ = 0.44-0.67 for 2 category scale) regarding the “best” treatment for each patient as agreed on by the patient and neurosurgeon. Agreement in the understanding of treatment options and general application was unexpectedly low (κ = 0.12 and 0.01 for 6-point Likert scale and κ = not applicable and −0.03, respectively, for 2 category scale). Agreement tended to be higher between experienced neurosurgeons and patients than non-experienced neurosurgeons and patients. Patients estimated much higher risks of stroke or death after surgical intervention (p < 0.001) or no intervention (p = 0.006) compared with the estimates offered by their neurosurgeons.
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  • Preoperative Endovascular Embolization for Hemangioblastoma in the Posterior Fossa
    Noriaki SAKAMOTO, Eiichi ISHIKAWA, Yasunobu NAKAI, Hiroyoshi AKUTSU, T ...
    2012 Volume 52 Issue 12 Pages 878-884
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.878
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    Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.
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  • Spontaneous Echo Contrast and Thrombus Formation at the Carotid Bifurcation After Carotid Endarterectomy
    Masahito KAWABORI, Tetsuyuki YOSHIMOTO, Masaki ITO, Shin FUJIMOTO, Tai ...
    2012 Volume 52 Issue 12 Pages 885-891
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.885
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    Spontaneous echo contrast (SEC) consists of numerous microechoes swirling in the cardiovascular lumen and is usually seen during blood stasis in dysfunctional left atrium. However, SEC and consecutive local thrombus formation at the carotid artery early after carotid endarterectomy (CEA) have not been reported. This study retrospectively investigated the clinical importance and therapeutic strategy of postoperative SEC and thrombus formation in 113 consecutive patients who underwent CEA between 2001 and 2009. Ultrasonography was routinely performed preoperatively, intraoperatively, and 1 day and 1 week after the operation. If SEC and/or thrombus was detected at any time after the operation, follow-up ultrasonography was performed at short intervals, once a week for inpatients and once every 1-2 months for outpatients. Eight of the 113 patients (7%) had SEC after the operation from Day 1 to 12 (mean 7.2 days), and 6 of these 8 patients developed local de novo thrombus formation at the site of SEC from Day 6 to 33 (mean 14.7 days). The maximum luminal narrowing by the thrombi were 26-62% (mean 37%). After administering anticoagulant therapy, all thrombi disappeared from Day 13 to 190 (mean 57 days) from CEA. SEC seen after CEA is highly associated with consecutive local thrombus formation. Postoperative geometric blood stasis with the absence of intima may be the causative factor for its development.
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  • Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy
    Tetsuro KAWAMURA, Hiroaki ONISHI, Yukihiko KOHDA, Genjiro HIROSE
    2012 Volume 52 Issue 12 Pages 892-898
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.892
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    Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiation-induced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.
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Case Reports
  • Progression of Stenosis Into Occlusion of the Distal Posterior Cerebral Artery Supplying an Occipital Arteriovenous Malformation Manifesting as Multiple Ischemic Attacks
    —Case Report—
    Hisaharu GOTO, Michiyasu SUZUKI, Tatsuo AKIMURA, Hirosuke FUJISAWA, Hi ...
    2012 Volume 52 Issue 12 Pages 899-902
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.899
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    A 31-year-old healthy male presented with a rare case of cerebral arteriovenous malformation (AVM) manifesting as repeated ischemic attacks and cerebral infarction causing left sensori-motor disturbance. Neuroimaging revealed cerebral infarction in the right thalamus as well as right occipital AVM without bleeding. The AVM was mainly fed by the right angular artery, and the right posterior cerebral artery (PCA) showed mild stenosis and segmental dilation at the P2-P3 portion. After referral to our hospital, transient ischemic attacks causing left homonymous hemianopsia, and left arm and leg numbness were frequently recognized. Additional imaging revealed a new ischemic lesion in the occipital lobe, and repeated cerebral angiography showed right PCA occlusion at the P2-P3 segment. Cerebral AVM presenting with cerebral infarction due to occlusion of feeding arteries is rare. In our case, intimal injury due to increased blood flow or spontaneous dissection of the artery were possible causes. We should monitor any changes in the architecture and rheology of the feeding vessels during the clinical course to prevent ischemic complications.
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  • Hyperperfusion Syndrome After Stent Placement for Subclavian Artery Stenosis
    —Case Report—
    Koichi ITO, Hirokatsu YONAHA, Yutaka KAI, Yohei HOKAMA, Hideki NAGAMIN ...
    2012 Volume 52 Issue 12 Pages 902-905
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.902
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    A 60-year-old woman presented with a rare case of hyperperfusion syndrome after stent placement for subclavian artery stenosis manifesting as dizziness due to vertebrobasilar insufficiency. Three days after undergoing stent placement to treat the severely stenotic (90%) right subclavian artery, she suffered intracranial hemorrhage related to hyperperfusion syndrome. Preoperative single-photon emission computed tomography findings of low cerebral perfusion and poor perfusion reserve might indicate the possibility of hyperperfusion syndrome after stenting in patients with subclavian artery stenosis.
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  • External Carotid Artery Stenting and Superficial Temporal Artery to Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion With External Carotid Artery Severe Stenosis
    —Case Report—
    Takayuki OKU, Kenichiro NOGAMI, Hiroyasu KOIZUMI, Hideyuki ISHIHARA, S ...
    2012 Volume 52 Issue 12 Pages 906-909
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.906
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    Superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis may have inadequate effects in patients with internal carotid artery (ICA) occlusion and severe stenosis of the ipsilateral external carotid artery (ECA), because poor blood flow in the STA leads to insufficient flow to the MCA. In these patients, dilation of the stenotic ECA is required to improve the blood flow in the STA before STA-MCA anastomosis. A 71-year-old man presented with left hemiparesis and dysarthria. Magnetic resonance imaging revealed an old watershed infarction in the right cerebral hemisphere. Right carotid angiography showed right ICA occlusion and severe ipsilateral ECA stenosis. Single photon emission computed tomography (SPECT) demonstrated severe hemodynamic insufficiency in the right MCA territory. Instead of endarterectomy of the ECA, angioplasty and stenting (CAS) for ECA was performed to ensure adequate blood flow in the STA, due to the history of myocardial infarction and bifurcation of the common carotid artery at a high level (C2 level). Then STA-MCA anastomosis was performed 1 month later. Postoperative SPECT demonstrated marked improvement of hemodynamic insufficiency in the right MCA territory. After treatment, the patient had no ischemic events. This case suggests external CAS together with STA-MCA anastomosis is a good therapeutic option for a patient with symptomatic ICA occlusion and severe stenosis of the ipsilateral ECA if external CEA is difficult to perform.
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  • Endovascular Revascularization of External Carotid Artery Occlusion Causing Tongue Infarction
    —Case Report—
    Hiroshi KAGAMI, Makoto INABA, Shinya ICHIMURA, Koichi HARA, Joji INAMA ...
    2012 Volume 52 Issue 12 Pages 910-913
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.910
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    A 62-year-old man with diabetes and a history of ischemic coronary disease visited the emergency department complaining of acute pain and swelling of the tongue. Physical examination found subtle swelling and pallor of the right side of the tongue, and he was initially diagnosed with glossitis. However, his symptoms were progressive, and the tongue had sustained serious tissue damage before the correct diagnosis was established. Digital subtraction angiography of the cervical vessels revealed occlusion of the right external carotid artery (ECA) and lingual artery without collateral circulation to the right side of the tongue from the contralateral ECA or ipsilateral vertebral artery (VA). Endovascular revascularization was performed to restore blood flow to the tongue using balloon angioplasty of the proximal segment of the right ECA followed by deployment of a self-expanding stent. Tongue pain subsided shortly after the procedure, and configuration of the tongue returned to normal 4 months after intervention. Tongue infarction is rare and usually associated with systemic vasculitides. Tongue infarction due to unilateral occlusion of the ECA is extremely rare because of the rich collateral circulation to the tongue from the ipsilateral VA and contralateral ECA. Atherothrombotic unilateral occlusion of the ECA should be included in the differential diagnosis of tongue infarction. Revascularization of the occluded ECA is worth attempting despite substantial tissue damage because of the viability of the tongue muscles and the minimal risk of complications in experienced hands.
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  • Repeated Brain Infarction Caused by Atherosclerosis of the Bovine Aortic Arch Successfully Treated With Arch Replacement
    —Case Report—
    Tae YAMASHITA, Hisaya HIRAMATSU, Naoki WASHIYAMA, Norihiko SHIIYA, Hir ...
    2012 Volume 52 Issue 12 Pages 914-917
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.914
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    A 62-year-old man presented with repeated embolic infarction over the last 3 years. Computed tomography angiography of the aortic arch revealed that the patient had a common trunk for the innominate and left carotid arteries, the so-called bovine aortic arch, with stenosis extending to both the left common carotid artery and innominate artery. Since antiplatelet therapy was not adequate for prevention of recurrent infarction, total replacement of the aortic arch was performed. Since then, no further ischemic events have manifested. Endovascular procedures are not safe enough for atherosclerotic lesions in the aortic arch, especially in a patient with bovine aortic arch, so surgical aortic arch replacement should be considered.
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  • Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage With Unilateral Third Cranial Nerve Palsy
    —Two Case Reports—
    Nobutake SADAMASA, Noritaka SANO, Nobuhiko TAKEDA, Kazumichi YOSHIDA, ...
    2012 Volume 52 Issue 12 Pages 918-920
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.918
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    Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage and is usually not associated with any focal deficit. We describe two rare cases of PNSAH with unilateral third cranial nerve palsy. Both patients were treated conservatively. The outcomes of our two cases were excellent. The third cranial nerve palsy resolved gradually in both patients, suggesting that the prognosis for third cranial nerve palsy concomitant with PNSAH is favorable. Unilateral third cranial nerve palsy may occur as the first clinical manifestation of PNSAH.
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  • Simultaneous Presentation of Two Cerebral Aneurysms
    —Case Report—
    Masahiro YOSHIDA, Masayuki EZURA, Kazuto SASAKI, Masashi CHONAN, Masak ...
    2012 Volume 52 Issue 12 Pages 921-923
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.921
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    A 48-year-old woman experienced sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage (SAH) and intracerebral hematoma in the right frontal lobe. Digital subtraction angiography revealed three aneurysms in the anterior communicating artery (AcomA), the right posterior communicating artery (PcomA), and the right middle cerebral artery. The AcomA aneurysm was treated with endovascular coiling. However, her oculomotor nerve palsy was aggravated after the procedure. Embolization of the right PcomA aneurysm was conducted immediately and her oculomotor nerve palsy recovered completely 3 months later. Simultaneous presentation of multiple aneurysms with separate symptoms is rare. We speculate that the progressive oculomotor nerve palsy was caused by tiny enlargement or morphological change of the aneurysm caused by elevated blood pressure and pulsatile effect after SAH.
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  • Endovascular Repair of Ruptured Aneurysm Arising From Fenestration of the Horizontal Segment of the Anterior Cerebral Artery
    —Case Report—
    Masahiro YOSHIDA, Masayuki EZURA, Kazuto SASAKI, Masashi CHONAN, Masak ...
    2012 Volume 52 Issue 12 Pages 924-927
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.924
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    A 50-year-old man presented with an aneurysm arising from a fenestration of horizontal portion (A1) of the anterior cerebral artery manifesting as subarachnoid hemorrhage. Coil embolization was conducted and the aneurysm was occluded easily. Most reported cases of these types of aneurysms underwent direct surgery. Aneurysm arising from the A1 fenestration is rare, but the present case shows that coil embolization can be an effective treatment modality. Three-dimensional rotational angiography and aneurysmography were helpful to characterize this complicated vascular structure.
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  • Ruptured Intracranial Aneurysms in Pediatric Polyarteritis Nodosa
    —Case Report—
    Keisuke TOYODA, Keisuke TSUTSUMI, Tomohito HIRAO, Tomonori ONO, Hideak ...
    2012 Volume 52 Issue 12 Pages 928-932
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.928
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    Polyarteritis nodosa (PAN) is a rare, systemic necrotizing vasculitis of small and medium size arteries that leads to aneurysms in various organs. Aneurysms associated with PAN are common in visceral arteries, however, intracranial aneurysms are rare, especially in childhood. A pediatric patient with PAN developed serial hemorrhagic strokes from a ruptured superior cerebellar artery aneurysm (subarachnoid hemorrhage) and a de novo aneurysm of the frontoorbital artery (intracerebral hemorrhage) after 9 months. Patients with PAN who present with intracranial aneurysms are candidates for intervention even if the aneurysm is unruptured and still small, and close observation is needed to detect de novo aneurysms in patients with chronic history of PAN.
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  • Repeated Delayed Onset Cerebellar Radiation Injuries After Linear Accelerator-Based Stereotactic Radiosurgery for Vestibular Schwannoma
    —Case Report—
    Kenta UJIFUKU, Takayuki MATSUO, Keisuke TOYODA, Shiro BABA, Tomohiro O ...
    2012 Volume 52 Issue 12 Pages 933-936
    Published: 2012
    Released on J-STAGE: December 25, 2012
    DOIhttps://doi.org/10.2176/nmc.52.933
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    A 63-year-old woman presented with right hearing disturbance and vertigo. Magnetic resonance (MR) imaging revealed the presence of right vestibular schwannoma (VS). Stereotactic radiosurgery (SRS) was performed with a tumor marginal dose of 14 Gy using two isocenters. She was followed up clinically and neuroradiologically using three-dimensional spoiled gradient-echo MR imaging. She experienced temporal neurological deterioration due to peritumoral edema in her right cerebellar peduncle and pons for a few months beginning 1.5 years after SRS, when she experienced transient right facial dysesthesia and hearing deterioration. Ten years after SRS, the patient presented with sudden onset of vertigo, gait disturbance, diplopia, dysarthria, and nausea. MR imaging demonstrated a new lesion in the right cerebellar peduncle, which was diagnosed as radiation-induced stroke. The patient was followed up conservatively and her symptoms disappeared within a few months. Multiple delayed onset radiation injuries are possible sequelae of SRS for VS.
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Editorial Committee
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