Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 53, Issue 4
Displaying 1-19 of 19 articles from this issue
Original Articles
  • Ying GUO, Hong ZHANG, Li SUN
    2013 Volume 53 Issue 4 Pages 201-206
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    The effects of intraoperative magnetic resonance (iMR) imaging on the neuromuscular blockade of vecuronium bromide were investigated in neurosurgery. Fifty patients with American Society of Anesthesiologists grades I-II scheduled for craniotomy operation were divided into two groups (n = 25 each) with no difference in demographic data: the iMR imaging group and control group. Train-of-four (TOF) stimulation through an accelerometer was used to monitor onset, maintenance, and recovery of muscle relaxation caused by vecuronium. Vecuronium bromide was intravenously injected after anesthesia induction. The dosage of vecuronium bromide in the iMR imaging group was larger than in the control group, but not significantly. Duration of vecuronium bromide administration and operation time were significantly longer in the iMR imaging group than in the control group. Time from drug discontinuation to operation termination, and to return to neurosurgery intensive care unit were not different. Time taken by first twitch (T1) in response to TOF stimulation to recover by 25%, and muscle relaxant recovery index were significantly greater in the control group than in the iMR imaging group. The body temperature of the patients increased gradually in the iMR imaging group but decreased in the control group. iMR imaging can prolong the operation time, increase the body temperature of the patient, and remarkably shorten the clinical action time and muscle relaxation recovery index of vecuronium.
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  • Takaaki HOSOYA, Jun HATAZAWA, Shinya SATO, Masafumi KANOTO, Akira FUKA ...
    2013 Volume 53 Issue 4 Pages 207-212
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    We would like to propose floating dural sac sign, which is observed as a hyperintense band or rim around the spinal dural sac on axial T2-weighted images, as a sensitive sign to identify cerebrospinal fluid (CSF) leakage. One hundred patients with orthostatic headache were prospectively registered in 11 hospitals. These patients were examined by brain magnetic resonance (MR) imaging (n = 89), radioisotope cisternography (n = 89), MR myelography (n = 86), axial T2-weighted imaging of the spine (n = 70), and computed tomography myelography (n = 2). In this study, we separately evaluated the imaging findings of intracranial hypotension and spinal CSF leakage. Among 100 patients, 16 patients were diagnosed as having spinal CSF leaks. Of 70 patients examined with axial T2-weighted imaging, 14 patients were diagnosed with spinal CSF leaks, and floating dural sac sign was observed in 17 patients, 13 patients with spinal CSF leaks and 4 without CSF leaks (sensitivity 92.9%, specificity 92.9%). Of 86 patients examined by MR myelography, extradural fluid was observed in only 3 patients (sensitivity 21.4%, specificity 100%). The floating dural sac sign was a sensitive sign that can be used to identify CSF leakage. Spinal axial T2-weighted imaging might be a good screening method for spinal CSF leakage that can help to avoid the need for lumbar puncture.
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Case Reports
  • —Two Case Reports—
    Nunung Nur RAHMAH, Tetsuyoshi HORIUCHI, Yoshikazu KUSANO, Tatsuya SEGU ...
    2013 Volume 53 Issue 4 Pages 213-216
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Cerebral perfusion monitoring is an important component of hyperacute stroke treatment. Arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging provides a noninvasive method of cerebral perfusion observation. Rapid changes in cerebral perfusion were demonstrated in two patients admitted one hour after onset of hyperacute stroke who underwent recombinant tissue plasminogen activator (rt-PA) treatment. Serial MR images and ASL images were taken on admission and after rt-PA administration. Cerebral blood flow (CBF) values were obtained using the CBF workstation and analysis software. Interpretable ASL images were taken in both patients. Perfusion deficits were consistent with symptoms and/or MR angiography imaging abnormalities. Delayed arterial transit effect was present in one patient; serial imaging showed improvement of CBF after rt-PA treatment in both patients. ASL perfusion MR imaging can provide rapid noninvasive multislice imaging in hyperacute ischemic stroke, and can depict early perfusion deficit and quantify regional CBF concomitantly.
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  • —Two Case Reports—
    Haruna KAMOCHI, Gen KUSAKA, Mami ISHIKAWA, Sane ISHIKAWA, Yuichi TANAK ...
    2013 Volume 53 Issue 4 Pages 217-220
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Late onset cerebrospinal fluid (CSF) leakage, such as rhinorrhea or otorrhea, is a rare complication of closed head injury. We encountered two cases of delayed CSF leakage more than 10 years after head injury. In both cases, surgical treatments were performed using intradural approaches, and the dural defects were closed with viable pedicled flaps. After surgery, the CSF leakage was completely cured and no remarkable complication was observed in either case. The present two cases of late onset CSF leakage suggest that surgical repair procedures should be performed as soon as the leaks are discovered. A bifrontal intracranial approach is recommended to treat frontal cranial base leakage. Temporal craniotomy is recommended to treat temporal base leakage. All cases should be treated using an intradural approach, and the dural defect is best repaired with viable pedicled flaps.
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  • —Case Report—
    Jian SHEN, Zuoxu FAN, Tao JI, Jianwei PAN, Yongqing ZHOU, Renya ZHAN
    2013 Volume 53 Issue 4 Pages 221-224
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Contralateral acute subdural hematoma (ASDH) occurring after removal of traumatic ASDH is a rare, but nearly devastating postoperative complication. We treated a 26-year-old male who developed a contralateral ASDH shortly after craniectomy for evacuation of a traumatic ASDH. Burr-hole craniotomy was performed before decompressive craniectomy, and the bleeding source was a cortex artery within the frontal lobe contusion. Despite supportive therapy with barbiturate and mild hypothermia he expired 3 days later of brain death. Literature review suggests that the old are more susceptible to contralateral ASDH following evacuation of traumatic ASDH. Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.
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  • —Case Report—
    Tomoji HATTORI, Taku TAKEUCHI, Ryusuke KABEYA, Kazuhiko ANDO, Fujio TO ...
    2013 Volume 53 Issue 4 Pages 224-227
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Dural arteriovenous fistula (DAVF) is rarely associated with parkinsonism. A 52-year-old woman presented with a rare case of DAVF manifesting as parkinsonism and subsequently akinetic mutism. She showed dramatic recovery after endovascular treatment. We also review 10 published reports of DAVF presenting with parkinsonism. The clinical features of these cases at presentation was more closely compatible with lower body parkinsonism or vascular parkinsonism rather than Parkinson's disease. Most lesions are located at the transverse-sigmoid sinus (TSS) with venous reflux into the straight sinus with probable venous congestion of the basal ganglia. Most importantly, parkinsonism due to TSS DAVF is reversible if embolization is achieved successfully.
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  • —Case Report and Embryological Considerations—
    Tetsuo SASAKI, Hisashi NAGASHIMA, Fusakazu OYA, Daisuke SATOH, Shigeak ...
    2013 Volume 53 Issue 4 Pages 228-232
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    A 68-year-old man presented with right cervical carotid artery stenosis manifesting as ipsilateral amaurosis fugax. Angiography showed non-bifurcating cervical carotid artery with atherosclerotic stenosis near the branching of the superior thyroid artery. Carotid artery stenting (CAS) was carried out using two balloons for embolic protection of the internal carotid artery and middle meningeal artery because the ophthalmic artery was supplied by the middle meningeal artery. No procedure-related complications or restenosis occurred after stenting. Non-bifurcating cervical carotid artery is a very rare anomaly, in which the branches of the external carotid artery directly arise from the common trunk of the carotid artery without forming a bifurcation. The present patient was successfully treated with CAS for atherosclerotic stenosis associated with non-bifurcating cervical carotid artery.
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  • —Case Report—
    Toshihide TANAKA, Naoki KATO, Ken AOKI, Aya NAKAMURA, Mitsuyoshi WATAN ...
    2013 Volume 53 Issue 4 Pages 233-236
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    A 63-year-old woman presented with a metastatic focus of papillary thyroid carcinoma in the cerebellopontine angle manifesting as lateral gazing nystagmus and slurred speech. Computed tomography demonstrated massive hemorrhage in the left cerebellar hemisphere. She was treated conservatively. Her symptoms resolved completely, but she experienced progressive deterioration in auditory acuity and ataxia over the next 6 months. Magnetic resonance imaging with gadolinium demonstrated an enhanced mass in the left cerebellopontine angle, and she was scheduled for elective resection of the tumor. Left retrosigmoid craniotomy was performed, and the tumor was subtotally removed except for a small amount at the junction of the trigeminal nerve and the pons. Histological examination confirmed a diagnosis of metastatic papillary thyroid carcinoma. The patient then underwent adjuvant gamma knife radiosurgery. Her clinical course was unremarkable, and her hypoacusis and ataxia resolved completely. Postoperative gallium scintigraphy revealed no residual tumor and no other systemic metastases. Hemorrhagic cerebellar metastasis from papillary thyroid carcinoma is extremely rare, but early recognition of metastatic cerebellar tumor should prompt immediate treatment to avoid the development of hearing loss, ataxia, and tonsillar herniation.
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  • —Case Report—
    Ming WANG, Huafeng WANG, Yongqing ZHOU, Renya ZHAN, Shu WAN
    2013 Volume 53 Issue 4 Pages 237-241
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Myxopapillary ependymoma (MPE) is a rare type of central nervous system neoplasm mostly located in the cauda equina and filum terminale regions. A previously healthy 22-year-old Chinese man presented with the first case of MPE in the third ventricle area and sacral canal initially manifesting as spinal cord compression. The patient was admitted with pain in the right lower extremity for 5 months and encopresis for 3 months. Magnetic resonance imaging of the lumbar spine revealed an intradural lesion at the S2 level. The patient accordingly underwent lumbar laminectomy surgery and gross total resection of the tumor. Shortly after surgery, a mass was found in the third ventricle. The patient subsequently underwent further craniotomy surgery, and the histopathological examination eventually revealed MPE. MPE usually undergoes intracranial retrograde metastasis, but we consider that our case was a dropped metastasis of the primary intracranial MPE. Neurosurgeons need to be aware of intracranial MPEs in patients with isolated spinal lesions, and long-term follow-up is important in patients who are diagnosed with MPE after surgical excision.
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  • —Case Report—
    Toshiyuki AMANO, Yuhei SANGATSUDA, Nobuhiro HATA, Daisuke INOUE, Megum ...
    2013 Volume 53 Issue 4 Pages 242-244
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    A 74-year-old female suffered hearing disturbance in the right ear persisting for several years, followed by sudden onset of right facial nerve palsy. Her symptoms gradually worsened and neuroradiological imaging revealed a 4-cm cerebellopontine angle (CPA) tumor. Intraoperatively, the tumor was found to originate from the facial nerve. Total removal of the tumor was achieved, followed by a split hypoglossal-facial nerve anastomosis. Facial nerve schwannomas are rare and extremely difficult to preoperatively distinguish from vestibular schwannomas, especially if arising from the CPA and the internal auditory canal. However, preoperative diagnosis of facial nerve schwannomas is important because functional preservation of the facial nerve is more challenging than for vestibular schwannomas. Facial nerve palsy is one of the most unique symptoms in patients with facial nerve schwannomas, but is rare with vestibular schwannomas. Facial nerve schwannomas should be included in the differential diagnosis of CPA tumors with atypical clinical manifestations, and patients should be informed before surgery of the possibility of facial nerve dysfunction and the consequent need for facial nerve graft or reconstruction.
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  • —Case Report—
    Toru YAMAGATA, Toshihiro TAKAMI, Naoki YAMAMOTO, Sayaka TANAKA, Kenich ...
    2013 Volume 53 Issue 4 Pages 245-248
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    A 28-year-old male presented with a rare case of primary intramedullary spinal Langerhans cell histiocytosis (LCH) manifesting as the chief complaint of a 6-month history of gait disturbance and back pain, and difficulty with sphincter control. Serial T2-weighted magnetic resonance imaging of the thoracic spine revealed enlargement and intramedullary hyperintensity of the spinal cord at T2 to T4. Biopsy of the lesion was performed. Histological examination of the biopsy specimens verified vascular proliferation and remarkable infiltration of histiocytes that were positive for CD1a, suggesting a diagnosis compatible with LCH. The patient was treated successfully by steroid pulse therapy. LCH is a rare disease that occurs mainly in children and may cause a broad range of manifestations, from a single osseous lesion to multiple lesions involving more than one organ or system. The present case illustrates the unexpected occurrence and important differential diagnosis of primary intramedullary spinal LCH of the thoracic spine in adult patients presenting with progressive paraparesis and back pain.
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  • —Three Case Reports and Review of the Literature—
    Tatsuya KOBAYASHI, Takahiko TSUGAWA, Chisa HASHIZUME, Norio ARITA, His ...
    2013 Volume 53 Issue 4 Pages 249-255
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Chordoid glioma of the third ventricle is considered to be a benign glial tumor located exclusively in the mid-anterior portion of the third ventricle near the hypothalamus and optic nerves, with the histological features of a chordoma and immuno-labeling for glial fibrillary acidic protein. Unfortunately, the clinical outcome of chordoid glioma has been poor, even in patients receiving gross total or partial removal with or without radiotherapy. Three cases of chordoid glioma of the third ventricle were treated with less invasive microsurgery for pathological diagnosis or partial removal without neuro-endocrinological complication, followed by gamma knife radiosurgery using a lower marginal dose for the optic nerves and hypothalamus. Gamma knife radiosurgery was performed after open biopsy in two patients, and after partial removal in the third patient using a lower marginal dose of 10.5 to 12 Gy. Serial magnetic resonance imaging revealed gradual decrease or at least no change in the tumor size, without significant complication at follow up 70 and 66 months later in two cases. The third patient accidentally died 13 months after gamma knife treatment. We conclude that low dose gamma knife radiosurgery after less invasive microsurgery is both safe and effective for the control of chordoid glioma of the third ventricle over a very long follow-up period.
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  • —Case Report—
    Hidehiro KIN, Eiichi ISHIKAWA, Shingo TAKANO, Satoshi AYUZAWA, Akira M ...
    2013 Volume 53 Issue 4 Pages 256-258
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    A 40-year-old bilingual man underwent removal of glioblastoma multiforme with intraoperative language mapping, mainly using the picture-naming and auditory responsive-naming tasks under cortical stimulation. Multiple language areas were identified, including one located in the middle of the inferior temporal cortex (ITC). Individual mapping for glioma patients must be performed because language areas might be located in various and unexpected regions, including the ITC.
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  • —Two Case Reports—
    Yoshihisa MATSUMOTO, Hiroshi AIKAWA, Sumito NARITA, Masanori TSUTSUMI, ...
    2013 Volume 53 Issue 4 Pages 259-262
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    The rise in the incidence of tuberculosis is generally related to human immunodeficiency virus infection. However, intracranial tuberculoma, a complication of tuberculosis considered to be a critical disease, can develop even in the absence of immunosuppressive state. Here, we describe 2 cases of intracranial tuberculoma occurring in patients with no evidence of immunosuppressive state or past history of tuberculosis. In Case 1, lesions were observed in the right lateral ventricle, with histological examination revealing granulomatous lesions. In Case 2, scattered lesions were observed in the cranium and the lung fields. In both cases, the QuantiFERON Test (QFT) was positive, and improvements were observed in the symptoms following administration of antituberculous drugs. Intracranial tuberculoma cannot be considered rare, and needs to be included in the differential diagnosis of intracranial lesions. Diagnosis can be tricky since this disease can develop in a patient in a non-immunosuppressive state or without a past history of tuberculosis. The QFT is an effective test to enable the diagnosis of tuberculomas in atypical patients.
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  • —Case Report—
    Christopher BEYNON, Jan-Oliver NEUMANN, Julian BÖSEL, Andreas W. ...
    2013 Volume 53 Issue 4 Pages 263-265
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Listerial rhombencephalitis and brain abscesses are rare, but potentially life-threatening conditions. Early initiation of antibiotic therapy is crucial, but establishing the diagnosis of listerial brainstem abscess can be difficult. Stereotactic biopsy and drainage of space-occupying abscesses of the brainstem should be considered especially in cases of rapid clinical deterioration. We successfully performed stereotactic biopsy and drainage of a listerial brainstem abscess in a 42-year-old male patient who deteriorated despite antibiotic treatment, demonstrating that this approach is suitable in such patients.
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  • —Case Report—
    Tim KILLEEN, Chani TROMOP-VAN-DALEN, Hamish ALEXANDER, Agadha WICKREME ...
    2013 Volume 53 Issue 4 Pages 266-269
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Rarely, midline or unilateral posterior fossa arachnoid cysts (ACs) exert local mass effect resulting in the symptoms and signs of cerebellar and brainstem dysfunction. These cysts are sometimes seen in conjunction with cerebellar tonsillar ectopia (TE), although the relationship between these two entities is unclear. Bilateral ACs in the posterior fossa are virtually unprecedented. We describe the case of a 33-year-old man with a history of multiple minor head injuries observed to harbour asymptomatic, bilateral cerebrospinal fluid-density collections over the cerebellar hemispheres. Six years later, he presented with headaches, limb paraesthesias, and drop attacks. Computed tomography, magnetic resonance imaging, and operative findings during burrhole drainage of the lesions showed bilateral posterior fossa ACs, with associated cerebellar TE of 11 mm. The cysts partially recurred, necessitating reopening of the burrholes, after which the patient's symptoms resolved entirely. We then discuss the challenges in diagnosing this unusual case, the relationship between AC and TE, and the role of minor head injury in the symptomatic progression of AC.
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  • —Case Report—
    Hidetoshi NAKAMOTO, Takemasa KAWAMOTO, Sakiko SUZUKI, Kenzo HIROSHIMA, ...
    2013 Volume 53 Issue 4 Pages 270-272
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    A 56-year-old woman presented with a cystic skull lesion in the right temporal bone detected after resection of breast cancer. She underwent resection of the skull tumor for pathological diagnosis and treatment. The tumor was covered with ciliated epithelium and there were no malignant findings. The pathological diagnosis was ciliated epithelial inclusion cyst. Intradiploic inclusion cysts of the skull presenting as a calvarial defect include epidermoid cysts and dermoid cysts, which are clinically difficult to differentiate. Ciliated epithelium lining an intradiploic inclusion cyst is very rare. Surgical resection is essential for a definitive diagnosis and differentiation from a neoplasm.
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Technical Note
  • —Technical Note—
    Masahiko TOSAKA, Kazuya SAKAMOTO, Saiko WATANABE, Masahiko YODONAWA, H ...
    2013 Volume 53 Issue 4 Pages 273-278
    Published: 2013
    Released on J-STAGE: April 25, 2013
    JOURNAL OPEN ACCESS
    Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The “closed condition” represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The “open condition” includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the “open condition,” shortens the operation time, and achieves good irrigation of the hematoma.
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