巻号一覧
54 巻, 4 号
選択された号の論文の15件中1～15を表示しています
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Original Articles
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Yu TERANISHI, Michihiro KOHNO, Shigeo SORA, Hiroaki SATO2014 年 54 巻 4 号 p. 261-266
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/08ジャーナル オープンアクセスAppropriate placement of the keyhole at the transverse and sigmoid sinus (T/S) junction is important for performance of safe and accurate lateral suboccipital craniotomy with minimum bone loss. Here, we report a method for predicting the position of the T/S junction and investigate the relationship between the T/S junction and asterion. The subjects were 88 patients treated surgically via a lateral suboccipital approach. These cases included 78 acoustic neuromas, 4 meningiomas, 1 trigeminal schwannoma, 1 epidermoid cyst, 2 trigeminal neuralgias, and 1 hemifacial spasm. To expose the T/S junction, we usually place the keyhole lateral to asterion by a half diameter of the burr hole. The distance of the T/S junction from asterion was investigated using three-dimensional computed tomography (3DCT) images. We investigated the differences between the actual and predicted positions of the T/S junction based on skull landmarks, and we compared our method with other literature methods. The mean distances were 5.7 mm caudal and 6.6 mm lateral. The difference between the actual and predicted positions was significantly smaller in our approach compared to other methods. Placing the keyhole lateral to a provisional burr hole just caudal to asterion and lateral by half the diameter of the burr hole was useful for exposure of the T/S junction. The best approach is to use preoperative 3DCT, but this may be limited by equipment problems, emergency cases, or allergy to contrast medium. Determination of the appropriate keyhole position with reference to skull landmarks is a universally useful method.抄録全体を表示PDF形式でダウンロード (1953K) -
Noritaka AIHARA, Shingo MURAKAMI, Mariko TAKAHASHI, Kazuo YAMADA2014 年 54 巻 4 号 p. 267-271
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/12/27ジャーナル オープンアクセスWe classified the results of preoperative auditory brainstem response (ABR) in 121 patients with useful hearing and considered the utility of preoperative ABR as a preliminary assessment for intraoperative monitoring. Wave V was confirmed in 113 patients and was not confirmed in 8 patients. Intraoperative ABR could not detect wave V in these 8 patients. The 8 patients without wave V were classified into two groups (flat and wave I only), and the reason why wave V could not be detected may have differed between the groups. Because high-frequency hearing was impaired in flat patients, an alternative to click stimulation may be more effective. Monitoring cochlear nerve action potential (CNAP) may be useful because CNAP could be detected in 4 of 5 wave I only patients. Useful hearing was preserved after surgery in 1 patient in the flat group and 2 patients in wave I only group. Among patients with wave V, the mean interaural latency difference of wave V was 0.88 ms in Class A (n = 57) and 1.26 ms in Class B (n = 56). Because the latency of wave V is already prolonged before surgery, to estimate delay in wave V latency during surgery probably underestimates cochlear nerve damage. Recording intraoperative ABR is indispensable to avoid cochlear nerve damage and to provide information for surgical decisions. Confirming the condition of ABR before surgery helps to solve certain problems, such as choosing to monitor the interaural latency difference of wave V, CNAP, or alternative sound-evoked ABR.抄録全体を表示PDF形式でダウンロード (353K) -
Kuniaki SAITO, Akitake MUKASA, Yoshitaka NARITA, Yusuke TABEI, Nobusad ...2014 年 54 巻 4 号 p. 272-279
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/20ジャーナル オープンアクセスRadiation therapy with concomitant and adjuvant temozolomide (TMZ) is the standard therapy for nonelderly patients with glioblastoma. However, TMZ-based chemoradiotherapy for elderly patients with glioblastoma is controversial. The aim of this study was to investigate the benefits and adverse effects of this combined therapy in elderly patients with glioblastoma. Of the 76 newly diagnosed glioblastoma patients who were treated with standard radiotherapy (60 Gy/30 fractions) and TMZ, treatment toxicity and therapeutic outcome were evaluated in 27 elderly patients (age 65 years or older) and compared with those of 49 nonelderly counterparts (age younger than 65 years). The incidence of common toxicity criteria Grade 4 adverse events during the concomitant course was higher in the elderly group than that in the nonelderly group (26% versus 8%; p = 0.046). Cognitive dysfunction was observed only in the elderly group (p = 0.042). The median overall survival (OS) and median progression-free survival in the elderly group were 15.2 months (95% confidence interval [CI]; 12.9–18.5) and 8.4 months (95% CI; 5.1–11.7), respectively. OS was significantly shorter in the elderly group than in the nonelderly group (p = 0.021). The recursive partitioning analysis score was a prognostic factor for OS. TMZ-based chemoradiotherapy was associated with an increased risk of Grade 4 adverse events in the elderly patients during concomitant use. Thus, elderly patients who undergo a concomitant course of TMZ must be closely monitored for adverse events. Treatment of glioblastoma in elderly patients must be optimized to reduce toxicity to acceptable levels and to maintain efficacy.抄録全体を表示PDF形式でダウンロード (546K) -
Shunsuke TAKENAKA, Yoshitaka ASANO, Jun SHINODA, Yuichi NOMURA, Shingo ...2014 年 54 巻 4 号 p. 280-289
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/12/05ジャーナル オープンアクセスThe aim of this study is to assess the different metabolic activities characteristic of glioma recurrence and radiation necrosis (RN) and to explore the diagnostic accuracy for differentiation of the two conditions using 11C-methionine (MET), 11C-choline (CHO), and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET). Fifty patients with lesions suggestive of recurrent glioma by MRI underwent MET, CHO, and FDG-PET. All patients who had previously been treated with radiotherapy for malignant glioma were subjected to open surgery and pathological diagnosis (17 recurrent grade 3- gliomas (Gr.3s) comprising 7 anaplastic astrocytomas (AAs) and 10 anaplastic oligodendrogliomas (AOs), 17 recurrent glioblastomas (Gr.4s), and 16 RNs). We measured the PET/Gd volume ratio, the PET/Gd overlap ratio, and the lesion/normal brain uptake ratio (L/N ratio) and determined the optimal index of each PET scan. The PET/Gd volume ratio and the PET/Gd overlap ratio for RN were significantly lower than those of glioma recurrence only with MET-PET (P < 0.05). The L/N ratio of RN was significantly lower than that of Gr.4 with all PET imaging (P < 0.001) and was significantly lower than that of Gr.3, especially for AO, only with MET-PET images (P < 0.005). Receiver operating characteristic (ROC) analysis showed that the area under the curve of MET, CHO, and FDG was 92.5, 81.4, and 77.4, respectively. MET L/N ratio of greater than 2.51 provided the best sensitivity and specificity for establishing glioma recurrence (91.2% and 87.5%, respectively). These results demonstrated that MET-PET was superior to both CHO and FDG-PET for diagnostic accuracy in distinguishing glioma recurrence from RN.抄録全体を表示PDF形式でダウンロード (10956K) -
Tomokazu AOKI, Ryo NISHIKAWA, Kazuhiko SUGIYAMA, Naosuke NONOGUCHI, No ...2014 年 54 巻 4 号 p. 290-301
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/29ジャーナル オープンアクセスCarmustine (BCNU) implants (Gliadel® Wafer, Eisai Inc., New Jersey, USA) for the treatment of malignant gliomas (MGs) were shown to enhance overall survival in comparison to placebo in controlled clinical trials in the United States and Europe. A prospective, multicenter phase I/II study involving Japanese patients with MGs was performed to evaluate the efficacy, safety, and pharmacokinetics of BCNU implants. The study enrolled 16 patients with newly diagnosed MGs and 8 patients with recurrent MGs. After the insertion of BCNU implants (8 sheets maximum, 61.6 mg BCNU) into the removal cavity, various chemotherapies (including temozolomide) and radiotherapies were applied. After placement, overall and progression-free survival rates and whole blood BCNU levels were evaluated. In patients with newly diagnosed MGs, the overall survival rates at 12 months and 24 months were 100.0% and 68.8%, and the progression-free survival rate at 12 months was 62.5%. In patients with recurrent MGs, the progression-free survival rate at 6 months was 37.5%. There were no grade 4 or higher adverse events noted due to BCNU implants, and grade 3 events were observed in 5 of 24 patients (20.8%). Whole blood BCNU levels reached a peak of 19.4 ng/mL approximately 3 hours after insertion, which was lower than 1/600 of the peak BCNU level recorded after intravenous injections. These levels decreased to less than the detection limit (2.00 ng/mL) after 24 hours. The results of this study involving Japanese patients are comparable to those of previous studies in the United States and Europe.抄録全体を表示PDF形式でダウンロード (1075K) -
Yukihiko SONODA, Ryuta SAITO, Masayuki KANAMORI, Toshihiro KUMABE, Hir ...2014 年 54 巻 4 号 p. 302-309
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/12/27ジャーナル オープンアクセスSurgical resection is identified as an important prognostic factor for survival in patients undergoing initial resection of glioblastoma (GBM). However, in patients with tumor recurrence, the benefits of repeat surgery remain unclear. Recent reports have stated that the association between initial surgery for GBM and subventricular zone (SVZ) influences survival. The current study examined the relationship of SVZ involvement in recurrent GBM to survival time after reoperation. We conducted a retrospective review of 61 consecutive patients who had undergone repeat surgery for recurrent GBM at our institution between 1997 and 2010. Survival after repeat surgery were compared between patients with (n = 29) and without (n = 32) SVZ involvement at recurrence using univariate analysis with known prognostic factors, including sex, age, Karnofsky Performance Status (KPS) score at recurrence, recurrent tumor size, initial SVZ involvement, and adjuvant therapy after repeat surgery, as variables. All 26 SVZ-positive tumors at initial diagnosis recurred as SVZ-positive tumors, while 32 of 35 SVZ-negative tumors at initial diagnosis remained SVZ-negative at recurrence; the remaining three were SVZ-positive at recurrence. Survival after repeat surgery was decreased in patients with recurrent GBM involving the SVZ at recurrence (p = 0.022). No other prognostic factors for survival after repeat surgery were identified in this study. This finding may have prognostic and therapeutic significance.抄録全体を表示PDF形式でダウンロード (1368K)
Case Reports
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Natsuki SUGIYAMA, Satoshi TSUTSUMI, Chihiro AKIBA, Hajime NAKANISHI, I ...2014 年 54 巻 4 号 p. 310-313
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/10/21ジャーナル オープンアクセスA 33-year-old male became aware of a painless soft mass in the left occipital region. His medical and family history were unremarkable for neurofibromatosis type 1 (NF1) or other genetic disorders. Physical examination showed no signs of NF1. Neurological and ophthalmological examinations found no abnormality. Cranial computed tomography showed an isodense mass located subcutaneously with irregular deformities in the adjacent occipital bone. Magnetic resonance (MR) imaging demonstrated that the lesion, 7.5 × 5.5 cm in diameter, was hypointense both on T1- and T2-weighted images and intensely enhanced after gadolinium infusion. The patient requested to remove the large mass. The subcutaneous tumor was well circumscribed, encapsulated, and less vascular, and resected en bloc. The histological diagnosis was neurofibroma without findings of cell atypia, whereas genomic exploration identified abnormal gains in NF1 gene, and resultant absence of neurofibromin, a protein coded on NF1 gene. Solitary neurofibromas in “clinically” non-NF1 patients may originate from the genomic changes in NF1 gene.抄録全体を表示PDF形式でダウンロード (4125K) -
Mamoru MURAKAMI, Makoto HIRAI, Takehiko SAKAKIBARA, Tarumi YAMAKI, Kat ...2014 年 54 巻 4 号 p. 314-316
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/10/25ジャーナル オープンアクセスA 50-year-old female presented with more than 20-year history of a large subcutaneous mass in the left parieto-occipital portion. Magnetic resonance (MR) imaging revealed the lipomatous mass to show a high signal intensity in both T1- and T2-weighted images. A part of the lipomatous lesion progressed into the underlying hyperostosis and skull. The preoperative diagnosis was skull invasion of a well-differentiated liposarcoma. The tumor was removed completely, including the underlying hyperostosis and skull. Microscopy confirmed a lipoma without any lipoblasts, which was firmly attached to the reactive hyperostosis, and islands of lipoma were involved in the underlying hyperostosis and skull cortex. A pathological diagnosis of parosteal lipoma with reactive hyperostosis was made. Long-term progression of parosteal lipoma may cause to involve the underlying hyperostosis and skull, and led to the diagnosis of invasion of a malignant tumor on MR imaging.抄録全体を表示PDF形式でダウンロード (1699K) -
Mayu TAKAHASHI, Junkoh YAMAMOTO, Masaru IDEI, Yoshiteru NAKANO, Yoshit ...2014 年 54 巻 4 号 p. 317-320
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/10/21ジャーナル オープンアクセスA 71-year-old woman with active rheumatoid arthritis (RA) was referred to our department because of multiple intracranial nodules. On admission, the RA disease activity was very high even after the treatment of methotrexate in other hospital. She underwent open biopsy to confirm a histopathological diagnosis of the intracranial lesions. Surgical specimen mainly consisted of necrosis surrounded by epithelioid cells. The masses were reduced spontaneously in size without additional treatment. Eleven month later, the lesions were relapsed. She underwent treatment with corticosteroid, and the lesions were remarkably regressed. The clinical course and histological examination were compatible with rheumatoid nodule (RN). Intracranial RN is extremely rare and its clinical course is not completely understood. In active RA patients, RNs should be considered, and histological diagnosis is inevitable for following suitable treatment.抄録全体を表示PDF形式でダウンロード (8709K) -
—Case Report—Masaki IWASAKI, Toshihiro KUMABE, Ryuta SAITO, Masayuki KANAMORI, Yoji ...2014 年 54 巻 4 号 p. 321-326
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/10/21ジャーナル オープンアクセスResection of insulo-opercular gliomas carries the risk of postoperative hemiparesis caused by ischemia of the corona radiata resulting from injury to the long insular arteries. However, intraoperative identification of these perforating arteries is challenging. We attempted intra-operative motor evoked potential (MEP) monitoring under temporary occlusion of the suspected long insular artery arising from the opercular portion of middle cerebral artery in two patients with insulo-opercular gliomas. Temporary occlusion of the artery caused decrease in MEP amplitude, which recovered after release in one patient, who had no postoperative motor deficits or ischemic lesion in the corona radiata. Temporary occlusion of the artery caused no changes in MEP amplitude, so that the artery was sacrificed for tumor removal in the other patient, who had no motor deficits but ischemic lesion was present in the corona radiata in the territory of the long insular artery sparing the descending motor pathway. These cases show that great care should be taken during surgical manipulations near the posterior part of the superior limiting sulcus to preserve the perforating branches to the corona radiata, and temporary occlusion of the branches under MEP monitoring is useful to identify the arteries supplying the pyramidal tract.抄録全体を表示PDF形式でダウンロード (8433K) -
Takeo ANDA, Masaru HONDA, Tokuhiro ISHIHARA, Toshiaki KAMEI2014 年 54 巻 4 号 p. 327-330
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/08ジャーナル オープンアクセスThe authors describe a male patient who developed a large intracranial meningioma during the hormone therapy for pre-existing prostate cancer. A 70-year-old man received a brain check-up, and no intracranial abnormality was detected. Five months later, prostate cancer was diagnosed, and he underwent prostatectomy. Leuprorelin acetate, a luteinizing hormone-releasing hormone (LH-RH) agonist, was subsequently administered to the patient once a month for 3 years. After that he presented with a large parasagittal mass, which was excised. The tumor was histologically diagnosed as meningothelial meningioma, and LH-RH receptors were verified immunohistochemically in the cytoplasm of the tumor cells. Leuprorelin acetate may accelerate the rapid growth of meningioma in this patient.抄録全体を表示PDF形式でダウンロード (13246K) -
Shunsuke SHIBAO, Saeko HAYASHI, Kazunari YOSHIDA2014 年 54 巻 4 号 p. 331-336
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/08ジャーナル オープンアクセスSchwannomas of the abducens nerve are uncommon. Nineteen cases have been reported in the literature and are classified into two types: Type 1, in the cavernous sinus, and Type 2, in the prepontine area. However, a dumbbell-shaped type has not yet been reported. Here we report the first case of a dumbbell-shaped abducens schwannoma and classify this type into a new category (Type 3). A 36-year-old woman presented with left hearing disturbance for 4 years, dizziness for 2 years, and dysphagia for 6 months. Neurological examination showed left sensorineural hearing impairment, hypesthesia in the distribution of the left first and second branches of the trigeminal nerve, left curtain sign, and gait disturbance. Computed tomography and magnetic resonance imaging revealed a dumbbell-shaped tumor located in the cavernous sinus that extended to the right cerebellopontine angle. She underwent a two-staged operation; the first operation was via ananterior transpetrosal approach for the lesion in the middle fossa and the upper part in the posterior fossa, and the second surgery was via alateral suboccipital approach for the lower part in the posterior fossa. In the first operation, the abducens nerve was sacrificed. Histological examination confirmed schwannoma. Postoperatively, hearing disturbance and ataxia were improved and complete abducens nerve paresis appeared. The dumbbell-shaped abducens schwannoma has novel clinical features, difficulty of sixth nerve preservation, and unique surgical approach.抄録全体を表示PDF形式でダウンロード (4564K) -
Mei-Ling Sharon TAI, Rukumani Devi VELAYUTHAN2014 年 54 巻 4 号 p. 337-340
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/08ジャーナル オープンアクセスSphingomonas paucimobilis is an aerobic gram-negative bacillus. The bacteria can cause infections, which can be devastating and, therefore, the patients need adequate and early antibiotic cover. We are presenting an interesting case of meningitis secondary to an unusual S. paucimobilis infection. This is the second case to our knowledge in the literature on meningitis due to S. paucimobilis. The 31-year-old previously healthy man presented with 2 months’ history of weight loss and loss of appetite. He had fever and headache for 3 weeks. He was also speaking irrelevantly for 3 weeks. He had change of behaviour for 1 day. The patient was a farmer and worked in the soil. On examination, he was not responding to questions and was not obeying commands. Computed tomography (CT) brain with contrast revealed meningeal enhancement and cerebral oedema. Lumbar puncture was performed. Cerebrospinal fluid (CSF) opening pressure was more than 50 cm H2O. CSF analysis showed meningitis picture with raised white cell count of 210/μL (predominantly neutrophils), glucose 3.1 mmol/L, and raised protein 2.47 g/L. He was given intravenous ceftriaxone. The following day, his condition deteriorated. CSF culture grew S. paucimobilis sensitive to ceftriaxone. S. paucimobilis causes severe meningitis. This can lead to hydrocephalus, which results in a need for extraventricular drainage. A good occupational history is important with regard to finding the aetiology of serious meningitis (including rare bacteria) even before the culture result is known. Appropriate treatment can be given early and adequately to prevent mortality.抄録全体を表示PDF形式でダウンロード (1393K) -
Mizuho INOUE, Atsushi SAITO, Hiroyuki KON, Hiroki UCHIDA, Shinya KOYAM ...2014 年 54 巻 4 号 p. 341-347
発行日: 2014年
公開日: 2014/04/15
[早期公開] 公開日: 2013/11/20ジャーナル オープンアクセスLactococcus lactis cremoris (L. lactis cremoris) infections are very rare in humans. Only three case reports of brain abscess have been reported and the infectious routes and pathological features are still unknown. We experienced a subdural empyema due to L. lactis cremoris in an immunocompetent adult. A 33-year-old man was admitted with fever, right facial pain, left hemiparesis, and left hemianopsia. Computed tomography demonstrated low density fluid collection in the right falcotentorial subdural space. Magnetic resonance (MR) images revealed a high signal lesion on a diffusion-weighted image (DWI) and fluid attenuated inversion recovery (FLAIR) images in the right paratentorial and parafalcine subdural space, right maxillary sinus, and bilateral ethmoidal sinus. He underwent two sequential open surgeries for removal and drainage of empyema and was treated with antibiotics including meropenem and ampicillin. To our knowledge, this is the first report of subdural empyema caused by L. lactis cremoris infection. We report the case and discuss the pathological features with the previous literature.抄録全体を表示PDF形式でダウンロード (14878K)
Editorial Committee
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2014 年 54 巻 4 号 p. EC7-EC8
発行日: 2014年
公開日: 2014/04/15
ジャーナル オープンアクセスPDF形式でダウンロード (47K)
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