Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
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Volume 54, Issue 8
Displaying 1-18 of 18 articles from this issue
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Review Article
  • Adult Growth Hormone Deficiency: Current Concepts
    Izumi FUKUDA, Naomi HIZUKA, Toko MURAOKA, Atsuhiro ICHIHARA
    2014 Volume 54 Issue 8 Pages 599-605
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: July 28, 2014
    DOIhttps://doi.org/10.2176/nmc.ra.2014-0088
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    The clinical syndrome of adult growth hormone deficiency (AGHD) was widely recognized in the 1980s. In this review, we first describe the clinical features and diagnosis of AGHD and then state the effects of growth hormone (GH) therapy for these patients. The main characteristics of AGHD are abnormal body composition, dyslipidemia, insulin resistance, and an impaired quality of life (QoL) due to decreased psychological well-being. For diagnosing AGHD, the international consensus guidelines have suggested that an insulin tolerance test (ITT) is the gold standard, but in Japan, the growth hormone releasing peptide-2 (GHRP-2) test is available and is recommended as a convenient and safe GH stimulating test. The cut-off for diagnosing severe AGHD is a peak GH concentration of 9 g/L during the GHRP-2 test. Since 2006, GH therapy has been approved for Japanese patients with severe AGHD. For adults, GH replacement therapy should be initiated at a low dose (3 g/kg body weight/day), followed by individualized dose titration while monitoring patients’ clinical status and serum insulin-like growth factor-I (IGF-I) concentrations. A variety of favorable effects of GH replacement have been indicated; however, it has not yet been established fully whether there is a direct effect of GH treatment on reducing mortality.
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Original Articles
  • Usefulness of Intraoperative Monitoring of Visual Evoked Potentials in Transsphenoidal Surgery
    Yoshinobu KAMIO, Naoto SAKAI, Tetsuro SAMESHIMA, Goro TAKAHASHI, Shini ...
    2014 Volume 54 Issue 8 Pages 606-611
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: July 28, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2014-0023
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    Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS). Intraoperative visual evoked potential (VEP) monitoring has been reported to have little usefulness in predicting postoperative visual outcome. To re-evaluate its usefulness, we adapted a high-power light-stimulating device with electroretinography (ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under total venous anesthesia. The detectability rates of N75, P100, and N135 were 94.0%, 85.0%, and 79.0%, respectively. The mean latencies and amplitudes of N75, P100, and N135 were 76.8 ± 6.4 msec and 4.6 ± 1.8 μV, 98.0 ± 8.6 msec and 5.0 ± 3.4 μV, and 122.1 ± 16.3 msec and 5.7 ± 2.8 μV, respectively. The amplitude was defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for amplitude changes was defined as a > 50% increase or 50% decrease in amplitude compared to the control level. The surgeon was immediately alerted when the VEP changed beyond these thresholds, and the surgical manipulations were stopped until the VEP recovered. Among the 28 cases with evaluable VEP recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4 cases. In these 4 cases, no postoperative vision deterioration was observed. One patient, whose VEP amplitude decreased without subsequent recovery, developed vision deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light stimulation by the new stimulus device was reliable and feasible in preserving visual function in patients undergoing TSS.
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  • Endoscopic Endonasal Surgical Approach to the Oculomotor Trigone from the Cavernous Sinus
    Naoki WAKUTA, Tetsuya UEBA, Hiroshi ABE, Tooru INOUE, Manfred TSCHABIT ...
    2014 Volume 54 Issue 8 Pages 612-616
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: July 04, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0237
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    Knowledge of anatomy visualized endoscopically is necessary to perform endoscopic surgical procedures safely. The cavernous sinuses are complicated structures with major blood vessels and nerves seated deeply in the center of the skull base. Anatomical orientation during surgery is essential for deep and narrow skull base surgery. While performing surgery involving the cavernous sinuses, understanding of the structures identifiable via a transsphenoidal view can allow comprehension of the relationship between a lesion and the surrounding structures, thus preventing intraoperative complications. The objective of this study was to dissect the neurovascular structures in the cavernous sinus deeply inside the oculomotor trigone through a transsphenoidal view, and to determine the relationships among anatomical landmarks in the path of surgery. Ten fresh silicone-injected cadaveric heads were evaluated. Four millimeter-diameter rigid endoscopes with 0° and 30° rod-lenses were utilized to perform an endonasal transsphenoidal approach. The detailed position and course of the major components in each cavernous sinus were assessed under panoramic view. We also validated the utility of this approach by successfully excising a huge pituitary adenoma.
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Technical Notes
  • Modified Hemostatic Technique Using Microfibrillar Collagen Hemostat in Endoscopic Endonasal Transsphenoidal Surgery: Technical Note
    Yasunori FUJIMOTO, Taisuke KOBAYASHI, Masahiro KOMORI, Pedro MARIANI, ...
    2014 Volume 54 Issue 8 Pages 617-621
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: July 28, 2014
    DOIhttps://doi.org/10.2176/nmc.tn.2014-0024
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    Microfibrillar collagen hemostat (MCH) is accepted as an effective topical hemostatic agent during endoscopic endonasal transsphenoidal surgery (EETS), particularly to achieve venous hemostasis; however, handling MCH may be troublesome because of its adherence to gloves and instruments. We describe here a method of “injection” of MCH suspension using a syringe applicator. This technique allows a rapid and precise delivery of MCH to the bleeding points and thereby results in effective hemostasis; in addition, it is easy to prepare and it is also inexpensive.
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  • A Modified Combined Transseptal/Transnasal Binostril Approach for Pituitary Lesions in Patients with a Narrow Nasal Space: Technical Note
    Mitsuhiro TAKEMURA, Yasunori FUJIMOTO, Taisuke KOBAYASHI, Masahiro KOM ...
    2014 Volume 54 Issue 8 Pages 622-628
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: July 28, 2014
    DOIhttps://doi.org/10.2176/nmc.tn.2014-0004
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    We describe a modification of the combined transseptal/transnasal binostril approach using a two-surgeon, four-handed technique (modified Stamm’s approach) for pituitary lesions in patients with narrow nasal spaces. This approach comprises of a transseptal route through one nostril and a transnasal route without harvesting a pedicled nasoseptal flap (NSF) through the other. On the transseptal side, the nasal septum was removed using an endoscopic septoplasty technique. On the transnasal side, the mucosa containing the septal branch of the sphenopalatine artery over the face of the sphenoid and nasal septum was preserved for harvesting the NSF if an intraoperative cerebrospinal fluid leak was encountered. This approach was performed in six patients with pituitary lesions, including four non-functioning macroadenomas, one growth hormone-producing macroadenoma, and one Rathke’s cleft cyst, all of which were associated with a severe deviation of the nasal septum and/or narrow nasal space. The meticulous and comfortable manipulation of an endoscope and instruments were achieved in all six patients without surgical complications. Our findings, although obtained in a limited number of cases, suggest that the modified Stamm’s approach may be useful for selected patients, particularly those with a severe deviation of the nasal septum, without considerable damage to the nasal passages.
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Case Reports
  • Clinical Characteristics of Streptococcus Pneumoniae Meningoencephalitis after Transsphenoidal Surgery: Three Case Reports
    Nobuyuki KOBAYASHI, Noriaki FUKUHARA, Takahito FUKUI, Mitsuo YAMAGUCHI ...
    2014 Volume 54 Issue 8 Pages 629-633
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: January 10, 2014
    DOIhttps://doi.org/10.2176/nmc.cr.2013-0008
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    We report three extremely rare cases of Streptococcus pneumoniae meningoencephalitis (SPM) after trans-sphenoidal surgery (TSS). Between 2004 and 2010, we experienced three cases of severe SPM after surgery out of 1,965 patients undergoing TSS (0.15%). The three cases included a 4-year-old boy with a large cystic craniopharyngioma, a 40-year-old man with a non-functioning pituitary adenoma, and a 55-year-old man with acromegaly. The similarity among these SPM patients was that severe clinical events occurred suddenly 1–2 months postoperatively without any history of sinusitis or pneumonia. Despite intensive care these patients notably had residual neurological sequelae. In no case was rhinorrhea associated with SPM. It should be noted that SPM was not detected from bacterial cultures of the sphenoidal sinus mucous membranes (BCSM) obtained during TSS in two of the patients examined. Severe postoperative SPM can occur suddenly without cerebrospinal fluid (CSF) leakage within 2 months after surgery and requires emergency treatment. Reduced resistance to infection may play a role in the occurrence of SPM in our three patients. Our study indicates that BCSM is not useful for predicting postoperative meningitis.
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  • Delayed Cerebrospinal Fluid Leak after Watertight Dural Closure with a Polyethylene Glycol Hydrogel Dural Sealant in Posterior Fossa Surgery: Case Report
    Junya JITO, Naoki NITTA, Kazuhiko NOZAKI
    2014 Volume 54 Issue 8 Pages 634-639
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2013-0010
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    A polyethylene glycol (PEG) hydrogel sealant recently has been approved as an adjunct to sutured dural closure in Japan. We treated consecutive six patients with PEG hydrogel sealant in posterior fossa operation. Three of six cases suffered delayed cerebrospinal fluid (CSF) leak after watertight dural closure with the PEG hydrogel sealant, although there was no leak case which was treated with fibrin glue, before 2 years until the adoption of the new material. These patients underwent posterior fossa craniotomy and discharged without remarkable CSF leak. The pseudomeningocele under the occipital wound caused the CSF leak occurr from 5th to 7th week postoperatively. All CSF leak cases needed surgical repair. At the repair, the PEG hydrogel was liquefied and almost absorbed. A fistula on the closure line and a dead space after the absorption of the PEG hydrogel was observed. When the absorbable PEG hydrogel sealant plugs in small gaps of sutured dura, its properties to prevent adhesion might suppress healing process of dural closure, so that CSF could leak through the gaps and collect as a pseudomeningocele in the dead space after absorption of the PEG hydrogel. In posterior fossa surgery a PEG hydrogel sealant should be applied when dural edges are closed tightly without any gaps.
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Original Articles
  • Usefulness of a New Gelatin Glue Sealant System for Dural Closure in a Rat Durotomy Model
    Hisashi KAWAI, Ichiro NAKAGAWA, Fumihiko NISHIMURA, Yasushi MOTOYAMA, ...
    2014 Volume 54 Issue 8 Pages 640-646
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: July 28, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2014-0005
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    Watertight dural closure is imperative after neurosurgical procedures, because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. We used a rat durotomy model to test the usefulness of a new gelatin glue as a dural sealant in a rat model of transdural CSF leakage. All rats were randomly divided into one of the following three treatment groups: no application (control group: N = 18), application of fibrin glue (fibrin glue group: N = 18), and application of the new gelatin glue (new gelatin glue group: N = 18). The craniotomy side was re-opened, and CSF leakage was checked and recorded at 1, 7, and 28 days postoperatively. The new gelatin glue was adequate for stopping CSF leakage; no leakage was observed at postoperative days 1 or 7, and leakage was observed in only one rat at postoperative day 28. This result was statistically significant when compared to the control group (P = 0.002, P = 0.015, P = 0.015, respectively). The pathologic score of the new gelatin group was not different from that of the control or fibrin glue groups. We conclude that our new gelatin glue provides effective watertight closure 1, 7, and 28 days after operation in the rat durotomy model.
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  • Evaluation of Antibiotic-loaded Calcium Phosphate Bone Cement in an Cranium-infected Experimental Model
    Yoshiaki SAKAMOTO, Hiroko OCHIAI, Ikuko OHSUGI, Yoshikazu INOUE, Yoko ...
    2014 Volume 54 Issue 8 Pages 647-653
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: March 27, 2014
    DOIhttps://doi.org/10.2176/nmc.oa.2013-0295
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    Treatment of calvarial defects has remained a challenge in reconstruction surgery, especially because of infection at these sites. We produced a bactericidal biomaterial for treating infected bone defects by using calcium phosphate bone cement mixed with antibiotics. We evaluated the usefulness of this material mixed with the antibiotic vancomycin in a cranium-infected rat model. The concentration of vancomycin used was 5.0 wt%, as reported in our previous study. In order to establish the rat model, a cranium defect (diameter, 5 mm) was made that was infected with methicillin-resistant Staphylococcus aureus (MRSA). Thirty-six rats were divided into 6 groups depending on whether an autologous graft or bone cement with or without antibiotic was used for the defect. After 1 and 4 weeks, abscess formation was checked, tissue bacterial counts were determined, and pathological examination was performed. At both 1 and 4 weeks, no MRSA was detected on tissue bacterial culture or pathological examination in groups that received bone cement with antibiotics. In groups that received bone cement without antibiotic, MRSA was detected, and the bone cement had compromised and disintegrated into several slices. In conclusion, bone cement that contains antibiotics appears to be effective not only for reconstruction in cases of cranial defect, but also in terms of preventing infection.
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Case Reports
  • Oculomotor Nerve Schwannoma Associated with Acute Hydrocephalus: Case Report
    Keiya IIJIMA, Masahiko TOSAKA, Takuro NAGANO, Hiroyuki YAOITA, Nozomi ...
    2014 Volume 54 Issue 8 Pages 654-658
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0418
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    A 37-year-old woman presented with an extremely rare large oculomotor schwannoma associated with acute hydrocephalus manifesting as semicoma and anisocoria. Brain computed tomography and magnetic resonance imaging revealed a tumor in the oculomotor cistern. Cerebral angiography revealed separation of the posterior cerebral artery (PCA) and superior cerebellar artery (SCA). The tumor was removed subtotally by two stage surgery. Histological examination revealed ordinary schwannoma. The diagnosis of oculomotor nerve schwannoma was based on the intraoperative finding of the tumor origin in the oculomotor nerve. Oculomotor nerve schwannoma can cause acute hydrocephalus and manifest as impaired consciousness. The angiographical separation of the PCA and SCA was very useful for the preoperative diagnosis of oculomotor nerve schwannoma.
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  • A Case of Difficult Management of Fluid-electrolyte Imbalance in Choroid Plexus Papilloma
    Atsushi SAITO, Shinjitsu NISHIMURA, Tomoaki FUJITA, Tatsuya SASAKI, Mi ...
    2014 Volume 54 Issue 8 Pages 659-663
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0380
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    A 22-month-old boy presented with nausea and gradual deterioration of gait disturbance. Computed tomography (CT) demonstrated an intraventricular mass lesion in the right lateral ventricle. He was referred to our department 3 weeks after onset. Acute hydrocephalus gradually proceeded 4 days after admission, and external ventricular drainage (EVD) was performed. EVD revealed cerebrospinal fluid (CSF) overproduction (800–1,500 mL/day) under constant pressure of 10 cm H2O above external auditory meatus. Magnetic resonance imaging showed a multi-lobular mass in the inferior horn of the right lateral ventricle. A choroid plexus tumor was suspected. The ratio of blood urea nitrogen:creatinine (BUN:Cre) remained between 30 and 40, and hemoglobin was between 14.0–17.0 mg/dL, suggesting marked dehydration. Serum sodium varied between 117 and 140 mmol/L, and serum potassium between 2.2 mmol/L and 6.9 mmol/L. The amount of EVD was unstable and fluid balance management was difficult. Hypotonic fluid with sodium chloride supplement was used to adjust the fluid and electrolyte imbalance. Surgical removal of the tumor was performed6 days after EVD and tumor was grossly and totally removed. The high BUN:Cre ratio decreased to about 15 and hemoglobin recovered to 7.5–9.0 mg/dL after removal. Electrolytes returned to the normal range. Overproduction of CSF also markedly improved to < 300 mL/day. Histopathological examination diagnosed choroid plexus papilloma.We experienced a case of choroid plexus papilloma associated with fluid-electrolyte imbalance due to over-drainage after EVD, which could not be effectively controlled before tumor removal. Cautious fluid management and emergent surgical resection might be required to managethe overproduction of CSF and fluid-electrolyteimbalance.
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  • Sunitinib Treatment for Multiple Brain Metastases from Jejunal Gastrointestinal Stromal Tumor: Case Report
    Hayato TAKEUCHI, Hiroshi KOIKE, Tomoaki FUJITA, Hitoshi TSUJINO, Yoshi ...
    2014 Volume 54 Issue 8 Pages 664-669
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: November 20, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0426
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    Gastrointestinal stromal tumors (GISTs) are rare malignant tumors and only a few reported cases of brain metastases can be found. Introduction of a new molecular targeted agent, imatinib mesylate in the last decade has dramatically changed the treatment strategy and prognosis. However, imatinib is usually ineffective for brain metastasis from GISTs. The authors present the case of multiple brain metastases from jejunal GIST. The brain metastasis in the right prefrontal gyrus was detected 20 months after resection of the primary lesion when left hemiparesis began although the patient was on imatinib. Then the patient began taking sunitinib instead of imatinib, and the lesion shrunk and the symptom improved. However, after the dose reduction due to side effects, a new brain metastasis was found and this time, stereotactic radiation was effectively done. Sunitinib is one of the promising receptor tyrosine kinase inhibitors used for metastatic renal cell carcinomas or imatinib-refractory GISTs. Sunitinib is thought to penetrate blood-brain barrier, and recent reports indicate effectiveness to brain metastasis. To the authors’ knowledge, this is the first report of brain metastases from jejunal GIST responding to sunitinib therapy.
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  • Intracranial Meningioma as Initial Clinical Manifestation of Occult Lung Carcinoma: Case Report
    Megumi CHATANI, Ichiro NAKAGAWA, Shuichi YAMADA, Tadashi SUGIMOTO, Yas ...
    2014 Volume 54 Issue 8 Pages 670-672
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2013-0061
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    Intracranial meningioma with intratumor metastasis have been occasionally reported. However, to our knowledge, there are almost no reports of malignant tumors initially discovered due to metastasis to meningioma. A 74-year-old woman presented with amnesia. Magnetic resonance imaging showed a well-defined mass arising from falcotentorial junction and homogeneous enhancement. Histopathologic findings showed that the mass was a meningothelial meningioma, with the majority of the tumor cells propagating in sheets, however, a single area in the tumor tissue showed the different histology. Immunohistologically, cytokeratin 7 (CK7), thyroid transcription factor-1 (TTF-1), and Napsin were positive, which led to lung adenocarcinoma metastasis. Furthermore, E-cadherin staining showed a 70% positive rate in lung adenocarcinoma and 30% in meningothelial meningioma. We report our experiences regarding a case of lung cancer that metastasized to intracranial meningioma and its clinical presentation and pathology.
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  • Brain Metastasis from Invasive Thymoma Mimicking Intracerebral Hemorrhage: Case Report
    Shinya HARYU, Atsushi SAITO, Mizuho INOUE, Seiya SANNOHE, Hidekachi KU ...
    2014 Volume 54 Issue 8 Pages 673-676
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2012-0430
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    A 55-year-old man with an 8-year history of invasive thymoma presented with sudden onset of left hemiparesis. Computed tomography (CT) and magnetic resonance (MR) imaging showed a right frontal lobe intracerebral hemorrhage and the possibility of brain metastasis could not be rejected. The patient underwent removal of the hematoma. Histological examination showed brain metastasis from invasive thymoma. To the best of our knowledge, this is the first reported case of hemorrhagic brain metastasis from invasive thymoma (non-cancerous) mimicking intracerebral hemorrhage.
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  • Long-term Survival of Diffuse Large B Cell Lymphoma of the Trigeminal Region Extending to the Meckel’s Cave Treated by CHASER Therapy: Case Report
    Toshihide TANAKA, Naoki KATO, Kuniaki ITOH, Yuzuru HASEGAWA
    2014 Volume 54 Issue 8 Pages 677-680
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2013-0095
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    A 52-year-old man with a history of malignant lymphoma of the cecum presented with lancinating facial pain in the left. Magnetic resonance imaging (MRI) revealed a tumor in the Meckel’s cave extending along the trigeminal nerve. The tumor was partially removed via left retrosigmoid lateral suboccipital craniotomy. Histological examination showed findings consistent with diffuse large B cell lymphoma, which was later confirmed to be metastatic lesion from the cecal lesion. Postoperative chemotherapy with cyclophosphamide, high dose, cytarabine, steroid (dexamethasone), etoposide, and rituximab (CHASER) followed by whole brain irradiation (30 Gy) resulted in complete remission. Although facial pain persisted, the patient’s general condition remained favorable and he did not experience recurrence over the 51-month follow-up period. Histological confirmation and awareness of malignant lymphoma are very important to determine the therapeutic strategy and to avoid misdiagnosis or delayed diagnosis. Long-term survival of patients with metastatic malignant lymphoma in the Meckel’s cave extending along the trigeminal nerve was very rare. In addition, metastatic malignant lymphoma in the extra-axial and peripheral nervous tissue might be different from primary central nervous system lymphoma in the white matter, since the efficacy of chemotherapeutic agents against malignant lymphomas in the extra-axial regions is not attenuated by the blood brain barrier.
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  • Two Cases of Subfrontal Schwannoma, Including a Rare Case Located between the Endosteal and Meningeal Layers of the Dura
    Hiroaki OKAMOTO, Toshihiro MINETA, Tomihiro WAKAMIYA, Haruhisa TSUKAMO ...
    2014 Volume 54 Issue 8 Pages 681-685
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: December 05, 2013
    DOIhttps://doi.org/10.2176/nmc.cr2013-0153
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    Subfrontal schwannomas arising from the olfactory groove are rare and their origin remains uncertain because olfactory bulbs do not possess Schwann cells. We present two cases of subfrontal schwannomas treated with surgical resection. In one case, the tumor was located between the endosteal and meningeal layers of the dura mater. This rare case suggests that subfrontal schwannomas may originate from the fila olfactoria.
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  • Microcystic Meningioma with Late-phase Accumulation on Thallium-201 Single-photon Emission Computed Tomography: Case Report
    Fumihiro MATANO, Koji ADACHI, Yasuo MURAI, Takayuki KITAMURA, Ryuji OH ...
    2014 Volume 54 Issue 8 Pages 686-689
    Published: 2014
    Released on J-STAGE: August 15, 2014
    Advance online publication: January 10, 2014
    DOIhttps://doi.org/10.2176/nmc.cr.2013-0220
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    Microcystic meningiomas are rare but benign brain tumors. Previous reports have shown that Thallium-201 single-photon emission computed tomography (201Tl SPECT) demonstrated a higher late-phase accumulation of 201Tl in malignant or recurrent meningiomas than in nonaggressive meningiomas. No study has reported 201Tl SPECT findings in microcystic meningiomas. We here describe a case of a microcystic meningioma with a high 201Tl SPECT retention rate in a 62-year-old woman who complained of headache. Computed tomography revealed an intracranial tumor in the right frontal lobe. Moreover, 201Tl SPECT revealed a high uptake of 201Tl in the tumor, which was particularly prominent in the delayed phase. The uptake index on an early image was 1.46 and that on a delayed image was 1.35. Therefore, the retention index was 0.92. After 2 years of tumor growth, we performed successful radical resection, and histological examination revealed the presence of a microcystic meningioma. Therefore, we concluded that 201Tl SPECT may be useful for the preoperative diagnosis of microcystic meningiomas and that late-phase accumulation of 201Tl is not a specific finding of malignant brain tumors. Therefore, we need to be careful in the evaluation and judgment of high retention in a delayed image of 201Tl SPECT.
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Editorial Committee
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