全文: "シルヴィウス裂"
63件中 1-20の結果を表示しています
  • 田中 輝彦, 藤本 俊一, 斎藤 和子, 中村 公明
    1991年 19 巻 1 号 148-151
    発行日: 1991/04/30
    公開日: 2012/10/29
    ジャーナル フリー
    It seems that the ordinary approach is best in the direct treatment of middle cerebral artery aneurysms. But, sometimes, it is very dangerous with some special types of aneurysms which project rostrally or laterally and/or are attached to the dura mater. The procedure may cause premature rupture, due to retraction of the frontal lobe and the middle cerebral artery itself.
    The distal approach is best suited for such types of aneurysms.
    But then, we prefer to use the superior approach, by which we are able to treat the aneurysmal neck easily with safety without any brain damage, to the usual type of aneurysm.
    The selection of the approach is based on a lateral view of the CAG. If the aneurysmal shadow is obviously rostral from M1 and origin of M2 branches, the distal approach should be selected.
    The only indication for the ordinary approach is on aneurysm of early bifurcation of the middle cerebral artery.
  • 田中 輝彦, 安藤 彰, 須賀 俊博
    1983年 12 巻 65-68
    発行日: 1983/12/31
    公開日: 2012/10/29
    ジャーナル フリー
    The ordinary approach to bifurcation aneurysm of middle cerebral artery mainly recommended is as follows. Ipsilateral internal carotid artery was identified at first, then the stem of middle cerebral artery was followed distally to keep Ml, M2 and neck of aneurysm. This approach is, however, not suited for aneurysm which projected rostrally or laterally from M1 and attached to dura mater. Because, premature rupture may occur before finding internal carotid artery by the retraction of middle cerebral artery. We prefer to use another method, called distal approach, for such cases. Using this approach it is easy to keep distal M1, proximal M2 and aneurysmal neck. Technically, sylvian fissure is opened about 2-3 cm long distally from aneurysm and the branches of middle cerebral artery are followed proximally to distal M1. Once the distal M1 and proximal M2 are identified, the neck of aneurysm is easily treated. The indication of this approach is decided by CAG findings. When the projection of aneurysm is laterally or inferiorly from M2 at AP view and is obviously rostrally from M1 and M2 at lateral view, it is good indication of this approach. Especially, when the top of the aneurysm is thought to attach to dura matter, it is the absolute indication. By our experiences, the lateral view findings seem to be more useful. During a 15-year period, distal approach was used in 48 of 111 cases of ruptured bifurcation aneurysm and premature rupture was seen in only one case. It is necessary neither cortical incision nor parenchymal resection for treatment of bifurcation aneurysm of middle cerebral artery.
  • 大野 喜久郎, 小松 清秀, 青柳 傑, 高田 義章, 若林 伸一, 平川 公義
    1996年 24 巻 1 号 5-10
    発行日: 1996/01/31
    公開日: 2012/10/29
    ジャーナル フリー
    Seventeen patients with aneurysms of the internal carotid bifurcation were treated by direct microsurgery.
    Two patients had unruptured and asymptomatic aneurysms. Six patients were operated on in the acute stage, while the remaining 9 patients were operated on in the chronic stage. Fifteent (88%) of the 17 patients had a good result. There was no mortality.
    However, 6 patients had postoperative neurological deficits, though 4 of them were transient. In 4 of the 6 patients, circulatory disturbance of the anterior choroidal artery or perforating arteries was responsible for such operative complications.
    We stress that direct surgery should be performed for patients not only with ruptured aneurysms of the internal carotid bifurcation but also with unruptured, incidentally discovered ones, because they tend to bleed at a younger age, compared with aneurysms at other sites.
    Furthermore, based on our experiences, surgical consideration for aneurysms at this location includes (1) wide opening of sylvian fissure, especially in patients with large aneurysms or long internal carotid artery, (2) dissection strategy pertinent to the projection of the aneurysm, (3) gentle but complete dissection of aneurysm neck, (4) temporary or tentative clipping in difficult cases, (5) careful and reasonable application of clip to aneurysm neck, and (6) preservation of perforating arteries of the anterior and middle cerebral, and posterior communicating arteries, Heubner's artery, and the anterior choroidal artery.
  • 御供 政紀
    1985年 17 巻 2 号 115-125
    発行日: 1985年
    公開日: 2011/08/10
    ジャーナル フリー
    小児の脳と頭蓋の発達過程を, 2回以上の追跡CTを行った400例から検討した. 頭蓋の発達は2歳まで急勾配を示し, 脳の発育は1歳まで急速である. 前頭蓋内板と前頭葉間隙, 半球間裂は4~10カ月の乳児期で拡張していることが多いが, これは生理的変化と考えられる. 正常群に比し異常群では, この拡張が12カ月以上まで遷延する傾向がある.
    灰白質部と白質部の識別は1カ月以内および7カ月以上で明らかである. この原因は出生時における頭蓋・脳・循環の急激な変化, 水分含量の変化, 髄鞘化, 蛋白成分の変動など, 諸要因の複合的結果と考えられる.
  • 森永 一生, 上田 幹也, 大川原 修二
    1996年 18 巻 3 号 241-247
    発行日: 1996/06/25
    公開日: 2009/09/16
    ジャーナル フリー
    脳動脈瘤の自然血栓化の過程で, 親動脈まで血栓が進展した左中大脳動脈瘤の1例を経験したので, 発生機序を考察し報告した.症例は57歳男性で, 脳梗塞にて発症し, 脳血管撮影にて明らかな閉塞血管は認めないものの, 左中大脳動脈に約15mm×の脳動脈瘤が存在し, 根治術を予定していた.しかし, その待期中に失語が出現し, 再度脳血管撮影を施行したところ, 脳動脈瘤の血栓化と左中大脳動脈分枝閉塞を呈しており, 手術は延期され, 昇圧・輸液負荷療法と抗血小板剤の投与を開始した.左中大脳動脈の閉塞は, M1起始部まで進行し, 強い運動性失語と右半身脱力を後遺したが, 言語・運動療法にて, 社会復帰可能な状態まで回復した.本症例は, 動脈瘤内からのretrograde thrombosisや血栓化脳動脈瘤による親血管の伸展・屈曲, さらに周辺血管に存在する強い動脈硬化所見が, 親動脈まで血栓を進展させた要因と推定している.
  • 浮田 弘美, 阿部 和夫
    1999年 40 巻 2 号 101-106
    発行日: 1999/04/20
    公開日: 2010/06/22
    ジャーナル フリー
    進行性非流暢型失語症例の呼称能力が初診時 (発症後5年目) から3年後までの3年間にどのように変化していったかを検討した.呼称能力検査には100単語呼称検査を用いた.その結果, 初診時は正答率60%であったのが, 39%, 25%, と次第に低下していき, 3年後には15%となった.本症例の誤反応は無反応・語性錯語・字性錯語・保続・不明語に分けることができた.無反応は全検査で認められ, その割合は常に一番高かった.語性錯語も数は少ないが全検査に現れた.しかし, 字性錯語は2年後に, 不明語や保続は3年後になって初めて出現した.また, 語頭音ヒントの有効性が顕著に低下したのは2年後からであった.なお, 初診時から3年間, 発声発語器官に器質的な異常はまったく認めなかった.以上より, 本症例の呼称能力は単に正答数の減少という量的な変化だけでなく, 誤反応の変化にみられたように質的な変化も起こっていることが明らかとなった.
  • Oncologyの進歩
    1998年 8 巻 1 号 41-46
    発行日: 1998年
    公開日: 2012/10/29
    ジャーナル フリー
  • 藤田 郁代
    2016年 57 巻 4 号 372-381
    発行日: 2016年
    公開日: 2016/11/29
    ジャーナル 認証あり

    原発性進行性失語(PPA: primary progressive aphasia)は脳の神経変性によって言語機能障害が潜行性に発症し,緩徐に進行する症候群である.本稿ではPPAの概念と最近の診断基準・サブタイプ分類(Gorno-Tempiniら,2011)について概説し,次いで言語聴覚療法を実施した非流暢/失文法型PPAの自験例2例を紹介し,その経過について説明した.1例は臨床症状の変化を長期にわたってフォローし,剖検によって皮質基底核変性症と診断された症例であり,もう1例は呼称訓練を実施しその意義を検討した症例である.呼称訓練を実施した症例では訓練語の改善を認め,それは短期間,維持されたが,非訓練語には般化しなかった.本例の訓練効果は限定的であったが,生活活動が活発化し積極的にコミュニケーションをとるようになった.最後にPPAの臨床評価の方法について解説し,介入ストラテジーとその意義について考察した.

  • 大沢 道彦, 小林 茂昭
    1993年 21 巻 1 号 31-36
    発行日: 1993/01/25
    公開日: 2012/10/29
    ジャーナル フリー
    The dorsal internal carotid artery (ICA) aneurysm is a saccular aneurysm with a wide or semifusiform neck and often its wall and surrounding arterial wall are very fragile.
    The authors describe details of the operative features of four illustrative cases of dorsal ICA aneurysm. The following are some technical points useful for safe and complete clipping:
    1. It is desirable that the aneurysm dome has been dissected and exposed completely before applying a clip so that the clip can be placed parallel to the parent artery and also pressed against the artery to include the thin portion of the surrounding arterial wall in the brades. 2. In order to avoid premature rupture during the approach to the aneurysm, unroofing the optic canal and removing the anterior clinoid process are often helpful to secure the proximal parent artery for temporary occlusion; exposure of the ICA in the neck may be advisable when the aneurysm is located proximally. 3. Subpial dissection of the dome is useful especially when the aneurysm is buried in the brain or tightly adherent with the arachnoid membrane. 4. The aneurysm can grow in various directions from the dorsum of the ICA. The most difficult case for clipping is one in which the aneurysm protrudes toward the inner side of the curve of the parent artery, because parallel clipping without leaving a residual neck is difficult. In such cases, one needs to have various options including the above techniques as well as wrapping.
  • 板東 充秋
    1999年 1 巻 2 号 141-144
    発行日: 1999/11/07
    公開日: 2011/07/05
    ジャーナル フリー
  • 中岡 勤, ベラスケス ヘルマン, 松浦 浩, 山本 佳子, 鎌田 英世
    2003年 16 巻 1 号 11-15
    発行日: 2003年
    公開日: 2005/06/24
    ジャーナル フリー
    We studied eleven cases of intracranial tumor by contrast sonographic imaging using the pulse inversion harmonic imaging (PIHI) method and investigated its clinical usefulness. The patients comprised 5 males and 6 females, with an average age of 47.7 years. We examined the perfusion of the tumor through a temporal bone window (TBW), the tumor site or the brain surface.
    The instrument used for ultrasound sonography was HDI 5000 with a broad-band sector probe (P4-2). The probe was placed on the TBW (6 cases) or the brain surface (7 cases) at a slice level that gave a good image.
    The microbubbled contrast agent was injected into the right median cubital vein during an interval of 30 s. The frame rate was set to trigger images once every 2 cardiac cycles and to record for 3 min. In this way, we were able to obtain contrast sonographic images and transfer them to a personal computer. We analysed the images using HDILab and obtained the time intensity curves (TIC).
    Many TIC parameters have clinical significance.
    It was found that intracranial contrast sonographic imaging by PIHI provided clearer images than transcranial one Influenced by attenuation, especially through the TBW. The subtraction images showed clear discrimination of intracranial brain structures similar to that of CT and MRI.
  • 鈴木 二郎, 新妻 博
    1983年 12 巻 23-28
    発行日: 1983/12/31
    公開日: 2012/10/29
    ジャーナル フリー
    Five hundred and fifty-eight out of 586 cases of anterior communicating artery aneurysms were operated on using bifrontal craniotomy during the years from 1961 to 1982. Details of approach and technical key point for treating this type of aneurysm are discussed in this paper.
    Small but enough craniotomy with four burr holes is adopted. The anterior edge of the bone flap should be cut down frontally as close to the orbital edge as possible.
    Dura mater is also opened as frontally as possible to preserve the frontal bridging veins and superior sagittal sinus.
    One of the defects of this approach was the loss of olfaction. However, a new technique has been developed in order to preserve bilateral olfactory nerves.
    Bilateral A1 and A2 are exposed to prepare for temporary occlusion at the time of aneurysm rupture. We can make the operation under dry field even when the aneurysm ruptures during the operation. In order to prolong the arterial occlusion time, 500ml of 20% mannitol solution (before May 1982) or mixture of 500ml of 20% mannitol solution, 300mg of Vitamine E and 50mg of dexamethasone (after June 1982) is administrated intravenously just before putting the temporary clips. We can safely occlude the any cerebral arteries for 40 minutes by this method.
    It is very important to expose the whole anerysm. To expose only the neck portion is dangerous because it is possible to overlook another aneurysm, small bulging of the vessels or a small artery hidden behind.
    In acute surgery of ruptured aneurysm, removal of subarachnoid clot decides the postoperative prognosis. In this approach, we can remove the subarachnoid clot in bilateral sylvian fissure, interhemispheric fissure and around the chiasmal cistern. Continuous ventricular drainage is routinely set in acute cases during surgery as well as in the postoperative course to control the intracranial pressure.
    There were 36 deaths out of 586 cases (6.1%). Surgical results of 346 cases of anterior communicating artery aneurysms operated on during the years from 1961 to 1975 are as follows; 195 excellent cases (56.4%), 64 good cases (18.5%), 41 fair cases (11.8%), 27 poor cases (7.8%) and 19 deaths (5.5%).
  • 相馬 芳明
    1997年 17 巻 2 号 149-154
    発行日: 1997年
    公開日: 2006/05/12
    ジャーナル フリー
    作業記憶の下位システムである音韻性 (構音性) ループは,言語性の短期記憶 (STM) から発展した概念であり,内容的にはほぼ同一である。心理学領域,神経心理学領域のさまざまな知見から,音韻性ループの細分化の必要性が生じ,Vallerらは入力側の要素として音韻性短期貯蔵庫,出力側の要素として音韻性出力バッファーをそのモデルのなかに加えた。主として伝導失語からなる脳損傷例のdigit spanの結果から,このモデルの神経解剖学的基盤を検討した。音韻性短期貯蔵庫は上側頭回に,音韻性出力バッファーは中心前回に,音韻性ループは両者を結ぶ頭頂葉に,おのおの対応するとの仮説を提示した。今後は,健常者を対象としたPET賦活研究やfunctional MRIによる知見の集積が期待され,これらの研究と病巣研究が互いの欠点を補完しあうことが期待される。
  • 近藤 正樹
    2016年 32 巻 4 号 311-321
    発行日: 2016/12/25
    公開日: 2017/01/18
    ジャーナル フリー

    後頭葉病変では純粋失読が主体であり,後頭葉病変による失書の発症は後頭葉と頭頂葉,側頭葉の境界域を含めた病巣の広がりと関係していると考えた.頭頂葉であれば角回への広がり,側頭葉であれば中・下側頭回への広がりにより失読失書が出現し,後頭葉から離れて頭頂葉ないし側頭葉寄りになると純粋失書になることが想定された.境界に関係する部位として,側頭葉では中・下側頭回,頭頂葉では角回への病変の広がりに注目する必要がある.また,純粋失読にまつわる話題として,視覚性語形領域(visual word form area:VWFA)に関する最近の知見,数字読み,逐次読みの病態機序に関する報告を紹介した.

  • 清水 弘之
    2001年 33 巻 2 号 153-158
    発行日: 2001/03/01
    公開日: 2011/08/10
    ジャーナル フリー
    小児てんかん手術において重要なことは, てんかん発作の抑制と精神運動発達の荒廃を可及的に予防する点にある.今回は14例の乳幼児における半球切除術の経験を報告した.原因疾患はいずれも脳形成異常であった.手術法としては, 前頭弁蓋の切除腔から患側半球の線維を離断する経前頭弁蓋半球離断術 (transopercular hemispherotomy) を用いた.手術結果は75%で著明な発作の改善, 25%で有意な改善が得られた.術後の合併症としては, 水頭症や脳梁の不完全離断などを認めた.術後の残存発作は, 健側脳の潜在性形成異常が原因と推定された.術後発作が改善し発育が促進された症例では, 健側脳の膨隆が見られた.
  • 菊地 顕次, 須田 良孝, 塩屋 斉, 進藤 健次郎
    1998年 26 巻 6 号 449-456
    発行日: 1998/11/30
    公開日: 2012/10/29
    ジャーナル フリー
    Six patients with aneurysms arising from the anterior wall of the internal carotid artery were reviewed to investigate clinical and radiographic characteristics and operative findings. The role of 3D-CT angiography (3D-CTA) was also analyzed in 3 recent patients to determine clinical usefulness in the diagnosis and surgical management of this lesion. They were all females ranging in age from 25 to 62 years with a mean age of 47.5. Five patients presented with subarachnoid hemorrhage and the remaining had an unruptured aneurysm in association with another ruptured aneurysm. The aneurysms arose from the right carotid artery in 5 patients and from the left in 1 patient. The 3 recent patients underwent 3D-CTA immediately after they were transferred to our hospital following aneurysm rupture.
    At surgery 2 of 4 saccular aneurysms, which adhered to and were buried in the frontal lobe, were dissected subpially. Two patients had a blister type of the aneurysms with a wide neck, and the remaining 4 patients had a saccular type of the aneurysms with a narrow and distinct neck. A small, blister-like aneurysm in 1 patient was wrapped with thin sheets of cottonoid together with the parent artery, followed by clip placement. In the remaining 5 patients a variety of angled clips were placed in parallel to the parent artery. The 3D images generated by 3D-CTA were of great value in assessing the exact site of the aneurysms, their growth projection, the shape and the size of the fundus, and their anatomical relationships to the adjacent arteries and other landmarks such as the anterior clinoid process and the optic canals. They were also a great help in surgical planning and simulation for aneurysm dissection and neck clipping.
  • 上田 幹也, 佐藤 宏之, 井上 慶俊, 大川原 修二, 武田 聡
    1990年 12 巻 3 号 301-306
    発行日: 1990/06/25
    公開日: 2009/09/03
    ジャーナル フリー
    症例は51歳男性.既往歴として中学生の頃より全身の皮下腫瘤・皮膚色素沈着に気がついていた.くも膜下出血で発症し, 脳血管撮影では右前大脳動脈末梢部・左頭蓋外椎骨動脈 (V3 segment) に嚢状動脈瘤を認め, くも膜下出血の原因として右前大脳動脈末梢部動脈瘤破裂と診断し根治術を施行した.同時に試験切除した皮下腫瘤は病理組織学的にはneurofibromaで, 浅側頭動脈には内膜・外膜の繊維性肥厚, 内弾性板の断裂を認めた.neurofibromatosisに脳動脈瘤を合併した13例の臨床的特徴・病因について考察した.
  • Oncologyの進歩
    1998年 8 巻 1 号 63-66
    発行日: 1998年
    公開日: 2012/10/29
    ジャーナル フリー
  • 伊達 裕昭, 大井 静雄
    2009年 41 巻 3 号 172-174
    発行日: 2009年
    公開日: 2016/05/11
    ジャーナル フリー
  • 唐沢 淳, 菊池 晴彦
    1974年 2 巻 103-108
    発行日: 1974年
    公開日: 2012/10/29
    ジャーナル フリー
    The number of our cases with the intracranial aneurysm is 133, of which 17 cases (13%) are multiple intracranial aneurysms-lower percentage compared with approximately 20% reported by other investigators. If intracranial aneurysm which has not passed more than 7 days after the last rupture is defined as an acute stage of ruptured intracranial aneurysm, 6 cases of multiple intracranial aneurysms were operated at an acute stage.
    As for acute cases of intracranial aneurysm after subarachnoid hemorrhage, we make it a rule to conduct surgical treatment as soon as possible by diagnosing intracranial aneurysm which is the bleeding source by means of cerebral angiography on the admission day. When there are no neurological focal signs or there are signs suspected of aneurysm in the region of the left internal carotid artery, performed are left carotid angiography and right retrograde brachial angiography. When there are signs suspected of aneurysm in the region of the right internal carotid artery, both right and left carotid angiographies are conducted with the addition. of postoperative vertebral angiography. In all 6 cases all aneurysmal necks were clipped on the same day. The way to approach was as follows; frontolateral incision in the case at unilateral internal carotid artery and the anterior part of the circle of Willis, bilateral frontolateral cranitomies after coronal incision in the case at the bilateral carotid arteries, and atypical coronal incision in the case at the internal carotid artery and the distal part of anterior cerebral artery.
    When the preoperative level of consciousness is in coma or semicoma, it is recommended to defer the operation of the non-bleeding aneurysm until the improvement of the consciousness after clipping of the ruptured intracranial aneurysm.
    In the case of the operation of the ruptured intracranial aneurysm at an acute stage, the neck clipping of the aneurysm would be impossible without the microsurgical technique since the operative field is extremely limited.
    The postoperative results indicated two cases of mental disturbance and one case of hemiparesis. Two patients, having intraventricular hematoma and G-I tract bleeding, respectively, died.