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ABSTRACT: Spinal meningeal cysts in the sacrum (SMC) are known to be occasionally symptomatic with low back pain as well as leg pain, but no distinct prevalence of this pathological entity including asymptomatic lesions has been described. This prospective study investigated the prevalence of SMCs based on magnetic resonance (MR) myelography in 102 consecutive Japanese women with gynecological problems, who underwent pelvic conventional MR imaging. Ten of 102 patients were suspected of being positive for SMC (9.8%), but pseudo-positive findings were possible. A high probability of positive SMC was found in 7/102 (6.9%). MR myelography was better to detect SMCs than conventional MR imaging. Multiplicity and female preponderance may be other features of SMC. The speculated prevalence of SMCs in Japanese females ranged from 6.9% to 9.8%.
Neurologia medico-chirurgica 01/2013; 53(2):91-4. · 0.61 Impact Factor
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ABSTRACT: To perform interbody distraction and to obtain spinal curvature correction during anterior cervical discectomy and fusion (ACDF), the authors recently adopted a new stand-alone device, a disc space-fitted distraction device (DFDD). In this preliminary report the authors introduce this unique device and discuss some advantages in terms of short-term clinical and radiological evaluations.
The most unique aspect of the DFDD is the function of gentle distraction at anterior disc space with maximum lordotic correction of up to 8 degrees while rotating a screw at the front of the device. Additional advantages are related to its configuration such as disc space-matched shape in all dimensions, tapering contour for easy insertion into the disc space, multiple spikes to avoid dislodgment, wider contact area to the vertebral endplate for diminishing sinking process, and sufficient space for accommodation of bone-conductive materials. Twenty-four patients who have been observed more than 12 months after ACDF were involved in this evaluation.
The objective clinical outcome, measured by the Neurological Cervical Spine Scale, was significantly improved. In radiological evaluation, statistically significant improvement compared with preoperative values was noted on the curvature index, C2-7 curvature, and disc angle (p < 0.01) throughout the entire postoperative period, up to 12 months. A high fusion rate and remodeling process around the implants were also observed.
The DFDD may have some advantages over other devices-its distraction action, diminished sinking, and early solid bone union resulted in maintaining sufficient correction of the spinal curvature. This corrected spinal curvature may play an important role in preventing progressive adjacent-disc degeneration subsequent to ACDF in the long term.
Journal of neurosurgery. Spine 04/2010; 12(4):342-6. · 1.61 Impact Factor
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ABSTRACT: Many commercially available hydroxyapatite (HA) spacers for cervical laminoplasty have been introduced but have disadvantages such as lack of plasticity, easy cracking, and occasional difficulty in fixation by sutures. Here we present the short-term results of a newly designed titanium spacer (Laminoplasty Basket) in open-door cervical laminoplasty, and evaluated clinically and radiologically. The titanium box-shaped spacer with two arms for fixation was easily inserted and fixed into the laminoplasty space with 4-mm or 5-mm length screws after the posterior cervical arch was repositioned for the canal expansion. Twenty-one patients with cervical myelopathy due to spondylosis or ossification of the longitudinal ligament or developmental narrow canal observed for more than 6 months postoperatively were enrolled in this study. The neurological condition of these patients improved from 9.4 points on the Japanese Orthopaedic Association scale preoperatively to 13.5 points at 6 months after surgery. Postoperative radiological evaluation showed no laminar closure or implant failure and cervical spine curvature was maintained. These results seemed to have no significant difference compared with those using HA spacers. This titanium spacer is a potential substitute for conventional HA or other similar devices in cervical laminoplasty.
Neurologia medico-chirurgica 01/2010; 50(12):1132-6. · 0.61 Impact Factor
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ABSTRACT: A 3-month-old boy presented with critically elevated intracranial pressure (ICP) due to bilateral subdural hematomas, which resulted in diffuse cortical laminar necrosis, manifesting as a 1-week history of appetite loss, fever, and intermittent seizure. Initial computed tomography revealed bilateral subdural fluid collections. Burr hole drainage was carried out to control the ICP. T(1)-weighted magnetic resonance imaging on day 26 revealed diffuse linear hyperintense lesions, which suggested cortical laminar necrosis. This is an extremely unusual case of cortical laminar necrosis caused by elevated ICP due to subdural hematoma in an infant.
Neurologia medico-chirurgica 07/2008; 48(7):326-9. · 0.61 Impact Factor
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ABSTRACT: We report, with serial angiograms, a case worsening of dural arteriovenous fistulae (DAVFs) located at the hypoplastic right cavernous sinus and draining into the left superior ophthalmic vein across the inter-cavernous sinus. The patient presented with sudden onset of external ophthalmoplegia and deterioration of visual acuity on the left. An imaging work-up at the day of admission included contrast-enhanced computed tomography and conventional catheter angiography, which demonstrated complete thrombosis of the left cavernous sinus. There was no strong evidence to suggest DAVFs other than small faint opacification of the posterior cavernous sinus on the right at the late arterial phase. For this reason a diagnosis of left cavernous sinus thrombosis was made, followed by aggressive anticoagulation therapy with intravenous administration of antibiotics. Although the patient's eye symptoms improved significantly after the anticoagulation therapy, the follow-up angiogram obtained 5 days after admission demonstrated small right cavernous sinus DAVFs, which drained into the left superior ophthalmic vein. The patient was followed up conservatively at the out-patient clinic. Three-month follow up angiograms demonstrated spontaneous cure of the DAVF. Also noted was a complete recovery of external ophthalmoplegia with significant improvement of left visual acuity. The alternation of clinical and angiographic findings in this case may help to understand the etiology of paradoxical worsening of cavernous sinus DAVF. In selected cases, anticoagulation therapy may help to improve the prognosis of paradoxical worsening.
No shinkei geka. Neurological surgery 10/2005; 33(9):911-7. · 0.13 Impact Factor
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ABSTRACT: In thrombolytic therapy for acute ischemic stroke, it is essential to obtain rapid thrombolysis before ischemic neuronal injury occurs. To develop a new technique of thrombolysis for acute ischemic stroke, the effect of transcranially applied ultrasound (TUS) on thrombolysis was examined.
An occlusion model of rabbit femoral artery was produced with thrombin after establishment of stenotic flow and endothelial damage. After stable occlusion was confirmed, monteplase (mtPA) was administered intravenously, and ultrasound (490 kHz, 0.13 W/cm2) was applied through a piece of temporal bone (TUS group; n=9). The control group received mtPA alone (tissue plasminogen activator [tPA] group; n=12). To verify the efficacy of TUS, femoral artery flow was measured during the procedure.
The recanalization ratio was 16.7% (2 of 12) in the tPA group and 66.7% (6 of 9) in the TUS group. The recanalization ratio in the TUS group was higher than that in the tPA group (P=0.03). Patency flow ratio, which was defined as recanalization flow divided by baseline flow, of the TUS group (44.6+/-13.9%) was significantly greater than that of the tPA group (9.9+/-6.8%) at 60 minutes (P=0.025). Patency flow ratio became higher in the TUS group than in the tPA group between 20 and 30 minutes from the start of thrombolysis.
Low-frequency and low-intensity TUS enhanced thrombolysis by mtPA in a rabbit femoral artery occlusion model. This technique should be clinically useful for thrombolysis in acute ischemic stroke.
Stroke 06/2002; 33(5):1399-404. · 5.73 Impact Factor
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ABSTRACT: Visual allesthesia, in which visual images are transposed from one homonymous half-field of visual field to another, is a rare phenomenon. Palinopsia is the persistence or recurrence of visual images after the exciting stimulus object has been removed. Some authors have reported these phenomena, but these pathophysiology has not been understood. We report a right-handed 63-year-old woman, with a right falcotentorial meningioma. She paroxysmally experienced illusory transpositions of objects viewed in the right homonymous visual field into the left, and she recognized her face in it. The illusory images were palinoptic, persisting for up to a few minutes after the real objects were no longer in view. Administration of anticonvulsant medications resulted in the decrease of frequency of this phenomenon. Radiological and surgical findings revealed that the tumor was compressing the very localized visual cortex, especially the Brodmann's area 18 and 19. After resection of the tumor, visual allesthesia and palinopsia completely disappeared. These areas are associated with memory and recognition of visual images as visuopsychic area. This case provides some insight into the mechanisms of this phenomenon, and we consider that it could be caused by seizure activity in this lesion.
Nō to shinkei = Brain and nerve 04/2002; 54(3):255-9.
