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ABSTRACT: A 38-year-old man presented with a rare case of syringomyelia associated with Paget disease of the skull. Syringosubarachnoid (SS) shunting was performed. We speculate that deformation of the skull secondary to Paget disease caused narrowing of the foramen magnum with progressive impairment of the cerebrospinal fluid circulation, which led to syringomyelia and neurological symptoms. SS shunting is safe, effective, and technically simple, so may be a useful initial treatment for syringomyelia associated with Paget disease of the skull.
Neurologia medico-chirurgica 01/2013; 53(2):115-8. · 0.61 Impact Factor
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ABSTRACT: A 15-year-old boy presented with a case of middle cranial fossa arachnoid cyst associated with subdural effusion and manifesting as headache and vomiting after minor head injury. Computed tomography disclosed a cystic lesion in the left middle cranial fossa and ipsilateral subdural effusion. Fundoscopic examination revealed papilledema. A small tear of the cyst wall was confirmed endoscopically. Fenestration of the cyst was performed under the operating microscope. Postoperative course was uneventful. The tear in the outer wall of an arachnoid cyst may suggest the mechanism of occurrence of subdural effusion associated with middle cranial fossa arachnoid cyst.
Neurologia medico-chirurgica 01/2010; 50(6):512-4. · 0.61 Impact Factor
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ABSTRACT: The sex difference in the seasonal occurrence of subarachnoid hemorrhage (SAH) and the association of meteorological factors in Japan were analyzed in 1006 consecutive patients with SAH in Toyama, Japan from 1996 to 2000. The study investigated whether these meteorological factors could explain the seasonality of the incidence of SAH in each sex. Seasonal variation of SAH occurrence peaked in spring in men, but peaked in spring and winter in women. The difference between maximum temperature and minimum temperature was the greatest on the day previous to SAH occurrence in multiple individuals in men, whereas mean humidity was the greatest on that day in women. Interestingly, the difference between maximum temperature and minimum temperature peaked in spring and mean humidity in winter from the meteorological data over the 5 years. The relationship between humidity and occurrence of SAH may explain the sex difference of the incidence of aneurysmal SAH. The humidity change may be a specific and additional meteorological factor for the incidence of SAH in women.
Neurologia medico-chirurgica 04/2008; 48(3):101-7. · 0.61 Impact Factor
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Kimiko Umemura,
Ichiro Kato,
Yutaka Hirashima,
Yoko Ishii,
Takao Inoue,
Junken Aoki,
Nozomu Kono,
Takeshi Oya,
Nakamasa Hayashi,
Hideo Hamada,
Shunro Endo,
Masaya Oda,
Hiroyuki Arai,
Hiroyuki Kinouchi,
Koichi Hiraga
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ABSTRACT: Platelet-activating factor (PAF) and oxidized unsaturated free fatty acids have been postulated to aggravate neuronal damage in the postischemic brain. Type II PAF-acetylhydrolase (PAF-AH II) not only terminates signals by PAF by its PAF-hydrolyzing activity but also protects cells against oxidative stress. We examined whether PAF-AH II can rescue cerebral neurons against ischemic insults.
Transgenic mice overexpressing human PAF-AH II in neurons were generated and enzyme expressions were examined biochemically and histochemically. The mice were subjected to 60 minutes of transient middle cerebral artery occlusion followed by reperfusion for 24 hours. The infarction and apoptosis were estimated by TTC staining and fluorescence TUNEL staining, respectively.
Overexpression of PAF-AH II was found in brains of transgenic mice by Western blot and enzymatic activity analyses. In immunohistochemistry, human PAF-AH II expression was found throughout the central nervous system, especially in neurons of neocortex, hippocampus, and basal ganglia. The neurological deficit scores, cerebral edema index, and relative infarction volume were all significantly (P<0.05) lower in transgenic mice (1.30+/-0.72, 1.12+/-0.04, and 14.0+/-7.7%, respectively) than in wild-type mice (2.56+/-0.93, 1.23+/-0.12, and 31.9+/-9.7%, respectively). Percentages of apoptotic cells were also significantly (P<0.001) lower in transgenic mice (cortex, 5.2+/-3.3%; hippocampus, 3.4+/-7.0%) than in wild-type mice (cortex, 41.1+/-16.9%; hippocampus, 58.9+/-15.3%).
These results indicate that PAF-AH II exerts strong neuroprotective effects against ischemic injury and suggest a possibility for clinical use of this enzyme in cerebral ischemia.
Stroke 03/2007; 38(3):1063-8. · 5.73 Impact Factor
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ABSTRACT: Endoscopic third ventriculostomy (ETV) has been widely performed for the treatment of noncommunicating hydrocephalus. In cases of hydrocephalus in conjunction with deformed and complex ventricular anatomy, it is preferable to use a rigid-rod endoscope for ETV, because the excellent visibility provided by this instrument yields a smooth and correct orientation in the ventricle. The authors report on ETV procedures in which they used a transparent endoscopic sheath that has a common channel in which a rigid-rod endoscope and an instrument can be inserted.
In 15 cases of noncommunicating hydrocephalus, a transparent endoscopic sheath and a rigid endoscope were used for ETV. In 11 of the 15 patients, the diameter of the foramen of Monro and the width of the third ventricle were greater than 5 mm, and thus a transparent endoscopic sheath and a rigid endoscope could be smoothly introduced through the foramen of Monro and an ETV successfully performed. Four patients had congenital or acquired narrowing of the foramen of Monro and an anatomically deformed ventricular system. In three of the patients, opening of the narrowed foramen and an ETV were successfully performed using the transparent endoscopic sheath under direct visualization through the rigid-rod endoscope.
A transparent endoscopic sheath increases safety by offering a corridor to the third ventricle. It also provides excellent visibility without troublesome bleeding from tissues surrounding the foramen of Monro during endoscopic procedures in which a rigid endoscope is used.
Journal of Neurosurgery 06/2006; 104(5 Suppl):321-5. · 2.96 Impact Factor
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ABSTRACT: A 68-year-old man presented with occlusion of the internal carotid artery (ICA) manifesting as a 6-month history of progressive sensory and motor disturbance of the left lower limb. Angiography clearly demonstrated a collateral arterial network between the ICA and external carotid artery (ECA) through the vidian artery, a small branch of both the ICA and ECA. The vidian artery may form an unusual but important ECA-ICA collateral pathway in patients with occlusive lesion of the ICA.
Neurologia medico-chirurgica 10/2005; 45(9):470-1. · 0.61 Impact Factor
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ABSTRACT: Preoperative magnetic resonance imaging of 4 cases of quadrigeminal cistern arachnoid cyst were retrospectively reviewed and patterns of extension to surrounding cisterns from the quadrigeminal cistern were examined. Relationship between patterns of extension to surrounding cisterns and selected surgical approach were evaluated. In 2 cases, the cyst extended anteriorly and compressed the quadrigeminal plate. These two cases had hydrocephalus due to aqueductal stenosis. The anteroirly extending cyst was treated with endoscopic ventriculocystocisternostomy via the lateral and third ventricles. In one case, the cyst extended superiorly to the velum interpositum cistern, and was treated with endoscopic ventriculocystocisternostomy via the lateral ventricle. In one case, the cyst extended laterally to the ambient cistern and compressed the posterior horn of the lateral ventricle. This case had loculated hydrocephalus of the inferior horn. The laterally extending cyst was treated with resection of the wall of the arachnoid cyst via an infratentorial supracerebellar approach assisted by endoscope. All cysts were successfully treated. Injury of the foramen of Monro occurred during a procedure using a flexible endoscope in a case with an anterior extending cyst. Exact analysis of the preoperative imaging and selection of appropriate surgical approach are key factors for successful treatment of a quadrigeminal cistern arachnoid cyst.
No shinkei geka. Neurological surgery 06/2005; 33(5):457-65. · 0.13 Impact Factor
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ABSTRACT: The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p = 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p = 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.
Neurologia medico-chirurgica 05/2005; 45(4):177-82; discussion 182-3. · 0.61 Impact Factor
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ABSTRACT: A 48-year-old woman presented with a unique case of isolated third and fourth ventricles associated with neurosarcoidosis, manifesting as upward gaze palsy. She had a past history of surgery for intracranial sarcoid granuloma 10 years previously and placement of a ventriculoperitoneal shunt 3 years later. Magnetic resonance imaging revealed isolated third and fourth ventricles. Endoscopic plasty of the right foramen of Monro, fenestration of the septum pellucidum, and revision of the ventriculoperitoneal shunt were performed. Postoperatively the size of the third and fourth ventricles was reduced, and the upward gaze palsy resolved. Endoscopic treatment is less invasive and effective for the treatment of multiple septum formation in the ventricular system.
Neurologia medico-chirurgica 09/2004; 44(8):435-7. · 0.61 Impact Factor
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ABSTRACT: A 60-year-old female presented with gait disturbance, urinary incontinence, and recent memory disturbance. Computed tomography and magnetic resonance imaging revealed a partially calcified mass lesion without enhancement in the left caudate head and mild ventriculomegaly. She underwent endoscopic tumor biopsy. The histological diagnosis was astrocytoma grade 2. After the endoscopic procedure she presented with prolonged consciousness disturbance caused by tension pneumocephalus. Tension pneumocephalus is one of the potential complications of neuroendoscopic procedures.
Neurologia medico-chirurgica 05/2004; 44(4):205-8. · 0.61 Impact Factor
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ABSTRACT: Dynamic computed tomography (CT) is an established method for the evaluation of perfusion in acute ischemic stroke, but is not frequently used to assess infratentorial ischemia. Eleven patients with vertebrobasilar ischemia underwent dynamic CT on admission and/or during the follow-up period. The time of appearance (TA) and time to peak (TTP) were mapped and differences in TA (deltaTA) and TTP (deltaTTP) between the bilateral middle cerebral artery and posterior cerebral artery (PCA) territories were calculated. Conventional angiography and brain imaging including CT and magnetic resonance imaging were also performed. The TA and TTP maps obtained within 48 hours after onset exhibited time delay in eight of nine patients in the bilateral PCA territories. deltaTA and deltaTTP were greater in patients with stenosis or occlusion of the bilateral vertebral arteries or the basilar artery, and in patients without collateral circulation via the posterior communicating arteries than in control subjects. Furthermore, TA and TTP normalized dramatically in patients with recanalization of the arteries. deltaTA and deltaTTP were also normalized. deltaTA and deltaTTP were negatively correlated with the time from onset to examination. Dynamic CT can provide important information in patients with vertebrobasilar ischemic stroke, and may allow the diagnosis of acute ischemia and monitoring of the course.
Neurologia medico-chirurgica 04/2004; 44(3):105-10; discussion 110-1. · 0.61 Impact Factor
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ABSTRACT: The clinical features and endoscopic findings were investigated in 20 patients with isolated lateral ventricle treated by neuroendoscopic septostomy to establish cerebrospinal fluid communication and open an isolated ventricular compartment. The endoscopic procedure was incomplete because of thickened septum pellucidum and insufficient working space in two adults with postmeningitic hydrocephalus. Two children underwent second septostomy. In all other cases, results were good and there were no complications related to endoscopic procedures. Endoscopic septostomy is less invasive and has few complications. Intraoperative navigation and the biportal approach may be required in difficult cases with multiple septum formation and severe postmeningitic hydrocephalus. Adequate stomal size is required in high-risk groups including children under 2 years of age.
Neurologia medico-chirurgica 01/2004; 43(12):582-7; discussion 588. · 0.61 Impact Factor
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ABSTRACT: Paraventricular fluid cysts have recently been treated by endoscopic fenestration performed from the cysts to the ventricular system. However, correct orientation and safe navigation of the endoscope may be difficult in patients with abnormal anatomy. Endoscopic fenestration from the ventricular system to a cyst was performed through penetration of the septum pellucidum via the anterior horn of the contralateral lateral ventricle. The advantage of this approach is correct orientation and introduction of the endoscope to the periventricular lesion because the usual landmarks can be identified in the normal contralateral lateral ventricle.
Neurologia medico-chirurgica 03/2002; 42(2):99-101; discussion 102. · 0.61 Impact Factor
