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ABSTRACT: We report a rare case of gamma knife radiation-induced undifferentiated sarcoma in the cavernous sinus. A 24-year-old woman underwent resection of a growth hormone-secreting pituitary adenoma and gamma knife radiosurgery (maximal dose 24 Gray (Gy); marginal dose 16Gy) for residual adenoma in the right cavernous sinus. Follow-up MRI showed the disappearance of the adenoma. Fifteen years later, she developed right oculomotor nerve palsy. MRI revealed a new tumor in the right cavernous sinus. Partial removal of the tumor was performed via a transsphenoidal approach. Histological diagnosis revealed undifferentiated sarcoma. The patient received three cycles of chemotherapy containing doxorubicin and ifosfamide, then carbon ion radiotherapy (65 GyE in 26 fractions). Subsequent MRI showed tumor regression for five months. To our knowledge, this is the first report of undifferentiated sarcoma following gamma knife radiosurgery for pituitary adenoma. As patients undergoing radiosurgery face the possibility of such neoplasms developing, long-term follow-up is required.
Journal of Clinical Neuroscience 04/2013; · 1.25 Impact Factor
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ABSTRACT: Hemangiopericytoma develops from many organs. In the central nervous system, most tumors arise in the intracranial portion, and tumors originating from the spinal cord are rare. Its clinical course and neurological characteristics have not been disclosed. We present a case of a 51-year-old woman with gradually progressing paraparesis. Magnetic resonance (MR) images of the thoracic spine demonstrated an intradural tumor at the 6 and 7 thoracic vertebral body level. The patient underwent total excision of the tumor. The histological diagnosis was hemangiopericytoma. MR images after the operation showed no residual tumor and the patient was followed up without adjuvant therapy. However, 5 years later, the patient complained of back pain and gait disturbance again, and MR images showed a recurrence of the tumor. We resected the tumor under motor evoked potential (MEP) monitoring and removed the extradural part of the tumor, but the part of the tumor which had infiltrated the spinal cord was left due to the lowering of MEP amplitude. The operation resulted in partial resection. Spinal intradural hemangiopericytoma is very rare, and only 15 cases including the present case have been reported. This paper will discuss the clinical characteristics and treatment for this tumor.
No shinkei geka. Neurological surgery 04/2012; 40(4):351-7. · 0.13 Impact Factor
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Clinical neurology and neurosurgery 01/2012; 114(6):786-8. · 1.30 Impact Factor
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ABSTRACT: We studied the clinical feature and treatment strategy of pituitary adenomas associated with intracranial aneurysms. Among 102 pituitary adenoma patients (mean age: 54.8 years old) who received MR angiography and/or 3D-CT angiography, seven patients (6.9%) had intracranial aneurysms. The association of an aneurysm was more common in large size adenomas (p<0.05). According to the location of the aneurysms, five patients had these in the paraclinoid portion or cavernous portion of the internal carotid artery. Using MR images, we classified the aneurysms associated with pituitary adenomas as non-adjacent, adjacent, and intra-adenoma types. In non-adjacent types, an aneurysm is located apart from the adenoma, and has less chance of exposure during transsphenoidal surgery. In adjacent types, an aneurysm is located adjacent to the adenoma, and could be exposed during transsphenoidal surgery. In intra-adenoma types, an aneurysm is encased in the adenoma. In non-adjacent type aneurysms, a resection of the pituitary adenoma can be carried out before aneurysm treatment due to the low risk of rupture during surgery. In adjacent types, a tumor resection can precede aneurysm treatment in cases of low rupture risk aneurysms and untreatable aneurysms. In intra-adenoma types, adenoma resection should come after treatment of the aneurysms. Neurosurgeons should be careful about not only the presence of aneurysms in preoperative images during transsphenoidal surgery planning, but also their locations and proximity to adenomas. Such information may be crucial in deciding the order of treatment.
No shinkei geka. Neurological surgery 01/2012; 40(1):15-21. · 0.13 Impact Factor
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ABSTRACT: The authors report a rare case of multiple intraosseous inflammatory myofibroblastic tumors presenting with an aggressive clinical course.
A 60-year-old man presented with a 3-month history of headache and 2 weeks of jaw pain. Magnetic resonance imaging showed a homogeneously enhancing mass in the right parietal bone with subcutaneous and intracranial invasion. Bone scintigraphy revealed 4 intraosseous lesions involving the cranium, mandible, ischium, and calcaneum. After admission, the patient showed left hemiparesis and seizures caused by rapid intracranial tumor extension. The cranial and mandible tumors were resected. Histopathological examinations of both specimens revealed myofibroblastic spindle cell proliferation with inflammatory cell infiltration, and a diagnosis of inflammatory myofibroblastic tumor was made. Two days postoperatively, the patient presented with a high fever and disturbance of consciousness with swelling of the subcutaneous tissues of the head and mandibular lesions. Magnetic resonance imaging revealed a massive intracranial extension of the tumor. Corticosteroid therapy induced remarkable shrinkage of all lesions, and relief from symptoms was obtained. Radiotherapy was then performed for residual tumors.
Multiple intraosseous inflammatory myofibroblastic tumors of the bone are very uncommon and may mimic malignant tumors. It is important to recognize that this entity can occur in the cranium and as multiple bony lesions. The recommended treatment is complete surgical resection with adjuvant steroid treatment. Considering the aggressive nature of this entity, additional chemo- and/or radiotherapy may be warranted.
Neurosurgery 05/2011; 69(4):E1010-5; discussion E1015-6. · 2.79 Impact Factor
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ABSTRACT: A 52-year-old man underwent resection of an oligodendroglioma in the left frontal lobe, followed by chemoradiation therapy in 1989. He presented with a de novo aneurysm arising from the feeding artery of a recurrent malignant glioma in 2009. Serial follow-up magnetic resonance imaging showed no tumor progression until 19 years after the initial diagnosis. Angiography revealed an intratumoral aneurysm of the dilated feeding artery. The recurrent tumor was resected together with the aneurysm. Histological examination revealed that the tumor was an anaplastic oligodendroglioma, and the aneurysm was encased in the tumor. Clinicians should carefully look for tumor recurrence and aneurysm formation during follow up of patients treated for malignant glioma.
Neurologia medico-chirurgica 01/2011; 51(4):306-10. · 0.61 Impact Factor
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ABSTRACT: We report a 62-year-old woman patient who slipped and hit the occipital portion of her skull and suffered an acute spinal subdural hematoma caused by head injury. She complained of headache, neck pain, vomiting, dizziness, and was transferred to our hospital. A skull roentgenogram and CT showed occipital bone fracture and thin subarachnoid hemorrhage, and a small amount of acute subdural hematoma on the contra lateral side. Three hours after the accident, she complained of aggravating neck pain. A repeated CT showed acute subdural hematoma at the cranio-vertebral junction extending to the C3 vertrebral body level. At the emergent operation, we found a dural laceration at the foramen magnum just beneath the fracture, and acute spinal subdural hematoma. After evacuation of the hematoma, the patient recovered completely. Spinal acute subdural hematomas after head injuries are relatively rare. In this case, the migration of the extradural hematoma through the dural laceration at the cranio-vertebral junction was supposed to be responsible for the spinal subdural hematoma. It is crucial that a cervical CT be taken to rule out the possibility of spinal hematoma for patients with head injuries complaining of neck pain.
No shinkei geka. Neurological surgery 04/2010; 38(4):365-70. · 0.13 Impact Factor
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ABSTRACT: We report a rare case of gamma knife radiation-induced cavernous hemangioma.
A 35-year-old man underwent resection of a left vestibular schwannoma and gamma knife radiosurgery (maximal dose, 24 Gy; marginal dose, 12 Gy) for the residual schwannoma. Follow-up magnetic resonance images showed no tumor progression. Ten years later, he developed right hemihyperesthesia and mild hemiparesis. Magnetic resonance imaging revealed a size reduction at the resected tumor site and a newly developed lesion in the adjacent pons. No connection was observed between the new mass and the previous tumor. The T2-weighted image showed the new mass as heterogeneous and "popcorn-like" with a mixed signal intensity core and a hypointense hemosiderin rim. Two years after its appearance, the new lesion appeared hypointense on the T2-weighted image, with a hyperintense core on the T1-weighted image. These findings were compatible with cavernous hemangioma.
We diagnosed the new lesion as a radiation-induced cavernous hemangioma. Ten days after admission, symptoms improved without surgical intervention.
Gamma knife radiosurgery induced this rare case of cavernous hemangioma in an area that received a low dose of irradiation and was distant from the primary tumor. Because patients undergoing radiosurgery face the possibility, although small, that such neoplasms may occur, they should be followed for many years.
Neurosurgery 06/2009; 64(5):E1006-7; discussion E1007. · 2.79 Impact Factor
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ABSTRACT: A 55-year-old woman presented with multiple calvarial cavernous hemangiomas manifesting as right frontal swelling. Craniography and computed tomography showed an osteolytic lesion. Magnetic resonance imaging demonstrated multiple intraosseous lesions, and radioisotope bone scintigraphy identified even more numerous lesions. Total resection of the right frontal lesion and cranioplasty was performed. Histological examination confirmed the lesion as a cavernous hemangioma. Computed tomography of the abdomen revealed multiple hepatic lesions, which might be cavernous hemangiomas. Cavernous hemangioma is a rare bony tumor that should be considered in the differential diagnosis of skull tumors. A patient with multiple cavernous hemangiomas should undergo systemic examination to look for latent lesions, and regular follow-up examinations.
Neurologia medico-chirurgica 05/2009; 49(4):162-6. · 0.61 Impact Factor
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ABSTRACT: An 8-year-old boy presented with a rare case of optic nerve apoplexy caused by an arteriovenous malformation (AVM) manifesting as severe headache and blurred vision. Computed tomography (CT) showed a hyperdense suprasellar mass. Magnetic resonance (MR) imaging indicated a hematoma in the right optic nerve. MR angiography showed normal vessels. Right fronto-temporal craniotomy identified an aggregate of abnormal, nidus-like vessels adhering to the medial surface of the swollen right optic nerve and a drainer-like ectatic red vein. The diagnosis was probable AVM. To avoid optic nerve damage, the malformation was left intact. Two years later, the boy was readmitted with headache. CT showed bleeding, and angiography revealed feeder arteries and nidus in the suprasellar lesion. The diagnosis was optic nerve apoplexy due to AVM. His symptoms improved without intervention within days. He has not experienced any recurrence of the bleeding for 2 years.
Neurologia medico-chirurgica 11/2008; 48(10):460-5. · 0.61 Impact Factor
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ABSTRACT: A 27-year-old female was admitted to our department due to gait disturbance and disorientation. Computed tomography (CT) scan revealed symmetrical ventricular dilatation. She was pregnant at 25 weeks of gestation. At the age of 16 years, she had received a ventriculo-peritoneal (VP) shunt for hydrocephalus, induced by a cerebellar medulloblastoma. Neurological examination at the current admission showed that she was disoriented with ataxic gait and convergence nystagmus. Analysis of the cerebrospinal fluid showed normal cell composition. Magnetic resonance images (MRI) and Thalium-single photon emission tomography (CI-SPECT) revealed no recurrence of the tumor. The radio-isotope shunt flow study showed there was no obstruction of the shunt tube or retardation of intraabdominal diffusion. The patient was diagnosed as having shunt malfunction without obstruction of the shunt tube. We performed pumping of a flushing device for the shunt system. As a result her symptom was gradually improved. The follow-up MRI, 20 days after the using, showed complete disappearance of hydrocephalus. She was discharged from our hospital 1 month later. She continued pumping of the flushing device by herself at home. Three months later, she delivered a healthy infant by vaginal labor. She has not need to do pumping after that. And MRI showed no sign of hydrocephalus.
No shinkei geka. Neurological surgery 03/2006; 34(2):181-7. · 0.13 Impact Factor
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ABSTRACT: We report a patient who complained of severe occipitalgia caused by destruction of the atlantooccipital joint by tumor invasion. Her symptoms were relieved by tumor resection and occipitocervical fixation. Histological examination of the resected tumor revealed that the tumor cells had an irregular arrangement, remarkable atypia, and pleomorphism with multinucleated bizarre giant cells. The tumor demonstrated no definitive sarcoma differentiation and was identified as malignant fibrous histiocytoma. After tumor resection, the patient received adjuvant radiation and chemotherapy. The tumor regrew outside the radiation field. Chemotherapy with ifosfamide, cisplatin, and etoposide caused remarkable tumor reduction, but suspension of chemotherapy resulted in tumor recurrence. The results of our drug protocol suggest that this regimen is feasible as postoperative adjuvant chemotherapy for malignant fibrous histiocytoma. The role of adjuvant chemotherapy and radiation therapy for this highly malignant rare tumor should be evaluated in a prospective study with precise histological diagnosis.
Brain Tumor Pathology 02/2006; 23(2):101-5. · 1.19 Impact Factor
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ABSTRACT: This paper reports a new type of syndromic craniosynostosis that was diagnosed by DNA analysis of the patient's fibroblast growth factor receptor (FGFR) genes. At birth, a male infant had ocular proptosis, a pseudotail, and obstructed respiration. He developed craniosynostosis, craniofacial dysmorphism, hydrocephalus, and bilateral contracture of his elbow joints. His treatment included fronto-orbital advancements and a ventriculoperitoneal shunt. Genetic analysis revealed that he was heterozygous for a missense mutation in exon 9 of the FGFR2 gene that resulted in an amino acid substitution of cysteine for serine at residue 351 (Ser351Cys). Seven cases with this mutation had previously been reported. All had severe craniosynostosis with midface hypoplasia, elbow joint contracture, developmental retardation, and early death.
Pediatric Neurosurgery 02/2006; 42(2):108-12. · 0.70 Impact Factor
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ABSTRACT: Craniosynostosis patients treated with one-stage cranioplasty often have bleeding from the dura mater, fluid collection in the extradural space, and poor wound healing due to skin overstretching. To avoid these complications, we began using distraction osteogenesis. To determine the advantages and disadvantages of the procedure, we retrospectively compared distraction osteogenesis with conventional cranioplasty.
We treated 24 patients with fronto-orbital advancement. Fifteen had one-stage cranioplasty; 9 received distraction osteogenesis. The one-stage operation patients averaged 25.5 months of age at surgery, 289 min of operating time, and 154 ml of intraoperative blood loss. For the distraction group, the average age was 16.6 months, average operating time was 196 min, and average blood loss was 76 ml.
Compared with one-stage cranioplasty patients, distraction osteogenesis patients had significantly less intraoperative bleeding and shorter operating times. The disadvantages of distraction treatment were the need for multiple surgeries, prolonged hospitalization, wound infection, and dislocation of the distraction device.
Pediatric Neurosurgery 02/2006; 42(5):288-92. · 0.70 Impact Factor
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ABSTRACT: We report a case of hepatocellular carcinoma (HCC) arising in nonalcoholic steatohepatitis (NASH). The patient, a 64-year-old man, was incidentally found to have multiple tumors in the liver when admitted for pneumonia. He had been obese, had been receiving a standard dose of valproic acid since clipping surgery for subarachnoid hemorrhage 17 years previously, and had not consumed any alcohol since the surgery. Laboratory data revealed moderate hyperlipidemia and no evidence of diabetes mellitus, hepatitis B or C infection. The patient died of hepatic insufficiency, and an autopsy was performed. A tumor, a maximum of 13 cm in diameter, grossly occupied the entire left lobe and one third of the right lobe of the liver. Histologically, moderately differentiated HCC was found with foci of poorly differentiated HCC. The non-tumorous area showed NASH with moderate bridging fibrosis, without interface hepatitis, hemochromatosis, or copper accumulation. In this patient, obesity, hyperlipidemia, and long-term treatment with valproic acid could have all been associated with induction of NASH. The present case suggests that HCC could develop in non-cirrhotic NASH liver, and that chronic inflammation in itself could be an important risk factor in the development of HCC.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 01/2006; 447(6):996-9. · 2.49 Impact Factor
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ABSTRACT: A 53-year-old man with renal failure presented with symptoms of shunt malfunction 11 years after placement of a ventriculoperitoneal shunt. Computed tomography showed high-density lesions on the lateral ventricle wall around the shunt tube. The shunt tube was replaced under monitoring with a neuroendoscope. The resected specimen from the ventricle wall lesion showed calcification and fibrosis. Disturbed calcium and phosphate metabolisms associated with renal failure may have been involved in this abnormal calcification on the ventricle wall.
Neurologia medico-chirurgica 01/2005; 44(12):674-6. · 0.61 Impact Factor
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ABSTRACT: A 70-year-old woman presented with meningioma with metastasis to the skin incision. Neuroimaging demonstrated a tumor of the falx extending to the frontal bone. The tumor was grossly totally resected through a coronal skin incision. The histological diagnosis was meningotheliomatous meningioma. The tumor recurred in the ethmoid sinus 2 years later, and was resected through the transfacial approach. One year later, the tumor recurred in the ethmoid sinus and orbit, and was resected through the transcranial approach. Six months later, she noticed an isolated small mass under the skin incision, distant from a further recurrence of the tumor. Both tumors were resected. The histological diagnosis was atypical meningioma. Resection of atypical meningioma carries the risk of iatrogenic metastasis. Surgeons should wash out the operative field carefully and change surgical tools frequently.
Neurologia medico-chirurgica 12/2004; 44(11):600-2. · 0.61 Impact Factor
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ABSTRACT: High mobility group I-C (HMGI-C) protein is a non-histone DNA-binding factor that organizes active chromatin. This protein is expressed during the limited phase of embryonic development and may regulate the expression of genes critical for embryonic cell growth and differentiation. As embryonic mechanisms are also known to play a role in the development of some neoplasms, we investigated human brain tumors for the expression of HMGI-C to determine its role in the differentiation of glial cell tumors. Immunohistochemical analysis revealed HMGI-C in all of the low-grade astrocytomas, in 2 of 3 anaplastic astrocytomas (grade 3), but in only one of 8 glioblastomas. The results were confirmed at the mRNA level by nested reverse-transcription polymerase chain reaction analyses. Loss of HMGI-C was also demonstrated in a case of glioblastoma transformed from the low-grade astrocytoma strongly expressing HMGI-C protein. These results suggest that HMGI-C may be involved in the differentiation of glial tumor cells, and that loss of HMGI-C expression may contribute to the transformation of low-grade astrocytoma into glioblastoma.
Pathology - Research and Practice 02/2004; 200(9):619-24. · 1.21 Impact Factor
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ABSTRACT: Long-term follow-up results were examined to verify the efficacy of anterior osteophytectomy for cervical spondylotic myelopathy and radiculopathy, in particular the outcome for patients with developmentally narrow cervical canals and patients with associated ossification of the posterior longitudinal ligament (OPLL). One hundred thirty-nine patients who had undergone anterior osteophytectomy with interbody fusion between 1976 and 1990 were followed up for 1 to 22.5 years (mean 11.4 years). Overall results evaluated by the neurosurgical cervical spine scale scoring and grading showed significant improvement in both improvement score (2.7 +/- 2.3) and improvement rate (52.3 +/- 45.7%). Lower extremity motor function improved in 66.1% of patients, upper extremity motor function in 82.0%, and sensory/pain function in 70.5%. Improvement ranged from one to three grades. Severely affected patients showed good recovery. Outcome for patients with narrow cervical canals (41 patients, 29.5%) did not differ significantly from that for patients with normal canals (98, 70.5%). Patients with associated OPLL (32 patients, 23.0%) had approximately the same outcomes as those with only spondylosis (107, 77.0%). Fifteen patients (10.8%) underwent reoperation because of myelopathy due to disc degeneration adjacent to the fused level (11 patients) or OPLL (4 patients). Anterior osteophytectomy with interbody fusion can achieve good outcomes in patients with cervical spondylotic myelopathy and radiculopathy, regardless of the size of the spinal canal and association with OPLL.
Neurologia medico-chirurgica 06/2003; 43(5):228-40; discussion 241. · 0.61 Impact Factor
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ABSTRACT: For tumor growth, proteolytic remodeling of the extracellular matrix (ECM) is a key factor. To determine proteolytic activity in human glioma cells, fibrinolytic activity, mRNA expression of fibrinolytic factors, and fibrinolytic inhibitors were studied in human glioma cell lines. The effect of platelet activating factor (PAF), a potent mediator of inflammatory and immune responses, on this fibrinolytic activity was also examined.
The fibrinolytic activities of conditioned medium and cell lysates from human glioma cell lines, A172, T98G, U87 and TM1 were studied by fibrin plate zymography. mRNA expression of tissue plasminogen activator (tPA), urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitors (PAI-1, PAI-2) was measured by Northern blot analysis. PAF was added to the medium, and its effects on cell proliferation, fibrinolytic activity, mRNA expression of plasminogens and inhibitors were studied.
mRNA expression of plasminogens and inhibitors differed between individual cell lines. Only the medium and cell lysates from A172 cells revealed fibrinolytic activity. A172 cells showed mRNA expression of tPA. PAF at low concentrations, such as 1 nM, stimulated A172 cell proliferation, and high concentrations of PAF inhibited proliferation. PAF stimulated tPA release into the conditioned medium. mRNA expression of tPA was stimulated by low concentrations of PAF and inhibited by high concentrations.
The variability of mRNA expression of plasminogen activators (PAs) between different glioma cell lines may indicate that plasminogens and their inhibitors do not directly correlate with brain tumor growth. PAF may be an important factor in the local control of fibrinolytic activity in glioma and its proliferation.
Journal of Neuro-Oncology 10/2002; 59(3):193-8. · 3.21 Impact Factor
