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ABSTRACT: The aim of this study was to clarify the relationship between the histological features of GH-producing adenomas surgically resected at the Toranomon Hospital and the clinical features of the patients. Histological examinations, including immunohistochemistry for anterior pituitary hormones and cytokeratin (CK), were performed on 242 consecutively excised GH-producing pituitary adenomas. Immunohistochemistry showed 45% of the adenomas to be monohormonal and 55% to be plurihormonal, producing GH-PRL (77%), GH-TSH (13%), and GH-PRL-TSH (10%). One-fourth of the monohormonal GH adenomas had a dot-like pattern of CK immunoreactivity in the majority of the tumor cells (>80%); they were significantly more common in female or younger patients and usually tended to be larger and more invasive than monohormonal GH adenomas with perinuclear CK. Interestingly, CK-immunonegative adenomas were found in only 5% of the patients; they also showed a tendency to be larger, suggesting that they are a distinct type of GH adenoma with clinically aggressive features. Serum hormone levels correlated well with tumor size only in GH-producing adenomas with a perinuclear pattern of CK immunoreactivity. Each histological subtype of adenoma, classified according to the pattern of CK immunoreactivity, was associated with distinct clinical characteristics. This information is useful for understanding the pathophysiology of acromegaly-causing GH-producing adenomas.
ISRN endocrinology. 01/2013; 2013:723432.
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ABSTRACT: Cerebral aneurysms are the predominant cause of spontaneous subarachnoid hemorrhage(SAH). However, if an aneurismal cause has been excluded, there remains but a short list of meningiomas or metastatic lesions as possible causes. This article details a case of neoplasm that presented exclusively with SAH. A 31-year-old male presented with a SAH with normal cerebral angiography. The initial magnetic resonance image(MRI)revealed a lesion in the left uncus thought to be recovering hemorrhage. Subsequent MRI, however revealed the mass to be expanding. A neuroendoscopical biopsy of the lesion established a diagnosis of glioblastoma. An affirmation is made that patients experiencing "angiographically-negative" SAH should undergo MRI, occasionally on a serial basis, to exclude other etiologies for hemorrhage, including neoplasma.
No shinkei geka. Neurological surgery 01/2013; 41(1):37-43. · 0.13 Impact Factor
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ABSTRACT: OBJECTIVE: We report our initial experience of real time intraoperativeC-arm computed tomography (C arm-CT: DynaCT)-guided navigation surgery for pituitary tumors. METHODS: Recent advancement of Flat panel technology enables to obtain CT like images by using rotation of C-arm of Digital Subtraction Angiography (DSA) system. Specially designed new suite, which has C-arm CT imaging capability DSA in combination with Navigation system (VectorVision Sky, Brain Lab, Germany) allows neurosurgeons to perform an endoscopic transsphenoidal procedures under real-time navigation support. Thirty one pituitary tumor patients were examined.During or after tumor removal, contrast enhanced DynaCT was conducted to rule out residual tumor in 12 cases. When enhanced tumor was confirmed, additional removal was continued without moving the patients. RESULTS: DynaCT and subsequent image transfer to navigation system was performed in all cases without difficulties, requiring only additional 15minutes of surgical time. Sellar fenestration in relation to tumors and absence of hidden hematomas was confirmed in all cases. The contrast enhanced DynaCT was found contributing to a better handling of the residual tumor. In 9 of these 12 cases (75%), residual tumor was detected on DynaCT, consequently further removal was considered. In 2 cases (16%), there was no enhanced lesion, indicating complete removal. CONCLUSION: The proposed technique of intraoperative visualization in the hybrid operating room can be an easy to perform and may be useful adjunct to conventional transsphenoidal surgery for improved resection rate and less cavernous sinus and internal carotid artery injury.
World Neurosurgery 10/2012; · 0.68 Impact Factor
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ABSTRACT: A 20-year-old man presented with a rare case of germinoma with a large component of epithelioid cell granuloma manifesting as oscillopsia. Magnetic resonance imaging demonstrated a mass in the pineal region with homogeneous enhancement with gadolinium. Craniotomy was performed, ending in biopsy. The initial histological diagnosis was epithelioid cell granuloma, but systemic investigation detected no evidence of granulomatous disorder. A revised diagnosis of germinoma was based on positive immunohistochemical staining for placental alkaline phosphatase (PLAP) and c-kit. Histological diagnosis is sometimes incorrect if granulomatous reaction is dominant. Immunohistochemical staining for PLAP and c-kit should be performed if germinoma is clinically suspected.
Neurologia medico-chirurgica 01/2009; 48(12):573-5. · 0.61 Impact Factor
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ABSTRACT: The facial nerve schwannoma is a rare tumor and it seldom extends into the middle cranial fossa. The typical clinical presentations are progressive facial paralysis and hearing disturbance. We report here a case of huge facial nere facial nerve schwannoma extending into the middle cranial fossa without facial palsy. A 50-year-old man presented with left hearing disturbance. Neurological examination on admission revealed no deficits except for sensorineural hearing loss. MRI demonstrated a cystic tumor extending into the ddle cral fossa from the petrous bone CT the middle cranial fossa from the petrous bone. CT of the temporal bone showed destruction of the surrounding bone around the geniculate ganglion and invasion of the tumor into the tympanic cavity and internal auditory canal. The intracranial tumor was totally removed and the operative specimen demonstrated that the tumor was a schwannoma. The patient was discharged without neurological deficit. The facial nerve schwannoma extending into the middle cranial fossa without facial palsy is rare and only 4 cases have been reported in the literature. The tumor origin was in the greater superficial petrosal nerve and geniculate ganglion. The symptom is conductive hearing loss caused by the tumor extending into the tympanic cavity. We should bear in mind that there is a also rare type of facial nerve schwannoma manifesting hearing disturbance alone.
No shinkei geka. Neurological surgery 07/2007; 35(6):591-8. · 0.13 Impact Factor
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ABSTRACT: Olfactory neuroblastoma is a rare tumor of the nasal cavity. It is a locally aggressive tumor with local recurrence, and distant metastasis occurs in 22-40% of patients. We report a case of olfactory neuroblastoma with cauda equina metastases. A 49-year old male had undergone surgery twice previously; the first for olfactory neuroblastoma in October, 1990, and the second for its intracranial and orbital metastasis in September, 1999. He complained of lumbago in autumn, 2005 and MRI showed two enhanced lesions in the cauda equina. The mass was partially removed and histologically diagnosed as olfactory neuroblastoma metastasis. Whole-spine irradiation of 32 Gy and lumber-spine irradiation of 10 Gy were performed. The mass at L2/3 was disappeared after the irradiation although the mass at L4/5 was not changed in size. The patient was discharged without neurological deficit and is now kept under observation as an outpatient. Olfactory neuroblastoma with spinal metastasis is rare and only 11 cases have been reported in the literature. A very poor prognosis was observed in the patients of olfactory neuroblastoma with spinal metastasis. Olfactory neuroblastoma is a radiosensitive tumor, and radiotherapy for spinal metastasis was reported to be effective. However, effectiveness of chemotherapy was still uncertain. The patient with olfactory neuroblastoma should be observed carefully even though no local recurrence had been detected over 10 years. Radiotherapy and further treatment including chemotherapy should be considered in case of spinal metastasis.
No shinkei geka. Neurological surgery 06/2007; 35(5):503-8. · 0.13 Impact Factor
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ABSTRACT: Aneurysms of the petrous internal carotid artery are rare, and surgical treatment of the aneurysm in the petrous bone carries high risk with procedure. We report a case of large petrous internal carotid artery aneurysm associated with otitis media. A 58-year-old female was admitted to our institution with left hearing loss and facial palsy. She had 4-year history of left exudative otitis media. Imaging studies demonstrated a 17 mm left petrous internal carotid artery aneurysm, destroying osseous partition between carotid canal and Eustachian tube, and protruding into left middle cranial fossa. Endosaccular coil embolization with balloon assist technique was performed successfully without neurological deficit. Follow up magnetic resonance angiogram demonstrated complete obliteration of the aneurysm without parent artery occlusion. Traumatic, mycotic, radiation, and congenital origin have been implicated for petrous internal carotid artery aneurysm. In a review of the literature, 11 cases of mycotic aneurysms in this location were reported and all of them were complicated with chronic otitis media. Because of its close proximity of middle ear and Eustachian tube, adventitial infection of the artery weakens the arterial wall, and gives rise to formation of aneurysm. We conclude that our case is of mycotic origin, and endosaccular coil embolization is effective and less invasive treatment.
No shinkei geka. Neurological surgery 05/2006; 34(4):415-9. · 0.13 Impact Factor
