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ABSTRACT: Primary T-cell lymphoma of the central nervous system lymphoma (T-PCNSL) is an extremely rare tumor. A human T-cell lymphoma virus type I(HTLV-I) associated adult TCL often involves the CNS during its course but disease limited to the CNS is exceptional. We report a case of a 63-year-old male with a highly malignant TCL localized in the bilateral cerebral hemispheres. The patient was HTLV-I positive but no systemic disease was detected after various examinations. We discuss the clinico-pathological features of TCL in the CNS reported in the literature including our case and compare them with those of B-cell lymphomas.
No shinkei geka. Neurological surgery 10/2011; 39(10):969-73. · 0.13 Impact Factor
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ABSTRACT: To establish the validity and utility of motor-evoked potential (MEPs) monitoring for skull base tumor resection, we explored the relationship between MEP monitoring results and postoperative motor function.
MEPs were successfully monitored during 76 operations in 68 patients with a high risk of motor morbidity. MEP monitoring data were correlated with perioperative clinical motor function.
MEPs remained stable in 56 operations (73.7%), and no postoperative motor deterioration was observed. Transient or permanent deterioration of MEPs (<50% of the initial amplitude before surgery) occurred in 20 operations (26.3%). This deterioration was reversible after intervention in seven cases (9.2%). Irreversible deterioration in MEPs was seen in 13 cases (17.1%). In five cases, the final amplitude was greater than 10%. Two of these patients experienced transient loss of MEPs and moderate to severe hemiparesis. Both patients showed full recovery within 6 months after the operation. The other three patients experienced no postoperative worsening of motor function. The final MEP amplitude was less than 10% in the other eight patients, including five with permanent MEP loss. All of these patients experienced severe postoperative motor dysfunction. Recovery of motor function was worse in most participants in this group compared with those in the other groups.
Intraoperative MEP monitoring is a valid indicator of pyramidal tract pathway function for skull base tumor surgery.
Acta Neurochirurgica 06/2011; 153(6):1191-200; discussion 1200. · 1.52 Impact Factor
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ABSTRACT: Intraoperative fluorescence angiography with indocyanine green (ICG) as a tracer has recently been introduced as a novel technique for neurosurgery. We evaluated the feasibility and efficacy of near-infrared (NIR) indocyanine green (ICG) videoangiography for patients undergoing carotid endarterectomy (CEA).
Sixty patients (7 females, 53 males; mean age, 71.8 years) undergoing CEA for severe stenosis of the internal carotid artery (ICA) were included. During CEA, microscope-integrated intraoperative NIR videoangiographic recording was performed before and after the excision of the plaque and closure of the ICA.
During the 60 CEA procedures, 60 consecutive ICG videoangiographic examinations were performed. All patients tolerated the intravenous injection of ICG well with no adverse effects. The videoangiographic study showed the blood stream of the ICA in all cases and the position of plaque in some cases.
Microscope-based ICG videoangiography is simple, and provides reliable and rapid intraoperative assessment of CEA.
Acta Neurochirurgica 04/2011; 153(8):1641-4; discussion 1644. · 1.52 Impact Factor
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ABSTRACT: Hyperperfusion syndrome is a significant complication after carotid endarterectomy (CEA) or carotid artery stenting (CAS). A few reports have shown that an increase in the ratio of mean flow velocity (MFV) of the middle cerebral artery (MCA) of the affected side by transcranial color-coded sonography (TCCS) is useful for the evaluation of hyperperfusion after CEA or CAS. We report a case of hyperperfusion syndrome after CAS in which not only the increased ratio of the affected side based on preoperative mean flow velocity, but also the left to right ratio (L/R ratio) was useful for monitoring hyperperfusion. A 48-year-old man was admitted to our hospital because of cerebral infarction of the right internal carotid artery (ICA) due to stenosis of the right ICA at origin. The preoperative L/R ratio of MFV of the MCA by TCCS was 0.58. We performed CAS and the patient then developed hyperperfusion syndrome with epilepsy and was intubated under the management of strict blood control. We performed TCCS daily and the patient was extubated when the L/R ratio of MFV of the MCA decreased to 1.1 from a maximum of 2.6, although the increased ratio of MFV of the MCA of the affected side was still higher than 1.4. The patient went home without any complications from hyperperfusion. When there is preoperative laterality of cerebral blood flow, the L/R ratio of MFV by TCCS can be useful for monitoring hyperperfusion after CEA or CAS.
No shinkei geka. Neurological surgery 02/2011; 39(2):149-54. · 0.13 Impact Factor
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ABSTRACT: The prognosis of symptomatic intracranial artery stenosis (SIAS) by medical treatment is poor. Percutaneous balloon angioplasty (PTA) or stenting is effective for SIAS. However, recently, aggressive medical intervention (AMI) has progressed and some drugs have been reported to improve stenosis or prevent the progression of stenosis. We describe a case where combination of PTA and the AMI improved symptomatic basilar artery stenosis with a tortuous access route. Case: A 78-year-old man was admitted to our hospital suffering from acute brain infarction due to severe basilar artery stenosis. The AMI including cilostazol, statin, and eicosapentaenoic acid failed to prevent recurrence of the brain infarction. We performed PTA and 45% of the residual stenosis remained. We continued the AMI and the stenosis improved to 30% after 3 months. Conclusion: PTA with minimal risk should be considered for SIAS resistant to AMI. Even if residual stenosis remains, continuation of AMI may prevent recurrence of a brain infarction. The strategy of a combination of PTA with minimal risk and AMI may result in a better prognosis for SIAS.
No shinkei geka. Neurological surgery 10/2010; 38(10):933-7. · 0.13 Impact Factor
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ABSTRACT: The authors describe an intraoperative technique in which a triangular rubber dam is inserted between the aneurysm and the perforating arteries. In this way, we can avoid obstruction of perforating arteries on application of a clip. This technique is especially useful for deep-seated aneurysms, such as basilar bifurcation aneurysms.
Acta Neurochirurgica 09/2010; 152(9):1547-8. · 1.52 Impact Factor
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ABSTRACT: The stabilization of a guiding catheter is one of the important factors for achieving successful endovascular treatments. However, obtaining sufficient stabilization is sometimes difficult due to the tortuousity of the approach route. A goose neck snare is useful not only for the retrieval of intravascular foreign bodies but also for holding a guiding catheter. This report presents a case of parental artery occlusion for a non-ruptured giant thrombosed aneurysm occurring in the right vertebral artery using a goose neck snare to hold a guiding catheter.
No shinkei geka. Neurological surgery 07/2010; 38(7):663-8. · 0.13 Impact Factor
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ABSTRACT: Several reports in Western countries have demonstrated the net benefit and an acceptable long-term survival of carotid endarterectomy (CEA) for severe carotid stenosis. However, long-term follow-up after CEA for carotid stenosis is not well-documented in Japan. The aim of this study was to determine long-term outcomes of CEA in our hospital.
38 consecutive patients underwent 42 CEAs at the Kyushu Medical Center between May, 1994 and December, 1998. Survival follow-up was conducted in December 2008 and the incidence of late stroke was investigated in all surviving patients.
A total of 37 CEAs in 30 patients (83.3%) were registered. There were 28 males and 2 females, 25 symptomatic and 5 years asymptomatic, mean ages 68+/-7 years. Survival rate after CEA was 80.0% after 5 and 53.3% after 10-years, respectively. The 10 year survival ratio free from cerebral infarction was 36.7%.
For the patients in this study, CEA is associated with an acceptable long-term survival as well as a satisfactory benefical effect in stroke prevention.
No shinkei geka. Neurological surgery 05/2010; 38(5):437-40. · 0.13 Impact Factor
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ABSTRACT: Surgical loupes and headlights are mainly used in the cardiovascular field. Neurosurgeons use a loupe and a headlight less commonly especially in Japan. In our institute, all six neurosurgeons have their own loupes and two headlights. Both an operator and an assistant use loupes and headlights in every operation. Loupes and headlights are useful also in the neurosurgical field since they give us a clearer and wider surgical field than the macroscopic view and make it possible to move the surgical field quicker than using a microscope.
No shinkei geka. Neurological surgery 04/2010; 38(4):335-9. · 0.13 Impact Factor
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Yasushi Miyagi,
Tsuyoshi Okamoto,
Takato Morioka,
Shozo Tobimatsu,
Yoshitaka Nakanishi,
Kazuyuki Aihara,
Kimiaki Hashiguchi,
Nobuya Murakami,
Fumiaki Yoshida,
Kazuhiro Samura, Shinji Nagata,
Tomio Sasaki
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ABSTRACT: Spectral analysis of local field potential (LFP) recorded by deep brain stimulation (DBS) electrode around the subthalamic nucleus (STN) in patients with Parkinson's disease was performed.
The borders of the STN were determined by microelectrode recording. The most eligible trajectory for the sensorimotor area of the STN was used for LFP recording while advancing the DBS electrode.
The low-frequency LFP power (theta- to beta-band) increased from a few millimeters above the dorsal border of the STN defined by microelectrode recording; however, the low-frequency power kept the same level beyond the ventral border of the STN. Only high beta-power showed close correlation to the dorsal and ventral borders of the STN.
A spectral power analysis of LFP recording by DBS electrode helps with the final confirmation of the dorsal and ventral borders of the STN of Parkinson's disease in DBS implantation surgery.
Stereotactic and Functional Neurosurgery 07/2009; 87(4):211-8. · 1.85 Impact Factor
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ABSTRACT: We report an operated case with terminal myelocystocele and holocord hydrosyringomyelia (syrinx). The patient exhibited a subcutaneous mass at the right lumbosacral region with multiple anomalies including scoliosis and hyperdactylia of the right foot and systemic disease such as hydronephroureter. Neurological examination revealed palsy of the left diaphragm, and left upper and right lower limbs. Constructive interference in steady-state (CISS) images demonstrated a terminal myelocystocele with a huge syrinx extending to the medulla. The curvilinear reconstruction of the CISS sequence depicted continuous cystocele and whole syrinx. At day 37, sac excision and untethering of the spinal cord were performed. The caudal part of the central canal was opened to the subarachnoid space (terminal ventriculostomy), resulting in a slight improvement of limb palsy and shrinkage of the holocord syrinx. CISS imaging is useful to detect the complicated pathology, and terminal ventriculostomy should be performed to improve associated syrinx.
Pediatric Neurosurgery 02/2009; 44(6):509-12. · 0.70 Impact Factor
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Daisuke Kuga,
Masahiro Mizoguchi,
Yanlei Guan,
Nobuhiro Hata,
Koji Yoshimoto,
Tadahisa Shono,
Satoshi O Suzuki,
Yoji Kukita,
Tomoko Tahira, Shinji Nagata,
Tomio Sasaki,
Kenshi Hayashi
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ABSTRACT: We have employed a laser-capture microdissection technique and single-nucleotide polymorphism arrays to characterize genomic alterations associated with the development of glioblastoma multiforme (GBM). Combined analysis of loss of heterozygosity (LOH) and copy number revealed that more than half (56.3%) of the 254 identified LOH loci showed no copy-number alteration, indicating the presence of copy-number neutral LOH (cnLOH). Furthermore, we found a GBM case that showed cnLOH in 18 of the 22 autosomes. These results were confirmed by quantitative real-time PCR, microsatellite analysis, and fluorescence in situ hybridization. The high rate of cnLOH suggests that epigenetic abnormalities of many genes are involved in the development and progression of GBMs.
Neuro-Oncology 09/2008; 10(6):995-1003. · 5.72 Impact Factor
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ABSTRACT: We report the case of a 35-year-old woman who developed right medial temporal lobe epilepsy associated with misplacement of a ventricular shunting catheter in the apex of the right temporal lobe. At 8 years of age, the patient had undergone total removal of a cerebellar astrocytoma and placement of a Torkildsen's ventriculo-cisternal shunt for obstructive hydrocephalus. Although the postoperative course was uneventful, she developed medically intractable psychomotor seizures with secondary generalization at 24 years of age. CT revealed that the tip of the shunting catheter was misplaced in the apex of the right temporal lobe, through the posterior and inferior horn of the right lateral ventricle. Intraoperative electrocorticography revealed frequent paroxysmal activity in the hippocampus, so hippocampectomy as well as removal of the shunting catheter was performed. Postoperatively, the patient became seizure-free, and pathological examination revealed hippocampal sclerosis.
Journal of Clinical Neuroscience 09/2008; 15(8):939-42. · 1.25 Impact Factor
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ABSTRACT: OEIS complex has been described as a combination of defects consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal defects (S). As the first three defects are life-threatening and treated on a priority basis, neurosurgical intervention for spinal defects is deferred until recuperation from abdominogenital repair. However, the best timing for neurosurgical operation has not been precisely described.
We reviewed our neurosurgical management of three cases (case 1: myelomeningocele; cases 2 and 3: terminal myelocystocele). At 2-6 (3.6 on average) months after birth, neurosurgical procedures, including reduction of the size of the lumbosacral cystic lesion and untethering of the spinal cord, were performed.
During this period, the patients' weights increased from 1,911 to 3,368 g on average, and the lumbosacral cystic lesion was markedly enlarged. In all cases, no neurological deterioration was seen, and ventriculoperitoneal shunt was not indicated.
Thus, neurosurgical procedures can be performed in patients weighing 3-4 kg and/or at an age of 3 months, after confirming recuperated conditions from abdominogenital repair. Careful observation should be made of the size of the lumbosacral cystic lesion and neurological deterioration.
Child s Nervous System 07/2008; 24(6):723-9. · 1.54 Impact Factor
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ABSTRACT: CASE REPORT: Focal cortical dysplasia (FCD) with calcification is rare. We presented a 13-year-old epileptic patient with FCD and calcification in the left frontal lobe. At age 24, the FCD lesion and the surrounding epileptogenic cortex and underlying subcortex were removed after chronic subdural electrode recording. Histological examination showed that the calcified lesion was not independent of the FCD lesion but located in the subcortical area of the FCD lesion. A neoplastic nature was ruled out for the lesion. DISCUSSION: The pathophysiological mechanism involved in the coexistence of FCD and calcification is discussed.
Child s Nervous System 06/2008; 24(5):619-22. · 1.54 Impact Factor
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Yanlei Guan,
Nobuhiro Hata,
Daisuke Kuga,
Koji Yoshimoto,
Masahiro Mizoguchi,
Tadahisa Shono,
Satoshi O Suzuki,
Tomoko Tahira,
Yoji Kukita,
Koichiro Higasa,
Nobuhiko Yokoyama, Shinji Nagata,
Toru Iwaki,
Tomio Sasaki,
Kenshi Hayashi
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ABSTRACT: Mapping loss of heterozygosity (LOH) regions in the genomes of tumor tissues is a practical approach for identifying genes whose loss is related to tumorigenesis. Conventional LOH analyses using microsatellite or single nucleotide polymorphism (SNP) markers require the simultaneous examination of tumor- and matched normal-DNA. Here, we improved the previously developed SNP-based LOH assay using single strand conformation polymorphism (SSCP) analysis, so that LOH in tumor samples heavily contaminated with normal DNA can now be precisely estimated, even when matched normal DNA is not available. We demonstrate the reliability of the improved SSCP-based LOH detection method, called the LOH estimation by quantitative SSCP analysis using averaged control (LOQUS-AC), by comparing the results with those of the previous "LOH estimated by quantitative SSCP assay" (LOQUS) method. Using the LOQUS-AC assay, LOH was detected at a high consistency (98.1%) with the previous LOQUS method. We then applied this new method to characterize LOH profiles in 130 meningiomas, using 68 SNPs (i.e., a mean inter-SNP interval of 441 kbp) that are evenly distributed throughout chromosome 1p36. Benign, atypical and anaplastic meningiomas exhibited 1p36 LOH at frequencies of 48.39, 84.62 and 100.00%, respectively, using LOQUS-AC. Subsequently, we detected a candidate common LOH region on 1p36.11 that might harbor tumor suppressor genes related to malignant progression of meningioma.
International Journal of Cancer 05/2008; 122(8):1820-6. · 5.44 Impact Factor
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ABSTRACT: Bursal cysts (bursitis) are attributed to repeated microtrauma of the connective tissue around the synovial joint and are rare in the coccygeal region.
A 10-year-old boy had a subcutaneous tumor at the midline of the buttock. He could not walk and slid himself in a seated position because of psychomotor retardation. MR images showed a cystic lesion overlying the coccygeal bone, the intensity of which was identical to cerebrospinal fluid (CSF). Although meningocele was suspected, constructive interference in steady-state (CISS) MR images clearly depicted a discontinuity between the cyst and CSF space.
It was conceivable that repeated friction between the coccygeal bone, which projected posteriorly, and overlying subcutaneous tissue during movement resulted in the formation of a bursal cyst. In addition to total removal of the cyst, the coccygeal bone was planed away to prevent friction. We should keep this rare clinical entity in mind in cases that appear to be sacrococcygeal meningocele.
Child s Nervous System 05/2008; 24(4):533-5. · 1.54 Impact Factor
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ABSTRACT: CASE REPORT: It is well known that magnetic resonance imaging (MRI) findings of focal cortical dysplasia (FCD) can change with maturation of myelination. In this paper, we report a patient with intractable epilepsy and negative MRI at the age of 2.5 years, after completion of myelination. Follow-up MRI at the age of 6 years revealed typical FCD findings in the right frontal lobe. During these 3.5 years, electroencephalogram (EEG) consistently depicted an area of irritation in accordance with de novo MRI findings. Intraoperative electrocorticogram showed frequent paroxysmal activity in the right frontal lobe; excision of the epileptogenic cortex resulted in a reduction in seizures. CONCLUSION: It is possible that FCD becomes apparent on MRI even after maturation of myelination; thus, repeated MRI is recommended while EEG continues to demonstrate focal findings.
Child s Nervous System 03/2008; 24(2):269-73. · 1.54 Impact Factor
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ABSTRACT: To study the validity of a co-registration method for postimplantation computed tomography (CT) images for localizing the location of an intracranial deep brain stimulator.
Three-dimensional reconstruction images of postimplantation CTs were co-registered with preoperative CTs by stereotactic planning software and used to localize 18 leads in the subthalamic nuclei of 10 patients with Parkinson's disease. Our conventional method using superimposition of sagittal postimplantation magnetic resonance (MR) images were employed as a comparison.
The co-registered CT images separately visualized four individual contacts; on the other hand, the MR superimposition method demonstrated the leads as a group of no MR signal areas. Although laterality of the distal contact did not differ between two methods, the distal contact was located more anteriorly and inferiorly by the MR superimposition method than by the CT co-registration method.
The CT co-registration method is superior to MR in visualizing deep brain stimulation contacts and resolves problems of MR safety in patients treated with a neurostimulator.
Stereotactic and Functional Neurosurgery 02/2008; 86(3):162-6. · 1.85 Impact Factor
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ABSTRACT: In surgery for epileptogenic glioneuronal tumor in the temporal lobe, whether additional hippocampectomy is needed remains in dispute. We retrospectively analysed clinical profile and seizure outcome in a consecutive series of six patients, paying special attention to pathophysiologic conditions in the ipsilateral hippocampus. Long-term video electroencephalography (EEG) monitoring showed attenuation of background activity, followed by ictal discharges in the ipsilateral temporal region in five cases. (18)Fluorodeoxyglucose-positron emission tomography (FDG-PET) in five cases showed hypometabolism in the ipsilateral medial temporal lobe. Intraoperative electrocorticography (ECoG) after removal of the tumor revealed frequent paroxysmal activity or electrographic seizure activity on the hippocampus in five cases. A high incidence of hippocampal pathology, such as hippocampal sclerosis in four cases and dysgenesis in one case, was demonstrated. Five patients who underwent additional hippocampectomy along with resection of the tumor became completely seizure-free. Our findings indicated a proclivity for the epileptogenic zone to encompass the medial structures and for hippocampal pathology to be present even when no direct medial tumor involvement was identified. Thus, it is conceivable that removal of the hippocampus with the guidance of pre- and intraoperative multimodal examinations, in addition to resection of the tumor, may be recommended to achieve 'complete' freedom from seizures.
Neurological Research 01/2008; 29(8):807-15. · 1.52 Impact Factor
