著者

守山 英二

出版者

一般社団法人 日本脳神経外傷学会

雑誌

神経外傷 (ISSN:24343900)

巻号頁・発行日

vol.37, no.1, pp.7-17, 2014-06-20 (Released:2020-04-28)

参考文献数

21

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Objective: The Cerebrospinal Fluid Hypovolemia Research Group beneficiary of a scientific research grant from the Ministry of Health, Labour and Welfare (MHLW) has con­cluded, that minor traumas, including motor vehicle accident, may cause spinal CSF leak. Because the first aim of MHLW research group was to confirm the occurrence of spinal CSF leak after minor trauma, very strict image diagnostic criteria were adopted. The purpose of this study is to weigh the MHLW criteria against the existing image diagnostics.Materials and Methods: Between March 2011 and January 2013, 178 patients suspected with spinal CSF leak underwent combined radioisotope cisternography (RIC) and computed tomography myelography (CTM). Serial spinal MRIs were performed before and after combined RIC ⁄ CTM studies.Results: RIC revealed overt RI leak in 47 patients (Group P), and CTM confirmed CSF leaks in 27 patients. In 52 patients with indirect RIC findings including early bladder filling and/or accelerated RI clearance (Group I), CTM confirmed CSF leaks in 7 patients. Eleven patients presented with typical clinical and radiological features of spontaneous intracranial hypotension (SIH) (Group P: 7, Group I: 4). Serial spinal MRI after combined RIC ⁄ CTM showed increased CSF leak in 33 ⁄ 47 patients (Group P), and 15 ⁄ 52 patients (Group I). In these patients, most CSF leaks were located at thoracolumbar junction.Conclusion: This study shows spinal CSF leak is a complication of minor trauma. In the diagnosis of spinal CSF leak, RIC has several advantages in addition to its inherent ability, especially when combined with CTM. Combined RIC ⁄ CTM often increases CSF leak, resulting in the enhanced sensitivity of spinal MRI.

著者

守山 英二 BECK Hiroichi MIYAMOTO Toshihiko

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica = 神経外科 (ISSN:04708105)

巻号頁・発行日

vol.39, no.5, pp.350-357, 1999-05-15

被引用文献数

2 20

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過去20年間にVL thalamotomyで治療したParkinson病(PD)患者53名の治療成績を分析した。―側手術例44例では、振戦、筋強剛に対する効果は良好で、平均8.8年の追跡期間中効果が持続していた。無動に対しては効果は乏しく、その進行がADL低下の主因であった。両側手術例9例でも同様の傾向で、無動の顕著でない例は長期間良好なADLが維持されていた。重大な合併症は、凝固部位の脳内血腫1例、軽度なものは、一過性麻庫4例、一過性意識障害2例、けいれん発作2例であった。振戦、筋強剛がADL低下の主な原因となっているPD患者はthalamotomyの良い適応であり、他の治療法と組み合わせることによりPD患者の治療予後改善に役立つと考えられた。