著者

Nobuhisa FUKAYA Takafumi TANEI Yusuke NISHIMURA Masahito HARA Nobuhiro HATA Yoshitaka NAGASHIMA Satoshi MAESAWA Yoshio ARAKI Ryuta SAITO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.349-355, 2022-12-31 (Released:2022-10-13)

参考文献数

26

被引用文献数

5

---

Spinal cord parenchymal lesions may induce intractable neuropathic pain. However, the efficacy of conventional spinal cord stimulation for the neuropathic pain following spinal cord lesions remains to be controversial. In this study, we present three cases of spinal cord stimulation using a paddle lead at the rostral side of the spinal lesion causing pain symptoms. Good pain reductions were achieved using conventional stimulation in one case and using differential target multiplexed stimulation in two cases. Case 1: A 55-year-old man presented with neuropathic pain affecting his bilateral upper extremities due to a traumatic cervical spinal cord injury. Conventional stimulation via a paddle-type electrode was able to reduce the pain from 8 to 4 via a visual analog scale. Case 2: A 67-year-old man had undergone three spinal surgeries. He presented with pain and numbness of bilateral lower extremities due to a spinal cord lesion by thoracic disc herniation. Differential target multiplexed stimulation via a paddle-type electrode achieved excellent pain reduction, that is, from 9 to 2 on the visual analog scale. Case 3: An 80-year-old man presented with pain in his bilateral upper extremities due to a cervical spinal cord lesion caused by compression and spinal canal stenosis. Posterior cervical decompression and paddle-type electrode placement were performed simultaneously. Differential target multiplexed stimulation was able to achieve excellent pain reduction, from 7 to 2 on the visual analog scale. Spinal cord stimulation using a paddle lead at the rostral side of the spinal lesion and differential target multiplexed stimulation may provide significant opportunities for patients with intractable neuropathic pain following spinal cord lesions.

著者

Tatsuya HAGIOKA Takeshi SHIMIZU Kazuhiro TOUHARA Motohide TAKAHARA Yuhei HOSHIKUMA Takamune ACHIHA Tomoaki MURAKAMI Maki KOBAYASHI Shingo TOYOTA Haruhiko KISHIMA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.343-347, 2022-12-31 (Released:2022-10-13)

参考文献数

18

---

A 72-year-old man who had undergone a lumboperitoneal shunt for idiopathic normal pressure hydrocephalus was admitted to our emergency department with fever and disturbance of consciousness 8 days after placement. Computed tomography scan showed pneumocephalus and a right-sided temporal porencephalic cyst with a small bone defect in the right petrous bone. Shunt valve pressure was raised from 145 mmH2O to "virtual off" setting. After 2 weeks, follow-up computed tomography showed improvement of pneumocephalus, and the shunt valve pressure was lowered to 215 mmH2O. Since that time, the patient has a good clinical course without recurrence.Tension pneumocephalus following shunt placement for idiopathic normal pressure hydrocephalus is rare and has never been reported in the early postoperative stage after lumboperitoneal shunt, except for the present one. Temporary raising shunt valve pressure is effective in improving the pneumocephalus. Preoperative screening for congenital bone defects by thin-slice computed tomography may be useful for selecting types of shunt valve and determining postoperative pressure setting.

著者

Atsushi KUWANO Koji YAMAGUCHI Takayuki FUNATSU Yosuke MOTEKI Seiichiro EGUCHI Isamu MIURA Momo UCHIDA Kaname ITO Tatsuya ISHIKAWA Takakazu KAWAMATA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.337-342, 2022-12-31 (Released:2022-10-13)

参考文献数

19

被引用文献数

1

---

Cavernous malformations of the midbrain have a higher rate of hemorrhage and a poorer prognosis than vascular malformations of other brain areas. Surgical resection of these lesions is often necessary to avoid neurological deficits in affected patients. Herein, the literature surrounding cavernous malformations was examined, and the case of a 48-year-old man with left hemiparesis and diplopia caused by incomplete right oculomotor nerve palsy, who was diagnosed with a hemorrhage from a midbrain cavernous malformation, was discussed. The lesion expanded gradually on magnetic resonance imaging and was symptomatic; radical removal of the lesion before the onset of irreversible symptoms due to recurring bleeding was therefore considered to be beneficial for the patient. Surgical removal of the entire cavernous malformations of the midbrain was performed using an interhemispheric transcallosal subchoroidal approach, with excellent postoperative results and complete recovery from the oculomotor nerve palsy and left hemiparesis. This case shows that this approach is the most appropriate for surgical resections of lesions in the upper midbrain.

著者

Makoto MIZUSHIMA Yukitomo ISHI Hiroshi IKEDA Ikuma ECHIZENYA Takuya OTSUKA Tomoko MITSUHASHI Shigeru YAMAGUCHI Miki FUJIMURA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.237-242, 2022-12-31 (Released:2022-07-27)

参考文献数

25

被引用文献数

5

---

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) occurs in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX). MTX-LPD is typically associated with Epstein-Barr virus (EBV) infection and regresses with MTX discontinuation. On the other hand, EBV-negative MTX-LPDs are less common and are more likely to show partial or no regression after MTX discontinuation. There were no standard chemotherapeutic options for refractory MTX-LPD. We present a case of EBV-negative MTX-LPD in the central nervous system (CNS) that was successfully treated with rituximab, methotrexate, procarbazine, and vincristine (R-MPV), followed by reduced-dose whole-brain radiotherapy (rdWBRT), following the same treatment protocol as primary CNS lymphoma. A 59-year-old woman with RA treated with MTX presented with gradually developing staggered gait, memory deficit, and disorientation. Multiple lesions with heterogeneous contrast enhancement were discovered using brain magnetic resonance imaging. The patient was suspected of having MTX-LPD, but discontinuing MTX did not result in regression of the brain lesions. She underwent a biopsy from the left parietal lesion. The tissue was pathologically diagnosed as diffuse large B-cell lymphoma. Furthermore, pathological examination through EBV-encoded ribonucleic acid in situ hybridization demonstrated a lack of EBV infection. She was ultimately diagnosed with EBV-negative CNS MTX-LPD. We applied chemotherapy with R-MPV and rdWBRT. The patient achieved a complete response. In the case of CNS MTX-LPD without EBV infection, chemotherapy with R-MPV followed by rdWBRT may be considered.

著者

Keita YOKAWA Yuji MATSUMOTO Keina NAGAKITA Yoko SHINNO Kenichiro KUDO Nanami NIGUMA Kosaku SUENOBU Hideyuki YOSHIDA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.323-328, 2022-12-31 (Released:2022-09-23)

参考文献数

21

被引用文献数

1

---

Leptomeningeal metastasis (LM) is a rare but devastating cancer complication. LM occurs when cancer spreads into the leptomeningeal layer or cerebrospinal fluid. Intracranial magnetic resonance (MR) images of LM are characterized by the diffuse enhancement of the leptomeninges along the cerebral sulci, cerebellar folia, and cranial nerves. Here, we report an extremely rare case of LM with an atypical MR image revealing tumor mass confinement to the arachnoid membrane. The case involves an 85-year-old man who was referred to our hospital with a three-day history of dysarthria. Radiological examination revealed a solid lesion with heterogeneous enhancement and a cystic component in the extra-axial region of the right parietal lobe. Upon subsequent general examination, multiple lung cancer metastases were suspected. The patient underwent gross total resection of the brain mass in the right parietal region. Although the tumor slightly adhered to the dura mater, it was sharply demarcated from the surrounding parenchyma and pia mater. Based on pathological examination, the tumor was diagnosed as small cell lung cancer metastasis. This metastatic brain tumor was exclusively confined to the arachnoid membrane and, except for a few blood vessels, the dura mater was not infiltrated by metastatic tumor cells. To our knowledge, this is the first reported case of LM in which the tumor mass is confined only to the arachnoid membrane. Thus, in cases with atypical MR images, a general examination considering the possibility of LM is important for prompt and accurate diagnosis.

著者

Taketo HANYU Masahiro NISHIHORI Takashi IZUMI Kazuya MOTOMURA Fumiharu OHKA Shunsaku GOTO Yoshio ARAKI Kinya YOKOYAMA Kenji UDA Ryuta SAITO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.289-294, 2022-12-31 (Released:2022-09-15)

参考文献数

23

被引用文献数

1

---

In this article, we report a case wherein a brain tumor was suspected based on computed tomography and magnetic resonance imaging findings. We made an initial diagnosis of malignant brain tumor based on methionine-positron emission tomography (PET) findings, but the correct diagnosis was dural arteriovenous fistula (DAVF). The patient was a 45-year-old man with DAVF who developed headache. Methionine-PET imaging showed high methionine uptake in the lesion. Although the tumor was strongly suspected from the findings of methionine-PET, the diagnosis of DAVF could be made correctly only by interpreting digital subtraction angiography and computed tomographic angiography. The findings of methionine-PET, which is considered useful in the diagnosis and denial of brain tumors, made the diagnosis of DAVF more difficult. The increased uptake of methionine-PET in DAVF is an important finding because, to our knowledge, this study is the first to report such finding. The results of this study might be useful for differential diagnoses when the diagnosis is uncertain.

著者

Ryo MIZUTA Yoshihiro OTANI Kentaro FUJII Atsuhito UNEDA Joji ISHIDA Takehiro TANAKA Shuntaro IKEGAWA Nobuharu FUJII Yoshinobu MAEDA Isao DATE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.275-280, 2022-12-31 (Released:2022-09-03)

参考文献数

22

---

Although high-dose methotrexate (HD-MTX) is the standard therapy for primary central nervous system lymphoma (PCNSL), the prognosis remains poor. Because 90% of PCNSL is diffuse large B-cell lymphoma (DLBCL), chimeric antigen receptor (CAR) -T cell therapy is expected to be beneficial. However, there are limited reports on CAR-T cell therapy for PCNSL because of the concern of neurotoxicity. Here, we report a case of relapsed PCNSL treated with anti-CD19 CAR-T cell therapy. A 40-year-old woman presenting with visual disturbance in her left eye was initially diagnosed with bilateral uveitis. Her histological diagnosis was DLBCL, and she was positive for CD19. Although she received chemotherapy including HD-MTX, the tumor relapsed in her right occipital lobe. She underwent remission induction therapy and then anti-CD19 CAR-T cell therapy. Cytokine release syndrome (CRS) grade 2 occurred, but there were no complications of CAR-T cell-related encephalopathy syndrome (CRES). She has achieved complete response for more than 1 year. Anti-CD19 CAR-T cell therapy is a revolutionary immunotherapy for treating relapsed or refractory (R/R) B lineage malignancies. Although there are concerns regarding CRS and CRES in central nervous system lymphoma, the use of anti-CD19 CAR-T cells to treat R/R PCNSL is safe and feasible.

著者

Tamon ANDO Tatsuya ISHIKAWA Takayuki FUNATSU Koji YAMAGUCHI Yosuke MOTEKI Seiichiro EGUCHI Momo UCHIDA Makiko SAKAGUCHI Masahiko NISHITANI Takakazu KAWAMATA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.269-273, 2022-12-31 (Released:2022-08-26)

参考文献数

20

---

Kissing aneurysms refer to the condition in which two cerebral aneurysms with separate necks are in contact with each other. At present, there is scarce information on kissing aneurysms occurring near the vertebral artery (VA) -posterior inferior cerebellar artery (PICA). We report the first case of VA-PICA and nonbranched PICA kissing aneurysms, which were successfully treated with contralateral stenting after the anchor coil technique using two microcatheters. A 64-year-old woman was diagnosed with a left VA-PICA aneurysm (5.5 mm) and an adjacent small PICA aneurysm (2.5 mm) with the aneurysmal walls in close contact. For stenting, microcatheters were navigated to the PICA from the contralateral side, and framing coils for the anchor were placed into each aneurysm from the ipsilateral side. Next, a Neuroform Atlas stent was deployed from the PICA to the distal side of the VA, and coiling was completed using the jailing technique. The patient had a good postoperative course, and a left vertebral angiogram revealed complete occlusion of both aneurysms after 6 months. Adequate surgical planning and application of an appropriate stent-assisted coil embolization technique contributed to the success of the procedure in this rare case.

著者

Tomoaki AKIYAMA Tsutomu HITOTSUMATSU

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.255-261, 2022-12-31 (Released:2022-08-20)

参考文献数

28

---

First bite syndrome (FBS) is an extremely rare complication of carotid endarterectomy (CEA). FBS presents with unique characteristics, development of brief and intense pain in the ipsilateral parotid region at the first bite of each meal, and improvement with subsequent mastication. Here, we report two cases of FBS following CEA. Both cases had anatomical difficulty of a high carotid bifurcation and a high cervical lesion. The lingual and facial arteries (or their common arterial trunk) branched off the external carotid artery (ECA) close to a high carotid bifurcation. The operations required exposure of the ECA distal to these two branches and the distal internal carotid artery (ICA) with a wider range of dissection for clamping the vessels. Several days or weeks after CEA, the patients developed FBS, and their meal-related pain completely resolved in the ensuing weeks. Especially in patients with a high carotid bifurcation, several branches of the ECA tend to originate from the proximal portion of the ECA, similar to octopus arms. During CEA, in these patients, dissection around the ECA and its branches in a wider range is required for exposure of each vessel and placement of the cross-clamp. These procedures can lead to injury to the external carotid nerve and plexus, possibly causing FBS. Additionally, because of the close location of the superior cervical ganglion, external carotid nerves, and distal ICA, manipulation for exposure of the distal end of a high plaque can increase the risk of injury to the cervical sympathetic nerves.

著者

Ryo OKADA Toshinori SAKAI Toshihiko NISHISHO Akihiro NITTA Shigeyuki TAKAHARA Koichi OBA Koichi SAIRYO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.249-253, 2022-12-31 (Released:2022-08-20)

参考文献数

16

被引用文献数

1

---

Transforaminal full-endoscopic spine surgery (TF-FESS) is a novel minimally invasive spine surgery that requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. To perform TF-FESS safely and efficiently, preoperative planning is quite important as the intervention requires anatomical understanding and high technical skills. Recently, three-dimensional (3D) printing has become a useful tool in various surgeries, and several studies have addressed its efficacy; however, there are no reports on the application of 3D printing to FESS. In this study, we present two cases of severe lumbar deformities for which preoperative 3D printing was useful. The 3D printing enabled the surgeons to visualize and plan the drilling of the superior articular process for a successful foraminoplasty at a low cost. The manufacturing equipment cost about USD 900 and is able to produce an actual-size model at a cost of less than USD 10 per patient. In conclusion, preoperative planning using 3D printing should be adopted to safely perform FESS.

著者

Asuka NAKAZAKI Shigeru YAMAGUCHI Hiroaki MOTEGI Yukitomo ISHI Michinari OKAMOTO Miki FUJIMURA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.213-216, 2022-12-31 (Released:2022-07-19)

参考文献数

12

被引用文献数

1

---

Facial nerve function improvement is a challenging goal in facial nerve schwannoma (FNS) surgery. Intraoperative continuous monitoring of evoked facial nerve electromyograms (CFN-EMGs) is performed in acoustic neuroma surgery to preserve facial nerve function. CFN-EMGs were applied in decompression surgery for FNS with severe facial paresis. A 39-year-old woman presented with a sudden onset of vertigo, left hearing disturbance, and severe left facial palsy with House-Brackmann (HB) grade 5. FNS was strongly suspected based on the patient's clinical course and magnetic resonance imaging findings, and the patient underwent surgical decompression of the internal auditory canal (IAC) to improve facial nerve function 9 weeks after onset. CFN-EMG responses suddenly improved after removing the posterior wall of the IAC and incising its dura matter. Since the patient's facial nerve paresis improved to HB grade 2 after surgery, CFN-EMGs could detect the moment of facial nerve decompression. This would be the first report to show that CFN-EMGs applied in decompression surgery for FNS could detect the effects of decompression during surgery in real-time. Thus, CFN-EMGs may be an effective monitoring method in decompression surgery for FNS.

著者

Mari KUSUMI Hidehiro OKA Hidehito KIMURA Hitoshi YAMAZAKI Koji KONDO Toshihiro KUMABE

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.217-223, 2022-12-31 (Released:2022-07-19)

参考文献数

24

被引用文献数

1

---

There has been a noted increase in the incidence of intracranial aspergillosis; this is often attributed to the wider use of antibiotics, corticosteroids, and immunosuppressants. Fungal cerebral aneurysms due to aspergillosis after neurosurgery remain extremely rare; in fact, only seven cases have been reported in the literature. In this study, we present a patient with an Aspergillus aneurysm that elicited subarachnoid hemorrhage after endoscopic endonasal surgery (EES) for craniopharyngioma. A 70-year-old woman with recurrent craniopharyngioma and steroid treatment underwent uneventful EES. On the 5th postoperative day, she suffered subarachnoid hemorrhage. As per her computed tomography angiography findings, an aneurysm was detected on the left internal carotid artery (ICA). Subsequent digital subtraction angiography showed occlusion of the ICA and an irregularly shaped wall. The diagnosis was pseudoaneurysm. We then performed craniotomy to place a left high-flow bypass and to trap the pseudoaneurysm. Despite continuous intensive care, she died on the 25th postoperative day of a huge, left cerebral infarct. The final diagnosis was made at autopsy; it revealed destruction of the ICA and Aspergillus invasion of the vessel wall, confirming the presence of a true fungal aneurysm. Perioperatively, patients with potential immunosuppression must be carefully managed. Advanced age is a risk factor. As surgery via the paranasal sinuses raises the risk for aspergillosis, fungal infection must be ruled out in patients whose postoperative course is deemed concerning.

著者

Yuichiro OHNISHI Tomofumi TAKENAKA Sho FUJIWARA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.193-198, 2022-12-31 (Released:2022-06-21)

参考文献数

18

被引用文献数

2

---

Tentorial dural arteriovenous fistula (DAVF) is an aggressive vascular lesion causing progressive neurological deficits. Venous congestive cervical edema is a rare phenomenon caused by tentorial DAVF. Obliteration of the fistula and venous drainage should be the goal of treatment. A 62-year-old man was admitted with lower limb weakness and numbness. Magnetic resonance imaging (MRI) revealed extensive edema of the upper cervical cord with signal flow void at the anterior spinal cord. Internal carotid angiography revealed a tentorial arteriovenous shunt near the superior petrosal sinus fed mainly by the tentorial artery. The petrosal vein was dilated, with the transverse pontine vein, medial medullary vein, and anterior spinal vein as the main drainage route. This suggests that venous hypertension triggered the upper cervical cord edema. MRI with gadolinium enhancement showed that the varix was located just distal to the shunt. Microsurgical obliteration of the fistula and venous drainage were achieved via a suboccipital approach. A postoperative evaluation showed the disappearance of the cervical cord edema with improved clinical symptoms. Tentorial DAVF with spinal venous drainage presents with mild and slow progression of symptoms. Differential diagnosis and definite treatment are mandatory to avoid a delayed diagnosis and irreversible symptoms.

著者

Hiroyuki MISHIMA Junichi AYABE Mutsumi TAKADERA Yusuke TSUCHIYA Taisuke KAWASAKI Masayuki OKANO Masanori ISODA Yoshihide TANAKA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.209-212, 2022-12-31 (Released:2022-07-08)

参考文献数

9

---

The causes of spinal epidural hematoma (SEH) have been attributed to coagulopathy, trauma, vascular anomalies, and so forth. The incidence of vascular anomalies shown by digital subtraction angiography has been reported to be 15%, and most cases have been reported to be spinal epidural arteriovenous fistulae. SEH has rarely been caused by venous congestion. We report a case of SEH in a 78-year-old male who presented to our emergency department with sudden-onset back pain, followed by complete paraplegia with bladder and rectal disturbance. Magnetic resonance imaging revealed a dorsally placed extradural hematoma extending from T10 to L1. An urgent laminectomy from T11 to L2 was performed. Computed tomography angiography (CTA) performed 1 week after the operation showed compression of the left renal vein between the aorta and superior mesenteric artery with dilation of the surrounding veins, including the spinal epidural venous plexus, at the same level as the hematoma. This was diagnosed as Nutcracker syndrome (NCS), which was consistent as a cause of SEH. The patient's symptoms gradually improved, and after 6 months, he regained normal strength in his lower extremities, but bladder and rectal disturbance remained and required intermittent self-catheterization. We chose conservative treatment for NCS, and SEH did not recur until the patient died of a cause unrelated to SEH or NCS. SEH could occur secondary to venous congestion including NCS. We emphasize the importance of investigating venous return to evaluate the etiology of SEH, which can be clearly visualized using CTA.

著者

Satoshi TANAKA Ryosuke TOMIO Norihiko AKAO Tsunemasa SHIMIZU Toshio ISHIKAWA Takeshi FUJIMOTO Terumasa NISHIMATSU

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.177-181, 2022-12-31 (Released:2022-06-21)

参考文献数

19

---

Gelatin-based hemostatic agents are widely used in neurosurgery. This is a case of postoperative aphagia strongly suspected to be caused by an allergic reaction to a gelatin-based hemostatic agent after anterior cervical decompression and fusion for central cervical cord injury. A 55-year-old man underwent cervical anterior decompression and fusion at the C3/4 and 4/5 levels for central cervical cord injury. Immediately after the surgery, he could not swallow saliva at all, but his voice was not hoarse. Postoperative cervical computed tomography and magnetic resonance imaging showed significant edema from the post-hypopharynx wall to the front of the vertebral body. The retropharyngeal space was remarkably enlarged to 15.8 mm with cervical spine X-rays. Without neurological symptom improvement, his condition was diagnosed as marked edema of the area where Surgiflo (porcine-derived gelatin-based hemostatic agent; Johnson & Johnson Wound Management, Somerville, NJ, USA) had been applied during the operation. It was strongly suspected to be caused by an allergic response to the porcine-derived gelatin. When methylprednisolone 1000 mg was administered for 3 days from the 5th postoperative day, swallowing became almost normal within a few hours after the initial administration, and his neurological symptoms improved. The patient left the hospital on the 12th day after the operation. Before using porcine-derived gelatin products during surgery, special consideration should be given to patients with an allergy history before surgery.

著者

Shunsuke SHIBAO Kazunari YOSHIDA Junki SOGANO Katsuhiro MIZUTANI Hideyuki TOMITA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.171-176, 2022-12-31 (Released:2022-06-21)

参考文献数

9

---

We report a rare case of hypoglossal canal meningioma in a 65-year-old woman who presented with dysphagia. Neurological examination revealed left hypoglossal nerve palsy. Head computed tomography and magnetic resonance imaging revealed a lesion around the left hypoglossal canal. She underwent a total resection with a midline suboccipital transcondylar approach. There were no postoperative complications, and the hypoglossal nerve palsy improved. There was no recurrence nine months after the surgery. Choosing a surgical approach that considers the site of origin and extent of tumor extension is important.

著者

Jun-ichi NOMURA Shota TSUTSUI Yuiko HATCHOME Toshinari MISAKI Hiromu KONNO Kuniaki OGASAWARA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.183-186, 2022-12-31 (Released:2022-06-21)

参考文献数

18

---

Aneurysms of the A1 segment of the anterior cerebral artery tend to develop in combination with various vascular anomalies of the A1 segment. Arterial branches that originate from the A1 segment and perfuse cortical regions are known to be rare. In this report, we describe a 48-year-old woman who presented with a ruptured aneurysm at the origin of an anomalous cortical artery arising from the A1 segment, for which microsurgical neck clipping was performed. Intraoperatively, the anomalous artery was seen to originate from the A1 segment, running into the interhemispheric fissure. An aneurysm was located at the bifurcation of the anomalous artery and the A1 segment. Postoperative angiography showed that the anomalous artery has branched into the fronto-orbital artery and the frontopolar artery and terminated as the anterior internal frontal arteries. We report a rare case of an aneurysm arising from an anomalous callosomarginal artery that arose from the A1 segment and perfused the cortical region. It is of significance to recognize that an aneurysm can develop at the origin of an anomalous artery that arises from the A1 segment.

著者

Takuya SUEMATSU Tomoaki MURAKAMI Jumpei TAKAMATSU Takeshi SHIMIZU Shingo TOYOTA Takuyu TAKI

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.157-163, 2022-12-31 (Released:2022-06-15)

参考文献数

24

---

Penetrating neck injury by a crossbow bolt is extremely rare and can be life-threatening. When removing a crossbow bolt from the neck, it is necessary to protect against fatal bleeding from the carotid vessels. We report removing a crossbow bolt penetrating the neck, with an endovascular approach. A 49-year-old woman was shot in the neck by a crossbow and was transferred to our hospital. On presentation, the crossbow bolt totally penetrated the neck from right to left. Her level of consciousness was clear, with no significant neurological deficits except for right peripheral facial palsy. Neck contrast-enhanced computed tomography revealed the crossbow bolt in contact with bilateral external and internal carotid arteries and that the bolt caused dissection of the left main trunk of the external carotid artery. Under general anesthesia, the crossbow bolt was removed under fluoroscopy with the assistance of an endovascular approach. First, we performed coil embolization for the dissected external carotid artery. Second, we prepared for fatal bleeding from the carotid arteries during crossbow bolt removal under protection using guiding catheters placed in bilateral common carotid arteries. The bolt was removed successfully without significant bleeding, and no complications occurred during the procedure. We report the successful removal of a crossbow bolt penetrating the neck. When removing a crossbow bolt penetrating the neck, endovascular assistance may be feasible to protect against fatal bleeding from the carotid arteries.

著者

Yusuke SAKAMOTO Kenko MAEDA Masaya TAKEMOTO Jungsu CHOO Mizuka IKEZAWA Ohju FUJITA Fumihiro SAGO Daiki SOMIYA Akira IKEDA

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.129-133, 2022-12-31 (Released:2022-05-31)

参考文献数

11

被引用文献数

4

---

Posterior inferior cerebellar artery (PICA) aneurysms often require cerebral vascular reconstruction for surgical treatment because of their characteristic morphology. Despite its potential complications, the occipital artery-to-posterior inferior cerebellar artery (OA-PICA) bypass is a typical treatment because of its versatility. Although a few cases of intracranial-to-intracranial bypass have been reported, this type of vascular reconstruction is only regarded as an alternative to the OA-PICA bypass because of the uncertainty of bypass feasibility and potential risk of ischemic complications. In this article, we report a case of proximal PICA ruptured aneurysm that was treated with a PICA-to-PICA (PICA-PICA) bypass. A 79-year-old man presented with a chief complaint of sudden, severe headache and disturbances in consciousness. Radiological examination revealed a right proximal PICA fusiform aneurysm. The patient had many systemic disorders such as microscopic polyangiitis and steroid-induced diabetes mellitus that could have caused wound dehiscence and cerebrospinal fluid (CSF) leakage. We performed the PICA-PICA bypass and trapping surgery rather than the OA-PICA bypass to avoid skin problems and CSF leakage. The postoperative course was uneventful, and the patient was discharged on day 64 without any neurological disorders. In comparison with the OA-PICA bypass, the PICA-PICA bypass is less likely to cause CSF leakage and skin complications, although it carries the risk of specific ischemic complications and requires advanced surgical techniques. For some patients with systemic disorders, the PICA-PICA bypass could be an optimal treatment option for proximal fusiform PICA aneurysms rather than as an alternative to the OA-PICA bypass.

著者

Daiichiro ISHIGAMI Satoshi KOIZUMI Satoru MIYAWAKI Hiroki HONGO Yu TERANISHI Jun MITSUI Nobuhito SAITO

出版者

The Japan Neurosurgical Society

雑誌

NMC Case Report Journal (ISSN:21884226)

巻号頁・発行日

vol.9, pp.139-144, 2022-12-31 (Released:2022-05-31)

参考文献数

17

被引用文献数

2

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Stenotic developmental venous anomalies (DVAs) often present with neurological deficits. In addition, cerebral capillary telangiectasia (CCT) coexisting with DVA is rarely encountered, and its pathophysiology, including the underlying genetics, and appropriate management remain uncertain. A 46-year-old man without any medical history of note was referred to our hospital with gradually worsening cerebellar ataxia. Two months after symptom onset, ataxic dysarthria and gait emerged. Brain magnetic resonance imaging showed CCT occupying the pons and left cerebellar peduncle. Subsequent catheter angiography demonstrated a DVA leading from the mass into the cavernous sinus with marked outlet stenosis and flow stagnation. We hypothesized that venous congestion was the source of gradual neurological deterioration and therefore initiated anticoagulation. Symptoms showed mild improvement, and his neurological status has remained stable as of 1 year after symptom onset. Whole-exome sequencing of germline DNA did not reveal any rare variants in genes previously reported as pertinent to vascular malformations. Anticoagulation may be a useful option in patients with non-thrombotic, stenotic DVA for whom neurological status did not improve under expectant management. Genetic analysis of this patient did not reveal any pathogenic mutations, and further investigation of somatic mutations is necessary to elucidate potential genetic causes.