著者

Takamitsu YAMAMOTO Yoichi KATAYAMA Toshiki OBUCHI Kazutaka KOBAYASHI Hideki OSHIMA Chikashi FUKAYA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.7, pp.475-481, 2012 (Released:2012-07-25)

参考文献数

32

被引用文献数

3 32

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Minimally conscious state (MCS) is characterized by inconsistent but clearly discernible behavioral evidence of consciousness, and can be distinguished from coma and the vegetative state (VS). Ten MCS patients were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury, and were treated by spinal cord stimulation (SCS). A flexible four-contact, cylinder electrode was inserted into the epidural space of the cervical vertebrae, and placed at the C2-C4 levels. Stimulation was applied for 5 minutes every 30 minutes during the daytime at an intensity that produced motor twitches of the upper extremities. We used 5 Hz for SCS, considering that the induced muscle twitches can be a useful functional neurorehabilitation for MCS patients. Eight of the 10 MCS patients satisfied the electrophysiological inclusion criteria, which we proposed on the basis of the results of deep brain stimulation for the treatment of patients in the VS. Seven patients recovered from MCS following SCS therapy, and were able to carry out functional interactive communication and/or demonstrate the functional use of two different objects. Cervical SCS increased cerebral blood flow (CBF) diffusely in the brain, and CBF increased by 22.2% during the stimulation period compared with CBF before stimulation in MCS patients (p < 0.0001, paired t-test). Five-Hz cervical SCS could increase CBF and induce muscle twitches of the upper extremities. This SCS therapy method may be suitable for treating MCS.

著者

中尾 哲 山本 豊城 福光 太郎 伴 貞彦 本崎 孝彦 佐藤 慎一 大塚 信一 中津 正二 田渕 哲 幸 茂男

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.28, no.11, pp.1113-1118, 1988 (Released:2006-09-05)

参考文献数

21

被引用文献数

8 15

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Intracranial lipomas are rare, especially in the cerebellopontine angle. Only 21 cases have so far been reported. In this communication, the case of a left cerebellopontine angle lipoma in a 48-year-old male is described and the relevant literature is reviewed.

著者

Takaaki HOSOYA Jun HATAZAWA Shinya SATO Masafumi KANOTO Akira FUKAO Takamasa KAYAMA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.53, no.4, pp.207-212, 2013 (Released:2013-04-25)

参考文献数

23

被引用文献数

1 13

---

We would like to propose floating dural sac sign, which is observed as a hyperintense band or rim around the spinal dural sac on axial T2-weighted images, as a sensitive sign to identify cerebrospinal fluid (CSF) leakage. One hundred patients with orthostatic headache were prospectively registered in 11 hospitals. These patients were examined by brain magnetic resonance (MR) imaging (n = 89), radioisotope cisternography (n = 89), MR myelography (n = 86), axial T2-weighted imaging of the spine (n = 70), and computed tomography myelography (n = 2). In this study, we separately evaluated the imaging findings of intracranial hypotension and spinal CSF leakage. Among 100 patients, 16 patients were diagnosed as having spinal CSF leaks. Of 70 patients examined with axial T2-weighted imaging, 14 patients were diagnosed with spinal CSF leaks, and floating dural sac sign was observed in 17 patients, 13 patients with spinal CSF leaks and 4 without CSF leaks (sensitivity 92.9%, specificity 92.9%). Of 86 patients examined by MR myelography, extradural fluid was observed in only 3 patients (sensitivity 21.4%, specificity 100%). The floating dural sac sign was a sensitive sign that can be used to identify CSF leakage. Spinal axial T2-weighted imaging might be a good screening method for spinal CSF leakage that can help to avoid the need for lumbar puncture.

著者

Yasunobu NAKAI Yoshiro ITO Masayuki SATO Kazuhiro NAKAMURA Masanari SHIIGAI Tomoji TAKIGAWA Kensuke SUZUKI Go IKEDA Satoshi IHARA Toshiyuki OKUMURA Masashi MIZUMOTO Koji TSUBOI Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.12, pp.859-864, 2012 (Released:2012-12-25)

参考文献数

26

被引用文献数

3

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A total of 29 cerebral arteriovenous malformations (AVMs) treated at the University of Tsukuba with multimodality treatment including proton beam (PB) radiotherapy for cerebral AVMs between 2005 and 2011 were retrospectively evaluated. Eleven AVMs were classified as Spetzler-Martin grades I and II, 10 as grade III, and 8 as grades IV and V. For AVMs smaller than 2.5 cm and located on superficial and non-eloquent areas, surgical removal with/without embolization was offered as a first-line treatment. For some small AVMs located in deep or eloquent lesions, gamma knife (GK) radiosurgery was offered. Some AVMs were treated with only embolization. AVMs larger than 2.5 cm were embolized to achieve reduction in size, to enhance the safety of the surgery, and to render the AVM amenable to GK radiosurgery. For larger AVMs located in deep or eloquent areas, PB radiotherapy was offered with/without embolization. Immediately after the treatment, 24 patients exhibited no neurological worsening. Four patients had moderate disability, and 1 patient had severe disability. Three patients suffered brain damage after surgical resection, and 2 patients suffered embolization complications. However, no neurological worsening was observed after either GK radiosurgery or PB radiotherapy, but 3 patients treated by PB radiotherapy suffered delayed hemorrhage. Fractionated PB radiotherapy for cerebral AVMs seems to be useful for the treatment of large AVMs, but careful long-term follow up is required to establish the efficacy and safety.

著者

Noriaki SAKAMOTO Eiichi ISHIKAWA Yasunobu NAKAI Hiroyoshi AKUTSU Tetsuya YAMAMOTO Kei NAKAI Masanari SHIIGAI Hideo TSURUSHIMA Tomonori ISOBE Shingo TAKANO Koji TSUBOI Akira MATSUMURA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.12, pp.878-884, 2012 (Released:2012-12-25)

参考文献数

27

被引用文献数

9 30 5

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Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.49, no.Supplement, pp.S1-S25, 2009 (Released:2009-10-27)

被引用文献数

8 22

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1. Total Registered Number   1) Number of Primary and Metastatic Brain Tumors   2) Age Distribution of Primary Brain Tumors (1984-2000)   3) Annual Trend of Frequency of Various Brain Tumors   4) Annual Trend of Frequency of Brain Tumors by Age Distribution (1984-2000) 2. Resident Area & Birthplace: All Primary Brain Tumors 3. Frequency of Primary Brain Tumors 4. Age Distribution of Various Brain Tumors (1984-2000) 5. Age Distribution of Brain Tumors by Sites (1984-2000) 6. General Features of Brain Tumors in Children: Age 0-14 7. General Features of Primary Brain Tumors (1984-2000) 8. Mode of Therapy (1984-2000) 9. General Features of Metastatic Brain Tumors (1984-2000)

著者

Hideki OSHIMA Yoichi KATAYAMA

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.50, no.9, pp.845-852, 2010 (Released:2010-09-25)

参考文献数

50

被引用文献数

4 12 6

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The theoretical basis of some deep brain stimulation (DBS) trials undertaken in the early years was the phenomenon of “brain stimulation reward (BSR),” which was first identified in rats. The animals appeared to be rewarded by pleasure caused by the stimulation of certain brain regions (reward system), such as the septal area. “Self-stimulation” experiments, in which rats were allowed to stimulate their own brain by pressing a freely accessible lever, they quickly learned lever pressing and sometimes continued to stimulate until they exhausted themselves. BSR was also observed with DBS of the septal area in humans. DBS trials in later years were undertaken on other theoretical bases, but unexpected BSR was sometimes induced by stimulation of some areas, such as the locus coeruleus complex. When BSR was induced, the subjects experienced feelings that were described as “cheerful,” “alert,” “good,” “well-being,” “comfort,” “relaxation,” “joy,” or “satisfaction.” Since the DBS procedure is equivalent to a “self-stimulation” experiment, they could become “addicted to the stimulation itself” or “compulsive about the stimulation,” and stimulate themselves “for the entire day,” “at maximum amplitude” and, in some instances, “into convulsions.” DBS of the reward system has recently been applied to alleviate anhedonia in patients with refractory major depression. Although this approach appears promising, there remains a difficult problem: who can adjust their feelings and reward-oriented behavior within the normal range? With a self-stimulation procedure, the BSR may become uncontrollable. To develop DBS to the level of a standard therapy for mental disorders, we need to discuss “Who has the right to control the mental condition?” and “Who makes decisions” on “How much control is appropriate?” in daily life.

著者

所 安夫

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.20, no.4, pp.415-424, 1980-04-15

被引用文献数

1 1

著者

Hayato TAKEUCHI Kazuhide IWAMOTO Mao MUKAI Tomoaki FUJITA Hitoshi TSUJINO Yoshihiro IWAMOTO

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.cr2012-0376, (Released:2013-11-08)

参考文献数

27

被引用文献数

1 4

---

Pathological laughing, one subgroup of psuedobulbar affect, is known as laughter inappropriate to the patient’s external circumstances and unrelated to the patient’s internal emotional state. The authors present the case of a 76-year-old woman with no significant medical history who experienced pathological laughing after subarachnoid hemorrhage (SAH) due to rupture of an aneurysm, which was successfully treated with craniotomy for aneurysm clipping. In the acute stage after the operation she suffered from severe vasospasm and resulting middle cerebral artery territory infarction and conscious disturbance. As she regained consciousness she was afflicted by pathological laughing 6 months after the onset of SAH. Her involuntary laughter was inappropriate to the situation and was incongruent with the emotional state, and she could not control by herself. Finally the diagnosis of pathological laughing was made and treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI), effectively cured the symptoms. Her pathological laughing was estimated to be consequence of infarction in the right prefrontal cortex and/or corona radiata, resulting from vasospasm. To the authors’ knowledge, this is the first report of pathological laughing after aneurysmal SAH. The authors offer insight into the pathophysiology of this rare phenomenon. Effectiveness of sertraline would widen the treatment modality against pathological laughing.

著者

YONEKAWA Yasuhiro FANDINO Javier

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.38, no.5, pp.301-303, 1998-05-15

被引用文献数

1

著者

Yasuo HIRONAKA Tetsuya MORIMOTO Yasushi MOTOYAMA Young-Sue PARK Hiroyuki NAKASE

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa2012-0379, (Released:2013-10-21)

参考文献数

52

被引用文献数

1 13

---

Surgical treatment for degenerative spinal disorders is controversial, although lumbar fusion is considered an acceptable option for disabling lower back pain. Patients underwent instrumented minimally invasive anterior lumbar interbody fusion (mini-ALIF) using a retroperitoneal approach except for requiring multilevel fusions, severe spinal canal stenosis, high-grade spondylolisthesis, and a adjacent segments disorders. We retrospectively reviewed the clinical records and radiographs of 142 patients who received mini-ALIF for L4-5 degenerative lumbar disorders between 1998 and 2010. We compared preoperative and postoperative clinical data and radiographic measurements, including the modified Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back and leg pain, disc height (DH), whole lumbar lordosis (WL), and vertebral wedge angle (WA). The mean follow-up period was 76 months. The solid fusion rate was 90.1% (128/142 patients). The average length of hospital stay was 6.9 days (range, 3–21 days). The mean blood loss was 63.7 ml (range, 10–456 ml). The mean operation time was 155.5 min (range, 96–280 min). The postoperative JOA and VAS scores for back and leg pain were improved compared with the preoperative scores. Radiological analysis showed significant postoperative improvements in DH, WL, and WA, and the functional and radiographical outcomes improved significantly after 2 years. The 2.8% complication rate included cases of wound infection, liquorrhea, vertebral body fractures, and a misplaced cage that required revision. Mini-ALIF was found to be associated with improved clinical results and radiographic findings for L4-5 disorders. A retroperitoneal approach might therefore be a valuable treatment option.

著者

Zongli HAN Yanli DU Hui QI Wei YIN

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.53, no.9, pp.630-634, 2013 (Released:2013-09-25)

参考文献数

22

被引用文献数

1 10

---

To add a further contribution to the literature supporting the relationship between previous head trauma and the development of glioma. We present the first case of pregnancy-related post-traumatic malignant glioma in a 29-year-old female who was admitted because of left sided hemiplegia and epilepsy due to a malignant glial tumor. She had been operated for a right frontal hematoma caused by a motorbike accident 9 years before. Neuroimaging showed a large neoplasia in the right frontal region beneath the material used for cranialplasty, and postoperative pathological revealed a glioblastoma multiforme (GBM) in continuity with the scar resulting from the trauma. While epidemiologic studies may not be conclusive, a pathologic basis has been suggested which show that trauma act as a cocarcinogen in the presence of an initiating carcinogen. Our case fulfilled the widely established criteria for brain tumors of traumatic origin. We believe that in specific cases it is reasonable to acknowledge an etiological association between head trauma and glioma. And additional factors such as pregnancy may promote the manifestation of the clinical symptoms.

著者

高久 晃 福井 仁士 JUNG Hee-Won HAN Dae Hee O-Ki Kwon CHO Byung-Kyu CHOI Kil Soo 森田 明夫 若井 晋 島 健 端 和夫 早川 徹 桐野 高明

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.38, no.5, pp.305-321, 1998-05-15

著者

杉田 保雄 YONEDA Shigeaki WATANABE Toshinori SHIGEMORI Minoru

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.35, no.8, pp.591-593, 1995-08-15

参考文献数

7

被引用文献数

2 6

---

脳動脈破裂によるくも膜下出血と隔たった場所に同時発症した高血圧性脳内出血の一症例について報告した。症例は77歳の女性で高血圧の既往があった。左内頚動脈撮影では左内頚一後交通動脈瘤が認められた。CTでは基底槽から左シルビウス裂にくも膜下出血が認められた。また破裂脳動脈瘤と同側の内包後脚にくも膜下出血とは別個に脳内出血が認められた。発症から3週後にネッククリッピング術が杉田のNo.26の有窓クリップにて施行された。脳内出血の影響による全身血圧の上昇が内頚一後交通動脈瘤の破裂の誘因と考えられた。

著者

NAKASE Hiroyuki OHNISHI Hideyuki TOUHO Hajime MIYAMOTO Susumu WATABE Yasuharu ITOH Tamio YAMADA Keisuke KARASAWA Jun SAKAMOTO Takanori KUREHARA Koukichi SHIMIZU Kiyoshi

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.33, no.9, pp.621-624, 1993-09-15

被引用文献数

1 17

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Twenty-three patients with epileptic type moyamoya disease are reviewed among 200 moyamoya disease patients. Ten boys and 13 girls aged 5 months to 12 years were followed over 6 months to 17.3 years. Six had generalized seizure and 17 had focal seizure. Operations were performed within 1 year in eight patients, within 1-3 years in five, and more than 3 years after onset in 10. Nineteen patients improved and suffered no seizure without receiving antiepileptic drugs, but four patients developed true epilepsy and three of these suffered cerebral infarction. Multivariate analyses showed that toddlers aged less than 1 year and mild or severe abnormal computed tomographic (CT) findings correlated with a bad outcome. This study showed that epileptic type moyamoya disease has the same clinical features as transient ischemic attack or infarction type. Age under 1 year and CT abnormalities indicate a poor prognosis and necessity for early reconstructive surgery.

著者

Tetsuya UEBA Omi HAMADA Toshiyasu OGATA Tooru INOUE Etsuji SHIOTA Yoshiyuki SANKAI

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.53, no.5, pp.287-290, 2013 (Released:2013-05-24)

参考文献数

18

被引用文献数

10 51

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Acute phase rehabilitation is an important treatment for improving the functional outcome of patients after stroke. The present cohort study analyzed the feasibility and safety of acute phase rehabilitation using the hybrid assistive limb robot suit in 22 patients, 7 males and 15 females (mean age 66.6 ± 17.7 years). Neurological deterioration, mortality, or other accidents were recorded as adverse events. Baseline characteristics of each patient were recorded at the first hybrid assistive limb rehabilitation. Hybrid assistive limb rehabilitation was conducted for 12.1 ± 7.0 days with the patients in stable condition. Acute phase hybrid assistive limb rehabilitation was performed a total of 84 times with no adverse events recorded except for orthostatic hypotension. Good functional outcomes were obtained in 14 patients. Orthostatic hypotension was observed during the first hybrid assistive limb rehabilitation in four patients, and was significantly associated with intracerebral hemorrhage (p = 0.007) and lower Brunnstrom stage (p = 0.033). Acute phase rehabilitation using the hybrid assistive limb suit is feasible and safe. Patients with intracerebral hemorrhage and lower Brunnstrom stage should be carefully monitored for orthostatic hypotension.

著者

Chihiro AKIBA Takanori ESAKI Maya ANDO Tsuyoshi FURUYA Kazuyuki NODA Yasuaki NAKAO Takuji YAMAMOTO Yasuyuki OKUMA Kentaro MORI

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.51, no.2, pp.140-143, 2011 (Released:2011-02-25)

参考文献数

9

被引用文献数

2 5

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A 62-year-old male presented with a rare case of possible neuro-Sweet Disease (NSD) mimicking brain tumor in the medulla oblongata, manifesting as numbness in the bilateral upper and lower extremities, gait disturbance, dysarthria, and swallowing disturbance which gradually deteriorated over 3 months. Magnetic resonance imaging showed a mass lesion in the medulla oblongata, extending to the upper cervical cord with rim enhancement by gadolinium. The preoperative diagnosis was brain tumor, such as glioma, or inflammatory disease. His neurological symptoms gradually deteriorated, so biopsy was performed through the midline suboccipital approach. Histological examination showed infiltration of inflammatory cells, mainly lymphocytes and macrophages. Human leukocyte antigen typing showed Cw1 and B54 which strongly suggested possible NSD. Steroid pulse therapy was started after surgery and the clinical symptoms improved. Neurosurgeons should be aware of inflammatory disorders such as NSD mimicking brain tumor.

著者

矢野 大仁 SAWADA Motoshi SHINODA Jun FUNAKOSHI Takashi

出版者

日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.35, no.7, pp.450-453, 1995-07-15

被引用文献数

15 26

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症例は27歳男性。突然の激しい頭痛にて発症した。来院時、昏迷状態で軽度の頭痛と右不全麻痺を認めた。CTにてくも膜下出血と左前頭葉に脳内血腫を認めた。左内頚動脈写にてA4に紡錘状の拡張を認め、解離性動脈瘤と診断した。第3病日、動脈瘤の切除術を施行した。動脈瘤は硬くひょうたん型を呈していた。末梢領域に対する血行再建術は行っていない。病理にて中膜-外膜間で解離した解離性動脈瘤と判明したが、原因は不明であった。術後も軽度の右不全身麻痺などを認めたが、次第に改善し、術後約40日で独歩退院した。前大脳動脈に限局した解離性脳動脈瘤の報告は稀で、特に治療方針につき文献的考察を加え報告した。

著者

長尾 省吾 角南 典生 筒井 巧 本間 温 門間 文行 西浦 司 西本 詮

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.24, no.6, pp.396-400, 1984 (Released:2006-09-21)

参考文献数

15

被引用文献数

3 7

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Correlations between changes in wave V of the auditory brain-stem response, intracranial pressure, and neurological signs of uncal herniation as graded by Plum and Posner were investigated in 12 patients with supratentorial mass lesion. In three of the five patients who later showed signs of uncal herniation, the latency of wave V, which presumably originated in the inferior colliculus, was already significantly prolonged. In 6 cases which progressed to the early third nerve stage of uncal herniation, the latency of wave V was prolonged in 5 cases. In 7 cases which progressed to the late third nerve stage or worse, the latency was prolonged in 6 cases and suppressed in one. In four of six attempts (three cases), lowering of the intracranial pressure by 10% glycerol solution resulted in normalization of the latency of wave V without clinical improvement. These results strongly indicate that measurement of wave V can predict the beginning of uncal herniation and can assess the effectiveness of medical or surgical decompression on brain-stem function.

著者

Committee for Guidelines for Management of Aneurysmal Subarachnoid Hemorrhage Japanese Society on Surgery for Cerebral Stroke

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.52, no.6, pp.355-429, 2012 (Released:2012-06-25)

参考文献数

336

被引用文献数

18 34