著者
Kohei CHIDA Tatsuhiko TAKAHASHI Suguru IGARASHI Kentaro FUJIMOTO Yasushi OGASAWARA Shunrou FUJIWARA Takahiro KOJI Yoshitaka KUBO 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.95-100, 2022-12-31 (Released:2022-04-28)
参考文献数
19

The coronavirus disease 2019 (COVID-19) pandemic continues to spread around the world, and widespread vaccination is considered the most effective way to end it. Although the efficacy of COVID-19 vaccines has been confirmed, their safety remains a concern. In this paper, we report two cases of ruptured vertebral artery dissecting aneurysm (VADA) immediately after messenger RNA (mRNA) anti-COVID-19 vaccination. In Case 1, a 60-year-old woman experienced sudden headache 3 weeks before her first dose of the Moderna mRNA-1273 COVID-19 vaccine. Magnetic resonance imaging showed dilatation of the right vertebral artery (VA) without intracranial hemorrhage. A day after the vaccination, she developed subarachnoid hemorrhage with pulmonary effusion due to a ruptured right VADA. She underwent endovascular internal trapping and parent artery occlusion under general anesthesia. In Case 2, a 72-year-old woman with a previous history of the left VA occlusion due to arterial dissection developed subarachnoid hemorrhage 7 days after the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine due to a ruptured right VADA and underwent stent-assisted coil embolization under general anesthesia. The postoperative courses of these two cases were uneventful. The accumulation of more cases and further study are warranted to clarify the relationship between COVID-19 mRNA vaccination and ruptured intracranial dissecting aneurysms.
著者
Yutaka MITSUHASHI Koji HAYASAKI Taichiro KAWAKAMI Takashi NAGATA Yuta KANESHIRO Ryoko UMABA Kenji OHATA
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.56, no.6, pp.326-339, 2016 (Released:2016-06-15)
参考文献数
75
被引用文献数
13 22

The cavernous sinus (CS) is one of the cranial dural venous sinuses. It differs from other dural sinuses due to its many afferent and efferent venous connections with adjacent structures. It is important to know well about its complex venous anatomy to conduct safe and effective endovascular interventions for the CS. Thus, we reviewed previous literatures concerning the morphological and functional venous anatomy and the embryology of the CS. The CS is a complex of venous channels from embryologically different origins. These venous channels have more or less retained their distinct original roles of venous drainage, even after alterations through the embryological developmental process, and can be categorized into three longitudinal venous axes based on their topological and functional features. Venous channels medial to the internal carotid artery “medial venous axis” carry venous drainage from the skull base, chondrocranium and the hypophysis, with no direct participation in cerebral drainage. Venous channels lateral to the cranial nerves “lateral venous axis” are exclusively for cerebral venous drainage. Venous channels between the internal carotid artery and cranial nerves “intermediate venous axis” contribute to all the venous drainage from adjacent structures, directly from the orbit and membranous skull, indirectly through medial and lateral venous axes from the chondrocranium, the hypophysis, and the brain. This concept of longitudinal venous axes in the CS may be useful during endovascular interventions for the CS considering our better understandings of its functions in venous drainage.
著者
Shinichi YOSHIMURA Kazutaka UCHIDA Nobuyuki SAKAI Hiroshi YAMAGAMI Manabu INOUE Kazunori TOYODA Yuji MATSUMARU Yasushi MATSUMOTO Kazumi KIMURA Reiichi ISHIKURA Takeshi MORIMOTO
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.rc.2021-0311, (Released:2021-12-24)
参考文献数
19
被引用文献数
3

Endovascular therapy is strongly recommended for acute cerebral large vessel occlusion (LVO) with an Alberta stroke program early computed tomography score (ASPECTS) ≥6 due to occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. However, the effect of endovascular therapy for patients with a large ischemic core with an ASPECTS ≤5 (0–5) was not established. A multicenter, randomized, open-label, parallel-group trial was conducted to investigate the superiority of endovascular therapy over medical therapy without endovascular therapy for a large ischemic core with ASPECTS (3–5). Patients were randomly assigned to receive endovascular therapy or without endovascular therapy at a ratio of 1:1. The primary outcome was a moderate functional outcome, defined as a modified Rankin scale (mRS; scores ranging from 0 [no symptoms] to 6 [death]) ≤3 after 90 days. The secondary outcomes were defined as ordinal mRS, good functional outcome (mRS ≤2), excellent functional outcome (mRS ≤1), mRS shift analysis after 90 days, and early improvement of neurological findings at 48 hours. A total sample size of 200 was estimated to provide a power of 0.9 with a two-sided alpha of 0.05, for the primary outcome, considering a 15% dropout rate. This randomized clinical trial reported the applicability of endovascular therapy in patients with acute cerebral LVO with a large ischemic core.
著者
Takahiro OTA Shogo DOFUKU Masayuki SATO
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.9, pp.69-72, 2022-12-31 (Released:2022-04-01)
参考文献数
11

Posterior inferior cerebellar artery (PICA) variations are well recognized; however, their mechanisms have not been well understood. Primitive lateral basilovertebral anastomosis (PLBA) was described in 1948 by Padget and is one of the embryological transient longitudinal channels in the hindbrain. This study reports a PICA aneurysm associated with PLBA. A 48-year-old man presented with subarachnoid hemorrhage. Cerebral angiography showed a 3.6-mm fusiform aneurysm with a bleb of the left PICA just at the origin of the PICA from the vertebral artery. Furthermore, a direct anterior inferior cerebellar artery (AICA) -PICA anastomosis parallel to the basilar artery was revealed. This direct anastomosis between the AICA and PICA is explained by the partial persistence of PLBA. Variations in the three cerebellar arteries and vertebrobasilar junction can be caused by persistence of PLBA.
著者
Ai NISHIYAMA Hidetaka WAKABAYASHI Shinta NISHIOKA Ayano NAGANO Ryo MOMOSAKI
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.oa.2019-0002, (Released:2019-05-22)
参考文献数
23
被引用文献数
12

Our aim was to clarify the nutritional status and energy intake needed for activities of daily living (ADL) improvement among convalescent stroke patients. This retrospective cohort study of stroke patients used data from the Japan Rehabilitation Nutrition Database. Mean energy intake per ideal body weight was 26 kcal/kg/day at 1 week after hospitalization. Patients were divided into two groups according to energy intake: ≥26 kcal/kg/day (high) and <26 kcal/kg/day (low). ADL was evaluated using Functional Independence Measure (FIM), and nutritional status was evaluated using the mini nutritional assessment short form score. We created an inverse probability weighted (IPW) model using propensity scoring to control and adjust for patient characteristics and confounders at the time of admission. The analysis included 290 patients aged 78.1 ± 7.8 years. There were 165 patients with high energy intake and 125 patients with low energy intake. FIM score was significantly higher in the high group compared with the low group (median 113 vs 71, P <0.001). FIM efficiency was also higher in the high group (median 0.31 vs 0.22, P <0.001). FIM efficiency was significantly higher in the high energy intake group than in the low energy intake group after adjustment by IPW (median 0.31 vs 0.25, P = 0.011). Nutritional status improvement was also higher in the high energy intake group after adjustment by IPW (60.6% vs 45.2%, P <0.001). High energy intake was associated with higher FIM efficiency and nutritional status improvement at discharge among convalescent stroke patients.
著者
Yoshimichi Sato Ryuta Saito Masayuki Kanamori Teiji Tominaga
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.7, no.1, pp.39-41, 2020 (Released:2020-01-01)
参考文献数
7
被引用文献数
1

Cystic tumors, such as craniopharyngiomas and Rathke’s cleft cysts, as well as arachnoid cysts have been reported to rupture occasionally. Approximately 8–10% of glioblastomas (GBMs) are known to have a significant cystic component; however, to the best of our knowledge, no studies have reported cystic rupturing of GBMs. Here, we describe a unique case of cystic GBM rupturing and penetrating into the cerebral ventricle. A 77-year-old man with a right frontal lobe lesion suspected as GBM with a large cyst was referred to our hospital. At admission, disorientation and left facial weakness were detected. Consciousness disturbance worsened on the 8th day of hospitalization. Computed tomography (CT) revealed prominent shrinkage of the tumor and intratumoral cyst. Signs of meningeal irritation were observed, and chemical meningitis due to cystic tumor rupture and leakage of necrotic components into the ventricle was highly suspected. Surgical resection of the right frontal lobe tumor was performed on the 10th day of hospitalization. During the surgery, clear and colorless cerebrospinal fluid was obtained upon penetration of the tumoral cyst, suggesting traffic of tumor cysts and cerebral ventricle. Adjuvant chemoradiation therapy was initiated postoperatively. Local recurrence was noted at the corpus callosum 7 months postoperatively and was treated with a gamma knife. Further therapy was performed after this recurrence. However, his condition gradually deteriorated 15 months postoperatively, and he was subjected to terminal care. To the best of our knowledge, this is the first report on a cystic GBM rupture.
著者
Mariko NODA Motoki INAJI Jun KARAKAMA Yukika ARAI Masae KUROHA Kaoru TAMURA Yoji TANAKA Taketoshi MAEHARA
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.9, pp.13-17, 2022-12-31 (Released:2022-02-23)
参考文献数
23
被引用文献数
1

It has been reported that bevacizumab, an agent administered as an adjuvant therapy for high-grade gliomas, causes thromboembolic complications. We report a cerebral infarction with newly developed cerebral artery stenosis occurring during treatment with bevacizumab for an anaplastic astrocytoma. A 48-year-old female underwent excision surgery for an anaplastic astrocytoma on the right temporal lobe and received radiation therapy and chemotherapy with temozolomide. Twenty months after the maintenance therapy, treatment with bevacizumab was introduced for tumor recurrence. After the 14th course of bevacizumab at 6 months, 27 months after radiation therapy, the patient began experiencing mild right hemiparesis. Magnetic resonance imaging revealed scattered cerebral infarcts on the left frontal lobe and diffuse cerebral artery stenosis of the bilateral internal carotid artery system both inside and outside the radiation-treated area. Antiplatelet medication was commenced, and there was no recurrence of ischemic stroke. The morphological transition of the cerebral arteries should be carefully monitored via magnetic resonance angiography during post-radiation treatment with bevacizumab.
著者
Yutaro TAKAYAMA Kazutaka JIN Shin-ichiro OSAWA Masaki IWASAKI Kazushi UKISHIRO Yosuke KAKISAKA Teiji TOMINAGA Tetsuya YAMAMOTO Nobukazu NAKASATO
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.8, no.1, pp.773-780, 2021 (Released:2021-11-02)
参考文献数
32

Cognitive decline is a well-known chronic side effect of multidisciplinary treatment of pineal region tumors, whereas epilepsy is an under-reported chronic consequence caused by multiple potential factors including radiotherapy, surgery, or chemotherapy. Some long-term survivors have suffered drug-resistant epilepsy after treatment, which impaired the quality of life. We report five consecutive patients with drug-resistant epilepsy after combined treatment of pineal region tumor (5 men, aged 21–42 years) among 1201 epilepsy patients who underwent comprehensive evaluation in our tertiary epilepsy center from 2011 to 2018. The comprehensive epilepsy evaluation included medical interview, long-term video electroencephalography (EEG) monitoring (VEM), and magnetic resonance (MR) imaging. The patients started to have seizures at 2–22 years after initial treatment for the tumor. Four of the five patients had focal impaired awareness seizures, whereas one patient had only visual aura. All patients had EEG seizures during VEM, which confirmed the diagnosis of focal epilepsy, but three patients had no interictal epileptiform discharges (IEDs). Two patients had diagnoses of focal epilepsy arising from the left occipital region based on ictal EEG findings. Both patients had MR imaging lesion in the left occipital lobe, radiation-induced cavernoma, or surgical injury. The remaining three patients showed poor localization of epileptogenic foci based on VEM and MR imaging. Drug-resistant epilepsy after multidisciplinary treatment of pineal region tumor is characterized by focal impaired awareness seizures with poorly localized EEG onset or rare interictal spikes.
著者
Takamasa KINOSHITA Hirohito YANO Noriyuki NAKAYAMA Natsuko SUZUI Tomohiro IIDA Saori ENDO Shiho YASUE Michio OZEKI Kazuhiro KOBAYASHI Tatsuhiko MIYAZAKI Toru IWAMA
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.8, no.1, pp.151-157, 2021 (Released:2021-06-05)
参考文献数
43

Giant cell glioblastoma (GCG) is a rare subtype of glioblastoma multiforme (GBM), and it often occurs in younger patients; however, its onset in children is extremely noticeable. A 7-year-old girl presented with a headache and restlessness. A giant tumor that was 7 cm in diameter was found by magnetic resonance imaging (MRI) in the left frontal lobe with intracranial dissemination. Because the tumor had extended to the lateral ventricles and occluded the foramen of Monro causing hydrocephalus, she underwent ventricular drainage and neuro-endoscopic biopsy from the left posterior horn of the lateral ventricle. The initial pathological diagnosis was an atypical teratoid/rhabdoid tumor (AT/RT). When the dissemination subsided after the first chemotherapy with vincristine, doxorubicin, and cyclophosphamide, she underwent the first tumor resection via a left frontal transcortical approach. After surgery, the second chemotherapy with ifosfamide, cisplatin, and etoposide was not effective for the residual tumor and intracranial dissemination. The second surgery via a transcallosal approach achieved nearly total resection leading to an improvement of the hydrocephalus. The definitive pathological diagnosis was GCG. Despite chemo-radiation therapy, the dissemination in the basal cistern reappeared and the hydrocephalus worsened. She was obliged to receive a ventriculo-peritoneal (VP) shunt and palliative care at home; however, her poor condition prevented her discharge. Ten months after admission, she died of tumor progression. The peritoneal dissemination was demonstrated by cytology of ascites. In conclusion, although unusual, pediatric GCG may be disseminated at diagnosis, in which case both tumor and hydrocephalus control need to be considered.
著者
Noriko HIRAO Takashi MORISHITA Kazuya SAITA Tomohiro TAKAGI Shinsuke FUJIOKA Tooru INOUE
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.8, no.1, pp.445-450, 2021 (Released:2021-08-06)
参考文献数
15

Dystonia is a movement disorder that has various treatment options. For primary dystonia, stereotactic procedures such as deep brain stimulation (DBS) have demonstrated favorable outcomes. For secondary dystonia, however, the treatment outcomes remain inconclusive, and the heterogeneous etiological background is considered to contribute to the poor outcomes of the disease. Here, we report a rare pediatric case of post-stroke focal dystonia treated with conventional radiofrequency ventro-oral (Vo) thalamotomy. The patient was an 11-year-old girl with secondary focal dystonia in her right hand. The dystonia was considered to result from a stroke lesion in the putamen due to vasculitis following varicella-zoster virus infection. We hypothesized that the infarction of the putamen resulted in hyperactivity in the thalamus, and, thus, performed a radiofrequency Vo thalamotomy. Markedly decreased muscle tone in her right hand was noted immediately after surgery. However, the improvement was temporary, as her symptoms returned to baseline level by the 6-month follow-up. Although the observed improvement was temporary in this case, our findings may elucidate the possible mechanisms of secondary focal dystonia. Further studies are needed to establish an effective surgical treatment for secondary focal dystonia.
著者
Etsuro MORI Masatsune ISHIKAWA Takeo KATO Hiroaki KAZUI Hiroji MIYAKE Masakazu MIYAJIMA Madoka NAKAJIMA Masaaki HASHIMOTO Nagato KURIYAMA Takahiko TOKUDA Kazunari ISHII Mitsunobu KAIJIMA Yoshihumi HIRATA Makoto SAITO Hajime ARAI
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.52, no.11, pp.775-809, 2012 (Released:2012-11-25)
参考文献数
253
被引用文献数
149 402

Among the various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. After the publication of the first edition of the Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus in 2004 (the English version was published in 2008), clinical awareness of iNPH has risen dramatically, and the number of shunt surgeries has increased rapidly across Japan. Clinical and basic research on iNPH has increased significantly, and more high-level evidence has since been generated. The second edition of the Japanese Guidelines was thus published in July 2011, to provide a series of timely evidence-based recommendations related to iNPH. The revision of the Guidelines has been undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project on “Studies on the epidemiology, pathophysiology, and treatment of normal pressure hydrocephalus.” This English version of the second edition of the Guidelines was made to share these ideas with the international community and to promote international research on iNPH.
著者
Ayaka SASAGAWA Takeshi MIKAMI Yusuke KIMURA Yukinori AKIYAMA Shintaro SUGITA Tadashi HASEGAWA Masahiko WANIBUCHI Nobuhiro MIKUNI
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.oa.2020-0309, (Released:2020-12-29)
参考文献数
23
被引用文献数
2

Gliomas are sometimes difficult to differentiate from strokes and are often misdiagnosed on magnetic resonance imaging (MRI); thus, the terms “stroke mimics” and “stroke chameleons” have been introduced. In this study, we analyzed stroke mimics and stroke chameleons in glioma and discussed the diagnostic perplexity.We retrospectively reviewed cases that were removed from lesions that were considered to be brain tumors. This study enrolled 214 patients who underwent tumor resection for suspected glioma. Clinical characteristics and radiological findings of the patients were compared between the masquerade findings group, which was further divided into two groups: the stroke chameleons and stroke mimics according to their final diagnosis, and the intelligible findings group.Stroke chameleons and stroke mimics were significantly higher in age and smaller in lesion size than the intelligible findings group. In the multivariate analysis, the predictive factor of the masquerade finding group was higher age and smaller size. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different.Proper diagnosis of glioma and stroke affects a patient’s prognosis, and should be diagnosed as soon as possible. However, stroke mimics and stroke chameleons caused by glioma can occur. Thus, the diagnosis of a stroke should take into consideration the possibility of a glioma in real clinical situations.
著者
Shota YAMASHITA Ryuta SAITO Shin-ichiro OSAWA Kuniyasu NIIZUMA Kazushi UKISHIRO Masayuki KANAMORI Kazuo KAKINUMA Kyoko SUZUKI Teiji TOMINAGA
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.61, no.11, pp.661-666, 2021 (Released:2021-11-15)
参考文献数
21
被引用文献数
2

In cases of malignant gliomas located at language eloquent area, it is often difficult to preoperatively detect those area with functional MRI. Awake surgery is often used to spare the language eloquent area during surgery for such tumors; it is not available for a patient whose intracranial pressure is elevated due to the malignant tumor. The Wada test involves infusing anesthetic agents into the internal carotid artery to determine language dominancy before surgery for epilepsy or brain tumor. The super-selective Wada test is a technique to detect more detailed functional localization by infusing anesthetics into far distal middle cerebral artery branches. We present a 37-year-old man suffering from a left frontal lobe glioblastoma, in whom detection of an artery supplying Broca’s area was attempted by a super-selective Wada test. The super-selective Wada test successfully detected the branch of middle cerebral artery supplying Broca’s area. Total resection of the contrast-enhancing area was achieved without damaging the artery supplying Broca’s area without any neurological sequelae. This is the first report describing the usefulness of the super-selective Wada test in glioblastoma treatment. Our findings suggest that the super-selective Wada test is a powerful and useful means to distinguish the artery that supplies the language area from the tumor feeding artery in cases of tumors in the language eloquent area.
著者
Kazuhiro ANDO Hitoshi HASEGAWA Bumpei KIKUCHI Shoji SAITO Jotaro ON Kohei SHIBUYA Yukihiko FUJII
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.oa.2019-0051, (Released:2019-07-04)
参考文献数
14
被引用文献数
8

We retrospectively reviewed the cases of three patients with infectious intracranial aneurysms (IIAs), and discuss the indications for surgical and endovascular treatments. We treated two men and one woman with a total of six aneurysms. The mean age was 43.3 years, ranging from 36 to 51 years. One patient presented initially with an intraparenchymal hemorrhage, one with mass effect, and the other one had four aneurysms (one causing subarachnoid hemorrhages and the other causing delayed intraparenchymal hemorrhages). The average size of all aneurysms was 12.2 mm (range, 2–50 mm). They were preferentially located in the distal posterior cerebral artery, and then, in the middle cerebral artery. All cases were caused by infective endocarditis. We selected endovascular treatments for five aneurysms and treated all but one within 24 h from detection. One aneurysm was treated by combined therapy with endovascular intervention and surgery. After treatment, none of the IIAs presented angiographical recurrence or re-bleeding. If feasible, endovascular treatment is probably the first choice, but a combined surgical and endovascular approach should be considered if surgery or endovascular treatment alone are not feasible. The method of treatment should be individualized. For cases with high risk of aneurysm rupture, treatment should be performed as soon as possible.
著者
永関 慶重 深町 彰 小泉 英仁 田崎 健 若尾 哲夫
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.20, no.12, pp.1239-1246, 1980 (Released:2006-11-10)
参考文献数
30

The authors reported a case of acute epidural hematoma which developed four hours after irrigation of the chronic subdural hematoma. A 56-year-old man was admitted. He was drowsy and disorientated with a one-month history of headache and dysarthria, but no other neurological deficits were noted. Laboratory data including bleeding and coagulating time, were all within the normal ranges. CT scanning and left carotid angiography showed a large left subdural hematoma. Irrigation of the subdural hematoma was performed the next day through two burr holes in the left fronto-parietal region under local anesthesia. About 150 ml of subdural hematoma was removed. Four hours after irrigation, he was semicomatose with right hemiplegia. CT scanning was immediately performed and reveled a epidural hematoma in the left parieto-occipital region. About 120 g of epidural hematoma was removed by left parieto-occipital craniotomy nine hours after the first operation. He gradually improved, and was discharged ambulant on the 51st postoperative day. The presumptive pathogenesis responsible for the development of the epidural hematoma in this case was bleeding from small dural vessels after detachment of the dura from the skull in the left parieto-occipital region. It was considered that the detachment occurred at the posterior burr hole in the beginning and was then accelerated by postoperative intensive evacuation of the hematoma through a closed-system drain.
著者
Yuta KOKETSU Takafumi TANEI Takenori KATO Takehiro NAITO Ko OKADA Risa ITO Kento HIRAYAMA Toshinori HASEGAWA
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.9, pp.25-30, 2022-12-31 (Released:2022-02-23)
参考文献数
27

A 36-year-old woman presented with sudden onset of a right-sided headache that awoke her from sleep. She had no episodes of trauma or abuse. She was initially able to speak, but fell into a coma within an hour. The right pupil was dilated, with slow pupillary reflexes to light on both sides, and she showed left hemiparalysis. Computed tomography scan showed a right acute epidural hematoma, approximately 4 cm in thickness, and there were no findings of trauma such as skin wounds, subcutaneous hematomas, or skull fractures. In the emergency room, decompression of intracranial pressure by one burr hole was performed, and her dilated right pupil improved to normal size. She was then moved to the operating room, and hematoma removal was performed by craniotomy. Her blood pressure trended downward despite rapid blood transfusion and vasopressor therapy. There were no abnormal findings apparent intraoperatively, except for oozing from the whole surface of the dura mater and epidural space. Her consciousness improved postoperatively, and her left hemiparalysis improved within a few days. No causative diseases, risk factors, or vascular abnormalities were found on laboratory and radiological surveys. Two months postoperatively, the bone flap was removed because of infection. Eight months postoperatively, a cranioplasty using artificial skull was performed, and her postoperative course was uneventful. One year after the initial surgery, she has no neurological deficits, and there has been no recurrence of epidural hematoma.
著者
Elizabeth OGANDO-RIVAS Paul CASTILLO Jesus Q. BELTRAN Rodolfo ARELLANO Isabel GALVAN-REMIGIO Victor SOTO-ULLOA Roberto DIAZ-PEREGRINO Diana OCHOA-HERNANDEZ Pablo REYES-GONZÁLEZ Elias SAYOUR Duane MITCHELL
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.2022-0116, (Released:2022-10-25)
参考文献数
93

We understand only a small fraction of the events happening in our brains; therefore, despite all the progress made thus far, a whole array of questions remains. Nonetheless, neurosurgeons invented new tools to circumvent the challenges that had plagued their predecessors. With the manufacturing boom of the 20th century, technological innovations blossomed enabling the neuroscientific community to study and operate upon the living brain in finer detail and with greater precision while avoiding harm to the nervous system. The purpose of this chronological review is to 1) raise awareness among future neurosurgeons about the latest advances in the field, 2) become familiar with innovations such as augmented reality (AR) that should be included in education given their ready applicability in surgical training, and 3) be comfortable with customizing these technologies to real-life cases like in the case of mixed reality.
著者
松本 勝美 滝本 洋司 正木 伸 中谷 進
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
vol.26, no.6, pp.491-494, 1986-06-15 (Released:2006-09-21)
参考文献数
31

A case of thrombosis of the dural sinus resulting in hydrocephalus is reported. This 60-year-old female had suffered from chronic right otitis media for 40 years. Recently she suddenly developed headache, vertigo and vomiting. The otitis media was treated surgically and with antibiotics. Thrombosis of the right sigmoid sinus was found at the time of operation. Headache persisted after the operation. Postoperative computed tomography (CT) scan showed ventricular dilatation and periventricular lucency. Cerebral angiography revealed stenosis of the superior sagittal sinus, the straight sinus, the right lateral sinus, and the right sigmoid sinus. After a ventriculo-peritoneal shunt operation, her symptoms and hydrocephalus were alleviated. It was suggested that hydrocephalus in this case was induced by sinus hypertension associated with dural sinus thrombosis secondary to recurrent otitis media. This phenomenon is known to occur usually in infants, but rarely in adults. Possible mechanisms accounting for the development of hydrocephalus secondary to sinus hypertension are discussed.
著者
Shogo DOFUKU Daisuke SATO Rika NAKAMURA Shotaro OGAWA Seiei TORAZAWA Masayuki SATO Takahiro OTA
出版者
The Japan Neurosurgical Society
雑誌
Neurologia medico-chirurgica (ISSN:04708105)
巻号頁・発行日
pp.2022-0164, (Released:2022-10-13)
参考文献数
30

Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) is a novel, minimally invasive treatment. The indications and treatment practices for MMAE are variable and remain controversial. This study aimed to evaluate a strategy involving sequential MMAE after burr hole surgery for treating recurrent CSDH. We performed a retrospective analysis of data from consecutive patients who had undergone MMAE using liquid embolic agents within approximately 2 weeks after burr hole surgery for recurrent CSDH from September 2020 to March 2022. We analyzed patient characteristics, procedural details, CSDH recurrence after MMAE, surgical rescue, and complications. Six of the nine patients who underwent MMAE for CSDH recurrence were male, and the median age was 85 (range, 70-94) years. Five of the nine patients were being administered antithrombotic agents. The median duration between the burr hole surgery and MMAE procedure was 10 (range, 3-25) days. Anterior and posterior convexity branches were targeted for embolization using low-concentration N-butyl cyanoacrylate (NBCA), and the abnormal vascular networks with a cotton wool appearance disappeared after embolization in all cases. The NBCA distribution was observed by high-resolution computed tomography during the procedure; in three of nine cases, the NBCA penetrated not only the MMA but also the inner membrane. No recurrence, surgical rescue, or complications were observed in any patient during the median follow-up period of 3 months. As a minimally invasive treatment for recurrent CSDH, sequential MMAE after burr hole surgery may be a safe and effective option for preventing recurrence.
著者
Kazuma DOI Yukoh OHARA Takahiro OUCHI Rie SASAKI Futaba MAKI Junichi MIZUNO
出版者
The Japan Neurosurgical Society
雑誌
NMC Case Report Journal (ISSN:21884226)
巻号頁・発行日
vol.9, pp.145-149, 2022-12-31 (Released:2022-05-31)
参考文献数
16
被引用文献数
1

Various COVID-19 vaccines are associated with numerous adverse side effects. Associations between vaccinations and neurological disorders, such as transverse myelitis, stroke, Bell's palsy, acute disseminated encephalomyelitis, and Guillain-Barré syndrome, have been reported. A 27-year-old Japanese woman presented with paresthesia four days after receiving a second dose of the COVID-19 vaccine. One month after vaccination, she started to feel left lower limb weakness, and her symptoms almost improved after two steroid pulse therapies. Spinal cord tumor biopsy could potentially help make a definitive diagnosis in clinical situations. However, it is very important to review the patient's medical history, including vaccinations received, before performing a direct spinal cord biopsy, which is invasive and does not guarantee a definitive diagnosis.