No shinkei geka. Neurological surgery
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The negative motor area and anterior and posterior language areas were localized by intraoperative electrical cortical stimulation under the awake condition to evaluate the clinical significance of these areas. Thirty-seven awake craniotomies with language mapping were performed in 36 patients with brain tumors. The negative motor area was determined in 17 cases, and the anterior and posterior language areas were found in 12 and 6 cases, respectively. ⋯ Both the negative motor area and the anterior language area were determined in 8 cases. Anterior language areas in these 8 cases were located anterior and/or inferior to the negative motor areas. The negative motor area is an easily determined, important landmark for intraoperative language mapping.
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Review Case Reports
[Glioblastoma multiforme developing separately from the initial lesion 9 years after successful treatment for gliomatosis cerebri: a case report].
Gliomatosis cerebri is a diffuse growth pattern of glioma consisting of exceptionally extensive infiltration of at least three cerebral lobes. We report a case of histologically confirmed glioblastoma multiforme in the cerebellar vermis which occurred 9 years after treatment for gliomatosis cerebri. A 33-year-old woman presented to our department for evaluation of visual disturbance. ⋯ The patient received gamma knife irradiation for the remnant lesion in the cerebellar vermis, and the lesions in the cerebellar hemisphere and left posterior limb of the internal capsule, and chemotherapy with temozolomide. However, multiple enhanced lesions were detected in the cerebellar vermis 2 months after the start of the temozolomide chemotherapy, and she died 8 months later. This case suggests that glioblastoma multiforme could develop in the long term after initial treatment for gliomatosis cerebri, and in a location separate from the initial lesion.
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Case Reports
[Spontaneous cervical epidural hematoma presenting with hemiparesis following neck extension: a case report].
A 42-year-old woman suddenly developed weakness in her left extremities when stretching her neck two days after the onset of a nuchal pain. Because computed tomography (CT) of the brain did not show any apparent lesion, the patient had initially been treated as having a cerebral infarction until magnetic resonance imaging (MRI) of the cervical spine revealed a presence of a cervical epidural hematoma the next day. She was therefore transferred to our hospital, and a neurological examination showed moderate left hemiparesis, dissociated sensory loss under C6 on the right side, urinary incontinence, and left miosis and ptosis. ⋯ The patient underwent an emergent laminoplasty from C3 to C7. Although her neurological signs were consistent with Brown-Sequard syndrome, which was associated with left-sided Homer's sign, they gradually and completely subsided following surgery. The authors therefore emphasize that cervical lesions should be considered in the differential diagnosis in patients with acute onset of hemiparesis.