Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Oct 2005
Craniovertebral junction realignment for the treatment of basilar invagination with syringomyelia: preliminary report of 12 cases.
Twelve selected patients, eight males and four females aged 14 to 50 years, with syringomyelia associated with congenital craniovertebral bony anomalies including basilar invagination and fixed atlantoaxial dislocation, and associated Chiari I malformation in eight, were treated by atlantoaxial joint manipulation and restoration of the craniovertebral region alignment between October 2002 and March 2004. Three patients had a history of trauma prior to the onset of symptoms. Spastic quadriparesis and ataxia were the most prominent symptoms. ⋯ Following surgery all patients showed symptomatic improvement and restoration of craniovertebral alignment during follow up from 3 to 20 months (mean 7 months). Radiological improvement of the syrinx could not be evaluated as stainless steel metal plates, screws, and spacers were used for fixation. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of syringomyelia leads to remarkable and sustained clinical recovery, and is probably the optimum surgical treatment.
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Neurol. Med. Chir. (Tokyo) · Oct 2005
Case ReportsPeritoneal shunt tube migration into the stomach--case report--.
A 47-year-old man presented with repeated headache and feverishness 3.5 years after undergoing ventriculoperitoneal shunt surgery for normal pressure hydrocephalus secondary to subarachnoid hemorrhage. Abdominal computed tomography revealed that the peritoneal catheter was encased by fibrous tissue and the distal end of the catheter had migrated into the stomach. The diagnosis was spontaneous gastric perforation by the ventriculoperitoneal shunt. The fibrous tissue was expected to seal the very small gastric perforation, so the catheter was successfully extracted through a scalp incision without abdominal surgical intervention.
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Neurol. Med. Chir. (Tokyo) · Sep 2005
Case ReportsRapid disappearance of acute posterior fossa epidural hematoma.
A 34-year-old man presented with an acute epidural hematoma that resolved within 24 hours after a fall. On admission, neurological examination found no abnormalities. Computed tomography (CT) indicated a linear fracture in the occiput. ⋯ Conservative management with pentothal was performed in the intensive care unit. Follow-up CT 21 hours after the initial injury showed complete resolution of the hematoma and an increase in the CT density of the pericranial soft tissue near the hematoma. The pressure gradient between the subgaleal and epidural space may have been important in the rapid disappearance of this epidural hematoma.
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Neurol. Med. Chir. (Tokyo) · Aug 2005
Case ReportsMetastatic renal cell carcinoma mimicking pituitary adenoma: case report.
A 54-year-old man, with a past history of renal cell carcinoma, presented with bitemporal visual field defect, hyponatremia, and diabetes insipidus. Endocrinological examination revealed panhypopituitarism. Computed tomography and magnetic resonance imaging showed an intrasellar mass with suprasellar extension. ⋯ The tumor was decompressed via the transsphenoidal route. Histological examination revealed metastatic renal cell carcinoma. The clinical characteristics of metastatic pituitary carcinoma appear to be panhypopituitarism, and neuroimaging findings of strong enhancement of the tumor and bony destruction without marked sellar enlargement.
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Neurol. Med. Chir. (Tokyo) · Aug 2005
Review Historical ArticleRole of Japan in the future of neurosurgery in Asia.