Neurologia medico-chirurgica
-
Neurol. Med. Chir. (Tokyo) · Nov 1998
Case ReportsAngiographic documentation of de novo aneurysm--case report.
A 49-year-old female presented with a case of de novo aneurysm which was documented angiographically 10 years after the initial aneurysm rupture. The de novo aneurysm arose as a blister-like aneurysm from a previously normal location 7 years after the first ictus. The de novo aneurysm progressed to a saccular aneurysm and ruptured after another 3 years. We recommend late angiography in high-risk patients to prevent repeat ictus.
-
Neurol. Med. Chir. (Tokyo) · Nov 1998
Case ReportsModel-based surgical planning and simulation of cranial base surgery.
Plastic skull models of seven individual patients were fabricated by stereolithography from three-dimensional data based on computed tomography bone images. Skull models were utilized for neurosurgical planning and simulation in the seven patients with cranial base lesions that were difficult to remove. Surgical approaches and areas of craniotomy were evaluated using the fabricated skull models. ⋯ The disadvantages of using skull models include the time and cost of making the models. The skull models provide a more realistic tool that is easier to handle than computer-graphic images. Surgical simulation using models facilitates difficult cranial base surgery and may help reduce surgical complications.
-
Neurol. Med. Chir. (Tokyo) · Aug 1998
Case ReportsTwo-staged resection of a left frontal astrocytoma involving the operculum and insula using intraoperative neurophysiological monitoring--case report.
A 29-year-old right-handed male with a 12-year education presented with a 2-month history of generalized epileptic activity. Neuroradiological imaging demonstrated a large lesion in the left frontal lobe involving the insulooperculum and in the temporal tip. Neurological and neuropsychological examination revealed no abnormality. ⋯ The medially extended insular tumor was then resected stepwise with frequent neurological monitoring with the patient awake. Surgery for intraaxial insuloopercular lesions in the dominant hemisphere carries a high risk of speech and motor deficit. This staged operation enables maximum tumor resection of dominant-side large frontal gliomas involving the insuloopercular region, with preservation of both motor and speech functions.
-
Neurol. Med. Chir. (Tokyo) · Jun 1998
Case ReportsIdiopathic hypertrophic cranial pachymeningitis of the cavernous sinus mimicking lymphocytic hypophysitis.
A 56-year-old female presented with idiopathic hypertrophic cranial pachymeningitis manifesting as headache, hypopituitarism, and diabetes insipidus, mimicking lymphocytic hypophysitis. Five months later, she complained of double vision and unusual right facial sensation. The diagnosis was based on magnetic resonance imaging, angiography, and meningeal biopsy via transsphenoidal surgery, and exclusion of other know causes of pachymeningitis. ⋯ The clinical presentation of idiopathic hypertrophic cranial pachymeningitis is variable, and it may develop with signs of adjacent tissue involvement. Resultant secondary hypophysitis must be differentiated from lymphocytic hypophysitis. Initial steroid therapy is effective in improving symptoms, but should be carefully considered since the natural course of this disease seems to be self-limited.
-
Neurol. Med. Chir. (Tokyo) · Jun 1998
Case ReportsClinical usefulness of 11C-MET PET and 201T1 SPECT for differentiation of recurrent glioma from radiation necrosis.
The clinical usefulness of L-methyl-11C-methionine positron emission tomography (11C-MET PET) and thallium-201 single photon emission computed tomography (201T1 SPECT) for distinguishing glioma recurrence from radiation-induced changes was evaluated. Ten patients with lesions highly suggestive of recurrent glioma on magnetic resonance imaging underwent 11C-MET PET and 201T1 SPECT studies. Two patients were examined twice, so a total of 12 studies were performed. ⋯ Four of the seven radiation necrosis lesions also appeared as increased uptakes on the 201T1 SPECT scans. In contrast, only one radiation necrosis appeared as increased uptake on the 11C-MET PET scans. There was no significant difference in 201T1 SPECT indices between radiation necrosis and tumor recurrence, but the ratio of the differential absorption ratio of tumor tissue to that of the homologous contralateral gray matter in PET of recurrent glioma was significantly higher than that of radiation necrosis. 11C-MET PET is superior to 201T1 SPECT for the differentiation of tumor recurrence from radiation necrosis and delineation of the extent of the tumor.