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Neurologia Medico-chirurgica

Mauro Dobran, Davide Nasi, Stefano Chiriatti, Maurizio Gladi, Lucia di Somma, Maurizio Iacoangeli, Massimo Scerrati
The prognostic relevance of epilepsy at glioblastoma (GBMs) onset is still under debate. In this study, we analyzed the value of epilepsy and other prognostic factors on GBMs survival. We retrospectively analyzed the clinical, radiological, surgical and histological data in 139 GBMs. Seizures were the presenting symptoms in 50 patients out of 139 (35.9%). 123 patients (88%) were treated with craniotomy and tumor resection while 16 (12%) with biopsy. The median overall survival was 9.9 months from surgery. At univariable Cox regression, the factors that significantly improved survival were age less than 65 years (P = 0...
January 16, 2018: Neurologia Medico-chirurgica
Kazuta Yamashita, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Masatoshi Morimoto, Yutaka Kinoshita, Akihiro Nagamachi, Takashi Chikawa, Hiroshi Yonezu, Kosaku Higashino, Tadanori Sakamaki, Koichi Sairyo
Lumbar spondylolysis usually occurs as a stress fracture in the pars interarticularis of the vertebra. It is a prevalent sports-related disorder and a common cause of low back pain. We encountered five athletes (4 males, 1 female) with severe low back pain. Mean age was 14.5 years. All five patients were found to have bilateral pars fracture. In all cases, staging based on the findings from computed tomography scan of the right and left pars fracture was different. On short tau inversion recovery magnetic resonance imaging (STIR-MRI) of the comparatively newer more recently injured side, high signal intensity changes were obvious and dominant at the intra- and extraosseous area, which would indicate tissue edema and/or bleeding...
December 25, 2017: Neurologia Medico-chirurgica
Kouhei Nii, Hayatsura Hanada, Fumihiro Hiraoka, Ayumu Eto, Takafumi Mitsutake, Masanori Tsutsumi
We investigated the safety and efficacy of consciousness sedation with dexmedetomidine (DEX) during the endovascular treatment of patients with acute cerebral infarction. Between April 2014 and November 2016, 38 stroke patients underwent endovascular thrombectomy (EVT) under local anesthesia and DEX consciousness sedation. The continuous intravenous administration of low-dose DEX (0.3-0.4 μg/kg/h) was started before entering the operating room. Patients not completely immobilized received an iv bolus of pentazocine (PTZ) and/or DEX (0...
December 19, 2017: Neurologia Medico-chirurgica
Norihiro Isogai, Shunji Asamoto, Satoshi Nakamura, Kiminori Sakurai, Shinichi Ishihara, Masayuki Ishikawa, Makoto Nishiyama, Fumitaka Yoshioka, Kazuhiro Samura, Masatou Kawashima
There are few cases of spinal cord injury with ankylosing spondylitis (AS). This study investigated the clinical results of a spinal cord injury with a fracture in elderly patients with AS. Nine patients who had sustained a spinal cord injury with vertebral fractures in ankylosed spines were included in this study. The mean age was 79.3 years; two were male and seven were female. The mechanism of injury, the level of vertebral fractures, clinical methods, the follow-up period, and treatment outcomes were investigated...
December 19, 2017: Neurologia Medico-chirurgica
Takeo Uzuka, Fumi Higuchi, Hadzuki Matsuda, Ryohei Otani, Phyo Kim, Keisuke Ueki
Intravascular lymphoma (IVL) has been characterized in many case reports by multiple white matter lesions reflecting ischemic changes. In contrast, there are very few case reports of cerebral or cerebellar hemorrhage resulting from IVL. A 56-year-old woman was referred to our department with two-week history of headache, nausea, and poor appetite. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed dilated veins on the cerebellar surface. No ischemic lesions were detected on diffusion-weighted images...
December 15, 2017: Neurologia Medico-chirurgica
Hiroyuki Toi, Nobuhisa Matsushita, Yukari Ogawa, Keita Kinoshita, Kohei Satoh, Hiroki Takai, Satoshi Hirai, Keijiro Hara, Shunji Matsubara, Masaaki Uno
Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes...
December 1, 2017: Neurologia Medico-chirurgica
Masahiko Nishimura, Shigetaka Kobayashi, Yuki Kinjo, Yohei Hokama, Kenichi Sugawara, Yukio Tsuchida, Daisuke Tominaga, Shogo Ishiuchi
The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients...
December 1, 2017: Neurologia Medico-chirurgica
Shoichi Haimoto, Yusuke Nishimura, Masahito Hara, Yasuhiro Nakajima, Yu Yamamoto, Howard J Ginsberg, Toshihiko Wakabayashi
A single-center retrospective comparative study was designed to identify the risk factors for restenosis of lumbar foraminal stenosis (LFS) after microscopic foraminal decompression (MFD). 21 consecutive patients who underwent single-level MFD with an average of 19-month follow-up were divided into two study groups based on clinical outcomes; group 1 (7 patients with poor outcomes requiring revision surgery), group 2 (14 patients with good outcomes with no revision surgery required). Changes of lumbar spinal alignment on plain standing radiographs were compared and analyzed between two study groups to investigate the pathology and risk factors associated with restenosis after MFD...
November 24, 2017: Neurologia Medico-chirurgica
Ken Takizawa, Mitsunori Matsumae, Naokazu Hayashi, Akihiro Hirayama, Fumiya Sano, Satoshi Yatsushiro, Kagayaki Kuroda
The advent of magnetic resonance imaging (MRI) enables noninvasive measurement of cerebrospinal fluid (CSF) motion, and new information about CSF motion has now been acquired. The driving force of the CSF has long been thought to be choroid plexus (CP) pulsation, but to investigate whether this phenomenon actually occurs, CSF motion was observed in the ventricular system and subarachnoid space using MRI. Eleven healthy volunteers, ranging in age from 23 to 58 years, participated in this study. The MRI sequences used were four-dimensional phase-contrast (4D-PC) and time-spatial labeling inversion pulse (t-SLIP)...
November 16, 2017: Neurologia Medico-chirurgica
Takuma Matoba, Nobuhiro Hanai, Hidenori Suzuki, Daisuke Nishikawa, Eiji Tachibana, Takeshi Okada, Shingo Murakami, Yasuhisa Hasegawa
Carcinoma of the external and middle ear is a very rare disease. Despite the various treatment modalities available, its prognosis is still poor. We aimed to analyze the treatment modalities, outcomes, and validity of surgical approaches, especially in advanced tumors in the ear. Twenty-five patients with carcinoma of the external and middle ear were retrospectively analyzed. The modified Pittsburgh staging system was used for staging of the patients. Overall and disease-free survival was estimated using of Kaplan-Meier method...
November 15, 2017: Neurologia Medico-chirurgica
Yoshiki Obata, Yoshihisa Kawano, Yoji Tanaka, Taketoshi Maehara
The aim of this study was to evaluate the importance of pre- and post-operative volumetric measurement of the cerebellopontine angle (CPA) using 3 Tesla (3T) magnetic resonance imaging (MRI). Between April 2012 and December 2015, a total of 87 consecutive patients underwent microvascular decompression (MVD) for trigeminal neuralgia (TN), of whom 51 with primary TN caused by arterial compression were enrolled in this study. Bilateral CPA cistern volume was evaluated using 3T MRI before and after surgery; the Cistern Deviation Index was used to represent the degree of deviation of the CPA cistern...
November 14, 2017: Neurologia Medico-chirurgica
Yasuo Iwadate
The marked heterogeneity in glioblastoma (GBM) may be induced through dynamic differentiation and dedifferentiation process of glioma cells. The hypothesis that environmental stimuli induce these phenotypic changes, including dedifferentiation into the stem cell phenotype which contributes to the high invasiveness and resultant poor outcome in GBM patients, is recently being proven. In the process of cancer invasion and metastasis, the phenotypic change has also been described as epithelial-mesenchymal transition (EMT)...
November 13, 2017: Neurologia Medico-chirurgica
Jin Pyeong Jeon, Eun Pyo Hong, Jeong Eun Kim, Eun Jin Ha, Won-Sang Cho, Young-Je Son, Jae Seung Bang, Chang Wan Oh
Elastin encoded by elastin gene (ELN) is a crucial extracellular matrix protein responsible for arterial resilience. The objective of this study was to identify single nucleotide polymorphisms (SNPs) of ELN gene susceptible to intracranial aneurysm (IA) in Korean population. Two SNPs of ELN gene, rs2071307 (Gly422Ser) and rs2856728 (intron), were genotyped in 90 patients with IA and 90 age and frequency matched controls. Fisher's exact test was conducted to evaluate allelic association with IA. Of the two SNPs in ELN gene, T allele of rs2856728 (intron) showed statistically significant association with increased development of IA (odds ratio [OR]: 2...
November 10, 2017: Neurologia Medico-chirurgica
Yasuo Aihara, Kentaro Chiba, Seiichiro Eguchi, Kosaku Amano, Takakazu Kawamata
Optic pathway/hypothalamic gliomas (OP/HGs) are rare astrocytic tumors that appear more commonly among young children and often are unresectable. They comprise approximately 2% of all central nervous system tumors and account for 3-5% of pediatric intracranial tumors. Initial manifestations are often visual disturbances, endocrinopathies and hypothalamic dysfunction such as the diencephalic syndrome, and sometimes hydrocephalus due to cerebrospinal fluid (CSF) outflow obstruction. In many cases, the tumors are diagnosed late in the clinical course because they silently enlarge...
November 9, 2017: Neurologia Medico-chirurgica
Yoshifumi Mizobuchi, Makoto Ohtani, Junichiro Satomi, Kiyohide Fushimi, Shinya Matsuda, Shinji Nagahiro
Microvascular decompression (MVD) is a widely used, safe, and effective treatment for trigeminal neuralgia (TGN). However, the extent of application of this therapeutic method and its outcomes in Japan are currently unclear. To address these questions, the authors analyzed the use of MVD for the treatment of TGN during the 33-month period from July 2010 to March 2013, using data contained in the Diagnosis Procedure Combination database. The analysis revealed that MVD was used for the treatment of TGN in 1619 cases (608 men, 1011 women), with approximately 1...
November 2, 2017: Neurologia Medico-chirurgica
Noriaki Matsubara, Takashi Izumi, Shigeru Miyachi, Keisuke Ota, Toshihiko Wakabayashi
Contrast-induced encephalopathy is a very rare complication associated with endovascular treatment of intracranial aneurysms. Patients with renal dysfunction may be prone to developing contrast medium neurotoxicity as a result of delayed elimination of the contrast medium in renal metabolism. This article focuses on our experience with contrast-induced encephalopathy in patients with end-stage renal disease requiring hemodialysis. The authors retrospectively reviewed five patients diagnosed with contrast-induced encephalopathy who underwent aneurysm coil embolization at their institution from January 2006 to December 2015...
October 31, 2017: Neurologia Medico-chirurgica
Masaki Okada, Keisuke Miyake, Takashi Tamiya
Although current treatment advances prolong patient survival, treatment for glioblastoma (GBM) in the elderly has become an emerging issue. The definition of "elderly" differs across articles; GBM predominantly occurs at an age ≥65 years, and the prognosis worsens with increasing age. Regarding molecular markers, isocitrate dehydrogenase (IDH) mutations are less common in the elderly with GBM. Meanwhile, O(6)-methylguanine DNA methyltransferase (MGMT) promoter methylation has been identified in approximately half of patients with GBM...
October 30, 2017: Neurologia Medico-chirurgica
Michihiro Tanaka
Functional vascular anatomy is the study of anatomy in its relation to the function that figures out the normal and pathological vascularization of the brain and spinal cord. The mechanism of anatomical variations (e.g. fenestration of the basilar artery, persistent primitive trigeminal artery, and aberrant subclavian artery) can be explained according to the embryological development of the cardiovascular system. The most developmental process is common among the species of the vertebrates from the fish to the mammalian in the early phase of embryo...
November 15, 2017: Neurologia Medico-chirurgica
Koichi Kato, Hiroshi Ujiie, Hiroshi Nakano, Shunsuke Nomura, Masanori Nakagawa, Takashi Higa, Shigeru Kadoyama, Akira Teramoto
Accurate and long-term transposition of offending vessels is required in microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS) and trigeminal neuralgia (TN). We created ion-beam implanted of an expanded-polytetrafluoroethylene (i-ePTFE) surface to transpose offending vessels in MVD. In 13 patients with MVD, we concealed and transposed offending vessels with tape-shaped i-ePTFE, and relieved facial and trigeminal nerve compression by attaching the i-ePTFE to the dura with fibrin glue...
November 15, 2017: Neurologia Medico-chirurgica
Hiroki Ohkuma, Norihito Shimamura, Masato Naraoka, Takeshi Katagai
The number of elderly patients with an aneurysmal subarachnoid hemorrhage (aSAH) has been increasing in aging- or aged societies in many countries. A treatment strategy for the elderly with aSAH has not been established, although many studies have been published emphasizing poor outcome for aSAH. The aim of this study was to analyze the factors and treatments affecting outcome in aSAH in the elderly in a systematic review of the literature by investigating patients over age 75. A literature search was done for "elderly aSAH" in PubMed and Embase...
November 15, 2017: Neurologia Medico-chirurgica
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