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Neurologia Medico-chirurgica

Takeshi Funaki, Jun C Takahashi, Susumu Miyamoto
In this article, the authors review the literature related to long-term outcome of pediatric moyamoya disease, focusing on late cerebrovascular events and social outcome of pediatric patients once they reach adulthood. Late-onset de novo hemorrhage is rare but more serious than recurrence of ischemic stroke. Long-term follow-up data on Asian populations suggest that the incidence of de novo hemorrhage might increase at age 20 or later, even more than 10 years after bypass surgery. Social adaptation difficulty, possibly related to cognitive impairment caused by frontal ischemia, continues in 10-20% of patients after they reach adulthood, even if no significant disability is present in daily life...
May 21, 2018: Neurologia Medico-chirurgica
Hideaki Matsumura, Eiichi Ishikawa, Masahide Matsuda, Noriaki Sakamoto, Hiroyoshi Akutsu, Shingo Takano, Akira Matsumura
A 43-year-old man was operated on for right frontal oligoastrocytoma. 14 years after the surgery, magnetic resonance imaging and positron emission tomography revealed a new lesion near the surgical cavity. He underwent gross total resection of the lesion and implantation of bis-chloroethylnitrosourea (BCNU) wafers after intraoperative pathological diagnosis of recurrent high-grade glioma. A few days after the operation, the level of consciousness gradually worsened and left hemiparesis developed. A computed tomography scan revealed a cyst remote to the surgical cavity which did not exist 3 days prior...
May 21, 2018: Neurologia Medico-chirurgica
Hirotaka Hasegawa, Shunya Hanakita, Masahiro Shin, Mariko Kawashima, Wataru Takahashi, Osamu Ishikawa, Satoshi Koizumi, Hirofumi Nakatomi, Nobuhito Saito
It is debated whether the efficacy and long-term safety of gamma knife radiosurgery (GKRS) for arteriovenous malformations (AVMs) differs between adult and pediatric patients. We aimed to clarify the long-term outcomes of GKRS in pediatric patients and how they compare to those in adult patients. We collected data for 736 consecutive patients with AVMs treated with GKRS between 1990 and 2014 and divided the patients into pediatric (age < 20 years, n = 144) and adult (age ≥ 20 years, n = 592) cohorts. The mean follow-up period in the pediatric cohort was 130 months...
May 17, 2018: Neurologia Medico-chirurgica
Kenichi Amagasaki, Masami Nagayama, Saiko Watanabe, Naoyuki Shono, Hiroshi Nakaguchi
Microvascular decompression (MVD) is widely accepted as an effective surgical method to treat trigeminal neuralgia (TN), but the risks of morbidity and mortality must be considered. We experienced a case of acute angle-closure glaucoma attack following MVD for TN in an elderly patient, considered to be caused by lateral positioning during and after the surgery. A 79-year-old female underwent MVD for right TN in the left lateral decubitus position, and TN disappeared after the surgery. Postoperatively, the patient tended to maintain the left lateral decubitus position to prevent wound contact with the pillow, even after ambulation...
May 17, 2018: Neurologia Medico-chirurgica
Hisashi Nagashima, Kazuhiro Hongo, Alhusain Nagm
The purpose of this study is to elucidate the hemodynamic changes after palliative angioplasty and the timing of second stage carotid artery stenting (CAS) in staged angioplasty for patients with severe hemodynamically compromised carotid artery stenosis. Among consecutive 111 patients with carotid artery stenosis, chronological changes in the cerebral blood flow of all 11 hemodynamically compromised patients treated with CAS were evaluated with single photon emission computed tomogram (SPECT) in each stage of the treatment...
May 11, 2018: Neurologia Medico-chirurgica
Shuhei Kawabata, Shoichi Tani, Hirotoshi Imamura, Hidemitsu Adachi, Nobuyuki Sakai
The precise mechanism of the development of chronic subdural hematoma (CSDH) as a postoperative complication after aneurysmal clipping remains unclear. The purpose of this study was to identify the independent risk factors for CSDH after craniotomy for aneurysmal clipping and to elucidate the relationship between CSDH and subdural air (SDA) collection immediately after surgery. The medical records and radiologic data of 344 patients who underwent surgical clipping of unruptured aneurysms from July 2010 to July 2016 were retrospectively evaluated...
May 11, 2018: Neurologia Medico-chirurgica
Tatsuya Sasaki, Takashi Agari, Ken Kuwahara, Ittetsu Kin, Mihoko Okazaki, Susumu Sasada, Aiko Shinko, Masahiro Kameda, Takao Yasuhara, Isao Date
The success of deep brain stimulation (DBS) depends heavily on surgical accuracy, and brain shift is recognized as a significant factor influencing accuracy. We investigated the factors associated with surgical accuracy and showed the effectiveness of a dural sealant system for preventing brain shift in 32 consecutive cases receiving DBS. Thirty-two patients receiving DBS between March 2014 and May 2015 were included in this study. We employed conventional burr hole techniques for the first 18 cases (Group I) and a dural sealant system (DuraSeal) for the subsequent 14 cases (Group II)...
May 1, 2018: Neurologia Medico-chirurgica
Takashi Yagi, Toru Horikoshi, Nobuo Senbokuya, Hiroaki Murayama, Hiroyuki Kinouchi
The aim of this study is to clarify the details of distribution patterns of spinal epidural fluid and to establish it as measure of spontaneous intracranial hypotension (SIH) syndrome diagnosis. Magnetic resonance imaging findings of the spine were analyzed in 37 patients, 24 women and 13 men (mean age 46.3 years), with SIH. Detection rate, thickness and patterns of the fluid collection were evaluated at every vertebral level. Follow-up spinal MRI findings were also analyzed for changes in epidural fluid collection and association with clinical symptoms...
May 1, 2018: Neurologia Medico-chirurgica
Shigeru Miyachi, Hiroyuki Ohnishi, Ryo Hiramatsu, Ryokichi Yagi, Toshihiko Kuroiwa
A 48-year-old female with a symptomatic giant carotid cavernous aneurysm underwent endovascular treatment with multiple Pipeline Flex embolic devices (PED). The delivery catheter had to take a complicated course of multiple turns to cross the aneurysm, and its loop was tied in the aneurysm. When the catheter was to be withdrawn, it was apparent that the tied catheter had made a tight knot that bound the tail of the previous PED together. We successfully retrieved all of the system including the tied PED, and we used telescoping stents with five PEDs in the next operation...
May 1, 2018: Neurologia Medico-chirurgica
Takashi Asahi, Michi Sato, Takuto Nakamura, Yuki Kon, Hiroyuki Kajimoto, Genko Oyama, Akito Hayashi, Kazunori Tanaka, Shunya Nakane, Takao Takeshima, Masami Fujii, Satoshi Kuroda
The hanger reflex (HR) is an involuntary head rotation that occurs in response to a clothes hanger encircling the head and compressing the unilateral fronto-temporal area. Here, we developed an elliptical device to induce the HR and examined its utility for the treatment of cervical dystonia (CD). The study included 19 patients with rotational-type CD. The device was applied to each subject's head for at least 30 min/day for 3 months. Severity scores on part 1 of the Toronto Western Spasmodic Torticollis Rating Scale were evaluated at baseline and after the 3-month trial...
March 31, 2018: Neurologia Medico-chirurgica
Leszek Herbowski
The commonly accepted practice in recognizing the scientific priority of a discovery requires finding a hitherto unknown phenomenon, publishing it to other scholars and doing it for the first time. And this is what happened regarding the discovery of the intracranial fluid presence by the Venetian anatomist Massa in 1536. This finding fulfills all the conditions necessary for the recognition of the scientific discovery.
March 30, 2018: Neurologia Medico-chirurgica
Yoshiro Ito, Wataro Tsuruta, Yasunobu Nakai, Tomoji Takigawa, Aiki Marushima, Tomohiko Masumoto, Yuji Matsumaru, Eiichi Ishikawa, Akira Matsumura
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are not appropriate treatment procedure for internal carotid artery stenosis (ICAS) in some patients. The importance of plaque vulnerability and the treatment risk evaluation has been reported. We analyzed whether treatment selection contributes to the outcome. We retrospectively examined 121 patients who underwent CEA or CAS. Treatment was selected based on plaque vulnerability and the treatment risk evaluation. We selected CAS for patients with stable plaques and CEA for patients with unstable plaques, and considered the other treatment for high-risk patients...
May 15, 2018: Neurologia Medico-chirurgica
Nobuyuki Sakai, Shinzo Ota, Yasushi Matsumoto, Rei Kondo, Tetsu Satow, Michiya Kubo, Tomoyuki Tsumoto, Yukiko Enomoto, Taketo Kataoka, Hirotoshi Imamura, Kenichi Todo, Mikito Hayakawa, Hiroshi Yamagami, Kazunori Toyoda, Yasushi Ito, Kenji Sugiu, Yuji Matsumaru, Shinichi Yoshimura
REVIVE SE (REVIVE) is a closed-ended, self-expanding stent retriever used in the RIVER JAPAN study. We present our early experience with REVIVE for revascularization of acute ischemic stroke (AIS) in patients who have failed or are ineligible for intravenous recombinant tissue plasminogen activator treatment. This prospective, single-arm, non-randomized, multicenter registry study followed up patients undergoing mechanical thrombectomy with REVIVE for 90 days. The primary endpoint was a post-procedure Thrombolysis in Cerebral Infarction (TICI) score ≥2a...
April 15, 2018: Neurologia Medico-chirurgica
Masanori Yonenaga, Shingo Fujio, Mika Habu, Hiroshi Arimura, Takaaki Hiwatari, Shunichi Tanaka, Yasuyuki Kinoshita, Hiroshi Hosoyama, Hirofumi Hirano, Kazunori Arita
The criteria for surgical cure of acromegaly have become more stringent during the past decades and a change from Cortina to new consensus criteria has recently been proposed. However, the superiority of the new consensus over Cortina criteria with respect to postoperative metabolic parameters remains to be ascertained. We retrospectively assessed metabolic parameters, the body habitus, and other health-related parameters of 48 patients with surgically controlled acromegaly who met the Cortina criteria [normalized insulin-like growth factor-1 (IGF-1) level and nadir growth hormone (GH) level <1...
April 15, 2018: Neurologia Medico-chirurgica
Tsuyoshi Ohta, Masanori Morimoto, Kenji Okada, Maki Fukuda, Hirokazu Onishi, Noritaka Masahira, Toshiki Matsuoka, Takaya Tsuno, Mitsuhiro Takemura
The purpose of this study was to investigate whether patients with low preoperative Diffusion-weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) could benefit from mechanical thrombectomy for acute anterior circulation occlusion. This was a retrospective, non-blinded, cohort study. From September 2012 to August 2016, 83 consecutive patients of acute anterior circulation occlusion were treated with thrombectomy using second-generation devices or medical management. The DWI-ASPECTS was scored after the first MRI...
April 15, 2018: Neurologia Medico-chirurgica
Yoshinori Maki, Ryota Ishibashi, Hitoshi Fukuda, Miyako Kobayashi, Masaki Chin, Sen Yamagata
Vertebral arteriovenous fistula (VAVF), which can cause subarachnoid hemorrhage (SAH) when having a perimedurally drainage, has been reported as a rare vascular abnormality in patients with neurofibromatosis type 1 (NF-1). In addition, extracranial vertebral aneurysm (EVAn) coexisting with VAVF and NF-1 is considered rare, and further complication with SAH is extremely rare in patients. There is only one reported case of NF-1 complicated with SAH from VAVF with an EVAn. Here, we present a case of a middle-aged patient with NF-1...
April 15, 2018: Neurologia Medico-chirurgica
Daisuke Ichinose, Satoru Tochigi, Toshihide Tanaka, Tomoya Suzuki, Jun Takei, Keisuke Hatano, Ikki Kajiwara, Fumiaki Maruyama, Hiroki Sakamoto, Yuzuru Hasegawa, Satoshi Tani, Yuichi Murayama
A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted...
April 15, 2018: Neurologia Medico-chirurgica
Ryota Sasaki, Yasushi Motoyama, Ichiro Nakagawa, Young-Su Park, Hiroyuki Nakase
To present a unique case of the internal carotid artery-posterior communicating artery (ICA-PcomA) aneurysm penetrating the oculomotor nerve presenting a pure acute subdural hematoma (ASDH) without any oculomotor dysfunction. A 71-year-old woman presented with a sudden headache and drowsiness. She had no history of head trauma and did not manifest any neurological deficits including oculomotor nerve palsy. Computed tomography (CT) of her head revealed left ASDH. Subsequent CT angiography showed an aneurysm originating from the left ICA with an inferior projection having continuity with the hematoma...
April 15, 2018: Neurologia Medico-chirurgica
Yu Yamamoto, Masahito Hara, Yusuke Nishimura, Shoichi Haimoto, Toshihiko Wakabayashi
Transvertebral foraminotomy (TVF) combined with anterior cervical decompression and fusion (ACDF) can be used to treat multilevel cervical spondylotic myelopathy and radiculopathy; however, the radiological outcomes and effectiveness of this hybrid procedure are unknown. We retrospectively assessed 22 consecutive patients treated with combined TVF and ACDF between January 2007 and May 2016. The Japanese Orthopedic Association (JOA) score and Odom's criteria were analyzed. Radiological assessment included the C2-7 sagittal Cobb angle (CA) and range of motion (ROM)...
March 15, 2018: Neurologia Medico-chirurgica
Toshiyuki Okazaki, Hiroshi Nakagawa, Hitoshi Hayase, Shinsuke Irie, Toru Inagaki, Osamu Saito, Motoshige Yamashina, Shinji Nagahiro, Koji Saito
Spontaneous and chronic epidural hematoma (SSEH) in the lumbar spine is rare, and idiopathic and chronic SSEH in the lumbar spine is extremely rare disease. Most of lumbar SSEH were acute and secondary with trauma, hematologic disorders, drug, and surgical procedure. Only 20 cases of chronic SSEH in the lumbar spine have been reported and 14 cases among them were considered to be idiopathic. Definitive guidelines for management of this condition are not clear and surgical total evacuation was performed in most of the cases...
March 15, 2018: Neurologia Medico-chirurgica
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