Hidenori Ohta

A Case of Pineocytoma Presenting with Symptoms like Normal Pressure Hydrocephalus

A pineocytoma in an old man, whose initial symptoms resembled a normal pressure hydrocephalus, is reported. This 67-year-old man gradually became uncommunicative and difficult to walk alone in three months. Just before visiting our clinic, his family also noticed his nocturnal urinary incontinence. CT scan on admission disclosed tumor in the posterior wall of the third ventricle, and subsequent hydrocephalus. This oval, isodense tumor was homogeneously enhanced after the injection of contrast medium on CT scan. The vertebral angiography showed a mass in the pineal region with no vascular staining. Ventricular drainage, the opening pressure of which was 100 mmH2O, could not offer cytological verification of the tumor. By the infratentorial supracerebellar approach, the tumor was successfully extirpated, and the post-operative course was uneventful. The microscopic study revealed the nature of this tumor to be well compatible with that of a pineocytoma.

Effects of Hyperoxia, Glycerol and Ventricular Drainage on ICP and CBF in Patients with Increased ICP Due to Hydrocephalus

The effects of hyperoxia, glycerol, and ventricular drainage on ICP and CBF were studied in 21 patients with hydrocephalus due to subarachnoid hemorrhage (SAH) or intraventricular hematoma in the acute stage. Ventricular fluid pressure was monitored for ICP. CBF was measured by the 10 mCi 133Xe intravenous injection method. Initial slope index (ISI) of whole brain was used for the CBF value.

Indications for Shunting in Normal Pressure Hydrocephalus: Time-dependent analysis of EEG and intracranial pressure

A new method has been developed for estimating the need for cerebrospinal fluid (CSF) shunting in patients with normal pressure hydrocephalus (NPH). The method was based on long-term electroencephalography (EEG) monitoring during CSF drainage and computerized analysis of the relationship between the EEG data and CSF pressure changes. Lumbar CSF pressure were monitored. Recordings were first obtained with a closed CSF drainage catheter in place. Subsequently, CSF drainage was carried out at various pressure and graphs of time-dependent trends in EEG parameters and CSF pressure were produced. According to the data obtained, if the magnitude or duration of alpha or beta waves increase and those of delta waves decrease in response to a reduction in CSF pressure, the patient is a good candidate for CSF shunting.