Hiroshi Tochio

Intracranial aneurysm associated with moyamoya disease in childhood

We report a 6-year-old girl with an intracranial aneurysm associated with moyamoya disease. The patient did not have a subarachnoid hemorrhage but had an ischemic attack. The aneurysm, located on the proximal portion of the lateral posterior choroidal artery, disappeared after external carotid-internal carotid anastomosis. The characteristics of the aneurysms associated with moyamoya disease are briefly reviewed. We emphasize that the treatment of choice in moyamoya disease is cerebral revascularization, because it reduces the increased blood flow through the moyamoya vessels, basilar artery and other uninvolved cerebral arteries, the sites where the aneurysms in this disease frequently develop, as the blood flow through the external carotid system is increased by such an operation.

Hypertensive putaminal hemorrhage: Analysis of 182 patients

The results of treatment for 182 patients with hypertensive putaminal hemorrhage are described. The patients are graded according to the level of consciousness on admission; grade 1, fully conscious; grade 2, somnolent; grade 3, stuporous; grade 4, semicomatose; and grade 5, deeply comatose. Removal of hemorrhage was performed in 44 patients (24%), and conservative treatment was given in 138 patients (76%). One-month mortality in the surgical group was 27%; it was 22% in the conservative group. At 6 months after surgical treatment, the percentages of patients who returned to full-time work or independent life without disability or with minimal disability (good recovery) were 40% in grade 1, 30% in grade 2, 22% in grade 3, 11% in grade 4, and 0% in grade 5; after conservative treatment, percentages with good recovery were 77% in grade 1, 56% in grade 2, 29% in grade 3, 7% in grade 4, and 0% in grade 5. This study shows that surgical treatment does not give better results in the management of hypertensive putaminal hemorrhage.

Intratumoral hemorrhage after a ventriculoperitoneal shunting procedure.

Ventriculoperitoneal shunting has been accepted as a safe and useful preliminary procedure that lowers the mortality and morbidity of definitive surgery for tumors causing obstructive hydrocephalus. We are reporting four patients with intratumoral hemorrhage as a complication of shunting. The hemorrhage was massive and fatal in two patients, one with an unverified pineal tumor and the other with a malignant astrocytoma of the thalamus. The hemorrhage was small and limited in the other two patients, one with a glioblastoma of the thalamus and the other with a cerebellar astrocytoma. On the basis of this experience, we conclude that the possibility of intratumoral hemorrhage should be taken into consideration when planning the preoperative management of obstructive hydrocephalus caused by brain tumors. It is possible that ventricular decompression may result in rapid motion and distortion of the intracranial structures and a sudden imbalance between intracranial and intratumoral pressures, leading to vascular insufficiency, congestion, and then hemorrhage within the tumor.

Spontaneous resolution of chronic epidural hematomas: report of three cases.

We report three cases of the spontaneous resolution of a traumatic chronic epidural hematoma. The patients were young adults with only mild headache after trauma. All patients were treated conservatively because of the very mild symptoms and the time lapse of 1 to 2 weeks between trauma and our unexpected detection of the frontal epidural hematomas. Slow, spontaneous resolution of the hematoma occurred in all three cases.

Chondrosarcoma of the ethmoid sinus extending to the anterior fossa

A 27-year-old women with chondrosarcoma of the ethmoid sinus extending to the anterior fossa had initial symptoms of blurred vision on the left and slight proptosis. Neuroradiological examination, however, disclosed that the tumor extended not only to the anterior cranial fossa, but also to the orbit, nasal cavity, and maxillary sinus. It is difficult to predict the biological behavior of chondrosarcoma by means of histological examination. The effectiveness of radiotherapy, chemotherapy, or both is also a matter of controversy. Clinical aspects of chondrosarcoma are briefly discussed.

Chondroma of the spine in a newborn infant: case report.

We report a newborn infant with a chondroma of the spine covered by a large lipoma. The child had no neurological deficit. Presenting as a tumor of the back, the chondroma was successfully excised. A review of the pertinent literature emphasizes the rarity of this lesion.

Experimental Hypertensive Putaminal Hemorrhage

Putaminal hemorrhage is the most common among the hypertensive intracerebral hemorrhages. The optimal form of treatment still remains controversial. Some neurosurgeons, especially in Japan, believe surgical treatment is superior, while others hold that hypertensive putaminal hemorrhage should be treated conservatively. Our clinical results have shown that the surgical treatment is not superior to the conservative one and that the results depend upon the size and extent of the hemorrhage (Waga and Xamamoto 1983; Waga et al. 1986)