Jiro Obashi

Cerebral Neoplasms Initially Presenting with Massive Intracerebral Hemorrhage

In three patients, clinically silent brain tumors led to massive intracerebral hemorrhage. These patients represented 0.6% of 497 consecutive patients with primary or secondary brain tumors and 2.5% of 119 patients with hypertensive or spontaneous intracerebral hemorrhage. Examination by computed tomography and angiography provided no evidence suggestive of the presence of neoplasms. All three patients were surgically treated and the lesions were histologically confirmed to be metastatic bronchogenic carcinoma, metastatic clear-cell carcinoma and low-grade astrocytoma, respectively.

Parasellar metastases: Four autopsied cases

Four patients with histologically confirmed parasellar metastases are reported. The main symptoms and signs were persistent right facial pain followed by diplopia (patient 1), headache and minimal right abducens palsy (patient 2), acute, total left ophthalmoplegia (patient 3), and acute, total bilateral ophthalmoplegia (patient 4). Positive radiologic evidence was present only in patient 1: there was bony erosion of the petrous apex and computed tomography scan showed an enhanced parasellar mass. This patient underwent partial surgical removal of the tumor. Patient 3 was treated with irradiation. All patients died within 14 weeks of the onset of the initial symptoms and all were autopsied. Their primary lesions were hepatoma, stomach cancer, lung cancer, and mesenteric liposarcoma.

Primary ectopic extracalvarial meningioma

Abstract A 62-year-old woman with a primary ectopic meningioma that developed extracranially from the calvarial periosteum is reported. The relevant literature on ectopic meningioma is reviewed.

Schwannoma of the skull base with intracranial extension

A case is reported of solitary schwannoma involving the skull base with extension into the middle cranial fossa and parasellar region. The patient presented with an exophthalmos and ipsilateral facial numbness. The tumor was successfully excised via a two-stage procedure involving an initial intracranial and subsequent transmaxillary approach. The relevant literature on the presentation and treatment of schwannomas of the skull base with intracranial extension is also reviewed.

Sudden appearance of occipital-vertebral arterial anastomoses during therapeutic embolization

A 66-year-old woman with a dural arteriovenous malformation in the posterior fossa, who developed a vertebrobasilar stroke during therapeutic embolization of the occipital artery, is reported. Postembolization arteriograms demonstrated previously invisible anastomoses of the occipital-vertebral artery. The literature is reviewed with respect to the complications and risks of therapeutic embolization of the external carotid artery, and the possible mechanism underlying the opening of these anastomoses is discussed.

Closure of carotid-cavernous fistulae by use of a fibrin adhesive system

A case of carotid-cavernous fistula successfully closed by injecting fibrin glue into the cavernous sinus through the superior ophthalmic vein is reported. This case was a recurrent spontaneous carotid-cavernous fistula after ligation of the internal carotid artery. The use of the fibrin adhesive system for the treatment of carotid-cavernous fistulae is discussed.

Arteriovenous malformation associated with occluded middle cerebral artery.

脳動静脈奇形 (AVM) に脳の主幹動脈閉塞が合併することは稀であるが, この合併例の手術は危険であると思われるので報告する.症例 : 48歳の男性で右麻痺と失語症で発症し, CTにて左脳内血腫を認めた.血管撮影では, 左中大脳動脈の閉塞を認めモヤモヤ血管と左前大脳動脈を介して左frontalにAVMを認めた.開頭を行いnidusを問題なく摘出したが, その後に, 脳の著明な腫脹と突然動脈性出血が一斉に起こり, 止血は全く不可能でそのまま閉頭した.術直後よりbarbital coma therapyを開始し, 5日後再開頭により大きな血腫を摘出した.その後患者の症状は改善し独歩退院した.AVMと同側の主幹脳動脈の合併例ではAVM周辺にモヤモヤ血管のような異常血管が発達し, また周辺脳は虚血状態にあり, AVM摘出の際に生じる急激なhemodynamicsの変化により術中, 術後の出血が起こり易いと考えられるので, 手術の際には特別な配慮が必要である.