Kazuaki Sugiura

The Edinburgh-2 Coma Scale: A New Scale for Assessing Impaired Consciousness

In the management of patients with acute cerebral disturbances, it is essential to determine precisely the degree of impaired consciousness. However, a coma scale for assessing impaired levels of consciousness has not yet been standardized internationally. The Edinburgh-2 coma scale (E2 CS) is introduced and compared with the Glasgow coma scale (GCS). The reliability of the E2 CS was tested by comparing levels of the E2 CS with the outcome of patients who underwent neurosurgical operations. A good correlation was observed between the levels of the E2 CS and the outcome. A change of two levels suggests that some change influencing the outcome has occurred or exists within the cranium of the patient. A correlation between the E2 CS and the GCS was proven to exist. The merits and drawbacks of both scales are discussed. One advantage of the E2 CS is that it has removed ambiguous terms, which are still present in the GCS. Also it is easier to grasp changes in a patients condition shown on a chart because the levels of the E2 CS are arranged first-dimensionally. Use of the GCS should not preclude the use of other scales, such as the E2 CS; the E2 CS could be used together with the GCS. The accumulation of data on both scales would provide information useful in improving the existing coma scales.

Structural mechanics of the blowout fracture: numerical computer simulation of orbital deformation by the finite element method.

Blowout fractures most frequently involve the orbital floor. The contour of the orbit has been postulated as one of the factors responsible for this phenomenon, but only a few studies have been carried out. The present study was planned to determine the effect of the contour of the orbit when intraorbital pressure is raised to simulate the hydraulic mechanism of blowout fracture. The profile of the orbit was estimated from five dry human skulls, and the measurements were approximated to frame models. The deformation of these models by raised intraorbital pressure was calculated by computer simulation using the finite element method. In all of the orbital models, the deformation of the orbital floor was significantly greater than that of the roof. These findings verified that the orbital roof has a higher resistance than the floor against raised intraorbital pressure. We suspect that this resistance is due to the arched shape of the orbital roof, whereas the floor is rather flat.

Parasellar chondroma: A case report

A case of a 19-year-old man with a right parasellar chondroma examined with computed tomography (CT) and nuclear magnetic resonance (NMR) scan is reported. The literature about CT and NMR scan findings of intracranial chondroma is reviewed. Typical CT findings are a round, high density mass with calcification, that is only slightly enhanced by contrast medium.

Rapidly Growing Histologically Benign Meningiomas: Cell Kinetic and Deoxyribonucleic Acid Ploidy Features

We present three cases of histologically benign meningiomas with a rapid and known time course to the development of symptoms. Tumor doubling time calculated from sequential computed tomographic scans and computer-assisted image analysis of proliferating cell nuclear antigen reactivity suggested rapid growth. Feulgen staining indicated deoxyribonucleic acid aneuploidy. Tests for progesterone and estrogen receptor immunoreactivity were negative. These cases are noteworthy for their uncharacteristically rapid growth in the absence of histological evidence of atypia.

Rapidly Growing Histologically Benign Meningiomas

: We present three cases of histologically benign meningiomas with a rapid and known time course to the development of symptoms. Tumor doubling time calculated from sequential computed tomographic scans and computer-assisted image analysis of proliferating cell nuclear antigen reactivity suggested rapid growth. Feulgen staining indicated deoxyribonucleic acid aneuploidy. Tests for progesterone and estrogen receptor immunoreactivity were negative. These cases are noteworthy for their uncharacteristically rapid growth in the absence of histological evidence of atypia.

Intracranial pressure monitoring by a subdurally placed silicone catheter: technical note.

A silicone catheter manufactured originally for ventricular fluid drainage was used for continuous monitoring of intracranial pressure. It can be placed under the dura mater immediately before replacing the craniotomy flap or by introduction through an ordinary burr hole. Pressure is monitored isovolumetrically by connecting the catheter to a pressure transducer mounted at the bedside. This technique has been used in 34 neurosurgical patients for periods of up to 12 days without any untoward effects. This monitoring system by a subdurally placed silicone catheter is simple, safe, inexpensive, and acceptably reliable. It has a place in clinical practice, particularly when the lateral ventricle cannot be tapped because of its deviation or collapse.

Postoperative Morphological Recovery of Deformed Brain in Cases with Chronic Subdural Hematoma: The Difference Between a Burr Hole Closed Drainage and a Burr Hole Irrigation

This study was planned to evaluate morphologically whether a burr hole closed drainage (BD) is superior to a burr hole irrigation (BI) for a smoother re-expansion in cases with chronic subdural hematoma (CSDH). 107 cases with CSDH were treated either by BI or BD. The post-operative changes in clinical symptoms and CT findings in both groups were compared. Post-operative changes in clinical symptoms were not different significantly between the two surgical methods. The re-expansion of brain took a biphasic pattern in the BI group. In contrast, in the BD group, the course of re-expansion was not biphasic but more straight. We consider that BD is superior to BI by allowing steadier and slower re-expansion of the compressed brain.

Multivariate analysis of factors influencing outcome of patients with putaminal hematoma. Comparison between clinical and CT observations.

被殻出血の転帰に関わる因子について検討した.個々の因子と転帰との関係をX2検定し, 5%の有意水準で転帰と関係があると判定された因子を多変量解析 (数量化2類) した。X2検定で有意差を認め, 多変量解析に用いた因子はEdinburgh 2 Coma Scale (E2CS) による意識レベル, 瞳孔所見, 呼吸状態, 麻痺の程度, 発症から当科入院までの時間, 飲酒歴, 高血圧の既往歴, およびCT上の血腫の大きさ, 正中偏位, 脳室穿破の有無である。臨床観察因子による判別率は83%と最も高く, CT所見因子による判別率は78%, 臨床観察およびCT所見因子からの判別率は81%であった.これらの結果から臨床観察因子がCT所見因子よりも予後判別に対してより大きな影響を与えていることが推察された。

Interchangeable and adjustable-length microneurosurgical instruments.

A new system of microneurosurgical instruments is presented in which a number of shafts with different tips are interchangeable and the length of the shafts are adjusted easily. With this system, the surgeons tasks in microneurosurgery are quicker and smoother.

A simple fluid collection system for neurosurgical operations

A simple and inexpensive fluid collection bag system for neurosurgical operations is described. It is quite satisfactory for preventing operators from soiling their feet and their gowns.