Kazuko Kamiya

Malignant intraventricular meningioma with spinal metastasis through the cerebrospinal fluid

A 67-year-old man developed a malignant meningioma of the right lateral ventricle at the trigone, for which he underwent total removal of the tumor and local irradiation. Six months after the operation, a spinal tumor developed and subtotal removal of the tumor was made. The spinal tumor was considered to be a metastasis via the cerebrospinal fluid in view of its histologic identity with the primary tumor, histologic findings of malignancy, absence of von Recklinghausens disease, and lack of tumor attachment to the dura.

A case of malignant teratoma developing from the septum pellucidum 7 years after removal of a mature teratoma in the pineal region

A report is presented on a case of teratoma with a malignant component arising from the septum pellucidum 7 years after total surgical removal of a mature teratoma in the pineal region. The patient was successfully treated with radiotherapy and total surgical resection of the second tumor. The case is characterized by the development of a second malignant tumor and by the long interval from complete resection of the primary tumor to the occurrence of the second tumor. Our case is not considered to be a recurrence of the mature teratoma of the pineal region but to be a multiple tumor of germ-cell tumor having multicentricity and a different temporal variety.

Jugular foramen meningioma

A case of jugular foramen meningioma is presented with a review of the related literature. The value of computed tomography in the diagnosis of the lesion and in the planning of the operative approach is discussed.

Acute aggravation of traumatic carotid-cavernous fistula after venography through the inferior petrosal sinus

A report is presented on a patient with acute aggravation of traumatic carotid-cavernous fistula after venography through the inferior petrosal sinus. After direct puncture of the internal jugular vein and insertion of the catheter tip to reach the inferior petrosal sinus, venography was conducted, but immediately thereafter bruit decreased and proptosis and chemosis increased. Though the fistula may have been occluded through the endarterial approach, the cause of acute aggravation is considered to have been thrombosis of the inferior petrosal sinus. The risk involved in venography or the transvenous approach for traumatic carotid-cavernous fistulas is discussed.

Effect of temporary pacing on patients with bradycardia in the acute stage following subarachnoid hemorrhage.

In nine cases of bradycardiac arrhythmia of less than 50 bpm that arose during cerebral vasospasm following aneurysmal rupture the patients were treated by temporary pacing. In patients with cerebral vasospasm, in whom autoregulation of the cerebral circulation is impaired, bradycardia aggravates the risk of decreased cerebral blood flow. This study demonstrated that temporary pacing is an effective and safe procedure in maintaining heart rate during vasospasm.

Medulloblastoma in infancy associated with omphalocele, malrotation of the intestine, and extrophy of the bladder

A successfully treated case of infantile medulloblastoma is presented that was associated with omphalocele, malrotation of the intestine, and extrophy of the bladder. A 5-month-old boy was admitted due to disturbance of consciousness and was diagnosed by computed tomography as having a medulloblastoma. Ventricular drainage, subduralperitoneal shunt, and removal of the tumor were performed, and postoperatively radiation therapy was administrated with 4,000 rad to the whole brain. He was discharged in good condition and no evidence of recurrence was observed at the 14th postoperative month. Medulloblastomas associated with congenital anomaly of the abdomen have been only rarely reported. The authors postulate that between the second and third month of gestation an intrinsic or extrinsic factor may have caused the development of the medulloblastoma, as well as anomalies of the abdomen such as omphalocele, malrotation of the intestine, and extrophy of the bladder.

Usefulness of Temporary Clipping for Patients with Ruptured Intracranial Aneurysms and Premature Rupture during Surgery

A study was made on the usefulness and problematic points of temporary clipping and on premature rupture during surgery. Direct aneurysm operation was performed on 232 of the 393 patients with ruptured intracranial aneurysms. Of these cases, a temporary clip was applied in 129 cases (56%), designated as group A in this study, but not in 103 cases (44%), designated as group B. An analysis was made on the difference between groups A and B with regard to age, preoperative computed tomography (CT) findings, site of ruptured aneurysms and Glasgow Outcome Scale six months after surgery. In addition, study was done on the rate of premature rupture by timing of surgery, by preoperative Hunt & Hess Grade, by site of ruptured aneurysms and by Glasgow Outcome Scale six months after surgery. The proportion occupied by elderly patients more than 60 years of age was 43% in group A and 63% in group B; that is, the rate in which a temporary clip was applied was lower in elderly patients (p<0.01). As for site of ruptured aneurysms, a tendency was observed for the frequency of use of temporary clip to be high for anterior communicating artery aneurysms (p<0.01). However, no significant difference could be found between groups A and B in the preoperative CT and surgical results. Of the 232 cases operated on, premature rupture occurred in 9 (4%) and a temporary clip was applied in all these cases of premature rupture. As for timing of surgery, a tendency was observed for premature rupture to occur during early operation performed within day 3. No significant difference could be found between premature rupture and preoperative grade. Analysis of the rate of premature rupture by site of ruptured aneurysms showed 3 (14%) out of 21 cases of internal carotid artery aneurysm, 5(8%) out of 63 cases of anterior communicating artery aneurysm, and 1 (3%) out of 35 cases of middle cerebral artery aneurysm. Prognosis six months after surgery was somewhat unsatisfactory in the group with premature rupture during surgery. However, as the number of cases in this group was very small, the effect of prematue rupture on prognosis could not be determined accurately. In patients in whom there is a possibility of premature rupture during surgery, it may be advisable to prevent such premature rupture by temporary clipping of the parent artery.

Electrocardiographic abnormalities associated with ruptured cerebral aneurysms in acute stage

Day3 (発症日をday0として) 迄の急性期破裂脳動脈瘤患者121例の入院時心電図上の頻脈・徐脈・不整脈・QTc延長・ST変化・T波増高・T波逆転・U波・左室肥大の9項目と神経学的重症度・CT所見・動脈瘤破裂部位・脳血管写上の血管攣縮との相関について検討した.96%に何らかの所見があった.頻脈・不整脈・ST-T変化は重症例に多かったが, 徐脈・QTc延長・U波・左室肥大は重症度による差がなかった.CT上のくも膜下凝血の範囲に相関したのはU波のみで, 左右差は何れの所見でもみられなかった.破裂部位では徐脈が前交通動脈に多く, 不整脈は左側例に, T波逆転は右側例に多かった.脳血管攣縮では, 左室肥大は攣縮高度例に多かった以外, 明らかな関係はなかった.くも膜下出血における心電図異常に関しては, 視床下部一カテコールアミンが重要と考えられているが, QTc延長・徐脈などでは別の機序を考える余地があると思われた.

Cushing's disease: pituitary microadenoma demonstrated by high resolution computed tomography with thin slices

A girl 16 7/12; years of age with Cushings disease secondary to pituitary microadenoma is described. The tumor was very clearly demonstrated by high-resolution contrast-enhanced computed tomography (CT) with thin slices and was removed by transsphenoidal micro-adenomectomy. In some patients with Cushings disease levels of ACTH and cortisol are not always high. Therefore, high-resolution contrast-enhanced CT with thin slices should be performed when the diagnosis of Cushings disease is suspected even when the definite diagnosis cannot be established by endocrinological examinations.