Masashi Morikawa

Treatment of tuberculum sellae meningiomas:a long-term follow-up study

Surgical techniques and their results for tuberculum sellae meningiomas were studied. Thirty-three cases, the first of which was operated in 1980, were analysed. There were 4 men and 29 women with an average age of 46.7 years. Eight cases underwent reoperations. The mean follow-up was 10.7 years. Approaches were pterional for 15 patients, FOZ/FO for 10, bilateral subfrontal for 6, and others for 2. Simpsons grade (I, II, III, IV) were 12, 9, 0, and 12 cases respectively. Recurrence rate was 0% for grade I and 58.3% for grade IV. The FOZ/FO approach resulted in a lower Simpsons grade (P=0.05), but other factors were not related to Simpsons grade (P=0.05). The postoperative visual outcome did not depend on total (grade I and II) or subtotal (grade III and IV) removal (P=0.01). We conclude that radical removal of the tumours may result in lower recurrence rate without increasing surgical complications. Furthermore, skull base approaches can improve the rate of radical removal of tuberculum sellae meningiomas.

Intrasellar Pituitary Gangliocyto-Adenoma Presenting with Acromegaly: Case Report

OBJECTIVE AND IMPORTANCE A gangliocytoma in the sellar region is extremely rare. We describe a rare case of intraseller gangliocytoma coexisting with a growth hormone-producing pituitary adenoma, which presented with acromegaly. CLINICAL PRESENTATION AND INTERVENTION A 64-year-old woman was admitted to our hospital with headache and acromegaly. Endocrinological studies revealed an elevated serum level of growth hormone (GH). Magnetic resonance imaging showed a tumor at the intrasellar and suprasellar regions. The tumor was totally removed via a transsphenoidal approach. RESULTS A histological examination of the resected specimen showed areas of ganglionic cells and adenomatous cells. Immunohistochemical examination demonstrated GH-releasing hormone-positive ganglionic cells and GH-positive pituitary adenoma. CONCLUSION Based on these immunohistochemical findings, we hypothesized that the intrasellar gangliocytoma promoted the growth of the pituitary adenoma, which had been transformed from a region of pituitary hyperplasia by chronic overstimulation from excess GH-releasing hormone produced by the intrasellar gangliocytoma.

Cerebellar pilocytic astrocytoma with leptomeningeal dissemination: Case report

The authors present an extremely rare case of histologically benign cerebellar pilocytic astrocytoma that had already disseminated to the leptomeninges at the initial presentation.

A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular Doppler sonography: case report.

BACKGROUND Complete interruption of a dural arteriovenous fistula (DAVF) has been confirmed intraoperatively by visual inspection and intraoperative angiography. To confirm complete interruption of the shunt flow during the surgical treatment of a tentorial DAVF, we used intraoperative microvascular doppler monitoring. CASE DESCRIPTION A 71-year-old man suffered from severe subarachnoid hemorrhage. Angiography showed a tentorial DAVF with pure leptomeningeal drainage associated with a venous pouch. After the patients neurologic condition had improved, he underwent interruption of the draining vein via a right suboccipital approach. An arterialized drainage vein was easily identified by applying the microvascular doppler probe to the shunting vessels and was completely obliterated by clipping. There were no complications associated with use of the microvascular doppler. The postoperative course was uneventful and follow-up angiography showed complete obliteration of the DAVF. CONCLUSION Intraoperative microvascular doppler monitoring is a useful technique not only for evaluating arterialized leptomeningeal drainage veins but also for confirming the complete obliteration of these vessels.

Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm

BACKGROUND Hiccups are defined as sudden-onset involuntary contractions of the diaphragm followed by immediate inspiration and laryngeal closure, and they are considered intractable if prolonged beyond 1 month. A reflux arc involving phrenic, vagal, and central midbrain modulation is likely responsible for hiccups. We herein report a case of intractable hiccups caused by compression of the dorsal aspect of the medulla oblongata after treatment of a partially thrombosed distal posterior inferior cerebellar artery (PICA) aneurysm. CASE DESCRIPTION A 51-year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage. Magnetic resonance imaging and cerebral angiography showed a partially thrombosed distal PICA aneurysm associated with a fusiform aneurysm in the ipsilateral vertebral artery. Based on the limited distribution of the clot, we performed endovascular coil occlusion of the aneurysm lumen followed by parent vessel occlusion for the distal PICA aneurysm. After the procedure, the patient presented with hiccups that could not be controlled by any medications. Magnetic resonance imaging showed an area of hyperintensity at the bilateral dorsal part of the medulla adjacent to the embolized aneurysm. The hiccups spontaneously disappeared 1 month after the procedure, and the abnormal signal findings also disappeared within the same period. The hiccups did not recur for 30 months postoperatively. CONCLUSIONS In this case, the precise location of the culprit lesion causing the patients hiccups was the dorsal medulla oblongata. Clinicians should be aware of the possibility of structural or functional disorders of the reflux arc in patients with intractable hiccups.