Michio Nishikawa

Extracalvarial meningiomas (2 cases)

Case I . A 50-year-old housewife was admitted to the hospital on Sept. 2, 1968, because of a slowgrowing, hard mass in the right temporal region. The patient had noted the mass accidentally while combing her hair three years prior to admission. Since then the mass had grown slowly but progressively. On examination there was a hard ovoid mass, 5 by 7 cm. in size, over the right parietotemporal region, projecting 2 or 3 cm. above the normal level of the skull. The overlying scalp showed no abnormality. Neurological examination and electroencephalograms were normal. Spinal puncture showed an opening pressure of 120 mm. of water and clear fluid. Laboratory tests all gave normal results. Skull roentgenograms disclosed circumscribed hyperostosis of the outer table in the right parietotemporal region and an adjacent extracranial soft tissue mass. Tomograms showed that the inner table of the skull was completely smooth. The squamous suture ran just under the mass. Right common carotid angiograms showed no essential abnormality. Preoperative diagnosis was an osteoma arising from the outer table. A t operation, a well-circumscribed tumor, osseous in consistency and color, was found attached to the outer table (Fig. 1). The scalp, including skin, subcutaneous tissue, galea aponeurotica, and subaponeurotic tissue, were normal. The tumor was covered completely by pericranium, which was partly adherent to the tumor. The tumor, together with the surrounding skull, was completely excised. The inner side of the inner table and the dura were found to be normal. The skull defect was repaired by cranioplasty, using resin. The postoperative course was uneventful and the patient was discharged on Sept. 20, 1968.

Bilateral Metachronous Germinoma of the Basal Ganglia Occurring Long after Total Removal of a Mature Pineal Teratoma: Case Report

OBJECTIVE AND IMPORTANCE We report the extremely rare occurrence of a second germ cell tumor at a different site and with different histological types long after total removal of a mature pineal teratoma. CLINICAL PRESENTATION A 10-year-old boy who presented with headache and vomiting was admitted to our hospital. Neuroradiological studies revealed a tumor in the pineal region. The tumor was totally removed. Histologically, the tumor proved to be a mature teratoma. The patient’s postoperative course was uneventful. The patient received no adjuvant therapy and was followed in the outpatient clinic. Three years later, he was readmitted with transient left upper limb weakness and vomiting. Neuroradiological studies showed a tumor in the bilateral basal ganglia. INTERVENTION The second tumor, which was located in the right basal ganglion, was partially removed for biopsy. Histologically, the tumor proved to be a germinoma. The patient received three cycles of combination chemotherapy consisting of carboplatin and etoposide with radiotherapy. After the second course of chemotherapy, magnetic resonance imaging studies revealed no evidence of the tumor. CONCLUSION The second tumor was considered to be a de novo metachronous neoplasm rather than a recurrence of the original mature teratoma. We think that if primordial germ cell groups exist along the midline of the brain, more than two primordial germ cell groups could give rise to metachronous neoplasms at different sites and with different histological types.

Triple primary brain tumors of different histological types: Case report

We report a case of triple primary intracranial tumors of different histologic types: meningioma, astrocytoma, and pituitary adenoma. Von Recklinghausens disease or other etiologic factors supposedly associated with multiple primary brain tumors were not recognized in this 64-year-old female patient. Triple primary brain tumors with no association of von Recklinghausens disease are rare--there is only one reported case with histologic studies.

Endovascular coil embolization of a recurrent giant internal carotid artery aneurysm via the posterior communicating artery after cervical carotid ligation: Case report

The case of a 29-year-old man with a giant fusiform aneurysm of the left internal carotid artery (ICA) is presented. The aneurysm, treated by cervical ICA ligation and extracranial-intracranial bypass, recurred 4 years later owing to recruitment of the posterior communicating artery (PCoA). Because of the previous bypass surgery a direct surgical approach was excluded. After an initial failure with balloon embolization, the aneurysm was embolized successfully with occlusive platinum microcoils through the microcatheter navigated into the aneurysm via the enlarged PCoA. Endovascular coil embolization may be useful in the treatment of cerebral aneurysms not amenable to direct surgery or balloon embolization.

Congenital subclavian steal syndrome with anomaly of the aortic arch

A case of congenital subclavian steal syndrome associated with an anomalous right-sided aorta is reported. A 41-year-old man complaining of vertigo and a loss of consciousness was admitted. Physical examination revealed a blood pressure differential between the arms that was 20 mm Hg less in the left. Aortography showed a right aortic arch from which arose the right subclavian and both common carotid arteries. The left subclavian artery did not opacify. Right vertebral angiography showed retrograde filling of the left vertebral. A left carotid-subclavian bypass was performed. Postoperatively, the patient is symptom free with equalized blood pressure.

Cerebral Hemodynamics and Functional Prognosis in Hydrocephalus

The functional outcome of cerebral hemodynamics in the chronic stage of juvenile hydrocephalus was determined using single photon emission computed tomography (SPECT). Five patients including three with aqueductal stenosis, one with post-meningitic hydrocephalus, and one case with hydrocephalus having developed after repair of a huge occipital encephalocele. Early images of cerebral blood flow (CBF) were obtained 25 minutes after intravenous injection of 123-I-Iodoamphetamine (IMP), and late images were scanned 3 hours later. Cerebral blood volume (CBV) was also measured using 99mTc in three patients. Twenty cases with adult communicating hydrocephalus were also investigated from the point of view of shunt effectiveness. Although there was no remarkable change in the cerebrovascular bed in the juvenile cases, CBF of the remnant brain parenchyma was good irrespective of the degree of ventricular dilatation. There was a periventricular-reduced IMP uptake in each case, however it somehow matched the ventricular span. Functional outcome one to 23 years after the initial shunt operation was good in every case, despite multiple shunt revisions. Redistribution on late images had no bearing on clinical states. In adult cases, 8 patients with effective shunting demonstrated a relatively localized periventricular low perfusion, with preoperative increased cerebrospinal fluid (CSF) pressure. On the contrary, 12 patients with no improvement with or without shunting showed disproportionately widespread periventricular-reduced IMP uptake, despite low CSF pressure. The present study indicates that periventricular hemodynamics may play an important role in cerebral function compromised by hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)