Mitsunori Hatano

Epidemiological studies on patients with a persistent vegetative state

Persistent vegetative state after severe brain damage was studied epidemiologically in 110 cases from 1973 to 1976. The causes of brain damage were varied. More than one-third of the cases were due to trauma, and about one-fifth were the result of vascular accidents. Three year observation revealed that 65% of the patients died during this period. Mean survival time for dead patients was 38 months. Reactivity, clinical signs, EEG findings, methods of management, and results of various trials of treatment were investigated in connection with the patients prognosis.

Five-year follow-up study of patients with persistent vegetative state

One hundred and ten patients with persistent vegetative state, were followed up for a period of five years from 1973 to 1978. Seventy-three per cent of the patients died during the period while about 10% of them recovered partially from the vegetative state. Among the recovered patients, only three became able to communicate, but two of these are not independent for their daily activites. Reactivity and clinical symptoms of 30 survivors were examined, but no great changes occurred during the last two years of the study.

Disease with abnormal intracranial vascular network complicated with intracerebral haematoma

A case of so-called Japanese cerebrovascular disease in association with intracerebral haematoma is presented. The patient had had no neurological symptoms before the onset, in spite of an extensive intracranial occlusive vascular process. Diagnosis was established preoperatively and massive haematoma was surgically evacuated from the left frontal lobe. The postoperative course was uneventful and residual neurological deficit was minimal.

Pineal and suprasellar metastasis of lung cancer : Case report and review of the literature

A very rare case of simultaneous pineal and suprasellar metastasis of lung cancer in a 46-year-old man is reported. Simultaneous mass lesions in these regions are usually diagnosed as primary germ cell tumors in the central nervous system. The clinical features and differential diagnosis are discussed.

Etiological factors and surgical treatment of pericallosal aneurysm

In spite of the belief that pericallosal bifurcation is the predilectional site for aneurysm, only a few reports have so far been available. Since 1963 nine cases of such aneurysms have been encountered at the Yamaguchi University Hospital. All aneurysms located on so-called pericallosal bifurcation at the genu of the corpus callosum. Seven aneurysms were saccular and two were fusiform. Multiple aneurysms were found in one case, while another case had a combined arteriovenous malformation at the periphery of the aneurysm. In one case, the internal carotid artery on the opposite side was occluded.Seven of the 9 patients were treated surgically. Ligation of the afferent artery was performed in the case with combined arteriovenous anomaly. Direct attack to the aneurysm was safely done in the remaining 6 cases through interhemispheric approach, neck clipping in 3 cases and adhesive coating in 3. Postoperative results were excellent in all cases but one, in which postoperative meningitis developed.In view of the disastrous outcome of pericallosal aneurysm when left alone, we believe that the direct surgical attack is the treatment of choice. Fortunately, an aneurysm at this site can be handled easier and safer than deep seated aneurysms in connection with Williss circle, since it can be approached by interhemispheric route.