Nobuhito Nonaka

Hemangioma of the temporalis muscle: Case report and review of the literature

A 51 year-old man presented with a 10-year history of a painless, slowly growing mass (35 x 25 x 15 min) in the right temporal fossa. The T1-weighted image on magnetic resonance imaging demonstrated a partial, low-signal intensity lesion with high intensity in the lower part and significant enhancement with contrast medium. The tumor, which lay within the temporal muscle, was totally excised, and histological examination confirmed the lesion to be an intramuscular, cavernous type of hemangioma. The therapeutic options are described.

The Quantitative Analysis of Psychiatric Sequelae after Direct Surgery of Anterior Communicating Aneurysms

Follow-up study of 50 cases with directly operated anterior communicating aneurysm was made, ranging from 6 months to 5 years and 6 months. Forty six cases were alive and the condition of all these cases was evaluated through questionnaires, and 42 cases of them were examined utilizing the WAIS and Y-G test. Four patients out of 46 cases showed decreased ADL and they needed help in their daily activity. About 60% of the cases have resumed full activity of previous occupation, although 68% of the 46 cases have complained of slight headache, forgetfullness and worries about their illness being never cured. The number of cases with the above complaints decreased markedly 2 years after surgery was performed. Verbal IQrecovered sooner than Performance IQobtained on WAIS, and the profile of recovery showed quite a resemblance in the repeated WAIS. Comparing pre and post-operative cases in short term the cause of the poor IQ at present study was considered due to subarachnoid hemorrhage itself rather than to surgical intervention. Poor preoperative condition, such as grade III, IV, of Hunt and Hess, showed delay in recovery. There was no definite evidence of disturbing IQrecovery by angiospasm, ventricular dilatation, direction of aneurysm etc., as far as preoperative grade I, and II groups were concerned. The ultimate evaluation of the patient in regard to social adaptability from IQ test required a 2 year period. Symptoms of so called normal pressure hydrocephalus due to subarachnoid hemorrhage showed sometimes remarkable recovery of the mental state after shunt operation, but in other cases, shunt procedure failed to show persistent effect and several patients showed good IQ in the follow-up study, although the shunt device lost patency in early stage of follow-up. Y-G test showed interesting fact that the cases of poor IQ, especially poor Performance IQ, assumed types of passive adaptability.

Arteriovenous Malformations of the Posterior Fossa

Clinical characteristics of 20 patients with arteriovenous malformations of the posterior fossa were investigated. Nineteen of 20 patients presented with intracranial hemorrhage (intracerebellar and/or subarachnoid hemorrhage), which was recurrent in 5 cases (26%). One patient demonstrated progressive neurological deficits. AVM located in the cerebellar hemisphere in 10 patients, vermis in 7, tonsil in 1, and brain stem in 2. Four of 20 patients (20%) had concomitant aneurysms relating to the feeding arteries of AVM. Operative intervention was directed at primary excision in 16 patients, total excision in 14, subtotal excision in 1, and partial excision and feeder clipping in 1. One patient underwent ventricular drain age only. This patient died of recurrent hemorrhage 11 days after the drainage. Three patients did not receive any treatment, and 1 of 3 patients died of pneumonia. Seventeen of 20 patients (85%) had a good result, 1 patient (5%) a poor result, and 2 patients (10%) died. Good results could be expected of surgery in the treatment of AVM localized in the cerebellar hemisphere.

Effect of Sodium Ozagrel and Nizofenone in the Treatment of Patients with Cerebral Vasospasm after Subarachnoid Hemorrhage

One hundred twenty six patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm were admitted to our service between June 1988 and November 1989. Of these, 79 patients were treated with sodium ozagrel, thromboxane A9 synthetase inhibitor, or nizofenone, cerebral protector for ischemic cerebral damage. The effects were evaluated by the outcome of patients, incidence of symptomatic vasospasm and fatal vasospasm. Sodium ozagrel improved the outcome of patients and reduced the incidence of fatal vasospasm; however, it did not reduce the incidence of symptomatic vasospasm. Nizofenone was effective as well, but less so than sodium ozagrel. These results suggested that both drugs were effective in the treatment of delayed ischemic neurological deficits (DIND) due to cerebral vasospasm after subarachnoid hemorrhage.