Seisho Abiko

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.

The effect of EC-IC bypass surgery on resting cerebral blood flow and cerebrovascular reserve capacity studied with stable Xe-CT and acetazolamide test

SummaryCerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were measured by stable xenon computerized tomography (Xe-CT) and acetazolamide test in 15 patients with cerebrovascular disease before and after extracranial-intracranial (EC-IC) bypass surgery for minor stroke, reversible ischemic neurological deficit or transient ischemic attack. All had angiographically shown occlusive lesions of the major arterial trunk. In the present series, global analysis showed that the bypass did not increase the resting rCBF, but did increase the rCRC. We divided the patients into four groups according to the preoperative resting rCBF and rCRC. All 3 patients with normal resting rCBF and reduced rCRC showed postoperative improvement of rCRC. Of 6 patients with reduced CBF and reduced CRC, three had postoperative increase in resting CBF and four had increased CRC. One of two patients with reduced CBF and normal CRC showed only an increase in CRC. We propose that reduced CRC or reduced CBF with reduced CRC are criteria for selection of candidates for bypass surgery. We conclude that Xe-CT with the Diamox test is a useful and simple method for evaluating cerebral hemodynamics. Preoperative grouping with a combination of preoperative resting cCBF and preoperative rCRC is useful for predicting the effect of EC-IC bypass surgery.

Intrasphenoidal encephalocele: report of a case.

&NA; The diagnosis of intrasphenoidal encephalocele may be difficult because of its rarity and its nonspecific signs and symptoms. The authors report a patient with intrasphenoidal encephalocele who was operated on by the transsphenoidal approach with a good result. They also review five reported cases, with discussion of their clinical characteristics and operative indications.

True posterior communicating artery aneurysm

ABSTRACT Two rare cases of true posterior communicating artery aneurysm are reported. One case was a saccular aneurysm, which was successfully clipped. The other was a case of fusiform trapped aneurysm, and hemiparesis and oculomotor palsy appeared transiently after surgery. In general, this type of aneurysm is included in the category of internal carotid‐posterior communicating aneurysm, although some special considerations are necessary in surgical treatment.

Bilateral intracranial fibrous xanthoma

We present a case of fibrous xanthoma in a 6-year-old boy who showed disturbance of consciousness and signs of increased intracranial pressure. A computed tomographic (CT) scan showed bitemporal enhanced masses and hydrocephalus. The patient was operated on in two stages. The tumors were located intradurally and extracerebrally and were firmly attached to the dura mater at the base of the middle fossa. Glial fibrillary acidic protein stain was negative, and histologic examination suggested a diagnosis of bilateral fibrous xanthoma. Postoperative CT scan showed residual tumors and an enlarged choroid plexus adjacent to it. A CT scan at 12 years of age showed no enhanced tumor, but disclosed bitemporal high-density areas and diffuse brain atrophy; the choroid plexus reverted to normal size. The patient showed mental and physical retardation, perhaps owing to the compression of the hypothalamus during early childhood. This would appear to be the first known case of bilateral intracranial fibrous xanthoma.

Growing skull fracture in childhood. A recurrent case treated by shunt operation

The authors report a case of growing skull fracture in which watertight dural closure was difficult at the first operation because a dural defect extended deep into the middle fossa. Bulging of the cranioplasty site occurred 2 months later. In the second operation, instead of reinforcement of the dura mater, a shunt operation was performed to decompress the cyst and the locally dilated ventricle, which was thought to contribute to the intracranial expansive forces. The bulging did not recur. In the treatment of growing skull fracture, a shunt operation should be considered when watertight closure of the dural defect cannot be achieved and in case of recurrence after failure of the first operation.

Surgical strategy for cavernous angioma in hypothalamus

A very rare case of cavernous angioma in the hypothalamus is presented. The patient was successfully treated by total excision of the haematoma and angioma, and there was no regrowth of the lesion on follow-up MRI. Complete excision of the angioma is the recommended surgical strategy even for patients with deep-seated lesions.

Direct surgery for giant aneurysm exhibiting progressive enlargement after intraaneurysmal balloon embolization

A case of giant intracranial carotid artery aneurysm exhibiting progressive enlargement after incomplete intraaneurysmal balloon embolization is presented. The patient was successfully treated by the trapping and decompression of the aneurysm with a superficial temporal artery-middle cerebral artery anastomosis. The thrombus surrounding the intraluminal balloons was very soft and poorly organized. Either direct surgery with extracranial-intracranial arterial bypass or complete intravascular surgery should be performed for giant aneurysms when direct clipping is impossible.

Surgical modulation of the natural course of collateral circulation in chronic ischemic patients

The purpose of this study was to evaluate hemodynamic compromise in terms of baseline CBF and CRC in patients with chronic cerebral occlusive lesions and its modulation by a superficial temporal artery to middle cerebral artery (STA‐MCA) anastomosis. The study subjects were 10 healthy volunteers and 49 chronic ischemic patients with stenosis or occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA) The hemodynamics were measured using stable xenon enhanced computed tomographic CBF measurement with the acetazolamide challenge. The compromised hemodynamics in patients with chronic steno‐occlusive lesions did not improve during their natural course after two months. STAMCA bypass modulated hemodynamic compromise in the ischemic patients. We recommend STAMCA bypass for patients with reduced CRC, regardless of whether baseline CBF is reduced or normal. Hemodynamic classification using a combination of baseline CBF values and CRC values is useful for evaluating cerebral hemodynamics and for choosing the best treatment for cerebral ischemia with occlusive lesions.