Tadashige Kano

Usefulness of Preoperative Surgical Simulation with Three-Dimensional Fusion Images for Resection of Cerebral Cavernous Malformations Near Broca’s Area

Treating subcortical brain lesions in or near eloquent areas is challenging not only because lesions must be resected while preserving brain tissue involved in essential functions, but also because lesions often cannot be easily identified from the surface of the brain. Here, we report 2 cases of cerebral cavernous malformations near Brocas area. In both cases, lesions were surgically removed by utilizing three-dimensional fusion images created using preoperative magnetic resonance imaging and computed tomography data. Excisions were completed without any worsening of speech function, and the use of presurgical simulations was found to be useful in the design and execution of the actual operations. The technique described in this report serves as a useful tool in simulating surgical strategies by using brain gyri and sulci as surgical landmarks. Furthermore, in contrast to other intraoperative techniques, this method can aid in shortening the duration of surgery and can help limit damage to eloquent areas of the brain.

Speech-induced modulation of interhemispheric inhibition

This study aimed to determine the effects of speech and mastication on interhemispheric inhibition between the right and left primary motor areas (M1s) by using transcranial magnetic stimulation (TMS). Motor-evoked potentials (MEPs) were recorded from the first dorsal interossei (FDIs) of each hand of 10 healthy right-handed subjects under 3 conditions: at rest (control), during mastication (non-verbal oral movement), and during speech (reading aloud). Test TMS was delivered following conditioning TMS of the contralateral M1 at various interstimulus intervals. Under all conditions, the MEPs in the left FDIs were significantly inhibited after conditioning of the left M1 (i.e. inhibition of the right M1 by TMS of the left hemisphere). In contrast, the left M1 was significantly inhibited by the right hemisphere only during the control and mastication tasks, but not speech task. These results suggest that speech may facilitate the activity of the dominant M1 via functional connectivity between the speech area and the left M1, or may modify the balance of interhemispheric interactions, by suppressing inhibition of the dominant hemisphere by the non-dominant hemisphere. Our findings show a novel aspect of interhemispheric dominance and may improve therapeutic strategies for recovery from stroke.

Neurenteric Cysts Found on the Outer Membrane of a Subdural Haematoma

We report on a patient initially diagnosed with a chronic subdural haematoma that was resistant to treatment. After the second burr hole craniostomy within a half month failed to resolve the subdural haematoma (SDH), we performed a craniotomy to identify the point of bleeding. Macroscopic evaluation showed that most of the outer membrane of the SDH was transparent; however, further examination revealed the presence of multiple white regions. Pathologic examination showed that the white regions were fluid filled and surrounded by columnar ciliated epithelial cells. These lesions were pathologically diagnosed as neurenteric cysts. To our knowledge, this is the first report on a patient with neurenteric cysts found on the outer membrane of a CSDH. We agree that a craniotomy is a treatment of last resort for recurrent CSDHs; however, sometimes this procedure can be very useful for identifying underlying causes of obstinate SDHs as well as for their treatment.