Takeo Shimizu

Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament

Multi-level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well-documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi-level spondylosis and OPLL. They consisted of 19 patients with cervical spondylosis, 12 with OPLL, and 14 with combined lesions of both cervical spondylosis and OPLL. There were 32 men and 13 women. The mean age was 55 years, ranging from 35 to 70 years. In all of our 45 patients, anterior vertebrectomy, discectomy, removal of posterior osteophytes and OPLL, and interbody fusion were done for progressive myelopathy refractory to conservative treatment. In 2 of 45 patients, 5 vertebral bodies were resected; in 3 patients, 4 vertebral bodies were resected; in 12 patients, 3 vertebral bodies were resected, in 19 patients, 2 vertebral bodies were resected; and in 9 patients, 1 vertebral body was resected. Thirty-nine of 45 patients (87%) had good results. Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion.

Intratumoral hemorrhage after a ventriculoperitoneal shunting procedure.

Ventriculoperitoneal shunting has been accepted as a safe and useful preliminary procedure that lowers the mortality and morbidity of definitive surgery for tumors causing obstructive hydrocephalus. We are reporting four patients with intratumoral hemorrhage as a complication of shunting. The hemorrhage was massive and fatal in two patients, one with an unverified pineal tumor and the other with a malignant astrocytoma of the thalamus. The hemorrhage was small and limited in the other two patients, one with a glioblastoma of the thalamus and the other with a cerebellar astrocytoma. On the basis of this experience, we conclude that the possibility of intratumoral hemorrhage should be taken into consideration when planning the preoperative management of obstructive hydrocephalus caused by brain tumors. It is possible that ventricular decompression may result in rapid motion and distortion of the intracranial structures and a sudden imbalance between intracranial and intratumoral pressures, leading to vascular insufficiency, congestion, and then hemorrhage within the tumor.

Pituitary Apoplexy Caused by Ruptured Internal Carotid Artery Aneurysm

Background and Purpose — We report the first case of pituitary apoplexy caused by the rupture of an intracavernous carotid artery aneurysm embedded in a pituitary adenoma. Case Description — A 46-year-old man presented with clinical and CT findings typical of pituitary apoplexy. MRI showed an unusual flow-void protrusion into the intratumoral hematoma, which, however, was not diagnosed as a ruptured aneurysm until severe intraoperative bleeding occurred. Angiography after surgery revealed an intracavernous carotid artery aneurysm. Conclusions — The possible association of adenoma and aneurysmal rupture should be kept in mind when assessing any case of pituitary apoplexy.

Diencephalic syndrome of emaciation (Russell's syndrome)

Diencephalic syndrome of emaciation (Russells syndrome) characteristically presents with the symptoms of marked emaciation in spite of normal linear growth and marked increased of serum growth hormone in infancy and early childhood. It is usually caused by a low-grade glioma, most often an astrocytoma, of the anterior third ventricle including the optic nerve and chiasm. Usually it is not associated with von Recklinghausens neurofibromatosis. We describe two unusual cases of diencephalic syndrome; one case was caused by a low-grade astrocytoma involving the anterior third ventricle associated with neurofibromatosis, and the other by a malignant astrocytoma of the anterior third ventricle.

Dandy-walker cyst associated with occipital meningocele

Two cases of Dandy-Walker cyst associated with occipital meningocele are presented. Only 9 cases with such association have been described in the literature. In our patients computed tomography clearly demonstrated direct communication of a posterior fossa cyst with an occipital meningocele at one end and with the fourth ventricle at the other. Occipital meningocele might simply be an expression of increased intracystic pressure in Dandy-Walker cyst in embryonic life, or such association might suggest its morphogenetic situation during embryogenesis.

Transvenous Balloon Occlusion of the Cavernous Sinus: An Alternative Therapeutic Choice for Recurrent Traumatic Carotid-Cavernous Fistulas

We report a case of traumatic carotid-cavernous fistula (CCF) that recurred some 9 years after carotid trapping. The recurrent CCF was accompanied by a huge aneurysmal dilatation of the cavernous sinus. Transarterial balloon occlusion of the proximal internal carotid artery failed to occlude the fistula completely because of collateral flow to the fistula. the fistula was completely occluded by a transvenous approach via the jugular vein and inferior petrosal sinus using detachable balloons. The transjugular-inferior petrosal approach to the cavernous sinus can be an alternative for the treatment of traumatic CCF when the transarterial approach has failed to occlude the cavernous sinus.

Intraventricular noncolloid epithelial cyst in an infant

A rare case of giant intraventricular noncolloid epithelial cyst associated with multicompartmental hydrocephalus in an infant is presented. The cyst was located in the third ventricle and extended through the foramina of Monro into the lateral ventricles. Multiple modes of therapy were performed, including shunting procedures and transcortical and transcallosal cystostomies. It is concluded that extensive cystostomy coupled with a shunting procedure is the preferred method of treatment for giant cystic lesions around the foramina of Monro, if total excision is not feasible.

Successful removal of air gun bullets from the third ventricle.

A patient with air gun bullets in the 3rd ventricle associated with delayed ventricular hemorrhage is presented. Through an anterior transcallosal approach, the surgeon successfully removed the bullets without any significant permanent sequelae.