Tatsuo Yuge

Spontaneous regression of primary malignant intracranial lymphoma

A rare case of intracranial multiple tumor, which disappeared spontaneously on serial cranial computed tomography (CT) scans, is described. The initial CT scan showed multiple, well-enhanced lesions in the right frontal and parietal lobes. The lesions disappeared spontaneously without any treatment during the 2 following months of observation. One month later, however, a newly formed tumor was found on serial CT-scanning. Surgical intervention confirmed the histologic diagnosis of a non-Hodgkins, large, and diffuse-type malignant lymphoma. The possible mechanism of temporal disappearance of tumors on CT scanning is discussed.

Intraventricular Malignant Triton Tumour

Summary¶ The authors present the clinical and pathological features of a malignant triton tumour (MTT) in the lateral ventricle with neurofibromatosis type 1. A 57 year-old man presented with disorientation and memory disturbance. A Computed tomographic scan and magnetic resonance imaging studies revealed an enhancing lesion in the left lateral ventricle. A parieto-occipital transcallosal approach was taken and resection of the lesion was performed. The operative findings suggested that the tumour arose from the perivascular nerves. The final pathological diagnosis was a MTT. This is the first case of an intraventricular MTT. Aggressive treatment including radical surgery combined with radiochemotherapy is recommended for a MTT of the central nervous system.

Giant aneurysm at the origin of the accessory middle cerebral artery.

BACKGROUND Aneurysms of the A1 portion of the anterior cerebral artery are rare. The accessory middle cerebral artery is also a rare anomalous artery. CASE REPORT We operated on a 53-year-old man because of a giant aneurysm which arose at the junction of the accessory middle cerebral artery and the horizontal portion of the anterior cerebral artery (A1 portion). CONCLUSION This is the first report of a giant aneurysm of that region. A detailed evaluation of the angiogram is necessary prior to the operation, in order to select the most appropriate operative method to secure the blood flow of the accessory middle cerebral artery and distal anterior cerebral artery.

Massive traumatic haematoma of the Corpus callosum

SummaryFive unusual cases with massive haematoma of the corpus callosum caused by blunt head trauma are presented. Aside from the callosal haematomas, intraventricular and subarachnoid haemorrhages or small haemorrhagic foci in the basal ganglia or thalamus were common concomitant lesions on the computerized tomographic (CT) scan. The sites of the impacts were the frontal and occipital areas which were close to the midline and above the level of the corpus callosum. Severe and diffuse brain dysfunction was suggested by the severity of the Glasgow coma score (GCS) and the abnormality on multimodality evoked potentials. An intensive medical treatment such as barbiturate could be promising since a direct surgical approach was dubious because of additional damage to the severely injured brain.

Treatment of Acute Subdural Hematoma

Three types of surgical treatment and adjunctive barbiturate therapy were evaluated by analyzing their outcome in patients with traumatic acute subdural hematoma. From June, 1982 to December, 1990, 120 patients underwent surgery for acute subdural hematoma at Kurume University Hospital. Of these, 108 patients admitted to the hospital with a Glasgow Come Scale (GCS) score of 8 or less, and 75 with a GCS score of 5 or less. Removal of the hematoma with craniotomy (RH), removal of the hematoma with decompressive hemicraniectomy (DH) and hematoma irrigation with trephination therapy (HITT) were performed in 42, 51 and 27 patients, respectively. Of those with uncontrolled intracranial pressure over 30 mmHg, 23 were treated with barbiturates. The overall mortality rate was 51.7%, and the rate of good outcome was 26.7%. The rate of good outcome was singnificantly higher in the patients who underwent RH (47.6%), although the mortality rate of them was higher than that of the patients who underwent DH when the GCS score was 5 or less. Among the patients with a GCS score of 8 or less, the mortality rate was significantly higher in those who underwent HITT (74.1%). In patients with barbiturate therapy, RH had the best result. This study suggests that RH is preferable for acute subdural hematoma, although DH appears to be better for improving the mortality rate. HITT is not recommended in patients with a GCS score of 8 or less.