Tetsuya Tanigawara

Surgical treatment of cavernous angioma involving the brainstem and review of the literature

SummaryFive cases of symptomatic cavernous angioma involving the brainstem are reported. Magnetic resonance (MR) imaging is of greatest value in the diagnosis and for surgical indication. All cases were treated by radical extirpation. All of them improved postoperatively. The surgical indications for this lesion of the brainstem are briefly discussed with a review of the literature, including 28 previous cases, operated on directly.

The relationship between Moyamoya disease and bacterial infection

To examine the relationship between Moyamoya disease and bacterial infections, authors studied the serum of 85 cases of Moyamoya disease and the influence of Propionibacterium acnes (P. acnes) infection on intracranial arteries in rats. The serum levels of P. acnes antibody, IgM, transferrin (Tf), alpha 2-macroglobulin (alpha 2M) were significantly higher in Moyamoya disease than in normal volunteers. Moyamoya-like changes of the intracranial internal carotid arteries were histopathologically demonstrated in P. acnes infectious rats. These findings suggest that P. acnes and immunological factors might play a role in the pathogenesis of Moyamoya disease.

Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature

BACKGROUND Distal aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Most of the reported cases have been located near the internal auditory meatus. Among these cases, only six located in the internal auditory meatus have been reported in the literature. METHODS A 64-year-old female presented with sudden onset of severe headache. Computed tomography (CT) revealed moderate subarachnoid hemorrhage and Gd-DTPA enhanced magnetic resonance imaging (MRI) showed a small high-intensity mass at the right cerebellopontine angle. Although initial digital subtraction angiography (DSA) showed no vascular abnormalities, repeated DSA disclosed a saccular aneurysm at the top of the meatal loop of the right AICA. The patient underwent a suboccipital craniectomy on the 18th day after the hemorrhage RESULTS . In this case, the aneurysm was completely buried in the internal auditory meatus. After unroofing the meatus, the aneurysm was successfully clipped. After 3 months of hospitalization, the patient was discharged with right-sided deafness, partial facial palsy, and no other complications. CONCLUSIONS We discuss some of the clinical features and pitfalls in the surgical management of intracanalicular AICA aneurysms and review previous reports of similar cases.

Studies on cytomegalovirus and Epstein-Barr virus infection in Moyamoya disease

In this study, measurement of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) viral antibody titers and analysis of both viral genomic sequences using polymerase chain reaction (PCR) were performed to clarify the correlation of viral infection and Moyamoya disease. Serum samples were obtained from 64 patients with Moyamoya disease. The ages ranged from 5 to 66 years, with a mean age of 35.1 years. There were 23 males and 41 females. The serum antibody titers to CMV and EBV were measured by means of compliment fixation test and fluorescent antibody method respectively. Those titers of the patients were compared with those of 13 patients of atherosclerotic internal carotid occlusion and 34 normal volunteers. On the other hand, CMV and EBV genomic sequence using PCR, which was utilized with specific primer pairs, were performed in 22 patients of Moyamoya disease and ten normal volunteers. The following results were obtained; The antibody titer of EBV in Moyamoya disease was significantly higher than that in controls. However, no significant difference of antibody titer against CMV was detected. In EBV DNA analysis by use of PCR, EBV DNA was proved in 15 out of 20 patients with Moyamoya disease and four out of nine normal controls. Namely, EBV DNA was seen more frequently in patients with Moyamoya disease, compared with normal controls. In inverse, CMV DNA was not seen in patients with Moyamoya disease nor normal controls. In conclusion, the antibody titer of EBV revealed high levels in Moyamoya disease and EBV DNA was also detected more frequently in patients with Moyamoya disease. These results suggested a possibility that EBV infection might be involved in the pathogenesis of Moyamoya disease.

Supracerebellar Subarachnoid Hemorrhage After Evacuation of Supratentorial Chronic Subdural Hematoma

Subarachnoid hemorrhage located in the supracerebellar cistern is an unusual complication of supratentorial neurosurgery. To the best of our knowledge, only 5 case reports have described the occurrence of this rare hemorrhage after burr hole surgery/drainage for the treatment of chronic subdural hematoma. We present the case of a patient with this rare postoperative complication of subarachnoid hemorrhage located in the supracerebellar cistern immediately after the burr hole evacuation of chronic subdural hematoma without continuous subdural drainage. A possible underlying mechanism is also discussed. Although the complication may be associated with significant morbidity and mortality, most cases follow a benign clinical course as observed in our case.

Retroperitoneal Neuroblastoma Metastatic to the Cerebellopontine Angle

Neuroblastoma is the most common extracranial solid tumor in children. Survival rates have improved because of advances in treatment with aggressive chemotherapy and autologous bone marrow transplantation. Usual sites of recurrence and/or metastases include the site of the primary tumor, residual gross disease, bones, bone marrow, liver, and lungs. Central nervous system metastases have been regarded as uncommon; however, it is being increasingly diagnosed due to prolonged overall survival rates. Herein, we describe a 3-year-old boy with stage 4 primary adrenal gland neuroblastoma that metastasized to the pyramidal bone and rapidly extended into the cerebellopontine cistern while he was in the course of therapy for idiopathic thrombocytopenic purpura. He underwent an emergent debulking surgery, and the cerebellopontine angle metastatic lesion almost completely resolved after radical chemotherapy. Although our case is only the fourth case report of the metastatic cerebellopontine angle neuroblastoma in the literature, all clinicians involved in the treatment of pediatric neoplasms need to take this rare disease into consideration as a potential differential diagnosis.

1H-Magnetic resonance spectroscopy in a case of Moyamoya disease with revascularization surgery

Moyamoya disease is a clinical entity characterized by progressive obstruction of the internal carotid artery and the proximal cerebral arteries, and is associated with the formation of a characteristic net of collateral vessels in the basal ganglia. Clinical signs and symptoms in children include cerebral ischemia, epilepic seizures and intracranial hemorrhage. A variety of operative methods have been described for treating patients with Moyamoya disease, where encephalo-duroarterio-myo-synangiosis (EDAMS) is a new form of revascularization surgery. 1 We present here a case of Moyamoya disease with right frontal cerebral infarction treated by bilateral EDAMS and discuss the vascular change and cerebral metabolites in this patient before and after EDAMS using serial cerebral angiography and magnetic resonance (MR) spectroscopy.

Clinical study of cavernous angioma.

Cryptic vascular malformationの1つであるcavernous angioma (CA) の20例を対象として臨床的検討を加えた.発症年齢は6～75歳平均34歳, 15歳以下5例, 男女比は7対13であった.初発症状は3型に分けられ, 急性巣症状型が40%, 痙攣発作型が40%, その他20%であった.CAはplain CTで95%がhigh densityな病巣として示され, MRIでは全例異常なintensityとして描出され, うち85%がheterogeneousであった.4例は2～26ヵ月の経過観察中再出血や病巣の増大による症状の増悪を示した.CAの局在は天幕上12例, 天幕下5例, 多発3例で, うち5例は脳幹であった.1例は家族発生例であった.全例開頭術によりCAを摘出し, 症状は術前に比べ悪化したものはなく諸症状の改善がみられた.これらの結果から, CAは自然経過において出血を繰返すこと, MRIが診断および摘出術の方法決定に有用であること, 脳幹部発生例でも摘出によって神経諸症状の改善と良好な予後が得られることが示された.