Tohru Tsurutani

P2 aneurysm approached via the temporal horn: technical case report.

OBJECTIVE AND IMPORTANCE We report the use of a transcortical transventricular approach to a P2 aneurysm, which was located near the choroidal fissure, protruded into the temporal horn, and was considered to be too difficult to approach by the conventional subtemporal route. CLINICAL PRESENTATION An 81-year-old woman suddenly developed severe headache with vomiting and subsequently lost consciousness. Computed tomographic scans revealed a diffuse intraventricular hemorrhage and subarachnoid hemorrhage. Cerebral angiography disclosed a saccular aneurysm in the right P2 segment. INTERVENTION On the 16th day after admission, successful neck clipping was easily performed through the temporal horn via the inferior temporal gyrus. The postoperative course was uneventful. CONCLUSION This special approach may be preferable in such cases, because it protects the brain from the detrimental effects of strong temporal retraction and provides a wider working space.

Early, evolving Wallerian degeneration of the pyramidal tract in cerebrovascular diseases: MR study.

Objective The purpose of this study was to demonstrate the early features of the Wallerian degenerative process and their relationship with the severity of motor deficit. Materials and Methods Fourteen patients with infarction or hemorrhage of the basal ganglia were studied by MRI of the same coronal slice along the pyramidal line. Results The earliest sign of abnormal signal intensity was detected 0.7 month after the initial insult. On proton-density (PD) imaging, low signal intensity was observed on 11 (73.3%) of 15 occasions from 0.7 to 2.0 months, and abnormal signal intensity was not detected 5 (83.3%) of 6 times from 2.1 to 3.7 months. High signal intensity was revealed on 11 (78.6%) of 14 occasions after 3.8 months. The widest extent of the low-intensity signal band on PD imaging was closely related to the severity of motor deficits at >4 months. Conclusion The development of the Wallerian degenerative process was divided into four stages by MRI. We conclude that the extent of Wallerian degeneration is related to the severity of motor deficit.

Transient hydrocephalus due to movement of a clot plugging the aqueduct

A rare case of transient hydrocephalus is reported. A 64-year-old woman presented with headache. Computerized tomography (CT) scan revealed hydrocephalus with tiny blood clots in the left foramen of Monro and in the aqueduct. Six hours after the onset, the signs and symptoms disappeared spontaneously. The second CT showed improvement of the hydrocephalus with migration of the clot into the i.v. ventricle. Aqueductal trapping and releasing of the clot formed by bleeding from the choroid plexus located in the left foramen of Monro was suspected for the origin of the transient hydrocephalus.

Coronal MR imaging for visualization of wallerian degeneration of the pyramidal tract.

A coronal image taken along a straight line between the front edge of the medulla and the deepest point of the interpeduncular cistern clearly displayed wallerian degeneration of the segment of the pyramidal tract between the internal capsule and the pons, the medulla, or the decussation. This visualization was verified in 21 patients with moderate or severe hemiparesis following a stroke episode.

Ultrasound Imaging for Stereotactic Evacuation of Hypertension-Associated Intracerebral Hematomas with Aqua-Stream and Aspiration

Stereotactic aqua-stream and aspiration (SASA) has been used for the evacuation of intracerebral hematomas. The authors have introduced ultrasound imaging (US) to monitor the evacuations of the hematoma during the surgical procedure. Hematomas were reproduced in an agar hematoma model which showed that if air collected in the hematoma cavity, it produced a strong artifact, and the hematoma could not be monitored. In the clinical trial, hematomas were visualized, and the surgical procedures were monitored in real time. The needle of the SASA and the air that collected in the hematoma cavity produced only weak artifacts, and the SASA water jet showed as a hyperechoic region on US, so that the procedure could be monitored in real time. In all cases, the average amount of evacuated hematoma exceeded 92%, as calculated from the preoperative and postoperative computed tomography images. The level of consciousness improved from a preoperative level of 1-20 (Japan Coma Scale) to 0-3 postoperatively. The addition of US monitoring to computed tomography guided stereotactic evacuation of hematomas with SASA enabled hypertension-associated intracranial hematomas to be evacuated more safely and more completely than has been achieved hitherto.

Pineal and suprasellar metastasis of lung cancer : Case report and review of the literature

A very rare case of simultaneous pineal and suprasellar metastasis of lung cancer in a 46-year-old man is reported. Simultaneous mass lesions in these regions are usually diagnosed as primary germ cell tumors in the central nervous system. The clinical features and differential diagnosis are discussed.

Thrombolytic therapy by pro-urokinase combined with tissue plasminogen activator in an acute internal carotid occlusion

Acute occlusion of the internal carotid artery by a cardiac embolus was quickly recanalized by the new thrombolytic agent, pro-Urokinase, combined with tissue plasminogen activator, without any side-effects. This is the first reported case of thrombolytic therapy of a cerebral artery using these agents in combination.