Intractable hiccup caused by syrinx in Chiari type I malformation. Two cases report.

Background: Intractable hiccups (IH) due to syringomyelia or syringomyelia/syringobulbia associated with Chiari type I malformations (CMI) are extremely rare. Here, we present two patients who presented with IH; one had a CMI with syringomyelia/syringobulbia, and the other, with CMI and syringomyelia. Case Description: The first patient was an 18-year-old female who presented with IH attributed to a holocord syrinx and syringobulbia involving the right dorsolateral medulla. The second patient was a 22-year-old female with a C3-5 syringomyelia. Both patients successfully underwent foramen magnum decompressions that improved their symptoms, while subsequent magnetic resonance studies confirmed shrinkage of their syringobulbia/syringomyelia cavities. Conclusion: IH was due to cervical syringomyelia/syringobulbia in one patient and cervical syringomyelia in the other; both were successfully managed with foramen magnum decompressions.

Factors Associated with Rapidly Deteriorating Myelopathy in Patients with Spinal Arteriovenous Shunts.

Spinal arteriovenous (AV) shunts are rare conditions that sometimes present with myelopathy symptoms. The progression of the symptoms is usually gradual; however, some cases show rapid deterioration. We retrospectively investigated the factors that induced the rapid deterioration of myelopathy symptoms in patients with spinal AV shunts. We treated 33 patients with myelopathy with spinal AV shunts at our institutions, eight of whom experienced rapid deterioration (within 24 hours: 24.2%). Of these, three were related to the body movement or particular postures associated with playing golf, 30 minutes of Japanese straight sitting, and massage care. One patient showed deterioration after embolization for a tracheal aneurysm. The remaining four patients received steroid pulse therapy (high-dose steroid infusion) shortly before the rapid deterioration. These symptoms stopped progressing after cessation of steroid use. While positional or physical factors contributing to myelopathy deterioration might exist, we could not identify specific factors in this study. Nevertheless, rapid deterioration was frequently observed after high-dose steroid use. We must take care not to administer high-dose steroids for myelopathy caused by spinal AV shunt disease.

Case of lumbar ligamentum flavum hematoma with epidural hematoma resulting in cauda equina compression.

Background: Lumbar ligamentum flavum hematomas (LFHs) are rare. However, when they occur and contribute to epidural cauda equina compression, timely surgical intervention is frequently warranted. Case Description: A 69-year-old female presented with the left lower extremity sciatica and gait disturbance of 2 weeks' duration that ultimately evolved into a paraparesis/cauda equina syndrome. When the lumbar MRI revealed left-sided L4-L5 epidural compression attributed to a hemorrhage into the hypertrophied ligamentum flavum (HLF), she successfully underwent a bilateral fenestration/decompressive procedure. Pathologically, neovascularization and rupture of the ventral layers of the degenerated and thickened HLF contributed to the LFH. Conclusion: Arterial neovascularization (i.e., arterial feeding vessels from paramuscular/prelaminar lumbar branches) contributed to a left-sided L4-L5 LFH that resulted in epidural cauda equina compression in a 69-year-old female. Following surgical focal fenestration/decompression, the patient's symptoms/signs resolved.

"Motion-specific Headache": A Predictor for Diagnosis and Favorable Prognosis after Surgery in Young Patients with Chiari Malformation Type 1.

As headache is known as one of the most common symptoms in the patients with Chiari malformation type 1 (CM1), it is difficult to find out CM1-related headache among the symptoms because headache itself is commonly seen. Herein, we retrospectively review the cases of six CM1 patients complaining only of headache by which they complained of deterioration in daily life activities. The symptom of headache worsened during anteflexion (n = 2; 33%), retroflexion (n = 1; 17%), jumping (n = 3; 50%), going up the stairs (n = 1; 17%), and running (n = 1; 17%). Mean age at the onset was 15.7 years old (ranging 11-18) and four out of six were female. These inductive factors were clearly different from "Valsalva-like maneuvers," although the mechanism might originate from dynamic tonsil changes. We named these headaches as "motion-specific." These headaches radiated to the posterior side. MRI revealed that the extent of tonsillar ectopia was 11.3 mm, while syringomyelia was observed in three out of six patients (50%). All patients underwent surgical treatment, with the "motion-specific headache" completely disappearing 12.5 days thereafter. Although headaches are common, "motion-specific headache" may be a good candidate symptom to distinguish CM1 patients, especially among teenagers with headaches, and a good predictor for favorable outcomes after surgical treatment.

Sulfonated polybenzophenone/poly(arylene ether) block copolymer membranes for fuel cell applications.

Sulfonated polybenzophenone/poly(arylene ether) block copolymers were designed and synthesized via Ni-mediated coupling polymerization. The block copolymers were obtained as high-molecular-weight (Mn = 70-110 kDa, Mw = 150-230 kDa) with low polydispersity index (Mw/Mn = 2.0-2.3). The block copolymer membranes showed well-developed hydrophilic/hydrophobic phase separation and high proton conductivity and low gas permeability. The membrane showed better fuel cell performance and durability compared with those with Nafion, state-of-the-art proton conducting membrane.

Spontaneous regression of multicentric pilocytic astrocytoma with CSF dissemination in an adult.

We present a case of spontaneous regression of multicentric pilocytic astrocytoma with cerebrospinal fluid (CSF) dissemination without neurofibromatosis type 1 (NF1) in an adult, the first such case reported. Magnetic resonance imaging (MRI) showed multiple low signal intensity lesions on T1-weighted images and high signal intensity areas on T2-weighted images in the bilateral thalamus, basal ganglia and midbrain. Contrast-enhanced MRI revealed that small, enhanced lesions were seen in the basal ganglia and the pineal region. Neuroendoscopic biopsy and third ventriculostomy were performed. Intraoperative findings demonstrated CSF dissemination. Histologically, the specimens showed pilocytic astrocytoma. Serial MRIs showed regression of the tumor without any additional treatment. The clinical features of spontaneous regression of pilocytic astrocytoma are discussed.

Solitary metastatic cauda equina tumor from breast cancer -case report-.

A 45-year-old woman presented with a rare case of metastatic cauda equina tumor from breast cancer without spinal column or brain metastasis. She had undergone resection of breast cancer 4 years previously. She presented with a 2-month history of severe low back pain. Magnetic resonance imaging showed a well-enhanced intradural extramedullary mass at the L1 level without other intradural lesions. At surgery, the tumor was partially removed to preserve the nerve root function under electrophysiological monitoring. The histological diagnosis was adenocarcinoma. The tumor was located in the subarachnoid space, suggesting hematogenous metastasis from the breast cancer. Postoperatively the pain subsided and no neurological deficit occurred. She underwent adjuvant therapy and rehabilitation. Cauda equina tumors may be relatively progressive regardless of imaging findings and clinical symptoms, so preoperative systemic investigation should be conducted, considering the possibility of metastatic tumor. A comprehensive therapeutic strategy involving adjuvant therapy after surgery is important to establish, considering the preservation of postoperative nerve function.

Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery: technical note.

BACKGROUND: Ultrasonic surgical aspirators have been used mainly for removing brain tumors. Because of their longitudinal and torsional tip, they are used for cutting the bone structures in spinal surgery installing a scalpel-type tip. The purpose of this report is to describe the effectiveness and surgical pitfalls of an ultrasonic bone curette in laminoplastic laminotomy and hemilaminotomy. METHODS: We present 12 patients who underwent laminoplastic laminotomy and hemilaminotomy. We used a SONOPET UST-2001 ultrasonic bone curette with HB-05S handpieces (M and M Co, Ltd, Tokyo, Japan). After a tumor was removed, titanium plates were used for the laminoplastic laminotomy and hemilaminotomy. The technical advantage of an ultrasonic bone curette and procedure-related complication were examined. RESULTS: There were no major procedure-related complications such as cord injury. Wound infection and subcutaneous fluid collection caused by cerebrospinal fluid leakage did not occur for reconstruction of posterior bony structure. In 1 patient with calcified dura mater associated with tumor, dural tear occurred. The width of the tip was narrow enough for resected laminae to be fused postoperatively, and spinal instability did not occur in all cases. CONCLUSION: The scalpel-type ultrasonic bone curette is useful for cutting bone and effective for reconstruction of the laminae. Laminotomy with an ultrasonic bone curette is safe and minimally invasive. To prevent dural tear, we recommend drilling laminae to make the bone thin as the first step, followed by cutting the remaining laminae using a bone curette especially in cases with calcified or tense dura mater.

Telesurgery of Microscopic Micromanipulator System "NeuRobot" in Neurosurgery: Interhospital Preliminary Study.

OBJECT: Robotic surgery can be applied as a novel technology. Our master-slave microscopic-micromanipulator system (NeuRobot), which has a rigid endoscope and three robot-arms, has been developed to perform neurosurgical procedures, and employed successfully in some clinical cases. Although the master and slave parts of NeuRobot are directly connected by wire, it is possible to separate each part and to apply it to telesurgery with some modifications. To evaluate feasibility of NeuRobot in telesurgery, some basic experiments were performed. METHODS: The quality of telemedicine network system between Shinshu University and one of the affiliated hospitals, which was completely separated from other public network systems, was investigated. The communication delay was calculated from the transmitting and the receiving records in the computers set in each hospital. The relationship between the change in communication delay from the master part to the slave part of NeuRobot (0, 100, 300, 500 and 700 ms) respectively and feasibility of NeuRobot was investigated. The task performance time in each time changing group was compared. Feasibility of NeuRobot in telesurgical usage was evaluated. The master part and the slave part of NeuRobot placed in each hospital were connected through private network system. Interhospitally connected NeuRobot was compared with directly connected one in terms of task performance time. RESULTS: Less than 1 ms was required for corresponding the data in a steady transmitting state. Within 2 seconds after connection, relative time delay (maximum 40 ms) and packet loss were sometimes observed. The mean task performance time was significantly longer in over 500 ms delayed group compared with directly connected NeuRobot. There was no significant difference in the task performance time between directly connected NeuRobot and interhospitally connected NeuRobot. CONCLUSION: Our results proved that telesurgical usage of NeuRobot was feasible. Telesurgical usage of telecontrolled manipulator system is recommended for application in a private network system in order to reduce technical and ethical problems. Some technical innovations will bring breakthrough to the telemedicine field.

Investigation of radiofrequency-induced temperature elevation of aneurysm clips in a 3.0-tesla magnetic resonance environment.

OBJECTIVE: Burn injuries associated with excessive heating of medical metallic devices have been reported, but a definite mechanism for magnetic resonance imaging-induced heating remains unresolved. The aim of this study is to evaluate temperature elevation of metallic wires, aneurysm clips, and clips attached to metallic wires under 3.0-T magnetic resonance imaging. METHODS: The temperature of the metallic wires, the aneurysm clips, and the clips attached to the metallic wires was measured with a fiber optic thermometer sensor system. RESULTS: Although the specific absorption rate was less than that observed during standard use, the temperature rapidly increased in the metallic wire. Furthermore, temperature elevation was observed when the clips were attached to metallic wires. On the other hand, not all clips showed obvious temperature elevation when they were placed alone in a 3.0-T magnetic resonance imaging environment. CONCLUSION: Aneurysm clips, when placed alone in a 3.0-T magnetic resonance imaging environment, are confirmed to be safe during temperature elevation.

[Clinical analysis of treatment and long-term outcome in 56 craniopharyngiomas].

In order to improve QOL in patients with craniopharyngioma, retrospective analysis was performed to discover factors for influencing functional outcome and the best treatment strategy. 56 patients were treated between 1978 and 2005. They were initially treated with surgery and surgical cure was obtained in 29 patients (Group A). Subtotal tumor resection with prophylactic radiation was performed in 8 patients (Group D). Tumor recurrence was noted in 19 patients and stereotactic radiation or 2nd operation was performed in 11 patients (Group B). 2nd operation and fractionated radiation were undertaken in 8 patients (Group C). Endocrine, vision and recognition were scored from 2 to 0, respectively; 2 indicates normal, 1 partially disturbed, 0 fully disturbed. The mean score before treatment was 4.7 and the final score was 3.9. Factors leading to poor outcome included extrasellar origin, solid tumor, bad score before treatment, 2nd surgery for recurrence. The change of scores after the treatment was -0.1 in group A, -0.7 in Group B, -0.9 in Group C and 0.3 in Group D. Maximum tumor removal should be attempted with functional preservation. Subtotal removal with prophylactic radiation is recommended if the patient has normal hypothalamic function.

Gold(I)-phosphine catalyst for the highly chemoselective dehydrogenative silylation of alcohols.

[reaction: see text] A gold(I) complex of Xantphos AuCl(xantphos) catalyzes the dehydrogenative silylation of alcohols with high chemoselectivity and solvent tolerance. It is selective for the silylation of hydroxyl groups in the presence of alkenes, alkynes, alkyl halides (RCl, RBr), ketones, aldehydes, conjugated enones, esters, and carbamates.