Orbital schwannoma extending to the lateral wall of the cavernous sinus through the superior orbital fissure--case report.

A 58-year-old man presented with a rare orbitocavernous sinus schwannoma that originated from the orbital opthalmic nerve, and manifested as slowly progressive hypesthesia of the right side of the forehead, proptosis, and ocular pain with rapidly worsening visual acuity. Magnetic resonance imaging revealed a huge orbital tumor extending to the lateral wall of the cavernous sinus through the superior orbital fissure. Microsurgical total resection of the tumor was achieved using an epidural orbitofrontal approach with orbito-fronto-zygomatic craniotomy. The histological diagnosis was schwannoma with Antoni type A formation. The postoperative course was uneventful except for the hypesthesia on the right side of the forehead and transient oculomotor paralysis. Surgery was effective to relieve the symptoms and improve the activities of daily living.

[Case report of intrathecal baclofen administration in a child with severe spasticity attributable to traumatic brain injury].

We report a pediatric case of intrathecal baclofen therapy for severe spasticity following traumatic brain injury. A 14-year-old boy suffered from traumatic brain injury by traffic accident in 2005. Subsequently, he experienced tetraparesis and severe spasticity with spontaneous spasms. He underwent baclofen screening test, and his spasticity was improved. Thereafter intrathecal baclofen therapy was performed. Following baclofen pump implantation, Ashworth Score decreased from 4.0 points to 3.0 in lower limbs, and from 3.0 to 1.5 in upper limbs. His muscle tone was reduced and occurrence of spontaneous spasms stopped. Intrathecal baclofen therapy was observed to be an effective treatment for severe spasticity in childhood. Since children receiving the therapy demonstrated longer survival period than adults, long-term follow-up of this therapy is warranted.

[A case of brain metastasis of renal pelvic carcinoma].

A 68-year-old woman was referred t o our urological department with the complaint of hematuria and right abdominal mass. Contrast-enhanced computed tomography (CT) revealed renal tumor and multiple lung metastases. Right nephroureterectomy was performed. Pathological examination was transitional cell carcinoma. After nephroureterectomy, combination chemotherapy consisting of methotrexate, doxorubicin and cisplatin was performed. Oral administration of tegafur was continued outside the hospital. Eight months after the nephroureterectomy, she suffered from left hemiconvulsion and was transferred to our hospital. Contrast-enhanced CT of the head revealed a heterogeneous enhancement tumor in the parietal lobe. Surgical resection was performed by right parietal craniotomy. Because the tumor was invasive in the superior sagittal sinus, subtotal removal of the tumor was performed. Pathological examination indicated transitional cell carcinoma the same feature as in the renal pelvis. After surgical resection, she was treated by gamma knife stereotactic radiosurgery. She returned to ordinary life, but 7 months later tumor recurrence took place. Repeated surgical resection and stereotactic radiosurgery was performed, but she died 44 months after the initial nephroureterectomy due to the relapse of brain metastasis. Brain metastasis of renal pelvic carcinoma is extremely rare, and we have found only three case reports. We describe the course of our patient, and review the three cases of brain metastasis of renal pelvic carcinoma that are in the literature.

Effect of carotid artery stenting on ocular circulation and chronic ocular ischemic syndrome.

BACKGROUND: The authors evaluated the effect of carotid artery stenting (CAS) on ocular circulation and chronic ocular ischemic syndrome. METHODS: We examined 38 patients with carotid artery stenosis (>80%) at its origin treated with CAS. Ocular circulation and symptoms were examined before, within 24 h, and 1 week, 1 month, and 3 months after CAS based on ophthalmic artery color Doppler flow imaging and ophthalmological examinations. RESULTS: Ocular circulation: Before CAS, 13 patients showed reversed ophthalmic artery flow, and 25 antegrade flow. Average peak systolic flow velocity was -0.038 m/s. Within 24 h after CAS, all patients showed antegrade ophthalmic artery flow; reversed flow before CAS was thus resolved. Average peak systolic flow velocity rose significantly to 0.36 m/s (p < 0.05). One week, 1 month and 3 months after CAS, there were no significant changes compared to the findings at 1 week after CAS. Ocular symptoms: Before CAS, 8 patients showed chronic ocular ischemic syndrome. During the follow-up period (mean: 2.8 years), the visual acuity improved in 7 cases. Average retinal artery pressure and arm-to-retina circulation time improved significantly to the normal level (p < 0.05). The other 30 patients complained of recurrent and worsened visual symptoms during the follow-up period. CONCLUSION: CAS was effective in improving ocular circulation, and also improved the chronic ocular ischemic syndrome caused by the severe carotid artery stenosis.

New device for endoscopic image display during microsurgical clipping of cerebral aneurysms--technical note--.

Endoscopy in microsurgery is most effective when a single surgeon can monitor both endoscopic and microscopic images simultaneously. However, monitoring systems of this kind, such as a contemporary microscope equipped with a picture-in-mode function, are expensive. The present display system is connected to the endoscope video camera and mounted on the surgeon's head. The liquid crystal display is positioned just under the microscope eyepieces, so reducing the need for the surgeon to refocus and redirect the gaze during surgery. This system allows nearly simultaneous endoscopic and microscopic monitoring. No changes to the surgical microscope are necessary.

[High-dose radiation-induced meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia].

A 12 year-old girl was treated with prophylatic cranial irradiation for acute lymphoblastic leukaemia (ALL). At the age of 39, she was admitted to our hospital for status epilepticus. Computed tomography demonstrated two, enhancing bilateral sided intracranial tumors. After surgery, this patient presented meningiomas which histologically, were of the meningothelial type. The high cure rate in childhood ALL, attributable to aggressive chemotherapy and prophylatic cranial irradiation, is capable of inducing secondary brain tumor. Twelve cases of high-dose radiation-induced meningioma following ALL are also reviewed.