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1.
Neurol Med Chir (Tokyo) ; 60(3): 136-146, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31902873

RESUMO

The histone H3K27M-mutant diffuse midline glioma is often seen in children and has a very poor prognosis regardless of its histological grade. Although it can occur in adults, few studies on adult cases have been reported. We examined adult midline glioma cases for their histological grade, presence of H3K27M mutation, and expression of related factors-enhancer of zeste homolog 2 (EZH2), H3K27me3, p16, and methylthioadenosine phosphorylase. These tumor characteristics were also evaluated for their prognostic value in adult midline glioma. High histological grade, H3K27M-mutant, high EZH2 expression, and high H3K27me3 expression was detected in 12/23 (53%), 11/23 (48%), 9/23 (39%), and 12/23 (52%) cases, respectively. Histological grade and prognosis were significantly correlated (P <0.01). The high expression of EZH2 and the low expression of H3K27me3 correlated with histological malignancy (P = 0.019 and 0.009) and prognosis (P = 0.048 and 0.047). To broaden the scope of our analysis, a review of cases reported in the literature (2014-2019) was performed. In the 171 cases, H3K27M-mutant showed poor prognosis in the young adult group (P = 0.001), whereas H3K27 status had no effect on prognosis in the older age group (P = 0.141). Histological grade was correlated with prognosis in both young adults and older groups (P <0.001, P = 0.003, respectively). We demonstrate differences in prognostic factors for diffuse gliomas in the midline region for children and adults. Importantly, the H3K27M mutation significantly influences prognosis in children, but not necessarily in adults. Contrarily, histological grading and immunostaining are important prognostic tools in adults.

2.
World Neurosurg ; 134: e1037-e1046, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759155

RESUMO

OBJECTIVE: The usefulness of endoscopic procedures for chronic subdural hematoma (CSDH) has been described, but the indications in patients of very advanced age have not been analyzed. The aim of this study was to evaluate the feasibility, safety, and usefulness of introduction of an endoscopic procedure for such patients. METHODS: We retrospectively analyzed the data of 540 CSDHs treated by burr-hole surgery with endoscopic examination. The safety of the endoscopic procedure was assessed according to postoperative complications, morbidity, and mortality. The outcome was evaluated by statistical comparison among 4 different age-groups, and the recurrence rate and risk factors for recurrence was investigated in patients of very advanced age. RESULTS: Postoperative complications occurred in 7 cases (1.5%). The 6-month morbidity and mortality were 13.5% and 4.5%. No complications, morbidity, or mortality associated with the additional endoscopic procedure occurred even in patients of very advanced age. The endoscopic features of trabecular structures and residual septa separating the cavity were also risk factors for recurrence in patients of very advanced age. Releasing of the septa showed the possibility of decreasing the risk of recurrence to 6.6% in patients aged ≥85 years as well as in younger patients. There were some inevitable problems such as prolongation of the surgical time and inadequate endoscopic surgical skill. CONCLUSIONS: An endoscopic procedure for CSDH can be safely indicated and useful even in patients aged ≥85 years. However, clinicians should carefully select the patients based on clinical information associated with risk factors for recurrence.

3.
World Neurosurg ; 133: e281-e287, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31518739

RESUMO

BACKGROUND: The spot sign (SS) in spontaneous intracerebral hemorrhage has been reported to be a predictive factor of poor outcome; however, how SS is related with the clinical outcome remains unclear. We aimed to investigate how etiology associated with SS affects the clinical outcome of endoscopic surgery. METHODS: We retrospectively analyzed data from 104 patients (43 women and 61 men, mean age: 64.2 ± 11.0 years) who underwent endoscopic surgery for supratentorial intracerebral hemorrhage. The outcome variables analyzed were in-hospital mortality and modified Rankin scale score at 90 days from onset. RESULTS: The prevalence of intraventricular hemorrhage and the mean initial modified Graeb score were greater in SS-positive than in SS-negative patients (100% vs. 47.7%, P < 0.001, and 14.4 ± 5.4 vs. 10.6 ± 6.0, P = 0.03, respectively). Postoperative rebleeding occurred more frequently in SS-positive than -negative patients (25.0% vs. 6.8%, P = 0.045). The in-hospital mortality rate was 7.7% and was not significantly different between the groups (18.8% vs. 5.7%, P = 0.09). There was a significant unfavorable shift in modified Rankin scale scores at 90 days among SS-positive patients compared with SS-negative patients in an analysis with ordinal logistic regression (adjusted common odds ratio, 4.38; 95% confidence interval 0.06-0.79, P = 0.02). CONCLUSIONS: Intraventricular hemorrhage and postoperative rebleeding were considered to be associated with the poor outcome in patients with SS. The SS on computed tomography angiography may be valuable in predicting rebleeding and clinical outcome after surgery.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Hematoma/diagnóstico por imagem , Neuroendoscopia , Idoso , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/cirurgia , Comorbidade , Feminino , Hematoma/complicações , Hematoma/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
4.
World Neurosurg ; 2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30593956

RESUMO

OBJECTIVE: Possible factors associated with bleeding from endoscopy-detected chronic subdural hematomas (CSDHs) have rarely been analyzed. We therefore evaluated intraoperative endoscopic findings to elucidate the clinical course and assess predictors of CSDH recurrence. METHODS: Altogether, 540 CSDHs were reviewed in this retrospective study. Six possible signs of bleeding were detected in the cavity: spotty bleeding on the outer membrane, hematoma clots, cerebral parenchymal suspension, stretched cortical vessels, intraluminal trabecular structures, and septa separating the cavity. We evaluated the association of each with the radiologic findings, endoscopic features, and interval from trauma to surgery and then assessed the correlation between each endoscopic feature and CSDH recurrence. RESULTS: Spotty bleeding, cerebral parenchymal suspension, and stretched cortical vessels occurred during every period. Hematoma clots exhibited a 2-peak pattern with significant resurgence during the chronic phase. Trabecular structures significantly increased 61 days after the trauma, reaching 71.2% of patients on day 91. Septa were found in the cavity in only 12.5% during the initial 30 days but subsequently increased significantly to 37.3%. At 2 months, an exacerbation stage was inferred. The multivariable analysis revealed that trabecular structures and residual septa were significant independent risk factors for recurrence. We opened most septa intraoperatively. Their recurrence rate was 7.5%, which is lower than has been previously reported. CONCLUSIONS: Evaluation of the changes in the endoscopic findings and their association with recurrence was useful for clarifying the mechanism of CSDH enlargement, the risk of recurrence, and the potential for endoscopic surgery.

5.
Acta Neurochir Suppl ; 129: 135-140, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30171326

RESUMO

Cerebellar hemorrhage (CH) is a severe life-threatening disorder, and surgical treatment is often required in an emergency situation. Even in cases in which the surgical procedure is successful, functional recovery is likely to be delayed because of cerebellar symptoms such as ataxia and gait disturbance. Here, we briefly review the efficacy of hybrid assistive limb (HAL) treatment in neurosurgical practice and propose a new comprehensive treatment strategy for CH to facilitate early neurological recovery. We have experienced cases of ataxic gait due to various etiologies, treated with rehabilitation using the HAL, and our data showed that HAL treatment potentially improves ataxic gait and balance problems. HAL treatment seems to be an effective and promising treatment modality for selected cases. Future studies should evaluate gait appearance and balance, in addition to walking speed, to assess improvement in cerebellar symptoms.


Assuntos
Doenças Cerebelares/complicações , Exoesqueleto Energizado , Marcha Atáxica/etiologia , Marcha Atáxica/reabilitação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Oncol Lett ; 16(4): 4243-4252, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30214559

RESUMO

Brain metastases (BM) are common in patients with lung adenocarcinoma, and represent a significant cause of morbidity in the disease. A more comprehensive understanding of the clinicopathological characteristics that serve as prognostic factors for survival in patients with BM from lung adenocarcinoma may aid in informing treatment strategies for this patient population. In the present study, clinicopathological factors, including EGFR mutation status, were evaluated in 59 patients who were diagnosed with BM from lung adenocarcinoma, and underwent BM resection between January 1985 and December 2014 at Fukuoka University Hospital. The most frequent subtype of BM from lung adenocarcinoma was solid adenocarcinoma (57.6%), followed by papillary adenocarcinoma (22.0%) and acinar adenocarcinoma (18.6%). A total of 14 patients (23.7%) exhibited EGFR mutations, which were significantly associated with female sex (9/14, 64.3%), non-smoker status (8/14, 57.1%), BM in the frontal lobes (9/14, 64.3%) and papillary adenocarcinoma (5/14, 35.7%). Statistical analysis revealed a significant association between non-smoker status and BM in the frontal lobes, and more favorable disease prognosis. The results of the present study suggest that histological and genetic analysis of tissue from BM provides information useful for managing treatment of patients with resectable BM arising from lung adenocarcinoma.

7.
Surg Neurol Int ; 9: 68, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29721347

RESUMO

Background: Spontaneous cerebellar hemorrhages (CHs), which frequently require surgical intervention, are life-threatening and can be complicated by intraventricular hemorrhages (IVHs) and obstructive hydrocephalus. Commonly, endoscopic surgery is performed to remove CHs via a suboccipital approach (SA) alone. At our institution, when patients exhibited supratentorial IVH-associated hydrocephalus, we used a combined frontal and suboccipital approach (CA) to evacuate both CHs and supratentorial IVHs. The present study retrospectively evaluated the effectiveness and safety of this CA, as no prior studies examining this approach currently exist. Methods: Twenty-six patients with spontaneous CH were surgically treated at our hospital from April 2009 to March 2016. Twenty-two patients who could independently perform activities of daily living before the onset underwent endoscopic surgery to evacuate the CHs; among these, 13 patients underwent the SA alone, while nine underwent the CA. We assessed and compared the patients' baseline characteristics, surgical results, and prognosis at 1 month after the intervention between the SA and CA groups. Results: Patients who underwent the CA had significantly poorer consciousness before the surgery owing to IVH extension and obstructive hydrocephalus. However, the surgical results and prognosis at 1 month were not significantly different between the two approaches. The CH-associated IVHs were successfully removed with the CA and resulted in shorter external ventricular drainage (EVD) placement durations. Conclusion: Endoscopic surgery performed via the CA appeared to neutralize the deteriorating effects of CH-associated IVHs. Surgical strategies employing the CA may have the potential to improve the prognosis of patients with CH.

8.
J Neurosurg ; : 1-6, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29799345

RESUMO

OBJECTIVEIn patients with spontaneous intracerebral hemorrhage (sICH), postoperative recurrent hemorrhage (PRH) is one of the most severe complications after endoscopic evacuation of hematoma (EEH). However, no predictors of this complication have been identified. In the present study, the authors retrospectively investigated whether PRH can be preoperatively predicted by the presence of the spot sign on CT scans.METHODSIn total, 143 patients with sICH were treated by EEH between June 2009 and March 2017, and 127 patients who underwent preoperative CT angiography were included in this study. Significant correlations of PRH with the patients' baseline, clinical, and radiographic characteristics, including the spot sign, were evaluated using multivariable logistic regression models.RESULTSThe incidence of and risk factors for PRH were assessed in 127 patients with available data. PRH occurred in 9 (7.1%) patients. Five (21.7%) cases of PRH were observed among 23 patients with the spot sign, whereas only 4 (3.8%) cases of PRH occurred among 104 patients without the spot sign. The spot sign was the only independent predictor of PRH (OR 5.81, 95% CI 1.26-26.88; p = 0.02). The following factors were not independently associated with PRH: age, hypertension, poor consciousness, antihemostatic factors (thrombocytopenia, coagulopathy, and use of antithrombotic drugs), the location and size of the sICH, other radiographic findings (black hole sign and blend sign), surgical duration and procedures, and early surgery.CONCLUSIONSThe spot sign is likely to be a strong predictor of PRH after EEH among patients with sICH. Complete and careful control of bleeding in the operative field should be ensured when surgically treating such patients. New surgical strategies and procedures might be needed to improve these patients' outcomes.

9.
World Neurosurg ; 116: e513-e518, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29758369

RESUMO

BACKGROUND: Endoscopic evacuation of hematoma (EEH) has recently been applied to treat patients with spontaneous intracerebral hemorrhage (sICH). Intraoperative active bleeding (IAB), which is occasionally observed in EEH, might lead to greater blood loss, further brain damage, and more postoperative recurrent hemorrhage. However, no definite predictor of IAB has been established. Because the spot sign is associated with other hemorrhagic complications, we aimed to evaluate whether it predicts IAB. METHODS: We retrospectively assessed the incidence and risk factors of IAB, including the spot sign, in 127 sICH patients who underwent EEH within 6 hours after computed tomography angiography at our institution between June 2009 and December 2017. RESULTS: The study included 53 women and 74 men with an average age of 66.7 ± 11.8 years. IAB occurred in 40 (31.5%) of the 127 patients, and it was more frequent in patients with the spot sign than in patients without it (14/24 [58.3%] vs. 26/103 [25.2%]; P = 0.003). Multivariable regression analyses suggested that the spot sign was an independent predictor of IAB (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.10-8.30; P = 0.03). In addition, earlier surgery gradually increased the risk of IAB, and surgery within 4 hours of onset was an independent risk factor (OR, 4.34; 95% CI, 1.12-16.9; P = 0.03, referring to postonset 8 hours or more). CONCLUSIONS: The spot sign and early surgery were independent predictors of IAB in EEH for sICH. In patients with sICH and spot sign, complete treatment of IAB by electrocoagulation might be important for minimizing surgical complications.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Monitorização Neurofisiológica Intraoperatória/métodos , Neuroendoscopia/efeitos adversos , Idoso , Angiografia Cerebral/métodos , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
10.
Acta Neurochir (Wien) ; 160(2): 287-290, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29197023

RESUMO

Klippel-Trenaunay-Weber syndrome (KTWS) involves a triad of conditions, including cutaneous hemangiomas, venous varicosities, and osseous and soft-tissue hypertrophy of the affected limb. We describe a rare case of multiple cavernomas in the central nervous system in a patient with KTWS. A-64-year-old man with KTWS and a previous brain hemorrhage presented with sudden onset of gait and vesicorectal disturbance. The magnetic resonance imaging scan showed a cavernoma associated with hemorrhage in his lumbosacral spinal cord. Moreover, numerous cavernomas were identified in his brain. He was treated conservatively with no adverse events. Gait disturbance improved, but vesicorectal disturbance did not improve.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Síndrome de Klippel-Trenaunay-Weber , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias Encefálicas/complicações , Incontinência Fecal/etiologia , Transtornos Neurológicos da Marcha/etiologia , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemorragia/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal , Neoplasias da Medula Espinal/complicações , Retenção Urinária/etiologia
11.
Neurosurg Rev ; 40(4): 643-646, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28130656

RESUMO

Unilateral spatial neglect (USN) is known to depress the activities of daily living. The purpose of this study was to clarify that categorizing the type of USN using line cancelation and line bisection tests is important when evaluating patients with acute intracerebral hemorrhage (ICH). In this study, patients with ICH were prospectively evaluated for the presence of USN using line cancelation and line bisection tests. They were classified into an incomplete USN group (iUSN = abnormal results in either test) or a complete USN group (cUSN = abnormal findings in both tests). We compared the initial severity of ICH and the outcomes of USN in the two groups. We were able to assess 16 patients, among whom 10 showed USN. Seven were then categorized as having iUSN and three as having cUSN. The median hematoma volume was larger in the cUSN group than in the iUSN group. The USN symptoms of patients in the iUSN group disappeared during the chronic phase, whereas the symptoms of patients in the cUSN group continued. The type of USN was associated with the initial severity of ICH and the persistence of USN.


Assuntos
Atividades Cotidianas , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/psicologia , Transtornos da Percepção/diagnóstico , Transtornos da Percepção/psicologia , Adulto , Idoso , Atenção , Hemorragia Cerebral/terapia , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Transtornos da Percepção/terapia , Estudos Prospectivos
12.
Neurol Med Chir (Tokyo) ; 55(12): 901-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26511112

RESUMO

The efficacy of hybrid assistive limb (HAL) rehabilitation in the acute phase of stroke remains unclear. The purpose of this study was to evaluate the outcomes of patients with acute intracranial hemorrhage (ICH) who were treated with or without HAL rehabilitation. Among 270 patients with acute ICH from 2009 to 2014, 91 patients with supratentorial ICH were included in this retrospective study. Of these, 14 patients (HAL group) received HAL rehabilitation at approximately 1 week after ICH occurrence, while the remaining 77 patients received usual rehabilitation without HAL (N-HAL group). We obtained various patient data from the hospitals where the patients were moved to for further rehabilitation. Statistical comparisons were performed for the characteristics of the ICH patients, and outcomes between the HAL and N-HAL groups. There were no differences in outcomes between the HAL and N-HAL groups. However, patients with right ICH in the HAL group exhibited a significant association with a functional independence measure (FIM) score of ≥ 110 compared with patients in the N-HAL group (HAL group: 81.8%, N-HAL group: 43.9%, P = 0.04). In patients with right ICH, HAL rehabilitation was associated with improved outcomes as evaluated by the FIM score. Thus, HAL rehabilitation may improve outcomes of acute ICH in appropriately selected patients.


Assuntos
Extremidades/fisiopatologia , Hemorragias Intracranianas , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Neurol Surg Rep ; 76(1): e59-61, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26251812

RESUMO

The trigeminocerebellar artery (TCA) is a branch of the basilar artery that may have an intraneural course and may cause trigeminal neuralgia. We report a case of trigeminal neuralgia with right vertebral artery aneurysm caused by an intraneural TCA that compressed the trigeminal nerve in multiple places. We performed proximal trapping for the fusiform aneurysm with extra-intracranial bypass to preserve flow of the posterior inferior cerebellar artery, followed by microvascular decompression that successfully changed the course of the TCA. This procedure provided relief from the neuralgia without direct bisection of the trigeminal nerve that may cause severe nerve injury. Reshaping of the course of the artery can achieve good pain relief.

14.
No Shinkei Geka ; 42(1): 47-52, 2014 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-24388940

RESUMO

A 57-year-old man presented with sudden-onset consciousness disturbance. He had a 10-year history of a subarachnoid hemorrhage(SAH)caused by a ruptured aneurysm in the right middle cerebral artery, and had undergone aneurysmal clipping. He could perform all his daily life activities independently. Computed tomography showed diffuse SAH with intraventricular hemorrhage. Digital subtraction angiography(DSA)demonstrated mild fusiform dilatation of the left A2 portion of the left anterior cerebral artery(ACA)and the terminal portion of the left internal carotid artery with no sign of right middle cerebral artery(MCA)aneurysm recurrence. We could not identify the bleeding lesion at that time; therefore, conservative treatment was selected in the acute phase. Fourteen days later, repeated DSA showed fusiform dilatation of the left A2 portion leading to a diagnosis of ACA dissection. We initially performed superficial temporal artery(STA)-ACA anastomosis and secondary internal trapping with detachable coils in the operating room. Postoperative DSA revealed complete obliteration of the dissection and parent artery. Endovascular treatment with STA-ACA bypass is a safe and effective alternative for the treatment of ACA dissection.


Assuntos
Aneurisma Roto/cirurgia , Artéria Cerebral Anterior/cirurgia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Aneurisma Roto/diagnóstico , Angiografia Cerebral/métodos , Humanos , Aneurisma Intracraniano/diagnóstico , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 23(6): 1332-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24462461

RESUMO

Significant carotid stenosis is known to cause ischemic stroke and cognitive impairment. However, it remains controversial whether carotid endarterectomy (CEA) can improve cognitive function in patients with carotid stenosis. We used the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) to compare cognitive function between before and after CEA. Patients were prospectively registered to evaluate cognitive function from October 2011 to December 2012 after we determined them to have significant carotid stenosis. Patients were examined by 3-dimensional computed tomographic angiography or digital subtraction angiography. Although symptomatic cases were included, their modified Rankin Scale was grade 0 or 1 before CEA. All CEA procedures were performed by the same neurosurgical team. Cognitive function was evaluated by MoCA and MMSE performed before and after surgery. Data were analyzed statistically using the Wilcoxon signed rank test. Thirty-six patients were included in this study. The MoCA score after surgery, whereas the MMSE score was not. After surgery, the MoCA score improved in patients who were 73 years or younger, who underwent CEA in the left side of their carotid lesion, who had severe carotid stenosis of more than 80%, who had bilateral lesion, who did not have abnormal lesion on diffusion-weighted imaging after surgery, or who had cerebral blood flow of pre-CEA over 34.5 mL. In conclusion, MoCA was feasible in patients soon after undergoing CEA. Using MoCA not MMSE, CEA may improve cognitive function in patients with significant carotid stenosis.


Assuntos
Estenose das Carótidas/cirurgia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/cirurgia , Cognição/fisiologia , Endarterectomia das Carótidas , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Estenose das Carótidas/psicologia , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
16.
J Clin Neurosci ; 20(9): 1264-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23830690

RESUMO

Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the safety and feasibility of combined coiling and neuroendoscopy for treating severe SAH with massive IVH. Between April 2008 and June 2011, 49 patients with a severe SAH were treated at the Department of Neurosurgery, Fukuoka University, Japan; 10 of these patients had a massive IVH with a ruptured aneurysm. All 10 patients (three men and seven women; mean age, 63.1±8.5 years) were treated with coiling and neuroendoscopic removal of the IVH within 2 days of onset. Coiling was successfully performed at a mean volume embolization ratio of 21.8±5.5%. Neuroendoscopic removal of the IVH reduced the mean Graeb score from 10.5±2.0 to 4.8±2.5 (p=0.005). All external drains were removed on day 3. No rebleeding or acute hydrocephalus was noted. The Glasgow Outcome Scale scores at discharge indicated two patients with good recovery, three with moderate disability, four in a vegetative state, and one dead. A good modified Rankin Scale (mRS) score (0-2) at least 6 months later (mean follow-up period, 15.4±9.2 months) was observed for five patients (50%), and a poor mRS score (3-6) was observed for the remaining four patients. Neuroendoscopically removing the IVH from all of the ventricles between the lateral and the fourth ventricle and coiling the ruptured aneurysm is a safe, feasible approach for treating severe SAH with massive IVH.


Assuntos
Ventrículos Cerebrais/cirurgia , Ventriculografia Cerebral , Neuroendoscopia/métodos , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Idoso , Ventriculografia Cerebral/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
J Neurosurg ; 118(3): 632-6, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23311937

RESUMO

OBJECT: Indocyanine green (ICG) videography is commonly used in the neurosurgical field for minimally invasive neurosurgery. The aim of this study was to evaluate a new intraoperative imaging modality by performing transdural ICG videography during surgery for meningiomas. METHODS: Between March 2011 and April 2012, 10 patients with meningiomas received intravenous injection of 12.5 mg ICG just prior to dural opening. The cases comprised 8 convexity meningiomas and 2 foramen magnum meningiomas. Efficacy of the transdural ICG videography was assessed in terms of the tumor volume, the circulation time from the first appearance of the vessel to the appearance of the venous sinus, the tendency to bleed, and the discrimination of the venous sinus. RESULTS: The mean tumor volume was 71.6 ± 87.9 ml (the mean is expressed ± SD throughout). The cortical arteries, veins, and the venous sinus were identified by the ICG videography transdurally. The projection of the meningiomas was identified by a shadow (which the authors call the eclipse sign). Total eclipse signs were obtained in 8 cases and partial eclipse signs were obtained in 2 cases; tumor volume in the latter was more than 200 ml. In 5 of 10 cases the adjacent venous sinuses were exposed and were successfully visualized by ICG videography in 5.92 ± 1.05 seconds from the first appearance of the vessel. In 5 of 10 cases the total and the partial eclipse signs were diminished in 3.46 ± 1.31 seconds. The diminishment of the total and the partial eclipse sign was earlier than the visualization of the venous sinus (p = 0.011, t-test), revealing bleeding from the tumor that was observed until coagulation of the feeding arteries from the intracranial arteries. CONCLUSIONS: Prior to opening of the dura mater, transdural ICG videography was used successfully to visualize the dural attachment of meningiomas and the venous sinus, resulting in safe and appropriate dural opening. The diminishment of the total and partial eclipse signs may represent significant feeding from the intracranial arteries and a tendency to bleed during resection.


Assuntos
Corantes , Verde de Indocianina , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Procedimentos Neurocirúrgicos/métodos , Gravação em Vídeo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/etiologia , Meios de Contraste , Cavidades Cranianas , Dura-Máter , Feminino , Gadolínio , Humanos , Período Intraoperatório , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Estudos Retrospectivos
18.
Anticancer Res ; 29(3): 889-95, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19414324

RESUMO

BACKGROUND: Ultrasound has recently been applied to the treatment as well as the diagnosis of various pathologies, and its antitumor effects in the treatment of human cancer and experimental models of cancer have been demonstrated. In addition, it is possible that certain photosensitizers will enhance the antitumor effects of ultrasound. However, very few studies have been reported on how the blood-brain barrier is affected by sonodynamic therapy. The purpose of this study was to evaluate disruption of the blood-brain barrier with focused ultrasound with a photosensitizer, for clinical application of sonodynamic therapy to brain tumors. MATERIALS AND METHODS: Rat brains were subjected to focused ultrasound irradiation via a transducer with or without prior intravenous injection of photosensitizer, and lesions were examined histologically by electron microscopy. RESULTS: Electron microscopically, swelling of astroglial processes, denatured cells, protoplasm of endothelial cells, and mitochondria were observed in the center and border of regions of ultrasonic irradiation. There were numerous pinocytotic vesicles in the cytoplasm of the endothelial cells. In addition, disruption of the cytoplasmic membrane of endothelial cells and astroglia was found in these regions. CONCLUSION: These findings suggest that sonodynamic therapy with a photosensitizer affects the blood-brain barrier, and that blood vessel permeability increases not only as a result of destruction of the blood-brain barrier but also by disruption of the cytoplasmic membrane of endothelial cells.


Assuntos
Barreira Hematoencefálica/efeitos dos fármacos , Barreira Hematoencefálica/diagnóstico por imagem , Fármacos Fotossensibilizantes/uso terapêutico , Rosa Bengala/uso terapêutico , Terapia por Ultrassom , Animais , Astrócitos/ultraestrutura , Permeabilidade Capilar/efeitos dos fármacos , Membrana Celular/efeitos dos fármacos , Endotélio Vascular/ultraestrutura , Feminino , Mitocôndrias/ultraestrutura , Ratos , Ratos Wistar , Ultrassonografia
19.
Anticancer Res ; 29(3): 943-50, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19414331

RESUMO

UNLABELLED: In this study we sought to determine the optimal focused ultrasound acoustic conditions with photosensitizers for the ablation of experimental intracranial glioma in rats. MATERIALS AND METHODS: Normal rat brains were sonicated via a transducer placed on the dural surface with or without a prior intravenous injection of the photosensitizer Rose Bengal (50 mg/kg of body weight). The ultrasound intensity was varied to 25, 110 or 150 W/cm(2), and the duration of irradiation was 10 s, or 1, 3, or 5 min. In experimental intracranial gliomas, one week after inoculation of C6 rat glioma cells in the rat brain, the rat brain was sonicated through a 10 mm-diameter craniotomy. RESULTS: A selective antitumor effect against cerebral glioma while sparing normal brain tissues was achieved by sonodynamic focused therapy consisting of focused ultrasound at 25 W/cm(2) at 1 MHz for 5 min and Rose Bengal (50 mg/kg of body weight). The areas of tumors in sham-operated rats and in rats that received sonodynamic therapy without and with Rose Bengal at an intensity of 25 W/cm(2) for 5 min were 19.53+/-3.89, 10.64+/-2.21 and 3.01+/-1.74 mm(2), respectively. The tumor area was significantly smaller in the ultrasound therapy groups than in control non-treated animals (p=0.002). There was no significant temperature change in tumor tissues during sonication with 25 W/cm(2) at 1 MHz. CONCLUSION: This is the first report to demonstrate the usefulness of sonodynamic therapy consisting of focused ultrasound and photosensitizer for the treatment of experimental malignant glioma.


Assuntos
Neoplasias Encefálicas/terapia , Modelos Animais de Doenças , Glioma/terapia , Fármacos Fotossensibilizantes/uso terapêutico , Rosa Bengala/uso terapêutico , Terapia por Ultrassom , Animais , Neoplasias Encefálicas/patologia , Terapia Combinada , Glioma/patologia , Masculino , Ratos , Ratos Wistar , Sonicação , Células Tumorais Cultivadas
20.
Neurol Med Chir (Tokyo) ; 49(1): 30-2, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19169000

RESUMO

We report a case of ruptured tectal arteriovenous malformation (AVM) that was demonstrated angiographically only after removal of an unruptured occipital AVM. A 57-year-old man presented with sudden onset of diplopia and tinnitus. Computed tomography revealed a small hemorrhage in the right tectum mesencephali with intraventricular hemorrhage. Magnetic resonance imaging and angiography disclosed AVM in the right occipital lobe which was separate from the hemorrhagic lesion. Angiography demonstrated that the right occipital AVM was fed by the parieto-occipital artery and drained into the superior sagittal sinus and vein of Galen. However, no abnormal vascular lesion was detected near the tectum mesencephali. As venous hypertension was considered the reason for hemorrhage, the occipital AVM was completely resected. Postoperative angiography demonstrated disappearance of the occipital AVM, but it also disclosed a small tectal AVM fed by branches from the superior cerebellar artery, which had not been detected on preoperative angiography. This was considered the true cause of hemorrhage, and gamma knife surgery was accordingly performed. Even if an AVM is demonstrated, if the lesion does not correspond to the hemorrhage we recommend serial angiographical evaluation so that a small AVM is not missed.


Assuntos
Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Complicações Pós-Operatórias/etiologia , Teto do Mesencéfalo/irrigação sanguínea , Angiografia Cerebral , Diplopia/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/cirurgia , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Lobo Occipital/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Radiocirurgia , Ruptura Espontânea , Teto do Mesencéfalo/diagnóstico por imagem , Teto do Mesencéfalo/patologia , Teto do Mesencéfalo/cirurgia , Zumbido/etiologia , Tomografia Computadorizada por Raios X
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