Biomedical subjects
Publications and source records attributed to J Handa.
A spontaneous regression of the lesion seen in sequential computertomographic scans does not necessarily indicate a non-neoplastic nature of the pathological process. Two patients with pathologically verified glioma of the brain which showed a temporary regression of the mass effect are reported, and the mechanism of the regression of computertomographic mass signs is discussed.
A rare case of intrasacral perineurial cyst is presented. Findings on metrizamide myelography and computed tomography scan are described, and their usefulness in the diagnosis of this rare condition is emphasized. The literature is reviewed, and the clinical and pathological features of the 17 reported cases including our own are summarized. Indication for operation and surgical approach are briefly discussed.
Cervical laminoplasty was performed in 31 patients with compressive myelopathy due to developmental stenosis of the spinal canal, using apatite beads as implants. Bilateral foraminotomies were performed at C-5-C-8 levels in an attempt at preventing aggravation of radicular symptoms. Laminae of C-3 through C-7 (or T-1) were removed en bloc and then replaced maintaining an increased anteroposterior diameter of the bony canal by means of insertion of apatite beads between the cut surfaces of the laminae. The literature on posterior decompression for cervical canal stenosis is reviewed, and the advantage of the present method is briefly discussed.
We have devised a new drill burr that is particularly suitable for an anterior approach to the spinal cord. The drill burr is conical in shape, with a shaft attached to its top and fine diamond edges on the curved slope, but not on its tip. The bone is scraped off while the burr is being gently pulled up but not pressed down. This new drill burr has proved to be most useful in safely removing osteophytes and hypertrophied uncovertebral joints without damaging the already compromised spinal cord.
A 51-year-old woman with an unruptured giant aneurysm of the internal carotid artery was treated by gradual occlusion of the internal carotid artery in the neck combined with a superficial temporal artery to middle cerebral artery bypass graft. Visual field defects improved after the operation, and thrombosis of the aneurysm was confirmed by angiography and computed tomography. Nevertheless, a fatal hemorrhage occurred 34 days after the final turn of the Selverstone clamp. The possible mechanism of rupture of the apparently thrombosed aneurysm is discussed. There is a risk of rupture of the aneurysm as long as the aneurysmal lumen remains after proximal ligation, no matter how small it may be.
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A case of primary haemangioblastoma with a marked blood supply from multiple meningeal branches of the internal and external carotid arteries is reported, and the clinical implication of detailed angiographic study of unusual feeders in this highly vascular tumour is discussed.
The authors report eight cases of aneurysm of the anterior cerebral artery proximal to the anterior communicating artery (A1 segment). In six of these cases, the aneurysms arose from the proximal anterior cerebral artery at the origin of either a cortical branch (on case), the accessory middle cerebral artery (one case), or a perforating branch (four cases). In another case the aneurysm arose at the proximal end of the fenestration, whereas in the one remaining case no branch was present at the site of the aneurysmal neck.
A rare case of cerebral varix associated with a venous angioma is reported. Findings on dynamic computed tomography were highly characteristic and closely correlated to those on angiography. To our knowledge, such a combination of cerebral vascular anomalies has been reported only once previously.
Fusiform aneurysms have often been reported on the internal carotid or vertebrobasilar arteries, but those solely involving the more distal segment of a cerebral artery seem to be exceptional. In a patient harboring two saccular cerebral aneurysms, angiography of the carotid arteries revealed a fusiform dilatation restricted to the anterior communicating artery. At autopsy, this dilatation proved to be a fusiform aneurysm.
We report an unusual case of meningeal dissemination of medulloblastoma in which multiple cerebrospinal fluid entrapment cysts developed within the cerebral fissures and cisterns. The condition was first diagnosed by CT. Cysts reduced in size following radiotherapy.
During the last three years we have experienced 20 cases of atlanto-axial dislocation (AAD) of various types. The series consists of 10 cases of traumatic anterior pure AAD, 2 traumatic anterior AAD with dens fracture, 2 os odontoideum, 1 rheumatic AAD, 1 Jefferson's fracture, and 3 "rotatory dislocation" (1 pure traumatic rotatory dislocation and 2 rotation deformity after Wackenheim). All patients were studied by plain X-ray, tomography, myelography with water soluble contrast media and computed tomography (CT) scanning. All of the operated patients and a part of the non-operated patients were also examined by CT myelography (met. CT) 3 hours after myelography. A special attention was paid to the shape of the spinal cord and the thecal sac at the level of dislocation, in several positions of the head such as hyperextension, neutral position, flexion, lateral bending and right or left rotation. A met. CT could clearly demonstrate that the thecal sac and the spinal cord were compressed by the dens and/or posterior arch of the atlas in traumatic pure anterior AAD. In all cases of ADD with dens fracture or os odontoideum, however, the spinal cord was compressed not by the dens but by the posterior margin of body of the axis. The fractured dens always moved with anterior arch of the atlas. This finding was most clearly documented by met. CT in flexion. In some cases of AAD accompanying rheumatic changes or narrowing of the spinal canal, a posterior decompression with postero-lateral fusion is indicated. A transoral anterior fusion in hyperextended position of C1 and C2 together with the fractured dens, followed by a Halo vest fixation, is the treatment of choice in traumatic AAD with dens fracture and os odontoideum. A posterior C1 and C2 fixation using Urlich's metal plate is also recommended for anterior pure AAD. CT scanning, especially met, CT, is by far the better than the conventional radiologic examinations to determine the indication, approach and mode of operation in AAD.
Pontine gliomas have been considered to be out of indication for operative treatment. However, in case of a cystic type, evacuation of the cyst alone can possibly extend the survival time of the patient. Since the advent of high resolution CT the nature of the pontine tumor, whether cystic or solid, can be easily differentiated, and cystic ones subjected to operation will be increasing in number. We report a case of cystic pontine glioma associated with von Recklinghausen's disease. The patient showed a remarkable improvement in her neurological status after evacuation of the cyst. A 16-year-old girl was admitted to our clinic with complaints of tinnitus and hearing difficulty of the left ear, progressive gait disturbance and double vision. Neurological examination revealed a sensory disturbance on the left side of the face, left abducens palsy, left facial paresis, left deafness, left cerebellar ataxia, right hemiparesis and right hemisensory disturbance excluding the face. Signs and symptoms of increased intracranial pressure were absent. There were many cafe-au-lait spots and several subcutaneous nodules. CT scan demonstrated a cystic lesion with a mural nodule in the left cerebello-pontine angle. The patient underwent left suboccipital craniectomy, and a puncture of the cyst between the trigeminal and facial-acoustic nerves which were displaced dorsally yielded yellowish fluid. The content of the cyst was evacuated and its wall was widely opened. After the operation the patient showed a remarkable improvement in her neurological deficits only with left deafness remained unchanged. Histological examination showed anaplastic astrocytoma. She was discharged after irradiation of 5000 rads.(ABSTRACT TRUNCATED AT 250 WORDS)