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T Isu

Publications and source records attributed to T Isu.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Intraoperative monitoring of facial electromyographic responses during neurovascular decompressive surgery for hemifacial spasm].

UNLABELLED: In this paper, we reported our experience of intraoperative facial electromyographic recordings obtained during microvascular decompression for hemifacial spasm. MATERIALS AND METHODS: Intraoperative electromyographic recordings from the mentalis muscle during stimulation of the temporal branch of the facial nerve has been attempted in 31 patients. No muscle relaxants were used except for those before intubation. Of 31 patients, 22 were female and 9 were male. The age on admission ranged from 31 to 60 years with a mean of 54 years. RESULTS: 1. Abnormal response appeared with a latency of about 10 msec after stimulation. This response disappeared in 30 out of 31 patients at the end of operation. In 4 patients, the abnormal response disappeared prior to decompression of the nerve. 2. 30 patients in whom the abnormal response disappeared were free of spasm immediately after surgery. Hemifacial spasm has been relieved in 28 patients with a follow up period of 6 months to 2 years and 7 months. The remaining two patients had mild spasm. The one patient in whom the abnormal response did not disappear had persistent hemifacial spasm. CONCLUSION: The authors think that intraoperative facial electromyographic recording is useful to identify the blood vessel that is causing the spasm and to ensure that decompression of the nerve has been accomplished.

Adult↗
PubMed1991

Spinal cord herniation associated with an intradural spinal arachnoid cyst diagnosed by magnetic resonance imaging.

Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst.

Adult↗
PubMed1991

Acute aggravation of subdural effusion associated with pachymeningitis carcinomatosa: case report.

The authors present a case of acute aggravation of subdural effusion associated with pachymeningitis carcinomatosa. Microscopic examination of a surgical specimen revealed diffuse involvement of the dura mater by a metastatic adenocarcinoma in which the tumor cells invaded venules located in the areolar layer in particular. The rapid increase in capillary transmural pressure resulted in extravasation of plasma components, causing an increase in subdural effusion.

Adenocarcinoma↗
PubMed1991

[Post-traumatic syringomyelia. Report of three cases].

Three cases of post-traumatic syringomyelia are presented and the mechanism of syrinx formation is discussed. Two cases were examined radiologically. Computed tomography and magnetic resonance images (MRI) showed an expansive syrinx with adhesive arachnoiditis in the thoracic levels below the injury site and a localized syrinx on the posterolateral gray matter in the cervical levels above the injury site. These syrinxes existed below the C2 level and had no communication with the fourth ventricle. The other was an autopsy case. Postmortem examination revealed that a syrinx existed from C2 to Th6 and had no communication with the fourth ventricle or the central canal. It is concluded that small traumatic cavities in the gray matter evolve to an extensive syrinx by cerebrospinal fluid (CSF) entering via the posterior root entry zone, and adhesive arachnoiditis is an important factor in increasing the CSF which is entering. MRI was useful for the diagnosis.

Adult↗
PubMed1991

[Magnetic resonance imaging of posttraumatic syringomyelia and its surgical treatment].

Posttraumatic syringomyelia is an uncommon but significant late complication of spinal cord injury. It occurs in approximately 1.1 - 3.2% of cases of spinal injuries. With the increasing availability of CT and magnetic resonance imaging (MRI), the incidence of posttraumatic syringomyelia is increasing. The purpose of this report is to show MRI of posttraumatic syringomyelia and to assess the results of surgical treatment. Materials and Methods This series included 16 cases of posttraumatic syringomyelia studied with MRI. 9 out of 16 cases showed delayed deterioration of neurological symptoms following spinal injuries. The interval between the trauma and the delayed symptoms of deterioration was from 2 years 2 months to 32 years (mean, 8 years and 5 months). There were 13 men and 3 women. The age ranged from 22 to 69 years, with a mean age of 42 years. The initial spinal cord injury was located in the lower cervical region in 4 cases, the thoracic region in 8, and the upper lumbar region in 4. All the patients were studied with resistive 0.15T system (Toshiba MRT 15 A) or a superconductive 0.5T system (Toshiba MRT 50 A) or a superconductive 1.5T system (GE Sigma or Siemens Magnetom). Six patients underwent 8 operative procedures for posttraumatic syringomyelia. Syringoperitoneal shunt was performed in 4 patients, syringosubarachnoid shunt in 3 and ventriculoperitoneal shunt in one. Results 1. MRI In all cases, the posttraumatic syringomyelia was easily diagnosed by MRI. The syrinx extended superiorly and/or inferiorly from the area of the old trauma. In 4 out of 16 cases, the syrinx extended into the medulla oblongata.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Diagnosis and surgical treatment of spinal hemangioblastoma].

Spinal hemangioblastoma is a rare tumor. Its incidence varies from 1.6 to 2.1% of primary spinal cord tumors. In this report, the authors described MRI (magnetic resonance imaging) of spinal hemangioblastoma and its surgical results. [MATERIALS AND METHODS] This series included 10 spinal hemangioblastomas studied with CT or MRI. There were 8 men and 2 women. The age ranged from 21 to 68 years, with a mean age of 45 years. 6 patients were preoperatively and postoperatively studied with a resistive 0.15 T system (Toshiba MRT 15A) or a superconductive 1.5 T system (GE Signa or Siemens Magnetom). The lesions were single in 8 out of 10 patients and multiple in 2. 10 spinal hemangioblastomas were located in intramedullary space and 2 in both intramedullary and extramedullary space. 8 out of 10 patients (80%) were associated with cyst. [RESULTS] (1) MRI In T1-weighted MR images after administration of Gd-DTPA, the solid component of the tumor enhanced brilliantly. The enhanced lesions contained serpiginous areas of signal void, reflecting vascular structures in 5 out of 6 cases. The intrinsic spinal cord signal was heterogenous with low intensity areas representing the associated cyst. The cyst appeared either isointensive to cerebrospinal fluid (CSF) or hyperintense relative to CSF and slightly hypointense relative to the spinal cord. The precise delineation of the tumor was impossible without enhancement. Noncontrast T1-weighted MR images displayed diffuse widening of the spinal cord. On T2-weighted MR images, all regions of the spinal cord enlargement increased in signal. (2) Postoperative results All 10 cases of spinal hemangioblastomas were totally removed with good postoperative results and the associated cysts were drained. The postoperative MRI showed the disappearance of the tumor and significant reduction in the size of the cyst. [CONCLUSION] (1) Gd-DTPA enhanced MRI was useful in defining and outlining the solid component of spinal hemangioblastoma. (2) The complete removal of the tumor with only drainage of the cyst was possible with good postoperative results.

Adult↗
PubMed1991

[Stab wounds of the spinal cord by a kitchen knife: report of a case].

A case of spinal cord injury due to stab wounds by a kitchen knife is presented. A 41-year-old male was hospitalized because of spinal cord injury resulting from stab wounds inflicted with a kitchen knife in the posterior cervical area. Neurological examination on admission showed paraplegia, disappearance of deep tendon reflex in both lower extremities, sensory disturbance below T1 level, left Horner's syndrome and urinary disturbance. In addition to these symptoms cerebrospinal fluid was leaking from the wounds. An emergency operation was performed. After laminectomy of C7 and T1, we found that the spinal cord was almost completely split at C7/T1 level. Dural plasty was performed. Neurologically, sensory disturbance was slightly improved at 4 months after the injury. Initial MRI (TR: 200 msec, TE: 20 msec) revealed high intensity at C7/T1 level which was damaged by the kitchen knife. MRI 5 months after the injury revealed low intensity on T1 weighted imaged, high intensity on T2 and proton weighted image. The occurrence of the spinal cord injury due to stab wounds by a kitchen knife is very rare in Japan. MRI is useful in the diagnosis of stab wounds of the spinal cord.

Adult↗
PubMed1991

[A case report: intraspinal canal osteochondroma at the cervicothoracic junction causing spinal cord compression].

Osteochondromas are one of the most common benign tumors. They typically develop on long, tubular bones, only rarely compressing the spinal cord. We report the case of a 9-year-old boy who suffered paraparesis secondary to a cervical osteochondroma based at the vertebral body. The tumor was removed using laminectomy. CT scanning, plain X-ray films, and MR imaging were used in the preoperative assessment of the lesion and the operative method.

Child↗
PubMed1990

Syringo-subarachnoid shunt for syringomyelia associated with Chiari malformation (type 1).

The authors report the surgical results of 28 patients with syringomyelia associated with Chiari malformation (type 1). 28 patients underwent 34 operative procedures. Syringo-subarachnoid shunt was performed in 28 patients, foramen magnum decompression with syringo-subarachnoid shunt in three, ventriculo-peritoneal shunt in one, terminal syringostomy in one, and foramen magnum decompression with terminal syringostomy in one. In an average postoperative follow-up period of 3 years and 9 months ranging from one year to 7 years and one month, neurological symptoms and signs improved in 24 out of 28 patients (82%). Some improvement was noted in sensory deficit and motor weakness. In 3 patients, the symptoms did not change. In 3 patients whose symptoms were unchanged, preoperative studies demonstrated atrophy of the spinal cord, in which irreversible changes were shown. The symptoms deteriorated in one patient. In one patient whose symptoms increased 3 months after syringo-subarachnoid shunt, shunt insufficiency due to postoperative adhesive arachnoiditis was responsible for neurological deterioration. The authors propose that syringo-subarachnoid shunt is effective as a surgical procedure for syringomyelia associated with Chiari malformation (type 1) if the patient does not have symptoms due to Chiari malformation or has only mild signs and symptoms which do not require foramen magnum decompression, such as nystagmus or atrophy of sternocleidomastoid muscle.

Adolescent↗
PubMed1990

Hydrosyringomyelia associated with a Chiari I malformation in children and adolescents.

The clinical presentation, radiological features, and results of surgical treatment were analyzed in 17 cases of hydrosyringomyelia associated with a Chiari malformation, in children and adolescents younger than 20 years of age. The initial symptoms were a skeletal abnormality (71%), such as scoliosis (11 patients) or pes cavus (1 patient), pain or numbness (24%), and motor weakness (6%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (85%), muscle weakness (64%), muscle atrophy (35%), and lower cranial nerve palsy (35%). The characteristic neurological findings were unilateral sensory and motor deficits (65%) with decreased or absent deep tendon reflexes on the same side. The localization of the syrinx on the axial section varied according to the level, even in the same patient. In 11 patients with unilateral sensory disturbances or unilateral sensory and motor deficits, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance at the cervical or thoracic level. On the other hand, in 6 patients with bilateral sensory and motor deficits, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side. A syringosubarachnoid shunt was placed in 16 patients, foramen magnum decompression without closure of the obex was performed in 1 patient, ventriculoperitoneal shunt in 1 patient, terminal syringostomy in 1 patient, and foramen magnum decompression with terminal syringostomy in 1 patient. In 15 of 17 patients (88%), the neurological symptoms improved after an average follow-up of 4 years and 1 month. We think that as a surgical treatment, placement of a syringosubarachnoid shunt is effective.

Adolescent↗
PubMed1990

[Effect of mannitol administration and myelotomy on acute experimental spinal cord injury: investigation by spinal cord evoked potential].

The authors reported the changes in spinal cord evoked potential following impact injury by the weight-dropping technique in untreated and treated animals. The effect of mannitol and myelotomy therapy on spinal cord evoked potential in experimental spinal cord injury was discussed. (Materials and Methods) 32 adult dogs, ranging in weight from 9 to 13 kg, were used. 28 dogs received 300 gm-cm contusion of the T10 spinal cord. Eight dogs were not treated and twenty dogs were treated with mannitol. Ten dogs were treated with intravenous continuous infusion of mannitol (1g/kg/hr) 30 minutes after the injury, and ten dogs with intravenous bolus injection of mannitol (2 g/kg) at 30 minutes and 3 hours after the injury. At one hour after the injury, five dogs with 400 gm-cm contusion were treated with posterior midline myelotomy. The spinal cord evoked potential following direct stimulation of the spinal cord was recorded from the epidural space for 5 hours. The recording electrode was located cephalad to the site of the impact injury. (Results and Discussion) In each group, the amplitude of I potential decreased remarkably immediately after the injury. Subsequently, gradual recovery was obtained. In the untreated 300 gm-cm contusion group, no apparent improvement was seen from one hour after injury. On the other hand, in the mannitol-treated group, the recovery of the amplitude was superior to that found in the untreated group at a significant level of P less than 0.05. However, in the group with intravenous bolus injection of mannitol, the recovery was transient.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Spinal cord evoked potential in experimental spinal cord injury--the changes in spinal cord evoked potential following impact injury, and effect of mannitol administration on acute experimental spinal cord injury].

The authors reported the changes of spinal cord evoked potential following impact injury by the weight dropping technique in untreated and treated animals. The correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs was also discussed. (Materials and Methods) The spinal cord of 57 adult dogs was traumatized by the weight dropping technique at the level of Th10. 37 dogs were not treated. The trauma consisted of 300 gm-cm impact injury, 400 gm-cm impact injury and 500 gm-cm impact injury. The motor function of the dogs was observed by clinical scale for rating hind limb motor function (modified Tarlov score) for one month after trauma. 20 dogs with 300 gm-cm contusion were treated with mannitol. 10 dogs were treated with intravenous continuous infusion of mannitol (1 g/kg/hr) 30 minutes after injury and 10 dogs with intravenous bolus injection of mannitol (2 g/kg) at 30 minutes and 3 hours after injury. The spinal cord evoked potential following direct stimulation of the spinal cord was recorded from the epidural space for 5 hours. The recording electrode was located cephalad to the site of the impact injury. (Results and Conclusion) 1. In each group, the amplitude of I potential decreased remarkably immediately after injury. Subsequently, gradual recovery was obtained. The spinal cord evoked potential following impact injury by the weight dropping technique could be estimated one hour after trauma in 300 gm-cm, 30 minutes after trauma in 400 gm-cm injury and immediately after trauma in 500 gm-cm injury. 2. Spinal cord evoked potential was useful in monitoring the recovery potential of the spinal cord. Recovery of amplitude more than 40% indicated a favorable prognosis. On the other hand, recovery of amplitude less than 19% showed a poor prognosis. However, the precise prognosis for motor recovery could not be accurately estimated in dogs with recovery of amplitude between 39% and 20%. 3. In mannitol-treated group with intravenous continuous infusion, the recovery of the amplitude was superior to that in untreated group at a significance level of p less than 0.05. However, in the group with intravenous bolus injection of mannitol, the recovery was transient.

Animals↗
PubMed1990

[An autopsy case of amyotrophic lateral sclerosis associated with cervical syringomyelia].

An autopsied case of amyotrophic lateral sclerosis complicated by cervical syringomyelia was reported. The case was a 59-year-old man, who first noticed weakness of both lower extremities at 54-year-old. The weakness spread to both upper extremities within 2 years. Cervical myelography revealed multi-level cervical spondylosis and anterior fusion of C5-C7 was done. But the weakness and atrophy of proximal muscle, diminished deep tendon reflex on upper extremities, hyperreflexia and pathological reflexes on both legs, tongue fasciculation and respiratory muscle weakness developed successively, and the patient died of respiratory distress at 59-year-old. Autopsy revealed multiple independent four syrinxes located at the level between C2-C7. One of these syrinxes had ependymal cell lining and thought to be idiopathic syringomyelia. The other three syrinxes were considered to be the cavitation in association with cervical spondylotic myelopathy. Degeneration and decreasing of spinal anterior horn cells, atrophy of medullary pyramis and Bunina bodies were observed as features of typical amyotrophic lateral sclerosis. Cervical spondylosis as causative lesion of multiple syrinxes was discussed, and relationship between ALS and the syrinxes was not indicated clearly.

Amyotrophic Lateral Sclerosis↗
PubMed1990

[Anterolateral approach to giant cell tumor in T4 vertebral body].

A case of giant cell tumor involving the Th4 vertebral body is reported. A 27-year-old man, who had a 2 month history of back pain and paraparesis, was admitted to our department in August, 1986. On the first admission, he manifested severe paraparesis and sensory disturbance below the Th5 dermatome level. Neuroradiological examination demonstrated an epidural tumor involving the Th4 vertebral body and compressing the spinal cord. Emergency laminectomy for decompression and biopsy was performed. The surgical specimen was a giant-cell tumor. 6 weeks after the first operation, total removal of the tumor and anterior fusion of the Th 3-5 with iliac bone graft was performed through the anterolateral transthoracic approach. Postoperative course was uneventful. A curative resection and immediate stabilization was thus able to be undertaken through the anterolateral transthoracic approach, when the epidural tumor was confined to the thoracic vertebral body.

Adult↗
PubMed1990

[Metastatic Grawitz's tumor to the cauda equina: case report].

A case of Grawitz's tumor metastasizing to the cauda equina is presented. A 51-year-old male was hospitalized due to severe low back pain radiating to the left lower extremity. Neurological examination showed only hyporeflexia of the left patella reflex and positive Lasegue's sign. MRI showed intradural mass at the L4 level. Preoperatively, we diagnosed a cauda equina tumor. A laminectomy of both L3 and L4 was performed, and total removal of the cauda equina tumor was performed. Microscopically, the tumor cells were large, the appearance of the cytoplasm ranging from optically clear with sharply outlined boundaries, to deeply granular, with many transitional forms. These histological findings were typical findings of Grawitz's tumor, and were the same as those of this patient's renal tumor. Finally, we diagnosed Grawitz's tumor metastasizing to the cauda equina. Metastatic cauda equina tumor from outside the central nervous system is very rare and only 7 cases have been reported. This case is the first one of Grawitz's tumor spreading to the cauda equina.

Carcinoma, Renal Cell↗
PubMed1990

[MR imaging of cervical disc disease: value GRASS imaging].

Since magnetic resonance imaging (MRI) technology has been greatly improved, MRI for cervical disc disease has become widely used in many facilities. Among non-invasive procedures, MRI is regarded as one of the most useful ones. Conventional myelography, CT myelography, and MRI were performed on 10 patients with cervical disc disease. The authors discussed the correlation between conventional myelography, CT myelography, and MRI as regards their ability to determine the localization and the laterality of disc protrusion and osteophyte. In our MRI study, we use both short-echo (SE) images and GRASS images. The parameters of our GRASS included 5mm-thick sections. TR = 200, TE = 20, and flip angles of 10 degrees. This pulse sequence generates images with high signal cerebrospinal fluid (CSF), resulting in a high-contrast CSF-spinal cord, osteophyte, and disc protrusion. As yet, although it easily shows the localization and laterality of the disc and/or osteophyte, image quality of the GRASS is not yet sufficient to allow us to evaluate detailed deformity of the spinal cord and nerve root. The authors stress the usefulness of this GRASS image for the evaluation of suspected cervical disc disease.

Adult↗
PubMed1990

[Clinical and neuroradiological features of syringomyelia associated with Chiari malformation].

The clinical presentation and radiological features were analyzed in 30 cases of syringomyelia associated with Chiari malformation. None of the patients had spinal dysraphism. The age on admission ranged from 6 to 59 years with a mean of 27 years. Syringomyelia was diagnosed by CT myelography and or MRI from 1982 to 1988. The initial symptoms were skeletal abnormality (43%) such as scoliosis (12 cases) or pes cavus (one case), unilateral pain or numbness (40%) and unilateral motor weakness (17%). Frequently seen signs on admission were sensory deficit (100%), scoliosis (57%), muscle weakness (57%), muscle atrophy (37%) and lower cranial nerve palsy (40%). The neurological findings were asymmetrical in all patients. The characteristic neurological findings in the cases presenting under 20 years of age were unilateral sensory and motor deficits (61%) with decreased or absent deep tendon reflex on the same side. The localization of the syrinx in axial section varied according to the level even in the same case. In 15 cases with unilateral sensory disturbance or unilateral sensory and motor deficit, the syrinx was located in the region corresponding to the posterolateral portion on the same side as that of sensory disturbance in the cervical or thoracic level. On the other hand, in 15 cases with bilateral sensory and motor deficit, the syrinx was located in the central portion and extended into the posterolateral portion of the more affected side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗