[Computer assisted neurosurgery based on individualized functional anatomy].
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Adolescent↗
Biomedical subjects
T Yoshimine
Publications and source records attributed to T Yoshimine.
Primary lymphoma of the brain developing in a boy after a 5-year history of encephalitis: polymerase chain reaction and in situ hybridization analyses for Epstein-Barr virus.
A 7-year-old boy presented with headache, vomiting, fever, epileptic seizure, and a left hemiparesis. Computed tomography revealed low-density areas in the left frontal lobe and right occipital lobe. Incisional biopsy of the right occipital lesion showed a diffuse and laminar destruction accompanied by microglial reaction in the cortex. An encephalitis of unknown etiology was suspected without data on viral titers in the serum and cerebrospinal fluid. Two months later right hemiparesis and ataxia appeared that were alleviated by prednisolone. Thereafter, similar symptoms repeatedly appeared, but disappeared after treatment with prednisolone. Approximately 5 years later, hemiparesis recurred: computed tomography revealed an 8 x 5 cm mass in the right lobe. A brain biopsy revealed non-Hodgkin's lymphoma of diffuse large, predominantly non-cleaved cell type of B-cell nature. The patient died 1 week after the surgery. The first biopsy specimen (taken at 7 years of age) did not contain Epstein-Barr virus genomes even when examined by polymerase chain reaction. The polymerase chain reaction and in situ hybridization techniques on the second biopsy specimens (taken at 12 years of age) revealed the Epstein-Barr virus sequences in the nuclei of diffuse large cell lymphoma. These findings suggested that the Epstein-Barr virus infection occurring between the first and second biopsies played an etiologic role in the pathogenesis of the brain lymphoma.
Brain Neoplasms↗
Two-step procedure for early neonatal surgery of fetal hydrocephalus.
This retrospective study analyzed the diagnosis and treatment of 36 infants with central nervous system anomalies diagnosed antenatally by ultrasonographic studies between December, 1987 and December, 1990. Magnetic resonance imaging of the fetuses without maternal or fetal sedation/anesthesia was very useful, as the fetal ventricular system was depicted clearly. Twenty-three infants with hydrocephalus underwent early postnatal surgical emplacement of a miniature Ommaya's reservoir. Continuous cerebrospinal fluid aspiration was combined with intracranial pressure monitoring. Observation of the ventricular size used ultrasonography through the anterior fontanelle. This technique controlled the intracranial pressure during the early neonatal period without serious complications. A ventriculoperitoneal shunt was emplaced 1 month later as the second, more permanent treatment. This two-step procedure achieves brain reconstitution and prevents irreversible neurological damages. Clinical and radiographic findings are presented to illustrate the effectiveness of this approach.
Brain↗
[Neuropsychological findings of functional cortical mapping in patients with brain tumors].
In 3 patients with brain tumors involving language areas, we investigated functional cortical regions and epileptogenic foci using subdural electrode stimulation before operation. These stimulation studies were useful in preserving postoperatively their language function. The following neuropsychological findings were obtained; (1) Stimulation of Broca area (Brodmann 44 and 45) did not produce anarthria (phonetic disintegration), but semantic and phonemic parahasias and word finding difficulties. (2) Stimulation of lower motor cortex elicited anarthria. (3) Buccofacial apraxia was not produced only by stimulation of frontal operculum. (4) When anarthria was elicited by stimulation, difficulty in retrieving both Kana and Kanji letter-forms and paragraphia in Kana letters were sometimes observed. (5) Stimulation at Exner's writing centre did not produce writing deficits, but elicited word finding difficulties and paraphasias.
Adult↗
[Spinal extradural angiolipoma: a case report].
Growth of angiolipoma of the central nervous system is a rare occurrence. Only about 40 cases can be collected in the literature. A 67-year-old man was admitted because of intermittent severe pain in both legs after walking. He had chillness in both legs during the past 5 years which gradually worsened. MR image showed a spinal mass lesion at the level of Th12 to L1. The lesion was isointense on T1-weighted image and slightly hyperintense on T2-weighted image. The tumor was located on the left side of the spinal cord and was markedly enhanced after intravenous Gd-DTPA. At the operation, a soft, dark-red mass was found situated in the epidural space at the level of Th12 to L1, which was totally removed. On histological examination, the tumor was shown to be mainly composed of mature fatty cells and of numerous blood vessels with enlarged lumens. Postoperative course was uneventful and the symptoms subsided during the following few months.
Aged↗
Protective effect of NGF atelocollagen mini-pellet on the hippocampal delayed neuronal death in gerbils.
Very recently, contradictory results were presented as to the effects of exogenous nerve growth factor (NGF) on the hippocampal delayed neuronal necrosis following transient ischemia. In the present study, we administered a large amount of NGF with the atelocollagen mini-pellet system, measured the local NGF contents, and evaluated the effect of this neurotrophic factor on the postischemic hippocampal pyramidal cells in gerbils. We concluded that the exogenous NGF, when given continuously at sufficient concentrations, prevents pyramidal cell damage. The possible cause of discrepancy in previous studies is discussed.
Animals↗
Effects of glucocorticoid and chemotherapy on the peritumoral edema and astrocytic reaction in experimental brain tumor.
To study the effects of glucocorticoids and chemotherapeutic agents on the pathophysiology of the tumor-induced brain edema, the site of Evans blue-albumin extravasation, the distribution of extravasated serum albumin, and the extent of local astrocytic reaction were examined in a rat model of implanted brain tumor. Experimental brain tumors were produced by implanting small pellets of Walker 256 carcinosarcoma into the cerebral cortex of Wistar rats. In the steroid group, rats were administered with intraperitoneal methylprednisolone succinate (15 mg/kg) daily on and after the 6th day postimplantation, and sacrificed on the 14th day. In the chemotherapy group, rats were given an intravenous injection of cyclophosphamide (30 mg/kg) on the 14th day, and sacrificed on the 21st day. Rats in the untreated group were sacrificed on the 14th day without any therapy. Each animal was sacrificed by the transcardiac perfusion with paraformaldehyde 30 min after intravenous injection of Evans blue. Firstly, coronal blocks of the brain were examined for Evans blue staining macroscopically. Paraffin embedded sections were studied for the Evans blue fluorescence and for the immunohistochemical reaction to serum albumin and GFAP. The examination of Evans blue demonstrated that the origin of extravasation of serum albumin was the tumor and the adjacent brain with dense tumor cell infiltration in any group of rats. The extravasated serum albumin distributed widely and the astrocytic reaction was prominent in the brain of the untreated group. A positive correlation was observed between the intensity of albumin immunoreaction and the degree of astrocytic proliferation. Chemotherapy effectively decreased the size of tumor and reduced the extravasation of serum albumin. The astrocytic reaction was however, not reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
The liver in systemic lupus erythematosus: pathologic analysis of 52 cases and review of Japanese Autopsy Registry Data.
We present pathologic findings for 52 livers (51 autopsy specimens and one wedge biopsy specimen) from patients with systemic lupus erythematosus (SLE). Hepatic congestion was the most common disease (40 livers), followed by fatty liver (38), arteritis (11), cholestasis (nine), peliosis hepatis (six), chronic persistent hepatitis (six), nonspecific reactive hepatitis (five), cholangiolitis (four), nodular regenerative hyperplasia of the liver (three), and hemangioma (three). The data obtained here suggest that arteritis of the SLE liver is more common than has been recognized previously. One patient had hepatic infarction complications induced by arteritis. On the basis of the findings in the present study and a review of the literature, we suggest that hepatic infarction resulting from arteritis is rare in SLE. On the other hand, while occurrence of nodular regenerative hyperplasia of the liver in SLE patients has been considered to be rare, our findings suggest that it may be more common than has been recognized previously. Although congestion and cholestasis may be acute terminal illnesses, fatty change is considered to be specific to the SLE liver. Statistical analysis indicates that exposure to a large dosage of glucocorticoids is a significant factor in the etiology of severe fatty liver. In addition, our review of Japanese autopsy registry data for 1,468 patients with SLE indicates that the incidence of chronic liver diseases in SLE autopsy cases is as follows: chronic hepatitis, 2.4%; cirrhosis, 1.1%; and liver fibrosis, 0.8%.
Adolescent↗
A case of Hallervorden-Spatz disease: progressive and intractable dystonia controlled by bilateral thalamotomy.
We present a 10-year-old girl with Hallervorden-Spatz disease diagnosed clinically from the neurological manifestations and the characteristic MRI findings. Her main symptom, dystonia, was progressive and resistant to medication, but this dystonia was controlled by bilateral thalamotomy. No clinical progression of the symptoms was recognized at 21 months from the last operation.
Child↗
[The analysis of nuclear organizer regions of astrocytomas with various histologic malignancies].
Nucleolar organizer regions (NORs) correspond to the loops of DNA which encode the ribosomal RNA. Acid proteins related to NORs can be stained by the silver colloidal technique (AgNORs). Since the configurations of AgNORs may be related to the protein metabolism or the proliferative activity of the cell, we tried to evaluate the corelationship between the morphology of AgNOR and the histologic malignancy in astrocytic tumors. For the quantitative evaluation the histographic pattern of AgNORs was analysed. Twenty-seven surgical specimens of astrocytomas (astrocytoma; 7 Cases, anaplastic astrocytoma; 9 cases, glioblastoma; 11 cases) were examined. The average of the means of AgNOR count in astrocytoma, anaplastic astrocytoma, glioblastoma were 1.68, 1.85 and 2.76 respectively. The averages of standard deviations (S. D.) of AgNOR count were 0.87, 1.03 and 1.26, respectively. In those tumors, the AgNOR histograms were flattered and the means and S. D. increased significantly as the malignancy increased. We speculate that the increased number and variations of AgNOR count could be a reflection of phenotypic alterations of astrocytoma cells such as cellular anaplasia and pleomorphism.
Astrocytoma↗
A frameless, armless navigational system for computer-assisted neurosurgery. Technical note.
A computer-assisted neurosurgical navigational system has been developed which displays intraoperative manipulation on the preoperative computerized tomography (CT) scans or magnetic resonance (MR) images. The system consists of a three-dimensional digitizer, a personal computer, and an image-processing unit. Utilizing recently developed magnetic field modulation technology, the three-dimensional digitizer determines the spatial position and orientation angles of the resin probe, triangle-shaped pointer, or suction tube with a small attached magnetic field sensor. Four fiducial markers on the scalp were used to translate the spatial data of the probe onto the preoperative CT scans or MR images of the patient. With this frameless, armless navigational system, CT or MR-imaging stereotaxy can be applied to conventional open neurosurgery without limiting the operative field or interfering with the surgical procedures.
Adult↗
[Computer assisted neurosurgery: development of a frameless and armless navigation system (CNS navigator)].
We have developed a computer assisted neurosurgical navigation system, which displays the point of ongoing surgical manipulation on the CT or MR images. The system utilizes magnetic field modulation technology for the detection of the 3 dimensional position and orientation angles of the probe, a resin pointer or suction tube with a small magnetic field sensor. Four fiducial markers on the scalp were used to translate the spatial data of the probe onto the CT/MRI images. This frameless and armless navigator with a spatial accuracy of 4mm, introduces CT/MRI-stereotaxy to conventional open neurosurgery without limiting the operative field or interfering with surgical procedures.
Adult↗
[Metastases to the brain--prognosis and surgical indications].
The prognosis of the patients with metastases to the brain is very poor. Based on the data obtained from the Brain Tumor Registry in Japan, relative survival rate curve of the cases with metastatic brain tumors is extremely similar to that of the cases with glioblastoma multiforme which is the most malignant primary brain tumor. Data obtained from the Department of Neurosurgery of Osaka University Medical School, the Center for Adult Diseases, Osaka demonstrated that the brain lesions were the direct causes of death only in 26% of the cancer patients with brain metastases. The result might have indicated that brain metastasis itself could be more controllable than the other lesions of systemic in most of the cases. The indications for surgical treatment of metastatic brain tumors are, in general, as follows; (1) the primary cancer is cured or to be cured, (2) no metastasis to other organs, (3) the brain metastasis is single, solitary and surgically accessible, and (4) the general condition is good enough. But recent advancement in the diagnosis, surgery and patient care are going to extend the indications for surgical treatment. Surgical mortality becomes less than a few percent. The changes of performance status by surgery were investigated in the patients treated in Department of Neurosurgery, Osaka University Medical School and the Center for Adult Diseases, Osaka. Improvement of the performance status after surgery was obtained in 57.8%, stationary in 30.5%, and worsening only in 11.8%.
Brain Neoplasms↗
Long-term survival after removal of primary intracranial malignant melanoma. Case report.
A 57-year-old male with primary intracranial malignant melanoma who survived 9 years and 6 months is reported. He underwent surgical removal of the tumour three times during the decade 1978 to 1988, and received chemo-immuno-radiotherapy during that time. Acute tumour growth, suggesting tumour dissemination, was seen in the CT scans after the third removal of recurrent tumour, but then it disappeared after combined chemoradiotherapy with DTIC. He gradually became inactive, probably because of brain atrophy caused by high-dose radiotherapy and chemotherapy, and died of renal failure without any sign of recurrence on CT scans.
Brain Neoplasms↗
Ovarian cysts in precocious puberty.
We describe a 7-year-old girl with precocious puberty in whom a single large cyst (5 cm) and several small cysts (8-10 mm) in the single remaining ovary were detected by the ultrasound examination. Endocrinological examinations confirmed the diagnosis of central precocious puberty. Pathologic findings after the removal of the cystic lesions revealed that the large cyst was derived from degenerated follicular cysts and the small cysts were identical to follicular cysts: all were considered to have been formed by gonadotropin stimulation. In general, surgical removal of an ovarian follicular cyst in central precocious puberty is inappropriate. However, in this unusual patient who had a degenerated large cyst, surgery seemed to be appropriate because of a previously removed teratoma in the contralateral ovary.
Child↗
[Immunohistochemical study of c-myc oncogene product in human brain tumors].
C-myc oncogene is widely distributed in eukaryotic cells and is supposed to play an important role in the cellular proliferation and differentiation. Enhanced expression of this oncogene is reported in many kind of tumors, which is often associated with increased malignancy. It seems, therefore, important to study the expression of this oncogene in analyzing the cell biologic features of brain tumors. In the present paper we investigated the distribution of this oncogene product in paraffin-embedded tissue of various kind of brain tumors with a monoclonal antibody to synthetic c-myc peptide. The results demonstrated that c-myc product was detectable in most of the astrocytoma lineage. The immunoreaction within the cell nuclei was more intense in grade 3 and grade 4 astrocytomas than in grade 2 tumors. The expression in grade 4 tumors was, however, rather weaker that in grade 3 tumors. In benign, non-glial tumors like meningiomas and neurinomas, the nuclear immunoreaction was usually absent or only weak, although it was enhanced in a case of acoustic and spinal neurinomas associated with von Recklinghausen's disease.
Astrocytoma↗
[Antenatal detection of developing nervous system abnormalities and perinatal surgical management].
As the use of prenatal ultrasound sonographic study becomes more popular, it is likely that several fetal anomalies of the central nervous system will be diagnosed in utero more frequently and accurately. Obstetric sonogram correlates well with the results of postnatal CT scanning. Now, with improved diagnosis and support facilities for the newborn, neurosurgical intervention is being requested, as more concern is expressed for such fetus. We have experienced seven cases of fetal disorders of the central nervous system-meningocele, meningoencephalocele, myeloschisis, arachnoid cyst and maximal hydrocephalus. When diagnosed late in gestation (after the 2nd trimester), it may be reasonable to consider early delivery at the time of pulmonary maturity, and extrauterine management to decrease secondary damage to the developing central nervous system. The method of delivering a fetus must be tailored to suit each case. We present our program for the management of fetal hydrocephalus-placement of a subcutaneous low profile Ommaya's reservoir for neonate immediately after birth, and then subsequently conversion to a ventriculoperitoneal shunt three or four weeks later. As advances are made in antenatal diagnostic techniques and appropriate therapy, prognostic data on congenital abnormalities of the central nervous system will increase and become more pertinent.
Arachnoid↗
[Transoral transclival approach: anatomical and technical notes].
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Anesthesia, General↗