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Biomedical subjects

A Hakuba

Publications and source records attributed to A Hakuba.

At least 73 records · Page 4Linked to original sources
PubMed1989

[A variant of persistent trigeminal artery associated with a petroclival meningioma. Case report].

A 52-year-old female was admitted with a chief complaint of progressive gait disturbance over the previous 16 months. Neurological examination revealed impairment of the Vth and VIIIth cranial nerve functions and cerebellar ataxia on the left side. Computed tomography showed a petroclival tumor of 5 x 5 x 4.5 cm. Left carotid angiography disclosed tumor staining fed by branches of the tentorial artery. Also, an anomalous artery branched from the internal carotid artery between the C5 and C6 portions and supplied the region usually fed by the anterior inferior cerebellar artery. The tumor was removed via a combination of transpetrosal-transtentorial and transzygomatic approaches. The anomalous artery was confirmed to course along the Vth cranial nerve, replacing the anterior inferior cerebellar artery. Twenty-seven cases of variant persistent trigeminal artery have been reported in the world literature, including this case. The embryological and clinical features of this anomaly are discussed.

Carotid Arteries↗
PubMed1989

Trigeminal neurinomas: operative approach in eight cases.

The authors report eight cases of trigeminal neurinoma managed over the past 13 years with radical resection at a single-stage operation. Three patients were male and five were female, ranging in age from 25 to 56 years (mean 41.5 years). One had von Recklinghausen's disease. The tumors were located mainly within the middle fossa in two cases and within the posterior fossa in two, and extended both supra-and infratentorially in four cases. Facial pain and hearing disturbance were the main symptoms, with various other symptoms such as focal seizures, hemiparesis, gait disturbance, increased intracranial pressure, and visual disturbance also being noted. All patients underwent radical tumor resection with either a transpetrosal transtentorial or orbitozygomatic infratemporal surgical approach; the approach depended on the topography of the tumor. Total removal was performed in all cases. Only one patient, treated early in the series, required a second operation to remove the tumor completely. In another case the tumor recurred 5 years after the operation. There has been no operative mortality, but injury or permanent damage to the trigeminal branches was inevitable in many cases. The surgical results were excellent in three patients and good in five.

Adult↗
PubMed1989

A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus.

The authors present four cases of vascular lesions and 10 cases of tumors involving the cavernous sinus. They were operated on via a combined orbitozygomatic infratemporal epidural and subdural approach. With this approach, multisided exposure of the cavernous sinus can be achieved via the shortest possible distance with minimal retraction of the neural structures in and around the cavernous sinus. In one patient the carotid artery had been occluded previously, but in the other 13 patients it was preserved. There was no mortality, and all patients except one returned to work within 6 months after surgery.

Brain Neoplasms↗
PubMed1988

Microsurgical removal of intramedullary spinal cord tumours: report of 22 cases.

The management of patients with intramedullary spinal cord tumours is controversial. The authors have treated these tumours in accordance with the principles of radical resection, using microsurgical techniques. There have been 22 cases of intramedullary spinal cord tumours (4 astrocytomas, 3 glioblastoma multiformes, 5 ependymomas, 7 haemangioblastomas, 1 dermoid, 1 lipoma and 1 schwannoma) thus treated at our department during the past 13 years. Sixteen were adults and six were children. The early and late results of their surgical treatment have been analyzed, with follow-up periods ranging from 10 months to 12 years. Of the 22 patients, total removal was performed in 16, subtotal removal in 5 and biopsy in 1. Guidetti's criteria were adopted in assessing the results of surgery. Long-term results were as follows: 8 very good, 5 good, 3 fair, 3 poor and 3 deceased. The 3 latter cases were glioblastoma multiformes. Gross total removal of intramedullary tumours is technically feasible and compatible with neurological recovery. Since the majority of intramedullary tumours are benign and their course may span not only years but decades, long-term follow-up is essential.

Adolescent↗
PubMed1988

MR imaging of intraspinal tumors--capability in histological differentiation and compartmentalization of extramedullary tumors.

Magnetic resonance (MR) images of 29 consecutive patients with intraspinal neoplasms (9 intramedullary tumors, 20 extramedullary tumors) were reviewed to evaluate the utility of MR imaging in distinguishing the intraspinal compartmental localisation and signal characteristics of each lesion. Compartment and histology of all neoplasms were surgically proven. MR correctly assigned one of three compartments to all lesions, 9 intramedullary, 14 intradural extramedullary (6 schwannomas, 3 neurofibromas, 5 meningiomas), and 6 extradural (3 schwannomas, 1 meningioma, 1 cavernous hemangioma, 1 metastatic renal cell carcinoma). All intramedullary tumors showed swelling of the spinal cord itself. In all five extradural tumors a low intensity band was visualized between the spinal cord and tumor. On the other hand, a low intensity band was demonstrated in no cases with intradural tumors. Visualization of this low intensity band is important in differentiating extradural from intradural-extramedullary lesions. We call this low intensity band, "the extradural sign". Signal intensity of intradural tumors varied with histology. In extramedullary tumors, signal intensity of schwannomas was similar to that of the cerebrospinal fluid (CSF) both on T1 weighted (inversion recovery) and T2 weighted spin echo (SE) images. On the other hand, meningiomas tended to be isointense to the spinal cord on both T1 and T2 weighted SE images. We found relatively reliable signal characteristics to discriminate meningioma from schwannoma.

Astrocytoma↗
PubMed1988

MR appearance of Rathke's cleft cysts.

Two of three patients who proved to have symptomatic Rathke's cleft cysts presented with visual field deficit and all with diabetes insipidus. CT showed intra- and suprasellar cystic low density lesions with ring enhancement. MR showed intra- and suprasellar masses. On the T1-weighted images two of the three had hyperintense portions similar to fat and the other a hyperintense portion similar to white matter within the cysts. These portions were isointense to brain on the T2-weighted images in all cases. This characteristic intensity on MR images provides differentiation from cystic pituitary adenomas and cystic craniopharyngiomas, and leads to correct diagnosis of Rathke's cleft cyst.

Adult↗
PubMed1988

A gigantic neurilemoma originating in the pterygopalatine fossa. Case report.

A 7-year-old girl complained of gradually progressing right nasal obstruction, right exophthalmos, and deterioration of right visual acuity. Computed tomography scanning showed a large mass originating in the pterygopalatine fossa and extending to both the pterygomaxillary fossa and the orbital apex on the right side. The tumor was totally removed via the orbitozygomatic infratemporal approach. The literature is reviewed and the operative approach is discussed.

Cerebral Angiography↗
PubMed1988

A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas.

A combined retroauricular and preauricular transpetrosal-transtentorial approach is described for the resection of meningiomas arising from the clivus. Via radical mastoidectomy the sigmoid sinus is exposed down to the jugular bulb, and via the transmastoideal-subtemporal approach the retroauricular petrosal bone, 1 cm in depth from the petrosal ridge, and the roof of the internal auditory meatus are removed, the middle ear and fallopian canal being left intact. Additionally, via a transzygomatic-subtemporal approach the preauricular petrosal bone is removed anteriorly up to the petrosal tip and laterally as far as the petrosal portion of the internal carotid artery, while the cochlea is preserved. By this means, the triangular portion of the posterior petrosal dura mater, delimited by the superior petrosal sinus, inferior petrosal sinus, and sigmoid sinus, is well exposed extradurally. By opening the subtemporal and posterior petrosal dura mater, in combination with a tentoriotomy, adequate exposure of the basilar artery, vertebral arteries, ventral and lateral portions of the brainstem, and cranial nerves is achieved with minimal retraction of the temporal lobe and cerebellum.

Cranial Fossa, Posterior↗
PubMed1988

[Magnetic resonance imaging (MRI) of intracranial chordomas].

MR images of 5 patients with intracranial chordoma were evaluated and compared with those of other clival lesions (1 clival osteomyelitis, 1 metastatic clival tumor, 3 clival meningiomas). The MR examination was performed using a 0.5 T superconductive magnet, with approximately 10 mm section thickness, one average and a 256 x 256 matrix. T1 weighted images were obtained by inversion recovery (IR) with TR 2100-2500 msec, TI 600 msec and TE 40 msec. T2 weighted images were obtained by spin echo pulse sequence with TR 1800-2500 msec and TE 120 msec (long SE). In several cases, the spin echo pulse sequences with TR 1000 msec and TE 40 msec (short SE) were also done. Multiplaned images were obtained. Four of 5 intracranial chordomas were low in intensity compared to cerebral gray matter on T1 weighted images, and all of 5 chordomas were as high in intensity as cerebrospinal fluid or higher than that of cerebrospinal fluid on T2 weighted images. Clival fatty marrow is high intensity on T1 weighted images. Clival involvement by a tumor was a clearly demonstrated as disappearance of this high intensity in all cases. In two cases, the tumor extended to the retropharyngeal space and this was detected clearly on short SE image. Although clival fatty marrow was disappeared, osteomyelitis and metastatic tumor in clivus were iso-intense to cerebral gray matter on both T1 and T2 weighted images.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Magnetic resonance imaging: lumbosacral lipoma.

To evaluate the clinical efficacy of magnetic resonance imaging (MRI) of lumbosacral lipomas, the magnetic resonance images of nine patients were reviewed. T1- and T2-weighted spin echo sequences were used with a 0.5-T magnetic resonance system. The tethered or low-positioned conus medullaris, the lipoma itself, the lipoma--cord interface, the subarachnoid space, and hydromyelia were clearly disclosed. The nerve rootlets were not as clear. These results indicate the possible discontinuance of myelography and metrizamide computed tomography (CT) cisternography for such imaging. The diagnostic modalities of choice for lumbosacral lipoma imaging are plain spine films, plain CT scan, and MRI.

Adolescent↗