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Biomedical subjects

A Hakuba

Publications and source records attributed to A Hakuba.

At least 127 records · Page 7Linked to original sources

Total removal of a parasagittal meningioma of the posterior third of the sagittal sinus and its repair by autogenous vein graft. Case report.

Total removal is reported of a parasaggital meningioma that invaded the lateral wall and lateral recess of the posterior third of the superior sagittal sinus. The operation was performed by using a silicone rubber non-collapsible tube with an inflatable balloon cuff at each end for the bypass of the sinus blood, and entailed repair of the defect in the sinus wall by a saphenous vein graft. The clinical results and angiographic findings are presented.

Brain↗

Jugular foramen neurinomas.

Three patients with neurinomas of the jugular foramen are described. One of them had a small tumor confined within the jugular foramen and each of the other two had a tumor originating from the glossopharyngeal nerve. The common feature in all these patients was the presence of marked enlargement of the jugular foramen. Polytomography, jugular venography and bilateral retrograde vertebral arteriography were used to make the diagnosis. Total removal of their tumors was successfully accomplished using microsurgical technique. Forty-two other cases in the world literature are reviewed and analyzed.

Accessory Nerve↗

Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs.

A series of 40 patients with degnerative discopathy was effectively treated to means of trans-unco-discal approach, which is a combined anterior and lateral approach to cervical discs. Interbody fusion is not performed except for special cases such as significant kyphosis and unstable cervical spine. Twenty patients who had this approach without interbody bone graft have been followed clinically and radiographically for 9 to 36 months. The author describes the surgical techniques, complications, and results.

Adult↗

[A midline vertebral artery aneurysm operated via transoral transclival approach (author's transl)].

A detail of an unsuccessful trial of transoral transclival operation for an aneurysm arising from the left vertebral artery was reported. The patient was 66 years old male who had bronchial asthma and difficulty in phonation and swallowing. The angiograms showed that the aneurysm, 1.5X1.5X2.0 cm in size, was situated in the midline at the level of caudal one-third of the clivus. A transoral transclival operation was performed following preoperative tracheostomy and gastrostomy to improve his pulmonary and nutritional condition. A midline incision on the palate was followed by the removal of the posterior half of palatal bone. The upper part of incision on the retropharyngeal mucosa was placed approximately 1 cm off the midline to facilitate closure afterwords. A caudal 1/3 of the clivus, anterior arch of the atlas and a part of the odontoid process were removed. The aneurysm, fusiform in shape, was then collapsed by needle puncture after the left vertebral artery was trapped between the posterior inferior cerebellar artery and the vertebro-basilar junction. Closure of the dura with a fascial patch was incomplete due to an extensive incision and coagulation of the dura. Closure of the retropharyngeal mucosa around the orifice of the Eustachian tube was also incomplete in spite of the paramedian incision described above. Postoperative course was complicated by an frequent occurrence of the attack of bronchial asthma causing loss of gastic juice from the gastrostomy and resultant hypoproteinemia, although the recovery of lower cranial nerve palsy was good. There was no signs of infection until the 21st postoperative day when meningitis developed. The patient died in the 28th postoperative day. The importance of complete closure of the dura and retropharyngeal mucosa to prevent meningial infection was discussed. Since the mucosa around the orifice of Eustachian tube was extremely friable and the closure was almost impossible, the risk of meningial infection was considered to be high, especially when the intradural procedure was necessary through transoral high clivotomy.

Aged↗

A case of cerebral aneurysm associated with complex partial seizures.

We report a 20-month-old girl with an unruptured aneurysm of the middle cerebral artery. The initial sign was complex partial seizures. Magnetic resonance angiography showed an aneurysm of the right middle cerebral artery. Cerebral angiography confirmed the presence of a saccular aneurysm. After 3 months, the aneurysm spontaneously thrombosed without neurological deficit. The seizures were controlled by anti-convulsants. The aneurysm was probably near the focus of the complex partial seizures. This is a rare case of a childhood cerebral artery aneurysm that first manifested itself by complex partial seizures.

Cerebral Arteries↗

Facial nerve neuromas: CT findings.

Although neuromas of the facial nerve are rare, they present with uniform clinical and radiological findings. Their pluridirectional tomography findings have been well described; however, the appearance of the intracranial extension of the neuroma which is best visualized by CT has not been emphasized. We report five cases of facial nerve neuromas with particular attention to their intracranial extension. For comparative purposes we also have reviewed 10 cases of acoustic and eight cases of trigeminal neuromas, all involving the cerebellopontine angle (CPA) and the middle cranial fossa. Two of the five facial nerve neuromas affected the second and third segments of the facial canal, and three involved both the CPA and the middle cranial fossa spreading across the midpetrosal bone. This type of tumor extension seems to be characteristic of facial nerve neuromas. In acoustic and trigeminal neuromas the tumor crossing toward the middle fossa takes place via the tentorial hiatus (acoustic) and the petrous apex (trigeminal).

Adult↗

Displacement of the quadrigeminal plate in tumors of the fourth ventricle: MR appearance.

Magnetic resonance studies of 12 fourth ventricle tumors were reviewed. The relationship between the tumor and surrounding structures, such as the corpus medullare, the superior medullary velum, and the quadrigeminal plate, was assessed on midsagittal inversion recovery images. Two of the 12 tumors displaced the superior medullary velum superiorly. Seven of the 12 tumors displaced the corpus medullare posteriorly. The superior medullary velum was not recognized in 10 cases and the corpus medullare in 5. Ten of 12 quadrigeminal plates were displaced superoposteriorly due to focal enlargement of the cerebral aqueduct secondary to large intraventricular tumors. In the remaining two cases the tumor was not large enough to enlarge the cerebral aqueduct. The larger the tumor was, the more frequent was the displacement of the quadrigeminal plate. On T2-weighted images, CSF flow-void sign was seen around the tumor in 5 of 12 cases. We consider superoposterior displacement of the quadrigeminal plate to be a relatively constant and reliable sign accompanying fourth ventricle tumors.

Cerebral Aqueduct↗