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1.
Surg Neurol Int ; 13: 372, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36128090

RESUMO

Background: Imaging with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and 11C-methionine (MET)-PET can delineate primary and metastatic brain tumors. Lesion size affects the sensitivity of both scans and histopathological features can also influence FDG-PET, but the effects on MET-PET have not been elucidated. Case Description: We report an unusual case of metastatic brain tumors without accumulation of FDG or MET, contrasting with high FDG uptake in the primary lung lesion. The brain lesions were identified as adenocarcinoma with a more mucus-rich background, contributing to the indistinct accumulation of both FDG and MET. Conclusion: Histopathological characteristics can affect both MET and FDG accumulation, leading to findings contradicting those of the primary lesion.

2.
Fukushima J Med Sci ; 65(2): 43-49, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31292304

RESUMO

The appropriate strategy for treating multiple malignant brain tumors has not been well established. We discuss the indications and surgical considerations of multiple craniotomies in the same surgical session, and present three such cases. A 41-year-old woman (case 1) and a 65-year-old man (case 2), both presented with two metastatic brain lesions, one in each hemisphere. The third case was a 65-year-old woman with multiple recurrent atypical meningiomas, who underwent surgical removal in two stages. In the first surgery, only the superior sagittal sinus lesion was excised. Then in the second surgery, multiple disseminated bilateral convexity tumors were excised through a craniotomy on each side. All cases had a remarkable neurological improvement immediately after surgery. We suggest that the indications for surgical removal of multiple brain tumors with two or more craniotomies in the same surgical session are: 1) progressing neurological symptoms, 2) tumors with a maximum diameter more than 2 cm, 3) resistance to radiation and/or chemotherapy, 4) ability to tolerate the scheduled surgical time, 5) vital prognosis anticipated to be more than 3 months, 6) expectation of significant neurological improvement, and 7) single-session surgery not carrying more risk than multiple surgeries.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/métodos , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Feminino , Glioma/cirurgia , Humanos , Masculino , Neoplasias Meníngeas/terapia , Meningioma/cirurgia
3.
Neurol Med Chir (Tokyo) ; 59(6): 213-221, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31061256

RESUMO

The efficacy and predictive factors associated with successful spinal cord stimulation (SCS) for central post-stroke pain (CPSP) have yet to be definitively established. Thus, this study evaluated the rates of pain relief found after more than 12 months and the predictive factors associated with the success of SCS for CPSP. The degree of pain after SCS in 18 patients with CPSP was assessed using the Visual Analog Scale preoperatively, at 1, 6 and 12 months after surgery, and at the time of the last follow-up. After calculating the percentage of pain relief (PPR), patients were separated into two groups. The first group exhibited continuing PPR ≥30% at more than 12 months (effect group) while the second group exhibited successful/unsuccessful trials followed by decreasing PPR <30% within 12 months (no effect group). Pain relief for more than 12 months was achieved in eight out of 18 (44.4%) patients during the 67.3 ± 35.5 month follow-up period. Statistically significant differences were found for both the age and stroke location during comparisons of the preoperative characteristics between the two groups. There was a significantly younger mean age for the effect versus the no effect group. Patients with stoke in non-thalamus were significantly enriched in effect group compared with those with stoke in thalamus. Multivariable analysis using these two factors found no statistical differences, suggesting that these two factors might possibly exhibit the same behaviors for the SCS effect. These results suggest that SCS may be able to provide pain relief in young, non-thalamus stroke patients with CPSP.


Assuntos
Neuralgia/etiologia , Neuralgia/terapia , Estimulação da Medula Espinal , Acidente Vascular Cerebral/complicações , Fatores Etários , Idoso , Vértebras Cervicais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Medição da Dor , Estudos Retrospectivos , Vértebras Torácicas , Fatores de Tempo , Resultado do Tratamento
4.
Neurol Med Chir (Tokyo) ; 58(10): 422-434, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30158352

RESUMO

The long-term effects of motor cortex stimulation (MCS) and spinal cord stimulation (SCS) remain unknown. To identify the long-term effects after MCS or SCS and determine any associated predictive factors for the outcomes. Fifty patients underwent MCS (n = 15) or SCS (n = 35) for chronic neuropathic pain. The degree of pain was assessed preoperatively, at 1, 6, and 12 months after surgery, and during the time of the last follow-up using Visual Analog Scale (VAS). Percentage of pain relief (PPR) was calculated, with "long-term effect" defined as PPR ≥ 30% and the presence of continued pain relief over 12 months. Outcomes were classified into excellent (PPR ≥ 70%) and good (PPR 30-69%) sub-categories. Long-term effects of MCS and SCS were observed in 53.3% and 57.1% of the patients, respectively. There were no predictive factors of long-term effects identified for any of the various preoperative conditions. However, the VAS at 1 month after surgery was significantly associated with the long-term effects in both MCS and SCS. All patients with an excellent outcome at 1 month after the surgery continued to exhibit these effects. In contrast, patients with the good outcome at 1 month exhibited a significant decrease in the effects at 6 months after surgery. The long-term effects of MCS and SCS were approximately 50% during the more than 8.5 and 3.5 years of follow-up, respectively. The VAS at 1 month after surgery may be a postoperative predictor of the long-term effects for both MCS and SCS.


Assuntos
Dor Crônica/terapia , Estimulação Encefálica Profunda , Córtex Motor , Neuralgia/terapia , Estimulação da Medula Espinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
No Shinkei Geka ; 43(3): 241-6, 2015 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-25748810

RESUMO

Resection of posteromedial temporal lobe lesions is challenging because surgical access through standard approaches requires excessive retraction or resection of temporal cortex. The utility of the supratentorial-infraoccipital approach for posteromedial temporal lobe lesions was first reported in 1995. Here, we report two cases of glioma located at the medial posterior temporal lobe. In both, total tumor removal was achieved by a supratentorial-infraoccipital approach using neuronavigation and intraoperative magnetic resonance imaging. Both patients presented with postoperative quadrantanopia because of optic radiation damage, but did not have worsening language, memory, or cognitive functions.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Lobo Temporal/cirurgia , Adulto , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias Encefálicas/patologia , Feminino , Glioma/irrigação sanguínea , Humanos , Período Intraoperatório , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
6.
No Shinkei Geka ; 42(9): 837-40, 2014 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-25179197

RESUMO

INTRODUCTION: Biopsy procedures of intra-parenchymal lesions are divided into needle biopsy (stereotactic or frameless) or navigation-guided endoscopic biopsy. METHODS: We retrospectively reviewed 36 consecutive patients with intra-parenchymal lesions who underwent biopsy at our institution. Fourteen patients underwent navigation-guided endoscopic biopsy (endoscopic group) and 22 patients underwent needle biopsy (needle group). Rates of pathological diagnosis and postoperative hemorrhage were compared between groups and analyzed using Fisher's exact test. Probability values of <0.05 were considered statistically significant. RESULTS: Pathological diagnostic rates were 100% (14/14) for the endoscopic group and 96% (21/22) for the needle group, showing no significant difference. The postoperative hemorrhage rate was 7.1% (1/14) in the endoscopic group and 27.3% (6/22) in the needle group (p=0.21). Symptomatic postoperative hemorrhage was seen in 0% (0/14) of the endoscopic group and 18.2% (4/22) in the needle group (p=0.14). CONCLUSION: Both needle and endoscopic biopsies are accurate procedures with high rates of pathological diagnosis. Postoperative hemorrhage tended to be less frequent with endoscopic biopsy than with needle biopsy. Here, we described procedure selection and ingenuity of accurate and safe biopsy at our institution.


Assuntos
Neoplasias Encefálicas/patologia , Biópsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes
7.
No Shinkei Geka ; 42(9): 867-71, 2014 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-25179201

RESUMO

A 28-year-old male presented with language and behavior disorders a few days prior to examination. Magnetic resonance images and cerebral angiography revealed an arteriovenous malformation (AVM) in the right frontal lobe. The size of the nidus was 2.0 cm, and it was fed by the middle cerebral arteries and drained by the superior sagittal and transverse sinuses. The AVM was completely surgically resected without any complications. Ten months after the surgery, the patient presented with behavior disorders again and general convulsion. Computed tomography showed a small intracranial hemorrhage at the right frontal lobe, where the AVM was located. Blood examination revealed severe rhabdomyolysis (CK:536,620U/L)and acute kidney injury (Cr:5.20mg/dL). After admission, it became clear that the patient had used synthetic cannabinoid (SC). SC refers to a variety of herbal/chemical mixtures, which mimic the effects of marijuana. Little data is available on the psychopathological and physical effects of SC. This is the first report of severe rhabdomyolysis and intracranial hemorrhage associated with SC use in Japan.


Assuntos
Canabinoides/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Rabdomiólise/induzido quimicamente , Adulto , Angiografia Cerebral , Humanos , Hemorragias Intracranianas/patologia , Imageamento por Ressonância Magnética , Masculino
9.
No Shinkei Geka ; 41(8): 679-85, 2013 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-23907474

RESUMO

OBJECTIVE: Central post-stroke pain(CPSP)is the most difficult type of central neuropathic pain to control with medical treatment. Opioids are commonly used for chronic neuropathic pain, but their efficacy in treating central neuropathic pain, particularly CPSP, is not clear. Tramadol is an opioid analgesic that, in combination with acetaminophen, has been approved since 2011 for the treatment of non-cancer pain in Japan. In this study we evaluated the efficacy of tramadol/acetaminophen medication for CPSP. METHODS: We retrospectively reviewed nine cases of CPSP that received oral tramadol/acetaminophen medication. All cases received tramadol/acetaminophen medication after first taking pregabalin then antidepressant medication. Pain levels were assessed before tramadol/acetaminophen medication began and one month after a maintenance dose was reached, using a visual analogue scale(VAS)and the McGill pain questionnaire(MPQ). RESULTS: The mean dose of tramadol was 121±61.6 mg/day. Tramadol/acetaminophen medication was effective in reducing pain in seven of nine cases(77.8%). The VAS improved 32.9±13.8% from pre-to post-medication, and the MPQ improved from 15.4±9.1 pre-medication to 8.1±4.7 post-medication(p<0.05). These effects continued 9.3±4.5 months during follow up periods. Side effects were observed in six cases(one severe, one moderate, two mild, two transient), but medication was continued in eight cases. CONCLUSION: Oral tramadol/acetaminophen medication was effective at reducing pain levels in patients with CPSP, and is a medication option for the treatment of CPSP.


Assuntos
Acetaminofen/uso terapêutico , Dor/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Tramadol/uso terapêutico , Acetaminofen/administração & dosagem , Idoso , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor/métodos , Acidente Vascular Cerebral/complicações , Tramadol/administração & dosagem , Resultado do Tratamento
10.
Neurol Med Chir (Tokyo) ; 53(7): 501-10, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23883562

RESUMO

The usefulness of 1.5-T high-field intraoperative magnetic resonance (iMR) imaging during transsphenoidal surgery for functioning pituitary adenomas was retrospectively evaluated based on long-term endocrine remission from the records of 14 patients who underwent transsphenoidal surgery with iMR imaging for functioning pituitary microadenomas and small adenomas located in the intrasellar region. The maximum tumor diameter was 9.3 ± 2.6 mm. Patients were diagnosed with acromegaly (n = 7), prolactinoma (n = 4), and Cushing's disease (n = 3). If iMR imaging detected tumor remnants after resection, the resection cavity was reexamined and further resection was performed. Postoperative endocrine follow-up period was mean 33.7 ± 13.3 months. Tumor remnants were detected after the first resection in seven patients. Further resection was performed in five of these patients, and three achieved long-term endocrine remission. As a result, the overall long-term endocrine remission rate was 78.5% (11/14), instead of the 57.1% (8/14) that would be expected if iMR imaging had not been performed. Long-term endocrine remission had a tendency to be associated with the absence of tumor remnants on the final iMR images, but this was not significant (p = 0.09). Long-term endocrine remission was associated with presence of tumor remnants in the cavernous sinus on the final iMR images (p = 0.03). High-field iMR imaging is useful for depicting tumor remnants after resection, and increased the long-term endocrine remission rate for patients with functioning pituitary microadenomas and small adenomas.


Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Cirurgia Assistida por Computador/métodos , Adenoma/diagnóstico , Adulto , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico , Neoplasia Residual/cirurgia , Hipersecreção Hipofisária de ACTH/cirurgia , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/cirurgia , Reoperação , Sela Túrcica/cirurgia
11.
Neurol Med Chir (Tokyo) ; 52(8): 617-21, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22976149

RESUMO

Endoscope biopsy guided navigation for intra-parenchymal lesions is safe and effective, but determination of the entry point and trajectory of the endoscopic biopsy is less clear. We describe preoperative planning based on stereotactic methods, and achieving the plan using several techniques. The preoperative planning was based on stereotactic methods such as determining target, entry point, and trajectory. A transparent sheath was advanced under guidance of the navigation system and specimens collected under visual endoscopic monitoring. After collecting specimens, intraoperative magnetic resonance imaging was performed for confirming accurate sampling. Correct specimens were obtained in 6 cases as confirmed by intraoperative magnetic resonance imaging. The histological diagnoses were diffuse large B-cell type malignant lymphoma (n = 3), astrocytoma (n = 1), glioblastoma (n = 1), and inflammatory changes without neoplastic cells (n = 1). No postoperative intracranial hemorrhage or other operative complications occurred. Preoperative planning based on stereotactic methods and procedures guided by navigation systems can achieve endoscopic biopsy for intraparenchymal lesions safely and accurately.


Assuntos
Biópsia/instrumentação , Neoplasias Encefálicas/patologia , Neuroendoscopia/métodos , Neuronavegação/métodos , Adulto , Idoso , Biópsia/métodos , Encéfalo/patologia , Encéfalo/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroendoscópios , Neuroendoscopia/instrumentação , Planejamento de Assistência ao Paciente , Hemorragia Pós-Operatória/prevenção & controle
12.
Nagoya J Med Sci ; 74(1-2): 173-9, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22515124

RESUMO

A 41-year-old woman presented with disturbance of consciousness, right hemiparesis, and symptoms of Gerstmann syndrome. She had a history of malignant melanoma resections of an ear mole and her right neck lymph nodes and parotid gland, with subsequent chemotherapy and radiotherapy. Computed tomography showed two large lesions in the right frontal and left parietal lobes surrounded by severe brain edema. Magnetic resonance images revealed that the two lesions were strongly enhanced with cystic change, and a small round lesion was located in the left head of the caudate nucleus. (18F) fluoro-2-deoxyglucose positron emission tomography showed high accumulation in both lesions, and no sign of metastatic lesions except within the brain. The two lesions were large, causing increased intracranial pressure. Simultaneous surgical resections were performed using two approaches. The patient's neurological symptoms were greatly improved after surgery, and her Karnofsky Performance Status improved from 20% to 90%. She was discharged to her home almost completely free of neurological deficits. Although, simultaneous one-stage tumor resections for multiple metastatic brain tumors do not extend the survival period, they improve the quality of the patient's limited remaining life, and may be a treatment choice for young patients with well-controlled systemic disease.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Craniotomia , Lobo Frontal/cirurgia , Melanoma/secundário , Melanoma/cirurgia , Lobo Parietal/cirurgia , Neoplasias Cutâneas/patologia , Adulto , Evolução Fatal , Feminino , Lobo Frontal/patologia , Humanos , Imageamento por Ressonância Magnética , Lobo Parietal/patologia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
No Shinkei Geka ; 40(4): 325-9, 2012 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-22466231

RESUMO

Spinal cord stimulation (SCS) has become the preferred option for neurosurgical management of several intractable pains. To evaluate effects of dual lead SCS using two quad leads for central post-stroke pain (CPSP), we retrospectively reviewed eight consecutive patients with CPSP who underwent SCS. Six (75%) of eight patients obtained more than 50% pain relief during test stimulation, and the efficacies continued for about 12 months in five (83%) of six patients. There were no significant complications. SCS is less invasive neurostimulation treatment and provides pain relief for some cases of CPSP.


Assuntos
Dor Intratável/terapia , Acidente Vascular Cerebral/complicações , Estimulação Elétrica Nervosa Transcutânea/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Intratável/etiologia , Medula Espinal/fisiologia
14.
Cytotherapy ; 14(6): 733-42, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22424217

RESUMO

BACKGROUND AIMS: Dendritic cell (DC)-based vaccination targeting tumor-associated antigens is an attractive approach to overcoming the limitations of current treatments for malignant gliomas (MG). Interleukin-13 receptor α2 chain (IL-13Rα2) is a promising target because of its abundant and specific expression in MG. We conducted a phase I trial of DC vaccination in patients with recurrent MG using two IL-13Rα2-derived peptides restricted to HLA-A*0201 and -A*2402. The objective was to evaluate the safety and clinical and immunologic responses. METHODS: Eight recurrent MG patients were enrolled. DC were generated from peripheral blood and pulsed with HLA-matched peptide; 1 × 10(7) DC were administered every 2 weeks for a maximum of six immunizations. The T-cell response in peripheral blood was evaluated by tetramer and ELISPOT assays in HLA-A*2402 patients. RESULTS: All enrolled patients except one completed at least four DC vaccinations. No severe adverse events were observed. A positive T-cell response was detected in two out of three evaluable HLA-A*2402 patients. One patient achieved stable disease for 16 months and another patient showed a dramatic regression for one lesion for 4 months. CONCLUSIONS: The regimen was feasible and safe, and the HLA-A*24-restricted peptide exhibited a capacity to induce immune responses. These results warrant further studies to evaluate whether add-on regimens to post-operative chemoradiotherapy delays recurrence in newly diagnosed MG patients.


Assuntos
Vacinas Anticâncer/imunologia , Células Dendríticas/imunologia , Células Dendríticas/transplante , Glioma/terapia , Antígeno HLA-A2/imunologia , Antígeno HLA-A24/imunologia , Subunidade alfa2 de Receptor de Interleucina-13/imunologia , Peptídeos/imunologia , Adolescente , Adulto , Alelos , Vacinas Anticâncer/administração & dosagem , Vacinas Anticâncer/efeitos adversos , Progressão da Doença , Feminino , Glioma/imunologia , Glioma/prevenção & controle , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva , Vacinação/efeitos adversos , Vacinação/métodos , Adulto Jovem
15.
Neurol Med Chir (Tokyo) ; 52(1): 44-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22278027

RESUMO

A 47-year-old man presented to our hospital after suffering transient loss of consciousness and falling to the floor. On admission, his Glasgow Coma Scale score was 11 (E3V3M5), and he exhibited restlessness. Blood examination revealed hyperthyroidism. Computed tomography showed slight traumatic subarachnoid hemorrhage. He developed fever and tachycardia, and was diagnosed with thyroid crisis. Magnetic resonance imaging showed a brain contusion in the right frontal lobe, and encephalopathy signs in the right frontal and insular cortex. Immunocytochemical examinations suggested Hashimoto's disease, and hormone examinations revealed plasma levels were undetectably low of adrenocorticotropic hormone (ACTH) and low of cortisol. Pituitary stimulation tests showed inadequate plasma ACTH and cortisol response, consistent with isolated ACTH deficiency (IAD). The final diagnosis was IAD associated with Hashimoto's disease. Hydrocortisone replacement therapy was continued, and the patient was nearly free from neurological deficits after 18 months. The neuroimaging abnormalities gradually improved with time.


Assuntos
Insuficiência Adrenal/etiologia , Encefalopatias/complicações , Lesões Encefálicas/complicações , Traumatismos Craniocerebrais/complicações , Doença de Hashimoto/complicações , Crise Tireóidea/etiologia , Insuficiência Adrenal/fisiopatologia , Encefalopatias/patologia , Encefalopatias/fisiopatologia , Lesões Encefálicas/patologia , Lesões Encefálicas/fisiopatologia , Traumatismos Craniocerebrais/patologia , Traumatismos Craniocerebrais/fisiopatologia , Encefalite , Doença de Hashimoto/patologia , Doença de Hashimoto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Crise Tireóidea/fisiopatologia , Resultado do Tratamento
16.
Neurol Med Chir (Tokyo) ; 51(1): 56-9, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21273747

RESUMO

A 60-year-old man presented with a rare case of primary angiitis of the central nervous system mimicking a tumor-like lesion and manifesting as slight disorientation, left hemiparesis, and motor aphasia. Computed tomography showed multiple low density lesions in the left frontal lobe, brain stem, and right parietal lobe. Magnetic resonance images revealed a slightly enhanced mass lesion in the right parietal lobe with surrounding brain edema. Serum, cerebrospinal fluid, and other image examinations did not show any abnormal findings, so surgical removal of the right parietal mass was performed. Histological examination revealed that the mass consisted of hemorrhagic infarction without cellular atypia. Proliferations of endothelial cells in small and medium arteries, and infiltration of macrophages in the perivascular space were detected in the infarction tissues. The histological diagnosis was primary angiitis of the central nervous system.


Assuntos
Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Vasculite do Sistema Nervoso Central/diagnóstico , Afasia de Broca/etiologia , Neoplasias Encefálicas/diagnóstico , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/patologia , Hemorragia Cerebral/cirurgia , Infarto Cerebral/diagnóstico , Infarto Cerebral/patologia , Infarto Cerebral/cirurgia , Endotélio Vascular/patologia , Lobo Frontal/irrigação sanguínea , Lobo Frontal/patologia , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Exame Neurológico , Paresia/etiologia , Lobo Parietal/irrigação sanguínea , Lobo Parietal/patologia , Vasculite do Sistema Nervoso Central/patologia , Vasculite do Sistema Nervoso Central/cirurgia
17.
No Shinkei Geka ; 38(8): 745-50, 2010 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-20697149

RESUMO

A 20-year-old female presented with sudden severe headaches. Computed tomography showed an intraventricular hemorrhage and slightly dilated lateral ventricles. Her neurological examinations revealed no abnormalities. Magnetic resonance (MR) images and cerebral angiography revealed arteriovenous malformation (AVM) in the right parietal lobe. The size of the nidus was 1.8 cm, and it was located in the deep white matter. It was fed by middle cerebral arteries and drained by the vein of Galen. Diffusion tensor tractography (DTT) demonstrated that the right pyramidal tract was situated close to the nidus. The AVM was surgically resected completely, without any complications, using intraoperative neuronavigation image guidance. Neuronavigation images combined with DTT are useful for surgical resection of AVM that is located close to the pyramidal tract.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Neuronavegação , Imagem de Tensor de Difusão , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Lobo Parietal/irrigação sanguínea , Tratos Piramidais , Adulto Jovem
18.
World Neurosurg ; 74(1): 153-61, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21300007

RESUMO

BACKGROUND: Our goal is to indicate the importance of combining intraoperative tractography with motor-evoked potential (MEP) monitoring for glioma surgery in motor eloquent areas. METHODS: Tumor removal was performed in 28 patients with gliomas in and around the corticospinal tract (CST), in an operation theater equipped with an integrated high-field intraoperative magnetic resonance imaging and a neuronavigation system. Diffusion-tensor imaging-based tractography of the CST was implemented preoperatively and intraoperatively. When the surgically manipulated area came close to the corticospinal pathway, MEP responses were elicited by subcortical stimulation. Responsive areas were compared with the locations of fibers traced by preoperative and intraoperative tractography. Imaging and functional outcomes were reviewed. RESULTS: Intraoperative tractography demonstrated significant inward or outward shift during surgery. MEP responses were observed around the tract at various intensities, and the distance between MEP responsive sites and intraoperative tractography was significantly correlated with the stimulation intensity (P < 0.01). The distance from preoperative tractography was not correlated. A more than subtotal resection was achieved in 24 patients (85.7%). Transient motor deterioration was seen in 12 patients (42.8%), and a permanent deficit was seen in 1 patient (3.5%). CONCLUSIONS: We found that intraoperative tractography demonstrated the location of the CST more accurately than preoperative tractography. The results of the linear regression between distance and stimulation intensity were informative for guiding approaches to tumor remnants without impinging on the CST. The combination of intraoperative tractography and MEP monitoring can enhance the quality of surgery for gliomas in motor eloquent areas.


Assuntos
Neoplasias Encefálicas/cirurgia , Córtex Cerebral/cirurgia , Imagem de Difusão por Ressonância Magnética/métodos , Potencial Evocado Motor/fisiologia , Glioblastoma/cirurgia , Glioma/cirurgia , Processamento de Imagem Assistida por Computador/métodos , Monitorização Intraoperatória/métodos , Neuronavegação , Tratos Piramidais/cirurgia , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/fisiopatologia , Córtex Cerebral/fisiopatologia , Infarto Cerebral/etiologia , Infarto Cerebral/fisiopatologia , Craniotomia , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Glioblastoma/fisiopatologia , Glioma/fisiopatologia , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Tratos Piramidais/fisiopatologia , Sensibilidade e Especificidade , Adulto Jovem
19.
Neurol Med Chir (Tokyo) ; 49(8): 340-9; discussion 349-50, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19706999

RESUMO

Initial experiences are reviewed in an integrated operation theater equipped with an intraoperative high-field (1.5 T) magnetic resonance (MR) imager and neuro-navigation (BrainSUITE), to evaluate the indications and limitations. One hundred consecutive cases were treated, consisting of 38 gliomas, 49 other tumors, 11 cerebrovascular diseases, and 2 functional diseases. The feasibility and usefulness of the integrated theater were evaluated for individual diseases, focusing on whether intraoperative images (including diffusion tensor imaging) affected the surgical strategy. The extent of resection and outcomes in each histological category of brain tumors were examined. Intraoperative high-field MR imaging frequently affected or modified the surgical strategy in the glioma group (27/38 cases, 71.1%), but less in the other tumor group (13/49 cases, 26.5%). The surgical strategy was not modified in cerebrovascular or functional diseases, but the success of procedures and the absence of complications could be confirmed. In glioma surgery, subtotal or greater resection was achieved in 22 of the 31 patients (71%) excluding biopsies, and intraoperative images revealed tumor remnants resulting in the extension of resection in 21 of the 22 patients (95.4%), the highest rate of extension among all types of pathologies. The integrated neuro-navigation improved workflow. The best indication for intraoperative high-field MR imaging and integrated neuro-navigation is brain tumors, especially gliomas, and is supplementary in assuring quality in surgery for cerebrovascular or functional diseases. Immediate quality assurance is provided in several types of neurosurgical procedures.


Assuntos
Período Intraoperatório/instrumentação , Imageamento por Ressonância Magnética/instrumentação , Neuronavegação/instrumentação , Neurocirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Salas Cirúrgicas/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/cirurgia , Criança , Feminino , Glioma/patologia , Glioma/cirurgia , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/prevenção & controle , Período Intraoperatório/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Neurocirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Salas Cirúrgicas/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Adulto Jovem
20.
J Neurosurg ; 109(1): 117-22, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18590440

RESUMO

OBJECT: The human leukocyte antigen-A24 (HLA-A24) allele is highly expressed in Asians. This allele is expressed in 60% of the Japanese population and in a significant number of people of other ethnicities. The interleukin-13 type alpha2 receptor (IL-13Ralpha2) has been shown to be a glioma-specific antigen, and is abundantly expressed in a majority of high-grade astrocytomas. In this study, the authors first investigated the suitability of IL-13Ralpha2 as a target antigen of malignant glioma cells, and then identified a potential HLA-A24-restricted peptide derived from IL-13Ralpha2. METHODS: The expression of IL-13Ralpha2 in glioma tissues was examined by reverse transcription-polymerase chain reaction analysis. To identify the desired epitope, the authors selected 5 candidate peptides from IL-13Ralpha2 that were predicted to bind to HLA-A24. The lytic activity of cytotoxic T lymphocytes (CTLs) induced by peptide-pulsed dendritic cells was analyzed against various glioma cell lines and freshly isolated human glioma cells. RESULTS: In a series of glioma tissues obtained in 29 patients, the authors found that > 50% of high-grade gliomas expressed IL-13Ralpha2. Of the 5 peptides tested, P174 (WYEGLDHAL) was found to be the most useful for the induction of HLA-A24-restricted and IL-13Ralpha2-specific CTLs. A CTL line induced by P174 also showed antigen-specific cytotoxicity to surgically removed glioma cells depending on their level of expression of IL-13Ralpha2 and HLA-A24. CONCLUSIONS: Interleukin-13Ralpha2 is a glioma-specific antigen, and the immunogenic peptide P174 may contribute to a peptide-based immunotherapy against malignant glioma cells expressing HLA-A24.


Assuntos
Antígenos de Neoplasias/metabolismo , Neoplasias Encefálicas/imunologia , Epitopos de Linfócito T/fisiologia , Glioma/imunologia , Antígenos HLA-A/metabolismo , Subunidade alfa2 de Receptor de Interleucina-13/fisiologia , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Estudos de Casos e Controles , Linhagem Celular Tumoral , Citotoxicidade Imunológica/fisiologia , Glioma/metabolismo , Glioma/patologia , Humanos
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