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Satsumasendai, Japan

Ogawa Y.,Kohnan Hospital | Watanabe M.,Tohoku University | Tominaga T.,Tohoku University
Acta Neurochirurgica | Year: 2013

Background: Rathke's cleft cyst (RCC) with significant squamous and/or stratified epithelium including smooth transition from single cuboidal to squamous epithelium (tRCC) is rare and possibly represents an intermediate form to craniopharyngioma. Methods: Twelve patients with histologically confirmed tRCC were retrospectively investigated from a series of 167 cases of RCC and 96 cases of craniopharyngiomas. Clinical data were reviewed, and immunohistochemistry findings for cytokeratins and β-catenin were examined. Results: All lesions were located in the sella turcica with marked extension to suprasellar cistern. Six of the 12 patients had suffered postoperative re-enlargement, and three of these six patients required more than two additional operations and irradiation. CAM5.2 was positive in the glandular epithelium in all tRCCs and focally positive in the squamous epithelium of all these tRCCs. 34βE12 was positive in the squamous epithelium in all tRCCs and focally positive in the glandular epithelium in all but one tRCC. The findings of cytokeratin expression of tRCCs were very similar to those of craniopharyngioma. β-Catenin showed nuclear translocation in five cases. All patients with nuclear translocation of β-catenin suffered postoperative re-enlargement. Conclusions: tRCC carries an extremely high risk of re-enlargement. Cytokeratin expression resembles that in craniopharyngioma, which might indicate a very close origin of these pathologies. Nuclear translocation of β-catenin may be related to the aggressive clinical course. © 2013 Springer-Verlag Wien. Source


Shimizu H.,Tohoku University | Matsumoto Y.,Kohnan Hospital | Tominaga T.,Tohoku University
Clinical Neurology and Neurosurgery | Year: 2010

Objective: Parent artery occlusion with/without bypass surgery is one of the treatment choices for the internal carotid artery (ICA) aneurysm difficult to treat by clipping or coiling. There have been few reports regarding postoperative cerebral blood flow (CBF) changes after surgery. This study evaluated the present bypass selection strategy based on balloon test occlusion (BTO) in terms of clinical and hemodynamic outcomes. Methods: Twenty-one consecutive patients with ICA aneurysms underwent parent artery occlusion. High flow bypass (n = 9), superficial temporal artery-middle cerebral artery bypass (n = 10), or no bypass (n = 2) was performed depending on the changes in clinical symptoms and CBF during BTO. Quantitative CBF measurement with acetazolamide challenge was performed in the chronic stage. Results: Overall outcome at discharge was good recovery 18, moderate disability 2, and severe disability 1. Two patients suffered symptomatic embolic or perforator infarction associated with the surgical manipulations. Preoperative cranial nerve pareses improved completely or partially in all patients except one. CBF in the chronic stage (n = 18) demonstrated no significant difference between the surgical and non-surgical cerebral hemispheres. No cerebral ischemic event was observed during the follow-up period (mean 2.9 years). Conclusion: The present surgical strategy based on preoperative BTO provides a reliable tool to achieve acceptable clinical and hemodynamic outcomes in patients with complex ICA aneurysms to be treated by parent artery occlusion. © 2009 Elsevier B.V. All rights reserved. Source


Ogawa Y.,Kohnan Hospital | Tominaga T.,Tohoku University
Acta Neurochirurgica | Year: 2012

Background Recent advances in minimally invasive surgery have allowed extended transsphenoidal approaches to treat large and complex lesions beyond the sella turcica including basal meningiomas, but the inclusion criteria and limitations of this approach remain unclear. Methods Retrospective review of 19 consecutive patients (5 males and 14 females aged from 43 to 79 years) with tuberculum sellae meningioma with a maximum diameter of less than 30 mm surgically treated between December 2006 and August 2011 by a single surgeon. Operative outcomes and limitation-based indications were investigated. Findings Total removal was achieved in 15 cases including Simpson's grade 1 in 2 cases (78.9%). All tumor remnants were located in the lateral portion of the internal carotid artery (ICA), as indicated by preoperative magnetic resonance (MR) imaging. Additional oblique imaging along the longitudinal axis of the C1-2 portion of the ICA revealed a paradoxical presence of tumor in between both sides of the ICA in some patients, even in the case with lateral extension over the ICA on coronal MR imaging. Total removal could be achieved in these patients, and after the introduction of additional preoperative oblique MR imaging, total removal was achieved in all patients. Visual outcomes of eyes showed improvement in 23, remained steady in 11, and showed deterioration in 4, and 89.5% eyes recovered to a good state. Deterioration was caused by injury of a small vein in one patient and previous disruption of the arachnoidal sheath in the remaining three. One patient suffered cerebrospinal fluid leakage and required re-operation. None of the patients developed endocrinological deficits or required prolonged hormonal supplementation. Conclusions The extended transsphenoidal approach has equivalent potential to transcranial surgery for tuberculum sellae meningiomas with a maximum diameter of less than 30 mm. The tumors with lateral extension over the ICA have fewer chances of total removal. ICA-oriented simulation and surgical planning are important. © Springer-Verlag 2012. Source


Abe H.,Tohoku University | Kondo T.,Tohoku University | Oouchida Y.,Tohoku University | Suzukamo Y.,Tohoku University | And 2 more authors.
Stroke | Year: 2012

Background and Purpose-: The aim of this study was to determine if side of cerebral hemisphere lesion affects the prevalence and time course of pushing behavior (PB) after stroke. Methods-: A total of 1660 patients with acute stroke were investigated. PB was assessed using the standardized Scale for Contraversive Pushing. Risk ratios were used to evaluate the differences in the prevalence of PB between right cerebral hemisphere-damaged (RCD) and left cerebral hemisphere-damaged (LCD) patients. The differences in the time course among 35 (27 RCD and 8 LCD) patients were evaluated by analyzing Scale for Contraversive Pushing scores with the Kaplan-Meier Method using a log-rank test. Results-: PB was observed in 156 (9.4%) patients. The prevalence of PB was significantly higher in RCD (97 of 556 [17.4%]) than in LCD (57 of 599 [9.5%]) patients; risk ratio was 1.83 (95% CI, 1.35-2.49). The log-rank test indicated that RCD patients exhibited a significantly slower recovery than LCD patients (P=0.027). Conclusions-: The number of RCD patients who exhibited PB was higher than that of LCD patients. The duration of recovery from PB was longer in RCD patients than in LCD patients. © 2012 American Heart Association, Inc. Source


Ogawa Y.,Kohnan Hospital | Tominaga T.,Tohoku University
Journal of Neurosurgery | Year: 2010

A Rathke cleft cyst is considered to arise from the remnants of the Rathke pouch, and it consists of single cuboidal or columnar epithelium including cilia and goblet cells, which secrete mucus into the cyst. Magnetic resonance imaging characteristically shows a thin membranous cystic wall that enhances with Gd, and homogeneous intensity of the content suggesting fluid collection. Cases with an irregularly thickened and/or calcified cyst wall, presumably due to chronic inflammation of the wall, are rare. A 21-year-old woman presented with an extremely rare case of a solid and cystic Rathke cleft cyst with partial ossification, manifesting as bitemporal hemianopia. Magnetic resonance imaging showed a massive solid sellar lesion extending upward and compressing the optic chiasm and floor of the third ventricle. Transsphenoidal surgery was performed, resulting in total removal of the lesion and immediate recovery of visual function. Postoperative histological examination disclosed that the major part of the lesion consisted of various phases of clotting and granulation with significant fibrosis. Mature bone formation and abundant cholesterin clefts were also seen. Single cuboidal epithelium including goblet cells and cilia was found along this granulation, and the diagnosis was a Rathke cleft cyst. An ossified Rathke cleft cyst is extremely rare, and a solid Rathke cleft cyst has not before been reported. This case illustrates the extremely long and complex nature of this disease. Source

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