[Dysphagia caused by ossification of the anterior longitudinal ligament associated with diffuse idiopathic skeletal hyperostosis: report of 2 cases]
Mizuno J. Nakagawa H. Isobe M.
Department of Neurological Surgery, Aichi Medical University, Japan.
Two cases of ossification of the anterior longitudinal ligament (OALL) associated with diffuse idiopathic skeletal hyperostosis (DISH) presenting as dysphagia are reported. DISH has long been regarded as a radiological entity manifesting flowing ossification adjacent to the anterior and lateral borders of at least four contiguous vertebral bodies, maintenance of disc spaces, and a dearth of bony ankylosis and erosion of the apophyseal and sacroiliac joints. In the majority of cases, this entity shows an innocuous clinical course, but the dysphagia shown in our cases has also been documented in previous literature. Case 1 was a 63-year-old male developing progressive dysphagia and rhinolalia. Cervical X-rays and CT showed flowing OALL in the entire cervical spine. MRI demonstrated displacement of the trachea and esophagus by this mass. There was OALL in the thoracic and lumbar spine. Case 2 was a 62-year-old male who had undergone removal of ossification of the posterior longitudinal ligament (OPLL) from C2 to C5. He developed dysphagia and myelopathy. Cervical X-rays and CT demonstrated projection of OALL as well as posterior osteophytes at C5/6. MRI suggested that OALL had caused dysphagia, and osteophytes deteriorated myelopathy. Removal of OALL was carried out in these two cases. In case 2, removal of the osteophytes and herniated disc was carried out at the same time. Postoperative course was unremarkable with improvement of symptoms. Treatment of dysphagia due to OALL is considered to be conservative. However, surgical decompression should be considered in cases of marked projection of OALL obstructing the esophagus as shown in our cases.
[A case of sigmoid colon perforation by a V-P shunt tube resulting in pneumocephalus]
Karibe H. Ishibashi Y.
Division of Neurosurgery Watanabe Hospital, Japan.
A 47-year-old male presented with headache 3 years after V-P shunt procedure. Initial CT revealed pneumocephalus, and a shunt tube migration into the sigmoid colon was detected by contrast medium injection into the shunt tube. The patient's condition was complicated with bacterial meningitis, and the infected shunt tube was removed. After chemotherapy, the V-P shunt was reinstalled. This is the first case showing pneumocephalus occurring as an initial symptom of bowel perforation by a V-P shunt tube. In this case, the abdominal tip of the shunt tube had been anchored at the same place for 6 months before bowel perforation. This finding may support the hypothesis that fibrous encasement of a shunt tube may trigger abdominal complications, as previously suggested.
[A case of hemangiopericytoma with multiple extracranial metastasis: a case report]
Niwa M. Kobayashi T. Kuchiwaki H. Furuse M.
Department of Neurosurgery, Nakatsugawa Municipal General Hospital.
A case of a patient with hemangiopericytoma with multiple extracranial metastasis, who has survived for more than twenty years is reported. A fifty-five-year-old male presented brain tumor twenty years ago. He underwent total removal of the tumors, but recurrences occurred each time. Liver metastasis was found seven years ago. After that multiple metastases extended to the lung, vertebra and pancreas and operations and irradiations were performed. At present, there is no progression of the tumors and he enjoyed a high quality of life. We concluded that, to ensure long time survival, a patient with hemangiopericytoma must be monitored carefully for local recurrence and systemic metastases.
[Multiple bacterial aneurysms: case report]
Suzuki Y. Kawamata T. Omura M. Matsumoto K.
Department of Neurosurgery, Chiba-Nishi General Hospital, Japan.
A 59-year-old man presented with an internal carotid artery (ICA) bacterial aneurysm which ruptured during surgery for treatment of another bacterial aneurysm. He had been admitted to our hospital because of the recurrence of colon cancer. He had undergone aortic and mitral valve replacement because of closure incompetence due to bacterial endocarditis two months previously. Two months after treatment for colon cancer, he developed fever, and arterial blood culture demonstrated. Staphylococcus epidermidis. A few days later, he suddenly suffered severe headache and vomiting, followed by deterioration of consciousness. CT showed subarachnoid hemorrhage and angiography showed a saccular aneurysm at the opercular portion of the left middle cerebral artery (MCA). Immediate clipping of the aneurysm was attempted. The carotid cistern was opened via a left frontotemporal craniotomy, but an ICA aneurysm, which had not been previously recognized, ruptured suddenly. The ICA aneurysm was wrapped with Vascwrap with some difficulty. The MCA aneurysm was then trapped. Postoperatively, the patient continued to be stuporous for a few days. Two weeks later, he died of complications caused by pneumonia. Bacterial aneurysm is more likely to be located in the distribution of the distal arterial tree, mainly in the distribution of the MCA. The difficulty of preoperative diagnosis and the unpredictable clinical course of bacterial aneurysms are emphasized.