Effect of mechanochemical inclusion of triamterene into sulfobutylether-β-cyclodextrin and its improved dissolution behavior.

The formation of inclusion complexes between triamterene (TT) and cyclodextrins (CDs) to increase the water apparent solubility of TT was investigated. UV data showed that the binding constant of the TT/sulfobutylether-β-cyclodextrin (SBE-β-CD) inclusion complex was 510 L/mol. The phenyl ring of TT was inserted into the secondary hydroxy face of SBE-β-CD, as demonstrated by H-H rotating frame nuclear Overhauser effect spectroscopy NMR.

Extended middle cranial fossa approach for vestibular schwannoma: technical note and surgical results of 896 operations.

From 1976 to 2006, 896 vestibular schwannomas were operated on using an extended middle cranial fossa approach. With this approach, the operative field can be extended according to tumor size and the facial and cochlear nerves can be preserved more easily with cooperation between the neurosurgeon and ENT surgeon. The mortality rate among 896 vestibular schwannoma patients was 0.

Anterior transpetrosal approach to the prepontine epidermoids.

We have operated on nine patients with a prepontine epidermoid extending to the bilateral cistern or the unilateral middle fossa using the anterior transpetrosal approach since 1986. The preoperative symptoms were unilateral trigeminal neuralgia, hearing disturbance, gait disturbance, double vision, facial hypesthesia, hemifacial spasm, and dysphagia. The most common neurological sign was unilateral trigeminal nerve disturbance.

Glomus jugulare tumor presenting with intracerebellar hemorrhage.

What is believed to be the first case of a glomus jugulare tumor presenting with intracerebellar hemorrhage is described. A 25-year-old normotensive man suddenly suffered from severe headache, nausea, vomiting, vertigo, and ataxia due to an intracerebellar hemorrhage. Magnetic resonance imaging and angiography revealed a highly vascular jugulare foramen tumor extending into the intracranial space adjacent to the hematoma.

Use of the ultrasonically activated scalpel in acoustic neuroma surgery: preliminary report.

Recently, the ultrasonic activated scalpel (the Harmonic Scalpel, HS) has been introduced in laparoscopic surgery. We have applied the HS in debulking the tumor in the posterior fossa and concluded that this is useful in acoustic neuroma surgery. Fifteen patients with a tumor extending more than 20 mm into the posterior fossa were included in this study.

Haemorrhagic venous infarction following the posterior petrosal approach for acoustic neurinoma surgery: a report of two cases.

The authors report two surgical cases with acoustic neurinoma in which haemorrhagic infarction occurred via a compromise in cerebral deep venous outflow. In both cases, surgery was performed via the posterior petrosal approach, and the neurinomas were completely removed. In the first case, the haemorrhagic infarction was considered to have resulted from transection of the tentorial sinus, the presence of which had not been predictable by preoperative angiography.

Medial (intra-cisternal) acoustic neuromas.

The clinical characteristics of "medial" or "intra-cisternal" acoustic neuroma (AN) treated in our institute were reviewed. Among 466 patients with ANs in our series during the last 20 years, 6 patients (1.3%) were considered to fill the criteria of medial AN definition.

The long-term outcome of hearing preservation following vestibular schwannoma surgery.

Objective: The aim of this study is to describe the long-term outcome of preserved hearing after vestibular schwannoma surgery.

Methods: Subjects are 20 unilateral vestibular schwannoma patients whose class A hearing of the AAO-HNS classification was preserved successfully after tumor removal. Hearing preservation surgery was attempted via the middle cranial fossa (MCF) or the extended MCF approach.

Long-term prognosis of profound facial nerve paralysis secondary to acoustic neuroma resection.

The long-term prognosis of profound facial nerve paralysis was reviewed in 107 patients who, despite preserved nerve continuity, showed no facial movement after acoustic neuroma resection. Spontaneous recovery occurred in 77 patients. However, there was no apparent recovery in 30 patients.

Quality of hearing preservation in acoustic neuroma surgery.

Objective: This study aimed to investigate the factors affecting the quality of postoperative hearing in acoustic neuroma.

Study Design: The study was designed as a retrospective case review.

Setting: The study was performed at the Department of Otolaryngology, School of Medicine, Keio University, Tokyo, Japan.

[Cooperative multicentre study on posttraumatic epilepsy].

A multicentre cooperative prospective study have been conducted to investigate the factors influencing posttraumatic epilepsy (PTE) and to evaluate the prophylactic effect of anticonvulsants. Since April 1994, patients with head injury have been observed following our protocol as follows; anticonvulsants are administered only to the patients with brain parenchymal injury for one month just after head trauma and no anticonvulsants are administered after one month after trauma to any patients except those with posttraumatic epilepsy (PTE). Brain parenchymal injury included traumatic subarachnoid hemorrhage, acute subdural hematoma, contusion, intracerebral hematoma, and diffuse axonal injury.

Electromyographic analysis of profound facial nerve paralysis following acoustic neuroma resection.

The aim of our retrospective study was to determine whether electromyographic findings (motor unit action potentials, MUAPs) can be used in long-term prognosis for profound facial nerve paralysis in patients whose nerve continuity is preserved during surgery for acoustic neuroma. The orbicularis oris, frontal, and orbicularis oculi muscles were examined for the occurrence of MUAPs in 48 such patients. In 30 patients who recovered from complete paralysis within 10 months after surgery, MUAPs in the first two muscles tended to precede the first sign of facial movement.

Hearing preservation surgery in acoustic neuroma patients with normal hearing.

Acoustic neuroma (AN) patients who had normal hearing accounted for 7% of all our AN cases. It is important to identify AN patients who have normal hearing but are suffering from tinnitus, dizziness, or vertigo, or a combination of these symptoms (without hearing loss), in order to make an early diagnosis. Patients who experience sudden hearing loss and recover completely should also be thoroughly examined in order to rule out AN.

Accidentally detected brain tumors: clinical analysis of a series of 110 patients.

The clinical records of 1,155 patients with 1,159 brain tumors who drained on Keio University Hospital between 1983 and 1994 were reviewed. Apparently asymptomatic patients and those whose complaints or neurological deficits were not caused by the brain tumors were defined as accidental cases. For example, patients with a headache which was considered to be unrelated to the presence of a tumor were included in this series.

Developmental patterns and characteristic symptoms of petroclival meningiomas.

Thirty-six cases of petroclival meningiomas with clearly defined anatomical features were selected to analyze the site of tumor attachment and the displacement of the trigeminal nerve. The tumors were classified into four categories according to the origin and extension of the tumor: clival origin medial to the trigeminal nerve (upper clivus type), clival origin with dumbbell extension to the cavernous sinus (cavernous sinus type), tentorial origin over the trigeminal nerve (tentorium type), and petrous apex origin lateral to the trigeminal nerve (petrous apex type). Patients with tumors in each category had characteristic neurological symptoms.

Surgical approaches for vertebro-basilar trunk aneurysms located in the midline.

Fourteen cases of midline vertebro-basilar trunk aneurysms were operated on by four routes of surgical approach: middle fossa anterior transpetrosal approach (ATP), presigmoid transpetrosal approach (PTP), conventional lateral suboccipital approach (LSO) or suboccipital transcondylar approach (STC). There was no mortality, but the morbidity was different depending on the surgical approach. In basilar trunk aneurysms located higher than the internal auditory canal, excellent results were obtainable by ATP, especially in the case of posteriorly projecting aneurysms.

[Cooperative multicentric study on posttraumatic epilepsy].

A multicenter cooperative study was conducted to investigate factors influencing posttraumatic epilepsy (PTE) and to evaluate the prophylactic effect of anticonvulsants. A retrospective study of 102 PTE patients revealed the following typical clinical features: occurrence in young males, traffic accidents, contusion and/or cerebral hematoma. The latent period after the injury was longer in children.

[Usefulness of 3-dimensional image analysis of skull base lesions].

We have evaluated three-dimensional (3D) images of the skull base lesions for planning cranial base surgery. Fifty 3D images were reconstructed from computed tomographies (CT), and/or magnetic resonance (MR) images or MR angiographic images of 30 patients with skull base lesions. These images have provided useful information for pre-operative evaluation.

Unusual location of intracranial vagus neurinoma--case report.

A 55-year-old male presented with hearing disturbance and tinnitus in the left ear. Computed tomography (CT) and magnetic resonance imaging demonstrated a well-defined, homogeneously enhanced mass in the left cerebellomedullary cistern without extension close to the jugular foramen. A three-dimensional image reconstructed from thin-slice CT scans demonstrated that the mass was clearly separated from the jugular foramen.

Accumulation of nerve growth factor in cerebrospinal fluid and biological activity following neurosurgery.

Perioperative nerve growth factor (NGF) levels in cerebrospinal fluid (CSF) of patients with acoustic neurinoma (14 cases), tentorial meningioma (1 case), or subarachnoid hemorrhage (1 case) were examined. Preoperative NGF levels in CSF were below the level of detection in all patients. However, NGF was found to accumulate transiently in CSF following neurosurgery.

Planning and surgical strategies for early management of vertebral artery and vertebrobasilar junction aneurysms.

Selection of the approach and technique for surgical repair of aneurysm of the vertebrobasilar artery system is mainly based on angiographic features. This report emphasizes that planning the surgical procedure should also include preoperative evaluation of the individual skull base configuration, as well as the relationship between aneurysm site and surrounding bony structures. These features are evaluated on thin slice CT scans using bone tissue algorithms and are particularly important for adequate exposure of distal vertebral artery (VA) or midline aneurysms, because these cases require drilling of the jugular tubercle.

Hearing preservation by the extended and nonextended middle cranial fossa approach for acoustic neuroma.

The results of 248 cases of acoustic neuroma surgery carried out mainly by the extended middle cranial fossa approach during a 16-year period from 1976 to 1991 are analyzed. Hearing preservation was attempted in 69 cases and successfully achieved in 35 (51%) cases. Hearing was preserved in 24 (57%) of 42 cases in which a tumor was 20 mm or smaller in diameter, pure-tone hearing level was 50 dB or lower, and speech discrimination score was 50% or higher.