Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Better overall survival (OS) reported in patients with incidental diffuse low-grade glioma (iLGG) in comparison to symptomatic LGG (sLGG) may be overestimated by lead-time and length-time. METHODS: We performed a systematic review and meta-analysis of studies on adult hemispheric iLGGs according to the PRISMA statement to adjust for biases in their outcomes. Survival data were extracted from Kaplan-Meier curves. Lead-time was estimated by 2 methods: Pooled data of time to become symptomatic (LTs) and time calculated from the tumor growth model (LTg). RESULTS: We selected articles from PubMed, Ovid Medline, and Scopus since 2000. Five compared OS between patients with iLGG (n = 287) and sLGG (n = 3117). The pooled hazard ratio (pHR) for OS of iLGG to sLGG was 0.40 (95% confidence interval [CI] {0.27-0.61}). The estimated mean LTs and LTg were 3.76 years (n = 50) and 4.16-6.12 years, respectively. The corrected pHRs were 0.64 (95% CI [0.51-0.81]) by LTs and 0.70 (95% CI [0.56-0.88]) by LTg. In patients with total removal, the advantage of OS in iLGG was lost after the correction of lead-time. Patients with iLGG were more likely to be female pooled odds ratio (pOR) 1.60 (95% CI [1.25-2.04]) and have oligodendrogliomas (pOR 1.59 [95% CI {1.05-2.39}]). Correction of the length-time bias, which increased the pHR by 0.01 to 0.03, preserved the statistically significant difference in OS. CONCLUSIONS: The reported outcome in iLGG was biased by lead-time and length-time. Although iLGG had a longer OS after correction of biases, the difference was less than previously reported.

DOI： 10.1093/nop/npac073

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There has been only one previous published report of focal aware somatosensory seizures with paresis as a postoperative complication of chronic subdural hematoma (cSDH). This is the second case report of this condition captured on electroencephalography (EEG) as a postoperative complication of cSDH. A 76-year-old man with no history of epilepsy was taken to the emergency department of Shiga University of Medical Science Hospital because of transient weakness of the lower extremities. Head computed tomography showed bilateral cSDH that was larger on the left. Seven days after burr-hole evacuation of the left cSDH, the patient experienced a brief clonic seizure of the right hand without postoperative recurrence of cSDH. He then experienced a tingling sensation in, followed by clumsiness and weakness of, the right upper extremity without fluctuations in consciousness or convulsive movements. These symptoms appeared repeatedly, with intermittent improvement, persisting for 6 days after onset. Scalp EEG showed an electrographic seizure in the left central area, suggesting that the symptoms corresponded to focal aware somatosensory seizures with paresis. The symptoms and epileptiform patterns and electrographic seizures on the EEG disappeared with antiseizure medications.

DOI： 10.1016/j.ebr.2023.100621

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BACKGROUND: Lymphomas of the cranial vault are rare and are often misdiagnosed preoperatively as presumptive meningioma with extracranial extension. CASE DESCRIPTION: A 58-year-old woman was referred and admitted to our department with a rapidly growing subcutaneous mass over the right frontal forehead of 2 months' duration. The mass was approximately 13 cm at its greatest diameter, elevated 3 cm above the contour of the peripheral scalp, and attached to the skull. Neurological examination showed no abnormalities. Skull X-rays and computed tomography showed preserved original skull contour despite the large extra and intracranial tumor components sandwiching the cranial vault. Digital subtraction angiography showed a partial tumor stain with a large avascular area. Our preoperative diagnostic hypothesis was meningioma. We performed a biopsy and histological findings were characteristic of a diffuse large B-cell lymphoma. A very high preoperative level of soluble interleukin-2 receptor (5390 U/mL; received postoperatively) also suggested lymphoma. The patient received chemotherapy but died of disease progression 10 months after the biopsy. CONCLUSION: Several preoperative features of the present case are clues to the correct diagnostic hypothesis of cranial vault diffuse large B-cell lymphoma rather than meningioma, including a rapidly growing subcutaneous scalp mass, poor vascularization, and limited skull destruction relative to the size of the soft-tissue mass.

DOI： 10.25259/SNI_1040_2022

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BACKGROUND: Cranial vault lymphomas are rare and their clinical features are often similar to those of cranial vault meningiomas. The objective of this review was to identify the features helpful for differentiating lymphomas of the cranial vault, from meningiomas which were the most common diagnosis before the definitive pathological diagnosis. METHODS: The inclusion criterion was a histologically proven malignant lymphoma initially appearing in the calvarium. We conducted a literature search of the electronic PubMed and Ichushi-Web databases up to June 1, 2020. Cranial vault lymphoma that was diagnosed after an original diagnosis of lymphoma in a nodal or soft-tissue site was excluded from the study. Descriptive analyses were used to present the patient characteristics. RESULTS: A total of 111 patients were found in 98 eligible articles. Almost all studies were case reports. The most common symptom was a growing subcutaneous scalp mass (84%) present for a mean duration of 5.9 months before the patient presented for treatment in analyzable cases; this fast growth may distinguish lymphomas from meningiomas. The tumor vascularization was often inconspicuous or poor, unlike well-vascularized meningiomas. A disproportionately small amount of skull destruction compared with the soft-tissue mass was observed in two-thirds of the analyzable cases. CONCLUSION: This qualitative systematic review identified several features of cranial vault lymphomas that may be useful in differentiating them from meningiomas, including a rapidly growing subcutaneous scalp mass, poor vascularization, and limited skull destruction relative to the size of the soft-tissue mass.

DOI： 10.25259/SNI_28_2022

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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OBJECTIVE: Frontal lobectomy is often used as a surgical treatment for frontal lobe epilepsy, especially when a large epileptogenic zone in the frontal lobe is inferred from preoperative evaluation. The frontal lobe is important for cognitive functions such as executive functions and verbal fluency, but the neuropsychological outcome after a frontal or prefrontal lobectomy that includes both the dorsolateral prefrontal cortex and ventral prefrontal cortex has not been studied thoroughly. In the present study, we evaluated neuropsychological outcomes after patients with frontal lobe epilepsy received a frontal or prefrontal lobectomy. METHODS: We retrospectively reviewed the data of patients with frontal lobe epilepsy who underwent a frontal or prefrontal lobectomy that includes both the dorsolateral prefrontal cortex and ventral prefrontal cortex at 16 years or older from October 2004 to December 2014, with a minimum postoperative follow-up of 24 months. We analyzed and compared neuropsychological outcomes, including executive functions, verbal fluency, intelligence, and memory, before and after the operation. RESULTS: Eighteen patients were 16 years or older and underwent pre- and postoperative (2 years after the operation) neuropsychological evaluations. Patients showed significant deterioration only on the Benton Visual Retention Test. Performance on tests of frontal lobe functions, such as executive function and verbal fluency, showed no significant deterioration. CONCLUSIONS: Overall cognitive performance, including functions widely thought to depend on the frontal lobe, is stable after a frontal or prefrontal lobectomy to treat frontal lobe epilepsy.

DOI： 10.1016/j.yebeh.2021.108240

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：Japanese   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：日本神経感染症学会  

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Hyperkinetic seizures are usually associated with frontal lobe epilepsy. However, some patients have hyperkinetic seizures of temporal lobe origin. The semiological differences in hyperkinetic seizures between frontal and temporal lobe epilepsy have not been well studied. Here, we retrospectively assessed ictal semiology in order to distinguish between hyperkinetic seizures of frontal lobe origin and those of temporal lobe origin. We retrospectively reviewed data on patients who had undergone surgery for hyperkinetic seizures of temporal or frontal lobe origin and achieved favourable seizure outcomes (Engel Class I) with a minimum postoperative follow-up of 24 months. We reviewed seizure histories, imaging reports, video-EEG monitoring data, operative records, and pathological findings. We analysed and compared the hyperkinetic semiology of video-recorded seizures of temporal lobe origin and those of frontal lobe origin. Forty hyperkinetic seizures in eight patients (seven adult patients and one 12-year-old patient) with temporal lobe epilepsy and 45 hyperkinetic seizures in nine patients (eight adult patients and one 16-year-old patient) with frontal lobe epilepsy were analysed. Emotional facial expressions (such as fear, laughing, or anger), bilateral forceful elbow flexion, bilateral forceful grasping, facial flushing, and bilateral facial contraction were observed significantly more frequently in seizures of frontal lobe origin. Oroalimentary automatisms, seizures during wakefulness, salivation, and bilateral drop of the corners of the mouth were observed significantly more frequently in seizures of temporal lobe origin. Observation of a number of signs during hyperkinetic manifestations may help to predict whether a seizure originates from the frontal lobe or the temporal lobe.

DOI： 10.1684/epd.2019.1047

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DOI： 10.1016/j.wneu.2018.11.219

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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The amygdala and uncus are located close to important neurovascular structures. We describe a safe technique for resection of amygdala and uncus. Under general anesthesia, the patient is positioned supine, with the head rotated approximately 20 degrees to the unoperated side and slightly extended. By using a trans-anterior T1 subpial approach, the inferior horn of the lateral ventricle is opened, and hippocampectomy is performed. We treat an imaginary plane formed by the inferior circular sulcus of the insula, the endorhinal sulcus, and the inferior choroidal point as the upper border of amygdalar resection. After confirming the position of the inferior choroidal point, the border between the temporal stem and uncus is exposed from anterior to posterior. This border is continuous with the endorhinal sulcus. By exposing the endorhinal sulcus, the anterior choroidal artery and optic tract can be visualized. The amygdala is disconnected through complete exposure of the endorhinal sulcus to the inferior choroidal point. After the lateral side of the uncus is disconnected, the amygdala and uncus are removed en bloc. Since April 2014, we have used the described procedure to remove amygdalar-uncal lesions in 15 patients. The lesion was completely removed in all cases without complications. Histological specimens were obtained in all cases. Our procedure enables safe and complete removal of amygdalar-uncal lesions. Imagining the plane formed by the inferior circular sulcus, inferior choroidal point, and endorhinal sulcus is essential for complete removal of the lesion and for preserving important structures.

DOI： 10.2176/nmc.oa.2018-0117

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

DOI： 10.1016/j.wneu.2018.01.200

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Medknow Publications  

DOI： 10.4103/sni.sni_272_16

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DOI： 10.4103/sni.sni_289_17

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BACKGROUND: A single inflammatory demyelinating brain lesion sometimes mimics a brain tumor on conventional magnetic resonance imaging (MRI), and thus poses a considerable diagnostic challenge. We assessed the usefulness of a new MRI technique, fast imaging employing steady-state acquisition (FIESTA), for the diagnosis of inflammatory demyelinating disease (IDD). METHODS: Three patients (2 males, 1 female) with a histopathologically proven inflammatory demyelinating brain lesion which mimicked a brain tumor on MRI were evaluated with a post-contrast three-dimensional FIESTA sequence before biopsy and treatment. Those images were compared with the images of intra-axial brain tumors (n = 147). RESULTS: Preoperative FIESTA showed an iso- or slightly hyperintense distinct intralesional structure that appeared reticulate or broad-line in patients with IDD. These structures traversed a hyperintense demyelinating lesion in the deep grey matter (DGM) and were connected to the surrounding extralesional area, which appeared to be dense fibers between DGM. Such distinct intralesional structures were not observed in most brain tumors. CONCLUSION: Reticulate or broad-line-like intralesional structures on FIESTA may, therefore, be suggestive of IDD rather than indicate a brain tumor.

DOI： 10.4103/sni.sni_272_16

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier B.V.  

DOI： 10.1016/j.inat.2016.05.003

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Language：Japanese   Publisher：(NPO)日本脳神経血管内治療学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Medknow Publications  

DOI： 10.4103/2152-7806.185781

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BACKGROUND: Mammalian target of rapamycin (mTOR) complex 1 (mTORC1) acts as a downstream effector of phosphatidyl-inositol-3 kinase, which is frequently hyperactivated in glioblastoma multiforme and links to cell signaling in cellular proliferation, differentiation, metabolism, and survival. Although many studies have suggested the importance of mTORC1 in tumorigenesis, its role remains unclear in brain tumors other than glioblastoma. METHODS: In the present study, we evaluated the activation of mTORC1 in 24 cases of primary central nervous system lymphoma (PCNSL). RESULTS: Immunohistochemical analysis showed overexpression of Rheb, which is immediately upstream of mTORC1, in 20 cases of PCNSL. Immunohistochemical analysis also showed overexpression of phospho-4E-BP1 (Thr37/46) and phospho-S6 (Ser235/236), which are increased after mTORC1 activation as mTORC1 downstream effectors in 17 and 21 cases, respectively. CONCLUSION: Our data suggest that abnormal activation of the mTORC1 signaling pathway may cause tumor growth in patients with PCNSL.

DOI： 10.4103/2152-7806.185781

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BACKGROUND: Perioperative straight sinus thrombosis is extremely rare. CASE DESCRIPTION: A 59-year-old female was admitted to our department because of incidentally found small anterior cerebral artery (A1) aneurysm with microbleeding. After clipping the cerebral aneurysm, she had delayed emergence from anesthesia, total aphasia, and right hemiparesis. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the head showed hyperintensity in the bilateral caudate nuclei, putamina, and thalami, and computed tomography of the head showed a hyperdense straight sinus, suggesting straight sinus thrombosis. Her neurologic symptoms improved gradually, and she achieved a full clinical recovery, with radiological evidence of recanalization of the straight sinus at follow-up. CONCLUSION: The possibility of straight sinus thrombosis should be considered in postoperative patients with unexplained postoperative deficits when MRI demonstrates hyperintensity in the bilateral basal ganglia and thalami on FLAIR signal images.

DOI： 10.4103/2152-7806.181822

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BACKGROUND: Primary Ewing's sarcoma originating in the pericranium is an extremely rare disease entity. CASE DESCRIPTION: A 9-year-old female patient was admitted to our department due to a left temporal subcutaneous mass. The mass was localized under the left temporal muscle and attached to the surface of the temporal bone. Head computed tomography revealed a mass with bony spicule formation on the temporal bone, however, it did not show bone destruction or intracranial invasion. F-18 fluorodeoxyglucose positron emission tomography showed no lesions other than the mass on the temporal bone. Magnetic resonance imaging showed that the mass was located between the temporal bone and the pericranium. The mass was completely resected with the underlying temporal bone and the overlying deep layer of temporal muscle, and was diagnosed as primary Ewing's sarcoma. Because the tumor was located in the subpericranium, we created a new classification, "pericranial Ewing's sarcoma," and diagnosed the present tumor as pericranial Ewing's sarcoma. CONCLUSION: We herein present an extremely rare case of primary pericranial Ewing's sarcoma that developed on the temporal bone.

DOI： 10.4103/2152-7806.183545

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Medknow Publications  

DOI： 10.4103/2152-7806.166777

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Language：Japanese   Publisher：(一社)日本核医学会  

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DOI： 10.1016/j.wneu.2014.08.054

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DOI： 10.1111/ejn.12835

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BACKGROUND: "Headbanging" is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma. CASE DESCRIPTION: A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging. CONCLUSIONS: Headbanging has the hazardous potential to cause a subdural hematoma.

DOI： 10.4103/2152-7806.166777

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小脳動静脈奇形に対する集学的治療の有用性について検討した。小脳動静脈奇形12例を対象とした。出血発症9例中のうち、動脈瘤からの1例を除き、すべて小脳出血であった。mRS 4から5点が5例で、4例において緊急血腫除去あるいは外減圧を施行した。深部静脈への流出は11例であった。全例で、摘出術あるいは放射線手術に先立ち塞栓術を施行した。最終的に手術摘出は7例、放射線手術は4例で施行したが、2例を除き血管撮影で消失を確認した。

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Language：Japanese   Publisher：日本脳腫瘍病理学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Neurosurgical Society  

DOI： 10.2176/nmc.cr2013-0010

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DOI： 10.2176/nmc.cr2012-0143

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DOI： 10.1016/j.clineuro.2012.12.036

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Language：Japanese   Publisher：The Japanese Society on Surgery for Cerebral Stroke  

The main aim of the treatment of ruptured cerebral arteriovenous malformations (AVMs) is to prevent rebleeding. We analyzed the rate and the timing of re-hemorrhage of ruptured cerebral AVMs in a consecutive series of patients admitted to our institute. The total number of patients was 127 (79 males, 48 females), admitted in our university hospital from 1979 to 2009. Hemorrhagic and non-hemorrhagic presentation was recorded in 68 and 59 cases, respectively. The AVMs were diagnosed with catheter angiography, magnetic resonance imaging or enhanced computed tomography. Spinal AVM, dural arteriovenous fistula, cavernous malformation and venous angioma were excluded. <br> The data of patients admitted to our hospital before 2008 were searched retrospectively, whereas data from patients admitted from 2008 and later were subjected to prospective tracing surveys, and the location of nidi, treatment modality, timing of hemorrhage after the onset and neurological outcomes were investigated. We specially focused on the re-hemorrhagic rate in the acute phase and analyzed the data minutely. Re-hemorrhagic risk decreased 400 days after the first hemorrhage and became constant. Re-hemorrhage during the follow-up period seems to be one of the causes of neurological deterioration, but re-hemorrhage in the acute phase did not result in a significant incidence of mortality. <br> Early re-hemorrhage of cerebral AVMs was not considered as frequent or catastrophic as ruptured aneurysms. Our clinical data support our treatment strategy of avoiding aggressive early treatments for ruptured cerebral AVMs.<br>

DOI： 10.2335/scs.41.21

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Xanthomatous meningioma is an extremely rare variant of meningioma that is characterized histopathologically by the presence of tumor cells with lipid-filled vacuolated cytoplasm. In this report, we describe the fifth documented case of xanthomatous meningioma and review its clinicopathological features. A 76-year-old Japanese male presented with dizziness. Magnetic resonance imaging demonstrated a well-circumscribed tumor in the left parasagittal to frontal region with attachment of the dura mater. Histopathological examination of the resected specimen revealed proliferation of polygonal to spindle cells with eosinophilic cytoplasm and bland round to oval nuclei. Whorl formation and psammomas were scattered, and mitotic figures were rarely seen. A peculiar finding was the presence of extensive xanthomatous change continuing to the above-mentioned typical meningothelial meningioma. These tumor cells had clear vacuolated cytoplasm and bland round to oval nuclei. Immunohistochemically, xanthomatous cells were positive for epithelial membrane antigen. Accordingly, an ultimate diagnosis of xanthomatous meningioma was made. Our clinicopathological analysis revealed that xanthomatous meningioma affects children to young persons or the elderly, and four of five cases were located in the supratentorial region. Although the detailed mechanism underlying the xanthomatous change has not been clarified, this change is thought to result from a metabolic abnormality of the neoplastic meningothelial cells. Further, xanthomatous change has also been reported in atypical and anaplastic meningiomas. Therefore, it is important to recognize that xanthomatous change can occur in meningiomas, and to avoid misidentifying these cells as macrophages.

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DOI： 10.2176/nmc.52.607

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DOI： 10.2176/nmc.51.445

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DOI： 10.2176/nmc.51.239

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DOI： 10.2176/nmc.51.88

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Edizioni del Centauro  

DOI： 10.1177/197140091102400506

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Language：Japanese   Publishing type：Research paper (international conference proceedings)   Publisher：Japanese Congress of Neurological Surgeons  

DOI： 10.7887/jcns.20.42_1

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Language：Japanese   Publisher：The Japanese Society on Surgery for Cerebral Stroke  

The treatment goal for cerebral AVMs is mainly to prevent hemorrhage. Bleeding risks of cerebral AVMs depend on several factors such as size/location of the nidus, types of presentation, and angiographical cure does not necessarily mean no risk of hemorrhage. The treatment strategy based on Spetzler-Martin grading is proposed in several guidelines: Grade I, II, and III are a therapeutic target; Grade IV and V should be treated conservatively. According to AHA Scientific Statement, surgical extirpation should be conceded for Spetzler-Martin Grade I and II, and surgical extirpation with preoperative feeder embolization is often effective for Spetzler-Martin Grade III, but single surgical extirpation is not recommended for Spetzler-Martin Grade IV and V. Although low grade AVMs are reported to be amenable to extirpation with low morbidity, patient selection bias seems to reduce estimates of risk. <br> It is difficult to decide the treatment only by the Spetzler-Martin grading system because of degraded ability of AVM patients to communicate, and wide ranges of risk of hemorrhage and risk of extirpation in each patient. Treatments should be individualized using adequate pre-, and intra-operative assessment of risk.<br>

DOI： 10.2335/scs.39.24

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DOI： 10.1111/j.1528-1167.2009.02055.x

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DOI： 10.1111/j.1528-1167.2008.01595.x

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DOI： 10.1523/JNEUROSCI.5516-05.2006

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Language：Japanese   Publisher：日本神経感染症学会  

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Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：(一社)日本てんかん学会  

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Language：Japanese   Publisher：The Japanese Congress of Neurological Surgeons  

A 58-year-old woman with progressive disturbance of consciousness was admitted to our hospital. CT scans and MR images revealed a large tumor expanded to the bilateral anterior cranial fossae. The tumor was composed of two components. One containing the falx in the mid portion was expanded to the left anterior cranial fossa with calcification inside, and the other occupied the right anterior cranial fossa including some cysts. Pathological study showed fibrous meningioma (WHO grade I ) in the left component, and atypical meningioma (WHO grade II) with mitosis in the right component. It was considered to be a case of large falx meningioma, which grew rapidly with a partial malignant transformation.

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