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Taguchi K, Ito K, Nakajima Y, Ogawa H, Murofushi K. Incidence and Prognostic Factors of Painful Vertebral Compression Fracture Caused by Spine Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e152-e153. [PMID: 37784738 DOI: 10.1016/j.ijrobp.2023.06.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Most studies of vertebral compression fracture (VCF) caused by stereotactic body radiotherapy (SBRT) do not mention the symptoms. We aimed herein to determine the rate and prognostic factors of painful VCF caused by SBRT for spinal metastasis. MATERIALS/METHODS Between August 2013 and December 2021, spinal segments with VCF were retrospectively identified in patients treated with spine SBRT. Iatrogenic VCFs, excluding pathological fractures, were classified into a modified group and graded using CTCAE v5.0 as grade 1 (painless), grade 2 (mildly painful), or grade 3 (intensely painful, requiring hospitalization or surgery). The primary endpoint was the rate of painful VCF (grades 2-3). Moreover, various factors specific to the patient, tumor, and treatment were evaluated to determine their value in predicting the rate of painful VCF. RESULTS In total, 934 spinal segments in 387 patients were analyzed. The median follow-up after SBRT was 14 (range: 0-107) months. Sixty iatrogenic fractures (6.4%) comprising 31 de novo fractures and 29 existing VCF progressions were identified. The patients' median age was 68 (range: 38-79) years, and 31 (52%) spinal segments had a history of radiotherapy. Grade 1, 2, and 3 VCFs were confirmed in 41, four, and 15 segments, respectively. The rate of grade 3 VCF was 2.0% (19 / 934) of the spinal segments treated with SBRT. Eight (0.9%) VCFs required surgery for stabilization or decompression of spinal canal stenosis. None of the 17 VCFs treated with posterior decompression and fixation before SBRT developed into a painful VCF. On univariate analysis, the painful VCF rate was significantly higher in patients with no posterolateral tumor involvement than in those with bilateral or unilateral involvement (56.3% vs 22.7%; p = 0.026). Other spinal instability neoplastic score (SINS) components (Location, Pain, Bone lesion, Alignment, Vertebral body collapse), SINS (Stable/ Potentially unstable vs Unstable), age, number of spinal levels, radiation history, existing VCF, and interval between SBRT and VCF showed no significant correlation with painful VCF. CONCLUSION Although VCF is a known adverse effect of spine SBRT, 68% of the cases examined were painless (grade 1). Intensely painful VCFs (grade 3) were confirmed in only 1.6% of all the treated spinal segments. The absence of posterolateral tumor involvement was significantly associated with painful VCF.
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Affiliation(s)
- K Taguchi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Ito
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Y Nakajima
- Department of Radiological Sciences, Komazawa University, Tokyo, Japan
| | - H Ogawa
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Murofushi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Takizawa T, Kito S, Ogawa H, Nemoto H, Taguchi K, Suda Y, Yasui K, Arai Y, Watanabe S, Najima Y, Doki N, Murofushi K. Dosimetric Evaluation of Targets and Organs at Risk in Dose Escalation Study for Total Marrow and Lymphoid Irradiation. Int J Radiat Oncol Biol Phys 2023; 117:e724. [PMID: 37786110 DOI: 10.1016/j.ijrobp.2023.06.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Total marrow and lymphoid irradiation (TMLI) delivers radiation dose to the bone marrow and lymph nodal region while reducing the dose to non-target organs. We conducted a dose-escalation study of TMLI to improve treatment outcomes while reducing OAR doses using intensity-modulated radiation therapy. However, this dose escalation strategy may cause increasing risk of recurrence and adverse events because of dose uniformity compromises of the target. We hypothesized that the homogeneity index (HI) could become worse with increased target's dose while maintaining reduced OAR doses for the nine patients enrolled in the TMLI phase Ⅰ clinical trial. MATERIALS/METHODS Nine patients treated with TMLI using a treatment delivery system from September 2019 to August 2021 were included. The prescribed doses were 14 Gy/6 fr, 16 Gy/6 fr, and 18 Gy/6 fr twice daily for 3 days, with three patients allocated each prescription. Bone marrow, lymph nodal region, spleen, testis, brain, and liver were designated as targets. The bone marrow was divided into eight parts (see Table); an individual PTV margin was added to each structure. We intended to deliver the D80% prescription dose for PTV. For the brain and liver, the prescribed dose was 12 Gy in consideration of function preservation. Lenses, oral cavity, parotid glands, lungs, heart, esophagus, stomach, kidneys, intestines, and breasts were defined as OAR. Targets were evaluated with HI that was calculated using the formula HI = (D2%-D98%)/D50%, based on ICRU report 83. For OARs, Dmax, D2%, D10%, and mean dose constraint were evaluated. RESULTS The table lists HI for the PTV_ALL and each target. The HI of PTV_ALL rose with increasing prescription dose and was highest at 18 Gy. The highest HI was 0.632 for PTV_Rib at 18 Gy, and the lowest HI was 0.045 for PTV_testis at 14 Gy. OAR Dose constraints were achieved in all patients. The average OAR doses in all cases for lenses, oral cavity, parotid glands, lungs, heart, esophagus, intestines, kidneys, and breast were 4.7±0.80, 4.4±0.51, 6.7±0.48, 7.6±0.22, 7.8±0.19, 6.7±0.18, 7.4±1.12, 6.9±0.96, and 14.7 Gy, respectively. The Dmax of the lenes, D2% of the esophagus, and D10% of the stomach were 7.2 ± 1.09, 11.5 ± 0.47, and 10.9 ± 0.98 Gy, respectively. CONCLUSION In the TMLI phase I clinical trial, we evaluated the dose uniformity to the targets and the OAR dose constraints. Although the HI for PTV_ALL worsened with increasing prescription dose, compliance with OAR dose constraints was achieved in all patients.
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Affiliation(s)
- T Takizawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - S Kito
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - H Ogawa
- Department of Radiation Oncology, Miyagi Cancer Center, Miyagi, Japan
| | - H Nemoto
- University of Yamanashi, Chuo, Japan
| | - K Taguchi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Y Suda
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Yasui
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Y Arai
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - S Watanabe
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Y Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - N Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - K Murofushi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Murofushi K, Kuribayashi S, Ohnishi K, Hayakawa S, Tsuchida K, Inoue Y, Ohkawa A, Ishida T, Machitori Y, Nakai K, Takizawa D. Multi-Institutional Fact-Finding Study: Association between Geriatric Assessment and Reduction in Intensity of Radiotherapy for Elderly Cancer Patients without Metastasis. Int J Radiat Oncol Biol Phys 2023; 117:S126-S127. [PMID: 37784325 DOI: 10.1016/j.ijrobp.2023.06.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Vulnerable patients receive a low-intensity, palliative treatment rather than the standard treatment. Defining vulnerability in terms of standard or reduced radiation intensity can result in appropriate radiotherapy for elderly cancer patients without excessive adverse events and poor outcomes. However, it is difficult to define vulnerability, because radiation oncologists hesitate to include vulnerable patients in clinical trials involving radical radiotherapy. We hypothesized that for elderly cancer patients without metastasis, vulnerability scores, obtained by geriatric assessment (GA), could help in predicting the reduction in radiation intensity determined by radiation oncologists based on their experience. MATERIALS/METHODS In this multicenter prospective study, we enrolled cancer patients (70 years or older) without metastasis. The reduction in radiation intensity was categorized into 3 groups as follows: i) standard schedule of radiotherapy, but conversion of irradiation fields, ii) standard irradiation fields, but converted schedule of radiotherapy, and iii) conversion of radiotherapy schedule and irradiation fields. Standard radiotherapy was defined as recommended doses and radiation fields according to the guidelines for the primary tumors analyzed. GA was performed by calculating geriatric 8 (G8) and vulnerable elders survey (VES-13) scores before radiotherapy and 3-5 and 8-16 weeks after completion of radiotherapy. The primary endpoint was to evaluate the correlation between vulnerability assessed by G8 and change in radiation intensity. RESULTS Between November 2020 and February 2022, 317 patients were included in this study at 13 centers in Japan. The median age was 77 (range, 70-90) years. The primary cancer sites were head and neck, esophagus, lungs, breasts, pancreas, bladder, uterus, and prostate in 63, 22, 62, 48, 6, 5, 26, and 85 patients, respectively. High-precision radiotherapy was performed for 199 patients (63%). Of the 31 patients (10%) whose radiation intensity was reduced, 14, 9, and 8 patients were provided i, ii, and iii category, respectively. Planned radiotherapy was completed for 312 patients (98%). G8 and VES-13 vulnerability scores were obtained for 201 and 61 patients, respectively, before radiotherapy. The mean G8 and VES-13 scores were 13.3 ± 2.4 and 1.8 ± 1.8, 12.9 ± 2.6 and 2.0 ± 2.0, and 13.4 ± 2.4 and 2.0 ± 1.9 before radiotherapy and 3-5 and 8-16 weeks after completion of radiotherapy, respectively. Multivariate analysis revealed that reduction in radiation intensity was significantly associated with vulnerability assessed using VES-13 (p < 0.001) but not G8 (p = 0.06). CONCLUSION An excellent completion rate was obtained for planned radiotherapy, and vulnerability assessed using VES-13, not G8, was associated with the reduction in intensity of radiotherapy.
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Affiliation(s)
- K Murofushi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - K Ohnishi
- National Center for Global Health and Medicine, Chiba, Japan
| | - S Hayakawa
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Y Inoue
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan
| | - A Ohkawa
- Mito Medical Center, Ibaraki, Japan
| | - T Ishida
- Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Tsukuba, Japan
| | - Y Machitori
- Tokyo Metropolitan Bokutou Hospital, Tokyo, Japan
| | - K Nakai
- Departement of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - D Takizawa
- Hitachi General Hospital, Ibaraki, Japan
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Matsuo Y, Murofushi K, Kokubo M, Sakamoto T, Morita S, Hiraoka M, Nakamura M, Mizowaki T. Long-Term Results of a Multi-Institutional Study of Dynamic Tumor Tracking-Stereotactic Body Radiotherapy for Lung Tumors. Int J Radiat Oncol Biol Phys 2023; 117:S31. [PMID: 37784474 DOI: 10.1016/j.ijrobp.2023.06.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We had conducted a multi-institutional phase II study to evaluate the safety and efficacy of dynamic tumor tracking-stereotactic body radiotherapy (DTT-SBRT) for lung tumors. The primary endpoint was 2-year local control, which was reported to be 95.2%. After the initial evaluation of the primary endpoint, the study was extended as an observational study which was designed to evaluate 5-year survival and late toxicities. We present the long-term results of DTT-SBRT for lung tumors. MATERIALS/METHODS The main eligibility criteria for the study were as follows: (1) primary or metastatic lung cancer with a diameter of 5 cm or less, and up to 3 lesions without any extrapulmonary lesions; (2) ineligibility to standard surgery, or patient's refusal of surgery; (3) ECOG-PS of 0 to 2; and (4) expected range of respiratory motion of 10 mm or more. The study included 48 patients from four institutions with the median age of 80 years (range, 49-90 years). Forty-two patients had primary non-small-cell lung cancer, and 6 patients had metastatic lung tumors. Forty-eight tumors (median diameter, 23.5 mm; range, 5-47 mm) in 48 patients were targeted for DTT-SBRT using a gimbal-mounted linear accelerator. Prior to treatment planning, spherical gold markers were placed around the tumor to detect internal tumor motion using fluoroscopy. The prescribed dose was 50 Gy in four fractions. Treatment beams were delivered with DTT according to a 4D model that predicts internal tumor motion with abdominal wall motion. DTT-SBRT was successfully delivered to all but one patient who had poor correlation between abdominal wall and tumor motion. RESULTS Median follow-up period at data cutoff was 5.0 years (interquartile range, 3.1-6.3 years). Twenty-nine patients died; the causes of death were cancer-specific in 10 patients, comorbidity in 14 patients (pulmonary disease, renal failure, cerebral infarction, other malignancies, etc.), and unknown in 5 patients without cancer recurrence. Overall survival at 5 years was 51.5% (95% confidence interval [CI], 36.5-64.6%). Progression-free survival and local control at 5 years were 41.0% (95% CI, 27.0-54.5%) and 92.6% (95% CI, 78.7-97.6%), respectively. There were no grade 4-5 toxicities. One patient (2%) developed grade 3 radiation pneumonitis at 3 months. Grade 2 toxicities were observed in 9 patients (19%), including dyspnea, radiation pneumonitis, pleural effusion, rib fracture, and dermatitis. CONCLUSION Dynamic tumor tracking SBRT achieved the long-term efficacy with low incidence of severe toxicities in lung tumors with respiratory motion. In this elderly patient cohort, non-cancer deaths were observed more than cancer-specific deaths.
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Affiliation(s)
- Y Matsuo
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Murofushi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - M Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - S Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Hiraoka
- Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - M Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Mizowaki
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nakajima Y, Ito K, Taguchi K, Minakami S, Kito S, Murofushi K. Prospective Dosimetric Comparison Study Between Volumetric Modulated Arc Therapy and Intracavitary Brachytherapy for Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e700. [PMID: 37786055 DOI: 10.1016/j.ijrobp.2023.06.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Although volumetric modulated arc therapy (VMAT) boost can achieve highly conformal dose distributions for cervical cancer, VMAT has the disadvantage of requiring set-up and organ motion margins. This study prospectively recruited patients with the cervical cancer and compared VMAT plan with intracavitary brachytherapy (ICBT) plan. MATERIALS/METHODS All patients treated with ICBT for locally advanced cervical cancer between April 2020 and September 2022 were enrolled. Patients had whole-pelvis radiotherapy, followed by CT scans with and without the tandem and ovoid in the same session (for the planning of ICBT and VMAT, respectively). ICBT planning characterizes the high-risk clinical target volume (HR-CTV) as the target volume and the bladder, rectum, sigmoid colon and small bowel loop as the organ at risk (OAR). VMAT planning defines the HR-CTV + 3 mm as the target volume and bladder, rectum + 3 mm (planning organ at risk volume (PRV) rectum), sigmoid colon + 3 mm (PRV sigmoid) and bowel bag as the OAR to account for set-up and organ motion. ICBT and VMAT plans were optimized for maximal dose received by at least 90% (D90%) of the target volume without impairing the dose constraints for the OARs. The prescribed dose (PD) was 26 Gy in 4 fractions. The dose constraints were determined as 25.2 Gy for D2 ml in the bladder and 20 Gy for D2 ml in the other OARs. The D90% and D100% of the target volume and D2 ml of OARs were compared between 2 plans using paired two-tailed Student's t test. RESULTS Seventeen patients were enrolled. Dose and volume parameters for the 2 plans are shown in Table 1. Of the 17 patients, D90% of the target volume received 100% PD in 4 cases with ICBT plans, in 6 cases for VMAT plans, and in 2 cases with both methods. For D90% of the target volume, ICBT plans were greater than VMAT plans in 4 cases, with a maximum difference of 5.6 Gy (ICBT: 26.0 Gy, SBRT: 20.4 Gy). VMAT plans were higher than ICBT plans in 11 cases, with a maximum difference of 10.3 Gy (ICBT: 14.5 Gy, SBRT: 24.8 Gy). The dose-limiting OARs to attain D90% of target volume were bladder in 12 cases and small bowel loop in 1 case for ICBT plans, while PRV rectum in 11 cases, PRV sigmoid in 4 cases and bowel bag in 1 case for VMAT plans. CONCLUSION This prospective study with 17 ICBT-eligible patients revealed D90% of the target volume demonstrated no substantial difference between VMAT and ICBT plans, while D100% showed a significant increase in VMAT plan compared to ICBT plan. Even with a set-up and organ motion margins on the HR-CTV and OARs, VMAT may have a dosimetric advantage over ICBT if the target geometry is complicated and close to the OARs.
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Affiliation(s)
- Y Nakajima
- Department of Radiological Sciences, Komazawa University, Tokyo, Japan; Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Ito
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Taguchi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - S Minakami
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - S Kito
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Murofushi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Nakajima S, Murofushi K, Matsuda S, Shimada S, Shimoji K, Nakao Y, Yamamoto T. A case report of hydrocephalus due to diffuse villous hyperplasia of the choroid plexus: surgical treatment by combination a flexible videoscope with a rigid endoscope. Childs Nerv Syst 2023; 39:2045-2051. [PMID: 37393333 DOI: 10.1007/s00381-023-06012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Diffuse villous hyperplasia of the choroid plexus (DVHCP) and choroid plexus papilloma (CPP) are rare benign tumors usually diagnosed as a result of progressive hydrocephalus, especially in childhood. We present the case of a Japanese boy diagnosed with progressive hydrocephalus due to DVHCP. METHODS Case: A 2-year and 3-month-old Japanese boy was found to have delayed motor development (equivalent to 1 year and 2 months old), an enlarged head circumference of 51 cm within + 1.5 standard deviation (S.D.), and incomplete closure of the anterior fontanel. The magnetic resonance imaging (MRI) showed lobular enlargement of the bilateral choroid plexuses extending from the trigone to the body and inferior horn of the lateral ventricle. The endoscopic choroid plexus coagulation surgery was performed to reduce the CSF formation rate. RESULTS DVHCP was diagnosed both pathologically and clinically. Postoperatively, the patient progressed without complications, such as cerebrospinal fluid leakage. Although ventricular enlargement persisted, the anterior fontanel recessed, and the expansion of the head circumference stopped. CONCLUSION Few cases of bilateral DVHCP and CPP have been reported in the literature. We encountered a case in which effective choroid plexus coagulation was performed for hydrocephalus due to DVHCP using less invasive endoscopic technique. It also represented an association between DVHCP and the gain of chromosome 9p.
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Affiliation(s)
- Shintaro Nakajima
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Keisuke Murofushi
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Shinpei Matsuda
- Department of Pediatrics, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Shino Shimada
- Department of Pediatrics, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare Hospital, Narita City, Chiba, Japan
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan.
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Adachi S, Ueno H, Magami S, Fujita N, Nakajima S, Ikemura R, Ueki Y, Takaki Y, Murofushi K, Nakao Y, Yamamoto T. Cerebrospinal fluid rhinorrhea with meningoencephalocele related to Sternberg's canal: A report of two cases. Surg Neurol Int 2023; 14:228. [PMID: 37404491 PMCID: PMC10316184 DOI: 10.25259/sni_260_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023] Open
Abstract
Background Cerebrospinal fluid (CSF) rhinorrhea with meningoencephalocele (MEC) associated with Sternberg's canal is rare. We treated two such cases. Case Description A 41-year-old man and a 35-year-old woman presented with CSF rhinorrhea and mild headache worsening with standing posture. Head computed tomography showed a defect close to the foramen rotundum in the lateral wall of the left sphenoid sinus in both cases. Head magnetic resonance (MR) imaging and MR cisternography revealed that brain parenchyma had herniated into the lateral sphenoid sinus through the defect of the middle cranial fossa. The intradural and extradural spaces and bone defect were sealed with fascia and fat through both intradural and extradural approaches. The MEC was cut away to prevent infection. CSF rhinorrhea completely stopped after the surgery. Conclusion Our cases were characterized by empty sella, thinning of the dorsum sellae, and large arteriovenous malformations that suggest chronic intracranial hypertension. The possibility of Sternberg's canal in patients with CSF rhinorrhea with chronic intracranial hypertension should be considered. The cranial approach has the advantages of lower infection risk and the ability to close the defect with multilayer plasty under direct vision. The transcranial approach is still safe if performed by a skillful neurosurgeon.
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Affiliation(s)
- Satoshi Adachi
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Hideaki Ueno
- Department of Neurosurgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Shunsuke Magami
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Naohide Fujita
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Shintaro Nakajima
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Ryogo Ikemura
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Yasuhito Ueki
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Yuki Takaki
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Keisuke Murofushi
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
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Murofushi K, Murofushi W, Komazawa M, Ohnishi K, Shimizuguchi T, Ito K, Hayakawa S, Ishikawa H. Preliminary Study on Establishing a Heart Rate Variability–Based Method for Objectively Evaluating Bone Metastasis Pain. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ogawa H, Konishi T, Najima Y, Kito S, Ohashi K, Doki N, Murofushi K. Phase I Dose Escalation Trial of 3-Day Total Marrow and Lymphoid Irradiation for Leukemia as Part of Myeloablative Conditioning in Unrelated Bone Marrow Transplantation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Murofushi K, Tomita T, Ishida T, Baba K, Numajiri H, Mizumoto M, Ohnishi K, Nakai K, Ishikawa H, Okumura T, Sakurai H. The Incidence of Venous Thromboembolism Induced by Prolonged Bed Rest during Interstitial Brachytherapy for Gynecological Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakamura M, Ohnishi K, Okumura T, Numajiri H, Murofushi K, Mizumoto M, Nonaka T, Ishikawa H, Sakurai H. Definitive Photon or Proton Radiotherapy for Oligo-recurrences at the Regional Lymph Nodes after Surgery in Patients with Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Sekino Y, Okumura T, Fukumitsu N, Iizumi T, Miyauchi D, Mizoguchi N, Murofushi K, Ohnishi K, Mizumoto M, Nonaka T, Nakai K, Ishikawa H, Tsuboi K, Sakurai H. EP-1420 Utility of FIB-4 index for hepatocellular carcinoma patients treated with proton beam therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Shimizu S, Okumura T, Mizoguchi N, Numajiri H, Murofushi K, Onishi K, Oshiro Y, Mizumoto M, Nonaka T, Ishikawa H, Sakurai H. EP-1444 Clinical results of proton beam therapy for unresectable intrahepatic cholangiocarcinoma. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Ishikawa H, Nonaka T, Ohnishi K, Ohno T, Mizoguchi N, Murofushi K, Iizumi T, Sekino Y, Okumura T, Sakurai H. Long-Term Follow-Up Results of Concurrent Chemo-Proton Therapy for Esophageal Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Horie H, Matsusaka S, Ishihara S, Kondo K, Uehara K, Oguchi M, Murofushi K, Ueno M, Mizunuma N, Shimbo T, Kato D, Okuda J, Hashiguchi Y, Nakazawa M, Sunami E, Kawai K, Yamashita H, Okada T, Nakajima T, Watanabe T. S-1 plus oxaliplatin combined with radiation (SOX/RT) for preoperative locally advanced rectal carcinoma: final results of a phase II study (JACCRO CC-04: SHOGUN trial). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Kumai Y, Oguchi M, Miyagi Y, Ito Y, Iwase T, Akiyama F, Yoshida K, Harada A, Okubo H, Asari T, Murofushi K, Toshiyasu T, Kozuka T, Sumi M. EP-1164: Outcomes of postmastectomy radiotherapy in patients with 1 to 3 positive nodes in single institute. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Ohnishi K, Okumura T, Ishikawa H, Oshiro Y, Mizumoto M, Murofushi K, Numajiri H, Fukumitsu N, Aihara T, Tsuboi K, Sakurai H. High Dose (74 GyE) Proton Beam Therapy With Concurrent Chemotherapy for Stage III Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Murofushi K, Kanuma R, Numajiri H, Mizumoto M, Ohnishi K, Aihara T, Fukumitsu N, Ishikawa H, Okumura T, Sakurai H. Clinical Outcome of Interstitial Brachytherapy for Locally Recurrent Gynecologic Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Okumura T, Fukumitsu N, Mizumoto M, Ishikawa H, Ohnishi K, Murofushi K, Numajiri H, Fukuda K, Abei M, Aihara T, Sakae T, Tsuboi K. PO-0704: Proton beam therapy for hepatocellular carcinoma with extensive portal vein tumor thrombosis. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Murofushi K, Kitamura N, Yagi Y, Kozuka T, Takeshima N, Sakurai H, Oguchi M. Early Outcomes and Dose-Volume Parameters for CT-Based Treatment Planning in Brachytherapy for Cervical Cancer With Severe Vaginal Invasion or Vaginal Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Murofushi K, Kitamura N, Machida H, Kozuka T, Takeshima N, Takizawa K, Sakurai H, Oguchi M. The Impact of Vicryl Mesh Sheet Placed on Pelvic Wall for Reducing the Irradiated Bowel Volume in VMAT of Cervical Cancer: Planning Study. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Kitamura N, Murofushi K, Hashimoto M, Nakajima M, Matsubayashi F, Saotome S, Takahashi R, Eba J, Sato T, Oguchi M. The Threshold CT Value Difference in the Deformed Volume With Good Conformality. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Murofushi K, Oguchi M, Kozuka T, Sakurai H. Radiation-induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome in Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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24
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Murofushi K. [Regulation of cell proliferation by lysophosphatidic acid]. Tanpakushitsu Kakusan Koso 1993; 38:1396-401. [PMID: 8337407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- K Murofushi
- Department of Biology, Faculty of Science, Ochanomizu University, Tokyo, Japan
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Murofushi K. [To enter the world of patients with senile dementia]. Kurinikaru Sutadi 1986; 7:1138-42. [PMID: 3640162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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26
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Murofushi K. [Bedside care of the aged with senile dementia. The relationship between the psychiatric state of the patient and the care]. Kango Gijutsu 1985; 31:1567-72. [PMID: 3851867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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27
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Murofushi K, Tanaka Y, Goto M. [Clinical characteristics of senile dementia]. Nihon Rinsho 1981; 39:502-9. [PMID: 7265494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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28
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Tanaka Y, Murofushi K, Ando S, Suwa K, Hayashi M. [Combined degeneration of the globus pallidus, cerebellar nuclei and their efferent systems in 2 siblings; primary systemic degeneration of the globus pallidus and the cerebellar nuclei]. No To Shinkei 1977; 29:95-104. [PMID: 560197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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29
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Miyagawa K, Ando S, Seino M, Murofushi K. [An autopsy case of inflammatory diffuse sclerosis (adult case of Schilder's disease)--clinicopathological study (author's transl)]. Seishin Shinkeigaku Zasshi 1976; 78:815-28. [PMID: 1037130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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30
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Hori A, Murofushi K, Iizuka R. [Dysgenesis of CNS in dyscranio-pygo-phalangia (author's transl)]. Acta Neuropathol 1976; 35:327-32. [PMID: 822683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A rare case of dyscranio-pygo-phalangia was studied neuropathologically. The patient was a 19 days old boy, who showed multiple anomalies: protuberance of forehead, narrow eye fissures, microphthalmos, micrognathia, microauriculae with dysplasia, hexadactylia of extremities, cryptorchism, asymmetric thorax, congenital heart disease and hypoplasia of the right lung. There were multiple dysgeneses in the central nervous system, especially the cerebellum: floccular heterotopia; heterotopias of cortex type, cerebellar nucleic type and Purkinje cell type; external granular layer cells in the white matter; dentate spindle-cell-dysgenesis. Other findings were glio-neurono-mesenchymal dysgenesis on the surface of the brain, residual fetal external granular layer on the surface of the pons, partial hypoplasia of corpus callosum, heterotopic nerve cells in the molecular layer of the periinsular cortex.
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31
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Ogasawara Y, Ito K, Murofushi K. [Congenital muscular dystrophy associated with micropolygyria of the cerebrum and cerebellum]. No To Shinkei 1976; 28:451-7. [PMID: 1036064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The characteristic features of micropolygyria were demonstrated in the cerebral and cerebellar gray matter of two cases, 5 and 16 years old males, of congenital muscular dystrophy. (Fokuyama type). The micropolygyria of the cerebral cortex showed an undifferentiated cytoarchitecture, e. g. status verrucosus deformis. On the surface of cortical molecular layer, subpial mesenchymal fibres, tangential myelin fibres and marginal glial fibres were observed to be still proliferated even at the stages examined and all the fibres were caved into the cortical cell layer associated with the molecular layer, without secondary sulcus formation. It is proposed that micropolygyria without secondary sulcus formation described in the present paper is named as "pachygyric micropolygyria", while four-layered type of micropolygyria with normal sulcus formation is "eugyric micropolygyria". On the other hand, micropolygyria of the cerebellar cortex was found to be consisted of various sized fragments in which basic structures of the cerebellum were preserved. On a part of surface of the cerebellar cortex the cytoarchitecture of cell layers was shown in inverse order. The Purkinje cell were irregularly migrated and the external granular layer remained in the molecular layer showing ectopic features. Tangential myelin fibres, connecting with fibres of the folial white matter, were observed to exist on the surface of the internal granular layer.
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Murofushi K. [Symmetrical pseudocalcium deposits in the basal ganglia and white matter of the brain with moderate leukoencephalopathy in Down's syndrome]. Neuropadiatrie 1974; 5:103-8. [PMID: 4274397 DOI: 10.1055/s-0028-1091692] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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34
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Morimatsu Y, Murofushi K, Handa T, Shinoara T, Shiraki H. [Pathology in severe physical and mental disabilities in children--with special reference to 4 cases of nodding spasm]. Shinkei Kenkyu No Shimpo 1972; 16:465-70. [PMID: 5066188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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35
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Murofushi K, Morimatsu Y, Handa T, Shinoara T. [Neuropathology of severe physical and mental disabilities--with special reference to the relationship between clinical and pathological observations of severe cerebral palsy due to brain damage]. Shinkei Kenkyu No Shimpo 1972; 16:422-37. [PMID: 5066185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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36
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Murofushi K. [Brain malformation and mental retardation]. Shinkei Kenkyu No Shimpo 1972; 16:218-25. [PMID: 4260443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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37
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Morimatsu Y, Murofushi K, Handa T, Shinohara T, Shiraki H. [Autopsy cases of children with severe physical and mental handicaps--with special reference to 2 cases of athetosis with atrophy of the Ammon's horn]. Shinkei Kenkyu No Shimpo 1971; 15:745-61. [PMID: 4255263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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38
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Murofushi K, Morimatsu Y, Handa T, Shinohara T. [A pathological study on patients with severe physical and mental disturbances, with special reference to the relationship with clinical observations]. Seishin Shinkeigaku Zasshi 1971; 73:136-50. [PMID: 4252195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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39
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Murofushi K, Minagawa M. [Case of carbon monoxide poisoning with aging phenomena]. Shinkei Kenkyu No Shimpo 1969; 13:39-48. [PMID: 5816802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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40
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Murofushi K, Arai Y. [Brain pathology in Down's syndrome]. Saishin Igaku 1968; 24:297-302. [PMID: 4239270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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41
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Murofushi K. [Acute necrotizing encephalitis. Study of the structuration of this type and the role of edematous and vascular factors in the mechanism of necrosis on a series of 22 supervised cases]. Acta Neurol Psychiatr Belg 1968; 68:26-85. [PMID: 4177518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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