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IKEDA N, TAMURA Y, MATSUSHITA Y, KANEMITSU T, NONOGUCHI N, FURUSE M, KAWABATA S, TAKAMI T, KUROIWA T, WANIBUCHI M. Characteristic and Management of Symptomatic Septum Pellucidum Cyst in Extreme Elderly Patient: Case Report and Literature Review. NMC Case Rep J 2022; 9:19-23. [PMID: 35340330 PMCID: PMC8906833 DOI: 10.2176/jns-nmc.2021-0342] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Septum pellucidum cyst is rare and is defined as a fluid-filled space between the lateral ventricles; it has a width of 10 mm or more. In this case report, a surgical patient of symptomatic septum pellucidum cyst (SPC) in extreme age is described. To the best our knowledge, this is the first report of an extremely aged patient with symptomatic SPC that was successfully treated using a flexible neuroendoscope. An 85-year-old male complained of gradually worsening gait disturbance, dementia, and urinary incontinence without headache and was admitted to our hospital. MRI revealed a huge cyst between the lateral ventricles as well as ventricle dilatation with periventricular hyperintensity in T2-weighted image. The patient was diagnosed with symptomatic hydrocephalus with SPC and underwent neuroendoscopic fenestration of the cyst with the use of a flexible endoscope without cerebrospinal fluid shunt placement. Immediately after the surgery, the patient's gait disturbance and dementia were dramatically improved. In extremely aged patients, SPC tended to develop with idiopathic normal pressure hydrocephalus-like symptoms, including gait disturbance without increasing intracranial pressure, sensorimotor disturbances, and psychological disorders. Neuroendoscopic cyst fenestration with the use of a flexible scope for SPC is a less-invasive procedure and should be considered even for extreme elderly symptomatic patients.
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Affiliation(s)
- Naokado IKEDA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Yoji TAMURA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Yoko MATSUSHITA
- Department of Neurosurgery, Tesseikai Neurosurgical Hospital
| | - Takuya KANEMITSU
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Naosuke NONOGUCHI
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Motomasa FURUSE
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Shinji KAWABATA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Toshihiro TAKAMI
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Toshihiko KUROIWA
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
| | - Masahiko WANIBUCHI
- Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical and Pharmaceutical University
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FURUSE M, NONOGUCHI N, OMURA N, SHIRAHATA M, IWASAKI K, INUI T, KUROIWA T, KUWABARA H, MIYATAKE SI. Immunotherapy of Nivolumab with Dendritic Cell Vaccination Is Effective against Intractable Recurrent Primary Central Nervous System Lymphoma: A Case Report. Neurol Med Chir (Tokyo) 2017; 57:191-197. [PMID: 28331101 PMCID: PMC5409273 DOI: 10.2176/nmc.cr.2016-0330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/02/2017] [Indexed: 01/05/2023] Open
Abstract
We report effective treatment with nivolumab of a patient with recurrent primary central nervous system lymphoma (PCNSL) after multiple therapies. A 41-year-old woman with a right parietal PCNSL underwent treatment with high-dose methotrexate and radiotherapy. After recurrence in the left frontal lobe, the patient received several chemotherapies, including methotrexate and rituximab, and underwent surgery. The tumor was refractory to these treatments, and the patient then underwent intensity-modulated radiotherapy (IMRT). Multiple small, new recurrent tumors appeared in the right frontal lobe and the left frontoparietal region 2 months after IMRT. The patient received nivolumab 3 mg/kg with dendritic cell vaccination. Complete remission of the tumors was achieved after six cycles of nivolumab, and remission was maintained for 10 months after the initiation of nivolumab. Nivolumab could be a novel treatment for intractable recurrent PCNSL in the future.
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Affiliation(s)
- Motomasa FURUSE
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naosuke NONOGUCHI
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naoki OMURA
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Mitsuaki SHIRAHATA
- Department of Neurosurgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Osaka, Japan
| | - Koichi IWASAKI
- Department of Neurosurgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Osaka, Japan
| | - Toshio INUI
- Saisei Mirai Medical Corporation, Moriguchi, Osaka, Japan
| | - Toshihiko KUROIWA
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroko KUWABARA
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shin-Ichi MIYATAKE
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
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AOKI T, NISHIKAWA R, SUGIYAMA K, NONOGUCHI N, KAWABATA N, MISHIMA K, ADACHI JI, KURISU K, YAMASAKI F, TOMINAGA T, KUMABE T, UEKI K, HIGUCHI F, YAMAMOTO T, ISHIKAWA E, TAKESHIMA H, YAMASHITA S, ARITA K, HIRANO H, YAMADA S, MATSUTANI M. A multicenter phase I/II study of the BCNU implant (Gliadel(®) Wafer) for Japanese patients with malignant gliomas. Neurol Med Chir (Tokyo) 2013; 54:290-301. [PMID: 24739422 PMCID: PMC4533485] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/17/2013] [Indexed: 03/14/2024] Open
Abstract
Carmustine (BCNU) implants (Gliadel(®) Wafer, Eisai Inc., New Jersey, USA) for the treatment of malignant gliomas (MGs) were shown to enhance overall survival in comparison to placebo in controlled clinical trials in the United States and Europe. A prospective, multicenter phase I/II study involving Japanese patients with MGs was performed to evaluate the efficacy, safety, and pharmacokinetics of BCNU implants. The study enrolled 16 patients with newly diagnosed MGs and 8 patients with recurrent MGs. After the insertion of BCNU implants (8 sheets maximum, 61.6 mg BCNU) into the removal cavity, various chemotherapies (including temozolomide) and radiotherapies were applied. After placement, overall and progression-free survival rates and whole blood BCNU levels were evaluated. In patients with newly diagnosed MGs, the overall survival rates at 12 months and 24 months were 100.0% and 68.8%, and the progression-free survival rate at 12 months was 62.5%. In patients with recurrent MGs, the progression-free survival rate at 6 months was 37.5%. There were no grade 4 or higher adverse events noted due to BCNU implants, and grade 3 events were observed in 5 of 24 patients (20.8%). Whole blood BCNU levels reached a peak of 19.4 ng/mL approximately 3 hours after insertion, which was lower than 1/600 of the peak BCNU level recorded after intravenous injections. These levels decreased to less than the detection limit (2.00 ng/mL) after 24 hours. The results of this study involving Japanese patients are comparable to those of previous studies in the United States and Europe.
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Affiliation(s)
- Tomokazu AOKI
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto
| | - Ryo NISHIKAWA
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Kazuhiko SUGIYAMA
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
| | | | | | - Kazuhiko MISHIMA
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Jun-ichi ADACHI
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Kaoru KURISU
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
| | - Fumiyuki YAMASAKI
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
| | - Toshihiro KUMABE
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa (current affiliation)
| | - Keisuke UEKI
- Department of Neurosurgery, Dokkyo Medical University Hospital, Shimotsuga, Tochigi
| | - Fumi HIGUCHI
- Department of Neurosurgery, Dokkyo Medical University Hospital, Shimotsuga, Tochigi
| | - Tetsuya YAMAMOTO
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Eiichi ISHIKAWA
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
| | - Hideo TAKESHIMA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Miyazaki
| | - Shinji YAMASHITA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Miyazaki
| | - Kazunori ARITA
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima
| | - Hirofumi HIRANO
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima
| | | | - Masao MATSUTANI
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - for the NPC-08 study group
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima
- Department of Neurosurgery, Kitano Hospital, Osaka, Osaka
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi
- Department of Neurosurgery, Dokkyo Medical University Hospital, Shimotsuga, Tochigi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Miyazaki
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima
- Nobelpharma Co., Ltd., Tokyo
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa (current affiliation)
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