Surg Neurol
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Superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease prevents cerebral ischemic attack by improving CBF, whereas recent evidence suggests that the temporary neurologic deterioration because of postoperative cerebral hyperperfusion could occur despite its low-flow revascularization. The present study investigates the incidence and the risk factors for symptomatic hyperperfusion after STA-MCA anastomosis in patients with moyamoya disease. ⋯ The STA-MCA anastomosis is a safe and effective treatment of moyamoya disease, although adult-onset and/or hemorrhagic-onset patients had higher risk for symptomatic hyperperfusion. We recommend routine CBF measurement especially for these patients because the management of hyperperfusion is contradictory to that of ischemia.
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The purpose of this study was to evaluate the clinical outcomes of patients with metastatic thoracic and lumbar tumors after palliative surgery using PTA with posterior instrumentation. ⋯ The PTA with posterior instrumentation for metastatic thoracic and lumbar spinal tumors achieved good surgical results. Palliative surgery for patients with a Tomita's prognostic score of more than 8 may be considered in selected cases, especially in those with ECOG grade III.
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Case Reports
Brachial plexopathy due to massive swelling of the neck associated with craniotomy in the park bench position.
During prolonged neurosurgical procedures, anesthetized patients are at risk for position-related complications. We report a rare combination of neck swelling and brachial plexopathy as operative position-related complications. ⋯ Possible pathologic mechanisms are kinking of the jugular vein due to extremely flexed neck position during surgery and associated delayed swelling of the neck and brachial plexus. The cerebral venous return may have been maintained by anastomosis between the internal jugular and the vertebral venous system. To prevent such complications, we must take great care of the anesthetized patients when placed in the forced neck position.
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Parent artery occlusion (PAO) is an alternative surgical strategy for complex internal carotid artery (ICA) aneurysms, which are unclippable because of their anatomical structures, including a broad neck, fragile dome, critical branch, and cavernous sinus location. Despite revascularization, ischemic complications occur after the PAO because of several factors, such as hypoperfusion, embolism, and perforator impairment. ⋯ The distal location of ICA aneurysms is a risk factor for the perforator impairment, when treated by PAO, and PAO by clip placement is preferred to endovascular coiling to prevent of perforator impairment.
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Case Reports
Diabetic amyotrophy coexisting with lumbar disk herniation and stenosis: a case report.
Clinical differentiation of diabetic neuropathy from HLD or lumbar stenosis may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. The authors report a case of diabetic amyotrophy coexisting with, rather than misdiagnosis of, HLD or lumbar stenosis. ⋯ Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from HLD, lumbar stenosis, or other space-occupying lesion. Thorough history taking and neurologic examination are needed to differentiate between these diseases, and the possibility of coexistence of or overlapping with these diseases should be considered. When the 2 diseases coexist as pain sources, treatment of both diseases may be needed for relief of the patient's pain.