No shinkei geka. Neurological surgery
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Review Case Reports
[Three cases of carotid anterior cerebral anastomosis].
Three cases are presented with rare carotid-anterior cerebral anastomosis (anomalous ACA) originating from the internal carotid artery at the level of the origin of the ophthalmic artery, running first underneath and then between both optic nerves, and finally joining the anterior communicating artery. Case 1 (47 year-old woman) and case 2 (56 year-old man) were both admitted with subarachnoid hemorrhage from a ruptured aneurysm, which was located at the anomalous ACA (carotid-ACA anastomosis). Case (61 year-old man) was diagnosed as having left occipital intracerebral hematoma on CT, and bilateral anomalous ACA was found on angiograms. ⋯ Postoperative course was uneventful in each case. Case 3 was treated conservatively. From the angiographical and operative findings, we prefer to use "carotid-anterior cerebral artery anastomosis" as the medical terminology best suited to describe this condition.
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We reported a case of a patient who developed a diffuse stenotic change in the large intracranial arteries and repeated episodes of cerebral infarction after irradiation therapy for medulloblastoma. A three-year-old girl underwent the subtotal removal of cerebellar medulloblastoma and the subsequent irradiation therapy in the whole brain and spine (30 Gy in the whole brain, 20 Gy in the local brain, and 25 Gy in the whole spine). Two years later, she again underwent surgery and irradiation therapy because a recurrence of medulloblastoma had manifested itself in the frontal lobe; (40 Gy in the whole brain, 20 Gy in the local brain, and 25 Gy in the whole spine). ⋯ Stenotic arteriopathy after irradiation has rarely been recognized in patients with malignant brain tumor. However, life expectancy is increasing even for those with malignant brain tumor, and it may make stenotic arteriopathy after irradiation recognized more commonly in patients with malignant brain tumor. Careful irradiation and subsequent angiographical examination should be required even in patients with malignant brain tumor.