No shinkei geka. Neurological surgery
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Intraoperative rupture of an aneurysm can lead to disastrous results when the rupture occurs at the neck. The authors have encountered eight cases (5%) of intraoperative rupture in a series of 155 patients. All patients were operated on in the acute stage by one of the authors of this paper (T. ⋯ These encounters dramatically demonstrated that a very thin-walled aneurysm or a recurrent aneurysm has a fragile neck. In surgical treatment of these unusual aneurysms, a clip should be placed on the neck parallel to the parent artery. Furthermore, temporary clipping is advisable when dissecting the neck or applying the clip to the neck to reduce the damage to the neck.
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Clinical Trial
[Intraoperative monitoring for functional neurosurgery during intravenous anesthesia with propofol].
We studied the effects of propofol on electrophysiologic monitoring for functional neurosurgery. In six patients with intractable epilepsy, electrocorticograms (ECoGs) were monitored for epilepsy surgery, and in two of them, somatosensory evoked potentials (SEPs) were monitored because of the focus adjacent to the central sulcus. In four patients with hemifacial spasm, brain stem auditory evoked potentials (BAEPs) and abnormal muscle responses (AMRs) were monitored during microvascular decompression (MVD). ⋯ To record neural noise levels, the infusion of propofol was decreased in two cases of posteroventral pallidotomy, and it was stopped in one case of Vim thalamotomy. In these patients, neural noise levels were recorded and were useful for identifying the target. Propofol is a potentially useful anesthetic agent for electrophysiologic monitoring during functional neurosurgery.