No shinkei geka. Neurological surgery
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Review Case Reports
[Superselective fibrinolysis for a middle cerebral artery embolism caused by a left atrial myxoma: case report].
A case of successful treatment by local fibrinolysis of a middle cerebral artery embolism caused by a thrombus from a left atrial myxoma is reported. A 62-year-old woman using a pacemaker and suffering from sick sinus syndrome was admitted on December 29th 1996, complaining of transient restlessness. CT and cerebral angiography revealed no abnormal vascular lesions. ⋯ It is also hard to discover during emergent cerebral angiography with fibrinolytic therapy. Therefore, in the case of patients with cerebral embolism for which local fibrinolysis is ineffective, it should be presumed that cardiac myxoma is the source of the embolus. Direct PTA alone may be effective for such tumoral embolism.
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We described our experience of three cases treated with endoscopic evacuation of intraventricular hematoma and third ventriculostomy for a tight intraventricular hematoma associated with intracerebral hemorrhage. A steerable endoscope was introduced into the anterior horn of the lateral ventricle contralaterally to the intracerebral hemorrhage, through a 14 Fr. peel-away sheath. First, the hematoma in the lateral ventricle contralateral to the hemorrhage was evacuated by direct aspiration using a syringe connected to the operative channel of the endoscope, and evacuation of the hematoma was subsequently carried on the third ventricle, aqueduct and the fourth ventricle. ⋯ Finally, the procedure was completed with septostomy and evacuation of the hematoma in the lateral ventricle ipsilateral to the hemorrhage. Sufficient evacuation of the hematoma was obtained in all cases and no major complications were encountered. We conclude that for patients with intraventricular hematoma associated with intracerebral hemorrhage endoscopic evacuation of intraventricular hematoma brings about sufficient removal of hematoma, reduction of hospitalization time and prevention of subsequent hydrocephalus.
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The authors reported two cases of pyogenic cervical discitis presenting tetraparesis. Case 1: A 66-year-old male patient entered the hospital because of tetraparesis. Two weeks before the hospitalization, he had become feverish and awakened with motor weakness in all extremities. ⋯ On the 7th postoperative day, symptoms caused by radiculopathy of the left C5 appeared, but gradually ameliorated. The patient was free from motor weakness in the 8th month after the surgical treatment. Surgical intervention is a useful treatment for pyogenic cervical discitis with symptoms due to compression of the spinal cord both in the acute and subacute stages.
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Near infrared spectroscopy (NIRS) have been accepted as a useful modality for non-invasive monitoring of brain oxygenation state. Using a newly developed NIRS apparatus, HEO-200, the authors continuously monitored the changes in the oxygenation state of brain hemoglobin during carotid endarterectomy (CEA) or carotid balloon occlusion tests (BOT) in 21 patients. Somatosensory evoked potentials (SEP), regional cerebral blood flow (rCBF) or transcranial Doppler sonography (TCD) were also employed to compare with the NIRS-responses. ⋯ Restoration of blood flow immediately resolved these findings. The other 14 patients demonstrated no or only transient changes on NIRS as well as on SEP and rCBF study. HEO-200 could non-invasively monitor the relative changes of cerebral oxygenation state with good time resolution, and detect critical ischemia during CEA and carotid BOT.