No shinkei geka. Neurological surgery
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Review Case Reports
[Superior sagittal sinus occlusion caused by a compound depressed skull fracture: a case treated by emergency surgery].
Depressed skull fractures compressing major venous sinuses are rare, and the treatment is a matter of controversy. The majority of depressed fractures are treated conservatively for fear of bleeding from venous sinuses, but surgical intervention was conducted in a few cases. We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). ⋯ The patient exhibited slight disorientation and was transferred to another hospital for further rehabilitation. Because of symptomatic severe venous congestion, we had to perform emergency surgical decompression and removal of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.
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The combination of trigeminal neuralgia and ipsilateral hemifacial spasm, known as painful tic convulsif (PTC), is a relatively rare entity in neurovascular compression syndrome. A case of PTC attributable to different offending arteries is described, the mechanisms and characteristics of PTC are discussed, and a review of the literature is presented. This 80-year-old woman had a 10-year history of left trigeminal neuralgia and ipsilateral hemifacial spasm. ⋯ Microvascular decompression of the lesions via left lateral suboccipital craniotomy resulted in immediate and complete symptom improvement. Our case demonstrates that different arteries can affect the trigeminal and facial nerve at a stage that precedes compression by a tortuous vertebrobasilar artery. We suggest that the presence of PTC should be considered in patients with a tortuous vertebrobasilar artery, irrespective of the offending arteries.