No shinkei geka. Neurological surgery
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A case report of penetrating head injury due to 8 nails and a review of multiple penetrating head injury by nails were described. The patient who was a 48-year-old man with a history of for psychiatric care was transferred to our emergency room on May 2007. He had shot his head with 8 nails using a nail-gun in a suicide attempt. ⋯ Penetrating head injury with nail-gun use is sometimes seen, but cases with multiple nails are rare. Operative strategies were discussed in the review. It also suggested the need for the care of mental or background problems.
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Integration of neuronavigation into brain tumor surgery can improve the accuracy and precision of resection, but most neuronavigation systems require rigid pin fixation of the patient's head throughout the operation. We describe use of a noninvasive skull reference tool, which can replace rigid pin fixation in awake craniotomy and pediatric surgery, when standard pin fixation cannot be used. ⋯ The use of this skull reference tool provides an accurate and comfortable method of frameless navigation in patients undergoing awake craniotomy and pediatric patients.
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We report a case of dural arteriovenous fistulas (DAVFs) at the craniocervical junction, which are supplied by the radicular arteries from bilateral vertebral arteries separately, and drainaged into intracranial sinuses. A 58-year-old man with intermittent neck pain visited our hospital. T2-weighted magnetic resonance (MR) imaging showed flow voids on the dorsal surface of the medulla and upper cervical cord without any signal changes suggesting ischemia. ⋯ Even in such a case, direct interruption of the fistulas using micro Doppler sonography is the most effective treatment. In addition. MRDSA could be useful for screening and perioperative studies.