No shinkei geka. Neurological surgery
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Trigeminocardiac reflex (TCR) is a type of vasovagal reflex which happens in stimulation of the trigeminal nerve. We present a case of TCR in the pterional approach for clipping of an unruptured anterior communicating artery (Acom) aneurysm. A 69-year-old female was evaluated because of syncope. ⋯ During the operation for clipping this aneurysm, only when we manipulated the dura attached to the sphenoid ridge, a total of three times, asystole appeared temporarily. In this case, a branch of the trigeminal nerve accompanying the middle meningeal artery was stimulated, then TCR may have been induced, leading to asystole. Furthermore, it seems that remifentanil used for anesthesia is related to TCR.
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In the clinical diagnosis of lumbosacral radicular symptoms, dermatome maps are commonly used, by which the segmental location of the affected nerve can be determined. However, the diagnosis is often difficult because the pattern of sensory disturbance does not necessarily match the patterns of classical dermatomes, and there are many dermatome maps made by different methods. The author examined the area of pain and numbness in cases of lumbosacral radiculopathy. ⋯ The distinctive region was the lateral part of the calf. It was found that the regions of pain and numbness formed a continuous band-like zone from thigh to leg in 8% of L3, 45% of L4 and L5, and 35% of S1 radiculopathy. Using a visual analogue scale, the degree of leg pain was more severe than low back pain in 68% of the patients, but in 5% of patients, low back pain was more severe.