No shinkei geka. Neurological surgery
-
We report a case of longstanding asymptomatic direct carotid-cavernous fistula (CCF) which caused fatal subarachnoid hemorrhage (SAH). A 91-year-old female with no history of previous head trauma and optic symptoms presented acute subarachnoid hemorrhage. ⋯ The patient underwent transvenous coil embolization for intercavernous sinus and leptomeningeal venous reflux was successfully obliterated and opacification of the varix was diminished. The past history of this patient and angiographical findings strongly suggest long standing asymptomatic CCF caused SAH.
-
Case Reports
[Migration of the distal catheter of ventriculo-peritoneal shunt into the thoracic cavity].
A 69-year-old woman suffered from ataxia of her right upper and lower limbs and infection in a distal tube of a ventriculo-peritoneal shunt (VPS). She had a thirty-year history of treatment for intracranial hemangioblastoma due to von Hippel-Lindau disease and hydrocephalus. Head magnetic resonance imaging demonstrated recurrent multiple hemangioblastoma in the cerebellum without hydrocephalus. ⋯ The distal tube most likely migrated through the intercostal space because the patient was very skinny. Migration of the distal catheter of VPS into the thoracic cavity may occur when the course of the distal tube is close to the thoracic cavity, especially in thin patients. Care should be taken when routing the distal catheter after VPS in skinny patients.