No shinkei geka. Neurological surgery
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Case Reports
[Significance of susceptibility-weighted angiography for endovascular thrombectomy of acute ischemic stroke].
Efficacy of intravenous systemic thrombolysis is limited in patients with large-vessel occlusion and for whom more than 4.5 hours have passed since onset. As such, mechanical thrombectomy has been the mainstay therapy for these patients. ⋯ In all 3 cases, clot localization by SWAN was consistent with that by angiography, and recanalization was successful. Identifying clot location and composition may help determine the optimal treatment and predict successful recanalization.
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A 57-year-old man presented with sudden-onset consciousness disturbance. He had a 10-year history of a subarachnoid hemorrhage(SAH)caused by a ruptured aneurysm in the right middle cerebral artery, and had undergone aneurysmal clipping. He could perform all his daily life activities independently. ⋯ We initially performed superficial temporal artery(STA)-ACA anastomosis and secondary internal trapping with detachable coils in the operating room. Postoperative DSA revealed complete obliteration of the dissection and parent artery. Endovascular treatment with STA-ACA bypass is a safe and effective alternative for the treatment of ACA dissection.
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Review Case Reports
[Contralateral suboccipital approach for clipping of an unruptured vertebral artery-posterior inferior cerebellar artery aneurysm].
Numerous approaches have been used to access aneurysms of the vertebral artery(VA)-posterior inferior cerebellar artery(PICA)complex for microsurgical clipping. Here, we report the case of a patient with an unruptured aneurysm of the left VA-PICA complex that was successfully treated using a contralateral suboccipital approach. Computed tomography angiography demonstrated a small saccular aneurysm arising from the lateral aspect of the left V4 segment just distal to the PICA origin. ⋯ After surgery, slight dysphagia and hoarseness appeared, but dysphagia disappeared within several days and hoarseness disappeared within 5 months. VA-PICA aneurysms can vary in their relationship to cranial nerves, brainstem, and bones of the skull base. Neurosurgeons should consider using a contralateral approach for certain aneurysms arising from a tortuous VA that has crossed the midline.
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Case Reports
[Intracranial inflammatory pseudotumor resected after transcatheter embolization: a case report].
A 63-year-old man presented with an exceptionally rare case of intracranial inflammatory pseudotumor manifesting as speech and gait disturbance. Magnetic resonance imaging showed a left convexity mass with significant peritumoral edema. The mass was attached to the convexity dura and mimicked meningioma. ⋯ Only a small number of IgG4-positive cells were observed. The diagnosis was consistent with inflammatory pseudotumor. This disease entity, the histological differential diagnosis, its subtypes, and preoperative embolization are discussed.