No shinkei geka. Neurological surgery
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Three cases of bilateral traumatic abducens nerve palsy were presented and the mechanism of damage to the abducens nerve was discussed in relation to the analysis of traumatic force at the time of impact and topographical anatomy of the abducens nerve in detail. Case 1. A 70 year old man sustained a traffic accident with one hour loss of consciousness. ⋯ It is greatly speculated that both abducens nerves are streched by the lineal accerelated force on mid sagittal plane at the time of impact, then the apex of petrous pyramid acts as the fulculum, so that the abducens nerves are compressed, contused and streched at this point (Fig. 5-a). The authors pointed out that the abducens nerve are impossible to be damaged at the petroclinoid ligament (Grüber's lig.) by the upward movement of the brainstem, because the abducens nerve is fixed downward below this ligament by the dura and apex of the petrous pyramid (Fig. 4-b, c). One case showed bilateral acquired retraction syndrome with slight increase in size of the pupil on each side of lateral gaze, the fact greatly suggesting that the sympathetic nerve have intimate relationship to the miss direction during the recovery stage of abducens nerve palsy.
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Clinical use of four-vessels angiography increased the frequency of detection of intracranial aneurysm in patients who had episode of subarachnoid hemorrhage. However, some cases of subarachnoid hemorrhage did not show intracranial and intraspinal source of bleeding angiographically. Bjökesten and Troupp pointed out that some cases who were negative in angiography may have a very small intracranial aneurysm. ⋯ In the case who showed questionable shadow as miliary intracranial aneurysm, the repeated angiography under modified direction of X-ray and modified head position of patient is required. The magnification cerebral angiography of three fold is also useful in diagnosis of miliary intracranial aneurysm. The intracranial treatment of miliary intracranial aneurysms were done by coating except one case whose aneurysm was clipped.
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Shunt dysfunction due to an obstructed ventricular catheter can be avoided, at least in part, by placing the of the catheter anteriorly to the Foramen of Monro. However, once the catheter is obstructed, surgical removal under general anesthesia is almost inevitable. Irrigation method for an obstructed ventricular catheter enables us to gain scarcely anything and accumulation of instilled fluid in the ventricle often causes the dangerously increased intracranial pressure. 1) Technique for placement of the ventricular catheter. ⋯ Percutaneous technique was successful in releasing the obstructions in 12 times of these 8 patients and remaining 2 patients were subsequently operated upon for the following reasons. One patient, because of dislodging of the reservoir cap after successful release of obstruction and the other, due to extraventricular location of the tip of the catheter prior to the percutaneous management. No serious complications has been encountered and the technique was proved to be safe and simple ensuring good functional return of the shunt in long-term follow-up.
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On May 7, 1973, a 23-year-old female, para ii, gravida ii, suddenly developed severe chest pain at 10th month of her pregnancy and soon after became paraplegic with sensory impairment lower than the level of 5th thoracic nerve and urinary incontinence. On May 8, she was admitted to our clinic and 4 days after, labour was induced by Caesarean section. ⋯ On June 26, about 1.5 months after delivery total removal of arteriovenous malformation (from Th2 to Th6)) was performed by the use of operative microscope. 10 months after operation, the patient could walk with her baby in her arms and no urinary incontinence was seen. We discussed the clinical characteristics and the treatment of spinal cord arteriovenous malformation during pregnancy.