No shinkei geka. Neurological surgery
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The authors report and discuss a calvalial metastasis of alveolar soft part sarcoma which primarily developed in the left arm. A 13-year-old girl noted a painless tumor in the left upper arm at the age of 7 years. The tumor was excised and histologically alveolar soft part sarcoma. 5 years later, a rapid growing tumor was noted in the parietal area. ⋯ It must be emphasized that the slective angiography is important to differentiate angiographically alveolar soft part sarcoma, meningiosarcoma, malignant melanoma from meningioma or angioma. Radiotherapy is not effective to the pulmonary metastatic lesion. Selective angiography should be emphazied to be essential for differentiation of alveolar soft part sarcoma from angioma or meningioma.
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The best material for cranioplasty of large skull bone defect as a result of decompressive surgery is a patient's own bone flap, since it fits exactly where it was and no recipient's reactions are elicited. Ideally the bone flap should be alive. ⋯ The reasons we choose this site for temporary implantation are as follows: 1) Sufficient space can be easily made to accommodate a bone flap. 2) Curvature of a bone flap fits that of a thigh without difficulties and extreme protrusions caused by implanted bone flap can be avoided. 3) The site of storage is well away from the operative field and independent from each other. 4) It is possible to get the fascia lata through the same skin incision for a large dural patch when needed. When the bone flap is too large to be comfortably accommodated and causes significant stretching and protrusions of the covering skin at the bone edge, it is simply divided into two pieces and these are implanted in the same place.
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"Spontaneous intraspinal canal hematomas' are rare clinical conditions. These are classified as epidural, subdural and subarachnoid. Especially, subarachnoid hematoma is rare only two cases being reported by Bouzarth (1968). ⋯ Etiology of the legion was not identified. The patient made an uneventful recovery. This case suggests that intraspinal canal hematoma needs an operation as soon as possible, especially with urinary retention.