No shinkei geka. Neurological surgery
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Delayed ischemic deficit following subarachnoid hemorrhage(SAH)is a major source of morbidity and mortality after rupture of an intracranial aneurysm. Once symptomatic cerebral vasospasm has occured, available treatments do not provide good outcomes for all patients. Symptomatic vasospasm results in serious sequelae for 10-15% of patients and the etiology and pathogenesis remain unclear. ⋯ Clinical symptoms due to cerebral vasospasm and frequency of severe spasm were compared between each of the groups. The frequencies of severe spasm appearing on angiography(age>65)and symptomatic cerebral vasospasm were lower in the cilostazol group than in controls. These findings suggest that cilostazol may prevent symptomatic cerebral vasospasm after subarachnoid hemorrhage.
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Case Reports
[Harvest of the superficial temporal artery using the Lone Star Retractor System TM: technical note].
Extracranial-intracranial(EC-IC)bypass is an important method of treating ischemic stroke and intracranial disease requiring sacrifice of the parent artery. The most commonly used donor artery for EC-IC bypass surgery is the superficial temporal artery(STA). But there are few reports of details of harvest methods of the STA. ⋯ The incised wound was tensioned by the blunt hooks(elastic stay)of the Lone Star Retractor SystemTM. Connective tissue around the STA was dissected and cut by a high voltage bipolar coagulator from the distal to the proximal side of the STA. The advantage of using of The Lone Star Retractor SystemTM for the STA harvest is that, using a surgical microscope, it is easy to set the elastic stay on the wound.
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Infected subdural hematoma(ISH)is a rare disease caused by hematogenous infection of a preexisting subdural hematoma. We report a rare case of ISH accompanied by cerebral infarction. A 76-year-old man who had suffered a closed head injury 3 months before presented fever, headache and left hemiparesis during the medical treatment of acute cholangitis and obstructive jaundice with pancreatic cancer at the department of surgical gastroenterology. ⋯ Cerebral angiography showed a vasospasm at the cortical segment of the right middle cerebral artery near the residual abscess. Eventually we carried out a small craniotomy to evacuate the abscess. Our case showed that prompt surgical treatment is required in case of ISH and the whole hematoma and abscess should be removed as soon as possible with an image diagnosis and an additional surgical operation.
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Review Case Reports
[Hemifacial spasm caused by a dissecting aneurysm of the vertebral artery, and resulting in acute exacerbation].
The authors report a rare case of a symptomatic hemifacial spasm caused by a dissecting vertebral artery aneurysm and by an anterior inferior cerebellar artery(AICA). A 54-year-old man presented with left hemifacial spasm persisting for 5 years, and the spasm had undergone acute aggravation. ⋯ Microvascular decompression of the facial nerve with proximal clipping of the vertebral artery dissecting aneurysm was successfully performed. The hemifacial spasm disappeared immediately after the surgery.