No shinkei geka. Neurological surgery
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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.
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Dural and perimedullary arteriovenous fistula (AVF) at the craniocervical junction tend to cause subarachnoid hemorrhage (SAH). However, their natural history and clinical manifestations still remain to be elucidated. From 2003 to 2009, we encountered 5 cases of dural and perimedullary AVF presented with SAH. ⋯ Following this treatment we performed coil embolization and repeated open surgery with the aid of intraoperative DSA, respectively. In 1 patient out of the remaining 2 patients, we utilized intraoperative DSA to confirm complete disappearance of AVF composed of multiple feeders. These observations show that SAH caused by dural and perimedullary AVF at the craniocervical junction should be mainly treated by open surgery with the aid of intraoperative DSA in order to accomplish obliteration of the feeders because, otherwise, we might fail to confirm complete disappearance of AVF.
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Case Reports
[Successful microvascular decompression of the medulla oblongata for a case with respiratory failure: case report].
We report a case of the medulla oblongata syndrome successfully treated by microvascular decompression surgery. The patient was a 75-year-old woman and had been suffering from gradual progressive dyspnea since July, 2009. Two month later, intubation and medial ventilator treatments were began because of severe respiratory problems. ⋯ Her hypoventilation graduately improved after the surgery and she needed neither ventilator nor oxygen in several months. She is able to perform daily activities by herself. We report the case, and discuss the cause of respiratory problems especially by compression of the medulla oblongata.
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Spontaneous spinal epidural hematoma (SSEH) is rare. There was not enough information about diagnosis and treatment of SSEH, although they require emergency surgery and some surgeons may hesitate to use alternative treatments. We report our six cases SSEH and discuss treatment of SSEH from the literature. ⋯ We successfully treated 6 cases of SSEH. MRI is useful for diagnosis of SSEH, and CT scan can also diagnose it as in our cases. Cases with severe neurological deficit would be considered as needing surgical treatment at an appropriate time and the cases without neurological deficit should be kept under observation until surgery becomes necessary.
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A 61-year-old man presented with a rare case of spontaneous vertebral arteriovenous fistula manifesting as radiculopathy of the left arm. MRI demonstrated an abnormal dilated vascular space on the left ventral aspect of the spinal canal and compression of the spinal cord and subarachnoid space. ⋯ The fistula was successfully obliterated by coil embolization with preservation of patency of the left vertebral artery, resulting in improvement of the signs and symptoms. Retrospectively this spontaneous vertebral arteriovenous fistula was considered in association with fibromuscular dysplasia.