No shinkei geka. Neurological surgery
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Case Reports
[Depiction of the trigeminal nerve deviated by a tumor lesion, using probabilistic diffusion tensor tractography].
We attempted presurgical visualization of the trigeminal nerve deviated by tumor compression using the probabilistic diffusion tractography (PDT) technique, which is used to analyze diffusion tensor imaging (DTI) data. We acquired DTI data of 3 patients with a tumor lesion around the trigeminal nerve (2 patients with trigeminal neurinomas and 1 with epidermoid) using the 3T magnetic resonance imaging system. The DTI data was analyzed by PDT using the Diffusion Toolbox, and the software of FMRIB (FDT; www.fmrib.ox.ac.uk/fsl). ⋯ Especially in 2 cases with the tumor mainly located in the Meckel's cave, the location of the nerve was determined only by PDT. All these findings obtained by PDT were concordant with the intraoperative observation of the actual nerves. In conclusion, PDT is a useful technique for visualization of the trigeminal nerve even when it is severely deviated by tumor compression, and this technique could have potential for evaluating other cranial nerves in surgical cases with a tumor in the skull base.
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Case Reports
[Ketamine treatment for severe neuropathic pain with cervical spondylotic myelopathy. A case report].
This 60-year-old man with cervical spondylosis experienced bilateral arm pain and weakness. After anterior cervical fusion and posterior decompression at a local hospital his symptoms worsened and he was admitted to our hospital. On admission he manifested bilateral motor weakness, neuropathic pain, and numbness below the C5 level. ⋯ Therefore, we continued daily ketamine treatment for 6 months, after which we changed to codeine phosphate. His symptoms were controlled without any complications. Ketamine is useful for the control of severe neuropathic pain, however, as long-term ketamine administration is inadvisable, we suggest that treatment be tailored to each patient's particular clinical status.