No shinkei geka. Neurological surgery
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In recent years, stereotactic electroencephalography(SEEG)has been focused on as a new invasive method for epileptic focus detection. Although the covering area of the brain surface is smaller than the invasive estimation with subdural electrodes, SEEG can evaluate foci that are deeply seated, noncontiguous leaves, and/or bilateral hemispheres. In addition, SEEG can capture consecutive changes in seizure activity in three dimensions. ⋯ Insertion was difficult for some electrodes, which could be due to the lack of adequate surgical device and large skull angle. Hopefully, the official installation of SEEG will be planned in the near future. We hereby reported tips and pitfalls of SEEG implantation through our own experience in a single institute.
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Vertebral artery injury(VAI)associated with cervical spine trauma has the potential to cause catastrophic vertebrobasilar stroke. However, there are no well-defined treatment recommendations for VAI. The purpose of this study was to identify an effective treatment strategy for VAI following cervical spine trauma. ⋯ Aggressive screening for VAI is important in patients with cervical spine trauma in order to ensure adequate treatment. Although the treatment strategy described here could yield good results, it may require modification according to the needs of the individual patient.
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A 63-year old man with fever, headache, aphasia, and right hemiparesis was admitted to our hospital one month after the initial burr-hole surgery for left chronic subdural hematoma. Computed tomography(CT)revealed no regrowth of residual subdural hematoma. However, on the basis of the findings from magnetic resonance imaging(MRI)with diffusion-weighted images(DWI), an infection due to residual subdural hematoma was suspected. ⋯ The patient's symptoms resolved, and he returned to work two months later. Subdural empyema caused by P. acnes after burr-hole surgery for chronic subdural hematoma is rare. We should consider infection due to residual hematoma in patients with recurrent symptoms and signs of inflammation, even in the absence of apparent regrowth of residual hematoma after burr-hole surgery.
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We report a case of transverse sinus-sigmoid sinus dural arteriovenous fistula(T-S dAVF)with venous flow congestion, which was accompanied by sigmoid sinus stenosis and treated with percutaneous transluminal sinus stenting. A 76-year-old woman presented with dementia and disturbance of consciousness. Magnetic resonance imaging(MRI)on admission revealed subcortical edema in the left occipital lobe and angiography demonstrated a left T-S dAVF with right transverse sinus occlusion and sigmoid sinus stenosis. ⋯ Immediately after stent placement, retrograde shunt flow to the straight sinus and superior straight sinus dramatically disappeared and cortical venous congestion improved. Follow-up angiography 1 year after treatment showed neither new development of T-S dAVF nor re-stenosis of the stent in the left sigmoid sinus, although some shunt flow remained. Percutaneous transluminal sinus stenting for sinus stenosis associated with dAVF appears effective to improve venous congestion and intracranial venous hypertension.
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A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. ⋯ Gradually, the patient's respiratory and cardiac function improved. Here, we describe a very rare case of TCM and neurogenic pulmonary edema(NPE)following an acute cerebral infarction, which was treated with alteplase intravenous administration. TCM and NPE have a poor prognosis, therefore diagnosis, management, and treatment in the acute phase is required.