No shinkei geka. Neurological surgery
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Case Reports
[Sacroiliac joint dysfunction with groin pain after an operation for lumbar spinal disorder. A case report].
A 75-year-old male presented with groin pain after an operation to treat lumbar spondylolisthesis (L5). Groin tenderness was localized to the medial border of the anterior superior iliac spine (ASIS). Radiographical and physical examination raised the suspicion of sacroiliac joint (SIJ) dysfunction. ⋯ Long periods spent in the abnormal posture due to lumbar spondylolisthesis induced SIJ stress. After the operation, an improvement in daily activity actually increased stress on the SIJ, resulting in SIJ dysfunction. Certain pathologies, including SIJ dysfunction, should be considered as residual symptoms after operations for lumbar spinal diseases.
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Review Case Reports
[Use of intracerebral microdialysis in severe traumatic brain injury].
Brain microdialysis (MD) is a well-established technique to monitor the chemistry of the extracellular space in the brain during neurointensive care. MD may be useful in severe cases of traumatic brain injury (TBI) in which monitoring of intracranial pressure and cerebral perfusion pressure is required. Lactate/pyruvate (L/P) ratio, glucose, glutamate, and glycerol can be measured using a bedside device. ⋯ Our preliminary results indicate that MD L/P ratios are higher and more fluctuated in poor outcome patients compared to those in favorable outcome patients. MD in association with other brain monitoring techniques is safe and may be useful in preventing and relieving secondary ischemic injury, predicting outcome and guiding therapy after severe TBI. However, the value of MD as a tool in routine neurointensive care decision-making remains unclear.
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We retrospectively reviewed the mortality rate of the patients with subarachnoid hemorrhage (SAH) who received initial treatment in Kurashiki Central Hospital, for the 10-year period from 1999 through 2008. The overall mortality was 18.1% (120/662). The average fatality rate in such cases has shown a decreasing trend, from 24.2% in 1999-2002 to 15.9% in 2005-2008 (p=0.016). Transition in initial diagnostic modality from the time-consuming digital subtraction angiography to the less-invasive computed tomographic angiography, appropriate indication for the operation, and improvement in postoperative management might affect this decline in fatality cases.
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With the increase in terrorist activity in recent times, the number of blast injuries has also increased in civilian and military settings. In a recent war, the number of patients who suffered blast traumatic brain injury (bTBI) increased, so treatment of bTBI is currently a very important issue. Blast injury is complicated and can be divided into 4 categories: primary, secondary, tertiary, and quaternary. ⋯ Such studies have so far shown that blast waves can cause damage to the brain tissue and cognitive deficits; however, detailed investigations on this topic are still required. Treatment of bTBI patients may require clinical knowledge and skills related to intensive care, neurology, and neurosurgery. Moreover, further research is required in this field.
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Case Reports
[Cyst formation after radiosurgery for brain arteriovenous malformation treated with cystoperitoneal shunt].
Gamma knife and CyberKnife radiosurgery are well established and less invasive treatments for arteriovenous malformation. Delayed cyst formation is a rare but well-known complication of radiosurgery for arteriovenous malformations. The optimal treatment of cysts forming after radiosurgery remains debatable. ⋯ Therefore, an Ommaya reservoir was established; aspiration of the cyst through this reservoir brought about an initial reduction in cyst size and alleviation of symptoms; however, no further reduction in cyst size or improvement in symptoms could be achieved. Twenty months after the placement of the Ommaya reservoir, we performed a C-P shunt operation. After the operation, further reduction in the cyst size and complete symptomatic recovery were observed.