No shinkei geka. Neurological surgery
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Lumbar canal stenosis (LCS) and lumbar foraminal stenosis (LFS) are frequently observed in elder patients. For patients with radiculopathy caused by both LCS and LFS, surgical manipulations require nerve root decompression from its exit zone to the lateral part of the vertebral foramen, and often need spinal instrumentation. In the present report, we performed a new strategy of surgical decompression without spinal fixation. ⋯ The patient was relieved from the radicular pain after the operation, and returned to her previous activity of daily living. One-year after the operation, she was free from the radiculopathy, and radiograms showed no fracture in the preserved left L4 lamina. Lateral fenestration combined with bilateral spinal canal decompression through contralateral laminotomy is potentially a surgical option for radiculopathy caused by both LSC and LFS.
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Extradural removal of the anterior clinoid process (ACP) is useful and essential for approaching aneurysmal and tumor lesions in and around the cavernous sinus. A safe, rapid and less invasive technique is beneficial for this basic skull base surgery. We developed a new technique by sharply cutting the ACP together with the part of the sphenoid ridge bone followed by complete replacement. ⋯ After operation, the once removed clinoid process is replaced in situ using a titanium plate screw. Extradural en bloc removal and in situ replacement of the ACP can be safely done by this cutting procedure. This can provide a good cosmetic result without causing enophthalmos or transient oculomotor palsy.
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Review
[Operative neurosurgery: personal view and historical backgrounds. 6. Positioning, instruments].
Important points of positioning and instruments at the time of performing microneurosurgery according to the traditional Zuerich school style were presented based on the experience of ca. 1,000 surgeries/year for around 13.5 years. Most of the instruments and equipment had been taken over from the time of Prof. Yaşargil. ⋯ For the same reason, foot pedals for the bipolar coagulator, drilling and trepanation should be stepped by other than the surgeon, so that he can concentrate on the tip the of instrument for precise maneuvering. As tissue destruction apparatus, we prefer to use CUSA to laser, as the former enables preservation of blood vessels at the time of tissue destruction and suction by appropriate power application. Besides these, the followings items were discussed: scissors (blunt tips), Lyla retractor (variously tapered tips and fixation or holding at the other peripheral end), drilling (turning direction adjustable, cutting and diamond burr) etc.
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Case Reports
[Cerebral infarction suspected due to dissection of intracranial carotid artery in 2 children].
Intracranial cerebral artery dissection in children is very rare. We report 2 children who were diagnosed as having cerebral infarction which was suspected to be due to dissection of intracranial cerebral artery. Case 1: An 11-year-old girl presented with conscious disturbance and hemiparesis after seizure. ⋯ Follow-up angiography showed improvement of stenosis. In pediatric cases of cerebral artery dissection, improvement with conservative therapy is frequently reported. It is necessary to follow-up such patients closely using magnetic resonance angiography or conventional angiography to determine whether or not surgery is indicated.