No shinkei geka. Neurological surgery
-
Review Case Reports
[Remote cerebellar hemorrhage after cervical spinal surgery: two case reports and literature review].
Remote cerebellar hemorrhage (RCH) following spinal surgery is extremely rare. We present two cases of RCH following cervical spinal surgery. The first case is a 71-year-old female. ⋯ Rapid loss of a great amount of cerebrospinal fluid might be the causative factor of RCH. RCH might occur after any type of spinal surgery with dural tear or intradural manipulation. Early diagnosis is particularly important for the treatment of RCH following spinal surgery and spinal drainage might be useful to manage cerebrospinal fluid leakage.
-
The aim of this study was to examine the usefulness of an uncalibrated radial arterial pressure-based cardiac output monitor (FloTrac, Edwards Lifesciences, Irvine CA, USA) for dobutamine-induced hyperdynamic therapy in patients with cerebral vasospasm following subarachnoid hemorrhage (SAH). In 18 SAH patients diagnosed with vasospasm, the cardiac index (CI) was analyzed continuously via the radial FloTrac system. The time-course changes in hemodynamic variables following dobutamine infusion at each dose increment (3-24 microg/kg/min) for reversing vasospasm-related delayed ischemic neurological deficit (DIND) and infarction were measured. ⋯ However at high-dose (20-24 microg/kg/min), dobutamine depressed stroke volume which was compensated for by increasing the pulse rate, thus raising CI only slightly from the baseline values. These data suggest that step-up increase of dobutamine dosage is not always effective in raising CI in patients suffering from post-SAH vasospasm, but rather may cause some adverse effects associated with increased myocardial oxygen consumption as evidenced by high-dose infusion. The less-invasive FloTrac system might be useful as a device for tracking trends in hemodynamic outcomes of hyperdynamic therapy.
-
Case Reports
[A case of non-traumatic tension pneumocephalus 12 years after initial ventriculo-peritoneal shunt].
The authors presented a patient with non-traumatic tension pneumocephalus 12 years after initial ventriculo-peritoneal shunt. A 60-year-old man had a past history of subarachnoid hemorrhage. At ÿtime, he underwent clipping surgery and emplacement of a ventriculoperitoneal shunt with a low pressure valve, and was discharged from hospital in a bedridden condition. ⋯ Postoperative clinical course was uneventful and the patient was discharged. About 6 month after the operation, cranioplasty and lumbo-peritoneal shunt was performed. We must recognize that appropriate management of intracranial pressure after installation of a ventriculo-peritoneal shunt is necessary for prevention of tension pneumocephalus.
-
Patients with malignant gliomas have an even worse prognosis than other cancer patients, and they sometimes undergo surgery and chemo-radiotherapy without having been informed of the nature of the disease and its prognosis in Japan. Often, patients with glioblastoma are only told that they have a brain tumor, although other family members are told of the real diagnosis and prognosis. Since patients with glioblastoma, often experience a rapid deterioration in their condition, they usually do not have enough time to seek a second opinion regarding their disease. We surveyed neurosurgeons in Japan with regard to their policies and attitudes concerning the disclosure of a diagnosis of glioma and their thoughts on the end-of-life care of glioma patients. ⋯ Most neurosurgeons have difficulty disclosing a diagnosis of glioma and providing end-of-life care. This survey will help to develop guidelines regarding disclosure and the decision to pursue end-of-life care for patients with gliomas. (Received : March 19, 2009, Accepted : June 8, 2009)
-
Review Case Reports
[Spinal subdural abscess in the cervical region: a case report].
The authors present a patient with a spinal subdural abscess (SSA) in the cervical region and review the relevant literature. A 48-year-old man suffering from intractable high fever and back pain was admitted to our hospital with a diagnosis of meningitis. Despite antibiotic therapy, his condition deteriorated and he developed neurological deficits including left hemiparesis, sensory disturbance and bladder dysfunction. ⋯ The high fever and the back pain subsided immediately and his neurologic condition gradually recovered. The majority of SSA cases involve the thoracic or lumbar region and are rarely found in the cervical region. Because they are associated with a high morbidity, early diagnosis with MRI and urgent surgical interventions including decompressive laminectomy, copious irrigation and drainage followed by appropriate antibiotic therapy are vital.