No shinkei geka. Neurological surgery
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Case Reports
[A successful surgical case of a hypothalamic hamartoma with gelastic seizure: a case report].
Gelastic seizure is a rare form of epilepsy defined as automatic bouts of laughter without mirth commonly associated with a hypothalamic hamartoma. Surgical treatment of hypothalamic hamartomas is associated with a high risk of complications because of the close vicinity of adjacent structures such as the optic tracts and mammillary bodies. This case was an 11-year-old girl who presented with gelastic seizure and complicated partial seizure. ⋯ Pathological findings confirmed the diagnosis of hypothalamic hamartoma. Postoperative MRI demonstrated that the hypothalamic hamartoma was successfully resected. Twenty four months after surgery, complicated partial seizure in this patient has improved to Engel's class 1a and gelastic seizure has improved to Engel's class IIIa.
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The inpact of the International Subarachnoid Aneurysm Trial (ISAT) trial publication in 2002 and major technical advances in neuroimaging, endovascular devices and techniques have resulted in increasing numbers of patients with ruptured aneurysms undergoing endovascular coiling, as first-line treatment for aneurysm occlusion. We treated six cases of ruptured aneurysms with this strategy, with choice of clipping as as additional treatment following intentional partial coiling. In this series, patients ranged in age from 36 to 74 years and included one man and five women. ⋯ The mean interval between the first partial coiling and final clipping was 33 days. All cases were successfully clipped without difficulties and coil removal were performed in 3 cases for follow up examination. It is proposed that the choice of this strategy contributes to progresses in overall outcomes in cases of aneurysmal subarachnoid hemorrhage.
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Case Reports
[Retrieval of migrated microcatheter with retrieval forceps during cerebral aneurysm embolization: a case report].
Endovascular embolization for a cerebrovascular lesion has been increasingly performed. We experienced disruption of the microcatheter during a cerebral aneurysm embolization and removed the catheter fragment with retrieval forceps. A 56-year-old woman was brought to our hospital because of consciousness disturbance. ⋯ Microscopical observation of the catheter end revealed relatively sharp disruption and extension of the stainless steel blade. Microcatheter disruption and migration is a rare but significant complication of endovascular embolization. Percutaneous technique with retrieval forceps for the extraction of intravascular foreign objects was useful.
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Far-out syndrome (FOS) is caused by L5 nerve root entrapment at the L5-S1 extraforaminal area surrounded by the sacral alar and the transverse process. Here, we report a case with right L5 radiculopathy caused by L4-5 lumbar canal stenosis (LCS) and FOS. A 57-year-old man suffered from progressing right sciatica and leg pain in the L5 nerve root distribution. ⋯ Visual analogue scales of pain and numbness were 8.7 and 8.7 respectively at first examination. These scores decreased to 5.5 and 3.7 two months after the first operation for LCS, and to 0 and 0 one month after the second operation for FOS. We recommend that more attention be paid to FOS when patients with L5 radiculopathy are diagnosed.