No shinkei geka. Neurological surgery
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In patients presenting with brain metastases, the evaluation for extracranial metastases is important to determine the therapeutic strategies and predict the patients outcome. We investigated the findings of whole-body FDG-PET/CT in 30 patients with metastatic brain tumors. The patients were divided into two groups consisting of 16 patients with precocious or synchronous metastases (PS group), or 14 patients with metachronous metastases (M group), according to the brain metastatic patterns. ⋯ Two of them have been clinically independent for more than 20 months. 22 (73.3%) of all patients presented extracranial metastases when brain lesions were found. FDG-PET/CT is a useful modality in detecting the primary cancer and evaluating extracranial systemic metastases. It is important to establish a refined clinical staging system and predict the patient's prognosis based upon the findings of FDG-PET/CT in patients with brain metastasis.
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Review Case Reports
[Operative neurosurgery: personal view and historical backgrounds. (5) Meningioma].
The author reports his experience of 410 surgeries of meningiomas on 365 cases during the last 13.5 years, including 51 surgeries on recurrent meningiomas and 8 surgeries with the change of initial approach on the same meningiomas. In the surgical management of meningiomas, following comments are to be emphasized: Appropriate approach and interruption of blood supply are of cardinal importance in surgical management of meningiomas. For the latter purpose, preoperative embolization of feeding arteries is recommended especially in deep seated and large meningiomas more than 3 cm in diameter for carrying out their surgical extirpation fast and radically. ⋯ Difficulties of management of recurrent meningiomas represented by atypical or anaplastic meningiomas WHO grade II or III which can not be managed only by surgical removal is discussed by presenting some example cases. Biological activity of meningiomas in different location can be quite different in multiple recurrent meningiomas. Meningiomas intractable to irradiation and/or chemotherapy are another challenging topic, being beyond the scope of this paper.
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This article reports a case of a 59-year-old male who suffered from left brachial plexopathy occurring at night in bed. He had experienced multiple surgical courses of thyroid tumor resection including neck dissection and had presented left secondary jugular phlebectasia Jugular phlebectasia is mainly congenital and sometimes secondarily induced by compression, mechanical ventilation, trauma, thrombosis, etc. ⋯ To our knowledge, this is the first report of brachial plexopathy accompanied by ipsilateral jugular phlebectasia. We hypothesized the etiology of this case through multimodal examinations and reviewed the literature about jugular phlebectasia and brachial plexopathy.