No shinkei geka. Neurological surgery
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Case Reports
[Ruptured P1-2 junction aneurysm associated with bilateral agenesis of the internal carotid artery].
We report a case of bilateral agenesis of the internal carotid artery which was revealed by oclulomotor palsy and subarachnoid hemorrhage. Angiography showed a ruptured aneurysm of the left P1-2 junction and bilateral absence of the internal carotid artery. ⋯ Complete clipping easily compromised the middle cerebral circulation. This case suggested that STA-MCA bypass should be considered in the surgery of agenesis of the internal carotid artery in which the preoperative hemodynamic status is usually normal.
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Case Reports
[Langerhans cell histiocytosis of the temporal bones with infiltration of temporal muscle: a case report].
A 9-year-old boy presented a painful right painful parietal mass that rapidly enlarged within a month. He had no other symptom of infection or malignancy. Laboratory findings were normal. ⋯ The parietal bone mass was soft and successfully removed. Histological examination disclosed Langerhans cell histiocytosis (LCH) infiltrating the temporal muscle. MR imaging is useful for diagnosis of LCH of the skull with soft tissue involvement.
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Despite advances in surgical techniques and improvements in perioperative care, the incidence of perioperative strokes has not decreased, reflecting the aging of the population and the increased number of patients with complication. We investigated the cases who were consulted due to perioperative stroke. From April, 2004 to March, 2007, a total of 102 patients were referred for neurological evaluation because of perioperative stroke. ⋯ The cause of the cerebral infarction was considered as cerebral embolism in 19 cases. Those who were consulted preoperatively were treated to prevent intraoperative stroke and did not suffer neurological complication. Most stoke in patients undergoing surgery were not related to hypoperfusion but due to embolism.