No shinkei geka. Neurological surgery
-
Review Case Reports
[Four cases of direct surgery for anterior inferior cerebellar artery aneurysms].
Anterior inferior cerebellar artery (AICA) aneurysms are very rare. We carried out four direct operations for AICA aneurysms including two distal AICA aneurysms using lateral suboccipital retrosigmoid approaches (LSRA). We successfully performed the clipping by LSRA. but hearing loss occurred except in one of our cases which involved a chronic term operation in in our cases, In a 72 years old female with a ruptured dissecting aneurysm of the AICA anterior pontine segment, we performed the OA-PICA anastomosis first because of its being an AICA-PICA type, and then we continued to carry out the trapping operation of dissecting artery on day 0. ⋯ From results of case reports (75 distal AICA aneurysms), we found that pA: 5 (6.7%), pL: 2 (2.8%), pM: 0, m-loop: 54 (72%), cL: 8 (11%), cM: 6 (8.3%). The followings factors were also found. (1) Occlusion of the parent artery of P-group without revascularization of peripheral circulation may entail the risk of death. (2) On the other hand, as for the C-group, the parent artery was able to be occluded without severe consequences, but hearing loss and/or cerebellar infarction occurred. We believe that this classification is simple and very useful for therapeutic strategies in both direct surgery and intravascular treatments for distal AICA aneurysms.
-
Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). Seizure is known as a rare complication after revascularization for moyamoya disease, although its underlying mechanism is undetermined. We investigated the relationship between seizure attack and postoperative alteration in CBF in patients with moyamoya disease. ⋯ The neurologic deficits were resolved and no seizure attack recurred in three patients. Seizure following STA-MCA anastomosis can be caused by hyperperfusion in patients with moyamoya disease. When seizure attacks occur, routine CBF measurement is recommended to differentiate hyperperfusion and ischemia, since the treatments for these conditions are contradictory.
-
We report a case of brain abscess caused by a penetrating head injury that occurred 9 years earlier. A 14-year-old girl presenting with fever, headache, and stiff neck was admitted to our hospital. She was diagnosed with aseptic meningitis and treated conservatively. ⋯ The patient was discharged with only slight hyposmia after a 4-week course of antibiotics. This case showed that it is necessary to remove a residual foreign body and to close the dural fistula if there is a possibility of recurrent central nervous system infection. When a child presents with brain abscess, previous penetrating head injury should be considered.
-
The effects of electrical stimulation on the nervous system have been known for many years. Electrical stimulation has been employed as a treatment of functional diseases of the nervous system and has been mainly developed on the basis of deep brain stimulation (DBS), motor cortex stimulation (MCS), and spinal cord stimulation (SCS). Over the past two decades, DBS has replaced lesioning techniques as a treatment for movement disorders, and DBS has been shown to be safe and efficacious. ⋯ Research for the understanding of the effects of electrical stimulation at the neuronal level is still in progress, and knowledge from these research will eventually improve the effectiveness of this therapy. Moreover, these basic research and preliminary clinical studies will call for the re-examination of the basic effects of electricity on living tissues because it is now clear that electrical stimulation has a wider application. In this review, we summarizes the history and rationale behind electrical neurostimulation therapy and the recent applications of this technique for various functional diseases of the nervous system.