No shinkei geka. Neurological surgery
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Intrasacral fixation technique devised by Jackson is said to provide rigid lumbosacral fixation. We treated 3 cases of lumbosacral lesions using this technique in which lumbosacral segment had become extremely unstable during surgical intervention adding to the effect of original lesions. In all cases, surgeries were performed in 2 stages, intrasacral fixation and anterior stabilization. ⋯ One week after the first operation, the L5/S1 disc and the suppurtive vertebral bodies were resected through the extraperitoneal approach and anterior stabilization was performed with iliac bone grafts. At follow-up for a minimum of 6 months, initial fixation was maintained in all 3 cases and bony fusion was obtained. The intrasacral fixation technique was considered to be effective for extremely unstable lumbosacral lesions.
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We report 3 cases of de novo aneurysms that developed long after neck clipping of the initial aneurysms (range, 7 to 20 years, mean 12 years). Case 1 was a 58-year-old female who had undergone clipping of a ruptured aneurysm 17 years previously. Ten years later, she suffered another subarachnoid hemorrhage due to rupture of a new aneurysm, for which neck clipping was performed. ⋯ Conventional angiography revealed three and one new aneurysms, respectively. Since case 1 was a special case of multiple aneurysms in which lesions appeared in series rather than in parallel, all three patients harbored multiple aneurysms. It is recommended that patients with multiple aneurysms, especially those after a long period postoperatively, undergo periodic examination on an outpatient basis to detect formation of de novo aneurysms by magnetic resonance angiography or 3D-CT angiography.
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To evaluate the influence of the primary management on the outcome in severe head-injured-patients, we retrospectively studied the patients transported to our hospital directly and the those referred from other hospitals. ⋯ The doctor-helicopter system, in which emergency physicians arrive at the site shortly after the occurrence of injury, and start primary examination, will influence outcomes of multiple injuries accompanying severe head injury. Severe head-injured patients by high-impact injury should be transported as early as possible to the emergency medical center, and neurosurgeons have an important role in the primary management.
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The aim of this study was to investigate cardiac performance and volume status after subarachnoid hemorrhage (SAH). Hemodynamic and volumetric parameters including cardiac index (CL), intrathoracic blood volume index (ITBVI), and extravascular lung water index (EVLWI) were evaluated by single indicator transpulmonary thermodilution (PiCCO) from days 1 to 4 in 32 patients with SAH treated surgically or endovascularly within 24 hours. Higher CL and lower ITBVI values were observed after SAH. ⋯ Relationship between CL and SI were well correlated (r = 0.77, p < 0.0001). The results indicate that SAH predisposes patients to hyperdynamic and hypovolemic states associated with sympathetic hyperactivity, especially in patients with poor clinical grade. Bedside monitoring with the PiCCO system may be a powerful tool for the management of patients after SAH.