No shinkei geka. Neurological surgery
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We report here a case of giant internal carotid artery (ICA) pseudoaneurysm as a complication of transsphenoidal surgery. This 50-year-old acromegalic male presented to our clinic with a status of hypovolemic shock due to serious epistaxis. Neuroradiological examinations at his admission revealed a giant aneurysm in the right cavernous portion projecting into the sphenoid sinus. ⋯ Emergent angiography suggested a rupture of the un-obliterated aneurysm neck remnant. Thus, trapping of the aneurysm combined with high flow bypass was necessitated. Relevant literatures are reviewed, and possible therapeutic strategies for this rare lesion are discussed.
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Symptomatic arachnoid cyst in an adult patient is rare. We present a case of a 51-year-old female with an arachnoid cyst of the right occipital convexity who developed homonymous hemianopsia. She had complained of numbness in the limbs at the age of 47 and based on MRI was diagnosed with a cystic space-occupying lesion in the right occipital convexity. ⋯ She underwent membranectomy, which resulted in the disappearance of visual disturbance. This case is comparatively rare among previously reported cases of symptomatic arachnoid cyst with regard to both location and symptom. Membranectomy is one of effective methods for treating symptomatic arachnoid cyst in the occipital convexity.
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Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows attenuated packing of the coils. However, during the course of the embolization, coils project over and obscure the parent vessel. Here we report a novel technique for endovascular parent vessel reconstruction with aneurysm embolization. ⋯ Furthermore, the angle of the image intensifier was manipulated to visualize the inside of the stent. Postoperative course was uneventful and follow-up MRI three moths later demonstrated obliteration of the aneurysm and patency of the parent artery. This technique provides a practical treatment strategy for the management of a circumferential aneurysm.
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Case Reports
[Motor cortex stimulation for post-stroke pain using neuronavigation and evoked potentials: report of 3 cases].
Although motor cortex stimulation (MCS) has been accepted as an effective therapeutic option for central pain, the efficacy of MCS widely varies among previous reports. In this report, we describe our recent trial for successful MCS in 3 patients with central pain due to cerebral stroke. Medical treatments were transiently effective, but gradually became ineffective in all of the cases. ⋯ After surgery, pain almost resolved in 2 of 3 patients and markedly improved in another. The pain relief depended on their motor function. These findings strongly suggest that both patient selection and intraoperative monitoring for targeting the motor cortex are quite important for successful MCS, although further studies were essential.
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Hair removal or shaving, even if partial, increases mental anguish of patients, especially in female. Several reports demonstrating successful cranial surgery without hair removal led us to start cranial surgery with completely preserving hair. The purpose of this study was to demonstrate our methods and tips of cranial surgery without hair removal and to evaluate the rate of postoperative infection in these patients. ⋯ There was no significant difference between the rate of wound complication in patients whose heads were shaven (5/82) and the rate in those whose head were not shaven (7/82). So we suggest that neurosurgery without shaving is safe, and does not increase the risk of severe wound infection. In addition, it helps patients to look normal and to start their routine earlier.