No shinkei geka. Neurological surgery
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Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). But little is known about the changes of CBF and its effect on neurological status during the acute stage after direct bypass for moyamoya disease. ⋯ Postoperative decrease in TTP by PWI could be a sensitive parameter for the normalization of CBF after STA-MCA anastomosis in patients with moyamoya disease. Postoperative increase in CBV may suggest cerebral hyperperfusion and could be the optimal predictor for hyperperfusion syndrome after STA-MCA anastomosis in patients with moyamoya disease.
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A 41-year-old male had presented with severe neck pain and was diagnosed as having a left vertebral artery (VA) dissecting aneurysm. During the observation period, he suddenly suffered from a pain on his left temple. MR imaging revealed neither SAH nor cerebral infarction. ⋯ Because of the chronological change of radiological findings compatible with the symptom, we diagnosed the second episode as a MCA dissecting aneurysm manifesting with isolated pain. Among the previous forty-four MCA dissecting aneurysms, all but one case presented with hemorrhagic or ischemic event. In addition, this is the only case of multiple dissecting aneurysms of VA and MCA manifesting with isolated pain.
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The authors report a rare case of petrotentorial meningioma presenting as acute subdural hematoma. A 60-year-old female was introduced to our hospital complaining of sudden headache and gait disturbance. CT and MRI demonstrated a petrotentorial tumor with a subdural hematoma in the posterior fossa. ⋯ Histological examination showed a meningothelial meningioma with high vascularity in part. She recovered uneventfully and was discharged on foot. We discussed the etiology of an acute subdural hematoma caused by intratumoral hemorrhage and reviewed past literatures.
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The fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is a well established method for the treatment of brain tumor, especially malignant glioma. However, there is no report on photodynamic diagnosis (PDD) for spinal tumor. In the present study, we evaluated the usefulness of PDD for spinal ependymoma using 5-ALA. ⋯ The results of this study indicate the usefulness of 5-ALA-induced tumor fluorescence in guiding resection of spinal ependymoma. 5-ALA-induced porphyrin fluorescence may label spinal ependymomas easily and clearly enough to enhance the completeness of tumor removal.