No shinkei geka. Neurological surgery
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We evaluated the treatment results of nonfunctioning pituitary adenomas in the era of radiosurgery. Between January 1994 and December 2003, we operated on 44 patients with nonfunctioning pituitary adenomas. 43 patients were operated on by transsphenoidal surgery and one patient was operated on by the transcranial approach. Total removal was able to be achieved in 13 patients (30%). ⋯ None of the patients suffered from new cranial nerve deficits. This included optic neuropathy. Surgical resection using transsphenoidal surgery and subsequent gamma knife radiosurgery for residual and recurrent tumor proved to have a highly effective tumor growth control rate, and maintained the quality of life in patients with nonfunctioning pituitary adenomas.
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A case of subarachnoid hemorrhage (SAH) resulting from a ruptured intracranial dissecting aneurysm of the internal carotid artery (ICA) is reported. A 58-year-old woman presented with headache and vomiting. A CT showed diffuse SAH. ⋯ SAH caused by the rupture of a dissecting aneurysm of the ICA has been considered rare. To our knowledge, there have been only 29 cases. We discuss the clinical characteristics with a review of the literature.
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The surgical procedures for treating chronic subdural hematoma (CSH) are carried out with a variety of different methods. The generally used operative method is a less invasive burr hole irrigation under local anesthesia. ⋯ We also analyzed the endoscopic findings in the hematoma cavities and reported a high recurrence rate in patients with clots in the hematoma cavity, which suggest the importance of clot removal to reduce recurrence. In this study, the advantage of endoscopic surgery for chronic subdural hematoma is demonstrated.
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The deep brain stimulation (DBS) is an effective treatment modality of the functional neurosurgery for disorders such as Parkinson's disease, essential tremor and generalized dystonia. Recently, the targets of DBS for treatment of Parkinson's disease are the thalamus, the Globus pallidus and subthalamic nucleus (STN). The STN-DBS induces improvements in axial motor fluctuation and the on-off phenomenon. ⋯ We devised a three-dimensional atlas to see an image at a free angle on a personal computer. It provided us with more useful information about structures than ones by two-dimentional images. Three-dimensional atlas also helped us make a decision for placement of the deep brain electrode and appropriate electrophysiological recording.