No shinkei geka. Neurological surgery
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Case Reports
[Single burr hole surgery for acute spontaneous subdural hematoma in the aged: patient reports of three cases].
The method of treatment for acute spontaneous subdural hematoma in aged patients is controversial. Three cases of acute spontaneous subdural hematoma in aged patients, treated by single burr hole drainage without irrigation, were reported. The first case, an 80-year-old male was admitted with complaints of headache and stupor without any history of head trauma. ⋯ She recovered completely and was discharged and return home 1 month after the surgery. Single burr hole drainage is less invasive than craniotomy. Our three cases indicate that this method may be one of the best methods for aged patients with acute spontaneous subdural hematoma which manifests mixed density in CT.
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Comparative Study
[Experience of treatment for blunt traumatic out-of-hospital cardiopulmonary arrest patients over 24 years: head injury v.s. non-head injury].
We investigated blunt traumatic out-of-hospital cardiopulmonary arrest patients whether any clinical differences between with and without head injury existed or not. ⋯ Among lethal blunt traumatic injuries, there were no different backgrounds between with and without head injury. The return of spontaneous circulation in the blunt traumatic patients with head injury became higher than without head injury, however the outcomes were similarly extremely poor.
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The purpose of this study was to assess the complication risk rate and diagnostic yield in a series of 211 procedures performed by a consistent method at one institute. ⋯ This study provided evidence that stereotactic biopsy was a safe and reliable tool for patients with unresectable malignant brain tumors.
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The purpose of this investigation was to study the incidence rate of rupture with respect to the site and size of multiple cerebral aneurysms that include both ruptured and unruptured aneurysms. Site and size were investigated in 58 cases of this type of multiple cerebral aneurysm. All cerebral aneurysms were examined with MR angiography, 3D-CT angiography and digital subtraction angiography, as well as seeing measured using 3D-CT or digital subtraction angiography. ⋯ The accumulated incidence rate of rupture of middle cerebral aneurysms rose in a gently sloping parabola beginning at 4 mm, and stabilized at 20% upon reaching 10 mm. These results suggest that each site is associated with a characteristic size and rate of aneurismal rupture. Special attention should thus be paid to large and anterior communicating aneurysms when operating on multiple cerebral aneurysms.
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Case Reports
[Normalization of cerebral hemodynamics and metabolism after carotid stenting in patients unfit for major surgery].
There is increasing evidence that stenting is a useful strategy for internal carotid artery (ICA) stenosis in patients unfit for drastic surgery. However, it should be remembered that perioperative complications including seizure or intracerebral hemorrhage due to hyperperfusion are not so rare. The authors describe a case with severe ICA stenosis, who successfully underwent stenting as a result of intensive medical care for postoperative hyperperfusion. ⋯ His blood pressure was carefully controlled to avoid "hyperperfusion syndrome" including headache, seizure and intracerebral hemorrhage. Follow-up SPECT/PET studies showed a normalization of hemodynamic and metabolic parameters. SPECT/PET studies are quite valuable to predict and prevent hyperperfusion syndrome after carotid stenting, and result in good clinical outcome.