No shinkei geka. Neurological surgery
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Review Case Reports
A case of basilar impression complicated with left frontal meningioma.
A 75-year-old baikarian woman was admitted to our hospital for treatment of seizures. From the results of neurological and radiological examination, a left frontal meningioma was suspected and the patient was referred to our department for neurosurgical intervention. At admission, the MRI showed a basilar impression accompanied by Klippel-Feil syndrome of C4/5/6/7, but neurological symptoms of basilar impression were absent. Subsequently, the tumor was resected via the left frontal approach using microsurgical technique. Histological examination disclosed fibroblastic meningioma. ⋯ The coincidence of basilar impression with a brain tumor is a relatively rare occurrence. There are a few reports about craniovertebral junction anomaly including basilar impression associated with spinal or cerebral tumor. This time, we present an interesting combined case of BI and Klippel-Feil syndrome associated with left frontal meningioma.
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We report two very rare cases of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm in the cingulate sulcus. Only two surgically treated cases have been reported. Case 1: A 69-year-old woman suffered headache and was admitted to our hospital the next day. ⋯ CT revealed diffuse SAH in the basal and interhemispheric cistern. Cerebral angiography showed an aneurysm at the origin of the callosomarginal trunk arising from the anterior communicating artery complex and another at the callosomarginal-frontopolar bifurcation in the cingulate sulcus. Both aneurysms were successfully clipped on the day of admission, and the frontopolar artery aneurysm was shown to be the cause of the SAH.
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We report a patient suffering from delayed facial palsy after microvascular decompression (MVD) for hemifacial spasm, in whom the pathogenesis was proved. A 56-year-old man with a left hemifacial spasm was admitted to our hospital. Preoperative MR imaging showed that the left anterior inferior cerebellar artery (AICA) was compressing the left facial nerve. ⋯ Serum antibody of varicella-zoster virus (VZV) was increased, and Gd enhanced MR imaging demonstrated an enhancement of a geniculate ganglion of the left facial nerve, indicating inflammation. These findings suggested that delayed facial palsy after MVD was caused by a re-activation of VZV. The facial palsy disappeared completely over a period of nine months.