No shinkei geka. Neurological surgery
-
An incidentally found arteriovenous malformation (AVM) of the inferior medullary velum behind the medulla was removed by the lateral approach to the fourth ventricle originally described by Seeger in 1980. A wide posterior fossa craniotomy was performed to move the cerebellar tonsil laterally with C-1 laminectomy. The tela chroidea and inferior medullary velum, the two main sheets of tissue that form the lower half of the roof of the fourth ventricle can be exposed by gently displacing the tonsils laterally without splitting the vermis. ⋯ The nidus was removed in a dry field without bleeding. This report is the first report of surgical removal of unruptured AVM of the inferior medullary velum through the so-called telovelar or transcerebellomedullary fissure approach. We propose to call this approach the uvulotonsillar approach to emphasize the dissecting plane between the uvula and the tonsil.
-
A juvenile case of locked-in syndrome (LiS) caused by pontine infarction was reported. A 26-year-old woman suddenly complained of speech disturbance, weakness of the left upper and lower limbs, and occipital headache. She was admitted to an emergency hospital. ⋯ Vertebral and carotid angiography demonstrated complete occlusion of the basilar artery between the bilateral superior cerebellar artery and the bilateral anterior inferior cerebellar artery. As she was able to move her head, she began training to use a personal computer equipped with a special device as a communication tool. Three years from the onset, she stays at her home, takes her favorite foods, and enjoys her life.
-
Review Case Reports
[Multiple dural arteriovenous fistulas involving both the cavernous sinus and the posterior fossa: report of two cases and review of the literature].
Multiple dural arteriovenous fistulas (DAVFs) are rare, accounting for 7% of all intracranial DAVFs. The authors describe two cases of multiple DAVFs involving both the cavernous sinus and the posterior fossa. The first patient was a 45-year-old man who presented with visual disturbance, chemosis, exophthalmus, and tinnitus. ⋯ Preexisting cavernous sinus DAVFs induce sinus thrombosis and/or venous hypertension, which results in the formation of multiple lesions. A third possibility is that they are due to other factors, including increased angiogenic activity and some technical problems associated with TVE. Our review indicates that careful follow-up for several years should be made after treatment of cavernous DAVFs.