No shinkei geka. Neurological surgery
-
An autopsy case of small cell glioblastoma, showing multiple extracranial metastases, is reported with special reference to histopathological differentiation from metastatic small cell carcinoma. Widely spread lesions in the bilateral lungs were developed after an operation and chemo-radiotherapy for glioblastoma, and the lung lesions led to fatal respiratory failure. Postmortem examination revealed multiple tumors in the lung, lymph nodes, and the heart, as well as local invasion of the primary tumor to the dura, skull, and the scalp. The mechanism of extracranial metastasis of brain tumor is discussed.
-
Cavernous sinus dural arteriovenous shunt (CdAVS) usually presents with exophthalmos, conjunctival chemosis, ophthalmoplegia, headache, bruit, or pulsatile tinnitus. Intracranial hemorrhage associated with CdAVS is rare. We describe a patient with CdAVS presenting with subarachnoid hemorrhage and acute subdural hematoma. ⋯ Unfortunately, the patient died 3 days after the operation. We concluded that subarachnoid hemorrhage and subdural hematoma were due to the rupture of engorged cortical veins. Our case report suggests that CdAVS with angiographic findings such as aneurysmal dilatation of the draining veins and leptomeningeal drainage should be treated urgently because of the high risk of the life-threatening complications resulting from a surgically uncontrollable hemorrhage.
-
Review
[Hemodynamic effects of STA-MCA anastomosis on patients with occlusion of the main cerebral artery].
We studied cerebral circulation in patients with occlusion of the main cerebral artery and investigated the efficacy of STA-MCA anastomosis. ⋯ STA-MCA anastomosis could improve cerebral circulation of patients with low CBF or low CVR due to occlusion of the main cerebral arterial. It was concluded that STA-MCA anastomosis may contribute to the reduction of stroke recurrence, if perioperative complications are reduced.
-
A report of a case of a patient with severe head trauma with pneumonia and cerebral infarction transported by helicopter. An eighty-year-old male was referred to our hospital because of dyspnea after a fall during sightseeing at Hiroshima. He was lucid at first, but, after two days presented restlessness due to brain contusional hemorrhage and edema. ⋯ The patient was carried to a waiting ambulance and transported to the hospital. Total transport time was only two hours and thirty minutes. This is a case showing a helicopter could safely transport a patient with severe brain damage over a long distance in a short time.