No shinkei geka. Neurological surgery
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The authors reported two cases of pyogenic cervical discitis presenting tetraparesis. Case 1: A 66-year-old male patient entered the hospital because of tetraparesis. Two weeks before the hospitalization, he had become feverish and awakened with motor weakness in all extremities. ⋯ On the 7th postoperative day, symptoms caused by radiculopathy of the left C5 appeared, but gradually ameliorated. The patient was free from motor weakness in the 8th month after the surgical treatment. Surgical intervention is a useful treatment for pyogenic cervical discitis with symptoms due to compression of the spinal cord both in the acute and subacute stages.
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Near infrared spectroscopy (NIRS) have been accepted as a useful modality for non-invasive monitoring of brain oxygenation state. Using a newly developed NIRS apparatus, HEO-200, the authors continuously monitored the changes in the oxygenation state of brain hemoglobin during carotid endarterectomy (CEA) or carotid balloon occlusion tests (BOT) in 21 patients. Somatosensory evoked potentials (SEP), regional cerebral blood flow (rCBF) or transcranial Doppler sonography (TCD) were also employed to compare with the NIRS-responses. ⋯ Restoration of blood flow immediately resolved these findings. The other 14 patients demonstrated no or only transient changes on NIRS as well as on SEP and rCBF study. HEO-200 could non-invasively monitor the relative changes of cerebral oxygenation state with good time resolution, and detect critical ischemia during CEA and carotid BOT.
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Stereotactic radiosurgery (SRS) for brain metastasis results in a high local control rate. But cystic metastatic tumor should have been a contraindication for SRS. Because it is often found that a cyst is too large to be irradiated, the tumor does not exist in the center of the irradiation field. ⋯ Median survival was 30 weeks from the date of radiosurgery. All of the patients died and the causes of death were related with the primary lesion. We conclude that our technique, a combination of stereotactic cyst aspiration and SRS is an effective measure which leads to palliation of neurologic symptoms and is a low risk treatment for patients with cystic brain metastasis.
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A method for intraoperative electrophysiological mapping of the intracranial root of the trigeminal nerve was studied in five patients with trigeminal neuralgia. During surgery, the trigeminal nerve root was stimulated centrally with a bipolar electrode, and antidromic responses were recorded peripherally from three branches of the trigeminal nerve in the face. In all patients, the fibers of the individual subdivisions of the trigeminal nerve root were successfully localized based on the peripheral sites of antidromic response. ⋯ As a result of mapping, the fibers of the trigeminal division subserving the pain were clearly confirmed to be compressed by the artery in all four patients who were undergoing microvascular decompression. Likewise, the antidromic responses precisely identified the first division of the trigeminal nerve, which should be preserved to avoid postoperative corneal ulcers in patients undergoing rhizotomy. Based on these findings, it was concluded that this technique enables surgeons to precisely identify which fibers of the trigeminal nerve root should be decompressed or divided during surgery for trigeminal neuralgia.
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Comparative Study
[Detection of the venous system of the skull base using three-dimensional CT angiography (3D-CTA): utility of the subtemporal approach].
Three-dimensional computed tomography angiography (3D-CTA) was compared with digital subtraction angiography (DSA) for the delineation of the skull base venous system in presurgical planning of the subtemporal approach in 201 sides of 109 patients. The axial stereoscopic images and multi-projection images were used in 3D-CTA, and the anteroposterior views and lateral views were used in DSA. DSA showed that the vein of Labbe (VL) was the most common venous flow on the lateral or basal surface of the temporal lobe, whereas 3D-CTA demonstrated that the involvement of the temporo-basal vein (TBV) was equal to that of VL in frequency. 3D-CTA showed that the VL flowed into the transverse sinus (TS) on 132 sides, the sigmoid sinus-TS junction on 29 sides, and the lateral tentorial sinus (LTS) on 40 sides. ⋯ Axial stereo and multi-projection images of 3D-CTA provided practical images of the deep veins of the skull base venous system and showed the relative anatomical relationships of the arteries and bony structures. This information can specify the venous inflow point, and help to determine the direction of approach and working space, and also help to identify intraoperative landmarks for the subtemporal approach. Presurgical examination of the deep venous system with 3D-CTA may help to minimize unexpected injury to veins and venous infarction.