No shinkei geka. Neurological surgery
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Review Case Reports
[Positron emission tomographic evaluation for frontal hypertrophic cranial pachymeningitis using 11C-methyl-L-methionine].
A case of frontal hypertrophic cranial pachymeningitis was presented with positron emission tomography (PET) using (11C-methyl)-L-methionine (11C-Met). A 55-year-old male developed right hemiparesis after generalized tonic convulsion one month prior to admission. MR images revealed patchy enhancement extending from the dura mater to the cerebral parenchyma surrounding high T2-weighted signal in the left frontal region. ⋯ Follow-up MR images three months after the surgery showed the enhancing lesion to be diminished and a marked regression of the vasogenic edema. Spatial determination of viable lesions permitting differentiation from biological inactive or vasogenic edema is an important guideline in selecting an appropriate surgical procedure in the diagnosis and treatment of hypertrophic cranial pachymeningitis. Met-PET would appear useful in delineating inflammatory lesions such as hypertrophic cranial pachymeningitis.
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Postoperative spondylodiscitis (POD) is a rare but severe complication of lumbar disc surgery. There were five patients with POD among 875 patients undergoing surgery for herniated lumbar discs, in the last 16 years. For detecting risk factor of discitis, a POD group of 5 patients was matched to a control group of 870 patients with respect to sex, age, disc type and operation. ⋯ T2-weighted image showed iso signal intensity in L5 and S1 vertebral bodies. Gadolinium-enhanced T1-weighted image had mild homogenous enhancement in the posteroinferior portion of the L5 vertebral body. Three months after treatment of POD, there was major signal change in neither T1 nor T2 weighted images, though T2 showed subtle abnormalities with decreased signal intensity adjacent to the L5/S1 disc space.
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Case Reports
[A case of multiple cerebral arteriovenous malformations treated by gamma knife radiosurgery].
We reported a case of multiple cerebral arteriovenous malformations (AVMs) treated by gamma knife radiosurgery. A 6-year-old girl was admitted because of systemic tonic convulsion. At the first admission, we performed only vertebral angiography, which showed a 15 mm cerebral AVM. ⋯ We treated both cerebral AVMs bv gamma knife radiosurgery. Follow-up angiograms performed 2 years after radiosurgery confirmed the disappearance of both AVMs. We then discuss treatment of multiple cerebral AVMs.
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A very rare case of directly penetrating injury of the head, neck and chest caused by a nail-gun was reported. A 56-year-old male was admitted to our critical care center due to chest injury. On admission, he showed numbness of the hand & leg, left hemiparesis and hypalgesia. ⋯ He was discharged one month after surgery. Some injuries caused by a nail-gun have been reported in the world literature but in Japan this multiple injury case was the first reported. Since nail-gun injuries can cause multiple damage, systemic X-ray examination was very important.
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Penetrating injury to the vertebral artery is a very rare accident and no case except ours has been reported to date in Japan. We reported a case of successful treatment of a penetrating injury by a nail to the left vertebral artery with the use of interventional radiologic procedure. ⋯ Left vertebral angiography revealed that a nail had penetrated into the vertebral artery at the C6 level. Considering the possibility of thrombus formation around the metallic foreign body and the risk of uncontrollable bleeding, we performed embolization of the injured vertebral artery with Interlocking Detachable Coil.