No shinkei geka. Neurological surgery
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Two cases of vertebral artery injury following mild neck trauma are reported. A 52-year-old man was hospitalized with gait disturbance 7 days after mild traffic accident. Right vertebral angiogram revealed complete occlusion of the rt. vertebral artery (VA) and MR images revealed infarction in the rt. cerebellar hemisphere and rt. dorsolateral part of the medulla oblongata and revealed the thrombus in the rt. ⋯ It is said that vertebral artery injuries in association with head and neck trauma are relatively rare, but this condition is possible to be more common than realized, considering that the case of unilateral VA occlusion or the case with well developed collateral circulation is sometimes well tolerated for ischemia and that this condition can occur even after mild head and neck injury. The diagnosis must be established by vertebral angiogram, but MRI and MRA are very useful as ancillary methods. The therapeutic point is to prevent propagation of the thrombus and distal embolism, accordingly wearing a collar and anticoagulation are important.
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A case of aneurysm arising from the posterior communicating artery itself clipped by contralateral frontotemporal craniotomy (pterional approach) is presented. A 65-year-old female developed sudden severe headache and chest pain in January of 1993. Neurological examination on admission revealed consciousness disturbance such as stupor and nuchal stiffness. ⋯ The left IC-PC junction aneurysm was thought to be ruptured because of its size and contour, so left frontotemporal craniotomy was undertaken. By the left pterional approach, successful clipping of all three aneurysms involving the one arising from the contralateral posterior communicating artery was achieved. The aneurysm at the posterior communicating artery itself was found to arise from the non-branching site and to project inferiorly, thus the successful clipping through the prechiasmal cistern could be performed without compromising any small perforating arteries.
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Case Reports
[Ruptured distal anterior cerebral artery aneurysms presenting with acute subdural hematoma: report of two cases].
Two cases of ruptured distal anterior cerebral-artery aneurysms presenting with acute subdural hematoma are reported. Case 1 was a 55-year-old male, who showed abrupt disturbance of consciousness. An emergency CT revealed acute subdural hematoma at the right parietal convexity and interhemispheric fissure with moderate midline shift. ⋯ Ruptured distal anterior cerebral artery aneurysms presenting with acute subdural hematoma without subarachnoid hemorrhage are rare. It is suggested that CT scans and history of patients are most important but an emergency angiography was prerequisite for correct diagnosis. Surgical treatment should be the best management in such cases.
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Case Reports
[Postlaminectomy kyphosis of the cervical spine complicating spinal cord tumor in the foramen magnum].
Postlaminectomy kyphosis is rarely encountered as a sequela of decompression of the upper cervical spine, especially in adults. We present a case of disabling cervical kyphosis which developed after laminectomy for excision of a foramen magnum tumor and was treated successfully by occipito-vertebral fusion. A sixty-one-year old female was treated by laminectomy of the first through to the third cervical spine for a foramen magnum meningioma. ⋯ After we confirmed a lessening of the pain and improvement of the neurological symptoms during an axial traction using a halo-vest, posterior occipito-cervico-thoracic fusion was performed using Luque segmental spinal instrumentation and autogenous bone graft. After surgery the pain decreased and neurological symptoms improved. It is important to be aware of the complication of kyphotic deformity after laminectomy and once it has developed, it is recommended to stabilize the progression by early spinal fusion.