No shinkei geka. Neurological surgery
-
Case Reports
[A case report of hemangioma of the petrous bone which caused facial spasm and facial palsy].
A rare case of hemangioma of the petrous bone is described. A 31-year-old woman suffered from right facial twitching and palsy. So she underwent a craniectomy intending microvascular decompression of the facial nerve, but no compressing vessels or tumors were found. ⋯ Using the epidural subtemporal approach, the tumor was totally removed and the facial nerve remained intact. Histologically it was diagnosed as hemangioma. Hemangioma of the skull base bone is rare, and it is interesting that the tumor in this case caused abnormal facial contraction like hemifacial spasm.
-
Since 1983, the authors encountered 270 cases of lumbar disc hernia, which were operated on with the microsurgery. In the present study, the operative procedures were described and the results, especially the results of the reoperations were examined. Good results were obtained in 252 patients (93%). ⋯ Adhesion or fibrosis around the nerve root also played an important role. From the results of the present study, microsurgical lumbar discectomy with good illumination and high magnification has proved to bring satisfactory results. Recurrence, however, can occur after this procedure, so further inventions are required to ensure more satisfactory results.
-
Fifty-two cases of acute phase subarachnoid hemorrhage were studied by brain CT scanning to determine the presence and incidence of ischemic myocardial disorder, the relationship between ischemic change and severity, disease prognosis, and the relationship between acute phase circulatory dynamics and so-called neurogenic pulmonary edema. In all cases, ECGs were carried out and CPK-MB determined. Some of the patients underwent Tl myocardial scintigraphy, echocardiography, cardiac catheterization, as well as circulatory dynamic investigation (by Swan-Ganz catheter) and arterial blood gas analysis. ⋯ This could account for onset of symptoms. These findings support the need for adequate circulatory management in cases of acute subarachnoid hemorrhage with pulmonary edema and/or changes on ECG. In such cases, concurrent catheterization and cerebral angiography (cerebro-cardiac catheterization: CCC) proved effective for evaluating cardiac function and determining whether heart disease was also present.
-
A case of spinal cord injury due to stab wounds by a kitchen knife is presented. A 41-year-old male was hospitalized because of spinal cord injury resulting from stab wounds inflicted with a kitchen knife in the posterior cervical area. Neurological examination on admission showed paraplegia, disappearance of deep tendon reflex in both lower extremities, sensory disturbance below T1 level, left Horner's syndrome and urinary disturbance. ⋯ MRI 5 months after the injury revealed low intensity on T1 weighted imaged, high intensity on T2 and proton weighted image. The occurrence of the spinal cord injury due to stab wounds by a kitchen knife is very rare in Japan. MRI is useful in the diagnosis of stab wounds of the spinal cord.
-
Review Case Reports
[Three cases of carotid anterior cerebral anastomosis].
Three cases are presented with rare carotid-anterior cerebral anastomosis (anomalous ACA) originating from the internal carotid artery at the level of the origin of the ophthalmic artery, running first underneath and then between both optic nerves, and finally joining the anterior communicating artery. Case 1 (47 year-old woman) and case 2 (56 year-old man) were both admitted with subarachnoid hemorrhage from a ruptured aneurysm, which was located at the anomalous ACA (carotid-ACA anastomosis). Case (61 year-old man) was diagnosed as having left occipital intracerebral hematoma on CT, and bilateral anomalous ACA was found on angiograms. ⋯ Postoperative course was uneventful in each case. Case 3 was treated conservatively. From the angiographical and operative findings, we prefer to use "carotid-anterior cerebral artery anastomosis" as the medical terminology best suited to describe this condition.