No shinkei geka. Neurological surgery
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We report a case in which a large abdominal pseudocyst developed following a ventriculo-peritoneal shunt (V-P shunt) for hydrocephalus due to pineal germinoma. A 24-year-old man had undergone a V-P shunt and radiotheraphy for unbiopsied posterior third ventricle tumor. ⋯ The shunt tube was clearly deomonstrated in the cavity by computed tomography. It is suggested that, in a patient suspicious of having abdominal pseudocyst who developed abdominal symptoms and signs following V-P shunt, abdominal computed tomography and/or ultrasonotomography provide a definitive diagnosis of this entity.
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Case Reports
[The diagnosis of lumbosacral lipomeningocele by computed tomography (author's transl)].
A case of 2-month-old girl with lumbosacral lipomeningocele was reported. She was admitted for evaluation of a large soft mass in the lumbosacral area, initially noted at birth. On examination, the tumor was 7 cm in diameter and 3 cm in height. ⋯ Myelography is valuable but caution is needed at time of lumbar or cisternal puncture. But spinal computed tomography is noninvasive and allows for precise diagnosis without contrast myelography. CT scan is extremely useful in diagnosing congenital abnormality of the spine.
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Treatment of upper cervical chordoma is generally considered to be difficult one, because of serious troubles in supporting cranio-spinal junction after the surgery and at the recurrence. Clinical course of a 22-year-old man with chordoma originated from C2 vertebral body was reported, and the operation for such a condition were discussed with emphasis on the mode of craniovertebral fixation. Simple subtotal removal of the vertebral chordoma was carried out by posterior approach at the first operation. ⋯ This procedure of fixation not only enabled a sufficient removal of the residual tumor without loosening the bone graft, but also shortened the bedridden time following the subsequent operations for the recurrence, and finally resulted in an excellent recovery in his clinical symptoms. It is considered to be important to select the most adequate approach of surgery, including fixation technique, according to the extension of the tumor. We would emphasize the usefulness of paramedian posterior fusion of the cranio-spinal junction for such a condition of wide tumor invasion in the high cervical region.