No shinkei geka. Neurological surgery
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Case Reports
[Cranioplasty following decompressive craniectomy--analysis of 300 cases (author's transl)].
Three hundred cases of cranioplasty, following large decompressive craniectomy for various diseases, were analyzed. 1. Neurological status was evaluated before and after cranioplasty in 52 patients with remaining neurological deficit. There observed no changes in 13 patients with skin flap of full or bulging type. ⋯ In one case, there occurred 3 episodes of fracture. 4. Infected cranioplasty, in all as epidural empyema, was seen in 10 (3%) of 300 cases. One of the most important factors related to infection, was the time interval after the primary surgery; all infected cases were operated on within 3 months.
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The neural mechanism of the modulating effects of spinal cord stimulation upon intractable pain was studied in cats under local anaesthesia. The electrical activity at the centre median nucleus of the thalamus (CEM), which responded to noxious stimuli and was inhibited by nitrous oxide inhalation, was recorded as an indicator of the degree of pain sensation. The suppressed effect upon the evoked potential responding to sciatic stimulation (1 Hz) was recorded during and after train stimulation of various parts of the spinal cord by means of silver ball bipolar electrode. ⋯ This effect corresponds to the inhibitory effect by 75% N2O gas inhalation. Upon dorsal column stimulation, the intraspinal electrical activity is found in the central gray matter the antero-lateral quandrants of the spinal cord as well as the dorsal column. 2) Following lateral or anterior column stimulation as well as dorsal column stimulation, the CEM evoked potential responding to sciatic stimulation is inhibited by about 50% of its amplitude. 3) Following bilateral dorsal tractotomy cranial, caudal or both to the stimulating point, the CEM evoked potentials responding to sciatic stimulation are inhibited by dorsal column stimulation. According to the experimental results, it may be concluded that the inhibitory modulating mechanism by dorsal column stimulation for pain relief is not only mediated through the dorsal column, but also through other ascending spinal pathways.
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Out of 122 hydrocephalic infants and children treated by cerebrospinal fluid shunt, post-shunt subdural hematoma was found in 11 patients in total, 8 cases with non-tumorous hydrocephalus and 3 cases with brain tumors obstructing the cerebrospinal fluid pathway. In most cases the diagnosis of subdural hematoma was delayed since signs of increased intracranial pressure were absent initially. The signs of increased intracranial pressure appeared later, when the shunted venricle collapsed and could not give any more space to the growing subdural hematoma. ⋯ Post-shunt subdural hematoma was apparently induced by the tear of the bridging vein or leakage of the cerebrospinal fluid into the subdural space through the torn arachnoid membrane due to over-drainage of the cerebrospinal fluid, especially when the patients took the erect position. Since such a complication is not rare and difficult to be diagnosed, intensive follow-up is necessary in the post-shunt period. The precautionary measures as well as the treatment for these subdural hematoma were also discussed.
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Post-shunt subdural hematoma was found in two patients with hydrocephalus due to subarachnoid hemorrhage. The first case was a 46-year-old man with two episodes of subarachnoid hemorrhage from anterior communicating aneurysm. Two weeks after neck-clipping for the aneurysm, a ventriculo-peritoneal shunt with Pudenz's system was performed since hydrocephalus with moderately increased pressure had been found. ⋯ After cerebral angiogram, the subdural hematoma was removed and the shunt tube was ligated. He became free of these symptoms in two weeks. The cerebrospinal fluid shunt is recommended for hydrocephalus induced by subarachnoid hemorrhage, but careful follow-up is necessary since these patients might develop post-shunt subdural hematoma, especially after head trauma as shown in our cases.