Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2010
ReviewTechnical advancements and utilization of spine surgery--international disparities in trend-dynamics between Japan, Korea, and the USA.
Spine surgery has made radical advancements in the last two decades and provision has expanded a great deal. The history of the technical development is briefly reviewed. ⋯ Medico-socioeconomic conditions underlying the variations are discussed. Adequate surgeon training has to be supplied in a matched volume, and the number of surgeons to balance the need is estimated.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyComparative analysis of spinal hemangioblastomas in sporadic disease and Von Hippel-Lindau syndrome.
The clinical differences were evaluated in spinal hemangioblastoma between patients with sporadic disease and patients with von Hippel-Lindau (VHL) syndrome. The distribution of hemangioblastomas in the central nervous system was investigated in 56 patients treated between 1988 and 2008 at the University of Tokyo Hospital. The characteristics of spinal hemangioblastomas were compared in 35 patients including 17 with sporadic disease and 18 with VHL syndrome treated between 1988 and 2008 at our hospital and three affiliated institutions. ⋯ Tumor recurrence was correlated with partial removal of lesions (p = 0.05). One third of patients with VHL syndrome developed new lesions every 2 years. The major finding of this study is that the incidence of spinal hemangioblastoma, distributed through all spinal levels, may be as high as 88% in patients with VHL syndrome, which is much greater than previously reported.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Long-term follow up of patients with good outcome after intra-arterial thrombolysis for major arterial occlusion in the carotid territory: clinical and magnetic resonance imaging evaluation.
Long-term clinical symptoms, including extrapyramidal signs, and magnetic resonance (MR) imaging studies were retrospectively analyzed in 21 patients with good outcome (modified Rankin scale scores 0-2) after successful recanalization of occluded major arteries by intra-arterial thrombolysis with mechanical disruption. Changes in high intensity areas (HIAs) and cerebral atrophy in the ischemic hemisphere were evaluated on follow-up fluid-attenuated inversion recovery MR images. Extrapyramidal signs, short-stepped gait and/or masked face, were observed in 12 of 21 patients during the follow-up period (11 to 68 months, mean 42 months). ⋯ More than half of the patients with good outcome showed extrapyramidal signs. Extrapyramidal signs in patients with small infarction may indicate rapid progression of cerebral atrophy. The occurrence of extrapyramidal signs might be related to delayed neuronal death in atrophic areas.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyImpact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage.
The present study aimed to evaluate the impact of early surgical evacuation of sylvian hematoma caused by ruptured middle cerebral artery (MCA) aneurysm on clinical outcome after subarachnoid hemorrhage. Hospital records and computed tomography scans for 26 patients with MCA aneurysm who underwent surgical clipping between June 2001 and January 2008 were retrospectively reviewed. All patients presented with sylvian hematoma associated with subarachnoid hemorrhage and received surgery at 7.9 +/- 3.6 (mean +/- standard deviation) hours of ictus. ⋯ Better functional outcomes were obtained in patients with successful evacuation (p < 0.05), as assessed by improvement of hemiparesis on manual muscle testing scale at postoperative 1-month follow up and by the modified Rankin scale at postoperative 3 and 6 months. Clinical outcomes were also better in the achievement group. These results suggest that better clinical course and outcome can be expected in patients who undergo early successful hematoma evacuation with surgical clipping of a ruptured MCA aneurysm.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsProptosis caused by partially thrombosed orbital varix of the superior orbital vein associated with traumatic carotid-cavernous sinus fistula--case report.
A 49-year-old female presented with proptosis and slight chemosis with diplopia on the right. The patient had a past history of skull base fracture occurring one year before the onset of the symptoms. Magnetic resonance imaging showed a partially thrombosed varicose aneurysm (varix) of the superior ophthalmic vein (SOV). ⋯ Proptosis was due to the direct mass effect of the thrombosed varix of the SOV. The thrombosed varix was removed after right carotid artery trapping with external carotid artery-middle cerebral artery (M(2)) high flow bypass. The symptoms subsided after the surgery.