Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsEfficacy of motor cortex stimulation for intractable central neuropathic pain: comparison of stimulation parameters between post-stroke pain and other central pain.
Motor cortex stimulation (MCS) has now become the preferred option for neurosurgical management of intractable central neuropathic pain such as post-stroke pain and trigeminal neuropathic pain. However, the efficacy of MCS for other central neuropathic pain such as pain resulting from spinal cord or brainstem lesions is unclear. We retrospectively reviewed 11 consecutive patients with intractable central neuropathic pain who underwent MCS in our institution. ⋯ These efficacies continued for 6 months after surgery without significant change in the stimulation parameters compared with the parameters at 1 month in both groups. The mean amplitude at 1 month and frequency at 6 months after surgery were significantly higher in the brainstem-spinal group than the thalamic group, although the patient number was small. MCS is effective for other central neuropathic pain, but higher intensity stimulation parameters may be necessary to gain adequate pain reduction.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsChronic subdural hematoma in a patient with congenital afibrinogenemia successfully treated with fibrinogen replacement.
A 37-year-old woman with congenital afibrinogenemia presented with chronic subdural hematoma (CSDH) manifesting as severe headache, nausea, and somnolence after a minor head trauma. Brain computed tomography scans showed a right subdural hematoma associated with midline shift. Laboratory studies showed prolongation of prothrombin time, activated partial thromboplastin time, and undetectably low level of fibrinogen. ⋯ Burr-hole evacuation and drainage of CSDH was successfully performed using fibrinogen concentrate. The development of CSDH with afibrinogenemia is very rare. Although the past repeated administrations of fibrinogen concentrate were suspected to generate CSDH, paradoxical thrombotic complications caused by upregulation of prothrombin activation, thrombin generation, and growth factors released from platelets might be related to the development of CSDH with congenital afibrinogenemia.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyBiomechanical and morphometric evaluation of occipital condyle for occipitocervical segmental fixation.
Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. ⋯ Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsDe novo aneurysm in the feeding artery of a recurrent malignant glioma - case report - .
A 52-year-old man underwent resection of an oligodendroglioma in the left frontal lobe, followed by chemoradiation therapy in 1989. He presented with a de novo aneurysm arising from the feeding artery of a recurrent malignant glioma in 2009. Serial follow-up magnetic resonance imaging showed no tumor progression until 19 years after the initial diagnosis. ⋯ The recurrent tumor was resected together with the aneurysm. Histological examination revealed that the tumor was an anaplastic oligodendroglioma, and the aneurysm was encased in the tumor. Clinicians should carefully look for tumor recurrence and aneurysm formation during follow up of patients treated for malignant glioma.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsMiddle cerebral-anterior cerebral-radial artery interposition graft bypass for proximal anterior cerebral artery aneurysm.
A 74-year-old man underwent pterional craniotomy to treat a left proximal anterior cerebral artery (ACA) aneurysm. The orifice of the aneurysm was located at the origin of the proximal segment of the ACA, and the right A(1) segment of ACA was hypoplastic. After failed attempts at neck plasty with fenestrated clips, trapping and bypass were performed. ⋯ Trapping of the aneurysm was successfully achieved without ischemic event. Intracranial-intracranial bypass has been employed in the treatment of complex cerebral aneurysm in an increasing number of selected patients. The present case shows that MCA-ACA-RA interposition graft bypass is an effective procedure to provide blood supply to the ACA territory if a proximal A(1) lesion requires trapping with incompetent contralateral A(1).