Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Case ReportsPosterolateral sulcus approach for spinal intramedullary tumor of lateral location: technical note.
Posterolateral sulcus (PLS) approach of the spinal cord, being equivalent to the dorsal root entry zone myelotomy, may offer the satisfactory exposure of the spinal intramedullary tumor if applied appropriately. Eight consecutive patients with spinal intramedullary tumors of lateral location underwent the surgery of PLS approach in our institute. There were 6 male and 2 female patients, ranging in age from 34 to 72 years (mean, 57 years). ⋯ Average grade of the sensory pain scale was 2.7 before surgery and improved to 1.7 at 3 months after surgery. PLS approach can be one of the surgical choices to the spinal intramedullary tumors, if applied appropriately. Better indication for PLS approach may be the tumors of the uneven location within the spinal cord associated with moderate or severe local pain.
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A 34-year-old female presented with trigeminal neuralgia caused by a venous malformation in the right cerebello-pontine region. Computed tomography and magnetic resonance imaging demonstrated the abnormal draining veins from the venous malformation. The dilated vessels extended around the trigeminal nerve and compressed the root entry zone. ⋯ Good outcome depends on decompression of the root entry zone without injury to the vessel. Surgical injury in this region can cause severe neurological deficits. Several treatment options should be prepared for the surgery, such as MVD or rhizotomy.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
ReviewConus medullaris-cauda arteriovenous malformation and Klippel-Trenaunay syndrome: what is the treatment goal?
A 29-year-old man with Klippel-Trenaunay syndrome (KTS) presented with a symptomatic conus medullaris-cauda arteriovenous malformation (AVM) manifesting as back and right limb pain, which abruptly worsened with the onset of right limb weakness and urinary retention. He was treated by multisession endovascular embolization resulting in improved neurological status. ⋯ Embolization treatment may represent a safe option to minimize complications and possibly improve the neurological status in patients with spinal AVM associated with KTS, if one or both legs are already impaired by hypertrophy or other vascular malformations. Genetic analysis may reveal an underlying angiogenesis change, so closer follow up might be indicated in selected patients.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Review Case ReportsContralateral acute subdural hematoma following traumatic acute subdural hematoma evacuation.
Contralateral acute subdural hematoma (ASDH) occurring after removal of traumatic ASDH is a rare, but nearly devastating postoperative complication. We treated a 26-year-old male who developed a contralateral ASDH shortly after craniectomy for evacuation of a traumatic ASDH. ⋯ Literature review suggests that the old are more susceptible to contralateral ASDH following evacuation of traumatic ASDH. Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.
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Stroke during pregnancy is rare, but after occurring, most patients develop serious neurological conditions. Hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, often requires emergency surgical intervention. ⋯ Whether the patients receive general or spinal and epidural anesthesia is another clinically significant issue. Finally neurosurgeons, anesthesiologists, and obstetricians should cooperate to manage pregnant women with stroke.