Neurologia medico-chirurgica
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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 ReportsParaspinal arteriovenous fistula presenting with subarachnoid hemorrhage and acute progressive myelopathy--case report.
A 60-year-old man presented with paraspinal arteriovenous fistula (AVF) manifesting as subarachnoid hemorrhage (SAH) and acute progressive myelopathy. The patient presented with sudden onset of low back pain and paraparesis. Spinal magnetic resonance imaging revealed a vascular malformation on the lumbar spinal canal. ⋯ The clinical symptoms were progressing rapidly, so transarterial embolization and surgical drainage ligation were performed. Paraspinal AVF may present with SAH and cause acute progressive myelopathy. Prompt examination and treatment are necessary.
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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).
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsCerebral infarction along the distribution of perforating arteries during aneurysm surgery in a patient with pheochromocytoma--case report.
A 58-year-old woman with refractory hypertension presented with subarachnoid hemorrhage. Digital subtraction angiography and three-dimensional computed tomography (CT) angiography revealed a ruptured left vertebral artery (VA) aneurysm and an unruptured left middle cerebral artery (MCA) aneurysm. The patient successfully underwent neck clipping of the left VA aneurysm. ⋯ Her symptoms gradually improved, and the pheochromocytoma was removed by laparoscopic surgery. Sustained severe hypertension and depletion of blood volume resulting from excess catecholamine release from the pheochromocytoma may have caused the complications. Hypervolemic fluid infusion and maintenance of normotensive blood pressure during surgery may avoid such ischemic events.