Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsSplitting of the oculomotor nerve by the posterior communicating artery--case report.
A 62-year-old woman presented with subarachnoid hemorrhage manifesting as sudden onset of headache, but without visual symptoms or extraocular movement disturbances. Computed tomography angiography showed a 7-mm size aneurysm originating from the internal carotid-posterior communicating artery (PcomA). After the neck of the aneurysm was clipped, the PcomA was confirmed to have split the oculomotor nerve. Splitting of the oculomotor nerve by the PcomA was probably caused by arterial blood pulsation in the tortuous PcomA.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Poor-grade ruptured middle cerebral artery aneurysm with intracerebral hematoma: bleeding characteristics and management.
Poor-grade ruptured middle cerebral artery aneurysm is frequently associated with intraparenchymal hemorrhage, which is associated with high morbidity rates. We analyzed the clinical presentations and surgical strategies of 23 cases of ruptured middle cerebral artery aneurysm. Hematomas were divided into three types: temporal hematoma (7 patients), sylvian hematoma (10 patients), and frontal hematoma (6 patients). ⋯ Patients with frontal hematomas presented with both uncal herniation and brainstem signs preoperatively, but this subgroup showed unexpectedly good recovery. Patients with sylvian hematomas had relatively poor outcomes. The present series suggests that aggressive decompression and evacuation of hematoma in the acute stage may prevent significant postoperative brain swelling, and will not compromise the treatment of vasospasm.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Assessment of cognitive function before and after surgery for posterior cranial fossa lesions using computerized and conventional tests.
Cognitive function has not been well studied after neurosurgery for posterior fossa lesions despite its potential importance in determining surgical indications and approaches. The present study evaluated changes in cognitive functions after posterior fossa surgery to detect any differences between the middle cranial fossa and lateral suboccipital approaches in 50 patients with posterior fossa lesions such as tumors and vascular diseases. Twenty-five patients underwent surgery via the middle fossa and 25 via the lateral suboccipital approaches. ⋯ The middle fossa approach and operation time showed correlations with the postoperative neuropsychological declines. The computerized tests could be performed easily and were beneficial for detecting subtle changes of the cognitive function after surgery. Cognitive function, especially short-term memory, may decline temporarily with the middle fossa approach and long operation time.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Evaluation of intraoperative brain shift using an ultrasound-linked navigation system for brain tumor surgery.
Image-guided neurosurgery using navigation systems is an essential tool to increase accuracy in brain tumor surgery. However, brain shift during surgery has remained problematic. The present study evaluated the utility of a new ultrasound (US)-linked navigation system for brain tumor surgery in 64 patients with intracranial tumors. ⋯ Integration of the US scanner with the navigation system allowed comparisons between the intraoperative US and preoperative images, thus improving interpretation of US images. The system also improved the rate of tumor resection by facilitating the detection of remnant tumor tissue. This US-linked navigation system provides information on brain shift, and improves the accuracy and utility of image-guided surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Comparative StudyEffect of recombinant human erythropoietin on serum S100B protein and interleukin-6 levels after traumatic brain injury in the rat.
Erythropoietin (EPO) has a neuroprotective effect in the animal model of ischemia/hypoxia, but the mechanisms underlying the EPO effect in traumatic brain injury (TBI) are not well understood. This study examined the potential neuroprotective mechanisms of recombinant human EPO (rhEPO) in rats after TBI. Sixty healthy adult male Sprague-Dawley rats were randomly divided into 5 groups: 1000 U/kg rhEPO-treated, 3000 U/kg rhEPO-treated, 5000 U/kg rhEPO-treated, citicoline, and normal saline (control) groups. ⋯ The decrease in serum S100B protein level was correlated with the dosage of rhEPO. Medium doses of rhEPO achieved the optimum decreases in the serum IL-6 level. Therefore, inhibition of the composition and secretion of S100B protein and IL-6 levels by EPO might be one of the mechanisms involved in decreasing inflammatory reaction in the brain, and may be responsible for the neuroprotective effect after TBI.