Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Aug 2009
Clinical indications for high-field 1.5 T intraoperative magnetic resonance imaging and neuro-navigation for neurosurgical procedures. Review of initial 100 cases.
Initial experiences are reviewed in an integrated operation theater equipped with an intraoperative high-field (1.5 T) magnetic resonance (MR) imager and neuro-navigation (BrainSUITE), to evaluate the indications and limitations. One hundred consecutive cases were treated, consisting of 38 gliomas, 49 other tumors, 11 cerebrovascular diseases, and 2 functional diseases. The feasibility and usefulness of the integrated theater were evaluated for individual diseases, focusing on whether intraoperative images (including diffusion tensor imaging) affected the surgical strategy. ⋯ The integrated neuro-navigation improved workflow. The best indication for intraoperative high-field MR imaging and integrated neuro-navigation is brain tumors, especially gliomas, and is supplementary in assuring quality in surgery for cerebrovascular or functional diseases. Immediate quality assurance is provided in several types of neurosurgical procedures.
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A hypertensive 69-year-old man presented with an incidentally discovered non-ruptured aneurysm of the persistent primitive olfactory artery (POA). The POA originates at the terminal portion of the internal carotid artery, runs along the olfactory tract anteriorly toward the crista galli, and forms an acute angle with the distal anterior cerebral artery. The aneurysm was located at this characteristic acute angle. The persistent POA aneurysm associated with an anterior communicating artery aneurysm with wide neck was successfully treated by clipping surgery.
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Neurol. Med. Chir. (Tokyo) · Jul 2009
Endovascular treatment with bare platinum coils for middle cerebral artery aneurysms.
Middle cerebral artery (MCA) aneurysms often have unfavorable anatomical characteristics preventing successful endovascular occlusion. We reviewed the outcomes of our series of endosaccular embolization of MCA aneurysms using bare platinum coils, angiographic images, and medical records. Immediate and follow-up angiographic results were categorized as complete occlusion, residual neck, and residual flow. ⋯ Forty-four of the 45 patients with unruptured aneurysms treated endovascularly had no changes in their neurological status. One of 5 patients with complications had permanent morbidity. For patients with MCA aneurysms suitable for endovascular surgery, bare platinum coil embolization can be performed with acceptable low morbidity and mortality rates, with a lower risk of postprocedural aneurysmal bleeding.
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Neurol. Med. Chir. (Tokyo) · Jul 2009
Case ReportsEmergent surgical repair for penetrating injury of the cervical carotid artery associated with shock.
A 41-year-old male presented with penetrating carotid artery injury after being stabbed in the left neck with a knife. He had profuse bleeding from the wound and was in hemorrhagic shock. No neuroimaging evaluation was possible, so emergent surgery was begun with continuous manual compression of the left neck. ⋯ He recovered well without neurological deficits. Urgent hemostasis is required for patients with penetrating carotid artery injury presenting with shock. Surgical reconstruction of the carotid artery with a vascular graft is a safe option.
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Neurol. Med. Chir. (Tokyo) · Jul 2009
Spontaneous regression of a spinal extradural arteriovenous fistula after delivery by cesarean section.
A 23-year-old Japanese woman presented with a newly developed spinal extradural arteriovenous fistula (AVF) during pregnancy. She had been followed up for a suspected spinal cavernous angioma and became unable to walk during the 29th week of her pregnancy. Magnetic resonance (MR) imaging showed a spinal extradural AVF at the T3 to T4 levels compressing the spinal cord. ⋯ MR imaging confirmed spontaneous regression of the AVF. This case suggests that exacerbated neurological symptoms and AVF growth triggered by pregnancy can improve after delivery without interventional treatment. Careful follow up of neurological findings is required to prevent unnecessary interventional procedures in pregnant women with spinal AVF.