Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jun 2006
Case ReportsNeuronavigation-assisted transoral-transpharyngeal approach for basilar invagination--two case reports.
Two patients presented with congenital basilar invagination manifesting as progressive myelopathy. Both patients underwent surgery using a neuronavigation-assisted transoral-transpharyngeal approach. The Brain-LAB Vector Vision navigation system was used for image guidance. ⋯ After decompression, posterior stabilization was performed. Both patients had an uneventful postoperative course. The transoral-transpharyngeal approach with the neuronavigation system provides safe exposure and decompression for basilar invagination.
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Neurol. Med. Chir. (Tokyo) · May 2006
Case ReportsHyperperfusion syndrome after clipping of an unruptured aneurysm. Case report.
A 41-year-old man developed hyperperfusion 24 hours after undergoing successful clipping surgery for an unruptured middle cerebral artery aneurysm with temporary occlusion for 7 minutes. The patient exhibited motor aphasia 24 hours after surgery. ⋯ He returned to his previous job 2 months after surgery. Hyperperfusion syndrome is possible following any aneurysm surgery, including surgery for unruptured aneurysms using the temporary occlusion technique.
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Neurol. Med. Chir. (Tokyo) · Apr 2006
Case ReportsTrigeminal neuralgia associated with an anomalous artery originating from the persistent primitive trigeminal artery.
A 31-year-old man presented with typical trigeminal neuralgia caused by an anomalous variant type of anterior inferior cerebellar artery (AICA) directly branching from the primitive trigeminal artery (PTA). Three-dimensional computed tomography angiography, magnetic resonance angiography, and magnetic resonance cisternography disclosed that this anomalous artery originated from the PTA and coursed to the AICA territory of the cerebellum. ⋯ Careful and thorough inspection around the trigeminal nerve verified that the PTA did not conflict with the nerve. This unusual case was caused by compression of the trigeminal nerve from the AICA directly originating from the PTA, without the more common involvement of the PTA.
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Neurol. Med. Chir. (Tokyo) · Apr 2006
Optimal extent of resection in vestibular schwannoma surgery: relationship to recurrence and facial nerve preservation.
Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. ⋯ The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p=0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p=0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.
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Neurol. Med. Chir. (Tokyo) · Apr 2006
Case ReportsIsolated oculomotor nerve paresis in anaplastic astrocytoma with exophytic invasion.
A 30-year-old man presented with a supratentorial malignant glioma manifesting as isolated progressive left oculomotor nerve paresis. Computed tomography and magnetic resonance imaging showed an intra-axial tumor in the left temporal lobe, extending to the basal and prepontine cisterns, and compressing the brainstem. ⋯ The histological diagnosis was anaplastic astrocytoma. Malignant glioma with exophytic growth in the temporal lobe should be considered in the differential diagnosis of isolated oculomotor nerve paresis.