Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Nov 2003
Case ReportsRuptured infectious aneurysm of the distal middle cerebral artery manifesting as intracerebral hemorrhage and acute subdural hematoma--case report.
A 21-year-old woman with severe mitral valve regurgitation due to infectious endocarditis was transferred to our institute in a deep coma with intracerebral hemorrhage and acute subdural hematoma. She had no history of head injury. ⋯ The aneurysm originated from a branch of the angular artery and was successfully resected on Day 22. Histological examination of the aneurysm section showed no infectious nature, but the final diagnosis was infectious intracranial aneurysm based on the presence of infectious endocarditis.
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Neurol. Med. Chir. (Tokyo) · Sep 2003
Operative anatomy and classification of the sylvian veins for the distal transsylvian approach.
Methods for preservation of the sylvian veins in the transsylvian approach have not been established because of the considerable variations. This study attempted to classify the sylvian veins to facilitate systematic dissection of the sylvian fissure for sylvian veins to be preserved. The operative anatomy of the sylvian vein was examined in 82 hemispheres. ⋯ The frontobasal bridging vein (FBBV) drained into the sphenoparietal sinus in 47 cases. The type of connection was further subdivided into four types according to the connections with the DMCV and FBBV. The venous anatomy of sylvian fissure indicates that dissection (skeletonization) of the main stem of sylvian veins from the temporal lobe should be performed to preserve the tributaries from the frontal lobe.
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Neurol. Med. Chir. (Tokyo) · Jul 2003
ReviewBranches of the anterior cerebral artery near the anterior communicating artery complex: an anatomic study and surgical perspective.
The anatomy of the branches of the anterior cerebral artery (ACA) near the anterior communicating artery (ACoA) complex were investigated to minimize neurovascular morbidity caused by surgical procedures performed in this region. Thirty-one cadaver brains were perfused with colored silicone, fixed, and studied under the operating microscope. The recurrent artery of Heubner (RAH), orbitofrontal artery (OFA), and frontopolar artery (FPA) were identified as the branches of the ACA arising near the ACoA complex. ⋯ The RAH, OFA, and the FPA are three branches that arise from the ACA near the ACoA complex. These vessels have similar diameters, but can be distinguished by the final destination. Distinguishing these vessels is important since the consequences of injury or occlusion of the FPA and OFA are significantly less than of the RAH.
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Neurol. Med. Chir. (Tokyo) · Jun 2003
Case ReportsCerebral aneurysm regrowth and coil unraveling after incomplete Guglielmi detachable coil embolization: serial angiographical and histological findings.
A 69-year-old woman suffered subarachnoid hemorrhage due to rupture of an aneurysm at the tip of the basilar artery. The aneurysm was treated by endovascular treatment using Guglielmi detachable coils but the aneurysm dome could not be completely packed. ⋯ Examination of the aneurysm showed further regrowth and "relative coil compaction" of the coil mass. Histological examination of the resected aneurysm showed no endothelialized membrane in the orifice and only minimal organized thrombus in the body of the aneurysm.
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Neurol. Med. Chir. (Tokyo) · May 2003
Case ReportsSevere tension pneumocephalus caused by opening of the frontal sinus by head injury 7 years after initial craniotomy--case report.
A 46-year-old man presented with severe tension pneumocephalus triggered by mild head injury 7 years after craniotomy. He had a history of subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm, coating of the aneurysm performed via a craniotomy, and a ventriculoperitoneal (VP) shunt inserted. He fell from bed in a rehabilitation hospital. ⋯ The patient had a good postoperative course without meningitis. Tension pneumocephalus may occur as a complication several years after a craniotomy because of the chronic lowering of intracranial pressure induced by a VP shunt. Complete frontal sinus repair is important during the initial craniotomy.