Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Dec 2002
Case ReportsGross total removal of gliomas in the pulvinar and correlative microsurgical anatomy.
Tumors in the pulvinar tend to present as circumscribed lesions with exophytic growth into the lateral and third ventricles. These lesions may be best explored via a parietal-transcortical-transventricular approach. If the tumor extends posteriorly or inferiorly, a posterior-interhemispheric-transtentorial approach may provide a good angle of access. ⋯ These patients are now doing well as students about 6 years following the first operations. During tumor removal, a posterior-interhemispheric-transtentorial approach combined with above-mentioned approaches was useful for orientation of the critical structures in the posterior incisural space. Knowledge of the anatomical relationships of the pulvinar to the crus of the fornix and the choroid plexus, and to the critical structures located in the posterior incisural space is extremely important for neurosurgeons.
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Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. ⋯ In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild transient urinary incontinence. These long-term results indicate that stereotactic psychosurgery is a safe and effective method of treating some medically intractable psychiatric illnesses.
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Neurol. Med. Chir. (Tokyo) · Aug 2002
Case ReportsSpontaneous subfalcial transcallosal migration of a missile to the contralateral hemisphere causing deterioration in neurological status--case report.
A 26-year-old man sustained a gunshot injury. Computed tomography (CT) demonstrated the missile in the right parietal region. Twenty-four hours later, the missile had moved towards the midline. ⋯ CT during the second week demonstrated that the missile had stopped close to the left parietal bone. Spontaneous migration of a missile to the contralateral side via a subfalcial-transcallosal route with deterioration in neurological status is unusual. The missile may have moved under the influence of the intracranial pressure and pulsatile effect of the cerebrospinal fluid.
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Neurol. Med. Chir. (Tokyo) · Apr 2002
Case ReportsMigration of ventriculoperitoneal shunt into the heart--case report.
A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. ⋯ The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity.
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Neurol. Med. Chir. (Tokyo) · Apr 2002
Case ReportsSuccessful clipping of a distal posterior inferior cerebellar artery aneurysm located on the anterior surface of the medulla oblongata--case report.
A 55-year-old male presented with a ruptured distal posterior inferior cerebellar artery (PICA) aneurysm manifesting as subarachnoid hemorrhage. Angiography demonstrated a saccular aneurysm arising from the lateral medullary segment of the left PICA and located on the medial side of the left vertebral artery (VA) and the anterior surface of the medulla oblongata. A transcondylar fossa approach was used to ensure a sufficient operating field and to obtain adequate visualization of the aneurysm, the parent artery, and the perforating arteries to the medulla oblongata. ⋯ The aneurysm was successfully clipped with minimum retraction of the cerebellar hemisphere and medulla oblongata. Distal PICA aneurysms can be located at various sites in the posterior fossa. The exact location of the aneurysm must be established to select the best surgical approach.