Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Mar 1998
Case ReportsThreaded fusion cage for lumbar spondylolisthesis.
Fifteen patients with Meyerding I spondylolisthesis causing disabling lumbago underwent threaded fusion cage implantation at the unstable segments. Low back pain and intermittent claudication subsided in all patients postoperatively. The preoperative Japan Orthopaedic Association score was 11.5 on average, and improved to 23.5 after surgery. ⋯ No patient required supplemental fixation such as pedicle screws to achieve stable fusion. One patient had an inflammatory course but re-surgery was not necessary. The threaded fusion cage is an effective and promising device for the relief of low back pain when used to promote fusion of the lumbar spine in patients with low-grade spondylolisthesis.
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Neurol. Med. Chir. (Tokyo) · Mar 1998
ReviewOutcome after external decompression for massive cerebral infarction.
Acute ischemic stroke involving the entire vascular distribution of a carotid or middle cerebral artery can cause massive cerebral edema. This study evaluated external decompression for the treatment of massive stroke and analyzed possible prognostic factors. Twenty-four patients with acute massive cerebral infarction, which had progressed to tentorial herniation and impending death, underwent external decompression after medical therapy failed to achieve an effective response. ⋯ Six patients with dominant hemisphere stroke had some measure of communicative skills in spite of aphasia. External decompression is a life-saving treatment for patients with massive cerebral infarction and can provide a reasonable quality of life even for those with dominant hemisphere strokes. Decompressive surgery should be considered and performed as soon as possible if computed tomography demonstrates signs of descending tentorial herniation.
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Neurol. Med. Chir. (Tokyo) · Mar 1998
Case ReportsEmbolization of cerebral aneurysms using Guglielmi detachable coils--problems and treatment plans in the acute stage after subarachnoid hemorrhage and long-term efficiency.
This study investigated the problems in treating ruptured aneurysms using Guglielmi detachable coils (GDCs) in the acute stage and evaluated the long-term efficacy in a series of 25 patients with 29 aneurysms. Eight patients with ruptured aneurysm treated within 2 weeks of the onset of subarachnoid hemorrhage (SAH) suffered no mortality or morbidity related to the procedure. Five patients achieved good outcomes despite severe SAH and returned to their previous lives. ⋯ Embolization using GDCs in the acute stage after SAH can prevent rerupture of cerebral aneurysms. However, recanalization due to coil compaction was the major problem in the chronic stage. Intensive follow-up and additional embolization, if necessary, is important.
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Regional anesthesia for carotid endarterectomy is a simple, reliable, and virtually complication-free technique. We began to perform a series of carotid endarterectomy under regional anesthesia at our institution in May 1990. This report describes our experience with 180 operated patients from May 1990 till December 1995, with regional anesthesia. ⋯ The main advantage of this technique of anesthesia is that it is the only exact method of assessing the need of a shunt by using the neurological status of the awaken patient during trial carotid cross-clamping. The regional anesthesia allows carotid endarterectomy to be safely performed on patients with advanced cardiac disease or severe chronic obstructive pulmonary disease who were not good candidates for general anesthesia. In this 180 patients we performed 198 consecutive endarterectomies (10% bilateral) with a total morbidity-mortality rate of 2.0%.
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Neurol. Med. Chir. (Tokyo) · Jan 1998
ReviewThe effect and management of delayed vasospasm after aneurysmal subarachnoid hemorrhage.
Delayed cerebral vasospasm after aneurysm rupture is one of the major complications of subarachnoid hemorrhage. The purpose of this review was to determine the true incidence of vasospasm. All literature on cerebral aneurysms from 1960 onwards was reviewed, and the figures extracted from publications that mentioned vasospasm. ⋯ The 21-aminosteroid tirilazad mesylate has been the subject of several trials. In one the overall outcome of all patients was improved, but the effect was essentially in males only. Further studies with larger doses in females are being analyzed.