Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 1998
Multimodality treatment for large and critically located arteriovenous malformations.
To define the current status of the multimodality treatment for large and critically located arteriovenous malformations (AVMs), we have made a retrospective review of 54 consecutive patients with Spetzler-Martin grade IV and V AVMs. The size of nidus is larger than 3 cm in diameter in all cases. Initially, all but one were treated by nidus embolization with the aim of size reduction. ⋯ Repeat radiosurgery was performed for the patients with remaining AVMs at 3-year follow-up review. This study indicates that a certain number of large and critically located AVMs can be safely treated by either microsurgery or radiosurgery following a significant volume reduction by nidus embolization. The present data also suggest the need and possible role of repeat radiosurgery in improving complete obliteration rate of large difficult AVMs, since many of those AVMs have significantly responded to initial radiosurgery.
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Neurol. Med. Chir. (Tokyo) · Jan 1998
Case ReportsAcute traumatic subdural hematoma originating from a convexity meningioma--case report.
A 68-year-old male presented with a traumatic subdural hematoma originating from a convexity meningioma the day after a motorcycle accident. Computed tomography disclosed a right temporal subdural and/or epidural mass. ⋯ The histological diagnosis was angiomatous meningioma with hemorrhagic foci. The operative and histological findings indicated that the tumoral tissue was the source of the subdural hematoma.
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Neurol. Med. Chir. (Tokyo) · Jan 1998
Factors influencing surgical outcome of the basilar bifurcation aneurysms.
To contribute to a better understanding of the clipping operation of the basilar bifurcation aneurysm, factors influencing the surgical outcome were analyzed in 80 patients. The age range of the patients was 34-74 years, with a mean age of 58.4 years, and there were 61 females and 19 males. Fifty-eight patients had been admitted because of subarachnoid hemorrhage and a basilar bifurcation aneurysm ruptured in 49 patients. ⋯ Division of the posterior communicating artery significantly contributed to the surgical outcome as an intraoperative factor (Mann-Whitney's U test, p = 0.01). The larger the aneurysm size was, the more often the posterior communicating artery was sectioned. Extreme care should be taken to obliterate a large aneurysm with a clip graft especially when division of the posterior communicating artery is required.
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Neurol. Med. Chir. (Tokyo) · Jan 1998
Successful resection of arteriovenous malformations in eloquent areas diagnosed by surface anatomy scanning and motor evoked potential.
Successful resection of cerebral arteriovenous malformations (AVMs) involving the sensorimotor cortex was achieved in 17 cases. The theoretical basis for performing resection of AVMs in eloquent areas is the fact that the brain in and around the nidus about 1 mm in thickness is considered not to be functioning. It is also considered that any center of important function, when an AVM is involved, shifts to the near-by cortex from the original site. ⋯ Apparent neurological improvements were achieved in 15 of 17 patients treated surgically (88%). With this result, we think that AVMs in eloquent areas can be treated successfully when the surgery is well-designed and well-oriented with the combined use of diagnostic imaging and monitoring. As for control of intraoperative bleeding, careful attention to small but important surgical techniques avoids troublesome bleeding during AVM surgery.
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Neurol. Med. Chir. (Tokyo) · Nov 1997
Staged transsphenoidal surgery for fibrous nonfunctioning pituitary adenomas with suprasellar extension.
Staged transsphenoidal surgery was performed in seven patients with nonfunctioning pituitary adenomas with suprasellar extension. Remnant adenomas were present in a supersellar position after complete removal of the intrasellar tumor, and did not descend into the sella because of the fibrous nature in five patients or fibrous nature and dumbbell shape in two. Magnetic resonance images were obtained every 2 weeks following initial surgery. ⋯ Patients were followed up over 6 to 58 months (mean +/- SD 24.7 +/- 18.9 months). There were no major surgical complications or recurrence of tumor on follow-up images. Our postoperative imaging studies and surgical results demonstrated that staged transsphenoidal surgery is an effective and safe treatment for fibrous nonfunctioning pituitary adenomas with suprasellar extension.