No shinkei geka. Neurological surgery
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The authors report a 54-year-old woman with headache in whom a cyst was detected at the posterior part of the left temporal lobe following a traffic accident in 1993. Symptoms had recently worsened and computed tomography demonstrated an enlarged cyst in 2007. Thereafter, the patient underwent cyst fenestration. ⋯ We expected an arachnoid cyst with a single cavity, but this lesion was multilocular. Retrospectively, cine magnetic resonance image (MRI) seemed to show multilocular cysts. Cine MRI might be an effective tool to determine whether a cyst is multilocular.
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Integration of neuronavigation into brain tumor surgery can improve the accuracy and precision of resection, but most neuronavigation systems require rigid pin fixation of the patient's head throughout the operation. We describe use of a noninvasive skull reference tool, which can replace rigid pin fixation in awake craniotomy and pediatric surgery, when standard pin fixation cannot be used. ⋯ The use of this skull reference tool provides an accurate and comfortable method of frameless navigation in patients undergoing awake craniotomy and pediatric patients.
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We report a case of dural arteriovenous fistulas (DAVFs) at the craniocervical junction, which are supplied by the radicular arteries from bilateral vertebral arteries separately, and drainaged into intracranial sinuses. A 58-year-old man with intermittent neck pain visited our hospital. T2-weighted magnetic resonance (MR) imaging showed flow voids on the dorsal surface of the medulla and upper cervical cord without any signal changes suggesting ischemia. ⋯ Even in such a case, direct interruption of the fistulas using micro Doppler sonography is the most effective treatment. In addition. MRDSA could be useful for screening and perioperative studies.
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A case report of penetrating head injury due to 8 nails and a review of multiple penetrating head injury by nails were described. The patient who was a 48-year-old man with a history of for psychiatric care was transferred to our emergency room on May 2007. He had shot his head with 8 nails using a nail-gun in a suicide attempt. ⋯ Penetrating head injury with nail-gun use is sometimes seen, but cases with multiple nails are rare. Operative strategies were discussed in the review. It also suggested the need for the care of mental or background problems.
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The aim of this study was to examine the usefulness of an uncalibrated radial arterial pressure-based cardiac output monitor (FloTrac, Edwards Lifesciences, Irvine CA, USA) for dobutamine-induced hyperdynamic therapy in patients with cerebral vasospasm following subarachnoid hemorrhage (SAH). In 18 SAH patients diagnosed with vasospasm, the cardiac index (CI) was analyzed continuously via the radial FloTrac system. The time-course changes in hemodynamic variables following dobutamine infusion at each dose increment (3-24 microg/kg/min) for reversing vasospasm-related delayed ischemic neurological deficit (DIND) and infarction were measured. ⋯ However at high-dose (20-24 microg/kg/min), dobutamine depressed stroke volume which was compensated for by increasing the pulse rate, thus raising CI only slightly from the baseline values. These data suggest that step-up increase of dobutamine dosage is not always effective in raising CI in patients suffering from post-SAH vasospasm, but rather may cause some adverse effects associated with increased myocardial oxygen consumption as evidenced by high-dose infusion. The less-invasive FloTrac system might be useful as a device for tracking trends in hemodynamic outcomes of hyperdynamic therapy.