No shinkei geka. Neurological surgery
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[Effects of Endovascular Treatment on Cranial Nerve Palsy due to Unruptured Intracranial Aneurysms].
This study aimed to assess the effects of endovascular treatment on cranial nerve palsy due to unruptured intracranial aneurysms. Endovascular coiling was performed in 203 patients with intracranial aneurysms between April 2002 and March 2012 in our hospital. Of these patients, 8(3.9%)presented with cranial nerve palsy due to unruptured intracranial aneurysms. ⋯ Optic nerve dysfunction did not improve after coiling. Incomplete oculomotor nerve palsy, early treatment(≤15 days), and small aneurysms(≤10 mm)were likely to be associated with complete recovery after coiling. This study indicates that endovascular coiling may resolve cranial nerve palsy due to unruptured intracranial aneurysms in patients who have incomplete oculomotor nerve palsy due to small aneurysms and are treated as early as possible after symptom onset.
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Review Case Reports
[A Case of Cervical Spinal Dural Arteriovenous Fistula with Extradural Drainage Presenting with Subarachnoid Hemorrhage due to a Ruptured Anterior Spinal Artery Aneurysm].
We report a rare case of a cervical spinal dural arteriovenous fistula(AVF)at the C2 level presenting with subarachnoid hemorrhage(SAH)due to a ruptured anterior spinal artery aneurysm. A 61-year-old man presented with sudden onset headache. Initial computed tomography revealed SAH around the brainstem. ⋯ Therefore, a second surgery was performed. After the second open surgery, DSA showed that the dural AVF and aneurysm disappeared. The patient also showed no neurological deterioration after the second surgery.
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We report a case of cavernous sinus dural arteriovenous fistula (dAVF) that developed after the treatment of a transverse-sigmoid sinus dAVF using transvenous embolization (TVE). ⋯ TVE has been widely recognized as an effective treatment for dAVF. However, dAVF may develop at a different location after TVE in a few cases. A long-term follow-up is therefore recommended.
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We report a woman whose anterior communicating artery (AcomA) aneurysm was clipped via an anterior interhemispheric approach when she was 49 years old. At the age of 51, she presented with a subcutaneous abscess and osteomyelitis, so the cranioplastic bone was removed. Six months later, she underwent cranioplasty using hydroxyapatite. ⋯ A silicone T-tube was placed in the bifrontal epidural cavity (previous frontal sinus), and its tip was inserted into the nasal cavity through the nasofrontal duct for abscess drainage. After 3 months, the tube was removed. A CT scan acquired 10 years later showed no brain abscess, perifocal edema, or epidural and subcutaneous abscesses.
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Cerebral venous sinus thrombosis after mild head trauma without skull fracture or intracranial hematoma is exceptionally rare. We describe an unusual case of progressive intracranial hypertension due to superior sagittal sinus thrombosis following mild head trauma. A 17-year-old boy presented with nape pain a day after a head blow during a gymnastics competition (backward double somersault). ⋯ After 7 days of conservative treatment, his symptoms resolved completely, and he was discharged from the hospital. Follow-up MR venography performed on Day 55 showed complete recanalization of the superior sagittal sinus. The exact mechanism of sinus thrombosis in this case is not clear, but we speculate that endothelial damage caused by shearing stress because of strong rotational acceleration or direct impact to the superior sagittal sinus wall may have initiated thrombus formation.