No shinkei geka. Neurological surgery
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Case Reports
[Efficacy of MR angiographic original images on surgery for posterior communicating artery aneurysms].
This study evaluated the usefulness of axial source images of magnetic resonance angiography (MRA) on preoperative depiction of surgical topography around posterior communicating artery aneurysms. Twenty patients with posterior communicating artery aneurysms, two ruptured and eighteen unruptured, underwent conventional angiography as well as axial source and projection images obtained by three-dimensional time-of-flight MRA techniques. By comparing the topography based on these angiograms to that confirmed during surgery, we evaluated useful information specific to the source images of MRA. ⋯ The information suggested a satisfactory direction of safe aneurysmal clipping so as not to occlude the posterior communicating artery. It was concluded that the source images of MRA provided additional useful information on surgical topography in 60% of the cases involving posterior communicating artery aneurysms. Although not essential in every case, the information would be beneficial in cases with the aneurysmal dome suspected to be in the temporal lobe or when the surrounding topography can not be clearly understood by angiography.
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Intracranial hypotension causes the postural headache that sometimes follows lumbar puncture. When postural headache and associated symptoms occur after lumbar puncture, the diagnosis is usually obvious. However, similar symptoms may occur after minor trauma or without an obvious precipitating cause (spontaneous intracranial hypotension: SIH). ⋯ SIH is one of the important differential diagnoses of patients complaining of postural headache. Meningeal enhancement of gadolinium-enhanced MRI is an important finding to diagnose SIH. We have to consider SIH when diagnosing postural headache.
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Review Case Reports
[Ruptured traumatic aneurysms of the peripheral anterior cerebral artery: study of delayed hemorrhage after closed head injury].
We report three cases of ruptured traumatic aneurysms of the peripheral anterior cerebral artery after closed head injury. These cases were all young men with closed head injury due to traffic accidents. Consciousness level on admission was coma in all three cases. ⋯ None of the delayed hemorrhages involved subarachnoid hemorrhage. Subdural hematoma was seen in the distal middle cerebral artery and frontal hemorrhage was found in the distal anterior cerebral artery. We consider that frontal hemorrhage is a predictive finding for the type of delayed hemorrhage due to traumatic aneurysm in the distal anterior cerebral artery.
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Review Case Reports
[Symptomatic arteriovenous fistula in a patient with neurofibromatosis type I].
This paper reports the case of a 54-year-old woman who had a history of neurofibromatosis (NF I) presenting progressive quadriplegia and urinary incontinence due to a cervical arteriovenous fistula (AVF). MRI revealed a huge flow void mass in the cervical subcutaneous tissue as well as within the spinal canal. These flow voids originated in the left vertebral artery. ⋯ Endovascular treatment using a Goldvalve detachable balloon successfully obliterated the AVF. Postoperative MRI and angiography showed evidence of the disappearance of AVF and postoperatively, the patient's neurological signs improved gradually. Sixteen reported AVFs accompanied with NF were reviewed.
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Case Reports
[Basilar artery aneurysm associated with agenesis of unilateral internal carotid artery: two case reports].
Two patients presented with a basilar artery aneurysm associated with agenesis of the right internal carotid artery. In both cases, the right middle cerebral artery was supplied by the basilar artery via the enlarged right posterior communicating artery, and the right anterior cerebral artery was supplied by the left internal carotid artery via the anterior communicating artery. The first patient was a 65-year-old woman who suffered from a subarachnoid hemorrhage due to rupture of a basilar bifurcation aneurysm, which was demonstrated as a "de novo" aneurysm 13 years after successful clipping of the anterior communicating artery aneurysm. ⋯ Endovascular embolization was performed with mechanically detachable coils, and the aneurysm was incompletely occluded. The patient regained complete strength in the left arm after the treatment, but the follow-up angiography at 5 months disclosed recanalization of the treated aneurysm, associated with shift of the packed coils. Hemodynamic stress resulting from unique collateral circulation with agenesis of the internal carotid artery may cause a predisposition to "de novo" aneurysm formation or recanalization of an occluded aneurysm with coils.