Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsDural sinus thrombosis with marked enlargement of the venous sinus--case report.
A 36-year-old female presented with dural sinus thrombosis manifesting as marked enlargement of the venous sinus, which could not be differentiated from epidural hematoma on computed tomography during the acute phase. Magnetic resonance imaging showed characteristic serial changes of the thrombus in the healing process. We believe this condition developed from use of oral contraceptives. Systemic anticoagulant therapy was effective without hemorrhagic complication.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
ReviewRole of γ knife radiosurgery in neurosurgery: past and future perspectives.
The gamma knife was the first radiosurgical device developed at the Karolinska Institute in 1967. Stereotactic radiosurgery using the gamma knife has been widely accepted in clinical practice and has contributed to the development of neurosurgery. More than 500,000 patients have been treated by gamma knife stereotactic radiosurgery so far, and the method is now an indispensable neurosurgical tool. ⋯ There is a risk of radiation-induced adverse events, which are usually mild and less frequent. However, especially in large or invasive lesions, those risks are not negligible and pose limitations. Advancement of irradiation technology and dose planning software have enabled more sophisticated and safer treatment, and further progress will contribute to better treatment outcomes not only for brain lesions but also for cervical lesions with less invasive treatment.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsMassive epistaxis from a thrombosed intracavernous internal carotid artery aneurysm 2 years after the initial diagnosis--case report.
A 77-year-old woman presented with a rare case of nontraumatic intracavernous internal carotid artery (ICA) aneurysm causing epistaxis. The thrombosed aneurysm was discovered incidentally, and was not treated. However, she suffered massive nasal bleeding 22 months after the initial diagnosis. ⋯ The present case shows that thrombosed intracavernous ICA aneurysm may still carry the risk of rupture. Radiological evidence of erosion of the sphenoid sinus wall and repeated minor bleeding may be important predicting signs for massive nasal bleeding. Parent artery occlusion including the aneurysm may be the best treatment for intracavernous ICA aneurysms if sufficient collateral blood flow to the territory of the affected ICA is expected.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsProptosis caused by partially thrombosed orbital varix of the superior orbital vein associated with traumatic carotid-cavernous sinus fistula--case report.
A 49-year-old female presented with proptosis and slight chemosis with diplopia on the right. The patient had a past history of skull base fracture occurring one year before the onset of the symptoms. Magnetic resonance imaging showed a partially thrombosed varicose aneurysm (varix) of the superior ophthalmic vein (SOV). ⋯ Proptosis was due to the direct mass effect of the thrombosed varix of the SOV. The thrombosed varix was removed after right carotid artery trapping with external carotid artery-middle cerebral artery (M(2)) high flow bypass. The symptoms subsided after the surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
Case ReportsMotor cortex stimulation for intractable neuropathic facial pain related to multiple sclerosis.
A 33-year-old man presented with ongoing severe right facial pain and sensory disturbances caused by multiple sclerosis (MS). Neuroimaging demonstrated demyelinating lesions in the right dorsal pons and medulla oblongata. ⋯ The patient underwent motor cortex stimulation (MCS), resulting in >60% pain relief, reduction in the required doses of pain medications, and discontinuation of ketamine administration. MCS is effective for MS-related neuropathic facial pain.