Neurologia medico-chirurgica
-
Neurol. Med. Chir. (Tokyo) · Jan 2011
Randomized Controlled Trial Comparative StudyEfficacy and safety of fasudil in patients with subarachnoid hemorrhage: final results of a randomized trial of fasudil versus nimodipine.
Fasudil is believed to be at least equally effective as nimodipine for the prevention of cerebral vasospasm and subsequent ischemic injury in patients undergoing surgery for subarachnoid hemorrhage (SAH). We report the final results of a randomized, open trial to compare the efficacy and safety of fasudil with nimodipine. A total of 63 patients undergoing surgery for SAH received fasudil and 66 received nimodipine between 1998 and 2004. ⋯ The proportion of patients with good clinical outcome was 74.5% (41/55) in the fasudil group and 61.7% (37/60) in the nimodipine group. There were no serious adverse events reported in the fasudil group. The present results suggest that fasudil is equally or more effective than nimodipine for the prevention of cerebral vasospasm and subsequent ischemic injury in patients undergoing surgery for SAH.
-
Neurol. Med. Chir. (Tokyo) · Jan 2011
Comparative StudyPrediction of the microsurgical window for skull-base tumors by advanced three-dimensional multi-fusion volumetric imaging.
The surgery of skull base tumors (SBTs) is difficult due to the complex and narrow surgical window that is restricted by the cranium and important structures. The utility of three-dimensional multi-fusion volumetric imaging (3-D MFVI) for visualizing the predicted window for SBTs was evaluated. Presurgical simulation using 3-D MFVI was performed in 32 patients with SBTs. ⋯ The simulated window allowed observation of the expected microsurgical anatomies including tumors, vasculatures, and cranial nerves, through the predicted operative window. We could not achieve the planned tumor removal in only 3 patients. 3-D MFVI afforded high quality images of the relevant microsurgical anatomies during the surgery of SBTs. The intraoperative déjà-vu effect of the simulation increased the confidence of the surgeon in the planned surgical procedures.
-
Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsFrontal sinus mucocele with intracranial extension associated with osteoma in the anterior cranial fossa.
A 70-year-old man presented with a rare case of paranasal osteoma with secondary mucocele extending intracranially, manifesting as a generalized convulsion. Computed tomography showed a large calcified tumor adjacent to the cystic mass in the left frontal lobe. He underwent left frontal craniotomy, and the cystic lesion was totally removed. ⋯ The giant paranasal sinus osteoma prevented growth of the mucocele into orbital recess and extension into the orbital space and paranasal sinus. The mucocele disrupted the dura in the anterior cranial fossa, resulting in a giant cystic intracranial lesion. Frontal osteoplastic craniotomy was effective for exposing both lesions and plastic repair of the dural perforation to prevent cerebrospinal fluid leakage and secondary infection.
-
Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsRuptured internal carotid artery bifurcation aneurysm presenting with only intracerebral hemorrhage without subarachnoid hemorrhage--case report.
A 55-year-old man presented with intracerebral hemorrhage (ICH) without subarachnoid hemorrhage (SAH) manifesting as acute onset of consciousness disturbance and right hemiparesis. Computed tomography showed ICH mainly localized in the left putamen, but no evidence of SAH. ⋯ Although ICH without SAH is a rare presentation of cerebral aneurysm, ruptured cerebral aneurysm should be considered as a potential cause of ICH. The localization and extent of ICH may be suggestive of latent cerebral aneurysm in such cases.
-
Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsLumbar discal cyst with spontaneous regression and subsequent occurrence of lumbar disc herniation.
A 39-year-old man presented with an extremely rare discal cyst at the L3-4 level manifesting as a left L4 radiculopathy. Two months after onset, he suffered right L4 radiculopathy with new lumbar disc protrusion. ⋯ Most cases of discal cyst are surgically treated, with only two previous cases of spontaneous regression. The present case suggests clinical and radiological recovery of symptomatic lumbar discal cyst can be obtained by only conservative therapy.