Neurologia medico-chirurgica
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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.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsCoil embolization for a ruptured posterior cerebral artery aneurysm with vertebrobasilar dolichoectasia.
A 74-year-old man suffered sudden loss of consciousness at home. Computed tomography revealed severe subarachnoid hemorrhage and an unusual posterior cerebral artery (PCA) aneurysm with vertebrobasilar dolichoectasia (VBD). ⋯ VBD associated with a distal lesion makes endovascular treatment difficult because of the elongation and tortuosity of the access route. However, endovascular coil embolization was successful for the present ruptured PCA aneurysm with VBD.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsSurgical treatment of sacral perineural cyst--case report.
A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. ⋯ Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.
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Neurol. Med. Chir. (Tokyo) · Jan 2011
Case ReportsDural arteriovenous fistula between inferolateral trunk of the internal carotid artery and superficial sylvian vein.
A 40-year-old Brazilian man presented with headache followed by consciousness disturbance. Computed tomography showed subarachnoid hemorrhage with right frontal hematoma. Angiography revealed a dural arteriovenous fistula (dAVF) fed by the inferolateral trunk of the internal carotid artery and draining into the superficial sylvian vein with varix formation. ⋯ A ventriculoperitoneal shunt was needed for normal pressure hydrocephalus during his hospitalization. The modified Rankin scale at discharge was grade 2 with mild cognitive dysfunction. This case of dAVF may represent congenital dAVF.
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Posterior decompression of the cervical spine is an accepted treatment for patients with cervical canal disease, but some patients experience postoperative axial pain and C5 or C6 palsy that affect their quality of life. Here we describe selective posterior decompression using a spinous process-splitting approach to prevent these complications performed in 17 patients with myelopathy treated at median 2.4 levels by selective posterior decompression via the transspinous approach. Clinical symptoms, axial pain, and C5 or C6 palsy were compared before and after treatment. ⋯ None of our 17 patients experienced significant postoperative axial pain after selective posterior decompression via the transspinous approach. Minimal spinal cord shift at the C5 level may have contributed to the reduced incidence of postoperative C5 or C6 palsy in our series. Selective posterior decompression is less invasive and effective in some patients with cervical canal disease.