Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsBilateral supratentorial epidural hematomas: a rare complication in adolescent spine surgery.
A 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. ⋯ Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsClip blade scissoring with titanium bayonet clip in aneurysm surgery. Two case reports.
Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. ⋯ The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsGlioblastoma associated with intratumoral abscess formation. Case report.
A 45-year-old man presented with a rare case of glioblastoma associated with intratumoral abscess formation manifesting as headache and vomiting after an appendectomy. Computed tomography and magnetic resonance imaging demonstrated a ring-enhanced lesion mimicking malignant glioma. ⋯ Histological examination revealed glioblastoma with abscess, and the etiological agent was anaerobic Gram-negative bacilli. The suspected route of microbial migration and colonization in this tumor was bacteremia from appendicitis.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
ReviewEfficacy and limitations of stereotactic radiosurgery in the treatment of glioblastoma.
Treatment of recurrent glioblastoma is still challenging. Stereotactic radiosurgery has been accepted as a treatment option for recurrent glioblastoma after standard chemotherapy and irradiation. However, the efficacy of stereotactic radiosurgery at recurrence has been limited, mainly due to the highly infiltrative nature of the tumor which makes the lesion difficult to define as the target. ⋯ Radiation-induced adverse event is another problem after stereotactic radiosurgery for recurrent glioblastoma because almost all patients underwent irradiation as a part of the initial treatment. To overcome the side effects associated with re-irradiation, use of bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, has shown some efficacy. Advances in irradiation technology, neuroimaging, and adjuvant treatment are needed to enhance the efficacy of stereotactic radiosurgery for recurrent glioblastoma and reduce the morbidity associated with irradiation.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
ReviewValidation and the future of stimulation therapy of the primary motor cortex.
The use of electrical motor cortex stimulation (EMCS) for post-stroke pain was established in Japan and has spread globally. EMCS has been used for the treatment of neuropathic pain, Parkinson's syndrome, and recovery of motor paresis. ⋯ New methods and devices for rTMS therapy are under development, and rTMS of the M1 is likely to be established as an effective therapy for some neurological disorders. The present review discusses EMCS and rTMS of the M1 concisely.