Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Case ReportsSupra-diaphragmatic pituitary adenoma removed through the trans-tuberculum sellae approach. Case report.
A 59-year-old woman presented with a rare supra-diaphragmatic pituitary adenoma manifesting as a mass lesion. Her baseline data and the response of anterior pituitary hormones to the provocation test were within the normal range. ⋯ Her postoperative course was uneventful and the histological diagnosis was pituitary adenoma located in the suprasellar region. The trans-tuberculum sellae approach is a less invasive method to remove pituitary adenoma located in the suprasellar region.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Clinical TrialEarly cerebral circulatory disturbance in patients suffering subarachnoid hemorrhage prior to the delayed cerebral vasospasm stage: xenon computed tomography and perfusion computed tomography study.
Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. ⋯ Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Clinical TrialWatertight dural closure constructed with DuraSeal TM for bypass surgery.
Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is a common procedure for the treatment of cerebral ischemia and is useful for cerebral aneurysms and tumors. The STA has to pass through the dura and the dura cannot be sutured tightly around the STA to prevent vessel narrowing, so subcutaneous cerebrospinal fluid (CSF) collection is common. This study analyzed the feasibility of using a synthetic dural sealant in the STA-MCA anastomosis to establish watertight closure. ⋯ Only two patients developed subcutaneous CSF collection, which was managed conservatively. The patency of the anastomosis was proven by magnetic resonance angiography in all cases, and no ischemic complication suggesting chemical spasm of the STA due to the sealant occurred. With DuraSeal(TM), watertight dural closure can be obtained easily and safely in bypass surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Clinical TrialSpinal cord stimulation for the treatment of abnormal posture and gait disorder in patients with Parkinson's disease.
Patients with advanced Parkinson's disease (PD) often present with axial symptoms, including abnormal posture, postural instability, and gait disorder. Although spinal cord stimulation (SCS) is effective for pain, little is known about the effect of SCS on motor function in PD patients. The present study investigated the effect of SCS on posture and gait in 15 PD patients, 5 men and 10 women aged 63-79 years (mean 71.1 years), with low back pain and leg pain who received SCS. ⋯ Timed 10-Meter Walk tests also demonstrated that patient gait was significantly improved at 3 months and 12 months after surgery. Most advanced stage PD patients suffer considerable pain that causes abnormal posture and gait disturbance. SCS is expected to lead to both amelioration of pain and improvement of motor function in such patients.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Effectiveness of maximal safe resection for glioblastoma including elderly and low Karnofsky performance status patients: retrospective review at a single institute.
Elderly and low Karnofsky performance status (KPS) patients have been excluded from most prospective trials. This retrospective study investigated glioblastoma treatment outcomes, including those of elderly and low KPS patients, and analyzed the prognostic factors using the medical records of 107 consecutive patients, 59 men and 48 women aged from 21 to 85 years (median 65 years), with newly diagnosed glioblastoma treated at our institute. There were 71 high-risk patients with age >70 years and/or KPS <70%. ⋯ Multivariate analysis of 73 patients in the subtotal and partial groups found age ≤65 years (p = 0.047), 60 Gy irradiation (p = 0.009), O(6)-methylguanine-deoxyribonucleic acid methyltransferase-negative (p = 0.027), and more than subtotal removal (p = 0.003) were significant prognostic factors. The median postoperative KPS score tended to be better than the preoperative score, even in the high-risk group. We recommend maximal safe resection for glioblastoma patients, even those with advanced age and/or with low KPS scores.