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1.
Acta Neurochir (Wien) ; 164(10): 2667-2671, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35972558

RESUMO

INTRODUCTION: Low back pain (LBP) from superior or middle cluneal nerve entrapment has been addressed surgically. We recorded patient satisfaction with this treatment. METHODS: We included 22 consecutive patients who had undergone surgery for unilateral cluneal nerve entrapment (superior: n = 17, middle: n = 5). The numerical rating scale (NRS) for LBP, the Oswestry Disability Index (ODI) score, and the EuroQOL 5-dimension, 5-level (EQ-5D-5L) scale before and 6 months after the operation were compared. Using these scores, the treatment outcome was compared with the patients' preoperative expectations. RESULTS: LBP was ameliorated in all 22 patients; their NRS, ODI, and EQ-5D-5L were significantly improved after surgery. Surgical satisfaction based on the postoperative NRS scores was recorded as 8.8 ± 1.1 (range 7-10). While the postoperative was significantly better than the expected NRS, the postoperative ODI was significantly higher than expected by the patients (both: p < 0.05). There was a moderate correlation between the postoperative NRS and ODI and postoperative patient satisfaction. CONCLUSION: Patient satisfaction with the surgical result was rated as acceptable.


Assuntos
Dor Lombar , Síndromes de Compressão Nervosa , Humanos , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Procedimentos Neurocirúrgicos/métodos , Satisfação do Paciente , Resultado do Tratamento
2.
J Stroke Cerebrovasc Dis ; 31(9): 106664, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35908346

RESUMO

OBJECTIVES: Minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has become increasingly popular in recent years. However, there are no reports on the recent trends in surgical procedures for spontaneous ICH. To investigate current trends in surgical methods for spontaneous ICH using a nationwide inpatient database from Japan. MATERIALS AND METHODS: Patients who underwent surgery for spontaneous ICH between April 2014 and March 2018 were identified in a nationwide inpatient database from Japan. We examined patient characteristics, diagnoses, types of surgery, complications, and discharge status. RESULTS: We identified 21,129 inpatients who underwent surgery for spontaneous ICH. The procedures were as follows: 16,256 (76.9%) transcranial hemorrhage evacuations, 3722 (17.6%) endoscopic hemorrhage evacuations, and 1151 (5.4%) stereotactic aspirations of hemorrhage. Patients tended to receive transcranial hemorrhage evacuations in hospitals with fewer surgical cases. The proportions of endoscopic hemorrhage evacuations increased annually, whereas those of stereotactic surgery decreased. The proportions of transcranial surgery remained almost unchanged. Tracheostomy and hospitalization costs were lower in the stereotactic aspirations of hemorrhage group, and the proportions of reoperation were higher in the endoscopic hemorrhage evacuations group. CONCLUSIONS: The use of endoscopic surgery for spontaneous ICH has increased in Japan. This study can form the basis of future clinical investigations into spontaneous ICH surgery.


Assuntos
Hemorragia Cerebral , Procedimentos Cirúrgicos Minimamente Invasivos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Endoscopia/efeitos adversos , Humanos , Japão , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
3.
Endocr J ; 68(5): 561-571, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33504715

RESUMO

Pituitary tumors are discovered either incidentally by imaging studies (incidentalomas) or via evaluation of certain clinical symptoms (symptomatic tumors). In this study, we first surveyed patients with incidentalomas who underwent surgery. Cases included 62.3% non-functioning adenomas (NFPAs), 14.5% functioning adenomas, and 13.8% Rathke's cleft cysts. Next, we compared the clinical features and surgical outcomes of 145 patients whose preoperative diagnosis was NFPA (incidentalomas [n = 79] vs. symptomatic tumors [n = 66]). The patients with incidentalomas were older (59.9 vs. 55.3 years, p < 0.05) and had smaller tumors compared with the patients with symptomatic tumors (mean maximum diameter: 23.1 vs. 27.5 mm, p < 0.01). The main reason for undergoing imaging studies was headache (n = 25) in the incidentaloma group and visual disturbance (n = 46) in the symptomatic tumor group. The incidence of preoperative pituitary hormone deficiencies was lower in the incidentaloma than symptomatic tumor group (growth hormone deficiency: 37.7% vs. 66.7%, p < 0.01; gonadotropin deficiency: 19.0% vs. 39.4%, p < 0.01; adrenocorticotropic hormone deficiency: 3.8% vs. 18.2%, p < 0.01; thyroid stimulating hormone deficiency: 6.3% vs. 12.1%, p = 0.25). Postoperative pituitary function was better preserved in the incidentaloma than symptomatic tumor group (no deficiency: 58.2% vs. 28.8%, p < 0.01). The difference in postoperative complications between groups was not statistically significant (incidentalomas vs. symptomatic tumors: 21.5% vs. 19.7%, p = 0.84). In conclusion, incidentalomas were detected while smaller size and lower incidence of hormone deficiency than symptomatic tumors, and the pituitary hormones were also preserved after surgery. It is important to observe incidentalomas carefully and to judge whether to operate appropriately before they become symptomatic tumors.


Assuntos
Adenoma/cirurgia , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Fatores Etários , Feminino , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Resultado do Tratamento
4.
No Shinkei Geka ; 45(5): 431-436, 2017 May.
Artigo em Japonês | MEDLINE | ID: mdl-28490686

RESUMO

A 60-year-old woman presented with a 1-year history of pain and numbness in the left anterolateral thigh. The symptoms aggravated on walking and standing. Her visual analogue scale(VAS)score was 7.1/10. Tinel's like sign was positive over the lateral femoral cutaneous nerve(LFCN), in the inguinal ligament region. LFCN block at the trigger point, in the inguinal ligament, resulted in relief of the symptoms and we diagnosed meralgia paresthetica(MP), which is the entrapment neuropathy of the LFCN. Initially, we performed observation therapy with oral medication and LFCN blocks. However, these treatments failed to relieve the symptoms. Therefore, we performed neurolysis with a microscope under local anesthesia. The symptoms improved immediately after surgery and her VAS score of thigh symptom improved from 7.1 to 1.9 after 3 months. Conservative and surgical treatment for MP generally yield good outcome and we should pay attention to the MP as a differential diagnosis for thigh numbness and pain.


Assuntos
Síndromes de Compressão Nervosa/cirurgia , Doenças da Coluna Vertebral/cirurgia , Imagem de Difusão por Ressonância Magnética , Feminino , Neuropatia Femoral , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Procedimentos Neurocirúrgicos , Doenças da Coluna Vertebral/diagnóstico por imagem , Coxa da Perna/diagnóstico por imagem , Resultado do Tratamento
6.
Neurosurg Rev ; 38(3): 551-6; discussion 556-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25675847

RESUMO

With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called "fascia patchwork closure" for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.


Assuntos
Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Técnicas de Fechamento de Ferimentos , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/etiologia , Competência Clínica , Humanos , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
7.
Neurol Med Chir (Tokyo) ; 63(3): 116-121, 2023 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-36682791

RESUMO

We compared the treatment satisfaction of patients who had undergone surgery for tarsal tunnel syndrome (TTS) and carpal tunnel syndrome (CTS). We enrolled 44 patients in this study; 23 were operated for CTS and 21 for TTS. All patients had received surgery under a microscope and under local anesthesia. Using the numerical rating scale (NRS) for numbness/pain (range 0-10) we compared their preoperative outcome expectations with their satisfaction with our treatment 6 months after the operation. We also recorded their pre- and postoperative EuroQol 5-dimension 5-level (EQ-5D-5L) scale for their health-related quality of life (QOL). The subjective assessment of their QOL showed that it was significantly lower in TTS- than CTS patients both pre- and postoperatively. Six months after the operation, the NRS for symptoms and the (EQ-5D-5L) scale for the QOL were significantly improved in TTS- and CTS patients; however, these scores were significantly better after CTS- than TTS surgery. Also, the postoperative NRS was significantly lower in the CTS- than the TTS patients. Our comparison of the patients' expected- and actual surgical outcome showed that the result was better than expected after CTS- and TTS surgery; in CTS patients the difference was significant. Overall, CTS- were more satisfied than TTS patients with the treatment outcome. Satisfaction with the treatment was greater after CTS- than TTS surgery. TTS- experienced less symptom relief than CTS patients although the actual- exceeded the expected outcome in patients operated for TTS.


Assuntos
Síndrome do Túnel Carpal , Satisfação do Paciente , Humanos , Síndrome do Túnel Carpal/diagnóstico , Qualidade de Vida , Resultado do Tratamento , Descompressão Cirúrgica
8.
Neurol Med Chir (Tokyo) ; 63(8): 356-363, 2023 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-37286484

RESUMO

Internal carotid artery (ICA) ligation for placing a high-flow extracranial-intracranial (EC-IC) bypass is used in patients with aneurysms on the cavernous portion of the ICA. Recanalization and rupture after proximal ICA ligation can occur. We present four patients who underwent endovascular distal ICA occlusion and report our surgical technique and treatment results. We ligated the ICA to place an EC-IC bypass using a radial artery (RA) graft. Failure to obtain spontaneous occlusion in the distal region required endovascular treatment an average of 219 days later. A guide catheter was placed in the common carotid artery, a guide or distal access catheter was introduced in the RA graft from the external carotid artery, and a microcatheter was navigated into the cavernous aneurysm through the RA graft. Using detachable coils, endovascular ICA occlusion was from just distal to the aneurysmal neck to a site proximal to the origin of the ophthalmic artery. Aneurysmal occlusion was completed by endovascular occlusion of the distal ICA. Complications were RA graft stenosis and transient consciousness disturbance due to local subarachnoid hemorrhage. Outpatient follow-up for a mean of 109.5 months revealed no recurrences. Distal occlusion of the ICA through the implanted RA graft is simple and presents a low risk for cerebral infarction due to thrombus formation during the procedure. To treat cavernous carotid aneurysms that do not disappear after placing the EC-IC bypass after ICA ligation at the aneurysmal neck, we offer our procedure as a treatment option.


Assuntos
Doenças das Artérias Carótidas , Revascularização Cerebral , Aneurisma Intracraniano , Trombose , Humanos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Resultado do Tratamento , Ligadura , Procedimentos Neurocirúrgicos/métodos , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Revascularização Cerebral/métodos
9.
J Clin Neurosci ; 89: 206-210, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119268

RESUMO

BACKGROUND AND IMPORTANCE: In cardiogenic cerebral embolism, early recanalization is the most important factor for good prognosis. However, endovascular thrombectomy often fails to achieve recanalization. We present an open surgical embolectomy technique and discuss its advantages. CLINICAL PRESENTATION: A 79-year-old woman developed right hemiparesis and severe aphasia. Magnetic resonance imaging revealed an acute cerebral infarction caused by left middle cerebral artery (MCA) occlusion. We attempted endovascular thrombectomy but failed because it was impossible to guide the catheter to the occlusion site. Hence, we converted to open surgical embolectomy. Sylvian fissure was widely opened. After confirming the range of thrombosis using indocyanine green videoangiography (ICGVAG), the proximal and distal arteries were secured, and a temporary clip was placed on the distal M2 to prevent distal thrombosis migration. MCA was cut approximately 3 mm from the bifurcation, and thrombosis was removed using micro-forceps. The proximal clip was simultaneously inserted but was not clamped because the thrombus was extruded by proximal vascular flow. Immediately after removing the thrombus, intense bleeding occurred from the proximal flow. An assistant clamped the proximal artery using the prepared clip, and the incised area of MCA was sutured using 9-0 threads. We finally confirmed blood flow after recanalization using ICGVAG. The time from skin incision to recanalization was 27 min. After the procedure, the patient developed slight aphasia but had no hemiparesis and was later transferred to a rehabilitation hospital. CONCLUSION: Open surgical embolectomy may be a secondary rescue treatment option in the case of endovascular thrombectomy failure.


Assuntos
Embolectomia/métodos , Procedimentos Endovasculares/métodos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/cirurgia , Trombectomia/métodos , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Isquemia Encefálica/cirurgia , Feminino , Humanos , Infarto da Artéria Cerebral Média/complicações , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/cirurgia , Imageamento por Ressonância Magnética/métodos , Resultado do Tratamento
10.
Curr Oncol ; 28(1): 726-739, 2021 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-33572546

RESUMO

Neurofibromatosis type 2 (NF2) causes bilateral vestibular schwannomas (VSs), leading to deafness. VS is treated by surgery or radiation, but neither treatments prevent hearing loss. Bevacizumab was found to be effective in suppressing the tumor's growth and may help to improve hearing. We are conducting a randomized, double-blind, multicenter clinical trial to verify the efficacy and safety of bevacizumab in NF2-related VS. The primary objective is to evaluate the efficacy of bevacizumab in improving hearing in the affected ear. One of the secondary objectives is to evaluate bevacizumab's efficacy in rechallenge treatment in relapsed cases. Sixty patients will randomly receive either bevacizumab or a placebo and will be clinically observed for 48 weeks in the initial intervention phase. In the first half (24 weeks), they will receive either 5 mg/kg of bevacizumab or a placebo drug. In the second half, all patients will receive 5 mg/kg of bevacizumab. If hearing function deteriorated in a patient who had shown improvement during the first phase, a rechallenge dose with bevacizumab would be offered.


Assuntos
Neurofibromatose 2 , Neuroma Acústico , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Humanos , Neurofibromatose 2/complicações , Neurofibromatose 2/tratamento farmacológico , Neuroma Acústico/complicações , Neuroma Acústico/tratamento farmacológico , Resultado do Tratamento
11.
J Nippon Med Sch ; 87(4): 172-183, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32238731

RESUMO

OBJECTIVE: Petrous internal carotid aneurysm (PA) concomitant with a mass lesion and cranial nerve palsy is relatively rare. Flow-diverter stent implantation is now widely used as an alternative treatment for PA. However, alternative treatments sometimes cannot be used because of tortuosity of the carotid artery, allergies to contrast material, and high costs. The outcomes of different treatment methods should therefore be assessed. Here, we review the available literature on treatments for PA. METHODS: In a search using the terms "aneurysm", "carotid artery", and "petrous" on PubMed, MEDLINE, and databases such as OvidSP, 221 articles were identified. We also performed a literature review and discuss and compare the causes, symptoms, treatment methods, and clinical outcomes of PA. RESULTS AND CONCLUSIONS: Onset of secondary aneurysm was generally heralded by bleeding (p<0.001), while onset of primary aneurysm was heralded by cranial nerve deficit (p= 0.0014). Outcomes after treatment of 34 cranial nerve palsies in 25 patients are reported.


Assuntos
Aneurisma/cirurgia , Artéria Carótida Interna/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/complicações , Criança , Doenças dos Nervos Cranianos/complicações , Procedimentos Endovasculares/métodos , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
J Nippon Med Sch ; 86(4): 248-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484881

RESUMO

Tumors of the skull base, such as meningiomas, tend to recur. With progress in free vascularized flap surgery, an increasing number of studies are investigating skull base reconstruction with free flaps after tumor removal. In this report, we discuss the results of second free flap surgery after skull base reconstructive surgery. We retrospectively analyzed data from patients treated at our center during the period from 2013 through 2017. All four patients identified had skull base anaplastic meningioma and had undergone radiotherapy. In all cases, the flap and donor blood vessel were sourced from sites that differed from those used in the previous surgeries. No complications developed, such as cerebrospinal fluid leakage, meningitis, wound infection, wound hemorrhage, or flap necrosis. Because the first flap was found to be unviable, it was difficult to preserve and was removed. Essential points in preventing complications are anchoring at the appropriate site, pinprick testing of the created flap, and use of multilayered countermeasures to prevent cerebrospinal fluid leakage.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Adulto , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Reoperação , Neoplasias da Base do Crânio/diagnóstico por imagem , Resultado do Tratamento
13.
World Neurosurg ; 118: e659-e665, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30017766

RESUMO

OBJECTIVE: Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by compression around the inguinal ligament. We report a surgical alternative for the treatment of meralgia paresthetica under local anesthesia and its outcomes. METHODS: We operated on 12 patients with unilateral meralgia paresthetica whose age at surgery ranged from 62 to 75 years. The mean postoperative follow-up period was 19 months. Microsurgical deep decompression of LFCN was performed with the patient under local anesthesia. Clinical outcomes of surgical treatment were assessed based on the patient's most recent follow-up visit and were classified into 3 categories: complete, partial, or no relief of symptoms. Symptoms of pain or numbness in the anterolateral part of the thigh were evaluated, using a visual analog scale, before surgery and after surgery, i.e., at the most recent follow-up visit. RESULTS: All patients reported symptom improvement: complete relief in 9 patients (75%) and partial relief in 3 patients (25%). In the 3 patients with partial relief, the remaining symptoms did not affect their daily living. Overall, the visual analog scale scores were significantly improved in all patients (P < 0.05), and no patient experienced postoperative recurrence of their symptoms at the time of the last follow-up visit. CONCLUSIONS: Symptoms of meralgia paresthetica can resemble those of a lumbosacral disorder. Microsurgical deep decompression under local anesthesia produces good surgical outcomes. The use of local anesthesia contributes not only to reduction of pain during surgery but also eliminates excessive surgical procedures and reduces the duration of hospital stay.


Assuntos
Anestesia Local , Descompressão Cirúrgica , Plexo Lombossacral/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Idoso , Anestesia Local/métodos , Descompressão Cirúrgica/métodos , Feminino , Neuropatia Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Parestesia/etiologia , Parestesia/cirurgia , Coluna Vertebral/cirurgia , Resultado do Tratamento
14.
J Neurosurg ; 124(1): 244-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26140484

RESUMO

OBJECT The tentorial branch of the posterior cerebral artery was first identified in a cadaver dissection study. However, the tentorial branch of the superior cerebellar artery (SCA) has not been clearly described in autopsy or normal anatomical studies. In this study, a dural branch of the SCA that was found during the surgical treatment of trigeminal neuralgia is described. METHODS Between April 2011 and March 2014, 70 patients with idiopathic trigeminal neuralgia underwent microvascular decompression. The records of 58 patients were reviewed to investigate the meningeal branch of the SCA. RESULTS The meningeal branch of the SCA was visualized in 15 of the 58 patients (25.9%). In 4 patients, it was necessary to divide this branch in order to achieve decompression of the trigeminal nerve without eliciting postoperative neurological deficits. CONCLUSIONS This is the first identification of the meningeal branch of the SCA in living subjects, and such branches were rather frequently found. Recognition of this branch is important for the management of lesions in the cerebellopontine angle and tentorial lesions, using either an open microsurgical or endovascular method.


Assuntos
Cerebelo/cirurgia , Artérias Cerebrais/cirurgia , Meninges/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Ângulo Cerebelopontino/patologia , Ângulo Cerebelopontino/cirurgia , Cerebelo/anatomia & histologia , Cerebelo/irrigação sanguínea , Artérias Cerebrais/anatomia & histologia , Circulação Cerebrovascular , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meninges/anatomia & histologia , Cirurgia de Descompressão Microvascular , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Neuralgia do Trigêmeo/patologia , Neuralgia do Trigêmeo/cirurgia
15.
J Nippon Med Sch ; 82(6): 287-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26823032

RESUMO

We report an extremely rare case of proximal entrapment neuropathy of the median nerve above the elbow in a 44-year-old man who presented with paresthesia with median nerve distribution. Tinel's sign was located in the upper arm medial to the biceps and 5 cm proximal to the elbow. The patient underwent microsurgery under local anesthesia. The fascia covering the brachial- and the biceps brachii muscle entrapped median nerve. After operation, he reported symptom improvement. Lesions above the elbow should be considered as possible causative factors of entrapment neuropathy of the median nerve.


Assuntos
Cotovelo , Nervo Mediano/patologia , Neuropatia Mediana/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Adulto , Fasciotomia , Humanos , Masculino , Nervo Mediano/cirurgia , Neuropatia Mediana/complicações , Neuropatia Mediana/cirurgia , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/cirurgia , Parestesia/etiologia , Parestesia/cirurgia , Resultado do Tratamento
16.
J Nippon Med Sch ; 81(4): 194-202, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25186573

RESUMO

BACKGROUND: Unruptured intracranial aneurysms are common, but their rupture can cause subarachnoid hemorrhage. When managing unruptured intracranial aneurysms, we must assess the natural course and management risks of individual aneurysms. In this paper, we summarize current knowledge based on the literature about the natural course of these aneurysms and management risks and present our management strategy. METHODS: An extensive literature review was performed to find risk factors affecting the natural course and management outcomes of unruptured intracranial aneurysms. RESULTS: Risk factors for rupture, strongly supported by the literature, were the size, specific location, and shape of the aneurysms. Management morbidity was significantly affected by aneurysm size and location and the patient' age. CONCLUSIONS: Unruptured intracranial aneurysms have various clinical characteristics, such as size, shape, and location and the patient's clinical condition, upon which management strategy should be stratified. In Japan, with national efforts to improve surgical and management standards, a national cohort study and individual case series have shown that the management morbidity of unruptured intracranial aneurysms is low. To improve care and to perform safer interventions, we must continue to seek better and less-invasive management methods and techniques.


Assuntos
Aneurisma Roto/etiologia , Aneurisma Roto/patologia , Progressão da Doença , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/patologia , Humanos , Resultado do Tratamento
18.
Neurol Med Chir (Tokyo) ; 54(12): 983-90, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25446379

RESUMO

In recent years, resections of midline skull base tumors have been conducted using endoscopic endonasal skull base (EESB) approaches. Nevertheless, many surgeons reported that cerebrospinal fluid (CSF) leakage is still a major complication of these approaches. Here, we report the results of our 42 EESB surgeries and discuss the advantages and limits of this approach for resecting various types of tumors, and also report our technique to overcome CSF leakage. All 42 cases involved midline skull base tumors resected using the EESB technique. Dural incisions were closed using nasoseptal flaps and fascia patch inlay sutures. Total removal of the tumor was accomplished in seven pituitary adenomas (33.3%), five craniopharyngiomas (62.5%), five tuberculum sellae meningiomas (83.3%), three clival chordomas (100%), and one suprasellar ependymoma. Residual regions included the cavernous sinus, the outside of the intracranial part of the internal carotid artery, the lower lateral part of the posterior clivus, and the posterior pituitary stalk. Overall incidence of CSF leakage was 7.1%. Even though the versatility of the approach is limited, EESB surgery has many advantages compared to the transcranial approach for managing mid-line skull base lesions. To avoid CSF leakage, surgeons should have skills and techniques for complete closure, including use of the nasoseptal flap and fascia patch inlay techniques.


Assuntos
Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Neuroendoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Base do Crânio/cirurgia , Adenoma/cirurgia , Adulto , Vazamento de Líquido Cefalorraquidiano/etiologia , Cordoma/cirurgia , Craniofaringioma/cirurgia , Fasciotomia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Retalhos Cirúrgicos/cirurgia , Técnicas de Sutura
19.
Neurol Med Chir (Tokyo) ; 51(12): 861-2, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22198112

RESUMO

A 57-year-old man presented with recurrent parasagittal anaplastic meningioma of frontoparietal region. The tumor was extensively removed, and the dura was repaired with Gore-Tex surgical membrane. After the operation, subcutaneous cerebrospinal fluid (CSF) collection was observed in the fronto-parietal area and a lumboperitoneal shunt was placed. Four weeks after the shunt procedure, he complained of right scrotal swelling and recurrence of the CSF collection. Radiography revealed the coiled catheter in the scrotum. The catheter was surgically removed through a small incision in the skin of the scrotum under local anesthesia. Lumboperitoneal shunt is a simple and useful procedure to control CSF pressure, but catheter migration has been reported in infants and children. Shunt catheter can migrate into the scrotum even in an adult, as the vaginal process, through which the catheter seemed to have entered the scrotum, is patent in 5% of the adult population. In these cases, direct removal through a small incision is appropriate to remove the catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Derivações do Líquido Cefalorraquidiano/instrumentação , Migração de Corpo Estranho/patologia , Escroto/patologia , Derivações do Líquido Cefalorraquidiano/métodos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Escroto/diagnóstico por imagem , Escroto/cirurgia , Resultado do Tratamento
20.
Neurol Med Chir (Tokyo) ; 50(8): 674-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20805653

RESUMO

A 27-year-old woman presented with vertebral hemangioma manifesting as sudden onset of paraplegia, and bladder and bowel dysfunction during pregnancy. Magnetic resonance imaging revealed a mass lesion that had infiltrated into the entire T2 vertebral body and expanded to the vertebral canal. Laminectomy from T1 to T3 and biopsy of the lesion were performed. Biopsy confirmed the diagnosis of vertebral hemangioma, but laminectomy resulted in no neurological changes. The patient was transferred to our hospital, where radical treatment comprising embolization of the feeding arteries, posterior stabilization of the vertebrae, and anterior excision of the tumor was performed. Symptoms resolved gradually but steadily, and she made a full recovery by 18 months postoperatively. Radical operation might be extremely effective for extradural vertebral hemangioma, even in the delayed phase or in the presence of severe neurological deficit.


Assuntos
Descompressão Cirúrgica/métodos , Hemangioma/cirurgia , Complicações Neoplásicas na Gravidez/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas , Adulto , Feminino , Hemangioma/complicações , Hemangioma/patologia , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Laminectomia/métodos , Imageamento por Ressonância Magnética , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento
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