[A Case of Encapsulated Peritoneal Sclerosis Associated with a Ventriculo-Peritoneal Shunt].

We experienced a case of encapsulated peritoneal sclerosis(EPS)that developed as a result of peritoneal deterioration induced by ventriculo-peritoneal(VP)shunting. The patient was a 48-year-old man who underwent VP shunting five times since 1 month of age. Six months after the last operation, abdominal symptoms developed and the patient was hospitalized. A localized cyst was recognized in the left upper abdomen, and we diagnosed him with a cerebrospinal fluid pseudocyst. Soon, a shunt tube translocation was performed to another portion of the abdominal cavity, but a new short-term cyst appeared. During laparotomy, the inner surface of the abdominal cavity was very strong due to adhesions and the peritoneum was thickened. A large portion of the intestines and the mesentery was covered with a translucent film-like substance. Afterward, an ileus developed and he was diagnosed with EPS intraoperatively. We judged that an additional VP shunt was impossible, so a ventriculo-atrial shunt was placed. Afterward, his symptoms disappeared and the EPS improved. Although a few similar reports exist, this condition is thought to be extremely rare. Clinicians should recognize EPS as a complication of VP shunting.

A recurrent intradural cervical neurenteric cyst operated on using an anterior approach: a case report.

The neurenteric cyst is an uncommon congenital lesion. In most reported cases, it has been operated on via a posterior approach using a laminectomy, despite the fact that the cyst is usually located ventral to the spinal cord. Reports have shown that early postoperative results have been good with the posterior approach, but very few studies of the long-term postoperative recurrence of neurenteric cysts have been conducted. Here, we report on a case of recurrent neurenteric cyst that was operated on using an anterior approach.A 42-year-old woman presented with a cervical neurenteric cyst that had recurred eight years after its partial removal via a posterior approach. The patient complained of pain on the lateral side of her upper arms, and an magnetic resonance imaging showed that the recurrent cyst was located ventral to the spinal cord and compressed the cord dorsally at the C4-6 level. The patient was operated on via an anterior approach using a vertebrotomy at the lower half of C5 and the upper half of C6. The cyst was attached to the spinal cord firmly and was subtotally removed, with the thickest portion adhering to the cord not being removed. The caudal end of the cyst was observed with the assistance of a rigid endoscope.A neurenteric cyst may recur after partial removal, and the patient's condition may deteriorate during postoperative follow-up. The anterior surgical approach provides good visualization and facilitates safe removal of the lesion.

Operative findings in cases of trigeminal neuralgia without vascular compression: proposal of a different mechanism.

Trigeminal neuralgia is known to be caused by vascular compression at the trigeminal root entry zone (REZ) and microvascular decompression provides good outcome in most of cases. However, in some cases, no vascular compression was observed at the REZ. Over the last 2(1/2) years, the first author operated on 53 cases of trigeminal neuralgia with microvascular decompression and encountered nine cases where no offending vessels were noted at or near the REZ. They were divided into two groups: five cases involving an initial operation and four cases involving a second operation. In the former, arachnoid thickening, angulation or torsion of the root axis were common findings. Dissection of thick arachnoid around the root along the whole length reversed the root to be straight and flaccid. Complete pain relief was noted in four of five cases. In one case of atypical pain, constant facial pain remained. In the latter four cases, where the first operations were done more than 4 years before, thick granulation was noted around REZ without new offending vessels in two cases. In the remaining two cases, where no offending vessels were noted in the first operation, thick adhesion of a distal portion of the root with dura on the pyramidal bone was noted. Meticulous dissection of t he whole length of the root was done and complete pain relief was obtained. Delayed but complete pain relief in these nine cases was noted. Based on operative findings, arachnoid thickening or granulomatous adhesion between the root and surrounding structures can cause an abnormal course of the trigeminal nerve root, which causes root angulation and/or torsion. They can also cause pulsatile movement of the trigeminal nerve root. This tethering effect can promote abnormal root stretching force, especially at REZ, which might promote hyperexitability of the nerve. This speculative mechanism suggests that it is important to make the root free along the entire length, especially at its distal portion in cases with no offending vessels.