Traumatic pericallosal artery aneurysm

Pericallosal artery aneurysms comprise about 1.5 to 9% of all intracranial aneurysms. Some of them are caused by head injury. We report a 66-year-old male patient with ruptured left pericallosal artery aneurysm, 2.6 x 3.2 mm in size. The patient fell 2 months ago. Operation was done under right interhemispheric approach. The parent artery was avulsed while the clip was adjusted. The avulsed part was sutured and postoperative CAG revealed totally obliteration of the aneurysm while the repaired artery was patent. The patient recovered well after operation

Microvascular decompression in trigeminal neuralgia

Trigeminal neuralgia, like other rhizopathies, has defied categorization, clarification in pathology and effective treatment, despite several efforts, in several disciplines. The different rhizopathies like trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, tinnitus, spasmodic torticollis, etc., all share a common pathology i.e., a vascular compression of the cranial nerve at the root entry zone. A comprehensive description of the features of trigeminal neuralgia and the surgical management with microvascular decompression is detailed in this article. Microvascular decompression is a relatively safe surgery and complications are very unlikely in dexterous hands

Postoperative mental functions in patients with frontal meningiomas

The meninges [dura mater, arachnoid, pia mater] are the site of numerous pathological lesions including inflammation and neoplasm Meningiomas are the most frequently observed lesions and the most common of primary meningeal tumours. Over the years, meningiomas has been histologically classified and some entities have been added to the cadre of meningioma variants, while others have been designated as other types of tumours. The 200 revision of the World Health Organisation [WHO] grading system provided diagnostic guidelines. Most meningiomas are biologically benign and correspond to the WHO grade. However, certain meningiomas have an increased tendency to recur or follow an aggressive clinical behavior and are assigned an WHO grade and have a substantially increased incidence of recurrence. Rhabdoid meningioma, papillary meningioma and anaplastic meningioma corresponding to WHO grade have an even higher incidence of recurrence and may be associate with systemic metastasis or brain invasion. There is some information regarding the nature of mental deficits caused by intracranial meningiomas. In this study the authors examined the mental functioning of patients with frontal meningiomas. Twenty-one patients with frontal meningiomas were examined for various neurological symptoms after surgery. Observed neurological symptoms were memory deficits [verbal and fungal], attention and executive functions. The time period between onset of the effect on mental functions of meningioma and postoperative observations ranged from 2-3 months. Postoperative findings revealed a few or no differences in memory or executive functions, although, a postoperative improvement in attentional function was observed. The results of the study indicate that the surgical removal of frontal meningiomas does not impair patients' mental functioning

Distal anterior cerebral artery aneurysms, traumatic and non-traumatic

Distal anterior cerebral artery [ACA] aneurysms are rare and compose less than 5% of all intracranial aneurysms. Most of the aneurysms in this location are congenital, saccular ones, but it is also a well-known location for traumatic aneurysm. The mechanism of aneurysm development, clinical scenario and/or surgical difficulty are different between these two groups. Between March 2005 to February 2006, 6 cases of distal ACA aneurysms were treated at the Department of Neurosurgery, Fujita Health University, Aichi Prefecture, Japan. The clinical presentations, neurological findings, and treatment were analyzed. Of 6 patients, 2 were male and 4 were female, aged from 66-79 years. Of 6 cases, one was traumatic aneurysm, which occurred 2 months after a fall injury. Of the 5 congenital aneurysms, one was unruptured, the other 4 were all ruptured. One patient had multiple aneurysms. We believe that there are differences between the congenital and traumatic aneurysms in respect to the mechanism of development, aneurysm location, and treatment difficulties

Experience with anterior petrosal approach for aneurysms of mid-basilar artery

Anterior petrosal approach [Kawase's approach] is an established technique for the management of basilar artery aneurysms arising near the origin of anterior inferior cerebellar artery [Ba-AICA], however the extent of petrosectomy may vary from patient to patient. Authors report their experience with Kawase's approach for the management of these aneurysms in 5 patients. During the last 10 years, anterior petrosal approach was used to clip aneurysms of Ba-AICA junction in five patients, who were not suitable for endovascular therapy. Both ruptured and unruptured aneurysms were included in this series. Successful clipping could be achieved in all but one patient. In this patient with a large aneurysm and complex morphology, residual filling was noted in the postoperative angiogram. Postoperatively one patient developed hemiparesis and transient sixth nerve palsy. There was no operative mortality in this series. For patients with small Ba-AICA shoulder aneurysms, where clipping is preferred method of treatment, sufficient exposure is achieved through Kawase approach, however minor variation may be required while resecting the petrous bone

Fundamentals of AVM surgery: an institutional experience

Arteriovenous malformations [AVM] of the brain are congenital lesions and remain dormant for many years but can haemorrhage, cause seizure or impair brain function. Modern therapeutic modalities for AVM include microsurgery, intravascular neurosurgery and stereotactic radiosurgery. There is significant risk of intraoperative haemorrhage due to abnormal vessels as well as due to change in haemodynamic pattern of surrounding brain after excision. Inadequate coagulation of feeding vessels and draining channels, loss of plane between nidus and normal brain, persistent residual or daughter sinus and inadequate intraoperative blood pressure control are the main causes of haemorrhage. The main important aspect in AVM surgery is to identify the plane between the nidus and normal brain and work around the nidus. It is very important to aggressively reduce intraoperative haemorrhage and prevent or minimize the dilation of abnormal capillaries and arteries on the basis of fundamental surgical strategy, i.e., feeder-nidus-drainer. Adequate control is the key factor in prevention and treatment of haemorrhage. In a period of 8 years, from 1994-2003, our department dealt with 290 cases of AVM. In 212 patients, operative removal was performed, which included 89 cases with intracerebral haematoma. In 39 cases, embolisation and/or gamma knife was preferred

Treatment of severe subarachnoid haemorrhage -440 cases clipping versus coiling

We reviewed the ruptured cerebral aneurysm treatment in Fujita Health University Hospital with multimodalities of treatment. Form 1996 to 2002, cerebral aneurysms were treated by two methods: direct microsurgical clipping and endovascular coiling. Both were selected based on definite guidelines of clinico-radiological criteria as follows: endovascular therapy comprised of GDC embolisation and CSF washout with UK or TPA performed in cases with Hunt and Kosnik grade 4 [GCS 7,8], and grade 5 [without hydrocephalus or intracranial haemorrhage], age > 70 years, subacute stage [4-14 days of vasospasm], basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with drainage procedure was performed in cases with Hunt and Kosnik grade 0-3, grade 4 [GCS 9-12], age less than 70 years, grade 5 with hydrocephalus or intracerebral haematoma and acute stage [0-3 days after bleed]. The patient's outcome was measured using Glasgow Outcome Score [GOS] at the time of discharge. In our series of severe [poor grade] SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Though they accounted for 37.8% and 48% of total SAH cases respectively, the outcome was satisfactory. In each treatment modality, a favourable outcome [good recovery/moderate disability] was found in 75.4% of clipping cases and 55.2% of coiling cases clipping had a better outcome than coiling in cases of acute severe SAH in our series and is in contrast to ISAT results

The Effect of Acupuncture Therapy on Headache and Post Cerebral Apoplexy Symptoms / 全日本鍼灸学会雑誌

The purpose of this study is to determine the efficacy of acupuncture in treatment of neurosurgical diseases, especially intractable head ache or post cerebral apoplexy symptoms (i. e. paresthesia, stiffness, pain, etc.)<br>METHOD<br>230 outpatients of the neurosurgical section, whose headache or symptoms of cerebrovascular disease or injury had not been controlled with any analgesics, were divided into two groups. Electrical acupuncture was applied to Group I for 7 minutes once a week, and to Group II for 20 minutes twice a week. Moxa needle therapy was also undertaken for Group II. In order to determine the effect of acupuncture, the degree of relief in their symptoms was rated on a percentage basis (severity of pretreatment symptoms was rated as 100%). The duration of the effect and the influences of drugs were also examined.<br>RESULT<br>Migraine was relieved by about 50% in Group I, and by about 70% in Group II. The duration of the effect was longer in Group II. Headache from cerebrovascular disease was relieved by about 60% in both groups, without any difference between the groups or between underlying diseases. Paresthesia in the extremities, pain in the shoulder or extremities and stiffness was relieved by 30-50% in both groups.<br>DISCUSSION<br>Acupuncture is effective in relieving headache, especially of non-cerebrovascular origin. It seems that other migraine or paresthesia can be well relieved with longer and more frequent sessions of electro-acupuncture. It is noteworthy that paresthesia, peculiar to post cerebral apoplexy symptoms, can be ameliorated with the combined use of acupuncture and drugs.