Intra-arterial injection of indocyanine green in cerebral arteriovenous malformation surgery.

Surgical microscope-integrated intraoperative angiography with intra-venous injection of indocyanine green (ICG) has been widely used during bypass or aneurysm surgery. Instead of intra-venous injection of ICG, we describe a case of intraoperative video angiography with intra-arterial injection of ICG in cerebral arteriovenous malformation (AVM) surgery. During the surgery, we injected ICG through a catheter placed in the internal carotid artery in each step. The technique was feasible and useful to distinguish feeders from normal arteries and to observe changes in flow dynamics. Intra-arterial injection of ICG had better phase contrast than intra-venous injection of ICG and better spatial resolution than digital subtraction angiography. Therefore, this technique can be helpful in cerebral AVM surgery.

[A case of primary T-cell central nervous system lymphoma (T-PCNSL) relevant to HTLV-I].

Primary T-cell lymphoma of the central nervous system lymphoma (T-PCNSL) is an extremely rare tumor. A human T-cell lymphoma virus type I(HTLV-I) associated adult TCL often involves the CNS during its course but disease limited to the CNS is exceptional. We report a case of a 63-year-old male with a highly malignant TCL localized in the bilateral cerebral hemispheres. The patient was HTLV-I positive but no systemic disease was detected after various examinations. We discuss the clinico-pathological features of TCL in the CNS reported in the literature including our case and compare them with those of B-cell lymphomas.

Near-infrared indocyanine green videoangiography for assessment of carotid endarterectomy.

BACKGROUND: Intraoperative fluorescence angiography with indocyanine green (ICG) as a tracer has recently been introduced as a novel technique for neurosurgery. We evaluated the feasibility and efficacy of near-infrared (NIR) indocyanine green (ICG) videoangiography for patients undergoing carotid endarterectomy (CEA). METHODS: Sixty patients (7 females, 53 males; mean age, 71.8 years) undergoing CEA for severe stenosis of the internal carotid artery (ICA) were included. During CEA, microscope-integrated intraoperative NIR videoangiographic recording was performed before and after the excision of the plaque and closure of the ICA. RESULTS: During the 60 CEA procedures, 60 consecutive ICG videoangiographic examinations were performed. All patients tolerated the intravenous injection of ICG well with no adverse effects. The videoangiographic study showed the blood stream of the ICA in all cases and the position of plaque in some cases. CONCLUSION: Microscope-based ICG videoangiography is simple, and provides reliable and rapid intraoperative assessment of CEA.

[A case of parental artery occlusion for a non-ruptured giant thrombosed aneurysm at the right vertebral artery using a goose neck snare to hold a guiding catheter].

The stabilization of a guiding catheter is one of the important factors for achieving successful endovascular treatments. However, obtaining sufficient stabilization is sometimes difficult due to the tortuousity of the approach route. A goose neck snare is useful not only for the retrieval of intravascular foreign bodies but also for holding a guiding catheter. This report presents a case of parental artery occlusion for a non-ruptured giant thrombosed aneurysm occurring in the right vertebral artery using a goose neck snare to hold a guiding catheter.

The 'triangle' rubber dam interposition technique: preservation of the arteries around an aneurysm.

The authors describe an intraoperative technique in which a triangular rubber dam is inserted between the aneurysm and the perforating arteries. In this way, we can avoid obstruction of perforating arteries on application of a clip. This technique is especially useful for deep-seated aneurysms, such as basilar bifurcation aneurysms.

[A Japanese hospital reports long-term survival for 10 years after carotid endarterectomy].

BACKGROUND: Several reports in Western countries have demonstrated the net benefit and an acceptable long-term survival of carotid endarterectomy (CEA) for severe carotid stenosis. However, long-term follow-up after CEA for carotid stenosis is not well-documented in Japan. The aim of this study was to determine long-term outcomes of CEA in our hospital. METHODS: 38 consecutive patients underwent 42 CEAs at the Kyushu Medical Center between May, 1994 and December, 1998. Survival follow-up was conducted in December 2008 and the incidence of late stroke was investigated in all surviving patients. RESULTS: A total of 37 CEAs in 30 patients (83.3%) were registered. There were 28 males and 2 females, 25 symptomatic and 5 years asymptomatic, mean ages 68+/-7 years. Survival rate after CEA was 80.0% after 5 and 53.3% after 10-years, respectively. The 10 year survival ratio free from cerebral infarction was 36.7%. CONCLUSIONS: For the patients in this study, CEA is associated with an acceptable long-term survival as well as a satisfactory benefical effect in stroke prevention.

[Usefulness of surgical loupes and headlights for the neurosurgical field].

Surgical loupes and headlights are mainly used in the cardiovascular field. Neurosurgeons use a loupe and a headlight less commonly especially in Japan. In our institute, all six neurosurgeons have their own loupes and two headlights. Both an operator and an assistant use loupes and headlights in every operation. Loupes and headlights are useful also in the neurosurgical field since they give us a clearer and wider surgical field than the macroscopic view and make it possible to move the surgical field quicker than using a microscope.