[An Extracranial Aneurysm in the Distal Posterior Inferior Cerebellar Artery Located at the Tonsillomedullary Segment:Case Report and Review of the Literature].

We report a rare case of subarachnoid hemorrhage(SAH)due to ruptured extracranial aneurysm originating at the caudal loop of the left posterior inferior cerebellar artery(PICA). A 50-year-old woman presented with severe headache and mild consciousness disturbance. Computed tomography(CT)revealed SAH and intraventricular hemorrhage. Vertebral angiography showed an extracranial aneurysm located on the tonsillomedullary segment of the left PICA. During the surgery, no vessel branches were confirmed near the aneurysm, and the aneurysm was successfully clipped through suboccipital craniotomy with C1 laminectomy. The patient showed significant recovery and was discharged without neurological deficit.

[Ruptured Aneurysm of Bihemispheric Anterior Cerebral Artery A1-A2 junction:A Case Report].

We report a rare case with a ruptured aneurysm of the bihemispheric anterior cerebral artery(ACA), a rare anomaly of the ACA. A 50-year-old female experienced a sudden onset of severe posterior cervical pain. CT revealed diffuse subarachnoid hemorrhage(SAH)and intra cerebral hemorrhage of the left rectal gyrus. Cerebral angiography showed the left bihemispheric ACA and hypoplasia of the right ACA. A saccular aneurysm was indicated at the A1-A2 junction of the left bihemispheric ACA. A neck clipping was performed completely through the right transsylvian approach. There are several reports of an aneurysm with bihemispheric ACA, but all cases are distal ACA aneurysms. In this case, the aneurysm was proximal to the bihemispheric ACA and such aneurysms have not been reported.

Clinical evaluation of hydrocolloid dressings for neurosurgical wounds.

BACKGROUND: Empirical methods in postoperative wound care have been performed by individual neurosurgeons. We evaluated a hydrocolloid dressing for neurosurgical wounds according to the modern concept of wound healing. METHODS: From May 2005 to March 2007, we performed 117 cranial neurosurgical procedures in consecutive 100 patients. Karayahesive (ALCARE, Tokyo, Japan), a transparent hydrocolloid dressing, was affixed onto all wounds immediately postoperatively. Clinical evaluations were performed for wound healing, wound infection, and cost-effectiveness. RESULTS: Excellent wound healing and cosmetic results were obtained in all patients. There was no incisional surgical site infection. Analysis of cost-effectiveness suggested Karayahesive as superior to conventional gauze-and-tape dressings. CONCLUSION: Karayahesive fits with the modern concept of wound healing and is a useful dressing for neurosurgical wounds.

[Pachymeningoencephalitis: case report].

A 59-year-old man presented with generalized convulsion. MR imaging demonstrated a homogeneously enhanced dural lesion infiltrating the parenchyma in the right parietal region. He had no history of sinusitis and the lesion a resembled malignant tumors, so surgical treatment was performed. The histopathological studies showed pachymeningitis extending to the cerebral parenchyma, so the diagnosis of pachymeningoencephalitis was made. After the operation, the patient had no neurological deficits and anticonvulsant therapy was continued. We report the third case of idiopathic local pachymenigoencephalitis that we could range extensively in the world. The clinical features and pathogenesis are discussed.