Functional prognosis after treatment of spinal dural arteriovenous fistulas.

We statistically evaluated the functional outcome after surgery or embolization therapy of 43 patients with spinal dural arteriovenous fistula including 10 patients of our own and 33 previously reported cases in the literature. This study prompted us to consider that a patient under 70 years old who is treated within 2 years 6 months after the onset of symptoms and whose gait or urinary disturbance is slight or moderate without absence of deep tendon reflexes in the lower extremities is expected to get a good functional prognosis after treatment.

Postoperative seizures: epidemiology, pathology, and prophylaxis.

The risk of epileptic seizures after craniotomy is extremely important but the incidence of postoperative epilepsy varies greatly, depending on the patient's conditions such as primary diseases, severity of surgical insult, and pre-existing epilepsy. Animal studies suggest that neurosurgical insults lead to seizures by two different mechanisms: One mechanism is mediated by free radical generation and the other by impaired ion balance across the cell membrane caused by ischemia or hypoxia. Conventional antiepileptic agents such as phenytoin, phenobarbital, carbamazepine, and valproic acid are promising for the prevention of early seizures, but the effect in preventing postoperative epilepsy is still controversial.

Preserved musical abilities following right temporal lobectomy.

It has been widely accepted that the right temporal lobe plays a major role in the processing of music. One of the main lines of evidence was derived from Milner's study, published in 1962, which reported that right temporal lobectomy led to a decline in patient scores on four of the six subtests (Tonal Memory, Timbre, Loudness, and Time subtests) of the Seashore Measures of Musical Talents. That finding had led some surgeons and patients to hesitate in choosing right temporal lobectomy as a treatment for intractable epilepsy.

Cortical and subcortical SEPs following posterior tibial nerve stimulation.

Intra-operative cortical and subcortical SEPs from the cerebral convexity and from the inter-hemispheric fissure were recorded following posterior tibial nerve (PTN) stimulation. Cortical and subcortical SEPs from the cerebral convexity after contra-lateral PTN stimulation consisted of N38 and P46, and their polarity reversed when the ipsi-lateral site was stimulated. On the other hand, cortical SEPs from the inter-hemispheric fissure always showed P38 and N46, whether the right or the left PTN was stimulated.

A cervical dural arteriovenous fistula in a patient presenting with radiculopathy. Case report.

A 51-year-old man presenting with radiculopathy a rare cervical dural arteriovenous fistula (AVF) is reported. Angiography revealed that the cervical dural AVF was fed mainly by the left C-3 and C-4 radicular arteries and drained into the internal vertebral venous plexus with no communication with intradural structures. The dural AVF was treated surgically after embolization therapy.

Instrumentational posterior fusion for atlanto-axial subluxation in a young child with Down's syndrome--case report.

A 3-year-old girl with Down's syndrome and myelopathy caused by atlanto-axial subluxation (AAS) was treated by C-1 to C-2 posterior fusion with a one-piece cervical device (OPCD). Instrumentation was required because the posterior arch of C-1 was too tiny and fragile to tolerate wiring. Postoperative immobilization was another major problem in this mentally retarded young child, but a hard plastic cervical corset effectively restrained the neck.

Functional prognosis after treatment of spinal radiculomeningeal arteriovenous malformations.

Background: We performed surgical treatment successfully in six patients with spinal radiculomeningeal arteriovenous malformation (AVM); however, only four patients showed improvement of gait function postoperatively.

Methods: These experiences prompted us to review the clinical findings and their possible association with the functional outcome in 33 reported cases of radiculomeningeal AVM together with those in our six patients.

Results: Statistical analysis revealed that the duration from onset of symptoms until diagnosis, the age at the time of treatment, the condition of the deep tendon reflexes (DTR) in the lower extremities, as well as the severity of both gait and urinary disturbance before treatment were significantly correlated with the functional outcome.

[Surgical outcome of cervical flexion myelopathy in young adults].

We encountered five young male patients with cervical flexion myelopathy, and treated them all surgically. Symptoms were first noted at 15 to 18 years of age (mean: 16.6 years), and their ages at the time of admission to our hospital, ranged from 19 to 25 years old (mean: 20.

Lateral temporal polar approach to mesial temporal lesions.

A newly developed lateral temporal polar surgical approach to the mesiobasal temporal region was applied to 25 consecutive patients with mesially confined temporal lobe lesions. This approach is characterized by a very limited resection of the lateral temporal cortex and a direct approach to the uncal area. The advantages of this method are clear orientation to the mesial temporal structures, easy access to the posteromesial part of the temporal lobe, and preservation of functionally important structures, such as the lateral temporal speech area, optic radiation, and temporal stem.

Intracarotid amobarbital injection produces hippocampal EEG changes in patients with temporal lobe epilepsy.

EEGs of hippocampi of both sides were analyzed during intracarotid amobarbital tests in 12 patients with temporal lobe epilepsy. The number of paroxysms occurring 1 min before the injection ipsilaterally and contralaterally was compared with that occurring 1 min after the injection. The hippocampal EEG ipsilateral to the injection showed an increase in paroxysms irrespective of the laterality of the epileptogenic side.

[Congenital extradural cyst causing a 30-year history of myelopathy with long-term remission].

We reported a peculiar case of a patient with a thoracic extradural cyst, who had a 30-year history of thoracic-myelopathy with a very long-term remission. A 42-year-old male was admitted to our hospital complaining of gait disturbance and hypesthesia of his bilateral lower limbs. Neurological examination revealed that he had spastic paraparesis and hypesthesia of all sensory modalities below Th11/12 dermatomes.

Aphasic seizure caused by focal epilepsy in the left fusiform gyrus.

We report a patient with paroxysmal aphasia evoked by ictal epileptiform discharges localized to the left fusiform gyrus, where a small brain tumor existed. The intracranial EEG recordings during other seizures demonstrated a close functional link between the left fusiform gyrus and Wernicke's area. The patient also showed transient aphasia with electrical stimulation of the left fusiform gyrus.

Mesial temporal subdural electrode as a substitute for depth electrode.

As a substitute for depth electrodes, mesial temporal subdural electrodes were devised. This electrode has a slender trapezoid shape and is easily introduced to the inner uppermost portion of the parahippocampal gyrus. Our results have shown that mesial temporal electrodes can detect not only interictal spikes but also subclinical and clinical seizure discharges from the mesiolimbic structures, and they have excellent capability for lateralization of the mesial temporal epileptic focus.

[An infant case of spinal arteriovenous malformation with a large venous aneurysm].

An 18-month-old boy was admitted to our hospital with sudden onset of paraplegia, analgesia of the lower limbs, dysuria and constipation. His gestational and birth histories were unremarkable. Past history revealed he had lymphangioma in his left inguinal region, and had been treated in another hospital.

Problems related to dorsal root entry zone lesions.

Several clinical problems related to the dorsal root entry zone lesions (DREZLs) in 15 patients with chronic pain are presented and discussed in terms of ratings of pain relief following surgery, development of sensory or motor weakness and postmortem histologies. Subjective pain relief exceeding 70% was achieved at around 2 weeks after the operations in most patients (13/15), and then decreased in some to 30 from 70% in the follow-up observations. Our new "objective" pain relief score was tested in these patients.

[Repair of widely infected scalp defect and osteomyelitis with free radial forearm flap: a case report].

A 60-year-old female was admitted with large frontal scalp defect associated with osteomyelitis due to chronic infection. Debridement of the infected scalp and frontal bone and the transplantation of the free radial forearm flap with vascular anastomosis was carried out. The wound cured uneventfully.

Multiple subpial transection (MST) for the control of seizures that originated in unresectable cortical foci.

Multiple subpial transection (MST) was applied to 12 cases with intractable epilepsy, the foci of which were located in unresectable essential areas. The result proved that MST is effective in controlling seizures, and no explicit neurological deficits have incurred postoperatively.

Modifications of temporal lobectomy according to the extent of epileptic foci and speech-related areas.

The authors applied combined depth and subdural electrodes in patients with intractable complex partial seizures to detect the precise extent of epileptic foci and functionally map speech-related areas. The medial temporal structures were explored with depth electrodes and the lateral temporal cortex with subdural electrodes. On the speech-dominant side, electrical stimulation was given to demarcate the speech-related areas in the lateral temporal cortex.