Optimal access route for pontine cavernous malformation resection with preservation of abducens and facial nerve function.

Objective: The aim of this study was to analyze the differences between posterolateral and posteromedial approaches to pontine cavernous malformations (PCMs) in order to verify the hypothesis that a posterolateral approach is more favorable with regard to preservation of abducens and facial nerve function.

Methods: The authors conducted a retrospective analysis of 135 consecutive patients who underwent microsurgical resection of a PCM. The vascular lesions were first classified in a blinded fashion into 4 categories according to the possible or only reasonable surgical access route.

Neuroendoscopic Technique for Recurrent Chronic Subdural Hematoma with Small Craniotomy.

Aim: To present a case series describing an endoscopic technique with a small craniotomy for recurrent chronic subdural hematoma (rCSDH) treatment.

Material And Methods: A total of 17 patients with rCSDH underwent neuroendoscopic hematoma removal with a small craniotomy under local or general anesthesia. The skin incision of the initial surgery on the convexity of the skull was extended, and a burr hole was created for a small craniotomy.

Fibrous Meningioma with Skull Invasion.

In patients with meningiomas, the presence of skull invasion is known to be a predictor of aggressive clinical behavior, which may negatively influence patient outcomes. In the present report, we discuss a case of fibrous meningioma with skull invasion. A 42-year-old woman was referred to our department presenting with hyperostosis in the right parietal bone.

Effects of Surgery and Radiotherapy on Recurrent Skull Base Meningiomas: Clinical and Biological Analyses.

We reviewed the medical records of 392 patients who underwent initial surgery for skull base meningiomas between 1983 and 2008. Among them, 32 (8.2%) showed tumor recurrence.

Brain metastasis from urachal carcinoma.

Background: Urachal carcinoma (UC) is a rare variant of bladder carcinoma. Only seven cases of brain metastasis from UC have been reported in the literature thus far.

Case Description: A 77-year-old female was diagnosed with a brain tumor in her left cerebellum 2 years after she underwent surgery for a primary UC in the bladder.

Intradural Combined Transpetrosal Approach for Primary Pontine Hemorrhage.

Objective: The standard combined transpetrosal approach (CTPA) is fundamentally an epidural approach that has been quite successfully practiced for many decades. However, it has some disadvantages, such as cosmetic problems, difficulties with custom-tailored petrosectomy, and cerebrospinal fluid leakage, as it is a complicated epidural procedure. We describe here a case of primary pontine hemorrhage via intradural CTPA (iCTPA), which is a modified technique of CTPA and includes intradural anterior petrosectomy and partial posterior petrosectomy without mastoidectomy and skeletonization of the sigmoid sinus.

Autologous bone dust technique for one burr hole surgery to prevent severe skin depression.

Objective: One burr hole surgery is a common treatment modality for initial chronic subdural hematoma and stereotactic hematoma surgery, but severe skin depression is often a postoperative complication. We report the autologous bone dust technique, which uses autogenous bone dust generated during burr hole creation to prevent cosmetic deformity.

Patients And Methods: The autologous bone dust technique was performed for 51 sides on which burr hole surgery was conducted mainly for chronic subdural hematoma and stereotactic hematoma removal.

Neuroendoscopic hematoma removal with a small craniotomy for acute subdural hematoma.

The present study evaluated the safety and effectiveness of neuroendoscopic hematoma removal with a small craniotomy for the treatment of acute subdural hematoma (ASDH). Five patients (4 men and 1 woman) with ASDH underwent neuroendoscopic surgery with a small-size craniotomy between October 2016 and June 2018. The mean age was 87.

Contiguous Metastasis of Pulmonary Adenocarcinoma to Meningioma.

Background:  Metastasis from one tumor into another is known as tumor-to-tumor metastasis. We report a case of a contiguous occurrence of meningioma and brain cancer metastasis.

Patient:  A 91-year-old woman presented with a sudden onset of weakness in her right limbs and gait disturbance.

Surgical Treatment for Primary Brainstem Hemorrhage to Improve Postoperative Functional Outcomes.

Background: It remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly by surgical evacuation of the hematoma. In the present study, we discuss 5 cases of PBH that were treated surgically and the ability of surgical management to improve postoperative functional outcomes.

Methods: The 4 patients with pontine and medullary hemorrhage underwent surgery via the lateral or midline suboccipital and trans-rhomboid fossa approach in the half-sitting position.

Improvement of Respiratory Depression in a Patient with Primary Medullary Hemorrhage Following Removal of Hematoma in the Half-sitting Position.

Primary medullary hemorrhage is a rare event that may result in ataxic respiration. Although it remains controversial whether primary medullary hemorrhage should be managed conservatively or surgically, recent advancements in neuroimaging and microsurgical techniques have shown promise for improving outcomes and prognosis following surgery. The present report discusses the case of a 70-year-old woman admitted to our institution due to sudden-onset nausea and vomiting.

Incidental ethmoidal dural arteriovenous fistula coexisting with a pituitary adenoma exacerbating post-transsphenoidal epistaxis.

A 64 year-old man with pituitary adenoma developed massive epistaxis after an uneventful endoscopic transsphenoidal surgery. Angiography showed extravasation from the sphenopalatine artery, to which embolisation was performed. An incidentally coexisting ethmoidal dural arteriovenous fistula supplied by the ophthalmic artery aberrantly originated from the middle meningeal artery caused increased haemorrhage.

Intradural anterior transpetrosal approach.

The standard anterior transpetrosal approach (ATPA) for petroclival lesions is fundamentally an epidural approach and has been practiced for many decades quite successfully. However, this approach has some disadvantages, such as epidural venous bleeding around foramen ovale. We describe here our experience with a modified technique for anterior petrosectomy via an intradural approach that overcomes these disadvantages.

Treatment of Hyponatremia with Tolvaptan in a Patient after Neurosurgical Treatment of a Pituitary Tumor: Case Report and Review of Literature.

Hyponatremia is a frequent complication following pituitary surgery. We report a case with hyponatremia after surgery of a pituitary adenoma that was successfully treated with tolvaptan. A 68-year-old man with a pituitary tumor presented with mild hyponatremia (133 mEq/L) before surgery.

Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage.

Objective: This study evaluated executive dysfunction in patients with subarachnoid haemorrhage (SAH) using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and correlated the occurrence of executive dysfunction with cerebral blood flow (CBF) reduction in the frontal lobe as assessed by single photon emission computed tomography (SPECT).

Design: Correlational study.

Subjects: Twenty-two patients who underwent microsurgical clipping at least 3 months after SAH.

A case of intraosseous microcystic meningioma without a mass lesion.

Both intraosseous and microcystic meningiomas are rare tumor types. We report the case of a 66-year-old woman with intraosseous microcystic meningioma without a mass lesion. She presented with a rare intraosseous microcystic meningioma manifesting as pain.

A case of large anterior paraclinoid aneurysm with intraoperative premature rupture.

We report here troubleshooting of intraoperative premature rupture with large anterior paraclinoid aneurysm, which was successfully clipped. A 61-year-old woman with left nasal hemianopia was referred to our institute. Preoperative three-dimensional computed tomography angiography and a left internal carotid artery angiogram showed a large left anterior clinoid aneurysm adjacent to the anterior clinoid process.

Endovascular revascularization of external carotid artery occlusion causing tongue infarction: case report.

A 62-year-old man with diabetes and a history of ischemic coronary disease visited the emergency department complaining of acute pain and swelling of the tongue. Physical examination found subtle swelling and pallor of the right side of the tongue, and he was initially diagnosed with glossitis. However, his symptoms were progressive, and the tongue had sustained serious tissue damage before the correct diagnosis was established.

Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach--technical case report.

The drainage of the superficial middle cerebral vein (SMCV) is classified into four subtypes. The sphenobasal vein (SBV) drains from the SMCV to the pterygoid venous plexus at the temporal skull base. Epidural procedures in the standard anterior transpetrosal approach (ATPA) may damage the route of the SBV.

Greater petrosal nerve schwannomas-analysis of four cases and review of the literature.

Schwannomas arising from the greater petrosal nerve (GPN) are exceedingly rare: only 10 such cases have been reported in the English literature. We report on four cases of GPN schwannomas and discuss the surgical approach for their removal. Four patients with GPN schwannomas underwent surgery at Keio University Hospital.

Assessment of cognitive function before and after surgery for posterior cranial fossa lesions using computerized and conventional tests.

Cognitive function has not been well studied after neurosurgery for posterior fossa lesions despite its potential importance in determining surgical indications and approaches. The present study evaluated changes in cognitive functions after posterior fossa surgery to detect any differences between the middle cranial fossa and lateral suboccipital approaches in 50 patients with posterior fossa lesions such as tumors and vascular diseases. Twenty-five patients underwent surgery via the middle fossa and 25 via the lateral suboccipital approaches.

Surgical approach for hypoglossal schwannomas to prevent deformity of the atlanto-occipital joint.

Background: Hypoglossal schwannomas are very rare tumors that often enlarge the hypoglossal canal and jugular foramen, and erode the bone bridge of the occipital condyle. We compared pre- and postoperative 3D bone CT images and discussed the ideal craniotomy to prevent fracture formation.

Method: Seven patients with hypoglossal schwannomas underwent surgery in our department.

Dumbbell-shaped intradiploic epidermoid cyst involving the dura mater and cerebellum.

A 55-year-old woman presented with an epidermoid cyst extending to the cerebellum manifesting as headaches and pain in the left eye. Magnetic resonance imaging showed an intradiploic part with ring enhancement and an intracerebellar part. Intraoperative inspection revealed erosion of the occipital bone and defective dura mater.