Extradural Anterior Clinoidectomy and Optic Canal Unroofing for Paraclinoid and Basilar Aneurysms: Usefulness of a No-Drill Instrumental Method.

The authors describe extradural anterior clinoidectomy without the use of a high-speed drill or ultrasonic device to clip paraclinoid and basilar aneurysms, which can eliminate potential complications related to traditional power drilling or ultrasonic device use. This method involves four steps: (1) partial osteotomy of the sphenoid wing at the superior orbital fissure (SOF); (2) peeling of the dura propria of the temporal lobe from the inner cavernous membrane of the SOF; (3) isolation and resection of the exposed meningo-orbital band to expose the superolateral aspect of the anterior clinoid process (ACP); and (4) piecemeal rongeuring of ACP and the roof of the optic canal. The entire procedure was performed using surgical instruments, including micro-rongeurs, a fine Kerrison punch, and micro-dissectors.

Effects of Surgery With Salvage Stereotactic Radiosurgery Versus Surgery With Whole-Brain Radiation Therapy in Patients With One to Four Brain Metastases (JCOG0504): A Phase III, Noninferiority, Randomized Controlled Trial.

Purpose Whereas whole-brain radiotherapy (WBRT) has been the standard treatment of brain metastases (BMs), stereotactic radiosurgery (SRS) is increasingly preferred to avoid cognitive dysfunction; however, it has not been clearly determined whether treatment with SRS is as effective as that with WBRT or WBRT plus SRS. We thus assessed the noninferiority of salvage SRS to WBRT in patients with BMs. Patients and Methods Patients age 20 to 79 years old with performance status scores of 0 to 2-and 3 if caused only by neurologic deficits-and with four or fewer surgically resected BMs with only one lesion > 3 cm in diameter were eligible.

Autologous clavicle bone graft for anterior cervical discectomy and fusion with titanium interbody cage.

A variety of donor-site complications have been reported for anterior cervical discectomy and fusion (ACDF) using autologous iliac bone graft. To minimize such morbidities and to obtain optimal bony fusion at the ACDF surgery, a novel technique was used to harvest cancellous bone from the autologous clavicle instead of the popular iliac crest graft. After a routine cervical discectomy of the affected level, a 1.

Surgical stress during operation for gastrointestinal cancer increases plasma thioredoxin levels and decreases mitochondrial membrane potential in peripheral blood lymphocytes.

Surgical stress is difficult to evaluate quantitatively. It has been reported that mitochondrial membrane potential (delta psi(m)) in the peripheral blood lymphocytes (PBLs) is decreased by surgical stress. Thioredoxin (TRX), a small protein with redox-active dithiol/disulfide in the active site, is induced by a variety of oxidative stresses and secreted from the cells.

Cerebellopontine angle epidermoids presenting with cranial nerve hyperactive dysfunction: pathogenesis and long-term surgical results in 30 patients.

Objective: To provide the characteristics and long-term surgical results of patients who present with cerebellopontine angle epidermoids and trigeminal neuralgia (TN) or hemifacial spasm.

Methods: A total of 30 patients (23 women, 7 men) who presented with cerebellopontine angle epidermoids and TN (28 patients) or hemifacial spasm (2 patients) between 1982 and 1995 were reviewed, with emphasis being placed on the clinical manifestations, the mechanisms of symptom development, the long-term follow-up results, and the anatomic relationship between the tumor and the surrounding neurovascular structures.

Results: The average age of the patients was 37.

Prolapsing gyrus rectus as a cause of progressive optic neuropathy.

The pathogenesis of optic neuropathy caused by neurovascular compression or by similar mechanisms is unclear. Thin-slice magnetic resonance (MR) imaging was performed in 69 patients with optic neuropathy without demonstrable ophthalmological lesions (57.0 +/- 17.

Massive subependymal hemorrhage caused by an occult vascular malformation--two case reports.

Two patients presented with massive subependymal hemorrhage caused by vascular anomalies occult to angiography, computed tomography (CT) scanning, and magnetic resonance (MR) imaging. A 47-year-old male initially presented with a headache and became comatose 3 weeks later. CT and MR imaging demonstrated a massive hematoma in the right caudate head projecting into the lateral ventricle.

Contralateral deafness following unilateral suboccipital brain tumor surgery in a patient with large vestibular aqueduct--case report.

A 68-year-old female developed contralateral deafness following extirpation of a left cerebellopontine angle epidermoid cyst. Computed tomography showed that large vestibular aqueduct was present. This unusual complication may have been caused by an abrupt pressure change after cerebrospinal fluid release, which was transmitted through the large vestibular aqueduct and resulted in cochlear damage.

Combined hyperactive dysfunction syndrome of the cranial nerves: trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: 11-year experience and review.

Objective: A pathological condition caused by vascular compression at the root entry/exit zone of the cranial nerves is designated hyperactive dysfunction syndrome (HDS) of the cranial nerves. Patients with HDS who exhibited a combination of trigeminal neuralgia (TN), hemifacial spasm (HFS), and/or glossopharyngeal neuralgia were retrospectively reviewed, to study the incidence, etiological factors, and demographic characteristics for this combined HDS group.

Methods: Medical and surgical records were analyzed for 41 patients with combined HDS, of 1472 consecutive patients with HDS who were treated between 1984 and 1994.

Neuroradiological characteristics of ecchordosis physaliphora. Case report and review of the literature.

An extremely rare case of ecchordosis physaliphora is presented in which the authors focus especially on its radiological characteristics. The patient complained of a headache with no other neurological abnormalities. A thorough radiological examination revealed a small intradural prepontine mass with no bone destruction of the clivus.

Chordoid meningioma in a child. Case report.

A case of chordoid meningioma occurring in a 15-year-old girl is presented. The patient manifested seizures as the initial symptom and subsequently exhibited subclinical microcytic hypochromic anemia. The tumor, located in the falcotentorial region and associated with diffuse edema, was totally resected.

Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia.

Unlabelled: Glossopharyngeal neuralgia (GPN) is an uncommon disorder that is characterized by a severe lancinating pain commonly induced by swallowing. There has been some debate among various authors as to which surgical procedure should be adopted to treat cases of GPN: microvascular decompression (MVD) or partial rhizotomy. The latter necessitates the partial destruction of normal neural structures.

Choroid plexus papilloma in the posterior third ventricle: case report.

Objective And Importance: The case of a 42-year-old woman with a choroid plexus papilloma (CPP) arising from the posterior wall of the third ventricle is described. This case is very unusual because the tumor did not have any connection with the choroid plexus but was attached to the normal brain parenchyma.

Clinical Presentation: The patient presented with the symptoms of increasing intracranial pressure.

Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm.

Objective: We evaluated the follow-up results of microvascular decompression in 1032 patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS), who underwent operations between 1976 and 1991 and were followed for more than 5 years.

Method: Patients were divided into two groups, and their follow-up results were compared and studied. The early series, Group A (1976-1986), comprised 588 patients (127 with TN and 461 with HFS) followed from 10 to 20 years (mean, 12.

Solitary metastatic breast carcinoma in a trigeminal nerve mimicking a trigeminal neurinoma. Case report.

An unusual case of a metastatic adenocarcinoma located entirely within the trigeminal nerve is reported. The patient, with a history of breast cancer, presented with a pure trigeminal mononeuropathy. The neurological and neuroradiological findings in this patient were quite similar to those of a patient with trigeminal neurinoma.

Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases.

Trigeminal neuralgia and hemifacial spasm were false localizing signs in three patients with contralateral space-occupying mass lesions in the posterior cranial fossa. According to radiological observations, the brainstem was remarkably displaced and distorted toward the side contralateral to the mass in all three cases. In the two cases with trigeminal neuralgia, the fifth cranial nerve was embedded in a thick arachnoid membrane and strongly compressed and angulated between the brainstem and the petrous bone, but there was no apparent vascular involvement.

Trigeminal neuralgia: association with tentorial meningioma and persistent primitive trigeminal artery.

A rare case of trigeminal neuralgia caused by tentorial meningioma associated with a persistent primitive trigeminal artery (PTA) is reported. This case involved a 59-year-old female patient with a more than 6 month history of left trigeminal neuralgia. A left cerebello-pontine angle (CP angle) meningioma was found associated with a right PTA connecting the proximal portion of the cavernous internal carotid artery with the basilar artery, supplying the bilateral superior cerebellar arteries.

[Studies concerning the pathogenesis of trigeminal neuralgia caused by cerebellopontine angle tumors].

It has been well recognized that neurovascular compression can elicit trigeminal neuralgia (TN) and microvascular decompression surgery has become popular as a radical treatment of this clinical symptom. Cerebellopontine (C-P) angle tumors, however, as well known, can also cause TN. Four hundred fifty six patients with TN underwent posterior fossa exploration between 1984 and 1992 in our clinic, and among them, 45 (9.

Hemifacial spasm in childhood and adolescence.

Hemifacial spasm (HFS), a hyperactive dysfunction of the facial nerve, is rarely seen in young people. Between 1984 and 1994, we treated 924 patients with HFS by microvascular decompression at our institution. Of these, 8 (0.

Intraorbital malignant lymphoma presenting with tumor stain on angiography--case report.

A 58-year-old male presented with a 1 month history of left retro-orbital pain and diplopia. Computed tomography demonstrated an isodense intraorbital tumor with slight homogeneous enhancement. Magnetic resonance imaging showed the tumor was isointensity on T1-weighted imaging, slightly high intensity on T2-weighted imaging, and slightly enhanced by gadolinium-diethylenetriaminepenta-acetic acid.

[Treatment of intractable postherpetic neuralgia and blepharospasm: intraneural injection of adriamycin].

Adriamycin, an anthracycline antineoplastic agent, can swiftly be transported to the sensory or somatic motor neurons by way of axoplasmic transport when injected into the subepineurium of the trigeminal nerve or sciatic nerve in experimental animals, and is consequently able to induce degeneration of the neurons without any systemic side effects. Intraneural injection of this agent was carried out for the treatment of a total of 22 patients presenting with intractable neural dysfunction (12 with neuralgia, including 7 with post-herpetic neuralgia and 10 with facial dystonia). The nerve which innervated the affected site was exposed under local anesthesia and approximately 10-60 microliters of 1-20% adriamycin was injected into the subepineurium.

Unusual presentation of brain metastasis from hepatocellular carcinoma--two case reports.

Two unusual cases of brain metastasis from hepatocellular carcinoma (HCC) are described. A 15-year-old boy presented with intracerebral hemorrhage from brain metastasis from HCC, and died of rebleeding 1 month after surgery. Cerebral metastatic HCC in a child is quite rare, and has not previously been reported.

[Diploic epidermoid on the petrous bone: a case report].

An unusual case of a congenital petrous bone epidermoid which resulted in a sudden deafness is reported. The patient was a 25-year-old man who suddenly developed a right deafness and tinnitus. Neurological examination on admission revealed slight hearing disturbance in the high sound area.

[A case of macrocystic cervical neurinoma diagnosed by MRI with Gd-DTPA].

The authors report a rare case of a large cystic cervical neurinoma. A 45-year-old female was admitted to our clinic because of motor weakness of the right upper extremity, numbness of the right fingers and right posterior cervical pain. Metrizamide CT myelography demonstrated the outline of a low density mass.