Technique for shaping microcatheter tips in coil embolization of paraclinoid aneurysms using full-scale volume rendering images of 3D rotational angiography.

Introduction: In coil embolization of paraclinoid aneurysms, it is sometimes difficult to introduce and stabilize microcatheter tips in the aneurysms. We report a new technique for shaping microcatheter tips in the coil embolization of paraclinoid aneurysms.

Methods: From May 2007 to May 2008, this new technique was applied to 10 paraclinoid aneurysms undergoing coil embolization.

Complete Cure of Superior Sagittal Sinus Dural Arteriovenous Fistulas by Transvenous Embolization through the Thrombosed Sinus in a Single Therapeutic Session. A Case Report.

Endovascular treatment often fails to completely eliminate dural arteriovenous fistulas (dural AVFs) involving the superior sagittal sinus (SSS). We report a successful case of dural AVF involving the SSS using transvenous embolization through the thrombosed sinus in a single therapeutic session.

Technique to detect coil migration using mask images of rotational angiography during stent-assisted coil embolization for ultra-wide necked aneurysms: technical note.

A novel technique was developed to detect coil migration to the stent interior using mask images of rotational angiography. Stent-assisted coil embolization under x-ray fluoroscopy control was simulated with a hand-made vessel model. The stent interior was observed with a rigid endoscope during coil embolization.

Simultaneous treatment with intravenous recombinant tissue plasminogen activator and endovascular therapy for acute ischemic stroke within 3 hours of onset.

Background And Purpose: Because intravenous (IV) recombinant tissue plasminogen activator (rtPA) does not always lead to a good outcome in a considerable proportion of patients, combined IV rtPA and rescue endovascular therapy (ET) have been performed in several recent studies. However, rescue therapy after completion of IV rtPA often results in late ineffective recanalization. We examined the efficacy and safety of combined IV rtPA and simultaneous ET as primary rather than rescue therapy for hyperacute middle cerebral artery (MCA) occlusion.

Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage. Case report.

The authors report the case of a 65-year-old woman with atlantoaxial subluxation caused by rheumatoid arthritis. The patient had been hospitalized because of an infection after a total-knee replacement, when she suddenly lost consciousness and became apneic after an episode of intractable neck pain. Cranial computed tomography scanning demonstrated subarachnoid hemorrhage (SAH), and angiography revealed a dissecting aneurysm of the radiculomedullary artery that had originated from an extracranial vertebral artery dissection at the level of the atlantoaxial joint.

Intravenous 3D digital subtraction angiography in the diagnosis of unruptured intracranial aneurysms.

Recent progress in digital subtraction angiography (DSA) devices makes it possible to perform rotational angiography with high resolution and high sensitivity. We tried intravenous (IV) 3D DSA in patients who had undergone MR angiography (MRA) suggestive of unruptured intracranial aneurysms. IV 3D DSA can be used as an alternative method for imaging unruptured intracranial aneurysms suggested on MRA.

Postischemic administration of HMG CoA reductase inhibitor inhibits infarct expansion after transient middle cerebral artery occlusion.

Infarcts expand over a period of several days after focal cerebral ischemia. Inhibition of infarct expansion would be a promising strategy for the protection of the brain after ischemic insult. In this study, we examined the effect of statin treatment initiated 2 days after transient occlusion of the middle cerebral artery for 80 min.

Long-term outcome after STA-MCA anastomosis for moyamoya disease.

A long-term assessment was performed to determine the posttreatment clinical course of 113 patients with moyamoya disease. All patients sustained cerebral ischemic attacks and underwent superficial temporal artery-middle cerebral artery anastomosis with or without temporal muscle grafting. The follow-up duration was 3 to 24 years (mean 14.

Evaluation of cardiac sympathetic nerve function by myocardial 123I-metaiodobenzylguanidine scintigraphy before and after endoscopic sympathectomy.

Object: The purpose of this study was to analyze the change in cardiac sympathetic function by performing a 123I-metaiodobenzylguanidine (MIBG) imaging study after endoscopic upper thoracic sympathectomy (EUTS) in patients with palmar hyperhidrosis before and after surgery.

Methods: Between February 1999 and February 2002, 135 patients underwent bilateral EUTS to treat palmar hyperhidrosis. Between September 2001 and February 2002, 12 of these consecutively enrolled patients were also included in a 123I-MIBG imaging study.

Carbon dioxide insufflation for chronic subdural haematoma: a simple addition to burr-hole irrigation and closed-system drainage.

Burr-hole irrigation with closed-system drainage is a common surgical method used for chronic subdural haematoma. However, the subdural space with air that entered during surgery sometimes remains for a prolonged period after surgery and may hamper uncomplicated healing of the subdural space. We combined a simple procedure, insufflation of carbon dioxide (CO2) into the subdural space through a drainage catheter, with conventional burr-hole irrigation and closed-system drainage.

Transaqueductal aspiration of pontine hemorrhage with the aid of a neuroendoscope. Technical note.

The authors advocate the use of a 1.7-mm fiberscope to evaluate a hypertensive bilateral tegmental pontine hemorrhage that has ruptured, in part, into the fourth ventricle. In applying this new technique, a fiberscope, which contains a guide tube in the working channel, is inserted into the aqueduct.

Endoscopically assisted harvesting of the superficial temporal artery: technical note.

Objective: We developed an endoscopic method for harvesting the superficial temporal artery (STA) through a small incision away from the artery. This method was used to harvest the frontal branch of the STA through an incision made along the parietal branch.

Methods: A 7-cm linear incision is made along the parietal branch of the STA.

Endoscopically aided retroperitoneal placement of a lumboperitoneal shunt. Technical note.

The authors developed a method for retroperitoneal placement of a lumboperitoneal (LP) shunt with the aid of endoscopic monitoring. To perform this procedure, the patient is positioned laterally, the retroperitoneum is entered and dilated with a balloon through a small incision in the flank, and the space is maintained with CO2 insufflation. A peritoneal catheter is introduced into the cavity from the lumbar incision, through which the spinal catheter has been inserted.

Peritoneal shunt migration into the pulmonary artery--case report.

A 48-year-old man underwent ventriculoperitoneal shunting for hydrocephalus secondary to subarachnoid hemorrhage due to left vertebral artery dissection, which had been successfully treated by trapping. The peritoneal catheter was correctly positioned via a right upper abdominal incision, and symptoms related to the hydrocephalus disappeared. One month later, the patient began to complain of pain on the right side of the neck.

Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report.

A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis. The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis. His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation.

Patch angioplasty to repair the arteriotomy defect in the wall of the middle cerebral artery after failure of superficial temporal artery-middle cerebral artery anastomosis in moyamoya disease--case report.

A 65-year-old woman presented with moyamoya disease associated with a saccular aneurysm of the posterior cerebral artery. The surgical plan required superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis to be conducted before neck clipping of the aneurysm to provide collateral flow via the STA to prevent ischemia if temporary occlusion of the parent artery of the aneurysm was needed. However, the anastomotic procedure failed because the STA was occluded at the site of temporary clip application.

Endoscopic cranioplasty with calcium phosphate cement for pterional bone defect after frontotemporal craniotomy: technical note.

Objective: Postoperative pterional depression is a minor but unpleasant sequela of frontotemporal craniotomy. We developed a simple method for repair of this condition with the use of an endoscope and calcium phosphate cement.

Methods: The cranial defect was approached by means of endoscopic visualization through a small incision within the hairline.

[Extracorporeal ventriculoatrial shunt with the use of one-way ball valve].

We developed a simple system of an "extracorporeal" ventriculoatrial (VA) shunt using a one-way ball valve (Acty valve II, Kaneka Medix) to release the patient from postoperative constraint during the ventricular drainage. The system is constructed in such a way that the ventricular drainage tube is connected to the central venous catheter via a one-way valve. The CSF is regulated by using the valve and is diverted into the systemic circulation as in the conventional ventriculoatrial shunt.

Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings.

Object: Although the spontaneous occurrence of an unruptured vertebral artery (VA) dissection has increasingly been recognized as a relatively common cause of stroke, and the clinical aspects of this lesion have gradually been determined, its natural course remains obscure. The main goal of this study was to clarify the management protocol for this condition by examining serial angiographic changes in patients with unruptured VA dissections.

Methods: Seventeen patients with unruptured VA dissections, including 13 men and four women, were clinically and angiographically examined between 1993 and 1998.

Is sedation necessary for demented patients under infiltration anesthesia?

Background: Sedation for intraoperative patients under infiltration anesthesia is often used, however, disadvantages of sedation for demented patients may sometimes exceed its advantages because some of the demented patients are already apathetic about their surroundings. The authors prospectively investigated whether sedation for alert or demented patients receiving surgery under infiltration anesthesia is useful and safe for intraoperative management.

Methods: Sixty patients undergoing irrigation and drainage of chronic subdural hematoma under infiltration anesthesia were divided into four groups.

End-to-end anastomosis of the posterior inferior cerebellar artery before excision of a meningioma involving the lower clivus and the foramen magnum. Case report.

Background: Petroclival and foramen magnum meningiomas sometimes encase the vertebrobasilar arterial system. Magnetic resonance imaging can clearly reveal such encasement. The case presented here was of a meningioma involving the lower clivus and the foramen magnum, encasing a lateral segment of the posterior inferior cerebellar artery (PICA), despite the fact that no definitive diagnosis of the encasement of the PICA was made on preoperative radiological examination.

Falx meningioma presenting as acute subdural hematoma: case report.

Background: Acute subdural hematomas caused by meningiomas have been rarely encountered. Pathophysiologic mechanisms and clinical considerations in these patients have not been sufficiently explored. We addressed the possible mechanism of spontaneous hemorrhage in our case and briefly discuss the optimal treatment.