[Spike discharge detected by intra-arterial electroencephalography from intra-arterial guide wire in temporal lobe epilepsy].

The implantation of electrodes for intracranial electroencephalography (EEG) recording as presurgical evaluation of patients with intractable epilepsy is at present most important for planning epilepsy surgery. This method is most effective in temporal lobe epilepsy. We carried out intracranial EEG by means of insulated micro guide wire for endovascular surgery in two temporal lobe epilepsy cases, and spike discharges could be detected in lesional medial temporal lobe.

Transbrachial approach with turn over technique for selective cerebral angiography--technical note.

A new technique to obtain selective internal carotid, external carotid and vertebral artery angiograms through the transbrachial route using a special 4-Fr long catheter and long guidewire positioned by a turn over technique is described. The technique was used in 25 geriatric patients to obtain angiograms without persistent complications.

Long-term follow-up study of "epileptic type" moyamoya disease in children.

Twenty-three patients with epileptic type moyamoya disease are reviewed among 200 moyamoya disease patients. Ten boys and 13 girls aged 5 months to 12 years were followed over 6 months to 17.3 years.

Cortical blood flow response to hypercapnia during anaesthesia in Moyamoya disease.

Cortical blood flow (CoBF) was measured continuously by the laser-Doppler method to evaluate the effect of hypercapnia on cortical blood flow during ten surgical procedures in ten young patients (mean +/- SD 9.3 +/- 6.4 yr) with Moyamoya disease.

Anastomosis of occipital artery to anterior inferior cerebellar artery with interposition of superficial temporal artery. Case report.

A 56-year-old man with vertebrobasilar insufficiency and associated findings including quadriparesis, dysarthria, cerebellar ataxia, nystagmus, and somnolence underwent left occipital artery (OA) to anterior inferior cerebellar artery (AICA) anastomosis with interposition of a superficial temporal artery (STA) graft. This procedure was chosen because cerebral angiograms demonstrated occlusion of the right vertebral artery (V3) and severe stenosis of the V4 segment of the left vertebral artery, with perfusion of the territory of the left posterior inferior cerebellar artery via the ipsilateral AICA, and because dissection of the OA is a relatively difficult and time-consuming procedure. Dissection of the STA, on the other hand, is much easier.

Cerebral revascularization using omental transplantation for childhood moyamoya disease.

Between January, 1986, and October, 1990, 30 children with moyamoya disease, aged from 2 to 17 years, underwent omental transplantation to either the anterior or the posterior cerebral artery territory. The mean follow-up period was 3.8 years, ranging from 1.

Surgical reconstruction of failed indirect anastomosis in childhood Moyamoya disease.

Thirty-one patients with moyamoya disease, who had been treated for encephaloduroarteriosynangiosis (EDAS), encephalomyosynangiosis (EMS) or EMS with encephaloarteriosynangiosis (EAS) in other hospitals, were admitted to Osaka Neurological Institute from January 1985 to September 1991. Twenty-seven of 57 sides treated by indirect anastomosis showed good filling of the middle cerebral artery (MCA) territory via the anastomosis, whereas 16 and 14 showed fair and poor collaterals via the anastomosis, respectively. Twenty-eight cerebral hemispheres treated by indirect anastomosis underwent further surgery and received superficial temporal artery-MCA anastomosis with or without EMS for still-existent recurrent transient ischemic attacks or completed stroke even after the indirect anastomosis.

Comparison of dynamic CT and stable xenon CT in ischemic cerebrovascular disease.

Purpose: To investigate a new hemodynamic parameter that can be obtained by dynamic CT and that reflects cerebral blood flow (CBF), in patients with ischemic cerebrovascular disease.

Methods: CBF and hemodynamic parameters including the area under the time-dependent contrast-medium dilution curve (A) and mean transit time (MTT) were measured in 23 patients with ischemic cerebrovascular disease. They included 17 patients in the chronic stage (more than 1 month after onset) and six with acute occlusion of the internal carotid or middle cerebral artery (within 24 hours of onset).

[Clinical application of calculation software of the four rules of arithmetic on computed tomography].

Calculation program software of the four rules of arithmetic in computed tomography (CT) has been introduced for clinical purposes since 1990. Evaluation of hemodynamic reserve and cerebral autoregulation can be calculated using this software in ischemic cerebrovascular diseases and delayed cerebral vasospasm after ruptured intracranial aneurysms. Eight hemodynamic maps can be entered and calculation based on the four rules of arithmetic can be performed between them and shown visually.

[Surgical excision of a huge olfactory groove meningioma by extensive transfrontal approach].

A case with a huge olfactory groove meningioma was cured surgically by extensive transfrontal approach. A 46-year-old female was admitted with complains of left visual disturbance. CT revealed a large high-density mass in the base of the frontal fossa which was enhanced homogenously.

[Multiple subpial transection after lesionectomy in an intractable epilepsy case].

A Sixty-one-year-old man was admitted to our hospital because of generalized convulsion. He had suffered from intractable epilepsy for 26 years. CT and MRI showed the right frontal cavernous angioma.

[Surgical excision of a cavernous angioma of the cerebral peduncle by orbito-fronto-malar approach].

A case with cavernous angioma at the left cerebral peduncle was cured surgically. A 36-year-old male was admitted with complaints of right facial palsy, right motor disturbance and cheiro-oral syndrome. CT revealed a round high-density mass in the left cerebral peduncle and thalamus.

Superselective embolization of spinal arteriovenous malformations using the Tracker catheter.

Eighteen patients with spinal arteriovenous malformations had been treated with conventional embolization, surgical removal, feeder ligation, and/or feeder coagulation between February 1985 and March 1990. The lesions included six glomus, four juvenile, three extramedullary, and five dural arteriovenous malformations or fistulas. Embolic therapy was conducted in 14 patients by introducing the tip of a catheter into the segmental arteries and injecting polyvinyl alcohol strips (500-1000 microns) (conventional embolization).

Evaluation of therapeutically induced hypertension in patients with delayed cerebral vasospasm by xenon-enhanced computed tomography.

Serial cerebral blood flow (CBF) measurements were made with stable xenon-enhanced computed tomography in 20 patients with angiographically confirmed ruptured intracranial aneurysms, before and during induced hypertension with continuous infusion of dopamine. All patients showed angiographic vasospasm during their course. Twelve patients without symptomatic vasospasm (Group 1) had the lowest hemispheric CBF on the craniotomy side of 31.

Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease.

Between May, 1974, and March, 1991, 104 patients with moyamoya disease, all under 16 years old at the time of first surgery, underwent superficial temporal-to-middle cerebral artery anastomosis and/or encephalomyosynangiosis. The mean follow-up period was 9.6 years (range 4.

Direct calorimetry using Swan-Ganz catheter for evaluation of general metabolic expenditure in acute cerebrovascular disease--comparison between direct Fick method and indirect calorimetry technique.

Oxygen consumption calculated by the direct Fick method using a Swan-Ganz catheter (D-VO2) and indirect calorimetry using a metabolic computer (ID-VO2), carbon dioxide production calculated by the latter method, and respiratory quotient were determined pre- and postoperatively in 12 patients with acute hypertensive intracerebral hemorrhage and eight patients with acute ruptured intracranial aneurysm. The mean D-VO2 value was slightly lower than the mean ID-VO2 value, but had a significantly positive correlation. The regression curve was very close to the line of identity.

Successful excision of a juvenile-type spinal arteriovenous malformation following intraoperative embolization. Case report.

The case of a 57-year-old woman with a 14-year history of progressive paraparesis is presented. Selective spinal angiography revealed a juvenile-type spinal arteriovenous malformation (AVM) with a typical large size and rapid flow. The AVM was located primarily in the retromedullary space at the cervicothoracic junction.

Neurosurgical application of a flow-directed oximetry thermodilution catheter for evaluation of cerebral blood flow--technical note.

The neurosurgical application was evaluated of a flow-directed oximetry thermodilution catheter for measurement of oxygen saturation in the jugular vein, which reflects cerebral blood flow (CBF). The catheter allows estimation of changes in CBF during carotid endarterectomy and therapeutically induced hypertension in the management of delayed vasospasm after subarachnoid hemorrhage.

Continuous alprenolol infusion for control of hypertension in the acute stage of ruptured intracranial aneurysms.

The clinical benefits and hemodynamic effects of continuous alprenolol infusion for control of hypertension in the acute stage of ruptured cerebral aneurysms were investigated. Twenty-five patients manifesting systemic hypertension (greater than 160/100 mmHg) were treated with alprenolol, a beta-adrenergic antagonist, phentolamine, an alpha-adrenergic antagonist, and trimethaphan camsilate, a ganglionic blocker, given intravenously. All drugs decreased the mean arterial blood pressure significantly.

Cerebral blood flow measurements using stable xenon CT with very short inhalation times.

A noninvasive, simplified method using inhalation of stable xenon (Xe(s)) and computed tomographic (CT) scanning to estimate regional cerebral blood flow (rCBF) and regional partition coefficient (r lambda) is described. Twenty-four patients with cerebrovascular occlusive disease and six volunteer controls inhaled 30% Xe(s) and 70% oxygen for 180 seconds and exhaled for 144 seconds during serial CT scanning without denitrogenation. The end-tidal Xe(s) concentration was continuously monitored with a thermoconductivity analyzer to determine the build-up range (A value) and build-up rate constant (K value) for arteries with the curve fitting method.

Hemodynamic evaluation in patients with superficial temporal artery-middle cerebral artery anastomosis--stable xenon CT-CBF study and acetazolamide.

Sixteen patients with minor completed stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The acetazolamide-activated regional cerebral blood flow (rCBF) was measured 20 minutes after the injection using inhalation of stable xenon and computed tomographic scanning (Xes CT-CBF study) pre- and postoperatively. Eleven patients (Group 1) showed immediate improvement in neurological state within a few days of the operation, while five (Group 2) showed no improvements.

Mechanism of the re-buildup phenomenon in moyamoya disease--analysis of local cerebral hemodynamics with intra-arterial digital subtraction angiography.

The authors investigated the mechanism of the re-buildup phenomenon on electroencephalogram in 14 patients of moyamoya disease with superficial temporal artery-middle cerebral artery anastomosis. Visualization of the lateral view of the common carotid angiography was performed with intra-arterial digital subtraction angiography (IA-DSA), using a 4/sec x 3 sec + 2/sec x 5 sec + 1/sec x 5 sec film sequence. The catheter tip was inserted into C5/6 level and 250 mgI/ml of iopamidol was used as the contrast agent; 6 ml in total was injected over 1.

Vertebrobasilar insufficiency: stable xenon computed tomography-cerebral blood flow study in posterior circulation revascularization.

Preoperative and postoperative local cerebral blood flow were measured by the stable xenon computed tomography-cerebral blood flow technique in 15 patients with vertebrobasilar insufficiency. The surgery included end-arterectomy or angioplasty of the vertebral artery (five cases), superficial temporal artery-superior cerebellar artery anastomosis (eight cases), and superficial temporal artery-posterior cerebral artery anastomosis (two cases). Fourteen (93.