Hiroyuki Jimbo

Rapid De Novo Aneurysm Formation after Rathke Cleft Cyst Rupture.

BACKGROUND Spontaneous rupture of a Rathke cleft cyst is very rare, and rapid de novo aneurysm formation associated with pituitary apoplexy is rare. CASE DESCRIPTION A 66-year-old woman experienced severe left temporal pain. Magnetic resonance imaging showed a Rathke cleft cyst, and transsphenoidal surgery was planned. However, the patient suddenly developed severe headache, vomiting, visual disturbance, and a lowered level of consciousness about 3 weeks after the first onset. The clinical course and neuroradiologic characteristics suggested Rathke cleft cyst rupture. The patient received hormone replacement, and the visual abnormalities resolved. However, subsequent neuroradiologic evaluation demonstrated that a de novo aneurysm in the cavernous sinus portion of the internal carotid artery had formed within 8 days after rupture of the Rathke cleft cyst. This de novo aneurysm was not apparent on initial magnetic resonance angiography. CONCLUSIONS This case features a rare clinical presentation of rapid de novo aneurysm formation after Rathke cleft cyst rupture. The severe inflammation around the vasculature after rupture of the Rathke cleft cyst might have been involved in aneurysm formation.

Acute management of early post-traumatic epilepsy in patients with mild to moderate traumatic brain injury:

Background Continuous electroencephalography (EEG) monitoring for up to 24 h has been suggested to detect non-convulsive epileptic seizures during the acute phase of severe traumatic brain injury (TBI). However, simpler management systems are needed for patients with mild to moderate TBI. Methods This retrospective single-institution study examined 105 patients admitted for treatment of mild to moderate TBI between 1 June 2012 and 31 March 2016. The study period was 14 consecutive days immediately after TBI. During the acute phase, patients received antiepileptic drug therapy based on physical examination and EEG findings and were subsequently monitored for recurrent or new-onset seizures. Results In all 105 patients, prophylactic administration of an antiepileptic drug was instituted on hospital admission. Based on physical examination and EEG data obtained during the first 72 h after admission, the patients were divided into three groups: those with (1) epileptiform spikes/waves (n = 23), (2) no epileptiform spikes/waves (n = 18), and (3) no EEG measurement (n = 64). Prophylactic administration of the antiepileptic drug was (1) combined with an adjuvant antiepileptic drug, (2) continued, or (3) discontinued. None of the patients had recurrent or new-onset post-traumatic epilepsy (PTE) or EEG findings indicative of PTE after the combined pharmaceutical intervention during the study period. Conclusion Our acute management system involving repeated short-duration EEG monitoring allowed for favorable treatment outcomes as no patients developed recurrent or new-onset PTE. This is theoretical grounds for a prospective study of this method to establish a more comprehensive management system with reduced physical and economic burdens on patients.

Modified Goel’s Methods for Basilar Impression: A Case Report with Literature

We report the case of a 57-year-old woman who had basilar impression manifesting as severe myelopathy and occipital neuralgia and was treated by distraction and fixation performed using a modification of Goel’s method. Magnetic resonance imaging (MRI) and computed tomography (CT) scans showed severe myelocompression by the dens of the axis from the ventral side and occipitalization of the atlas. After traction using a Halo vest, C1–2 facet distraction and fixation was performed in one stage using a modified Goel’s method. Although Goel et al. used a custom-made spacer to distract the facet joints, we used a threaded titanium cylindrical cage that was inserted into the joint to fix the C1–2 facet joint with posterior fixation from occipital bone to C5. Postoperatively, gradual symptomatic and neurological amelioration were observed. The atlantoaxial joints were bone-fused at 3 years post-operation. Distraction and fixation performed using this modified version of Goel’s method was effective for treating basilar invagination. The threaded titanium cylindrical cage provided adequate C1–2 space and strong initial fixation.

Minimally invasive space shuttle laminotomy for degenerative lumbar spinal canal stenosis

Study Design: Technical note. Objectives: To show microsurgical technique, considering the meticulous anatomy of the ligamentum flavum (LF). Background: Different methods are available for treating lumbar spinal canal stenosis (LSCS). A minimally invasive surgery, namely, space shuttle laminotomy, has recently been proposed. Here, we describe the surgical method for this novel technique. To conduct this surgery accurately, surgeons must have perfect knowledge of anatomy, especially regarding the LF. Materials and Methods and Results: We use this interlaminectomy technique for all cases of LSCS. All patients with LSCS recovered from their neurological deficits in shorter hoslital stays than regular laminectomy. Conclusion: Minimally invasive space shuttle laminotomy (MISSL), which involves a microsurgical technique, is a safe, complication-free procedure.

Positioning of Neurosurgical Patients

In order to reach the lesions through the minimal invasive corridor, patients are sometimes immobilized in specific postures that seem nonphysiological during neurosurgical procedures. There is concern that these positions may result in peripheral neuropathy and formation of pressure ulcers. The limitations of movements in the diaphragm and rib cage may affect respiratory functions. It is not uncommon that the skull is placed in anteflexion or greatly rotated, thus causing inhibition of venous return and increased intracranial pressure. If the head position is elevated extremely high and the pressure in the venous sinus becomes negative, there is a risk of the development of an air embolism.