Kentaro Koshino

Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: relationship between site of occlusion and clinical outcome.

Six cases of unclippable vertebral aneurysms were treated by therapeutic occlusion of the proximal vertebral artery. In three cases, the vertebral artery was clipped proximal to the posterior inferior cerebellar artery (PICA), and all of these patients had a postoperative embolic complication or a fatal subarachnoid hemorrhage. In two cases, the vertebral artery was clipped distal to the PICA and in one case the PICA was absent and the vertebral artery was clipped proximal to the aneurysm. All three of these patients did well without any neurological deficit. Possible mechanisms of the complications are discussed, and the importance of not clipping the PICA is stressed.

Analysis of lateral column units related to vesical reflexes.

Abstract Our aim was to confirm with electrophysiological techniques the concept previously based on anatomical studies that ascending fibers related to bladder sensation project to bulbar levels via a tract in the lateral funiculus, designated the “sacro-bulbar tract”. Thirty-two units, discharge patterns of which were altered during reflex “isovolumetric” vesical contraction, were recorded at the upper lumbar level of this tract. Unitary discharge was induced cystometrically in decerebrate cats. Fifteen units were accelerated during vesical contraction, and seventeen were inhibited. The injection of a barbiturate to suppress supraspinal influences on lateral column units, with the simultaneous intravesical infusion of pilocarpine to evoke a drug-induced vesical contraction, proved useful in assessing the centripetal or centrifugal nature of the responses.

Clinicoanatomical Study of Thalamic Stimulation for Pain Relief

Our small experiences with electrical stimulation in the VPL and VPM for dysesthetic pain show that it provoked only paresthesia and induced some relief of pain. It does not increase the beta-endorphin level in CSF. To clarify the anatomical substrata in VPL stimulation, neuroanatomical studies were done about the inputs to VPL in man, monkey and cat by the Fink-Heimer method. The spinothalamic tract terminates in VPL in a patchy fashion in the monkey. The corticothalamic fibers from SI and SII cortex project to VPL and VPM in somatotopical organization in the cat. SI and SII cortices have reciprocal connections, in addition to projections to area 5 or SIII cortex. The corticofugal fibers to the magnocellular and gigantocellular tegmental fields are suggested in addition to the dorsal column nuclei, spinal trigeminal nuclei and spinal posterior horn in cat. The medial lemniscus input to VPL and the above neural circuits are thought to be associated with VPL stimulation.

Prediction of ICP and Pressure Wave Discrimination with Our Intelligent Monitor System (IMNIC-1)

The clinical importance of continuous monitoring of ICP with other polygraphic data for intensive care of neurosurgical cases is already well-known. Successful feed-back of these polygraphic data for automated control of critically ill cases was reported in other fields (4, 5). There are few reports on the trials of automated control of ICP by signals from a continuous monitor (3), since the theoretical basis of pathophysiological mechanism of ICP is not yet well-established in spite of a numerous reports on clinical and experimental analysis of ICP.

Clinical Experiences of Non-destructive Transcutaneous Afferent Electrical Stimulation Therapy for Pain Relief

Clinical experiences of the transcutaneous afferent electrical stimulation therapy for various types of intractable pain are reported. A total of 29 pain patients included 9 residual or recurrent chronic pain patients who had had various destructive pain treatment, 15 non-malignant chronic pain patients and 5 patients with pain due to malignant tumors. In 93% of the patients complete or partial relief of pain was observed. After the subsequent successive stimulation therapy from a week to two years and ten months 86% of the 22 patients who could use the stimulator by themselves in free of charge got pain relief in more or less degree. Only 42% of these patients, however, wished to continue this therapy for their pain relief. All the malignant tumor patients and many posttraumatic chronic headache patients with Barre-Lieou syndrome discontinued electrical stimulation. Good benefits are to be expected from this non-destructive treatment for chronic pain in combination with medication and/or destructive treatment.