Mitsuaki Takada

Surgical treatment of cavernous angioma involving the brainstem and review of the literature

SummaryFive cases of symptomatic cavernous angioma involving the brainstem are reported. Magnetic resonance (MR) imaging is of greatest value in the diagnosis and for surgical indication. All cases were treated by radical extirpation. All of them improved postoperatively. The surgical indications for this lesion of the brainstem are briefly discussed with a review of the literature, including 28 previous cases, operated on directly.

Analysis of reruptured cerebral aneurysms and the prophylactic effects of barbiturate therapy on the early stage

During the past seven years, we have studied 661 cases of ruptured intracranial aneurysms. Rebleeding occurred in 65 cases (10%) and, within this group, 43 cases (70%) rebled within the first 6 hours after initial subarachnoid haemorrhage (SAH). Analysis of these 43 cases led to the following conclusions: 22 patients incurred rebleeding from causes such as transfer (6 cases), neuroradiological examinations (13 cases), and tracheal intubation during anaesthesia etc. (3 cases), while no special causative factors were discovered in the other 21 cases. Rebleeding occurred in 19 patients even while on absolute bed rest and in 11 patients who had induced systemic arterial hypotension (under 140 mmHg) through treatment. Six cases experienced rebleeding while undergoing angiography within 6 hours after the first subarachnoid haemorrhage. Eight of 17 reruptured anterior cerebral complex (Acom) aneurysm cases and 8 of 11 reruptured middle cerebral artery (MCA) aneurysm cases had an intracerebral haematoma on initial CT-scan following the first attack, demonstrating that the risk of rebleeding was very high in cases of intracerebral haematoma. The mortality rate for these rebleeding cases was high i.e. 65%. Therefore, because the time factor could precipitate rebleeding, early transfer and operation was considered optimal for minimizing rebleeding soon after an aneurysm rupture, even though angiography within 6 hours of the first SAH was a serious risk. Barbiturate therapy, performed as early as possible for serious cases, was considered to be effective in preventing rebleeding.

Cranioplasty utilizing a preserved autogenous bone flap coated with acrylic resin.

SummaryCranioplasty utilizing a resin-coated preserved autogenous skull flap was devised and used in 36 cases, 14 of them being followed up radiologically. It has been confirmed that this method is advantageous in that it repairs the skull defect satisfactorily both from surgical and cosmetic points of view. Furthermore this method causes no anxiety to the patient because of the autogenous origin of the bone flap. We recommend this method for cranioplasty when an autogenous bone flap is preserved.

Clinical study of subcortical hematoma

過去4年間に取り扱った外傷脳動脈瘤破裂を除く皮質下出血は68例で, うち特発性28例, 高血圧性17例であった.特発性を病理組織学的にsmall angiomatous malformationが証明されたcryptic AVM群 (13例) と真の特発性, すなわち原因不明群 (15例) に分け, 高血圧群と比較検討した.1) 発症年齢はcryptic AVM群では平均40歳であったが各年齢層に及び, 必ずしも若年者とは限らなかった.又, crypticAVM群には女性が多かった.2) 初発症状は高血圧性が片麻痺, 言語障害で発症したのに対し, cryptic AVMは頭痛, 悪心で発症し進行が緩徐であった。3) 血腫部位は高血圧群, cryptic AVM群は頭頂葉, 原因不明群は後頭葉に多かった.4) 脳血管撮影ではcryptic AVM群の5例にearly venous filling, extravasationなどを認めた.5) cryptic AVMの発見には術中の検索が大切で, 高血圧性と思われても探索を怠ってはならない.6) 予後は高血圧群, cryptic AVM群, 原因不明群とも良好例が多かったが70歳以上の高齢者は合併症の為, 不良であった.