Yusuke Tanabe

Clinical analysis of a series of vertebral aneurysm cases.

We reviewed 38 cases of aneurysms of the vertebral artery treated over the last 10 years: 26 (68%) located at the junction of the vertebral and posterior inferior cerebellar arteries, 10 (26%) at the vertebral artery, and 2 (5%) at the vertebrobasilar union. There were three distinct forms of aneurysms: 20 saccular (53%), 10 fusiform (26%), and 8 dissecting (21%). Among these 38 aneurysms, 33 (87%) had ruptured: 18 of the saccular aneurysms (90%), all 10 of the fusiform aneurysms (100%), and 5 of the dissecting aneurysms (63%). Computed tomography of the 28 ruptured aneurysms revealed diffuse subarachnoid hemorrhage in the basal cistern combined with intraventricular hemorrhage in 24 cases (86%). Magnetic resonance imaging was useful for differentiating between fusiform and dissecting aneurysms. Abnormalities such as a double lumen of the vertebral artery were demonstrated in four of the dissecting aneurysms. The overall surgical results were good for 22 of the 27 surgically treated cases (81%). New bleeding was observed in 8 (24%) of the 33 ruptured aneurysms. The rate of new bleeding was high (60%) in the patients with dissecting aneurysms, and occurred mostly in the acute stage. The incidence of vasospasm was 27%, and only two patients suffered permanent neurological deficits. These findings indicate that the rate of new bleeding tends to be high in patients with saccular and dissecting aneurysms, and thus, they should be treated as early as possible. A preoperative balloon occlusion test should be conducted if proximal occlusion of the vertebral artery is necessary, since proximal occlusion is not always safe, despite angiographic evidence of sufficient contralateral arterial flow.

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.

Preventive therapy against delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage: Trials of thromboxane A2 synthetase inhibitor and hyperdynamic therapy

SummaryThe effects of thromboxane A2 synthetase inhibitor and hyperdynamic therapy on delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage were evaluated in a series of twenty eight patients, who underwent aneurysmal clipping with 72 hours after subarachnoid haemorrhage. Postoperatively, 13 patients were treated with thromboxane A2 synthetase inhibitor, Xanbon® {sodium (E)-3-[p-(1H-imidazol-1-ylmethyl)phenyl]-2-propenoate}. Hyperdynamic therapy with dobutamine was given to the remaining 15 patients. Of the 13 patients treated with Xanbon®, nine patients (69%) developed delayed cerebral ischaemia and cerebral infarcts occurred in eight patients (62%). On the other hand, of the 15 patients treated with hyperdynamic therapy, only three patients (20%) manifested delayed cerebral ischaemia and two patients (13%) developed cerebral infarcts.In the present study, the patients treated with hyperdynamic therapy met an expected incidence of ischaemic events after subarachnoid haemorrhage by todays standards, while those treated with thromboxane A2 synthetase inhibitor did not.

Cervical cord compression by the vertebral artery causing a severe cervical pain: Case report

A case of a cervical cord compression by the vertebral artery within the spinal canal is reported in a 47-year-old man. The clinical presentation, radiologic features, and the operative treatment are summarized. The mechanism by which this lesion caused a severe cervical pain is discussed.

Arteriovenous Malformation of the Spinal Cord and Cauda Equina Fed by Branches of the Internal Iliac Artery and Associated with Vertebral Hemangiomas

A rare case of an arteriovenous malformation (AVM) of the spinal cord is presented. The patient was a 35-year-old man who experienced progressive paraparesis and rectovesical disturbances. In this patient a spinal AVM was fed by branches of the left internal iliac artery and was associated with a sacral hemangioma. An additional hemangioma of the third lumbar vertebral body was also found. On reviewing the literature, only 4 cases, including ours, of spinal AVM with feeding vessels originating from the internal iliac artery were found. One of these patients had an associated vertebral hemangioma.