Usefulness of Motor-Evoked Potentials Monitoring for Neurosurgical Treatment of an Unusual Distal Anterior Choroidal Artery Aneurysm

A 35 years old woman presented with an acute meningeal syndrome following an intra ventricular haemorrhage without subarachnoid haemorrhage. The angiography demonstrated a 6 mm partially thrombosed saccular aneurysm at the plexal point of the right anterior choroidal artery (AChoA). It was surgically approached inside the ventricle through a trans-temporal corticotomy. The aneurysm was excised after distal exclusion of the feeding artery under motor-evoked potentials monitoring. Of the 19 cases of distal AChoA aneurysm neurosurgical treatment, this is the only one performed under electrophysiology monitoring, a simple and safe method to detect and prevent motor tract ischemia. We discuss this rare case, along with a comprehensible review of the literature of the previous surgical cases of distal AChoA aneurysms.

Tratamiento quirúrgico de aneurisma de la arteria cerebelosa postero inferior gigante embolizado / Surgical treatment of embolized giant posteroanterior cerebellar artery aneurysm

Objetivo: descripción de la resolución quirúrgica de un aneurisma complejo, gigante de circuito posterior (arteria cerebelosa posteroinferior), embolizado previamente, y la evolución postoperatoria. Descripción: Paciente de 48 años de edad con antecedentes de hidrocefalia obstructiva, e hipertensión de fosa posterior, la cual fue tratada por vía endovascular hace 4 años, con colocación de derivación ventricular, y craniectomía descompresiva de fosa posterior, con evolución progresiva de déficit de pares craneales bajos, y síndrome de hipertensión endocraneana. Intervención: Se realizó abordaje extremo lateral con drilado parcial del cóndilo occipital, control proximal de la arteria vertebral, y reconstrucción de la pared aneurismática del sector arteria vertebral- arteria cerebelosa posteroinferior (PICA), mediante microcirugía, con posterior apertura del saco dural y remoción de coils y trombosis intraaneurismática, removiendo el efecto de masa aneurismático. Conclusión: El tratamiento microquirúrgico con la técnica de la reconstrucción parietal del aneurisma y el control proximal del mismo, en conjunto con abordajes de base de cráneo permiten el definitivo y adecuado tratamiento para los aneurismas gigantes de la pica.

Objective: to describe the surgical treatment for complex, giant, embolized, PICA aneurysm and the follow up.Description: 48 years old, female patient with clinical history of obstructive hydrocephalus and posterior fossa´s hipertension. The treatment was endovascular surgery with coils and venricular shunt with posterior fossa´s deccompresive surgery 4 years ago. The clinical evolution was poor. Due to low cranial nerves déficit and progressive posterior fossa´s hipertension, we performed microsurgical treatment Intervention: We performed extreme lateral approach with partial drilling of occipital condile, wiht proper proximal vascular vertebral control, and vascular parietal artery reconstruction in the vertebral-posterior inferior cerebellar artery (PICA) aneurysmatic segment,with microsurgery, posterior opening of the dome and coils remotion. Conclusion: Microsurgical treatment with reconstruction parietal technique, proximal vascular control and skull base approaches are the definitive and more adecuated treatment for giant PICA aneurysms.

Urodynamic Evaluation of Neurosurgical Effect in Myelodysplasia / 대한비뇨기과학회지

PURPOSE: To evaluate neurosurgical effect in the pediatric patients with myelodysplasia we reviewed preoperative and postoperative videourodynamic results. MATERIALS AND METHODS: All the 24 patients received untethering of spinal cord. Twenty postoperative urodynamic studies were performed between 6 months and 1 year, and 4 were performed at 3 months after operation. Uninhibited contraction and detrusor-sphincter dyssynergia(DSD) were checked in the patients having detrusor contraction and leak pressure was measured in areflexic bladder. RESULTS: Preoperative normal urodynamic finding was found in 6 patients. Among them one patient showed hyperreflexia with synergic voiding after operation. Normal detrusor contraction with DSD was found in 2 patients preoperatively One of these patients changed to high pressure areflexia Nine patients showed hyperreflexia preoperatively. Four patients among them had DSD. Five hyperreflexic bladders without DSD showed normoreflexia without 858 in one, low pressure areflexia in 3 and no change in one after operation. Out of four patients with hyperreflexia having DSD 2 showed high pressure areflexia, 1 showed atomic bladder and no change was seen in one. Seven patients had areflexia preoperatively. One patient with low pressure areflexia preoperatively showed high pressure areflexia postoperatively and 6 patients with high pressure areflexia preoperatively showed hyperreflexia with DSD in two and atonic bladder in one and no changes in 3 patients. CONCLUSIONS: From the above data we think that main urodynamic effect by neurosurgical treatment is decreasing detrusor activity. Although this effect on detrusor contraction is likely to be beneficial to myelodysplastic patients, more durable sphincteric activity may offset this profit.