Bone Flap Preservation in Subcutaneous Abdominal Pocket for Decompressive Craniectomy.

We report our experiences of two pediatric cases in which a bone flap was preserved in the subcutaneous abdominal pocket for decompressive craniectomy. In one case, the bone flap was divided and preserved for cranioplasty without complications; in the other case, the bone flap was left intact as one piece. In pediatric patients, the storage space for a bone flap is sometimes difficult to achieve, and the technique described herein is useful in such situations. Notably, because the bone resorption rate with cryopreservation is higher in pediatric patients, in vivo preservation may be more useful in this population.

Successful Surgical Management of Traumatic Intracranial Hemorrhaging After Revascularization Surgery for Moyamoya Vasculopathy: A Case Report and Review of Literature.

BACKGROUND: Traumatic intracranial hemorrhaging associated with revascularization surgery for moyamoya vasculopathy is a potentially devastating problem that requires meticulous management, including surgery. However, only a few studies on this subject have been reported, and the clinical characteristics are poorly understood. We report a case of successful surgical management for a patient with traumatic intracranial hematoma managed with encephalo-duro-arterio-myo-synangiosis (EDAMS). The purpose of this article is to clarify the specific features of clinical scenarios, hemorrhagic sites, and operative techniques by reviewing all published cases. CASE DESCRIPTION: A 10-year-old Japanese girl with a history of EDAMS for quasi-moyamoya disease was referred to our institution after minor head trauma. Cranial computed tomography scans revealed a right intracranial hematoma overlying the temporal muscle flap. After admission, hematoma developed, and emergency hematoma evacuation was performed. Venous hemorrhaging from the fascia of the temporal muscle flap was confirmed. Collaterals from indirect bypass were preserved in the surgery. Postoperative diffusion-weighted imaging revealed no ischemic complications. She immediately recovered and returned to her preinjury baseline. CONCLUSION: In moyamoya vasculopathy, intrinsic collaterals or de novo anastomoses from revascularization surgery are easily injured, even with mild head trauma. Furthermore, the administration of antiplatelets agents increases the risk of hematoma development. Sacrifice of collaterals can lead to acute cerebral infarction. During emergency surgery for traumatic intracranial hematoma, a careful surgical strategy is needed to preserve the collateral supply.

Infected multilocular hydrocephalus treated by rigid and flexible endoscopes with electromagnetic-guided neuronavigation: a case report.

BACKGROUND: Endoscopic surgery assisted by a navigation system has greatly aided treatment of infected multilocular hydrocephalus, especially in children. CASE REPORT: We describe a 2-year-old boy with multilocular hydrocephalus caused by repeated shunt infection, presenting with fever and vomiting. Magnetic resonance images (MRI) showed extraventricular cysts and severe ventricular deformity. There were three ventriculoperitoneal shunts and one residual ventricular catheter. With a flexible endoscope, we fenestrated the wall of extraventricular cysts and removed the residual catheter. We then used a rigid endoscope to fenestrate ventricular components. Both procedures were guided by electromagnetic (EM) navigation, and hydrocephalus was controlled with one ventricular catheter. CONCLUSION: We have successfully treated a case suffered from infected multilocular hydrocephalus in infants using rigid and flexible endoscopes combined with EM navigation.

Germinoma in the bilateral basal ganglia presented with cognitive deterioration.

PURPOSE: Here, we report a case of pediatric germinoma located in the bilateral basal ganglia, which presented with severe cognitive deteriorations. CASE REPORT: A 15-year-old boy presented with decreased school performance and mild cognitive disturbances. Magnetic resonance images (MRI) of the brain revealed T2 hyperintensity in the bilateral basal ganglia. The patient was initially observed by a local hospital and had screening for metabolic diseases or inflammatory diseases. Lesions with similar characteristics were also found in the pituitary stalk and infundibulum, and these lesions were enhanced with gadolinium (Gad). MR spectroscopy suggested that these should be neoplastic lesions other than metabolic or inflammatory diseases. Biopsy was performed with ventriculoscope, which proved all lesions of infundibulum, pineal, and basal ganglia were pathologically germinoma. The lesions responded well to the chemotherapy and radiation, and his cognitive function improved significantly. CONCLUSION: A case of germinoma in the bilateral basal ganglia which significantly affect cognitive functions is reported. Differential diagnoses of cognitive symptoms are various, but germinoma could be considered as a possible pathology for it. Early MRI and tumor marker exams are recommended, unless organic brain diseases are completely denied. MR spectroscopy and biopsy with ventriculoscope are useful for diagnosis.

[Resolution of migraine with aura by removing pilocytic astrocytoma of the occipital lobe].

Migraine is one of the symptoms frequently encountered in daily neurological and neurosurgical clinical work. Here we report a case of pilocytic astrocytoma in the right occipital lobe presenting as migraine with aura. A 20-year-old female was referred to our hospital with the complaint of a migraine with visual aura. Her symptom did not respond to medical treatment. MRI of the brain disclosed a tumor involving the right occipital lobe. Total removal of the tumor (pilocytic astrocytoma, WHO grade 1) relieved her migraine completely. It has been previously reported that brain tumors are associated with migraine. But this is the first report of occipital pilocytic astrocytoma presenting as migraine with aura. As for other brain tumors manifesting migraine, all of them had focal neurological deficits or symptoms associated with increased intracranial pressure (ICP). The present case stresses the significance of exploration of brain tumor, or other organic abnormalities, even in patients suffering from migraine without neurological deficits or increased ICP symptoms.

[A case report of bilateral cerebral peduncular infarction manifesting tetraparesis and pseudobalbur palsy].

A 63-year-old female had presented with right hemiparesis and slight dysarthria. MRI had showed the infarction of left pons and left peduncle. Three months later she further presented with left hemiparesis, severe dysarthria and swallowing disturbance. MRI showed bilateral cerebral peduncular infarction. And the angiogram showed the occlusion of basilar artery at the just distal portion of the superior cerebellar artery. We recognized our case as the infarction due to the basilar artery occlusion. The 16 cases of bilateral cerebral peduncular infarction were reported. In these reports, the symptoms of bilateral cerebral peduncular infarction were locked-in syndrome in 15 cases and persistent vegetative state in only one case. Our patient presented with tetraparesis and pseudobalbur palsy not with locked-in syndrome, probably because the area of infarction was limited within almost lateral portion of peduncle. The sparing of posterior cerebral artery was one of the reason of such a condition. This is the first report of bilateral cerebral peduncular infarction manifesting tetraparesis and pseudobalbur palsy.