[L1-2 lumbar disc herniation: a case report].

A 49-year-old female presented a two-year history of pain in the right thigh and lower back. Neurological examination on admission demonstrated weakness of the right iliopsoas and quadriceps, hypesthesia on the right L1-2 dermatome. Radiological examination including myelography, CT myelography and discography disclosed an L1-2 herniated disc. Sagittal MRI also revealed an L1-2, an L4-5 and L5-S1 protruded disc. A posterior microdiscectomy (Love's method) was performed for the L1-2 disc. A controlateral protruded disc which compressed the L-2 nerve root was identified and partially removed. The postoperative myelography showed residual disc. The patient was free from pain and regained normal sensorimotor function. Love's posterior microdiscectomy has a disadvantage in that the operative field is limited. Careful surgical procedure was needed to avoid injury to nerve roots and the cauda equina in a tight L1-2 lumbar canal.

Treatment of type II perimedullary arteriovenous fistulas by intraoperative transvenous embolization: case report.

BACKGROUND Perimedullary arteriovenous fistulas (AVFs) are abnormal vascular connections between medullary arteries and veins without an intervening nidus. It is thought to be difficult to treat Type II AVFs which have multiple feeding branches. We performed intraoperative transvenous embolization to treat Type II AVFs. CASE REPORT A 30-year-old man with Type II perimedullary arteriovenous fistulas (AVFs), present at the level of the L-1 vertebral body, underwent surgical and endovascular treatment. The patient displayed slight motor weakness (4/5) and slight hypesthesia in the right lower extremity. Angiograms demonstrated that an anterior spinal artery and posterior spinal arteries were feeding arteries for the perimedullary AVFs. The patient underwent surgical occlusion of the fistulas three times. Fistulas present on the dorsal surface of the spinal cord were occluded with hemoclips, while those located on the ventral and ventolateral aspect of the spinal cord were occluded transvenously with isobuthyl-2-cyanoacrylate (IBCA) during surgery. Total occlusion of the perimedullary AVFs was achieved with these procedures, and no change was noted postsurgically in the patient's symptoms. CONCLUSIONS In summary, Type II perimedullary AVFs are sometimes difficult to treat using either embolization or open surgery. In such cases, both open surgery and intraoperative transvenous embolization should be performed in order to obtain occlusion of multiple fistulas.

Lipoma in the quadrigeminal cistern--case report.

A 65-year-old male presented with a rare lipoma in the quadrigeminal cistern manifesting as left abducens nerve paresis which was effectively treated by total extirpation. The usual neurological symptoms of lipoma in the quadrigeminal cistern are intracranial hypertension and hydrocephalus which can be successfully treated by shunt operation. Direct surgery is indicated when the symptoms are ascribed to localized symptoms, but tumor removal should be partial if the superior cerebellar arteries are involved.

Intraoperative electrophysiologic monitoring of cranial motor nerves in skull base surgery.

BACKGROUND: Intraoperative cranial nerve monitoring has been applied for the preservation of nerve function during skull base surgery. However, its usefulness is controversial because clinical results reported are limited. METHODS: We evaluated the usefulness of intraoperative electrophysiologic monitoring of the third to seventh cranial motor nerves in 15 patients undergoing skull base surgery. Intracranial bipolar electrical stimulation of each nerve was performed, and compound muscle action potentials (CMAP) were recorded from the innervated muscles. RESULTS: CMAPs were successfully recorded from 23 of the innervated muscles. The loss of the CMAP response during the manipulation of lesions or high stimulus intensity at the end of manipulation seem to be related to the postoperative deficits of nerve function. CONCLUSIONS: The results suggest that intraoperative electrophysiologic monitoring of cranial motor nerves is useful for prediction of postoperative nerve function.

[Aspiration and drainage for brain abscess causing massive bleeding from abscess capsule: case report].

The authors report a rare complication during aspiration of a brain abscess. A 23 year-old man who had undergone surgery for empyema two months previously presented himself at our hospital complaining of headache, deterioration of activity and conscious level. An emergency computed tomography demonstrated a left frontal brain abscess. Aspiration and drainage were performed. However, this resulted in massive hematoma in and around the abscess capsule. Following craniotomy and excision of the abscess, the patient was cured. Microscopic examination of the abscess revealed the formation of a complete capsule consisting of fibroblasts and collagen fiber. In addition to this, significant neovascularization with inflammatory cells was apparent around the capsule. These findings suggest that profuse hemorrhage may occur in aspiration and drainage surgery.

[A case of posterior cerebral artery giant aneurysm with xanthochromic content].

We reported a case of posterior cerebral artery giant aneurysm with xanthochromic content. A 28-year-old male patient was admitted to our department suffering from lapses into unconsciousness once a month for the previous two years and a half. CT scan demonstrated a mass 2 cm in diameter in the right ambient cistern. The density of the inside of the mass was low, and that of outer border was high. The mass was not enhanced. MRI demonstrated that the intensity of the inside of the mass was low, and the outer part was iso-low in the T1 weighted image, while the inside was high and the outer part low in the T2 weighted image. Cerebralangiography showed an aneurysm of 5 mm in diameter at the bifurcation of the posterior cerebral artery (PCA) and the posterior inferior temporal artery. There was occlusion of the PCA. Accordingly, we diagnosed it as a calcified giant aneurysm with fluid-like content, and carried out surgery using the extended subtemporal approach. Inside the very stiff yellow-white wall of the aneurysm, there was only xanthochromic fluid without thrombus, and the structure of the aneurysm was cystic. The aneurysm was resected following neck clipping. After the operation, the patient's lapses into unconsciousness were able to be well controlled with anticonvulsants, and he left our department without any neurological deficit about a month afterwards. The histological findings of the specimen show the inner wall of the artery. Cases of giant aneurysms with xanthochromic content have rarely been reported. Only two are recorded, and this is the first case diagnosed using MRI.(ABSTRACT TRUNCATED AT 250 WORDS)