[Carotid-ophthalmic aneurysms and visual abnormalities].

The direct neck clipping for carotid-ophthalmic aneurysm is hazardous and difficult as compared with other intracranial aneurysms because of its location adjacent to the anterior clinoid process, the optic nerve, and the cavernous sinus. The authors discuss the visual abnormalities accompanied by carotid-ophthalmic aneurysm on the basis of our experiences with 30 patients with 33 aneurysms. Ten patients (4 of 14 with ruptured aneurysms, 6 of 16 intact aneurysms) had preoperative visual abnormalities. Of our series of patients, visual acuity and visual field were impaired in one eye. The most common field abnormalities were unilateral inner or upper side defects. In the patients whose aneurysms were intact, visual abnormalities had been slowly progressive over many months. Otherwise, 2 cases with ruptured aneurysm experienced their first visual symptoms at the same time their hemorrhage. According to the projection of aneurysm with respect to internal carotid artery, superomedial and posteromedial projections were common in the patients with visual abnormalities. Seven patients with visual dysfunctions were operated on. Improvement of the visual symptoms was observed in 3 cases. In these cases, complete collapse of the aneurysm with good decompression of the optic nerve was obtained at operation. Two patients deteriorated following surgery; this occurred in relation to attempts to clip the aneurysm neck directly, and optic nerve was probably excessively manipulated. Two patients had no change in visual symptom: one was treated with trapping of internal carotid artery combined with STA-MCA anastomosis, another had direct hemorrhage into the ipsilateral optic nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical characteristics of contrast medium extravasation from intracranial aneurysms during cerebral angiography: studies on personal experience and review of the literature].

Angiography is essential to diagnosis and treatment for the patients with ruptured intracranial aneurysm in early stage, but on the other hand angiography always involves a risk that extravasation (EV) occurs from the aneurysm during angiography. Once EV occurs, the patient's outcome is poor and, in general, the patient tends to be regard as hopeless of recovery. Over the past 5 years, in 154 patients with ruptured intracranial aneurysm angiography was performed, and in 7 of them EV occurred. We performed neck clipping for ruptured aneurysm in 3 of 7 patients and were able to save the life of 2 patients. We investigated factors to cause EV and to decide outcome in 7 cases and 75 cases of literature, totally 82 cases. Following results were obtained. Occurrence of EV seems to be related to the causal factors of the time interval (within 6 hours) from SAH to angiography and the severity of disturbance of consciousness prior to angiography. It is considered that the patient's outcome is related to age, pre-angiographic severity of disturbance of consciousness, and also time interval from SAH to angiography, but the extent of EV and the number of past history of SAH are not important as the factors related to the outcome. Consequently, the utmost care must be taken for cerebral angiography particularly in patients within 6 hours after the onset of SAH, and in patients with severe disturbance of consciousness. Even if EV should occur, there is a fair chance for life-saving by an emergency surgery in cases with mild disturbance of cerebral function before angiography.

[A microsurgery operation for lumbar disc herniation (author's transl)].

An application of operating microscope for lumbar disc herniation surgery may reduce surgical trauma as compared to non-microsurgical procedure. This can be done very easily by monosegmental approach and employing of the improved optical conditions. This procedure implies better differentiation of anatomical structures and therefore also gentler manipulation of nerve root and dural sac. This procedure can be led to (1) much less bleeding, (2) much less (little) damage of muscle and nerve, (3) less local complication due to postoperative muscular insufficiency, (4) short period of the hospitalization and (5) easiler having postoperative rehabilitation.