[A case of bilateral extracranial carotid artery aneurysms caused by Takayasu's arteritis].

We describe here successful surgical treatment of a rare case of a rapidly enlarged aneurysm due to Takayasu's arteritis. A 22-year-old woman presented with a 1-month history of hoarseness and left neck pain. Contrast-enhanced computerized tomography showed an unruptured partially thrombosed aneurysm, and angiography revealed a large aneurysm of the common carotid artery. After hospitalization, the symptoms, interestingly, resolved spontaneously. While angiography at 2 weeks after admission showed the aneurysm to have reduced in size, 2 months later it showed the left common carotid artery aneurysm to be substantially enlarged in size and aneurysmal formation of the right external carotid artery. Surgical intervention was performed for the left common carotid artery aneurysm because rapid enlargement indicated the risk of aneurysmal rupture, and the thrombosis might cause embolic occlusion of the cerebral arteries. The left common carotid artery including enlarged aneurysm was trapped and anastomosed with a Gore-Tex graft (6-mm inner diameter) to left internal carotid artery. Histological examination of the arterial wall showed inflammatory change, destruction of the medial elastic fibers, and granulation with multinucleated giant cells. The postoperative course was uneventful, and no new vascular lesion was observed 3 years after operation. We demonstrated the bilateral extracranial carotid artery aneurysms caused by Takayasu's arteritis, which was the first case to be reported in the literature.

Analysis of the extent of astrocytic tumour resection evaluated by magnetic resonance images.

One of the most important prognostic factors in brain tumours is the extent of tumour resection. Its evaluation has been difficult on computed tomography (CT); however, magnetic resonance imaging (MRI) can clearly determine the extent of tumour resection. Using MRI, we analyzed 77 patients with astrocytic tumours that were surgically treated at our department from 1994 to 2001. The tumours were classified into the following types: (a) well-circumscribed: single lesions that can be distinguished from normal brain; (b) localised: single lesions that are localised in one gyrus; and (c) diffuse: other tumours. Our treatment of glioma resection is to use sulcus opening and gyrectomy, a technique based on identification and dissection of the sulcus adjacent to the tumour followed by en bloc tumour resection. Almost total tumour resection (> or =95% resection) was achieved in 76.8% in the well-circumscribed type, 100% in the localised type, and only 10.5% in the diffuse type. Nearly total resection was achieved in 61%, which is considerably more than in the literature of the CT era (10.4-23.5%). The sulcus opening and gyrectomy technique based on MRI achieved radical glioma removal in cases which could be identified by MRI, resulting in a better tumour removal rate than that based on CT.