[Show abstract][Hide abstract] ABSTRACT: The authors introduced a new approach for clipping of the incidental aneurysm of the middle cerebral artery (MCA) and reported the clinical results. We retrospectively reviewed 26 patients with 27 incidental MCA aneurysms who were treated from January 2010 to December 2012. All clippings were performed through a small temporal craniotomy and linear skin incision. Follow-up imaging showed complete occlusion of 26 aneurysms (96.3%), residual neck in one (3.7%). In one case, residual neck of the aneurysm did not grow on serial follow up. In one of 26 cases (3.8%), approach-related complication was retraction injury of the temporal cortex. Two patients developed postoperative infarction on the MCA territories due to vasospasm and on the cerebellum due to unknown causes. These were not approach-related complications. Operation time was 95 min-250 min (mean 143 min). There were no complications of temporal muscle atrophy, scar deformity, paresthesia, or pain around the scalp incision and frontalis palsy. This approach offers good surgical possibilities and little approach related morbidity in the clipping of incidental MCA aneurysms.
Journal of cerebrovascular and endovascular neurosurgery. 03/2014; 16(1):32-8.
[Show abstract][Hide abstract] ABSTRACT: This article aimed to investigate the incidence rate and possible risk factors for catheter-induced hemorrhage (CIH) after brain parenchymal catheterization. Between January 2011 and March 2013, 381 patients (572 punctures) who underwent brain parenchymal catheterization were retrospectively evaluated. All patients were checked by computerized tomography scan for the detection of hemorrhage within 48 hours after catheter insertion. CIH was defined as any evidence of new hemorrhage on the post-procedural computerized tomography scan. The incidence rate and the possible risk factors were analyzed by surgeon (4 different surgeons performed the procedures), characteristics of the catheter device, and patient background. Of 381 patients, 572 punctures were performed and CIH developed in 122 puncture cases (122/572, 21.3%). The risk factors related to CIH were Glasgow Coma Scale (GCS) score ≤8 (p<0.01) and prothrombin time international normalized ratio (PT INR) ≥1.3 (p=0.038). The amount of hemorrhage was minimal without additional operations. A low GCS score and high PT INR are implicated as potential risk factors for CIH after brain parenchymal catheterization. Careful and delicate operative technique can help to reduce postoperative complications in these patients.
[Show abstract][Hide abstract] ABSTRACT: The pathogenesis of juxtafacet cysts is closely related to degenerative instability of the lumbar spine and degenerative changes in the ligamentum flavum and the facet joint. A 56-year-old man presented with severe right thigh pain and numbness for 1 month after a laminar fracture of the L4 spine. Magnetic resonance imaging revealed a heterogenous cystic mass surrounding the facet joint between the fourth and fifth lumbar vertebrae on the right side. Conservative therapy was unsuccessful and the lesion was removed by surgical decompression alone without fusion. The histological examination showed a fragmented, cystic wall-like structure composed of myxoid degenerative tissue without lining epithelium. Here we present this case of a ganglion cyst that appeared to be associated with facet joint instability.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the clinical effect of a continuous infusion of urokinase in cerebral stoke patients who were late admitted over 6 hours after onset. From January to December in 2008, acute cerebral stroke patients (n=143) treated with intravenous urokinase infusion (Group I, n=93) or not (Group II, n=50) after 6 hours and within 72 hours of stroke onset were reviewed. Continuous intravenous infusion of urokinase was done for 5 days. The clinical outcome for each patient was evaluated by using the modified National Institutes of Health Stroke Scale (NIHSS) on admission and on the day of discharge. The NIHSS score was decreased at discharge compared with admission in the urokinase treatment group (Group I; from 4.8±2.2 to 3.8±1.9; p=0.002). There was an improvement in the patients who initiated urokinase treatment within 24 hours from stroke onset in Group I (from 5.1±1.9 to 3.9±1.5; p=0.04). In patients with initiated urokinase treatment within 24 hours from stroke onset, intravenous urokinase infusion could be an effective modality in acute ischemic stroke patients admitted later than 6 hours after onset.