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Neurological Changes after Surgical Intervention for Intrinsic Cavernous Anigoma

Open Journal of Modern Neurosurgery 2012年第4期2卷 63-65页

作者： takafumi nishizaki Norio Ikeda Shigeki Nakano Tomomi Okamura Takanori Sakakura Department of Neurosurgery Ube Industries Central Hospital Nishikiwa Ube Yamaguchi Japan

We report neurological changes and circulatory and pulmonary symptoms after surgical intervention in cases of brainstem cavernous angioma. Eight patients who underwent surgical intervention for brainstem cavernous angiomas were retrospectively reviewed. Two of 4 patients who underwent total removal of the mass showed marked resolution of the preoperative signs including IX nerve palsy, MLF syndrome, cerebellar sign and homonymous hemianopsia, and two patients who underwent partial removal of the lesions had permanent neurological deficits. Inadequate excision results in not only recurrence of hemorrhage, but also postoperative neurological deterioration. Bradycardia can occur during the surgical intervention, and careful monitoring is mandatory for a couple of days after operation to detect circulatory and pulmonary failure such as atrial flutter.

关键词： Surgical Intervention Brainstem Cavernous Angioma Postoperative Neurological Changes Circulatory Pulmonary Symptoms

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Clinical Status of Patients with Cerebrospinal Fluid Hypovolemia Treated with an Epidural Blood Patch

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Open Journal of Modern Neurosurgery 2015年第4期5卷 107-112页

作者： takafumi nishizaki Norio Ikeda Shigeki Nakano Takanori Sakakura Natsumi Fujii Tomomi Okamura Ube Industries Central Hospital Ube Japan

Objective: Use of an epidural self-blood patch (EBP) is the most effective form of therapy for patients with cerebrospinal fluid (CSF) hypovolemia. However, even if the symptoms are resolved, other clinical aspects of this condition frequently prevent patients resuming social activity. In the present study, we investigated the clinical course of patients with CSF hypovolemia after treatment with an EBP to assess the factors affecting return to work or school, and considered the treatment of patients with progressive chronic subdural hematoma. Patients and Results: We investigated a group of 10 patients with CSF hypovolemia. After initial application of an EBP, 8 of these patients were completely relieved of postural headache and associated symptoms, and the other 2 recovered after a second application. However, 3 patients who had cervical spondylosis or psychosis were still unable to return to work or school. Two patients who were forced to retire have potential for rehabilitation after EBP. One patient has recovered from the illness, but could not return to school due to persistent medical history of psychosis. These patients had suffered symptoms for a long period before EBP (mean, 17.8 months;range 7 months to 3 years) relative to those who were able to resume social activity (mean, 2.0 months;range 7 days to 5 months) (P < 0.05). Three had progressive bilateral chronic subdural hematoma. One of these patients required emergency burr-hole drainage to resolve the neurological deterioration. Conclusions: Both physicians and patients need to be aware of CSF hypovolemia, and the fact that it requires appropriate treatment without delay. While application of an EBP is a fundamentally important therapy even for patients with hematoma, careful follow-up is required for patients showing marked neurological deterioration or an increasing hematoma volume with a brain midline shift, and burr-hole drainage must sometimes be considered in combination with EBP.

关键词： CSF Hypovolemia Epidural Self-Blood Patch Chronic Subdural Hematoma

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Factors Determining the Outcome of Pontine Hemorrhage in the Absence of Surgical Intervention

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Open Journal of Modern Neurosurgery 2012年第2期2卷 17-20页

作者： takafumi nishizaki Norio Ikeda Shigeki Nakano Takanori Sakakura Masaru Abiko Tomomi Okamura Department of Neurosurgery Ube Industries Central Hospital Ube Japan

Objectives and Importance: Although pontine hemorrhage is very often fatal, the clinical manifestations vary accord-ing to the location and extent of the hematoma. We investigated the prognostic factors of pontine hemorrhage by assessing clinical manifestation and CT findings in relation to outcome. Materials and Methods: The outcome and clinical features of 19 patients with pontine hemorrhage without surgical intervention were analyzed. The CT features of the hematoma were classified into four types: massive, tegmento-basilar, transverse oval, and small unilateral. The Glasgow Outcome Scale (GOS) was used to assess patient outcome (G, good recovery;MD, moderate disability;SD, severe disability, V, vegetative state, D, death) at discharge. Results: The outcome was MD in 7 cases, SD in 3, and D in 9. Eight of 9 patients with acute hydrocephalus died, whereas only one of 10 patients without hydrocephalus died (p 12, tetraparesis, or respiratory failure (p < 0.01, 0.05, 0.01, respectively). Four of 5 patients with CT evidence of massive hemorrhage died, and another patient became vegetative. The outcome in 6 patients with tegmento-basilar-type hematoma included D in 3, V in 2, and MD in 1, and that in 7 patients with transverse oval hematoma included D in 2, V in 1, SD in 1, and MD in 3. Five (65%) of the 8 patients with transverse oval or small unilateral hematomas were able to walk (MD) with or without assistance, whereas only 2 (18%) of 11 patients with tegmento-basilar-type and massive hematoma were ambulatory at discharge (p < 0.05). Conclu-sion: On the basis of CT classification, the functional prognosis of transverse oval pontine hemorrhage is as favorable as that of the small unilateral type.

关键词： Pontine Hemorrhage CT Findings Prognosis

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