Management with a programmable pressure valve of subdural hematomas caused by a ventriculoperitoneal shunt: case report.
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Biomedical subjects
Publications and source records attributed to S Kamano.
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A case of aneurysm of the anterior inferior cerebellar artery at the internal auditory meatus is presented in which severe subarachnoid haemorrhage was followed by facial palsy. Eighteen cases in the literature are reviewed and their diagnostic and surgical implications discussed.
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A cerebellar abscess developed in a child with a penetrating transorbital wound extending deep into the cerebellum. The computed tomographic (CT) scans at first demonstrated the image of the residual foreign body as a sharp, low density track. This changed to high density with suggestion of granulation along the lesion. The cerebellar abscess developed at the tip of the track with CT ring enhancement. Antibiotic treatment reduced the size and density of the abscess.
Two cases of cervical dumb-bell tumour were operated on through the eroded and enlarged intervertebral foramina after the exact position of the tumours had been revealed by CT scan. This anterolateral approach was probably the best route for minimizing any operative damage to the spinal cord in these very advanced cases.
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A case of grade IV arteriovenous malformation(AVM) with 2 giant aneurysms, deeply seated in the dominant hemisphere speech and motor-sensory area, improved remarkably by a total excision, after an incapacitating rebleeding which occurred 4 months after a subtotal excision of the AVM. The author has learned importance of audacity on the part of the neurosurgeon. Personal experience of 37 CVM's (including 30 AV angiomas, 4 cryptic AVM's, and 3 other types of CVM's was analyzed. Of 37, 34 were operated on. Three were considered inoperable and were treated with radiotherapy (including proton beam). Of the 34 operated (30 AVM), 31 (24 AVM) were totally removed. None of them died or exhibitied deterioration. Of the 3 partially operated cases, one improved, two remained unchanged, but one of the two died of rebleeding 3 months later. Two of the radiated cases were later severely incapacitated due to rebleeding. One that underwent proton therapy is still under observation without deterioration after 18 months.
Posterior inferior cerebellar arteries originating from the vertebral arteries between the axis and the atlas were demonstrated angiographically in a 12-year-old boy. The patient presented with tetraparesis of sudden onset after a gymnastic exercise. There was no recognizable trauma.
The essential feature of tumour therapy rests upon host-tumour interaction. To achieve therapeutic effects, a prerequisite to immunotherapy is the reduction of tumour cells in the host's body. Such measures should not be immunosuppressive. Cytotoxic chemotherapy is not appropriate in this regard. Supraradical surgery and non-specific radiotherapy are not desirable for preservation of nervous function, if their immunosuppression is not as severe as cytotoxic substances. Boron-neutron capture therapy is a highly specific and least immunosuppressive means of reducing tumour cells of the central nervous system. A brief introductory review of basic research is presented. The interim clinical results are: (i) Treatment of recurrent glioblastoma: Survival extension obtained by neutron capture therapy is 21.9 +/- 7.2 mos in contrast to that obtained by conventional treatments of 6.7 +/- 0.6 mos (p less than 0.001), (Total survival 26.3 +/- 6.7 mos); and (ii) only three patients including two glioblastoma cases were treated with neutron by the same surgeon who, by performing the first tumour operation, had the advantage in topographic knowledge for determining the radiation field. They survived 4, 5, and 6 years in almost fully active conditions. The new Musashi Institute of Technology Reactor Thermal Neutron Therapy Facility and the increased domestic production of boron-10 isotope have enlarged the therapeutic capacity to two dozen patients a year.
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After the first report on ventriculography with a water-soluble contrast medium, Conray, by Campbell et al., many authors reported complications such as convulsion which are attributable to the irritating effect of this agent. On the other hand its value has been appriciated. Recently Gonsette recommended a new water-soluble contrast medium, meglumine iocarnate (Dimer-X), for ventriculography and reported that this new agent is less epileptogenic and less harmful. Because of these advantages, they have been performing ventriculography routinely with Dimer-X and recognized its usefulness. The only noticeable complication has been the transient elevation of body temperature in almost a half of the series. As far as our experience goes there is no case of convulsive seizure as complication. As compared to gas ventriculography, the fine details of dimension and configuration of the ventricles are far more beautifully delineated with the water-soluble contrast media.
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