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Biomedical subjects

T Sonokawa

Publications and source records attributed to T Sonokawa.

7 recordsLinked to original sources
PubMed2001

Penetrating injury of the brain by the burr of a high-speed air drill during craniotomy: case report.

The most critical complications of craniotomy are caused by the plunging of a skull drill, and there have been no reports of penetrating brain injury caused by the broken burr of a high-speed air drill during craniotomy. Left orbitofrontal craniotomy was performed to clip two aneurysms in a 44 year old man. While cutting the lateral orbital rim with the burr of an Ultra Power surgical drill system, the burr broke off and penetrated the frontal lobe down to the falx cerebri. There were no discernible contusion or haemorrhage in the brain. The accident occurred because a long burr for the angled attachment of a Surgairtome was erroneously attached to the angled attachment of an UltraPower surgical drill. The mismatch between the steel strength and torque of the two burrs designed for different drill systems seemed responsible for breakage of the burr. We learned a valuable lesson from this failure: that all new instruments, including high-speed air drills, must be studied carefully so that staff become thoroughly familiar with their handling.

Adult↗
PubMed2000

Arteriovenous malformation of the medulla oblongata supplied by the anterior spinal artery in a child: treatment by microsurgical obliteration of the feeding artery.

We report a unique case of a 3-year-old boy with a pial arteriovenous malformation (AVM) in the medulla. The patient presented with a subarachnoid hemorrhage. Magnetic resonance (MR) imaging revealed a 3 x 1 cm flow void area in the premedullary cistern that was compressing the medulla posteriorly. Cerebral angiography and MR angiography showed an aneurysm-like vascular pouch that was fed by the anterior spinal artery and had multiple draining veins. The case was diagnosed as a fistula-type AVM. Treatment options consisted of endovascular embolization or open surgery. We used a left far lateral approach to obliterate the anterior spinal artery. Immediately after the clip was applied to the feeding artery, the pouch began to shrink, and the color of the draining veins changed from red to blue. An intraoperative angiography showed that the AVM had disappeared. The patient recovered fully 1 month after surgery. This case was classified as fistula-type AVM, pial arteriovenous fistula (AVF). Microsurgical obliteration of the anterior spinal artery is considered to be the treatment of choice for perimedullary AVF located in the premedullary cistern if the endovascular treatment is not considered to be feasible.

Arteries↗
PubMed1998

[Surgical interruption of draining vein or dural sinus: treatment for petrotentorial dural arteriovenous malformation].

The authors report three cases with petrotentorial dural arteriovenous malformation who underwent surgical interruption of the draining vein or dural sinus. They discuss the rationale and feasibility of this surgical procedure. Case 1 (70-year-old man) presented with trigeminal neuralgia and cerebellar ataxia caused by subarachnoid and cerebellar hemorrhage. Case 2 (68-year-old man) with trigeminal neuralgia due to venous mass effect. Case 3 (48-year-old man) with dementia caused by venous ischemia in the bilateral thalami. Cases 1 and 2 underwent lateral suboccipital craniotomy followed by infratentorial supracerebellar approach, and the draining vein was interrupted by aneurysmal clip under the cerebellar tentorium. Case 3 underwent surgical occlusion of the straight sinus by occipital transfalcine transtentorial approach after transarterial embolization had failed. Intraoperative digital subtraction angiography revealed the disappearance of dural AVMs in all three cases. The clinical symptoms disappeared postoperatively, and follow-up 6-vessel-angiography 2, 20, 11 months later, respectively, revealed no recurrence of dural AVMs. It has recently been proposed that many cranial dural AVMs with leptomeningeal venous drainage require only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination. The striking clinical and radiological improvement in these cases emphasizes the pivotal role of surgical occlusion of the draining vein for petrotentorial dural AVMs which are not amenable to cure by endovascular procedures.

Aged↗
PubMed1996

Dural arteriovenous malformation manifesting as tic douloureux.

BACKGROUND: Although cerebral arteriovenous malformation (AVM) is an established cause of trigeminal neuralgia, dural AVM has rarely been reported to cause tic douloureux. Treatment of dural AVM in the tentorial and torcular regions by transarterial embolization is rarely curative. It has recently been proposed that many cranial dural AVMs with leptomeningeal venous drainage require only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination. CASE REPORT: We present a case of 65-year-old man with typical trigeminal neuralgia caused by a dural AVM. Carotid angiography revealed a dural AVM in the petrotentorial region with enlarged and serpiginous draining veins, which compressed the trigeminal nerve. Facial pain had been completely relieved for 2 months after successful transarterial embolization, but the symptom recurred. The patient subsequently underwent surgical interruption of the draining veins just beneath the cerebellar tentorium. The dural AVM disappeared, and the trigeminal neuralgia was completely relieved. CONCLUSION: The literature concerning the etiology of tic douloureux is reviewed and the selection of treatment modality of this case is discussed. The striking clinical and radiologic improvement in this case emphasizes the pivotal role of simple interruption of the arterialized vein for petrotentorial dural AVMs, which are not amenable to cure by endovascular procedures.

Aged↗
PubMed1995

Reversible dural arteriovenous malformation-induced venous ischemia as a cause of dementia: treatment by surgical occlusion of draining dural sinus: case report.

We report a unique case of thalamic dementia caused by tentorial dural arteriovenous malformation (AVM), which was successfully treated by surgical occlusion of the straight sinus after attempts to occlude the dural AVM by endovascular procedures had failed. The tentorial dural AVM was fed by bilateral posterior meningeal arteries and occipital arteries, with early retrograde venous drainage into the straight sinus, inferior sagittal sinus, basal vein of Rosenthal, and dural veins in the falx cerebri. The venous ischemia in bilateral thalamus was revealed as low-density areas in computed tomographic scans, as high-intensity areas in T2-weighted magnetic resonance images, and as decreased cerebral blood flow and increased cerebral blood volume in single-photon positron emission computed tomography. Because this patient was not amenable to cure by endovascular embolization, an open surgical approach, surgical occlusion of the draining venous channel (the straight sinus), was performed. Postoperatively, dural AVM in angiography and venous ischemia in bilateral thalamus were resolved, as revealed by magnetic resonance imaging and single-photon positron emission computed tomography. Dementia caused by bilateral thalamic ischemia was also resolved. This case clearly illustrates the pathophysiological mechanism of venous ischemia in the bilateral thalamus to cause reversible dementia.

Brain Ischemia↗
PubMedDate not supplied

Cerebral edema associated with craniectomy and arterial hypertension.

The present studies were performed to determine whether cerebral edema will develop as a consequence of arterial hypertension and/or craniectomy. Arterial hypertension was induced for 30 minutes by inflation of a balloon catheter situated in the descending aorta, and a parietal craniectomy was performed. The cerebral edema noticed was evaluated by macroscopic and microscopic observations, BBB permeability of HRP and Evans blue and water content. In addition, ICP was measured in the cisterna magna and ICPP by a catheter-tip transducer. In arterial hypertension or craniectomy alone, some small areas of Evans blue extravasation with increased water content were seen in the cortex, which corresponded to the occipito-parietal parts of the arterial boundary zones. In contrast, when arterial hypertension was combined with craniectomy, these lesions extended further into underlying white matter with increased water content. Forty-eight hours later, extensive brain edema with a shift of midline structures developed on the side of craniectomy which differed from that in arterial hypertension or craniectomy alone. It is suggested that some hydrostatic pressure gradients, particularly between blood vessel and surrounding extracellular space and among different areas within the brain parenchyma, may play an important role in the development of brain edema.

Animals↗