Internal carotid (IC) flow was monitored in 35 patients during aneurysm surgery using an electromagnetic flowmeter around the carotid artery in the neck. This was advantageous in patients with large aneurysms to reveal internal stenosis or kinking of a related artery, that was not suspected from the surgical observation. It was also useful for control of induced hypotension to prevent ischemic complications, especially for patients with severe SAH (grade III, IV). Autoregulation response, studied before craniotomy, was lost and IC flow severely decreased under mild hypotension. Systemic blood pressure did not always give indications for caution against cerebral ischemia.
In the central nervous system, motor and sensory system are a convinient context in which to observe some physiological response. Additionally the rela-tionship between behavior and neurophysiological findings are easy to identify. The purpose of this paper is to clarify the mechanism of recovery of motor function after making small lesions which are small in comparison with those studied earlier. Furthermore an attempt was made to elucidate the relation-ship between motor control and sensory evoked responses. Measurements of behavioral motor function, evoked movements by brain stimulation and sensory evoked responses were taken from monkeys with array of 36 electrodes chroni-cally implanted in sensory motor cortex, before and after small electric lesion. The study was performed in two groups, the group of sensorimotor cortical damage and that of the small damage in the internal capsule. The change of three parameters showed the correlation with each other during recovery in the group 1. In the group 2, on the other hand, three parameters were not always similar in the recovery process. In the recovery of motor function, participation of the function of the area adjacent to the injured site could represent one of the important factors. Observation on sensory evoked re-sponse provided a better indicator of the recovery of motor function in the group 1 than in the group 2.
The most significant surgical complication with vertebral artery aneurysms located at or close to the midline is retraction damage to the VIIth to XIIth cranial nerves. From our experience with three patients, we have found the best surgical approach to minimize the cranial nerve injury. The location of the aneurysms related to the jugular tubercle was an important factor for selection of the surgical approach. The procedures we recommend are described below. For aneurysms which are located higher than the level of the jugular tubercle, a posterior transpetrosal approach should be adopted. A lateral suboccipital approach should offer sufficient surgical space for aneurysms which are located on or lower than the level of the jugular tubercle by removal of the jugular tubercle or occipital condyle (transcondyle approach). A transoral transclival approach might be indicated for aneurysms located lower than the level of the jugular tubercle
A case of a recurrent and growing giant aneurysm following repeated endovascular treatment is discribed. The patient finally underwent direct clipping of the aneurysm. A surgical specimen of the aneurysm showed marked neovasculization in both the aneurysmal wall and mural thrombus. These findings suggest that this aneurysm grew by repeated bleeding between the aneurysmal wall and the outer layers of the thrombosed sac. Possible explanation of the enlarging aneurysms and risk of endovascular surgery as a treatment for this aneurysm are discussed.
Thirteen patients with primary brain lymphoma (PBL) were treated with radiotherapy. Three patients also had ocular involvement with retinal masses at initial presentation. All but one patient received conventional whole brain irradiation and, in addition, spinal irradiation, intrathecal methotrexate or orbital irradiation were given in two, two and four patients respectively. The radiation doses for involved sites ranged from 40 to 65 Gy, and for prophylactic sites from 30 to 50 Gy. After radiotherapy, all patients had complete regression of the tumor on computed tomography. Nine patients relapsed, 5 of them with brain recurrence. Two patients had ocular recurrence exclusively as their first relapse. The remaining two relapsing patients had bone lesions. One patient died intercurrently. As a result, only three patients are alive and free of disease after 16 to 36 months and all three received some adjuvant treatment in addition to whole brain irradiation.
