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全文: "Sylvian fissure"
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  • Hiroaki Iwasaki
    Internal Medicine
    2017年 56 巻 18 号 2545-2546
    発行日: 2017/09/15
    公開日: 2017/09/15
    [早期公開] 公開日: 2017/08/21
    ジャーナル オープンアクセス
  • 波出石 弘, 鈴木 明文, 師井 淳太
    脳卒中の外科
    2006年 34 巻 5 号 340-346
    発行日: 2006年
    公開日: 2008/08/08
    ジャーナル フリー
    In surgical procedures to dissect the sylvian fissure, the fissure is commonly unfolded by the attachment of all sylvian veins to the temporal lobe. During this procedure, cerebral edema and contusion in the frontal lobe are often caused by sacrificing bridging veins from the frontal lobe and excessive retraction on the frontal lobe. In this procedure, some sylvian veins must be kept on the side of the frontal lobe to preserve the bridging vein. In many cases, detachment of the sylvian vein from the surface of the temporal lobe is required. The sylvian vein can be detached from the temporal lobe using the space around the temporal artery right under the sylvian vein.
    For detachment of adhesions between the frontal and temporal lobes, a “paper knife technique” is available in which a surgical site is generated by cutting upwards from the subarachnoid space around M1. In a “denude technique,” a wide surgical field can be obtained with less retraction of the frontal lobe by detaching the arachnoid membrane from the sylvian vein and thus allowing venous extension. During dissection of the sylvian fissure, arteries and veins belonging to the temporal lobe spread while adhering to the frontal lobe. In this case, the site to dissect is the frontal-lobe side where the vessels are located, even if the sylvian fissure is widely unfolded. Conversely, when cerebral vessels belonging to the frontal lobe are attached to the temporal lobe, the site to dissect is on the temporal lobe side, where the vessels are located. Thus the concept of a “microvascular sylvian fissure” in which detailed vessel structures are captured at a microscopic level is important in terms of preventing damage to blood vessels, pia matter and brain tissue. It is crucial to obtain a large surgical field and confirm where blood vessels belong.
    To detach an aneurysm attached to arteries such as M2, A2 or perforating arteries and deep veins, without causing damage, using the tip of micro-forceps for microvascular anastomosis as a raspatory is useful. Other detailed technical ideas are introduced. These include: pulling the aneurysm into the surgical site by transposing the artery and aneurysm using brain spatulas, silk threads, and Aron alpha to confirm adjacent vascular structures such as perforating arteries; using a “double-clip technique” to confirm complete clipping with 2 clips; and deliberately shifting the bayonet clip to preserve perforating arteries.
  • Hiroyuki TOI, Nobuhisa MATSUSHITA, Yukari OGAWA, Keita KINOSHITA, Kohei SATOH, Hiroki TAKAI, Satoshi HIRAI, Keijiro HARA, Shunji MATSUBARA, Masaaki UNO
    Neurologia medico-chirurgica
    2018年 58 巻 2 号 85-90
    発行日: 2018年
    公開日: 2018/02/15
    [早期公開] 公開日: 2017/12/01
    ジャーナル オープンアクセス

    Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes. This procedure was termed “Sylvian ICG”. We observed ICG fluorescence quickly in all cases. Sylvian veins that appeared unclear in the standard microscopic operative field covered with subarachnoid hemorrhage were extremely clearly depicted. These Sylvian ICG findings were helpful in identifying entry points and the dissecting course of the Sylvian fissure. At the time of clipping, no residual fluorescence from Sylvian ICG was present, and aneurysm clipping was not impeded. Sylvian ICG for SAH patients is a novel technique to facilitate dissection of the Sylvian fissure. We believe that this technique will contribute to improved safety of clipping surgery for ruptured aneurysms.

  • 中村 歩希, 小野寺 英孝, 松森 隆史, 中山 博文, 榊原 陽太郎, 田口 芳雄
    脳卒中の外科
    2010年 38 巻 2 号 119-123
    発行日: 2010年
    公開日: 2010/10/27
    ジャーナル フリー
    We report a case of sylvian hematoma enlarging 3 days after neck clipping for a ruptured anterior communicating artery aneurysm, in the contralateral sylvian fissure to the operative approach.
    This 65-year-old man was admitted with sudden loss of consciousness by ambulance. Angiography revealed a saccular aneurysm at the anterior communicating artery complex, measuring 2.3×2.4 mm and pointing inferiorly. The aneurysmal neck was successfully clipped by using the right pterional approach. To minimize predictable vasospasm, the hematoma in the left sylvian stem was removed. Postoperative CT scan showed a considerable decrease in hematoma in the basal cistern, but a slight decrease in the vertical portion of the left sylvian fissure. The patient’s consciousness gradually recovered, but deteriorated again 3 days after the operation. CT scan showed a large high-density area in the sylvian fissure suggesting unexpected enlargement of sylvian hematoma. A left fronto-temporal craniotomy was performed. When the subpial hematoma around the sylvial fissure was removed, a large amount of bloody cerebrospinal fluid (CSF) flowed out. The cavity containing bloody fluid was located in the temporal lobe. Postoperative course was uneventful. He recovered well, but moderate sensory aphasia remained.
    Sylvian hematoma is rarely associated with ruptured anterior communicating artery aneurysms. Furthermore, there has been no report describing delayed onset sylvian hematoma as far as we are aware. The following mechanism was considered to explain this very rare condition. Removal of subarachnoid hematoma in the left sylvian fissure made a recovery of CSF flow up to the limen insulae, but CSF appeared to be blocked from entering the distal sylvian fissure by the thick subpial sylvian hematoma. Instead of normal CSF flow route, CSF may enter into the weakened subpial space to allow accumulation of bloody CSF in the temporal lobe. Subpial hematoma may act as a one-way valve.
  • Masayuki Yamagishi, Manoj Bohara, Soichiro Komasaku, Masahiko Yamada, Dan Kawahara, Yuko Sadamura, Masanao Mori, Yosuke Nishimuta, Takeshi Ishii, Hiroshi Tokimura
    NMC Case Report Journal
    論文ID: cr.2018-0215
    発行日: 2019年
    [早期公開] 公開日: 2019/03/21
    ジャーナル オープンアクセス HTML 早期公開

    Deep Sylvian meningiomas are rare, accounting for 0.3–0.4% of all meningiomas, and mostly present in young adults and children. We report on a 32-year-old man who presented with headache but had no neurological deficits. Computed tomography of brain revealed a 24 × 19 × 21 mm3 mass lesion in the right Sylvian fissure with calcification. Magnetic resonance imaging showed that the lesion was isointense on T1- and T2-weighted images (WI), with homogenous enhancement on post-gadolinium T1WI. The lesion was surgically removed via right fronto-temporal craniotomy. The tumor was located in deep Sylvian fissure and had no dural attachment. Histopathological examination of the lesion revealed both meningothelial and fibroblastic features, thereby suggesting the diagnosis of transitional meningioma (WHO grade I), with Ki-67 labeling index of 6.9%. Thus, meningioma should be considered as a differential diagnosis of enhancing mass lesions in the Sylvian fissure even in the absence of dural tail sign, especially in young adults and children.

  • 大里 俊明, 佐々木 雄彦, 早瀬 一幸, 高田 英和, 光増 智, 吉田 英人, 妹尾 誠, 武田 利兵衛, 中村 博彦
    脳卒中の外科
    2003年 31 巻 1 号 43-46
    発行日: 2003年
    公開日: 2008/03/18
    ジャーナル フリー
    The pterional approach is a fundamental technique for neurosurgeons, but difficulty for dissection of the sylvian fissure has considerable variety. Establishment of a safe and adequate technique to dissect the sylvian fissure is essential for all neurosurgeons.
    We introduce our operative technique for dissection of the sylvian fissure with the reverse plane view of arachnoid membrane and discuss the efficacy of this technique from an anatomical background.
    Dissection of sylvian fissure is started from the distal part, where arteries of the M2 segment are seated and adhesion of the frontal and temporal lobe is not so tight. Exposure of space around arteries of the M2 segment is necessary to obtain a direct view to the plane where the frontal and temporal lobe adhere more tightly with dissection progressing more medially. With the reverse plane view of arachnoid membrane of the proximal sylvian fissure, dissection between the frontal and temporal lobe can be achieved safely with a direct view.
    Our surgical technique facilitates dissection of the sylvian fissure and prevents damage of surrounding brain and vessels.
  • Ken KAZUMATA, Hiroyasu KAMIYAMA, Tatsuya ISHIKAWA, Katsumi TAKIZAWA, Takahiro MAEDA, Kennichi MAKINO, Satoshi GOTOH
    Neurologia medico-chirurgica
    2003年 43 巻 9 号 427-434
    発行日: 2003年
    公開日: 2005/04/27
    ジャーナル オープンアクセス
    Methods for preservation of the sylvian veins in the transsylvian approach have not been established because of the considerable variations. This study attempted to classify the sylvian veins to facilitate systematic dissection of the sylvian fissure for sylvian veins to be preserved. The operative anatomy of the sylvian vein was examined in 82 hemispheres. The type of drainage and the pattern of branching were investigated. The superficial sylvian vein (SSV) was classified into three types according to the number of stems draining into the dural sinus on the inner surface of the sphenoid bone: The SSV was absent or hypoplastic in eight cases, the SSV was single in 38 cases, and the SSV was double in 36 cases. The SSV drained into neither the sphenoparietal sinus nor the cavernous sinus in nine cases. An anastomosis between the SSV and the deep middle cerebral vein (DMCV) was observed in 42 cases. The frontobasal bridging vein (FBBV) drained into the sphenoparietal sinus in 47 cases. The type of connection was further subdivided into four types according to the connections with the DMCV and FBBV. The venous anatomy of sylvian fissure indicates that dissection (skeletonization) of the main stem of sylvian veins from the temporal lobe should be performed to preserve the tributaries from the frontal lobe.
  • Hung Tzu Wen, Albert L. Rhoton Jr., Eberval Gadelha Figueiredo, Manoel Jacobsen Teixeira
    脳神経外科ジャーナル
    2012年 21 巻 9 号 688-699
    発行日: 2012年
    公開日: 2012/10/29
    ジャーナル フリー
      Objective : The authors present the anatomical and angiographical details that enable surgeons to quickly locate middle cerebral artery (MCA) aneurysms and to gain proximal control without unnecessary delay or premature rupture.
      Materials and Methods : The anatomical dissections were performed in 10 adult cadaveric heads from 1993 to 2011 at the Department of Neurological Surgery, University of Florida. The angiographic and the surgical data were derived from 93 MCA aneurysms operated on by Hung Tzu Wen (HTW) from 1996 to 2012 at the Hospital das Clínicas, University of São Paulo and Hospital Samaritano, Brazil.
      Results : MCA aneurysms arise most frequently from the M1 segment and less frequently from M2. From a practical viewpoint, the M1 extends from the carotid bifurcation to the MCA genu (on the basal surface of the cerebrum) with specific topographical relationships along the way, and the M2 extends from the MCA genu to the sylvian or “M” point (on the lateral surface), also with specific topographical relationships. The key for the angiographical analysis of an MCA aneurysm is to establish its topographical relationship to the genu of the MCA. If it is proximal to the genu, it is important to estimate its distance to the carotid bifurcation and to the MCA genu. If it is distal to the MCA genu, it is important to estimate its distance to the genu and to the sylvian point ( “M” point). Also, it is important to evaluate the direction of the dome of the aneurysm, as it indicates the structures to which the dome is attached. The key for locating an MCA aneurysm intraoperatively is the relationship between the MCA genu and the tip of the pars triangularis. The tip of the pars triangularis is a reliable intraoperative landmark (even when it is obscured by severe subarachnoid hemorrhage) and it is located just distal to the MCA genu and approximately 2 cm distal to the sharp transition between the basal and the lateral surfaces of the cerebrum. Once the pars triangularis is identified, the MCA genu can also be quickly estimated and identified, and thereby so will the aneurysm.
      Conclusion : The carotid bifurcation, genu of the MCA, and the “M” point on the AP view carotid angiography, and the sylvian triangle on the lateral projection constitute the cardinal landmarks for locating MCA aneurysms angiographically. Correlating the angiographic location of the aneurysm to the pars triangularis of the inferior frontal gyrus constitutes the key for then locating the MCA aneurysm intraoperatively.
  • Yu Yamamoto, Sayaka Yamamoto, Shigehiro Kuroki
    Internal Medicine
    2012年 51 巻 14 号 1949
    発行日: 2012年
    公開日: 2012/07/15
    ジャーナル オープンアクセス
  • Sunil Kumar GUPTA, Virender Kumar KHOSLA, Rajesh CHHABRA, Sandeep MOHINDRA, Jaipali Rajeev BAPURAJ, Niranjan KHANDELWAL, Kanchan Kumar MUKHERJEE, Manoj Kumar TEWARI, Ashis PATHAK, Suresh Naraian MATHURIYA
    Neurologia medico-chirurgica
    2007年 47 巻 4 号 153-158
    発行日: 2007年
    公開日: 2007/04/25
    ジャーナル オープンアクセス
    Internal carotid artery (ICA) bifurcation aneurysms are relatively uncommon and frequently rupture at a younger age compared to other intracranial aneurysms. We have treated a total of 999 patients for intracranial aneurysms, of whom 89 (8.9%) had ICA bifurcation aneurysms, and 42 of the 89 patients were 30 years of age or younger. The present study analyzed the clinical records of 70 patients with ICA bifurcation aneurysms treated from mid 1997 to mid 2003. Multiple aneurysms were present in 15 patients. Digital subtraction angiography films were studied in 55 patients to identify vasospasm and aneurysm projection. The aneurysm projected superiorly in most of these patients (37/55, 67.3%). We preferred to minimize frontal lobe retraction, so widely opened the sylvian fissure to approach the ICA bifurcation and aneurysm neck. Elective temporary clipping was employed before the final dissection and permanent clip application. Vasospasm was present in 24 (43.6%) of 55 patients. Forty-eight (68.6%) of the 70 patients had good outcome, 14 (20%) had poor outcome, and eight (11.4%) died. Patients with ICA bifurcation aneurysms tend to bleed at a much younger age compared to those with other intracranial aneurysms. Wide opening of the sylvian fissure and elective temporary clipping of the ICA reduces the risk of intraoperative rupture and perforator injury. Mortality was mainly due to poor clinical grade and intraoperative premature aneurysm rupture.
  • 川口 哲郎, 藤田 稠清, 庄瀬 祥晃, 浜野 聖二, 谷本 敦夫
    脳卒中の外科
    1993年 21 巻 6 号 455-459
    発行日: 1993/11/30
    公開日: 2012/10/29
    ジャーナル フリー
    We report three cases of the sylvian fissure arteriovenous malformation (sylvian fissure AVM). The sylvian fissure AVM was a circumferential or penetrating type of AVM and many short feeding arteries of less than 1 mm were directly branched from the middle cerebral arteries (M2, M3). Preservation of the parent and transit arteries of the middle cerebral arteries was the most important goal of the operation.
  • Jiro SUZUKI, Akira TAKAKU, Hitoshi FUKASAWA
    Neurologia medico-chirurgica
    1966年 8 巻 269-270
    発行日: 1966年
    公開日: 2007/08/17
    ジャーナル フリー
  • Yuichi SATO, Shunsuke KAKINO, Kuniaki OGASAWARA, Yoshitaka KUBO, Hiroki KURODA, Akira OGAWA
    Neurologia medico-chirurgica
    2008年 48 巻 11 号 512-514
    発行日: 2008年
    公開日: 2008/11/25
    ジャーナル オープンアクセス
    A 53-year-old man presented with subarachnoid hemorrhage (SAH) in the left sylvian fissure. Preoperative computed tomography angiography revealed symmetrical aneurysms located at the bifurcations of the right and left middle cerebral arteries (MCAs). The left MCA aneurysm responsible for the SAH was clipped. The patient received post-surgical volume expansion treatment that did not induce hypertension. His systolic blood pressure ranged from 170 to 225 mmHg between the day of the first surgery and the 11th postoperative day. The postoperative course was uneventful until the 11th postoperative day when the patient suffered another SAH in the right sylvian fissure. The right MCA aneurysm was responsible for the second SAH and was clipped. The patient had multiple risk factors for rupture of concomitant unruptured aneurysm including a large, multilobed aneurysm, hypertension, smoking, and a family history of aneurysmal SAH. The present case suggests that all aneurysms should be simultaneously treated using endovascular coil embolization or several craniotomies if the patient has multiple risk factors.
  • 穂刈 正昭, 谷川 緑野, 林 恵充, 杉村 敏秀, 泉 直人, 橋爪 明, 藤田 力, 橋本 政明
    脳卒中の外科
    2003年 31 巻 5 号 349-354
    発行日: 2003年
    公開日: 2008/03/18
    ジャーナル フリー
    It is well known that the conditions of the superficial sylvian veins vary from patient to patient. But despite this considerable variation, a dissecting method of the sylvian veins in the transsylvian approach has not yet been systematically described. We introduce a simple, systematic 3-step approach, which is similar to the anterior interhemispheric approach by Ito Zentaro.
    Step 1: Open the Insular Cistern
    The incision of the arachnoid membrane is performed along the temporal side of the sylvian vein, beginning about 5cm distal from the temporal tip. The insular cistern should be exposed, during which time the M2 portion can be identified.
    Step 2: Dissect the fissure like opening an envelope with a knife
    The vertex of the head is slightly elevated at the beginning of this step. The arachnoid trabecula is incised toward the base of the sylvian fissure from the deep layer to the superficial layer, as if opening an envelope with a knife.
    Step 3: Open the Sylvian Vallecula
    The vertex of the head is slightly down at the beginning of this step. In this step, the sylvian vallecula should be exposed. Next, the carotid cistern is opened. As a result the M2-M1-ICA is exposed completely.
    By using these 3 steps, we dissect the sylvian fissure safely and easily and preserve all sylvian veins to prevent venous infarction.
  • Takayuki Mizunari, Yasuo Murai, Shiro Kobayashi, Shigeru Hoshino, Akira Teramoto
    Journal of Nippon Medical School
    2011年 78 巻 2 号 77-83
    発行日: 2011年
    公開日: 2011/05/06
    ジャーナル フリー
    Objective: To investigate the importance of sufficient dissection of the interhemispheric and sylvian fissures, an orbitocranial approach was used for clipping of ruptured anterior communicating artery aneurysms.
    Patients and Methods: From January 1998 through March 2009, 41 patients underwent surgery for subarachnoid hemorrhage caused by rupture of an anterior communicating artery aneurysm. Their mean age was 58.4 years, with a range of 37 to 84 years. The preoperative World Federation of Neurosurgical Societies grade was I to III in 32 patients and IV to V in 9 patients. The direction of the aneurysm was upward in 23 patients, forward in 14 patients, and backward in 4 patients. Seven patients had a large aneurysm.
    Results: All patients underwent surgery during the acute stage following the subarachnoid hemorrhage (day 0-2). A right orbitocranial approach was used for most patients, but a left orbitocranial approach was used for 9 patients because of the presence of a complicated aneurysm and the positional relationship of the left-right A2 segment. In 12 patients, external decompression was performed. The outcome, using the Glasgow Outcome Scale, was good recovery in 24 patients, moderately disabled in 8 patients, and severely disabled in 4 patients, and 5 patients died. Temporary eye movement disorders developed after surgery in 5 patients but resolved in all patients within 2 months. No patients had olfactory disturbance.
    Discussion: Using the orbitocranial approach and sufficient dissection of the interhemispheric and sylvian fissures, we could secure a broad field of vision and surgical field, which contributed to a safe operation. The only postoperative complication caused by the surgical approach was temporary eye movement disorder. Thus, for some patients with aneurysms of the anterior communicating artery, the orbitocranial approach contributes to improved outcomes.
  • 梅澤 邦彦, 金子 宇一, 西嶌 美知春, 田中 輝彦
    脳卒中の外科
    2004年 32 巻 6 号 408-415
    発行日: 2004年
    公開日: 2007/06/12
    ジャーナル フリー
    The surgical treatment of the middle cerebral artery (M1-2 bifurcation) aneurysm (MCA AN) employs the pterional approach and comprises much of aneurysm surgeries. But the surgical management of MCA AN remains a technically challenging problem especially for inexperienced neurosurgeons. This is largely caused by the difficulty of securing the M1 artery as the parent artery before exposing the whole aneurysm.
    In this study, we retrospectively analyzed the relationship between the approaches and operative difficulties in 90 MCA ANs in 86 of our patients operated on by the same neurosurgeon (K.U.). The variations of the MCA ANs were classified according to the following 3 points: the length of M1, M1 configuration on the angiogram (antero-posterior view), and the aneurysmal dome direction to M2. We subdivided the pterional approach into the following 4 groups: 1) the proximal approach (PA) to secure the proximal M1 after having controlled the internal carotid artery, 2) the distal approach (DA) to secure the distal M1 in the space between M2 arteries after having opened the distal sylvian fissure, 3) the superior approach (SA) to secure the distal M1 after having opened the distal sylvian fissure and followed the medial surface of M2 superior trunk, and 4) the inferior approach (IA) to secure the distal M1 after having opened the distal sylvian fissure and followed the lateral surface of M2 inferior trunk.
    The PA is effective in the cases of short M1 but in the cases of long M1 the DA is effective. The PA is safe for the cases in which the direction of the aneurysm is at the medial side of M2 arteries. On the other hand, in the cases in which the direction of the aneurysm is lateral to the M2 arteries, DA and SA are safe. In view of the results, we designed a scoring system to indicate the difficulties of securing M1 as the parent artery regarding the above-mentioned 3 points. Using these scores, we were able to decide the optimum approach preoperatively. To secure the parent artery is indispensable to safe aneurysm surgery. Comparing the points of each approach to the aneurysm with this scoring system, we were able to construct a better and safer micro-dissection plan with the goal of securing the parent M1 artery, and perform the operation by following the pre-operative plan. Surgical success or failure is determined by preoperative planning.
  • 平井 収, 松本 眞人, 岸 陽, 喜田 亜矢
    脳卒中の外科
    2004年 32 巻 4 号 275-279
    発行日: 2004年
    公開日: 2007/06/12
    ジャーナル フリー
    We report surgical treatment of 12 aneurysms located at early bifurcation of middle cerebral artery (MCA). The incidence of these aneurysms was 19.4% among 62 MCA aneurysms if the length of prebifurcation M1 of 15 mm or less was designated as the early bifurcation. Eight aneurysms were unruptured, and 4 patients presented with subarachnoid hemorrhage (SAH). The maximum diameter of aneurysms was less than 10 mm in 8 cases and 10 mm to 15 mm in 4 cases. The aneurysms were classified into 2 types: those buried deep in the sylvian fissure (Type I, 8 cases) and those projected anteroinferiorly and caged by deep sylvian veins and the sphenoid ridge (Type II, 4 cases). Small bridging veins were sacrificed in 6 cases to allow wide exposure and safe manipulation, and no venous infarction was encountered postoperatively. Surgical results were excellent in all but 1 patient with SAH where post-SAH hydrocephalus brought about some mental dysfunction. The patient was the only one who developed intraoperative aneurismal rupture.
    To accomplish proximal arterial control and optimal neck clipping, meticulous dissection of sylvian fissure was important for Type I cases, whereas extensive but careful drilling of sphenoid ridge and the making of working space around the caged aneurysm were necessary in Type II cases. For the purpose, some small bridging veins were reluctantly sacrificed.
  • Tetsuhiro KITAHARA, Hiroshi YONEDA, Shouichi KATO, Kouji KAJIWARA, Tatsuo AKIMURA, Michiyasu SUZUKI
    Neurologia medico-chirurgica
    2005年 45 巻 10 号 523-525
    発行日: 2005年
    公開日: 2005/10/25
    ジャーナル オープンアクセス
    A 67-year-old man presented with multiple aneurysms arising from the caudal loop of the posterior inferior cerebellar artery (PICA), possibly as a result of blunt trauma. Computed tomography of the head revealed subarachnoid hemorrhage in the posterior fossa and sylvian fissure. Repeated angiography demonstrated an aneurysmal dilatation and an irregular wall on the caudal loop of the PICA. Under the operating microscope, two lesions were observed 10 mm distal to the apex of the caudal loop, both consisting of a tiny hole on the vessel wall with a fragile fringe of connective tissue and covered with a firm clot. The height of the lesions corresponded to the C-l lamina, so the lesions were probably traumatic rather than saccular.
  • Hiroji MIYAKE, Tomio OHTA
    Neurologia medico-chirurgica
    2000年 40 巻 2 号 128-130
    発行日: 2000年
    公開日: 2005/09/02
    ジャーナル オープンアクセス
    Revisions were made to our new brain retractor with respect as follows. A knob was added to each shaft of the new brain retractor to facilitate handling. The angle between the shaft and the blade can now be adjusted from 60 to 135 degrees, which is useful in deep, narrow operative fields. Three blade lengths (20, 30, and 40 mm) are now available. The new retractor is entirely made from titanium. This revised brain retractor is very useful for the dissection of sylvian and interhemispheric arachnoid membranes, as well as in the extirpation of intracerebral masses via corticotomy.
  • 福島 庸行, 木村 知寛
    脳卒中の外科
    2010年 38 巻 3 号 191-194
    発行日: 2010年
    公開日: 2010/10/27
    ジャーナル フリー
    A 73-year-old male presented with hypertensive intracerebral hemorrhage that mimicked middle cerebral artery aneurysm on CT angiography. Nonenhanced CT showed hemorrhage in the right basal ganglia with extension to the sylvian fissure. CT angiography (CTA) revealed an aneurysm-like enhancement adjacent to the right M3 branch to M4. The location of the lesion was atypical and the neck was obscure for a middle cerebral artery aneurysm. On CTA performed 1.5 hour after initial CTA, the aneurysm-like enhancement had vanished. The patient underwent hematoma evacuation by craniotomy. No aneurysm was found in an intraoperative view or on digital subtraction angiography performed after the operation.
    We considered the aneurysm-like enhancement on CTA as contrast extravasation in the acute stage of hypertensive intracerebral hemorrhage.
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