Japan Carotid Atherosclerosis Study : JCAS (EBM of Neurosurgical Disease in Japan)

The recent randomized trials, North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Asymptomatic Carotid Atherosclerosis Study, have demonstrated the effectiveness of carotid endarterectomy to reduce the incidence of cerebral infarction in patients with symptomatic and asymptomatic high-grade carotid artery stenosis. However, no studies on Japanese patients have been done until now, and recent progress in endovascular stent treatment has been made. The present prospective, multicenter (not randomized) trial, the Japan Carotid Atherosclerosis Study, has started to analyze present practice and propose treatment guidelines for Japanese patients. Here, the protocol and early results of 565 patients registered until the end of January 2004 are presented

Multiple Cerebral Vascular Malformations and Spontaneous Regression : Case Report

A female infant manifested a rare case of spontaneous regression of a vascular malformation in the occipital lobe after removal of another arteriovenous malformation in the frontal lobe. She was born with multiple nevi on the face, body, and upper and lower extremities. She demonstrated developmental retardation at 8 months of age. Computed tomography at 11 months of age demonstrated ventricular enlargement and a mass in the subdural portion of the left anterior fossa. Magnetic resonance images demonstrated signal void signs in the left frontal lobe, which suggested vascular malformation. Cerebral angiograms disclosed two vascular malformations. The malformation in the frontal lobe was totally removed. Cerebral angiograms 25 days after the operation failed to demonstrate either vascular malformation previously observed. Hemodynamic change following the removal of the arteriovenous malformation may have contributed to the occlusion of the remaining malformation

Vidian Artery as a Collateral Channel Between the External and Occluded Internal Carotid Arteries : Case Report

A 68-year-old man presented with occlusion of the internal carotid artery (ICA) manifesting as a 6-month history of progressive sensory and motor disturbance of the left lower limb. Angiography clearly demonstrated a collateral arterial network between the ICA and external carotid artery (ECA) through the vidian artery, a small branch of both the ICA and ECA. The vidian artery may form an unusual but important ECA-ICA collateral pathway in patients with occlusive lesion of the ICA

Idiopathic Interdural Hematoma Looking Like a "Chinese Dumpling" : Case Report

A 79-year-old man presented with an interdural hematoma manifesting as headache. Computed tomography revealed a right parietal intracranial hematoma. Magnetic resonance imaging revealed the hematoma had divided the dura mater into two layers. Craniotomy was performed and a dural pouch containing a solid hematoma was totally removed. Histological examination showed the hematoma had divided the meningeal dura into two layers. This case confirms the location of interdural hematoma