Correlations Among Consistency, Computed Tomography Values, and Histopathological Subtypes of Spinal Meningioma

The consistency of spinal meningiomas is important to consider when performing tumor removal surgery. This study evaluated the correlations between spinal meningioma consistency and both preoperative computed tomography (CT) values and histopathological subtypes. Fifteen consecutive patients who underwent surgical resection of spinal meningioma at our institution were identified, and preoperative CT values and the signal intensity of T2-weighted magnetic resonance images of the tumor were determined retrospectively. The consistency of the spinal meningioma was defined based on the ultrasonic surgical aspirator output during tumor debulking. Patients were assigned to 2 groups: a soft group (n=4) and a hard group (n=11). The T2 signal intensity was significantly higher in the soft group than in the hard group (p=0.001). While the CT values were considerably higher in the hard group, the difference was not significant (p=0.19). Regarding the histopathological subtypes, psammomatous meningioma exhibited significantly higher CT values than meningothelial meningioma (p=0.019); however, there was a higher frequency of hard tumors in meningothelial meningioma cases than in psammomatous meningioma cases. Although neither robust correlations between tumor consistency and CT values nor a relationship between tumor consistency and histopathological subtype has been established, these results might help with the perioperative manegement of spinal tumors

Usefulness of needle holder with a function of fine forceps for bypass surgery in both hands

Background:In bypass surgery, a single-handed needle holder is usually used with other handed fine forceps. Recently, a needle holder with the function of fine forceps has been developed.Methods:In this technical note, usefulness of newly developed needle holders in both hands is presented in bypass surgery.Results:With this method, surgeons can make stitches and ties by both hands without exchanging instruments.Conclusions:This method is effective and may result in faster anastomotic procedure comparing with the traditional one.ArticleSurgical Neurology International.6:55(2015)journal articl

Clip Blade Scissoring With Titanium Bayonet Clip in Aneurysm Surgery - Two Case Reports

Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. The present cases suggest the following points. Bayonet clips in addition to straight clips may display the scissoring phenomenon during clipping surgery. The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 52(2):84-86 (2012)journal articl

Early Changes in Tissue Perfusion After Tissue Plasminogen Activator Administration in Hyperacute Ischemic Stroke: Initial Experiences With Arterial Spin Labeling Perfusion Magnetic Resonance Imaging-Two Case Reports

Cerebral perfusion monitoring is an important component of hyperacute stroke treatment. Arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging provides a noninvasive method of cerebral perfusion observation. Rapid changes in cerebral perfusion were demonstrated in two patients admitted one hour after onset of hyperacute stroke who underwent recombinant tissue plasminogen activator (rt-PA) treatment. Serial MR images and ASL images were taken on admission and after rt-PA administration. Cerebral blood flow (CBF) values were obtained using the CBF workstation and analysis software. Interpretable ASL images were taken in both patients. Perfusion deficits were consistent with symptoms and/or MR angiography imaging abnormalities. Delayed arterial transit effect was present in one patient; serial imaging showed improvement of CBF after rt-PA treatment in both patients. ASL perfusion MR imaging can provide rapid noninvasive multislice imaging in hyperacute ischemic stroke, and can depict early perfusion deficit and quantify regional CBF concomitantly.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 53(4):213-216 (2013)journal articl

Febrile neutropenia in a patient with non-small-cell lung cancer treated with atezolizumab: A case reportLearning points

Hematological immune-related adverse events (hem-irAEs) related to immunotherapy have not been extensively characterized, and there is no report of neutropenia caused by atezolizumab administration. Herein, we report a case of febrile neutropenia caused by a hem-irAEs due to atezolizumab, which was treated with granulocyte-colony stimulating factor (G-CSF) and antibiotic prophylaxis. It is important that oncologists be aware of the hematological toxicities of immune checkpoint inhibitors (ICIs). Furthermore, antibiotics and G-CSF should be administered until absolute neutrophil count recovery in cases of febrile neutropenia complicated by atezolizumab. Systemic corticosteroids should not be administered because they can accentuate the risk of infection

Clip Blade Scissoring With Titanium Bayonet Clip in Aneurysm Surgery

Scissoring of the cerebral aneurysm clip blades is a rare but potentially devastating complication of clipping surgery and results in aneurysm neck injury inducing rupture and/or cerebral infarction. Scissoring has been reported using titanium straight clips. Here we present two unusual cases of crossing of the blades of titanium bayonet clips by a scissors-like mechanism during surgery. The present cases suggest the following points. Bayonet clips in addition to straight clips may display the scissoring phenomenon during clipping surgery. The slipped clip should be removed immediately because the scissor-like deformed aneurysm clip may slip further and result in parent artery stenosis. Scissoring tends to happen in the presence of partial arteriosclerosis of the aneurysm neck. Before a titanium clip is used to treat an aneurysm with partially arteriosclerotic neck, reducing the amount of aneurysm filling by temporary clipping of the main vessel is useful to avoid slippage phenomena.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 52(2):84-86 (2012)journal articl

Early Changes in Tissue Perfusion After Tissue Plasminogen Activator Administration in Hyperacute Ischemic Stroke: Initial Experiences With Arterial Spin Labeling Perfusion Magnetic Resonance Imaging

Cerebral perfusion monitoring is an important component of hyperacute stroke treatment. Arterial spin labeling (ASL) perfusion magnetic resonance (MR) imaging provides a noninvasive method of cerebral perfusion observation. Rapid changes in cerebral perfusion were demonstrated in two patients admitted one hour after onset of hyperacute stroke who underwent recombinant tissue plasminogen activator (rt-PA) treatment. Serial MR images and ASL images were taken on admission and after rt-PA administration. Cerebral blood flow (CBF) values were obtained using the CBF workstation and analysis software. Interpretable ASL images were taken in both patients. Perfusion deficits were consistent with symptoms and/or MR angiography imaging abnormalities. Delayed arterial transit effect was present in one patient; serial imaging showed improvement of CBF after rt-PA treatment in both patients. ASL perfusion MR imaging can provide rapid noninvasive multislice imaging in hyperacute ischemic stroke, and can depict early perfusion deficit and quantify regional CBF concomitantly.ArticleNEUROLOGIA MEDICO-CHIRURGICA. 53(4):213-216 (2013)journal articl