SUCCESSFUL PAIN RELIEF BY MOTOR CORTEX STIMULATION FOR EXTENSIVE THALAMIC PAIN : CASE REPORT

Thalamic pain is known as the most difficult pain syndrome to treat. This paper describes our case treated successfully by motor cortex stimulation for extensive thalamic pain. A 59-year-old man with left thalamic pain was readmitted two years after an episode of right thalamic hemorrhage. He complained of tearing pain in the left eye, burning pain in the left upper and lower extremities, and chest pain. After one week of test stimulation, permanent implantation using two electrode arrays to include the area of the lower extremity was done. Excellent pain relief has been sustained for 10 months

POSTOPERATIVE VASOSPASM IN PITUITARY ADENOMA WITH PITUITARY APOPLEXY

A patient who developed complications relating to intracranial arterial vasospasm following transcranial removal of a pituitary adenoma with pituitary apoplexy is reported. A 23-year-old female was admitted because of headache. Computed tomography (CT) and magnetic resonance (MR) imaging revealed a pituitary adenoma with suprasellar extension and pituitary apoplexy and sinusitis in the right maxillary and ethmoid sinuses. A transcranial approach was selected because of active sinusitis. A large, pink intra- and suprasellar neoplasm and intratumoral clot were removed smoothly. Postoperatively, the patient remained stuporous and showed right hemiplegia. Angiography demonstrated stenosis of the left internal carotid artery and severe spasm of perforating arteries from the left middle cerebral artery. Large pituitary adenoma with pituitary apoplexy requires careful perioperative management, with particular attention paid to the surgical approach and procedures

Intraoperative acute brain swelling when performing indirect anastomosis in a patient with moyamoya disease -A case report-

A 6-year-old male patient who was suffering from a cold and a transient ischemic attack was scheduled to undergo encephalo-duro-arterio-synangiosis for treating his moyamoya disease. Acute brain edema occurred just after opening the dura mater. Head elevation, reduction of the head rotation and hyperventilation were done. The inhalational agents were discontinued and total intravenous anesthesia was started. The swelling was reduced after intravenously infusing mannitol. An abrupt return from hypocapnia to normocapnea during the induction of general anesthesia was thought to be the cause of the acute brain swelling. In conclusion, correction of hypocapnea needs to be performed gradually during the induction of anesthesia and when performing an operation for treating a patient with moyamoya disease

Intracranial internal carotid artery stenosis with vulnerable plaques successfully treated by stenting under cerebral protection.

Percutaneous transluminal angioplasty with stenting (PTA/stenting) for intracranial atherosclerotic stenoses is usually performed without any protection devices. We report a unique case of atherothrombotic stenosis with the vulnerable plaque in the cavernous portion of the internal carotid artery (ICA), which was successfully treated by PTA/stenting under cerebral protection with the flow reversal system. A 68-year-old woman presented repetitive transient ischemic attacks in the right ICA territory. Cerebral angiography revealed 80% stenosis in the cavernous portion of the right ICA. High-resolution magnetic resonance imaging (HR-MRI) demonstrated lipid-rich plaques at this lesion. PTA/stenting was performed with a proximal protection device under flow reversal. A filter device captured much amount of atherothrombotic debris with lipid-rich macrophages and leukocytes, which was consistent with HR-MRI findings. Some selected cases of intracranial atherothrombotic ICA stenoses may need endovascular treatment with cerebral protection system. HR-MRI is useful to evaluate plaque characteristics even in the cavernous portion of the ICA

Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage: a randomized experimental study in pigs

Abstract PURPOSE: To determine reciprocal and synergistic effects of acute intracranial hypertension and ARDS on neuronal and pulmonary damage and to define possible mechanisms. METHODS: Twenty-eight mechanically ventilated pigs were randomized to four groups of seven each: control; acute intracranial hypertension (AICH); acute respiratory distress syndrome (ARDS); acute respiratory distress syndrome in combination with acute intracranial hypertension (ARDS + AICH). AICH was induced with an intracranial balloon catheter and the inflation volume was adjusted to keep intracranial pressure (ICP) at 30-40 cmH2O. ARDS was induced by oleic acid infusion. Respiratory function, hemodynamics, extravascular lung water index (ELWI), lung and brain computed tomography (CT) scans, as well as inflammatory mediators, S100B, and neuronal serum enolase (NSE) were measured over a 4-h period. Lung and brain tissue were collected and examined at the end of the experiment. RESULTS: In both healthy and injured lungs, AICH caused increases in NSE and TNF-alpha plasma concentrations, extravascular lung water, and lung density in CT, the extent of poorly aerated (dystelectatic) and atelectatic lung regions, and an increase in the brain tissue water content. ARDS and AICH in combination induced damage in the hippocampus and decreased density in brain CT. CONCLUSIONS: AICH induces lung injury and also exacerbates pre-existing damage. Increased extravascular lung water is an early marker. ARDS has a detrimental effect on the brain and acts synergistically with intracranial hypertension to cause histological hippocampal damage