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✓The authors present a rare case of cervical myelopathy caused by dropped head syndrome. This 68-year-old woman presented with her head hanging forward. After 1 month, she was admitted to the medical service because of head drop progression. Examination of biopsy specimens from her cervical paraspinal muscles showed nonspecific myopathic features without inflammation, and isolated neck extensor myopathy was diagnosed. The patient’s condition did not respond to the administration of corticosteroids. During follow up as an outpatient, the patient’s head drop continued to gradually progress. At 1 year after onset, she developed bilateral weakness of the upper and lower extremities, clumsiness of the hands, and gait disturbance. A radiograph of the cervical spine obtained in a standing position showed a pronounced kyphotic deformity and instability at the level of C4–5. Magnetic resonance imaging demonstrated spinal cord compression at C-3 and C-4. The patient underwent a C3–4 laminectomy and occipitocervicothoracic fixation. Gait and hand coordination gradually improved, and she was able to walk with no support 1 month postoperatively. Surgical fixation was beneficial in this patient with dropped head syndrome, myelopathy, and cervical instability.

Complex cerebral artery bypass techniques are essential in the armamentarium of cerebrovascular for the treatment of complex lesions not amenable to endovascular therapy.

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Moyamoya disease is commonly diagnosed in children, and requires various vascular reconstruction to improve symptoms. Therefore, scar widening and hair loss after craniotomy, which sometimes occurs in this disease, are serious problems for patients. A variety of plastic surgical techniques in scalp have been reported to minimize the scar widening and hair loss. However, any neurosurgical reports describing this purpose have never been published for moyamoya disease. The objective of this study was to investigate whether these plastic surgical techniques could be applied to bypass surgery without any compromise of vascular reconstruction for moyamoya disease. We performed direct and indirect vascular reconstruction in six hemispheres of moyamoya disease patients not only in the middle cerebral artery territory but also in the anterior cerebral artery territory. The scalp incision was designed not parallel to the hair stream, and the bevelled incision was conducted not to jeopardize the hair follicles. The scar and hair loss were effectively camouflaged throughout the postoperative period in all cases. This study demonstrates that our design of scalp incision achieve effective vascular reconstruction and obscure the scar and hair loss.

No abstract

The operative approaches for ACom Aneurysms include the pterional approach and the interhemispheric approach, and we have used the latter approach in all of our cases. The interhemispheric approach appears to be useful in observing all vascular structures around the ACom complex, and to allow the neck of the aneurysm to be clipped in the ideal closure line. It is not easy to dissect the interhemispheric fissure, because visualizing the arachnoid trabeculae between the pia mater and the vessels can be complicated. The fissure can be separated without pial injury by identifying the microstructure surrounding the major vessels in the pericallosal cistern and the cutting the arachnoid trabeculae. The author describes technical points of interhemispheric approach.

A double cerebral protection system can resolve the intolerance to flow blockage, which is a problem with proximal protection devices. The goal of this study was to investigate the efficacy of a double cerebral protection system using distal filter and proximal embolic protection devices in carotid artery stenting (CAS). Diffusion-weighted MR imaging (MR-DWI) and major adverse events were used to evaluate this protective procedure.