BACKGROUNDIn epilepsy surgery for cavernoma with intractable focal epilepsy, removal of the cavernoma with its surrounding hemosiderin deposition and other extended epileptogenic zone has been shown to improve postsurgical seizures. However, there has been no significant association between such an epileptogenic zone and intraoperative electrocorticography (ECoG) findings. The authors recently demonstrated that high regular gamma oscillation (30–70 Hz) regularity (GOR) significantly correlates with epileptogenicity.OBSERVATIONSThe authors evaluated the utility of intraoperative GOR analysis in epilepsy surgery for cavernomas. The authors also analyzed intraoperative ECoG data from 6 patients with cavernomas. The GOR was calculated using a sample entropy algorithm. In 4 patients, the GOR was significantly high in the area with the pathological hemosiderin deposition. In 2 patients with temporal cavernoma, the GOR was significantly high in both the hippocampus and the area with the pathological hemosiderin deposition. ECoG showed no obvious epileptic waveforms in 3 patients, whereas extensive spikes were observed in 3 patients. All patients underwent cavernoma removal plus resection of the area with significantly high GOR. The 2 patients with temporal cavernomas underwent additional hippocampal transection. All patients were seizure free after surgery.LESSONSThe high GOR may be a novel intraoperative marker of the epileptogenic zone in epilepsy surgery for cavernomas.
Here we report two cases of a delayed mass after gamma knife surgery (GKS) for a cerebral arteriovenous malformation (AVM). Case 1 involved a 71-year-old man who had been treated with GKS for a ruptured AVM at 63 years of age. Computed tomography showed a cystic formation 2 years after the GKS. Magnetic resonance imaging 68 months later revealed a round mass in the irradiated area. The mass gradually increased in size and was resected 8 years after the GKS. Histological examination identified an expanding hematoma. Case 2 involved a 12-year-old girl who had been treated with GKS for a ruptured left occipital AVM diagnosed as Osler-Weber-Rendou disease at 5 years of age in another hospital. She presented with high fever, nausea, and general fatigue caused by an abscess in the left frontal lobe and a round mass with edema in the left occipital lobe. With conservative treatment, the frontal abscess disappeared and the occipital mass gradually reduced 3 months later. She was discharged without neurological deficits after 72 days. Our results show that serial long-term follow up is necessary, even if angiographic obliteration has been achieved after GKS for AVM.
• Abstract • Objective: Infection associated with coil embolization of cerebral aneurysm is very rare. We describe a case of brain abscess formation following coil embolization of a cavernous carotid artery giant aneurysm. Case presentation: This 59-year-old man complained of double vision due to a left cavernous carotid artery giant aneurysm. Embolization of the aneurysm using platinum coils was performed. However, the patient presented double vision again 1 year later. MRI showed brain abscess in the left temporal lobe, which appeared continuous with the aneurysm. His neurological condition rapidly deteriorated despite administration of antibiotic drugs. After additional aneurysm embolization and parent artery occlusion, brain abscess was surgically treated. Under the microsurgical view, the brain abscess directly connected the aneurysm and platinum coils were detected through a perforated wall of the aneurysm. Without removal of the coil, infection was completely resolved.
Conclusion:Coil infection of cerebral aneurysm should be noted, however it is very rare.•
Summary:One of the most important factors for successful operation of unruptured aneurysms is preservation of perforating arteries. Various surgical approaches and methods including MEP and ICG monitoring have been reported. However, a basic safe technique of manipulating the clip blade has not been related.To preserve perforating arteries, it is important to keep the tip of the blade in the visual field until completion of clipping.
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