Background: Given the popularity of pterional craniotomy, numerous modifications have been made to prevent postoperative deformities. With the advent of titanium plates, fixation has become both simple and excellent. However, titanium plates can cause skin problems, infection, or cause skull growth to fail. Methods: To develop a simple, cost-effective, and esthetically satisfactory fixation method, without the use of non-metallic materials, six young and older patients underwent pterional craniotomy. CranioFix Absorbable clamps were used to fix the bone flap in the frontal and temporal regions such that the frontal part was in close contact with the skull. After fixation, the bone chips and bone dust were placed in the bone gap and fixed with fibrin glue. We measured the computed tomography values of the reconstructed area and thickness of the temporal profiles postoperatively over time. Results: Bone fusion was achieved in all patients by 1 year after surgery. Both the thickness of the temporalis muscle and the thickness of the temporal profile had changed within 2 mm as compared with the preoperative state. Conclusion: Our simple craniotomy technique, gentle tissue handling, and osteoplastic cranioplasty yielded satisfactory esthetic results and rigidness in pterional craniotomy.

2013年1月〜2016年12月の頸部内頸動脈狭窄症患者で、頸動脈内膜剥離術中に大耳介神経をフィルムで湿潤保護したフィルムあり群10例(男9例、女1例、平均年齢74歳)と保護しなかったフィルムなし群10例(男9例、女1例、平均年齢71.9歳)を対象に、術後12ヵ月間の大耳介神経領域感覚障害の有無を患者より直接聴取して比較した。術後の感覚障害はフィルムあり群:フィルムなし群でそれぞれ、1ヵ月後に7例:9例、3ヵ月後に6例:9例、6ヵ月後に4例:7例、12ヵ月後に0例:1例であった。感覚障害消失までの期間の中央値はフィルムあり群が6ヵ月、フィルムなし群が12ヵ月であり、12ヵ月後にフィルムなし群で1例に下顎部違和感が残存した。感覚障害の部位はフィルムあり群6例とフィルムなし群9例でGrammaticaらの7つの領域のうち2と3に発生した。

症例は59歳女性で、起床時より激しい頭痛を認めたが自宅で経過をみていた。3日後に他院を受診し、頭部CTでくも膜下出血を認め、当院紹介となった。入院当日に動脈瘤コイル塞栓術を施行した。術後1日目より、尿量増加と尿比重低下、脱水、高ナトリウム血症を認め尿崩症と診断し、バソプレシン持続静注を開始した。術後3日目のMRIで動脈瘤周囲の前頭葉から視床下部に及ぶ浮腫を認め、術後7日目に左眼視力は1.2と保たれていたが左眼鼻側下1/4盲を認めた。術後52日目に左眼の視力が手動弁にまで増悪したため、視交叉の圧迫を早急に解除すべきと判断し、術後53日目に開頭術によりコイル塊を摘出した。術後、左眼視力は0.6に、左眼視野は増悪前の鼻側下1/4盲まで改善し、右眼視野欠損は消失した。開頭術後30日目に独歩自宅退院となった。

OBJECTIVE The vascular lumen of an acutely occluded internal carotid artery (ICA) generally contains numerous thrombi. Therefore, carotid angiography on the affected side during revascularization therapy of acute ICA occlusion has a potential risk of causing distal embolization. In this study the authors propose the use of contralateral carotid angiography. METHODS Six patients with acute ICA occlusion underwent revascularization therapy using a stent retriever or Penumbra system. Revascularization therapy was performed with placement of a 9-Fr balloon-guiding catheter (BGC) in the affected ICA and a 4-Fr diagnostic catheter in the contralateral ICA. During the procedure, the 9-Fr BGC was kept inflated, and all control angiography was performed from the 4-Fr diagnostic catheter. After thrombectomy, contralateral carotid angiography combined with manual aspiration from the 9-Fr BGC was performed to assess the presence or absence of residual thrombi in the affected ICA. The 9-Fr BGC was deflated only after the complete absence of residual thrombi in the affected ICA was confirmed. RESULTS The time required for introducing the 4-Fr diagnostic catheter into the contralateral ICA was within a few minutes in all patients. Residual thrombi in the affected ICA were found in 3 of 6 patients. The residual thrombi in these 3 patients were completely removed; thus, distal embolization was prevented. CONCLUSIONS Contralateral carotid angiography is useful for avoiding distal embolization during revascularization therapy of acute ICA occlusion. Further studies involving a larger number of patients are warranted to verify the clinical efficacy of this contralateral carotid angiography.