Ossification of the posterior longitudinal ligament OPLL in the thoracic spine cause myelopathy with anterior spinal cord compression, the cause is usually progressive and refractory to conservative treatment. Therefore, early decompressive surgery is imperative in such cases. However, decompression surgery of thoracic OPLL is difficult, and its outcome is often poor. We investigated whether anterior decompression and bony fusion via the anterior approach can be used for the treatment of myelopathy secondary to thoracic OPLL. The outcome and complications associated with this method were analyzed in 9 patients who were treated with this procedure. Of the 9 patients, 3 were treated using transsternal approach, and 6 were treated using transthoracic approach. Mean blood loss was 291.6 mL for the transsternal approach and 379.1 mL for the transthoracic approach. The Japanese Orthopaedic Association score JOA score was used to evaluate the severity of myelopathy possible highest score, 11 points. The recovery rate of JOA score was used to evaluate the surgical outcome. The mean preoperative JOA score was 4.7, and it improved to an average of 7.8 at the final evaluation. The average recovery rate of the JOA score was 52.2. The clinical symptoms and JOA score improved compared to the preoperative conditions in 8 patients but remained unchanged in 1 patient. Surgical complications included dural tear in 2 patients and intercostal neuralgia in 1 patient. One patient had to be transferred to a rehabilitation facility. In the other 8 patients, the mean hospitalization was 15.4 days. Anterior decompression and fusion is an effective surgical procedure for the treatment of thoracic OPLL and yields good and stable long term results. An anterior procedure that results in adequate decompression of the spinal cord and affords good spinal stability is recommended for anterior lesions such as OPLL, which compress the anterior spinal cord at the thoracic spine.

Objective: Currently, there are no established approaches for removal of devices, such as stents, which sometimes become difficult to recover during endovascular treatment. We report a new method to successfully remove a stent that has become snagged during thrombus removal.Case Presentation: An 82-year-old female who had undergone a mitral valve annuloplasty developed sudden aphasia, right hemiplegia, and right unilateral spatial neglect on postoperative day 10. Cranial MRI indicated occlusion of the horizontal segment of the left middle cerebral artery. During mechanical thrombectomy, a vasospasm snagged the stent, and re-sheathing attempts failed repeatedly. We wedged the microcatheter into the spasm site and slowly injected a solution containing 1 cc of nicardipine, 2 cc of contrast medium, and 2 cc of heparin in normal saline intra-arterially. After several minutes, we retracted the Trevo wire slightly and easily removed the stent. The thrombus adhered to the retrieved stent. Post-retrieval imaging showed that the branch was completely recanalized. Conclusion:In cases wherein a microwire or stent retriever becomes difficult to remove, we propose switching to a microcatheter with a sufficient diameter to allow vasodilator injection. If the microcatheter is difficult to remove, our method can be utilized by severing the hub, inserting a larger-bore catheter, and injecting vasodilators. Adding contrast medium to the intra-arterial injectate allows visualization of whether the solution has reached the spasm site. Furthermore, by injecting the solution through the wedged catheter, pooling of the solution at the spasm site can be confirmed.

No abstract

Summary: Surgical treatment of the cerebral arteriovenous malformations (AVMs) is one of the most difficult neurosurgical practices, because neurosurgeons may not get adequate practice operating on patients with AVMs and because the variation of the characteristics of these lesions makes it difficult to establish a standard technique and skill to effectively resect these complicated vascular tangles in the brain parenchyma. However, it is mandatory for any vascular neurosurgeon to manage patients with AVM who present with severe neurological deficits or moribund condition due to hemorrhage. Here we report on our experiences of AVM cases and suggest that it is possible to remove the AVMs safely if the surgeon can open the cerebral sulci widely without trauma and without any nidal venous compromise using basic arachnoid dissection technique. We present illustrated cases and discuss the importance of the dissection of the cerebral sulci and staged surgery for large AVMs.

We report 2 cases with subarachnoid hemorrhage (SAH) secondary to ruptured bloodblister aneurysms (BBAs) originating from the anterior wall of the internal carotid artery (ICA). Case 1: A 56-year-old man was transferred to our hospital with disturbed consciousness following a severe headache. Computed tomography (CT) showed diffuse subarachnoid hemorrhage, and cerebral angiography demonstrated a BBA originating from the anterior wall of the left ICA. We performed left ICA trapping with a high-flow bypass. His postoperative course was uneventful, and he was discharged without any neurological deficits. Case 2: A 49-year-old man was transferred to our hospital with disturbed consciousness. Although CT showed diffuse SAH, using cerebral angiography, we could not identify any aneurysms. CT repeated 16 days after admission revealed a BBA originating from his right ICA. We decided to perform direct neck clipping because we could identify the neck of the aneurysm. Direct neck clipping of the aneurysm was performed without any complications. The patient was discharged without neurological deficits. Although the treatment of BBAs is usually difficult, an individualized strategy should be considered in patients presenting with BBAs.