In most patients with superficial siderosis of the CNS, the exact source of bleeding remains unknown because of a lack of objective surgical data. The authors herein describe the case of a 58-year-old man with superficial siderosis of the CNS. The patient also had spinal CSF leakage due to a spinal dural defect. Repair surgery for the dural defect was performed using posterior laminoplasty with a transdural approach without spinal fixation. During repair surgery, the bleeding source was found to be the epidural vein around the defect. The intraoperative and histological results of the present case suggest that epidural veins exposed to CSF represent a chronic bleeding source in patients with superficial siderosis of the CNS complicated by CSF leakage. Dural repair surgery may result in discontinuation of the CSF leaks, resolution of the epidural CSF collection, and cessation of chronic epidural bleeding.

We report two cases with postoperative epidural haematomas (EDHs) associated with hydrocephalus and discuss the cause of haematoma development on the basis of a literature review. A 13-year-old boy presented with obstructive hydrocephalus caused by a sellar mass lesion. Multifocal EDHs occurred after partial resection of the lesion via a transcallosal approach following ventricular drainage. In the second case, a 26-year-old man who had a history of ventriculoperitoneal shunting for congenital hydrocephalus presented with hydrocephalus caused by ventricular catheter obstruction. An EDH occurred after replacement of the ventricular catheter with a new burr hole opening. On the basis of a review of 19 cases including our two cases, the authors concluded that postoperative EDH development associated with hydrocephalus was mostly caused by intraoperative overdrainage of cerebrospinal fluid, resulting in rapid shrinkage of the brain with dilation of the epidural space, a situation that may have caused dural venous bleeding.

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C orpus callosotomy is accepted as a palliative procedure for patients with, in particular, medically intractable generalized epilepsy and drop attack seizures. Although a 1-stage total corpus callosotomy can be performed in patients younger than 16 years, a 2-stage corpus callosotomy is preferred for patients older than 16 years given its lower risk for disconnection syndrome.14 At some institutions, posterior corpus callosotomy has been performed when the efficacy of anterior corpus callosotomy was insufficient. 1,[8][9][10]13 We have performed a second surgery for total callosotomy in cases that showed little or no clinical improvement in the 6-month follow-up after anterior partial callosotomy. The previous skin incision and craniotomy were generally reopened in the second surgery; 6 however, difficulties have been associated with this dissection because of intracranial adhesion, which is often observed following surgical intervention, and because of the long distance to the splenium of the corpus callosum, especially in adult cases. On the other hand, the shorter distance to the splenium in a posterior corpus callosotomy with a parietooccipital interhemispheric approach permits a safer, more precise dissection. Here, we present, as a second surgery, a technique for posterior callosotomy using a parietooccipital interhemispheric approach with a semiprone park-bench position. MethodsIn this retrospective study, we searched our institutional database for patients with epilepsy and drop attack seizures who had undergone anterior corpus callosotomy and an additional posterior corpus callosotomy for residual seizures in the period from 1999 to 2013. Patients with follow-up periods shorter than 3 months were excluded from our analysis. Magnetic resonance imaging was performed after surgery to evaluate the complete division. Surgical techniquesMagnetic resonance venography was performed in all cases preoperatively to determine which side was favorable for approach. The nondominant venous side was selected as the approach side; for example, when bridging veins were dominant in the right side, the left side was regarded as the approach side. A 2-stage corpus callosotomy is accepted as a palliative procedure for patients older than 16 years with, in particular, medically intractable generalized epilepsy and drop attack seizures and is preferable for a lower risk of disconnection syndrome. Although the methods by which a previously performed craniotomy can be reopened for posterior callosotomy have already been reported, posterior corpus callosotomy using a parietooccipital interhemispheric approach with the patient in a semi-prone park-bench position has not been described in the literature. Here, the authors present a surgical technique for posterior callosotomy using a parietooccipital interhemispheric approach with a semi-prone parkbench position as a second surgery. Although this procedure requires an additional skin incision in the parietooccipital region, it makes the 2-stage callosotomy safer and easier to perf...

Objective:We report two patients with cerebral infarction who underwent endovascular treatment for internal carotid artery dissection related to an elongated styloid process. On arrival, the NIHSS score was 8. MRI showed acute-stage infarction and narrowing of the high-level internal carotid artery adjacent to the left styloid process. Conservative treatment was administered. As there was a dissecting aneurysmal change at the stenotic site, carotid-stent-assisted coil embolization was performed. In the two patients, endovascular treatment led to a favorable prognosis. Conclusion:For the treatment of arteriogenic cerebral infarction related to atypical stenosis of the high-level cervical internal carotid artery, it is important to review therapeutic strategies, considering the possibility of an elongated styloid process.