We reviewed reports about the postoperative course of hemifacial spasm (HFS) after microvascular decompression (MVD), including in our own patients, and investigated treatment for delayed resolution or recurrence of HFS. Symptoms of HFS disappear after surgery in many patients, but spasm persists postoperatively in about 10–40%. Residual spasm also gradually decreases, with rates of 1–13% at 1 year postoperatively. However, because delayed resolution is uncommon after 1 year postoperatively, the following is advised: (1) In patients with residual spasms after 1 year postoperatively (incomplete cure) or who again experience spasm ≥ 1 year postoperatively (recurrence), re-operation is recommended if the spasms are worse than before MVD. (2) When re-operation is considered, preoperative magnetic resonance imaging (MRI) findings and intraoperative videos should be reviewed to ensure that no compression due to a small artery or vein was missed, and to confirm that adhesions with the prosthesis are not causing compression. If any suspicious findings are identified, the cause must be eliminated. Moreover, because of the risk of nerve injury, decompression of the distal portion of the facial nerve should be performed only in patients in whom distal compression is strongly suspected to be the cause of symptoms. (3) Cure rates after re-operation are high, but complications such as hearing impairment and facial weakness have been reported in 10–20% of cases, so surgery must be performed with great care.

Background: Nontraumatic acute subdural hematoma (ASDH) may be caused by rupture of a microaneurysm of a cortical artery. In some cases, microaneurysms may have been caused by earlier trauma. Although it is difficult to detect microaneurysms on contrast-enhanced computed tomography (CT) angiography or digital subtraction angiography, it may be suspected based on the plain CT scan results and the clinical course. Case Description: We experienced three cases presumed to be ASDH due to rupture of a microaneurysm. Plain CT scan showed that the midline shift was smaller than the hematoma thickness, and we judged from the clinical course that there was no trauma immediately before the onset. All three patients had decreased consciousness after arrival and underwent craniotomy for hematoma removal. The source of hemorrhage was in the distal part of the cortical artery, and a microaneurysm was found. In one case, histopathological examination was performed, and traumatic pseudoaneurysm was diagnosed. The postoperative course was good in all three cases. Conclusion: If nontraumatic ASDH is suspected, the source of hemorrhage may be located more distally to the middle cerebral artery than in traumatic ASDH; hence, extensive craniotomy is required to search for the location of hemorrhage.

No abstract

No abstract

Background: With aging of the Japanese population, there is an increasing number of senile patients with subarachnoid hemorrhage (SAH) undergoing direct surgery. However, the long-term prognosis remains to be elucidated. This study aimed to clarify treatment outcome and long-term prognosis of direct aneurysm surgery in SAH patients aged 80 and over. Methods: Medical charts of 34 consecutive patients with SAH over 80 years old, who underwent direct aneurysm surgery between February 2010 and August 2017, were retrospectively reviewed. The patients were classified into a good outcome group (mRS [modified Rankin Scale]: 0-3) and a poor outcome group (mRS: 4-6), and the characteristics, perioperative data, and long-term prognosis of each patient were analyzed. Results: Twelve patients (36%) had good outcome and 22 patients (64%) had poor outcome at discharge. Factors associated with good outcome included good activities of daily living (ADL) (mRS: 0-3) before the hemorrhagic event, short hospital stays, early walking exercise (within 14 days), and no postoperative symptomatic cerebral infarctions. There was no significant difference in the surgical time between the two groups. Patients with good outcome at discharge were associated with a significantly better long-term survival rate compared to those of the poor outcome group. Conclusions: Even in SAH patients older than 80 years, good outcome can be expected if they had good ADL before the event and if they do not present postoperative cerebral infarctions. Independent walking at discharge can be considered a good indicator of good prognosis in the long long-term.