tokyo,june 1-3 2010

8/4/2019 Tokyo,June 1-3 2010

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St.Marianna VisitMay 31- June 2, 2010

8/4/2019 Tokyo,June 1-3 2010


St.Marianna HospitalCase 1

• 58-year old woman with a complaint of visual disturbance

• Preoperative diagnosis: tuberculum sellae meningioma

• Right interhemispheric approach

• Intraoperative findings: large cortical vein entering to SSS was found, and care was taken so not to injure the vein during tumorremoval. The tumor was found quite soft, and margin with the surrounding structures was quite clear. Total removal wasachieved (Simpson grade 2)

• No new neurological deficit postoperatively

Pre op Post op

8/4/2019 Tokyo,June 1-3 2010



• 33-year old man with hypertension and high level of ACTH. MRI do not show any obvious mass in sella tursica. Dynamic MRIshowed slow enhancement on the right side of hypophysis, however cavernous sampling showed conflicting result, higher levelof ACTH on the left side.

• Preoperative diagnosis: microadenoma hypophysis, preclinical Cushing disease.

• Transsphenoid approach

• Intraoperative findings: No obvious mass was found either on the right or left sella tursica. Hypophysis was sliced in crossedpatterns, and samples from discolored area were taken for histological examination. The left one third of hypophyseal gland wasremoved.

• No new neurological deficit postoperatively

Pre op

Post opCavernous sampling

8/4/2019 Tokyo,June 1-3 2010



• 54-year old man with right side mild hemiparesis. 2 months ago he was admitted because of headache, and he was told to havemeningitis. One month ago, MRI showed a subdural collection, however, he rejected surgery because there was no neurologicaldeficit. Now, he is admitted for emergency surgery because he felt weakness on his right limbs.

• Preoperative diagnosis: subdural hemorrhage

• Intraoperative findings: 50 cc of blood was collected. spooling with water was done to rinse off the subdural space. subduraldrain was placed to ensure the drainage of the remaining blood.

• No neurological deficit postoperatively

Pre op Post op1 month ago

2 months ago

8/4/2019 Tokyo,June 1-3 2010


Keio Visit June 3, 2010

8/4/2019 Tokyo,June 1-3 2010


Keio Hospital: Case

• 59-year old man with incidentally found IC bifurcation aneurysm

• Right pterional approach

• Intraoperative findings: the walls of IC and proximal MCA were sclerotic, however, the spacearound the neck for clipping was easily visible, and neck of the aneurysm was not sclerotic.Bayonet clip was used.

• No neurological deficit postoperatively

Pre op Clip placement

8/4/2019 Tokyo,June 1-3 2010


Keio HospitalCadaver Dissection: Midline Suboccipital Approach

(unfortunately some parts of theskin and skull have been incised or

drilled). The head is placed in pronepos i t ion . Sk in inc i s ion wasperformed in S shape so that theinion and C1 are exposed. The skinand fascia are retracted to createwider operative field. Craniotomy ismade 5x5 cm, and foramen magnumis opened. Care should be takenduring exposure of foramen

magnum. Vertebral arteries arelocated on the lateral side of foramen magnum.

foramenmagnum

medulla

tonsil taeniachoroid

obex

vermis

cerebellum PICA PICA

vertebralartery

mediansulcus

Dura is incised in Y shape. Careshould be taken for occipital sinusduring dural incision. Rhomboidfossa could be seen by retracting thecerebellum and vermis up, and bycutting the taenia choroidea up tothe foramen Lushka, the fossa couldbe exposed even larger. Importantstructures of the posterior fossa canbe observed, such as s tr iamedullaris, obex, PICA, plexuschoroid, flocculus, lower CNs, CNVII & VIII, and vertebral arteries.

striae

medullaris

flocculus

IAC & CNVII,VIII

tokyo,june 1-3 2010

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