Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Low back pain (LBP) can be attributable to entrapment of the superior cluneal nerve (SCN) around the iliac crest. Surgical decompression is a useful treatment; however, finding all entrapped SCNs involved in patients with LBP can be difficult. We performed a retrospective study to help identify entrapped SCNs in the narrow surgical field. METHODS: We enrolled 20 LBP patient (22 sides) with SCN entrapment. They were 9 males and 11 females; their mean age was 72.5 years. We developed a 3-step procedure for successful SCN decompression surgery. In step 1, the thoracolumbar fascia is exposed and the SCN penetrating the fascia is released. In step 2, the fascia is opened and the SCN is released. In step 3, the fascia above the iliac crest is opened and the SCN is released. RESULTS: We successfully released 66 nerves; the average was 3.0 ± 0.8 (1-4) per patient. Step 1 detected 18 nerves (27.3%), step 2 identified 35 (53.0%), and in step 3, 13 (19.7%) were recognized. By tracing the thin nerves branching off the SCN, we found 7 nerves (10.6%). We performed 22 operations; step 1 identified 16 SCNs (72.7%), step 2 identified 21 (95.5%), and step 3 found 12 nerves (54.5%). CONCLUSIONS: The SCN is most readily identified upon opening of the thoracolumbar fascia. To identify as many SCN branches as possible, our 3-step method may be useful.

DOI： 10.1007/s00701-024-05960-z

PubMed

researchmap

Language：Japanese   Publisher：(株)メディカ出版  

researchmap

Language：Japanese   Publisher：(株)メディカ出版  

症例は48歳女性で、前日からの頭痛を主訴とした。頭部CTでくも膜下出血を脳底槽からシルビウス裂に認め、やや左優位であった。脳血管撮影では右内頸動脈・左内頸動脈・左中大脳動脈・左前大脳動脈に多発脳動脈瘤を認めた。造影MRIによるvessel wall imagingで破裂瘤は右内頸動脈前壁動脈瘤の可能性が高いと判断し、同日開頭クリッピング術を行ったが、術中破裂所見は認めず動脈瘤を切除した。翌日に左側開頭クリッピング術を行い、左前大脳動脈瘤を破裂瘤と判断し、中内脳動脈瘤と左内頸動脈瘤もクリッピングした。初回手術7日後に脳血管撮影にて各動脈瘤の消失を確認し、遺残した高次脳機能障害のリハビリテーション目的に第76病日に転院した。切除した右内頸動脈瘤の病理所見では脳動脈瘤壁に炎症細胞の浸潤および毛細血管の増生を認め、造影された原因と考えられた。

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Gentian violet ink is used as a skin marker in various surgical procedures, including neurosurgery. The dye is also used to visualize the edges of blood vessels during bypass surgery. However, gentian violet ink carries the risks of carcinogenicity and venous injury, which causes microvascular thrombosis. Objective The objective of this study was to compare the gentian violet-free dye C.I. Basic Violet 4 (BV4) and gentian violet. The usefulness, in terms of color, and the formation of microvascular thrombosis in anastomosis were compared. Methods We used the gentian violet-free dye in 20 cases involving 3 vascular anastomoses. The bone cutting lines on the bone surface, superior temporal artery, and middle cerebral artery were drawn using BV4 and gentian violet ink. Results The colors of BV4 and gentian violet ink were similar. No thrombus formation was observed at the vascular anastomosis when using BV4. Conclusion BV4 can be used similarly to gentian violet ink. No adverse effects such as thrombus formation in microvascular anastomosis were experienced using BV4.

DOI： 10.1055/a-2175-3295

PubMed

researchmap

Language：English   Publisher：MDPI  

Orbital emphysema after nose-blowing is an uncommon condition and can appear without a trigger. Herein, we reported a case of orbital emphysema after nose-blowing and performed a literature review. A 68-year-old man fell and sustained an injury near his left orbit. No symptoms were noted. He noticed a left periorbital swelling after blowing his nose. Through computed tomography examination, he was diagnosed with subcutaneous emphysema. There are no previous reports that have reviewed the clinical features, need for surgery, and severity of symptoms of subcutaneous emphysema after nasal swallowing due to different factors. We retrospectively analyzed a cohort of 48 cases by searching PubMed to clarify these issues. Regarding the emphysema trigger, 21 cases had an injury or had previously undergone surgery. In 34 cases, conservative treatment was required, while surgery was selected in the acute phase in 6 cases and after the acute phase as a radical cure in 8 cases. Reduced visual acuity, diplopia, exophthalmos, facial hypoesthesia, and color disorders were noted and were more common among surgical cases. The literature review revealed no association between fracture location and the need for surgery; furthermore, surgery was less required in non-trauma cases, excluding osteoma, than in trauma cases (p = 0.0169). Our study reveals that a strict follow-up examination of visual symptoms is necessary for the first 2 days in cases of subcutaneous emphysema caused by nose blowing after facial trauma.

DOI： 10.3390/reports5020021

Web of Science

researchmap