Preservation of the lesser occipital nerve during microvascular decompression for hemifacial spasm. Technical note

The authors report on their technique for preserving the lesser occipital nerve (LON) during lateral suboccipital craniotomy. In their technique, the LON, which runs along the surface of or just beneath the sternocleidomastoid muscle, is identified and preserved. Lesser occipital nerve preservation using their technique was attempted in 25 patients who underwent microvascular decompression for hemifacial spasm. The LON was successfully preserved in 16 of these patients, was impossible to preserve in two patients, and could not be identified in seven patients. Among the patients in whom LON preservation was successful, 87.5% were free of sensory disturbance 6 months after surgery, whereas both patients in whom the LON could not be preserved complained of sensory disturbances in the occipital area and the posterior part of the auricula. Fifty-seven percent of the patients whose LON could not be identified complained of sensory disturbance. Thus, this technique for preserving the LON reduces the incidence of sensory disturbance in the occipital region after suboccipital craniotomy for microvascular decompression for hemifacial spasm.     

Massive plexiform neurofibroma with associated meningo-encephalocoele and occipital bone defect presenting as a cervical mass.

The commonest skull manifestations in neurofibromatosis involve the orbit, with very few reports about occipital defects. We report a rare case of a 54-year-old lady with a massive plexiform neurofibroma extending from the auricular region down her left neck and into her shoulder, with an associated large left occipital and left petrous bone defect and extensive cerebellar meningo-encephalocoele, which presented with a relatively asymptomatic cervical mass and was treated with resection of the neurofibroma and advancement and rotational skin flaps.     

Sudden hypoxia during anesthesia in a patient with Kartagener's syndrome

We report a case of anesthesia in an adolescent with recurrent left pneumothorax, Kartagener's syndrome, and severe learning disability with behavioral difficulties. After induction of anesthesia, he rapidly developed severe desaturation as measured on pulse oximetry. Placement of an intercostal chest drain did not remedy the situation and he was found to have blocked the left main bronchus with viscous secretions. Subsequent suctioning relieved the obstruction. Despite successful postoperative thoracic epidural analgesia and minitracheostomy for bronchial toilet, he developed bronchopneumonia that resolved with antibiotics. We discuss anesthesia for patients with Kartagener's syndrome and for patients with pneumothorax.     

改良腓肠神经营养血管皮瓣修复足背软组织缺损

目的总结吻合小隐静脉的远端蒂腓肠神经营养血管皮瓣修复足背软组织缺损的经验，探讨本术式皮瓣的血循环特点、成活机制及术中注意事项。方法对2003年10月-2007年6月采用吻合小隐静脉的远端蒂腓肠神经营养血管皮瓣修复足背软组织缺损20例的病例资料进行回顾性分析，该20例足背均为不同程度的软组织缺顺，术中将皮瓣近端小隐静脉与受区大隐静脉或其属支吻合。结果20例术后皮瓣均成活，无静脉回梳障碍等并发症发生。仅1例远端部分坏死，经换药后愈合。术后随访6个月～4年，足部外形良好，皮瓣质地、色泽与周边相似，足功能恢复良好。结论吻合小隐静脉改善了腓肠神经营养血管皮瓣静脉回流，为皮瓣建立了通畅的静脉回流系统，改变了皮瓣血液循环模式，扩大了皮瓣的修复范围及能力，可使皮瓣向肢端延伸，能够修复足背远端软组织缺损，为临床修复足中远端软组织缺损提供了一种新方法。     

Bilateral occipital infarcts in a hemodialysis patient.

Cortical blindness as a complication of hemodialysis is not widely known, though visual disturbances related to uremia have been known for a long time. We recently observed cortical blindness caused by bilateral occipital infarcts in a patient after hemodialysis.     

Altitudinal neglect in a patient with occipital infarction

Visual neglect has been frequently described in a horizontal direction. Altitudinal neglect, however, has rarely been described and has been associated with bilateral lesions in the parieto-occipital or temporo-occipital region. The following case report presents a patient with marked altitudinal neglect of the inferior space which was elicited using a line bisection test. The previously healthy patient had well-defined lesions solely in the occipital cortex following an embolic infarction. The present case report underlines the possibility that bioccipital lesions themselves can be responsible for altitudinal neglect.     

Repair of experimental bone defect with a collagen block containing synthesized apatite

Summary Collagen solution extracted from the adult steer hide was mixed with the synthesized hydroxyapatite and after cross linking lyophilized. Small blocks of this sample were filled in bone defects of rabbit fibula. Two control groups were made, of which one was filled with the collagen block contained no apatite and the other group left as a sham operation. The experimental group showed more active bone formation than control groups.

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Zusammenfassung Aus Rindshaut extrahierte Kollagen-Lösung wurde mit synthetischem Hydroxylapatit vermischt und nach Quervernetzung gefriergetrocknet. Kleine Blöcke dieses Präparates wurden in Knochendefekte der Kaninchen-Fibula eingesetzt. Die Experimente zeigten eine stärkere Knochenbildung als in der Kontrollgruppe ohne das Kollagen-Apatit-Präparat.

     

Complete heart block during anaesthesia in a patient with sarcoidosis

An apparently fit young man with sarcoidosis developed complete heart block during an emergency mastoidectomy. A temporary transvenous pacemaker was inserted, but permanent pacing was required in the postoperative period. The clinical and pathological features of cardiac sarcoidosis are described; complete heart block is the commonest presentation of cardiac involvement. The role of anaesthesia as the precipitating factor in this case is discussed.