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  • Author or Editor: Hiromi Nishimura x
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Shunji Matsubara, Hiromu Hadeishi, Akifumi Suzuki, Nobuyuki Yasui and Hiromi Nishimura

Object. The goal of this study was to examine the growth of unruptured intracranial aneurysms with the focus on the risk factors and incidence of these lesions.

Methods. One hundred sixty-six untreated cerebral saccular aneurysms were analyzed in 140 patients. The age of the patients ranged from 29 to 82 years (mean 62.8 years), the female/male ratio was 94:46, and the mean follow-up period was 17.7 months. Aneurysms were located at the internal carotid artery (ICA) in 68 patients, the middle cerebral artery (MCA) in 43, the anterior cerebral artery in 38, the basilar artery (BA) in 13, and the vertebral artery in four patients. The maximum diameter of the lesions ranged from 2 to 20 mm (mean 4.1 mm). All patients were examined using serial computerized tomography angiography to evaluate signs of aneurysm growth.

Although growth was identified in 10 aneurysms (nine patients [6.4%]), no bleeding occurred. Growth-related changes were significantly associated with the size of the aneurysm and occurred in three (2.4%) of 125 aneurysms measuring 2 to 4 mm, three (9.1%) of 33 lesions measuring 5 to 9 mm, and four (50%) of eight lesions measuring 10 to 20 mm. These changes were more frequently found in aneurysms located at the BA bifurcation (two [40%] of five lesions) and the ICA (six [8.8%] of 68 lesions) than in those located at the MCA (zero of 43 lesions, p < 0.05). The 1-, 2-, and 3-year cumulative growth rates calculated using the Kaplan—Meier method were 2.5, 8, and 17.6%, respectively.

Conclusions. A diameter of at least 10 mm and a location at the BA bifurcation or the ICA were significant risk factors for aneurysm growth. The incidence of growth was 2.5% in the 1st year and this risk increased yearly. Computerized tomography angiography is useful for follow up of patients with aneurysms because it allows the detection of even subtle morphological changes.

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Akifumi Suzuki, Kimio Yoshioka, Hiromi Nishimura and Nobuyuki Yasui

Cortical somatosensory evoked potentials (SSEPs) can be used to localize the central sulcus during a craniotomy. In particular, contralateral median nerve stimulation producing SSEPs can disclose the location of the central sulcus around the sensorimotor hand representation area. However, the median nerve cannot be stimulated in patients who undergo craniotomy at locations other than the hand representation area. The present study attempts to localize the central sulcus in the lateral surface of the brain near the interhemispheric fissure by stimulating the contralateral femoral nerve to produce SSEPs. Somatosensory evoked potentials were recorded between the superior lip of the interhemispheric fissure and 1.5 to 2 cm laterally in the cortex. Only seven of the 12 patients studied showed a phase reversal of the initial component across the central sulcus. The polarity was negative in the postcentral gyrus and positive in the precentral gyrus. The other five patients did not show a phase reversal of the initial component across the central sulcus. The amplitude was highest in the postcentral gyrus and the polarity was positive. Based on these results, the authors hypothesize that stimulating the contralateral femoral nerve to produce SSEPs and then analyzing the distribution of the SSEPs may provide a method for functional localization of the sensorimotor cortex around the interhemispheric fissure during craniotomy.

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