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BACKGROUND: Aneurysm formation is a complication of moyamoya disease (MMD). Distal anterior cerebral artery (ACA) aneurysms account for approximately 1% of MMD-related aneurysms. We report a case of target bypass for adult patients with MMD who presented with intracranial hemorrhage due to rupture of a distal ACA aneurysm, whose disappearance was confirmed postoperatively. OBSERVATIONS: A 45-year-old woman presented with sudden-onset headache and loss of consciousness. Head computed tomography showed hemorrhage in the genu of the corpus callosum with intraventricular extension. Digital subtraction angiography (DSA) revealed Suzuki stage III MMD and a left A3 segment aneurysm. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and STA-ACA target bypass were performed to reduce hemodynamic stress on the left ACA. DSA 6 months after surgery showed patency of both bypasses and disappearance of the aneurysm. At the 20-month follow-up, the patient was asymptomatic and neurologically intact. LESSONS: Bypass revascularization may be an effective treatment to reduce hemodynamic stress and eliminate MMD-related aneurysms.

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In the title compound, C28H24O6·CHCl3, the two 4-meth-oxy-benzoyl groups at the 1- and 8-positions of the naphthalene ring system are aligned almost anti-parallel, the benzene rings making a dihedral angle of 25.76 (7)°. The naphthalene ring system makes dihedral angles of 72.51 (7) and 73.33 (7)° with the benzene rings. In the crystal, the naphthalene mol-ecules are linked by C-H⋯O inter-actions, forming a helical chain along the b-axis direction. A C-H⋯Cl inter-action is also observed between the aroylated naphthalene and chloro-form mol-ecules. The chloro-form mol-ecule is disordered over two positions with site occupancies of 0.478 (5) and 0.522 (5).

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The title compound, C32H32O6, crystallized with two independent molecules in the asymmetric unit. Each molecule has essentially the same feature of non-coplanar aromatic rings whereby the two 4-isopropoxybenzoyl groups are twisted in a perpendicular manner to the naphthalene ring and oriented in the same direction (syn-orientation). The benzene rings of the aroyl groups make dihedral angles of 16.13 (7) and 25.31 (7)° in the two molecules. These benzene rings make dihedral angles of 88.38 (8) and 75.32 (7)° with the naphthalene ring system in one molecule, and 89.71 (7) and 82.11 (7)° in the other. In the crystal, mol-ecules are linked via C-H⋯O hydrogen bonds, forming a three-dimensional network. In one independent molecule, the 2-propyl groups of both isoprop-oxy groups are disordered over two positions with site occupancies of 0.512 (3) and 0.488 (3).

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In the mol-ecule of the title compound, C(30)H(24)O(8), the two 4-acet-oxy-benzoyl groups at the 1- and 8-positions of the naphthalene ring system are aligned almost anti-parallel, and the two benzene rings make a dihedral angle of 54.21 (9)°. The dihedral angles between the benzene rings and the naphthalene ring system are 63.63 (8) and 78.54 (8)°.

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We describe a case of left temporal lobe epilepsy without hippocampal atrophy. A 31-year-old woman presented with typical symptoms of complex partial seizures. Magnetic resonance imaging demonstrated slightly obscure internal structures in the left hippocampus. Scalp electroencephalography revealed interictal epileptiform discharges in the left temporal lobe. A Wada test with propofol determined the language-dominant hemisphere to be the left. Intraoperative electrocorticography revealed active epileptic discharges in the hippocampus and the anterior temporal basal area. The hippocampal epileptic area was treated with multiple transection, which led to the complete cessation of epileptic discharges. After surgery, the Rey Auditory Verbal Learning Test score decreased from 12 to 9. However, it returned to the preoperative level 6months after surgery. We describe this case as a typical example demonstrating the efficacy of hippocampal transection for seizure control and the preservation of verbal memory.

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A goose neck snare is a useful device not only for the retrieval of intravascular foreign bodies, such as detachable coils and catheter fragments, but also for holding a guiding catheter. In carotid artery stenting, the guiding catheter should be kept stable in the proximal of the stenotic lesion, but it is sometimes difficult because of the tortuousity of the proximal common carotid artery. We present a case of carotid artery stenting for proximal part common carotid artery stenosis and discuss the usefulness of the goose neck snare from the brachial artery for holding the guiding catheter.

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Cranioplasty performed after external decompression for brain swelling due to cerebral infarction, injury and hemorrhage may be difficult because of the development of adhesions between the dura and the temporal muscle, subcutaneous layer. Preventing such adhesions, we have used Seprafilm instead of Gore-Tex membranes which had been used in neurosurgery. Seprafilm were placed between the temporal muscle and the dura with dural plasty using periostium or temporal fascia. Insertion of Seprafilm makes it easy for subsequent cranioplasty, to decrease operating time and blood loss, and avoids injury to the temporal muscle and dura. In addition, the price of Seprafilm is lower than Gore-Tex. Seprafilm is a safe and inexpensive material for preventing the adhesions after external decompression.

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A 48-year-old woman presented with subarachnoid hemorrhage originating from a dissecting aneurysm of the left vertebral artery (VA). Internal trapping with proximal flow arrest was planned. The origin of the left VA was too tortuous to allow positioning of an occlusion balloon catheter and a microcatheter in the left VA via the femoral artery. Therefore, the temporary subclavian steal technique was used for proximal flow arrest, by placing an occlusion balloon catheter in the subclavian artery proximal to the VA origin via the femoral artery. Thereafter, coil embolization was achieved through the left axillary artery. The patient recovered well after the procedure.

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Ruptured vertebral artery (VA) dissecting aneurysms are associated with a higher incidence of rebleeding than saccular aneurysms, so, it is encouraged that diagnosis be followed by early treatment. The standard treatment for VA dissecting aneurysms is internal trapping using an endovascular technique. In this procedure, a proximal flow arrest is sometimes used to ensure safety. In this report, we demonstrated the usefulness of proximal flow arrest. The subjects consisted of seven patients treated with endovascular treatment for ruptured VA dissecting aneurysms from 1997 to 2005. Two of the seven patients were treated without proximal flow arrest and one of the two encountered rerupture of the aneurysm at coil embolization. Five patients were treated with proximal flow arrest. Internal trapping was safely completed in these patients. Overall outcomes measurment by Glasgow Outcome Scale were good recovery in three, moderate disability in one, vegetative state in one and dead in two. Proximal flow arrest is considered to be useful for the following four reasons: 1) for the prevention of distal embolism; 2) for the prevention of distal coil migration; and 3) to block blood flow upon rerupture; 4) for the balloon occlusion test, but the necessity of this technique is now controversial. However it is difficult to prove the necessity, we believe it is an effective optional technique for safety embolization.

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