Objective: Postoperative seizures and epilepsy are common complications of craniotomy. In this study, we aimed to investigate the characteristics of seizures and epilepsy after craniotomy.Methods: A total of 293 consecutive craniotomy surgeries were analyzed. Infratentorial surgeries, epilepsy surgeries, surgeries using the same approach conducted for the same patients, and the cases with incomplete clinical data were excluded. A total of 211 surgeries were included in this study. We evaluated the following clinical characteristics in all patients: sex, age, preoperative epilepsy, use of preoperative antiseizure medication (ASM), indication for operation, early postoperative seizure (EPS), delayed postoperative seizure (DPS), and postoperative de novo epilepsy. The day of onset of EPSs was defined as within 7 days post-surgery, and the day of onset of DPSs was defined as later than 7 days and less than 60 days post-surgery.Results: Twenty-eight patients were previously diagnosed with epilepsy. Nine patients had EPSs (4.3%), and 10 patients had DPSs (4.7%). Seven cases of EPSs and six cases of DPSs were observed in 183 patients without previous epilepsy (3.8% and 3.3%, respectively). Three of the seven patients with EPSs (42.9%) and all six patients with DPSs (100%) developed de novo epilepsy. Postoperative de novo epilepsy was observed in 9 (4.9%) of the 183 patients without epilepsy. EPSs and DPSs were significant risk factors for epilepsy (p < 0.01). The odds ratios of EPSs and DPSs for the development of epilepsy were 12.71 (95% confidence interval [CI]: 3.94–112.80; p < 0.01) and 22.88 (95% CI: 5.38–55.72; p < 0.01), respectively. ASM was administered prophylactically to 51 patients. The prophylactic use of ASMs did not prevent EPSs or postoperative de novo epilepsy.Conclusion: EPSs and DPSs occurred in 4.3% and 4.7% of the patients, respectively, after craniotomy. Postoperative de novo epilepsy occurred in 4.9% of patients. This study revealed that EPSs and DPSs were risk factors for de novo epilepsy. Previous epilepsy was not a significant risk factor for EPSs. The prophylactic use of ASMs did not prevent EPSs or de novo epilepsy.

Most previous studies concerning the treatment of polydactyly of the foot have focused on surgical techniques for aesthetic improvement rather than functional alignment of the reconstructed toe. The purpose of this study was to present the authors' surgical procedures for preventing postoperative malalignment of the reconstructed toe and evaluate whether those procedures were useful for the treatment of polydactyly of the foot. The study included 30 feet from 26 patients, four male and 22 female, with four bilateral cases. The average age of the patients at surgery was 20 months, and average duration of the postoperative follow-up was 32 months. The ligamentous stability of the toe joint was reconstructed using the collateral ligament/periosteal sleeve from the excised toe. The authors evaluated postoperative complications of the toe involving varus or valgus deformities, thickening of the reconstructed toe, pigmentation of the grafted skin, and scar formation. No cases revealed any varus or valgus deformities, pigmentation of the grafted skin, functional disturbance, or pain in the reconstructed toe after surgery. Regarding postoperative complications, the authors observed visible thickening in eight toes and scar formation in three toes, although the parents' evaluation in each case was "very satisfied" or "satisfied." The authors recommend reconstruction of the ligamentous stability of the toe joint using the collateral ligament/periosteal sleeve from the excised toe to prevent postoperative malalignment. Therapeutic, IV.

Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare. We report the case of a 72-year-old man who presented with a 4-year history of swallowing disturbance and subsequently progressively worsening left-sided tongue atrophy. He was referred to our department by a neurologist due a magnetic resonance imaging detected left vertebral artery compression of the medulla. Neurological examination was unremarkable except for left hypoglossal nerve dysfunction, which presented as left-sided atrophy and impaired movement of the tongue. Three-dimensional computed tomography angiography showed proximal left posterior inferior cerebellar artery (PICA) origin fusiform aneurysm. Microvascular decompression was done through a left transcondylar fossa approach. Intraoperative findings were thickened arachnoid around the lower cranial nerves, fusiform aneurysm of the left PICA at its origin from the left vertebral artery which was severely adherent to and compressing the left hypoglossal nerve rootlets. The PICA has a very close relationship to the hypoglossal nerve, and its fusiform dilatation could cause isolated hypoglossal nerve dysfunction. Pathological adhesions between hypoglossal rootlets and the PICA aneurysm wall could be a possible contributor in the development and progression of hypoglossal nerve palsy.

Background: Recently, electrocorticographic (ECoG) studies have emphasized the importance of gamma band-based functional mapping in the presurgical localization of the eloquent cortex. Passive functional mapping using ECoG signals provides a reliable method for identifying receptive language areas without many of the risks and limitations associated with electrical cortical stimulation. We report a surgical case of left temporal malignant glioma with intraoperative passive language mapping.Case Description: A 78-year-old woman was diagnosed with left temporal glioma with inspection of her language difficulty. MRI showed a left temporal tumor measuring 74.6 × 50.0 × 51.5 mm in size. Real-time CortiQ-based mapping using high-gamma activity by word-listening and story-listening tasks was performed. Significant listening task-evoked high gamma activities were detected in 5 channels in the superior temporal gyrus and one channel in the middle temporal gyrus. The tumor was grossly removed except for the region corresponding to listening task-evoked high gamma activities. Postoperatively, the patient's symptoms of language comprehension difficulty improved, and no new neurological deficits were observed.Conclusion: Intraoperative passive language mapping was successfully performed, and the patient's language function was well-preserved. Intraoperative passive language mapping, which is applicable in a short time and under general anesthesia, can be an important tool for detecting language areas.

Motor threshold usually varies in the intraoperative motor evoked potential (MEP) by transcranial evoked stimulation (TES). This study investigated the degree of change in the motor threshold before and after surgery in TES-MEP monitoring with threshold criterion. This study aimed to evaluate the threshold change and discuss the factors influencing the motor threshold. We retrospectively analyzed TES-MEP monitoring during supratentorial surgery with frontotemporal craniotomy in 72 patients without pre- and postoperative motor weakness. We analyzed the percentage changes between the affected and the unaffected sides, correlating the changes on the two sides. The percentage change on the affected and the unaffected side was 4.4 ± 15.1% and 0.4 ± 6.5%, respectively. The percentage change on the affected side was significantly larger than that on the unaffected side. A significantly positive correlation between the percentage change on the affected and the unaffected sides was detected. The threshold for the TES-MEP varied significantly more than that on the unaffected side. It is important to understand the characteristics of threshold variation for the evaluation of TES-MEP.