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Abstract: Background: Plasmacytoma is a localized mass of metastatic plasma cells. These lesions rarely involve the petroclival region and carry a high risk of progression to MM and poor prognosis. Case Description: We report a 65-year-old woman who presented with a large clival plasmacytoma causing right trigeminal and abducens nerve palsies and was diagnosed with MM after transsphenoidal biopsy. She underwent neoadjuvant chemoradiotherapy followed by radical resection of the residual tumor. Conclusion: We presented our treatment strategy including neoadjuvant chemoradiotherapy followed by radical resection of the lesion. The patient has experienced complete remission, and succeeding MRI revealed no evidence of local recurrence. [Copyright &y& Elsevier]

Abstract: Background: It is still difficult to directly prove the involvement of hemodynamic ischemia in ischemic attacks in patients with occlusive carotid artery diseases. Case Description: In this report, we describe the case of a 52-year-old woman with right ICA occlusion who experienced repeated transient weakness of the left extremities during HD for chronic renal failure. Single-photon emission computed tomography showed reductions in CBF and CVR to acetazolamide in the right hemisphere. Real-time NIRS monitoring clearly showed a deterioration in the cerebral oxygenation state in the right hemisphere in response to a BP decrease during HD. Superficial temporal artery–MCA anastomosis improved SPECT as well as NIRS findings and resolved ischemic attacks during HD. Conclusion: This is the first study to show that NIRS can be a useful tool in detecting hemodynamic ischemia in patients with impaired cerebral perfusion reserves noninvasively and in real time. [Copyright &y& Elsevier]

Abstract: Background: In spinal surgery, repair of the dura is difficult when it is torn or fragile or is ossified as in cases with ossification of posterior longitudinal ligament. We report our experience with a nonsuture dural repair technique in patients undergoing spinal surgery; it uses a dura substitute composed of polyglycolic acid (PGA) mesh and fibrin glue. Here, we report the efficacy and safety of nonsuture duroplasty using PGA mesh and fibrin glue (PGA-fibrin sheet). Methods: The artificial dura mater is composed of a PGA-fibrin sheet. The dural defect is covered with a patch sprayed with fibrin glue without suturing to the dura mater. We first evaluated this technique in an experimental study by performing water leakage tests. Between May 2001 and January 2005, we used it in 160 spinal surgeries that required intraoperative dura repair. Results: Our preliminary tests showed that the threshold for water pressure without leakage was 161 ± 42 and 96.5 ± 32 mm Hg when the unsprayed margin around the perimeter of the patch was 5 and 2 mm, respectively. Of the 160 operated patients, 10 (6.3%) experienced subcutaneous cerebrospinal fluid (CSF) leakage. Of these, 6 required a second operation; in the other 4, the CSF collection diminished spontaneously. There were no other complications such as allergic reaction, adhesion, or infection. Conclusion: In combination with CSF diversion, the PGA-fibrin sheet is a viable alternative method for dural repair in spinal surgery. [Copyright &y& Elsevier]