Symptomatic Epidural Gas-containing Cyst from Intervertebral Vacuum Phenomenon

Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. The speculative mechanism of the nerve root compression is discussed. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present.

A Clinical Analysis of Anaplastic Oligodendroglioma

OBJECTIVE: The author evaluate the efficacy of surgery, radiation therapy and chemotherapy as a treatment methods for anaplastic oligodendroglioma patients to provide the standardized treatment option. METHODS: A retrospective analysis of ten pathologically proven cases of anaplastic oligodendroglioma was performed. RESULTS: The ten patients comprised four males and six females. The mean age at diagnosis was 34.4 year (8-70). The mean follow-up was 40.5 months, and two patients died of tumor progression during the follow-up (70, 86 months, respectively). All patients had craniotomy and the tumors were removed as much as possible. The tumos were resected totally in five cases, only subtotally in the rest. Radiation therapy was applied to seven patients, and PCV (procarbazine-CCNU-vincristine) based chemotherapeutic agent was administered to five patients. In the group with PCV therapy, complete remission was observed in two, partial remission was in one, stable disease in one, and disease progression in one who were died of tumor extension. During the follow-up, tumor recurrences were observed in four patients, and they were treated with additional operation and/or chemotherapy. CONCLUSION: Anaplastic oligodendrogliomas respond to the surgical and radiological treatment and especially to the chemotherapy, and have a relatively good prognosis. PCV is an effective and safe regimen for suppressing tumor growth, and is feasible for recurrent cases. PCV chemotherapy should be considered for primary treatment method for anaplastic oligodendroglioma patients.

Clinical Experience with the Programmable Valve for Hydrocephalus Patients

OBJECTIVE: The goal of this study is to establish the value of the programmable valve system. METHODS: The authors conducted a single center retrospective study of 41 consecutive patients who had undergone ventriculoperitoneal shunt with programmable valve for hydrocephalus of various etiology from March 1999 to February 2002. RESULTS: In 10 patients(24%), valve pressure adjustment was required at least 3 times or more for the reason of underdrainage or overdrainage. The range of pressure reprogramming was 10 to 120mmH2O. The clinical symptoms improved in 37 patients(90%). The radiologic improvement was obtained in 88%. Shunt was minimally functioning in 3 cases without any clinical effect at the pressure of 30mmH2O. CONCLUSION: The programmable valve has been particularly useful in changing ventricular size for the correction of overdrainage or underdranage by the easy control of valve pressure without any invasive procedure. The authors' preference is to use the programmable valve system for all conditions.

Multiple Aneurysms of the Distal Anterior Cerebral Artery: Case Report

Saccular aneurysms of the distal anterior cerebral artery are relatively rare, ranging from 1.5 to 9.2% of all intracranial aneurysms. A 61-year old woman presented with headache and nuchal rigidity. Cerebral angiographic image demonstrated multiple aneurysms of the distal anterior cerebral artery. We report a case of multiple aneurysms of the distal anterior cerebral artery without other vascular anomalies.

Endovascular Surgery of Vertebral Artery Dissecting Aneurysm

OBJECTIVE: This study was undertaken to demonstrate the usefulness of endovascular technique in treatment of vertebral artery dissecting aneurysms. METHODS: The clinical characteristics of vertebral artery dissecting aneurysms were reviewed in 11 patients with particular focus on clinical presentation, angiographic feature and outcome. RESULTS: All patients underwent the GDC embolization. One of them was managed with surgical trapping after failure of GDC embolization and the other with GDC embolization after failure of stent insertion. Nine patients were recovered with intact neurological feature, one patient died as result of sepsis and ARDS, and one patient was suffered from cerebellar infarction. CONCLUSION: Although the timing of the procedure and site of occlusion remain controversial, proximal GDC occlusion of vertebral artery appears to be a safe and effective therapy for patients with vertebral artery dissecting aneurysm. This procedure provides an important, less invasive alternative for this condition.

A Case of Traumatic Cerebral Infarction due to Injury of the Petrosal Internal Carotid Artery Resulting from Head Trauma

Deteriorated mental status and new neurological deficits after head trauma signify the formation of intracranial hematoma or brain edema. In a case of head trauma accompanied by basal skull fracture, even if without intracranial hematoma formation or edema, we should be alert to the possibility of injury of the petrosal carotid artery which needs prompt diagnostic evaluation and management. We report a case of traumatic cerebral infarction due to injury of the petrosal internal carotid artery and review the literatures.