Analysis on Surgical Outcome of Arnold-Chiari Malformation with Syringomyelia

The surgical outcomes of Arnold-Chiari malformation associated with syringomyelia have been reported with respect to improvement in symptoms and signs. But there are only a few studies about the changes of size in syrinx cavity after the era of magnetic resonance image. The authors employed two different surgical modalities and compared the difference in outcomes. Between 1988 and 1994, 17 patients suffering from Arnold-Chiari malformation associated with syringomyelia were treated by foramen magnum decompression(FMD), with or without shunt. Their ages ranged from 3 to 62 (median, 42) years; four were males and 13 were females. Eight were treated by FMD with syringosubarachnoid shunt (FMD with shunt group) and 9 by FMD only(FMD group). Changes in the extent of syrinx and clinical improvements were retrospectively compared between the two groups; the median follow-up period was 22(range 5-79) months. Changes in the extent of syrinx were analyzed by pre- and postoperative magnetic resonance images; improvements in symptoms or signs were classified by lower cranial nerves, the cerebellum and the spinal cord. The size of syrinx was decreased in 7/8 patients of FMD with shunt group(88%) and in 7/9 patients of FMD group (78%) and there was no significant difference in ratio statistically(p=0.54). Shrinkage of syrinx cavity was occurred regardless of its preoperative extent. In FMD with shunt group, 5/8 patients(63%) were improved in symptoms or signs and in FMD group, 6/9 patients(67%)(p=0.21). In all 3 cases which showed no collapse of syrinx cavity, the clinical improvements were not found. There was correlation between collapse of syringomyelia and improvement of clinical findings(p=0.035).

Survival Rates and Prognostic Factors in Patients with Intracranial Oligodendroglioma: A Retrospective Multivariate Analysis

In order to determine the survival rate and prognostic factors of patients with intracranial oligodendroglioma as predictors of survival, a retrospective analysis of a total of 68 cases treated between 1982 and 1992 at our institute was performed. The 5-year and 10-year survival rates were 84.5% and 55.1% respectively while the median survival time was 116+/-5.3 months. The significant factors identified by the univariate analysis included the presence of preoperative seizure, the pre- and postoperative status, the presence of signs of increased intracranial pressure before operation and pathologic grade of the tumors. Factors such as age, types of chief complaints, blood types, the preoperative neurologic deficit, the size of tumor, the enhancement of tumor, cysts in tumor, the extent of removal and the postoperative seizure had no correlations with survival rates. The only significant prognostic factor determined by the multivariate analysis was the pathological grade(p=0.04).

Cushing's Disease: Clinical Analysis and Surgical Outcome in 16 Cases

From March, 1984 to August, 1991, 16 patient were diagnosed as Cushing's disease and 14 of them were treated by transsphenoidal microsurgical procedure. Preoperrative endocrinological evaluation included plasma level of ACTH, serum cortisol concentration, urinary free cortisol and 17-hydroxycorticosteroid, dexamethasone suppression test and bilateral sampling of the inferior petrosal sinuses(IPS). The sensitivity of the last method was 88% for Cushing's disease but the expected laterality with the test was not always consistent with the surgical results. High resolution computed tomography(CT) and high field magnetic resonance imaging(MRI) were done as imaging devices. We cannot tell MRI is superior to CT is diagnosing microadenomas. All operations were performed through transsphenoidal approach. A selective microadenomectomy was done in 8 patients and all of them showed remission. A partial adenomectomy was done in 4 cases. Hypophysectomy was done in 2 cases, one of which was a failed case after the first trial and the other was one with no apparent tumor tissue in 7 successive frozen biopsies during operation. Overall surgical remission rate was 86.

Clinical Observation on the Surgical Treatment of the Intractable Pain

The purpose of this report is to present the results of clinical observations on the surgical treatment of 26 patients (16 male, 10 female) with intractable pain during the period from May, 1960 to April, 1972 at the Department of Neurosurgery, Seoul National University Hospital. Age at the time of operation raged from 27 to 69 years. Duration of the pain from the onset to surgery was less than one year in most of the cases. The most common causes of the pain were the pelvic malignancies, lung cancer, and metastatic spine tumors in the order. In 20 cases of anterolateral cordotomies, the main complications were urinary retention, ipsilateral motor weakness, and decubitus. The high cervical cordotomy produced high analgesic level and less dropping of established analgesic level postoperatively. Posterior rhizotomy for intercostal neuralgia and a case of thoracic commissurotomy for intramedullary tumor were of gratifying result. The higher the pain located, the longer the pain existed, the operation was less likely to relieve the pain. High cervical cordotomy seems to be superior to high thoracic cordotomy even in the pain of leg, when it is considered in the respect of the high analgesic level, the lack of "island" of pain, and technical easiness.