Correlation between Magnetic Resonance Image Signal Changes and Electromyographic Findings after Sciatic Nerve Transection in the Rat

No abstract available.

Carpal Tunnel Syndrome: Diagnostic Application of MRI and Sonography

OBJECTIVE: The diagnosis of carpal tunnel syndrome(CTS) can usually be made on the basis of clinical criteria and nerve conduction velocity. Until now, radiological examinations cannot give great influences on diagnosis and treatment of CTS. Recently, technology of MRI and sonography was advanced significantly as widely applicable they were used widely in the neurosurgical field. We investigated the usefulness of high resolution MRI and sonography for the diagnosis of CTS. METHODS: MRI of 30 wrists in 16 patients who had been clinically diagnosed as CTS was performed using axial T1-weighted and short tau inversion recovery sequences. The study of sonography consisted of 17 wrists in 10 patients and control group of 14 wrists in 7 people who were asymptomatic. We investigated the increased median nerve signal, swelling and flattening of the median nerve, bowing of the flexor retinaculum, and the change of median nerve configuration during wrist flexion and extension. RESULTS: Increased signal of the median nerve was seen in 14 patients(88%), proximal swelling and distal flattening of the median nerve in 13(81%), and bowing of the flexor retinaculum in 13(81%) by MRI. Increased signal of the thenar muscles was found in 13 wrists, which was more frequent than gross thenar muscle atrophy(9 wrists). MRI revealed causative pathologies in 5 patients, which were tumor (1), radius fracture (1), and tenosynovitis (3). The sonography revealed more increased flattening ratio(3.4+/-0.7) and increased cross area(16.5+/-7.7cm2) of the median nerve than control group(2.4+/-0.5 in flattening ratio and 7.2+/-1.4cm2 in cross area). There was no configuration change during wrist flexion and extension. But, no movement of the median nerve, suggesting adhesion, was revealed during wrist flexion and extension in one wrist. CONCLUSION: Although most cases of carpal tunnel syndrome are clinically straightforward, those with confusing clinical pictures may benefit from imaging studies. Imaging criteria for the diagnosis of carpal tunnel syndrome can apply to both sonography and MRI.

Comparison of Surgical Results between Anterior Cervical Interbody Fusion(ACIF) and Microsurgical Anterior Cervical Foraminotomy(MACF) for Cervical Disc Herniation

OBJECTIVE: Until recently anterior cervical discectomy with or without bone fusion has been widely used for the treatment of cervical disc herniation. After introduction of the microsurgical anterior cervical foraminotomy(MACF), there has been a tendency to preserve the functioning motion segment. But some worried about technical difficulties and complications such as injury to the vertebral artery. This study is to compare the short-term results of anterior cervical interbody fusion(ACIF) with that of MACF. METHODS: We reviewed medical records of 40 patients, 20 patients of ACIF performed during 30 months and 20 patients of MACF performed during 8 months. RESULTS: The average length of stay in the hospital was longer in cases of ACIF(12.9 days) than in those of MACF(7.1 days). The rate of the symptom relief within 1 day was higher in MACF(90%) than in ACIF(70%). The overall satisfaction experienced by the patients after surgery was higher in MACF(85%) than in ACIF(70%). The rate of the recommendation for surgical treatment to other people was higher in MACF(85%) than in ACIF(65%). But the differences were not significant statistically. The major complication was bone donor site pain in ACIF cases and neck and shoulder pain in MACF cases. CONCLUSION: This data demonstrate that MACF is of value in the treatment of cervical disc herniation, which can be performed with safety and good outcome like conventional ACIF.

Radial Tunnel Syndrome: Case Report

Radial tunnel syndrome is a rare disorder and it's symptoms sometimes so closely overlap those lateral epicondylitis, causing difficulties to differentiate. A 39-year-old man was presented who had a 2.5-year history of right elbow and forearm pain which was unseccesfully treated as 'tennis elbow'. Clinically, severe tender point over the forearm was relieved after a local anesthetic injection. Axial STIR(short tau inversion recovery) image showed high signal intensity at the origin of the extensor carpi radialis brevis, which was so minimal that it was not comparable to clinical symptoms. But radial nerve was revealed normal. So we decided that the symptoms were caused not by lateral epicondylitis but rather by radial tunnel sybdrome and an operation was performed. In the operative field, the most proximal part of the superficial head of the supinator muscle was tendinous and formed a fibrous arch, which was resected. After the operation, the right arm pain was relieved. This is a case diagnosed as lateral epicondylitis which showed no improvement under conservative treatment, but improved after a local anesthetic injection on the tender point. When a case with no correlations between lateral epicondylitis degree in MRI and clinical symptoms, one should take the possibility of radial tunnel syndrome into consideration.

Coexistence of Neoplasia and Cortical Dysplasia Associated with Intractable Epilepsy: A Clinical Study of Seven Surgical Patients and Surgical Strategies

A tumor and cortical dysplasia may be the concomitant cause of the causes of intractable epilepsy, but a few studies have examined so far. From among 249 patients who underwent surgery for intractable epilepsy at Dongsan Epilepsy Center, those in whom neoplasia and cortical dysplasia coexisted were selected for this study, and were reviewed the clinical, electrophysiological, neuroimaging and pathological findings. In 17 of 25 lesionrelated epilepsy patients, tumors including dysembryoplastic neuroepithelial tumor(DNT)(n=6), ganglioglioma(n=5), gangliocytoma(n=1), low grade astrocytoma(n=2), oligodendroglioma(n=2), hypothalamic hamartoma(n=1) were verified. Of these 17 cases involving tumors, concomitant cortical dysplasia was observed in 7(DNT; 6, ganglioglioma; 1). All these patients underwent sophisticated presurgical evaluation and intraoperative acute recording(EcoG) for the identification of adjacent or remote epileptogenic areas as well as functional brain mapping by electrical stimulation or SSEP to verify the eloquent areas. In intractable epilepsy, the coexistence of cortical dysplasia and neoplasia is not common, though careful intraoperative evaluation of the tumor and surrounding tissue using electrocorticogram (EcoG) may lead to its pathological identification and excellent surgical results for these rare lesions.

The Effect of Percutaneous Injection of Lumbar Nerve Roots in Diagnosis and Treatment of Sciatica

Clinical evaluation and imaging studies such as magnetic resonance imaging, computed tomography, and/or myelography can localize the pathologic process in most patients with lumbar radiculopathy. However, these studies occasionally fail to demonstrate exactly the cause and site for ongoing radicular symptom. So we evaluated 54 patients for the efficacy of selective nerve root blocks to identify a symptomatic nerve. The lumbar nerve root injections were performed at L3 root in 1 patients, at L4 root in 4 patients, at L5 root in 46 patients, and at S1 root in 3 patients. Among them, forty two patients were done before operation(HNP 32, stenosis 5, spondylolisthesis 5), 9 patients were done after operation due to poor results (root injury 2, infection 2, adhesion 1, incorrect diagnosis 4), and 3 patients had improved radiculopathies following nerve root injection(HNP 2, stenosis 1). The results of the nerve root injections and of the operations were not affected by age and sex. There was a good correlation between the response of the nerve root injection and the result of the operation(p<0.05). The concentration of bupivacaine 0.5% has no additional effect comparing to 0.25%(70%/73.5%) solution in spite of its adverse effect causing transient motor weakness. Additional use of depomedrol(50mg) proved to be no more beneficial. Three patients had Improved symptoms for a long period after nerve root injection which consequently made operation unnecessary. Five patients with previous history of operations had moderate pain relief. In summary, lumbar nerve root injection can be used as a functional diagnostic tool to predict operative result and as a treatment modality following failure of a previous surgery.

Choroid Plexus Papilloma in Third and Fourth Ventricle

Choroid plexus papilloma(CPP) is a rare intraventricular neoplasm occurring primarily in the lateral ventricle of children and the 4th ventricle of adults. The 3rd ventricle is an extremely rare site for CPP to occur. The authors report two cases of CPP of the 3rd ventricle in a 2-month-old girl and a 4-month-old boy, and one case of CPP of the 4th ventricle in a 17-year-old male. Two CPP of third ventricle were totally removed by transcortical-transventricular approach and transcallosal subchoroidal approach, respectively. The CPP in the fourth ventricle was totally removed by suboccipital approach. The subdural hygroma and hydrocephalus due to CSF overproduction was managed with subduroperitoneal shunt and ventriculoperitoneal shunt.

The Effects of Nimodipine and Intracisternal Urokinase on the Content of Leukotrience C4 in the Brain Tissue after Experimental Subarachnoid Hemorrhage in Rats

To find out whether early lysis of subarachnoid blood clot with intracisternal urokinase as well as intraperitoneal nimodipine prevents or decrease the breakdown of arachidonic acid(AA) of the brain after subarachnoid hemorrhage(SAH), we have investigated the levels of leukotrience(LT) C4, the metabolite of the lipooxygenase pathway of the AA metabolism, in the brain tissue after experimental SAH in rats. The experimental SAH was induced by an intracisternal autologous blood injection through the catheter which was inserted into the cisterna magna. Experimental animals were assigned to one of four groups as follows. The control group(I) was that intracisternal saline irrigation was done after SAH induction. The second group(II) was treated with an injection of nimodipine(4 times per a day of 1.2 mg/Kg until sacrificed) intraperitoneally after SAH induction, the third group(III) was tried with an intracisternal urokinase irrigation(3 times per a day of 0.1 ml, 1 ml : 20,000 unit urokinase, until sacrificed) and the fourth group(IV) was treated with intraperitoneal nimodipine and intracisternal urokinase(same regimen as above). Average levels of LT C4in each group was determined at 24 hours(subgroup a), 48 hours(subgroup b), 72 hours(subgroup c) after the induction of SAH by the radioimmunoassay method. The result showed that average levels of LT C4was significantly enhanced in the brain tissue at 48 hours after SAH induction in control group(group Ia vs. IB vs. Ic : 43.85+/-15.62 vs. 184.32+/-27.46 vs. 39.29+/-12.79 pg/ml, respectively. group Ia vs. Ib vs. Ic ; p<0.01) and was decreased by intraperitoneal nimodipine, intracisternal urokinase or combination of both at 48 hours after SAH induction (group Ib vs. IIb vs. IIIb vs. IVb : 184.32+/-27.46 vs. 41.99+/-5.94 vs. 37.68+/-10.4 vs.37.38+/-9.27 pg/ml, respectively group Ib vs. IIb vs. IIIb, and IVb ; p<0.05). However, there was no significant differences among the second, the third and the fourth group(group IIa vs. IIIa vs. IVa, group IIb vs. IIIb vs. IVb and group IIc vs. IIIc vs. IVc : 41.07+/-7.06 vs. 37.97+/-4.48 vs. 31.84+/-6.07 pg/ml, 41.99+/-5.94 vs. 37.68+/-10.43 vs. 37.38+/-9.27 pg/mi and 36.41+/-6.76 vs. 37.98+/-3.45 vs. 35.59+/-8.37 pg/ml, respectively). We concluded that the early lysis of subarachnoid blood clot with intracisternal urokinase had some benefits against the damage of neurons in the early period after SAH as much as intraperitoneal injection of nimodipine. However, the benefit of the combined treatment with intraperitoneal nimodipine and intracisternal urokinase, compared to intraperioneal nimodipine or intracisternal urokinase alone, has not been cleary established.

High Dose Urokinase Irrigation in the Management of Hypertensive Intracerebral Hematoma

It is well known that stereotaxic urokinase(UK) irrigation through a catheter is one of surgical methods in the management of hypertensive intracerebral hematoma(ICH) patients. Several authors recommended irrigation with 6000 IU UK, 4 times per a day. Based on authors' experience some patients who were managed with above protocol suffered from complications such as meningitis and/or pneumonia. It might be partially caused by prolonged duration of irrigation and immobilization of the patients. In order to reduce complications and to improve the final outcome of hypertensive ICH patients, we tried high dose UK irrigation(group II:irrigation with 50ml of normal saline mixed with 200,000 IU UK at immediate postoperative period, followed by two times of 20,000 IU UK irrigation per a day) to remove the ICH rapidly in those patients since Oct. 1991. We compared the rate of decreasing volume of hematoma, Glasgow coma scale(GCS) score change according to postoperative period, final outcome, and the rate of complications between this group(group II) and group I(4 times irrigation with 6,000 IU UK per a day). The results shows that the rate of decreasing volume of hematoma is slightly more rapid in group II than group I. The rate of poor outcome(vegetative and death) is lower in group II than I(group I vs. II:34% vs. 20% respectively). The rate of complication is lower in group II than I(group I vs. II:38.5% vs. 0.0%, respectively). One case(5%) of postoperative rebleeding was noted in group II. From this study, we concluded that, even if the beneficial effects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.

A Clinical Analysis of Treatment of Acute Cervical Spinal Injury

A retrospective study of 100 cervical spinal cord injury patients admitted consequtively to the Department of Neurosurgery, Dongsan Medical Center, Keimyung University between March, 1985 and June, 1989 was conducted. The average age was 42 and 84(84%) were male. The majority sustained their spinal cord injury in a motor vehicle accident(50%) or in a diving accident(36%). Thirty-three percent(33/100) of these patients had surgical intervention by anterior approach(14/33), posterior approach(17/33) and total laminectomy(2/33). The others were only immobilized by traction or neck brace. Not only neurological recovery in operated and nonoperated patients but also complete and incomplete injury was compared. The degree of the neurological injury was classified by the Frankel classification. 12 cases turned out to be more aggravated than the condition at admission, among them 9 cases were middle and low cervical incomplete injuries. At final follow-up no appreciable differences in achievement in activities of daily living and mobility were noted between patients treated with surgical stabilization of the cervical spinal column and those treated nonsurgically.

The Findings of Brainstem Auditory Evoked Pontential(BAEP) and Somatosensory Evoked Potential(SSEP) in Head Injury

There were 84 cases of brainstem auditory evoked potential(BAEP) and 90 cases of somatosensory evoked potential(SSEP) from the 124 cases of head injury. The studies were performed within the first three days after head injury in most cases and after ten days in emergency operative cases. The results of BAEP and SSEP studies recorded from 67 normal volunteers were used as a control group. The latency, amplitude and wave pattern of the evoked potential were examined and a peak or interpeak latency were considered abnormal when it exceeded the corresponding mean(2SD found in the control group. The wave patterns were arranged in BAEP as grade I:all waves were normal; grade II: waves I, II, III were abnormal;grade III:waves IV, V, VI were abnormal;grade IV:all waves were abnormal. In SSEP as grade I:all waves were normal;grade II:N13 wave was abnormal;grade III:N19wave was abnormal;grade IV:all waves were abnormal. The abnormal findings by percentage were:47.6% in latency of BAEP, 68.9% in latency of SSEP, 49.4% in wave pattern of BAEP and 87.8% in wave pattern of SSEP. The BAEP was superior to SSEP in correlation to clinical parameters including GCS, duration of coma, basal cisterns in initial brain CT scan and Glasgow outcome scale(GOS). As a BAEP criterion, the wave V latency and the BCT(III-V interpeak latency) and as a SSEP criterion, the central conduction time(N19-N13) were more correlated to duration of coma and GOS. The appearance of the basal cisterns on initial brain CT is significantly correlated with wave V and BCT of BAEP only. Grade I and II were reliable predictors of a good prognosis. Therefore, we concluded that BAEP and SSEP are adjunctively diagnostic tests for determining the outcome of head injuried patients.

A Case of the Suprasellar Arachnoid Cyst

We report a case of the suprasellar arachnoid cyst with hydrocephalus which was incidental finding after minor head injury. Preoperatively, we studied the CT cisternography through lumbar route with niopam. It revealed that the arachnoid cyst was communicated with ventricles and delayed filling and clearance pattern of the cyst. The suprasellar arachnoid cyst with hydrocephalus was treated by combined craniotomy with partial removal of the membrane wall and cystoperioneal shunt. We reviewed the literature and discussed the diagnosis and treatment of the suprasellar arachnoid cyst.

Intracranial Aneurysm Associated with Aplasia of the Internal Cartoid Artery

The authors report two cases of intracranial aneurysm associated with aplasia of internal carotid artery. The one case showed complete occlusion of left internal carotid artery just above the origin of ophthalmic artery and aneurysm which located at the junction of basilar-superior cerebellar artery. The blood supply of the left side of anterior cerebral came from the right carotid artery through the anterior communicating artery and the left middle cerebral artery came from basilar artery through the enlarged posterior communicating artery. The another case showed marked narrow cervical portion of right internal carotid artery which terminated as a posterior communicating artery just above the origin of ophthalmic artery and large aneurysm which located at the anterior communicating artery. The blood supply of the right side of anterior cerebral and middle cerebral artery came from the left internal carotid artery through the anterior communicating artery. We tried to surgical management of these two aneurysms. We reviewed the literature and discussed the related collateral circulation of this anomaly.