Ruptured Fusiform Anterior Cerebral Artery Aneurysm in an Infant : Case Report and a Literature Review

Ruptured intracranial aneurysms in infants are rare and infantile fusiform anterior cerebral artery (ACA) aneurysms are much rarer. In this report, we described the case of a 7-month-old infant with a ruptured fusiform ACA aneurysm who presented with seizure and underwent endovascular treatment. The patient was initially in a coma and the neurologic condition did not improve after treatment. The clinical characteristics of the case and literature review were discussed.

Blood Transfusion in Brain Surgery: A Comparison of Elective versus Emergency Operations / 대한수혈학회지

BACKGROUND: Blood transfusion is often performed to support successful brain surgery. In this study, we looked at two groups of surgery patients to analyze the transfusion requirements for patients undergoing brain surgery in our hospital. Group A patients received elective surgery, whereby blood products were prepared in advance, and Group B patients required emergency surgery which is often accompanied massive bleeding, and therefore adequate transfusion blood may not be available in advance. METHODS: During a one year period, patients who received brain surgery were classified as requiring either elective (Group A) or emergency (Group B) surgery. In each group, operation time and blood transfusion requirements were compared. RESULTS: Of the 35 total patients included in this study, 14 cases were Group A and 21 cases were group B. Average operation time was 4 hours and 13 minutes (253 minutes), and 2 hours and 50 minutes (170 minutes), respectively for Groups A and B. Red Blood Cell (RBC) transfusion was conducted in more than 90% of all patients. Average volume of RBC transfusion per operation was 2.5 units (Group A) and 3.1 units (Group B). Fresh frozen plasma (FFP) was transfused in 21% of Group A patients and in 38% of Group B patients. Platelet Concentrate (PC) was transfused in 19% of Group B patients, only. CONCLUSION: FFP and PC were more frequently transfused in patients who received emergency surgery than those who received elective surgery. Preparation of, not only RBC, but FFP and PC is required for emergency brain surgery. Therefore, efforts to retain adequate amounts of blood are needed to support emergency brain surgery.

The Early Detection of Recurrence of Malignant Peripheral Nerve Sheath Tumor by Frequent Magnetic Resonance Imaging

Surgery has a key role in the treatment of malignant peripheral nerve sheath tumors (MPNSTs), but the resectability of paraspinal MPNSTs is only 20%. Therefore, spinal MPNSTs show frequent recurrence and poor prognosis. Local recurrence is much more common than metastasis for MPNSTs, and surgery still has a key role in the treatment of local recurrence. Therefore, it is important that recurrence must be detected before resectability is lost. However, no evidence-based follow-up protocol has been established for MPNST. The authors performed gross total resection in a 34-year-old woman presented with thoracic MPNST. Adjuvant radiotherapy and chemotherapy were not administered since these adjuvant therapies generally do not improve survival in MPNST and may cause additional neurovascular damage. Instead, the authors monitored the primary site every 3 months using magnetic resonance imaging to detect local recurrence at the earliest opportunity. The tumor recurred locally on two occasions without overt symptoms at 21 and 24 months postoperatively. These recurrences were treated successfully by gross total removal.

Cerebral Aneurysm in the Long Fenestration at the Middle Portion of M1 Segment

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.

Probable Nonconvulsive Status Epilepticus after Drainage of a Chronic Subdural Hematoma in a Patient with Moyamoya Disease

A 52-year-old woman with hypertension and moyamoya disease presented with chronic subdural hematoma (CSDH). The presumed cause of bleeding was ascribed to administrated antiplatelet agents. She responded slowy and clumsily to verbal commands and had right arm weakness. After surgery, her clinical condition improved. But two days after surgery, her symptoms became aggravated and a convulsive seizure was noted within 24 hours. Brain magnetic resonance imaging showed no organic lesion except a small amount of residual CSDH. In addition, there was no laboratory evidence of metabolic brain disease. Moreover, after the administration of an antiepileptic drug (phenytoin), her manifestations disappeared. Therefore, the authors presume that her symptoms were resulted from nonconvulsive status epilepticus (NCSE), despite a lack of ictal period electroencephalographic findings. The authors were unable to find a single case report on postoperative NCSE in Korea. Therefore, the authors report this case of nonconvulsive status epilepticus after drainage of a CSDH in a patient with moyamoya disease.

Dorsal Short-Segment Fixation for Unstable Thoracolumbar Junction Fractures

OBJECTIVE: This study is to evaluate the efficacy of dorsal short-segment fixation in unstable thoracolumbar junction fractures. METHODS: The cases of 20 patients who underwent dorsal short-segment fixation were reviewed retrospectively. Clinical outcomes were analysed using Sonntag's pain level, work status, and neurological scale according to the modified Frankel classification. Radiological outcomes were analysed using Mumford's anterior body compression(%), canal compromise ratio, and Cobb's kyphotic angle. RESULTS: At the latest clinical follow-up (average=14.6 months), there were 19 (95.0%) in group I and 1 patient (5.0%) in II in pain level35). The postoperative work status were 17 (85.0%) in group I, 2 patients (10.0%) in II, and 1 patient (5.0%) in V. Surgery brought to improve the neurologic status. In success group (19 cases, 95%), the average canal compromise ratio was reduced from 0.57 (+/-0.07) to 0.05 (+/-0.08) (P<0.05), the average anterior body compression (%) was reduced from 41% (+/-17) to 18% (+/-14) (P<0.05), and the average preoperative kyphotic angle was 20.0 degrees (+/-9.0), and corrected to 5.7 degrees (+/-7.1) postoperatively, and progressed to 7.8 degrees (+/-6.2) at the latest follow-up. There was a case of implantation failure in an elderly osteoporotic patient. CONCLUSION: Although there are limitations in the patient number and follow-up period, the present study favors dorsal short-segment fixation for selective cases in unstable thoracolumbar junction fractures.

Prediction of Histologic Grade and Multidrug Resistance of Brain Tumors Using Brain SPECT

OBJECTIVE: Computerized tomography(CT) and magnetic resonance imaging(MRI) are very useful in detection of structural change in the brain including tumors. However, they can not inform functional and biological behavior of such lesions. 99m Tc-Methoxyisobutyl isonitrile(MIBI) is considered as a substrate for MDR1 gene-encoded permeability glycoprotein(P-gp) and it has been used in the evaluation of multidrug resistance(MDR) in various tumors. The purpose of the study is to demonstrate the presence of MDR in brain tumor and brain tumor grading by an external imaging with 201Thallium and 99m Tc-MIBI SPECT. METHODS: 201Thallium and 99m Tc-MIBI SPECT were performed in 18 patients with malignant tumors and in six patients with benign tumors. Immunohistochemical staining(IHC) of the tumor specimen for P-gp was also performed. The histologic grading of the tumors and immunohistochemical staining for P-gp were compared to the dual brain SPECT findings of 201Thallium and 99m Tc-MIBI SPECT studies. Brain tumor with positive 201Thallium SPECT and negative 99m Tc-MIBI SPECT is considered to be multidrug resistance. An uptake index obtained from brain SPECT was used for tumor grading. MDR1 gene-encoded P-gp was assessed by immunohistochemical staining using a monoclonal antibody for P-gp. RESULTS: The malignant group showed significantly higher uptake indices in the 201Thallium and 99m Tc-MIBI SPECT than benign group. The uptake index of 99m Tc-MIBI SPECT was inversely correlated with P-gp immunohistochemical staining without statistical significance. CONCLUSION: 201Thallium and 99m Tc-MIBI SPECT are useful for predicting histologic grade of brain tumors, and 99m Tc-MIBI SPECT might be useful for predicting the presence of MDR protein.