A Case of Cerebellar Infarction Caused by Vertebral Artery Injury / 대한이비인후과학회지

Injury to vertebral vessel is not usually associated with neurologic deficit and a lot of such injuries have not been recognized. Also, vertebral artery injuries are the least common arterial injuries because of their deep location in a bony canal. The incidence of vertebral artery injury occurring in penetration wound of the neck varies from 1.0% in gunshot wounds to 7.4% in stab wounds. But even vertebral artery injuries in penetration wound of the neck rarely results in cerebellar infarction. Authors experienced a case of cerebellar infarction induced by post-vertebral artery injury in penetration wound of the neck with hypoplastic contralateral verterbral artery. We thus report with a review of the related literature.

A Study of the Effects of Clinicobiological Factors upon the Meningioma-Associated Peritumoral Edema Formation

It is thought that the biological aggressiveness of meningioma is closely related to the development of peritumoral edema. However, the effects of mechanical tumor factors on the venous return of underlying brain tissue, as well as those of MIB-1 or p53 immunoreactivity on the brain edema formation are still not clear. To identify factors which may influence meningioma-associated peritumoral edema development, the authors examined 28 histologically proven intracranial meningiomas(22 benign, 4 atypical, and 2 malignant meningioma patients). Correlation between the degree of brain edema and various factors including volume of the tumor, venous sinus involvements, tumor location, histologic subtypes, MIB-1 labeling index(LI), and immunoreactivity of p53 protein was analyzed retrospectively. The degree of brain edema(edema ratio) was measured by maximum edema area to maximum tumor area as seen on T2 and T1 enhanced magnetic resonance images, respectively. Mean maximum tumor area and the volume of the tumor were 15.7cm2 and 50.2cm3, respectively. The mean area of maximum edema extension was 23.3cm2 and the mean ratio between maximum edema area and tumor area was 1.90(range: 0-11.5). Tumor volume and the area of edema showed significant correlation(p=0.015). MIB-1 LI, however, correlated inversely with edema ratio(p=0.039). p53 protein expression, venous sinus involvement, age, sex, and histologic characteristics did not correlated with edema area or ratio. In conclusion, this study showed there was inverse correlation between edema development and MIB-1 LI, and no correlation with p53 expression. It was thus speculated that peritumoral edema in meningioma may not be a sign of biological aggressiveness.

Surgical Treatment of Instability of Upper Cervical Spine Associated with Trauma

With the aim of determining the outcome of surgery, a review of patients undergoing trauma-associated atrantoaxial arthrodesis. Between 1993 and 1997, 16 patients underwent 19 proceedures, with a follow-up period of between six and 29 months. The most common reasons for surgery were odontoid fracture(n=12), os odontoideum(n=1) procedure, and neurofibrimatosis type I(n=1). Ten posterior wiring, four Halifax clamp application, one anterior screw fixation of dens, two transarticular screw fixations, and one staged operation(anterior odontoiddectomy and posterior occipitocervical fusion) were performed. All patients has been surgically managed for about three months with a Halo-vest or rigid cervical neck collar, during which time three complications associated with operative procedures arose : Halifax clamp dislodgement, malunion and subluxation kyposis. In 15 of 16 patients, fusion was successful. In caes involving complicated atlantoaxial dislocation, the authors recommend postoperative Halo-vest immobilization for sucessful fusion after posterior C1-C2 wiring or Halifax clamping