The Long Term Outcome of Percutaneous Endoscopic Discectomy

Between January 1995 and May 1998, 177 patients with proven lumbar disc herniation were treated by microdiscectomy or by percutaneous endoscopic discectomy(PED). Among them, 43(24.2%) patients underwent PED and were followed for long term outcome. We included only those patients who were followed up more than 13 months. Three patients who did not improved immediately after PED and underwent microdiscectomy were excluded for this study. Of remaining 40 patients, there were 22 men and 18 women who ranged in age from 23 to 68 years (mean 38.1 years). The disc herniations were located at L1-2(1), L2-3(1), L3-4(1), L4-5(26) and L5-S1(11). Three patients were treated by biportal approach. The mean follow up period was 34.7 months(range 13-47 months). Overall, excellent and good results were achieved in 12(30%) and 19(47.5%) patients, and fair and poor results in 7(17.5%) and 2(5%) patients, respectively. Thirty-eight(95%) patients returned to their previous works and the mean duration was 5.7 months. Thirty-three(82.5%) patients answered that they would recommend this procedure to others. There was no complication except for one patient who suffered from discitis. The indication of PED is restricted to contained or small subligamentous lumbar disc herniation without stenosis, spondylolisthesis and sequestration. PED can be performed under local anesthesia and tissue trauma, risk of epidural scarring, hospitalization time and postoperative morbidity are minimal. The result of the present study justify the assumption that PED can be a surgical alternative for patients suitable for its indications.

Orbital Cavernous Lymphangioma with Intracranial Extension: Case Report

Lymphangioma is a rare benign developmental vascular tumor that may be found in orbit, skull and elsewhere in head and neck. Few cases of extension of this benign but insidious tumor posteriorly out of the bony orbital cavity have been reported. The patient was 40-year-old man complaining of proptosis of right eye for one month. Physical examination revealed severe right exophthalmus, impairment of eyeball movement in all directions. Visual acuity was much impaired and he could percept only light with right eye. CT and MRI scans showed intraconal and extraconal involvement of ill-defined, heterogenous mass with extension of the tumor posteriorly beyond the orbital cavity involving right frontal and temporal lobe, skull and subcutaneous tissue. The tumor was subtotally removed via orbito-frontal approach without damaging vital neural and orbital component. Then, orbital roof reconstruction and cranioplasty were done with resin. Successful surgical removal of lymphangioma is very difficult due to its severe infiltration to surrounding tissue and tendency to bleed during debulking. We report a rare case of orbital cavernous lymphangioma with intracranial extension treated with surgical decompression, with review of literatures.

Usefulness of Computed Tomographic Angiography in the Detection and Evaluation of Aneurysms of the Circle of Willis

No abstract available.

Arteriovenous Fistula after C 1-2 Posterior Transarticular Screw Fixation

No abstract available.

Primary Mlignant non-Hodgkin's Lymphoma of Cranial Vault

Primary non-Hodgkin's lymphoma of the cranial vault is very rare. A 55-year-old woman presented with a right parietal subcutaneous scalp lump. Computed tomography(CT) scan showed a right parietal cranial vault lesion with scalp swelling and extradural and intradural involvement. Tumor removal, including portion of involved skull, followed by c ranioplasty with resin were performed. Histologic study revealed the features of a T-cell non-Hodgkin's lymphoma(high grade, large cell, diffuse, immunoblastic type) and there was no systemic involvement. The chemotherapy and radiotherapy were instituted after surgery.

Effects of Peripheral Inflammation on Brain-Derived Neurotrophic Factor and TrkB in Rat Dorsal Root Ganglia and Spinal Cord / 대한해부학회지

Recent study showed that peripheral inflammation induced an increased expression of brain-derived neurotrophic factor (BDNF) mRNA which was mediated by nerve growth factor in the dorsal root ganglion (DRG). Therefore, it is conceivable that peripheral inflammation may induce an increase in BDNF synthesis in DRG and consequently enhance the level of BDNF in the spinal cord and that gene expression of trkB mRNA may be altered. In the present study, we evaluated changes in BDNF-immunoreactivity and trkB mRNA in the DRG and spinal cord by means of immunohis-tochemistry and RT-PCR, respectively, following peripheral tissue inflammation produced by intraplantar injection of Freund's adjuvant into rat paws. In addition, coexistence of BDNF and preprotachykinin (PTT) mRNAs, BDNF and CGRP mRNAs or BDNF and trkB mRNAs in the DRG following inflammation was observed by means of in situ hybridization. The results obtained were as follows; 1. Inflammation induced a significant increase of the number of BDNF-immunoreactive (IR) neurons in the ipsilateral DRGs. The increase was observed 1 and 3 days after injection of adjuvant, and the levels had returned to normal by 7 days. In the spinal cord, inflammation also induced an elevation in the expression of BDNF-IR terminals in the medial superficial layers of the ipsilateral dorsal horn and in lamina V 1 and 3 days after injection. 2. There was significant increase of truncated trkB (t-trkB) mRNA in the ipsilateral DRG 3 days following inflammation. Changes in the expression of trkB mRNA in the DRG or trkB and t-trkB mRNAs in the spinal cord were not observed. 3. Many neurons showed increased coexistence of BDNF and PTT mRNAs or BDNF and CGRP mRNAs in the DRG following inflammation. 4. Few neurons showed coexistence of BDNF and trkB mRNAs in the DRG following inflammation. The results suggest a paracrine function for BDNF within the DRG in addition to an important role related with nociception following peripheral inflammation.

Anterior Cervical Interbody Fusion with versus without Plating System in Degenerative Cervical Disease

Anterior cervical interbody fusion(ACIF) is an effective method for the treatment of various cervical diseases, but complications from such procedure include non-union, absorption, collapse and displacement of graft bone, kyphosis and pseudoarthrosis. A retrospective study of 67 cases with ACIF with versus without plating system in degenerative cervical disease was performed to compare the arthrodesis level, average admission period, average ambulation period, fusion rate, complications, clinical outcome and reoperation rate for complications and to provide a efficacy and role of internal fixation(IF) after ACIF. Forty-five patients were operated through ACIF without IF and twenty-two patients were operated through ACIF with IF. In the group of ACIF without IF, the average admission period was 20.31 days, postoperative average ambulation period was 6.48 days, fusion rate was 97.7%, the rate of graft related complication was 31.1%, reoperation rate for graft related complications was 8.9%. In the group of ACIF with IF, the average admission period was 17.64 days, postoperative average ambulation period was 3.19 days, fusion rate was 100%, the rate of graft and plate related complications was 13.6%, reoperation rate for plate related complications was 9.1%. There was no reoperation for graft related complication in group of ACIF with IF. In conclusion, ACIF with IF had less chance of serious graft related complications and reoperation for graft related complications.

Congenital Cystic Supratentorial Hemangioblastoma Associated with Intracystic Hemorrhage: Case Report

Supratentorial hemangioblastomas are rare tumors. The first documented case of congenital cystic supratentorial hemangiblastoma associated with intracystic hemorrhage is presented; it occurred in a 38-day-old male infant.

Percutaneous Endoscopic Discectomy Compared to Microsurgical Discectomy: Preliminary Results

To help clarify the comparative effects of percutaneous endoscopic discectomy and microsurgical discectomy in the treatment of lumbar disc herniation, the authors studied 37 consecutive patients with discogenic symptoms who had not responded to conservative treatment. Their indications are restricted to discogenic root compression with"contained"or small"noncontained"lumbar disc. Patients with sequestrated disc, spinal stenosis, or spondylolisthesis were excluded. All patients underwent magnetic resonance imaging and if the radiological interpretation was confused with extruded migrated disc, a discogram was also obtained. Of the 37 patients, 18 underwent percutaneous endoscopic discectomy and 19, microsurgical discectomy. In order to compare the efficacy of the two methods, both groups were investigated. Disc herniations were located at L4-5(24 patients), L5-S1(11 patients), or L4-5 and L5-S1(2 patients). With regard to age and sex distribution, preoperative complaints, and clinical symptoms, there were no differences between the two groups. At the last follow-up evaluation after percutaneous endoscopic discectomy, low back pain had disappeared in three patients(17.6%), sciatica in nine(50.0%), sensory deficits in two(16.7%), motor deficits in three(42.5%), and reflex differences in one (50%). After microsurgical discectomy, low back pain had disappeared in one patient(5.6%), sciatica in nine(47.4%), sensory deficits in five(33.3%), motor deficits in six(66.7%), and reflex differences in three(75.0%). In 83.3% of patients in the percutaneous endoscopic discectomy group, the outcome was successful(excellent or good result), compared with 78.9% of those who had undergone microsurgical discectomy. One patient in the percutaneous endoscopic discectomy group suffered from discitis. For patients with"contained"or slight subligamentous lumbar disc herniations, percutaneous endoscopic discectomy offers a surgical alternative.

Traumatic Aneurysm in an Infant: Case Report

We report a case of traumatic aneurysm in a 50-day old male infant arising from the peripheral portion of right middle cerebral artery. The infant had suffered a major head injury with an iron bar before coming to the hospital. On admission he presented with generalized tonic-clonic seizure 15 days after the head trauma. Computed tomography(CT) scan demonstrated a round, mixed-density hematoma in the right temporoparietal cortex. During operation, an aneurysm was found within the hematoma under the operating microscope, and the aneurysm was assumed to be of traumatic origin. The aneurysm arising from the peripheral right middle cerebral artery was ligated and cauterized, and the hematoma was evacuated. After the operation, the infant had no incidence of any seizure attack nor any focal neurologic deficit. The incidence pathogenesis, clinical diagnosis, and treatment of traumatic aneurysm is discussed together with a review of the literature.

Clinical Analysis of the Result of Halo Immobilization Versus Surgical Fusion in the Management of Traumatic Cerical Spine Injury

In the mamagement of cervical spine injuries, it is difficult to determine when to use halo immobilization alone, surgical fusion alone or a combination of the two. To investigate the appropriate condition and relative effectiveness of the treatment of cervical spine injuries, a 3-year retrospective analysis was conducted. During this study the authors reviewed the medical records and X-rays of 46 patients with cervical spine injuries treated with either halo immobilization or surgical fusion. Eighteen patients were treated with the initial surgical fusion, yielding a fusion failure rate of 22%. On the other hand, the remaining 28 patients were initially treated with the halo immobilization, yielding a fusion failure rate of 35%. The main fracture types in patients that require surgical fusion after failure with halo immobilization were hyperflexion anterior subluxation and locked facet injuries. From these findings, we concluded that halo immobilization of hyperflexion anterior subluxation injury and unilateral or bilateral locked facet results in relatively high failure rates and therefore treatment by initial surgical fusion should be the method of choice. Close monitoring is mandatory following halo vest with any type of fracture and level.

A Case of Meningioma Compatible with Metastatic Glioblastoma Multiforme

We report a case of 54-year-old female with two intracranial tumors, a meningioma and multifocal glioblastoma multiforme with extracranial metastasis. The simultaneous occurrence of meningioma and glioblastoma multiforme and extracranial metastasis of glioblastoma multiforme are rare. We demonstrated additional clinical and pathological features of interest and reviewed the relevant literatures, and have speculated on the causes of this phenomenon.

Trial of Urokinase in Treatment of Traumatic Vertex and Posterior Fossa Epidural Hematoma

We encountered the danger of the bleeding the vertex and posterior fossa epidural hematoma(EDH) operation which were related with large sinuses. Traumatic vertex EDH and posterior fossa EDH were usually accompanied by the fractures of coronal, sagittal suture or occipital bone. And frequently, sources of the bleeding were venous sinuses or fracture site. The patients who had vertex EDH were paraparetic soon after injury and the patients who had posterior fossa EDH were dangerous due to brain stem compression. We treated successfully the 13 patients who had vertex EDH(7 patients) and posterior fossa EDH(6 patients) by the method of one or two burr holes and urokinase irrigation. The authors represented this method may occasionally be preferable to craniotomy for these lesions. Advantages of the methods were : 1) More simple, cosmatic procedure and no need of cranioplasty. 2) Reduced operation time and morbidity. 3) Enable to operate under local anesthesia. 4) Reduced rate of delayed intracranial hematoma due to acute decompression of epidural hematoma. 5) Reduced the date of admission. 6) Possibly, prevention of rebleeding and air embolism.