Neurologic and Histological Study of Clip Compression Model for Rat Thoracic Spinal Cord Injuries

OBJECTIVE: The purpose of this study was to assess the time-response of clip compression model for the relationship between the duration of the injury on the rat thoracic spinal cord, and histological and functional outcome measures. METHODS: After laminectomy at T9 in Sprague-Dawley rats, a modified aneurysm clip with a closing force of 30-gram was applied extradurally around the spinal cord at T9, and then rapidly released with cord compression persisting for 1, 5, and 10 minutes, respectively. The locomotor function, according to the Basso-Beattie-Bresnahan (BBB) scale, was assessed weekly for 4 weeks after the injury. The injured spinal cord was then examined histologically including quantification of cavitation. RESULTS: Spinal cord injury by clip compression resulted in worsened BBB scale scores. However, there was spontaneous functional improvement in times for all 3 injury severities, with the greatest improvement in the 1-minute compression group. From 1 week after the injury, BBB scores in the 1-minute group were significantly higher than in the 5 or 10-minutes groups until the end of the follow-up period (p<0.05). For histological analysis, the cavitation area and cavity volume at 4 weeks was directly proportional to the severity of the injury. CONCLUSION: The results of this study show that the rat thoracic cord clip compression model is a reliable and reproducible spinal cord injury model. The duration of clip compression injury in the rat thoracic cord has been correlated with both functional and histologic outcome measures.

Multiple Vertebral Involvement of Rheumatoid Arthritis in Thoracolumbar Spine: A Case Report

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.

Cervical Spinal Metastasis of Merkel Cell Carcinoma

Merkel cell carcinoma is a skin disease that rarely involves the spine. The common presentation of spinal involvement is quite confusing and may be easily misdiagnosed. However, once it spreads, the disease progresses rapidly, with an extremely poor outcome. We report on the case of a 30-year-old male with cervical spinal metastasis of Merkel cell carcinoma causing quadriparesis.

Remote Cerebellar Hemorrhage Complicated after Supratentorial Surgery: Retrospective Study with Review of Articles

OBJECTIVE: Remote cerebellar hemorrhage (RCH) is one of the rare complications occurring after supratentorial surgery, and its pathomechanism is poorly understood. We report 10 cases of RCH from our institution and review 154 cases from a database in order to delineate incidence, common presentation, risk factors, and outcomes of this complication. In addition, the means of prevention are discussed. METHODS: We reviewed the medical records of 10 patients who experienced RCH after undergoing supratentorial surgery at our institution between 2001 and 2008. A database search in Medline revealed 154 cases of RCH in the English literature. Characteristic features were analyzed and compared. RESULTS: There were 10 cases of RCH among 3307 supratentorial surgery cases, indicating a 0.3% incidence. All patients had characteristic imaging features of RCH, namely a streaky bleeding pattern in the superior folia of the cerebellum. Seven patients had a history of preoperative hypertension. Four cases were related to cerebral aneurysms, and other four developed after the removal of brain tumors. Cerebrospinal fluid (CSF) drainage apparatuses were installed postoperatively in all cases. Outcomes according to modified Rankin scale (mRS) were good in 7 patients, with 1 fatal case. CONCLUSION: RCH is a rare complication after supratentorial surgery, and the exact etiology still remains uncertain. Hypertension and perioperative loss of CSF seem positively correlated with RCH, but no single risk factor is totally responsible. Patients with RCH should be closely observed to improve their prognosis.

Retraction: Thoracic Intramedullary Clear Cell Meningioma

By carefully examining the above paper, we found that there are many same materials, expressions, and objects between this paper and a previously published paper on another journal (Park SH, Hwang SK, Park Ym: Intramedullary clear cell meningioma, Acta Neurochir (Wien) 148:463-466, 2006). Under these circumstances, the editorial committee concluded to retract this paper as soon as possible. We deeply apologize to the readers for any inconvenience caused by this retraction.

Thoracic Intramedullay Clear Cell Meningioma

Intramedullary clear cell meningioma(CCM), which is more aggressive than other variants of meningioma, is extremely rare. To date, only one case has been documented in spinal tumors. We report the first case of an intramedullary CCM originating in the spinal cord at the thoracic region.

Neurosurgical Approaches to and through the Frontal Sinus using Osteoplastic Frontal Sinusotomy

OBJECTIVE: The frontal sinus is frequently a troublesome anatomical obstacle to gain access to the medial anterior cranial base. Surgical approaches to and through the frontal sinus using osteoplastic frontal sinusotomy provide significant advantages to the treatment of lesions of the medial anterior cranial base in addition to the frontal sinus itself. However, appropriate management is necessary to avoid postoperative complications such as cerebrospinal fluid leakage, infection, mucocele formation, and deformity of the forehead. METHODS: The advantages and shortcomings of the approach along with the surgical technique are reported based on our clinical experience with pertinent literature review. The approach using the osteoplastic frontal sinusotomy was applied to two cases of osteoma in the frontal sinus, seven cases of craniofacial tumors, a case of chordoma in the sphenoid and clivus, and two cases of intradural lesions in the anterior cranial fossa. The frontal sinus was managed in such a way as to prevent the postoperative complications. RESULTS: All patients underwent gross total resection of the tumors. With a mean follow-up of 26 months, there were no postoperative complications related to frontal sinus violation. CONCLUSION: The neurosurgical approaches via the frontal sinus using osteoplastic frontal sinusotomy are versatile for various lesions of the anterior cranial base in patients with large frontal sinuses. In situations that the frontal sinus have to be violated to approach medial anterior cranial base, the osteoplastic frontal sinusotomy provides such advantages as optimal frontal sinus control to prevent postoperative complications; increases viewing angle with superior trajectory from nasofrontal suture; lower incidence of pnemocephalus due to minimal dural exposure; and excellent cosmesis without frontal burr holes.

Pituicytoma: Case Report

We report a case of Pituicytoma, which is a rare brain tumor occuring in the sellar region. A 44-year-old woman presented with polyuria, polydipsia, visual disturbance, amenorrhea and galactorrhea 1 year prior to admission. A magnetic resonance image revealed a well enhancing pituitary mass with large suprasellar extension. There was no area of normal hyperintensity showing the posterior lobe of the pituitary gland. The tumor was subtotally removed via transsphenoidal surgery. Pathological examination of the surgical specimen showed astrocytes with spindle-shaped fibrillary cytoplams. Immunohistochemical staining was positive for glial fibrillary acidic protein, S-100, vimentin. Radiotherapy was not given after surgery.

Primary Intracranial Epidermoid Carcinoma

Primary intracranial epidermoid carcinoma is an extremly rare sequela of epidermoid cysts. The authors had experienced a case of primary intracranial epidermoid carcinoma in the right cerebellopontine angle. Here, we report clinical, radiological, and histopathological features of this neoplasm with review of literatures.

Multiple Primary Brain Tumors: Association of Intraventricular Meningioma and Callosal Astrocytoma: Report of Two Cases

Two patients presenting with intraventricular meningioma and callosal astrocytoma are described. The first case is a 51 year old female presented with headache and paraparesis. Magnetic resonance imaging revealed meningioma in the left occipital horn of lateral ventricle and astrocytoma in the corpus callosum, which were confirmed by operative removal and biopsy respectively. The second patient had been removed the meningioma in the left lateral ventricle. Seven years later poorly marginated enhancing lesion was found on the corpus callusum which was confirmed as astrocytoma by computed tomography guided biopsy.

Gliomatosis Cerebri: Clinical Features and Prognosis

OBJECTIVES: Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of the underlying cytoarchitecture. The aim of this study is to evaluate clinical features, outcome of surgical treatment and adjuvant therapy of gliomatosis cerebri. METHODS: Between Jan. 1990 and Dec. 2000, 12 patients were diagnosed with gliomatosis cerebri based on characteristic radiological and histological findings. The patients' age ranged from 18 to 77(mean 44) years and the male to female ratio was 7: 5. Nine patients underwent decompressive surgery and three, biopsy only. Postoperative radiation therapy was given in all cases except three. In addition to radiation therapy, four patients received chemotherapy. The mean duration of follow-up period was 18.8 months. RESULTS: The most common presenting symptom were seizure and motor weakness. The mean duration of symptom was 5.9 months. There was 5 bilateral lesions and tumor involved corpus callosum in 5, basal ganglia-thalamus in 4, and brain stem in 2. There was no operative mortality but four patients died during the follow-up. The mean survival period for 11 patients was 20.5 months from the time of diagnosis. In univariate analysis, the lesion involving corpus callosum, basal ganglia-thalamus and brain stem correlated significantly with the short length of survival(p<0.05). Also, postoperative radiation as a adjuvant therapy prolonged the patient's survival(p<0.05). CONCLUSIONS: In the management of gliomatosis cerebri patients, early detection by MR imaging, active management of increased intracranial pressure, decompressive surgical removal and postoperative adjuvant therapy such as radiation is thought to be a good treatment modality.

Anterior Screw Fixation of Type II Odontoid Fracture

No abstract available.

Posterior C1-2 Transarticular Screw Fixation without C1-2 Sublaminar Wiring in Atlantoaxial Instability

No abstract available.

The Clinical and Radiological Analysis of Shunt-Dependent Hydrocephalus after Acute Hydrocephalus in Surgical Aneurysmal Patients

No abstract available.

Spontaneous Hematomyelia: Case Report

No abstract available.

Pedicle Screw Fixation and Posterolateral Fusion for Thoracolumbar Spine Fracture

From January, 1996 to December, 1997, 24 patients with unstable thoracolumbar spine fracture were treated with pedicle screw fixation and posterolateral fusion. The present study is a retrospective analysis on various clinical paramaters such as age, sex distribution, causes of injury, levels of injury and outcomes. The mean follow-up period was 17 months(range, 4-26 months) after their initial operation. Reduction and stabilization was attained without complications. Sixteen patients with Frankel Grade-C,D,E returned to full-time work, but 8 patients with Frankel grade-A, B were not significantly improved. Maximum neurologic recovery can be expected with prompt and adequate decompression, restoration of normal spinal alignment and rigid internal fixation.

Anterior and Posterior Fusion on Reduction-failure Unilateral Interfacetal Dislocation

OBJECTIVE: Unilateral interfacetal dislocation(UID) is a common injury in cervical spine, but diagnosis is somewhat difficult due to mild subluxation. Management of'locked facet' is not established yet and many authors advocate posterior fusion to secure stability. Because most of UID patients have minimal neurological symptom with normal activity, we tried anterior and posterior fusion simultaneously. PATIENTS AND METHODS: Various parameters, such as the radiological findings, operation time and methods, kinds of fixation devices, post-operative stability, neurological outcomes in 10 UID-patients, who showed no satisfactory closed reduction with Gardner tong traction. These patients underwent anterior fixation following posterior open reduction and fusion to maintain the definite stability. RESULTS: Median age was 40 years(18-64 range) and the male to female ratio was 7:3. Causes of injury consisted of 6 car accident, 3 fall-down, 1 diving accident. Mechanism of injury was flexion in all ten cases. Levels of injury were 2 in C4-5, 5 in C5-6 and 3 in C6-7. Operations were performed within 5 days of injury in eight patients. In two patients, who had no reduction procedures were operated on the 23rd day and the 4th month respectively. Kinds of device were: 7 titanium wire and 3 steel wire in posterior wiring, 9 Caspar nonlocking plate and 1 Orion locking plate in anterior plate fixation. All patients were ambulated at post-operative one day with Philadelphia cervical collar and showed post-operative stability with improved neurological outcome. CONCLUSION: In UID patients who failed in closed reduction with traction, anterior discectomy and bone fusion and plating following posterior open reduction and wiring proved good results.

Pediatric Head Injury

Pediatric head injury is a leading cause of disability or death in children. Reducing morbidity and mortality require careful attention to the factors leading to poor prognosis. In this regards authors reviewed the clinical features of pediatric head injury to find out the prognostic factors. From 1992 to 1996, 96 pediatric head injury patients were admitted to our hospital. Seventy eight of them(81.3%) were transferred from the other hospitals. Pedestrian vehicle accident and fall were the leading causes. Clear or drowsy patients account for 42.7 %, stuporous, semicomatose or comatose, 57.3%. Early seizures were noted in 18(18.8%). Outcome were good in 68(70.8%), moderate to severe disability 18(18.8%), vegetative 3(3.1 %), and died 7(7.3%). Consciousness level was the most significantly related with poor prognosis. Radiological deterioration, hematoma or edema, was noted in thirteen patients, and their prognosis was significantly worse than others(p=0.01). Those patients with complications occurred during admission such as pneumonia or electrolyte imbalance showed poorer prognosis (p<0.05). In conclusion outcome of the pediatric head in Jury was significantly related to the initial mentality, worsening of hematoma or edema on follow up CT scan, and complications such as pneumonia and electrolyte imbalance during admission . Early recognition of these factors would contribute to the improvement of the outcome of the pediatric head injury patients.

Anterior Cervical Fixation in Spine Injury Patients Requiring Tracheostomy

Because of the possibility of increased the risk of soft tissue or bone infection, surgeon have been somewhat reluctant to use the anterior cervical approach in spinal injury patients who had previously undergone tracheostomy. The authors investigated whether the use of a Caspar plate in such patients during anterior cervical fixation altered the risk of infection. We analyzed the mechanism and level of injury, operative procedures, post-operative course and infection in 12 cervical injury patients with previous tracheostomy. The procedure had been performed on the day of injury because of semicoma resulting from combined head injury in two cases, and because of multiple rib fracture with hemothorax, and old age with chronic obstructive lung disease in one case each; it had been performed between 1-6 days after injury because of high fever with pneumonia and atelectasis in eight cases. The interval between tracheostomy and anterior fixation was 5-20(average, 13) days. During clinical follow-up at 8-21 (average, 16) months, bone union without infection was observed in all patients. The authors concluded that in patients with cervical cord injury, tracheostomy did not increase the risk of infection in subsequent anterior cervical fixation using a Caspar plate.

Posterior and Anterolateral Approaches in a Single Stage to Dumbbell Tumors of the Spine

The surgical approach to spinal tumors varies not only with the level and location of the tumor, but also with the type and extent of the tumor. Some of the dumbbell neurofibroma(neurilemmoma) can be removed through simple laminectomy, but usually are approached through two separate incisions by two stages. In this report, posterior and anterolateral approaches in a single stage to dumbbell neurofibroma(neurilemmoma) of the spinal region are described. This approach provides full exposure of intra- and paraspinal portions of the tumor, thus permitting safe dissection and total removal. Six patients who underwent this procedure are described to illustrate its application.