Cervical Myelopathy Secondary to Atlanto-occipital Assimilation: The Usefulness of the Simple Decompressive Surgery

Atlanto-occipital assimilation is one of the most common osseous anomalies observed at the craniocervical junction. Most patients with atlas assimilation show no symptom, but some have neurological problems such as myelopathy that may require surgical treatment. Occipitocervical fusion may be required if atlato-occipital assimilation is accompanied by occipito-axial instability. However, in cases of symptomatic atlas assimilation with minor cord compression without instability, simple decompressive surgery may be the treatment modality. This report describes a case of successful treatment of a patient with myelopathy secondary to atlanto-occipital assimilation without instability, using posterior simple decompressive surgery.

Extensive Spinal Epidural Abscess: The Usefulness of Minimal Invasive Surgical Technique using Epidural Irrigation Catheter

Spinal epidural abscess (SEA) is a rare infection but may be devastating and fatal. We describe a case of a42-year-old male who presented with a posteriorly located SEA extending from C2 to the sacrum with severe neurologic deficits. We had the emergency surgery with the minimal invasive technique using epidural irrigation catheter, and then obtained an excellent recovery. The purpose of this report introduces the usefulness of minimal invasive surgical technique for extensive SEA.

Ethanol down regulates the expression of myelin proteolipid protein in the rat hippocampus / 대한해부학회지

It is well known that chronic ethanol treatment affects the synthesis of RNA and protein in the brain and the maintenance and function of nervous system. The changes in myelination-related genes are most prominent in human alcoholics. Previously, our cDNA microarray study showed altered Proteolipid protein (PLP), a major protein of central myelin. The present study aimed to gain more understanding of the expression of PLP after chronic ethanol treatment. Male Sprague-Dawley rats were daily treated with ethanol (15% in saline, 3 g/kg, i.p.) or saline for 14 days. Messenger RNAs from hippocampus of each group were subjected to cDNA expression array hybridization to determine the differential gene expressions. Among many ethanol responsive genes, PLP was negatively regulated by ethanol treatment, which is one of the most abundant proteins in the CNS and has an important role in the stabilization of myelin sheath. Using northern blot and immunohistochemical analysis, we showed the change in expression level of PLP mRNA and protein after ethanol treatment. PLP mRNA and protein were decreased in hippocampus of rat with chronic ethanol exposure, suggesting that ethanol may affect the stabilization of myelin sheath through the modulation of PLP expression and induce the pathophysiology of alcoholic brain.

Phosphorylation of 14-3-3zeta at serine 58 and neurodegeneration following kainic acid-induced excitotoxicity / 대한해부학회지

Oxidative stress-induced cell death leads to phosphorylation of 14-3-3zeta at serine 58. 14-3-3zeta is detected at significant levels in cerebrospinal fluid after kainic acid (KA)-induced seizures. Here we examined temporal changes in 14-3-3zeta phosphorylation in the hippocampus and amygdala of mice after KA treatment. Mice were killed at 2, 6, 24, or 48 h after KA (30 mg/kg) injection. We observed an increase in TUNEL and Fluoro-Jade B (FJB)-stained neurons in the hippocampus and amygdala of KA-treated mice. Phospho (p)-14-3-3zeta and p-JNK expression was increased in the hippocampus 2 and 6 h after KA treatment, respectively. In immunohistochemical analysis, p-14-3-3zeta-positive cells were present in the CA3 region of the hippocampus and the central nucleus of amygdala (CeA) of KA-treated mice. Thus, phosphorylation of 14-3-3zeta at serine 58 may play an important role in KA-induced hippocampal and amygdaloid neuronal damage.

Clinical Comparison between Simple Craniectomy and Lesionectomy in the Patients with Acute Cerebral Infarction / 대한뇌혈관외과학회지

OBJECTIVE: Life-threatening middle cerebral artery infarction may be accompanied by severe post-ischemic brain swelling due to cytotoxic vasogenic edema. The resultant progressive mass effect may prove fatal, owing to increased intracranial pressure and herniation. Recent studies have shown that early decompressive craniectomy decreases mortality, but no comparison has been performed between the outcomes achieved with simple craniectomy and those achieved with craniectomy combined with lesionectomy. This study was performed to compare the outcomes achieved after simple craniectomy and after craniectomy combined with lesionectomy. MATERIALS AND METHODS: We prospectively reviewed the records of 59 patients who presented with acute middle cerebral infarction between January 2001 and October 2007. Thirty-one patients (Group A) underwent simple decompressive craniectomy, and 28 patients (Group B) underwent lesionectomy with craniectomy. In all patients, lesion volume and mid-line shift were measured radiologically. Outcomes were quantified using the Glasgow Outcome Scale. RESULT: Patient factors (age, sex), Glasgow Coma Scale, radiologic findings, and lobe involvement were the same for the two groups. However, the outcomes for the two groups were different. At 6 months after surgery, the mean Glasgow Outcome Scale for Group A was 2.71 and that for Group B was 3.39 (p<0.05). CONCLUSION: Surgical treatment, especially decompressive craniectomy combined with lesionectomy, was beneficial in the setting of malignant cerebral infarction.

A1 Receptor-mediated Protection against Amyloid Beta-induced Injury in Human Neuroglioma Cells

Adenosine has been reported to provide cytoprotection in the central nervous systems as well as myocardium by activating cell surface adenosine receptors. However, the exact target and mechanism of its action still remain controversial. The present study was performed to examine whether adenosine has a protective effect against Abeta-induced injury in neuroglial cells. The astrocyte-derived human neuroglioma cell line, A172 cells, and Abeta25~35 were employed to produce an experimental Abeta-induced glial cell injury model. Adenosine significantly prevented Abeta-induced apoptotic cell death. Studies using various nucleotide receptor agonists and antagonists suggested that the protection was mediated by A1 receptors. Adenosine attenuated Abeta-induced impairment in mitochondrial functional integrity as estimated by cellular ATP level and MTT reduction ability. In addition, adenosine prevented Abeta-induced mitochondrial permeability transition, release of cytochrome c into cytosol and subsequent activation of caspase-9. The protective effect of adenosine disappeared when cells were pretreated with 5-hydroxydecanoate, a selective blocker of the mitochondrial ATP-sensitive K+ channel. In conclusion, therefore we suggest that adenosine exerts protective effect against Abeta-induced cell death of A172 cells, and that the underlying mechanism of the protection may be attributed to preservation of mitochondrial functional integrity through opening of the mitochondrial ATP-sensitive K+ channels.

Anterior and Posterior Stabilization by One Stage Posterolateral Approach in the Unstable Fracture of Thoracolumbar and Lumbar Spine

OBJECTIVE: The purpose of this study is to investigate the clinical results of anterior and posterior stabilization by one stage posterolateral approach for the unstable fracture of thoracolumbar and lumbar spine. METHODS: By posterolateral approach with curved skin incision, unilateral facet and pedicle were removed. Through this route, corpectomy was performed, and then this space was replaced with mesh cage filled up with autologous bone graft. Both side pedicle screw fixation was followed to upper and lower levels. RESULTS: Six of seven patients of this study showed neurological improvement. The other one patient showed no neurological change. One patient had postoperative infection, another patient had postoperative kyphosis. The other patient had epidural hematoma on operation site after surgery. And all patinets on this study made to have spinal stability except one patient happened postoperative kyphosis. CONCLUSION: In the unstable fracture of thoracolumbar and lumbar spine, one stage anterior and posterior stabilization and fusion by posterolateral approach seems to be an effective procedure, if we have more care and supplementation.

Anterior Cervical Interbody Fusion with the Carbon Composite Osta-Pek Frame Cage in Degenerative Cervical Diseases

OBJECTIVE: Different types of interbody fusion cages are available for use in the surgical treatment of degenerative cervical diseases. The purpose of this study is to assess the technical feasibility, clinical efficacy and radiological results of intervertebral fusion with a carbon composite Osta-Pek frame cage (Co-Ligne AG, Switzerland) following anterior cervical discectomy. METHODS: 41patients (25males and 16females) with minimum 6months follow-up were included in the study. Disc height, cervical lordotic angle, segmental angle, and fusion rate were assessed by lateral radiographs. In this retrospective analysis, clinical outcome was assessed as evaluated according to Odom's criteria. RESULTS: Fifty-four cages were implanted in 30 single-level, 9 two-level, and 2 three-level procedures. The mean disc height, cervical lordosis angle, segmental angle were 4.2+/-1.8mm, 23.5+/-7.2degrees, 2.3+/-3.3degrees pre-operatively and 5.3+/-2.1mm, 24.2+/-8.3degrees, 3.8+/-3.5degrees at 6months after the surgery. Six months after surgery, there was radiographic evidence of fusion in 92.7% (38/41) of the patients. According to Odom's criteria, 37 of 41 (90.2%) patients experienced good to excellent functional recovery. CONCLUSION: These clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft after anterior cervical discectomy for treatment of degenerative cervical disease.

Superior Orbital Rim Approach to the Anterior Circulation Aneurysms: Surgical Technique

OBJECTIVE: With the improvement of surgical techniques, instruments and diagnostic imaging, the aneurysmal surgery could be performed less invasively with less retraction of neural structure and more smaller craniotomy. The authors present a superior orbital rim approach as minimally invasive anterior circulation aneurysm surgery. METHODS: Superior orbital rim approach was performed for the treatment of the anterior circulation aneurysms with or without clinoidectomy. We considered the indications and limitations of this approach and compared this approach with conventional approaches. RESULTS: The operative technique can be used in all cases of anterior circulation aneurysms and could give us excellent results, especially, in internal carotid artery aneurysms. In cases of middle cerebral artery aneurysms, more wide and lateral approaches were used. In general, operation time was shortened and transfusion was not needed. CONCLUSION: The superior orbital rim approach is a good alternative procedure to conventional microsurgical approach in treating anterior circulation aneurysms.

Acute Nontraumatic Spinal Epidural Hematoma at Cervical Spine

The authors report a case of acute nontraumatic spinal epidural hematoma which extending from C4 to C6. A 70-year-old woman was presented with neck pain and left hemiparesis. T1-weighted magnetic resonance image revealed a mass isointense to the spinal cord and the mass was slightly enhanced after administration of gadolinium. T2-weighted images revealed high signal in the left posterolateral part of the spinal canal at the level of C4-C6. Evacuation of an epidural hematoma was performed with laminectomy. The pathological examination did not reveal any malformation within this hematoma. The patient showed complete recovery of the deficits. Medical investigation yielded thrombocytopenia and splenomegaly derived from liver cirrhosis. Thrombocytopenia and mechanical factor may be considered as etiologic factors in this case.

Superior Orbital Rim Approach for Anterior Communicating Artery Aneurysms: A Surgical Series of 27 Patients

There are debatable claims in the optimal approach for clipping of the anterior communicating artery (AcomA) aneurysm. The authors invented the superior orbital rim approach (SORA) as an alternative and minimally invasive approach for the treatment of AcomA aneurysm. The authors reviewed retrospectively all the medical records of 27 patients of subarachnoid hemorrhage due to ruptured AcomA aneurysm. who were admitted to Kosin University Gospel Hospital for last 2yr. Fourteen women (51.9%) and 13 men (48.1%) were from 29 to 79 yr in age. The mean aneurysm size was 6.2 mm ranging from 4 to 12 mm. A favorable Glasgow outcome scale (GOS) of 4 or 5 was achieved in 92.6%, a GOS score of 3 in 3.7%, and 1 death (GOS 1) occurred in 3.7% of the patients. During the follow-up between 4 and 28 months (mean, 17.5 months) after the surgery, the prognosis of the patients and the cosmetic results were favorable compared with conventional approach. We became to believe that it was an alternative, effective and minimally invasive approach to the surgical treatment of AcomA aneurysm.

Transaxillary Approach for First Rib Resection to Relieve Thoracic Outlet Syndrome

The authors report a case of thoracic outlet syndrome in left side. Thoracic outlet syndrome is a collective term in which symptoms and signs are due to bony and soft tissue compression of the neurovascular bundle at the thoracic outlet. It is a rare case in neurosurgical field. So we had experienced one case of thoracic outlet syndrome which was improved by transaxillary approach for resection of first rib. The clinical features, diagnostic test, radiological findings, and operative technique are presented with review of literatures.

Non-Watertight Intermittent Dural Closure in Neurological Surgery

No abstract available.

Hypothalamic Ganglioglioma: Case Report

No abstract available.