Anterior Cranial Fossa Dural Arteriovenous Fistulae Presenting as Subdural Hematoma

Anterior cranial fossa dural arteriovenous fistulae (DAVFs) are very rare and the bleeding rate is very high, especially in the presence of leptomeningeal draining vein and aneurysmal varix formation. A 85-year-old male patient presented with subdural hematoma (SDH). Magnetic resonance image (MRI) and transfemoral carotid angiography (TFCA) disclosed DAVF at the anterior cranial fossa with bilateral arterial feeders and leptomeningeal draining vein with varix formation. The lesion was treated by simple ligation of pial connecting vein using low frontal craniotomy. In comparison with DAVFs of the other sites, the anterior cranial fossa DAVF is difficult to manage by endovascular treatment due to not only the difficulty of transvenous access but the risk of visual impairment when using transarterial route. Surgical ligation of pial connecting vein is feasible and effective treatment.

Benign Osteoblastoma Located in the Parietal Bone

Benign osteoblastoma is an uncommon primary bone tumor, extremely rare in calvarium. We present a case of a 25-year-old female with an osteoblastoma of parietal bone which was totally resected. The authors discussed the clinical presentation, radiographic finding, differential diagnosis and management of the benign calvarial osteoblastoma with a review of the literature.

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion in Lumbar Degenerative Disease Patients

OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion(mini-TLIF) is an increasingly popular method because of several advantages, including rapid patient recovery, less postoperative pain, and minimized iatrogenic injury of soft tissue and muscle. The purpose of this study is to evaluate the clinical and imaging outcomes after mini-TLIF procedures. Results are compared with open posterior lumbar interbody fusion(oPLIF, Group B) and mini-TLIF(Group A) approach. METHODS: Between March 2007 and May 2008, mini-TLIF and oPLIF were performed in 23 and 36 consecutive patients with single or multilevel lumbar degenerative disease. Clinical outcomes were assessed by postoperative visual analogue scale(VAS) score, operation time, volume of blood loss, number of days to ambulation and duration of hospital stay. To assess fusion rate, all patients underwent postoperative radiography. And postoperative access were compared with an institutional reference series of 36 oPLIF procedures. RESULTS: Fusion success outcomes were obtained in 23(100%) out of 23 patients with mini-TLIF procedure. Mean VAS scores decreased from 8.2 to 1.9 in group A and from 8.1 to 2.4 in group B. The operation time, volume of blood loss, number of days to ambulation and duration of hospital stay were reduced in group A compared with group B. There was no complication associated to mini-TLIF procedure. CONCLUSION: Mini-TLIF yielded good clinical and radiological outcomes with safe and low complication. Further long- term investigating study is required to assess the definitive advantage of mini-TLIF.

Giant Arachnoid Granulation Misdiagnosed as Transverse Sinus Thrombosis

We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.

Craniospinal Metastasis from a Metastasizing Mixed Tumor of Salivary Gland : Unusual Presentation

Metastasizing mixed tumors (MMT) of salivary glands are inexplicably metastasize maintaining benign histology. There is no pathologic and flow cytometric analysis criteria to predict the metastasis. MMT is known to metastasize by local implantation, vascular and lymphatic embolization after multiple surgery to local recurrences of primary tumor. However, multiple metastasis including cranium and spine occurred even without surgery to the primary tumor in this case. No pathological evidence of malignancy could be found in both primary and metastatic tumor. MMT is considered as an low grade malignancy based on clinical behavior rather than histologic evidence, such as low mortality rate, long delay of metastasis after primary lesion. Cranial metastasis is also extremely rare and only two cases have been reported. We report this unusual case with a literature review.

A Morphometric Analysis of the Foramen Ovale and the Zygomatic Points Determined by a Computed Tomography in Patients with Idiopathic Trigeminal Neuralgia

OBJECTIVE: The purpose of this study is to measure the dimensions of foramen ovale and to localize the zygomatic point using computed tomography(CT) in Korean adults with idiopathic trigeminal neuralgia. METHODS: Facial axial CT scans using the orbitomeatal plane were performed in 67patients (39males and 28females; mean age 58.8years) with idiopathic classic trigeminal neuralgia. We measured the size of the foramen ovale and localized the zygomatic point which was a skin marker over the ipsilateral zygoma that approximates the lateral projection of a straight line joining the centers of the two foramen ovale. RESULTS: The axial dimensions of the foramen ovale on the orbitomeatal plane were of average length: 8.18+/-0.82mm (range 6.9~11.5mm), width: 4.06+/-0.86mm (2.5~5.7mm). The average distance between the external acoustic meatus and the zygomatic point was 21.64+/-1.99mm (16.3~25.0mm) and the average distance of anterior margin of condylar process of mandible to zygomatic point was 4.29+/-1.19mm (1.0~7.0mm). CONCLUSION: The anatomical understandings including the size of the foramen ovale and localization of the zygomatic point could be helpful in determining a plan of percutaneous approaches to foramen ovale.

Clinical Analysis and Treatment of Cervical Spine Injury

This study analyzed 88 patients who sustained a cervical spine injury during the past 4 years(Jan, 1993-May, 1996) in whom had 33 anterior, 21 posterior interventions were underwent and 34 remaining patients recieved conservative treatment with halovest. In 45 cases of upper cervical injuries, 16 operations were done. Among these, anterior approach was used in 3 patients and posterior approach in 13 patients. In 43 cases of lower cervical injuries, 39 operations were done. The anterior approach was used in 30 patients, posterior approach in 9 patients, and bilateral approached in remaing 4 cases. For patients with a predominent posterior ligamentous or osteoligamentous lesion, we selected anterior approach, when closed reduction was possible. Whenever the facet joint remained interlocked, a posterior approach was chosen. This report does not mentioned priority of anterior procedure at any case. Although clinical experience does not support the experimental data, we examined the reliability of anterior approach with use of internal fixation.

Delayed Nonunion of a Type II Odontoid Fracture, after Apparent Bony Fusion: Case Report

We managed a 27-year-old woman, who suffered from a type II odontoid fracture, with a halo-vest. After 12 weeks, we confirmed bony fusion on cervical spine CT and managed her with a neck collar. During the OPD follow up, we checked the cervical spine film every 1 month. After two and half months, displaced odontoid process was noted on routine cervical film, and a bony gap was found at the previous fracture wite on cervical spine CT. There is only one report in the literlature describing a nonunion after radiographically confirmed healing of a type II odontoid fracture. We report this case in order to emphasize the importance of scheduled follow up examination and evaluate precipitating factors of delayed nonunion of odontoid fracture.

The Influence of Taekwon / 대한정형외과학회잡지

The bone mineral densities of 60 middle school boys were measured with dual photon absorptiometry to define the influence of Taekwon-Do. They were divided into Taekwon-Do and control group, each comprising 30 boys. The bone mineral densities of the head, trunk, pelvis, both upper and lower extremities, and body total were measured. The results were as follows. 1. The BMD of head was 1.668 ± 0.153 in Taekwon-Do and 1.554 ± 0.153 0.167 in control. It was significantly increased in aekwon-Do(p 0.05). 3. The BMD of pelvis was 1.648 ± 0.153 0.112 in Taekwon-Do and 1.444 ± 0.153 0.215 in control. It was significantly increased in Taekwon-Do(p <0.005). 4. The BMD of right and left legs were 1.597 ± 0.153 0.118 and 1.579 ± 0.153 0.125 in Taekwon-Do and 1.425 ± 0.153 0.115 and 1.421 ± 0.153 0.113 in control group respectively. They were significantly increased in Taekwon-Do(p <0.005). 5. The BMD of right and left arms were 1.184 ± 0.153 0.090 and 1.178 ± 0.153 0.115 in Taekwon-Do and 1.056 ± 0.153 0.095 and 1.066 ± 0.153 0.097 in control group respectively. They were significantly increased in Taekwon-Do(p.<0.005). 6. The total body BMD was 0.932 ± 0.153 0.068 in Taekwon-Do and 0.846 ± 0.065 in control. It is significantly increased in Taekwon-Do(p<0.005). In conclusion, Taekwon-Do increases the total bone mineral density and the mineral densities of the head, pelvis and extremities but not that of trunk. It is thought that continued practice of Taekwon-Do throughout adult life might prevent the senile osteoporosis