Development of Delayed Acute Subdural Hematoma after Mild Traumatic Brain Injury: A Case Report / 대한신경손상학회지

We report a case involving the development of a delayed acute subdural hematoma (ASDH) after trauma, with the absence of any abnormal radiological and clinical findings at initial examination. A 54-year-old male visited the emergency department after a minor trauma. The patient only complained of mild headache after head injury. He presented no abnormal findings on neurological examination, and brain computed tomography (CT) did not show any intracranial lesion or skull fractures. However, he developed seizure with disorientation eight hours after trauma, and ASDH with midline shift was found during a follow-up CT. He recovered without neurological deficits after immediate primary care and admission to the neurosurgery department. On serial follow-up CT images, a gradually increasing mass effect of hematoma was detected, and removed by craniotomy. The patient recovered without neurologic deficits.

Comparison of Complications Following Cranioplasty Using a Sterilized Autologous Bone Flap or Polymethyl Methacrylate / 대한신경손상학회지

OBJECTIVE: The aims of current study are to compare complications following cranioplasty (CP) using either sterilized autologous bone or polymethyl methacrylate (PMMA), and to identify the risk factors for two of the most common complications: bone flap resorption (BFR) and surgical site infection (SSI). METHODS: Between January 2004 and December 2013, 127 patients underwent CP and were followed at least 12 months. Variables, including sex, age, initial diagnosis, time interval between decompressive craniectomy (DC) and CP, operation time, size of bone flap, and presence of ventriculo-peritoneal shunt, were analyzed to identify the risk factors for BFR and SSI. RESULTS: A total of 97 (76.4%) patients underwent CP using PMMA (Group I) and 30 (23.6%) underwent CP using autologous bone (Group II). SSI occurred in 8 (8.2%) patients in Group I, and in 2 (6.7%) in Group II; there was no statistically significant difference between the groups (p=1.00). No statistically significant risk factors for SSI were found in either group. In Group I, there was no reported case of BFR. In Group II patients, BFR developed in 18 (60.0%) patients at the time of CP (Type 1 BFR), and at 12-month follow up (Type 2 BFR) in 4 (13.3%) patients. No statistically significant risk factors for BFR were found in Group II. CONCLUSION: CP using sterilized autologous bone result in a significant rate of BFR. PMMA, however, is a safe alloplastic material for CP, as it has low complication rate.

1p36 deletion syndrome confirmed by fluorescence in situ hybridization and array-comparative genomic hybridization analysis / 소아과

Pediatric epilepsy can be caused by various conditions, including specific syndromes. 1p36 deletion syndrome is reported in 1 in 5,000–10,000 newborns, and its characteristic clinical features include developmental delay, mental retardation, hypotonia, congenital heart defects, seizure, and facial dysmorphism. However, detection of the terminal deletion in chromosome 1p by conventional G-banded karyotyping is difficult. Here we present a case of epilepsy with profound developmental delay and characteristic phenotypes. A 7-year- and 6-month-old boy experienced afebrile generalized seizure at the age of 5 years and 3 months. He had recurrent febrile seizures since 12 months of age and showed severe global developmental delay, remarkable hypotonia, short stature, and dysmorphic features such as microcephaly; small, low-set ears; dark, straight eyebrows; deep-set eyes; flat nasal bridge; midface hypoplasia; and a small, pointed chin. Previous diagnostic work-up, including conventional chromosomal analysis, revealed no definite causes. However, array-comparative genomic hybridization analysis revealed 1p36 deletion syndrome with a 9.15-Mb copy loss of the 1p36.33-1p36.22 region, and fluorescence in situ hybridization analysis (FISH) confirmed this diagnosis. This case highlights the need to consider detailed chromosomal study for patients with delayed development and epilepsy. Furthermore, 1p36 deletion syndrome should be considered for patients presenting seizure and moderate-to-severe developmental delay, particularly if the patient exhibits dysmorphic features, short stature, and hypotonia.

Clinical usefulness of the measurement of serum fructosamine in childhood diabetes mellitus

PURPOSE: Glycosylated hemoglobin (HbA1c) is often used as an indicator of glucose control. It usually reflects the average glucose levels over two to three months, and is correlated with the development of long-term diabetic complications. However, it can vary in cases of hemoglobinopathy or an altered red blood cell lifespan. The serum fructosamine levels reflect the mean glucose levels over two to three weeks. This study was designed to determine the clinical usefulness of the combined measurement of serum fructosamine and HbA1c in the management of childhood diabetes mellitus and the correlation between them. METHODS: Clinical data on 74 Korean children and adolescents with diabetes mellitus who were under management at the Department of Pediatrics of Dankook University Hospital were evaluated. Their fructosamine and HbA1c levels were reviewed based on clinical information, and analyzed using IBM SPSS Statistics ver. 21. RESULTS: Their HbA1c levels showed a strong correlation with their fructosamine levels (r=0.868, P<0.001). The fructosamine level was useful for the prompt evaluation of the recent therapeutic efficacy after the change in therapeutic modality. It was also profitable in determining the initial therapeutics and for the estimation of the onset of the disease, such as fulminant diabetes. CONCLUSION: The measurement of both fructosamine and HbA1c was useful in managing childhood diabetes mellitus, especially when there was discrepancy between the clinical information and the HbA1c level.

Clinical Analysis of Epidural Fluid Collection as a Complication after Cranioplasty

OBJECTIVE: The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes. METHODS: From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis. RESULTS: Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation. CONCLUSION: EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.

Lumbar Nerve Root Compression due to Leakage of Bone Cement after Vertebroplasty / 대한신경손상학회지

We experienced a 73-year-old male with lumbar nerve root compression due to leakage of bone cement after vertebroplasty. He was underwent vertebroplasty for acute osteoporotic L4 compression fracture at our hospital. After vertebroplasty, his back pain was improved but right leg pain was newly developed. Lumbar computed tomography scanning showed that bone cements were leaked along the L4 nerve root. The leaked cements around L4 nerve root were removed carefully via paraspinal muscle-splitting approach. After operation, severe right leg radiating pain was improved. We recommend proper entry point, high viscosity of polymethylmethacrylate and constant monitoring can reduce complication.

The Status of Dietary Supplements Intake in Korean Preschool Children: Data from the Korea National Health and Nutrition Examination Survey 2010-2012 / 대한소아소화기영양학회지

PURPOSE: The use of dietary supplements (DS) has increased in most nations. We investigated the amount of DS intake in the Korean population by analyzing a national survey, to support the preparation of a national institutional strategy regarding DS intake and marketing. METHODS: The data of the fifth Korea National Health and Nutrition Examination Survey (a year between 2010 and 2012) were investigated, analyzing the rate of DS intake, and the characteristics of the intake group and non-intake group in Korean preschool children. RESULTS: The intake rate of DS was 49.0-54.2% (1,313,874-1,491,240) and 19.6-30.3% (250,603-421,922) in children from 1 to 6 years old and in those less than 1 year, respectively, from 2010 to 2012. The highest intake rate was observed in the age group of five. The mean age was significantly higher in the DS intake group than in the non-intake group. Intake of essential nutrients, minerals, and vitamins were also higher in the DS intake group. The level of family income was significantly associated with the intake rate (p<0.001). In children less than 1 year, probiotics accounted for the highest intake of DS. CONCLUSION: Korean preschool children have high consumption of DS. Therefore, problems may arise from the waste of money purchasing unnecessary DS, and from the overuse of DS in preschoolers who do not require DS intake. We hope these results can be used to produce an appropriate national institutional strategy regarding DS intake and marketing.

The Usefulness of Brain Magnetic Resonance Imaging with Mild Head Injury and the Negative Findings of Brain Computed Tomography

OBJECTIVE: To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury. METHODS: During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly. RESULTS: Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105). CONCLUSION: Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.

Clinical characteristics of respiratory virus infection in children admitted to an intensive care unit

PURPOSE: To investigate the clinical characteristics and the risk factors for mechanical ventilator treatment and incidence of complications in children admitted to an intensive care unit (ICU) with detected respiratory viruses. METHODS: Eighty-two patients who were detected respiratory viruses by multiplex real-time polymerase chain reaction from nasopharyngeal aspirates were enrolled among the 123 children admitted to ICU with acute respiratory manifestations during the study period from January 2006 to December 2012. RESULTS: Detection rate of respiratory viruses were 66% and 13 patients (16%) had two viruses isolated. The most common respiratory virus isolated was respiratory syncytial virus (RSV) (35%) followed by rhinovirus (19%), adenovirus (13%), parainfluenza virus (11%), influenza virus (11%), human metapneumovirus (6%), and human coronavirus (5%). Pneumonia (70%) was the most common clinical diagnosis. The mean age of patient with RSV infection was the youngest and with influenza virus infection was the oldest among other viruses infection (mean+/-standard deviation, 5.9+/-10.1 months vs. 51.0+/-26.1 months; P=0.01). Forty Patients (49%) who had the underlying diseases were not associated with incidence of mechanical ventilator treatment and complications. Bacterial coinfection with respiratory virus was the significant risk factor of mechanical ventilator care and incidence of complications (odds ratio [OR], 50.003; 95% confidence interval [CI], 3.955-632.144; P=0.003, and OR, 15,569; 95% CI, 1.803-134.452; P=0.013). CONCLUSION: The significant morbidity of pediatric patient admitted to ICU with respiratory virus infection (RVI) was associated with bacterial coinfection. Furthermore, multicenter study should be performed to investigate the epidemiology of RVI in pediatric patients admitted to ICU in domestic.

How to Do in Persistent Diarrhea of Children?: Concepts and Treatments of Chronic Diarrhea / 대한소아소화기영양학회지

Chronic diarrhea is defined as passing watery stools that lasts for more than 2 weeks. Persistent diarrhea belongs to chronic diarrhea and is a chronic episode of diarrhea of infectious etiology. The etiology of chronic diarrhea is varied. It is important to consider the child's age and clinical manifestations with alarm signals for an application of proper treatments to children with chronic diarrhea. Vicious cycle is present in chronic diarrhea and nutritional rehabilitation can break the vicious cycle of chronic diarrhea and is one of the main one thing among treatments. We should know the exact concept of chronic diarrhea and provide appropriate treatments according to etiologies of chronic diarrhea.

Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

OBJECTIVE: There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. METHODS: Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. RESULTS: The mean ages were 69.4+/-12.1 and 55.6+/-9.3 years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. CONCLUSION: Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique.

Role of 'Spot Sign' on CT Angiography to Predict Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

OBJECTIVE: Patients with spontaneous intracerebral hemorrhage (ICH) presenting within 24 hours of symptom onset are known to be increased risk of hematoma expansion which is closely correlated with morbidity and mortality. We investigated whether tiny enhancing foci ('Spot sign') on axial view of 3-dimensional computed tomography angiography (3D-CTA) source images can predict subsequent hematoma expansion in spontaneous ICH. METHODS: During a 2-year period (March 2007-March 2009), we prospectively evaluated 3D-CTA of 110 patients with spontaneous ICH. Based on source images of 3D-CTA, patients were classified according to presence or absence of 'Spot sign'; 'Spot sign' (+) group, 'Spot sign' (-) group. Radiological factors and clinical outcomes were compared between two groups. RESULTS: Hematoma expansion occurred in 16 patients (15%). Mean Glasgow Coma Scale (GCS) score of patients with hematoma expansion was significantly different compared to score of patients without hematoma expansion (5 vs. 9, p < 0.001). Nineteen patients (16%) of 110 ICH patients demonstrated 'spot sign' on 3D-CTA. Among the 'spot sign' (+) group, 53% of patients developed hematoma expansion. Conversely 7% of patients without 'spot sign' demonstrated the hematoma expansion (p < 0.001). Initial volume and location of hematoma were significantly not associated with hematoma expansion except shape of hematoma. CONCLUSION: Our study showed that patients with hematoma expansion of spontaneous ICH had significant clinical deterioration. And the fact that 'spot sign' (+) group have higher risk of hematoma expansion suggests the presence of 'spot sign' on source images of 3D-CTA can give a clue to predict hematoma expansion in spontaneous ICH.

A Complicated Case of Endovascular Stent Assisted Coil Embolization of an Aneurysm / 대한뇌혈관외과학회지

Endovascular coiling is one of the recent methods for treating cerebral aneurysm and this method is considered to be an alternative method for treating aneurysms. Yet there are several disadvantages of endovascular coiling. As is well known, a wide-necked aneurysm is not completely treated with endovascular coiling. Infarction of the parent artery due to coil compaction, recanalization and embolization is a significant problem of endovascular coiling for a wide-necked aneurysm. Wide-necked aneurysms have been recently treated with stent assisted coil embolization. Stent-assisted coil embolization results in a higher rate of complication. In this case report, we present a case with complication after stent-assisted endovascular coiling. We concluded that precise, cautious procedures are needed when performing complicated stent assisted endovascular coiling to prevent thromboembolic complications.

Improvement of Readiness to Change in Heavy Drinkers by Group Drinking Education

BACKGROUND: This study was designed to evaluate the effectiveness of brief group education on improvement of readiness to change in heavy drinkers. METHODS: We selected 37 heavy drinkers categoriged in the state of precontemplation and contemplation stage according to readiness to change questionnaire (RTCQ). The readiness to change was re-evaluated after 4 sessions of drinking education. RESULTS: The mean (+/-SD) frequency of participation in group education was 3.5 (+/-0.6). According to the stage of readiness to change, the subjects were distributed into 11 (29.7%) in the stage of precontemplation and 26 (70.3%) in contemplation before participation in the program. After completion of educational program, the readiness to change in the subjects was significantly (P<0.001) changed into 1 drinker (2.7%) in the stage of precontemplation, 16 (43.2%) in contemplation and 20 (54.1%) in action. The influential factors associated with the improvement of the status of readiness to change was family APGAR score (odd ratio 1.75, 95% CI 1.02-3.03). CONCLUSION: Above results suggested that the readiness to change in heavy drinkers can be improved by brief group education program.

The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

OBJECTIVE: We investigated the incidence of the vascular abnormalities associated with spontaneous intracerebral hemorrhage (ICH) using three-dimensional computed tomographic angiography (3D-CTA). METHODS: We prospectively assessed consecutive 76 patients with spontaneous intracerebral hemorrhage (ICH) who underwent 3D-CTA between June 2003 and May 2005. The patients with a recent history of trauma or mainly subarachnoid hemorrhage were excluded. We investigated relationship between vascular abnormality and ICH location. The findings of 3D-CTA were classified as one of three patterns with ICH; type A (without evidence of vascular abnormality), type B (with no vascular abnormality as the source of hemorrhage, but with incidental vascular abnormality), and type C (presence of a vascular abnormality as the source of hemorrhage). RESULTS: Sites of ICH were lobar 26, basal ganglia 23, thalamus 17, posterior fossa 6 and dominant intraventricular hemorrhage (IVH) 4. Among 76 patients, sixteen (21.1%) vascular abnormalities were noted excluding 13 cases of stenoocclusive disease. Sixteen cases included 6 cases of cerebral aneurysms (7.9%), 5 moyamoya diseases (6.6%), 4 arteriovenous malformations (5.3%) and 1 dural sinus thrombosis (1.3%). Lobar ICH (30.8%) had a higher vascular abnormalities than other types, and younger age (<40) group had a higher incidence of vascular abnormalities than old age group. The patterns of 3D-CTA include sixty cases (79.0%) of type A, 6 cases (7.8%) of type B and 10 cases (13.2%) of type C. The vascular abnormalities were found in 8 (13.5%) of 59 hypertensive patients and 8 (47.0%) of 17 non-hypertensive patients (p=0.006). CONCLUSION: 3D-CT angiography is considered a useful screening tool for ICH patients with suspected cerebrovascular abnormalities and should be considered in such clinical settings, especially in lobar type and in non-hypertensive younger patients.

Benefits of the Various Pain Procedures as Therapeutic Option in Low Back Pain

OBJECTIVE: The authors retrospectively evaluate the benefits of the various pain procedures for the treatment of low back pain unresponsive to conservative management. METHODS: Over a period of 2 years from May 2002 and June 2004, the authors had performed various pain procedures on 106 patients with low back pain. Epidural block, facet joint block, sacroiliac joint block, and myofascial block were included among various pain procedures. The pain improvement, period of analgesic use, and degree of satisfaction were evaluated 1 day, 4 weeks, and 6 months after injections. The outcome of pain procedures was analyzed by using a modified Macnab criteria. RESULTS: Sixty-four patients had a single procedure with no combination and 42 patients (39.6%) received the combination of the various pain procedure. Regardless of the single or combination cases of procedure, combination of appropriate spinal level on each procedure was conducted in 104 (98.1%). Mean follow up period was 12.2 months. Eighty-two patients (77.4%) experienced significant pain relief and overall analgesic medication was reduced in 91 patients (85.8%) at 6 months after procedure. Unfavorable results were demonstrated in 10 patients. Permanent procedural complications did not occur. CONCLUSION: The various pain procedures are the possible therapeutic option for low back pain unresponsive to conservative management including medication or physical therapy.

Surgical Outcome of Spontaneous Intracerebral Hemorrhage in Less than Stuporous Mental Status

OBJECTIVE: Spontaneous supratentorial intracerebral hemorrhage can be considered as one of the most common forms of cerebravascular disease. Effective reduction of intracranial volume buffering capacity in elevated intracranial pressure is most important factor related to a poor prognosis in cases with huge hematoma and compromised mental status. The role of surgery in the management of such cases are still controversial. METHODS: Thirty patients with altered mental status less than stuporous and spontaneous supratentorial hematoma were underwent craniotomy or decompressive craniectomy and duroplasty. The hematoma volume were ranging from 31 to 120ml. In 14 patients, in whom a progression in secondary brain swelling was expected to occur after hematoma evacuation, a decompressive craniectomy with dural enlargement was performed. The overall clinical result was expressed as 30 day mortality, Glasgow outcome scale(GOS) and modified Rankin scale 1 year after surgery. The favorable outcome(GOS> or =4) were analyzed with variables [age, initial Glasgow coma scale(GCS), hematoma volume, location of hematoma, extent of midline shift, intraventricular hemorrhage, and time interval from ictus to surgery]. RESULTS: The overall clinical results showed 10% of 0-day mortality, 56.6% of favorable outcome and 53.3% of independency(< or =2 of modified Rankin scale). A significant statistical correlation was found between outcome and initial GCS and location of hematoma(p<0.05). The decompressive craniectomy and duroplasty proved some useful in increasing postoperative GCS of compromised patients. CONCLUSION: Surgical treatment of patients with spontaneous supratentorial intracerebral hemorrhage with altered mentality less than stuporous can have a positive role, in selected cases.

Clinical Analysis of Determining the Primary Rupture Site in Multiple Intracranial Aneurysms: Preliminary Report

OBJECTIVE: Misjudgement of rupture site may result in disastrous postoperative rebleeding from the unclipped but truly ruptured aneurysm. We assess the concordance rate between radiologic findings and operative ones, and then we document the problems in false localization of rupture site in multiple intracranial aneurysms. METHODS: From January 2001 to December 2002, We retrospectively analyzed 14 patients with a total of 32 multiple aneurysms to assess the primary rupture site. The rupture site was determined on the basis of computed tomographic and angiographic findings by neurosurgeons and one neuroradiologist. The operative findings such as healed thrombotic cap, localized clot, and easy collapse before and after clipping of ruptured aneurysms were compared with the predicted radiologic findings. On the other hand, we analyzed the causes in the cases of false localization. RESULTS: The location of ruptured aneurysm was verified at the time of surgery in 10 patients. The concordance rate of localized clot(100%) was higher than laterality of subarachnoid hemorrhage(66.7%) on CT scan, and those of focal vasospasm and nipple formation(100%) were also higher than size(72.7%) or irregularity(83.3%) of aneurysms on angiographic findings. Two of four misjudged patients were expired due to rebleeding from unclipped aneurysms. CONCLUSION: Although most reliable radiologic findings are useful in determination of rupture site, we should also consider less reliable radiologic findings and careful surgical inspection of the target aneurysm. And then early second operation should be performed as soon as possible in cases of misjudgment on initial diagnosis.

Improved Quality of Life after Percutaneous Vertebroplasty for Osteoporotic Vertebral Body Compression Fractures in the Elderly

OBJECTIVE: The purpose of this study is to assess the improvement of quality of life after percutaneous vertebroplasty for osteoporotic vertebral body compression fractures in the elderly. METHODS: Between September 1999 and September 2002, 30 patients underwent 41 percutaneous vertebroplasties for osteoporotic vertebral body (17 thoracic, 24 lumbar). The mean age was 72.9 years (range, 64-78 years) and mean follow-up period was 13.2 months (range, 6-35 months). Visual Analog Scale (VAS) scores, ambulatory status, and sleep status were determined by questionnaires. RESULTS: Twenty-eight patients (93.3%) had marked or complete pain relief immediately after procedure. The mean VAS score was 7.7 preoperatively, 2.3 at 48 hours, and 1.5 at 6 months follow-up (p<0.01). Analgesic consumption was reduced immediately and at 6 months follow-up in 28 patients (93.3%). Twenty-six patients (86.7%) slept more comfortably without analgesics (p<0.01) and 24 patients (80.0%) were fully ambulated at 6 months follow-up (p<0.05). Overall, 90% of the patients were satisfied with the results of the procedures and 10% reported no change. There were no significant complications related to the procedures. CONCLUSION: Vertebroplasty is safe and effective procedure to treat osteoporotic vertebral body compression fractures in the elderly. Vertebroplasty not only works to help stabilize spinal fractures but also helps to alleviate pain and improve the patient's quality of life.

Staged Operation of a Dumbbell-Shaped Schwannoma in High Cervical Region: Case Report

The authors report a case of high cervical giant dumbbell-shaped schwannoma. A 43-year-old man admitted for the evaluation of gait disturbance and hypesthesia below C2 dermatome for six years. Magnetic resonance imaging showed a large enhancing dumbbell-shaped mass, extending from carotid sheath to craniovertebral junction, and in C1, C2 spinal canal, which causes significant compression of the cervical cord posteriorly. we decided to do staged operations. First, the intraspinal portion was removed in order to decompress the spinal cord from the tumor. Second, residual extraspinal tumor was removed via high cervical retropharyngeal approach. The patient recovered well without any neurological deficit.