Selective Peripheral Denervation for the Treatment of Spasmodic Torticollis

OBJECTIVE: Various methods of treatment for idiopathic cervical dystonia have been tried in the past with unsatisfactory results. The authors report cases of five patients who underwent selective peripheral denervation for spasmodic torticollis. METHODS: Between July 2002 and December 2003, 5 patients underwent surgery at St. Mary's Hospital for spasmodic torticollis. Age of the patient at the onset of symptoms ranged from 29 to 56years (mean 43.75years). Selective peripheral denervation(SPD) was performed at 7 to 11months after the onset of symptoms (mean 8.75 months). A patient was considered to be the candidate for surgery if conservative methods were unsuccessful and symptoms persisted for longer than 7months. In addition, 2patients who refused treatment with botulinum toxin were also enrolled in this study. RESULTS: Although one patient underwent reoperation, all of the five patients' symptoms were improved after the operation. Clinically, patients with retrocollis showed better improvement than laterocollis patients. CONCLUSION: Although injection of botulinum toxin is the first-choice in treatment modality, when surgery is required, selective peripheral denervation provides good results with minimum side effects.

Management of the Extracranial and Intracranial Traumatic Arterial Lesions

OBJECTIVE: This study is designed to elucidate the requirements for angiographic evaluation and the selection of appropriate therapeutic approaches in patients who had strongly suggestive traumatic carotid arterial lesions. METHODS: Ten cases of traumatic internal carotid arterial lesions were analysed in this study. Injury mechanisms, neurological status, computed tomography scans, pre-and postoperative angiograms, and methods and results of the treatment were included. RESULTS: Of 10 cases, carotid-cavernous fistula(CCF) alone in three, CCF with intracranial pseudoaneurysms in three, pseudoaneurysm with dissection in one, extracranial internal carotid artery thrombosis in one, extracranial pseudoaneurysm in one, and the remaining one had all of the CCF, intracranial pseudoaneurysm and dissection. Seven of these 10 cases had sphenoid sinus wall fractures and six had subarachnoid hemorrhage. Six cases were treated with endovascular techniques, and four with direct parent artery occlusion and bypass surgery. No postoperative morbidity or additional permanent neurological deficits occurred except one patient who suffered from reperfusion hemorrhage after bypass surgery. CONCLUSION: Head trauma patients with facial bone fractures and thick subarachnoid hemorrhage should be evaluated for the development of traumatic injuries to the carotid artery as soon as possible. Endovascular treatment to these lesions have come to play an increasing role. Patients with traumatic internal carotid artery lesions who do not tolerate test occlusion require extracranial to intracranial bypass surgery before occlusion.

Intracerebral Hematoma after Reperfusion Procedures in Cerebral Ischemia / 대한뇌혈관학회지

Intracerebral hematoma (ICH) after reperfusion procedure in cerebral ischemia is a rare but serious complication. The authors present 4 cases with ICH after reperfusion procedures in cerebral ischemia. First case is ICH after superficial temporal artery-middle cerebral artery anastomosis in moyamoya patient, second case is ICH after graft bypass usuing saphenous vein in traumatic carotid artery injury patient, third case is ICH after intra-arterial urokinase therapy in acute internal carotid artery occlusion and forth case is ICH after temporary clipping to the middle cerebral artery in middle cerebral artery aneurysm surgery. Defective cerebrovascular autoregulation in ischemic brain regions may predispose patients to ICH after reperfusion procedure in cerebral ischemia. The authors suggest reperfusion procedure in ischemia must be executed prudently because of possibility of reperfusion injury including ICH.

in vitro and in vivo Photodynamic Activity Study of U-87 Human Glioma Cell with Photofrin

OBJECTIVE: The objective of this study was to determine the photodynamic therapeutic response of U-87 human glioma cell in vitro as well as in the nude rat xenograft model using photofrin as photosensitizer. MATERIAL AND METHOD: U-87 cells were cultured on 96-well culture plates, photofrin(Quadralogic Technologies Inc., Vancouver, Canada) was added into the cell culture medium at concentration of 1ng/ml, 2.5ng/ml, 5ng/ml, 10ng/ml and 20ng/ml. 24 hour after drug treatment, cells were treated with optical(632nm) irradiation of 100mJ/cm2, 200mJ/cm2 and 400mJ/cm2. Photofrin(12.5mg/kg, i.p.) was administered to 28 nude rats containing intracerebral U-87 human glioma as well as 26 normal nude rats. 48 hours after administration, animals were treated with optical irradiation(632nm) of 35J/cm2, 140J/cm2 and 280J/cm2 to exposed tumor and normal brain. The photofrin concen-tration was measured in tumor and normal brain in a separate population of animals. RESULTS: By MTT assay, there was 100% cytotoxicity at any dose of photofrin with optical irradiation of 200mJ/cm2 and 400mJ/cm2. But at the optical irradiation of 100mJ/cm2 cells were killed in dose dependent manner 28.5%, 49.1%, 54.4%, 78.2%, and 84.6% at concentration of 1ng/ml, 2.5ng/ml, 5ng/ml, 10ng/ml and 20ng/ml, respectively. Dose dependent PDT lesions in both tumor and normal brain were observed. In the tumor lesion, only superficial tissue damage was found with optical irradiation of 35J/cm2. However, in the optical irradiation group of 140J/cm2 and 280J/cm2 the volume of lesions was measured of 7.2mm3 and 14.0mm3 for treatment at 140J/cm2 and 280J/cm2, respectively. The U-87 bearing rats showed a photofrin concentration in tumor tissue of 6.53+/-2.16ng/g, 23 times higher than that found in the contralateral hemisphere of 0.28+/-0.15ng/g. CONCLUSION: Our data indicate that the U-87 human glioma in vitro and in the xenografted rats is responsive to PDT. At these doses, a reproducible injury can be delivered to human glioma in this model. Strategies to spare the normal brain collateral damage are being studied.

Efficacy of Unilateral Pallidotomy for Parkinson's Diesease

OBJECTIVES: For Parkinsonian patients who had not reacted favorably on drug therapy are good candidate for ventroposterolateral pallidotomy, although not curative. We studied these patients after unilateral pallidotomy, to confirm the effectiveness and safety of this procedure. METHODS: We evaluated the 17 patients with idiopathic Parkinson's diesease who had undergone unilateral posteroventral pallidotomy. All patients responded to levodopa initially. Mean age was 55 years(38-75years), and mean duration of disease was 9.8 years(3-20years). Pre-and postoperative evaluation at 3 month intervals included Unified Parkinson's Disease Rating scale(UPDRS) scoring, Hoehn and Yahr(H and Y) staging, and neuropsychological examinations. RESULTS: Pallidotomy significantly improved parkinsonian symptom(tremor, rigidity, bradykinesia, dyskinesia, sensory symptom). Nine of 10 patients who showed dyskinesia preoperatively significant improvement. The mean dose of levodopa in 9 patients was lowered. The mean H and Y score and UPDRS score were improved in on and/or off time in 15 patients. Among patients who were not improved, one patient worsened, and the others showed no change. The mean overall UPDRS off score changed from 76 preoperatively to 44(33%) at 6 months and from 70 to 52(25%) at 1 year. Transient surgical morbidity was showen in four patients and included dysarthria, hypotonia and confusion. CONCLUSION: We conclude that pallidotomy is safe and effective in patients who have levodopa-reponsive parkinsonism with severe symptom fluctuation. Unilateral pallidotomy also considered helpful to ipsilateral symptom. Unilateral pallidotomy can improve all of parkinsonian's symptom and allow to reduce the levodopa medication. Most of patients show satisfactory results.