ABSTRACT
We report a case of fatal aortic tumor embolism presenting as acute paraplegia. A four-year-old girl was referred from a local hospital with sudden paraplegia and a poor medical condition. A neighbor had noticed her fall from a bike, and she could not walk. She had no previous illness. Emergency spine MRI revealed no remarkable findings. During the process of evaluation, her general condition deteriorated progressively. Chest and abdominal CT showed a large mass in the left lung field, and a diagnosis of aortic occlusion was made. An emergency transfemoral embolectomy was attempted. However, the patency of the aorta was not recovered. On pathological examination of tissues taken from the embolectomy, a pleuro-pulmonary blastoma was found. The patient died 22 hours after the onset of her symptoms. We describe a possible mechanism for the tumor embolism. To the best of our knowledge, this is the first case report of aortic occlusion caused by an embolic malignancy, presenting as acute paraplegia.
Subject(s)
Female , Humans , Aorta , Diagnosis , Embolectomy , Emergencies , Lung , Magnetic Resonance Imaging , Neoplastic Cells, Circulating , Paraplegia , Spine , Thorax , Tomography, X-Ray ComputedABSTRACT
We report a case of spontaneous intracranial epidural hematoma following the intraoperative course of a patient who had undergone surgical removal of a thoracolumbar schwannoma in olivo-ponto-cerebellar atrophy. To our knowledge there is no reported case in which the thoracolumbar schwannoma removal was followed by such a complication. Mechanical events leading to this complication are unclear. Abnormal results of a neurological examination in the early postoperative period should suggest this possibility.
Subject(s)
Humans , Hematoma, Epidural, Cranial , Neurilemmoma , Neurologic Examination , Olivopontocerebellar Atrophies , Postoperative PeriodABSTRACT
We present a case of meningeal and brain metastasis of multiple myeloma. A 60-year-old woman who had been diagnosed as multiple myeloma two years ago, was referred to neurosurgery department because of headache and nausea. The magnetic resonance image of the brain showed a large epidural mass and the parenchymal enhancement. The patient received an operation of tumor removal and cranioplasty. A histological diagnosis of metastatic multiple myeloma was made.
Subject(s)
Female , Humans , Middle Aged , Brain , Diagnosis , Headache , Immunoglobulin G , Multiple Myeloma , Nausea , Neoplasm Metastasis , Neurosurgery , PlasmacytomaABSTRACT
We present a rare case of a pituitary adenoma revealing a sedimentation level on MRI, which has not been previously documented. This 55-year-old woman was referred with the diagnosis of craniopharyngioma. She presented with four-month history of progressive headache and visual dimness. Neurological examination revealed a bitemporal hemianopsia and decreased visual acuity. Laboratory data including endocrine examination were unremarkable. An additional three-dimensional MRI was taken for further evaluation, and demonstrated a sedimentation level within the tumor. The patient underwent transcranial removal of the tumor. About 12cc of dark-red blood was aspirated from the tumor. Histological examination revealed a pituitary adenoma with hemorrhage. Postoperatively, the patient showed gradual improvement of visual function. Considering that the pituitary adenoma is one of more common tumors that cause tumoral bleeding, a cystic sellar tumor that has a sedimentation level should be sought first for a pituitary adenoma rather than a craniopharyngioma. This may have an important impact when deciding surgical approach.
Subject(s)
Female , Humans , Middle Aged , Craniopharyngioma , Diagnosis , Headache , Hemianopsia , Hemorrhage , Magnetic Resonance Imaging , Neurologic Examination , Pituitary Apoplexy , Pituitary Neoplasms , Visual AcuityABSTRACT
OBJECTIVES: Anterior tunnelling technique consist of anterior cervical fractional interspace decompression without fusion. This method provides sufficient space for adequate neuroforaminal decompression but avoids the need for fusion or fixation. We report early clinical results of 32 cases that underwent anterior tunnelling operation for treatment of cervical radiculopathy. METHODS: This method is identical to conventional approach until the exposure of anterior cervical body and bilateral retraction of longus colli is made. A vertical window is then made at the vertebral bodies and disc space lateral to the insertion site of the longus colli. The window is deepened with drilling that follows a tunnelling fashion down to the compressive lesion. We analyzed clinical results from 32 patients who treated between December 1998 and August 2000. RESULTS: Satisfactory results were obtained in 87% of the patients. Two patients required revision surgery. None revealed surgical spinal instability on last follow-up. CONCLUSION: Anterior tunnelling operation is an acceptable surgical option for the treatment of cervical radiculopathy. Its advantages are short hospitalization, minimal postoperative discomfort, and technical feasibility.
Subject(s)
Humans , Decompression , Follow-Up Studies , Hospitalization , RadiculopathyABSTRACT
No abstract available.
Subject(s)
Humans , Magnetic Resonance Imaging, Cine , Spinal Cord DiseasesABSTRACT
The continuous measurement of jugular venous oxygen saturation(SjvO2) with a fibroptic catheter is evaluated as a method of detecting cerebral ischemia after head injury. Fifty patients admitted to the hospital who were unconscious after severe head injuries had continuous and simultaneous monitoring of SjvO2, intracranial pressure, arterial oxygen saturation, arterial blood pressure. Whenever SjvO2 dropped to less than 50%, a standardized protocol was followed to confirm the validity of the desaturation and to elucidate its cause. A total of 72 episodes of jugular venous oxygen desaturation occurred in 45 patients, possibly due to intracranial hypertension in 39 episodes, arterial hypoxia in 13, combinations of the above in 9, systemic hypotension in 7, and anemia in 4. Two episodes of hyp-eremia, SjvO2 more than 90%, occurred in 2 patients with carotid-cavernous fistula. The incidence of jugular venous oxygen desaturation found in this study suggests that continuous monitoring of SjvO2 may be of clinical value in patients with head injury.
Subject(s)
Humans , Anemia , Hypoxia , Arterial Pressure , Brain Ischemia , Catheters , Craniocerebral Trauma , Fistula , Hypotension , Incidence , Intracranial Hypertension , Intracranial Pressure , OxygenABSTRACT
The authors report two cases of radiologically documented transaqueductal migration of intraventricular neurocysticercus cysts. The patients had suffered from symptomatic hydrocephalus caused by neurocysticercosis. The migration of the cysts from third to forth ventricle and cisterna magna were clearly demonstrated on serial radiological studies. Since the exact route of the subarachnoid type of the neurocysticercosis has not been defined, these cases may provide a valuable clue in verifying the pathogenic pathway. The possibility of the cyst migration before surgery also should be kept in mind. The radiological appearance and the clinical significance of this condition are discussed with brief review of literatures.
Subject(s)
Humans , Cisterna Magna , Hydrocephalus , NeurocysticercosisABSTRACT
OBJECTIVE: It is not unusual to decompress two consecutive disc levels in treating patients with multiple radiculopathy or uncertain level diagnosis. However, the controversy over whether to use corpectomy or bisegmental diskectomy for anterior cervical fusion is still largely unsettled. The aim of this study is to define the properties of these two surgical options. PATIENTS AND METHODS: We performed a retrospective review of radiological data and clinical records only in patients whom the follow up period is longer than 12 months. Functional outcome, fusion rate, complication rate, and duration of anesthesia were analyzed in both groups. RESULTS: In total of 61 cases, corpectomy was performed in 34 and the bisegmental diskectomy in 27 patients. Mean follow-up periods were over 24 months in both groups. Anesthesia time was shorter in corpectomy patients(280 minutes vs. 300 minutes in segmental diskectomy). However, the bisegmental diskectomy group was better in achieving good clinical outcome(92.6% vs. 82%). Overall fusion rate in bisegmental diskectomy was 100%. Hardware failure rate was lower in bisegmental diskectomy group(11% vs. 18%). Revision was needed in 6% of corpectomy group. CONCLUSIONS: In conclusion, although the anesthesia time is slightly longer in bisegmental fusion, we believe the method of bisegmental diskectomy is better in accomplishing higher fusion rate and lower complication rate.
Subject(s)
Humans , Anesthesia , Diagnosis , Diskectomy , Follow-Up Studies , Radiculopathy , Retrospective StudiesABSTRACT
Temporary clipping on parent artery is widely accepted as a useful method to prevent intraoperative aneurysmal rupture, to dissect the aneurysm safely, and to obtain the clear operation field during intraoperative aneyrysm rupture. However, the exact role and adequate technique of the temporary clipping has yet to be determined. The authors performed an experimental study to investigate the effect of temporary clipping on intra-aneurysmal pressure. The experimental aneurysms, using side-to-side anastomosis between common carotid artery and the jugular vein, were made in 24 rabbits. The intra-aneurysmal pressure was monitored through a catheter inserted in the aneurysm. The intra-aneurysmal pressure was significantly decreased to 31.8+/-4.39mmHg after temporary clipping on the proximal common carotid artery(p<.05). On the contrary, intra-aneurysmal pressure was increased to 73.3+/-4.39mmHg after the distal parent temporary clipping. In case of the temporary clipping on both proximal and distal parent artery, the intra-aneurysmal pressure was markedly increased to 81. 0+/-11.7mmHg(p=0.0036 on t-test). In conclusion, the temporary clipping on the parent artery should be performed only on the proximal site of the aneurysm. Temporary clipping on both proximal and distal site would be rather dangerous since it causes sharp increase in intra-aneurysmal pressure during the clipping of aneurysm itself.
Subject(s)
Humans , Rabbits , Aneurysm , Arteries , Carotid Artery, Common , Catheters , Jugular Veins , Models, Theoretical , Parents , RuptureABSTRACT
Temporary clipping on parent artery is widely accepted as a useful method to prevent intraoperative aneurysmal rupture, to dissect the aneurysm safely, and to obtain the clear operation field during intraoperative aneyrysm rupture. However, the exact role and adequate technique of the temporary clipping has yet to be determined. The authors performed an experimental study to investigate the effect of temporary clipping on intra-aneurysmal pressure. The experimental aneurysms, using side-to-side anastomosis between common carotid artery and the jugular vein, were made in 24 rabbits. The intra-aneurysmal pressure was monitored through a catheter inserted in the aneurysm. The intra-aneurysmal pressure was significantly decreased to 31.8+/-4.39mmHg after temporary clipping on the proximal common carotid artery(p<.05). On the contrary, intra-aneurysmal pressure was increased to 73.3+/-4.39mmHg after the distal parent temporary clipping. In case of the temporary clipping on both proximal and distal parent artery, the intra-aneurysmal pressure was markedly increased to 81. 0+/-11.7mmHg(p=0.0036 on t-test). In conclusion, the temporary clipping on the parent artery should be performed only on the proximal site of the aneurysm. Temporary clipping on both proximal and distal site would be rather dangerous since it causes sharp increase in intra-aneurysmal pressure during the clipping of aneurysm itself.
Subject(s)
Humans , Rabbits , Aneurysm , Arteries , Carotid Artery, Common , Catheters , Jugular Veins , Models, Theoretical , Parents , RuptureABSTRACT
The authors investigated the serial changes of height and Cobb angle in the fused segments in the anterior cervical fusion. Patients who underwent anterior cervical fusion and fixation were investigated from September 1993 to August 1997. Total of 52 cases who met the following entry criteria were included in this study: (a) no history of prior cervical spine surgery or concomittent posterior fusion, (b) an anatomic radiculopathy or myelopathy that correlated with a radiographic study at the corresponding level, and(c) the clinical follow-up period of at least ten months. The radiographic data were obtained retrospectively from routine clinical radiographs, which included neutral radiographs preoperatively, immediate-postoperatively, and at 4-6 months postoperatively. The heights of the fixed segment were increased significantly after the operation(p<0.05 on Oneway ANOVA on ranks), and then decreased to preoperative value at last follow-up. The lordotic angles were increased after the operation and maintained throughout the study period(p<0.05 on Oneway ANOVA). In conclusion, on the contrary to the general belief that plate fixation can prevent the decrease in the segmental height, we found that the gain of height lasted only temporarily. Despiter this, postoperatively increased lordotic curve was maintained through the study period in spite of height loss. Therefore, we think that the lordosis of the cervical spine may reflects most of functional status of the whole cervical spine rather than height gain of the fused segment.
Subject(s)
Animals , Humans , Follow-Up Studies , Lordosis , Radiculopathy , Retrospective Studies , Spinal Cord Diseases , SpineABSTRACT
The authors present a rare case of orbital cavernous malformation associated with intracranial venous anomalies. A 7-year-old female patient was admitted to our hospital complaining of headache and progressive diplopia. Neurologic examination revealed a painful proptosis and limited movement of right eye. Magnetic resonance images demonstrated a cavernous malformation in the right orbit, intracerebral cystic cavernous malformation, and well-enhancing vascular marking in the right temporal lobe. On the cerebral angiography, dilated vein of Labb and duplicated transverse sinus were noted. The patient showed marked improvement of her vision after the total removal of the orbital lesion. We believe this is an another evidence that cavernous malformation may be derived from increased burden of cerebral blood flow and/or venous pressure.
Subject(s)
Child , Female , Humans , Cerebral Angiography , Diplopia , Exophthalmos , Headache , Hemangioma, Cavernous , Neurologic Examination , Orbit , Temporal Lobe , Veins , Venous PressureABSTRACT
In an attempt to investigate the effect of intracerebral hematoma on cortical blood flow and perifocal ischemia, an experimental rat model of intracerebral hematoma was used. In a total of 44 adult male rats, cortical blood flow was studied using on H2 clearance method. The ischemic zone was investigated under light microscopy. In order to potentiate the effect of intracerebral hematoma, bilateral ligation of the common carotid artery was simultaneously performed in twelve rats. Intracerebral hematoma was induced by injecting 30nl of autologous arterial blood. Ipsilateral cortical blood flow decreased to 67.4% of baseline after the formation of intracerebral hematoma in the basal ganglia ; bilateral ligation of the common carotid artery alone decreased cortical blood flow to 59.4% of baseline ; and intracerebral hematoma formation after ligation decreased the flow to 20.5% of baseline. Neurological grades were worst in the last mentioned group, and in no group was perifocal infarction detected by light microscopy. These data suggest that the occurrence of intracerebral hematoma markedly decreases the cortical blood flow. Additionally, in a situation of compromised cerebral blood flow, the development of intracerebral hematoma can lead to a further decrease in flow, resulting in a worse neurological outcome, despite the absence of detectable histological difference.
Subject(s)
Adult , Animals , Humans , Male , Rats , Basal Ganglia , Carotid Artery, Common , Hematoma , Infarction , Ischemia , Ligation , Microscopy , Models, AnimalABSTRACT
In order to define the prognostic implications of cervical myelopathy, we conducted a morphometrical analysis of spinal cords in patients suffering from this condition. Twenty patients who had undergone laminoplasty for their cervical myelopathy were the subject of this study. Cervical spondylosis was diagnosed in 14 patients and ossification of the posterior longitudinal ligament in six. Signal change of the spinal cord, its anteroposterior diameter, and the number of stenotic segments were determined by pre- and postoperative magnetic resonance imaging and simple X-ray. The patients' neurological status before and after surgery was evaluated by the Neurosurgical Cervical Scale. Patients whose cord revealed no signal change had better recovery rates than those who showed change (77.5% vs. 60.5%). The wider the diameter of the cord, the better the outcome of surgery(p<0.05 on one-way ANOVA). The number of stenotic segments was not significantly related to recovery rate. In conclusion, focal morphological changes of the spinal cord, regardless of the general stenotic area, are the main factors determining the outcomes of surgery.