Comparison of the Usefulness of the Computed Tomographic Angiography with Conventional Cerebral Angiography in Patients with Cerebral Aneurysm / 대한뇌혈관외과학회지

OBJECTIVE: Computed tomographic angiography (CTA) is useful for rapid and relatively noninvasive detection of aneurysms in the circle of Willis. The purpose of this study is to compare CTA with conventional cerebral angiography (CCA) and to assess usefulness of CTA in detection of the anatomic delination of intracranial aneurysms of the circle of Willis in subarachnoid hemorrhage. PATEINTS AND METHODS: 126 consecutive patients with known SAH or suspected intracranial saccular aneurysms underwent CTA and CCA from January 2002 to June 2003. Using surface shaded display post-processing technique, CTA was interpreted for the presence, location and anatomic features of the aneurysms and also the image obtained with CTA was compared with CCA image. RESULTS: In 112 operated patients, 125 aneurysms were detected. CCA revealed 123 cerebral aneurysms and CTA revealed 113 aneurysms. Two of the 125 cerebral aneurysms were located outside of the imaging volume of CTA, 10 cases were not detected and false positive were 2 cases. The sensitivity of CTA was 90.3%. The results obtained with CTA comparing with that of CCA were almostly equal in detection of aneurysm location and delineation of aneurysmal neck. However, CTA provided a 3-dimensional representation of aneurysm and also it was very useful for surgical planning. CONCLUSION: CTA can be a diagnostic tool for the patients with acute subarachnoid hemorrge due to a ruptured aneurysm of the circle of Willis and provides adequate anatomic detail for surgical planning especially to complex cerebral aneurysms. However, it is obvious that CCA is necessary because of the limitations of CTA including its difficulty in detecting unusually located aneurysms including those in cavernous sinus or distal artery, and acquiring dynamic flow information.

Surgical Results of Posterior Laminoforaminotomy and Discectomy for Cervical Disc Herniation

OBJECTIVE: Whether the anterior approach is better than the posterior one for cervical disc disease still remains unsettled. However, anterior discectomy and fusion procedures for all types of discs have been more popular than the posterior one. Posterior approach should not be underestimated since it has many benefits. To study it's feasibility, the effectivenes and safety of the lamino-foraminotomy for cervical disc disease, we review 10 surgical cases with posterior approach. METHODS: Ten consecutive cervical lateral disc protrusion cases which underwent lamino-foraminotomy with or without discectomy were reviewed. Patient's age, sex, main symptom, EMG studies, surgical procedure were studied retrospectively. The outcome was rated with Prolo's scale. RESULTS: There were one female and nine male patients. Major preoperative symptoms were radicular pain radiating to upper extremity, numbness, axial neck pain and motor weakness. Electromyography was performed in eight cases with six correspondent results. Lamino-foraminotomy was performed in all cases and discectomy was done in nine patients. By modified Prolo's outcome scale, nine patients enjoyed good results and one was moderate, nine patients were able to carry on their original occupations. The mean hospital stay was 14.6 days. There was no postoperative instability. CONCLUSION: With posterior approach, critical complications of anterior approach could be averted. No bone graft is needed. No graft donor site pain is expected either. Hospital stay could be shortened. The posterior foraminotomy is an easy and effective procedure in the treatment of patients for laterally located soft disc herniations.

A Case of Intradural Epidermoid Tumor in Lumbar Region

The authors describe a case of intradural epidermoid tumor in which the patient presented with low back pain and weakness of right lower extremity. The magnetic resonance imaging study showed intraspinal mass lesion at L2-3. The patient had no history of previous lumbar puncture. It was removed totally through laminectomy of L2 and L3 without any injury of the neural structure. The pathological findings were compatible with epidermoid tumor. The postoperative course was uneventful without any neurologic deficit. Characteristics of this lesion with a pertinent literature is reviewed.