Spinal Schwannoma; Analysis of 40 Cases

OBJECTIVE: This study is to report our experience of 40 cases of spinal schwannoma. METHODS: From 1995 to 2006, medical records were retrospectively reviewed in 40 cases of spinal schwannoma. RESULTS:We treated 40 spinal schwannomas in 38 (22 male and 16 female) patients. The mean age was 50.2. Four cases were sited in the cervical spine, 11 cases in the thoracic spine, and 25 cases in the lumbar spine. Two patients showed recurrences. Thirty-eight cases were intradural-extramedullary type and 2 cases were extradural. Two cases (5%) including 1 recurred case had no postoperative motor improvement. Ninety-five percents of patients improved on postoperative motor grade. CONCLUSION: Spinal schwannoma is mostly benign and extramedullary tumor. There were 2 recurred cases (5%) that had history of previous subtotal removal at first operation and had shown worse prognosis compared with the cases without recurrence. To reduce the recurrence of spinal schannoma, total excision of tumor mass should be done.

A Case of Pancreaticobiliary Duct Obstruction due to Pancreatic Tuberculosis Combined with a Colon Adenocarcinoma and Tuberculous Colitis / 대한소화기내시경학회지

Systemic manifestation of tuberculosis is common, but tuberculous biliary obstruction of the pancreas and a colon adenocarcinoma with combined colonic tuberculosis is an uncommon disorder. We encountered a case of the above condition in 63-year-old male that was admitted to our hospital because of fever, diffuse abdominal pain and rigidity. Abdominal computed tomography showed biliary and pancreatic duct dilatation with left colonic wall thickening and surrounding peritoneal infiltration. Emergency segmental resection of the descending colon with intraoperative T-tube choledochostomy was performed due to the colon mass and biliary obstruction. A colonofiberoscopy was performed for low abdominal pain and hematochezia at 12 days after surgery. It showed multiple colonic ulcerations with a partial stricture. A colonic biopsy showed granulomatous inflammation with acid-fast bacilli. The cause of the biliary obstruction was also revealed as pancreatic tuberculosis by an intraoperative pancreatic and mesenteric biopsy. The patient improved after antituberculous treatment and the patient has been in good health until the last outpatient follow-up visit.

Treatment of Hydrocephalus Following the Operation of Ruptured Intracranial Aneurysms

Hydrocephalus, which is one of the major complications following intracranial aneurysm operations, can prevent patients from improvement of consciousness, symptoms and signs that can be expected after operation. Whenever there is no evidence of appreciable improvement after intracranial aneurysm operation, follow-up brain CT scannings will reveal the development of hydrocephalus. And also radioisotope cisternography and clinical findings could be clarified as Glasgow coma scale(GCS) and Hunt & Hess classification, which will help clinicians making a decision on shunt operation. Among 183 patients of subarachnoiod hemorrhage admitted, 92 patients were operated on due to intracranial aneurysms. Nine patients(9.8%) of them were underwent shunt operations because of hydrocephalus following intracranial aneurysm operations. Eight patients showed improvement of clinical findings and 9 patients have been improved according to GCS score.

Clinical Analysis of Treatment of Chronic Subdural Hematoma

The authors analyzed 103 cases of chronic subdural hematoma(SDH) treated in the department of Neurosurgery, Yonsei University Hospital from January 1976 to September 1983. All of the cases were operated on except a single case, which was treated conservatively. The results of the analysis are summarized as follows: 1) The chronic SDH occurred most frequently in the 5th decade, and 71.8% of the patients were older than their 4th decade. The chronic SDH were far more common in men(84.5%) than women(15.5%). 2) Seventy two patients(79.6%) had a history of previous head injury. Chronic alcoholism was noted in thirteen patients(12.6%). 3) Presenting symptoms and signs in decreasing order were headache(76.9%), motor weakness(44.7%), mental disturbance(43.7%), papilledema(42.7%), and vomiting(35%). 4) Brain CT scan was not only the most accurate diagnostic procedure but also important for planning operative intervention as well as evaluating the prognosis. Four patterns of CT densities were noted in chronic SDH;hypodense(43.3%), isodense(37.8%), hyperdense(13.5%), and mixed density(5.4%). Cerebral expansion rates decreased with age, which was less than 80% in patients over their 40s. The chronic SDH was found on the right side in 45.6% of cases and 41.8% on the left, while 12.6% of chronic SDH were bilateral. 5) Operative procedures in 102 cases, were as follows; 32 Simple burr hole closed drainage, 31 Simple burr hole open drainage, 31 craniotomy and membranectomy, and 10 craniectomy and membranectomy. In conclusion, simple burr hole closed system drainage is the most effective and the least invasive procedure for the treatment of chronic SDH. Membranectomy with craniotomy or craniectomy should be reserved for such cases as recollection of SDH, failure of brain expansion, solid hematoma, and extensive swelling of the white matter subjacent to the hematoma.