Endovascular Treatment of Intracranial Aneurysms Using Polymer Polyglycolic-Lactic Acid Coated Coils / 이화의대지

OBJECTIVES: In treatment for intracranial aneurysms by coil embolization, recanalization remains the major limitation of coiling, particularly wide-necked or larger aneurysms. The aim of this study was to evaluate technical results and clinical outcome in a single center of consecutive patients with intracranial aneurysms treated with endovascular embolization using polyglycolic-lactic acid (PGLA) coated coils. METHODS: Between January 2005 and December 2010, 33 patients (male, 8 patients; female, 25 patients; mean age, 57 years) with saccular intracranial aneurysms were treated by means of an endovascular approach using PGLA coated coils. The endovascular procedures and technical outcomes were evaluated. The mean follow-up duration was 15.9 months (range, 6 to 72 months). RESULTS: Successful embolizations with satisfactory results were achieved in 91%. The degree of occlusion of the treated aneurysm was complete in 23 (69.6%), small neck remnant in 7 (21.2%), and residual filling in 3 (9%). Thirty patients (90.9%) showed no interval change of the residual neck. Three patients (9.1%) demonstrated the recanalization, and 2 of them were successfully recoiled. CONCLUSION: This preliminary study showed that PGLA coated coils may be safe option and preventable for recanalization in patients with intracranial aneurysms. Further study with more cases, longer follow-up data and well controlled design are required to confirm our results.

Dandy-Walker Malformation Associated with Neurocutaneous Melanosis

Neurocutaneous melanosis associated with Dandy-Walker malformation is a rare dysmorphogenesis that is associated with single or multiple giant pigmented cutaneous nevi and diffuse involvement of the central nervous system. In this article, we present a 2-month-old patient with neurocutaneous melanosis associated with Dandy-Walker malformation. In addition, we reviewed the literature and discussed the pathogenesis based on the preferred hypotheses.

Human telomerase catalytic subunit (hTERT) suppresses p53-mediated anti-apoptotic response via induction of basic fibroblast growth factor

Although human telomerase catalytic subunit (TERT) has several cellular functions including telomere homeostasis, genomic stability, cell proliferation, and tumorigenesis, the molecular mechanism underlying anti-apoptosis regulated by TERT remains to be elucidated. Here, we show that ectopic expression of TERT in spontaneously immortalized human fetal fibroblast (HFFS) cells, which are a telomerase- and p53-positive, leads to increases of cell proliferation and transformation, as well as a resistance to DNA damage response and inactivation of p53 function. We found that TERT and a mutant TERT (no telomerase activity) induce expression of basic fibroblast growth factor (bFGF), and ectopic expression of bFGF also allows cells to be resistant to DNA-damaging response and to suppress activation of p53 function under DNA-damaging induction. Furthermore, loss of TERT or bFGF markedly increases a p53 activity and DNA-damage sensitivity in HFFS, HeLa and U87MG cells. Therefore, our findings indicate that a novel TERT-bFGF axis accelerates the inactivation of p53 and consequent increase of resistance to DNA-damage response.

The Role of Lumbar Drainage to Prevent Shunt-Dependent Hydrocephalus after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage in Good-Grade Patients

OBJECTIVE: To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients. METHODS: One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms. RESULTS: One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure. CONCLUSION: Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.

Surgical Outcome of Cervical Arthroplasty Using Bryan(R)

OBJECTIVE: Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of Bryan(R) cervical disc prosthesis. METHODS: The authors retrospectively reviewed radiographic and clinical outcomes in 52 patients who received the Bryan(R) Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of functional spine unit (FSU), and the C2-7 Cobb angle. The range of motion (ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom's criteria, visual analogue pain scale (VAS) and neck disability index (NDI). RESULTS: A total of 71 Bryan(R) disc were placed in 52 patients. A single-level procedure was performed in 36 patients, a two-level procedure in 13 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made preoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom's criteria, and showed significant improvement by VAS and NDI score (p < 0.05). The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level (p < 0.05). 97% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 88.5% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 70% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 66.6% of the patients postoperatively. CONCLUSION: Arthroplasty using the Bryan(R) disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although the early results are promising, this is a relatively new approach, therefore long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

Types of Thromboembolic Complications in Coil Embolization for Intracerebral Aneurysms and Management

OBJECTIVE: We describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with a review of the literature. The types of thromboembolic complications were divided and the treatment modalities for each type were described. METHODS: Between August 2004 and March 2009 we performed endovascular embolization with Guglielmi detachable coils for 173 patients with 189 cerebral aneurysms, including ruptured and unruptured aneurysms at our hospital. Sixty-eight patients were males and 105 patients were females. The age of patients ranged from 22-82 years (average, 58.8 years). We retrospectively evaluated this group with regard to complication rates and outcomes. The types of thromboembolic complications were classified into the following three categories: mechanical obstruction, distal embolic stroke, and stent-induced complications, which corresponded to types I, II, and III, respectively. A comparison of the clinical results was made for each type of complication. RESULTS: Only eight patients had a thromboembolic complication during or after a procedure (4.6%). Of the eight patients, two had a mechanical obstruction as the causative factor; the other three patients had distal embolic stroke as the causative factor. The remaining three patients had stent-induced complications. In cases of mechanical obstruction, recanalization occurred due to the use of intra-arterial thrombolytic agents in one of two patients. Nevertheless, a poor prognosis was seen. In the cases of stent-induced complications, in one of three patients in whom a thrombus developed following stent insertion, a middle cerebral artery territory infarct developed with a poor prognosis despite the use of wiring and an intra-arterial thrombolytic agent. In the cases of distal embolic stroke, all three patients achieved good results following the use of antiplatelet agents. CONCLUSION: Treatment for thromboemboic complications due to mechanical obstruction and stent-induced complications include antiplatelet and intra-arterial thrombolytic agents; however, this cannot guarantee a sufficient extent of effectiveness. Therefore, active treatments, such as balloon angioplasty, stent insertion, and clot extraction, are helpful.

Ventriculostomy-Associated Infection : Analysis of Risk Factors and the Venue of External Ventricular Drainage / 대한뇌혈관외과학회지

OBJECTIVE: The purpose of this study is to evaluate the risk factors for ventriculostomy-associated infections (VAI) and to examine the differences among VAI according to the venue of catheter placement in our institute. Materials and METHODS: During a four-year period, 114 patients of the neurosurgical intensive care unit (NICU) who received an external ventricular drainage (EVD), were retrospectively studied. The use of prophylactic systemic antibiotics was not included in the evaluation of the risk factors for VAI, because this was applied to all patients in our trial. RESULTS: One hundred sixty-five catheters were placed, in 114 patients, among whom 7.9% developed ventriculitis. The risk of VAI was not significantly associated with age, intial Glasgow coma scale (GCS) score, indication for the catheter, craniotomy, duration of catheter, DM, hypertension and repeated catheter insertion. Furthermore, EVD catheterization in non-operating places was not associated with a trend toward higher VAI as well. CONCLUSION: Risk factors for an increased incidence of VAI were not observed in our trials. In our study, the risk of VAI was not associated with the venue of catheter placement. These findings suggest that EVD catheter insertion in non-operating places may be a safe procedure without the risk of VAI.

Outcome of Aneurysmal Subarachnoid Hemorrhage Patients with Hunt-Hess Grade III / 대한뇌혈관외과학회지

OBJECT: We designed this study to bring the outcome and the outcome predictors of Hunt-Hess grade III patients to light, and to be aid in determining treatment protocol of such a intermediate group. METHODS: All patients with non-traumatic subarachnoid hemorrhage who visited our hospital between January 1998 and December 2004, were reviewed. We selected 72 Hunt-Hess grade III aneurysmal subarachnoid hemorrhage patients for detailed review. 54 operations and 10 endovacular procedures were performed. The outcome of the patients were evaluated with Glasgow Outcome Scale (GOS). Through univariate and multivariate analysis, several clinical and operative factors were evaluated to determine the significance for the outcome. RESULT: Overall 58 patients were in good outcome group (GOS 4 or 5). overall 6-month mortality was 5.6%. Age, presence of intracerabral hemorrhage(ICH) on the initial computed tomography (CT) scan, and vasospasm were independently important in determining outcome. CONCLUSION: In the Hunt-Hess grade III aneurysmal SAH patient, age, presence of ICH on intial CT scan vasospasm have independent statistical significance to the outcome. More aggressive treatment of vasospasm can improve the outcome.

Feasibility, Safety and Prognostic Factors for Computed Tomography Guided Aspiration and Thrombolysis of Intracerebral Hematoma - Clinical Analysis - / 대한뇌혈관외과학회지

OBJECTIVE: The authors reviewed experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomography (CT) guided thrombolysis and aspiration and evaluated feasibility, safety and prognostic factors of this procedure. METHODS: One hundred and ten patients with supratentorial ICH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS) or =4) and bad (GOS<4) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 59.8 years. The baseline hematoma size ranged from 15 to 72 mL. ICH volume reduced by an average of 74.2%. At 6 months after the procedure, 56 patients had achieved a good recovery, 29 patients were dependent, and 10 remained vegetative. Fifteen patients died in hospital. The main good prognostic factors were young age, small ICH volume, high GCS, absence of rebleeding, underlying disease and complications. CONCLUSION: CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Patients of ICH presenting with bad prognostic factors should require frequent radiological investigation and more meticulous procedure. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, and disability outcome.

Urokinase Thrombolysis for Nonaneurysmal Spontaneous Intraventricular Hemorrhage

OBJECTIVE: The authors report our experience of urokinase thrombolysis in treating patients harboring nonaneurysmal spontanesous intraventricular hemorrhage(IVH) and evaluated complications, safety and feasibility of this procedure retrospectively. METHODS: Fifty-three patients with nonaneurysmal IVH>15mL without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale(GCS) or =3) and bad (GOS<3) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 60.2 years. The baseline hematoma size ranged 16 to 72mL. IVH volume reduction was done by an average of 74.2%. As complications, there were 3cases of rebleeding and 2cases of ventriculitis. No intracranial adverse effects were observed during thrombolytic theraphy. At 6months after the procedure, 29patients had achieved a good recovery, 15remained vegetative. 9patients died in hospital. The main good prognostic factors were young age, small IVH volume, and high GCS. CONCLUSION: The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

Sellar Chordoma Mimicking Pituitary Adenoma

Most chordomas involving the sellar region are parasellar or suprasellar, and largely or entirely sellar lesions are very rare. The authors report a case which chordoma involve pituitary fossa and surrounding structures and presented as nonfunctioning pituitary adenoma. Successful surgical removal was conducted via endonasal endoscopic approach. The pathology exhibited the typical histological patterns and immunophenotype of chordoma. The authors present a rare case of sellar chordoma and review the literature on that.

The Safety and Feasibility of Urokinase Thrombolysis for Nonaneurysmal Intraventricular Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVES: The authors report experience with patients harboring nonaneurysmal intraventricular hemorrhage treated urokinase thrombolysis and evaluated safety and feasibility of this procedure. METHODS: Fifty-three patients with nonaneurysmal IVH >25 ml without underlying structural etiology or coagulopathy were recruited. The patients with Glasgow Coma Scale (GCS) or =3) and bad (GOS<3) prognosis group, and performed comparative analysis between two groups. RESULTS: Mean age was 60.2 years .The baseline hematoma size ranged 16 to 72 ML. IVH volume reduction was done by an average of 74.2%. At 6 months after the procedure, 29 patients had achieved a good recovery, 15 remained vegetative. 9 patients died in hospital. The main good prognostic factors were young age, small IVH volume, high GCS, underlying disease and associated complications. CONCLUSION: The results of this study suggest that this relatively easy and safe method of treatment will improve the prognosis. However, further clinical studies also must assess optimal thrombolytic dosage, frequency, and timing of urokinase instillation for safety and effectiveness and must include controlled comparisons of mortality, disability outcome, quality of life, time until convalescence, and cost of care in treated and untreated patients.

The Outcome of Anterior Microforaminotomy for Single Level Cervical Radicular Disease

OBJECTIVE: Anterior cervical microforaminotomy has become one of surgical options to treat cervical rad iculopathy. The goal of this study is to evaluate the effectiveness of anterior cervical microforaminotomy for single-level cervical radicular disease. METHODS: We performed a prospective review of radiological data and clinical records only in patients whom the patients met the inclusion criteria for this study. Among 53 patients who underwent anterior cervical microforaminotomy between June 2000 and May 2002, 36 patients were evaluated in this study. RESULTS: Male to female rate was 2: 1 and mean age was 46.1(28-63) years. Compressive pathological lesions included disc herniation in 24 cases(66.7%), spondylosis 10 cases(27.8%), and a combined of the two in 2 cases(5.5%). Twenty eight patients(77.8%) experienced excellent results, six patients(16.7%) experienced good results, and two patients(5.5%) experienced fair results. No patient demonstrated a poor or unchanged outcome. All patients showed adequate decompression in their postoperative computed tomography or magnetic resonance images. There were no complications. Mean hospital stay was 3.9(3-12) days. CONCLUSION: Patients treated with the anterior cervical microforaminotomy procedure for single-level cervical radicular disease have good outcomes. It appears to be a good alternative procedure for cervical radicular disease. But this procedure have complications such as vertebral artery injury. And long term follow up should be analyzed for instability or recurrence of disc herniation.

Gliomatosis Cerebri in the Brain Stem and Unilateral Cerebellar Hemisphere: Case Report

Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of anatomical architecture and the sparing of the neurons. In this report, we present a gliomatosis cerebri in a 16-year-old girl which occurred in brain stem and unilateral cerebellar hemisphere.

Cerebrospinal Fluid Flow Study of Normal Craniocervical Neuraxis Using the Cine Phase Contrast Magnetic Resonance Technique in Korean

OBJECTIVE:To evaluate the normal figure of intracranial and intraspinal cerebrospinal fluid(CSF) dynamics, we report the results of the various parameters of cine phase contrast(PC) magnetic resonance(MR) CSF flow images throughout the whole neuraxis. METHODS: The MR images were obtained with 1.5T unit using the cine PC sequence with cardiac gating and gradient echo imaging in 10 normal persons(mean age, 30.4 years). The temporal velocity information from the anterior and posterior cervical pericord subarachnoid spaces, third and fourth ventricles, aqueduct, and lumbar cistern were plotted as wave forms. The wave forms were analyzed for configurations, amplitude parameters, and temporal parameters. The statistical significance of each parameter was examined with paired t-test. RESULTS: The actual flow of CSF were clearly visible with cine MR images. Throughout the whole neuraxis, the distinct reproducible configuration features were not obtained at ventricular or lumbar cistern, but at aqueduct and cervical pericord spaces. The temporal parameters were more important than the amplitude parameters. CONCLUSION: In this study, the authors demonstrated normal CSF dynamics and obtained further precision by plotting the temporal velocity information from the images as a waveform. This important basic information may be useful for understanding altered physiology in disease states such as syringomyelia and hydrocephalus.

Spontaneous Intracranial Epidural Hematoma Following Thoracolumbar Schwannoma Removal

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.

A Comparative Analysis of C-arm Fluoroscopic Guided and Computed Tomography-guided Stereotactic Catheter Drainage of Hypertensive Intracerebral Hematoma

OBJECTIVE: For the treatment of the hypertensive intracerebral hemorrhage, stereotactic catheter drainage of hematoma has been widely used as a less invasive and effective therapeutic modality. However stereotactic catheter drainage method occasionally can not be available. Here, we introduce C-arm fluoroscopic guided catheter drainage of hematoma as an alternative method. The authors compared the two methods and report the result with review of the literatures. METHODS: A total of 62 patients with hypertensive intracerebral hemorrhage who underwent catheter drainage between February 1996 and December 1999 were reviewed. The patients were divided into two groups according to the method of catheter insertion. The two groups were compared with respect to pre- and post-operative changes of hematoma volume and neurological deficit, hematoma drainage rate, duration of catheter placement, complication, and short term prognosis. RESULTS: The pre-operative hematoma volume was slightly large in the C-arm fluoroscopic guided method group. But post-operative hematoma volume, pre- and post-operative neurological deficit, hematoma drainage rate, duration of catheter placement, post-operative complication and short term prognosis were not different statistically between the two groups. The preparation time for operation was short in C-arm fluoroscopic guided group. CONCLUSION: C-arm fluoroscopic guided catheter drainage of intracerebral hematoma can be an alternative to the stereotactic guided method in the urgent situation or when the stereotactic system is not available

A Sedimentation Level in Pituitary Adenoma on Magnetic Resonance Imaging

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.

Endoscopic Surgery of a Subependymal Giant Cell Astrocytoma Associated with Tuberous Sclerosis: Case Report

No abstract available.

A Case of Penetrating Head Injury by a Western-Style Arrow: A Case Report

No abstract available.