ABSTRACT
The authors report a very unusual case of ruptured aneurysm by direct vessel invasion of anaplastic oligodendroglioma (WHO grade III) confirmed by histopathological examinations. As local invasion is the hallmark of malignant gliomas, malignant glial tumors invade neighboring structure and often cause microscopic endothelial proliferation, telangiectasias in small arteriols, but direct arterial invasion by glioma is very rare. Possible mechanisms of intracranial aneurysm development by glioma are thought to be related to the close proximity to the tumor, perivascular basement membrane breakage due to high tumor pressure and increased regional blood flow through the feeding artery of tumor. The aneurysm and tumor were treated in a single operation simultaneously.
Subject(s)
Aneurysm , Aneurysm, Ruptured , Anterior Cerebral Artery , Arteries , Basement Membrane , Glioma , Intracranial Aneurysm , Oligodendroglioma , Regional Blood Flow , Rupture , TelangiectasisABSTRACT
OBJECTIVE: Unilateral interfacetal dislocation(UID) is a common injury in cervical spine, but diagnosis is somewhat difficult due to mild subluxation. Management of'locked facet' is not established yet and many authors advocate posterior fusion to secure stability. Because most of UID patients have minimal neurological symptom with normal activity, we tried anterior and posterior fusion simultaneously. PATIENTS AND METHODS: Various parameters, such as the radiological findings, operation time and methods, kinds of fixation devices, post-operative stability, neurological outcomes in 10 UID-patients, who showed no satisfactory closed reduction with Gardner tong traction. These patients underwent anterior fixation following posterior open reduction and fusion to maintain the definite stability. RESULTS: Median age was 40 years(18-64 range) and the male to female ratio was 7:3. Causes of injury consisted of 6 car accident, 3 fall-down, 1 diving accident. Mechanism of injury was flexion in all ten cases. Levels of injury were 2 in C4-5, 5 in C5-6 and 3 in C6-7. Operations were performed within 5 days of injury in eight patients. In two patients, who had no reduction procedures were operated on the 23rd day and the 4th month respectively. Kinds of device were: 7 titanium wire and 3 steel wire in posterior wiring, 9 Caspar nonlocking plate and 1 Orion locking plate in anterior plate fixation. All patients were ambulated at post-operative one day with Philadelphia cervical collar and showed post-operative stability with improved neurological outcome. CONCLUSION: In UID patients who failed in closed reduction with traction, anterior discectomy and bone fusion and plating following posterior open reduction and wiring proved good results.
Subject(s)
Female , Humans , Male , Diagnosis , Diskectomy , Joint Dislocations , Diving , Spine , Steel , Titanium , TractionABSTRACT
The purpose of this study was to evaluate the role of anterior cervical plate after discectomy and autologous iliac bone graft in the treatment of cervical spondylosis. One hundred and seven cervical spondylotic patients from Jan. 1995 to Mar. 1998 were separated into two groups: Group 1. consisted of 58 patients treated with anterior discectomy, bone fusion, and anterior cervical plate fixations(54 cases of Caspar nonlocking plate and 4 cases of Orion locking plate system), Group 2. consisted of 49 patients treated with anterior discectomy and bone fusion. The mean follow-up duration was 26.5 months(from 6 to 45 months). The overall fusion rate did not showed any difference between the two groups, but in multi-level patients, graft materials related complications(extrusion or collapse of graft) were significantly high in group 2.(p<0.01). Group 1. patients ambulated on POD 1 with Philadelphia collar. The average admission period was 8.4 days following operation. Group 2. patients ambulated on POD 5-7 with Philadelphia collar. The average admission period was 11.9 days after surgery. In conclusion, bony fusion was successfully achieved in both groups and graft materials related complication rate showed no difference in the single level, but was significantly low in group 1 in the multilevel.