Isolated Fourth Ventricle Hydrocephalus

Mental deterioration and signs of cerebellar dysfunction developed 5 years after lateral ventricle shunting in 36-year-old hydrocephalic female patient. Fourth ventricle enlargement was seen on CT scan. Reevaluation of the cerebrospinal fluid pathways with metrizamide ventriculography showed isolated fourth ventricle with aqueductal stenosis. Shunting of the fourth ventricle with an Y-connector returned the patient to normal neurological status.

Thoracic Spinal Stenosis

A stenotic spinal canal in the cervical or lumbar region is a well-known clinical entity. However, stenosis involving a thoracic vertebra is rarely mentioned in the literature. Improved neuroimaging facilities, especially MRI, let us detect the thoracic canal stenosis not so infrequently as in the past years. The authors are reporting six operative cases of thoracic myelopathy associated with thoracic spinal stenosis. Motor & sensory abnormalities were found in all cases during the clinical course. Magnetic resonance imaging and Metrizamide CT scanning were useful in the diagnosis of thoracic spinal stenosis. Treatment consited of wide posterior decompression resulting in symptomatic improvement in five of six patients.

Surgical Repair of Cerebrospinal Fluid Rhinorrhea: Report of Five Operative Cases

This report describes five cases of cerebrospinal fluid(CSF) rhinorrhea which were caused by head injury in four cases and developed after surgical removal of brain tumor in one case. Intrathecally-enhanced brain computerized tomography(CT) with metrizamide, in addition to isotope cisternography, was helpful in localization of the CSF leakage site. All five cases which could not be managed conservatively were successfully repaired by surgical means using biological fibrin glue.

Management of Intracranial Arachnoid Cysts in Children

14 supratentorial and 6 infratentorial arachnoid cysts, diagnosed and treated at Kangnam St Mary's Hospital from 1983 to 1988, are reported. The most common presenting symptoms in children were craniomegaly, delayed development, increased ICP and neurological focal signs. Neuroradiological examination included plain skull X-ray, brain CT and metrizamide CT or isotope study. Therapeutic criteria according to the clinical and radiological findings were reviewed. The results were as follows; 1) The patient below age of 2 yrs who's brain had a potent ability of growth should be operated in any cases for reducing mass effect. 2) In sylvian lesion, Type II and III according to the classification of Galassi were well treated with C-P snunt. 3) In infratentorial lesion, all patients had hydrocephalus and the patient who had communicated with subarachnoid space in metrizamide CT were well treated with V-P shunt and who not communicated with subarachnoid space was well treated with Y-shunt. 4) We had good results by fenestration above the age of 3 yrs and by C-P shunt under the age of 2 yrs in supratentorial lesion.

Surgical Treatment of Spontaneous and Traumatic Delayed Cerebrospinal Fluid(CSF) Rhinorrhea

The authors presented 9 cases of surgically treated CSF rhinorrhea, two of which were spontaneous and 7 were traumatic delayed. The duration of leakage was longer than 1 month in most cases and seven of the nine cases were complicated by meningitis. The leakage site was most accurately detected by metrizamide computed tomographic cisternography(MCTC) and the most frequent leakage site was the cribriform plate. Good surgical results were obtained by direct repair and/or shunt without recurrence during follow-up period from 7 months to 2 years.

Comparative Study of the Clinically Diagnosed Herniated Nucleus Pulposus with the Computed Tomographic and Myelographic Finding / 대한정형외과학회잡지

79 patients with suspected H.N.P. of lumbar vertebrae were studied from June 1983 to June 1986 who had had both metrizamide myelography and computed tomography. Comparative study of the findings from clinical examination, CT and myelography of them are as follows. l. In physical examination, S.L.R.T. was most common sign, 58 patient(73.4% of study group) showed positive in S.L.R.T.(30~70 range). Of these positive patients in S.L.R.T. 41.4% was the patients who were younger than 30 years of age and also had pressure sign of nerve root on CT and myelography. These group showed highest positive rate in S.L.R.T. 2. In CT and myelographic study, the most frequent occurence of H.N.P. were seen in L4–5, L5–S1, L3–4 in order and myelography showed higher positive rate in L4–5 intervertebral space while CT showed higher positive rate in LS–S1. 3. On CT, facet joint arthritis or stenosis were seen in 49.4% of the study group and 53.7% of computed tomographic positive patients of H.N.P. 4. Corresponding rate of positive sign of H.N.P. between CT and myelographic findings were seen 71 intervertebral spaces, which means 84.5% of 84 positive spaces on CT and 88.8% of 80 positive spaces on myelography. 5. In 49 intervertebral spaces clinical sign, CT and myelographic findings were all positive. In another words 58.3% of 84 positive intervertebral spaces on CT and 61.3% of 80 positive spaces on myelography showed all positive sign on clinical examentation, CT and myelography. 6. L5–Sl intervertebral spaces showed most controversial results in comparative study of CT and myelography. 7. 25 of 26 positive spaces on CT(96.2%) and 23 of 26 positive spaces of myelography(88.5%) were confirmed by operation and all 3 false-negative on myelography were found in L5–Sl intervertebral space. 8. Most diagnostic differences were seen in L5–S1, which has wider epidural space. CT showed higher sensitivity than myelography in this study. For its higher sensitivity and non-invasiveness CT is thought to be first recommendable method for diagnosis of H.N.P. and myelography is recommended as second best choice where diagnostic differences are seen.

A Case of Basilar Impression

A case of basilar impression surgically treated in a female patient aged 22 years is presented. A myriad of abnormal neurologic findings were present that were secondary to compression of neural tissue by anormalous bony structure at craniovertebral junction. Metrizamide computerized tomography with coronal and sagittal reconstruction identified bony abnomalities and displacement of the surrounding neural structures. The surgical intervention for the treatment of the basilar impression consisted of ventral decompression by transoral odontoidectomy and of dorsal decompression by an enlargement of foramen magnum and by laminectomy of C1, followed by occipito-atlanto-axial bony fusion.

A Clinical Study of the Myelography Using Metrizamide / 대한정형외과학회잡지

The birth of myelography was presaged by Dandy's classic description of pneumoencephalography in 1919. After then, many contrast media, such as Pantopaque, Lipiodol, Abrodil, Dimer-X, and Conray-60, were developed and myelography was achieved in widespread popularity for diagnosis in low back pain, especially on the syndrome of herniated intervertebral disc. During the past few years, the picture has changed dramatically because of the availability of Metrizamide, a new, less toxic, non-ionic, aqueous medium. So, the authors have seen and studied 165 cases of. low back pain with respect to the diagnostic classification and clinical acceptance of Metrizamide myelographic examination from May, 1982 to April, 1985 at Department of Orthopaedic Surgery, College of Medicine, Soon Chun Hyang University. The results were summerized as followings; l. Among the 165 cases, myelographic finding was classified in 4 groups and 7 types, and showed as group 1(41), group 2 and type a(46), group 2 and type b(21), group 3 and type a(9), group 3 and type 1(15), group 3 and type c(16), and group 4(17). 2. The predominent type in the 57 operative cases was group 4(46, 27.9%). 3. In clinical analysis, tenderness was predominent in most types, but sensory changes in group 4. 4. Step by step in types, anatomical changes was seen more often than funtional changes in plain X-ray. 5. Myelographic accuracy was coincided with operative findings in 75.4% and 7 cases of false negative and 5 cases of false positive. 6. In disc findings, the extruded type was seen predominently in group 4 as 29.4%. 7. Above group 3 and type a, the prognosis of operative treatment was excellent than conservative.

Clinical Evaluation of Cervical Water-soluble Metrizamide Myelography via C1-2 Puncture

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.

Iopamidol Myelography

In a comparative, prospective randomized study 200 patients underwent myelography using iopamidol (150 patients) or metrizamide (50 patients) as contrast medium. Adverse reactions were few, mild, and short in duration in iopamidol myelography compared to metrizamide myelography. Seizure occured in 2 patients with the use of metrizamide. Iopamidol appears to be superior to metrizamide for intrathecal administration.

A Clinical Study of the Myelography with Metrizamide / 대한정형외과학회잡지

The authors have studied 60 cases of back pain with respect to diagnostic accuracy of myelography with metrizamide from January, 1983 to Decembar, 1984 at the Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University. The results were as followes; 1. Of the 60 cases, 57 cases (95%) showed excellent and good findings of myelography. 2. In case of the marginal clearance of the nerve-sleeve in myelography, the excellent finding was 93.3%.3. The side effect of myelography was slight and 44% of all patients complained of headache, which disappeared within 24 hours after onset in 92% of them. 4. The accuracy rate of myelography with metrizamide was 89. 2%.

A Clinical Study of the Spinal Cord Tumor

To provide a guideline of accurate diagnosis and proper methods of treatment of spinal cord tumor the author analyzed 83 cases of spinal cord tumor who had been operated at the Department of Neurosurgery of Yonsei University College of Medicine during last 10 old years. The results were summerized as follows ; 1) The ratio of male to female was 1.6: 1 and 41% of the 83 patients were in the 4th and 5th decade. 2) The most common histopathologic type was neurinoma(48.2%), and the rests were metastatic tumor(15.7%), astrocytoma(9.6%), and ependymoma(4.8%). The distribution of the tumors was thoracic(50.6%), cervical(26.5%), and lumbosacral (20.5%). The location of the tumors was intradural extramedullary(48.2%), extradural(25.3%), and intramedullary(19.3%). 3) The common clinical features were pain, motor disturbance, sensory disturbance, and sphincter disturbance. In radiologic diagnostic tests, there were abnormal findings in 49.3% of plain X-rays. The entire 77 cases of myelography showed subarachnoid blockade. The computerized tomographic metrizamide myelography(CTMM), regarded as the most accurate diagnostic method, showed the exact location of the tumor and the relationship of the tumor with the spinal cord and the dura in entire 8 cases. 4) Thirty six neurinomas(90%) and all 8 meningiomas(100%) could be excised totally. In 30 neurinomas(75%) and 5 meningiomas(62.5%), the patients regained their motor function postopratively. In 37 neurinomas(92.5%) and 8 meningiomas(100%), the patients' sphincter function was recovered. The results of operation were particulary excellent in the cases with neurinoma and meningioma. 5) Among the 10 astrocytomas, total excision was performed in 2 cases, and decompressive laminectomy with biopsy was performed in 4 cases. Postoperative radiotherapy was performed in 4 cases. Postoperative radiotherapy was performed in 2 cases. 6) Among the 3 intramedullary ependymomas, total excision was possible in 2 cases. Subtotal excision was performed in a case with caudal ependymoma. 7) In 9 metastatic tumors, primary tumors of which were unknown preoperatively, and in 3 metastatic tumors in which the stability of the spine was deranged, surgical treatment was performed. In 3 cases, radiation therapy was followed postoperatively.

Foramen Magnum Tumors

Foramen magnum tumors are uncommon. We experienced two cases of foramen magnum tumor. One case was meningioma, the other neurinoma. Metrizamide computerized tomography scanning and pantopaque myelography have been the radiographic test most commonly used to evaluate the foramen magnum. Moth cases underwent suboccipital craniectomy and total laminectomy in C1 & C2 with total removal of tumor mass. Postoperatively, both cases showed improvement without neurological sequelae. Both cases are discussed, and a review of literature is presented.

Comparison of CT and Myelography in spine Lesion / 대한정형외과학회잡지

CT and myelography, separately or combined together, have been used for the study of spine lesion. Metrizamide enhanced CT is a new diagnostic modality for the study of spine lesion. The purpose of this study was to compare the efficacy of metrizamide enhanced CT with those of CT and metrizamide myelography. Among 163 surgically proven cases, metrizamide CT was carried out on 49 cases, CT on 50 cases and myelography on 64 cases, at Department of Orthopedic Surgery, Seoul University Hospital for 3 years period from August 1981 to July 1984. 1. Overall diagnostic accuracy of CT was 90%, that of metrizamide myelography was 82.8%and that of metrizamide CT was 93. 9%. 2. Diagnostic accuracy of metrizamide CT in HIVD was 95%, in spinal stenosis 94.4% and in spondylolisthesis 80%. 3. Most of complications were observed in myelography, even they were minor. 4. It was concluded that plain CT was advisable on a clinically typical HIVD, considering complications and expenses of myelography and metrizamide CT. 5. Metrizamide CT was indicated on previously operated cases or atypical HIVD, spinal stenosis and spondylolisthesis.

A Study on the Myelography with Water Soluble Medium, Metrizamide (Amipaque) / 대한정형외과학회잡지

A total 48 cases of myelography using Metrizamide were performed between August 1981 and July 1983 at the department of Orthopedic Surgery, Kwangju Christian Hospital. Of these cases, H.N.P was 26, tuberculous spondylitis 16, spondylolisthesis 4, and multiple sclero-sis 2 cases. The advantages of this study were as folows: 1. Complications were minimal in most of the cases except a slight headache. 2. Large amount of infusion was possible. 3. Rootlet was clearly seen. 4. Removal of dye was not necessary. 5. It gave a good contrast for the radiologic study.

A Clinical Trial of Iopamidol Myelography in 27 Cases

27 Myelographies with Iopamidol and 27 myelographies with metrizamide were performed in order to compare adverse reactions, radiographic quality and effects on vital signs of the two contrast media after injection into the spinal subarachnoid space. Headache and nausea were less severe using Iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities which were noted in 7.4% of the metrizamide group but were not seen with the use of Iopamidol. Iopamidol was more stable than metrizamide in CSF. Image quality and diagnostic accuracy of Iopamidol myelography was equivalent to metrizamide for intrathecal application.

Clinical Analysis of Lumbar Myelography with Metrizamide

Metrizamide lumbar myelography were performed in 150 patients with suspected herniated lumbar disc. The examination is easier to perform than with gas or iophendylate. The advantage of metrizamide over gas or iophendylate are the improved root sleeve visualization and examination of small structure such as root, root pocket and blood vessel. And then this is a higher percentage of diagnostic accuracy than can be obtained with other myelogram. Most of adverse reactions during and after myelography are mild and transitory, and no serious adverse reactions occured. It probably has a lower neurotoxicity than any other water soluble contrast agent.