Usefulness of Multislice Computerized Tomographic Angiography in Evaluation of Intracranial Aneurysms: Surgical Correlation

OBJECTIVE: The usefulness of multislice computerized tomographic angiography(MCTA) in operating intracranial aneurysms is studied by comparing the features of MCTA with intraoperative findings. METHODS: From December 2001 to February 2003, 74 clippings of aneurysmal neck were carried out based mainly on the aneurysmal features of preoperative MCTA. MCTA studies consisted of four rows(multislice technology), with slice thickness of 1.25mm at 0.6mm reconstruction intervals and pitch of 0.75. Timing was determined using the Smart Prep automatic triggering system. The locations of aneurysms were classified into 3 subgroups: internal carotid artery, middle cerebral artery, and anterior communicating artery and distal anterior cerebral artery. The aneurysmal features on MCTA were compared with their operative findings, using our comparison items, and graded subsequently. RESULTS: A total of 77 intracranial aneurysms were identified among 64 patients on preoperative MCTA, and one of them was false positive. Two angiographically unrecognized microaneurysms were identified on operation. In the detection of intracranial aneurysm, MCTA had 98.4% sensitivity and 96.9% specificity on a perpatient basis. On a per-aneurysm basis, MCTA sensitivity and specificity were 98.6% and 97.3%, respectively. The shapes of aneurysms on MCTA were not related with the grade(chi-square test: X2=1.566, p=0.457), but each grades of simple, bilobulation, and multilobulation were grade 1. Sum of grading scores were related with site of aneurysm(Chi-square test: X2=48.635, p=0.001), In particular, sum of grading scores of MCA aneurysms were 5. Although fine vascular architectures such as hypoplastic A1 and posterior communicating artery, perforating artery of A-COM, and anterior choroidal artery were invisible on MCTA, the MCTA images of ICA and A-COM aneurysms were also found to be valuable in intracranial aneurysm surgery. CONCLUSION: MCTA is useful in planning the surgery of intracranial aneurysm compared to single detector CTA. Postoperative DSA of stabilized patient is mandatory for confirming operative results and any missing unruptured aneurysm after MCTA based cerebral aneurysm surgery.

Significance between Ultrasonographic and Operative Findings in Hypertrophic Pyloric Stenosis

PURPOSE: The diagnosis of hypertrophic pyloric stenosis(HPS) can be made by clinical manifestations and upper gastrointestinal(UGI) series in most cases. Recently, the ultrasonogram(US) is a more accurate and reliable method for the diagnosis of HPS in early stage. METHODS: We retrospectively studied 27 HPS patients confirmed surgically from January 1999 to March 2000. We reviewed clinical histories and physical and laboratory findings. Among these patients, ultrasonograms were carried out in 23 cases preoperatively. Therefore, we analyzed pyloric muscle thickness(PT), pyloric diameters(PD), and pyloric canal lengths(PL), and calculated pyloric volume(PV) by the equation of 'PV=pie(1/2PV)2xPL'. RESULTS: The mean age on admission was 39.0+/-20.4 days and 70.4% of the patients were under 6 weeks of age. The mean age at onset was 26.9+/-20.4 days and the duration of symptoms was 12.7+/-11.6 days. On physical examination, the pyloric tumors were palpated in 14 cases(51.9%) and the gastric peristalses were noted in 8 cases(29.6%). UGI series were carried out in 21 cases, and all of them had the characteristic findings of HPS. The mean PT was 5.23+/-1.05mm, the mean PD wase 13.56+/-2.25mm, the mean PL was 21.42+/-3.85mm, and the calculated PV was 3.23+/-1.35 mL. According to the criteria by Stunden, et al., PT(>=4mm), PD(>=12mm) and PL(>=15mm) were satisfied in 91.3, 73.9 and 91.3% respectively. The PV(>=1.4mL) was satisfied in 95.7% according to the criterion by Westra, et al. CONCLUSION: The US in the diagnosis of HPS is safe and useful. With measurements of PV parameter, the diagnosis by US will be more reliable and more accurate.

Clinical Features and Electrodiagnostic Findings of Ulnar Neuropathy at the Elbow

OBJECTIVE: To evaluate the clinical and electrodiagnostic findings of ulnar neuropathy at the elbow. METHOD: Sixty-two patients with ulnar neuropathy at the elbow were reviewed retrospectively to establish causes, severity and type of neuropathy, symptom, sign, operation name and operative findings. RESULTS: 1) Of total 62 cases, 41 were male and 21 were female and the most often were in their forties and fifties. 2) The main cause of the neuropathy is bone deformity caused by previous fracture or dislocation (43.6%). 3) The symptoms observed were motor weakness (66.1%), sensory change (79%) and muscle atrophy (35.5%). 4) Forty-nine cases showed abnormality in nerve conduction study and needle electromyography study, and 9 cases showed abnormality only in the needle electromyography study. 5) On needle electromyography, sparing of flexor carpi ulnaris was shown in 50 cases (80.6%). 6) Operative treatment was performed in 15 cases. Among them, electrodiagnostic and operative diagnosis coincided in only 12 cases (80%). CONCLUSION: We conclude that above clinical and electrodiagnostic findings are useful for the diagonosis ulnar neuropathy at the elbow with consideration of etiology, localization and for the selection of operative treatment.

Experience of Intracranial Gangliogliomas

Gangliogliomas are rare benign tumors of the central nervous system consisting of neoplastic ganglion and low grade glial cells. The purpose of our investigation was to evaluate the clinical, radiological, surgical, and pathological features and outcome of ten patients with intracranial ganglioglioma who underwent surgery between June 1989 and December 1996. The mean follow-up period was about 24 months(range, 6-66 months) after their initial operation. The series consisted of six males and four females, and their mean age was 29.7 years. The mean length of symptoms was 9.1 years. Seizure was the most common presenting symptom and occurred in eight of ten patients. MRI findings were variable, and showed no characteristic patterns. The temporal lobe was the most common site of involvement(6/10). During surgery, a sharp demarcation between tumor and normal brain tissue was seen in seven of ten cases. Five of ten cases were solid, and the remaining cases were cystic in two, cystic with mural nodule in two, and soft, suckable in one. Total resection was possible in seven of ten patients. Diagnosis was established by identifying a mixture of abnormal astrocytic and neuronal components. Two patients showed astrocytic predominance; four, a neuronal predominance; and four, an equal admixture of cell types. All cases were benign. Other histopathological findings included microcystic change, desmoplasia, eosinophilic granular body, microcalcification, and lymphocytic infiltration. At the time of writing, all seven patients who underwent total resection were alive without recurrence; of the three who underwent subtotal resection, two were alive and in a stable condition, while in the other, the tumor had progressed within 12 months of surgery and adjuvant radiation therapy had thus been required. The patients was, though, still alive. In seven of eight patients, the frequency of seizure had markedly decreased. Our study confirms that this tumor is a distinct clinical and histological entity with a predilection for the temporal lobe. Although the number of patients and follow-up period are limited, this study also shows that epilepsy is extremely well controlled and that survival after surgical resection is good.