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Objective@#To review the characteristics of distal middle cerebral artery (MCA) aneurysm treated by microsurgery, the detailed surgical options, and the clinical result. @*Methods@#We retrospectively reviewed cerebral aneurysm in the M2 and M3 segments of the MCA surgically treated between January 2015 and December 2022. The demographic data, aneurysm-related findings, type of surgical approach, surgical technique, and clinical outcomes of the enrolled patients were analyzed. @*Results@#Sixteen distal MCA aneurysms were treated with microneurosurgery (incidence, 1.0%; female, 12; mean age, 58.1 years; ruptured, three). Twelve aneurysms were in the M2 segment (insular segment), two aneurysms at the M2–M3 junction, and two aneurysms in the M3 segment (opercular segment). Twelve aneurysms were saccular (average size, 4.9 mm; multiplicity, 50%; average aneurysms, 3.0; partially thrombosed, 1; sidewall aneurysm, 2). Three aneurysms were fusiform, of which two were ruptured. Of the ruptured aneurysms, one was a ruptured dissecting aneurysm. The trans-sylvian and trans-sulcal approaches were used in fourteen and two patients, respectively. Neck clipping, wrap clipping, and surgical trapping were performed in twelve, one, and one patient, respectively. Proximal occlusion was performed in one patient. Bypass technique was required in two patients (neck clipping and proximal occlusion). The modified Rankin Score was 6 in the two patients with ruptured aneurysms. The remaining patients did not show further neurological deterioration after microneurosurgery. @*Conclusions@#Distal MCA aneurysms had a high incidence of being diagnosed with multiple other aneurysms and were relatively non-saccular.
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Many elderly people take warfarin due to underlying disease. Warfarin is a risk factor for developing chronic subdural hematomas and other intracranial hematomas. Our patient was on chronic warfarin treatment for longstanding atrial fibrillation and underwent burr hole trephination due to chronic subdural hematoma. Multiple intracerebral hemorrhages developed 7 days after surgery without resumption of warfarin. Here, we report and review this rare case.
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This case report presents a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH). The cause and prognosis of CVT can vary;CVT caused by SIH is uncommon and difficult to diagnose and treat. In this case, magnetic resonance imaging myelography showed definite cerebrospinal fluid leakage, and the patient's symptoms did not improve after conventional treatment. Furthermore, subdural hematoma occurred, causing mental deterioration; however, it improved dramatically after the blood patch procedure and burr hole drainage, which was performed after early cessation of anticoagulant therapy.
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Spinal surgery of the anterior aspect of the cervicothoracic junction is difficult and has technological challenges because of the kyphotic alignment of the upper thoracic spine. This approach requires knowledge of the cervicothoracic regional anatomy. Surgery in this region is rare because of its indications; despite this rarity, surgeons must be prepared to expose this region. In addition, surgery in this region demands extensive opening of the surgical field and results in severe postoperative pain. Therefore, a less invasive procedure must be considered. Six cases of cervicothoracic lesion operation have been reported. The patients were successfully treated using an anterior modified approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable anterior implant bone construction while preserving the posterior osseo-ligamentous tension band. Moreover, the modified anterior approach (J-type manubriotomy) provides the same exposure of the cervicothoracic junction without a full median sternotomy and avoids injury to subclavian vessels during resection of the clavicle or sternoclavicular junction. Therefore, the anterior cervical approach combined with J-type manubriotomy allows extensive exposure of the cervicothoracic junction and causes less complications. We performed preoperative radiological evaluation to identify the cases in which J-type manubriotomy was necessary.
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Humanos , Anatomía Regional , Clavícula , Dolor Postoperatorio , Columna Vertebral , Esternotomía , CirujanosRESUMEN
Trigeminal neuralgia is caused by compression of trigeminal nerve root and it leads to demyelination gradually. It was almost idiopathic and occurred unexpected. The upper cervical spinal cord contains the spinal trigeminal tract and nucleus. Fibers with cell bodies in the trigeminal ganglion enter in the upper pons and descend caudally to C2 level. We experienced a rare patient with facial pain, which was paroxysmal attack with severe pain after a clear event, cervical spinal injury (C2). So, this case reminds us of a possible cause of trigeminal neuralgia after a trauma of the head and neck.
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Humanos , Cuerpo Celular , Médula Cervical , Enfermedades Desmielinizantes , Dolor Facial , Cabeza , Cuello , Apófisis Odontoides , Puente , Médula Espinal , Traumatismos Vertebrales , Ganglio del Trigémino , Nervio Trigémino , Neuralgia del TrigéminoRESUMEN
OBJECTIVE: Chronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas. METHODS: From January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images. RESULTS: 60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group. CONCLUSION: Burr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.
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Humanos , Craneotomía , Drenaje , Hematoma , Hematoma Subdural Crónico , Hospitalización , Recurrencia , TrepanaciónRESUMEN
A 49-year-old female patient was admitted due to memory disturbances. Magnetic resonance (MR) imaging suggested gliomatosis cerebri (GC), which had spread to both insular lobes, both frontal and basal ganglia and the brain stem. A stereotactic biopsy was performed at the high signal intensity area of the T2-weighted MR image, and the revealed a diffuse astrocytoma. Radiation therapy was judged not to be an appropriate treatment for the patient because of her cognitive impairment. A combinatorial chemotherapy regiment consisting of Procarbazine, CCNU, and Vincristine (PCV) was agreed upon after discussion. The patient underwent six cycles of PCV chemotherapy (a full dose was applied until the 3rd cycle, and dose then was reduced to 75% for the remaining cycles). Although the patient exhibited side effects such as bone marrow suppression and gastrointestinal symptoms, these were managed by medication. Over the 28 months following initiation of treatment, the high signal area in the right frontal and temporal lobes in the T2-weighted MR image decreased, and the patient's cognitive function [global deterioration scale (GDS) 4 points, mini-mental state examination (MMSE) 25 point] also improved (GDS 1 points, MMSE 29 points). PCV chemotherapy can therefore be an alternative therapeutic option for patients with GC who cannot be treated with radiation therapy or other chemotherapies.
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Femenino , Humanos , Persona de Mediana Edad , Astrocitoma , Ganglios Basales , Biopsia , Médula Ósea , Tronco Encefálico , Quimioterapia , Lomustina , Memoria , Neoplasias Neuroepiteliales , Procarbazina , Lóbulo Temporal , VincristinaRESUMEN
BACKGROUND: Reduced pulmonary function is a common outcome in pulmonary patients with reduced bone mineral density. But, there are few studies on the relationship in adult females who do not have pulmonary diseases. Thus, this study was to assess the correlation between bone mineral density and pulmonary function in healthy women. METHODS: A total of 193 subjects was selected among adult females who visited a health promotion center. BMD was measured by Dual energy X-ray absorptiometry and T-score of lumbar spine (L1-L4) was used. Pulmonary function was measured by spirometer and questionnaire survey was used to obtain information from the subjects. RESULTS: Mean T-score of L-spine was -0.284, FEV1 (pred %) was 98.82% and BMI was 23.50 kg/m2. The results showed positive correlation (0.128) between BMD and FEV1 by multiple regression analysis (P<0.05). CONCLUSION: As FEV1 of subjects increased, BMD increased in adult women who did not have pulmonary diseases.
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Adulto , Femenino , Humanos , Absorciometría de Fotón , Densidad Ósea , Promoción de la Salud , Enfermedades Pulmonares , Columna Vertebral , Encuestas y CuestionariosRESUMEN
Benign solitary osteochondroma is uncommon in the vertebra (2%). Vertebral ostoechondroma arises predominantly in the lumbar and cervical regions, and rarely in the sacrum. We describe a case of a sacral solitary senescent osteochondroma compressing the sciatic nerve, producing sciatica. The tumor was removed by posterior paramedian incision. The excised mass was cylindrical, measuring 3.5x1x1 cm in size and consisting of lamellar bone with Haversian system similar to the architecture of normal cortical bone and trabecular bone.
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Osteón , Osteocondroma , Sacro , Nervio Ciático , Ciática , Columna VertebralRESUMEN
We compared 30 cases that had a laparoscopic cholecystectomy(L.C.) with 30 cases which revealed chronic cholecystitis on biopsy among the patients who had a standard open cholecystectomy(O.C.). The patients were treated at the Department of Surgery, Saint Columban Hospital, Mokpo, Korea, from January 1995 to July 1996. The results from the 60 patients are as follows: 1) The ratio of males to females was 1:2 in the L.C. group and 1:0.8 in the O.C. group. The prevalent age was the 6th decade in both groups. 2) Associated diseases were seen in 22 cases(73%) in the L.C. group and 20 cases(67%) in the O.C. group. 3) There were 6 cases(20%) of previous abdominal operations in the L.C. group and 7 cases(23%) in the O.C. group. 4) The mean operation time was 139.8+/-35.7 minutes in the L.C. group and 155.3+/-34.4 minutes in the O.C. group. 5) The mean hospital stay after the operation was shorter in the L.C. group(range: 4~7 days) than in the O.C. group(range:8~12 days). 6) Postoperative complications occurred in 2 cases(7%) in the L.C. group and 8 cases(27%) in the O.C. group. 7) The conversion rate from a laparoscopic cholecystectomy to an open cholecystectomy was 21%(8 cases). 8) Problem experienced during the laparoscopic cholecystectomy were bleeding at the operative field(4 cases), stone drop from gallbladder(3 cases), and bile leakage(1 case). 9) The time until postoperative oral intake was 2 postoperative days in the L.C. group and 4 postoperative days in the O.C. group. 10) The average duration of postoperative pain was 2.6+/-0.6 days in the L.C. group and 4.3+/-1.3 days in the O.C. group. 11) The average duration of narcotic requirement was 2.4+/-0.6 days in the L.C. group and 3.8+/-1.8 days in the O.C group.
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Femenino , Humanos , Masculino , Bilis , Biopsia , Colecistectomía , Colecistectomía Laparoscópica , Colecistitis , Hemorragia , Corea (Geográfico) , Tiempo de Internación , Dolor Postoperatorio , Complicaciones Posoperatorias , SantosRESUMEN
No abstract available.
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Niño , Humanos , Várices Esofágicas y Gástricas , Hipertensión Portal , Vena PortaRESUMEN
Gaucher's disease is an uncommon metabolic disorder, which was first described by Gaucher in 1882, characterized by accumulation of distinctive Gaucher's cells in the reticuloendothelial system such as spleen, liver, and bone marrow. The great majority of cases have been reported in Jews, and others in negros and orientals. We are presenting two cases in homozygous twins in Korea, whose clinical manifestations are hepatosplenomegaly and bone lesions due to expansion of involved bones.
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Humanos , Población Negra , Médula Ósea , Enfermedad de Gaucher , Judíos , Corea (Geográfico) , Hígado , Sistema Mononuclear Fagocítico , Bazo , GemelosRESUMEN
No abstract available.
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Femenino , Humanos , Lactante , Líquido Amniótico , Estudios ProspectivosRESUMEN
During the period of 18 months from December 1984 to May 1986, 41 cases(25.0%) of subpulmonic ventricular septal defect(VSD) were diagnosed among 164 cases of isolated VSD in the cardiac catheterization labortory. The incidence of aortic regurgitation associated subpulmonic VSD(19.5%) was much higher than that of the other types of VSD(2.4%). None of patients less than 1 year old developed aortic regurgitation, the incidence of which has increased with the age after that. That amount of left to right shunt through the VSD was smaller in the patients with aortic cusp prolapse than those without aortic cusp prolapse, and the severity of aortic regurgitation was correlated with that of aortic cusp prolapse. 10 out of 41 patients revealed more than 20mmHg pressure gradient through right ventricle outflow tract and 9 of these patient were as sociated with aortic cusp prolapse.