A Case of Multiple Schwannomas of the Trigeminal Nerves, Acoustic Nerves, Lower Cranial Nerves, Brachial Plexuses and Spinal Canal: Schwannomatosis or Neurofibromatosis?

In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.

Effects of Continuous Intravenous Analgesia Versus Epidural Analgesia after Lumbar Spinal Surgery: A Prospective Study

OBJECTIVE: The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. METHODS: Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. RESULTS: In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. CONCLUSION: CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.

Therapeutic Embolization of the Dural Arteriovenous Malformation Involving the Jugular Bulb

Pulsatile tinnitus is a rarely occurring symptom of vascular origin. Most frequently, the symptoms are due to an arteriovenous malformation, to a tumor of the jugular glomus or to a local arterial stenosis. A 39-yr-old Korean male suffering from pulsatile tinnitus of the left ear was diagnosed to have dural arteriovenous malformation of the jugular bulb. Magnetic resonance imaging and angiography revealed a high-velocity vascular lesion encroaching the internal jugular vein and sigmoid sinuses. Digital subtraction angiography demonstrated a dural arteriovenous malformation involving the jugular bulb. The arterial supply was from the neuromeningeal branch of the left ascending pharyngeal artery and inferior tympanic artery. Stenosis of the left jugular vein caused retrograde venous drainage through the contralateral transverse sinus. Superselective embolization of these feeding arteries was successfully performed using 25% mixture of N-butylcyanoacrylate and lipiodol. In postembolization period, his complaints of pulsatile tinnitus and buzzing noise behind his left ear disappeared.

Pain Control with Continuous Infusion of Epidural Morphine and Bupivacaine after Lumbar Spinal Surgery(A Prospective Study)

No abstract available.

Aneurysms Presenting with Neural Compression:Response to Treatment with Guglielmi Detachable Coils Embolization

No abstract available.

Conus Medullaris Hemangioblastoma

Conus medullaris hemangioblastoma is very rare. We report a hemangioblastoma which was removed after embolization in conus medullaris. It was associated with syringomyelia from cervical cord to conus medullaris. There was no manifestation of von Hippel-Lindau disease. The literature on conus medullaris hemangioblastoma is reviewed and the mechanism of the syringomyelia associated with the hemangioblastoma is discussed.

Delayed Hypoglossal Nerve Palsy Following Fracture of the Occipital Condyle: Case Report

Fracture of the occipital condyle is rare. We report the case of a patient with this fracture who presented with negative plain films and delayed hypoglossal nerve palsy. Diagnosis was estabilished with high resolution computed tomography. In a trauma patient with neck or occipital pain, with or without cranial nerve palsy, this fracture should be considered, even if a plain radiograph is negative.

Effect of Cyclosporin A in a Rat Spinal Cord Injury Model

The effect and mechanism of drugs for the recovery of motor function after acute spinal cord injury has not yet been fully elucidated. This study was aimed to examine the effect of cyclosporin(CsA) on the recovery of motor function and its accompanying histopathological changes in the spinal cord injury model. A certain range of spinal cord injury was made with NYU weight-drop impactor. Injured rats were divided into 3 groups; control(castor oil) group(group A), two CsA treated groups(40mg/kg, i.p.) at 10min(group B) or 4hour(group C) after cord injury. Locomon test was done using BBB(Basso, Beattie, and Bresnahan) locomotion rating scale. After the locomotion test which has been done for 14 days after cord injury, group B,C showed improved motor function compared to group A. Especally, remarkable motor function recovery was noted in group C. Immunohistochemical stain was made to examine histological change after cord injury. Spinal cord injury produced by NYU impactor was quite reproducible in parameters of the magnitude of trauma, the extent of tissue damage, and neural dysfunction measured in this study. In the immunohistochemical study, moreover, increased number of neurofilament and decreased number of macrophage were found in the group of CsA treated 4 hours after cord injury. These results indicate that CsA improves motor function after cord injury, and suggest that some actions of CsA on calcineurin, expression of surface markers or macrophage may contribute to these effects.

Evaluation of EDAS in Moyamoya Disease with Brain SPECT: Case Report

Moyamoya disease is characterized by progressive occlusion of major cerebral arteries and development of an abnormal vascular network. We performed EDAS(encephalo-duro-arterio-synangiosis) on 2 patients with moyamoya disease and obtained preoperative and follow-up brain SPECT to evaluate the effect of EDAS. In this study, moyamoya disease was confirmed by angiogram and the relation between the patient's clinical status and postoperative findings of SPECT was presented. In all cases, a marked increasing of blood perfusion was noticed on the implanted area together with improvement of clinical status.

Transthoracic Interbody Fusion with Carbon Cage for Thoracic Disc Herniation Which was Downward Migrated

The authors report a case of thoracic disc herniation at T11/12 level which was downward migrated, presenting with signs of progressive spinal cord compression. The lesion was diagnosed by MRI. The operation was done by transthoracic transpleural approach using surgical microscope and the rib was not resected due to floating ribs of T11, 12. A Carbon cage with cancellous bones were used for the graft at the partial corpectomy site. The result of operation was good.

A Brown-Sequard Syndrome Resulting from a Ruptured Cervical Disc Herniation: A Case Report

We present a case of Brown-Sequard syndrome due to a massive cervical disc herniation at C5/6 level, presenting sings of sudden and severe spinal cord compression. The lesion was diagnosed by MRI and herniated cervical disc was removed under the surgical microscope via anterior route. The result of operation was good. A brief review of the literature is given.

Overall Surgical Results and Causes of Unfavorable Outcome in Good Grade Patients with Intracranial Aneurysm

We analyzed the overall surgical results in 100 patients with intracranial aneurysms operated in Presbyterian Medical Center during the period from June 1990 to December 1993. Preoperatively, all patients were in Hunt and Hess grades I-III. Overall outcomes revealed 83 patients(83%) of good outcome, 10 patients(0%) of fair outcome. 3 patients(3%) of poor outcome, and 4 patients(4%) of dead outcome. The outcome was worse if surgery was performed in the 4 to 10 day post- bleed interval(P<0.05) and there was no statistical difference of the rate of good outcome between the parients operated at 0 to 3 days, and 11 day more after subarachnoid hemorrhage. In good grade patients, surgical trauma rather than delayed ischemic deficit was considered as the major cause of unfavorable outcome of aneurysm surgery. Intermedia to period operation increased the chance of postoperative delayed ischemic deficit. Systemic complications and vasospasm were the major causes of dead outcome in the oldaged patients.

Clinical Significance of CT/Discography in the Determining the Prognosis of Patients for Chemonucleolysis

We analysed the results of 34 herniated lumbar disc patients who were treated with chemonucleolysis and took CT/discography from Jan. 1991 to Jun. 1992 at the Department of Neurosurgery, Presbytrian Medical Center, Chonju, Korea. The overall success rate of chemonucleolysis was 82.4%. The CT/discographic findings were divided according to whether fluorescing or not, and degeneration or not. The success rates in fluorescing and non-fluorescing group were 95.2% & 61.5%, respectively, and those in degeneration and non-degeneration group were 66.7% & 100%, respectively. So, the results showed that the outcome of chemonucleolysis was better when the herniated disc fragment demonstrated a large uptake of contrast material visible, or there was no annular appearance to describe degeneration on CT/discography.

Stereotactic Surgical Management of Traumatic Intracerebral Hematoma

Nineteen patients suffering from post-traumatic intracerebral hematoma, being managed by stereotactic aspiration of hematoma were evaluated. The outcome in this series is quite satisfactory, with 58% of patients having a functional survival. Eight patients died, of which three patients died of brain swelling and 5 died of systemic causes such as respiratory failure, gastrointestinal(GI) bleeding, and renal failure. It is our belief that stereotactic aspiration is helpful in managing patients with traumatic intracerebral hematoma without herniation and wevere brain swelling.

Supraorbital Approach to Anterior Skull Base and Intraorbital Lesions

To get effective access to the floor of the frontal fossa and the superior orbit, the resection of supraorbital rim has been done. We performed the supraorbital approach as combined technique with uni- or bifrontal craniotomy in order to minimize frontal lobe retraction and achieve excellent exposure for safe manipulation in seven patients of anterior skull base and intraorbital lesions. Of seven patients, two patients of olfactory groove meningioma underwent the operation with supraorbital bifrontal craniotomy;one patient of tuberculum sellar meningioma, bifrontal supraorbital-pterional approach;four patients of intraorbital benign lesions(one patient of meningioma, one patient of neurilemmoma, two patients of benign lesions in lacrimal gland), supraorbital unifrontal craniotomy. There was little or no functional, anatomical, or cosmetic deficit associated with this approach technique. We believe the supraorbital approach to be a helpful technique as combined procedure of the uni- or bifrontal approach and the approach of choice for the intraorbital tumors except those in the inferior portion.

A Case of Neurofibromatosis 2 with Multiple Intracranial and Intraspinal Tumors:Neurofibromatosis 2(NF2)

Neurofibromatosis 1(NF-1, Von Recklinghausen disease) and Neurofibromatosis 2(NF-2, bilateral acoustic neurinoma) have been established as distinct disorders by the National Institutes of Health(NIH) Consensus Development Conference in 1988. We recently have encountered a patient of NF-2 who develop multiple intracranial and spinal tumors 12 years after the surgical treatment of Schwannoma of lumbar nerve roots. The tumors were right acoustic neurinoma, left cerebellopontine angle(CPA) meningioma, multiple intracranial meningiomas, intraorbital glioma, multiple ependymomas of the brain stem and cervical spinal cord, and meningiomas of cervical nerve roots. We present this case with a review of reported cases of neurofibromatosis.

Thoracolumbar Intramedullary Neurilemmoma

A case of thoracolumbar intrameduallary neurilemmoma diagnosed by magnetic resonance imaging and treated surgically is presented. Published reports of these rare lesions and possible mechanisms of their origin are reviewed. Magnetic resonance imaging is better than myelography and computed tomography at delineating the intramedullary extent of the tumor. We belive that complete resection is the treatment of choice.

Thoracolumbar Intramedullary Neurilemmoma

A case of thoracolumbar intrameduallary neurilemmoma diagnosed by magnetic resonance imaging and treated surgically is presented. Published reports of these rare lesions and possible mechanisms of their origin are reviewed. Magnetic resonance imaging is better than myelography and computed tomography at delineating the intramedullary extent of the tumor. We belive that complete resection is the treatment of choice.

Prognosis of Primary Subarachnoid Hemorrhage

A clinical analysis and follow-up study were performed with 35 cases of subarachnoid hemorrhage of unknown etiology among 217 cases of spontaneous subarachnoid hemorrhage who were diagnosed by cerebral pan-angiohraphy and brain C-T scan and treated at department of neurosurgery, Chonju Presbyterian Medical Center from 1977 to 1982. The duration of follow-up study was 6 months to 8 years(mean 4.4years). The author obtained the following results. 1) Subarachnoid hemorrhage of unknown etiology was 16% of 217 cases of spontaneous hemorrhage. 2) The incidence of subarachnoid hemorrhage of unknown etiology was high in 5th decade and higher in women. 3) Manifestations of subarachnoid hemorrhage of unknown etiology were similar to those of ruptured aneurysm. 4) When primary cerebral pan-angiography was normal, the secondary cerebral pan-angiography was not so meaningful. 5) The overall prognosis of the cases of unknown etiology was good in 30 among 35 cases(86%) who were able to return to their previous occupation. 6) Age and blood pressure were probably major prognostic factor.

Sylvian Lipoma: Case Report

Intracranial lipomas are rare tumor which are usually found along the midline cerebral cisterns. A case of sylvian lipoma located usually at sylvian fissure was diagnosed by CT scanning and was confirmed with operation. Only partial resection could be done. The literature was reviewed and therapeutic options are proposed.