Lipoma of the Sylvian Cistern

Intracranial lipoma is a rare benign brain tumor and ususally occurs in the midline structures, especially in the corpus callosum. The author report a case of intracranial lipoma in the left sylvian cistern. Sylvian cistern lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. The majority of cases are incidental or autopsy findings and direct surgical approach is only rarely indicated. The patient complained severe headache after head injury, the severe headache did not respose to medical therapy. Craniectomy was performed and then the tumor was removed. The literatures on this rare tumor are reviewed and discussed.

Congenital Hypoplasia of the Bilateral Internal Carotid Artery: A Case Report

Congenital agenesis, aplasia or hypoplasia of the internal carotid artery is rare vascular disease and usually combine with intracranial aneurysm, subarachnoid hemorrhage, or intracerebral hemorrhage. We report a case of bilateral congenital hypoplasia of internal carotid artery in a 36 year-old woman presented with semicomatose mentality. The brain computed tomography(CT) revealed intracerebral hemorrhage with intraventricular hemorrhage, and cerebral angiography showed hypoplasia of bilateral internal carotid artery without narrowing of the bony carotid canal on the temporal bone CT.

Idiopathic Spinal Epidural Lipomatosis

Spinal epidural lipomatosis, which causes symptomatic compression of neural elements, is a relatively uncommon disease. Although it has been reported frequently in association with the administration of exogenous steroids, a few cases of epidural lipomatosis with no association to exogenous steroids, have been reported. Idiopathic spinal epidural lipomatosis may be a separate disease from that induced by steroid. Here, the authors present two cases of symptomatic epidural lipomatosis with no history of steroid-dependent diseases and review the relevant literature.

Pain-reducing Effect by Transplants of Isolated Xenogeneic Chromaffin Cells in Mouse

OBJECTIVE: Adrenal medullary chromaffin cells are known to release analgesic substances such as opioides and catecholamines. Transplantation of them is a novel method that challenges current approaches in treating chronic pain. The transplantation of xenogeneic chromaffin cells into the central nervous system(CNS) supply antinociception in animals. In this study, we investigated the analgesic effects of rat adrenal medullary chromaffin cells transplanted into the CNS of the mouse. To study the antinociceptive efficacy of transplanted chromaffin cells, the survival of rat adrenal medullary chromaffin cells transplanted into the CNS of mouse was determined. METHODS: The adrenal medullary chromaffin cells isolated from rat were transplanted into the striatum of mouse. These cells were confirmed of the release of Met-enkephalin and Leu-enkephalin by HPLC, and immunoblots for tyrosine hydroxylase(TH). Two weeks after transplantation, we performed immunohistochemistry for TH to determine the survival of implanted cells and assessed pain sensitivity at the same time. RESULTS: The isolated rat adrenal medullary chromaffin cells were positive for anti-TH antibody and released Met-enkephalin and Leu-enkephalin more than rat endothelial cells. Transplanted rat chromaffin cells were stained with anti-TH antibody in striatum of mouse after 2 weeks. Pain sensitivity was reduced on the chromaffin cell-transplanted mouse compared to endothelial cell-transplanted mouse by the hot plate test. CONCLUSION: These results suggest that the rat chromaffin cells were suitably transplanted into the CNS of mouse. This approach could be used as a therapy for reducing of chronic pain induced by cancer or neuronal injury.

Immediate Replacement of Bone Fragments in Compound Comminuted Depressed Skull Fractures

No abstract available.

The Effects of Plate Stabilization on Maintenance of Interspace Height in Patients with Lower Cervical Lesion Underwent Anterior Cervical Interbody Fusion

OBJECTIVEL: Anterior cervical discectomy and fusion has been successfully performed for many years using a variety of techniques. Recently, the concept of internal fixation has been applied to the lower cervical lesions. The need for postoperative immobilization, usually required to stabilize the patient while the fusion mass heals, is decreased or negated by internal fixation. In order to determine the effects of plate stabilization on maintenance of interspace height during postoperative period, we assessed the potential differences between anterior interbody fusion without plate and fusion with plate in patients with lower cervical lesions. PATIENTS AND METHODS: The authors analyzed the results of 76 patients with lower cervical lesions, who underwent anterior interbody fusion between May, 1991 and December, 1997. Of these, 36 underwent only anterior interbody bony fusion and 40 underwent bony fusion plus interbody fixation with plate system. RESULTS: In order to compare the difference of two groups, we investigated the pre- and postoperative interspace height, clinical outcomes, and radiographic fusion success rates. Anterior interbody fusion with plate was found to be superior to anterior interbody fusion without plate after anterior cervical decompression procedures with respect to maintenance of cervical interspace height(p<0.01), and radiographic and clinical fusion success rates. CONCLUSION: The authors concluded that the use of anterior plate fixation may provide added security to the nervous system before bony fusion occurs, may potentiate the maintenance of interspace height, may increase the probability of successful fusion, and may permit early ambulation.

A Case of Intrahepatic Cholangiocarcinoma in Polycystic Liver Disease / 대한간학회지

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.

Inflammatory Pseudotumor of the Thoracic Spinal Cord Meninges: A Case Report

Inflammatory pseudotumor arising in the meninges of spinal cord is extremely rare and most of the cases have occurred in the lung. A case of a thoracic inflammatory pseudotumor causing myelopathy and mimicking an extradural mass is presented. The lesion was demonstrated by magnetic resonance imaging, and total removal of the mass was performed. Its histology was characterized by infiltration of three kinds of cells; histiocytes with slight epithelioid appearance, plasma cells with numerous Russell bodies, and lymphocytes. Although extrapulmonary inflammatory pseudotumors have been reported, the authors believe this is the second case of this type tumor in the spinal cord meninges.

Clinical Analysis of Metastatic Brain Tumors

Several prognostic factors have been implicated in survival prolongation in patients with metastatic brain tumors. Among these, surgery has been regarded as very significant one with respect to life prolongation and improving the quality of survival in such patients. From August 1982 through July 1996, a series of 31 patients with metastatic brain tumors among 785 patients with operated brain tumors, whose medical records, X-rays and follow-ups were avilable, was studied retrospectively to evaluate the beneficial effects of surgery. Despite the limitations inherent to the retrospective study and limited number of patients, we divided these patients into two groups to find out any statistical differences in terms of survival and quality of survival among them: 1) Conservative group(8 nonoperated patients: 5 patients with biopsy or partial resection): 13, and 2) Surgical treatment group(17 totally resected patients: one patient with subtotal resection): 18. The quality of survival was assessed by Karnofsky performance(KP) scale before and after each treatment. The survival of the patients in the surgical treatment group was longer than the conservative treatment group(14.5 months/10 months), but this was not statistically significant(p value: 0.3305). However, improvement of quality of survival, in terms of KP scale, was significantly higher in the surgical treatment group(p value: 0.0027). Although confounded by the lack of controlled, randomized study and limitations of retrospective study, aggressive surgery can be regarded to have a significant role in improving the quality of survival in patients with metastatic brain tumors.

Anterior Cervical Fusion and Plate Stabilization in Patients with Lower Cervical Lesions

Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc diseases. Refinements in instrumentation for the cervical spine have led to an increase in experience with these devices during the past decade. The need for postoperative immobilization, required to stabilize the patient while the fusion mass heals, is decreased or negated by internal fixation. The authors analyzed the results in 30 patients(22 traumatic; 8 non-traumatic) with lower cervical lesions, who underwent anterior interbody fixation with cervical plates between April, 1994 and June, 1996. We used either a unicortical(Orion TM) or bicortical screw system(Top TM): these two types of plates had no specific differences, but the Orion TM was easier and safer to operate. Although postoperative stability was successfully attained in all patients, two screw-related complications, which were fully resolved without causing any specific problems, were detected during the postoperative follow-up period. In nontraumatic lesions, we measured pre-and postoperative interbody heights at ten levels; postoperative interbody height was well preserved for one year. In conclusion, internal fixation may provide added security to the nervous system before bony fusion occurs, may lessen the number of levels requiring fusion, may increase the probability of successful fusion, and is conducive to early patient mobilization.

Lumbar Intraspinal Synovial Cyst: Case Report

True synovial cysts of the spine are rare, though they are included in the differential diagnosis of an extradural lesion in a patient with pain which is radicular or localized at the involved level of the spine. A case of a lumbar synovial cyst causing lumbar radiculopathy and mimicking an extradural tumor is presented. The lesion was demonstrated by magnetic resonance imaging, and the relief of symptoms was achieved by decompressive laminectomy and total removal of the mass.

Antioxidative Effect of Melatonin in Streptozotocin-Induced Diabetic Rats / 대한내분비학회지

BACKGROUND: An increase in oxidative stress has been suggested to play major roles in the complications of diabetes. The bulk of the experimental data favors enhanced free radicals in diabetes and antioxidant defense mechanisms may be reduced in diabetes. Melatonin, the major secretory product of the pineal gland has been shown to be a potent and specific hydroxyl radical scavenger. The purpose of our study was to determine the antioxidative effeet of melatonin in streptozotocin-induced diabetic rats. METHODS: Sprague-Dawley rats weighing 200-240 g were divided into 3 groups: normal controls(n-7), diabetic contmls(n-9), melatonin-treated diabetic animals(n-9). Diabetes was induced by intraperitoneal injection of streptozotoein(55 mg/kg body weight) and melatonin(6 mg/kg body weight) was orally administered for 20 days. At day 20 after streptozotocin administration, blood was collected for the assay of glucose, albumin and cholesterol. Erythrocyte membrane lipid peroxidation was determined by malonyldialdehyde(MDA) reactivity. RESULTS: 1) The MDA resctivity of erytbrocyte membrane in melatonin-treated diabetic animals (meanstandard deviation: 5.52+-1.52nmol/ml packed cells) were lower(p<0.05) than that in diabetic controls(7.68+-1.16nmol/mL packed cells). But, there was no significant difference between melatonin-treated diabetic animals and normal contls(4.93+-1.19 nmol/mL packed cells). 2) There were no significant differences of blood glucose and body weight between diabetic controls and melatonin-treated diabetic animals. CONCLUSION: These results show the antioxidative effect of melatonin in streptozotocin-induced diabetic rats. Further clinical and long-term experimental studies are needed to assess the effect of melatonin on development and progression of diabetic complications.

Clinical Outcome of Surgical Treatment with Instrumentation and Fusion in the Management of the Thoracolumbar Injured Patients

The goals of operation for unstable thoracolumbar spine injuries are decompression of any neural canal compression, restoration of normal anatomic contour of the spine and stabilization. A retrospective analysis on 64 thoracolumbar injured patients treated with internal instrumentation and fusion was performed from January 1991 to December 1996. The purpose of this study was to review the clinical outcome and efficacy of surgical treatment using internal instrumentation, and compare neurological, radiological and functional outcomes between anterior and posterior approach groups. Of these, 42 patients were operated via on posterior approaches and the other 22 patients by anterior approaches. At final follow up evaluation with mean period of 14.5 months, 50 patients(78%) were walking and 47 patients(92%) except 4 patients(A-A, three and C-C one patient) had improved using Frankel's grade in patients with neurological deficits(51 patients). No patient deteriorated. Radiological and functional outcomes were satisfactory in the majority of patients. In a comparison of the clinical outcomes between anterior and posterior approaches, there was no statistically significant difference in neurological outcome(the mean value of up-grade: anterior 1.05+/-.7, posterior 0.95+/-.9, p=0.42), but in radiological outcomes, there were no significant differences between the two groups in amount of restoration of vertebral compression(mean recovery rate: anterior 61.5%, posterior 50.9%), kyphotic deformity(mean recovery rate: anterior 47.9%, posterior 70.0%)(p>0.05), but the only difference was in the restoration of canal narrowing, with the anterior group more improved(recovery rate: anterior 86.4%, posterior 74.3%) (p<0.05). In functional outcomes by Prolo's scale, the anterior group was better than the posterior group(mean economic and functional status: anterior E(4.4), F(4.3); posterior E(3.5),F(3.9)). We conclude that agressive decompression, instrumentation and bone fusion has shown better clinical outcomes of the unstable thoracolumbar injured patients and the choice of surgical approaches depends on the general condition, age, status of bone mineral density, specific injury mechanism, radiological findings, and grade of neural injury at the time of injury of these patients.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Spinal Cysticercosis

Cysticercosis in the human is caused by infestation by larvae of pork tapeworm, taenia solium. Although they may grow anywhere in the body such as the liver, lung, eyes, heart, muscle, ect., they are most commonly found in the brain and its coverings. The cysticercus vesicles have occasionally been found in spinal structures other than the brain. We present a case of spinal cysticercosis in a 63-year-old male. The patient presented with a marked paraparesis and paresthesia below a T10 dermatome level, and moderately decreased deep tendon reflexes. After performing total laminectomies at T11-12 & L3-5, 30 cysticercus vesicles were removed.

Microvascular Decompression for Essential Hypertension

Idiopathic arterial hypertension, termed "essential" or "neurogenic", is a common generalized cardiovascular syndrome comprised of a sequence of pathologic changes and accommodations. Although an extensive literature exists concerning that, the primary etiology has been unclear yet. However, Jannetta and coworkers have reported a possible etiological connection between essential hypertension and intraoperatively observed neurovascular compression of the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves on the left, recently. They have also introduced one of new therapeutical concept for essential hypertension by microvascular decompression(MVD) of offending vessels. Based on Jannetta and coworker's hypothesis, the authors have made some operations for the control of hypertension. Seven essential hypertensive patients have been underwent retromastoid craniectomy and MVD in the left ventrolateral medulla between July 1992 and June 1993. Five of them showed multiple episodes of intracerebral hemorrhages, one was an intractable hypertension case and the other one had a left hemifacial spasm with essential hypertension. The most common offending vessel was the posterior inferior cerebellar artery and it had been confirmed during operation. Postoperatively, in three cases, blood pressure was lowered to normal without medications. Of remaining four cases, blood pressure was significantly improved in one and slightly improved in three. There were no major complications in patients with surgery and no poor outcomes. These results indicate that the MVD for essential hypertension is relatively safe procedure and alternative choice as one of the management of intractable essential hypertension, repeated hypertensive intracerebral hemorrhages and left cranial nerve hyperfunction disorders combined with essential hypertension.

Percutaneous Tracheostomy: a comparison with standard surgical tracheostomy / 대한마취과학회지

A prospective study was undertaken to compare, in intensive care patients, the safety and utility of a percutaneous tracheostomy teehnique with a surgieal tracheostomy technique. Between March of 1992 and June of 1993 we randomly selected 40 patients of the many who were in need of a tracheostomy. After dividing those patients into 2 groups, we per- formed the procedures. Twenty patients received a standard surgicsl traeheostomy, the other twenty received a percutaneous tracheostomy. We found complications occurring in 6 patients who received the standard surgical tracheostomy while only 1 patient suffered complications from the group having the percutaneous tracheostomy. The most common complications being subcutaneous emphysema, pneumothorax, pnemonia, and hemorrhage. Post-decannulation scar was 3.286+/-1.204mm in percutaneous group, 20.36+/-7.26mm in standard group. In comparison to standard surgical tracheoatomy, percutaneous tracheostomies were rapidly and easily performed and asaociated with significantly fewer complication and small post-decannulation scars.

Percutaneous Tracheostomy: a comparison with standard surgical tracheostomy / 대한마취과학회지

A prospective study was undertaken to compare, in intensive care patients, the safety and utility of a percutaneous tracheostomy teehnique with a surgieal tracheostomy technique. Between March of 1992 and June of 1993 we randomly selected 40 patients of the many who were in need of a tracheostomy. After dividing those patients into 2 groups, we per- formed the procedures. Twenty patients received a standard surgicsl traeheostomy, the other twenty received a percutaneous tracheostomy. We found complications occurring in 6 patients who received the standard surgical tracheostomy while only 1 patient suffered complications from the group having the percutaneous tracheostomy. The most common complications being subcutaneous emphysema, pneumothorax, pnemonia, and hemorrhage. Post-decannulation scar was 3.286+/-1.204mm in percutaneous group, 20.36+/-7.26mm in standard group. In comparison to standard surgical tracheoatomy, percutaneous tracheostomies were rapidly and easily performed and asaociated with significantly fewer complication and small post-decannulation scars.

A Surgical Experience of a Odontoid Type II Fracture by Transoral Approach and Internal Fixation with Screws and Mini-plate

With changing mechanisms of injury, heightened clinical awareness, and better diagnostic technology, odontoid fractures constitute 9~18% of cervical fractures in recent reports. The odontoid type II fracture is the most common axis fracture and it is also the most difficult to treat. Type II fractures with greater than 6mm dens dislocation have a higher incidence of nonunion with nonoperative therapy and should be offered early operative reduction with fusion. Recently we have experienced a young male patient with odontoid type II fracture. The degree of dens dislocation was 8mm. The fractured odontoid process was removed through transoral-transpharyngeal approach and bone fusion was performed with iliac bone. And the inserted bone was fixed with screws and mini-plate for further stabilization. The operative result was good without any serious complications. The operation technique is detailed.