A Case of Intramural Hematoma Coexisting with Autosomal Dominant Polycystic Kidney Disease and Intracranial Aneurysm

Autosomal dominant polycystic kidney disease(ADPKD) is one of the most common hereditary diseases, and frequently has well defined extrarenal manifestations. Among the fatal vascular complications associated with ADPKD, ruptured intracerebral aneurysm and ruptured abdominal aortic aneurysm are widely known. Intramural hematoma(IMH) is a rare but potentially disastrous complication, and clinicians should always consider this when dealing with patients with ADPKD who present with acute dyspnea or chest pain. We report a case of a 67-year-old woman with the IMH as a fatal complication of ADPKD and intracranial aneurysm.

The Quality of Life and Cognitive Deficits According to Treatment Modality of Anterior Communicating Artery Aneurysm: Surgery and GDC Embolization Group

OBJECTIVE: The authors present the difference of cognitive outcome of good recovery patients between direct surgery and Guglioma detachable coil(GDC) embolization group among anterior communicating artery aneurysm patients. METHODS: The clinical records of 21 patients who can be followed up and be answered questionnaires among good recovery patients fter ACoA(anterior communicating artery) aneurysm operation from 1990 to 1999 in our hospital were reviewed as surgery group. On the other hand, 20 good recovery patients after embolization of ACoA aneurysm in the other hospital from 1996 to 1999 are seleted as GDC embolization group. In the surgery group, the degree of brain swelling, the existence of rectus gyrus removal, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are examined. In GDC embolization group, problem during embolization, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are also investigated. After this investigation, patients and their family are questioned with Tidwell's cognitive outcome paper. The total records below 50 were considered as poor outcome. RESULTS: Ages, sex, Hunt and Hess grade, Fisher grade and size of aneurysm in two groups are similar conditions. The more patients get old, the cognitive outcome is worse in both group. In surgery group, those patients who have giant aneurysm, are removed rectus gyrus, are happened immediate post-operative transient neurological deficits and hypodense area in post operative brain CT are poor cognitive outcome. In the embolization group, Fisher grade III and post operative transient neurological deficit are happened, outcome was poor. In comparison with cognitive outcome between surgery and GDC embolization group, the embolization group has generally good result. CONCLUSION: The cognitive outcome is decided by age and the degree of brain injury according to aneurysmal rupture. Direct surgery method can make cognitive outcome poor due to perforator injury, brain retraction injury and removal of rectus gyrus during surgery, in the neuropsychological side and the GDC embolization is the better way than the direct surgery method.

The Quality of Life and Cognitive Deficits According to Treatment Modality of Anterior Communicating Artery Aneurysm: Surgery and GDC Embolization Group

OBJECTIVE: The authors present the difference of cognitive outcome of good recovery patients between direct surgery and Guglioma detachable coil(GDC) embolization group among anterior communicating artery aneurysm patients. METHODS: The clinical records of 21 patients who can be followed up and be answered questionnaires among good recovery patients fter ACoA(anterior communicating artery) aneurysm operation from 1990 to 1999 in our hospital were reviewed as surgery group. On the other hand, 20 good recovery patients after embolization of ACoA aneurysm in the other hospital from 1996 to 1999 are seleted as GDC embolization group. In the surgery group, the degree of brain swelling, the existence of rectus gyrus removal, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are examined. In GDC embolization group, problem during embolization, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are also investigated. After this investigation, patients and their family are questioned with Tidwell's cognitive outcome paper. The total records below 50 were considered as poor outcome. RESULTS: Ages, sex, Hunt and Hess grade, Fisher grade and size of aneurysm in two groups are similar conditions. The more patients get old, the cognitive outcome is worse in both group. In surgery group, those patients who have giant aneurysm, are removed rectus gyrus, are happened immediate post-operative transient neurological deficits and hypodense area in post operative brain CT are poor cognitive outcome. In the embolization group, Fisher grade III and post operative transient neurological deficit are happened, outcome was poor. In comparison with cognitive outcome between surgery and GDC embolization group, the embolization group has generally good result. CONCLUSION: The cognitive outcome is decided by age and the degree of brain injury according to aneurysmal rupture. Direct surgery method can make cognitive outcome poor due to perforator injury, brain retraction injury and removal of rectus gyrus during surgery, in the neuropsychological side and the GDC embolization is the better way than the direct surgery method.

Two Cases of Surgical and Medical Treatment of Infectious Intracranial Aneurysms: Case Report

OBJECT: To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. METHOD: Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. RESULT: Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. CONCLUSION: Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.

Analysis of Radiologic Factors Affecting Longterm Surgical Results of Anterior Cervical Fusion Patients

OBJECTIVE: Anterior cervical discectomy and fusion is accepted as appropriate surgical intervention for disease processes of the ventral cervical spine. In some cases, however, improvement of symptom following operation develop myelopathy or rhizopathy at longterm follow-up. We studied to clarify the correlation between clinical results and plain radiologic findings at long term follow-up. METHODS: A total of 86 patients who underwent anterior cervical discectomy and fusion were grouped into deteriorated and good recovery group. These two groups were compared in lateral functional roentgenograms on the cervical kyphosis and disc height at fused level, sagittal plane rotation and dynamic sagittal canal diameter at adjacent level. RESULTS: The presence of cervical kyphosis and disc height at fused level do not correlate with long term follow-up results. Sagittal plane rotation of more than 20 degrees were identified in 36% of the cases in deteriorated group, whereas the same findings were identified in 15% of the cases in good group. Sagittal diameter of less than 12mm were identified in 48% of the cases in deteriorated group, whereas the same finding were identified in 8% of the cases in good group. Preoperatively, sagittal plane rotation of more than 20 degrees at adjacent level were identified in 28% of the cases in deteriorated group, whereas the same findings were identified in 13% of the cases in good group. Preoperatively sagittal diameter of less than 12mm at adjacent level were identified in 40% of the cases in deteriorated group, whereas the same finding were identified in 7% of the cases in good group. CONCLUSION: Large sagittal plane rotation and small dynamic sagittal diameter at adjacent level were factors that might be associated with later clinical deterioration after cervical anterior fusion.

The Role of Radiologic Study in Diagnostic Work-up of Headache Patients

No abstract available.

Neurenteric Cyst in Upper Thoracic Spinal Canal: Case Report

No abstract available.

Morphometric Study of the Pedicles of Lumbar Vertebrae in Koreans

OBJECTIVE: This study was undertaken to study pedicle morphology in Koreans to provide a reference guide in transpedicular screw fixation. METHODS: Pedicle measurements were obtained from 35 dried human lumbar columns(175 lumbar vertebrae). Anatomic evaluation was focused on pedicle transverse diameter, pedicle axis length and the distance from the pedicle axis point to the midline of the transverse process. Pedicle angle and vertebral body length also were measured. RESULT: In the transverse plan, pedicle diameter increased from L1(7.8mm) to L5(15.5mm). But in 20.0% of L1 and L2, its diameters was under 6.0mm. In the sagittal plan, it was not as constant and had similar diameter from L1 to L5. In the transverse plan, the pedicle angle increased from L1 to L5. But in the sagittal plan it decreased from L1 to L5. Also, the pedicle axis length did not show concordant change, but rather had similar length in lumbar vertebrae. In 15%, its length was under 45mm. CONCLUSION: These results suggest that using above 6mm diameter and 45mm length of screw for L1 and L2 can violate the pedicle and vertebrae. Above L4, the pedicle axis point was superior to the midline of the transverse process, below L4, it was inferior to the midline of the transverse process. This information may prove to be helpful when contemplating the placement of screws to the lumbar pedicles.

Clinical Analysis of Surgically Managed Cervical Spondylosis by Anterior Approach

Microsurgical anterior foraminodiscectomy was developed to improve the surgical result of cervical radiculopathy. We reviewed 40 patients with cervical spondylosis after anterior foraminodiscectomy with or without bony fusion over 5 years. The tunnel of anterior foraminodiscectomy was made at lateral one-third of the disc trajectory to intersect the uncinate process at the level of neuroforamen. The compressed nerve root and spinal cord were decompressed by removing the spondylotic spur and disc. The most common presenting symtom was radiating pain to upper extremity. The most frequent site of involvement was the C5-6. Operation of one level was performed in 57% of cases, 2 levels in 40% of cases and three levels in 3%. Of the 40 cases, interbody fusion was performed in 45% of cases. In 92.5% of the patient, the outcome was excellent or good based on Odom's criteria. Postoperative complications were encountered in 7.5%. The correlation between the clinical factors and postoperative results was assessed. As to age, duration of symtoms, herniation of soft and hard disc, number of the operative levels and with and without bony fusion, the clinical results were not stastistically significant.

Clinical Applications of Cine MR

Evaluation of intracranial CSF flow was accomplished by the use of cine MR technique. In the cine MR, there were two methods of evaluation in CSF flow pattern. Qualitative and quantitative methods were called magnitude reconstruction and phase contrast mapping method, respectively. The image of magnitude reconstruction method can demonstrate areas of decreased CSF flow and help explain the cause of hydrocephalus. The image of phase contrast mapping method is more sensitive to fluid motion and may increase utility in the future for analysis of fluid flow. Cine MR is capable of showing both normal and abnormal intracranial CSF flow. Such a study can be easily added as an extra pulse sequence at the end of a routinely acquired MR examination. We evaluated 2 cases of the normal pattern of pulsatile flow within subarachnoid space and 3 cases of abnormal patterns of CSF flow(communicating hydrocephalus: 2 cases, arachnoid cyst in posterior fossa: 1 case). These observations were compared with pre- and post-operative CSF flow state. In conditions which result in alterations of flow, cine MR shows either obstruction or excessively turbulent flow within the CSF pathways. In our studies, the most distinctive pathological finding was bulk flow in the aqueduct of Sylvius. The authors suggest that this technique can be applied in a wide range of conditions where CSF pathway is altered including hydrocephalus, evaluation of the function of the shunt system and communication between arachnoid cyst and subarachnoid space . Moreover correct diagnosis is possible in patients with hydrocephalus, in whom the exact level of CSF obstruction can be determined. We believe that surgical decisions can be aided by careful analysis of these CSF cine MR studies. We discuss the normal and abnormal CSF flow findings and indications of cine MR CSF flow technique with literature review.

Clinical Analysis of the Sellar and Parasellar Lesions using the Bifrontal Basal Interhemispheric Approach

The authors describe the use of the bifrontal basal interhemispheric approach in the clinical analysis of sellar and parasellar lesions. This approach is a more basal modification of the conventional anterior interhemispheric approach extended to the nasion, and most bridging veins are preserved. After dividing the falx at its anterior end, frontal lobes are retracted bilaterally and olfactory nerves are dissected from the frontal lobe to the olfactory trigon. This approach was used ffor operationsinvolving ten patients : in seven, in whom a parasellar tumor had been detected, gross or near-total removal of this large mass was achieved, and three, with aneurysm of the anterior communicating artery aneurysm underwent clipping and aneurysmorrhapy. In one patient with a huge retrochiasmatic tumor, division of the anterior communicating artery was performed. After cutting the anterior communicating artery, no side effects were detected. Visual improvement and preservation of the pituitary stalk was achieved in 86% and 57% of cases, respectively. This approach, progressing from the midline, provided better orientation of the mass and its surrounding structures such as the hypothalamus, optic chiasm, pituitary stalk and perforating arteries. The authors discuss the indications, advantages and disadvantages of the bifrontal basal interhemispheric approach, and include a review of the literature.

A Case of Intradural Epidermoid Tumor of the Lumbar Spine

Histologically, epidermoid tumors are composed only of dermal epithelium and associated connective tissue. They arise from the epithelial tissue displaced during the closure of the neural tube between the third and fifth weeks of gestation. This tumor accounts for 0.6 to 1.1% of all spinal cord tumors; intradural and extramedullary epidermoid tumors are rarely found within the spinal canal. The authors describe a case of intradural epidermoid tumor, in which The patient presented with low back pain and weakness of the lower extremities. On axial and sagittal T1-weighted magnetic resonance imaging of the lumbar spine, a round, high signal intensity response revealed the presence of an intradural tumor at L3-4; it was totally removed. The pathological and clinical characteristics of epidermoid tumors are discussed.