Diagnosis and Management of the Spontaneous Intracranial Vertebral Artery Dissection

The authors have dealt with six cases of spontaneous intracranial vertebral artery dissection during the past 3 years. Most of the patients were in their fourth or fifth decade of life, and men predominated. All except one patient had severe antecedent headache and half of the 6 cases were hypertensive. The presenting clinical features were subarachnoid hemorrhage, Wallenberg's syndrome, brain stem RIND(reversible ischemic neurologic deficit) and cerebellar infarct. The locations of the dissection were right vertebral artery in four patients, right vertebral and basilar artery in one and left vertebral artery in another one. Most of the patients showed typical intramural hematoma or double lumen on the MRI. In the MR angiography, irregular segmental narrowing of vertebral artery or invisible pathologic vertebral artery were demonstrated. The angiographic findings included alternating irregular stenotic and dilated segment(pearl and string sign), aneurysmal dilatation, occlusion etc. four patients were treated medically while the other two were treated surgically by proximal vertebral artery clipping of the affected artery. Upon follow-up, the outcome were excellent in two, good in two and fair in two.

Multiple Intradural Schwannomas of the Cauda Equina in the Absence of Neurofibromatosis

A case of multiple intradural schwannomas of the cauda equina is reported without evidence of any other manifestations of neurofibromtosis. The patient had symptoms of cauda equina compression. Following a diagnosis of multiple intradural tumors of the cauda equina, based on lumbar spine MRI with contrast enhancement, the tumors at the L1 body, L3 body, L3-L4 intervertebral space level were removed completely, involving two rootlets. After the operation, the patient is asymptomatic apart from left S3 dermatome hypesthesia.

Complication and Reoperation after Surgery for Lumbar Disc Herniation

Retrospective analysis of reoperation and complication was made for 186 patients with lumbar herniated disc. The results showed complication rate of 7%(13 cases) and reoperation rate of 10.2%(19 cases). The primary complications were infections(9 cases), technical errors(2 cases), and scores(2 cases). Rate of discitis was 1.6%(3 cases). The outcomes of reoperation resulted in excellent recovery of 16%(3 cases) and good recovery of 58%(11 cases). The most common intraoperative findings of reoperation were inadequate disectomy or missed disc fragments 31.6% or 6 cases;epidural fibrosis 26.3% or 5 cases;and new herniation at other level 15.8% or 3 cases. Excellent and good results could be achieved in patients operated within 1 month or more than 6 months after while the patients who underwent reoperation between 1 month and 6 months showed poor results. The delicate perioperative menagement and complete discectomy, adequate bleeding control and laminectomy were considered to be essential in reducing the chance of complication and reoperation.

Nontraumatic Intracranial Dissecting Aneurysm of Vertebral Artery: Case Report

We present two cases with dissecting aneurysm of intracranial vertebral artery. One of them had brain stem infarction and the other one developed subarachnoid hemorrhage. Cerebral angiogram revealed fusiform dilatation with proximal and distal narrowing of the affected vessel. Magnetic resonance imaging showed subacute blood clot inthe right vertebral artery which suggested dissection. Differentiation from vasospasm and from atherosclerosis is critical. At surgical exposure, the aneurysms were appeared as dark-purplish sausage like masses. The proximal portions of the intracranial vertebral arteries were clipped. The post-operative courses were benign and at present they regained their normal daily lives.