Subclinical Cervical Osteochondroma Presenting as Brown-Sequard Syndrome after Trivial Neck Trauma

Osteochondroma is a rare condition in the spine that may be indolent due to its slow growth. The authors present a case of 32-year-old man with subclinical osteochondroma in the cervical spine presenting as Brown-Sequard syndrome after trivial neck trauma. After resection of the tumor through hemilaminectomy, his symptoms were improved with mild residual sequelae.

Subclinical Cervical Osteochondroma Presenting as Brown-Sequard Syndrome after Trivial Neck Trauma

Osteochondroma is a rare condition in the spine that may be indolent due to its slow growth. The authors present a case of 32-year-old man with subclinical osteochondroma in the cervical spine presenting as Brown-Sequard syndrome after trivial neck trauma. After resection of the tumor through hemilaminectomy, his symptoms were improved with mild residual sequelae.

Profiles of Spinal Cord Tumors Removed through a Unilateral Hemilaminectomy

OBJECTIVE: To present the profiles of spinal cord tumors that can be removed through a unilateral hemilaminectomy and to demonstrate its usefulness for benign spinal cord tumors that significantly occupy the spinal canal. METHODS: From June 2004 to October 2010, 25 spinal cord tumors were approached with unilateral hemilaminectomy. We calculated the cross-sectional occupying ratio (CSOR) of tumor to spinal canal before and after the operations. RESULTS: The locations of the tumors were intradural extramedullary in 20 cases, extradural in 2, and intramedullary in 3. The levels of the tumors were lumbar in 12, thoracic 9, and cervical 4. In all cases, the tumor was removed grossly and totally without damaging spinal cord or roots. The mean height and width of the lesions we195re 17.64 mm (3-47.5) and 12.62 mm (4-32.7), respectively. The mean CSOR was 69.40% (range, 27.8-96.9%). Postoperative neurological status showed improvement in all patients except one whose neurologic deficit remained unchanged. Postoperative spinal stability was preserved during the follow-up period (mean, 21.5 months) in all cases. Tumor recurrence did not develop during the follow-up period. CONCLUSION: Unilateral hemilaminectomy combined with microsurgical technique provides sufficient space for the removal of diverse spinal cord tumors. The basic profiles of the spinal cord tumors which can be removed through the unilateral hemilaminectomy demonstrate its role for the surgery of the benign spinal cord tumors in various sizes.

Erratum: Figure Correction

We found an error in our published article: Park KW, Im SB, Kim BT, Hwang SC, Park JS, Shin WH. Neurotoxic manifestations of an overdose intrathecal injection of gadopentetate dimeglumine. J Korean Med Sci 2010; 25: 505-8. The published Fig. 2 C and D are identical with Fig. 2 A and B on page 506 of above article. It was a mistake that occurred during editing process of figures by the publishing company. We have attached a corrected version of the Fig. 2.

Neurotoxic Manifestations of an Overdose Intrathecal Injection of Gadopentetate Dimeglumine

The intravenous administration of gadopentetate dimeglumine (GD) is relatively safe and rarely causes systemic toxicity in the course of routine imaging studies. However, the general safety of intrathecal GD has not been established. We report a very rare case of an overdose intrathecal GD injection presenting with neurotoxic manifestations, including a decreased level of consciousness, global aphasia, rigidity, and visual disturbance.

The Clinical Aspects of Subarachnoid Hemorrhage / 신경중재치료의학

Subarachnoid hemorrhage (SAH) is less frequent than ischemic stroke, but has a high public health relevance because it can affect young and middle-age adults, has considerable mortality and morbidity, it is treatable and preventable. Despite stable incidence, the mortality of SAH has decreased in the last two decades due to better neurosurgical techniques and neurocritical care and to advances in neuroendovascular treatment. Sudden headache is the cardinal feature. Rebleeding is the most imminent danger; a first aim is therefore occlusion of the aneurysms. Complications such as vasospasm/delayed cerebral ischemia, hydrocephalus, increased intracranial pressure, and seizures must be considered in the management of SAH. The authors reviewed the recent advances in the clinical aspects of SAH and grading system of the available evidence is included.

Spinal Dural Arteriovenous Fistula with Supply from the Lateral Sacral Artery: Case Report and Review of Literature

The authors report a case of spinal dural arteriovenous fistula (SDAVF) that is supplied by a lateral sacral artery. A 73-year-old male presented with gait disturbance that had developed 3 years ago. Spinal magnetic resonance imaging suggested a possible SDAVF. Selective spinal angiography including the vertebral arteries and pelvic vessels showed the SDAVF fed by left lateral sacral artery. The patient was subsequently treated with glue embolization. Three days after the embolization procedure, his gait disturbance was much improved.

Application of Neuronavigation System for the side Selection of Pterional Approach in Anterior Type of Anterior Communicating Artery aAneurysm / 대한뇌혈관외과학회지

OBJECTIVE: The purpose of this study is to evaluate the feasibility of neuronavigation system for side selection of pterional approach in anterior type anterior communicating aneurysm. METHODS: Forty six anterior type aneurysms were evaluated with neuronavigation system based on computed tomography angiography from October 2005 to September 2008. According to neuronavigation system images the approach were subdivided into two groups. The approach in open standing group defined as the craniotomy was done in the A2 of the approach side located more posteriorly than the contralateral A2. The approach in closed standing group was defined as craniotomy was done in the ipsilateral A2 located more anteriorly than the contralateral A2. We analyzed operation time, premature rupture rate, temporary clipping time, perforator injury on postoperative CT scan and Glasgow outcome scale (GOS) of two groups. RESULTS: Thirty-three cases of approaches in open standing group and thirteen cases of approaches in closed standing group were evaluated. In operation time, premature rupture rate, temporary clipping time and GOS, no significant difference was observed between approaches in closed standing group and open standing group. But, in closed standing group, the perforator injury on CT scan was occurred more frequently than open standing group (p=0.001) in postoperative 7 days. CONCLUSION: With the neuronavigation system, three dimensional angiographic images were reconstructed by the operator and actively used to side selection of pterional approach for the aneurysm neck clipping. The perforator injury could be avoided with this policy.

Vertebral Artery Dissection : Natural History, Clinical Features and Therapeutic Considerations

When a tear occurs in one of the major cervicocerebral arteries and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. Vertebral artery dissection (VAD) is an infrequent occurrence but is a leading cause of stroke in young and otherwise healthy patients. This article discusses recent developments in understanding of the epidemiology and pathogenesis of VAD and the various clinical manifestations, methods of diagnosis, and approaches to treatment.

Clinical Experience of Pineal Parenchymal Tumors

OBJECTIVE: Pineal parenchymal tumors (PPT) are rare; therefore, only limited clinical data regarding their behavior is available. The aim of this study is to evaluate the pathologic features, clinical behavior, and response to therapy of these tumors. METHODS: Thirteen patients with biopsy-proven PPT were treated from September 1992 to February 2004 in our hospital. Their medical records and radiologic studies were analyzed retrospectively. The tumors were divided into three groups: pineocytoma, pineoblastoma, and mixed pineocytoma-pineoblastoma or PPT with intermediate differentiation. Initial stages were made by spinal magnetic resonance images and cerebrospinal fluid cytology. Magnetic resonance images were used for defining the treatment response of the patients. RESULTS: The patients were divided into 4 pineocytomas, 5 pineoblastomas, and 4 mixed/intermediate PPT. The patients aged from 2 to 77 years. The patients presented with headache, nausea, vomiting, memory and gait disturbances, and impaired vision. Only one patient showed disseminated disease at initial staging. All patients that had surgery showed improvements of hydrocephalus. Two patients showed complete responses to treatment, six showed partial responses, two showed stable diseases, and two showed disease progression. Eleven patients were alive, but two were dead due to disease progression. CONCLUSION: Obtaining a tissue diagnosis in patients with PPT is important. Although our experience is limited, we consider that multimodality therapies including surgical resection, radiotherapy, chemotherapy, and radiosurgery must be considered for better outcome in treating patients with PPT. More experience is necessary to determine the optimal treatments of PPT.

Spinal Dural Arteriovenous Fistula from Lateral Sacral Artery

The authors report a rare case of spinal dural arteriovenous fistula (DAVF) that supplied by lateral sacral artery. A 71-year-old female initially presented with paraparesis and boring pain on lower extremities. Though magnetic resonance imaging suggested a possible spinal DAVF, routine angiographic evaluation was negative. Thereafter, the patient deteriorated progressively and became paraplegic. Definite diagnosis was made through selective pelvic angiogram. The patient was subsequently treated with embolization using mixture of glue and lipiodol. On three months after the embolization, the patient remained paraplegic, but her leg pain was improved remarkably.