Staged Operation of a Dumbbell-Shaped Schwannoma in High Cervical Region: Case Report

The authors report a case of high cervical giant dumbbell-shaped schwannoma. A 43-year-old man admitted for the evaluation of gait disturbance and hypesthesia below C2 dermatome for six years. Magnetic resonance imaging showed a large enhancing dumbbell-shaped mass, extending from carotid sheath to craniovertebral junction, and in C1, C2 spinal canal, which causes significant compression of the cervical cord posteriorly. we decided to do staged operations. First, the intraspinal portion was removed in order to decompress the spinal cord from the tumor. Second, residual extraspinal tumor was removed via high cervical retropharyngeal approach. The patient recovered well without any neurological deficit.

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.

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.