Extrasinusal Dural Arteriovenous Malformation Misdiagnosed as Intraorbital Tumor

Dural arteriovenous malformations are rare, accounting for 10-15% of all intracranial arteriovenous malformation and are thought to be acquired lesion caused by dural sinus thrombosis. The authors report a rare case of extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure. During the preceding 17 years, this 31-year-old female had complained of proptosis and ocular pain in the right eye. Computed tomography and magnetic resonance imaging showed a retrobular intraconal mass in the right orbit; Angiography revealed an extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure, which drains into the superior ophthalmic and inferior temporal vein. After embolization of the fistula by injection of N-butylcyanoacrylate(NBCA), we intended to remove the retrobulbar intraconal mass seen on CT and MRI by means of a unilateral partial orbitotomy on the supraorbital rim and orbital roof, and to this end, explored the right orbit. We were unable, however, to locate any mass lesion in the orbital cavity, and postoperative CT and MRI showed no such lesion. We were of the opinion that the mass shown on preoperative CT and MRI was a dilated intraorbital vein structure which disappeared after embolization, operative ligation and cutting of the dural arterivenous fistula. Finally, proptosis and ocular pain disappeared, and the patient recovered with any no neurologic deficit.

Primary Spinal Malignant Melanoma in the Cervical Spinal Cord: Case Report

The primary melanoma of spinal cord was rarely reported in the literatures. The authors report a case of primary spinal maligmant melanoma in the cervical spinal cord. A 41-year-old man presented several months history of right shoulder pain and right hemiparesis. Plain X-ray of the cervical spine, myelography, computerized tomography and magnetic resonance imaging showed intradural mass from third to fifth cervical spine level. The operation was performed, and intradural intra-and extramedullary brownish black tumor, which focally infiltrated to the dura and inner surface of lamina, was removed and the histological diagnosis was maligmant melanoma. And then chemotherapy with vincristine, bleomycin, cisplatine, followed by whole central nervous system radiation therapy was performed. The patient was discharged and followed up with no neurological interval change. The pertinent literature of spinal cord melanoma is reviewed and its rareness is discussed.

A Case of Axis Spondylolysis Causing Quadriparesis: Case Report

Cervical spondylolysis is an extremely rare abnomality of unknown etilogy, first described by Hadley. It is defined s a corticated cleft between the superior and inferior articular facets of the articular pillar, the cervical equivalent of the pars interarticularis in the lumbar spine. A 50-yar-old woman was presented with occipital headache, and pain in the upper neck region. Neurological examination revealed the patients inability to walk because of quadriparesis with mild hypesthesia in both hands and feet. The DTR was hyperactive and pathological reflexes, including Babinski's and Hoffman's, were positive bilaterally. CT showed the bilateral pars interarticularis defects and spinal canal stenosis. MRI revealed signal alteration on the upper spinal cord which was compromised due to the hypertrophied ligamentum flavum. Decompressive laminectomy of C2 was performed and the patient's neurological deficits had recovered to some extent and resulting to her ability to walk without assistance.

Aneurysmal Bone Cyst of the Second Cervical Spine

Aneurysmal bone cysts are lytic lesions that have been described in virtually every portion of the skeleton but most commonly occur as solitary lesions in the metaphyseal portions of long bones. One fifth of aneurysmal bone cysts occur in the spine where they most frequently involve the posterior elements. In the spine, aneurysmal bone cyst have been reported to occur in the lower thoracic and lumbar regions, but their occurrence in the cervicodorsal area is uncommon. In this case, the second cervical vertebral body and posterior elements are affected. Fortunately, the lesion didn't invade into the spinal canal. The main symptom on admission was pressure pain, tenderness and motion limitation of the cervical spine. We removed the lesion involving posterior elements of second cervical spine and used horse-shoe shaped pediatric C-D device for occipito-cervical fixation. The clinical symptoms were resolved after operation. The clinical, radiologic, operative and pathological findings are reported and the corresponding literature are reviewed.

The Effects of Intravenous Administration of Nimodipine on Cerebral Pial Vessels Following the Injection of Autogenous Hemolytic Blood into Cisterna Magna in Rabbits

The reactions of cerebral pial vessels following the injection of normal saline(0.05cc, at 37 degrees C, pH7.4) and autogenous hemolytic blood(0.05cc, 0.1cc 0.2cc) into the cisterna magna of rabbits were tested in vivo. This experiment was performed in order to observe the effect of intravenous nimodipine(30 microgram/kg) injection at the maximally constricted time of the pial vessels, about 6 hours after intracisternal injection of autogenous hemolytic blood. The diameter changes of the pial vessels were measured under operating microscope through a cranial window on craniectomized area. Pial vessels were not significantly changed after an intracisternal injection of normal saline. But after intracisternal injection of autogenous hemolytic blood(0.05cc, 0.1cc, 0.2cc), pial vessels were maximally constricted at 6 hours and the constriction was continued during the experiments. Percentile constriction was increased as the amount of subarachnoid hemolytic blood increased. According to the results, pial vessels, especially small pial artery, were constricted by autogenous hemolytic blood containing oxyhemoglobin. Nimodipine, calcium antagonist, showed dilating effect on vasospasm after experimental subarachnoid hemorrhage with autogenous hemolytic blood in rabbits.