Neurocognitive Dysfunction According to Hypoperfusion Territory in Patients With Moyamoya Disease

OBJECTIVE: To demonstrate the prevalence of cerebral hypoperfusion without focal cerebral lesions in patients with Moyamoya disease (MMD), and the relationship between areas of hypoperfusion and cognitive impairment. METHODS: Twenty-six MMD patients were included. Patients were categorized according to the presence/absence of hypoperfusion in the frontal, parietal, temporal, and occipital lobes on brain single-photon-emission computed tomography (SPECT) after acetazolamide challenge. Computerized neuropsychological test (CNT) results were compared between groups. RESULTS: Only 3 patients showed normal cerebral perfusion. Baseline characteristics were similar between groups. Patients with frontal lobe hypoperfusion showed lower scores in visual continuous performance test (CPT), auditory CPT, forward digit span test, backward digit span test, verbal learning test, and trail-making test. Patients with parietal lobe hypoperfusion showed lower backward digit span test, visual learning test, and trail-making test scores. Related to temporal and occipital lobes, there were no significant differences in CNT results between the hypoperfusion and normal groups. CONCLUSION: MMD patients without focal cerebral lesion frequently exhibit cerebral hypoperfusion. MMD patients with frontal and parietal hypoperfusion had abnormal CNT profiles, similar to those with frontal and parietal lesions. It is suggested that the hypoperfusion territory on brain SPECT without focal lesion may affect the characteristics of neurocognitive dysfunction in MMD patients.

A Case of Postpartum Ovarian Vein Thrombosis after Cesarean Section / 대한산부인과학회잡지

Postpartum ovarian vein thrombosis has been thought to be a rare disease of which clinical finding is not accurate. Most of postpartum ovarian vein thrombosis presents as symptoms consisting of fever, lower abdominal pain, abdominal mass. If the symptom does not response even with intravenous antibiotics therapy or diagnosis is inaccurate, a ultrasound or a CT scan should be obtained for diagnosis. We report a case of postpartum ovarian vein thrombosis after cesarean section diagnosed and treated, with a brief review of literatures.

Detection of Aneurysms in Patients with Spontaneous Subarachnoid Hemorrhage: A Comparison of Three-dimensional Computed Tomographic Angiography and Conventional Angiography

OBJECTIVES: Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography(CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). METHODS: We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. RESULTS: Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.

The Effect of Opening Lamina Terminalis on the Development of Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

No abstract available.

A Case of Rapidly Growing Huge Granulosa Cell Tumor of the Ovary / 대한산부인과학회잡지

Ovarian granulosa cell tumor is a uncommon low-grade feminizing malignancy. Its natural history shows slow growth without pain. It often reveals to be very large sized mass when diagnosed, and is confined to the involved ovary in many cases. Complete surgical removal is primary treatment and recurrences thereafter are relatively common. Postoperative adjuvant therapy including reoperation, chemotherapy, radiation therapy or a combination therapy has been used with various degrees of success. We experienced a case of huge ovarian granulosa cell tumor occupying whole abdominal cavity by rapid growth, which is presented with a brief review of corresponding literatures.

Anterior Cervical Fusion with the PCB Instrumentation (Cervical Plate Cage System) in Degenerative Cervical Disease

OBJECTIVE: The anterior interbody fusion for cervical spine disorder may not provide adequate immediate stabilization, whereas anterior cervical spine plating has overcome this main disadvantage. Recently, several types of hardware were introduced and the complications related to these were also reported. In case of degenerative cervical spine disorders, the adequate intervertebral disc space height and lordotic curvature are the major factors for preventing recurrence of symptoms. So we used the PCB instrumentation(cervical plate cage system) for these purpose. MATERIAL AND METHOD: From April 1998 to October 1998, 16 patients with degenerative cervical spine disorders who had radiculopathy or myelopathy were underwent anterior cervical spine fusion with the PCB instrumentation(cervical plate cage system). Single level fusion was accomplished in 8 patients and two level fusion in 8. The mean follow-up period was 4 month. RESULT: All patients show some recovery at discharge. There were no hardware problems. The intervertebral disc space height and lordotic curvature were not changed during follow up. CONCLUSION: These finding suggest that PCB instrumentation can be considered to be one of the useful hardwares for anterior cervical spine fusion in degenerative cervical spine disorders.

A Case of Pseudomyxoma Peritonei / 대한산부인과학회잡지

"Pseudomyxoma peritonei is a clinical entity in which the peritoneal surface and omentum are involved with gelatinous, mucinous implants, and often massive gelatinous ascites. Most cases originate from ruptured ovarian mucinous cysts or appendiceal mucoceles, and involve only the intraperitoneal cavity. But there is much confusion about its etiology, clinical manifestation, treatment, and prognosis. We experienced a case of pseudomyxoma peritonei originating from the mucinous cystic tumor of borderline malignancy in unilateral ovary with rupture. A case of pseudomyxoma peritonei is reported with a brief review of the literature."

Clinical Usefulness of Resectoscopic Surgery in Endometrial Factor of Infertility / 대한산부인과학회잡지

From May 1995 to February 1997, 46 patients underwent resectoscopic surgery for infertility. Of 46 patients, 32 patients had uterine synechiae, 5 patients had polyps, 3 patients had septums, 3 patients had bony foreign bodies, 2 patients had submucosal myomas, 1 patient had tuberculous endometritis. The resectoscopic procedure proved of special value for resection of intrauterine adhesion, submucosal myoma, septum and polyp. Except 5 patients, intrauterine conditions were improved and 10 patients were conceived. So it goes without saying that resectoscopic surgery is a effective and acceptable procedure for the management of infertility of endometrial factors. However, with the finding of slightly less satisfactory results with time and number, further follow-up is still needed to establish the usefulness of the procedure.

A Study of Therapeutic Modalities of Pineal Region Tumors

The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinoma, while a number of recent reports have demonstrated the safety of direct surgery. We analyzed 8 cases of pineal region tumors which had been treated at our institution over the past 7 years. Tissue diagnosis was obtained in 3 patients before irradiation and 5 patients underwent irradiation without histological diagnosis. Among 5 irradiated patients initially, four patients had been achieved complete remission by radiotherapy thus they were presumptively germinoma, but other one patient had no response, so she had been underwent surgery. Among 3 biopsy proven cases, 2 were teratoma and other one was embryonal carcinoma. Complete gross microsurgical excision of well encapsulated tumor was possible in two teratoma cases. MRI and other neuroradiological studies have ben found to be useful in indicating the biological nature and histological type of pineal tumor. So, consideration of MRI scans together with tumor markers and response to small dose irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumor less likely to response may be subject to primary surgery to obtain complete tumor extirpation or tissue diagnosis.

Surgical Experience of Transpedicular Screw Fixation of the Lumbar Spine

Transpedicular screw fixation of the lumbar spine has evolved rapidly and become one of the reliable methods to application. We treated 42 cases of lumbar spine disease using above method from October, 1987, to Febuary, 1993. The disease entities were spondylolisthesis 24 cases(58%), spondylolysis 14 cases(33%), fracture and dislocation 3 cases(7%), postsurgical instability 1 case(2%). The most frequent clinical symptom and sign was low back pain with radiating pain accompanying limitation of straight leg raising, which clinical outcome was excellent with wide laminectomy. The transpedicular screw fixation allow adequate neural decompression, short segment fixation and prevention of motion limitation of lumbar spine. But one of the important complication driven with this method was root injury which must be prevented by surgen's throught knowledge to pedicular anatomy and meticulous operative technique. The instrument failure is also the troublesome problem. The appropriate bone fusion will be the acceptable strategy to overcome the eventual possibility of instument failure.

A Study of Venous Angiomas

The clinical significance of venous angiomas is controversial. Owing to the increased resolution of modern CT scannes and the advent of magnetic resonance imaging(MRI) as well as an increased awareness of these lesions, venous angiomas has been recognized more frequently in routine neuroradiographic examinations. In a retrospective study of 1998 brain MR imaging performed at our institute between April, 1990 and April, 1992, 18 cases of venous angioma were diagnosed. Among them, 13 cases(72.2%) occur supratentorially and 5 cases(27.8%) occur in cerebellum. Their symptoms were headache(7 cases), hemorrhage(4 cases) seizure(3 cases), focal neurological sign(1 case) and no associated symptoms(3 cases). All cases have been managed conservatibely except one case(with massive cerebellar hemorrhage). During follow up period, no significant complications was happened in all cases. Long-term follow up is necessary to develop meaningful recommendations regarding the management of venous angiomas.

"Dural A-V Malformation of Lateral and Sigmoid Sinus Associated with Intracerebral Hematoma" A Successfully Surgical Treated Case: Case Report

Most of dural arteriovenous malformations(AVM's) of lateral and sigmoid sinuses are known to acquired lesions evolving from a previously thrombosed dural sinus. Their clinical symptoms and signs are variable and their natural history is usually that of gradual progression and hence surgery is frequent necessary. The preferred surgical treatment is complete isolation or excision of the lesion. The authors have experienced 1 case of AVM's of lateral and sigmoid dural sinuses associated with intracerebral hematoma which was treated with complete excision of involved sinus with good result.

Clinical Analysis of Syringomyelia

Eight patients were diagnosed as syringomyelia by MRI at the Department of Neurosurgery of Maryknoll hosptial, Pusan from April, 1990 to April, 1991. The causes were chiari type 1 malformation(2 cases), neoplasm(1 case), trauma(1 case) and idiopathic(4 cases). Six procedures were performed in the five patients. The procedures were foramen magmum decompression(1 case), formen magmum decompression combined syringosubarachnoid shunt(1 case), syringosubarachnoid(1 case), syringoperitioneal(2 cases) and syringopleural shunts(1 case). We have reviewed the modes of clinical presentations, diagnostic evaluations and surgical considerations.

Steroid-Induced Remission in Primary Malignant Lymphma of the Brain

A case of primary malignant lymphoma of the brain is described in which lesions seen on computed tomography scans disapperared and clinical remissions occurred by the administration of corticosteroid. In our patient, at least three remissions occurred over a span of about 44 months. The diagnosis was delayed because of easy disappearance and confusion with other conditions. A stereotactic biopsy was performed and diagnosed as Non-Hodgkin's lymphoma, diffuse, large noncleaved cell type, B cell origin by H & E and immunologic marker analysis. We present our case with review of the literatures.

A Clinical Analysis of Giant Intracranial Aneurysms

Intracranial aneurysms larger than 25mm in diameter are considered giant aneurysms and these comprise about 5% of all intracranial aneurysms. The authors report a series of 9 cases of giant cerebral aneurysms(>2.5cm in diameter) during a 7-year-period found among 212 cases with saccular cerebral aneurysms. Of the 9 patients, four patients were treated by direct neck clipping, one by trapping, and the other one by sac excision after direct neck clipping. This report presents an analysis of 9 cases of giant cerebral aneurysms. The results are as following : 1) In a review of our cases of giant aneurysms, approximately 4.3% were of all intracranial aneurysms. 2) Male : Female ratio was 4 : 5. 3) The greatest incidence was in the 6th decade of life. 4) The most common site was in the internal carotid artery portion. 5) Our all cases were saccular aneurysms. 6) In our cases, nonthrombosed aneurysms were more common. 7) Presenting symptom of SAH was more common. 8) There was no relationship between blood pressure and aneurysm rupture in our cases. 9) We found our all cases of ICA portion giant aneurysms presented with focal symptoms. 10) The most commonly presented focal neurologic sign was visual failure.

A Clinical Analysis of Metastatic Brain Tumors

We have studied 1927 cases of primary tumor patients, who were admitted, managed and registered at Cancer Center of Maryknoll Hospital from Nov. 1985 to Jun. 1988. Of these, 50 cases were metastasized to central nervous systems, and the cases of brain metastases were 31 cases. This report presents an analysis of 31 cases of metastatic brain tumors. The results are as followings: 1) The sexes were represented with 20 males and 11 females. In 20 cases(65%), the metastases occurred between the 6th decade and 7th decade. 2) The most frequent anatomical site of brain metastases was brain parenchyme(67.7%). 3) The most frequent site of primary malignancy was lung(45.2%), and the next order was choriocarcinoma of the uterus. 4) The clinical symptoms and signs of metastatic brain tumors were headache(87%), nausea, vomiting(35.5%) orderly. 5) In C-T scan findings, the metastatic brain tumors presented hyperdense area at 50% of cases before contrast enhancement, and were enhanced nearly almost of cases. 6) In cases which could be treated surgical procedure, radiation and chemotherapy seemed to improve the prognosis.

Intracerebral Tension Pneumatocele as a Complication of Fronto-ethmoid sinus Osteoma: Case Report

A case of intracerebral tension pneumatocele as a complication of an Osteoma in the Fronto-ethmoid sinus is reported. The commonest causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumors(e.g. osteomas carcinomas pituitary adenomas peripheral nerue tumors) and congenital neurenteric cysts or dural defects. Computed tomography permitted rapid diagnosis including localization of the air thus facilitating prompt treatment.

Multiple Meningioma: Case Report

Despite of their frequent occurrence among the brain tumor, meningiomas are rarely seen as a multiple growth. Most authors report an incidence ranging from 1 to 3% of all meningioma prior to the introduction of computed tomography. After the CT has introduced, diagnostic problems involved with multiple meningiomas were resolved, and its reported incidence was arisen to 8~8.9% of all meningiomas. It may be difficult to differenciate multiple meningioma from the special varient(forme fruste) of von Recklinghausen's disease. Although the pathogenetic factors related to the multiple meningiomas are unknown, various theories of the etiology have been studied and reported. We report a patient with multiple meningioma without evidence of von Recklinghausen's diseases.

A Case of Chondroma in Middle Cranial Fossa: Case Report

Intracranial chondromas are extremely rare tumors, but when present, are generally related to the synchondrosis of the base, and they have several distinct features. They are slow growing benign tumors, and plain roentgenogram frequently reveals lytic lesion and stippled calcification at base of the skull. They are radioresistant, and surgical removal is treatment of choice. We report the rare case of chondroma arisen from base of the skull which diagnosed by brain CT and confirmed by operation.

Atypical C-T Features of Intracranial Meningiomas and Pathological Correlation

Most intracranial meningiomas present on the C-T as typical features with homogeneous, occasionally lobulated mass of density equal or greater than of surrounding brain tissue. After contrast injection, there is uniform and homogeneous enhancement in the density. Infrequently a significant number present as atypical features which are regional inhomogenecity of tumor mass on C-T and common source of error in the diagnosis of meningioma. The authors reviewed 25 consecutive meningiomas, all confirmed pathologically. 7 cases have been encountered as atypical features on the C-T. Among them, 2 cases of peritumoral low density were diagnosed as meningioma with C-T only. 5 cases(2 cases of peritumoral cyst, 2 cases of intratumoral cyst, 1 case of peritumoral bleeding) were misdiagnosed initially as malignant lesion based on C-T findings. Those C-T patterns have been found to correlate with certain histologic and morphologic alternation in tumor anatomy. Close correlation with pathological findings of tumor necrosis, cystic changes and hemorrhage was noted.