Clinical Comparison between Microsurgical Decompression and Lumbar Interbody Fusion with Instrumentation for Lumbar Stenosis

OBJECTIVE: We report clinical results of the patients who received microsurgical decompression procedure(bilateral partial laminectomy and medial facetectomy: Group A) compared with lumbar interbody fusion with instrumentation(total laminectomy, interbody fusion and pedicle screw fixation: Group B). METHODS: From March 1996 to December 2000, twenty patients with symptomatic lumbar stenosis underwent microsurgical decompression and twenty-five patients underwent lumbar interbody fusion by two operators. Two groups of patients were compared retrospectively in respect to the mechanical back pain, leg pain, motor weakness, sensory hypesthesia(numbness) and clinical outcomes. The mean follow-up period was 30 months. RESULTS: In Group A, mechanical back pain, leg pain, motor weakness, and sensory hypesthesia were improved in 72.2%, 69%, 80%, 44.4% and 70%, 71%, 83.3%, 50% respectively in Group B. Clinical outcomes was excellent or good in 80% in Group A and 84% in Group B and no differences in clinical parameters between Groups were demonstrated. CONCLUSION: We recommend microsurgical decompression for the patients suffering from symptomatic lumbar stenosis with stable spine because microsurgical decompression provided a satisfactory clinical results equivalent to lumbar interbody fusion with instrumentation.

Interhemispheric Chronic Subdural Hematoma Showing Falx Syndrome: Case Report

Chronic subdural hematoma can be seen frequently in the cerebral convexity, however, it is rare in the interhemispheric space. It develops usually in patients with blood clotting disturbance, history of head trauma, chronic alcoholic abuse. When its volume becomes large, falx syndrome showing hemiparesis which is more prominent in the leg than in the arm or an isolated paresis of one leg, can be noticed. The interhemispheric chronic subdural hematoma can be managed by the conservativel treatment or surgical evacuation of hematoma. Decision on the treatment modality depends on the clinical course. Conservative management is the treatment of choice for patients without disturbances of consciousness and other neurological deficits. However, early surgical treatment is necessary in patients with progressive neurological deterioration. The authors report a case of chronic subdural hematoma in interhemispheric space which was managed by medical treatment.

CT Evaluation of Maxillary Sinus Aspergillosis: Morphological Patterns on CT

PURPOSE: In order to classify the involving patterns of maxillary sinus aspergillosis on CT that will be an important guidance for functional endoscopic sinus surgery(FESS) and to evaluate CT findings of each pattern. MATERIALS AND METHODS: We reviewed CT findings of 37 cases of maxillary sinus aspergillosis which were confirmed pathologically. These were classified into three patterns according to the location:the maxillary pattern(I), the infundibular pattern(11), and combined pattern(Ill). All cases were correlated with FESS findings. We also evaluated CT density, presence of contrast enahncement and calcifications, and surrounding bony changes of each pattern. RESULT: The combined pattern was most commonly seen in 24 of 37 cases(64.9%). The maxillary pattern was identified in 8(21.6%), with 5(13.5%)cases demonstrating the infundibular patttern. These patterns were consistent with FESS findings. Calcifications were seen in 28 cases(75.7%). 31 cases(83.8%) revealed hypodensity and 16cases among them showed peripheral enhancement. Central high density with peripheral low density rim was shown in 25%(2/8) of the maxillary pattern and 12.5%(3/24) of combined patttern. Surrounding bony changes were noted mainly in infundibular pattern and combined pattern. Erosion of uncinate process showed all cases of both patterns. Erosion or elevation of ethmomaxillary plate was seen in 3 of 5 cases of infundibular pattern and all cases of the combined pattern. CONCLUSION: CT fidnings of maxillary sinus aspergillosis can be classified into 3 patterns according to their distribution. These classification could be helpful for planning FESS approach. Calcifications are the most characteristic findings of maxillary sinus aspergllosis whereas CT density or enhancement pattern do not contribute to diagnosis.

Anatomic Variations on PNS CT

PURPOSE: To illustrate frequently encountered anatomic variations on PNS computed tomography(CT) and to assess their clinical significance. MATERIALS AND METHODS: CT findings of 1523 patients, who underwent PNS CT with no history of sinus surgery, were reviewed, and prevalence of each anatomic variation and its relationship with mucociliary clearance pathway was evaluated. RESULTS: Two categories of anatomic variations were encountered. The first group included variations of the turbinates, such as concha bullosa(28.6% ), paradoxical middle turbinate(31.5%), of the uncinate process, such as medially bent or folded(36.3%), laterally bent(3.7%) or uncinate bulla(0.5%), of the ethmoidal sinus, such as Haller's ce11(28.2%), large agger nasi ce11(9.6%) or large ethmoidal bulla(23.5%) and nasal septal deviation(24. 1%), which might cause obstruction of mucociliary clearance pathway and thus give rise to secondary obstructive sinusitis. The second group included Onodi ce11(1.4%) and medial depression of the lamina papyracea (3.5%), which were not related with obstructive sinusitis. 87 cases of large agger nasi cell were associated with obstruction of nasofrontal recess. Large ethmoidal bulla(452 cases), Haller's ce11(245 cases) and true concha bullosa (25 cases) contributed to narrowing of the infundibulum. Medially bent uncinate process(220 cases), concha bullosa(157 cases), paradoxical middle turbinate(126 cases) and nasal septal deviation(93 cases) were observed in middle meatal obstruction and supreme concha (3 cases) accompanied sphenoethmoidal recess obstruction. CONCLUSION: Recognition of anatomic variations on PNS CT is important to build a treatment plan in patients with obstructive sinusitis as they may represent causes of the disease, and to avoid critical complications during functional endoscopic sinus surgery.