Fatal Aortic Tumor Embolism Presenting as Acute Paraplegia

We report a case of fatal aortic tumor embolism presenting as acute paraplegia. A four-year-old girl was referred from a local hospital with sudden paraplegia and a poor medical condition. A neighbor had noticed her fall from a bike, and she could not walk. She had no previous illness. Emergency spine MRI revealed no remarkable findings. During the process of evaluation, her general condition deteriorated progressively. Chest and abdominal CT showed a large mass in the left lung field, and a diagnosis of aortic occlusion was made. An emergency transfemoral embolectomy was attempted. However, the patency of the aorta was not recovered. On pathological examination of tissues taken from the embolectomy, a pleuro-pulmonary blastoma was found. The patient died 22 hours after the onset of her symptoms. We describe a possible mechanism for the tumor embolism. To the best of our knowledge, this is the first case report of aortic occlusion caused by an embolic malignancy, presenting as acute paraplegia.

Meningeal and Cerebral Involvement of a Plasmacytoma in an IgG Multiple Myeloma Patient: Case Report

We present a case of meningeal and brain metastasis of multiple myeloma. A 60-year-old woman who had been diagnosed as multiple myeloma two years ago, was referred to neurosurgery department because of headache and nausea. The magnetic resonance image of the brain showed a large epidural mass and the parenchymal enhancement. The patient received an operation of tumor removal and cranioplasty. A histological diagnosis of metastatic multiple myeloma was made.

Spontaneous Intracranial Epidural Hematoma Following Thoracolumbar Schwannoma Removal

We report a case of spontaneous intracranial epidural hematoma following the intraoperative course of a patient who had undergone surgical removal of a thoracolumbar schwannoma in olivo-ponto-cerebellar atrophy. To our knowledge there is no reported case in which the thoracolumbar schwannoma removal was followed by such a complication. Mechanical events leading to this complication are unclear. Abnormal results of a neurological examination in the early postoperative period should suggest this possibility.

A Sedimentation Level in Pituitary Adenoma on Magnetic Resonance Imaging

We present a rare case of a pituitary adenoma revealing a sedimentation level on MRI, which has not been previously documented. This 55-year-old woman was referred with the diagnosis of craniopharyngioma. She presented with four-month history of progressive headache and visual dimness. Neurological examination revealed a bitemporal hemianopsia and decreased visual acuity. Laboratory data including endocrine examination were unremarkable. An additional three-dimensional MRI was taken for further evaluation, and demonstrated a sedimentation level within the tumor. The patient underwent transcranial removal of the tumor. About 12cc of dark-red blood was aspirated from the tumor. Histological examination revealed a pituitary adenoma with hemorrhage. Postoperatively, the patient showed gradual improvement of visual function. Considering that the pituitary adenoma is one of more common tumors that cause tumoral bleeding, a cystic sellar tumor that has a sedimentation level should be sought first for a pituitary adenoma rather than a craniopharyngioma. This may have an important impact when deciding surgical approach.

Anterior Tunnelling Operation for Cervical Radiculopathy: A Report of First 32 Cases

OBJECTIVES: Anterior tunnelling technique consist of anterior cervical fractional interspace decompression without fusion. This method provides sufficient space for adequate neuroforaminal decompression but avoids the need for fusion or fixation. We report early clinical results of 32 cases that underwent anterior tunnelling operation for treatment of cervical radiculopathy. METHODS: This method is identical to conventional approach until the exposure of anterior cervical body and bilateral retraction of longus colli is made. A vertical window is then made at the vertebral bodies and disc space lateral to the insertion site of the longus colli. The window is deepened with drilling that follows a tunnelling fashion down to the compressive lesion. We analyzed clinical results from 32 patients who treated between December 1998 and August 2000. RESULTS: Satisfactory results were obtained in 87% of the patients. Two patients required revision surgery. None revealed surgical spinal instability on last follow-up. CONCLUSION: Anterior tunnelling operation is an acceptable surgical option for the treatment of cervical radiculopathy. Its advantages are short hospitalization, minimal postoperative discomfort, and technical feasibility.

Accurate Placement of Parieto-occipital Ventricular Catheter Using CT Parameters

No abstract available.

A Case of Penetrating Head Injury by a Western-Style Arrow: A Case Report

No abstract available.

Endoscopic Surgery of a Subependymal Giant Cell Astrocytoma Associated with Tuberous Sclerosis: Case Report

No abstract available.

Cervical Epidural Hematoma Caused by Ruptured Arteriovenous Malformation: Case Report

No abstract available.

Clinical Usefulness of Phase-Contrast Cine MRI Evaluation in Patients with Cervical Myelopathy

No abstract available.

A Retrospective Analysis of MRI-verified 29 Cases of Transverse Myelitis

No abstract available.

Continuous Monitoring of Jugular Venous Oxygen Saturation in Severe Head-injured Patients

The continuous measurement of jugular venous oxygen saturation(SjvO2) with a fibroptic catheter is evaluated as a method of detecting cerebral ischemia after head injury. Fifty patients admitted to the hospital who were unconscious after severe head injuries had continuous and simultaneous monitoring of SjvO2, intracranial pressure, arterial oxygen saturation, arterial blood pressure. Whenever SjvO2 dropped to less than 50%, a standardized protocol was followed to confirm the validity of the desaturation and to elucidate its cause. A total of 72 episodes of jugular venous oxygen desaturation occurred in 45 patients, possibly due to intracranial hypertension in 39 episodes, arterial hypoxia in 13, combinations of the above in 9, systemic hypotension in 7, and anemia in 4. Two episodes of hyp-eremia, SjvO2 more than 90%, occurred in 2 patients with carotid-cavernous fistula. The incidence of jugular venous oxygen desaturation found in this study suggests that continuous monitoring of SjvO2 may be of clinical value in patients with head injury.

Transaqueductal Migration of the Neurocysticercus Cyst: Two Case Report

The authors report two cases of radiologically documented transaqueductal migration of intraventricular neurocysticercus cysts. The patients had suffered from symptomatic hydrocephalus caused by neurocysticercosis. The migration of the cysts from third to forth ventricle and cisterna magna were clearly demonstrated on serial radiological studies. Since the exact route of the subarachnoid type of the neurocysticercosis has not been defined, these cases may provide a valuable clue in verifying the pathogenic pathway. The possibility of the cyst migration before surgery also should be kept in mind. The radiological appearance and the clinical significance of this condition are discussed with brief review of literatures.

Intra-aneurysmal Pressure Changes according to Clippings on the Parent Artery and Aneurysm in Experimental Model of Rabbits: a Preliminary Study

Temporary clipping on parent artery is widely accepted as a useful method to prevent intraoperative aneurysmal rupture, to dissect the aneurysm safely, and to obtain the clear operation field during intraoperative aneyrysm rupture. However, the exact role and adequate technique of the temporary clipping has yet to be determined. The authors performed an experimental study to investigate the effect of temporary clipping on intra-aneurysmal pressure. The experimental aneurysms, using side-to-side anastomosis between common carotid artery and the jugular vein, were made in 24 rabbits. The intra-aneurysmal pressure was monitored through a catheter inserted in the aneurysm. The intra-aneurysmal pressure was significantly decreased to 31.8+/-4.39mmHg after temporary clipping on the proximal common carotid artery(p<.05). On the contrary, intra-aneurysmal pressure was increased to 73.3+/-4.39mmHg after the distal parent temporary clipping. In case of the temporary clipping on both proximal and distal parent artery, the intra-aneurysmal pressure was markedly increased to 81. 0+/-11.7mmHg(p=0.0036 on t-test). In conclusion, the temporary clipping on the parent artery should be performed only on the proximal site of the aneurysm. Temporary clipping on both proximal and distal site would be rather dangerous since it causes sharp increase in intra-aneurysmal pressure during the clipping of aneurysm itself.

Intra-aneurysmal Pressure Changes according to Clippings on the Parent Artery and Aneurysm in Experimental Model of Rabbits: a Preliminary Study

Temporary clipping on parent artery is widely accepted as a useful method to prevent intraoperative aneurysmal rupture, to dissect the aneurysm safely, and to obtain the clear operation field during intraoperative aneyrysm rupture. However, the exact role and adequate technique of the temporary clipping has yet to be determined. The authors performed an experimental study to investigate the effect of temporary clipping on intra-aneurysmal pressure. The experimental aneurysms, using side-to-side anastomosis between common carotid artery and the jugular vein, were made in 24 rabbits. The intra-aneurysmal pressure was monitored through a catheter inserted in the aneurysm. The intra-aneurysmal pressure was significantly decreased to 31.8+/-4.39mmHg after temporary clipping on the proximal common carotid artery(p<.05). On the contrary, intra-aneurysmal pressure was increased to 73.3+/-4.39mmHg after the distal parent temporary clipping. In case of the temporary clipping on both proximal and distal parent artery, the intra-aneurysmal pressure was markedly increased to 81. 0+/-11.7mmHg(p=0.0036 on t-test). In conclusion, the temporary clipping on the parent artery should be performed only on the proximal site of the aneurysm. Temporary clipping on both proximal and distal site would be rather dangerous since it causes sharp increase in intra-aneurysmal pressure during the clipping of aneurysm itself.

A Comparison of Corpectomy and Bisegmental Diskectomy in Anterior Cervical Fusion

OBJECTIVE: It is not unusual to decompress two consecutive disc levels in treating patients with multiple radiculopathy or uncertain level diagnosis. However, the controversy over whether to use corpectomy or bisegmental diskectomy for anterior cervical fusion is still largely unsettled. The aim of this study is to define the properties of these two surgical options. PATIENTS AND METHODS: We performed a retrospective review of radiological data and clinical records only in patients whom the follow up period is longer than 12 months. Functional outcome, fusion rate, complication rate, and duration of anesthesia were analyzed in both groups. RESULTS: In total of 61 cases, corpectomy was performed in 34 and the bisegmental diskectomy in 27 patients. Mean follow-up periods were over 24 months in both groups. Anesthesia time was shorter in corpectomy patients(280 minutes vs. 300 minutes in segmental diskectomy). However, the bisegmental diskectomy group was better in achieving good clinical outcome(92.6% vs. 82%). Overall fusion rate in bisegmental diskectomy was 100%. Hardware failure rate was lower in bisegmental diskectomy group(11% vs. 18%). Revision was needed in 6% of corpectomy group. CONCLUSIONS: In conclusion, although the anesthesia time is slightly longer in bisegmental fusion, we believe the method of bisegmental diskectomy is better in accomplishing higher fusion rate and lower complication rate.

Clinical Study of the Serial Changes of Fixed Segmental Height and Cobb Angle in Anterior Cervical Fusion

The authors investigated the serial changes of height and Cobb angle in the fused segments in the anterior cervical fusion. Patients who underwent anterior cervical fusion and fixation were investigated from September 1993 to August 1997. Total of 52 cases who met the following entry criteria were included in this study: (a) no history of prior cervical spine surgery or concomittent posterior fusion, (b) an anatomic radiculopathy or myelopathy that correlated with a radiographic study at the corresponding level, and(c) the clinical follow-up period of at least ten months. The radiographic data were obtained retrospectively from routine clinical radiographs, which included neutral radiographs preoperatively, immediate-postoperatively, and at 4-6 months postoperatively. The heights of the fixed segment were increased significantly after the operation(p<0.05 on Oneway ANOVA on ranks), and then decreased to preoperative value at last follow-up. The lordotic angles were increased after the operation and maintained throughout the study period(p<0.05 on Oneway ANOVA). In conclusion, on the contrary to the general belief that plate fixation can prevent the decrease in the segmental height, we found that the gain of height lasted only temporarily. Despiter this, postoperatively increased lordotic curve was maintained through the study period in spite of height loss. Therefore, we think that the lordosis of the cervical spine may reflects most of functional status of the whole cervical spine rather than height gain of the fused segment.

A Case of Orbital Cavernous Angioma Associated with Intracranial Venous Anomalies

The authors present a rare case of orbital cavernous malformation associated with intracranial venous anomalies. A 7-year-old female patient was admitted to our hospital complaining of headache and progressive diplopia. Neurologic examination revealed a painful proptosis and limited movement of right eye. Magnetic resonance images demonstrated a cavernous malformation in the right orbit, intracerebral cystic cavernous malformation, and well-enhancing vascular marking in the right temporal lobe. On the cerebral angiography, dilated vein of Labb and duplicated transverse sinus were noted. The patient showed marked improvement of her vision after the total removal of the orbital lesion. We believe this is an another evidence that cavernous malformation may be derived from increased burden of cerebral blood flow and/or venous pressure.

The Usefulness of Subfascial Temporalis Dissection Method in Pterional Craniotomy

The pterional craniotomy is the one of the most frequently used surgical procedures in the field of neurosurgery. Two main methods(muscle-splitting and interfascial technique) of the temporalis dissection and its modifications have been described in detail in the neurosurgical literature. But the muscle splitting technique may limit the exposure of the skull base and the interfascial dissection carries a significant risk of frontalis nerve palsy. The authors have used the subfascial dissection method and compared it with other two techniques in the aspects of functional and cosmetic outcomes. A total of 253 consecutive patients who underwent pterional craniotomies between January 1990 and June 1995 were selected. Among these, interfascial technique was used in 92 patients, muscle-splitting method in 93 patients, and subfascial temporalis dissection in 68 patients . The patients were examined to compare the incidence of facial nerve palsy, the presence of chewing difficulty, temporal asymmetry and the degree of maximal mouth opening. The interfascial approach showed the worst outcome in preserving frontalis nerve and maintaining temporal symmetry(p<0.05). There were no significant differences among these three techniques in maximal mouth opening and chewing difficulties. In conclusion, the subfascial temporalis dissection technique enable many surgeons to perform pterional craniotomies without fear of frontalis nerve injury while obtainig satisfactory operative exposure. We believe this is the choice of dissection method when performing pterional craniotomy.

Anterior Cervical Fusion: A Retrospective Analysis of 152 Cases

Anterior cervical fusion has enjoyed an increasing acceptance and frequency of utilization in the treatment of symptomatic degenerative, traumatic, and neoplastic disorders. Since the introduction of plate systems, cervical fusion with fixation has become popularized. We present our experiences of 152 cases of cervical fusion in degenerative and traumatic lesions, focusing on their surgical results and complications, along with our opinions about the various plate systems we used. Between March 1993 and May 1996, 152 patients with symptomatic degenerative and traumatic cervical lesions between C3-4 and C7-T1 levels were treated with anterior cervical fusions. These patients were retrospectively studied according to their medical records and radiological studies. A comparison between various plate systems were also done. There were 110 men and 42 women, aged from 21 to 77 years. Mean follow up period was 17 months. Mean fused segments were 1.4. Various plate systems were used: Caspar plate system in 14 patients; Top plate in 102; Orion plate in 21; and none in 15. Dislodgement of bone graft, screw loosening, and fusion failure that required reoperation were occurred in 8 cases. None of them were initially treated with unicortical type screws. Asymptomatic esophageal perforation was developed in one case among them. In conclusion, anterior cervical fusion with screw plate system can be carried out with acceptable complication rate. Although relative follow up period was short, we concluded that the locking type screw plate system was superior than the classic bicortical screw system in their procedural simplicity, unnecessary penetration of posterior cortex, and elimination of the fear for the neurological complication.