Clinical Outcome of Modified Cervical Lateral Mass Screw Fixation Technique

OBJECTIVE: The purpose of this study was 1) to analyze clinically-executed cervical lateral mass screw fixation by the Kim's technique as suggested in the previous morphometric and cadaveric study and 2) to examine various complications and bicortical purchase that are important for b-one fusion. METHODS: A retrospective study was done on the charts, operative records, radiographs, and clinical follow up of thirty-nine patients. One hundred and seventy-eight lateral mass screws were analyzed. The spinal nerve injury, violation of the facet joint, vertebral artery injury, and the bicortical purchases were examined at each lateral mass. RESULTS: All thirty-nine patients received instrumentations with poly axial screws and rod systems, in which one hundred and seventy-eight screws in total. No vertebral artery injury or nerve root injury were observed. Sixteen facet joint violations were observed (9.0%). Bicortical purchases were achieved on one hundred and fifty-six (87.6%). Bone fusion was achieved in all patients. CONCLUSION: The advantages of the Kim's technique are that it is performed by using given anatomical structures and that the complication rate is as low as those of other known techniques. The Kim's technique can be performed easily and safely without fluoroscopic assistance for the treatment of many cervical diseases.

Discal Cyst of the Lumbar Spine: A Case Report

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.

Discal Cyst of the Lumbar Spine: A Case Report

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.

Neurological Improvement after Cranioplasty in Patients with Surgical Bony Defects : The Usefulness of Acetazolamide Activated (99m)Tc-HMPAO SPECT

OBJECTIVE: The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow(CBF) and cerebrovascular reserve capacity(CVRC), and to investigate the usefulness of single photon emission computed tomography (SPECT) as a prognostic factor for neurological improvement after cranioplasty. METHODS: Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery(MCA) and internal carotid artery (ICA) were obtained by transcranial Doppler ultrasonography(TCD). The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT (Group 1, n=7) and hypoactivity to acetazolamide-activated SPECT (Group 2, n=17). These measurements were obtained two weeks prior to and two weeks after cranioplasty. RESULTS: The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased (P<0.05). Compared with Group 2, there was significant increase in CBF and neurological imrovement after cranioplasty in Group 1. CONCLUSION: Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

Role of Multislice Computerized Tomographic Angiography in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: We evaluate the role of multislice computerized tomographic angiography(MCTA) in the diagnosis of intracranial vasospasm following subarachnoid hemorrhage(SAH) in patients suspected of having vasospasm on clinical ground. METHODS: Between October 2003 and June 2005, patients with ruptured cerebral aneurysms of the anterior circulation clipped within 3 days of the onset were included. We performed follow-up MCTAs in patients who were suspected to have vasospasm on transcranial doppler sonography(TCD) findings and clinical grounds. Based on the clinical presentation of symptomatic vasospasm, we investigated the correlation between clinical, TCD, and MCTA signs of vasospasm and evaluated the role of MCTA in vasospasm. RESULTS: One hundred one patients met the inclusion criteria and symptomatic vasospasm developed in 25 patients (24.8%). We performed follow-up MCTAs in 28 patients. MCTA revealed spasm in the vessels of 26 patients. The sensitivity of MCTA was 100%. Among the 26 patients with MCTA evidence of vasospasm, 3 patients had TCD signs of vasospasm after symptomatic vasospasm presentation. Another 3 patients with symptomatic vasospasm had no TCD signs of vasospasm in daily serial recordings. Six other patients without symptomatic vasospasm showed MCTA evidence of vasospasm (false positive result) but these patients had also positive TCD signs of vasospasm. Volume rendering(VR) images tended to show significantly more exaggerated vasospasm than maximum intensity projection(MIP) images. The mean cerebral blood flow velocity of both proximal segment of the middle cerebral artery (M1) was significantly correlated with each reduced M1 diameter on MCTA (P<0.05). CONCLUSION: MCTA could be a useful tool for evaluation and planning management of critically ill patients suspected of having vasospasm; however, more randomized controlled trials are necessary to assess these points definitively.

Usefulness of Multislice Computerized Tomographic Angiography in Evaluation of Intracranial Aneurysms: Surgical Correlation

OBJECTIVE: The usefulness of multislice computerized tomographic angiography(MCTA) in operating intracranial aneurysms is studied by comparing the features of MCTA with intraoperative findings. METHODS: From December 2001 to February 2003, 74 clippings of aneurysmal neck were carried out based mainly on the aneurysmal features of preoperative MCTA. MCTA studies consisted of four rows(multislice technology), with slice thickness of 1.25mm at 0.6mm reconstruction intervals and pitch of 0.75. Timing was determined using the Smart Prep automatic triggering system. The locations of aneurysms were classified into 3 subgroups: internal carotid artery, middle cerebral artery, and anterior communicating artery and distal anterior cerebral artery. The aneurysmal features on MCTA were compared with their operative findings, using our comparison items, and graded subsequently. RESULTS: A total of 77 intracranial aneurysms were identified among 64 patients on preoperative MCTA, and one of them was false positive. Two angiographically unrecognized microaneurysms were identified on operation. In the detection of intracranial aneurysm, MCTA had 98.4% sensitivity and 96.9% specificity on a perpatient basis. On a per-aneurysm basis, MCTA sensitivity and specificity were 98.6% and 97.3%, respectively. The shapes of aneurysms on MCTA were not related with the grade(chi-square test: X2=1.566, p=0.457), but each grades of simple, bilobulation, and multilobulation were grade 1. Sum of grading scores were related with site of aneurysm(Chi-square test: X2=48.635, p=0.001), In particular, sum of grading scores of MCA aneurysms were 5. Although fine vascular architectures such as hypoplastic A1 and posterior communicating artery, perforating artery of A-COM, and anterior choroidal artery were invisible on MCTA, the MCTA images of ICA and A-COM aneurysms were also found to be valuable in intracranial aneurysm surgery. CONCLUSION: MCTA is useful in planning the surgery of intracranial aneurysm compared to single detector CTA. Postoperative DSA of stabilized patient is mandatory for confirming operative results and any missing unruptured aneurysm after MCTA based cerebral aneurysm surgery.

Effect of Culture Condition on Chondrocyte Viability Isolated from Articular Cartilage / 대한진단검사의학회지

BACKGROUND: Recent advance in tissue engineering in the biomedical field shed light on the replacement or regeneration of various organs with synthetic substitutes. Currently emerging cartilage tissue engineering therapies involve artificial cartilage fabricated from three dimensional cultures using appro-priate scaffolds. It is mandatory to expand or proliferate the chondrocytes in vitro to prepare the artificial cartilage. The purpose of this study was to find out the most favorable culture conditions for chon-drocyte viability in vitro. METHODS: Articulr chondrocytes or cartilage explants were isolated from the patellofemoral groove of adult pigs. And then we standardized the size and thickness of the cartilage explants as well as preparing alginate-chondrocyte beads for three-dimensional cultures. The cartilage explants, including 10% fetal bovine serum for 10 days, 36 days and passage 6. Cellualr viability was measured by methylthiazol tetrazolium (MTT) assay on monolayer, alginate bead and cartilage explant. SPSS 11.5 was used for data anaylsis. RESULTS: Chondrocytes cultured on monolayers in vitro showed no significant difference in cellular viability until passage 6 following isolation from the patellofemoral groove of adult pigs (P>0.05, n=4). Chondrocyte viability was markedly increased by day 16 both in the monolayer (148%) and three dimensional cultures (245%), and then slightly decreased 126% and 200%, respectively, at day 36. Three dimensional cultures using alginate bead were more favorable for chodrocyte viability than monolayer culture in chondrocyte primary culture (P=0.003, n=6). Chondrocyte viability in the algi-nate bead was increased 300% during 36 days' incubation period (P=0.001, n=3). Cellular viability in the cartilage explant culture was decreased after day 4 in both MTT score (P=0.022, n=10) and MTT OD (P=0.039, n=10). CONCLUSIONS: Three dimensional cultures using alginate bead were the most favorable for chon-drocyte viability in chondrocyte primary cultures.

Fenestrate Anomaly of a Vertebral Artery with Repeated Attacks of Ischemic Stroke

In angiographic examinations, abnormalities of vertebral arteries are incidental findings because they are, in most of cases, clinically asymptomatic. We report a case of young woman with a fenestrated anomaly of the left vertebral artery with ischemic strokes. The patient was suffered from repeated attacks of transient ishemic attack(TIA) and cerebral infarction. Vertebral angiography demonstrated a fenestrated anomaly of the left vertebral artery and a large intraluminal thrombus was detected at just proximal of the fenestration. Proximal balloon occlusion of the involved vertebral artery was done and the patient became free from ischemic attack. Follow-up angiography showed well visualization of the posterior circulation through right vertebral artery and the ballooned vertebral artery was well occluded. The left posterior inferior cerebellar artery(PICA) was filled well via collateral circulation from the opposite side.

Nontraumatic Spinal Epidural Hematoma - An Analysis of The Etiology -

Spontaneous spinal epidural hematoma is a rare entity. Various definitions for spontaneous epidural hematoma have been reported in the literature. The expression of nontraumatic spinal epidural hematoma seems to be less ambiguous and includes idiopathic hematomas and hematomas secondary to coagulopathy, vascular malformations, and tumors. We report three cases of nontraumatic spinal epidural hematomas observed from 1991 to 2000. The causes of the spinal epidural hematomas were not clear in two cases among them, but in the another one case, the cause was determined to be an acquired coagulopathy. We reviewed 24 cases reported in the Korean Journal of Neurosurgery and our three cases with particular emphasis on the various causes such as coagulopathy, vascular malformations and tumors. Among the 27 cases, numerous causes were detected such as three cases of vascular malformation, one case of anticoagulant treatment, five cases of combined lumbar disc herniation, two cases associated with pregnancy and postpartum, one case associated with hypertension, and one case associated with ossification of ligamentum flavum. No causes were detected in the ten cases. The authors reviewed the literature.

Agenesis of Right Internal Carotid Artery Associated with Intracranial Aneurysm: Case Report

The authors present a case of unilateral agenesis of internal carotid artery associated with an aneurysm at the unusual site. A 22-years old female was admitted with sudden headache and nausea. She was alert on admission and no focal neurologic deficit was detected. Brain computed tomography(CT) scan showed subarachnoid hemorrhage. In the cerebral angiography, right internal carotid artery was absent and an aneurysm was arisen from the junction of the right middle cerebral artery and posterior communicating artery. The blood supply of the right anterior cerebral artery was maintained from the left internal carotid artery via the anterior commuicating artery. The territory of the right middle cerebral artery was supplied from the basilar artery through enlarged right posterior communicating artery. Direct clipping of the aneurismal neck was performed through right pterional approach. In the postoperative high resolution CT scan, there was no carotid canal in the right skull base suggesting agenesis of the right internal carotid artery.

Solitary Schwannoma in the Psoas Muscle

The vast majority of schwannomas occur on cranial nerves, and rarely in the retroperitoneum. Solitary schwannoma in the psoas muscle is extremely rare. The authors present a case of retroperitoneal neoplasm in the psoas muscle identified as schwannoma which is not associated with von Recklinghausen's disease. A 68 years old female patient was admitted because of low back pain and weakness at the left leg. CT and MRI revealed a large cystic mass with well-defined margin and multiple internal septation within the left psoas muscle. The tumor was totally extirpated and histologically confirmed as a schwannoma.

Primary Osteosarcoma of the Sphenoid Bone: Case Report

No abstract available.

A Huge Posterior Fossa Arachnoid Cyst with Cervicothoracic Syringomyelia

The authors report a surgically treated patient with very unusual combination of a giant posterior fossa cyst in cerebellopontine area, Chiari I malformation and syringomyelia in cervico-thoracic area. Ventricles were not dilated. He complained weakness and clumsiness on the right upper extremity. His symptom was attributable to the syringomyelia of cervical spinal cord. The authors managed this patient by removing the arachnoid cyst and cystoperitoneal shunt on the assumption that this cyst has an influence on the formation of Chiari malformation and syringomyelia. After operation there was marked improvement in the motor power in the arm, and a follow-up MRI one month later showed a disappearance of syringomyelia. The authors believe that this very unusual condition is of interest in making the pathogenesis of syringomyelia clear.

A Case of Primary Intracranial Malignant Melanoma

The primary malignant melanoma arising in the leptomeninges of the central nervous system is extremely rare. We report a case of malignant melanoma, apparently thought to be originated from leptomeninges, with diffuse neoplastic process widely spreaded over the leptomeninges of 42 years old man, who had suffered severe headache, nausea and left hemiparesis. This patient is free of the symptoms for six months after operation. The literature on this subject is briefly reviewed.

A Case of Spontaneous Cervical Spinal Epidural Hematoma: Case Report

Spontaneous spinal epidural hematoma is a rare cause of spinal cord compression. Recently, at our hospital, the author et al had the opportunity of observing case with spontaneous cervical epidural hematoma in a 28 years old woman who had suddenly felt a strong pain in interscapular area. Rapidly after she noticed weakness in her legs and one day later she was completely paraplegia. The MRI of spine was done. There show tubular like low signal intensity at posterior epidural space of C7 level and ghigh signal intensity of cord at C7 level due to cord compression effect. In this article, we are adding one more rare case of spontaneous cervical spinal epidural hematoma confirmed by MRI.

Two Cases of Redundant Nerve Root Syndrome of Cauda Equina

Two cases of redundant nerve root syndrome of cauda equina in patient was described. The general clinical features were the intermittent neurologic claudication with improvement at rest, low back pain of long duration and radicular pain in one or both legs, sensory & motor change in one or both legs. Myelography revealed a partial to complete block with characteristic serpentine filling defects above or below the block simulating a vascular malformation. One case was associated with lumbar H.N.P and the other cases were associated with L-H.N.P and pseudospondylolithesis. In addition to, we reviewed the literature of redundant nerve root syndrome of the cauda equina.

Giant Serpentine Aneurysm of the Posterior Cerebral Artery: Case Report

Aneurysms of the posterior cerebral artery are rare, furthermore giant serpentine aneurysms-partially thrombosed aneurysms containing a tortuous vascular channel-of the posterior cerebral artery are extremely rare. The author et al. were able to remove 3.9cm x 2.9cm x 3.0cm sized giant serpentine aneurysm of the distal PCA totally, without any significant postoperative neurological sequela except transient ipsilateral third cranial nerve paresis and transient hemihypesthesia. Various kinds of surgical treatment were proposed by several authors in managing unclippable giant aneurysms:excision including partial excision;clipping of feeding artery and excision;trapping and excision;revascularization and excision;anastomosis only. We took subtemporal approach under the surgical microscope and trapping & excision was performed in several steps:proximal clipping of the PCA distal to the Pcom-PCA junction;reducing volume of the mass through piecemeal resection of the aneurismal wall;distal clipping of the PCA;total excision and final trapping just proximal and distal to the origin of the aneurysm. We are discussing the characteristics of the giant serpentine aneurysm, precognition of rich collateral circulation of the PCA distal to trapping and surgical management of the giant serpentine aneurysm.

A Case of Primary Malignant Leptomeningeal Melanoma of the Spinal Cord: Case Report

The primary malignant melanoma of spinal cord is a rare tumor cause of compression of the cord 6)7). We are reporting a case of malignant melanoma, apparently originating from leptomeninges, of with diffuse neoplastic process widely spreaded over the area of cervicothoracic spinal cord of 34-yr-old woman.