The authors describe three patients of syringomyelia associated with posterior fossa tumor. The lesions were diagnosed by magnetic resonance imaging. Total removal of tumor without decompression of foramen magnum was done and regression of syringomyelia and improvement of symptoms were demonstrated. It is suggested that the blockage of cerebrospinal fluid flow at the foramen magnum by tonsilar herniation may play an important role in syrinx formation.
Cerebrospinal Fluid ; Decompression ; Foramen Magnum ; Humans ; Infratentorial Neoplasms* ; Magnetic Resonance Imaging ; Syringomyelia*

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*

The detailed clinical characteristics of unilateral moyamoya disease (MMD) have not been fully elucidated. It has been reported that some patients with unilateral MMD progress to bilateral involvement, while others remain with the unilateral variant. In this series, we present a case of unilateral MMD that progressed to bilateral involvement over the course of just one month.
Humans ; Moyamoya Disease

OBJECTIVE: The authors report the evaluation of the surgical outcomes and postoperative complications for the 39 cases of parasagittal meningioma. METHODS: Thirty-nine patients have undergone operations for parasagittal meningioma between March 1994 and March 2002. The medical records and neuroimaging studies of thirty-nine patients were surveyed retrospectively to find out the perioperative clinical status, radiologic findings, operative methods, and postoperative complications. RESULTS: Preoperative symptoms were motor weakness(12), seizure(11), headache(11) and so on. The parasagittal meningioma was classified into lateral attachment(27), partial occlusion(4) or total occlusion(8) according to the degree of infiltration and into anterior one third(7), middle one third(28) or posterior one third(4) from the viewpoint of the origin site. The degree of tumor removal was classified into Simpson Grade: Grade I(13), Grade II(24), Grade III(2). Suture of the opened sinus was done in seven patients going through an operations. Four patients of them underwent sinus opening for mass removal and the others due to operative injury. Total removal of the sinus segment was carried out in six patients. The draining veins of six patients got injuried, those of four patients and the others respectively were coagulated and sutured. Postoperative complications were motor weakness(11), CSF leakage(9), seizure(1) and hemorrhage(1). CONCLUSION: However, most of the weakness is transient, the preservation of intracranial collateral circulation is important to minimize the motor weakness. The effort for complete tumor removal is required in parasagittal meningioma to take recurrence into account.
Collateral Circulation ; Humans ; Medical Records ; Meningioma* ; Neuroimaging ; Postoperative Complications* ; Recurrence ; Retrospective Studies ; Sutures ; Veins

OBJECTIVE: The authors review 17 cases of obstructive hydrocephalus treated with endoscopic third ventriculostomy to elucidate the adequate age, indication, surgical technique and radiologic criteria. METHODS: From March 1998 to August 2002, 17 endoscopic third ventriculostomies were performed(11 male and 6 female patients). The operation records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: The age of the patients ranged from 2 months to 70 years(mean age 21 years). Hydrocephalus was caused by aqueductal stenosis in 8 patients, tumor in 8(pineal mass: 5, cystic mass in third ventricle: 2 cerebellar mass: 1), cavernous angioma in 1. The overall success rate was 64.7%(11/17). In the present study, the preoperative increased intracranial pressure symptom was a reliable indicator of surgical outcome. The lateral ventricular size and the III ventricle width reduction, the presence of a signal void on the third ventricle floor appeared to correlate with clinical success. But the cystic mass in the third ventricle was less likely to benefit. Complications were bleeding in 3, infections in 2 and transient III and VI nerve palsy in one case, but there was no permanent morbidity or mortality. CONCLUSION: Endoscopic third ventriculostomy is a safe, simple, effective alternative treatment option of obstructive hydrocephalus in appropriate patient selection.
Abducens Nerve Diseases ; Female ; Hemangioma, Cavernous ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Pressure ; Male ; Mortality ; Neuroimaging ; Patient Selection ; Retrospective Studies ; Third Ventricle ; Ventriculostomy*

Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident involving a pituitary adenoma or an adjacent pituitary gland. Pituitary apoplexy may be associated with a variety of neurological and endocrinological signs and symptoms. However, isolated third cranial nerve palsy with ptosis as the presenting sign of pituitary apoplexy is very rare. We describe two cases of pituitary apoplexy presenting as sudden-onset unilateral ptosis and diplopia. In one case, brain magnetic resonance imaging (MRI) revealed a mass in the pituitary fossa with signs of hemorrhage, upward displacement of the optic chiasm, erosion of the sellar floor and invasion of the right cavernous sinus. In the other case, MRI showed a large area of insufficient enhancement in the anterior pituitary consistent with pituitary infarction or Sheehan's syndrome. We performed neurosurgical decompression via a transsphenoidal approach. Both patients showed an uneventful recovery. Both cases of isolated third cranial nerve palsy with ptosis completely resolved during the early postoperative period. We suggest that pituitary apoplexy should be included in the differential diagnosis of patients presenting with isolated third cranial nerve palsy with ptosis and that prompt neurosurgical decompression should be considered for the preservation of third cranial nerve function.
Brain ; Cavernous Sinus ; Decompression ; Diagnosis, Differential ; Diplopia ; Displacement (Psychology) ; Floors and Floorcoverings ; Hemorrhage ; Humans ; Hypopituitarism ; Infarction ; Magnetic Resonance Imaging ; Oculomotor Nerve ; Optic Chiasm ; Paralysis ; Pituitary Apoplexy ; Pituitary Gland ; Pituitary Neoplasms ; Postoperative Period

OBJECTIVE: Distal middle cerebral artery (MCA) aneurysms are the least frequent aneurysms of the MCA, and they represent about 1.1 to 5% of all MCA aneurysms. Patients with ruptured distal MCA aneurysms generally have a poor clinical outcome. The purpose of this article is to review the characteristics of distal MCA aneurysms to avoid the complications of microsurgical dissection and clipping of distal MCA aneurysms. METHODS: A total of 1187 patients with ruptured aneurysms were treated at our hospital between January 1997 and May 2008. All patients underwent surgical procedures. Computed tomography (CT) revealed rupture of distal MCA aneurysms in 15 (1.26%) patients. The location of the aneurysm were the M2 (insular) segment in seven patients, the M2-3 junction in three and the M3 (opercular) segment in five. Brain CT images revealed the presence of both subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH) in 11 of 15 (77.3%) patients, with a mean ICH volume of 14.5 cc (range : 5 to 32 cc). Rebleeding occurred in 7 out of the 15 (46.7%) patients. RESULTS: All the patients underwent early surgical procedures, including clipping in seven, trapping in two, bypass surgery in four, Guglielmi detachable coil embolization in one and exploratory craniotomy in one patient. The aneurysm had a fusiform appearance in 9 out of 15 cases (60%), and the mean size of the aneurysm was 10.4 mm (range : 2 to 35 mm). Three patients died due to severe brain swelling (20%). CONCLUSION: In this study, distal MCA aneurysms had a relatively fusiform shape as well as high rates of rebleeding and ICH. A good clinical outcome was associated with early surgery for adequately controlling brain swelling and preventing rebleeding.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Craniotomy ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage

OBJECTIVE: Despite several limitations, the Trauma Injury Severity Score (TRISS) is normally used to evaluate trauma systems. The aim of this study was to evaluate the preventable trauma death rate using the TRISS method in severe trauma patients with traumatic brain injury using our emergency department data. METHODS: The use of the TRISS formula has been suggested to consider definitively preventable death (DP); the deaths occurred with a probability of survival (Ps) higher than 0.50 and possible preventable death (PP); the deaths occurred with a Ps between 0.50 and 0.25. Deaths in patients with a calculated Ps of less than 0.25 is considered as no-preventable death (NP). A retrospective case review of deaths attributed to mechanical trauma occurring between January 1, 2011 and December 31, 2011 was conducted. RESULTS: A total of 565 consecutive severe trauma patients with ISS>15 or Revised Trauma Score<7 were admitted in our institute. We excluded a total of 24 patients from our analysis : 22 patients younger than 15 years, and 2 patients with burned injury. Of these, 221 patients with head injury were analyzed in the final study. One hundred eighty-two patients were in DP, 13 in PP and 24 in NP. The calculated predicted mortality rates were 11.13%, 59.04%, and 90.09%. The actual mortality rates were 12.64%, 61.547%, and 91.67%, respectively. CONCLUSION: Although it needs to make some improvements, the present study showed that TRISS performed well in predicting survival of traumatic brain injured patients. Also, TRISS is relatively exact and acceptable compared with actual data, as a simple and time-saving method.
Brain ; Brain Injuries ; Craniocerebral Trauma ; Emergencies ; Humans ; Injury Severity Score ; Retrospective Studies

We recently experienced a case of synovial sarcoma in the posterior neck, which involved adjacent bony structures. Synovial sarcoma is rare, malignant soft tissue tumor that occur predominantly in the lower extremities. Wide surgical excision with involved tissue is the treatment of first choice, because most synovial sarcomas reveal aggressive features. We removed the tumor with involved bony structures and patient was given postoperative radiation therapy. Despite these treatment options, the patient died 1 year after surgery. We report this case with a review of the literature.
Humans ; Lower Extremity ; Neck ; Sarcoma, Synovial

CONCLUSION: Vascular reconstruction is an important part of the treatment of complex intracranial aneurysms. We report our clinical experience using vascular reconstruction techniques without an extracranial arterial stump for the treatment of complex intracranial aneurysms. METHODS: We conducted a retrospective review of five patients who underwent in situ bypasses and two patients who underwent direct neck suture secondary to clip reinforcement for the treatment of complex intracranial aneurysms between January 1999 and May 2008. RESULTS: Five of the aneurysms were fusiform and the other two were blood blister-like aneurysms (BBAs). Fusiform aneurysms were located at the anterior cerebral artery (ACA) in two patients and the middle cerebral artery (MCA) in three patients. The aneurysms were treated with end-to-side anastomosis after aneurysm excision in three cases and end-to-end anastomosis after aneurysm excision in two cases. Two cases of BBA on the dorsal intracranial artery (ICA) wall were treated by direct suture secondary to the wrapping-clipping method. Follow-up angiography was performed in five patients and revealed patent bypasses in four patients. Follow-up angiography was not performed in two patients due to their poor postoperative condition, and it revealed delayed occlusion due to granuloma formation in one patient with BBA. The patient outcomes were excellent in five patients and poor in two patients whose clinical condition was Hunt- Hess grade V preoperatively. CONCLUSION: In situ bypass is an effective alternative to extracranial-intracranial bypass for distally located fusiform aneurysms. In addition, arterial suturing followed by the wrapping-clipping method is a useful technique for fragile aneurysms unamenable to direct clip or encircled clip for true ICA trunk aneurysms. Although technically challenging, this technique of vascular reconstruction without extracranial arterial graft should be considered for appropriate candidates.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Follow-Up Studies ; Granuloma ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck ; Reinforcement (Psychology) ; Retrospective Studies ; Sutures ; Transplants