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*

We report here on a case of a ruptured left posterior communicating artery (P-com) aneurysm that was treated by clipping in a patient with idiopathic thrombocytopenic purpura (ITP) and steroids were used to control the platelet count during the perioperative period. A 34-year-old female who had been suffering from ITP for four years experienced the sudden onset of a headache and vomiting while showering. She was referred to our hospital as a case of subarachnoid hemorrhage (SAH) due to a ruptured P-com aneurysm. Aneurysmal neck clipping was performed via the left pterional approach 6 hours after the ictus. The aneurysmal clipping was successful without an increased bleeding tendency during the operation. Intravenous steroid injection was given after aneurysmal clipping for 7 days and then it was tapered off. It is important to maintain an adequate platelet count in SAH patients with chronic ITP in order to avoid hemorrhagic diathesis during surgery. Intravenous steroid injection is a helpful method for maintaining an adequate platelet count in these patients during surgery.
Adult ; Aneurysm ; Arteries ; Female ; Headache ; Hemorrhage ; Hemorrhagic Disorders ; Humans ; Intracranial Aneurysm ; Neck ; Perioperative Period ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Steroids ; Stress, Psychological ; Subarachnoid Hemorrhage ; Vomiting

OBJECTIVES: In this study, we evaluated early surgical results including 30 days early stroke and death rate and complications in 168 cases carotid endarterectomy (CEA). METHODS: A retrospective review of patients who underwent CEA at our institute between September 1999 and August 2010 was done. Preoperative symptoms were stroke in 72 cases, transient ischemic stroke or reversible ischemic neurologic deficit in 56 cases and asymptomatic in 40 cases. Most of the patients had conventional cerebral angiography or neck computed tomography angiography (CTA) for preoperative evaluation. Immediate radiological follow up was performed by neck CTA 1 week postoperatively. RESULTS: The overall postoperative stroke rate including transient ischemic attack within 30 days of the treatment was 1.7%. Major stroke rate with morbidity and death rate within 30 days was 0.6% (1 : major stroke, 1 : death). The cause of death was airway occlusion due to wound hematoma. Cranial nerve palsy developed in two patients (1.1%) and neck hematoma in six patients (3.5%). Neck CTA revealed total occlusion of internal carotid artery in one patient with acute cerebral infarction and then recovered fully. Intracranial hemorrhage relating to the hyperperfusion syndrome developed in one patient. Radiological patency rate was 98.7%. The comparison of 30 days morbidity and mortality rate between CEA and carotid angioplasty and stenting were each 0.6% and 1.5%, but there was no statistical significance. CONCLUSIONS: Carotid endarterectomy provides considerable future risk prevention against stroke in patients with symptomatic and asymptomatic carotid stenosis.
Angiography ; Angioplasty ; Carotid Artery, Internal ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Cerebral Infarction ; Cranial Nerve Diseases ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

OBJECTIVES: In this study, we evaluated early surgical results including 30 days early stroke and death rate and complications in 168 cases carotid endarterectomy (CEA). METHODS: A retrospective review of patients who underwent CEA at our institute between September 1999 and August 2010 was done. Preoperative symptoms were stroke in 72 cases, transient ischemic stroke or reversible ischemic neurologic deficit in 56 cases and asymptomatic in 40 cases. Most of the patients had conventional cerebral angiography or neck computed tomography angiography (CTA) for preoperative evaluation. Immediate radiological follow up was performed by neck CTA 1 week postoperatively. RESULTS: The overall postoperative stroke rate including transient ischemic attack within 30 days of the treatment was 1.7%. Major stroke rate with morbidity and death rate within 30 days was 0.6% (1 : major stroke, 1 : death). The cause of death was airway occlusion due to wound hematoma. Cranial nerve palsy developed in two patients (1.1%) and neck hematoma in six patients (3.5%). Neck CTA revealed total occlusion of internal carotid artery in one patient with acute cerebral infarction and then recovered fully. Intracranial hemorrhage relating to the hyperperfusion syndrome developed in one patient. Radiological patency rate was 98.7%. The comparison of 30 days morbidity and mortality rate between CEA and carotid angioplasty and stenting were each 0.6% and 1.5%, but there was no statistical significance. CONCLUSIONS: Carotid endarterectomy provides considerable future risk prevention against stroke in patients with symptomatic and asymptomatic carotid stenosis.
Angiography ; Angioplasty ; Carotid Artery, Internal ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Cerebral Infarction ; Cranial Nerve Diseases ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

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

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: The incidence of subarachnoid hemorrhage (SAH) worldwide varies considerably. In spite of many reports about the incidence of SAH, there has been no report about the incidence of SAH on the basis of the Korean population. The purpose of this hospital-based study was to assess the actual incidence rates of aneurysmal SAH in Gwangju city and Jeollanamdo province. METHODS: All cases of SAH confirmed by computerized tomography (CT) between January 2007 and December 2007 were selected for analysis. For the data collection, three major training hospital and ten general hospitals working the CT in Gwangju city and four major general hospitals in Jeollanamdo province participate in this study. RESULTS: According to the official census of Korea, the population was 1,413,444 in Gwangju city and 1,929,836 in Jeollanamdo province in 2007. There were 163 patients in Gwangju city and 266 patients in Jeollanamdo province confirmed SAH by CT in 2007. The crude and the age- and sex-adjusted annual incidence rates per 100,000 population for all ages in Gwangju city were 11.5 and 12.4 for aneurysmal SAH and in Jeollanamdo province were 13.8 and 10.8. The incidence was higher in women and increased with age. The gender distribution varied with age. At young ages, the incidence was higher in men while after the age of 40 years, the incidence was higher in women. CONCLUSION: In the present study, the age- and sex-adjusted annual incidence rates is 11.8 in Gwangju city and Jeollanamdo province. The incidence was higher in women and increased with age.
Aneurysm ; Censuses ; Data Collection ; Female ; Hospitals, General ; Humans ; Incidence ; Korea ; Male ; Risk Factors ; Subarachnoid Hemorrhage

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