No abstract available.
Child* ; Humans

The application of stereotactic techniques and endoscopy dates back to the beginning of this century and is almost as old as neurosurgery itself. However, endoscopic techniques progressed slowly for several reasons. A reappraisal of endoscopic techniques become popular about 1985. The major indication of endoscope in neurosurgical field is intraventricular procedures. Recently it can be used selectively in the intraaxial mass lesion associated cavity. For example, cystic mass, with liquefied necrosis, blood clot can be approached with endoscope. Authors present its intraaxial application in basal ganglionic hematoma in three patients. Conventional stereotactic guidance of neuroendoscope was done and the hematoma was gently removed through continuous irrigation and suction under video-guidance. The clinical course was uneventful. Brief overview is given of this intraaxial neuroendoscopic procedure.
Endoscopes ; Endoscopy ; Ganglion Cysts* ; Hematoma* ; Humans ; Necrosis ; Neuroendoscopes ; Neurosurgery ; Stereotaxic Techniques ; Suction

No abstract available.
Ectopia Cordis*

Objective: To clearly identify the symptoms of sciatica in patients with piriformis syndrome, we retrospectively reviewed patients whose symptoms significantly improved over long-term postoperative follow-up. Methods: Among patients who underwent sciatic nerve decompression for piriformis syndrome over the past 3 years, the preoperative sciatic pain symptoms of 32 patients whose symptoms were confirmed to have improved by more than 50% during more than 1 year of follow-up were analyzed. To identify the characteristics of sciatic pain in piriformis syndrome, we investigated pain when sitting, pain when resting, pain when standing or walking, and pain when resting at night. In addition, the distribution of sciatic pain in the lower back, buttocks, lower extremities, and feet was investigated. Results: The most common symptom was pain when sitting, which was present in 25 patients (81%). Pain characteristically occurred even at rest, occurring in 62.5% of patients while lying down at night and in 53.1% of patients during daytime rest. Sciatic pain from piriformis syndrome was most commonly distributed in the buttock (90.6%) and also present in the lower back (37.5%). Pain was present in the posterior thigh in 23 patients (71.9%), in the calf in 68.8% of patients, and in the foot in 50% of patients. Conclusion Buttock pain exacerbated by sitting was the most common pattern of pain in patients with piriformis syndrome. However, the sciatic pain of this disease was also found to be characterized by pain that persisted even at rest.

Objective: To clearly identify the symptoms of sciatica in patients with piriformis syndrome, we retrospectively reviewed patients whose symptoms significantly improved over long-term postoperative follow-up. Methods: Among patients who underwent sciatic nerve decompression for piriformis syndrome over the past 3 years, the preoperative sciatic pain symptoms of 32 patients whose symptoms were confirmed to have improved by more than 50% during more than 1 year of follow-up were analyzed. To identify the characteristics of sciatic pain in piriformis syndrome, we investigated pain when sitting, pain when resting, pain when standing or walking, and pain when resting at night. In addition, the distribution of sciatic pain in the lower back, buttocks, lower extremities, and feet was investigated. Results: The most common symptom was pain when sitting, which was present in 25 patients (81%). Pain characteristically occurred even at rest, occurring in 62.5% of patients while lying down at night and in 53.1% of patients during daytime rest. Sciatic pain from piriformis syndrome was most commonly distributed in the buttock (90.6%) and also present in the lower back (37.5%). Pain was present in the posterior thigh in 23 patients (71.9%), in the calf in 68.8% of patients, and in the foot in 50% of patients. Conclusion Buttock pain exacerbated by sitting was the most common pattern of pain in patients with piriformis syndrome. However, the sciatic pain of this disease was also found to be characterized by pain that persisted even at rest.

Objective: To clearly identify the symptoms of sciatica in patients with piriformis syndrome, we retrospectively reviewed patients whose symptoms significantly improved over long-term postoperative follow-up. Methods: Among patients who underwent sciatic nerve decompression for piriformis syndrome over the past 3 years, the preoperative sciatic pain symptoms of 32 patients whose symptoms were confirmed to have improved by more than 50% during more than 1 year of follow-up were analyzed. To identify the characteristics of sciatic pain in piriformis syndrome, we investigated pain when sitting, pain when resting, pain when standing or walking, and pain when resting at night. In addition, the distribution of sciatic pain in the lower back, buttocks, lower extremities, and feet was investigated. Results: The most common symptom was pain when sitting, which was present in 25 patients (81%). Pain characteristically occurred even at rest, occurring in 62.5% of patients while lying down at night and in 53.1% of patients during daytime rest. Sciatic pain from piriformis syndrome was most commonly distributed in the buttock (90.6%) and also present in the lower back (37.5%). Pain was present in the posterior thigh in 23 patients (71.9%), in the calf in 68.8% of patients, and in the foot in 50% of patients. Conclusion Buttock pain exacerbated by sitting was the most common pattern of pain in patients with piriformis syndrome. However, the sciatic pain of this disease was also found to be characterized by pain that persisted even at rest.

Objective: To clearly identify the symptoms of sciatica in patients with piriformis syndrome, we retrospectively reviewed patients whose symptoms significantly improved over long-term postoperative follow-up. Methods: Among patients who underwent sciatic nerve decompression for piriformis syndrome over the past 3 years, the preoperative sciatic pain symptoms of 32 patients whose symptoms were confirmed to have improved by more than 50% during more than 1 year of follow-up were analyzed. To identify the characteristics of sciatic pain in piriformis syndrome, we investigated pain when sitting, pain when resting, pain when standing or walking, and pain when resting at night. In addition, the distribution of sciatic pain in the lower back, buttocks, lower extremities, and feet was investigated. Results: The most common symptom was pain when sitting, which was present in 25 patients (81%). Pain characteristically occurred even at rest, occurring in 62.5% of patients while lying down at night and in 53.1% of patients during daytime rest. Sciatic pain from piriformis syndrome was most commonly distributed in the buttock (90.6%) and also present in the lower back (37.5%). Pain was present in the posterior thigh in 23 patients (71.9%), in the calf in 68.8% of patients, and in the foot in 50% of patients. Conclusion Buttock pain exacerbated by sitting was the most common pattern of pain in patients with piriformis syndrome. However, the sciatic pain of this disease was also found to be characterized by pain that persisted even at rest.

OBJECTIVE: The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery. METHODS: Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;18.5-22.9 kg/m2), an overweight group (Group 2, BMI; 23-24.9 kg/m2), and an obese group (Group 3, BMI; 25.0-29.9 kg/m2) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups. RESULTS: IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) (p=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 (p=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position (p=0.022) and BMI (p<0.05). CONCLUSION: These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.
Anesthesia ; Body Mass Index ; Humans ; Overweight ; Prone Position ; Prospective Studies ; Skin ; Spine ; Supine Position ; Urinary Bladder

Simultaneous development of intrahepatic bile duct and gallbladder carcinoma is extremely rare. We report herein the case of an 86-year-old man found to have double cancer of the gallbladder and intrahepatic bile duct. Computed tomography and magnetic resonance cholangiopancreatography revealed a polypoid mass in the gallbladder and dilatation of the intrahepatic bile duct with intraductal papillary tumor in the left side of the liver. The patient underwent left hepatectomy, cholecystectomy with lymphadenectomy around the hepatoduodenal ligament. Pathological examination of the gallbladder revealed undifferentiated giant cell type carcinoma invading the muscularis propria. On the other hand, the liver tumor was intrahepatic intraductal papillary mucinous carcinoma in situ. Therefore, this was an extremely rare case of synchronous carcinoma of the gallbladder associated with intrahepatic cholangiocarcinoma.
Adenocarcinoma, Mucinous ; Aged, 80 and over ; Bile Ducts, Intrahepatic ; Carcinoma ; Cholangiocarcinoma ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Dilatation ; Gallbladder ; Gallbladder Neoplasms ; Giant Cells ; Hand ; Hepatectomy ; Humans ; Ligaments ; Liver ; Liver Neoplasms ; Lymph Node Excision ; Mucins

Intradural extramedullary (IDEM) ependymomas occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 57-year-old woman with an IDEM ependymoma. She was referred for the evaluation of a 4-month history of increasing neck pain and muscular weakness of the left extremities. Magnetic resonance imaging (MRI) of the cervical spine demonstrated an IDEM tumor with spinal cord compression. At the time of surgery, an encapsulated IDEM tumor without a dural attachment or medullary infiltration was noted, but the tumor capsule adherent to the spinal cord and root was left in place to minimize the risk of neurological sequelae. Histologic examination revealed a benign classic ependymoma. The post-operative course was uneventful and radiotherapy was performed. The patient showed an excellent clinical recovery, with no recurrence after 5 years of follow-up.
Ependymoma ; Extremities ; Female ; Follow-Up Studies ; Humans ; Hypogonadism ; Magnetic Resonance Imaging ; Middle Aged ; Mitochondrial Diseases ; Muscle Weakness ; Neck Pain ; Ophthalmoplegia ; Recurrence ; Spinal Cord ; Spinal Cord Compression ; Spine