OBJECTIVE: Various lesions including tumors occupying in the presellar and suprasellar regions have been traditionally removed by the transcranial approach. The new modified transsphenoidal approaches(TSAs) have been proposed to avoid the craniotomy and to get better surgical view. MATERIALS AND PATIENTS: The sellar floor and presellar anterior cranial fossa were removed through the sublabial transseptal transsphenoidal technique in the "transsphenoidal supradiaphragmatic intradural approach". One tuberculum sella meningioma and a suprasellar Rathke's cleft cyst confined to the pituitary stalk were removed via this approach. RESULTS: The dissection of the anterior intercavernous sinus, diaphragma sella, and arachnoid membrane allowed a wide surgical field of pre- and suprasellar areas and facilitated a safe removal of lesions without significant surgical complications in our cases. CONCLUSION: From the authors' limited experience, the advantages of this technique are as follows: 1) it can be easily applicable through a minor modification of the standard TSA, 2) excellent anatomical exposure of the structures located in the supradiaphragmatic suprasellar cistern, and 3) might be suitable to remove small lesions located in the presellar and adjacent to the pituitary stalk region.
Arachnoid ; Cranial Fossa, Anterior ; Craniotomy ; Humans ; Membranes ; Meningioma ; Pituitary Gland

To describe the detailed microsurgical anatomy of the clinoid(C5)segment of the internal carotid artery(ICA) and surrounding structures and clarify the anatomical relationships of this region emphasizing their clinical relevance, authors examined in 70 specimens from 35 formalin fixed cadaveric heads. Removal of the anterior clinoid process exposes the C5 segment of the ICA which is encircled by the thin inner dural layer of the cavernous sinus wall. Opening this membrane enables entrance into a narrow space that communicates with cavernous sinus through the proximal dural ring. Unlike the dura of the distal dural ring that is tightly attached to the ICA, the proximal dural ring is always incompetent. The C5 segment of the ICA has been considered by the majority of authors to be extracavernous. This understanding developed because most investigators overlooked the thin inner dural layer encircling the clinoid ICA. The narrow space between the inner dural layer and the ICA communicates with cavernous sinus through an incompetent proximal dural ring. Therefore, the clinoid ICA should be considered to be the most rostral portion of the cavernous (C4)segment of the ICA. The proximal dural ring is a surgical landmark rather than a true dural ring.
Cadaver ; Carotid Artery, Internal* ; Cavernous Sinus ; Formaldehyde ; Head ; Humans ; Membranes ; Research Personnel

In order to establish the predicted normal values of the systolic time intervals the duration of the systolic time intervals measured from simultaneous recordings of the electrocardiogram, the phonocardiogram and the carotid pulse tracing. The subjects studied were 160 healthy males and 160 females. The mean ages of males and females were 29 and 31 years old, respectively. The transformation period was not closely related to heart rate, and its mean values for males and females were 58 and 56 msec., respectively, and the mean for males and females combined was 57 msec. The remainder of the systolic time intervals, however, showed a significant linear and inverse relation to heart rate. Thus, based upon these data regression equations for the prediction of the normal values of electromechanical systole, left ventricular ejection time, mechinical systole, precjection period andisovolumiccontraction time for males, females, and males and females combined were obtained.
Adult ; Electrocardiography ; Female ; Heart Rate ; Humans ; Male ; Reference Values* ; Systole*

In the case presented a Botulinum toxin was injected into the extraocular muscles to treat limitation of eyeball movement due to retention of a metallic foreign body in the orbit. A 32-year-old man had had a major complaint of exohypotropia with diplopia for 15 years and a routine X-ray examination and C-T scan of the orbit revealed an approximately 5 cm long metallic foreign body bridging the right retrobulbar space, the right ethmoid sinus and the sphenoid sinus. During the course of extracting the foreign body, a lesion on the muscle, fatty tissue and fibrotic adhesion, resulting in disuse atrophy or mechanical damage of the right medial rectus and right superior rectus appeared likely. The injection of 5 units of Botulinum toxin into both the right lateral rectus and the right inferier rectus appeared clinically successful after 6 months, resulting in orthophoria and diminishing diplopia.
Adipose Tissue ; Adult ; Botulinum Toxins* ; Diplopia ; Ethmoid Sinus ; Foreign Bodies ; Humans ; Muscles ; Muscular Disorders, Atrophic ; Orbit* ; Sphenoid Sinus

Authors report a ganglion cyst located in spinal canal. The ganglion cyst is soft and movable mass in connective tissue around peripheral joints or tendon sheath. It has been rarely reported in lumbar spine. Symptoms and signs are usually difficult to distinguish it from other etiologies of radicular pain. The extradurally located ganglion cyst at L4-5 level which caused back pain and sciatica was removed with partial hemilaminectomy. Radiological finding of cyst in MRI may be variable, according to the composition of the cyst. Based on our experience and pertinent literatue, a ganglion cyst should be considered in the differential diagnosis of radicular pain in the presence of degenerative changes of the lumbar spine.
Back Pain ; Connective Tissue ; Diagnosis, Differential ; Ganglion Cysts* ; Joints ; Magnetic Resonance Imaging ; Sciatica ; Spinal Canal ; Spine* ; Tendons

BACKGROUND: Elderly-onset rheumatoid arthritis (EORA) is considered to be different from younger-onset rheumatoid arthritis (YORA) in clinical manifestations, laboratory indices, and in prognosis. However, the differences between these two diseases have not been clearly defined. The aim of this study was to more clearly define the clinical characteristics of EORA. METHODS: We retrospectively reviewed 50 EORA and 58 YORA patients who met the classification criteria established by the American College of Rheumatology (ACR). The two groups (EORA and YORA) were compared by three criteria. First, we considered the patterns of the joints involved and the presence of rheumatoid nodules. Second, we compared the disease activity indices and the level of auto-antibodies. Finally, we compared the use of medications. RESULTS: The mean age-of-onset and the women-to-men ratio in the EORA group was 66.2+/-5.5 years and 2.1:1, respectively. There was more large joint involvement seen in the EORA group. The titer of disease activity indices (ESR, CRP) and positive rate of auto-antibodies (rheumatoid factor, ANA, but not anti-CCP antibody) were also higher in the EORA group. We found no differences in the prescribed medications between the two groups. CONCLUSIONS: From these studies, we believe that EORA has higher disease activity indices at onset and greater joint involvement, along with higher titers of auto-antibodies as compared to YORA.
Aged* ; Aging ; Arthritis, Rheumatoid* ; Classification ; Humans ; Joints ; Prognosis ; Retrospective Studies ; Rheumatoid Nodule ; Rheumatology

Glomus jugulare tumors are usually slow growing, but highly vascularized tumor. The authors report the case of huge glomus jugulare tumor treated by surgical resection with preoperative embolization. A 32-year old male patient presented with a history of right-sided facial palsy and hearing disturbance. Magnetic resonance imaging demonstrated an irregular large mass with multiple signal voids in the right temporal area. Prior to surgical excision of tumor, the patient underwent superselective embolization. Embolization of the tumor and its dominant feeding arteries were achieved. Six days later, the patient underwent an infratemporal fossa approach to remove the tumor. The patient did well postoperatively except CSF leakage that was treated successfully by dura repair. We discuss the usefulness of preoperative embolization and infratemporal approach for the huge glomus jugulare tumor.
Adult ; Arteries ; Facial Paralysis ; Glomus Jugulare Tumor* ; Glomus Jugulare* ; Hearing ; Humans ; Magnetic Resonance Imaging ; Male

A new technique of endoscope assisted anterior cervical foraminotomy was developed to improve the conventional microsurgical anterior cervical foraminotomy. Microsurgical anterior cervical foraminotomy provides direct anatomical decompression of the compressed nerve root by removing the spondylotic spur or disc fragment while preserving the functioning segment of the disc. The authors modified the anterior cervical foraminotomy using the MED TM(Microendoscopic discectomy) system to minimize the skin incision, and to achieve safe drilling and easy retraction. The uncinate process was drilled under endoscopic visualization through a tubular retractor. This technique has been applied to 13 patients with single level radiculopathy due to posterolateral osteophyte or soft disc herniation. The nerve roots were decompressed successfully under endoscopic control as in conventional microsurgical foraminotomy through a 2cm skin incision. Postoperatively, all patients showed improvements in their radiculopathic symptomatologies. Corresponding CT scans confirmed satisfactory anatomical decompression in all patients. This surgical technique has shown good clinical outcomes with fast recovery.
Decompression ; Endoscopes* ; Foraminotomy* ; Humans ; Osteophyte ; Radiculopathy ; Skin ; Tomography, X-Ray Computed

To improve the surgical results of the removal of the pituitary tumors extending beyond the limit of the sella turcica, several modified transsphenoidal approachs have been proposed by many surgeons. A microanatomy of the sphenoid sinus, sellar, suprasellar and parasellar regions were studied in 50 formalin-fixed human cadaveric heads. Among them, microanatomical cadaveric dissections were performed in 5 specimens which were injected with colored silicone rubber. We aim to present a detailed microsurgical anatomy of structures surrounding the sella turcica. And also, the requisite microanatomical details necessary to extend the TSA to the medial compartment of the cavernous sinus and the supradiaphragmatic intradural space.
Cadaver ; Cavernous Sinus ; Head ; Humans ; Pituitary Neoplasms ; Sella Turcica ; Silicone Elastomers ; Sphenoid Sinus

Behcet's syndrome is a multi-systemic and chronic disorder that affects many organs. It has been suggested that the diagnosis was based on the presence of the 'major' and 'minor' clinical criteria. When thromobophlebitis, arthritis, central nervous system or gastrointestinal lesions are also present. Behcet's syndrome will be thought to be present in the appropriate geographic area. We report a case of superior vena cava syndrome caused by Behcet's disease in a 40-year-old man with recurrent oral aphthous ulcers and skin rashes on the anterior chest wall. There were multiple thrombosis of the superior vena cava, innominate and subclavian veins. This patient also had a solitary cecal ulcer with an ileocecal fistula and downhill varix. The chest CT, veno-cavography, pulmonary angiography and colon study were taken and follow-up was performed.
Adult ; Behcet's Syndrome/diagnosis ; Behcet's Syndrome/complications* ; Cecal Diseases/complications ; Human ; Intestinal Fistula/complications ; Male ; Superior Vena Cava Syndrome/etiology* ; Superior Vena Cava Syndrome/diagnosis ; Ulcer/complications