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

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

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

case of occult intrasacral meningocele associated with arachnoid cyst in a 35-year-male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and urinary incontinence for several months. Myelography revealed delayed filling of a meningocele. Computed tomographic(CT) myelography and magnetic resonance(MR) imaging showed huge intrasacral mass without neural elements. A favorable outcome was achieved by decompression of the cyst, obliteration of the conduit to subarachnoid space, and fenestration of arachnoid cyst into subarachnoid space.
Arachnoid* ; Constipation ; Decompression ; Humans ; Meningocele* ; Myelography ; Sacrum ; Subarachnoid Space ; Urinary Incontinence

The authors report a case of far lateral disc herniation at L4-5 found one year after percutaneous laser lumbar discectomy. The patient was found to be suffering from new-onset right lumbar radiculopathy 6 months after his first operation, and post operative lumbar MRI confirmed a far lateral extraforaminal disc herniation at L4-5, with compression of the nerve. This corresponded to the nucleotomy site of the probe. The patient underwent surgery employng the combined paraspinal intertransverse and interlaminar approach, and his symptoms were relieved. This case emphasizes the importance of removing nuclear material, and shows that remaining material can herniate through a percutaneous discectomy window.
Diskectomy* ; Diskectomy, Percutaneous ; Humans ; Magnetic Resonance Imaging ; Radiculopathy

The authors report a case of rostral mesencephalic dysfunction due to obstructive hydrocephalus secondary to periaqueductal tumor who suffered multiple shunt failures and shunt revision. This patient presented with clinical syndromes, including akinetic mutism and diencephalic autonomic epilepsy. He had computed tomography(CT) and magnetic resonance(MR) findings of dilatation of ventricular system with periaqueductal tumor. The anatomical substrates of clinical findings are reviewed. A discussion of the probable mechanism proposes that dilatation of 3rd ventricle and rostral aqueduct sufficiently explains the entire syndrome.
Akinetic Mutism ; Dilatation ; Epilepsy ; Humans ; Hydrocephalus* ; Mesencephalon*

The authors describe a case with an uneventful outcome following prolonged temporary arterial occlusion during surgery for an aneurysm of the dorsal internal carotid artery(ICA). It has been shown that in various situations arising during aneurysm surgery, temporary arterial occlusion effectively prevents a premature rupture. It is not possible, however, to predict beforehand what the permissible occlusion time for any individual patient might be. During dissection of a blister aneurysm of the ICA, premature rupture developed, and intermittent temporary occlusion of the ICA, which lasted for about 150 minutes, was then undertaken. In addition, intraoperative neuroprotection was effected in several ways, including intermittent reperfusion and the administration of mannitol, thiopental sodium and steroid. There were no significant postoperative neurological deficits. To the authors' knowledge, this report is unusual in that it documents prolonged temporary occlusion without major neurological sequelae in intracranial aneurysm surgery. Permissible temporary occlusion time and neuroprotective methods are also discussed.
Aneurysm* ; Blister ; Carotid Artery, Internal* ; Humans ; Intracranial Aneurysm ; Mannitol ; Reperfusion ; Rupture ; Thiopental