PURPOSE: To collect data regarding the pronator-sparing approach using an anatomical study, which compared the fractures of the distal radius and pronator quadratus (PQ) muscle of an adult cadaveric radius. MATERIALS AND METHODS: Fourteen adult cadaver wrists that did not have previous fractures or previous surgery and computed tomography data 32 fractures of the distal radius, were obtained. The size of the distal fracture fragment was measured using the picture archiving and communication system. The distance between the distal margin of the PQ muscles and the articular margin was measured using a caliper. RESULTS: The PQ muscles had an average distance of 10.9 mm (range, 8-13 mm) from the radial styloid process and 10 mm (range, 8-12 mm) from the distal radioulnar joint (DRUJ). The fracture sites were located an average of 21.8 mm (range, 10-39 mm) from the radial styloid process and an average of 14.4 mm (range, 10-28 mm) from the DRUJ. Distal radial fractures overlapped an average of 11.8 mm from the radial styloid process and an average of 3.5 mm from the DRUJ. CONCLUSION: The pronator-sparing approach could be applied to a functionally reduced fracture because the non-overlapping area of the distal fracture fragment was > or =10 mm and it is possible to repair the anatomic plate without detaching the PQ muscle.
Adult ; Cadaver ; Humans ; Joints ; Muscles ; Radius ; Wrist

No abstract available.

No abstract available.

The minimally invasive plate osteosynthesis (MIPO) which is extensively performed, is very dependent on the indirect reduction technique to prevent the exposure of fracture sites. Indirect reduction with the use of the femoral distractor is a much more efficient technique to restore the length in the fracture of lower limbs. However, the femoral distractor cannot be used for fracture of upper limbs, and other instruments for indirect reduction have not yet been reported. Therefore, we introduce the novel indirect reduction technique with the use of the lumbar spreader for the MIPO of upper limbs.
Lower Extremity ; Upper Extremity

Authors report 10 cases of intracranial inflammatory granulomatous lesions which were identified on CT scan and proven pathologically after surgical excision. They were composed of three cases of tuberculoma, three cases of degenerated cysticercus, two cases of healed abscess and two cases of non-specific inflammatory lesions. Most patients were children or young adults. Seizure was the most frequent presenting symptom. All cases had characteristic CT findings in common : a small nodular or ring-like lesion with strong enhancement surrounded by irregular-shaped low density area. Surgical exploration is of value in that specific diagnosis would not be possible with clinical and radiological findings only.
Abscess ; Child ; Cysticercus ; Diagnosis ; Granuloma* ; Humans ; Seizures ; Tomography, X-Ray Computed* ; Tuberculoma ; Young Adult

The simultaneous occurrence of multiple primary brain tumors of histologically different types is very rare, and accounts for only about 0.4% of all the primary brain tumors. Recently, we experienced two cases of double primary intracranial tumors in combinations of meningioma-glioblastoma and pituitary adenoma-lymphoma. First case is a 55-year-old woman who underwent surgery due to a mass in her left posterior parietal area detected by brain magnetic resonance imaging(MRI), and it was histologically confirmed as atypical meningioma. After radiation treatment, a new mass was detected in the right temporal lobe on follow-up MRI and glioblastoma was confirmed after the second operation. Second case is a 50-year-old woman who was found to have multiple masses in the suprasellar and right thalamic region. They were confirmed as pituitary adenoma and malignant lymphoma by transsphenoidal adenoidectomy (TSA) and stereotactic biopsy, respectively. Case 1 and 2 showed metachronous and synchronous development of secondary intracranial tumors, respectively. In case one, although the patient received radiotherapy, the radiation field was far from the second tumor and the latency period between irradiation and the appearance of the second tumor was too short. Therefore, in this case, we concluded that radiation did not play a major role in the development of the new tumor.
Adenoidectomy ; Biopsy ; Brain ; Brain Neoplasms ; Female ; Follow-Up Studies ; Glioblastoma ; Humans ; Latency Period (Psychology) ; Lymphoma ; Magnetic Resonance Imaging ; Meningioma ; Middle Aged ; Pituitary Neoplasms ; Rabeprazole ; Radiotherapy ; Temporal Lobe

Acute or subacute myelopathy with spontaneous thrombosis of the veins in a patient with a spinal arteriovenous malformation(AVM) has been referred to as "Foix-Alajouanine syndrome(FAS)". A previously healthy 15-year-old girl developed neurological illness with progressive lower extremity weakness and low back pain. The MRI demonstrated the diffuse swelling of the spinal cord around the 10th thoracic level, suggesting myelopathy. Her neurological symptoms deteriorated to paraplegia, voiding difficulty and areflexia. Spinal arteriography did not demonstrate a vascular lesions such as arteriovenous malformation(AVM) or arteriovenous fistula(AVF). Operation revealed diffuse necrosis of the spinal cord and one abnormal thrombosed drainage vein. Progressive clinical illness, the histopathology of the patchy necrosis of spinal cord tissue and many thickened blood vessels are compatible with Foix-Alajouanine syndrome. We report a case of Foix-Alajouanine syndrome with a review of the literature.
Adolescent ; Angiography ; Arteriovenous Fistula ; Arteriovenous Malformations ; Blood Vessels ; Drainage ; Female ; Humans ; Low Back Pain ; Lower Extremity ; Magnetic Resonance Imaging ; Necrosis ; Paraplegia ; Spinal Cord ; Spinal Cord Diseases ; Thrombosis ; Veins

The best treatment modality for spontaneous intracerebral hemorrhage still remains to be controversial. Stereotactic surgery can be performed safely and easily but its indication and optimal timing of operation have to be determined. We treated 80 patients with spontaneous intracerebral hemorrhage by stereotactic surgery from October 1994 to December 1997. We investigated clinical status of the patients before and after surgery, amount of hematoma, evacuation rate, timing of operation, transcranial Doppler sonography(TCD), and computerized tomography(CT) findings. The results were as follows: 1) The outcome of early surgery(within 24 hours of bleeding) was better than that of late surgery(after 24 hours of bleeding)(p=0.034). 2) The outcome was better in the patient with higher evacuation rate(p=0.014). 3) TCD monitoring showed beneficial effect of surgery on hemodynamic status. We conclude that the early surgery within 24 hours after bleeding is correlated with the better outcome, and TCD monitoring is useful for evaluation of perioperative hemodynamic change.
Cerebral Hemorrhage* ; Hematoma ; Hemodynamics ; Hemorrhage ; Humans

OBJECTIVE: To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. MATERIALS AND METHOD: To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection. RESULTS: The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit. CONCLUSION: Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.
Cellulose ; Cranial Nerves ; Facial Nerve ; Facial Nerve Injuries ; Follow-Up Studies ; Humans ; Incidence ; Mastoid ; Mortality ; Neuroma, Acoustic*

OBJECTIVE: Giant pituitary adenomas are rare. The location of these adenomas are close to vital neural and vascular structures with widespread extensions that makes the radical surgical management difficult. METHODS: From October 1994 to August 1998, we experienced 20 patients with giant pituitary adenomas out of 178 surgically treated pituitary adenoma patients. Giant pituitary adenoma was diagnosed on the basis of the longest diameter of being more than 4cm in MRI scan. We reviewed the clinical presentation, types of tumor, size and degree of suprasellar or parasellar extension, routes of surgical approach, postoperative surgical outcomes and complications. RESULTS: The incidence of giant pituitary adenomas was 11%. The most common chief complaint was visual disturbance(n=16). The non-functioning adenoms(n=16) were the majority and the other 4 patients were functioning adenomas(prolactinoma n=2, acromegaly n=1, cushing's disease n=1). The patients underwent transsphenoidal approach(TSA)(n=15) or transcranial approach(TCA)(n=5). Gross total or subtotal removal were achieved in 60% of TSA group(9 of 15) and 40% of TCA group(2 of 5). Postoperative complications were in 6 patients with TSA; cerebrospinal fluid(CSF) leakages(n=2), postoperative bleeding(n=2), transient diabetes insipidus(DI)(n=2). Visual function was improved in 69%(9 of 13) after TSA and 40% after TCA. Surgical results in the TSA group were better than those in transcranial approach group, and there were fewer and less severe postoperative complications. CONCLUSION: Even in the giant pituitary adenomas, conventional transsphenoidal approach was effective as the initial treatment modality in terms of effective decompression, functional recovery, and low morbidity.
Acromegaly ; Adenoma ; Decompression ; Humans ; Incidence ; Magnetic Resonance Imaging ; Pituitary Neoplasms* ; Postoperative Complications