Giant cavernous malformations (GCMs) occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 20-year-old woman with a GCM. She was referred due to two episodes of generalized seizure. Computed tomography and magnetic resonance image demonstrated a heterogeneous multi-cystic lesion of 7 x 5 x 5 cm size in the left frontal lobe and basal ganglia, and enhancing vascular structure abutting medial portion of the mass. These fingings suggested a diagnosis of GCM accompanying venous angioma. After left frontal craniotomy, transcortical approach was done. Total removal was accomplished and the postoperative course was uneventful. GCMs do not seem differ clinically, surgically or histopathologically from small cavernous angiomas, but imaging appearance of GCMs may be variable. The clinical, radiological feature and management of GCMs are described based on pertinent literature review.
Basal Ganglia ; Caves ; Craniotomy ; Female ; Frontal Lobe ; Gas Chromatography-Mass Spectrometry ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Spectroscopy ; Seizures ; Young Adult

No abstract available.
Horner Syndrome* ; Intervertebral Disc Displacement ; Spinal Cord Compression*

Cavernous malformations (CMs) arising from the optic nerve and chiasm are extremely rare. The authors present a case of 39-year-old woman with CMs of the optic chiasm. She was referred due to sudden onset of bitemporal hemianopsia and headache, the so-called 'chiasmal apoplexy'. MRI findings suggested a diagnosis of hemorrhage and vascular malformation of the optic chiasm. Pterional craniotomy revealed an intrachiasmatic cavernous malformation with hemorrhage. The malformation was totally excised, but field deficits remained unchanged after surgery.
Adult ; Caves ; Craniotomy ; Female ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Optic Chiasm ; Optic Nerve ; Stroke ; Vascular Malformations

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma.
Animals ; Gait ; Hand ; Humans ; Hypesthesia ; Intraoperative Neurophysiological Monitoring ; Laminectomy ; Lipoma* ; Lordosis ; Lower Extremity ; Male ; Neck Pain ; Neurologic Manifestations ; Outpatients ; Spinal Cord ; Spinal Dysraphism*

OBJECTIVE: The purpose of this study is to evaluate clinical and radiological outcomes analysis of the laminoplasty in the elderly patients, and to compare with the non-elderly patients. METHODS: A retrospective study of the short term result in patients who had treated with the laminoplasty for cervical spondylotic myelopathy (CSM) was performed. From January 2008 to December 2012, total 62 patients were operated with single open-door technique because of CSM; 28 patients were the elderly and 34 patients were the non-elderly. We evaluated some factors including sex, symptom duration, estimated blood loss during operation, operation time, hospitalization day, complications, pre- and postoperative modified Japanese Orthopedic Association (mJOA) score, recovery rate of mJOA score, achieved mJOA score, mean cervical canal width and expansion ratio of antero-posterior diameter in order to identify difference between the two group. Clinical outcomes were calculated with the recovery rate of mJOA score at the time of one year after operation. RESULTS: Mean age were 71.9 in the elderly group and 52.9 in the non-elderly group. Although postoperative mJOA score in the elderly group was lower than that of the non-elderly group, achieved mJOA score was statistically same between the two groups. Other clinical and radiological outcomes were also statistically same. CONCLUSION: We conclude that the laminoplasty also assures good clinical outcomes in the elderly patients with CSM, same as in the non-elderly group.
Aged* ; Asian Continental Ancestry Group ; Hospitalization ; Humans ; Orthopedics ; Retrospective Studies ; Spinal Cord Diseases*

Seizure following percutaneous endoscopic lumbar discectomy (PELD) is extremely rare. We report that generalized seizure occurred in a patient with radiating right leg pain after PELD under sevoflurane anesthesia. Cerebrospinal fluid (CSF) was detected from a dura tear in the operative field. On emergence from anesthesia, generalized tonic-clonic activity continued for approximately 2 minutes and the level of consciousness was decreased to a stuporous state. Under sedation, a pneumocephalus which was thought to be caused by the dura tear was evaluated with a brain computed tomography (CT) and a continuous slow wave was found on electroencephalography (EEG) without any epileptiform discharges. Eight hours postoperatively, the decreased level of consciousness recovered, and after 2 weeks, the patient was discharged without any neurologic sequealae. Clinicians should recognize the epileptogenic potential of sevoflurane and limit the maximum dose with avoidance of hypocapnia by hyperventilation. If an intracerebral lesion is accompanied, it may increase the possibility of the occurrence of seizure.
Anesthesia ; Brain ; Consciousness ; Diskectomy ; Electroencephalography ; Humans ; Hyperventilation ; Hypocapnia ; Leg ; Methyl Ethers ; Pneumocephalus ; Seizures ; Stupor

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a choice of surgical procedure for cervical degenerative diseases associated with radiculopathy or myelopathy. However, the patients undergoing ACDF still have problems. The purpose of the present study is to evaluate the radiologic results of 3 different methods in single-level ACDF. METHODS: We conducted a retrospective collection of radiological data from January 2011 to December 2014. A total of 67 patients were included in this study. The patients were divided into 3 groups by operation procedure: using stand-alone cage (group cage, n=20); polyether-ether-ketone (PEEK)-titanium combined anchored cage (group AC, n=21); and anterior cervical cage-plate (group CP, n=26). Global cervical lordosis (C2-C7 Cobb angle), fused segment height, fusion rate, and cervical range of motion (ROM) were measured and analyzed at serial preoperative, postoperative, 6-month, and final 1-year follow-up. RESULTS: Successful bone fusion was achieved in all patients at the final follow-up examination; however, the loss of disc height over 3 mm at the surgical level was observed in 6 patients in group cage. Groups AC and CP yielded significantly better outcomes than group cage in fused segment height and cervical ROM(p=0.01 and p=0.02, respectively). Furthermore, group AC had similar radiologic outcomes to those of group CP. CONCLUSION: The PEEK-titanium combined anchored cage may be a good alternative procedure in terms of reducing complications induced by plate after ACDF.
Animals ; Cervical Vertebrae ; Diskectomy* ; Female ; Follow-Up Studies ; Humans ; Lordosis ; Methods* ; Postoperative Complications ; Radiculopathy ; Radiography ; Range of Motion, Articular ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Fusion

Acute spontaneous subdural hematoma (SDH) of arterial origin is very rare. We report a case of acute spontaneous SDH that showed contrast media extravasation from cortical artery on angiograms. A 58-year-old male patient developed sudden onset headache and right hemiparesis. Brain CT scan demonstrated acute SDH at left convexity. The patient was drowsy mentality on admission. He had no history of head trauma. Cerebral angiography was performed and revealed a localized extravasation of the contrast media from distal cortical MCA branch. After angiography, the patient deteriorated to comatose mentality. Decompressive craniectomy for removal of SDH was performed. We verified the arterial origin of the bleeding and coagulated the bleeding focus. The histological diagnosis was aneurysmal artery. He recovered after surgery with mild disability. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered.
Aneurysm ; Angiography ; Arteries ; Brain ; Cerebral Angiography ; Coma ; Contrast Media ; Craniocerebral Trauma ; Decompressive Craniectomy ; Extravasation of Diagnostic and Therapeutic Materials ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Male ; Middle Aged ; Paresis

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

There have been very few reports in the literature of Guillain-Barre syndrome (GBS) after spinal surgery. We present a unique case of GBS following spinal fusion for thoracic vertebral fracture. The aim of this report is to illustrate the importance of early neurological assessment and determining the exact cause of a new neurological deficit that occurs after an operation.
Guillain-Barre Syndrome ; Spinal Fusion