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

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

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*

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*

Ganglioneuroma is an uncommon benign tumor and arise from neural crest cells or sympathetic and peripheral nerves. A 13-year-old boy was referred to our institute and presented with three-day history of right upper extremity weakness associated with neck pain for nearly one month. Magnetic resonance imaging showed right side dumbbell shaped extramedullary lesion at the C2-3 level extending outside through neural foramen. Paraspinal and posterior neck mass, cafe au lait spot was identified. We performed surgical decompression of the spinal cord by resection of intradural portion mass. Histopathological diagnosis was ganglioneuroma.
Adolescent ; Decompression, Surgical ; Diagnosis ; Ganglioneuroma* ; Humans ; Magnetic Resonance Imaging ; Male ; Neck ; Neck Pain ; Neural Crest ; Neurofibromatoses ; Peripheral Nerves ; Spinal Cord Compression* ; Spinal Cord* ; Upper Extremity

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

Syringomyelia associated with tuberculous meningitis is an extremely rare condition. Only a few studies have reported clinical experience with syringomyelia as a late complication of tuberculous meningitis. Twenty-six years after a tuberculous meningitis episode, a 44-year-old man presented with progressively worsening spastic paresis of the lower limbs and impaired urinary function for 2 years. Radiological examination revealed syringomyelia extending from the level of C2 to T9 and arachnoiditis with atrophy of the spinal cord between C2 and T3. We performed laminectomy from C7 to T1, dissected the arachnoid adhesion and placed a syringo-pleural shunt via keyhole myelotomy. One year after the operation, his neurological condition improved. The postoperative control magnetic resonance imaging revealed the correctly located shunt and significantly diminished syringomyelia cavities. We aim to discuss the mechanism of syrinx formation following tuberculous meningitis and to share our surgical therapeutic experience with this rare disease entity.
Adhesives* ; Adult ; Arachnoid* ; Arachnoiditis* ; Atrophy ; Cerebrospinal Fluid Shunts ; Humans ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Spasticity ; Paresis ; Rare Diseases ; Spinal Cord ; Syringomyelia* ; Tuberculosis, Meningeal*

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: This study is performed to compare the clinical courses (feature, treatment and outcomes) in patients with negative versus positive culture result in pyogenic spondylodiscitis. METHODS: From January 2001 to December 2006, we reviewed clinical data in 26 consecutive patients with pyogenic spondylodiscitis retrospectively. We exclude patients that underwent surgical irrigation or debridement with biopsy. We measured clinical outcomes, length of antibiotic administration, recurrence rate, laboratory studies (CRP, ESR and leukocyte counts) and complications between two groups. Clinical outcomes were rated with Macnab's criteria. RESULTS: Causative organisms were confirmed in 6 cases and the other 20 cases had negative culture result. Mean follow-up duration was 13 months. Mean intravenous antibiotics administration duration of patients having negative culture result was 8.4 weeks and oral was 5 months. On the other hand, in cases of positive culture result, mean intravenous duration was 8.7 weeks and oral was 5.2 months. Initial mean ESR and CRP were elevated, and decreased in both groups according to antibiotics medication (p<0.001 and p=0.001). But initial mean WBC count was normal range. There was no difference in tendencies of decrement of ESR and CRP between two groups (p=0.61 and p=0.571). Clinical outcomes (p=0.231) and complications (p=0.558) were not significantly different. There were no recurrence case for followup period. CONCLUSION: Negative culture results did not significantly affect the clinical course of pyogenic spondylodiscitis when we compared the clinical courses of both groups.
Anti-Bacterial Agents ; Biopsy ; Debridement ; Discitis ; Follow-Up Studies ; Hand ; Humans ; Leukocytes ; Recurrence ; Reference Values ; Retrospective Studies