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

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.
Aged ; Anesthesia, Epidural ; Female ; Humans ; Hypesthesia ; Knee ; Magnetic Resonance Spectroscopy ; Neurologic Manifestations ; Osteoarthritis ; Paraplegia ; Recovery Room ; Spine

OBJECTIVE: The purpose of this study is to evaluate the clinical characteristics and surgical outcome of cerebellopontine angle (CPA) epidermoids presenting with trigeminal neuralgia. METHODS: Between 1996 and 2004, 10 patients with typical symptoms of trigeminal neuralgia were found to have cerebellopontine angle epidermoids and treated surgically at our hospital. We retrospectively analyzed the clinico-radiological records of the patients. RESULTS: Total resection was done in 6 patients (60%). Surgical removal of tumor and microvascular decompression of the trigeminal nerve were performed simultaneously in one case. One patient died due to postoperative aseptic meningitis. The others showed total relief from pain. During follow-up, no patients experienced recurrence of their trigeminal neuralgia (TN). CONCLUSION: The clinical features of TN from CPA epidermoids are characterized by symptom onset at a younger age compared to TN from vascular causes. In addition to removal of the tumor, the possibility of vascular compression at the root entry zone of the trigeminal nerve should be kept in mind. If it exists, a microvascular decompression (MVD) should be performed. Recurrence of tumor is rare in both total and subtotal removal cases, but long-term follow-up is required.
Cerebellopontine Angle ; Follow-Up Studies ; Humans ; Meningitis, Aseptic ; Microvascular Decompression Surgery ; Recurrence ; Retrospective Studies ; Trigeminal Nerve ; Trigeminal Neuralgia

We describe a 75-year-old man with a cervico-thoraco-lumbar spinal epidural abscess was extended to the psoas muscle. The patient complained high fever and back pain, followed by weakness of the lower extremities. He had received multiple epidural injections in a local pain clinic just few days before the onset of fever. The multi-segmental epidural abscess which was demonstrated by MRI compressed dural sac and cord. The best way to recommend him was to undergo a surgical decompression, but he refused the surgery. Next, we chose nonsurgical treatment such as longstanding parenteral antibiotic therapy and percutaneous drainage of psoas abscess. We could cultivate a causative organism and chose appropriate antibiotics. The patient experienced immediate relief of fever and the improvement of laboratory findings, gradual relief of back pain and full neurological recovery.
Aged ; Anti-Bacterial Agents ; Back Pain ; Decompression, Surgical ; Drainage ; Epidural Abscess ; Fever ; Humans ; Injections, Epidural ; Lower Extremity ; Pain Clinics ; Psoas Abscess ; Psoas Muscles

A 31-year-old man was admitted to our hospital due to hydrocephalus with neurosarcoidosis. Ventriculo-peritoneal shunting was performed in the right lateral ventricle with intravenous methylprednisolone. Subsequently, after 4 months, additional ventriculo-peritoneal shunting in the left lateral ventricle was performed due to the enlarged left lateral ventricle and slit-like right lateral ventricle. After 6 months, he was re-admitted due to upward gaze palsy, and magnetic resonance image showed an isolated fourth ventricle with both the inlet and outlet of fourth ventricle obstructed by recurrent neurosarcoidosis. Owing to the difficulty of using an endoscope, we performed neuronavigator-guided ventriculo-peritoneal shunting via the left lateral transcerebellar approach for the treatment of the isolated fourth ventricle with intravenous methyl prednisolone. The patient was discharged with improved neurological status.
Adult ; Bays ; Central Nervous System Diseases ; Endoscopes ; Fourth Ventricle ; Humans ; Hydrocephalus ; Lateral Ventricles ; Magnetic Resonance Spectroscopy ; Methylprednisolone ; Paralysis ; Prednisolone ; Sarcoidosis ; Ventriculoperitoneal Shunt