OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

No abstract available.
Epidermolysis Bullosa ; Muscular Dystrophy, Duchenne ; Ornithine Carbamoyltransferase ; Polymerase Chain Reaction* ; Preimplantation Diagnosis*

We report a case of linear arranged multiple cutaneous leiomyoma in a 45-year-old man. About 20 years ago, multiple normal skin colored firm papules developed on the left anterior chest and increased in number and size arranging in linear pattern. Some larger nodular lesions changed into brown in color and became painful after cold exposure. The lesions looked like keloid at first sight but the histopathologic finding showed typical leiomyoma in which the interlacing bundles of smooth muscle fibers with varying amount of collagen bundles intermingled.
Collagen ; Humans ; Keloid ; Leiomyoma* ; Middle Aged ; Muscle, Smooth ; Skin ; Thorax

OBJECTIVE: Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. METHODS: From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. RESULTS: The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16+/-2.1 and 8.03+/-2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3+/-2.9 and 1.2+/-3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). CONCLUSION: Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.
Back Pain ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc ; Muscles ; Operative Time ; Skin ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

We present a case of acute subarachnoid hemorrhage in a 64-year-old male with sudden onset of left ophthalmoplegia. Cerebral angiography demonstrated a 10mm elongated aneurysmal sac which arose from the left internal carotid-anterior choroidal artery junction. The pterional approach was performed as an early surgery for aneurysm clipping. At operative field, the anterior choroidal artery aneurysm which directed posteromedially and compressed the origin of left oculomotor nerve was confirmed. And the blood blister like-aneurysm was also seen at the superolateral portion of the proximal bifurcation of the internal carotid-anterior choroidal artery. A large anterior choroidal artery aneurysm was clipped and the blood blister like-aneurysm was reinforced. No case report has been previously published describing a ruptured anterior choroidal artery aneurysm accomplished with third cranial nerve palsy. We reported a case of multiple aneurysms of anterior choroidal artery that caused ipsilateral oculomotor nerve palsy.
Aneurysm* ; Arteries* ; Blister ; Cerebral Angiography ; Choroid* ; Humans ; Male ; Middle Aged ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Subarachnoid Hemorrhage

We present a case of acute subarachnoid hemorrhage in a 64-year-old male with sudden onset of left ophthalmoplegia. Cerebral angiography demonstrated a 10mm elongated aneurysmal sac which arose from the left internal carotid-anterior choroidal artery junction. The pterional approach was performed as an early surgery for aneurysm clipping. At operative field, the anterior choroidal artery aneurysm which directed posteromedially and compressed the origin of left oculomotor nerve was confirmed. And the blood blister like-aneurysm was also seen at the superolateral portion of the proximal bifurcation of the internal carotid-anterior choroidal artery. A large anterior choroidal artery aneurysm was clipped and the blood blister like-aneurysm was reinforced. No case report has been previously published describing a ruptured anterior choroidal artery aneurysm accomplished with third cranial nerve palsy. We reported a case of multiple aneurysms of anterior choroidal artery that caused ipsilateral oculomotor nerve palsy.
Aneurysm* ; Arteries* ; Blister ; Cerebral Angiography ; Choroid* ; Humans ; Male ; Middle Aged ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Subarachnoid Hemorrhage

OBJECTIVE: Incidence of chronic subdural hematoma (CSDH) is gradually increasing in young adults for several reasons. In this study, we aimed to identify features of CSDH noted in young adults that distinguish the disease from CSDH diagnosed in the elderly. METHODS: One hundred eighty-two patients with CSDH who underwent a total of 218 surgical procedures between January 2003 and February 2010 were retrospectively reviewed with regard to clinical presentation, radiographic results and prognosis including recurrence. To compare younger patients with the elderly, patients were divided into three groups on the basis of age (Group A: < or =40, Group B: 41-64, Group C: > or =65 years). RESULTS: Group A showed a male predominance (p=0.0001), lower rate of recurrence (p=0.0012), shorter symptom duration (p=0.035), and fewer leading signs such as hemispheric symptoms (p=0.005) compared to Groups B and C. Radiologic findings such as maximal hematoma thickness (p<0.0001) and degree of midline shift (p=0.028) were less severe in Group A than Groups B and C. Alcoholism was the most prevalent illness in all three groups. When exempting infants with hematologic malignancy, non-recurrence, previous trauma history, headache as leading symptom, and no mortality were all common in younger adults (all p<0.05). CONCLUSION: Young adults with CSDH show less severe clinical and radiologic features as well as fewer recurrences than noted in the elderly population. Even if a clinician's index of suspicion of CSDH in young adults complaining of headache is not high, meticulous radiologic surveillance could find CSDH, leading to satisfactory results including less frequent recurrence.
Adult ; Aged ; Alcoholism ; Headache ; Hematologic Neoplasms ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Infant ; Male ; Prognosis ; Recurrence ; Retrospective Studies ; Young Adult

PURPOSE: To evaluate the prognostic factors and outcomes of dexamethasone intravitreal implant (DEX implant) for intravitreal bevacizumab refractory macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: This was a retrospective, interventional case series. Medical records were reviewed, and a total of 38 eyes that were treated with DEX implant for macular edema secondary to BRVO that did not respond to at least two consecutive intravitreal bevacizumab injections (IBIs) were included. Best-corrected visual acuity (BCVA), central subfield macular thickness, and central subfoveal choroidal thickness were evaluated at baseline, 2 months, and 6 months after DEX implantation. RESULTS: Patients had undergone an average of 6.32 ± 4.66 prior IBI treatments. The average BCVA improved from 0.53 ± 0.26 to 0.41 ± 0.25 and 0.44 ± 0.23 logarithm of the minimal angle of resolution (logMAR) at 2 and 6 months, respectively (p < 0.001). The average central subfield macular thickness was 504.00 ± 121.54 µm at baseline and changed to 293.21 ± 74.17 µm and 427.28 ± 119.57 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.002). Average central subfoveal choroidal thickness was 237.46 ± 92.21 µm at baseline and changed to 204.75 ± 74.74 µm and 226.86 ± 90.77 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.455). Twenty-two eyes (58%) gained ≥0.1 logMAR at 2 months, while 16 eyes showed no improvement. Low BCVA at symptom presentation, low baseline BCVA, and shorter duration of macular edema were correlated with increased BCVA after treatment. CONCLUSIONS: The DEX implant improves functional and anatomical outcomes for up to 6 months in about half of the patients treated with IBI refractory macular edema secondary to BRVO, particularly in patients with low initial and baseline BCVA.
Bevacizumab* ; Choroid ; Dexamethasone* ; Humans ; Intravitreal Injections ; Macular Edema* ; Medical Records ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity