To study the effect of extracranial-intracranial(EC/IC) bypass on symptomatic patients with hemodynamic cerebral ischemia, we prospectively reviewed 76 patients who underwent EC/IC bypass surgery in patients with occlusive cerebrovascular disease. A series of 76 patients treated in a 7 years period met following criteria. (1) symptomatic internal carotid artery(ICA) or middle cerebral artery(MCA) obstruction or stenosis over 80%. (2) decrease in basal cerebral blood flow(CBF) over 10%. (3) decreased reactivity of CBF in response to acetazolamide. Among these, the types of ischemic episodes were transient ischemic attack(TIA) or reversible ischemic neurological deficit(RIND) in 39, minor stroke in 22, and major stroke in 15. Based on our criteria, superficial temporal artery(STA)-MCA anastomosis was performed in 67 cases and EC-IC bypass grafting using saphenous vein or radial artery in 9. Average follow up period was 26 months(3 months~7 year). Patency of bypass was confirmed by postoperative angiography or magnetic resonence angiography(MRA) in all case except four cases. Of the 72 patients with patiency of bypass, 68 patients(94%) have had an excellent to good outcome with improvement of preoperative neurologic or cognitive dysfunction, 3 patients showed no improvement of preoperative neurologic symptoms and remaining one patient had new developed deficit. All 72 patients with patency of bypass had experienced no further cerebral ischemic events during following period. Postoperative significant improvement of CBF to acetazolamide was showed in 68 cases(94%) of the 72 cases with patency of bypass, while the basal CBF showed significant improved in 31cases. Postoperative permanent neurologic deficit occurred only in one. In view of these finding, the author suggest that EC-IC bypass surgery is a reliable and resonably safe method for establishing new pathways of collateral circulation to the brain and to be considered as an appropriate therapy for improvement of the cerebrovascular reserve capacity in patients with hemodynamic cerebral ischemia, defined using the strict selection criteria employed in this study.
Acetazolamide ; Angiography ; Brain ; Brain Ischemia ; Collateral Circulation ; Constriction, Pathologic ; Follow-Up Studies ; Hemodynamics ; Humans ; Neurologic Manifestations ; Patient Selection ; Prospective Studies ; Radial Artery ; Saphenous Vein ; Stroke ; Transplants

A rare case of intramedullary Cysticercosis, at the thoracic cord is introduced which was misdiagnosed as intramedullary tumor and was confirmed after operation. After myelogram developed progressive paraplegia, which was not improved after operation. The myelographic finding of intramedullary Cysticercosis can't differenciate from intramedullary tumor and we have to consider this condition making diagnosis of intramedullary tumor.
Cysticercosis* ; Diagnosis ; Paraplegia

The objective of aneurysm surgery is to exclude the aneurysm from the circulation while preserving blood flow distal to the lesion. In certain situations, the aneurysm neck cannot be clipped safely or the parent vessel reconstructed, primarily in large or giant size with incorporation of parent vessels or perforating arteries, calcification at the aneurysm base, and fusiform or dissecting aneurysms. In such cases, occlusion of the parent vessel is a treatment of option. In many patients, however, sacrifice of the parent artery has an associated risk of ischemic stroke. Therefore, sacrifice of the parent vessel can be supplimented with distal revascularization to provide the necessary distal blood flow while allowing the aneurysm to be trapped. The indications, options, and surgical approaches are described with review of literatures. Finally the authors' experiences of revascularization in 7 patients with unclippable aneurysms are reported.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Stroke

The authors analysed the results of 300 microvascular decompression(MVD) procedures for hemifacial spasm. The follow up period ranged from 6months to 3years. Of these, 70% were women(mean age 54). The vessel most frequently found to compress the facial nerve was the posterior inferior cerebellar artery(43.3%) followed by anterior inferior cerebellar artery(26.7%). For the surgical results, 210 patients(70%) had complete relief of spasm within 3 days after MVD, 65 patients(21.7%) subsequently experienced complete relief, noted in 4 days to 6 months after MVD, ten patients had delayed partial relief and remaining 15 patients showed no improvement. Twelve patients of these 15 unresponsive patients underwent reoperation without beneficial results. Recently the authors have monitored facial elctromyography(EMG) intraoperatively to observe the abnormal late response. There were few cases of permanant major complications, including two cases of ipsilateral hearing loss, ataxia and no operation-related death. These results suggest that MVD is a safe and definite treatment for hemifacial spasm, if performed by experienced surgeon with gentle operative technique, and with intraoperative monitoring such as auditory evoked potential and facial EMG, better surgical results with less complications can be expected.
Ataxia ; Evoked Potentials, Auditory ; Facial Nerve ; Follow-Up Studies ; Hearing Loss ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery* ; Monitoring, Intraoperative ; Reoperation ; Spasm

The surgical results of 1500 patients with intracranial aneurysms operated in the neurosurgical department of our university hospital during the 17 year period from 1978 to 1994 were analysed with regard to the preoperative neurological status, preoperative CT findings and timing of surgical intervention. On the follow up examinations taken between 6 months to 9 years after operations, 1115 patients(74.3%) were classified as those having a good recovery, but 206 patients(13.7%) and 88 patients(5.9%) suffered some morbidity(fair and poor outcome respectively), and 91 patients(6.1%) died. Surgical results for the patients with good neurological status at admission were generally good: good outcome for the patients with Hunt and Hess grade 1 was 87.8% and that for those with grade 2 was 80.9%, while it was 29.6% and 6.7% for patients with grade 4 and 5, respectively. There was no difference of the rate of good outcome between early(0 to 3 days after bleeding) and late surgery(14 days or more after subarachnoid hemorrhage) groups, if poor graded cases were excluded from the early surgery group. Outcome was worse if the surgery was performed during the period between 4th and 10th days after initial bleeding. The major causes of unfavorable outcome(poor and dead) were initial hemorrhagic insults and delayed ischemic deficits. For further improvement of the overall surgical outcome, several factors must be concerned. First, early surgical intervention is recommended in good grade patients on admission but it should probably be delayed in patients with poor grades. Second, active management of poor grade patients should be scrutinized. Third, incidence of delayed ischemia may be lowered with positive consideration and preventive treatment towards vasospasm.
Aneurysm, Ruptured* ; Follow-Up Studies* ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Ischemia

Primary intracranial melanoma is uncommon. These tumors most commonly occur at the temporal lobe, cerebellum and cerebellopontine angle. We report a case of intracranial malignant melanoma of the occipital lobe in a 60-year-old man who presented with headache and visual disturbance. The mass showed hyperintensity on T1-weighted images and hypointensity on T2-weighted magnetic resonance images. He underwent gross total removal of tumor and received radiotherapy. Followup imaging studies showed neither recurrence nor any signs of residual disease for 4 months.
Cerebellopontine Angle ; Cerebellum ; Follow-Up Studies ; Headache ; Humans ; Melanoma* ; Middle Aged ; Occipital Lobe ; Radiotherapy ; Recurrence ; Temporal Lobe

INTRODUCTION: Adult stem cells generate differentiated cells beyond their own tissue boundaries. To prove that stem cells derived from bone marrow is capable of therapeutic application in cerebral ischemic patients, we performed this study. MATERIAL AND METHOD: We transplanted adult stem cells derived from bone marrow of the patient's iliac bone to 5 patients with cerebral infarction. Of 5 patients, two patients had internal carotid artery occlusion, two patients had severe stenosis of the middle cerebral artery, remaining one patient had occlusion of the branch of the middle cerebral artery. At first, we performed extracranial-intracranial bypass surgery in all patients, and then implanted bone marrow stem cell in the infarcted brain and boder zone area directly under the microscopic navigator and also injected bone marrow stem cells through the grafted vessel to the infarcted area. Two weeks after bypass surgery, we confirmed the patency of bypass graft with external carotid angiography. In the same setting, mesenchymal stem cells acquired from autologous bone marrow were superselectively injected into the bypass graft via a microcatheter. Postoperative evaluation of the patients was decided to the neurological status and the degree of reduction of the high signal area on the T2 image of the postoperative MRI. RESULT: All patients who underwent bypass surgery with stem cell implantation had an uneventful postoperative course and showed some improvement of preoperative neurologic dysfunction. Postoperative significant improvement of cerebral vasoreactivity to acetazolamide was showed in all patients. On postoperative 3 months MRI, three patients showed significant reduction of the high signal area on the T2 image, and also improved neurological status on those patients. Other one patient showed moderate degree of the reduction of the high signal area on T2 image of the postoperative MRI, but neurological status of that patient slightly improved. Remaining one patient who showed poor circulation via bypass graft does neither reduction of the high signal area on T2 image of the postoperative MRI nor improvement of the neurological status of that patient. CONCLUSION: In patients of fixed cerebral infarction with major neurologic deficit, EC-IC bypass surgery is not effective, even though infarcted area filled by grafted vessel extensively. In those patients, autologous bone marrow stem cell implantation combined with bypass seems to be expect neuronal regeneration.
Acetazolamide ; Adult Stem Cells ; Angiography ; Bone Marrow* ; Brain ; Carotid Artery, Internal ; Cerebral Infarction* ; Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Mesenchymal Stromal Cells ; Middle Cerebral Artery ; Neurologic Manifestations ; Neurons* ; Regeneration* ; Stem Cell Transplantation* ; Stem Cells* ; Transplants

With a frame-based system, stereotactic dose of radiation is delivered to the target in one day. The patient is uncomfortable with a frame based system and the staff is forced to produce a treatment plan under time pressure. And then a single dose of radiation is delivered. Our frameless fractionated conformal stereotactic radiotherapy system uses markers, permanently placed in the head. There is more time to prepare and perform the treatment. The point reference system is a frameless system, allowing a separation in time between all of the steps in a stereotactic procedure. And these reference points allow physician precisely to set up the patient again and again. Our system is made to spare normal cells within target volume by fractionating the tumor dose. We have treated 43 patients with multifraction regimen using 6-MV linear accelerator. All patient tolerated the treatment well and no significant complication were seen. Although small in number experienced, this technique seems to be feasible and safe for treating brain tumor and vascular malformation.
Arteriovenous Malformations* ; Brain Neoplasms* ; Brain* ; Head ; Humans ; Particle Accelerators ; Radiotherapy ; Vascular Malformations

The intracranial blood vessels of the dura and the pia receive sensory afferent innervations from trigeminal nerve which has been believed to play a critical role in the mediation of vascular headache such as migraine. The purpose of this study was to discover the mechanism by which the interaction between trigeminal ganglion neurons and the function of cerebral blood vessels. Using electrophysiological recording, we studied the responses of trigeminal ganglion neurons to electrical stimulation of middle meningeal artery(MMA), superior sagittal sinus(SS) and transverse sinus(TS) in rats. Sumatriptan is a highly selective agonist for 5-HT1D receptor subtype which mediates vasoconstriction of cerebral blood vessels. We observed responses to electrical stimulation in trigeminal ganglion neurons and meningeal blood flow(MBF) after intravenous injection of sumatriptan. The results were as follows: 1) The presumed mean conduction velocities of the cells activated MMA, SS and TS by electrical stimulation were approximately 1.5, 2.9 and 2.9m/s, respectively. These were presumed to be nociceptive small myelinated or unmylinated sensory fibers. 2) The action potential discharges of trigeminal ganglion neurons on MMA, SS and TS in the experimental control groups were 671+/-39.49, 856+/-63.95 and 494+/-21.54microV, respectrely. The action potential discharges of sumatriptan groups on MMA, SS and TS(393+/-20.10, 562+/-32.26 and 262+/-18.94microV, respectively) were significantly decreased compared to that of the experimental control groups. 3) The mean MBF of normal control group was 63.29+/-7.54ml/100g/min. The mean MBF of the experimental control groups on MMA, SS and TS were 97.13+/-9.91, 104.28+/-12.54 and 91.82+/-6.41ml/100g/min, respectively(p<0.05). MBF of sumatriptan group before stimulation was significantly decreased(compared to normal: 37.17+/-4.76ml/100g /min vs 63.29+/-7.54ml/100g/min). The mean MBF of sumatriptan groups on MMA, SS and TS were 57.11+/-4.48, 66.56+/-6.23 and 56.07+/-5.00ml/100g/min, respectively. Compared to that of the experimental control groups, the MBF of the sumatriptan groups were significantly decreased. In conclusion, the activation of trigeminal sensory afferents by the electrical stimulation of the dural vessel may create vasodilatation and increase cerebral blood flow which may lead to vascular headaches via trigeminal ganglion to brain stem This pathway can be important for understanding the neural mechanism for the development of pharmacological and surgical approach to alleviate vascular headache.
Action Potentials ; Animals ; Blood Vessels ; Brain Stem ; Electric Stimulation ; Headache ; Injections, Intravenous ; Meningeal Arteries* ; Migraine Disorders ; Myelin Sheath ; Negotiating ; Neurons* ; Rats* ; Receptor, Serotonin, 5-HT1D ; Sumatriptan ; Superior Sagittal Sinus* ; Trigeminal Ganglion* ; Trigeminal Nerve ; Vascular Headaches ; Vasoconstriction ; Vasodilation

OBJECTIVE: This study is designed to elucidate the requirements for angiographic evaluation and the selection of appropriate therapeutic approaches in patients who had strongly suggestive traumatic carotid arterial lesions. METHODS: Ten cases of traumatic internal carotid arterial lesions were analysed in this study. Injury mechanisms, neurological status, computed tomography scans, pre-and postoperative angiograms, and methods and results of the treatment were included. RESULTS: Of 10 cases, carotid-cavernous fistula(CCF) alone in three, CCF with intracranial pseudoaneurysms in three, pseudoaneurysm with dissection in one, extracranial internal carotid artery thrombosis in one, extracranial pseudoaneurysm in one, and the remaining one had all of the CCF, intracranial pseudoaneurysm and dissection. Seven of these 10 cases had sphenoid sinus wall fractures and six had subarachnoid hemorrhage. Six cases were treated with endovascular techniques, and four with direct parent artery occlusion and bypass surgery. No postoperative morbidity or additional permanent neurological deficits occurred except one patient who suffered from reperfusion hemorrhage after bypass surgery. CONCLUSION: Head trauma patients with facial bone fractures and thick subarachnoid hemorrhage should be evaluated for the development of traumatic injuries to the carotid artery as soon as possible. Endovascular treatment to these lesions have come to play an increasing role. Patients with traumatic internal carotid artery lesions who do not tolerate test occlusion require extracranial to intracranial bypass surgery before occlusion.
Aneurysm, False ; Arteries ; Carotid Arteries ; Carotid Artery Thrombosis ; Carotid Artery, Internal ; Craniocerebral Trauma ; Endovascular Procedures ; Facial Bones ; Hemorrhage ; Humans ; Parents ; Reperfusion ; Sphenoid Sinus ; Subarachnoid Hemorrhage