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

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

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

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

OBJECTIVE: The authors were performed bypass graft for cerebral revascularization in the treatment of hemodynamic cerebral ischemia and unclippable traumatic aneurysm, which acute sacrifice of the internal carotid artery is necessary. The aim of this study was to assess effectiveness bypass graft for cerebral revascularization. METHOD: Of 6 patients, Four patients were hemodynamic cerebral ischemia and two patients were traumatic cerebral aneurysm and traumatic carotid-cavernous fistula (CCF). Revascularization was performed external carotid artery (ECA) to middle cerebral artery (MCA) bypass with radial artery (n=1), ECA to MCA bypass with long saphenous vein (n=1), main trunk of superficial temporal artery (STA) to MCA with short saphenous vein (n=2), and internal carotid artery (ICA) to MCA with long saphenous vein (n=2). RESULTS: There were two graft occlusion, which one is recanalization case of preoperative MCA obstruction and the other is traumatic CCF. Four patients with good patiency through bypass showed significant increase of postoperative cerebral blood flow and good surgical outcome. There was not operative complication except for graft failure of 2 cases. CONCLUSION: Extracranial to intracranial bypass graft with radial artery or saphenous vein is thought to alternative method for cerebral revascularization in cases with unsuitable STA to bypass, and ICA reconstruction, which acute sacrifice of ICA is necessary.
Aneurysm ; Brain Ischemia ; Carotid Artery, External ; Carotid Artery, Internal ; Cerebral Revascularization* ; Fistula ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Radial Artery ; Saphenous Vein ; Temporal Arteries ; Transplants*

OBJECTIVE: The purpose of this study was to determine whether the status of the hinge gutter affected clinical and radiographic outcomes of cervical open door laminoplasty. METHODS: We retrospectively analyzed 43 patients who had undergone cervical open door laminoplasty. 23 CT scans were performed at 2 days post-operation. The number of CT scans at 3, 6, 12 and 24 months were 16, 12, 21 and 11, respectively. We collected perioperative and follow-up data, including clinical and radiographic results. RESULTS: There were 7 patients without a hinge fracture and 16 patients with one or more hinge fractures at 2 days postoperation. There were 90 hinges, and the rate of ideal greenstick deformation of the hinge was 63% on 2-day-postoperative CT scans. Postoperative VAS scores of neck pain (p=0.012) in patients without a hinge fracture were higher than in patients with hinge fractures. The hinge healing rates were 37% at 3 months, 57.4% at 6 months, 86.4% at 12 months, and 85.4% at 24 months. Among the patients, 14 patients had healed hinges, and 7 patients had one or more hinge(s) that was/were not healed at 12 months post-operation. However, in clinical and radiographic outcomes, there was no difference between these patients. CONCLUSION: Cervical open door laminoplasty was safe and provided stable reconstruction of laminar expansion. In radiographs, the difference between hinges that had healed and hinges that had not healed was statistically negligible. Hinge fractures might not influence the clinical and radiographic outcomes of cervical open door laminoplasty.
Cervical Vertebrae ; Female ; Follow-Up Studies ; Humans ; Neck Pain ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

In the article, name of the first author, "Sang Hyuk Im", was printed mistakenly as "Sang Hyuk Yim" by negligence of the authors. Additionally, the correspondence author's address has been also corrected as follow at their request: Department of Neurosurgery, Catholic Neuroscience Center, Yeouido St. Mary's Hospital, College of Medicine, Catholic University, 82 Yeouido-dong, Yeongdeungpo-gu, Seoul, 150-713, Korea.

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