OBJECTIVES: Dopamine transporter concentrations have been known to decrease in Parkinson's disease(PD). The aim of the present study was to evaluate the correlation between SPECT measurements of [I-123]N-(3-iodopropene-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane(IPT) as an imaging agent for measuring changes in transporter concentrations with PD. PATIENTS AND METHODS:IPT labelled with 4.87+/-1.29mCi(180.19+/-47.73 MBq) of [I-123] was intravenously injected into 23 patients(age:58+/-12) with PD and three normal controls(NC)(age:37+/-7) as bolus. Brain SPECT were then performed at 1 hour and 2 hours after injection on a double headed camera. The statistical parameters were the contrast ratio of left basal ganglia(BG) and right basal ganglia to occipital cortex(OCC) per milli curies of injected radiotracer at 1 hour and 2 hours. The correlations were evaluated between these parameters and Hoehn-Yahr classification of the patients. RESULTS: The(BG-OCC)/OCC/mCi ratios at 1 hour and 2 hours for PD and NC were 0.14+/-0.07 and 0.27+/-0.07(1 hour) and 0.12+/-0.07 and 0.34+/-0.04(2 hour), respectively. The(BG-OCC)/OCC/mCi ratios of Parkinson's disease were decreased with higher grade of Hoehn-Yahr classification of the patients. The ratio between BG and OCC for PD were clearly separated from NC and may be useful outcome measures for clinical diagnosis. CONCLUSION: The findings suggest that IPT may be a very useful tracer for early diagnosis and treatment of PD and study of dopamine re-uptake site.
Basal Ganglia ; Brain ; Classification ; Diagnosis ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Early Diagnosis ; Head ; Humans ; Outcome Assessment (Health Care) ; Parkinson Disease ; Tomography, Emission-Computed, Single-Photon*

Patients with extra-axial mass lesions of the posterior fossa frequently demonstrate signs of brainstem dysfunction. These dysfunctions may be induced by the change of regional cerebral blood flow and electrophysiological status as well as mechanical compression and distortion of the brainstem. Frontal cortical regional cerebral blood flow(rCBF), pontine rCBF, brainstem autidory evoked potentials(AEPs), infratentorial intracranial pressure(infratentorial ICP) and mean arterial blood pressure(MABP) were recorded before and after expansion of an infratentorial epidural ballon in anesthetized experimental cat models. After the elevation of MABP during the increased infratentorial ICP, frontal cortical and potine rCBF, AEPs were recorded every 30 minutes. The results suggest that the elevating the MABP to improve cerebral perfusion pressure before irreversible change occurs in the brain may preserve cerebral function. We conclude that if the volume of the space in the posterior fossa that is occupied by the mass can be estimated, brain damage from low rCBF and brain compression due to intracranial hypertension can be prevented by the elevation of MABP before irreversible damage of the brain occurs.
Animals ; Blood Pressure* ; Brain ; Brain Stem ; Cats ; Evoked Potentials, Auditory* ; Humans ; Intracranial Hypertension ; Intracranial Pressure* ; Perfusion

We report a case of proximal internal carotid arterial spasm following pterional removal of pituitary adenoma. We discuss the possible mechanism of vasospasm associated with tumor resection.
Carotid Artery, Internal* ; Pituitary Neoplasms* ; Spasm

OBJECTIVE: We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. METHODS: In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. RESULTS: Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. CONCLUSION: Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.
Abducens Nerve Diseases ; Carotid Artery, Internal ; Cavernous Sinus ; Cranial Fossa, Anterior ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Craniopharyngioma ; Facial Paralysis ; Follow-Up Studies ; Hearing Loss ; Humans ; Hypesthesia ; Meningioma ; Neurilemmoma ; Oculomotor Nerve Diseases ; Paresis ; Pituitary Neoplasms ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Skull Base*

Background/Aims: Atrial fibrillation (AF)-related stroke accounts for 20% of ischemic strokes. Rivaroxaban use in AF patients for preventing stroke and systemic embolism was approved in 2013 in Korea. This study was to investigate the safety and effectiveness of rivaroxaban use in Korean patients with non-valvular AF in a real-world setting. Methods: This was an analysis of the Korean patients in Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific (XANAP), which was a prospective, observational cohort study including patients with non-valvular AF starting rivaroxaban treatment to prevent stroke or non-central nervous system systemic embolism (non-CNS SE), conducted in 10 Asian countries. Results: A total of 844 patients were enrolled in the Korean portion of the XANAP study. In XANAP Korea, the mean age was 70.1 years and 62.6% were males. The mean CHADS2 score was 2.5 and the mean CHA2DS2-VASc score was 3.8. 47% of the patients had experienced prior stroke or non-CNS SE or transient ischemic attack. 73.6% of the patients had CHADS2 score ≥ 2. Incidence proportions of 0.8% of the patients (1.1 per 100 patient-years) developed adjudicated treatment-emergent major bleeding. Death was observed in 1.2% of the patients. The incidence of non-major bleeding as well as thromboembolic event were 8.4% (11.6 per 100 patient-years) and 1.5% (2.0 per 100 patient-years), respectively. Conclusions This study reaffirmed the consistent safety profile of rivaroxaban. We found consistent results with overall XANAP population for rivaroxaban in terms of safety in non-valvular AF patients for the prevention of stroke and non-CNS SE.

Background/Aims: Atrial fibrillation (AF)-related stroke accounts for 20% of ischemic strokes. Rivaroxaban use in AF patients for preventing stroke and systemic embolism was approved in 2013 in Korea. This study was to investigate the safety and effectiveness of rivaroxaban use in Korean patients with non-valvular AF in a real-world setting. Methods: This was an analysis of the Korean patients in Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific (XANAP), which was a prospective, observational cohort study including patients with non-valvular AF starting rivaroxaban treatment to prevent stroke or non-central nervous system systemic embolism (non-CNS SE), conducted in 10 Asian countries. Results: A total of 844 patients were enrolled in the Korean portion of the XANAP study. In XANAP Korea, the mean age was 70.1 years and 62.6% were males. The mean CHADS2 score was 2.5 and the mean CHA2DS2-VASc score was 3.8. 47% of the patients had experienced prior stroke or non-CNS SE or transient ischemic attack. 73.6% of the patients had CHADS2 score ≥ 2. Incidence proportions of 0.8% of the patients (1.1 per 100 patient-years) developed adjudicated treatment-emergent major bleeding. Death was observed in 1.2% of the patients. The incidence of non-major bleeding as well as thromboembolic event were 8.4% (11.6 per 100 patient-years) and 1.5% (2.0 per 100 patient-years), respectively. Conclusions This study reaffirmed the consistent safety profile of rivaroxaban. We found consistent results with overall XANAP population for rivaroxaban in terms of safety in non-valvular AF patients for the prevention of stroke and non-CNS SE.

No abstract available.
Neurilemmoma*

People 65 years and older represent a rapidly growing proportion of the Korean population. During the last five years, the rate of population increasing in this age group has been 19.5%, in contrast to 4.6% among the general population. Before 1987, neurosurgery among the elderly was infrequent, but at our hospital, the percentage increased from 6.9% in 1991 to 13.5% in 1996. We analysed 119 geriatric neurosurgical cases(9.6% of all neurosur-gical cases) of our hospital over a recent three-year period. Cerebrovascular disease occurred most frequently(43 cases), while there were 22 cases of tumor, 15 of chronic subdural hematoma, 11 of head injury, seven of benign spinal lesion and six of hyperactive dysfunction syndrome. Among 119 cases, concomitant systemic disease was seen in 78%, with cardiovascular and pulmonary dysfunction usually present. In cases of benign spine lesion, chronic subdural hematoma, simple brain tumor and good grade aneurysm, the surgical outcome was good, but in patients with poor grade aneurysm, a large and complicated tumor or a large intracranial hematoma, the surgical outcome was relatively poor compared with that of the general population group. In the group in whom surgical outcome was good, concomitant systemic disease did not influence a patient's prognosis. The results of this study are as follows : 1) Old age in itself is not a contraindication for surgery. 2) Among geriatric neurosurgical patients, surgical decisions should be based on the pathology itself, type of surgery, envisioned, urgency of the surgical procedure and the presence of any coexisting disease that could influence the surgical outcome. 3) Agressive forms of surgical treatment of patients suffering from benign spinal lesion, chronic subdural hematoma, good grade aneurysm or simple brain tumor can be performed in the elderly ; they are safe and the results are effective. 4) Patients with poor grade aneurysm, a large intracranial hematoma with poor neurological status, or a brain tumor with systemic metastasis or severe intercurrent disease are not to be considered for surgery. 5) To reduce surgical mortality and morbidity in aging patients, careful patient selection and vigorous preoperative and postoperative care with regard to any coexisting disease are important.
Aged* ; Aging ; Aneurysm ; Brain Neoplasms ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Mortality ; Neoplasm Metastasis ; Neurosurgery* ; Pathology ; Patient Selection ; Population Groups ; Postoperative Care ; Prognosis ; Spine

In an attempt to decide the surgical approach to basilar tip aneurysms, 27 cases of ruptured aneurysms were retrospectively analysed for size of aneurysm, direction of fundus and height of bifurcation. The fundus pointed superiorly in 18 cases, posteriorly in six, and anteriorly in three. The aneurysm neck was positioned as follows : very high(more than 20mm above midsellar) in one case, high(between 10mm and 20mm above midsellar) in 13, mid(from midsellar to 10mm above it) in nine, low(from midsellar to sellar floor) in two, and very low(below the sellar floor) in two. In 11 cases, surgery followed the conventional pterional approach ; in eight, the orbitozygomatic ; in three, the pterional-anterior temporal ; in two, the subtemporal ; in two, the anterior transpetrosal ; and in one, the temporopolar. In complex aneurysms or basilar bifurcation was at an unusual height, surgery involved a skull-base or modified technique based on a conventional pterional and subtemporal approach. On the basic of our surgical data and related findings, our suggestious are as follows : surgery involving basilar tip aneurysms with an extremely high-positioned neck should follow the transsylvian route above the carotid bifurcation, or use a transventricular or intravascular approach ; in cases with a high positioned-neck, the orbitozygomatic temporopolar or transzygomatic subtemporal approach should be used ; in cases with a normal-positioned neck, the combined pterional-anterior temporal approach, which has a much wider operative field and wider angle of vision than the classic pterional and subtemporal approach ; in cases with a low-positioned neck, the subtemporaltranstentorial) pterional, with resection of the posterior clinoid process ; and in cases with a very low-positioned neck, the transpetrosal approach.
Aneurysm* ; Aneurysm, Ruptured ; Neck ; Retrospective Studies

To study the effect of extracranial-intracranial(EC/IC) bypass on symptomatic patients with hemodynamic cerebral ischemia, we prospectively reviewed 14 patients who underwent EC/IC bypass surgery. A series of 14 patients treated in a 2 years period met the following criteria, 1) symptomatic internal carotid artery(ICA) or middle cerebral aetery(MCA) obstruction or stenosis over 80M, 2) decrease in basal cerebral blood flow(CBF) over 10%, 3) hyporeactivity to acetazolimide of CBF Amomg these, the type of ischemic episode was transient ischemic attack(TIA) or reversible ischemic neurological deficit(RIND) in 4, minor stroke in 8, and major stroke in 2. Of these, 10 patients had multiple episode of ischemic attack. CT or MRI were showed infarction of the MCA territory in 3, border zone infarction in 5, basal ganglia infarction in 2 and multiple lacunar infarction in 4. Based on our criteria, superficial temporal artery(STA)-MCA anastomosis was performed in 13 cases and EC-IC bypass grafting using radial artery in one. Average follow up period was 24 months. Postoperative course was uneventful in 12 patients. One patient suffered a postoperative stroke with complete recovery and another suffered operative wound infection. Of the 14 patients 12(85.7 % ) have had an excellent to good outcome with complete resolution or significant improvement of preoperative neurologic symptom, remaining two show no improvement of preoperative neurologic deficit. Bypass patency was confirmed by postoperative angiography in all cases except for one. Postoperative follow up studies of the basal CBF and response to the acetazolamide of the CBF showed significant increased CBF activity to acetazolamide in 12 cases(85. 7%) while the basal CBF was essentially unchanged in all cases except for two. In view of these finding, the authors suggest that EC-IC bypass surgery to be considered as an appropritate 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 ; Basal Ganglia ; Brain Ischemia* ; Constriction, Pathologic ; Follow-Up Studies ; Hemodynamics* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Patient Selection ; Prospective Studies ; Radial Artery ; Stroke ; Stroke, Lacunar ; Transplants ; Wound Infection