Idiopathic arterial hypertension, termed "essential" or "neurogenic", is a common generalized cardiovascular syndrome comprised of a sequence of pathologic changes and accommodations. Although an extensive literature exists concerning that, the primary etiology has been unclear yet. However, Jannetta and coworkers have reported a possible etiological connection between essential hypertension and intraoperatively observed neurovascular compression of the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves on the left, recently. They have also introduced one of new therapeutical concept for essential hypertension by microvascular decompression(MVD) of offending vessels. Based on Jannetta and coworker's hypothesis, the authors have made some operations for the control of hypertension. Seven essential hypertensive patients have been underwent retromastoid craniectomy and MVD in the left ventrolateral medulla between July 1992 and June 1993. Five of them showed multiple episodes of intracerebral hemorrhages, one was an intractable hypertension case and the other one had a left hemifacial spasm with essential hypertension. The most common offending vessel was the posterior inferior cerebellar artery and it had been confirmed during operation. Postoperatively, in three cases, blood pressure was lowered to normal without medications. Of remaining four cases, blood pressure was significantly improved in one and slightly improved in three. There were no major complications in patients with surgery and no poor outcomes. These results indicate that the MVD for essential hypertension is relatively safe procedure and alternative choice as one of the management of intractable essential hypertension, repeated hypertensive intracerebral hemorrhages and left cranial nerve hyperfunction disorders combined with essential hypertension.
Arteries ; Blood Pressure ; Cerebral Hemorrhage ; Cranial Nerves ; Hemifacial Spasm ; Humans ; Hypertension* ; Intracranial Hemorrhage, Hypertensive ; Microvascular Decompression Surgery* ; Vagus Nerve

No abstract available.
Skull Fracture, Depressed*

True synovial cysts of the spine are rare, though they are included in the differential diagnosis of an extradural lesion in a patient with pain which is radicular or localized at the involved level of the spine. A case of a lumbar synovial cyst causing lumbar radiculopathy and mimicking an extradural tumor is presented. The lesion was demonstrated by magnetic resonance imaging, and the relief of symptoms was achieved by decompressive laminectomy and total removal of the mass.
Diagnosis, Differential ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Radiculopathy ; Spine ; Synovial Cyst*

Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc diseases. Refinements in instrumentation for the cervical spine have led to an increase in experience with these devices during the past decade. The need for postoperative immobilization, required to stabilize the patient while the fusion mass heals, is decreased or negated by internal fixation. The authors analyzed the results in 30 patients(22 traumatic; 8 non-traumatic) with lower cervical lesions, who underwent anterior interbody fixation with cervical plates between April, 1994 and June, 1996. We used either a unicortical(Orion TM) or bicortical screw system(Top TM): these two types of plates had no specific differences, but the Orion TM was easier and safer to operate. Although postoperative stability was successfully attained in all patients, two screw-related complications, which were fully resolved without causing any specific problems, were detected during the postoperative follow-up period. In nontraumatic lesions, we measured pre-and postoperative interbody heights at ten levels; postoperative interbody height was well preserved for one year. In conclusion, internal fixation may provide added security to the nervous system before bony fusion occurs, may lessen the number of levels requiring fusion, may increase the probability of successful fusion, and is conducive to early patient mobilization.
Diskectomy ; Follow-Up Studies ; Humans ; Immobilization ; Intervertebral Disc Displacement ; Nervous System ; Spinal Cord Diseases ; Spine ; Spondylosis

Congenital agenesis, aplasia or hypoplasia of the internal carotid artery is rare vascular disease and usually combine with intracranial aneurysm, subarachnoid hemorrhage, or intracerebral hemorrhage. We report a case of bilateral congenital hypoplasia of internal carotid artery in a 36 year-old woman presented with semicomatose mentality. The brain computed tomography(CT) revealed intracerebral hemorrhage with intraventricular hemorrhage, and cerebral angiography showed hypoplasia of bilateral internal carotid artery without narrowing of the bony carotid canal on the temporal bone CT.
Adult ; Brain ; Carotid Artery, Internal* ; Cerebral Angiography ; Cerebral Hemorrhage ; Female ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Subarachnoid Hemorrhage ; Temporal Bone ; Vascular Diseases

Osteomas are benign neoplasms consisting of mature normal osseous tissue. They are common on the long bones of the extremities and found in the sinuses, facial bones, skull and madible in the head and neck region. Much rarer, however, are osteomas arising from subdural space with displacement of the underlying brain. A 42-year-old woman presented with a history of intermittent left frontal headache that was proved to be due to an intracranial lesion. After surgical removal, it was found to be an subdural osteoma. We report this case with pertinent literatual reviews.
Adult ; Brain ; Extremities ; Facial Bones ; Female ; Head ; Headache ; Humans ; Neck ; Osteoma* ; Skull ; Subdural Space

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.
Classification ; Congenital Abnormalities ; Fracture Fixation* ; Humans ; Spinal Cord ; Spinal Injuries ; Spine*

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.
Classification ; Congenital Abnormalities ; Fracture Fixation* ; Humans ; Spinal Cord ; Spinal Injuries ; Spine*

Cysticercosis in the human is caused by infestation by larvae of pork tapeworm, taenia solium. Although they may grow anywhere in the body such as the liver, lung, eyes, heart, muscle, ect., they are most commonly found in the brain and its coverings. The cysticercus vesicles have occasionally been found in spinal structures other than the brain. We present a case of spinal cysticercosis in a 63-year-old male. The patient presented with a marked paraparesis and paresthesia below a T10 dermatome level, and moderately decreased deep tendon reflexes. After performing total laminectomies at T11-12 & L3-5, 30 cysticercus vesicles were removed.
Brain ; Cysticercosis* ; Cysticercus ; Heart ; Humans ; Laminectomy ; Larva ; Liver ; Lung ; Male ; Middle Aged ; Paraparesis ; Paresthesia ; Reflex, Stretch ; Spine ; Taenia solium

Intracranial lipoma is a rare benign brain tumor and ususally occurs in the midline structures, especially in the corpus callosum. The author report a case of intracranial lipoma in the left sylvian cistern. Sylvian cistern lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. The majority of cases are incidental or autopsy findings and direct surgical approach is only rarely indicated. The patient complained severe headache after head injury, the severe headache did not respose to medical therapy. Craniectomy was performed and then the tumor was removed. The literatures on this rare tumor are reviewed and discussed.
Autopsy ; Brain Neoplasms ; Corpus Callosum ; Craniocerebral Trauma ; Epilepsy ; Headache ; Humans ; Lipoma*