OBJECTIVE: Cranial nerve dysfunction is common after endovascular treatment of a cavernous sinus dural arteriovenous fistula and sometimes this symptom persists. We reviewed the treatment outcomes of the patients with cavernous sinus dural arteriovenous fistula and who were treated with endovascular technique, and we analyzed the characteristics of those patients who had cranial nerve palsy after treatment. METHODS: Between May 2003 and July 2010, 25 patients were treated by an endovascular technique at our institution. Their medical records were reviewed and we analyzed their data, including the clinical presentation, the neurological deficits, the radiographic features and the treatment outcomes. RESULTS: In our series, a total of 25 patients (28 cases) received endovascular treatment. There were four male patients and twenty one female patients with an age range of 26-78 years (mean age : 57.4 years). Complete occlusion was observed in nineteen cases (67.9%) and 5 cases (17.9%) showed near complete occlusion. Additional procedures were required for four cases with fistulas that were partially occluded by previous treatment. Twenty four patients (96%) showed improved symptoms during the follow up and only one patient suffered from persistent symptoms. Procedure-related complications were observed in 2 cases. New cranial nerve palsy was observed in four patients (16%) and two patients experienced aggravation of their existing cranial nerve palsy. One of them had persistent deficits at the final follow up. CONCLUSION: Sufficient occlusion and avoidance of over-compaction of coils are important to prevent cranial nerve palsy when performing endovascular treatment of cavernous sinus dural arteriovenous fistulas.
Cavernous Sinus ; Caves ; Central Nervous System Vascular Malformations ; Cranial Nerve Diseases ; Cranial Nerves ; Endovascular Procedures ; Female ; Fistula ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies

With the development of devices and techniques, including complex shape coils, balloons, multiple catheter techniques, and intracranial stents, endosaccular treatment of ruptured or unruptured wide-necked cerebral aneurysms has advanced rapidly with respect to indications and outcomes. In contrast to other options, stent-assisted aneurysm embolization has a distinct feature in which the stent is permanently implanted in the cerebral vessels. Therefore, we must consider the short-term effect of stent-assisted aneurysm embolization in the prevention of coil migration and adverse thrombogenicity, but also the permanent mechanical, hemodynamic, and biological influence on the parent vessels and the aneurysm. We have reviewed the current experimental and clinical data on stent-assisted coil embolization of cerebral aneurysms.
Aneurysm ; Catheters ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Parents ; Stents

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.
Angiography ; Arteries ; Central Nervous System Vascular Malformations* ; Cranial Fossa, Anterior* ; Cyanoacrylates ; Fistula ; Frontal Lobe ; Headache ; Hematoma ; Humans ; Middle Aged

To investigate effect of fatigue and anticipation on lower extremity joint load during a side-cutting maneuver in female collegiate soccer players, thirteen female collegiate soccer players whose right leg dominant participated in this study. Three dimensional motion analysis system and a force plate were used to record the 45degrees side cutting maneuver. In the first, anticipated and unanticipated cutting were measured in the pre-fatigue condition. Second, participations performed the fatigue protocol by the squat exercise with weight lifting. And then, two different type of cutting task were measured again after fatigue condition. The cutting direction let known before start their running in case of the anticipated cutting, the random signal of cutting direction were presented in the unanticipated condition. In the results, the most influential variable was anticipation factor. Lower limb angles represented significantly flexed posture during unanticipated cutting than anticipated condition. Maximum knee flexion moment represented significantly higher in unanticipated cutting than anticipated cutting. Adduction and internal rotation moment of lower limb joint decreased in unanticipated cutting. Fatigue factor was influenced by the initial contact angles of the ankle joint. Lower limb angles at the initial ground contact indicated more erect posture in post-fatigue condition. The unanticipation factor had more effect on locomotors ability of lower limb in this study. Therefore, the sensory-motor training to adapt to unanticipated situation should be considered for the injury prevention training program.
Ankle Joint ; Anterior Cruciate Ligament ; Fatigue ; Female ; Humans ; Joints ; Knee ; Leg ; Linear Energy Transfer ; Lower Extremity ; Posture ; Running ; Soccer ; Weight Lifting

OBJECTIVE: The purpose of this study was to analyze the biomechanical effects of three different constrained types of an artificial disc on the implanted and adjacent segments in the lumbar spine using a finite element model (FEM). METHODS: The created intact model was validated by comparing the flexion-extension response without pre-load with the corresponding results obtained from the published experimental studies. The validated intact lumbar model was tested after implantation of three artificial discs at L4-5. Each implanted model was subjected to a combination of 400 N follower load and 5 Nm of flexion/extension moments. ABAQUStrade mark version 6.5 (ABAQUS Inc., Providence, RI, USA) and FEMAP version 8.20 (Electronic Data Systems Corp., Plano, TX, USA) were used for meshing and analysis of geometry of the intact and implanted models. RESULTS: Under the flexion load, the intersegmental rotation angles of all the implanted models were similar to that of the intact model, but under the extension load, the values were greater than that of the intact model. The facet contact loads of three implanted models were greater than the loads observed with the intact model. CONCLUSION: Under the flexion load, three types of the implanted model at the L4-5 level showed the intersegmental rotation angle similar to the one measured with the intact model. Under the extension load, all of the artificial disc implanted models demonstrated an increased extension rotational angle at the operated level (L4-5), resulting in an increase under the facet contact load when compared with the adjacent segments. The increased facet load may lead to facet degeneration.
Information Systems ; Spine ; Total Disc Replacement

BACKGROUND: von Willebrand disease (VWD), characterized by quantitative or qualitative defects of von Willebrand factor (VWF), is the most common inheritable bleeding disorder. Data regarding the genetic background of VWD in Korean patients is limited. To our knowledge, this is the first comprehensive molecular genetic investigation of Korean patients with VWD. METHODS: Twenty-two unrelated patients with VWD were recruited from August 2014 to December 2017 (age range 28 months–64 years; male:female ratio 1.2:1). Fifteen patients had type 1, six had type 2, and one had type 3 VWD. Blood samples were collected for coagulation analyses and molecular genetic analyses from each patient. Direct sequencing of all exons, flanking intronic sequences, and the promoter of VWF was performed. In patients without sequence variants, multiplex ligation-dependent probe amplification (MLPA) was performed to detect dosage variants. We adapted the American College of Medical Genetics and Genomics guidelines for variant interpretation and considered variants of uncertain significance, likely pathogenic variants, and pathogenic variants as putative disease-causing variants. RESULTS: VWF variants were identified in 15 patients (68%): 14 patients with a single heterozygous variant and one patient with two heterozygous variants. The variants consisted of 13 missense variants, one small insertion, and one splicing variant. Four variants were novel: p.S764Efs*16, p.C889R, p.C1130Y, and p.W2193C. MLPA analysis in seven patients without reportable variants revealed no dosage variants. CONCLUSIONS: This study revealed the spectrum of VWF variants, including novel ones, and limited diagnostic utility of MLPA analyses in Korean patients with VWD.
Exons ; Genetic Background ; Genetics, Medical ; Genomics ; Hemorrhage ; Humans ; Introns ; Korea ; Molecular Biology ; Multiplex Polymerase Chain Reaction ; von Willebrand Disease, Type 3 ; von Willebrand Diseases ; von Willebrand Factor

Malignant fibrous histiocytoma(MFH) is a rare primary neoplasm that constitutes less than 1% of the malignant tumors of bone, and involvement of the skull is very rare. We present a case of malignant fibrous histiocytoma of the skull, presenting an intraosseous lesion in a 43-yr-old woman. She had a rapidly growing, tender mass in the right parietal region. A plain radiograph showed an osteolytic lesion of the right parietal bone. Magnetic resonance imaging revealed that the lesion showed heterogeneous low signal intensity on T1-weighted images and slightly high signal intensity on T2-weighted images. No evidence of an extraosseous extension to the adjacent dura and soft tissue was found, and a wide excision of the parietal bone was performed. Histologically, the tumor was a typical MFH displaying pleomorphic spindle cells in a storiform pattern. The results of immunohistochemical stainings revealed that the tumor cells were positive for vimentin, alpha-1-antitryp-sin, and p53, and negative for smooth muscle actin, S100 protein, desmin, and MyoD1. Three months later, a mainly cystic, recurrent mass was developed at the previously operated site. Before the resection, we first performed the percutaneous aspiration cytology, revealing diagnostic multinucleated pleomorphic cells. There-after, she had to receive repetitive resections of recurrent or residual lesions, and she died of postoperative meningoencephalitis two years after the first operation.
Actins/biosynthesis ; Adult ; Brain/pathology ; Desmin/biosynthesis ; Female ; Giant Cells/metabolism ; Histiocytoma, Fibrous/*diagnosis ; Human ; Immunohistochemistry ; Magnetic Resonance Imaging ; Mitosis ; Muscle, Smooth/metabolism ; MyoD Protein/biosynthesis ; Protein p53/biosynthesis ; S100 Proteins/biosynthesis ; Skull Neoplasms/*diagnosis ; Tomography, X-Ray Computed ; Vimentin/biosynthesis ; alpha 1-Antitrypsin/biosynthesis

An infraoptic anterior cerebral artery (ACA) arising at a low bifurcation of the internal carotid artery is a rare anomaly, of which about 33 cases have been reported to date, often in association with cerebral aneurysms. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. Angiography revealed the presence of an abnormal solitary ACA, arising from the intracranial proximal internal carotid artery near the origin of the ophthalmic artery, and a contralateral middle cerebral artery aneurysm. Magnetic resonance imaging showed that the ACA passed below the ipsilateral optic nerve, anterior to the optic chiasm, to join the normally positioned anterior communicating artery above the optic chiasm.
Angiography ; Anterior Cerebral Artery* ; Arteries ; Carotid Artery, Internal ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Ophthalmic Artery ; Optic Chiasm ; Optic Nerve

A 47-years-old woman presented with a 2-month history of a dry mouth and dry cough. The patient had been taking medication for Sjogren's syndrome for approximately 7 years. The chest radiography showed multiple cystic lesions and a hazy density in both lower lung fields. The HRCT showed a diffuse ground glass like appearance and multiple variable sized cystic lesions in both lung fields. After medication, the symptoms were aggravated. Bronchoscopy was preformed with a transbronchial lung biopsy. The biopsies showed an infiltration of lymphocytes, neutrophils, monocytes and histiocytes through the interstitial space of the alveola and a widening of the alveolar septa. However, the histological findings of the cysts were not obtained. Sjogren's syndrome is a slowly progressive inflammatory autoimmune disease, which is characterized by lymphocyte mediated destruction of the exocrine glands, with pulmonary involvement in approximately 19-65%, High-resolution CT is a sensitive technique for assessing the pulmonary involvement in patients with Sjogren's syndrome. Although a lung biopsy is not always necessary for establishing a diagnosis of an interstitial lung disease in Sjogren's syndrome. A lung biopsy may reveal a wide spectrum of changes ranging from a mild inflammatory response to end stage fibrosis with honeycombing. Because of the predominantly peribronchiolar inflammatory infiltration and inspissated secretions the cysts were suspected to have been formed by the ballvalve phenomenon. However, no definite evidence was obtained.
Autoimmune Diseases ; Biopsy ; Bronchoscopy ; Cough ; Diagnosis ; Exocrine Glands ; Female ; Fibrosis ; Glass ; Histiocytes ; Humans ; Lung Diseases* ; Lung Diseases, Interstitial* ; Lung* ; Lymphocytes ; Monocytes ; Mouth ; Neutrophils ; Radiography ; Sjogren's Syndrome* ; Thorax

We report on two cases of microguidewire breakage that occurred during endovascular treatment of intracranial aneurysms. The microguidewire can be broken when a part of the wire is stuck due to vascular tortuosity, and, subsequently, application of excessive rotational movement. The mechanical and physical properties of a microguidewire are also important factors in microguidewire breakage. We also suggest technical tips for avoidance of this problem.
Aged ; *Catheters ; Device Removal ; Embolization, Therapeutic/*instrumentation ; *Equipment Failure ; Female ; Humans ; Intracranial Aneurysm/*therapy ; Middle Aged ; Radiography, Interventional/*instrumentation