Laryngeal paragangliomas occur infrequently and are usually benign neoplasms. The overwhelming majority of these tumors are supraglottic, and submucosal lesions arise from the superior laryngeal parasympathetic paraganglia. MRI could find these lesions and evaluate vascularization of the tumor. It is important to distinguish between carcinoid, atypical carcinoid and medullary thyroid cancer. This can be done with histopathologic evaluation and immunohistochemical markers. Complete excision is recommended in the treatment of the tumor. We describe a case of a 32-year-old woman who had an laryngeal paraganglioma.
Adult ; Carcinoid Tumor ; Female ; Humans ; Magnetic Resonance Imaging ; Neuroendocrine Tumors ; Paraganglioma* ; Thyroid Neoplasms

OBJECTIVE: The purpose of this study was to provide management strategy and to improve management outcome of patients with unruptured intracranial aneurysms (UIA). PATIENTS AND METHODS: The authors reviewed the database as sources for identifying and analyzing patients, and analyzed the management outcome of patients with UIA. From June 1979 to June 1999, among total of 1,801 patients treated for intracranial aneurysms, 372 patients with 437 unruptured aneurysms were treated by surgery (335 patients) or neurointervention (37 patients). One hundred and forty - three patients with 158 UIA had no history of SAH from a different aneurysm (group 1), and 229 patients with 279 UIA had a ruptured aneurysm that have been repaired simultaneously or before treatment of UIA (group 2). We reviewed the rate of favorable (good, fair) and unfavorable (poor or dead) outcome one year after the treatment. RESULTS: The rate of favorable and unfavorable outcome in group 1 was 96.5% and 3.5% respectively. In Group 2, the rate was 93.5% and 6.5%. However, the most of the unfavorable outcome in group 2 came from treatment of the ruptured aneurysm, or SAH. The only significant factor contributed to unfavorable outcome in group 1 was size of UIA. Those of group 2 were age, Fisher grade, Hunt - Hess grade, and aneurysm number. Complications attributable to surgical or endovascular treatment of UIA that occurred in 38 of 372 patients (10.2%) were cerebral infarction (17), intracerebral hemorrhage (10), epidural hematoma (4), cranial nerve injury (3), infection (2), venous infarction (1), and subarachnoid hemorrhage (1). CONCLUSION: Rupture of an intracranial aneurysm is a devastating event. The safe size below which rupture is unlikely is unclear. There appears to be increased risk from unruptured aneurysms discovered in SAH patients. All unruptured aneurysms in healthy patients as well as in patients with history of SAH should be repaired.
Aneurysm ; Aneurysm, Ruptured ; Cerebral Hemorrhage ; Cerebral Infarction ; Cranial Nerve Injuries ; Hematoma ; Humans ; Infarction ; Intracranial Aneurysm* ; Rupture ; Subarachnoid Hemorrhage

Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons

The authors studied angiographic features in relation to risk of hemorrhage in 102 cerebral arteriovenous malformations(AVM;s). Statistical analysis demonstrated that AVM's with following characteristics had high risk of hemorrhage : 1) small nidus ; 2) deep, posterior fossa, cortico-callosal, cortico-ventricular location ; 3) one or two draining veins ; 4) deep venous drainage ; 5) high grade stenosis of major venous drainage. The authors suggest that as the venous drainage system is significantly associated with the risk of hemorrhage in AVM's, careful preoperative angiographic evaluation of the venous drainage system is mandatory for decision making in the management of patients with AVM's.
Arteriovenous Malformations ; Constriction, Pathologic ; Decision Making ; Drainage ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Veins

OBJECTIVES: To clarify the benefits and therapeutic effects of intra-arterial papaverine infusion on the symptomatic cerebral vasospasm, we analyzed the results of treatment in 32 patients retrospectively. METHODS: A total of 510 patients underwent surgical clipping or endovascular intra-aneurysmal treatment for ruptured intracranial aneurysm between May, 1996 and June, 1999. The delayed ischemic deficit(DID) was developed in 90 of 510 patients. Of these 90 patients, 32 developed symptomatic vasospasm inspite of using modest "3H therapy". The brain CT scan was taken before the intra-arterial infusion of papaverine. The 32 patients underwent 42 intra-arterial papaverine infusion. The symptomatic vasospasm was divided into three groups: deterioration of mental status(Group 1), appearance of a focal neurologic deficit(Group 2), or both(Group 3). We measured Glasgow Coma Scale(GCS), arterial diameters, and cerebral circulation time(CCT) at the time of pre- and postangioplasty. RESULTS: The number of patients in group 1, 2 and 3 were 26, 7, 9 respectively. Eighteen cases showed improvement of GCS more than 2 scores, 16 more than 1, and 8 showed no change of GCS. Average cerebral circulation time(CCT) was decreased ranging from 0.0%-67.5%, and arterial diameters were increased in 21 cases ranging from 1 to 4 folds. CONCLUSION: Intra-arterial papaverine infusion seemed to have therapeutic effects on symptomatic vasospasm by improving the neurological signs and increasing the arterial diameter. We suggest that intra-arterial papaverine infusion would be an useful adjunctive therapeutic modality in symptomatic vasospasm.
Aneurysm* ; Brain ; Coma ; Humans ; Infusions, Intra-Arterial ; Intracranial Aneurysm ; Papaverine* ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Surgical Instruments ; Tomography, X-Ray Computed ; Vasospasm, Intracranial*

OBJECTIVES: This study was to define the clinical characteristics and formulate the management strategies of the patients with infectious cerebral aneurysms. METHODS: During the past 30 years, among 2,830 patients who were treated with intracranial aneurysms, 11 patients had infectious cerebral aneurysms. The authors reviewed the database and the imaging studies as sources for identification and analysis. RESULTS: Nine patients had ruptured lesions: Five patients presented with subarachnoid hemorrhage (SAH) and 4 patients presented with intracerebral hemorrhage (ICH). Two patients were Hunt and Hess Grade I, 1 Grade II, 2 Grade III, 3 Grade IV, and 1 Grade V. Seven aneurysms were located at middle cerebral artery, 2 at anterior cerebral artery, 1 at internal carotid artery, and 1 at posterior circulation. Ten aneurysms were small ((8 mm). Seven aneurysms were fusiform, and the remaining 4 aneurysms were saccular. Five of the 11 patients (44.4%) had multiple aneurysms. All patient were treated by microsurgery. The obliteration methods of the aneurysms were trapping in 7 patients, and neck clipping in 4 patients. Nine patients showed favorable outcome (good : 7, fair : 2) and 2 patients showed unfavorable outcome (poor : 1, dead : 1). CONCLUSION: Infectious cerebral aneurysms had high frequency of ICH, fusiform-shape, multiple aneurysms, and initial poor clinical grade. Surgery was necessary for ruptured lesion and unruptured lesions which size was increased at follow up angiography. The ultimate management outcome was satisfactory. Co-work with cardiologist and cardiovascular surgeon is necessary.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Middle Cerebral Artery ; Neck ; Subarachnoid Hemorrhage

Despite modern advances in endovascular techniques, intraaneurysmal coil embolization may be associated with serious complications such as parent artery occlusion by thromboembolism and coil migration or incomplete treatment, which require surgery. We report 5 cases in which surgical interventions had been necessary following coil embolization with Guglielmi Detachable Coil, either due to incomplete aneurysm obliteration or acute complication of parent artery occlusion by coil migration and throm-boembolism. Surgical intervention include removal of the coils and clipping of the aneurysm. Immediate recanalization of the occluded artery by use of intra-arterial thrombolytics and surgery is very important. The role of neurosurgical management in the care of the patients suffering from unsuccessful endovascular therapy of aneurysm is demonstrated.
Aneurysm* ; Arteries ; Embolization, Therapeutic* ; Endovascular Procedures ; Humans ; Parents ; Thromboembolism

OBJECTIVE: To establish management strategy and to improve outcome of callosal arteriovenous malformations(AVMs), forty-six consecutive cases hospitalized from 1984 to 2001 are analyzed. METHODS: Clinical and radiologic files were reviewed. Average follow-up period was 20.3 months in microsurgery group, and 28.2 months in radiosurgery group. RESULTS: The resection rate of microsurgery was considered total in 12 patients(85.7% ), subtotal 2(14.3%). The final clinical outcome of microsurgery was good in 13 patients(92.8%), fair in 1(7.2%). One patient with splenial lesion had postoperative disconnection syndrome. Initial insults and hemodynamic complications were the major cause of an unfavorable outcome. In radiosurgery the complete regression of nidus was considered in 16 patients(51.6%), partial shrinkage in 13(41.9%), and no response in 2(6.5%). The clinical outcome of radiosurgery was good in 26 patients(83.9%), fair in 3(9.75%), and poor in 2(6.5%). Rebleeding during the latency period(3 patients), radiation necrosis(1 patients) and initial insults(1 patients) were the major cause of postradiosurgery morbidity. Rebleeding during the latency period occurred in 3 patients(9.7%). Two lesions were in the splenium, and one lesion in the body of corpus callosum. All lesions were larger than 3cm in diameter. Two of them occurred during the second year, and the rest one during the third year of latency period. CONCLUSION: Microsurgery, which eliminates the risk of bleeding immediately, is referred for callosal AVMs. Radiosurgery is another effective treatment modality for splenial lesions with large bridging veins that interfere with microsurgical approach, and combined endovascular treatment would be strongly recommended for the splenial lesions larger than 3cm in diameter that has higher risk of hemorrhage during the latency period.
Arteriovenous Malformations* ; Corpus Callosum ; Follow-Up Studies ; Hemodynamics ; Hemorrhage ; Humans ; Latency Period (Psychology) ; Microsurgery ; Radiosurgery ; Veins

BACKGROUND AND OBJECTIVES: This study is to find out whether laser tympanostomy (LT) with tympanostomy tube (TT) insertion has some potential role for the treatment of children with chronic otitis media with effusion (OME) under the topical anesthesia. SUBJECTIVES AND METHOD: We prospectively enrolled 89 OME children (2-7 yrs old, 139 ears) for LT with TT insertion under topical anesthesia. Following LT, TT insertion was done if the middle ear effusion was mucoid or if middle ear mucosa was inflammed, or if the child had poor prognostic factors. RESULTS: Ninety-four ears (68%) had mucoid effusion, 18 ears (13%) serous effusion, 11 ears (8%) purulent effusion, and 16 ears (12%) were dry. It was determined that TT insertion was not necessary in 26 ears (19%). TT insertion into the laser tympanostomy opening was tried on the other 113 ears. TT insertion had a success rate of 81% (91/113). After 3 months of follow-up, LT that did not need TT insertion showed 81% (21 ears) resolution rate. Therefore, the total efficacy of LT with TT insertion under topical anesthesia was 85%. CONCLUSION: Laser tympanostomy with TT insertion resulted in increased efficacy. Also, compared to knife myringotomy, it seems to have a potential role for lowering the age group of OME children whom can be managed under topical anesthesia.
Anesthesia* ; Child ; Ear ; Ear, Middle ; Follow-Up Studies ; Humans ; Middle Ear Ventilation* ; Mucous Membrane ; Otitis Media with Effusion ; Prospective Studies ; Treatment Outcome* ; Ventilation*

The purpose of the study was to evaluate short-term clinical results in 44 patients who had cerebral aneurysms and underwent endovascular treatment with Guglielmi detachable coil(GDC), and to establish selection criteria of the patients for this treatment. From March 1996 to November 1997, we treated 258 patients either by surgery or endovascular treatment, or by combination of both. Forty-four patients of them were assigned to endovascular GDC embolization as an initial treatment rather than surgery because of an anticipated technical difficulty for surgery due to anatomy of the aneurysm on cerebral angiography(25 patients), patient's poor physical or neurological condition(18 patients), or referring neurosurgeon's preference(one patient). Twenty patients were presented with ruptured aneurysm, 13 with unruptured aneurysm, 6 with mass effect, and 5 with initial incomplete clipping. Twenty-six patients had anterior circulation aneurysm and 18 had posterior circulation aneurysm. Among total of 44 patients, we were able to achieve 70 to 100% obliteration of the aneurysm in 32 patients (72.7%) but failed in 12(27.3%). Causes of failure were 5 wide neck, 4 vessel tortuosity, 2 difficult geometry, and a perforation of the distal basilar aneurysm. Seven of the failed patients were treated by subsequent clipping. Complications caused by the intra-aneurysmal endovascular treatment were a fatal perforation of the aneurysm with guide wire and an occlusion of the parent artery from over-packing of the coil, and distal migration of the coil in 2 patients, all of which could be retrieved. At an average 6-month follow-up, only one of six death was caused by the endovascular treatment. Short-term clinical results of the endovascular treatment of cerebral aneurysms indicate that this procedure is a useful alternative approach especially in selected patients with high risk aneurysm.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Neck ; Parents ; Patient Selection