Epidermoid tumors rarely occur in the central nervous system. Their incidence among intraspinal canal tumors is even less than 1% in most large series. Epidermoid tumors are generally understood as embryogenic or congenital tumor, however the etiologic importance of previous lumbar punctures in the formation of epidermoids has been also suggested by some papers, and almost confirmed by an extensive literature review and an animal experiment. Recently we have experienced a case of intraspinal epidermoid, which occurred at the same site as a lumbar puncture had been performed to carry out lumbar myelogram. To our knowledge, such a case has never been reported in a scientific journal in Korea yet. In this report we emphasize the importance of using a spinal puncture needle with a stylet in spinal taps, and of considering a lesion in the thoraco-lumbar junction on performing lumbar spine CT scan even in a patient only with lumbar disc symptoms.
Animal Experimentation ; Central Nervous System ; Humans ; Incidence ; Korea ; Needles ; Spinal Puncture* ; Spine ; Tomography, X-Ray Computed

No abstract available.
Animals ; Brain Edema* ; Brain Ischemia* ; Brain* ; Cerebral Infarction ; Glutamic Acid* ; Rats*

Arteriovenous malformation(AVM) of the medial temporal lobe would be interesting to neurosurgeons enough to draw their attentions because it's obscure location, making resection more difficult than the usual AVM and high possibility of operative morbidity caused by intraventricular hermorrhage and/or injury of the adjacent structures such as optic tract, brain stem and basal ganglia. A patient who underwent successful excision of AVM of this region is presented. It has ben confirmed that a transcortical surgical approach through the inferior portion of the temporal lobe could minimize retraction of the brain to avoid operative morbidity and manage a main feeding artery without difficulty.
Arteries ; Arteriovenous Malformations* ; Attention ; Basal Ganglia ; Brain ; Brain Stem ; Humans ; Temporal Lobe* ; Visual Pathways

OBJECTIVE: In the case of internal carotid-posterior communicating (ICPCom) artery aneurysm it is possible to successfully clip the aneurysmal neck without any difficulty. However, if the aneurysmal neck is wide, the aneurysmal sac is giant, the aneurysmal sac is hidden by the anterior clinoid process (ACP), or its dome is located in ventral portion or low-lying ICPCom aneurysm, it is difficult to open the proximal aneurysmal neck and we encounter a barrier in controlling bleeding in case of premature rupture of the aneurysm. They need to be resected the ACP for successful aneurysmal clipping. We propose angiographic criteria for predicting necessity of resection of the ACP before clipping of the ICPCom artery aneurysm. METHODS: Between 1999 and 2003, 16 patients with ICPCom artery aneurysm were treated with the resection of the ACP prior to applying the clip on the neck of the aneurysm. We retrospectively analyzed the preoperative cerebral angiographies, and the clinical and operative findings. We measured various radiometric parameters to reveal the angiographic characteristics. RESULTS: The mean value of the radiographic measurement in case of the cerebral angiography in 16 patients is as follows: angle A (the angle between the midline of the skull and the axis of the C1 segment on A-P view) ranged from 15 to 80 degrees (mean+/-SD, 42+/-5 degrees), angle B (the angle between the axes of the C1 and C2 segments on A-P view) ranged from 70 to 150 degrees (mean+/-SD, 110+/-15 degrees), and distance C (the distance between the tip of the ACP and the most proximal portion of the aneurysmal neck on the lateral view) ranged from 2 to 9 mm (mean+/-SD, 4.5+/-1 mm). CONCLUSION: We have resected the ACP in 16 of the 40 ICPCom aneurysms. The mean values of angle A, angle B, and distance C is 42+/-5 degrees, 110+/-15 degrees, and 4.5+/-1 mm, respectively. We did not encounter any difficulty in clipping in all the cases in which there was no premature rupture of the aneurysm. Most of cases had a good outcome.
Aneurysm* ; Arteries* ; Axis, Cervical Vertebra ; Cerebral Angiography ; Hemorrhage ; Humans ; Neck ; Retrospective Studies ; Rupture ; Skull

Thelaziases in human is an opportunistic infection. The worms usually lie in the conjunctival sac or in the lacrimal apparatus, causing foreignbody sensation, tearing and conjunctival irritation, In most cases, patients find the worms themselves and visit the hospital. Having experienced and confirmed 5 cases of human subconjunctival infestation of Thelazia callipaeda, we report these with literature review.
Humans* ; Lacrimal Apparatus ; Opportunistic Infections ; Parasites ; Sensation ; Thelazioidea

In cases that the ossified posterior longitudinal ligament(OPLL) is so adherent to the dura, operator has no choice but to extirpate the ossified portion and the dura as a whole, and CSF leaks out through the dura defect during anterior decompression in the cervical spine. However, a postoperative CSF fistula in operative wound in the neck has not been reported yet. The authors have experienced a case that the ossified mass was so incorporated with the dura in a wide extent that a large defect had to be left in the dura and intractable CSF leakage occurred eventually. The leakage had been managed with over 10-day-long lumar drainage of CSF, however, the leakage had got even worse. In the second operation for the CSF leakage, fibrin glue(Tissel(R) was used to enhance the result of CSF leakage repair, with packing of muscle in the dura defect. Postoperatively the patient was managed with another 2-week-long lumbar drainage, followed by complete repair of the CSF fistula. The experiences we gained with this case herald that CSF fistula can be another candidate for postoperative complication in the anterior decompression for OPLL, and fibrin glue has an excellent sealing property in the management of CSF fistula.
Cerebrospinal Fluid* ; Decompression* ; Drainage ; Fibrin ; Fibrin Tissue Adhesive ; Fistula* ; Humans ; Longitudinal Ligaments* ; Neck ; Postoperative Complications ; Spine* ; Wounds and Injuries

Somatosensory evoked potentials(SSEP's) are commonly employed to monitor cerebral and spinal cord function in patients with various lesions in the nervous system. In this study, we evaluated SSEP's as a means of measuring not only neurophysiological function but also the alteration of blood folw in the territory of cerebral ischemia. We examined SSEP's and regional cerebral blood flow(rCBF) in the bilateral suprasy1vian gyri following unilateral middle cerebral artery(MCA) occlusion in 15 cats(Group II). The duration of arterial occlusion was 30 minutes followed by 1 hour of recirculation. Five additional cats served as sham-operated groups(Group I). The animals in Group II were divided into 2 subgroups according to the change of the observed rCBF in the ipsilateral hemisphere. Immediately after MCA occlusion, rCBF decreased from around 50 to 14mg/100g/min. Decreased rCBF was remained below 20ml/100g/min throughout the ischemic period in 6 cats(Group IIb), and in the remaining 9 cats, the decreased rCBF was increasing during ischemia although the blood flow was subnormal(Group IIa). The recovery of rCBF during recirculation was faster in Group IIa than in Group IIb. In Group IIa and IIb, there was a significant slowing of the interpeak latency between dorsal column nuclei(Fz) and the major negative deflection(MN) (P<0.05) in the ipsilateral hemisphere and a precipitous decrease in the amplitude of the ipsilateral P1-MN complex immediately after occlusion(P<0.05). In Group IIb the suppressed SSEP's did not show any recovery during ischemia, and recovered late during recirculation. In Group IIa the suppressed SSEP's tended to recover during recirculation. In Group IIa the suppressed SSEP's tended to recover during ischemia and recovered early during recirculation. SSEP's were not completely abolished throughout the experiment in any experimental grup. The relationship between the changes in rCBF and amplitude of SSEP's in the ipsilateral hemisphere was significant(r=0.943, P<0.05) during occlusion of the middle cerebral artery in Group IIa. However there was not any other relationship in the other groups or among other wave components. These results indicate that the suppression of SSEP's and their failure to recover during focal cerebral ischemia correlate with the lack of collateral circulation. Furthermore, SSEP's can be useful means to evaluate the reversibility of cerebral ischemia, which may be decided by existence of collateral circulation. And it appers that the time threshold for abolition of SSEP's is more than 30 minutes in focal cerebral ischemia in the cat.
Animals ; Brain Ischemia* ; Cats ; Cerebral Infarction* ; Collateral Circulation ; Evoked Potentials, Somatosensory* ; Humans ; Ischemia ; Middle Cerebral Artery ; Nervous System ; Spinal Cord

A lesion in the cervico-thoracic junction can be of interest to neurosugeons, not only because its incidence is quite low, but also because there is not a published proper anterior approach. Currently the authors have experienced two cases of degenerative disease and one case of traumatic dislocation of the cervico-thoracic junction, in which the main lesions were located in the interspace or posterior portion of vertebral bodies at the junction between the cervical and thoracic spines and an anterior approach to the lesions should be considered. A supraclavicular approach has applied to these cases, by which a good surgical field was obtained. Furthermore the surgical results were good without any serious complication.
Dislocations ; Incidence ; Spinal Fusion ; Spine

A combined anterior and lateral approach to the anterior cervical canal was performed on 2 patients with cervical dumbbell-shaped tumors. The procedure consists of anterior discetomy and ispsilateral uncectomy, and removal of the posterolateral corners and posterior transverse fidges of the upper and lower verterbral bodies at the tumor. In one case of a large tumor in the spinal canal, additional removal of a limited segment from the lateral part of the vertebral body was performed and the bone defect was filled with a T-shaped bone graft. The higest level of the operation was C-2 and the lowes was C-4. The authors believe that any cervical dumbbell-shaped tumor below the C-2 level can be removed via anterolateral approach as long as no more than 3 levels of the spine are involved.
Foraminotomy ; Humans ; Spinal Canal* ; Spine ; Transplants

Section of the corpus callosum(SCC) is a useful surgical therapy in selected types of epilepsy, i.e., tonic, atonic, and intractable generalized convulsive seizures. The object of this study was to determine effect of SCC on behaviors, electroencephalography(EEG) and Fos expression in the lithium-pilocarpine model of status epilepticus in the rat. A total of 40 Sprague-Dawley rats were used. They were divided into two groups: control and lesioned group, 20 rats for each. The control group had no callosal section and was injected with lithium-pilocarpine. The lesioned group had callosal section before lithium-pilocarpine injection. In each group, ten rats were used for behavior and EEG monitoring and other 10 were used for Fos expression. The results were as follows: 1) In the SCC group, four(40%) rats never developed status epilepticus, among them two(20%) never exhibited any seizure, while all of the control group developed seizure and status epilepticus. None of the SCC animals died until 24 hours after lithium-pilocarpine injection but 70% of the control animals died within 24 hours of status epilepticus. This difference was statistically significant(p<0.05). 2) The mean latency to the first seizure, status epilepticus and periodic epileptiform discharges after lithium-pilocarpine injection were 34.7+/-2.6min, 32.3+/-1.8min and 180.4+/-9.8min, respectively, in the SCC group, while was 21.0+/-2.0min, 58.2+/-6.9min and 215.6+/-7.2min, respectively, in the control group. These latencies were significantly longer than in the control group(p<0.05). 3) There was a massive Fos expression on the cerebral cortex in the control group at 4 hours after lithiumpi-locarpine injection , while it was less in the SCC group. This difference was statistically significant(p<0.05). In conclusion, complete corpus callosotomy had contributed to the protective effect on the development of status epilepticus in the lithium-pilocarpine model which was similar to that observed in humans. And result of Fos expression suggest that Fos immunohistochemisty may be useful in the study of seizure pathways as a metabolic marker in the lithium-pilocarpine model.
Animals ; Cerebral Cortex ; Electroencephalography ; Epilepsy ; Humans ; Rats* ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus