Microsurgical tumor removal is the treatment of choice to relieve the mass effect for the treatment of acoustic neurinoma patients. Gamma knife radiosurgery is another treatment option for patients with tumor size of less than approximately 4cm. Between May, 1990 and March, 1994, 55 tumor lesions from 50 patients were treated with gamma knife radiosurgery at Asan Medical Center. Following microsurgery, 20 patients underwent gamma knife radiosurgery for tumors not removed surgically. The remaining 30 patients underwent gamma knife radiosurgery alone. For an average follow-up period of 26 months(ranging from 6 to 45 months), 37 lesions out of 39 lesions responded, giving a tumor growth control rate of 94.9%. Facial neuropathy and trigeminal neuropathy were noted in 8% and 6%, respectively. According to these results, it is suggested that gamma knife radiosurgery in an effective altrnative therapeutic modality for the management of small to moderate sized acoustic neurinomas.
Acoustics* ; Chungcheongnam-do ; Facial Nerve Diseases ; Follow-Up Studies ; Humans ; Microsurgery ; Neuroma, Acoustic* ; Radiosurgery ; Trigeminal Nerve Diseases

The authors present surgical experience with 33 patients who had incurred unstable thoracic or lumbar spine pathology(22 degenerative lumbar spine disease, 6 trauma, 3 tumor, 2 vertebral tuberculosis) and who were intraoperatively stabilized with the Texas Scottish Rite-Hospital(TSRH) universal instrumentation system over 20 months period. The 11 men and 22 women(mean age 45 years, range 23 to 71 years) presenting with signs or symptoms of neural compression underwent surgery consisting of neural decompression, internal fixation, and bone grafting. Spondylolisthesis were fused in situ without reduction. For thoracic and thoracolumbar junction pathology, multisegment fixations were performed. A 95% fusion rate was obtained with a mean follow-up period of 15 months. There were no cases of instrumentation failure. Major postoperative complications included 2 isolated nerve root deficits(one transient, one permanent) and 3 pulmonary embolism(one fatal). The construct design of the TSRH system offers some advantag es compared to other forms of interal fixation:simple assembly, rigid stability, safety, and ability to remove easily. This system provides a highly successful method to obtain arthrodesis for unstable thoracic or lumbar spine.
Arthrodesis ; Bone Transplantation ; Decompression ; Follow-Up Studies ; Humans ; Male ; Pathology ; Postoperative Complications ; Spinal Fusion ; Spine* ; Spondylolisthesis ; Texas

Paraclinoid aneurysms arose from the proximal internal carotid artery between the site of emergence of carotid artery from the roof of the cavernous sinus and posterior communicating artery. Surgery of these aneurysms presents special difficulties because of its complicated osseous, dura, and neurovascular structures;sella turcica, cavernous sinus, optic nerve. The clinical and radiological characteristics in twenty-seven patients with the paraclinoid aneurysms were reviewed and classified into four subgroups according to their branch of origin in this segment;1) carotid cave aneurysm(2 cases), 2) ophthalmic artery aneurysm(11 cases), 3) superior hypophyseal artery aneurysm(11 cases), 4) proximal posterior carotid artery wall aneurysm or global type aneurysm(3 cases). Surgery required orbital unroofing and removal of anterior clinid process with release of dural ring. To provide easy proximal control, exposure of cervical carotid artery was helpful in some cases. Preoperative balloon occlusion testing was man datory. Outcomes were considered as good to fair in 19 patients, poor in five, and three patients died. The patients who had poor results were poor preoperative status-four were grade IV, one was grade II(Hunt-Hess grade). The causes of death were premature rupture(2 cases) and extensive vasospasm(1 case). Preoperative classification of these lesions provides excellent correlation of operative findings and surgical preparation to expose the proximal part of internal carotid artery.
Aneurysm* ; Arteries ; Balloon Occlusion ; Carotid Arteries ; Carotid Artery, Internal ; Cause of Death ; Cavernous Sinus ; Classification* ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit

Central retinal artery occlusion (CRAO) typically causes severe and permanent visual loss in the affected eye and vision does not recover in 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Various methods have been introduced to recanalize the occluded artery and remove emboli but considered to fail except thrombolytic therapy. Retina is a part of the brain so basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Accordingly rapid procedure within therapeutic time window, choosing appropriate drugs and doses, reducing hemorrhagic and ischemic complications associated with neurovascular intervention is very important. However, clinical significance of CRAO is much different from that of acute cerebral arterial occlusion, therefore, neurointerventionists should perform this procedure within appropriate range of safety.
Arteries ; Brain ; Cerebral Arteries ; Humans ; Ischemia ; Plaque, Atherosclerotic ; Retina ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde ; Stroke ; Thrombolytic Therapy