OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Abducens Nerve Diseases ; Exophthalmos ; Female ; Fistula* ; Humans ; Orbit ; Punctures* ; Veins* ; Young Adult

No abstract available.
Neurilemmoma* ; Neurofibromatoses* ; Neurofibromatosis 2*

Despite significant advances in neurosurgical and neuroanesthetic techniques, certain lesions such as giant aneurysms still present significant challenge to neurosurgoens. The authors experienced a case of giant MCA bifurcation aneurysm surgery using a technique of deep hypothermia and circulatory arrest with excellent outcome. Cannulation for cardiopulmonary bypass can be done either centrally through a sternotomy(aortic-right atrial), or peripherally through a small inguinal incision(femoral-femoral). In our case, femoral-femoral cannulation was done which can eliminate many serious complications following the sternotomy. The rationale for the application of the deep hypothermia and circulatory arrest in the complex intaracranial aneurysm surgery and the benefits of the femoral cannulation are disccused.
Aneurysm* ; Cardiopulmonary Bypass ; Catheterization ; Hypothermia* ; Sternotomy

A 24-year-old female patient presented with a midline extra-axial posterior fossa lesion. We failed to suspect this lesion could be a giant thrombosed aneurysm of PICA(posteior inferior cerebellar artery) preoperatively, and didn't perform preoperative angiogram even after rather typical finding of thrombosed giant aneurysm on MRI. We suggest a giant thrombosed aneurysm should be included in the differantial diagnosis of any round extra-axial mass lesion in the skull base.
Aneurysm* ; Arteries* ; Diagnosis ; Female ; Humans ; Infratentorial Neoplasms* ; Magnetic Resonance Imaging ; Pica ; Skull Base ; Young Adult

Between January 1990 and August 1992 sixteen patients with sellar tumors underwent 16 transsphenoidal approaches at Kang-Nam Sacred Heart Hospital. Pathological diagnosis include 14 pituitary adenomas, of which six belonged to microadenomas and the remaining eight cases were classified as macroadenomas. Other pathologies were one craniopharyngioma and one sphenoid mucocele. Thirteen patients underwent TSA as the primary procedures and the remaining three patients were subjected to TSA as the secondary procedures to the primary treanscranial approaches. Of the 13 primary TSAs excellent or good results were achieved in 11 patients and the remaining two patients were subjected to the secondary transcranial approaches to achieve good results. Six patients with microadenomas achieved gross total or subtotal removal of their tumors in all cases(100%) however, satisfactory removal was achieved only in six macroadenoma cases(75%). There was neither surgical mortality nor major morbidity. Transient diabetes insipidus complicated in 6 patients(37.5%) and CSF rhinorrhea complicated in three cases*18.8%), which needed spinal drainage for three to ten days. Meningitis was complicated in one patient with CSF rhinorrhea(6.2%). This preliminary study agrees with that TSA is a safe and effective procedure even in macroadenoma cases.
Craniopharyngioma ; Diabetes Insipidus ; Diagnosis ; Drainage ; Heart ; Humans ; Meningitis ; Mortality ; Mucocele ; Pathology ; Pituitary Neoplasms

OBJECTIVE: We analyzed the main causes leading to a poor outcome (severe disability, a vegetative state and death) following surgical treatment for ruptured intracerbral aneurysms. METHODS: Between January 1994 and December 2007, we maintained a retrospective database of 339 patients who underwent surgical clipping. The various causes we investigated were the technical problems during operation, the initial SAH or ICH, vasospasm, hydrocephalus and the post-operative medical complications. The clinical outcome was assessed according to the Glasgow Coma Scale (GOS). RESULTS: There were 263 cases of good outcomes (77.6%) and 76 cases of poor outcomes (22.4%). The three main causes of a poor outcome were 1) preoperative causes such as the direct insult of the initial SAH and ICH in 21 cases (27.6%), 2) intra-operative causes such as the technical problems during dissection and clipping of the aneurysm neck in 29 cases (38.2%) and 3) postoperative causes such as clinical vasospasm in 16 cases (21.1%). The mean follow-up period was 17.6 months (range : 2 months to 9 years). CONCLUSION: A meticulous neck dissection and complete obliteration of the aneurysm preserving parent arteries and perforators are the most effective and prime methods that surgeons can employ to reduce the rate of poor outcomes when performing ruptured aneurysm surgery.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Microsurgery ; Neck ; Neck Dissection ; Parents ; Persistent Vegetative State ; Retrospective Studies ; Surgical Instruments

OBJECTIVE: The purpose of this study is to compare the incidence of shunt-dependent chronic hydrocephalus and symptomatic vasospasm in elderly patients following intracranial aneurysm rupture with those of younger patients. METHODS: We retrospectively reviewed the medical records of 189 patients who were treated with open surgery between May 1994 and December 2000. They were divided into two groups; elderly (> or =60 yrs) and younger (< or =59 yrs) group. Incidence of shunt-dependent chronic hydrocephalus and symptomatic vasospasm was analysed in each group during 6 months after surgery. RESULTS: Shunt-dependent chronic hydrocephalus has developed more frequently in the elderly group (27.8%) than in the younger group (7.3%). Incidence of symptomatic vasospasm was not significantly different between two groups, even though poor grade patients were more represented in the elderly group. CONCLUSION: Meticulous clinical long-term follow-up is needed to detect shunt-dependent chronic hydrocephalus as early as possble in the elderly patients with operated ruptured intracranial aneurysms and in that case, shunt operation should be undertaken.
Aged* ; Follow-Up Studies ; Humans ; Hydrocephalus* ; Incidence ; Intracranial Aneurysm* ; Medical Records ; Retrospective Studies ; Rupture

OBJECTIVE: The authors take a group of patient who have undergone radiosurgery for the treatment of metastatic brain tumor, and conduct a retrospective analysis on the therapeutic response and prognotic factors which influenced the outcome. METHODS: The cases of metastatic brain tumor managed with radiosurgery at our hospital between January of 1996 and December of 2000 were 26. Second radiosurgery was performed for new metastasis in two patients. RESULTS: Average age of patients was 59.3 years. A single lesion was found in 17 cases while multiple lesions were found in 11 cases. Median survival period of the pateints who have undergone radiosurgery was 53 weeks, and survival rate at 6 months, 12 months, and 24 months was 84.6%, 53.9%, and 19.6% respectively. Overall tumor-control-rate was 92.9%. There was one case of radiation necrosis as a complication. Extracranial metastasis, controlled primary cancer and above 70 of Karnofsky performance scale score were statistically significant prognostic factors for survival. CONCLUSION: Radiosurgery is safe and effective in the treatment of metastatic brain tumor. And the control of primary malignant tumor, the presence of extracranial metastasis and above 70 of KPS have seen shown to influence the therapeutic response and prognosis.
Brain Neoplasms* ; Brain* ; Humans ; Necrosis ; Neoplasm Metastasis ; Prognosis ; Radiosurgery* ; Retrospective Studies ; Survival Rate

It has been reported that malignant transformation of neurofibroma occurs in about 5 to 10 per cent of type I neurofibromatosis patients. This 68 year old female patient presented with a huge fungating mass lesion in the right parietal scalp, which had recently grown rapidly. She had multiple neurofibromas of varying sizes on the entire trunk, extremities, and face. On the basis of family history and opthalomologic examination, type I neurofibromatosis was diagnosed. The mass was totally removed and the pathologic report revealed malignant transformation of the benign neurofibroma to malignant schwannoma. According to the literature, the incidence of head and neck sarcomas is very low, in particular malignant schwannoma occurring in the scalp is extremely rare. This case was, then, a rare event associated with type I neurofibromatosis.
Aged ; Extremities ; Female ; Head ; Humans ; Incidence ; Neck ; Neurilemmoma* ; Neurofibroma ; Neurofibromatoses* ; Rabeprazole ; Sarcoma ; Scalp*

The effects of radiosurgery on the arteriovenous malformation(AVM) nidus are documented in some studies as endothelial hypertrophy followed by obliteration of the vascular lumen with thrombosis. According to the literature total angiographic obliteration of the AVM nidus after radiosurgery takes about two years, but few reports of the histologic changes after radiosurgery for AVM are found. The authors encountered a case in which AVM surgery was performed after three months of LINAC radiosurgery because of the AVM bleeding. Histologic changes seen in the AVM nidus after three months of radiosurgery were the endothelial hypertrophy and the perivascular inflammation as early features of obliteration.
Hemorrhage ; Hypertrophy ; Inflammation ; Radiosurgery* ; Thrombosis