No abstract available.
Intracranial Arteriovenous Malformations* ; Risk Factors*

No abstract available in English.
Knee Prosthesis ; Knee

For the management of small intracranial arteriovenous malformation(AVM), various methods were proposed and their clinical outcomes have been analyzed. Microsurgery, radiosurgery, and embolization can be effective for the treatment of small AVM. Small AVM is known to be at a higher risk of bleeding. Therefore, the aim of treatment should be the prevention of neurological deterioration from bleeding. Microsurgery has the advantage of prompt elimination of the risk of rebleeding by complete excision with single procedure. With the advance of microsurgical techniques, small AVM can be cured with minimal neurological deficit. Outcome of microsurgery depends on location, size, and numbers and patterns of draining veins, which mean Spetzler-Martin grades. Stereotactic device guided surgery, preoperative careful evaluation, intraoperative electrophysiological and hemodynamic monitoring, and experienced surgical skills can greatly reduce adverse brain injury and help complete and exact excision of malformations. Radiosurgery has its unique role for the deep seated AVM, but long term outcome remains to be evaluated. In the management of small AVM, surgery should be considered as the first line of treatment, and radiosurgery can be an alternative for the surgically inaccessible lesions.
Brain Injuries ; Hemodynamics ; Hemorrhage ; Microsurgery ; Radiosurgery ; Veins

On rare occasions, sudden hearing loss may be associated with a migraine. To our knowledge, there have only been two prior reports of sudden hearing loss attributed to migraines. A 40 years old man had suffered from recurrent headaches with hemiparesis, vertigo, and hearing loss for the past three years. At this time, he presented with severe bilateral sensorineural hearing loss of sudden onset, anarthria, right hemiplegia, tinnitus, and vertigo. An audiogram showed a down-sloping sensorineural hearing loss of 77dB by pure tone average on the right side and 72dB on the left. Sixteen days later, audiographic findings improved to 30dB of pure tone average on both sides. Vasospasm of the labyrinthine arteries instigated by migraine might explain these inner ear symptoms. A history of migraine should be sought in patients with sudden hearing loss and when found, anti-migraine medications such as calcium channel block-ers should be considered.
Adult ; Arteries ; Calcium Channels ; Ear, Inner ; Headache ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hemiplegia ; Humans ; Migraine Disorders* ; Paresis ; Tinnitus ; Vertigo

BACKGROUND: There exist considerable debates concerning about the effects of epilepsy surgery on cognitive function. To evaluate the effects of tailored anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) on intelligence and memory, we compared the pre- and post-operative cognitive function in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Thirty six patients who received unilateral tailored ATLAH from 1993 to 1997 and had been seizure-free for at least two years postoperatively were selected. Mean age at the time of surgery was 26.8 years and mean period of postoperative follow-up was 47 months. The change of cognitive function was assessed pre-and post-operatively using Korean Wechsler Adult Intelligence Scale (K-WAIS) and Rey memory test. We also assessed the correlation between the extent of hippocampal and lateral temporal cortical resection and cognitive changes respectively. RESULTS: In total patients (N=36), there was statistically significant improvement in performance IQ (PIQ, p<0.05), full scale IQ (FIQ, p<0.05), and auditory verbal learning test (AVLT). In the right temporal lobectomy group (N=16), improvement in PIQ, FIQ, and AVLT reached to statistical significance (p<0.05). In the left temporal lobecto-my group (N=20), improvement in PIQ was significant (p<0.05). In terms of the size of resection, there were tendencies that the cognitive function is more improved in patients with larger hippocampal resection (>2 cm) and in patients with smaller temporal cortical resection (4 cm). CONCLUSIONS: Patients became seizure free after tailored ATLAH may have improvement in performance IQ and full scale IQ. Right side resection, larger hippocampal resection, and smaller lateral temporal resection show better postoperative cognitive function. (J Korean Neurol Assoc 19(2):116~124, 2001)
Adult ; Anterior Temporal Lobectomy* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Intelligence* ; Memory* ; Seizures ; Temporal Lobe* ; Verbal Learning

BACKGROUND: There exist considerable debates concerning about the effects of epilepsy surgery on cognitive function. To evaluate the effects of tailored anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) on intelligence and memory, we compared the pre- and post-operative cognitive function in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Thirty six patients who received unilateral tailored ATLAH from 1993 to 1997 and had been seizure-free for at least two years postoperatively were selected. Mean age at the time of surgery was 26.8 years and mean period of postoperative follow-up was 47 months. The change of cognitive function was assessed pre-and post-operatively using Korean Wechsler Adult Intelligence Scale (K-WAIS) and Rey memory test. We also assessed the correlation between the extent of hippocampal and lateral temporal cortical resection and cognitive changes respectively. RESULTS: In total patients (N=36), there was statistically significant improvement in performance IQ (PIQ, p<0.05), full scale IQ (FIQ, p<0.05), and auditory verbal learning test (AVLT). In the right temporal lobectomy group (N=16), improvement in PIQ, FIQ, and AVLT reached to statistical significance (p<0.05). In the left temporal lobecto-my group (N=20), improvement in PIQ was significant (p<0.05). In terms of the size of resection, there were tendencies that the cognitive function is more improved in patients with larger hippocampal resection (>2 cm) and in patients with smaller temporal cortical resection (4 cm). CONCLUSIONS: Patients became seizure free after tailored ATLAH may have improvement in performance IQ and full scale IQ. Right side resection, larger hippocampal resection, and smaller lateral temporal resection show better postoperative cognitive function. (J Korean Neurol Assoc 19(2):116~124, 2001)
Adult ; Anterior Temporal Lobectomy* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Intelligence* ; Memory* ; Seizures ; Temporal Lobe* ; Verbal Learning

The authors report a case of giant fusiform aneurysm in posterior cerebral artery treated with trapping after temporal lobectomy. A 44-year-old woman presented with blurred vision and oculomotor nerve palsy of right eye. Cerebral angiography showed a giant fusiform aneurysm in posterior cerebral artery. A zygomatic-temporal approach and temporal lobectomy was performed for sufficient exposure of surgical field and the aneurysm was trapped. Postoperatively oculomotor nerve palsy was improved. We report a case of a giant fusiform aneurysm of posterior cerebral artery treated with trapping after temporal lobectomy and reviewed pertinent literatures regarding the treatment of giant fusiform aneurysms in posterior cerebral artery.
Adult ; Aneurysm* ; Cerebral Angiography ; Female ; Humans ; Oculomotor Nerve Diseases ; Posterior Cerebral Artery*

OBJECTIVE: Permanent occlusion of an aneurysm with platinum coil embolization is achieved by thrombus formation and subsequent organization of the thrombus. However, these processes are often delayed or imcomplete. In this study, the authors present the effects of autologous fibroblasts-attached platinum coils on thrombus organization. METHODS: Experimental aneurysms were made on common carotid arteries bilaterally in four dogs. During the operation, dermal fibroblasts were obtained from the neck skin. The fibroblasts were attached on platinum coils by a simple co-culture for 5 days. In each animal, one aneurysm was embolized with autologous fibroblast-attached platinum coils(study group) and the other with plain platinum coils(control group). Two weeks later, the degree of intraaneurysmal thrombus organization was compared. RESULTS: The study group aneurysms showed more advanced organization than the control group(area occupied by organized thrombus / aneurysm cross sectional area = 79% vs. 54%, p=0.02). CONCLUSION: As a pilot study, this experiment demonstrates autologous fibroblast-attached platinum coils can facilitate permanent aneurysm obliteration. Autologous fibroblast-attached platinum coils may be used for the treatment of intracranial aneurysms.
Aneurysm* ; Animals ; Carotid Artery, Common ; Coculture Techniques ; Dogs ; Embolization, Therapeutic ; Fibroblasts ; Intracranial Aneurysm ; Neck ; Pilot Projects ; Platinum* ; Skin ; Thrombosis

OBJECTIVE: We present an evaluation of the clinical outcome and an investigation of the optimal use of papaverine angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. METHODS: The authors retrospectively analyzed 24 cases of symptomatic vasospasm treated by papaverine angioplasty from July 1994 to February 1998. Detailed clinical features and detailed techniques of papaverine angioplasty including sex, age, symptoms, time interval from symptom onset to angioplasty, papaverine dose, concentration and duration of infusion were investigated. RESULTS: After papaverine angioplasty, immediate angiographic vasodilatation was achieved in 23 cases (96%). Fifty eight percent showed clinical improvement within 24 hours but symptomatic vasospasm recurred in 21% of them. Retreatment with papaverine for the recurred cases showed a less response than the initial treatment. Statistical analyses showed that time interval from symptom onset to angioplasty was the factor related to the effects of papaverine angioplasty. CONCLUSION: Our study shows that optimal timing of papaverine angioplasty is very important for clinical improvement.
Angioplasty* ; Papaverine* ; Retreatment ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vasodilation ; Vasospasm, Intracranial*

The purpose of this study was to understand the general features of pulmonary embolism in neurosurgical patients. The authors retrospectively reviewed 24 cases of pulmonary embolism from 1981 to 1994. The overall incidence of pulmonary embolism was 0.2%, but in the most prevalent year(194) it was 1.3%. Lower extremity weakness and immobilization was the most common predisposing condition. Of 24 patients with pulmonary embolism, 23 patients showed lower extremity weakness, and the mean duration of immobilization was 47 days. Most patients(80%) had symptoms of pulmonary embolism within 4 weks after operation. Medical prophylactic method had not been used in patients other than physical prophylactic method-graduated compression stocking, position change or physical therapy. Heparinization was given to 18 patients(75%), and minor hemorrhagic complication developed in 2 patients, but no major bleeding occurred. Inferior vena cava filter was applied in 2 patients. Only one patient suffered from recurrence and it w as not fatal. Of the 24 patients, 7 died, however only one patient died of pulmonary embolism. In our study, the prognosis of pulmonary embolism was not as serious as it has been reported in the literature. However, more precise studies will be needed to understand the fate of pulmonary embolism in Korean neurosurgical patients.
Hemorrhage ; Heparin ; Humans ; Immobilization ; Incidence ; Lower Extremity ; Neurosurgery ; Prognosis ; Pulmonary Embolism* ; Recurrence ; Retrospective Studies ; Stockings, Compression ; Vena Cava Filters