Arachnoid cyst of the velum interpositum is unusual and causes symptoms similar to those seen with a third ventricular mass. This report describes a case in which the arachnoid cyst occupied the cistern of the velum interpositum and was coincident with multiple cranial neuropathies. The patient was treated by endoscopic fenestration of the cyst. The surgery resulted in decreased in the size of the cyst but aggravation of cranial neuropathies. The patient underwent methylprednisolone pulse therapy and intravenous immunoglobulin administration under the impression of the multiple cranial neuropathies and recovered completely 3 months later. The authors conclude that combined neurological disease that needs medical treatment should be differentiated and priority of the treatment should be determined carefully if arachnoid cyst is associated with unrelated or ambiguous neurological symptoms and signs. Careful considerations of cause and effect may avoid an unnecessary surgical manipulation
Arachnoid* ; Cranial Nerve Diseases* ; Humans ; Immunoglobulins ; Methylprednisolone

Clinical studies on neuromodulation intervention for trigeminal neuralgia have not yet shown promising results. This might be due to the fact that the pathophysiology of chronic trigeminal neuropathy is not yet fully understood. Chronic trigeminal neuropathy includes trigeminal autonomic neuropathy, painful trigeminal neuropathy, and persistent idiopathic facial pain. This disorder is caused by complex abnormalities in the pain processing system, which is comprised of the affective, emotional, and sensory components, rather than mere abnormal sensation. Therefore, integrative understanding of the pain system is necessary for appropriate neuromodulation of chronic trigeminal neuropathy. The possible neuromodulation targets that participate in complex pain processing are as follows : the ventral posterior medial nucleus, periaqueductal gray, motor cortex, nucleus accumbens, subthalamic nucleus, globus pallidus internus, anterior cingulate cortex, hypothalamus, sphenopalatine ganglion, and occipital nerve. In conclusion, neuromodulation interventions for trigeminal neuralgia is yet to be elucidated; future advancements in this area are required

No abstract available.
Central Nervous System*

No abstract available.
Aneurysm*

OBJECTIVE: An usefulness and an accuracy of Neurosurgery Simulator(R)(NSS(R)) is evaluated for the clinical applications. The NSS(R) is a surgical planning tool for stereotactic and functional neurosurgery, recently developed in Korea. METHODS: Thirty-four surgical cases, performed with the NSS(R) from October 1999 to April 2002, were analyzed. The accuracy was examined by comparing the actual lesion with the planned target. The usefulness was discussed with time consuming factor and convenience for surgical steps. Results of surgical outcome were also reviewed. RESULTS: The precise coordinates of surgical target is directly acquired by designating an anatomical lesion on the magnetic resonance image with NSS(R) due to auto recognition algorithm of the fiducials on the MRI image. The correctness is confirmed again by examining the anatomical lesion with superimposing the Schaltenbrand-Wahren atlas on the image directly. Among eleven cases of the thalamotomy for tremors, five cases resulted in complete resolution, the remaining five patients showed significant reduction of tremors. Improvement of ADL and UPDRS was recorded in all 6 Parkinson's disease patients who had undergone pallidotomy. Seventy five percent of patient in pain and psychosurgery resulted in improvements. The NSS(R) achieved 100% accuracy in calculating stereotactic biopsy coordinates. There was no deviation in guiding surgical trajectory. There was no significant surgical complication. CONCLUSION: Stereotactic and functional neurosurgery performed with the assistance of the NSS(R) is relatively safe and accurate.
Activities of Daily Living ; Biopsy ; Humans ; Korea ; Magnetic Resonance Imaging ; Neurosurgery* ; Pallidotomy ; Parkinson Disease ; Psychosurgery ; Tremor

The purpose of this study is to identify a group of mild head injury patients having lesions on computerized tomography(CT) and to investigate the risk factors affecting the abnormal findings on CT scan. The study was limited to patients 16 years of age and older with a initial Glasgow Coma Scale(GCS) scores of at least 13 at the time of admission. Of a total of 243 patients studied, 156(64.2%) had abnormal CT findings. 49 patients(20.2%) required neurosurgical intervention(craniotomies for hematoma in 33, hematoma in 1 and subdural hygroma in 3). Four patients(2.4%) died of their cranial injury and three died of extracranial causes. The incidence of CT abnormalities for each GCS score was 86.7% in GCS of 13, 68.6% in GCS of 14, and 58.6% in GCS of 5. The factors affecting GCS scores at the time of admission were the presence of loss of consciousness and posttraumatic amnesia. The factors affecting abnormal CT scans were the presence of posttraumatic amnesia and skull fracture. A new lesion of extension of the initial finding on follow-up CT scans was found in 9.3% of 75 patients who underwent follow-up CT scans. Even though routine CT scans for mild head injury patients are not always necessary, these result suggest that all patients admitted to hospital after mild head injury should undergo CT scanning to enable early detection of an intracranial lesion.
Amnesia ; Coma ; Craniocerebral Trauma* ; Follow-Up Studies ; Glasgow Coma Scale ; Head* ; Hematoma ; Humans ; Incidence ; Risk Factors ; Skull Fractures ; Subdural Effusion ; Tomography, X-Ray Computed* ; Unconsciousness

Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Acute Kidney Injury ; Adult ; Arm* ; Cerebral Hemorrhage* ; Compartment Syndromes* ; Dacarbazine ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Female ; Humans ; Myalgia ; Renal Dialysis ; Resuscitation ; Rhabdomyolysis

Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Acute Kidney Injury ; Adult ; Arm* ; Cerebral Hemorrhage* ; Compartment Syndromes* ; Dacarbazine ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Female ; Humans ; Myalgia ; Renal Dialysis ; Resuscitation ; Rhabdomyolysis

Polymethl methacrylate (PMMA) screw reinforcement is frequently used in osteoporotic bone as well as in damaged pilot holes. However, PMMA use can be dangerous, since the amount of applied cement is uncontrolled. A 47-year-old male with traumatic cervical spondylolisthesis at C6-7 underwent anterior cervical plate fixation. During repeated drilling and tapping for false trajectory correction, a pilot hole was damaged. Although it was an unconventional method, PMMA augmentation was tried. However, PMMA was accidentally injected to the cervical spinal cord owing to lack of fluoroscopic guidance. The PMMA was surgically removed after corpectomy and durotomy. The patient had left side hemiparesis (Grade 2/5) immediately post operation. The patient improved spontaneously (Grade 4/5) except for 4th and 5th digit extension. Here, we report a rare complication of PMMA extrusion in the spinal cord during a damaged pilot hole injection, which has not previously been described.
Bone Cements/*adverse effects/therapeutic use ; Bone Screws ; Cervical Vertebrae/*surgery ; Humans ; Male ; Middle Aged ; Polymethyl Methacrylate/adverse effects/therapeutic use

OBJECTIVES: Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography(CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). METHODS: We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. RESULTS: Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.
Aneurysm* ; Angiography* ; Arteries ; Carotid Artery, Internal ; Circle of Willis ; Diagnostic Imaging ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Mass Screening ; Parents ; Retrospective Studies ; Subarachnoid Hemorrhage*