No abstract available.
Blood Platelets* ; Humans ; Platelet Aggregation* ; Plateletpheresis* ; Tissue Donors*

The following is a report of a case of intramedullary hemangioblastoma with diffuse cord enlargement. A 34 years-old man was admitted complaining of posterior neck pain developed ten months before. Spinal magnetic resonance image then revealed diffuse cord enlargement from the cervical to upper thoracic level, together with well enhancing intramedullary mass at the C7-T1 level. C6-T1 total laminetomy was performed and the enhancing mass was removed. Postoperative magnetic resonance image done on the 15 th day, revealed that the cord enlargement had disappeared and the signal intensity of the enlarged portion subsequently changed from high to low. The possible pathophysiology of this observation is discussed.
Adult ; Hemangioblastoma* ; Humans ; Neck Pain ; Spinal Cord*

The surgical outcomes of Arnold-Chiari malformation associated with syringomyelia have been reported with respect to improvement in symptoms and signs. But there are only a few studies about the changes of size in syrinx cavity after the era of magnetic resonance image. The authors employed two different surgical modalities and compared the difference in outcomes. Between 1988 and 1994, 17 patients suffering from Arnold-Chiari malformation associated with syringomyelia were treated by foramen magnum decompression(FMD), with or without shunt. Their ages ranged from 3 to 62 (median, 42) years; four were males and 13 were females. Eight were treated by FMD with syringosubarachnoid shunt (FMD with shunt group) and 9 by FMD only(FMD group). Changes in the extent of syrinx and clinical improvements were retrospectively compared between the two groups; the median follow-up period was 22(range 5-79) months. Changes in the extent of syrinx were analyzed by pre- and postoperative magnetic resonance images; improvements in symptoms or signs were classified by lower cranial nerves, the cerebellum and the spinal cord. The size of syrinx was decreased in 7/8 patients of FMD with shunt group(88%) and in 7/9 patients of FMD group (78%) and there was no significant difference in ratio statistically(p=0.54). Shrinkage of syrinx cavity was occurred regardless of its preoperative extent. In FMD with shunt group, 5/8 patients(63%) were improved in symptoms or signs and in FMD group, 6/9 patients(67%)(p=0.21). In all 3 cases which showed no collapse of syrinx cavity, the clinical improvements were not found. There was correlation between collapse of syringomyelia and improvement of clinical findings(p=0.035).
Arnold-Chiari Malformation* ; Cerebellum ; Cranial Nerves ; Female ; Follow-Up Studies ; Foramen Magnum ; Humans ; Male ; Retrospective Studies ; Spinal Cord ; Syringomyelia*

No abstract available.
Radiosurgery* ; Trigeminal Neuralgia*

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.
Anesthetics/therapeutic use ; Botulinum Toxins/therapeutic use ; Electric Stimulation ; Humans ; Magnetic Resonance Imaging ; Nerve Block ; Neuralgia/*diagnosis/surgery/therapy ; Spinal Nerves/anatomy & histology/*physiopathology ; Steroids/pharmacology

OBJECTIVE: Although hydroxyapatite (HA) spacer has been used for laminoplasty, there have been no reports on factors associated with fusion and on the effects of HA shape. METHODS: During January 2004 and January 2010, 45 patients with compressive cervical myelopathy underwent midline-splitting open door laminoplasty with winged (33 cases) and wingless (12 cases) HAs by a single surgeon. Minimal and mean follow up times were 12 and 28.1 months, respectively. Japanese Orthopedic Association (JOA) score was used for clinical outcome measurement. Cervical X-rays were taken preoperatively, immediately post-operatively, and after 3, 6, and 12 months and computed tomography scans were performed preoperatively, immediately post-operatively and after 12 months. Cervical lordosis, canal dimension, fusion between lamina and HA, and affecting factors of fusion were analyzed. RESULTS: All surgeries were performed on 142 levels, 99 in the winged and 43 in the wingless HA groups. JOA scores of the winged group changed from 10.4+/-2.94 to 13.3+/-2.35 and scores of the wingless group changed from 10.8+/-2.87 to 13.8+/-3.05. There was no significant difference on lordotic and canal dimensional change between two groups. Post-operative 12 month fusion rate between lamina and HA was significantly lower in the winged group (18.2 vs. 48.8% p=0.001). Multivariate analysis showed that ossification of the posterior longitudinal ligament, male gender, and wingless type HA were significantly associated with fusion. CONCLUSION: Clinical outcome was similar in patients receiving winged and wingless HA, but the wingless type was associated with a higher rate of fusion between HA and lamina at 12 months post-operatively.
Animals ; Asian Continental Ancestry Group ; Durapatite ; Follow-Up Studies ; Humans ; Longitudinal Ligaments ; Lordosis ; Male ; Multivariate Analysis ; Orthopedics ; Spinal Cord Diseases

OBJECTIVE: To analyze factors associated with fusion using allogeneic bone spacers for midline splitting cervical laminoplasty (MSCL). METHODS: During April 2012 and September 2013, seventeen patients with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) underwent MSCL with allogeneic bone spacers by a single surgeon. Mean follow up periods was 11.3 months (range, 6-19 months). Clinical outcomes were evaluated by the Japanese Orthopedic Association (JOA) scores at preoperative and postoperative 6 months. Simple cervical X-rays were taken preoperatively, immediate postoperatively, 3, and 6 months after operation. Computed tomography (CT) scans were performed preoperatively, immediate postoperatively and 6 months postoperatively. The differences between two diseases were analyzed on cervical lordosis, canal dimension, anteroposterior (AP) distance, fusion between lamina and allogeneic bone spacer and affecting factors of fusion. RESULTS: All surgeries were performed on 59 levels. There were no significant differences on the changes of lordosis (p=0.602), canal dimension (p=0.554), and AP distance (p=0.924) as well as JOA scores (p=0.257) between CSM and OPLL groups. Overall fusion rate was 51%. Multivariate analysis on the factor for the fusion rates between lamina and spacers showed that the immediate postoperative contact status between lamina and spacers in CT as significant factor of fusion (p=0.024). CONCLUSION: The present study suggests that CSM and OPLL did not show difference of surgical outcome in MSCL using allogeneic bone spacer. In addition, we should consider the contact status between lamina and bone spacer for the better fusion rates for this surgery.
Allografts ; Animals ; Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; Lordosis ; Multivariate Analysis ; Orthopedics ; Ossification of Posterior Longitudinal Ligament* ; Spinal Cord Diseases* ; Spinal Fusion ; Spondylosis

Spinal cord injury (SCI) is a catastrophic condition associated with significant neurological deficit, social, and financial burdens. Over the past decades, various treatments including medication, surgery, and rehabilitation therapy for SCI have been performed, but there were no definite treatment option to improve neurological function of patients with chronic SCI. Therefore, new treatment trials with stem cells have been studied to regenerate injured spinal cord. Among various types of stem cells, bone marrow derived mesenchymal stem cells is highly expected as candidates for the stem cell therapy. The result of the current research showed that direct intramedullary injection to the injured spinal cord site in subacute phase is most effective. Neurological examination, electrophysiologic studies, and magnetic resonance imaging are commonly used to assess the effectiveness of treatment. Diffusion tensor imaging visualizing white matter tract can be also alternative option to identify neuronal regeneration. Despite various challenging issues, stem cell therapy will open new perspectives for SCI treatment.
Bone Marrow ; Cell- and Tissue-Based Therapy ; Diffusion Tensor Imaging ; Humans ; Magnetic Resonance Imaging ; Mesenchymal Stromal Cells ; Neurologic Examination ; Neurons ; Regeneration ; Rehabilitation ; Spinal Cord Injuries* ; Spinal Cord* ; Stem Cells* ; White Matter

Spinal cord injury (SCI) is one of the most devastating conditions and many SCI patients suffer neurological sequelae. Stem cell therapies are expected to be beneficial for many patients with central nervous system injuries, including SCI. Adult stem cells (ASCs) are not associated with the risks which embryonic stem cells have such as malignant transformation, or ethical problems, and can be obtained relatively easily. Consequently, many researchers are currently studying the effects of ASCs in clinical trials. The environment of transplanted cells applied in the injured spinal cord differs between the phases of SCI; therefore, many researchers have investigated these phases to determine the optimal time window for stem cell therapy in animals. In addition, the results of clinical trials should be evaluated according to the phase in which stem cells are transplanted. In general, the subacute phase is considered to be optimal for stem cell transplantation. Among various candidates of transplantable ASCs, mesenchymal stem cells (MSCs) are most widely studied due to their clinical safety. MSCs are also less immunogenic than neural stem/progenitor cells and consequently immunosuppressants are rarely required. Attempts have been made to enhance the effects of stem cells using scaffolds, trophic factors, cytokines, and other drugs in animal and/or human clinical studies. Over the past decade, several clinical trials have suggested that transplantation of MSCs into the injured spinal cord elicits therapeutic effects on SCI and is safe; however, the clinical effects are limited at present. Therefore, new therapeutic agents, such as genetically enhanced stem cells which effectively secrete neurotrophic factors or cytokines, must be developed based on the safety of pure MSCs.

Spinal arteriovenous malformations(AVM's) may subject patients to the risk of paraplegia or quadriplegia. To determine the clinical features of patients with spinal AVM's, the authors reviewed the medical records of 26 such patients diagnosed and treated in our department, between 1986 and 1996. Among these, there were two cases of dural arteriovenous fistula(dural AVF), eight of perimedullary fistula, twelve of intramedullary AVM, and three of intramedullary cavernous angioma. In one case, the type of AVM was not identified. The most common presenting symptom was acute or slowly progressive myelopathy. The patients were treated with embolization, surgery, or both, and because of residual or recurrent disease, treatment was repeated in six cases, five of which were intramedullary AVM. All patients with dural AVF improved after treatment. Among patients with intradural AVM(perimeudllary AVF or intramedullary AVM), 25% were improved and 25% deteriorated : two of three patients with cavernous angiomas improved. Diagnostic and therapeutic considerations in the cases of AVM of the spinal cord are discussed. Since recurrence or residual arteriovenous shunting is a common problem in the treatment of this condition, follow-up observation of clinical and angiographic findings is mandatory.
Arteriovenous Malformations* ; Central Nervous System Vascular Malformations ; Fistula ; Follow-Up Studies ; Hemangioma, Cavernous ; Humans ; Medical Records ; Paraplegia ; Quadriplegia ; Recurrence ; Spinal Cord Diseases ; Spinal Cord*