Vestibular neurectomy is known as an effective procedure in the management of intractable peripheral vertigo from Meniere's disease and other episodic peripheral vertigo disorders. Various approaches have been developed for selectively sectioning the vestibular nerve, in order to preserve hearing and avoid facial nerve injury. Vestibular neurectomy is performed in two patients with Meniere's disease to control intractable episodic vertigo through retrolabyrinthine approach. Vertigo was improved with preserving their hearing. We report the surgical technique and advantages of retrolabyrinthine vestibular neurectomy in the treatment of vertigo.
Facial Nerve Injuries ; Hearing ; Humans ; Meniere Disease ; Vertigo* ; Vestibular Nerve

OBJECTIVE: The purposes of this study are to compare imaging features with operative findings and to determine significance of imaging studies for early detection of craniosynostosis(CS). METHODS: Plain radiograph of skull and three-dimensional(3D) CT reconstruction were analyzed in 10 consecutive patients with CS to assess the presence and the extent of synostosis. The radiological findings were investigated and compared with operative findings. RESULTS: The locations of lesion were coronal suture in 6, sagittal suture in 3 and multiple sutures in one patient, and the age ranged 1 to 53 months(mean age: 17.4 months). Reconstructive procedures with or without advancement of supraorbital rim were performed in coronal CS patients and PI-procedures or synostectomy were done in sagittal CS patients. Radi-ological abnormalities such as sutural indistinctness or sclerosis, bony ridge, bossing and other bony deformities were nearly consistent with surgical findings. CONCLUSION: The interpretation of imaging study are very important for early detection of craniosynostosis, especially, the plain radiographs of skull. Also 3D CT imaging is helpful in diagnosis and surgical planing of craniosynostosis. There are no significant differences between imaging features and operative findings in CS patients.
Congenital Abnormalities ; Craniosynostoses* ; Diagnosis ; Humans ; Sclerosis ; Skull ; Sutures ; Synostosis

during bone harvesting from the chin.
Anatomic Variation* ; Chin*

The purpose of this study is to evaluate the regenerative capacity of reconstruction in the atrophied posterior maxilla by comparing bone graft procedures and alveolar distraction osteogenesis (ADO) techniques. We performed the autogenous iliac bone graft (AGB group, 5 specimens in 3 patients), and the combination (Mixed group, 3 specimens in 3 patients) of the autogenous and deproteinized bovine bone (Bio-Oss(R), Geistlich Co., Switzerland) as the ratio of 2:1 in the sinus floor elevation procedures. ADO procedures using TRACK(R). (KLS Martin Co., Germany) were also performed to augment vertical alveolar height in atrophied posterior maxilla (ADO group, 5 specimens in 4 patients). Newly generated bone tissues were obtained with the 2.0mm diameter trephine bur (3i Co., USA) during implant fixture installation after 5-7 months. Routine histolomorphological observation, immunodot blot assay for quantitative evaluation, and immunohistochemical staining with antibodies to MMP-1, -9, -10, TIMP-1, -2, and BMP-2, -4 were all carried out. Lamellar bone formation was well shown in all specimens and new bone formations of ADO group increased than those of other procedures. In immunohistochemical staining, the strong expression of BMP-2 was shown in all specimens, and immunodot blot assay showed that bone formation is accompanied by the good induction of factors associated with angiogenesis and appeared more increased amount of osteogenic and angiogenic factors in ADO group. ADO is the most effective technique for new bone formation compared to sinus floor elevation with autogenous or mixed bone graft in the atrophied posterior maxilla. In the quantitative immunodot blot assay, the regenerated bone after ADO showed more increased products of VEGF, BMP-2, PCNA and MMP-1 than those after the other procedures, and these findings were able to be confirmed by immunohistochemical stainings.
Angiogenesis Inducing Agents ; Antibodies ; Bone and Bones ; Dental Implants* ; Evaluation Studies as Topic ; Maxilla* ; Osteogenesis ; Osteogenesis, Distraction ; Proliferating Cell Nuclear Antigen ; Tissue Inhibitor of Metalloproteinase-1 ; Transplants ; Vascular Endothelial Growth Factor A

No abstract available.
Carcinoma ; Cheek

Neurocysticercosis is the most common parasitic disease of the central nervous system in humans, caused by infection of the larval stage of the pork tapeworm, Taenia solium. However, cerebellar involvement is rarely reported. We report of a case of racemose cysticercosis in the cerebellar hemisphere. A 44-year-old man presented with headache and dizziness. Magnetic resonance imaging showed hydrocephalus and an ill-defined, multicystic cerebellar mass with hypersignal on T2-weighted images, hyposignal on T1-weighted images and rim enhancement after gadolinium injection. The patient underwent endoscopic third ventriculostomy and the cyst resection was done through a craniotomy. In surgical field, cysts were conglomerated in a dense collagen capsule that were severely adherent to surrounding cerebellar tissue, and transparent cysts contained white, milky fluid. Histological findings confirmed the diagnosis of cysticercosis. He received antiparasitic therapy with praziquantel after surgery. Racemose cysticercosis is rare in the cerebellar hemisphere but neurocysticercosis should be taken into consideration as a differential diagnosis of multiple cystic lesions in the cerebellum.
Adult ; Central Nervous System ; Cerebellum ; Collagen ; Craniotomy ; Cysticercosis ; Diagnosis, Differential ; Dizziness ; Gadolinium ; Headache ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Neurocysticercosis ; Parasitic Diseases ; Praziquantel ; Taenia solium ; Ventriculostomy

OBJECTIVE: Most of the studies that have described surgical procedures for moyamoya disease(MMD) have had the aim to improve the blood flow mainly in the middle cerebral artery(MCA) territory. The purpose of this study is to clarify the good indications for a multiple burrhole operation to treat MMD. METHODS: With the patient under local anesthesia, burrhole trephination with a diameter of 1.5 to 2cm at 3 to 5cm lateral to the midline was performed in a total of 18 hemispheres during 12 procedures. The burrholes were opened in the frontal lobe at 19 sites in 10 patients and in the parietal lobe at 22 sites in 12 patients. Revascularization through multiple burrholes and arachnoid openings was performed in 12 patients who suffered from MMD. RESULTS: As seen on the follow up angiograms, good revascularization was achieved in 27 of 41 burrholes, and mainly from the middle meningeal artery and then from the superficial temporal artery. The moyamoya vessels were decreased in four patients. The neovascularization covered 68.4% of the frontal lobe and 63.5% of the parietal lobe. Compared with the preoperative 99mTc-HMPAO-SPECT, 6 patients showed improvement of cerebral blood flow on the postoperative 99mTc-HMPAO-SPECT. Transient ischemic attack disappeared in three of the four patients who presented with this symptom, and the preoperative symptoms improved in both of the patients who presented with headache and cerebral infarction. CONCLUSIONS: A multiple burrhole operation is a simple technique. The results of our series suggest that the revascularization obtained for adult MMD patients who underwent a multiple burrhole operation is similar to that obtained with other indirect surgeries, but long term follow up studies are needed.
Adult ; Anesthesia, Local ; Arachnoid ; Cerebral Infarction ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Ischemic Attack, Transient ; Meningeal Arteries ; Moyamoya Disease ; Parietal Lobe ; Temporal Arteries

Peripheral scalp T-cell lymphoma is a very rare disease. We report a case of a 22-year-old man who presented an indolent large scalp mass in the right frontal scalp region. The patient’s physical examination demonstrated no palpable mass in the chest, abdomen, and extremities. The brain CT revealed a high-density large scalp mass of the subgaleal layer in the right frontal and a small scalp mass of the subgaleal layer in the left frontal. The brain MRI showed multifocal enhancing masses in the bilateral dura, the subgaleal layer of the scalp, and the skull. The patient underwent removal of the tumor found in the right frontal scalp. The histologic diagnosis was peripheral T-cell lymphoma. Bone marrow aspiration showed the involvement of T-cell lymphoma. The patient received chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP protocol) for 3 cycles. The patient was discharged without neurological deficit. The patient showed no evidence of recurrence 15 months after surgery. We report a rare case of peripheral T-cell lymphoma mimicking benign scalp tumors.

OBJECTIVE: Hyponatremia (Na<135 mEq/L) is associated with cerebral ischemia after subarachnoid hemorrhage (SAH) and the incidence was reported as 9-34% of treated cases of SAH. This study was undertaken to clarify the clinical factors of hyponatremia in ruptured intracranial aneurysms. METHODS: Total 170 consecutive patients with ruptured intracranial aneurysms were included in this study and the incidence and timing of hyponatremia were analyzed retrospectively. Clinical severity quantified by the Hunt and Hess grade and Fisher's grade at admission, location of ruptured aneurysm, presence of vasospasm, onset of hyponatremia, development of hydrocephalus and Glasgow Outcome Scale (GOS) were analyzed in patients with hyponatremia. RESULTS: Hyponatremia occurred in 32 (40.5%) of 79 patients with anterior cerebral artery (ACA) aneurysm group, in 18 (40.0%) of 45 patients with internal cerebral artery (ICA) aneurysm group and in nine (22.5%) of 40 patients with middle cerebral artery (MCA) aneurysm group. Hyponatremia occurred significantly more often in cases with vasospasm and hyrocephalus (p<0.05). Among vasospasm cases, hyponatremia was not associated with the location of aneurysm or hydrocepalus. Respective days of onset for symptomatic vasospasm and for hyponatremia were day 7.2+/-3.3 and day 9.9+/-5.5 following SAH (p<0.05). CONCLUSION: Hyponatremia occurred more frequently in patients with vasospasm and hydrocephalus. The onset of hyponatremia was delayed by 3 days following symptomatic vasospasm. Since careful observation for hyponatremia is required during therapy in patients with vasospasm.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Brain Ischemia ; Cerebral Arteries ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Hyponatremia* ; Incidence ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Retrospective Studies ; Subarachnoid Hemorrhage

Peripheral nerve injury frequently leads to neuropathic pain like hyperalgesia, spontaneous pain, mechanical allodynia, thermal allodynia. It is uncertain where the neuropathic pain originates and how it is transmitted to the central nervous system. This study was performed in order to determine which peripheral component may lead to the symptoms of neuropathic pain. Under halothane anesthesia, male Sprague-Dawley rats were subjected to neuropathic surgery by tightly ligating and cutting the tibial and sural nerves and leaving the common peroneal nerve intact. Behavioral tests for mechanical allodynia, thermal allodynia, and spontaneous pain were performed for 2 weeks postoperatively. Subsequently, second operation was performed as follows: in experiment 1, the neuroma was removed; in experiment 2, the dorsal roots of the L4-L6 spinal segments were cut; in experiment 3, the dorsal roots of the L2-L6 spinal segments were cut. Behavioral tests were performed for 4 weeks after the second operation. Following the removal of the neuroma, neuropathic pain remained in experiment 1. After the cutting of the L4-L6 or L2-L6 dorsal roots, neuropathic pain was reduced in experiments 2 and 3. The most remarkable relief was seen after the cutting of the L2-L6 dorsal roots in experiment 3. According to the fact that the sciatic nerve is composed of the L4-L6 spinal nerves and the femoral nerve is composed of the L2-L4 spinal nerves, neuropathic pain is transmitted to the central nervous system via not only the injured nerves but also adjacent intact nerves. These results also suggest that the dorsal root ganglion is very important in the development of neuropathic pain syndrome.
Animal ; Ganglia, Spinal/physiopathology ; Male ; Nervous System Diseases/physiopathology* ; Nervous System Diseases/complications ; Pain/physiopathology* ; Pain/etiology ; Rats ; Rats, Sprague-Dawley ; Spinal Nerve Roots/physiopathology ; Spinal Nerves/physiopathology