The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.
Aged ; Humans ; Spine ; Vertebral Artery

Cavernous angiomas (CAs) presenting with seizures have been regarded as a rather benign condition, because anti-epileptic drugs can be used as primary measures. Because CAs are frequently associated with diffusion of hemosiderin pigment into the surrounding brain tissue, there needs to be a special consideration in the management of CAs with seizures. The development of epilepsy surgery and neuro-imaging techniques, as well as the realization about the side effects of drugs are changing the concept of treatment of CAs. If the lesion is associated with intractable seizures, surgical treatment should be considered. Simple lesionectomy would relieve seizures significantly, but not always completely. The concept of epilepsy surgery needs to be recruited in such intractable cases, especially the lesion is located in the seizure-prone temporal lobe. Lesions located at or close to the eloquent areas can nowadays be removed safely by invasive and non-invasive functional mapping. Even though the seizures are not intractable, surgical resection can cure the rare seizures if the lesions are accessible. Careful assessment using comprehensive investigations on seizure itself, location of the lesion, and functional evaluation can cure the large proportion of patients suffering from seizures with CAs.
Brain ; Diffusion ; Epilepsy* ; Hemangioma, Cavernous* ; Hemosiderin ; Humans ; Seizures ; Temporal Lobe

Melanotic Schwannoma arising from the acoustic nerve is extremely rare and only three cases have been reported. We report an additional case of melanotic schwannoma occuring at the left cerebellopontine angle in a 53-year-old man presented with left facial numbness and tinnitus. After surgical removal of the mass, there has been no evidence of recurrence for 13 months.
Acoustics* ; Cerebellopontine Angle ; Cochlear Nerve ; Humans ; Hypesthesia ; Middle Aged ; Neurilemmoma ; Neuroma, Acoustic* ; Recurrence ; Tinnitus

Ketoprofen is an nonsteroidal anti-inflammatory drug derived from propionic acid. It has been widely used as topical preparations, as gel or patch. It has been reported that topical ketoprofen can cause contact dermatitis and photocontact dermatitis. We experienced five cases of contact dermatitis, developed after applying ketoprofen patch(Ketotop(R), Pacific pharmaceutical Co., Korea) for the control of oste omuscular or joint pain. While one patient had generalized urticarial eruption, the rest of patents showed localized erythematous pruritic eczematous skin eruptions. It was verified through intradermal skin test and pin prick test that ketoprofen itself was not the causative drug for the skin eruption. Patch test excluded the possibility of allergic skin reaction to rubber compounds. It should be elucidated which compounds are allergic or toxic to the skin, contained in woven fabrics.
Arthralgia ; Dermatitis, Contact* ; Dermatitis, Photoallergic ; Diethylpropion ; Humans ; Ketoprofen* ; Patch Tests ; Rubber ; Skin ; Skin Tests

Kaposi's sarcoma(KS) is a multicentric proliferative vascular tumor involving cutaneous and visceral tissues. KS was one of the first recognized manifestations of AIDS. A 71-year-old woman was seen with multiple violaceous nodules and painful erythematous cellulitis-like swelling on both lower legs. Easy bruising and senile purpura was also noted on her forearms. She had been suffered from lower back pain for 7 years, and had been treated with corticosteroids. Clinical picture and hormonal study revealed that she had iatrogenic Cushing's syndrome. The histopathologic study from skin lesion showed abnormally proliferated and dilated vessels, vascular slits, spindle shaped cells in the entire dermis. Human herpesvirus 8(HHV-8) was detected by nested polymerase chain reaction(PCR) using the paraffin-embedded skin tissue. She received localized radiotherapy(50 Gray) to both lower legs with favorable response. But five months later, her skin lesions had recurred and progressed into more aggressive pattern mainly on her left lower leg. We report a rare case of human herpesvirus 8 related KS in iatrogenic Cushing's syndrome.
Adrenal Cortex Hormones ; Aged ; Cushing Syndrome* ; Dermis ; Female ; Forearm ; Herpesvirus 8, Human* ; Humans* ; Leg ; Low Back Pain ; Purpura ; Sarcoma, Kaposi* ; Skin

Keloid is proliferative fibrous growths that result from an excessive tissue response to trauma. The earlobe is a common site for the formation of keloid and the frequent cause is ear piercing. Many modalities are available for the treatment of earlobe keloid. Surgical excision has been the most commonly used therapeutic modality but recurrence following excision is common. Intralesional triamcinolon, radiation therapy, compression device, cryosurgery, D-penicillamine or any combination of them were reported to be successful in the treatment of earlobe keloid. We report three cases of earlobe keloid treated with partial surgical keloidectomy of upper part and carbon dioxide laser vaporizing the residual keloid tissue. And then the defect was covered with a primary closure with flap. Pressure earrings were fitted 2 weeks after surgery, and were maintained for 3 months. There was no recurrence of keloid for follow-up period at least 9 months. We suggest that combined modality of CO2 laser vaporization and pressure earring after surgical keloidectomy may offer a better cosmetic and functional improvement in the treatment of primary and recurrent earlobe keloid.
Body Piercing ; Carbon Dioxide* ; Carbon* ; Cryosurgery ; Ear* ; Follow-Up Studies ; Keloid* ; Lasers, Gas* ; Penicillamine ; Recurrence ; Volatilization

OBJECTIVE: We investigated the treatment result and prognostic factors in patients with malignant cerebral infarction who underwent decompressive craniectomy during ongoing brain herniation. METHODS: We retrospectively reviewed the medical records and radiological findings of 31 patients who underwent decompressive craniectomy due to acute cerebral infarction. All patients showed progressive deterioration of neurological status with signs of brain stem compression at the time of surgery. Wide frontotemporoparietal craniectomy and duroplasty was done. Postoperatively, continuous intracranial pressure (ICP) monitoring and barbiturate coma therapy were performed. RESULTS: Seventeen out of thirty one patients (54.8 %) survived. At 6 months after the surgery, 14 patients recovered to Galsgow outcome scale 3 or more. Age, sex, and interval between symptom onset and operation did not affect the survival. Preoperative Glasgow coma scale (GCS) score was the only prognostic factor that was statistically significant. The mean GCS scores of the patients who survived and died were 10.1+/-3.8 and 6.6+/-2.3, respectively (p=0.002). Although the difference was not statistically significant, in patients who died, the infarct area tended to be more extensive and additionally involved basal ganglia or anterior cerebral artery (ACA) territory (p=0.157). CONCLUSION: It is suggested that the patients with massive cerebral infarction can be helped by decompressive craniectomy and aggressive intensive care even in the phase of brain stem dysfunction due to ongoing brain herniation. Preoperative GCS score is an important factor which should be considered in decision of the surgical treatment.
Anterior Cerebral Artery ; Basal Ganglia ; Brain ; Brain Stem ; Cerebral Infarction* ; Coma ; Decompressive Craniectomy* ; Glasgow Coma Scale ; Humans ; Critical Care ; Intracranial Pressure ; Medical Records ; Retrospective Studies

OBJECTIVES: To evaluate the diagnostic accuracy of three-dimensional digital subtraction angiography in the surgical or interventional treatment of intracranial aneurysms. MATERIAL AND METHODS: We reviewed the clinical records, radiological findings, and surgical results of seventy-two patients with eight-five aneurysms who had undergone 2-dimensional digital subtraction angiography (2-D DSA) and 3-D DSA as the diagnostic evaluation. 3-D images were compared with 2-D images and surgical or interventional results. The shape of the aneurysms, their necks, and their relationships to the parent vessels and other branches were evaluated. RESULTS: The existence of the aneurysms was diagnosed exclusively by 3-D DSA in 13 patients. The site (n=27) and the shape (n=15) of the aneurysms were evaluated more accurately with 3-D DSA than with 2-D DSA images. Depiction of aneurysmal necks and their relationships to the parent vessels was clearer with 3-D DSA images than with 2-D DSA images, especially in cases of the distal internal carotid artery aneurysms. CONCLUSION: With its advantages, such as unlimited projection, similarity to surgical view, and high resolution especially in the cavernous portion of ICA, the 3-D DSA provides more valuable information in the planning the surgical or interventional treatments of cerebral aneurysms.
Aneurysm ; Angiography, Digital Subtraction* ; Carotid Artery, Internal ; Diagnosis* ; Humans ; Imaging, Three-Dimensional ; Intracranial Aneurysm* ; Neck ; Parents

No abstract available.
Axons ; Hand ; Humans

OBJECTIVE: The purpose of this study is to assess the temporal course of seizure in patients with arteriovenous malformation(AVM) after radiosurgery. METHODS: This study included 48 patients with AVM who underwent LINAC radiosurgery. Seventeen patients(35%) presented with seizure before the diagnosis of AVM. Clinical symptoms, location and volume of AVM, and temporal course of seizure after radiosurgery were analyzed retrospectively. RESULTS: Among seventeen patients with seizure episode before radiosurgery, twelve(70.6%) improved progressively and one patient(5.9%) did not show change in seizure frequency during the follow up period. Transient increase of seizure frequency and subsequent improvement was observed in 4 patients(23.5%), and seizure was controlled in two of these patients during the follow-up. Cumulative seizure frequency of all patients increased transiently from six months to 18 months after radiosurgery, and then it began to decrease significantly. CONCLUSION: Radiosurgery is an effective treatment modality resulting not only in the obliteration of AVM but also improvement of epilepsy associated with AVM. However, in some patients, transient increase of seizure frequency was observed before subsequent improvement. It was around 18 months after radiosurgery that seizure frequency significantly decreased in the majority of the patients. These data suggest that there is a possibility of transient aggravation of epilepsy after radiosurgery even though epilepsy improved eventually in most of the patients.
Arteriovenous Malformations* ; Diagnosis ; Epilepsy ; Follow-Up Studies ; Humans ; Radiosurgery* ; Retrospective Studies ; Seizures*