Myxoma is a rare nonepithelial neoplasm of the larynx frequently misdiagnosed as a large vocal polyp due to its slow-growing nature. Myxoma is a benign but often infiltrating neoplasm of uncertain mesenchymal cell origin, characterized by irregular round, spindle or stellate cells within a matrix containing abundant mucoid material, scant vascularity and a variable meshwork of reticulum and collagen. We report one case of myxoma with life-threatening dyspnea requiring tracheotomy.
Case Report ; Critical Illness ; Human ; Laryngeal Neoplasms/complications* ; Male ; Middle Age ; Myxoma/complications* ; Respiration Disorders/surgery ; Respiration Disorders/etiology* ; Tracheotomy

No abstract available.
Glioblastoma*

Primary oligodendroglioma of the spinal cord is very rare tumor. On searching through the literature from 1931, we could find only about 46 cases, and this tumor is almost absent in Korea on the review of the literature. The authors present a case of 8-year-old female patient with the symptoms of paraparesis, urination difficulty, diffuse back pain and hypesthesia in both lower extremities. Spine MRI revealed the mass at the level of T3-T12, with combined nature of cystic and solid portion. Decompressive laminectomy and partial mass removal was performed, and then adjunctive radiotherapy and chemotherapy was done. The patient was improved after operation with radiotherapy and chemotherapy, so she walks alone and has no voiding difficulty at present(postoperative about 20 months) .
Back Pain ; Child ; Drug Therapy ; Female ; Humans ; Hypesthesia ; Korea ; Laminectomy ; Lower Extremity ; Magnetic Resonance Imaging ; Oligodendroglioma* ; Paraparesis ; Radiotherapy ; Spinal Cord* ; Spine ; Urination

The mortality and morbidity of the intraventricular hemorrhage(IVH) has been decreased since the introduction of external ventricular drainage(EVD) and direct intraventricular infusion of urokinase as an effective therapeutic method. In 1989, we already reported a series of 54 cases of IVH treated with simple EVD or EVD with urokinase irrigation in a few cases. Authors analyzed again a series of 50 cases of IVH treated by EVD with direct intraventricular urokinase irrigation after the pervious report. The mortality rate was 55.5% in former occasion, however 18% in this study and the complications were considerably low. We experienced again that the EVD with urokinase irrigation is an effective method and convenient, simple technique in the management of IVH even though there is no ICP monitoring. So we prefer EVD with urokinase irrigation therapy in managing the IVH even if the patient is moribund state.
Drainage* ; Hemorrhage* ; Humans ; Infusions, Intraventricular ; Mortality ; Urokinase-Type Plasminogen Activator*

OBJECTIVE: The goal of this study is to assess the safety and efficacy of the Codman Hakim programmable valve versus differential pressure valve in the treatment of patients with hydrocephalus. METHODS: The authors conducted a retrospective study of 83 patients who were implanted the Codmam Hakim programmable valve and differential pressure valve between January 1996 and April 2001. We analyzed complications, the number of shunt revision, and prognosis between the two groups. We analyzed initial pressure setting, the cause of reprogramming, and the number of reprogramming in Codman Hakim programmable valve. RESULTS: No statistically significant difference was apparent between the Codmam Hakim programmable valve group and a differential pressure valve group in complications, primary disease entities in shunt revision cases and prognosis(p>0.05). And statistically difference was not apparent in the number of shunt revision(p=0.07). The average pressure and range of initial pressure setting in the Codmam Hakim programmable valve was 97.1mmH2O and 50~150mmH2O, respectively. The number of cases of reprogragmming in the Codmam Hakim programmable valve was 12 in total, 1 time in 9 cases , 2 times in 2 cases, and 3 times in 1case. CONCLUSION: The Codmam Hakim programmable valve can decrease shunt revision caused by underdrainage and overdrainage complications. The optimal pressure settting is the key point to decreasing reprogramming and complications in the Codmam Hakim programmable valve and a differential pressure valve.
Humans ; Hydrocephalus* ; Prognosis ; Retrospective Studies

OBJECTIVE: The authors analyzed the postoperative radiological changes in chronic subdural hematoma (CSDH) after operation and its relation to the recurrence. METHODS: After reviewing the postoperative imagings of CSDH patients (90 cases, 70 patients), we classified them into 4 types according to the radiological changes in the hematoma area and calculated the prevalence of recurrence respectively. We also reviewed the preoperative images of the same patients and classified them into 4 types according to hematoma density and internal structure and investigated the prevalence of recurrence after operation respectively. RESULTS: The low density area in postoperative computerized tomography (CT) showed the same Hounsfield unit and signal intensity in magnetic resonance imaging (MRI) with the CSF in ventricles. The recurrence of CSDH was lower if the hematoma was totally replaced with CSF (Type III) or the brain re-expanded completely with total hematoma drainage (Type IV) on postoperative imagings (p<0.05). The location of catheter tip can be used as a valuable indicator of the boundary of newly collected CSF and residual hematoma. CONCLUSION: The low-density area found on postoperative CT medial to the residual hematoma in CSDH is filled with CSF and it can be a helpful factor in reducing the recurrence. The catheter tip location can be used as a good index and we can remove the catheter immediately after confirming the tip location on the inner surface of the skull.
Brain ; Catheters ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Prevalence ; Recurrence* ; Skull

This study is a retrospective clinical analysis of 134 cases of anterior communicating artery aneurysms surgically treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1990 to December 1996. The results of analysis were summarized as follows; 1) Peak age incidence was in the sixth decade and male to female ratio was 1: 1.2, showing female predominancy. 2) There was no statistically significant relationship between direction of aneurysm and Fisher's grade, and occurrence of hydrocephalus, and also between the direction, size and shape of aneurysm and preoperative Hunt-Hess grade. 3) There was statistically significant relationship between the shape of aneurysm and angiographic vasospasm; there was high incidence of vasospasm in lobulated and oval shape of aneurysm. But there was no statistically significant relationship between the direction, size of aneurysm and angiographic vasospasm. 4) The correlations between outcome and preoperative Hunt-Hess grade, and occurrence of angiographic vasospasm, and temporary clipping were statistically significant; the outcome was good in cases of no vasospasm, temporay clipping and better preoperative Hunt-Hess grade. 5) The direction, shape and size of aneurysm, existence or not of abnormality in circle of willis, timing of surgery and operative procedure had no statistically significant relationship with outcome. 6) Postoperative complications were vasospasm and infarction(18.7%), brain edema, hydrocephalus, in order of frequency, and the mortality rate was 3%.
Aneurysm ; Brain Edema ; Chungcheongnam-do ; Circle of Willis ; Female ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Neurosurgery ; Postoperative Complications ; Retrospective Studies ; Surgical Procedures, Operative

One hundreds eighty cases of traumatic intracerebral hematoma(TICH) among 1,633 head injury patients diagnosed with computerized tomography in neurosurgical department from Jan. 1990 to Jun. 1996. were classified into two TICH groups; TICH group associated with other traumatic intracranial lesions and TICH group without other traumatic intracranial lesions. The incidence of TICH was 11.0% and percentage of TICH with other traumatic intracranial lesions among 180 cases of TICH was 66.7%. TICH group with other traumatic intracranial lesions showed worse initial level of consciousness, more likely to have abnormal pupillary reflex, higher incidence of delayed traumatic intracerebral hematomas(DTICH), greater amount of hematoma, increased chance of surgery and worse outcome. In TICH group with other traumatic intracranial lesions, the factors affecting prognosis were initial Glasgow coma scale(GCS) score, pupillary reflex, amount of hematoma and treatment modality. In TICH only group, the factors affecting prognosis were initial GCS score, pupillary reflex, amount of hematoma and DTICH. The patients with 12-15 of GCS score, normal pupillary reflex, absence of DTICH, and amount of hematoma below 10cc, the presence of other traumatic intracranial lesions were found to be important prognostic factor. The overall mortality was 27.7% but in TICH group with other traumatic intracranial lesions, the mortality was 35.0% compared to 13.3% in TICH only group. It is concluded from this study that in the case with other traumatic intracranial lesions, TICH showed worse initial neurological status and prognosis compared to those without other lesions. Thus, these patients, although in conditions of good general clinical index at admission, should be considered to provide intensive care and treatment because these associated lesions will play as a bad prognostic factor.
Coma ; Consciousness ; Craniocerebral Trauma ; Hematoma* ; Humans ; Incidence ; Critical Care ; Mortality ; Prognosis ; Reflex, Pupillary

Rerupture of intracranial aneurysms during cerebral angiography is a rare complication and it usually occurs with in 24 hours after initial bleeding. We experienced three cases of aneurysmal rerupture during cerebral angiography, and in each case, angiography was performed after 24 hours from the initial attack. We have noticed extravasation of contrast medium to subarachnoid space or intraventricular space during angiography. In result, two patients died and one patient was disabled moderately.
Aneurysm ; Angiography* ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Subarachnoid Space

The authors report a case of symptomatic choroid plexus cyst, located in the trigone of the left lateral ventricle in a 18-year-old man who presented with headache and seizure attack. The cyst was diagnosed by magnetic resonance image(MRI), and was confirmed with surgery. The cyst had no communication with the ventricular system orsubarachnoid space. Total removal of cyst adhering to the choroid plexus was accomplished, with subsequent disappearance of the seizure and headache. A brief review of the literature is included.
Adolescent ; Choroid Plexus* ; Choroid* ; Headache ; Humans ; Lateral Ventricles* ; Seizures