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 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

Two cases of aneurysms in the P3 segment of the posterior cerebral artery are described. These were managed by the subtemporal approach. One giant aneurysm in a 47-year-old male was treated by clipping the afferent artery, and the other small saccular aneurysm in a 41-year-old female was treated by clipping the aneurysmal neck. There were no complications after surgery, and the patients were discharged without neurological deficit. The operative approaches and procedures are also discussed in relation to the anatomy of posterior cerebral artery aneurysms.
Adult ; Aneurysm ; Arteries ; Female ; Humans ; Intracranial Aneurysm* ; Male ; Middle Aged ; Neck ; Posterior Cerebral Artery*

A retrospective review of 54 patients with multiple intracranial aneurysms seen over a 5 year period was performed. Among the 252 patients with aneurysms, the incidence of multiple aneurysms was 21.4%. Multiple aneurysms were slightly more common in women with a female to male ratio of 1.35:1. But there was no different ratio for patients with three or more aneurysms. Common clinical features were headache(96%), meningeal sign(83%), and change of consciousness level(52%). The most common Fisher's grade was III(63%), according to brain CT finding. Common locations of multiple aneurysms were the PcomA(35.7%), MCA(24.8%), AcomA(17.8%), and ICA bifurcation(7.7%). However, the aneurismal locations with the highest incidence of rupture were the MCA(53.1%). AcomA(52.1%), basilar bifurcation(50%). The PcomA(34.7%) was the least likely site for rupture. On the distribution of multiple aneurysms according to location, unilateral and midline located multiple aneurysms were 49%. Size was more important than irregularity of the shape in identifying the site of rupture. Most ruptured aneurysms were 5mm or larger in size. Postoperative mortality was 4.4% and the most common cause of postoperative mortality was cerebral vasoapasm.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Consciousness ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Retrospective Studies ; Rupture

BACKGROUND: Chronic headache (CH) constitutes a significant public health problem, impacting on both the individual sufferer and society. Patients with CH, unresponsive to drug therapy or nerve block, suffer considerable disability due to the frequency and severity of attacks; therefore, they should be considered for novel therapy. Botulinum toxin type A (BoNT-A) has shown significant promise in the management of CH. In this paper, we review recent evidence on the efficacy of BoNT-A, and also report our experience with this treatment in CH patients. METHODS: BoNT-A was used to treat 69 CH patients, including 47 in a chronic migraine group and 22 in a non-migraine CH group, who showed therapy-resistance to palliative drug or nerve block. We investigated the demography, dosage and site of BoNT-A injection, and used a visual analogue scale (VAS) for pain and the degree of satisfaction. The data were analyzed using t-tests and a Friedman repeated measures analysis of variance on ranks. RESULTS: Significant decreases in the VAS for pain were found in both the chronic migraine and non-migraine CH groups, from 2, 4 and 12 weeks and from 4 and 12 weeks, respectively, after BoNT-A administration (P < 0.05). The chronic migraine group showed significantly lower VAS scores for pain than the non-migraine CH group from 2, 4 and 12 weeks after the BoNT-A administration (P < 0.05). Twenty eight patients (59.2%) in the chronic migraine group and eight (36.4%) in the non-migraine CH were satisfied with the BoNT-A treatment. CONCLUSIONS: This clinical study revealed that the use of BoNT-A demonstrated efficacy for CH patients resistant to drug therapy or nerve block. Moreover, BoNT-A proved itself more effective in the chronic migraine than non-migraine CH group.
Botulinum Toxins* ; Botulinum Toxins, Type A* ; Demography ; Drug Therapy ; Headache Disorders* ; Humans ; Migraine Disorders ; Nerve Block ; Public Health

OBJECTIVE: Oculo-cerebral syndrome is an intraocular hemorrhage and related ocular symptoms caused by sudden increase in intracranial pressure. The authors investigate the clinical significance of oculo-cerebral syndrome after spontaneous subarachnoid hemorrhage and analyze the characteristics of aneurysms which caused intraocular hemorrhage in order to help the treatment of intracranial aneurysm patients. METHODS: From January 2000 to May 2001, 103 patients were admitted to our hospital and diagnosed as spontaneous subarachnoid hemorrhage. We divided the patients into two groups:81 patients without intraocular hemorrhage(non-IOH) and 22 patients with intraocular hemorrhage(IOH). The authors prospectively analyzed the prognostic factors of spontaneous subarachnoid hemorrhage by chi-square test. RESULTS: The initial neurologic state was poor in the IOH group(p<0.001). The Fisher's grade was higher than non-IOH group(p<0.001), and intracranial hemorrhage was great in the IOH group(p<0.001). The prognosis was poor in the IOH group at discharge(p<0.001). The most common rupture site in the IOH group was the anterior communicating artery(p<0.001). Frontal intracerebral hematoma was specific to intraocular hemorrhage(p<0.05). There was a positive correlation between intraocular hemorrhage and rebleeding(p<0.001). CONCLUSION: The authors suggest that oculo-cerebral syndrome is clinically significant with a poor prognostic factor in patients with spontaneous subarachnoid hemorrhage.
Aneurysm ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Intracranial Pressure ; Prognosis ; Prospective Studies ; Rupture ; Subarachnoid Hemorrhage*

Aneurysmal bone cysts are uncommon bony lesions that usually occur in the metaphyseal region of the long bones in adolescents. Approximately 20% of the aneurysmal bone cysts occur in the spine, predominantly in the lumbar region. These lesions commonly arise from the posterior elements(ex, spinous process, laminae) and occasionally invade the pedicles and the vertebral body. We experienced a case of aneurysmal bone cyst on the entire 5th cervical vertebra(vertebral body, pedicle, laminae, spinous process and transverse process). We perfomed C5 corpectomy and fusion with ORION plate and autologous bone graft on C4-5-6, and C5 total laminectomy with gross total mass removal and posterior fusion with Heid lateral plate system and autologous bone graft and wiring on C4-5-6. The patient showed good recovery. We report a rare case of aneurysmal bone cyst on the whole involved 5th cervical vertebra
Adolescent ; Aneurysm* ; Bone Cysts* ; Bone Cysts, Aneurysmal ; Humans ; Laminectomy ; Lumbosacral Region ; Spine* ; Transplants