No abstract available.
Basilar Artery* ; Rabbits* ; Vasoconstrictor Agents* ; Vasodilator Agents*

In spite of technical advances in neuroradiology, neuroanesthesiology, and microneurosurgery, the treatment of giant aneurysms remains problematic. Between 1983 and 1995, the authors encountered 42 consecutive cases of giant aneurysms, and this study focuses on their clinical manifestations, management, and outcome. The patients' ages ranged from 5 to 73 years, with peak incidence in the sixth decade ; the male to female ratio was 12 : 30. The follow-up period was from 2 to 110(mean, 36) months. The most common presenting symptom was a mass effect found in 22 patients(52%), followed by subarachnoid hemorrhage in 16(38%). Thirty patients underwent a surgical or interventional radiological procedure, comprising direct neck clipping(n=13), proximal clipping(n=7), detachable balloon occlusion(n=4), wrapping(n=3), trapping(n=1), and partial clipping with thrombectomy(n=2). The mortality rate was 16.7% and the morbidity rate, 40% ; the most common postoperative complication was distal cerebral infarction. At the last follow-up, 22 patients(73%) were able to perform daily activities without assistance. In this clinical study, the authors reviewed general aspects of the treatment of giant aneurysms. In conclusion, treatment of giant aneurysms should-for best results-be tailored to patients' individual requirements, determined after thorough examination. Despite advanced neurosurgical techniques, morbidity and mortality rates remain high.
Aneurysm* ; Cerebral Infarction ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Neck ; Postoperative Complications ; Subarachnoid Hemorrhage

Parkinson disease (PD) is the second most common degenerative disease in the central nervous system following the Alzheimer's disease. Although the specific progressive degenerative change of dopamine-producing cells in the substantia nigra compacta has been well documented, neither the cause nor the underlying mechanism of degeneration has been identified. Long-term use of L-dopa causes dyskinesia, motor fluctuation, and other side effects, preventing the patients with advanced PD from further medication. Since deep brain stimulation (DBS) was introduced in the late 1980s by Dr. Benabid, it has become the standard surgical treatment for the patient with advanced PD who has developed drug-induced side effects or motor fluctuation after long-term use of L-dopa. Since DBS had been first reimbursed by the National Health Insurance System in January 2005 in Korea, many patients with advanced PD had a chance to be treated with DBS. The subthalamic nucleus (STN), globus pallidus interna (GPi), and thalamic VIM nucleus have been utilized as the target of DBS in the treatment of the patients with advanced PD. In this paper, the author briefly reviews the current methodology of surgical treatment of advanced PD, focusing on the STN DBS.
Alzheimer Disease ; Central Nervous System ; Deep Brain Stimulation ; Dyskinesias ; Globus Pallidus ; Humans ; Korea ; Levodopa ; National Health Programs ; Parkinson Disease ; Substantia Nigra ; Subthalamic Nucleus

Advances in deep brain stimulation (DBS) in relation to neuroimaging techniques and with intraoperative electrophysiological microrecordings and stimulations have replaced ablative procedures for medication-refractory movement disorders such as Parkinson's disease, dystonia, and essential tremor. DBS is an effective surgical treatment for these conditions and is now being extended to psychiatric diseases such as obsessive-compulsive disorder, depression, and addiction. Despite the proven clinical improvement by DBS, its precise mechanism of action remains unclear. Clinical improvement depends on the selection of the appropriate patients and the precise implantation of the stimulation electrodes, which is based on careful stereotactic targeting and extensive electrophysiological monitoring of the target area. Further studies are being performed to better understand the mechanism of action and identify new anatomical targets and clinical applications of DBS. We briefly introduce the surgical procedure and current clinical applications of DBS in this review.
Brain ; Deep Brain Stimulation ; Depression ; Dystonia ; Electrodes ; Essential Tremor ; Humans ; Movement Disorders ; Neuroimaging ; Obsessive-Compulsive Disorder ; Parkinson Disease

Because of their proximity to adjacent vital structures, and deep and narrow operative field in the surrounding compact bony structures, tumors located in the clival or petroclival regions represent a formidable technical challenge to neurosurgeons. Between April 1990 and May 1996, 25 patients(eight males and 17 females with a mean age of 44 years), harboring clival or petroclival tumors underwent surgery in our department involving the posterior transpetrosal transtentorial approach. The median follow-up period was 24 months. A total of 28 operations were performed ; in three cases, these involved two stages, in which different approaches were used. The surgical pathology included 15 meningiomas, seven neurinomas(four acoustic and three trigeminal), and one case each of myxoid chondrosarcoma, chondroid chordoma, and paratrigeminal epidermoid. Tumor size ranged from 2 to 8cm ; 16 were larger than 4cm. According to the extent of petrous resection, three different approaches were used ; retrolabyrinthine in ten cases, translabyrinthine in four, and transcochlear in eleven. The superior petrosal sinus was always sacrificed and the tentorium completely cut. Gross total removal was accomplished in 13 cases, and subtotal removal in 12. The causes of incomplete removal included cavernous sinus invasion in four cases, severe adhesion to the brain stem in two, extremely high consistency and vascularity of the tumor in two, insufficient exposure to the tumor in two, and unexpected residual tumors seen in two cases on postoperative MRI. There was no operative mortality in this series and the most common complication was cranial nerve palsy, which occurred in 15 cases. Other complications included hemiparesis in two cases, CSF leakage in two and an epidural hematoma in one. The authors conclude that the posterior transpetrosal transtentorial approach is advantageous for resecting petroclival tumors because, by avoiding unnecessary brain retraction, it significantly reduces the risk of postoperative complications, and helps provide shorter access and wider exposure of the lesion.
Acoustics ; Brain ; Brain Stem ; Cavernous Sinus ; Chondrosarcoma ; Chordoma ; Cranial Nerve Diseases ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; Mortality ; Neoplasm, Residual ; Paresis ; Pathology, Surgical ; Postoperative Complications

No abstract available.
Humans ; Pituitary Neoplasms*

The authors evaluated the usefulness of the positron emission tomography(PET) with fluorine-18-fluorodeoxy-glucose(18F-FDG) in diagnosing tumor recurrence and differentiating it from radiation necrosis following external beam irradiation of malignant gliomas. Patients were studied from the time they had first exhibited either clinical or radiological deterioration after an initial period of posttreatment stabilization. Ten studies were performed in ten patients, and 18F-FDG uptake by the lesion was then compared to uptake by adjacent normal gray matter. Four of ten cases demonstrated newly enhanced lesions on magnetic resonance imaging(MRI) and hypermetabolic foci in the PET examinations. All of these patients were diagnosed as tumor recurrence either clinically or histologically, during follow up period of the patients' progress. The remaining six cases had newly enhanced lesions on MRI and hypometabolic foci in the PET studies; five of them were diagnosed as radiation necrosis, but one lesion (0.8cm in diameter) was diagnosed clinically as a tumor recurrence. The overall accuracy of the PET study in differentiating the tumor recurrence from radiation necrosis was 90% and the sensitivity for detection of recurrence 80%. The authors conclude that the PET study with 18F-FDG is useful in differentiating the tumor recurrence from radiation necrosis in patients with malignant glioma and could be used to select the group of patients who may have benefits from antitumor therapy.
Electrons* ; Fluorodeoxyglucose F18* ; Follow-Up Studies ; Glioma* ; Humans ; Magnetic Resonance Imaging ; Necrosis* ; Positron-Emission Tomography* ; Recurrence*

Parkinson's disease (PD) is characterized by the selective loss of dopaminergic neurons of the substantia nigra pars compacta (SNc) with motor and nonmotor symptoms. Defective mitochondrial function and increased oxidative stress (OS) have been demonstrated as having an important role in PD pathogenesis, although the underlying mechanism is not clear. The etiopathogenesis of sporadic PD is complex with variable contributions of environmental factors and genetic susceptibility. Both these factors influence various mitochondrial aspects, including their life cycle, bioenergetic capacity, quality control, dynamic changes of morphology and connectivity (fusion, fission), subcellular distribution (transport), and the regulation of cell death pathways. Mitochondrial dysfunction has mainly been reported in various non-dopaminergic cells and tissue samples from human patients as well as transgenic mouse and fruit fly models of PD. Thus, the mitochondria represent a highly promising target for the development of PD biomarkers. However, the limited amount of dopaminergic neurons prevented investigation of their detailed study. For the first time, we established human telomerase reverse transcriptase (hTERT)-immortalized wild type, idiopathic and Parkin deficient mesenchymal stromal cells (MSCs) isolated from the adipose tissues of PD patients, which could be used as a good cellular model to evaluate mitochondrial dysfunction for the better understanding of PD pathology and for the development of early diagnostic markers and effective therapy targets of PD. In this review, we examine evidence for the roles of mitochondrial dysfunction and increased OS in the neuronal loss that leads to PD and discuss how this knowledge further improve the treatment for patients with PD.
Animals ; Cell Death ; Diptera ; Dopaminergic Neurons ; Energy Metabolism ; Fruit ; Genetic Predisposition to Disease ; Humans ; Life Cycle Stages ; Mesenchymal Stromal Cells ; Mice ; Mice, Transgenic ; Mitochondria ; Neurons ; Oxidative Stress ; Parkinson Disease* ; Pathology ; Quality Control ; Substantia Nigra ; Telomerase ; Biomarkers

From January 1996 to September 1996, we enrolled 30 patients with a clinical status over Hunt and Hess grade IV, presenting within 5 days after spontaneous subarachnoid hemorrhage to determine the effectiveness in early intervention of nimodipine on short-term outcome and its safety. The blood cell count and chemistry were performed before and 7 days after nimodipine treatment, and at discharge. The clinical outcome of the patients was assessed at discharge according to the Glasgow outcome scale. There was no evidence of abnormal change in blood chemistry including liver enzyme activity during the study. Four patients experienced episodes of decreased blood pressure;in one of them, drug administration was discontinued transiently. There was no significant difference in the short-term outcome between the nimodipine treated patients in this study and aneurysmal patients treated without nimodipine in our previous study. However, four of five patients experiencing symptomatic vasospasm in this study showed good o utcome at discharge. In conclusion, administration of nimodipine in the patients with spontaneous subarachnoid hemorrhage was safe and nimodipine seemed to have beneficial effect in protecting the patients with symptomatic vasospasm from severe ischemic damages.
Aneurysm* ; Blood Cell Count ; Chemistry ; Early Intervention (Education) ; Glasgow Outcome Scale ; Humans ; Liver ; Nimodipine* ; Subarachnoid Hemorrhage

Background and Objectives: This study aimed to examine factors of poor outcome by analyzing the outcomes of bilateral subthalamic deep brain stimulation in Parkinson’s disease after 3 years. Methods: We assumed that patients who could not manage independent life in their best stimulationon/medication-on condition after a defi ned period might not have been a good surgical candidate. A poor outcome is defi ned as a failure to maintain functional independence at three years during a stimulation-on/medication-on state. Results: A total of 84 patients underwent bilateral subthalamic deep brain stimulation and all were followed up for 3 years. We excluded one patient who had intracranial hemorrhage. Twenty-one patients of the 83 patients could not keep up independent life even during their best condition for the following reasons: freezing in 15 patients, dementia in 5, depression in 3, musculoskeletal problems in 7, and cancer in one patient. Conclusions: Many patients could not keep up independent life during their best condition as early as three years after deep brain stimulation. Musculoskeletal problems were one major cause of disabilities, as were freezing and dementia. We emphasize that musculoskeletal problems need more attention in the preoperative screening of deep brain stimulation candidates and during the follow up.