Craniogacial resection(CFR) is an ideal approaches for tumors involving the anterior skull base. This technique may be used for benign and malignant tumors arising from the paranasal sinus, nasal cavity, and orbit that extend into the anterior skull base. Recently, we have experienced 12 cases of craniogacial resection for anterior skull ase tumors. Most of them were recurrent tumors, and received previous local excision, preoperative radiotherapy, or chemotherapy before craniofacial resection. Histologic types of tumors included 6 squamous cell carcinomas, one each of adenoid cystic carcinoma, rhabdomyosarcoma, osteoma, ossifying fibroma, cavernous hemangioma, and malignant schwannoma. Two patients died after surgery; one from recurrent infection and the other from rupture of the tumor invaded ICA. Four malignant tumors recurred after the CFR. Remaining 5 patients are doing well without tumor recurrence. In conclusion, CFR is a commendable procedure for anterior skull base tumors, providing cure for benign tu mors and at least a local control for malignancies.
Carcinoma, Adenoid Cystic ; Carcinoma, Squamous Cell ; Drug Therapy ; Fibroma, Ossifying ; Hemangioma, Cavernous ; Humans ; Nasal Cavity ; Neurilemmoma ; Orbit ; Osteoma ; Radiotherapy ; Recurrence ; Rhabdomyosarcoma ; Rupture ; Skull Base* ; Skull*

We report a case of Klippel-Feil syndrome. The patient was a 37-year-old man who developed progressive motor weakness and on C4-5 and C6-7 segments combined with severe cervical stenosis, basilar impression and C1 assimilation. He showed progressive quadriparesis and respiratory difficulty. He had combined congenital anomaly of right side facial palsy of peripheral type and right side sensorineural hearing loss. In May 2002, we performed, via transoral approach, anterior fusion with Harm's mesh and hydroxyapatite from the clivus to the C3. But, one month after the operation, Harm's mesh with hydroxyapatite slipped anteriorly due to non-union. So, we removed the mesh and reoperated with fibular bone graft from the clivus to the C3. Simultaneously, posterior approach was performed with on-lay autologous rib bone graft and wiring from the occiput to the C2, 3, 4. One year after the operation, his motor weakness has been gradually improved and there is minimal difficulty in self-respiration.
Adult ; Constriction, Pathologic ; Cranial Fossa, Posterior ; Durapatite ; Facial Paralysis ; Hearing Loss, Sensorineural ; Humans ; Klippel-Feil Syndrome* ; Platybasia ; Quadriplegia ; Ribs ; Spondylosis* ; Transplants

OBJECTIVE: The aim of this study is to evaluate the transition of lumbar spinal treatments for geriatric patients over 70 years old over two decades. METHODS: We retrospectively assessed 730 patients who were 70 years and older and underwent lumbar surgery. We analyzed the number of diseases, operation methods and complications with 5-year intervals from 1987 to 2006. RESULT: The number of patients older than 70 years who underwent lumbar surgery increased according to our analysis of the period spanning from 1987 to 2006. Thirty-two (1%), 77 (1.7%), 232 (4.4%), and 389 (8.2%) patients over 70 years underwent lumbar spine surgeries. Among them, the 8, 29 and 45 patients had one level degenerative spondylolisthesis for the periods 1992-1996, 1997-2001 and 2002-2006. Twenty-four, 29 and 58 patients had lumbar stenosis during all these time periods. Over time, we performed a larger variety of operations as well as more aggressive operations. From January 2002 to December 2006, a total of 308 patients were over 70 years old and had lumbar spine surgeries performed on them. Among them, the ASA class I was 58 (19%), the ASA class II was 213 (69%) and the ASA class III was 37 (12%). During that period, PLIFs and PS fixations were performed on 69 patients. Among them, 8 patients were ASA III. Large numbers of lumbar arthorodesis have been performed in geriatric patients over the age of 70 years in our series. CONCLUSION: The surgical treatment of degenerative spine disease in the elderly patients was increased due to improved surgical technique and advances in medical treatment including anesthesia. The authors suggest that fusion surgery can be done safely in elderly patients even though they have high-grade ASA classification.
Aged ; Anesthesia ; Constriction, Pathologic ; Humans ; Retrospective Studies ; Spine ; Spondylolisthesis

OBJECTIVE: Electromyography(EMG) has been very helpful in establishing the diagnosis of carpal tunnel syndrome(CTS). But invasive procedure of EMG makes patients discomfort, who are suffering from consistent numbness. The authors investigate the diagnostic efficacy of Digital Infrared Thermographic Imaging(DITI) in CTS by comparing thermal changes between normal control group and patients group. METHODS: Among 31 patients who had operated due to CTS from march 1984 to February 2002 at the Spine Center, both EMG & DITI were used for diagnostic method in 24 patients. Authors have measured thermal differences(deltaT, degrees C) of symptomatic site between forearm and palm in 20 patients, and 30 normal controls. Authors have analyzed thermal differences(deltaT, degrees C) statistically using T-test. RESULTS: Average thermal difference(deltaT, degrees C) in symptomatic site was statistically higher than that of normal control group. Average thermal difference(deltaT, degrees C) is+0.984+/-0.342 degrees C in symptomatic site, +0.323+/-0.296 degrees C in normal control group, respectively. Significant thermal difference(deltaT, degrees C) was seen between two groups(p<0.005). Average thermal difference(deltaT, degrees C) in CT S was statistically higher than normal group, significantly. Average thermal difference(deltaT, degrees C) greater than 1 degrees C can be suspicious of CTS. CONCLUSION: Diagnostic usefulness of DITI in CTS is very high especially for the screening purpose.
Carpal Tunnel Syndrome* ; Diagnosis ; Forearm ; Humans ; Hypesthesia ; Mass Screening ; Spine

PURPOSE: We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases. MATERIALS AND METHODS: Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed. RESULTS: MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age > or = 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis. CONCLUSION: Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intervertebral Disk Displacement/diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Prevalence ; Spinal Diseases/classification/*diagnosis ; Spinal Stenosis/diagnosis ; Young Adult

OBJECTIVE: We report an analysis of the clinical outcome of surgical treatment of lumbar facet cyst. METHODS: From March, 1996 to June, 2001, we analyzed the symptom and sign, cyst level, combined disease, treatment method, pathology and surgical result(Prolo's scale) of 11 patients. RESULTS: Mean age of 11 patients was 55.6 years and mean follow up duration was 27 months. Of 11 patients, six cases had low back pain and five cases had radiating leg pain as chief complaint. Five had only facet cyst that compressed the nerve root without other combined diseases. Of six patients who had facet cyst with combined disease, three had intraspinal stenosis and the remaining three had spondylolytic spondylolisthesis. There was one case of bilateral facet cyst. We had totally excised facet cyst and treated combined degenerative disease such as lumbar stenosis, lumbar instability or spondylolytic spondylolithesis. The pathologic result were synovial cyst for eight cases and ganglion for three cases. In all cases, symptoms improved without complication or recurrence. CONCLUSION: Surgical outcome of lumbar facet cyst is good and surgical intervention is recommended in facet cyst with back pain, radiculopathy and combined degenerative diseases.
Back Pain ; Constriction, Pathologic ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Leg ; Low Back Pain ; Pathology ; Radiculopathy ; Recurrence ; Spondylolisthesis ; Synovial Cyst

Anterior cervical discectomy and fusion(ACDF) is a surgical treatment for cervical radiculopathy and myelopathy. Though this is a common surgery, spinal epidural hematomas occur rarely and an immediate treatment decision and surgical decompression are required in this situation. In this report, we discuss the proper treatment of spinal epidural hematoma after ACDF.
Decompression, Surgical ; Diskectomy ; Hematoma, Epidural, Spinal ; Radiculopathy ; Spinal Cord Diseases

Anterior cervical discectomy and fusion(ACDF) is a surgical treatment for cervical radiculopathy and myelopathy. Though this is a common surgery, spinal epidural hematomas occur rarely and an immediate treatment decision and surgical decompression are required in this situation. In this report, we discuss the proper treatment of spinal epidural hematoma after ACDF.
Decompression, Surgical ; Diskectomy ; Hematoma, Epidural, Spinal ; Radiculopathy ; Spinal Cord Diseases

OBJECTIVE: We experienced some cases of adjacent segment degeneration after spinal fusion and treated them by various reoperation methods. The authors report an evaluation of causes of adjacent segment degeneration after spinal fusion and treatment methods. METHODS: Sixteen patients was admitted to our hospital due to adjacent segment degeneration after spinal fusion from November 1997 to May 2001 and we operated 11 patients among 16 patients with various surgical methods. We analyzed clinical diagnosea, surgical methods, and disc degeneration status of adjacent segment following spinal fusion on 1st operation and 2nd operation, and also evaluated the clinical symptoms, type of adjacent segment degeneration, and time interval between the 1st operation and the 2nd operation. RESULTS: Clinical diagnoses on 1st operation were degenerative spondylolisthesis of four cases, chronic degenerative disc disease with spinal stenosis of six cases, and recurred herniated lumbar disc disease of one case. We treated eight cases by posterior lumbar interbody fusion, one case by 360degrees fusion, and two cases by pedicle screw fixation only. Disc degeneration on adjacent segment to spinal fusion existed already in nine among 11 patients before spinal fusion. Types of adjacent segment degeneration after spinal fusion were disc degeneration of two cases, lumbar instability of three cases, lumbar stenosis of four cases, and lumbar instability and stenosis of two cases. Most patients complained of low back pain due to disc degeneration and instability, and some patients complained of leg and buttock pain due to stenosis. Time interval from 1st operation to reoperation was 20 months through 99 months, mean time interval was 57 months. CONCLUSION: Inevitable compensatory mechanism occurs at adjacent segment after fusion, because of stress concentration and alteration of biomechanics after fusion. But, we achieve excellent or good results of reoperation surgical treatment for adjacent segment degeneration after spinal fusion.
Buttocks ; Constriction, Pathologic ; Diagnosis ; Humans ; Intervertebral Disc Degeneration ; Leg ; Low Back Pain ; Reoperation ; Spinal Fusion* ; Spinal Stenosis ; Spondylolisthesis

A 66 year-old woman was admitted to our hospital for progressive weakness of both lower extremities since a month ago. Imaging study, based on plain X-ray, computed tomography and magnetic resonance image revealed spinal stenosis owing to anterior slipping of T10/11 segment. Degenerative spondylolisthesis is common in the lumbar spine and rarely occurs in the cervical spine2, 5). But there was no report of degenerative spondylolisthesis in thoracic spine. The authors experienced a case of degenerative spondylolisthesis in the thoracic spine. And we achieved a satisfactory result with posterior decompressive laminectomy alone.
Aged ; Female ; Humans ; Laminectomy ; Lower Extremity ; Spinal Stenosis ; Spine* ; Spondylolisthesis*