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

Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery.
Arachnoid ; Arachnoid Cysts ; Humans ; Ligation ; Radiculopathy ; Spinal Cord

OBJECTIVE: This study is performed to evaluate the risk factors, clinical manifestations, treatments, and prognostic factors among patients with postoperative wound infection after spinal instrumentation. METHODS: The records and radiologic data of 28 patients diagnosed as postoperative wound infection from Jan. 1991 to Oct. 2002 who had underwent spinal instrumentation initially were retrospectively evaluated. RESULTS: All patients(mean age, 50.4 yrs) diagnosed as postoperative wound infection and subsequently received IV antibiotics and continuous irrigation system. The 13 among 28 cases had significant preoperative risk factors(for example, diabetes mellitus, obesity, alcoholism, long-term corticosteroid usage, and chronic renal failure). Infection was diagnosed at an average of 15.9 days after operation. The most common presenting features were local heating, fever, and wound discharge. All patients could be discharged after infection control. At follow up evaluation, 21 case(75%) have not shown recurrence but, the recurrence was developed among 7 cases. The C-reactive protein(CRP) was more correlated with clinical outcomes than other laboratory findings and the recurred group exhibited significant(p<0.05) higher CRP level, compared with the non-recurred group, from 7 days to 21 days after operation. CONCLUSION: Without removal of instruments, surgical removal of infective tissues and continuous irrigation with susceptible antibiotics can be effective in the treatment of postoperative wound infection after spinal instrumentation. CRP level can be an effective parameter of infection treatment and prognosis.
Alcoholism ; Anti-Bacterial Agents ; Diabetes Mellitus ; Fever ; Follow-Up Studies ; Heating ; Hot Temperature ; Humans ; Infection Control ; Obesity ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Spine* ; Surgical Instruments ; Surgical Wound Infection ; Wound Infection* ; Wounds and Injuries*

OBJECTIVE: To evaluate the effectiveness of posterior microforaminotomy in treatment of posterolateral cervical disc herniation, the authors retrospectively analyzed the result of posterior microforaminotomy in our institute. PATIENTS AND METHODS: Ten patients with radiculopathy due to posterolateral cervical disc herniation have been treated with posterior microforaminotomy from August 1996 to July 2000. We analyzed clinical results in all patients who were followed up for an average of 10 months. RESULTS: The mean age was 47.2 years and all patients were treated with posterior microforaminotomy as primary treatment. one patient was received anterior cervical interbody fusion with iliac bone 12 years before. Clinical improvement in the last follow-up were seen in all patients and there were no complications. CONCLUSION: Microcervical foraminotomy is considered useful operative method for posterolateral soft disc herniation. We conclude that the posterior microforaminotomy for radiculopathy due to soft posterolateral cervical disc herniation seems to be safe and effective in selective patients.
Follow-Up Studies ; Foraminotomy ; Humans ; Radiculopathy ; Retrospective Studies

OBJECTIVE: To evaluate the role of anterior lumbar interbody fusion in treatment of failed back surgery syndrome, the authors retrospectively analyzed the result of anterior lumbar interbody fusion performed in our institute. METHODS: Fifteen FBSS patients due to variable causes have been treated with anterior lumbar interbody fusion in our institute from April 1994 to June 1999. We analyzed clinical changes in 15 patients who were followed up for an average of 23 months. RESULTS: The etiologies of FBSS were post operative discitis(6 cases), post operative instability(3 cases), post operative adhesion(5 cases), and recurrence(1 case). These fifteen FBSS patients were treated with anterior lumbar interbody fusion. The overall treatment outcome was satisfactory(excellent and good) in 11 cases. Three patients were slightly improved, but post operative low back pain was remained. One patient who had underwent nerve root injury due to pedicle screw insertion showed no improvement. CONCLUSION: We conclude that the anterior lumbar interbody fusion for FBSS seems to be safe and favorable treatment in selective patients, because low incidence of nerve injury risk and post-operative infection.
Failed Back Surgery Syndrome* ; Humans ; Incidence ; Low Back Pain ; Retrospective Studies ; Treatment Outcome

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