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

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 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

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

Cervical cord compression due to osteochondroma in hereditary multiple exostosis (HME) is a rare condition, especially in young children. In this report, we discuss a rare case of cervical osteochondroma presenting as Brown-Sequard syndrome (BSS) in a 7-year-old boy with HME. The child was admitted because of hemiparesis involving the right limbs and hypoesthesia on the left side following mild trauma. MR image revealed cord compression by osteochondroma of the C7 lamina. We removed the osteocondroma and the neurological deficit was improved.
Brown-Sequard Syndrome ; Child ; Exostoses, Multiple Hereditary ; Extremities ; Humans ; Hypesthesia ; Osteochondroma ; Paresis