Collet-Sicard syndrome is one of the syndromes of the multiple lower cranial nerve palsies, characterized by unilateral paralysis of 9th through 12th cranial nerves. The present report describes a 34-year-old woman who had hoarseness, dysarthria, and loss of taste developed after febrile illness. Brain MRI, both T1WI and T2WI, showed high signal intensity in the left jugular foramen. Gd-GTPA contrast injection revealed thickening and enhancement of the left tentorium. Angiography disclosed nonvisualization of the left transverse and sigmoid sinus, and reconstruction of the left internal and external jugular vein by collaterals from the angular, facial, and posterior fossa veins. The patient improved spontaneously two months later. This is the first report of Collet-Sicard syndrome resulting from jugular vein thrombosis.
Adult ; Angiography ; Brain ; Colon, Sigmoid ; Cranial Nerve Diseases ; Cranial Nerves ; Dysarthria ; Female ; Hoarseness ; Humans ; Jugular Veins* ; Magnetic Resonance Imaging ; Paralysis ; Thrombosis* ; Veins

No abstract available.
Thanatophoric Dysplasia*

No abstract available.
Thanatophoric Dysplasia*

Carotid artery angioplasty and stenting (CAS) has become increasingly accepted as an alternative therapy to carotid endarterectomy for treatment of carotid artery stenosis. Central retinal artery occlusion (CRAO) is one of the diseases presented due to carotid artery stenosis. But CRAO without cerebral ischemia after CAS is uncommon. An 80-year-old man was admitted to the hospital with the right centrum ovale ischemic stroke and right proximal carotid artery stenosis. We performed CAS with a distal protection device after pre-ballooning 3 times, without post-ballooning. Then, 12 hours after the CAS, the patient complained of blindness in the right eye and was diagnosed with CRAO. However, Diffusion weighted magnetic resonance imaging (DW-MRI) showed no significant findings in the brain. CRAO after CAS without intracranial infarction is a rare complication.
Aged ; Aged, 80 and over ; Angioplasty ; Arteries ; Blindness ; Brain ; Brain Ischemia ; Carotid Arteries ; Carotid Stenosis ; Diffusion ; Endarterectomy, Carotid ; Eye ; Humans ; Infarction ; Magnetic Resonance Imaging ; Retinal Artery ; Retinal Artery Occlusion ; Stents ; Stroke

To evaluate the safe zone for the use of femoral artery puncture in the clinical practice and to understand the anatomic characteristics of the aortic arch (AA) and its major branches to build a foundation toward performing neuroendovascular surgery safely. The 40 formalin fixed adult Korean cadavers were investigated for inguinal area and AA respectively. The landmarks were the anatomical points on inguinal area and the lengths from each point to the bottom of femoral head (BOFH) were measured using a fluoroscopic view. We investigated several anatomical parameters on the AA, and its major branches with anatomical variations, curvatures, distances. The average length between BOFH and inguinal ligament of the right was 38.9+/-7.2 mm and left was 40.0+/-7.9 mm. The three major branches directly originated from AA in 21 (84%) of the cadavers. Average angle of AA curvature to the coronal plane was 62.2 degrees. Left common carotid artery (LSCA) and left subclavian artery originated from 12.3 mm and 22.8 mm on the left of the mid-vertebrae line. Mean distance from the brachiocephalic truck to the right common carotid artery was 32.5 mm. Mean distance from the LSCA to the left vertebral artery was 33.8 mm. Average angles at which the major branches arise from the AA were 65.3, 46.9 and 63.8 degrees. The safe zone for arterial puncture is considered to 0-20 mm above the BOFH on a fluoroscopic view. This study may provide comprehensive anatomical information to catheterize AA and its branches for safely performing transfemoral neuroendovascular approach.
Adult ; Aorta ; Aorta, Thoracic ; Cadaver ; Carotid Artery, Common ; Catheters ; Femoral Artery ; Formaldehyde ; Head ; Humans ; Ligaments ; Motor Vehicles ; Punctures ; Subclavian Artery ; Vertebral Artery

As an attempt to better understand the microanatomy during transpetrosal surgery and to determine the limitation of extradural middle fossa approach, 16 adults human cadaveric skull base speciments were dissected at the region of petroclivus and posterior cavernous sinus. The important landmarks chosen for this study included the following: a petrosigmoid intersection, arcuate eminence, foramen spinosum, foramen ovale, hiatus of greater superficial petrosal nerve (GSPN), porus acousticus internus, geniculate ganglion, cochlea and petrous portion of internal carotid artery(ICA). The resultant data are as follows: the length between the petrosigmoid intersection and the arcuate eminence was 23.1mm+/-1.9(20.1-26.5). The depth covering geniculate ganglion was 1.3mm+/-0.3(0.8-1.8). The length between the geniculate ganglion and the hiatus of GSPN as well as cochlea were 4.6mm+/-1.1(3.5-7.1) and 0.9mm+/-0.2(0.7-1.2) respectively. The whole length of the GSPN exposed the middle cranial fossa was 11.0mm+/-0.8(9.3-12.5). The diameter f the petrous portion of ICA was 5.9mm+/-0.2(5.5-6.4). The length of the horizontal segment of the petrous ICA that can be exposed for anastomosis was 10.8mm+/-0.9(9.0-12.3). The distance between geniculate ganglion and porus acousticus showed a sighificant difference in all measurements to be compared with right and left side(p<0.05). The angle between the internal acoustic meatus and GSPN correlated inversely to the length of horizontal segment of pertrous ICA(r=-0.54, p<0.05). Morphometric analysis and their correlation between bony landmarks and structures within the pyramid helped to decide the angle and direction from which bone removal could be accomplished more safely during transpetrosal surgery, including the middle fossa approach.
Acoustics ; Adult ; Cadaver ; Cavernous Sinus ; Cochlea ; Cranial Fossa, Middle* ; Foramen Ovale ; Geniculate Ganglion ; Humans ; Skull Base

No abstract available.
Hematoma*

Three-dimensional computerized tomography(3DCT) disclosed a valuable tool for the diagnosis of fracture/dislocation involving craniofacial and spinal bony and/or ligamentous structure. We compared the diagnostic accuracy between these non-invasive radiologic diagnostic techniques ; 3DCT, conventional 2DCT and plain X-ray films in patients with traumatic craniofacial or spine fracture. And the other purpose of this study is to define the role of 3DCT in the planning of surgical management. From Jan. 1991 to Jun. 1994, 31 patients with traumatic craniofacial or spine fracture have been studied 3DCT at Soonchunhyang University Hospital. The majority of the patients were male and 3rd decades in ages. 16 cases were operated according to clinical and radiological findings. In 15 cases with craniofacial fracture, 3DCT showed the extent, displacement, angulation, depression and separation of fracture better than plain X-ray or 2DCT. But in one case with frontal basal fracture, 3DCT imaging did not differentiate between skull defect and normal thinning bone. In 16 cases of spine fractures, 3DCT was better diagnostic than 2DCT, paticularlly with subtle lesions. But in 3 cases had bony fragment in spinal canal and one case with pedicle fracture of cervical spine, 2DCT was better accurate than 3DCT. Following conclusions are offered : 3DCT warrants 1) precise, easy looking of direction, extension and shape of fractures, 2) complete perspectives of fracture site in all direction, 3) accurate operative planning with reduced operation time and postoperative complications and 4) amenable to choose instrumentation type and direction of operative approach in spinal surgery. However 3DCT has some disadvantages, 1) It makes difficult to differentiate between normal thin skull basal portion and traumatic skull defect. 2) 3DCT gives an information to only surface cortical bone. 3) It takes additional time and cost for getting complete imaging films.
Depression ; Diagnosis* ; Humans ; Ligaments ; Male ; Postoperative Complications ; Skull ; Spinal Canal ; Spine* ; X-Ray Film

Seventy six patients with hemifacial spasm(HFS) were operated with microvascular decompression(MVD) at Soonchunhyang University Hospital from January, 1987 to June, 1994. We report an analysis of 30 patients who were not relieved from or had a recurrence of their symptoms immediately after MVD. 1) 14 patients(46.7%) showed delayed remission. Among them, 8 patients improved within 3 months and 1, after 6 months. 5 patients reoperated, at which time incomplete decompression of small vessels were identified in 4 patients. The vessels were then completely decompressed at the facial nerve root exit zone(FNREZ) and the surrounding pia-arachoid membrane were incised. 2) 12 patients(40%) showed partial remission. Among them, 9 patients did not show complete remission after the operation and continued to show only partial remission during the follow-up periods. 3 patients showed the same severity of HFS after the operation but 2 patients improved spontaneously at first and then at 3 months postoperatively. 3) 4 patients(13.3%) showed recurrence. The symptoms of one patient right 1 month after the operation, and 3 patients at 3 months. These findings suggest that the ideal time to evaluate the surgical outcome of MVD for HFS is 3 months or later after the operation, and that the procedure of opening up the piaarachnoid menbrane at FNREZ may be effective for a complete remission.
Decompression ; Facial Nerve ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Membranes ; Microvascular Decompression Surgery* ; Patient Rights ; Recurrence

To know recent research works in neurosurgical fields and to analyze neurosurgery related sites on the internet, authors have been searching sites on the web offering the neurosurgical resources. From December 1995 to October 1996 we used a modem(28.8Kbps) and thereafter connected to a LAN(local area network). Under the environment of Windows 95, we used web browsers with Netscape 2.02 and Netterm 2.89. We got an medical information with PC journals or seminars and graded the neurosurgical center/institutes from A to E according to the quality of web sites. We could use the internet resources more rapidly in the early morning than noon or evening. Best sites for neurosurgeon were MedMark(http://www.medmark.bit.co.kr/neurosur.html) and Neurosource (http://www.neurosource.com/). The more comprehensive academic neurosurgical site among all web were the Massachusetts General Hospital(http://neurosurgery.mgh.harvard.edu/) and the University North California (http://sunsite.unc.edu/Neuro/uncns/home.html). In 89 neurosurgical center/institutes, 72 sites(80.9%) couldn't supply sufficient information. In conclusion, there are many webs related to neurosurgery on the internet, but useful sites for neurosurgeon are not common. It is necessary to make an effort to find available sites offering more information in the future.
California ; Internet* ; Massachusetts ; Neurosurgery ; Web Browser