PURPOSE: We report two cases of mucocele formation after medial orbital wall fracture repair with an alloplastic implant. CASE SUMMARY: A 61-year-old man with a history of a medial orbital wall fracture repaired with an alloplastic implant five years earlier presented with a several-month history of left proptosis without diplopia, pain, or lid edema. A 55-year-old man with a history of a medial orbital wall fracture repaired with an alloplastic implant seven years prior, presented with a five.year history of left proptosis with diplopia. Computed tomography (CT) scans revealed a large cyst on the orbital medial wall, which surrounded the alloplastic implant and had no definite enhancement. The patients underwent orbital surgery to remove both the cyst and implant. Histologic examination of the cyst revealed a capsule lined with ciliated pseudostratified columnar epithelium. Both patients had an uncomplicated postoperative course with resolution of the proptosis. CONCLUSIONS: For cases that present with late proptosis after orbital fracture repair, mucocele formation should be included in the differential diagnosis.
Diagnosis, Differential ; Diplopia ; Edema ; Epithelium ; Exophthalmos ; Humans ; Middle Aged ; Mucocele ; Orbit ; Orbital Fractures

The gastrointestinal mesenchymal tumors (GIMTs) form a heterogenous group with controversy centering on both the cell of origin and the prediction of clinical behavior. They include a small group of tumors with mature smooth muscle or Schwann cell differentiation and a larger group with inconsistent or no evidence of differentiation. Tumors in the latter are now referred to as gastrointestinal stromal tumors (GISTs). A clinicopathologic and immunohistochemical study was performed on 53 cases of GIMTs to identify cellular differentiation and predictors of clinical behavior. Fifty three cases of GIMTs could be histologically and immunophenotypically divided into three categories, 6 leiomyomas (11.3%), 4 schwannomas (7.6%), and 43 GISTs (81.1%). All leiomyomas (SMA desmin ) and schwannomas (S-100 ) were located in stomach and negative for CD34 and CD117. Thirty nine cases of GISTs were either CD34 (n=26) or CD117 (n=23) immunoreactive. Of these 39 GISTs, 26 were negative for myoid (SMA, desmin) and neural marker (S-100), 10 SMA desmin-S-100-, two SMA-desmin-S-100 , and one SMA desmin-S-100 . Two out of 4 GISTs, which were negative for CD34 and CD117, were immunohistochemically considered leiomyosarcoma (SMA desmin ). GISTs of small intestine had a tendency to be malignant than those of stomach. Pathologic grade of GISTs was not correlated with cellular differentiation. In 29 GISTs with clinical follow-up information, tumor size, mitotic counts, Ki-67 labelling index, tumor necrosis, mucosal invasion, and CD34 expression were significantly correlated with metastasis/recurrence.
Cell Differentiation ; Desmin ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Intestine, Small ; Leiomyoma ; Leiomyosarcoma ; Muscle, Smooth ; Necrosis ; Neurilemmoma ; Stomach

PURPOSE: To analyze the clinical features and determine the factors that affect glaucomatous change of patients with Posner-Schlossman syndrome (PSS). METHODS: A retrospective analysis of 51 eyes of 51 patients diagnosed with PSS was performed. We analyzed the factors including age of first attack, highest intraocular pressure (IOP), duration of the disease, number of the attacks and interval between attacks among the patients who developed glaucoma and those who did not and compared the 2 groups. RESULTS: The age of first attack was 34.73 +/- 10.77 years, and highest IOP was 47.75 +/- 9.43 mm Hg. Duration of the disease was 62.06 +/- 69.84 months, number of the attacks was 6.20 +/- 7.73 times, and interval between attacks was 12.65 +/- 8.95 months. Of 51 eyes of 51 patients, 12 eyes (23.5%) of 12 patients showed significant glaucomatous change. In the glaucoma group, highest IOP was 52.81 +/- 7.87 mm Hg, number of attacks was 11.91 +/- 10.63 times, and interval between attacks was 8.07 +/- 3.97 months. In the non-glaucomatous group highest IOP was 46.19 +/- 9.14 mm Hg, number of attacks was 4.59 +/- 5.94 times, and interval between attacks was 14.59 +/- 9.79 months, respectively. Highest IOP was significantly greater, number of attacks was higher, and interval was shorter with statistical significance in the glaucoma group (p = 0.025, p = 0.001, p = 0.028). CONCLUSIONS: A significant number of patients with PSS tend to show glaucomatous change over time. Patients with high IOP during attacks and those having frequent attacks with short intervals should be closely monitored and evaluation for glaucomatous damage is recommended.
Glaucoma ; Humans ; Intraocular Pressure ; Retrospective Studies ; Risk Factors*

BACKGROUNDS: Moyamoya disease is a progressive occlusive cerebrovascular disease which has characteristics of distal ICA stenosis and basal collateral vessels. Various methods of surgical treatment are recommended in the literatures but surgical strategies and outcome are not well established yet. AIMS AND METHODS: The aims of study is to evaluate surgical outcomes of moyamoya disease and to establish surgical indications. Total 155 patients diagnosed with moyamoya disease since 1990, were analyzed retrospectively. Female was more predominant by 1.5 : 1. There were two peaks of age of onset at the 1st decade (39.0%) and 4th (15.9%). Familial occurrence was 6.8% (n=17). The mean duration of follow-up was 41.1 months (12-156 months). Moyamoya syndrome was excluded in this study. Surgical outcomes were measured by grading activity of daily living (ADL) and prognostic factors were analyzed statistically with SAS. RESULT: The most common clinical presentations were transient ischemic attacks (69.1%), followed by cerebral infarction (26.0%) and hemorrhage (4.9%) in pediatric patients, but in adult hemorrhage (49.2%) was the most prevalent. Recurrence of symptoms developed in 8 patients (11.4%) among 70 of cerebral infarction with mean intervals of 30.8 months and 7 patients (21.9%) among 32 of hemorrhage with mean interval of 42.3 months. Forty five (29.0%) of 155 patients showed stenosis of posterior cerebral arteries on cerebral angiography at the age of diagnosis. The surgical treatment were performed at 183 hemispheres of 115 patients, direct bypass surgery was done in 10 hemispheres, indirect bypass surgery in 169 hemispheres (106 EDAMS, 14 EDAS, 40 frontal EDS or burr hole, 6 EDAMS and EDAS, 3 others), combined direct and indirect bypass surgery in 4 hemispheres. The improvement of ADL was not so different between 68 (59.1%) of 115 patients treated with surgery and 23 (57.5%) in 40 patients with conservative care. The initial and final grade of ADL of pediatric patients were better than those of adult (p<0.01). The grades of ADL of patients with transient ischemic attack were better than those with infarction or hemorrhage (p<0.01). Those patients with recurrent hemorrhage were poorer in the outcome than recurrent infarction (p<0.05). The incidence of recurrent infarction in the surgical cares was lower than that in conservative care (5.9% vs 26.3%, p<0.05), but there was no statistical difference between two groups with regard to rebleeding (8.3% vs 30.0%, p>0.1). Significant prognostic factors affecting outcomes of moyamoya disease age at onset, clinical features, and initial grade of ADL. CONCLUSION: Children with transient ischemic attack were the best, but adults with recurrent hemorrhage were the worst in outcomes. Surgical treatment for moyamoya disease should be carefully tailored according to age of onset and clinical features regardless of surgical methods. Further prospective study is indicated to determine optimal treatment guideline for moyamoya disease.
Activities of Daily Living ; Adult ; Age of Onset ; Cerebral Angiography ; Cerebral Infarction ; Child ; Constriction, Pathologic ; Diagnosis ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Infarction ; Ischemic Attack, Transient ; Moyamoya Disease* ; Posterior Cerebral Artery ; Recurrence ; Retrospective Studies

PURPOSE: Cytomegalovirus (CMV) retinitis is common in patients with immunodeficient conditions caused by acquired immunodeficiency syndrome (AIDS), cytotoxic chemotherapy and immunosuppresive treatment. The purpose of this study was to assess the clinical manifestations and prognosis of CMV retinitis cases. METHODS: Thirty-one eyes of 21 patients who were diagnosed with CMV retinitis were retrospectively reviewed. The clinical manifestations and prognosis of all patients were analyzed. RESULTS: The average age of patients was 24.4+/-19.8 years. Eight patients were female and 13 patients were male. The predisposing conditions of patients were leukemia (nine patients), immunosuppressed conditions due to organ transplantation (three patients), AIDS (two patients) and other (seven patients). Eleven patients exhibited bilateral disease. The mean follow-up period was 31.3 months, and there were no differences between mean initial visual acuity (0.70+/-0.31) and mean visual acuity (0.77+/-0.20) at final visit. The major causes of visual loss were retinitis and atrophic changes involving the macula. Although retinitis was successfully treated with anti-viral agents in all cases, cataract (10 eyes, 31.3%), cystoid macular edema (four eyes, 12.5%), retinal detachment (two eyes, 6.3%), epiretinal membrane (two eyes, 6.3%) and immune recovery uveitis (two eyes, 6.3%) developed after the initial treatment. CONCLUSIONS: Although the visual prognosis of CMV retinitis was relatively good after administration of appropriate antiviral therapy, clinicians should remain alert for the development of late complications, including retinal detachment, cystoid macular edema and immune recovery uveitis.
Acquired Immunodeficiency Syndrome ; Cataract ; Cytomegalovirus ; Cytomegalovirus Retinitis ; Epiretinal Membrane ; Eye ; Female ; Follow-Up Studies ; Humans ; Leukemia ; Macular Edema ; Male ; Organ Transplantation ; Prognosis ; Retinal Detachment ; Retinitis ; Retrospective Studies ; Transplants ; Uveitis ; Visual Acuity

The authors present surgical experience with 33 patients who had incurred unstable thoracic or lumbar spine pathology(22 degenerative lumbar spine disease, 6 trauma, 3 tumor, 2 vertebral tuberculosis) and who were intraoperatively stabilized with the Texas Scottish Rite-Hospital(TSRH) universal instrumentation system over 20 months period. The 11 men and 22 women(mean age 45 years, range 23 to 71 years) presenting with signs or symptoms of neural compression underwent surgery consisting of neural decompression, internal fixation, and bone grafting. Spondylolisthesis were fused in situ without reduction. For thoracic and thoracolumbar junction pathology, multisegment fixations were performed. A 95% fusion rate was obtained with a mean follow-up period of 15 months. There were no cases of instrumentation failure. Major postoperative complications included 2 isolated nerve root deficits(one transient, one permanent) and 3 pulmonary embolism(one fatal). The construct design of the TSRH system offers some advantag es compared to other forms of interal fixation:simple assembly, rigid stability, safety, and ability to remove easily. This system provides a highly successful method to obtain arthrodesis for unstable thoracic or lumbar spine.
Arthrodesis ; Bone Transplantation ; Decompression ; Follow-Up Studies ; Humans ; Male ; Pathology ; Postoperative Complications ; Spinal Fusion ; Spine* ; Spondylolisthesis ; Texas

Gangliogliomas are rare benign tumors of the central nervous system consisting of neoplastic ganglion and low grade glial cells. The purpose of our investigation was to evaluate the clinical, radiological, surgical, and pathological features and outcome of ten patients with intracranial ganglioglioma who underwent surgery between June 1989 and December 1996. The mean follow-up period was about 24 months(range, 6-66 months) after their initial operation. The series consisted of six males and four females, and their mean age was 29.7 years. The mean length of symptoms was 9.1 years. Seizure was the most common presenting symptom and occurred in eight of ten patients. MRI findings were variable, and showed no characteristic patterns. The temporal lobe was the most common site of involvement(6/10). During surgery, a sharp demarcation between tumor and normal brain tissue was seen in seven of ten cases. Five of ten cases were solid, and the remaining cases were cystic in two, cystic with mural nodule in two, and soft, suckable in one. Total resection was possible in seven of ten patients. Diagnosis was established by identifying a mixture of abnormal astrocytic and neuronal components. Two patients showed astrocytic predominance; four, a neuronal predominance; and four, an equal admixture of cell types. All cases were benign. Other histopathological findings included microcystic change, desmoplasia, eosinophilic granular body, microcalcification, and lymphocytic infiltration. At the time of writing, all seven patients who underwent total resection were alive without recurrence; of the three who underwent subtotal resection, two were alive and in a stable condition, while in the other, the tumor had progressed within 12 months of surgery and adjuvant radiation therapy had thus been required. The patients was, though, still alive. In seven of eight patients, the frequency of seizure had markedly decreased. Our study confirms that this tumor is a distinct clinical and histological entity with a predilection for the temporal lobe. Although the number of patients and follow-up period are limited, this study also shows that epilepsy is extremely well controlled and that survival after surgical resection is good.
Brain ; Central Nervous System ; Diagnosis ; Eosinophils ; Epilepsy ; Female ; Follow-Up Studies ; Ganglioglioma* ; Ganglion Cysts ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroglia ; Neurons ; Recurrence ; Seizures ; Temporal Lobe ; Writing

The authors analyzed the surgical results of posterior C1-C2 fusion in 18 cases of atlantoaxial instability. Posterior C1-C2 wiring with bone fusion(11 cases), C1-C2 transarticular screw fixation(6 cases), and occipitocervical fusion(1 case) have been performed for unstable odontoid process fractures(10 cases), transverse ligament injury(4 cases), os odontoideum(3 cases), rheumatoid C1-2 instability(1 case). Follow-up examination was performed in all patientts after a mean postoperativeduration of 39.9 months. Follow-up x-rays showed successful stabilization in 17 cases(94%). Postoperative neurological evaluation showed improvement in 16 cases(89%), stabilization in 2 cases(11%) and there was no major operative complication.
Follow-Up Studies ; Ligaments ; Odontoid Process

Paraclinoid aneurysms arose from the proximal internal carotid artery between the site of emergence of carotid artery from the roof of the cavernous sinus and posterior communicating artery. Surgery of these aneurysms presents special difficulties because of its complicated osseous, dura, and neurovascular structures;sella turcica, cavernous sinus, optic nerve. The clinical and radiological characteristics in twenty-seven patients with the paraclinoid aneurysms were reviewed and classified into four subgroups according to their branch of origin in this segment;1) carotid cave aneurysm(2 cases), 2) ophthalmic artery aneurysm(11 cases), 3) superior hypophyseal artery aneurysm(11 cases), 4) proximal posterior carotid artery wall aneurysm or global type aneurysm(3 cases). Surgery required orbital unroofing and removal of anterior clinid process with release of dural ring. To provide easy proximal control, exposure of cervical carotid artery was helpful in some cases. Preoperative balloon occlusion testing was man datory. Outcomes were considered as good to fair in 19 patients, poor in five, and three patients died. The patients who had poor results were poor preoperative status-four were grade IV, one was grade II(Hunt-Hess grade). The causes of death were premature rupture(2 cases) and extensive vasospasm(1 case). Preoperative classification of these lesions provides excellent correlation of operative findings and surgical preparation to expose the proximal part of internal carotid artery.
Aneurysm* ; Arteries ; Balloon Occlusion ; Carotid Arteries ; Carotid Artery, Internal ; Cause of Death ; Cavernous Sinus ; Classification* ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit

Primary intracranial germ cell tumors(GCTs) are relatively rare brain tumors that show a diverse range of histologic features from benign to highly malignant conditions. To determine their clinical findings, pathology, treatment and outcome, we analyzed the medical records of 45 patients with primary intracranial GCTs treated at our hospital between June 1989 and December 1996. Thirty-two were males and 13 were females, and their ages ranged from three to 43 years. Fifteen cases were located in the pineal region and 13 in the suprasellar. The remaining locations were the basal ganglia in eight cases, both the pineal and suprasellar region in five, and others in four. In the pineal region, there was a male predominance(13:2), but in the suprasellar region, more cases(ten of 13) involved females. Of the 15 patients with tumors of the pineal region, increased intracranial pressure(IICP) was evident in 12 and six had Parinaud's syndrome. Of the 13 patients with tumors of suprasellar region, nine had diabetes insipidus; seven, visual deficit; and six, hypopituitarism. Germinoma was the most common histologic type. Other types of histology were two teratomas, three embryonal carcinomas, one endodermal sinus tumor, one choriocarcinoma, and five mixed GCTs. All patients except those with a teratoma underwent whole craniospinal irradiation. We performed gross total or subtotal removal in cases of non-germinomatous GCTs(NGGCTs) and mixed tumors, but biopsy or partial removal was preferred for the germinomas. Thirteen of 45 patients received adjuvant chemotherapy. All malignant NGGCT and mixed tumor patients were treated with adjuvant chemotherapy, as well as three of 33 germinoma patients. Three of five malignant NGGCT patients and two of five mixed tumor patients died of tumor progression. Two of 33 germinoma patients died not of disease progression but of other causes. Actuarial survival records showed that overall two-year and five-year survival rates were 89.9% and 71.9%, respectively. There were no statistically significant differences with regard to patient's age, sex, or tumor location. With regard to their histology and surgical extent, malignant NGGCTs and mixed tumors showed statistically significant differences. Five-year surival rates of germinoma and malignant NGGCT patients were 83.1% and 53.3%, respectively. We suppose that the appropriate combination of chemotherapy and surgery, with or without radiation therapy, remains to be defined, and that to determine the appropriate management protocol for malignant NGGCTs and mixed tumors, larger series of patients must be analyzed.
Basal Ganglia ; Biopsy ; Brain Neoplasms ; Carcinoma, Embryonal ; Chemotherapy, Adjuvant ; Choriocarcinoma ; Craniospinal Irradiation ; Diabetes Insipidus ; Disease Progression ; Drug Therapy ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Germinoma ; Humans ; Hypopituitarism ; Male ; Medical Records ; Neoplasms, Germ Cell and Embryonal* ; Ocular Motility Disorders ; Pathology ; Pregnancy ; Survival Rate ; Teratoma