Spinal adhesive arachnoiditis is an inflammation and fibrosis of the subarachnoid space and pia mater caused by infection, trauma, spinal vascular anomalies, and iatrogenic (surgery and/or puncture). Adhesive arachnoiditis develops various symptoms and signs (gait disturbances, radiating pain, paralysis, and incontinence). On the other hand, adhesive arachnoiditis associated with cauda equina syndrome has not been reported in Korea until now. The authors experienced cauda equina syndrome caused by adhesive arachnoiditis of the lumbar spine with satisfactory results following decompression. We report this case with a review of the relevant literature.
Adhesives ; Arachnoid ; Arachnoiditis ; Cauda Equina ; Decompression ; Fibrosis ; Hand ; Inflammation ; Korea ; Paralysis ; Pia Mater ; Polyradiculopathy ; Spine ; Subarachnoid Space

STUDY DESIGN: Review of literature on anatomical and pathophysiological features of cauda equina. OBJECTIVES: To look into the anatomical and pathophysiological features of cauda equina and support their basic knowledge of treating cauda equina syndrome. SUMMARY OF LITERATURE REVIEW: Cauda equina has different anatomical and pathophysiological features to peripheral nerve. MATERIALS AND METHODS: Review of literature. RESULTS: When compressing to cauda equina, the pathophysiologic mechanism develop as follows; increasing the vascular permiablity of nerve root, intraneural edema, and subsequent blood and nutritional impairment. Nerve root injury develops through this pathophysiologic mechanism. CONCLUSIONS: Cauda equina has an extensive ateriovenous anastomosis and guaze-like pia mater, which supply blood and neutrition to it. These anatomical features prevent it from complete cauda equina syndrome when compressing to it under arterial blood pressure.
Arterial Pressure ; Cauda Equina* ; Edema ; Peripheral Nerves ; Pia Mater ; Polyradiculopathy

OBJECTIVETo evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury.

METHODSFrom March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of pre- and postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale.The improvement rate of JOA score at the indicated time was recorded.

RESULTSPostoperative Frankel classification rating of 16 patients improved obviously.JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9 ± 2.3, 8.5 ± 1.6, 8.9 ± 2.1, and 12.4 ± 2.5, respectively, and significantly increased compared with that prior to surgery (5.5 ± 0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period.

CONCLUSIONIt is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.

Adult ; Bone Screws ; Decompression, Surgical ; methods ; Female ; Fracture Fixation, Internal ; Humans ; Laminectomy ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pia Mater ; surgery ; Spinal Cord Injuries ; diagnosis ; pathology ; physiopathology ; surgery

Perivascular space (PVS) is a crevice between two slices of cerebral pia maters, filled with tissue fluid, which be formed by pia mater emboling in the surrounding of cerebral perforating branch (excluding micrangium). Normal PVS (diameter < 2 mm) can be found in almost all healthy adults; however enlarged PVS (diameter > 2 mm) has correlation with neurological disorders probably. The article reviews the formation mechanism, imageology characteristics and the relation with neurological disorders of PVS, which is beneficial to the research of some neurological disorders etiopathogenesis and treatment.
Animals ; Blood Vessels ; pathology ; Humans ; Nervous System Diseases ; pathology ; Pia Mater ; pathology

OBJECTIVE: To elucidate the role of aquaporin-4(AQP4) in cerebral edema formation, we studied the expression and subcellular localization of AQP4 in astrocytes after focal cerebral ischemia. METHODS: Cerebral ischemia were induced by permanent middle cerebral artery(MCA) occlusion in rats and estimated by the discoloration after triphenyltetrazolium chloride(TTC) immersion. Change of AQP4 expression were evaluated using western blot. Localization of AQP4 was assessed by confocal microscopy and its interaction with alpha-syntrophin was analyzed by immunoprecipitation. RESULTS: After right MCA occlusion, the size of infarct and number of apoptotic cells increased with time. The ratio of GluR1/GluR2 expression also increased during ischemia. The polarized localization of AQP4 in the endfeet of astrocytes contacting with ventricles, vessels and pia mater was changed into the diffuse distribution in cytoplasm. The interactions of AQP4 and Kir with alpha-syntrophin, an adaptor of dystrophin complex, were disrupted by cerebral ischemia. CONCLUSION: The deranged spatial buffering function of astrocytes due to mislocalized AQP4/Kir4.1 channel as well as increased assembly of Ca2+ permeable AMPA receptors might contribute to the development of edema formation and the excitotoxic neuronal cell death during ischemia.
Animals ; Apoptosis ; Aquaporin 4 ; Astrocytes ; Blotting, Western ; Brain Edema* ; Brain Ischemia* ; Cell Death ; Cerebral Infarction ; Cytoplasm ; Dystrophin ; Edema ; Immersion ; Immunoprecipitation ; Ischemia ; Microscopy, Confocal ; Neurons ; Pia Mater ; Rats* ; Receptors, AMPA ; Receptors, KIR

Pituitary adenoma accounts for 10% to 20% of intracranial tumors. Surgical approach to pituitary adenoma had been performed via craniotomy until the early 20th century, but transsphenoidal approach has been accepted as a primary procedure since 1910. However, there are frequent complications in the nose including nasal mucosal laceration, nasal septal perforation, and external nose deformities. Furthermore, cerebrospinal fluid leakage, visual field loss or blindness rarely occur. When blindness occurs by postoperative hematoma compression, revision operation is usually required for bleeding control and hematoma removal under general anesthesia. However, optic nerve decompression with postoperative hematoma removal via transsphenoidal approach can be adequately performed by endoscopic technique under local anesthesia, because there is no sensory nerve innervation in the pia mater and arachnoid membrane. We report a case of successful hematoma removal with bleeding control by endoscopic technique under local anesthesia in a patient who became blind due to postoperative hematoma after transphenoid approach for pituitary adenoma removal.
Anesthesia, General ; Anesthesia, Local* ; Arachnoid ; Blindness* ; Cerebrospinal Fluid ; Congenital Abnormalities ; Craniotomy ; Decompression ; Hematoma ; Hemorrhage ; Humans ; Lacerations ; Membranes ; Nasal Septal Perforation ; Nose ; Optic Nerve ; Pia Mater ; Pituitary Diseases ; Pituitary Neoplasms* ; Visual Fields

OBJECTIVE: Acute spontaneous subdural hematoma(SDH) secondary to a ruptured intracranial aneurysm is a rare event. The authors present nine cases with aneurysmal SDH. METHODS: We analyzed nine cases of aneurysmal SDH from 337 patients who underwent treatment for a ruptured aneurysm between January 1998 and May 2004. Clinical and radiological characteristics and postoperative course were evaluated by reviewing medical records, surgical charts and intraoperative videos. RESULTS: The nine patients comprised four males and five females with a mean age of 53years (range 15-67years). The World Federation of Neurosurgical Societies grades on admission were I in one patient, II in two patients, III in five patients and V in one patient. With respect to location, there were four internal carotid-posterior communicating artery(ICA-Pcom) aneurysms, one distal anterior cerebral artery(DACA) aneurysm, one anterior communicating artery and three middle cerebral artery aneurysms. CT scans obtained from the four patients with ICA-Pcom aneurysms revealed SDH over the convexity and along the tentorium, and two of these patients presented with pure SDH without subarachnoid hemorrhage(SAH). In three patients with ICA-Pcom aneurysm, the ruptured aneurysm domes adhered to the petroclinoid fold. In the patient with the DACA aneurysm, the domes adhered tightiy to the pia mater and the falx. CONCLUSION: Ruptured intracranial aneurysm may cause SDH with or without SAH. In the absence of trauma, the possibility of aneurysmal SDH should be considered.
Aneurysm* ; Aneurysm, Ruptured ; Arteries ; Female ; Hematoma, Subdural* ; Humans ; Intracranial Aneurysm ; Male ; Medical Records ; Pia Mater ; Tomography, X-Ray Computed

OBJECTIVEMultiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas. To verify the effect of MST, an experimental study was performed first, followed by clinical application.

METHODSOn the basis of the experimental study, MST was performed in 200 intractable epileptic patients from 1991 to 2000. Of them, 80 cases underwent MST only while 120 others underwent MST combined with other techniques, such as corpus callosotomy, temporal lobectomy and focus resection. A series of modifications of the surgical techniques were made.

RESULTSThe results of the experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex. MST does not impair major functions of the cortex. After the clinical application and modifications, 160 patients were followed up for 1 to 8 years. Complete control of seizure was obtained in 100 cases (62.5%), significant reduction (more than 75%) in 32, reduction (more than 50%) in 20 and no change in 8. The total rate of effectiveness was 95.0%, and the significant rate of effectiveness was 82.5%. No functional defects were found in any patients.

CONCLUSIONSThe results indicate that MST is an effective approach to the surgical treatment of intractable epilepsy. MST can be combined with other approaches. The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group. To evade hemispheric disturbance, MST should be done first to avoid severe complications. Hemispherectomy should be performed only on poor effected cases of MST.

Adolescent ; Adult ; Child ; Child, Preschool ; Epilepsy ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pia Mater ; Surgical Procedures, Operative ; methods

Type IV spinal cord arteriovenous malformation is a spinal vascular anomaly supplied by the anterior spinal artery and drained directly into an enlarged venous outflow. Direct fistula lies completely outside the spinal cord and pia mater. We report a case of intradural perimedullary arteriovenous fistula in 58-years-old man who presented with progressive paraparesis. Angiographically single fistulous perimedullary communication with moderate-sized abnormal venous engorgement was demonstrated through anterior spinal artery. Direct surgical obliteration of the fistulous site was performed. Spinal angiographic evaluation and recognition of their exact pathophysiology according to individual types of spinal AVMs is the most important in successful execution of planned surgery and to achieve the good outcome.
Arteries ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Fistula ; Hyperemia ; Paraparesis ; Pia Mater ; Spinal Cord*

Type IV spinal cord arteriovenous malformation is a spinal vascular anomaly supplied by the anterior spinal artery and drained directly into an enlarged venous outflow. Direct fistula lies completely outside the spinal cord and pia mater. We report a case of intradural perimedullary arteriovenous fistula in 58-years-old man who presented with progressive paraparesis. Angiographically single fistulous perimedullary communication with moderate-sized abnormal venous engorgement was demonstrated through anterior spinal artery. Direct surgical obliteration of the fistulous site was performed. Spinal angiographic evaluation and recognition of their exact pathophysiology according to individual types of spinal AVMs is the most important in successful execution of planned surgery and to achieve the good outcome.
Arteries ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Fistula ; Hyperemia ; Paraparesis ; Pia Mater ; Spinal Cord*