• Journal of Korean Neurosurgical Society
• /
• v.60 no.6
• /
• pp.738-748
• /
• 2017

Objective : We present our experience of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) and evaluate the postoperative outcomes in accordance with four different operative techniques during MVD. Methods : In total, 30 patients with intractable primary typical GPN who underwent MVD without rhizotomy and were followed for more than 2 years were included in the analysis. Each MVD was performed using one of four different surgical techniques : interposition of Teflon pieces, transposition of offending vessels using Teflon pieces, transposition of offending vessels using a fibrin-glue-coated Teflon sling, and removal of offending veins. Results : The posterior inferior cerebellar artery was responsible for neurovascular compression in 27 of 30 (90%) patients, either by itself or in combination with other vessels. The location of compression on the glossopharyngeal nerve varied; the root entry zone (REZ) only (63.3%) was most common, followed by both the REZ and distal portion (26.7%) and the distal portion alone (10.0%). In terms of detailed surgical techniques during MVD, the offending vessels were transposed in 24 (80%) patients, either using additional insulation, offered by Teflon pieces (15 patients), or using a fibrin glue-coated Teflon sling (9 patients). Simple insertion of Teflon pieces and removal of a small vein were also performed in five and one patient, respectively. During the 2 years following MVD, 29 of 30 (96.7%) patients were asymptomatic or experienced only occasional pain that did not require medication. Temporary hemodynamic instability occurred in two patients during MVD, and seven patients experienced transient postoperative complications. Neither persistent morbidity nor mortality was reported. Conclusion : This study demonstrates that MVD without rhizotomy is a safe and effective treatment option for GPN.

• Proceedings of the Korean Society of Veterinary Clinics Conference
• /
• 2006.05a
• /
• pp.96-96
• /
• 2006

• Korean Journal of Veterinary Research
• /
• v.49 no.4
• /
• pp.291-295
• /
• 2009

A dead stray cat was necropsied for zoonotic feline disease monitoring. Grossly, there were no specific lesions. Major microscopic lesions included lymphocytic meningoencephalitis, malacia, and tissue cysts in the cerebral and cerebellar cortex. The size and shape of tissue cysts were identical to those of Apicomplexa including Toxoplasma (T.) gondii. Bradyzoites in the tissue cyst were strongly positive for T. gondii by immunohistochemistry. Electron microscopy revealed that bradyzoites within the tissue cyst were similar to the morphological features of T. gondii. Fresh tissue samples were examined by a polymerase chain reaction assay and resulted in a specific band of T. gondii only in the brain. Based on the results, this case was diagnosed as toxoplasmosis. This is the first case of toxoplasmic meningoencephalitis in a cat in Korea.

• Investigative Magnetic Resonance Imaging
• /
• v.19 no.3
• /
• pp.186-190
• /
• 2015

Acute disseminated encephalomyelitis (ADEM) is a demyelinating and inflammatory condition of the central nervous system, occurring predominantly in white matter. ADEM involving the rhombencephalon without affecting the white matter is very rare. Here, we present an unusual case of ADEM involving only the rhombencephalon in a 4-year-old Asian girl. The patient complained of pain in the right lower extremities, general weakness, ataxia, and dysarthria. The initial brain CT showed subtle ill-defined low-density lesions in the pons and medulla. On brain MRI, T2 high signal intensity (T2-HSI) lesions with mild swelling were present in the pons, both middle cerebellar peduncles, and the anterior medulla. The initial diagnosis was viral encephalitis involving the rhombencephalon. Curiously, a cerebrospinal fluid (CSF) study revealed no cellularity, and negative viral marker findings. Three weeks later, follow up brain MRI showed that the extent of the T2-HSI lesions in the brain stem had decreased. After reinvestigation, it was found that she had a prior history of upper respiratory infection. In this case, we report the very rare case of a patient showing isolated involvement of the rhombencephalon in ADEM, mimicking viral rhombencephalitis on CT and MR imaging. ADEM can involve unusual sites such as the rhombencephalon in isolation, without involvement of the white matter or deep gray matter and, therefore, should be considered even when it appears in unusual anatomical areas. Thorough history taking is important for making a correct diagnosis.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.16 no.6
• /
• pp.1291-1296
• /
• 2002

Blood circulation of brain is divided into two major categories; anterior one from carotid artery and posterior one from vertebrobasilar artery. In stroke patients, it is important to diagnose which is involved, because there is many difference in the aspects of clinical menifestations and prognosis, especially in the acute stage. In some cases of vertebrobasilar infarction, such as Wallenberg's syndrome, charicteristic cranial nerve signs, eye movement disorders and cerebellar signs are appeared. And in Dejerine's syndrome, only pure motor or sensory defecits can be appeared without any brainstem signs. So It shoud be differenciated by Brain MRI from those of the cerebral hemisphere lesions. And in the cases that nausea, vomitting and dysphagia are the first menifestations, it is frequently misdiagnosed as internal medical disease, causing appropriate treatment delayed. In this case report, we are to describe the clinical menifestations and progresses of two cases of brainstem infarctions, review previously published case reports about them and compare them to our cases. The first is Dejerine's syndrome i.e. medial medullary infarction, the second is Wallenberg's syndrome i.e. lateral medullary infarction. Simultaneously we are to investigate the oriental medical approach in the bran stem infarctions.

• Journal of Yeungnam Medical Science
• /
• v.15 no.2
• /
• pp.306-315
• /
• 1998

MR findings in nine patients(three female, six male) with neuro-Behcet's disease were retrospectively analyzed. NeuroBehcet's disease was diagnosed on the basis of typical clinical symptoms. Involved site, pattern, signal intensity, and contrast enhancement pattern on MRI were evaluated. In addition, follow up MR imaging was performed in four patients. The midbrain(7/9), internal capsule(7/9), pons(6/9), thalamus(6/9), basal ganglia (5/9), middle cerebella peduncle(4/9), medulla oblongata(2/9), and subcortical white matter(2/9) are involved on MRI. The size of lesions was 1cm to 3cm and their margin was ill-defined and patchy. Inhomogeneous high signal intensity on the T2-weighted images and low signal intensity on T1-weighted images was seen respectively. In four of nine cases, there was focal enhancement. On follow up MR imaging, improvement or recurrance of the lesions was found. Also in two cases of follow up cases, there was artophy in brainstem and(or) middle cerebellar peduncles. In conclusion, MR imaging with systemic clinical symptoms is useful for diagnosing neuro-Behcet's disease.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.11
• /
• pp.6337-6340
• /
• 2013

Through retrospective analysis of 13 cases of magnetic resonance image (MRI) manifestations of atypical meningiomas confirmed by operation and pathology in the First Affiliated Hospital of Xinxiang Medical University, the objective of this study was to evaluate the diagnostic value of MRI in order to improve the accuracy rate of preoperative diagnosis. In this retrospective analysis of MRI findings for atypical meningiomas in First Affiliated Hospital of Xinxiang Medical University from January to July in 2012, the location, morphology and tumor signals and other tumor imaging characteristics were covered. In 13 cases of atypical meningioma patients of this group, most tumors were located at typical sites (10/13), mainly the falx cerebri, parasagittal, convexity, saddle area. Only two cases were at atypical locations, 1 in the cerebellar hemisphere and 1 in a lateral ventricle. Most of the tumors showed T1 and T2 isointensity signals, and necrosis, calcification, and peritumoral edema were always featured. DWI showed isointensity in 11 cases (11/13), and hyperintensity in 2. Some 9 cases had dural tail signs, 12 had accurate positioning (12/13), and 2 were postoperative recurrences. MRI has high value in the diagnosis of atypical meningiomas, with important roles in early clinical diagnosis, treatment and prognosis evaluation.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.2
• /
• pp.867-870
• /
• 2014

Purpose: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) ependymoma data to identify predictive models and potential disparity in outcome. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for ependymoma. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome ('brain and other nervous systems' specific death in yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modeling errors. Risk of ependymoma death was computed for the predictors for comparison. Results: A total of 3,500 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 79.8 (82.3) months. Some 46% of the patients were female. The mean (S.D.) age was 34.4 (22.8) years. Age was the most predictive factor of outcome. Unknown grade demonstrated a 15% risk of cause specific death compared to 9% for grades I and II, and 36% for grades III and IV. A 5-tiered grade model (with a ROC area 0.48) was optimized to a 3-tiered model (with ROC area of 0.53). This ROC area tied for the second with that for surgery. African-American patients had 21.5% risk of death compared with 16.6% for the others. Some 72.7% of patient who did not get RT had cerebellar or spinal ependymoma. Patients undergoing surgery had 16.3% risk of death, as compared to 23.7% among those who did not have surgery. Conclusion: Grading ependymoma may dramatically improve modeling of data. RT is under used for cerebellum and spinal cord ependymoma and it may be a potential way to improve outcome.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.5
• /
• pp.405-410
• /
• 2013

Objective : The objective of this study was to investigate changes in the posterior cranial fossa in patients with symptomatic Chiari malformation type I (CMI) compared to a control group. Methods : We retrospectively reviewed clinical and radiological data from 12 symptomatic patients with CMI and 24 healthy control subjects. The structures of the brain and skull base were investigated using magnetic resonance imaging. Results : The length of the clivus had significantly decreased in the CMI group than in the control group (p=0.000). The angle between the clivus and the McRae line (p<0.024), as the angle between the supraocciput and the McRae line (p<0.021), and the angle between the tentorium and a line connecting the internal occipital protuberance to the opisthion (p<0.009) were significantly larger in the CMI group than in the control group. The mean vertical length of the cerebellar hemisphere (p<0.003) and the mean length of the coronal and sagittal superoinferior aspects of the cerebellum (p<0.05) were longer in the CMI group than in the control group, while the mean length of the axial anteroposterior aspect of the cerebellum (p<0.001) was significantly shorter in the CMI group relative to control subjects. Conclusion : We elucidate the transformation of the posterior cranial fossa into the narrow funnel shape. The sufficient cephalocaudal extension of the craniectomy of the posterior cranial fossa has more decompression effect than other type extension of the craniectomy in CMI patients.

• The Journal of the Korea Contents Association
• /
• v.10 no.4
• /
• pp.236-246
• /
• 2010

The 3-Acetylpyridine(3-AP) induces cerebellar injury which is chemoablation of the inferior olive nucleus. The purpose of this study was to investigate the effects of exercise(Ex) and electroacupuncture(EA) on muscle activity of hindlimb and serum brain derived neurotrophic factor(BDNF) in the ataxia rats by the 3-AP. 12-week-aged male Sprague-Dawley rats were randomly divided into the 5 groups: Control, 3-AP, 3-AP+Ex, 3-AP+EA and 3-AP+Ex+EA groups. Maximal Height Vertical Jump(MHVJ) was significantly decreased in the 3-AP compared with control group, and it was increased in Ex, EA and Ex+EA groups than 3-AP group. The muscle activity of hindlimb was significantly increased in the 3-AP groups than control group, also it was most decreased in Ex+EA group. The concentration of BDNF of the serum was significantly decreased in the Ex, EA and Ex+EA groups than 3-AP group. The results of this study showed that dynamic exercise and electroacupuncture have a positive effect on functional recovery and in the ataxia rats by the 3-AP.