• 한국임상수의학회지
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• 제31권5호
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• pp.439-444
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• 2014

체중 2.7 kg의 5세령 암컷 말티즈 견이 양측 슬개골 탈구와 후지 파행으로 지역동물병원에 내원하였다. 도르레절제술과 슬개골의 외측 보강 봉합법을 이용하여 슬개골 탈구 정복술을 실시하였으나, 수술 3주 후 등을 굽힌 자세의 보행과 후지의 운동실조, 흉요추부의 압통, 간헐적인 경련증상으로 재 내원하였다. 자기공명영상 촬영 결과, 우측 전두엽의 종괴와 경수에서부터 3번 요수까지의 공동성 변화가 확인되었다. 병리조직학적 소견으로 뇌종양은 느슨한 망상구조 또는 레이스 모양의 수막세포들로 구성되었으며, 세포 외부에 다양한 크기와 형태의 많은 낭포성 공간이 관찰되었다. 면역조직화학염색 결과 종양세포들은 vimentin 양성, 신경원 특이 에놀라제 및 신경교 섬유질 산성 단백질에는 음성을 나타내었다. 경수와 흉수 부위에는 부정형의 확장된 중심관 유사 동공이 관찰되었다. 이 증례는 개에서 특이적인 두개강 내 소낭성 뇌수막종과 연관되어 2차적으로 발생한 척수공동증의 임상소견과 영상학적 및 병리조직학적 특징을 보여주고 있다.

• Investigative Magnetic Resonance Imaging
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• 제18권3호
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• pp.232-243
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• 2014

목적: 축추이하 경추 손상시 발생하는 연속적, 비연속적 연골하골 압박손상의 빈도와 원발부위 손상 패턴에 대해 알아보고자 하였다. 대상과 방법: 축추이하 경추 손상이 있는 환자 47명의 전산화 단층촬영, 자기공명영상, 의무기록을 후향적으로 검토하여 연속적, 비연속적 연골하골 압박손상의 발생유무와 수, 레벨, 손상 부위를 기록하였다. 원발부위 손상 패턴을 알아보기 위하여 손상된 원발부위의 레벨, 수, 손상 형태, 전/후방 추간판인대복합체의 손상유무, 후방인대복합체의 손상유무, 척수 손상유무를 분석하고 손상 기전을 분석하였다. 분석된 원발손상 패턴과 손상기전은 Mann-Whitney U test, Pearson's chi square test, Fisher's exact test의 통계적 기법으로 연골하 압박손상의 발생유무와 연관성을 조사하였다. 결과: 총 18명에게서 (18/47, 38.29%) 연골하 압박손상이 발생했으며 그 중 9명은 원발부위와 인접하여 연속적으로, 다른 9명은 원발부위와 떨어져 비연속적으로 발생하였다. 3번 흉추에 가장 흔하게 발생하였고 (15/47, 31.91%), 세 개의 레벨에 걸쳐있는 경우가 가장 많았다 (6/18, 33.33%). 모든 연골하 압박손상은 척추체의 전상방 부위나 상종판 주변에 발생하였으며 강한 외력의 외상과 연관되었다. 연골하 압박손상의 발생은 원발부위의 손상형태와 후방인대복합체의 손상과 통계학적으로 유의한 연관성을 보였다. 비연속적 연골하 압박손상은 연속적 연골하 압박손상에 비해 비교적 상부 경추에 원발 손상부위가 있고 후방추간판인대 복합체의 손상을 동반하는 경우가 통계학적으로 유의하게 많았다. 그외 분석한 다른 인자들은 통계학적으로 유의한 결과를 보이지 않았다. 결론: 이차성 연골하 압박손상은 흔하며 강한 외력에 의한 굴곡압박성 경추 외상과 관련 있을 것이다.

• 한국임상수의학회지
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• 제39권5호
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• pp.235-239
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• 2022

A 10-year-old neutered male Siberian Husky presented with paraparesis and severe lethargy. On physical examination, the patient was unable to weight-bear and walk and exhibited significant muscle mass loss in both hindlimbs and generalized truncal alopecia with a dull coat of hair. On neurological examination, cranial lumbar vertebral pain, hind limb cross-extensor reflex, delayed hindlimb postural reaction, upper motor neuron bladder dysfunction, and total absence of cutaneous trunci reflex were identified. Computed tomography revealed diffuse idiopathic skeletal hyperostosis and spondylosis deformans of the cervical and thoracolumbar vertebrae. In addition, a generalized decrease in bone mineral density of the vertebrae was identified. Magnetic resonance imaging showed hyperplasia of the epidural fat compressing the spinal cord in the thoracolumbar region and concurrent mild multiple intervertebral disc herniations. No specific findings were observed in cerebrospinal fluid analysis. Blood analysis of thyroid function revealed decreased total T4 and free T4 levels, and increased TSH levels. The patient was tentatively diagnosed with spinal epidural lipomatosis (SEL) secondary to hypothyroidism. The patient was treated with levothyroxine, firocoxib, and gabapentin. Clinical signs gradually improved, and the patient showed normal ambulation 40 days after treatment initiation. SEL is extremely rare in dogs. To the best of our knowledge, this is the first case report of SEL secondary to hypothyroidism that was treated conservatively. Secondary SEL can be sufficiently managed by treating the underlying cause, if possible.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.176-178
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• 2009

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.237-247
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• 2020

Objective : Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods : We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.