• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.375-379
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• 2010

The Chiari 1.5 malformation is defined as a tonsillar hemiation within a Chiari I malformation with additional caudal descent of the brainstem through the foramen magnum. We describe a patient with Chiari I malformation who evolved to Chiari 1.5 malformation during longitudinal follow-up. A 15-year-old girl presented with neck pain during exercise for two years. She had been diagnosed with Chiari I malformation with mild hydrocephalus after minor cervical trauma at the age of six years. At that time, she was asymptomatic. After she complained of aggravated neck pain, neuroimaging (nine years after first imaging) revealed caudal descent of the brainstem and syringomyelia in addition to progression of tonsillar hemiation. Posterior fossa decompressive surgery resulted in complete resolution of neck pain. Based on neuroimaging and operative findings, she was diagnosed as Chiari 1.5 malformation. Neuroimaging performed seven months after surgery showed an increased anterior-posterior diameter of the medulla oblongata and markedly decreased syringomyelia. This case demonstrates progressive developmental process of the Chiari 1.5 malformation as an advanced form of the Chiari I malformation.

• The Korean Journal of Pain
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• v.30 no.3
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• pp.229-230
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• 2017

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.439-444
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• 2014

A 5-year-old, 2.7 kg female maltese dog was presented a local veterinary clinic with one week history of hindlimb lameness associated with patellar luxation. Reduction of bilateral medial patellar luxation was operated using trochlear resection and lateral reinforcement technique. Three weeks after the surgery, the dog showed bending spine with pain in thoracic and lumbar region, continuous ataxia and intermittent convulsion. Magnetic resonance imaging scanning revealed a hyperintense mass in right frontal lobe of brain and abnormal cavitation from cervical cord to third lumbar cord. Histopathologically, neoplasm in brain composed of meningothelial cells showed loosely reticular or lace-like morphology with numerous extracellular cystic spaces of variable size and shape. Neoplastic cells were positive for vimentin and negative for neuron specific enolase and glial fibrillary acidic protein. Irregular shaped enlarge central canal-like cavity was existed in cervical and lumbar cords. In our best knowledge, this report described the clinical findings, imaging and histopathologic characteristics of unusual intracranial microcystic meningioma with secondary syringomyelia in a dog.

• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.169-174
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• 2006

Objective : This study was conducted to examine the correlation between clinical outcomes and the size of the syrinx in post-operative magnetic resonance imaging[MRI] and symptom duration. Methods : The authors investigated twelve patients who underwent various operations for syringomyelia from January 1995 to December 2003. The authors retrospectively analyzed medical records. pre- and post-operative MRI findings, features and durations of symptoms, and the method of surgical treatments. The clinical outcomes were assessed on Prolo scale at 6 months of post-operative period. Results : Neurologic symptoms did not promptly disappear after the shrinkage of syrinx, but post-operative MRI demonstrated most patients showed reductions in the size of the syrinx. There is no statistical relationship between clinical improvements and decrements of the syrinx size. However, patients who underwent surgical treatment within 2 years from the symptom onset had more favorable outcome than those who had operations after 2 years from the onset of symptoms. Conclusion : Change in the size of the syrinx in post-operative MRI is not directly proportional to favorable clinical outcomes. However, symptom duration before surgical treatment has considerable impact on the clinical outcomes.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.241-243
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• 2006

Central pain is defined as pain associated with lesions of the central nervous system, and is among the most intractable of chronic pain syndromes. A 47 year-old-female, who had right arm and shoulder pain, was diagnosed with syringomyelia of the Arnold Chiari malformation type I and received foramen magnum decompression and a syringo-subarachnoid shunt. After the operation, the evoked pain was improved, but she complained of a continuous burning pain, coupled with cold and tactile allodynia. This symptom failed to fully subside on administration of oral medicine; therefore, brachial plexus block was performed, which relieved her pain transiently. Through repeated trials, a gradual decrease in the pain intensity and frequency was found. However, the way in which brachial plexus block improves spinal central pain is not completely known.

• Korean Journal of Veterinary Research
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• v.46 no.4
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• pp.399-403
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• 2006

Caudal occipital malformation syndrome (COMS) is relatively common disease which occurs at craniocervical junction. It has been known that this syndrome was developed mainly in Cavalier King Charles spaniels, but these days there are a lot of case reports about COMS in other small breed dogs. In this report, COMS was diagnosed in ten dogs presented to Haemaru Referral Animal Hospital using MRI examination from January 2005 to April 2006. These cases were also investigated about concurrent diseases and syringomyelia was the most common type of complication, but clinical signs were nonspecific. COMS could be controlled by medical therapy with corticosteroid except cases with concurrent meningitis. It is considered that the present report could provide information regarding imaging and clinical features of COMS such as concurrent diseases, clinical signs, and prognosis in small animal practice despite of limited case numbers.

• Journal of Korean Neurosurgical Society
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• v.59 no.5
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• pp.512-517
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• 2016

Objective : The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. Methods : Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (${\geq}50%$ decrease in the diameter of the syrinx) were investigated. The follow-up period was $72.7{\pm}55.6$ months. Results : Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. Conclusion : Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.

• Annals of Clinical Neurophysiology
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• v.15 no.2
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• pp.59-62
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• 2013

Man-in-the-barrel syndrome (MIBS) is a clinical syndrome of bilateral upper limb weakness with normal lower extremity function. It can be caused by various neurological conditions such as bilateral cerebral hypoperfusion, syringomyelia, motor neuron disease, or cervical myelopathies. We report a patient with MIBS after cervical spinal cord ischemia. It is postulated to be caused by ischemic insults of anterior spinal artery from repeated and prolonged neck extension.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1291-1299
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• 2001

Objectives : The authors present a retrospective analysis of 14 patients treated for spinal cord hemangioblastoma (SCH) between Dec. 1986 and Mar. 2000. This study was conducted to evaluate and compare the difference of the functional outcomes associated with the extent of surgical removal of SCH. Methods : Eleven patients were male and three patients were female. Their mean age was 37.2 years that ranged from 19 to 62 years. Preoperative magnetic resonance(MR) imaging of the spine was performed in all cases, and preoperative angiography in eleven cases. They were followed from 15 months to 161 months(median follow-up period, 47 months), and we investigated the change of neurological symptoms and functional outcomes with radiological features, especially on MR imaging. Results : Six patients were accompanied by von Hippel-Lindau disease, and three of them had multiple CNS tumors. Thirteen patients had intramedullary tumor, and the remaining one had extradural. Syringomyelia around the tumor was observed in ten cases. All patients underwent surgical removal, and gross total removal(GTR) was achieved in ten cases. Preoperative embolization was performed in four cases. In four patients who were treated with preoperative embolization, intraoperative loss of blood was minimal and GTR was possible. One patient developed a transient swallowing difficulty postoperatively without permanent postoperative neurological deficits. In three of four patients in whom GTR was not possible, their functional outcomes were worsened postoperatively. The functional status at discharge was improved in seven patients, stationary in four patients, and worse in three. At the last follow-up(15-161 months), one of four patients who had been stationary at discharge showed improvement but, the rest did not show any change. All patients who showed neurological improvement were patients with GTR, and the patients with GTR had significant better outcome than those without GTR(p=0.015). Conclusion : Surgical treatment, and especially, GTR is considered as treatment of choice for spinal cord hemangioblastoma. Preoperative embolization may prevent intraoperative bleeding and improve surgical outcome.

• Journal of Veterinary Clinics
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• v.34 no.6
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• pp.449-453
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• 2017

A 3-year-old castrated male Maltese dog, weighing 4.8 kg was referred with hindlimb ataxia and right forelimb proprioceptive deficits were shown for 20 months. Chiari-like malformation and syringomyelia diagnosed through MRI at a local animal hospital and Knuckling of right forelimb and reluctance to walk were managed with steroid. The medical management was getting ineffective to manage for the symptoms one month before referred. Physical and neurological examinations, radiography, computed tomography, and magnetic resonance imaging were performed and diagnoses of caudal occipital malformation syndrome (COMS) and subsequent syringomyelia (SM) were made. Given that pharmacological treatment was previously ineffective, surgical intervention was recommended. Foramen magnum decompression with duraplasty using $Lyoplant^{(R)}$ was performed. Three days post-surgery, the dog showed improved gait and activity. After 2 months, the dog received no additional prescription medications. At the 12-month follow-up after surgery, the dog showed no clinical problems or recurrences, despite complete cessation of pharmacological treatment. In present report, we applied $Lyoplant^{(R)}$ as a dural graft has been carried out in a dog with COMS. Surgical decompression with $Lyoplant^{(R)}$ was an effective long-term (12-month) treatment for COMS without the need for any pharmacological treatment.