• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.311-313
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• 2015

Chiari type I malformation is a tonsillar herniation more than 3 mm from the level of foramen magnum, with or without concurrent syringomyelia. Different surgical treatments have been developed for syringomyelia secondary to Chiari's malformations: craniovertebral decompression with or without plugging of the obex, syringo-subarachnoid, syringo-peritoneal, and theco-peritoneal shunt placement. Shunt placement procedures are useful for neurologically symptomatic large-sized syrinx. In this paper, authors define the first successful treatment of a patient with syringomyelia due to Chiari type I malformation using a pre-defined new technique of syringo-subarachnoid-peritoneal shunt with T-tube system.

• Investigative Magnetic Resonance Imaging
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• v.18 no.2
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• pp.144-150
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• 2014

Purpose : Intramedullary spinal lesions in the conus medullaris (CM), including tumors and vascular lesion, are rarely reported. We reported various MR features of intramedullary spinal cord lesions involving the CM including ependymoma, hemangioblastomas, dermoid cyst, ventriculus terminalis and spinal AVF and tried to discuss them for differential diagnosis. Materials and Methods: Six patients (male: female = 4:2, mean age = 44.3 year old) were enrolled from the clinical database of our institute from 2004 to 2010 and their radiological images and clinical symptoms were reviewed retrospectively. All patients had taken initial and postoperative MRI with contrast enhancement using gadopentate dimeglumine (Gd-DTPA). These images were analyzed by tumor size, location, signal intensity relative to the spinal cord, vascular flow voids, syrinx or cyst, edema and enhancement pattern. Results: Contrast enhancement was seen in all intramedullary masses. An eccentric enhancing nodule was noted in two hemangioblastomas and unusual peripheral rim enhancement with septation was seen in ventriculus terminalis. Patchy enhancement of the CM was observed in spinal arteriovenous fistula (AVF). Extensive cord edema adjacent to the intramedullary lesions was seen in four cases and syrinx was noted in three cases. Vascular signal voids were found in two hemangioblastomas and one spinal AVF. Conclusion: In evaluation of intramedullary spinal lesions in the CM, it is necessary to consider these unusual MR findings and discriminate various pathologies with prudence and caution.

• Journal of Physiology & Pathology in Korean Medicine
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• v.22 no.1
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• pp.246-251
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• 2008

Syringomyelia is a rare disorder that causes a cyst to form in spinal cord. This cyst, called a syrinx, can damage to the spinal cord and cause symptoms such as motor weakness, pain, sensory disturbance, etc. We experienced a case of tactile hypesthesia suspecting syringomyelia in 16 year old male patient. Syringomyelia in T2/3 level was diagnosed by magnetic resonance imaging. Hypesthesia was similar to mamokbulin in oriental medicine. And we assumed these symptoms induced by conditions called kiheo in analyzing patient's symptoms and signs. We treated the patient by acupuncture, herbal medicine improving kiheo, and other methods. In the result, the symptoms had withdrawn. This case suggested possibility to treat syringomyelia in oriental medicine, but single case is insufficient for evidence.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.236-241
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• 2015

Objective : We report on the technical feasibility and limitations of the transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape. Methods : Thirteen patients who underwent the fourteen transmanubrial approach for various CTJ lesions were enrolled during 2005-2014. For the evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel line defined as a straight line parallel to the inferior and superior plateau of the upper and lower healthy vertebrae, the angle of the two parallel lines and the distance from the sternal notch to lines at the sternum on preoperative magnetic resonance images. Surgical limitations and perspectives, as well as postoperative clinical outcomes were evaluated retrospectively. Results : The CTJ lesions were six metastases, three primary bone tumors, two herniated discs, and one each of a traumatic dislocation with syrinx formation and tuberculous spondylitis and ossification of the posterior longitudinal ligament. If two parallel lines pass below the sternal notch, the manubriotomy should be inevitably performed. The mean preoperative Visual analogue scale score was 8 (range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases showed an increase in Frankel score postoperatively. Conclusion : The spatial relationship between the sternal notch and the two parallel lines to the lesion was rational to determine the feasibility of manubriotomy. The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction.

• 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.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.85-90
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• 2001

Objective : DREZotomy is effective for the treatment of deafferentation pain as a consequence of root avulsion, postparaplegic pain, posttraumatic syrinx, postherpetic neuralgia, spinal cord injury, and peripheral nerve injury. We performed microsurgical DREZotomy to the patients with deafferentation pain and relieved pain without any serious complication. The purpose of this study is to evaluate the usefulness of the microsurgical DREZotomy for deafferentation pain. Methods : We evaluated 4 patients with deafferntation pain who were intractable to medical therapy. Two of them were brachial plexus injury with root avulsion owing to trauma, one was axillary metastasis of the squamous cell carcinoma of the left forearm, and the last was anesthesia dolorosa after surgical treatment(MVD and rhizotomy) of trigeminal neuralgia. Preoperative evaluation was based on the neurologic examination, radiologic imaging, and electrophysiological study. In the case of anesthesia dolorosa, we produced two parallel lesions in cephalocaudal direction, 2mm in distance, from the C2 dorsal rootlet to the 5mm superior to the obex including nucleus caudalis, after suboccipital craniectomy and C1-2 laminectomy, with use of microelectrode. In the others, we confirmed lesion site with identification of the nerve root after hemilaminectomy. We performed arachnoid dissection along the posterolateral sulcus and made lesion with microsurgical knife and microelectrocoagulation, 2mm in depth, 2mm in distance, to the direction of 30-45 degrees in the medial portion of the Lissauer's tract and the most dorsal layers of the posterior horn at the one root level above and below the lesion. Results : Compared with preoperative state, microsurgical DREZotomy significantly diminished dosage of the drugs and relieved pain meaningfully. One patient showed tansient ipsilateral ataxia, but recovered soon. There was not any serious complication. Conclusion : It may be concluded that microsurgical DREZotomy is very useful and safe therapeutic modality for deafferentation pain, especially segmentally distributed intermittent or evoke pain. Complete preoperative evaluation and proper selection of the patients and lesion making device are needed to improve the result.