• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.131-135
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• 2008

Objective : Hemifacial spasm (HFS) is considered as a reversible pathophysiological condition mainly induced by continuous vascular compression of the facial nerve root exit zone (REZ) at the cerebellopontine angle. As an offending vessel, vertebrobasilar artery tends to compress much more heavily than others. The authors analyzed HFS caused by vertebrobasilar artery and described the relationships between microsurgical findings and clinical courses. Methods : Out of 1,798 cases treated with microvascular decompression (MVD) from Jan. 1980 to Dec. 2004. the causative vessels were either vertebral artery or basilar artery in 87 patients. Seventy-nine patients were enrolled in this study. Preoperatively, computed tomography (CT) or brain magnetic resonance (MR) imaging with 3-dimentional short range MR technique was performed and CT was checked immediately or 2-3 days after anesthetic recovery. The authors retrospectively analyzed the clinical features. the compression patterns of the vessels at the time of surgery and treatment outcomes. Results : There were 47 were male and 32 female patients. HFS developed on the left side in 52 cases and on the right side in 27. The mean age of onset was 52.3 years (range 19-60) and the mean duration of symptoms was 10.7 years. Many patients (39 cases; 49.1%) had past history of hypertension. HFS caused only by the vertebral artery was 8 cases although most of the other cases were caused by vertebral artery (VA) in combination with its branching arteries. Most frequently, the VA and the posterior inferior cerebellar artery (PICA) were the simultaneous causative blood vessels comprising 32 cases (40.5%). and in 27 cases (34.2 %) the VA and the anterior inferior cerebellar artery (AICA) were the offenders. Facial symptoms disappeared in 61 cases (77.2%) immediately after the operation and 68 cases (86.1%) showed good outcome after 6 months. Surgical outcome just after the operation was poor in whom the perforators arose from the offending vessels concurrently (p<0.05). Conclusion : In case where the vertebral artery is a cause of HFS, commonly branching arteries associated with main arterial compression on facial REZ requires more definite treatment for proper decompression because of its relatively poor results compared to the condition caused by other vascular compressive origins.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.477-479
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• 2010

A case of delayed progressive extradural pneumatocele after microvascular decompression (MVD) is presented. A 60-year-old male underwent MVD for hemifacial spasm; the mastoid air cell was opened and sealed with bone wax during surgery. One month after surgery, the patient complained of tinnitus, and progressive extradural pneumatoceles without cerebrospinal fluid (CSF) leakage was observed. Revision surgery was performed and the opened mastoid air cell was completely sealed with muscle patch and glue. The patient's symptoms were resolved, with no recurrence of pneumatoceles at 6 month follow up. Progressive extradural pneumatocele without CSF leakage after posterior fossa surgery is a very rare complication. Previous reports and surgical management of this rare complication are discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권4호
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• pp.237-240
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• 2023

Dolichoectasia of the intracranial arteries is a rare condition characterized by elongated and tortuous arteries due to progressive destruction of the vessel walls. Although most patients present with cerebrovascular accidents, our patient presented with intractable facial pain along the distribution of the trigeminal nerve. Clinical examination revealed involvement of the 5th, 7th, and 8th cranial nerves, and subsequent MRI showed dolichoectasia of the left basilar artery. The patient experienced symptomatic relief after a trial of carbamazepine along with botulinum toxin injections.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.112-117
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• 2013

Objective : We performed this study to investigate whether the use of closed-suction drainage following microvascular decompression (MVD) causes cerebrospinal fluid (CSF) leakage. Methods : Between 2004 and 2011, a total of 157 patients with neurovascular compression were treated with MVD. MVD was performed for hemifacial spasm in 150 (95.5%) cases and for trigeminal neuralgia in 7 (4.5%) cases. The mean age of the patients was $49.8{\pm}9.6$ years (range, 20-69). Dural substitutes were used in 44 (28.0%) patients. Ninety-two patients (58.6%) were underwent a 4-5 cm craniotomy using drainage (drainage group), and 65 (41.4%) did a small 2-2.5 cm retromastoid craniectomy without closed-suction drainage (no-drainage group). Results : Eleven (7.0%) patients experienced CSF leakage following MVD based on the criteria of this study; all of these patients were in the drainage group. In the unadjusted analyses, the incidence of CSF leakage was significantly related with the use of closed-suction drainage following MVD (12.0% in the drainage group vs. 0% in the no-drainage group, respectively; p=0.003; Fisher's exact test). Those who received dural substitutes and the elderly (cut-off value=60 years) exhibited a tendency to develop CSF leakage (p=0.075 and p=0.090, respectively; Fisher's exact test). In the multivariate analysis, only the use of closed-suction drainage was significantly and independently associated with the development of CSF leakage following MVD (odds ratio=9.900; 95% confidence interval, 1.418 to infinity; p=0.017). Conclusion : The use of closed-suction drainage following MVD appears to be related to the development of CSF leakage.

• 동의신경정신과학회지
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• 제23권4호
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• pp.183-198
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• 2012

Objectives : This case series aims to report the efficacy of using oriental medical treatment with Melonis Calyx Vomiting Therapy for Hwa-Byung. Methods : Patients were diagnosed with Hwa-Byung through Hwa-Byung Diagnostic interview schedule (HBDIS). They were treated with Oriental medical treatment (Acupncture, Herb-medication) and Melonis Calyx Vomiting Therapy (MCVT). MCVT is a traditional treatment, which induces vomiting by eating Melonis Calyx powder with water. We used VAS score and Scott scale for the symptoms of patients and IOMEHB (instrument of oriental medical evaluation for Hwa-Byung), BDI, STAI for the psychological conditions of the patients. Results : After treatment, the chief complaint and other symptoms of Hwa-Byung have improved. The scores of IOMEHB, BDI, and STAI have decreased. Conclusions : This result suggests that using MCVT with Oriental medical treatment have a positive efficacy for Hwa-Byung.

• Journal of Korean Neurosurgical Society
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• 제52권5호
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• pp.480-483
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• 2012

The authors present a case of isolated dural arteriovenous fistula (DAVF) in the transverse sinus, which developed six years after microvascular decompression caused by hemifacial spasm via suboccipital craniectomy. The lesion was successfully treated by transarterial embolization using Onyx. We reviewed the related radiologic and therapeutic features of DAVF involving an isolated sinus and described the feasibility of the use of Onyx.

• 대한소아치과학회지
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• 제27권3호
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• pp.400-409
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• 2000

흰쥐의 안면신경핵을 구성하는 신경세포들의 시냅스 연결 양태 및 세포막 특성을 규명하기 위해 in vivo 필드전위 및 세포 내 전위 측정법을 이용하여 전기생리적 반응을 관찰하였다. 말초 안면신경 분지를 역행성으로 전기자극시 자극세기에 비례하여 전위의 크기가 증가되었고 필드 전위의 양태는 두 가지 반응으로 나타났는데 전기자극 직후 1ms 부근에서 정점을 나타내는 양태와 이와 더불어 $7\sim8ms$ 부근에서 후기 정점을 동반하는 양태가 있었다. 안면신경핵은 염색시 내측, 배외측, 중간측 및 외측등 4부분의 소핵으로 구분되었다. Neurobiotin으로 채워진 단일 신경세포를 형태학적으로 재구축하였는데 세포체는 추체형태를 나타내었고 주 수상돌기는 모든 방향으로 뻗어져 있었고 각 수상돌기의 영역은 해당 소핵 내에 한정되어 있었다. 일련의 과분극 전류 $(-1.2\sim+1.2nA)$를 세포내에 가하였을 때 동반되는 세포내 전위변화를 입력저항 값으로 계산하였을 때 그 기울기가 직선형으로 나타났다. 탈분극 전류를 세포내 주입시 지속적인 활동성 전위가 나타났으며 전류의 크기에 비례하여 각 전위의 개수가 증가하였고 spike-빈도 적응 현상이 나타났다. 그러나 시간 의존성 내향성 정류현상은 관찰되지 않았고 anodal break excitation이 나타났다. 이상의 실험결과로 보아 안면신경핵을 구성하고 있는 세포들 사이의 시냅스는 다양한 형태로 존재할 가능성이 있다고 사료되며 이들 시냅스간의 변화를 통하여 안면 신경마비, 반쪽 안면 경련, hypoglossal-facial anastomosis등에서 나타날 수 있는 임상적 신경성 증상 기전을 설명할 수 있을 것으로 여겨진다.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.149-151
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• 2014

The cerebello-pontine angle lipomas causing trigeminal neuralgia or hemifacial spasm are rare. A lipoma causing glossopharyngel neuralgia is also very rare. A 46-year-old woman complained of 2-year history of severe right throat pain, with ipsilateral episodic otalgic pain. The throat pain was described as an episodic lancinating character confined to the throat. Computed tomography and magnetic resonance imaging revealed a suspicious offending posterior inferior cerebellar artery (PICA) compressing lower cranial nerves including glossopharyngeal nerve. At surgery, a soft, yellowish mass ($2{\times}3{\times}3mm$ in size) was found incorporating the lateral aspect of proximal portion of 9th and 10th cranial nerves. Only microvascular decompression of the offending PICA was performed. Additional procedure was not performed. Her severe lancinating pain remained unchanged, immediate postoperatively. The neuralgic pain disappeared over a period of several weeks. In this particular patient with a fatty neurovascular lump causing glossopharyngeal neuralgia, microvascular decompression of offending vessel alone was enough to control the neuralgic pain.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1209-1214
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• 2000

Objectives : The measurement of resistance to cerebrospinal fluid outflow($R_o$) can clearly delineate cerebrospinal fluid dynamics in patients with ventricular dilatation and can help in selecting patients to undergo shunt placement. With regards to type of infusion method, bolus injection is known to be more practical and safer than continuous infusion. The purpose of this study was to obtain $R_o$ of normal adults using lumbar bolus injection method. Material and Methods : Twenty adults aged 25 to 52 years were studied using lumbar bolus injection method. Fifteen patients with hemifacial spasm and five with cerebral concussion underwent $R_o$ measurement under propofol general anesthesia and local anesthesia, respectively. Results : The mean values of $R_o$ determined 1 minute and 2 minutes after bolus injection were $4.8{\pm}1.7$ and $4.4{\pm}1.6mmHg/ml/min$, respectively. There was no significant difference of $R_o$ between propofol general anesthesia group and local anesthesia group. Two patients showed $R_o$ greater than 6mmHg/ml/min. One patient revealed unexpectedly high level of $R_o$ due to severe spinal stenosis. Conclusion : Mean Ro in this study was higher than that of Shapiro's study. Borderline Ro near 6mmHg/ml/min should be regarded with caution and compared with clinical symptoms and results of other studies. Patients with severe spinal stenosis should be evaluated with caution.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권2호
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• pp.90-95
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• 2013

Botulinum toxin, a neurotoxin, is known to be an inhibitor of cholinergic neuromuscular transmission. Recently, it was reported that the administration of botulinum toxin is effective for the treatment of focal neurological motor disorders such as cervical dystonia, blepharospasm, hemifacial spasm, spasmodic dysphonia, and writer's cramp. Several case studies reported that the botulinum toxin was administered for the treatment of motor tic or vocal tic. It was found that this toxin reduces the frequency and severity of the tic as well as the premonitory urge and symptoms. In our case study, a noticeable decrease of motor tic symptom was observed after an intramuscular injection of 300mg of botulinum toxin in an 18-year-old patient with Tourette's disorder who showed only a little improvement of motor tic and vocal tic symptoms after treatment with antipsychotic drugs for several years. This case is reported in our study and literature survey was undertaken for reviewing similar cases. In our study, an 18-year-old boy diagnosed with Tourette's disorder based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition presented with the following scores : the Clinical Global Impression scale, Yale Global Tic Severity Scale (motor/vocal/severity), Premonitory Urge Score, Korean Attention-Deficit Hyperactivity Disorder Rating scale, and Kovac Depression scale which were performed prior to the treatment were 5, 21/5/50, 100, 17, and 18 points, respectively. Two weeks after the injection of botulinum toxin, the scores were 4, 17/5/40, 50, 16, and 19 points, respectively. Eight weeks after the injection of botulinum toxin, they had become 3, 15/5/30, 25, 16, and 20 points, respectively, which clearly indicates a noticeable decrease of motor tic symptom.