• 한국임상수의학회지
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• 제40권1호
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• pp.56-61
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• 2023

A 5-month-old female domestic short-haired cat presented with a history of seizure episodes for two months following an animal bite injury to the head. There were no remarkable findings on physical and neurological examination or blood analysis. Computed tomography revealed a fracture of the left parietal bone with an inward displacement of the bone fragment while magnetic resonance imaging revealed an enlarged temporal horn of the left lateral ventricle and a pseudomeningocele compressing the adjacent cerebral parenchyma. Subsequently, cerebrospinal fluid analysis results were normal. The patient was diagnosed with traumatic brain injury (TBI), with subsequent post-traumatic hydrocephalus (PTH) and pseudomeningocele. Despite treatment with phenobarbital and levetiracetam, seizures were not sufficiently controlled. Craniectomy for bone fragment removal and duraplasty were performed after a week. The patient then returned to normal condition with no further seizure activity. On repeated MRI two months after discharge, the hydrocephalus of the lateral ventricle and pseudomeningocele were enlarged; however, the patient maintained a good clinical status without any neurological signs. To the best of our knowledge, PTH and intracranial pseudomeningoceles have not yet been reported in cats. PTH and pseudomeningocele are among the complications of TBI and may not have any significant relevance with the clinical signs in this case. Thus, to broaden our knowledge about PTH and pseudomeningocele in cats, we describe serial changes in the clinical findings of this cat over the treatment period.

• The Korean Journal of Pain
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• 제19권2호
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• pp.249-252
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• 2006

Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.

• Journal of Korean Neurosurgical Society
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• 제59권1호
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• pp.52-57
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• 2016

Objective : Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. Methods : We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. Results : Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). Conclusion : When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

• Journal of Korean Neurosurgical Society
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• 제54권6호
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• pp.525-527
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• 2013

Upward migration of the peritoneal catheter of a subgaleo-peritoneal (SP) shunt and coiling into the subgaleal space is an extremely rare complication of a SP shunt. A 32-year-old male patient visited our hospital presenting with a large skull defect due to a prior craniectomy performed elsewhere. The patient underwent a cranioplasty with methylmetacrylate, but subsequently developed progressive pseudomeningocele and subgaleal cerebrospinal fluid (CSF) collection. The patient underwent CSF diversion via a SP shunt. After SP shunting, the pseudomeningocele disappeared completely. Six months later, the patient presented with progressive scalp swelling. Skull X-ray showed migration and coiling of the distal catheter of the SP shunt. The patient was treated by removing the entire shunt catheter and the dura was covered with a subgaleal flap. We would like to report our experience with a very rare complication of subgaleo-peritoneal shunting.

• Journal of Korean Neurosurgical Society
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• 제54권5호
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• pp.444-447
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• 2013

In most intracranial surgery cases, a drain catheter is inserted to prevent the collection of the wound hematoma or seroma. A drain catheter is also inserted to drain the hematoma or the cerebrospinal fluid. The drain catheter itself does not cause complications; but many complications occur during its removal, such as hematoma, seroma, air collection and pseudomeningocele formation. To prevent these complications, neurosurgeons perform a suture on the catheter to remove the site. In this study, an additional horizontal mattress suture and an anchoring suture to the drainage catheter are proposed. This method maintains negative pressure in the catheter insertion site during the catheter removal, compresses the catheter tunnel site and attaches the external wounds strongly. The technique is easy and safe to perform, and does not require an additional suture to remove the catheter.

• Journal of Korean Neurosurgical Society
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• 제54권5호
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• pp.373-378
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• 2013

Objective : We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. Methods : From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. Results : Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. Conclusion : Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation.

• Investigative Magnetic Resonance Imaging
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• 제17권2호
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• pp.149-153
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• 2013

척추 수술의 합병증으로 뇌척수액 누출이 발생할 수 있는데 이를 영상학적으로 진단하는 것은 어려움이 있다. 이 연구에서는 자기공명척수조영술을 이용하여 척추 수술 후 뇌척수액 누출을 확인하였던 두 환자의 증례를 보고하고자 한다. 두 환자는 각기 요추 추간판 절제술과 척추 수막종 제거술을 받은 뒤 심한 두통을 호소하였다. 두 환자의 자기공명척수조영영상에서 척추 뇌수막액 누출 부위가 확인되었고, 이에 대해 환자들은 각각 epidural blood patch와 재수술을 받았다. 이 두 사례에서 자기공명척수조영술은 척추 뇌수막액의 누출 부위를 정확히 보여주었고, 척수강과 가성수막류 (pseudomeningocele) 사이의 교통로를 잘 나타내주었다. 척수 수술 후 뇌수막액 누출을 확인하기 위한 검사로 자기공명척수조영술이 유용한 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1120-1126
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• 2001

Objective : The development of magnetic resonance neurography(MRN) has made it possible to produce highresolution images of peripheral nerves themselves, as well as associated intraneural and extraneural lesions. We evaluated the clinical application and utility of high-resolution MRN techniques for the diagnosis and treatment of a variety of peripheral nerve disorder(PND)s. Material and Method : MRN images were obtained using T1-weighted spin echo, T2-weighted fast spin echo with fat suppression, and short tau inversion recovery(STIR) fast spin-echo pulse sequences. Fifteen patients were studied, three with brachial plexus tumors, five with chronic entrapment syndromes, and seven with traumatic peripheral lesions. Ten patients underwent surgery. Results : In MRN with STIR sequences of axial and coronal imagings, signals of the peripheral nerves with various lesions were detected as fairly bright signals and were discerned from signals of the uninvolved nerves. Increased signal with proximal swelling and distal flattening of the median nerve were seen in all patients of carpal tunnel syndrome. Among the eight patients with brachial plexus injury or tumors, T2-weighted MRN showed increased signal intensity in involved roots in five, enhanced mass lesions in three, and traumatic pseudomeningocele in three. Other associated MRI findings were adjacent bony signal change, neuroma, root adhesion and denervated muscle atophy with signal change. Conclusion : MRN with high-resolution imaging can be useful in the preoperative evaluation and surgical planning in patients with peripheral nerve lesions.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.33-40
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• 2001

Objective : Aneurysms of vertebral artery and its branches make up approximately 3% of all intracranial aneurysms. As the aneurysm have an intimate relationship with lower cranial nerves and medulla, surgical management of the aneurysms are one of the challenging neurosurgical problems. The authors analyzed the management outcomes for aneurysms arising from vertebral artery and its branches. Methods : At the authors' institution between May 1989 and Jan. 2000, 42 patients were treated with transcranial and endovascular surgery for aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Forty two patients were comprised of 28 female and 14 male patients aged from 26-80 year old(mean : 51.8). Of the 42 patients, 37 patients(88%) had subarachnoid hemorrhage. Of the 37 patients with subarachnoid hemorrahge, 35 patients(95%) were in good neurological status(Hunt Hess grade I-III), 2 patients(5%) in poor grade(H-H grade IV-V) before operation. Location of the aneurysm were 16 in vertebral artery, 12 in vertebro-PICA junction, and 14 in the peripheral PICA. Twenty nine patients were treated with transcranial surgery and 13 patients with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I and II ; 24, GOS III ; 2, GOS IV ; 1 and GOS V(death) ; 2. The causes of mortality related to transcranial surgery were rebleeding after failure in clipping in one and suspected brainstem infarct in one. Morbidity was attributed to vasospasm(3), lower CN palsy(7, including temporary dysfunction) and pseudomeningocele(1). The management outcome of the endovascular surgery was : Glasgow outcome scale(GOS) I-II ; 9, GOS III ; 1, GOS IV ; 1, and GOS V(death) ; 2. The causes of mortality related to endovascular surgery were sepsis from pneumonia(1) and vasospasm(1). There were one cerebellar infarct and one lateral medullary syndrome. Conclusion : Excellent and good surgical results can be expected in 80% of the patients with aneurysms of vertebral arery and its branches. The outcomes of endovascular surgery in treating vertebral artery aneurysm were satisfactory and endovascular surgery may offer a therapeutic alternative especially in vertebral dissecting aneurysm.

• 대한영상의학회지
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• 제85권1호
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• pp.36-53
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• 2024

척추 수술의 빈도 증가와 더불어 radiography, CT, MRI 등의 의료 영상 촬영 건수도 증가하고 있으며, 이와 관련된 영상 판독의 중요성이 점점 더 커지고 있다. 본 논문에서는 척추 수술 후 발생 가능한 다양한 합병증을 이해하고, 이를 정확하고 효과적으로 진단하는 영상 검사의 중요 소견에 대해 다루고자 한다. 특히, 수술 후 초기 및 중장기 합병증을 구분하여, 각 시기별 특징적인 영상 소견을 자세히 설명한다. 척추 수술 후 초기 합병증으로는 부적절한 수술 기구 배치(instrument malposition), 장액종(seroma), 혈종(hematoma), 거짓수막류(pseudomeningocele), 수술 주변 감염(infection) 등이 있으며, 중장기 합병증으로는 수술 기구 주변의 골용해(osteolysis), 융합 실패(failure of fusion), 인접 분절 질환(adjacent segment disease), 경막외 섬유화 또는 흉터 조직(epidural fibrosis or scar) 형성 등이 포함된다. 이러한 척수 수술 후 발생하는 합병증 관련 영상 평가에 대한 정확한 이해는 척추 수술 후 합병증을 적시에 정확하게 진단하여 효과적인 환자 치료에 기여할 것이다.