• Journal of Korean Neurosurgical Society
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• v.57 no.3
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• pp.167-173
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• 2015

Objective : Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH). Methods : Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality. Results : Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups. Conclusion : LD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up.

• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.475-477
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• 2007

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.409-412
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• 2009

There are several mechanisms for the dissemination of lipid material from a mature teratoma into the subarachnoid space or ventricles, including iatrogenic or traumatic rupture, but spontaneous rupture of a mature teratoma is rare We report the spontaneous rupture of a spinal mature teratoma into the subarachnoid space and ventricles. However, at surgery, there was no definite evidence of rupture into the perimedullary cerebrospinal fluid. We postulate that the central canal could be a migration pathway for ruptured material into the brain.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.283-287
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• 1996

Recently, continuous epidural catheter insertion is usually employed in operation and chronic pain control. Delayed migration of an extradural catheter into subdural space or subarachnoid space is a rare but life threatening complication of continuous epidural catheter insertion, especially with out patients. The symptoms may include lower extremity weakness, hypotension, drowsy and respiratory depression. We experienced two cases of lower extremity paralysis due to delayed migration into subdural or subarachnoid spaces at our pain clinic. The tecnical procedures for continuous epidural catheterization went smoothly without any complications. However, clinical signs of lower extremity paralysis and sensory loss developed gradually, about 2 hours and 30 minutes after the continuous epidural injection. Two cases were confirmed by subdurogram and myelogram.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.251-255
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• 1996

Headache after epidural block is the most frequent result of an unintentional dural puncture. This form of headache is usually caused by cerebrospinal fluid leakage through the dural puncture site. Another proposed cause of postdural puncture headache is the unintentional injection of air into the subarachnoid space. We experienced a case of severe headache with a patient after lumbar epidural block and discovered air in the intracranial subarachnoid space(pneumocephalus) with the aid of brain computerized tomography.

• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.534-537
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• 2010

Spinal extradural meningeal cyst has been rarely reported, whose etiologies are assumed to be the communication of cerebrospinal fluid (CSF) between intradural subarchnoid space and cyst due to the congenital defect in dura mater. Although the CSF communication due to this defect can be found, in most case, few cases in which there is a lack of the communication have also been reported. We report a case of the huge extradural meningeal cyst occurring in the thoracolumbar spine (from T10 to L2) where there was a lack of the communication between the intradural subarachnoid space and cyst in a 46-year-old man who presented with symptoms that were indicative of progressive paraparesis and leg pain. The patient underwent laminectomy and cyst excision. On intraoperative findings, the dura was intact and there was a lack of the communication with intradural subarachnoid space. Immediately after the surgery, weakness and leg pain disappeared shortly.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.609-614
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• 2000

Objective : A retrograde clinical study was undertaken to determine the effect of opening lamina terminalis on the development of hydrocephalus after aneurysmal subarachnoid hemorrhage(SAH). We compared the incidence ratios of the development of hydrocephalus with and without opening lamina terminalis during operation after aneurysmal SAH. Patients and Methods : From Oct. 1996 to Sep. 1998, we performed 138 aneurysm surgery for 122 patients. In 98 cases, the lamina terminalis was opened to make direct cerebrospinal fluid flow from the third ventricle to subarachnoid space for prevention of delayed hydrocephalus. We compared the incidence of hydrocephalus after opening lamina terminalis to those without opened lamina terminalis. Results : In 95 cases, the hydrocephalus was noticed in 2 cases(2.2%). It is significantly lower in the group with opening lamina terminalis than the group without opening lamina terminalis(about 10%). Conclusion : It is simple and easy procedure to open the lamina terminalis during aneurysm surgery. With this maneuver, we could reduce the incidence of hydrocephalus after aneurysmal spontaneous SAH. Thus, it is considered that the opening lamina terminalis is one of the effective methods for preventing the development of hydrocephalus after aneurysmal spontaneous SAH.

• Journal of Korean Neurosurgical Society
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• v.67 no.5
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• pp.586-592
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• 2024

Lateral spinal artery (LSA) aneurysms are extremely rare lesions that can rupture and cause subarachnoid hemorrhage (SAH) even though the spinal arteries communicate directly with the subarachnoid space. To date, six cases of LSA aneurysms have been reported in the literature. Herein, three such cases are reported. All patients presented to the emergency department with headaches. The patients in the first two cases were confirmed to have SAH and LSA aneurysms on a brain computed tomography (CT) angiography performed at the hospital. Two patients had prior instances of cerebral infarction and coronary disease, respectively, and were undergoing antiplatelet therapy. The antiplatelet medication was stopped for 2 weeks and 1 week, respectively, while conservative care was provided. Subsequently, a suboccipital craniectomy was performed, followed by aneurysm clipping. Following the surgery, both patients were discharged without any significant neurological deficits. Regarding the third patient, no aneurysm was found on brain CT angiography, and cerebral angiography was performed during the patient's hospital stay. She was hospitalized, where she received medication and conservative care, and was discharged with an improvement in bleeding without neurological symptoms. Subsequently, a LSA aneurysm was identified on a brain CT angiography performed at an outpatient clinic; however, the patient was transferred because she wanted to be treated at another hospital. LSA aneurysms are difficult to visualize using CT angiography; therefore, careful angiographic studies are required. Surgical clipping is the treatment of choice if the aneurysm is inaccessible by the endovascular treatment.

• Journal of Korean Neurosurgical Society
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• v.58 no.1
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• pp.30-35
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• 2015

Objective : The clinical and pathological characteristics of 10 cases of cerebral amyloid angiopathy (CAA)-related cerebral lobar hemorrhage (CLH) that was diagnosed at autopsy were investigated to facilitate the diagnosis of this condition. Methods : The clinical characteristics of 10 cases of CAA-related CLH were retrospectively reviewed, and a neuropathological examination was performed on autopsy samples. Results : The 10 cases included two with a single lobar hemorrhage and eight with multifocal lobar hemorrhages. In all of the cases, the hemorrhage bled into the subarachnoid space. Pathological examinations of the 10 cases revealed microaneurysms in two, double barrel-like changes in four, multifocal arteriolar clusters in five, obliterative onion skin-like intimal changes in four, fibrinoid necrosis of the vessels in seven, neurofibrillary tangles in eight, and senile plaques in five cases. Conclusion : CAA-related CLHs were located primarily in the parietal, temporal, and occipital lobes. These hemorrhages normally consisted of multiple repeated CLHs that frequently bled into the subarachnoid space. CAA-associated microvascular lesions may be the pathological factor underlying CLH.

• Journal of Korean Neurosurgical Society
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• v.52 no.1
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• pp.67-70
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• 2012

We report a rare case of a spinal intramedullary ependymal cyst in a 46-year-old female and review the 17 pathologically proven cases in the literature. The patient presented with a two-week history of gradually increasing tingling in her left posterior thigh and calf. A preoperative magnetic resonance image revealed a well-defined intramedullary cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion was hyper intense in T2-weighted images and hypointense in T1-weighted. The patient underwent a right-side hemilaminectomy at the T11 to T12 levels and fenestration of the cyst wall. After having the cyst wall partially removed and communication established between the cyst and the subarachnoid space, the patient improved neurologically. A histological study of the surgical specimens revealed that the cyst wall consisted of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall was positive for S-100 protein, glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin. We suggest that the optimal treatment of intramedullary ependymal cysts creates adequate communication between the cyst and the subarachnoid space.