• 대한의용생체공학회:의공학회지
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• 제43권4호
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• pp.193-198
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• 2022

Contrast enhanced magnetic resonance imaging using gadolinium-based contrast agent (GBCA) is a very useful in vivo technique to visualize the inner ear pathology including endolymphatic hydrops. Although systemic intravenous (IV) administration can visualize the perilymph space, the visualization was possible by indirect passage of contrast agent through blood-perilymph barrier. All animal experimental procedures were performed under anesthesia with 5% isoflurane. Lipopolysaccharide (LPS) was instilled into the left tympanic cavity through the tympanic membrane using a sterile 27gauge needle to induce hydrops model. Tucker-Davis Technologies system was used to measure Auditory Brainstem Responses (ABRs). For intracerebroven-tricular (ICV) administration, 25 µmol of GADOVIST (Bayer, Berlin, Germany) was used and diluted GADOVIST injection was 10 µl. MR imaging was acquired with a 9.4 Tesla MRI scanner. Transmit-receive volume coil with 40 mm inner diameter and 75 mm out diameter was used. ICV administration well demonstrated the strong enhancement along the cerebrospinal fluid (CSF) microcirculation pathway including CSF fluid in the subarachnoid space and CSF space of the inner ear structures. On the other hand, IV administration showed no contrast enhancement along the CSF microcirculation pathway and showed weak enhancement in the inner ear structures. In case of rat hydrops model, ICV administration showed that the reduced contrast enhancement in the perilymph space of the hydrops induced inner ear compared to the contrast enhancement in the perilymph space of the normal inner ear. New systemic ICV administration method provide contrast enhancement of GBCA in the inner ear through CSF microcirculation pathway.

• The Korean Journal of Pain
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• 제10권1호
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• pp.104-108
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• 1997

Spontaneous intracranial hypotension, a syndrome of low CSF pressure, occurs without preceding events such as lumbar puncture, back trauma, operative procedure or medical illness. The most characteristic symptom is an occipital or frontal headache which is aggrevated in the erect position and relieved in the supine position. This syndrome usually resolves spontaneously or with strict bed rest. When the headach persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of spontaneous intracranial hypotension. Epidural blood produces an organized clot which effectively tamponade any dural CSF leak. The rapid relief of headache immediately after the infusion of blood occur by some other mechanism, such as an increase in subarachnoid pressure that is known to occur with infusion of fluid into the lumbar epidural space. We report three cases of spontaneous intracranial hypotension successfully treated with epidural blood patch.

• The Korean Journal of Pain
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• 제14권2호
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• pp.276-279
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• 2001

Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.185-187
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• 2009

Although most of sacral perineural cysts are asymptomatic, some may produce symptoms. Specific radicular pain may be due to distortion, compression, or stretching of nerve root by a space occupying cyst. We report a rare case of S1 radiculopathy caused by sacral perineural cyst accompanying disc herniation. The patient underwent a microscopic discectomy at L5-S1 level. However, the patient's symptoms did not improved. The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.564-566
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• 2012

Non-Hodgkin's lymphoma rarely originates from bone, and even more infrequently from a vertebral body. Lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma, and results from an abnormality in adaptive immune cells. A 27-year-old man presented with a two-month history of night sweats, weight loss, and severe back pain. Radiological studies demonstrated an osteolytic lesion compressing the subarachnoid space at the T11 level. Posterolateral fusion with decompression was performed and a pathologic examination confirmed lymphoblastic lymphoma of the B-cell precursor type. To our knowledge, this is the first report of solitary lymphoblastic lymphoma from B-cell precursors in of the thoracic spine. Herein, we discuss the presenting symptoms and the management of this rare case of lymphoblastic lymphoma.

• Journal of Korean Neurosurgical Society
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• 제47권1호
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• pp.68-70
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• 2010

We report a case of intracranial dissemination developing approximately 4 months after partial removal of a spinal cord anplastic astrocytoma in a 22-year-old male. He presented with paraplegia on initial admission at a local hospital. Spinal magnetic resonance (MR) images disclosed multiple intramedullary lesions at the T3-11. The tumor was partially removed. The final histologic diagnosis was anaplastic astrocytoma. Four months after the operation, he was admitted with the symptoms of headache and deterioration of consciousness. MR images showed enhanced lesions in the anterior horn of the left lateral ventricle, and septum pellucidum. He underwent computed tomography-guided stereotactic biopsy and histological appearance was consistent with anaplastic astrocytoma. The clinical course indicates that the tumor originated in the spinal cord and extended into the subarachnoid space, first the spinal canal and later intracranial.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.356-360
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• 2001

Malignant peripheral nerve sheath tumor(MPNST, primary malignant schwannoma) within the spinal canal is very rare. The prognosis of MPNST in the spinal canal is very poor due to the tendency of perineural spread, dissemination throughout subarachnoid space and local recurrance. This report details the authors' experience on the case of primary malignant spinal schwannoma with review of the literatures and other studies.

• Clinical Endoscopy
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• 제55권1호
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• pp.146-149
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• 2022

Lumboperitoneal or ventriculoperitoneal shunt insertion is a standard therapy for hydrocephalus that diverts cerebrospinal fluid from the subarachnoid space into the peritoneal cavity. Gastrointestinal perforations due to this procedure occur rarely; however, accepted treatment strategies have not yet been established. Hence, the most common treatment approaches are open surgery or spontaneous closure without endoscopy. We report the case of a small intestinal perforation in a 73-year-old-woman that occurred after the insertion of a lumboperitoneal shunt. A positive cerebrospinal fluid culture and high cerebrospinal fluid white blood cell count indicated a retrograde bacterial infection, and computed tomography revealed that the peritoneal tip of the shunt catheter was located in the lumen of the gastrointestinal tract. We repaired the perforation endoscopically using an over-the-scope clip, and the patient's recovery was uneventful. Use of an over-the-scope clip could be an effective and minimally invasive treatment for intestinal perforations caused by lumboperitoneal or ventriculoperitoneal shunt insertion.

• Korean Journal of Radiology
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• 제1권1호
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• pp.11-18
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• 2000

Objective: To evaluate the hydrodynamic changes occurring in cerebrospinal fluid (CSF) flow in cervical spinal stenosis using the spatial modulation of magnetization (SPAMM) technique. Materials and Methods: Using the SPAMM technique, 44 patients with cervical spinal stenosis and ten healthy volunteers were investigated. The degree of cervical spinal stenosis was rated as low-, intermediate-, or high-grade. Low-grade stenosis was defined as involving no effacement of the subarachnoid space, intermediate-grade as involving effacement of this space, and high-grade as involving effacement of this space, together with compressive myelopathy. The patterns of SPAMM stripes and CSF velocity were evaluated and compared between each type of spinal stenosis and normal spine. Results: Low-grade stenosis (n = 23) revealed displacement or discontinuity of stripes, while intermediate- (n = 10) and high-grade (n = 11) showed a continuous straight band at the stenotic segment. Among low-grade cases, 12 showed wave separation during the systolic phase. Peak systolic CSF velocity at C4-5 level in these cases was lower than in volunteers (p < .05), but jet-like CSF propulsion was maintained. Among intermediate-grade cases, peak systolic velocity at C1-2 level was lower than in the volunteer group, but the difference was not significant (p > .05). In high-grade stenosis, both diastolic and systolic velocities were significantly lower (p < .05). Conclusion: Various hydrodynamic changes occurring in CSF flow in cervical spinal stenosis were demonstrated by the SPAMM technique, and this may be a useful method for evaluating CSF hydrodynamic change in cervical spinal stenosis.

• 대한의생명과학회지
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• 제11권4호
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• pp.435-439
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• 2005

To determine the appropriate concentration of papaverine hydrochloride(PPV) for therapeutic intraarterial infusion against cerebral vasospasm and to measure the mean blood flow velocity of the middle cerebral artery in rabbits. Vasospasm was induced in the experimental groups (3 days after infusion; group 1, n=3, 7 days after infusion; group 2, n=3) and a control group (n=l) by placing a blood clot in the subarachnoid space around the top of the internal carotid siphon. PPV (5 mg/kg) was infused into the internal carotid artery. The vascular diameters of the internal carotid artery (ICA) and middle cerebral artery (MCA) were measured on angiograms before and after infusion. The mean blood flow velocity in the MCA was measured on transcranial doppler sonograms before and 24 hours after infusion. After fixation, the MCA was dissected out, stained, and examined microscopically. After PPV infusion in both groups, vascular dilatation of about $20\%$ was seen. The mean increase in blood flow velocity in the group $1(30\%)$ was smaller than in the group $2(70\%)$. The mean blood flow velocity in the MCA decreased by about $30\%$ in both groups, but increased again after 24 hours nearly to the level before PPV infusion. PPV infusion may be more effective in early stages of vasospasm when vascular walls have fewer histologic changes.