Neuroendoscopic Fenestration of Quadrigeminal Cistern Arachnoid Cyst Presenting with Developmental Regression

Kim Sanghoon,김기홍 대한말초신경학회 2022 The Nerve Vol.8 No.2

Quadrigeminal cistern arachnoid cyst is rare and not usually located in the tectal plate region. Such a cyst may extend to the surrounding area and compress adjacent structures due to cystic expansion. Arachnoid cysts occasionally are associated with hydrocephalus and produce related symptoms. In our case, a 20-month-old boy presented with developmental regression and macrocephaly. Image study of the brain demonstrated a large cyst on the superior portion of the posterior fossa with extension to the supratentorial space and a compressed cerebellum inferiorly and brain stem anteriorly. Lateral and third ventricles were enlarged severely. We performed lateral ventriculo-cystostomy by neuroendoscope via a precoronal approach. Additional third ventriculostomy was performed on the floor of the third ventricle. At 9 months after surgery, the patient showed restored development, and postoperative image showed a reduction of arachnoid cysts and lateral and third ventricles.

Lumbar Calcifying Pseudoneoplasm as a Rare Cause of Cauda Equina Syndrome: A Case Report

De Bonis Costanzo,Chaurasia Bipin 대한말초신경학회 2023 The Nerve Vol.9 No.1

A calcifying pseudo-tumor of the spine, also called calcifying pseudoneoplasm of the neuraxis (CAPNON), is a rare non-neoplastic lesion that can occur anywhere in the central nervous system. Although CAPNON shows tumor-like behavior, it is believed to be benign and of inflammatory-reactive origin. It may cause many neurologic symptoms by compressing adjacent structures. We report the case of a 45-year-old man who presented with cauda equina syndrome. Magnetic resonance imaging revealed a partially calcified mass compressing the spinal cord. Gross total resection was carried out and the patient’s symptoms improved. Histopathology proved that the mass was CAPNON. Although spinal localization of CAPNON is rare, we should know and recognize this entity based on appropriate imaging findings because radical excision has an excellent prognosis.

Spontaneous Shrinkage of a Dumbbell-Shaped Schwannoma in the Cervical Spine: A Case Report

Lee Sang Yoon,Kim Kyung Hyun,Park Jeong Yoon,Chin Dong Kyu,Kim Keun Su,Cho Yong Eun,Jang Hyun Jun 대한말초신경학회 2023 The Nerve Vol.9 No.1

Cervical dumbbell-shaped schwannomas are uncommon and challenging; clinicians often face the choice between performing incomplete tumor resection and sacrificing nerve roots. Aggressive and total resection is the treatment of choice for this tumor, although surgical resection in asymptomatic patients remains a matter of debate. We present a case report of spontaneous shrinkage of a dumbbell-shaped schwannoma of the cervical spine. A 68-year-old female patient first presented in 2013 with a progressive history of pain in the lower back and both buttocks over the previous 10 years. A dumbbell-shaped cervical spine tumor that had a 30-mm maximum diameter with a foraminal obstruction was identified, along with multiple tiny intradural extramedullary tumors in the lumbar spine. The cervical tumor gradually decreased in size during annual follow-up visits through 2015. Magnetic resonance imaging conducted in November 2017 revealed that this dumbbell-shaped tumor had shrunk significantly, leaving only the paravertebral section with a maximal diameter of 14 mm. This case demonstrated a schwannoma that naturally decreased in size with no treatment. Clinicians should consider the possibility of a spontaneous reduction in schwannoma size when making treatment decisions in asymptomatic patients, in whom avoiding unnecessary surgery may prevent nerve root damage.

How Subsidence Affects Clinical and Radiological Outcomes after Stand-Alone Anterior Cervical Discectomy and Fusion on Patients with Degenerative Cervical Disease? A Long-Term Follow-Up Study

Yang In-Chul,한문수,Lee Gwang-Jun,Lee Seul-Kee,문봉주,Lee Jung-Kil 대한말초신경학회 2021 The Nerve Vol.7 No.2

Objective: We aimed to examine the long-term radiological and clinical outcomes after stand-alone anterior cervical discectomy and fusion (ACDF).Methods: In total, we enrolled 20 patients and 31 treated segments with degenerative cervical disease that underwent stand-alone ACDF with ≥60 months of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were evaluated. A visual analogue scale (VAS) and the neck disability index (NDI) were applied pre- and post-operatively and at the last follow-up.Results: Subsidence occurred in 9 (45%) patients and 15 segments (48.4%) at the last follow-up. The mean VAS and NDI scores had improved in both groups with and without subsidence. The mean SA at the last follow-up had significantly increased to 2.3°±8.5° in the subsidence group and to 1.7°± 5.2° degree in the non-subsidence group compared to the post-operative SA (p<0.001). The overall mean CSA at the last follow-up significantly increased overtime in both groups from the postoperative CSA (p=0.003). The fusion rate was 86.7% in the subsidence group and 81.3% in non-subsidence group. However, the difference in SA, CSA and fusion rates between the two groups were not statistically significant (p=0.119, 0.98, and 0.682, respectively).Conclusion: As a result of a long-term follow-up study after stand-alone ACDF, subsidence occurs to some extent. Still, it does not appear to significantly impact radiological and clinical outcomes if the clinician performs sufficient decompression of foramen during surgery. Subsidence seems to have a positive influence on the fusion rate.

Complication Profiles Associated with Sacral Alar Iliac Screw Fixation in Patients with Adult Spinal Deformity: A Comparative Analysis to the Conventional Iliac Screw Fixation

Park Ga-On,Choi Un-Yong,Kim Kyung Hyun,Park Jeong Yoon,Chin Dong Kyu,Kim Keun Su,Cho Yong Eun 대한말초신경학회 2021 The Nerve Vol.7 No.2

Objective: This study aimed to compare the radiographic and clinical outcomes between sacral alar iliac (SAI) screw fixation and conventional iliac (CI) screw fixation with a particular focus on the rate of reoperation, surgical site infection (SSI), sacroiliac joint pain, instrument failure, and screw prominence.Methods: Patients who underwent sacropelvic fixation in the authors’ institution from June 2011 to May 2017 were retrospectively investigated. Forty-three patients with SAI screw fixation and 25 with CI screw fixation were included. Preoperative patient and surgical characteristics and postoperative outcomes and complications were analyzed between the SAI and CI groups. Radiographic parameters were analyzed before and after surgery.Results: Lumbosacral fusion rates showed no statistically significant difference between the SAI group and CI groups (90.7% vs. 92.0%, p=0.878). The SAI group showed a significantly good result with regard to SSI compared to the CI group (0% vs. 16%, p=0.016), but had a significantly higher rate of distal screw fracture than the CI group (16.3% vs. 0%, p=0.042).Conclusion: The SAI screw fixation technique could achieve good outcomes of pain relief, deformity correction, and lumbosacral fusion rate with relatively lower complications such as the rates of reoperation, SSI, and screw prominence as compared to the CI screw fixation technique. However, distal instrument failure was observed more frequently in the SAI group, requiring further biomechanical studies.

Role of Supine and Standing Radiography in Vertebroplasty for Osteoporotic Compression Fractures”

Park Jae Hyun,Kim Sang Hyun,Hyun Noh Sung,Cho Pyung-Goo 대한말초신경학회 2021 The Nerve Vol.7 No.2

Objective: To confirm the benefits of vertebroplasty (VP) in selected patients with acute vertebral compression fracture (VCF) and analyze whether the study of a weight dynamic plain lateral radiograph would help in making decisions to perform VP. Using retrospective analysis, we aimed to determine the radiological characteristics of patients benefiting from VP.Methods: Data were collected from 54 patients (age, 56-97 years) diagnosed with osteoporosis and compression fractures between December 2013 and January 2018. Each patient was hospitalized with ≥2 weeks of absolute bed rest (ABR) and treated for osteoporosis. Plain lateral supine radiography of the fractured spine was performed prior to diagnosis, and both supine and standing spinal radiographs were taken 1 and 2 weeks after ABR. Patients were categorized into the VP and non-VP groups 2 weeks after ABR.Results: Although patients with worse pain and functional progress were selected to undergo VP, patients in the VP group presented better outcomes in the fourth week of evaluation than those in the non-VP group. In a retrospective analysis of the radiographic study, changes in the compression rate between supine and standing (weight-bearing) X-rays (ΔCR), showed a statistically significant correlation with the patient’s outcome in the second week.Conclusion: VP was found to be an effective management option for patients with VCF. A weightbearing radiographic study of VCFs provided valuable information on patient selection for VP. Therefore, patient selection based on subjective surveys and radiological studies to determine the benefits of VP could be a beneficial management strategy.

Differentiation between Spinal Intramedullary Astrocytoma and Spinal Multiple Sclerosis Using Clinical and Radiologic Factors

Jang Hyeongyu,Kang Moo Sung 대한말초신경학회 2021 The Nerve Vol.7 No.2

Objective: Both spinal multiple sclerosis (SMS) and spinal intramedullary astrocytoma (SIA) are rare space-occupying lesions in the spinal cord and clinically show various myelopathy symptoms. Both clinical and imaging findings are similar and are easily misdiagnosed. This study is to clarify clinical and radiographic finding that could be helpful to differentiate SMS from SIA.Methods: We compared the demographic, clinical, and radiographic characteristics between the SIA and SMS groups. The SIA group (n=13) was diagnosed postoperatively with pathologic confirmation, and the SMS group (n=25) was composed of patients who have a lesion in the spinal cord and met the McDonald criteria for the diagnosis of multiple sclerosis (criteria revised in 2010).Results: Clinically, patients with SIA had a significantly longer symptom duration before the first visit than SMS (4.9±4.4 vs. 2.1±3.6 months, p=0.008). All persons with SIA showed progressive disease course, whereas 95.8% of persons with SMS showed remission (p<0.001). In contrast to SMS, the involvement of both halves of the spinal cord was more frequently observed in patients with SIA (p<0.001). In addition, fusiform dilation in the sagittal plane (p<0.001) or tumoral cyst (p=0.001) also significantly suggested SIA rather than SMS.Conclusion: Despite many limitations of this study, the present data demonstrated the clinical and imaging features helpful in distinguishing SIA from SMS. As with most tumors, SIA tends to show a slowly progressive clinical course without remission. Occupation of both halves of the spinal cord, fusiform dilation, or cysts was favoring radiographic factor for the SIA.

Clinical and Radiologic Analysis of Disc Heights Change in Conservatively Treated Lumbar Herniated Disc Patients

Seo Dong-Min,조용재,Yang Na-Re 대한말초신경학회 2021 The Nerve Vol.7 No.2

Objective: The main purpose of this study was to evaluate the clinical and radiologic factors of disc height loss in spontaneous resolution of herniated lumbar disc patients.Methods: From January 2017 to December 2018, a total of 56 symptomatic herniated lumbar disc patients (36 men and 20 women) were investigated retrospectively in this study. Clinical findings including age, sex, pain, and smoking history were examined in each group (group A, patients with not-changed disc heights; group B, patients with decreased disc heights). Radiologically, the level, severity, laterality, modic change, and disc degeneration of lumbar disc herniation were investigated between groups. We compared demographic and radiologic findings between groups.Results: A total of 56 patients were enrolled (group A, 30 patients; group B, 26 patients). There were no significant statistical differences in age, sex, visual analog scale (VAS) scores, level of disc herniation, and laterality of disc herniation between groups. Group A had more protrusion cases (14/30 cases) and group B had more Sequestration (11/26 cases). About Modic change and disc degeneration classification, group B had more modic change cases and more disc degeneration cases than group B.Conclusion: In this study, there were no significant differences in demographic findings, level of disc herniation, the status of disc herniation, laterality of disc herniation, VAS of back pain between group A and group B.

Different Pathology of Peripheral Nerve Sheath Tumor in Neurofibromatosis Type 1: 3 Cases

Park Gi Jeong,Kim Sanghoon,Kim Ki Hong,Kim Dae Hyun 대한말초신경학회 2021 The Nerve Vol.7 No.2

Neurofibromatosis type 1 (NF1) is an autosomal-dominant genetic disease that predisposes affected individuals to tumors. Neurofibroma and malignant peripheral nerve sheath tumor (MPNST) are examples of PNSTs that occur either sporadically or as part of hereditary neurocutaneous diseases such as NF1. We treated three patients with NF1 who presented with different PNSTs. All patients underwent surgical resection, and pathologic findings indicated neurofibroma, atypical neurofibroma, and MPNST, respectively. We managed each case based on its pathology. The patient with MPNST died after chemoradiotherapy; the other patients did not experience recurrence for several months.

Computed Tomography/Diffusion Weighted Magnetic Resonance Imaging Fogging Effect in the Subacute Stage of Ischemic Cerebral Infarct: A Report of Three Cases

Park Geo-seong,Jang Hyoung-gyu,Park Jung-Soo,Lee Jong-Myong,Koh Eun-jeong,Choi Ha-Young 대한말초신경학회 2021 The Nerve Vol.7 No.2

Acute cerebral infarctions usually demonstrate hypodensity on non-contrast computed tomography (CT). However, in some cases, cerebral infarctions may appear to be isodense on imaging conducted during the subacute stage (2-3 weeks after onset). This phenomenon was previously called the fogging effect and has also been reported in magnetic resonance imaging. It is generally reported at T2 image, but can also be observed in diffusion-weighted image (DWI). We report three cases of the fogging effect demonstrated on CT and DWI that was conducted in the subacute stage of ischemic cerebral infarcts. The fogging effect can result in incorrect judgment during the diagnosis and treatment of cerebral infarction patients in the subacute stage. Therefore, it is important that clinicians anticipate this occurrence and necessitates the development of better detection methodologies.