Spinal Intradural Ventral Arteriovenous Fistula Mimicking an Intramedullary Ependymoma - A Case Report -

오선규,배채완,안재성,임승철 대한척추신경외과학회 2010 Neurospine Vol.7 No.2

We present a rare case of an intradural ventral arteriovenous fistula(AVF) mimicking an intramedullary ependymoma. A 46‐year‐old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole‐spine magnetic resonance imaging(MRI) scan revealed a 0.5‐cm‐sized intramedullary lesion of high signal with a dark signal rim on a T2‐weighted image at the T9 level. The T1‐weighted MRI after contrast enhancement revealed a nodular and rim‐like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened. Spinal angiogram demonstrated a small intradural ventral AVF with a single feeding artery from the upper limb of the radiculomedullary artery at the T9 level on the left side. Endovascular embolization was performed but failed due to unex- pected vasospasm resulting in paraplegia. Finally, the patient underwent re‐exploration and surgical ligation of the AVF. The postoperative angiogram demonstrated complete obliteration of the fistula. Most spinal AVFs are found in elderly patients, as spinal degenerative diseases or neoplasms. Although it is a rare disease, clinicians should be aware of the occurrence of spinal AVFs, because their misdiagnoses can result in progressively disa- bling neurologic conditions. Thus, clinicians must attempt to correctly diagnose spinal AVFs at the first examination. We present a rare case of an intradural ventral arteriovenous fistula(AVF) mimicking an intramedullary ependymoma. A 46‐year‐old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole‐spine magnetic resonance imaging(MRI) scan revealed a 0.5‐cm‐sized intramedullary lesion of high signal with a dark signal rim on a T2‐weighted image at the T9 level. The T1‐weighted MRI after contrast enhancement revealed a nodular and rim‐like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened. Spinal angiogram demonstrated a small intradural ventral AVF with a single feeding artery from the upper limb of the radiculomedullary artery at the T9 level on the left side. Endovascular embolization was performed but failed due to unex- pected vasospasm resulting in paraplegia. Finally, the patient underwent re‐exploration and surgical ligation of the AVF. The postoperative angiogram demonstrated complete obliteration of the fistula. Most spinal AVFs are found in elderly patients, as spinal degenerative diseases or neoplasms. Although it is a rare disease, clinicians should be aware of the occurrence of spinal AVFs, because their misdiagnoses can result in progressively disa- bling neurologic conditions. Thus, clinicians must attempt to correctly diagnose spinal AVFs at the first examination.

Current Concept of Stem Cell Therapy for Spinal Cord Injury: A Review

오선규,전상룡 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2

Spinal cord injury (SCI) is a catastrophic condition associated with significant neurological deficit, social, and financial burdens. Over the past decades, various treatments including medication, surgery, and rehabilitation therapy for SCI have been performed, but there were no definite treatment option to improve neurological function of patients with chronic SCI. Therefore, new treatment trials with stem cells have been studied to regenerate injured spinal cord. Among various types of stem cells, bone marrow derived mesenchymal stem cells is highly expected as candidates for the stem cell therapy. The result of the current research showed that direct intramedullary injection to the injured spinal cord site in subacute phase is most effective. Neurological examination, electrophysiologic studies, and magnetic resonance imaging are commonly used to assess the effectiveness of treatment. Diffusion tensor imaging visualizing white matter tract can be also alternative option to identify neuronal regeneration. Despite various challenging issues, stem cell therapy will open new perspectives for SCI treatment.

침상돌기 주변 비파열성 뇌동맥류 결찰술의 결과 및 합병증에 대한 분석

오선규,장인석,안재성,권도훈,권병덕 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.3

Objective : The study reports the clinical outcomes and complication rates of microsurgical clipping of unruptured paraclinoid aneurysms. Methods : From July 1997 to December 2008, 61 patients underwent microsurgical clipping for 61 unruptured paraclinoid aneurysms in our institute. Entire medical records, radiographic data, and operation records were reviewed retrospectively. Results : After the microsurgical clipping, complete obstruction was achieved in 56 patients (91.8%). Visual disturbance (nine cases, 14.8%) was the most frequent complication. Overall, 59 patients (96.7%) had a good long-term outcome (Glasgow outcome scale score of 4-5 3 months post-operatively). Conclusion : For patients with paraclinoid aneurysms, satisfactory outcomes can be achieved by microneurosurgical management. These results will be useful when considering treatment of an unruptured paraclinoid aneurysm. (Kor J Cerebrovascular Surgery 12(3):202-205, 2010)

Posterior Thoracic Cage Interbody Fusion (PTCIF) as an Alternative Fusion Technique after Laminectomy in Thoracic and Thoracolumbar Junctional Spine

Shin Hong Kyung,오선규,Il Choi,Sang Ryong Jeon 대한말초신경학회 2016 The Nerve Vol.2 No.1

Objective Thoracic spine fusion is used to surgically treat various spine lesions. However, posterior-only thoracic fusion by using the pedicle screw system can be complicated by pseudoarthrosis or instrument failure. Moreover, when laminectomy is performed for decompression, thus exposing the spinal cord in the thoracic spine, the fusion bed where the bone chips are applied for posterolateral fusion may be insufficient. Therefore, we conducted interbody fusion in posterior thoracic approach. Methods All patients underwent posterior only approach. After pedicle screw insertion at the decompressed level, the cages packed with autologous bone chips were inserted into interbody disc space and fixation was performed by rod and screw system. Four patients with thoracolumbar spinal injury and three patients with degenerative disease. Bone fusion was defined as the formation of bony continuity between the upper and lower end plates and around the fusion cages in the posterior thoracic cage interbody fusion (PTCIF) level, as determined by computed tomography (CT). Results The average follow-up period was 15.3 (range, 8-28) months. All patients with degenerative disease exhibited neurological improvement. Successful bone fusion was confirmed with CT in all patients more than 3 months after PTCIF. Operation-associated complications did not occur and there was no revision operation. Conclusion PTCIF was found to be safe and achieved good outcomes for spinal cord decompression and bone fusion in the thoracic and thoracolumbar junctional spine. Therefore, this surgical method could be considered as an alternative procedure for posterior thoracic decompression and fixation surgery.