You-Sub Kim

Traumatic Dural Venous Sinus Injury

Objective The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. Methods We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. Results Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. Conclusion When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.

Is stand alone PEEK cage the gold standard in multilevel anterior cervical discectomy and fusion (ACDF)? Results of a minimum 1-year follow up

INTRODUCTION This study was designed to evaluate the clinical and radiologic results of stand-alone synthetic polyetheretherketone (PEEK) cages for two- or three-level anterior cervical discectomy and fusion (ACDF), with a focus on subsidence. MATERIALS AND METHODS We retrospectively reviewed a total of 68 patients who underwent two- or three-level ACDF with a stand-alone PEEK cage between April 2005 and August 2016. Radiologic parameters were assessed on lateral radiographs, and fusion was assessed on computed tomography scans. For the evaluation of clinical outcomes, visual analogue scale, neck disability index, and modified Japanese Orthopedic Association scores were measured. RESULTS Among the total of 68 patients with a total of 144 segments, ACDF at two and three levels was performed in 60 and 8 patients, respectively, with a mean follow-up duration of 27.6 months. The overall fusion rate was 81.3% (117 of 144 segments), and subsidence occurred in 63 segments (43.8%) at the last follow-up. There was no statistically significant difference between the subsidence group and the nonsubsidence group in terms of fusion rate, radiologic outcomes, and clinical outcomes (p > .05). CONCLUSION Subsidence might be an inevitable course and only a radiologic phenomenon with no effect on the clinical and radiologic outcomes of the use of stand-alone cages.

Ruptured choroidal artery aneurysms in patients with moyamoya disease: Two case series and review of the literatures

Distal peripheral artery aneurysms in moyamoya disease (MMD) remain difficult to treat given their deep location, small size, and fragility. Here, we report two cases of choroidal artery aneurysms associated with MMD who were treated through direct clipping and coil embolization. Timing of aneurysm formation remains unclear, however, annual follow-up DSA for surveillance of hemodynamic status is necessary and prompt treatment of aneurysm should be performed when diagnosed. Moreover, choroidal artery aneurysms may benefit from endovascular coil embolization due to their characteristics.

Recurrent olfactory neuroblastoma in remote leptomeninges, mimicking intracranial meningioma.

BACKGROUND Olfactory neuroblastoma (ONB) is an uncommon neoplasm that arises from olfactory epithelium in the nasal cavity near the cribriform plate. Although local recurrence or direct extension along olfactory epithelium and metastasis to the central nervous system has been reported, remote leptomeningeal metastasis is quite rare. In our report of a leptomeningeal metastasis of ONB without recurrence of primary site, we discuss the possible pathogenesis of this rare phenomenon with a review of the literature. CASE DESCRIPTION A 56-year-old woman was admitted with epistaxis. Magnetic resonance imaging revealed a mass in the right cribriform plate and ethmoid sinus with intracranial extension. She was primarily treated with craniofacial resection followed by radiotherapy. Gross total resection was achieved, but annual follow-up magnetic resonance imaging showed a new enhancing mass in the left parietal meninges mimicking meningioma without local recurrence at 5 years after the first operation. A second operation was performed, and pathologic examination confirmed the lesion as metastatic olfactory neuroblastoma. CONCLUSIONS ONB is a locally aggressive tumor, but it also potentially spreads to remote leptomeninges via blood or cerebrospinal fluid. Therefore, careful evaluation is needed not to misdiagnose a meningioma and delay the treatment. Moreover, understanding the route of remote leptomeningeal metastasis and en-bloc resection of tumor at first operation might reduce leptomeningeal metastasis, irrespective of surgical corridors.

Spinal Burkitt's Lymphoma Mimicking Dumbbell Shape Neurogenic Tumor: A Case Report and Review of the Literature.

Non-Hodgkins lymphoma (NHL), a disease which may involve the spine, is frequently associated with advanced disease. Radiculopathy caused by spinal root compression as the initial presentation in patients with NHL is very rare and thought to occur in less than 5% of cases. A 69-year-old woman complained of a history of low back pain with right sciatica for 1 month prior to admission. Computed tomography and magnetic resonance imaging of the lumbar spine showed a dumbbell-shape epidural mass lesion extending from L2 to L3, which was suggestive of a neurogenic tumor. After paraspinal approach and L2 lower half partial hemilaminectomy, total excision of the tumor was achieved, followed by rapid improvement of back pain and radiating pain. The lesion was confirmed to be Burkitts lymphoma by histopathological examination. We then checked whole-body PET-CT, which showed multifocal malignant lesions in the intestine, liver, bone and left supraclavicular lymph node. Although a rare situation, Burkitts lymphoma should be considered in the differential diagnosis for patients presenting with back and lumbar radicular pain without a prior history of malignancy. Burkitts lymphoma could be the cause of dumbbell-shape spinal tumor.