| Eui Kyo Seo | 3 Articles |
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[English]
Moyamoya disease is a cerebrovascular disease of unknown etiology, which is characterized by bilateral stenosis or occlusion at terminal portion of internal carotid artery and at proximal portion of anterior cerebral artery and/or middle cerebral artery and abnormal vascular network in the vicinity of the arterial occlusions. It occurs frequently in Asian countries, particularly in Korea and Japan, but is rare in Western countries. To establish the etiology of moyamoya disease, much about the pathology from autopsies, factors involved in its pathogenesis, and its genetics have been studied. It may occur at any age from childhood to adulthood and in general, initial manifestation is cerebral ischemic symptoms in children and intracranial hemorrhage symptoms in adults. Because it progress and cause recurrent stroke, early diagnosis and proper management has been recognized. Cerebral angiography is essential for definitive diagnosis and treatment plan. Magnetic resonance imaging/magnetic resonance angiography is useful for diagnosis and follow-up tools after revascularization. Evaluation of the cerebral hemodynamics by single photon emission computed tomography and positron emission tomography is useful for diagnosis and assessment of the severity of cerebral ischemia in moyamoya patients. Surgical revascularization is effective for moyamoya disease manifesting as ischemic symptoms, to prevent further ischemia and infarction. In hemorrhagic type moyamoya disease, revascularization can be considered. Direct bypass, indirect synangiosis and combined methods are used. Outcomes of revascularization are excellent in preventing transient ischemic attacks in most patients. Citations Citations to this article as recorded by
[English]
Cravernous sinus surgery has been performed increasingly in the last 2 decades because of advance in modern neuroimaging rechiques, nuw surgical anatomy knowledge and surgical technoligies. We reviewed the surgicla approaches to cavernous sinus and surgical anatomy. Extradural approach to cavernous sinus has represented a refinement of the orifinal work performed on this topic by Parkinson, Dolenc, Hakba, and other enthusiastic neurosurgeons. Surgical access to cavernous sinus has traditionally been accomplished through pterinal, subtemporal, orbitozygomatic intradural or extradural, or combined intra-extradural approach. Extradural approach includes craniotomy with or without resection of zygomatic archm exposure of superior orbital fissure and skull base foramina, anterior clinoidectomy, unroofing of opic canal, dissection of laternal wall and entire cavernous sinus. And intraduaral approach has more procedure of dural incision and exposure of cranial nerves, intermal carotid artery and its branches. The most important part of extradural procedure is th identify and dissect the cleavage plane between the temporal dura and the deep layer of lateral wall of cavernous sinus. The other significant aspects of dissection are anterior clinoidectomy and preper orientation while dissecting the dura matter of superior orbital fissure to avoid damage to nerve and vessl. The cranial nerves in lateral wall of cavernous sinus have neural sheath which are probably well protected from mechanical injury during surgery. It is also important to maintain vascular supply for cranial nerves to avoid injury during dissecrion. The advancing interventional techinque is competion with direct surgical management of vascular lesion of cavernous sinous. Also the same may be applied to neoplastic lesions involving cavernous sinous, as radiosurgety like gamma knife is competing with surgical treatment. However, with improved knowlidge and surgocal techiques, most of lesions in cavernous sinus can be removed without additional neurological deficits. Citations Citations to this article as recorded by
[English]
Inflammatory response may play role in symptomatic nerve irritation that is associated herniated disc. Steroids decrease neurogenic inflamation, inhibit phospholipase A2 and produce membrane stabilization that result in pain relief. Local anesthetics are believed to break the cycle of pain that exists between local pain and a secondary muscle spasm. Epidural block with steroid combined with local anesthetics(EBSL) are recommended in patients with sign and symptoms of nerve root irritation. The purpose of this study was to asses of ESBL. A retrospective study undertaken of 20 patients who received ESBL from May 2004 to November 2005 at the pain clinic of Mokdong Hospital Ewha Womans Medical Center. The mean age of the patients was 52, with range from 18-82 years. Nine patients was male, eleven were female. The etiologies of the pain were low back strain(3 patients), bulging disc(9 patients), degenerative disc(4 patients), lumbar stenosis(2 patients) and spondylolisthesis(2 patients). Diagnostic workouts were history, physical and neurologic examinations, and labo-rative studies including simple X-ray and magnetic resonance image. The steroid preparation usedis methylprednisolone and the use of dilute local anesthetics Is mepibacaine. The method of technique of EBSL was median approach with loss of resistance technique. The clinical responsefall into four categories, 6 months follow up after therapy. An excellent response was defined ascomplete resolution of presenting symptoms. A good response was judged to greater than 75%improvement in symptoms with full resumption of the patients life style. A fair response was defined as improvement in the patients condition, whereas a poor response indicated little or noimprovement. The total numbers of blocks were 48 in 20 patients and 2.4/per patient. The duration symptoms within one month were 8 patients and the other 12 patients over one month. A detailed follow-up of 20 patients with EBSL showed a successful rate(good to excellent) 65%, fair 25%, and poor 10%. The effective responses of EBSL were depend on the etiologies, duration of pains and patients age. All patients of low back strain with one month duration or less have a response rate of very successful excellent. Also all patient with bulging disc who present with pain within one month have a response rate of excellent 3(60%), good 2(40%) and the patient who present with pain of over one month or more have a response rate excellent 1(25%), fair 2(50%) and poor 1(25%). All patients of degenerative disc present with pain of over one month have 50% relative success rate and good 2 patients. The response rate of two patients of spinal stenosis and two patients of spondylolisthesis present pain of long time(2-6 months) and response rate showed fair 3, poor 1, and 0% of successful rate. EBSL can safely performed and its efficacy has been established in patients with low back strain and bulging disc. The success of this therapeutic procedure depends on attention to selected of patient etiologies and concomitant therapies. In addition, well controlled studics are needed to evaluate any effectivness of EBSL on back pain and radiculopathy.
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