| Jun Hyeok Song | 2 Articles |
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[English]
Moyamoya disease is a cerebrovascular disease that features stenosis or occlusion at the distal internal carotid artery and proximal portion of the anterior and middle cerebal arteries. Before reversible changes occur to the brain revascularization surgery for patients of moyamoya disease is believed to prevent cerebral ischemic attacks by increasing and improving cerebral blood flow. The authors present the experiences of surgery for patents with ischemic or hemorrhage. Revascularization surgeries were performed in 10 patents with episode of ischemic, seizure and hemorrhage between 1994 and 1999. There were 3 male and 7 female, aged 5 to 54(mean32.4 years) and 6 patients with ischemic, 3 patients with hemorrhage and 1 patient with seizure. Procedure of EDAS was performed in 4 patients with ischemic and 1 patient with hemorrhage. EMS was performed in 3 patients with hemorrhage and 1 patient with seizure. Combined EDAS and EMS was performed in 1 patients with ischemic. One superior cerebellar artery aneurysm was demonstrated and clipped and pseudoaneurysms was obseved in one patient. The authors studies the relationship between efficasy and outcome of surgical treatments. All patients except one patient who died were followed up >3 years, from onset untill 1999. Improved and no recurred of symptoms and signs were observed in all patients who underwent EDAS procedure. Rebleeding was observed in 1 among 4 patients who underwent EMS procedure and the patient died of rebleeding 1 patient who underwent combined procedures EDAS and EMS resulted in improved and no recurrence of ischemic symptom. 1 superior cerebellar aneurysmal clipping was performed successfully. The pseudaneurysms arising dilating perforating moyamoya vessels in patient with hemorrhage were source of the hemorrhage and rebleeding. The surgically treated patient seems to have good results, but long term study of large numbers of patient needs further investigation. Although the procedure of EDAS and EMS were successful in producing effective indirect arterial anastomoses and improvement in symptoms, superficial temporal artery middle cerebral artery(STA-MCA) anastomosis combined with indirect arterial anastomotic procedures were recommended as the appropriate surgical treatment for refracting cases of moyamoya disease.
[English]
Cysticercosis is the most frequent parasitosis of the central nervous system. Often medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the occurence of complications, such as hydrocephalus. So a considerable group of patients require surgical procedures, especially in cases of neural compression or intracranial hypertension or epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocy-sticercosis using the stereotatic endoscopic system. We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF)analysis, enhanced com-puterized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all patients, partial sensory type in 3 cases who had reciprocal intraparenchymal lesion, generalized type in 1 case who had obstructive hydrocephalus by multple ventricular cysts. For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser and suction. Cystic forms were removed successfully but in solid form additional transgyral microscopic removal was needed. In intraventricular lesions, we first placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway patheter. Through the peelaway catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions were removed without specific complications except transient chemical meningitis in one case. Stereotactic endoscopic surgery make it possible to operate cystic lesions without dege-neration(vesicular stage)wherever they locate.
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, Jun Hyeok Song
