Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.49
Woowon Oh, Yeongu Chung, Jebeom Hong, Y. Won, P. Chung, M. Rho
Objective: Ruptured anterior cerebral artery (ACA) trunk aneurysms and middle cerebral artery (MCA) trunk aneurysms are rare, and little is known about them. This study was conducted to determine the difference between these and other types of aneurysms.Methods: We performed a retrospective review of patients diagnosed with subarachnoid hemorrhage over an 8-year period at a single institution. We analyzed the characteristics, clinical factors, and radiological components of aneurysms at the trunk portion of A-1 and M-1. Descriptive analysis and univariate analysis for factors were performed to determine the differences of ACA A-1 portion trunk and MCA M-1 portion trunk aneurysms from other ACA and MCA aneurysms, respectively.Results: Univariate logistic regression modeling showed that trunk aneurysms in MCA M-1 had a smaller dome size (p=0.026) and dome/neck ratio (p=0.048) than other MCA aneurysms. Likewise, through univariate logistic regression modeling, the ACA group showed differences in dome size including age (p=0.001) as well as dome size (p=0.038) and dome neck ratio (p=0.041) in the A1 region.Conclusion: MCA M-1 and ACA A-1 trunk aneurysms are likely to have several different characteristics such as small in size and a lower dome/neck ratio. Also, due to their close locations to the perforator arteries, there is a high possibility of perforator artery injury when treating these aneurysms. Thus, careful attention is required when setting the treatment methods, and further studies about these aneurysms are needed.
目的:破裂的大脑前动脉(ACA)干动脉瘤和大脑中动脉(MCA)干动脉瘤是一种罕见的动脉瘤，目前对其了解甚少。这项研究是为了确定这些动脉瘤和其他类型动脉瘤的区别。方法:我们对一家医院8年来诊断为蛛网膜下腔出血的患者进行回顾性分析。我们分析了A-1和M-1干部动脉瘤的特点、临床因素和影像学成分。采用描述性分析和单因素分析分别确定ACA A-1部分主干和MCA M-1部分主干动脉瘤与其他ACA和MCA动脉瘤的差异。结果:单因素logistic回归模型显示，MCA M-1主干动脉瘤的穹窿大小(p=0.026)和穹窿/颈比(p=0.048)均小于其他类型的MCA动脉瘤。同样，通过单变量logistic回归模型，ACA组在A1区域的圆顶大小(包括年龄(p=0.001)以及圆顶大小(p=0.038)和圆顶颈比(p=0.041)方面存在差异。结论:MCA M-1和ACA a -1主干动脉瘤可能具有体积小、圆颈比低等特点。此外，由于它们靠近穿支动脉，在治疗这些动脉瘤时，穿支动脉损伤的可能性很高。因此，在确定治疗方法时需要特别注意，并需要对这些动脉瘤进行进一步研究。
{"title":"Subarachnoid Hemorrhage from Ruptured Aneurysm in the Middle Cerebral Artery and Anterior Cerebral Artery Trunk: A Single-Center Study","authors":"Woowon Oh, Yeongu Chung, Jebeom Hong, Y. Won, P. Chung, M. Rho","doi":"10.21129/nerve.2021.7.2.49","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.49","url":null,"abstract":"Objective: Ruptured anterior cerebral artery (ACA) trunk aneurysms and middle cerebral artery (MCA) trunk aneurysms are rare, and little is known about them. This study was conducted to determine the difference between these and other types of aneurysms.Methods: We performed a retrospective review of patients diagnosed with subarachnoid hemorrhage over an 8-year period at a single institution. We analyzed the characteristics, clinical factors, and radiological components of aneurysms at the trunk portion of A-1 and M-1. Descriptive analysis and univariate analysis for factors were performed to determine the differences of ACA A-1 portion trunk and MCA M-1 portion trunk aneurysms from other ACA and MCA aneurysms, respectively.Results: Univariate logistic regression modeling showed that trunk aneurysms in MCA M-1 had a smaller dome size (p=0.026) and dome/neck ratio (p=0.048) than other MCA aneurysms. Likewise, through univariate logistic regression modeling, the ACA group showed differences in dome size including age (p=0.001) as well as dome size (p=0.038) and dome neck ratio (p=0.041) in the A1 region.Conclusion: MCA M-1 and ACA A-1 trunk aneurysms are likely to have several different characteristics such as small in size and a lower dome/neck ratio. Also, due to their close locations to the perforator arteries, there is a high possibility of perforator artery injury when treating these aneurysms. Thus, careful attention is required when setting the treatment methods, and further studies about these aneurysms are needed.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131057414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.92
Gi Jeong Park, Sang Hoon Kim, K. Kim, Dae-Hyun Kim
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.
{"title":"Different Pathology of Peripheral Nerve Sheath Tumor in Neurofibromatosis Type 1: 3 Cases","authors":"Gi Jeong Park, Sang Hoon Kim, K. Kim, Dae-Hyun Kim","doi":"10.21129/nerve.2021.7.2.92","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.92","url":null,"abstract":"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.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"s3-27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130111314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.96
Jung Jae Oh, Jong-Hyeok Park, Jong Tae Kim
Caudal epidural injection (CEI) is commonly used to manage patients with low back or leg pain, but cauda equine syndrome (CES) rarely results from epidural and/or subdural hematoma occurred after the procedure. A 71-year-old man presented at our outpatient department with voiding difficulty and radiating pain in both legs 8 days ago after CEI. The patient also complained pain and numbness of saddle area, CES. He had taken clopidogrel for 8 years after cardiac stent insertion. Lumbar magnetic resonance imaging (MRI) revealed subdural hematoma at the L5-S1-S2 level. The patient underwent urgent surgical treatment for hematoma evacuation. We finally recognized that subdural hematoma in lumbar MRI was found to subdural-extra arachnoid hematoma as considering intraoperative findings. To the best of our knowledge, few cases of this complication have been reported after CEI. Subdural hematoma often is concomitant with subarachnoid hematoma. Subdural and subarachnoid hematoma is associated with poor clinical outcomes due to severe edema of nerve rootlets. However, no evidence of edema and swelling of nerve rootlets was observed during surgery in our case. As a result, the patient achieved full recovery more than we expected unlike the case of subdural and subarachnoid hematoma.
{"title":"Cauda Equina Syndrome from Subdural Hematoma after Caudal Epidural Injection","authors":"Jung Jae Oh, Jong-Hyeok Park, Jong Tae Kim","doi":"10.21129/nerve.2021.7.2.96","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.96","url":null,"abstract":"Caudal epidural injection (CEI) is commonly used to manage patients with low back or leg pain, but cauda equine syndrome (CES) rarely results from epidural and/or subdural hematoma occurred after the procedure. A 71-year-old man presented at our outpatient department with voiding difficulty and radiating pain in both legs 8 days ago after CEI. The patient also complained pain and numbness of saddle area, CES. He had taken clopidogrel for 8 years after cardiac stent insertion. Lumbar magnetic resonance imaging (MRI) revealed subdural hematoma at the L5-S1-S2 level. The patient underwent urgent surgical treatment for hematoma evacuation. We finally recognized that subdural hematoma in lumbar MRI was found to subdural-extra arachnoid hematoma as considering intraoperative findings. To the best of our knowledge, few cases of this complication have been reported after CEI. Subdural hematoma often is concomitant with subarachnoid hematoma. Subdural and subarachnoid hematoma is associated with poor clinical outcomes due to severe edema of nerve rootlets. However, no evidence of edema and swelling of nerve rootlets was observed during surgery in our case. As a result, the patient achieved full recovery more than we expected unlike the case of subdural and subarachnoid hematoma.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131110910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.41
Jae Hyun Park, Sang Hyun Kim, Noh Sung Hyun, P. Cho
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.
{"title":"Role of Supine and Standing Radiography in Vertebroplasty for Osteoporotic Compression Fractures\"","authors":"Jae Hyun Park, Sang Hyun Kim, Noh Sung Hyun, P. Cho","doi":"10.21129/nerve.2021.7.2.41","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.41","url":null,"abstract":"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.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"167 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123298437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.106
G. Jang, S. Noh
Gorham-Stout disease (GSD) is a rare progressive osteolytic disease with intraosseous lymphangiomatosis. A previously healthy 55-year-old woman presented with left leg hypoesthesia and upper back pain. k pain, back pain, and bilateral shoulder pain. In radiologic examination, there was an osteolytic lesion in T3, 4, 5, 6 vertebra. And a dislocation in the T3/4 vertebrae and a compression fracture in the T4 vertebra were founded. She was treated with posterolateral fusion (PLF) from C7 to T7. For 1 year, she had no specific symptoms but a new osteolytic lesion was found on thoracic T8 on 1 year follow-up magnetic resonance imaging. Radiotherapy was performed with 40 Gy, and chemotherapy was performed with denosumab. This report described a case of GSD that involved the thoracic spine and was appropriately managed. In the present case of a middle-aged Asian woman, correction of severe thoracic instability and prevention of neurologic compromise were accomplished through PLF from C7 to T7. Recurrence was observed 1 year later, but it was appropriately treated with neoadjuvant therapy.
{"title":"Gorham-Stout Disease in a Middle-Aged Patient Treated by Posterior Lateral Fusion: A Case Report and Literature Review","authors":"G. Jang, S. Noh","doi":"10.21129/nerve.2021.7.2.106","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.106","url":null,"abstract":"Gorham-Stout disease (GSD) is a rare progressive osteolytic disease with intraosseous lymphangiomatosis. A previously healthy 55-year-old woman presented with left leg hypoesthesia and upper back pain. k pain, back pain, and bilateral shoulder pain. In radiologic examination, there was an osteolytic lesion in T3, 4, 5, 6 vertebra. And a dislocation in the T3/4 vertebrae and a compression fracture in the T4 vertebra were founded. She was treated with posterolateral fusion (PLF) from C7 to T7. For 1 year, she had no specific symptoms but a new osteolytic lesion was found on thoracic T8 on 1 year follow-up magnetic resonance imaging. Radiotherapy was performed with 40 Gy, and chemotherapy was performed with denosumab. This report described a case of GSD that involved the thoracic spine and was appropriately managed. In the present case of a middle-aged Asian woman, correction of severe thoracic instability and prevention of neurologic compromise were accomplished through PLF from C7 to T7. Recurrence was observed 1 year later, but it was appropriately treated with neoadjuvant therapy.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130811905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-31DOI: 10.21129/nerve.2021.7.2.126
Jaehwan Kim, Changik Lee, B. Son
The superficial peroneal nerve (SPN) supplies sensory innervation to the lower two-thirds of the lateral leg and the dorsum of the foot, with the exception of the first web space. Therefore, isolated entrapment of the SPN results in pain and sensory deficit of the dorsum of the foot or lateral lower leg without corresponding weakness of the peroneus muscle. Although entrapment of the SPN passing from the subfacial to the subcutaneous tissue in the peroneal tunnel was discovered as early as 1954, there were few reports of treatment of SPN entrapment. We report a case of a 73-year-old patient who presented with chronic numbness and allodynia of a 2-year duration due to entrapment of the SPN. Characteristic pain distribution and presentation of the symptoms were essential in preoperative diagnosis of SPN entrapment. The SPN and its branches were addressed in the peroneal tunnel and their courses were completely decompressed during the operation. Two months after the surgery, tingling pain and allodynia were recovered completely.
{"title":"Superficial Peroneal Nerve Entrapment Causing Chronic Pain in the Foot: A Case Report","authors":"Jaehwan Kim, Changik Lee, B. Son","doi":"10.21129/nerve.2021.7.2.126","DOIUrl":"https://doi.org/10.21129/nerve.2021.7.2.126","url":null,"abstract":"The superficial peroneal nerve (SPN) supplies sensory innervation to the lower two-thirds of the lateral leg and the dorsum of the foot, with the exception of the first web space. Therefore, isolated entrapment of the SPN results in pain and sensory deficit of the dorsum of the foot or lateral lower leg without corresponding weakness of the peroneus muscle. Although entrapment of the SPN passing from the subfacial to the subcutaneous tissue in the peroneal tunnel was discovered as early as 1954, there were few reports of treatment of SPN entrapment. We report a case of a 73-year-old patient who presented with chronic numbness and allodynia of a 2-year duration due to entrapment of the SPN. Characteristic pain distribution and presentation of the symptoms were essential in preoperative diagnosis of SPN entrapment. The SPN and its branches were addressed in the peroneal tunnel and their courses were completely decompressed during the operation. Two months after the surgery, tingling pain and allodynia were recovered completely.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126785026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-30DOI: 10.21129/NERVE.2021.7.1.20
Jessie Choi, B. Son
Corresponding author: Byung-chul Son, MD, PhD Department of Neurosurgery, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea Tel: +82-2-2258-6122 Fax: +82-2-594-4248 E-mail: sbc@catholic.ac.kr A 24-year-old, right-handed male patient presented with a 1-month history of continuous tingling paresthesia involving left medial hand and fingers accompanied by clumsiness of left hand and fingers. Thepain onset was sudden and marked by a severe aching pain in the medial elbow and medial scapular areas, without any prior cause. Two weeks of excruciating pain led to clumsiness of the left hand and fingers gradually occurred. Magnetic resonance imaging (MRI) of the left elbow revealed a swollen ulnar nerve with perineural enhancement involving anconeus epitrochlearis (AE) muscle within the cubital tunnel. The operation revealed adhesion of the AE muscle to the left ulnar nerve. Open in-situ decompression of the ulnar nerve without transposition eventually alleviated the pain and weakness associated with ulnar neuropathy. The patient slowly recovered 6 months after surgery. The AE muscle is a common anatomic variation, with a prevalence of up to 34%. However, the prevalence of ulnar neuropathy associated with the AE muscle is unknown. It is a congenital accessory muscle between the medial humeral epicondyle and the olecranon covering the posterior aspect of the cubital tunnel. It is usually diagnosed intraoperatively and not preoperatively in the absence of no imaging studies. The clinical presentation of ulnar neuropathy caused by the AE usually differs from idiopathic disease, including younger age at onset, rapid progression with a short duration of symptoms, and edema of the AE muscle on the MRI.
{"title":"Ulnar Neuropathy due to Cubital Tunnel Syndrome Caused by Anconeus Epitrochlearis: A Case Report","authors":"Jessie Choi, B. Son","doi":"10.21129/NERVE.2021.7.1.20","DOIUrl":"https://doi.org/10.21129/NERVE.2021.7.1.20","url":null,"abstract":"Corresponding author: Byung-chul Son, MD, PhD Department of Neurosurgery, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea Tel: +82-2-2258-6122 Fax: +82-2-594-4248 E-mail: sbc@catholic.ac.kr A 24-year-old, right-handed male patient presented with a 1-month history of continuous tingling paresthesia involving left medial hand and fingers accompanied by clumsiness of left hand and fingers. Thepain onset was sudden and marked by a severe aching pain in the medial elbow and medial scapular areas, without any prior cause. Two weeks of excruciating pain led to clumsiness of the left hand and fingers gradually occurred. Magnetic resonance imaging (MRI) of the left elbow revealed a swollen ulnar nerve with perineural enhancement involving anconeus epitrochlearis (AE) muscle within the cubital tunnel. The operation revealed adhesion of the AE muscle to the left ulnar nerve. Open in-situ decompression of the ulnar nerve without transposition eventually alleviated the pain and weakness associated with ulnar neuropathy. The patient slowly recovered 6 months after surgery. The AE muscle is a common anatomic variation, with a prevalence of up to 34%. However, the prevalence of ulnar neuropathy associated with the AE muscle is unknown. It is a congenital accessory muscle between the medial humeral epicondyle and the olecranon covering the posterior aspect of the cubital tunnel. It is usually diagnosed intraoperatively and not preoperatively in the absence of no imaging studies. The clinical presentation of ulnar neuropathy caused by the AE usually differs from idiopathic disease, including younger age at onset, rapid progression with a short duration of symptoms, and edema of the AE muscle on the MRI.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131884798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-28DOI: 10.21129/nerve.2020.6.2.114
Yunoh Hwang, B. Son
Sciatic nerve entrapment, which is a cause of non-discogenic extraspinal sciatica is characterized by buttock pain and sitting intolerance. If significant asymptomatic lumbar stenosis in the lower lumbar spine is found in patients with buttock pain and sciatica, caused by sciatic nerve entrapment, it is possible that needless spinal surgery may have been recommended. A 72-year-old male presented with a 2-year history of severe buttock and sole pain in his right lower extremity. His pain did not improve after decompression and fusion surgery for severe lumbar stenosis. A pelvic magnetic resonance imaging (MRI) used to evaluate the failed back surgery syndrome revealed a type II variation between the sciatic nerve and piriformis muscle. Transgluteal decompression of the sciatic nerve completely eliminated chronic disability associated with right buttock and sole pain. The patient's pain was improved by sciatic nerve decompression through a transgluteal approach. Although vascular claudication, hip joint pathology, and peripheral neuropathy have been suggested in the differential diagnosis of lumbar stenosis, sciatic nerve entrapment involving the gluteal region should be suspected in patients presenting with buttock pain associated with sciatica, combined with severe lumbar stenosis based on MRI.
{"title":"Sciatic Nerve Entrapment (Deep Gluteal Syndrome) as a Cause of Failed Back Surgery Syndrome: A Case Report","authors":"Yunoh Hwang, B. Son","doi":"10.21129/nerve.2020.6.2.114","DOIUrl":"https://doi.org/10.21129/nerve.2020.6.2.114","url":null,"abstract":"Sciatic nerve entrapment, which is a cause of non-discogenic extraspinal sciatica is characterized by buttock pain and sitting intolerance. If significant asymptomatic lumbar stenosis in the lower lumbar spine is found in patients with buttock pain and sciatica, caused by sciatic nerve entrapment, it is possible that needless spinal surgery may have been recommended. A 72-year-old male presented with a 2-year history of severe buttock and sole pain in his right lower extremity. His pain did not improve after decompression and fusion surgery for severe lumbar stenosis. A pelvic magnetic resonance imaging (MRI) used to evaluate the failed back surgery syndrome revealed a type II variation between the sciatic nerve and piriformis muscle. Transgluteal decompression of the sciatic nerve completely eliminated chronic disability associated with right buttock and sole pain. The patient's pain was improved by sciatic nerve decompression through a transgluteal approach. Although vascular claudication, hip joint pathology, and peripheral neuropathy have been suggested in the differential diagnosis of lumbar stenosis, sciatic nerve entrapment involving the gluteal region should be suspected in patients presenting with buttock pain associated with sciatica, combined with severe lumbar stenosis based on MRI.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126891676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-28DOI: 10.21129/nerve.2019.5.2.94
C. Hong, Yeongu Chung, Y. Won, P. Chung, M. Rho
Corresponding author: Yu Sam Won Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea Tel: +82-2-2001-2159 Fax: +82-2-2001-2157 E-mail: yusam.won@samsung.com Recurrent artery of Heubner (RAH) aneurysms are extremely rare and few cases have been reported in the literature. A 53-year-old woman was transferred for evaluation and management of spontaneous subarachnoid hemorrhage (SAH). Cerebral angiography revealed a rupture of RAH aneurysm. The aneurysm was secured with a fenestrated right-angled Yasargil clip along the RAH. Postoperative brain computed tomography showed a hypodense lesion at the left head of the caudate nucleus due to obliteration of the RAH. Fortunately, the patient experienced no neurologic deficits. To avoid iatrogenic obliteration of RAH, intraoperative careful confirmation of its flow should be performed. We report a case of RAH aneurysm in a patient with SAH.
{"title":"Ruptured Aneurysm of Recurrent Artery of Heubner: A Case Report","authors":"C. Hong, Yeongu Chung, Y. Won, P. Chung, M. Rho","doi":"10.21129/nerve.2019.5.2.94","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.94","url":null,"abstract":"Corresponding author: Yu Sam Won Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul 03181, Republic of Korea Tel: +82-2-2001-2159 Fax: +82-2-2001-2157 E-mail: yusam.won@samsung.com Recurrent artery of Heubner (RAH) aneurysms are extremely rare and few cases have been reported in the literature. A 53-year-old woman was transferred for evaluation and management of spontaneous subarachnoid hemorrhage (SAH). Cerebral angiography revealed a rupture of RAH aneurysm. The aneurysm was secured with a fenestrated right-angled Yasargil clip along the RAH. Postoperative brain computed tomography showed a hypodense lesion at the left head of the caudate nucleus due to obliteration of the RAH. Fortunately, the patient experienced no neurologic deficits. To avoid iatrogenic obliteration of RAH, intraoperative careful confirmation of its flow should be performed. We report a case of RAH aneurysm in a patient with SAH.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117152318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-28DOI: 10.21129/nerve.2019.5.2.90
Kyoung Jae Park, Y. Lim, S. Yoon
Corresponding author: Soo Han Yoon Department of Neurosurgery, Ajou University Medical Center, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5233 Fax: +82-31-219-5238 E-mail: ee80@hanmail.net A cerebrospinal fluid (CSF) shunt is the most common treatment known to date in the treatment of hydrocephalus. A ventriculoperitoneal (VP) shunt is one of the most commonly favored procedures for CSF diversion. We present a case of shunt revision from a VP shunt to a ventriculoatrial (VA) shunt. The patient was diagnosed with germinal matrix hemorrhage with intraventricular hemorrhage shortly after birth with a history of ileostomy surgery for neonatal necrotizing enterocolitis 10 days after birth. The patient began to develop hydrocephalus around 7 weeks after birth and she had VP shunt surgery at 6 months old for post-hemorrhagic hydrocephalus. After the VP shunt surgery, the patient experienced several months of vomiting and constipation along with worsening of the abdominal distension. Distal abdominal catheter externalization was temporarily performed, and 20 to 30 mL/kg of CSF was drained daily. Abdominal distension was still not resolved after 2 weeks and VA shunting was performed. The patient was discharged with improved abdominal distension and was followed for 3 years without any complications. We report a relatively rare case of a shunt revision to VA shunt due to long-term abdominal distension complicated by neonatal necrotizing enterocolitis and CSF overproduction after VP shunting.
通讯作者:Soo Han Yoon亚洲大学医学院神经外科，亚洲大学医学中心，亚洲大学医学院，164，世界杯，水原永通区16499，大韩民国电话:+82-31-219-5233传真:+82-31-219-5238 E-mail: ee80@hanmail.net脑脊液分流术是迄今为止已知的治疗脑积水最常见的治疗方法。脑室-腹膜(VP)分流术是脑脊液分流术中最常用的方法之一。我们提出一个病例分流修正从副心室分流到心室心房(VA)分流。患者出生后不久被诊断为生发基质出血伴脑室内出血，出生后10天因新生儿坏死性小肠结肠炎进行回肠造口手术。患者出生后约7周开始出现脑积水，6个月大时因出血性脑积水行VP分流手术。在VP分流手术后，患者经历了几个月的呕吐和便秘，并伴有腹胀的恶化。暂时外置腹远端导管，每日排出20 ~ 30ml /kg脑脊液。2周后腹胀仍未消除，行静脉分流术。患者出院时腹胀改善，随访3年，无任何并发症。我们报告一个相对罕见的病例，分流修改为VA分流由于长期腹胀合并新生儿坏死性小肠结肠炎和脑脊液过量后VP分流。
{"title":"Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report","authors":"Kyoung Jae Park, Y. Lim, S. Yoon","doi":"10.21129/nerve.2019.5.2.90","DOIUrl":"https://doi.org/10.21129/nerve.2019.5.2.90","url":null,"abstract":"Corresponding author: Soo Han Yoon Department of Neurosurgery, Ajou University Medical Center, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5233 Fax: +82-31-219-5238 E-mail: ee80@hanmail.net A cerebrospinal fluid (CSF) shunt is the most common treatment known to date in the treatment of hydrocephalus. A ventriculoperitoneal (VP) shunt is one of the most commonly favored procedures for CSF diversion. We present a case of shunt revision from a VP shunt to a ventriculoatrial (VA) shunt. The patient was diagnosed with germinal matrix hemorrhage with intraventricular hemorrhage shortly after birth with a history of ileostomy surgery for neonatal necrotizing enterocolitis 10 days after birth. The patient began to develop hydrocephalus around 7 weeks after birth and she had VP shunt surgery at 6 months old for post-hemorrhagic hydrocephalus. After the VP shunt surgery, the patient experienced several months of vomiting and constipation along with worsening of the abdominal distension. Distal abdominal catheter externalization was temporarily performed, and 20 to 30 mL/kg of CSF was drained daily. Abdominal distension was still not resolved after 2 weeks and VA shunting was performed. The patient was discharged with improved abdominal distension and was followed for 3 years without any complications. We report a relatively rare case of a shunt revision to VA shunt due to long-term abdominal distension complicated by neonatal necrotizing enterocolitis and CSF overproduction after VP shunting.","PeriodicalId":229172,"journal":{"name":"The Nerve","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130416874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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