ObjectiveTo investigate a diagnostic value of ultrasonography in carpal tunnel syndrome (CTS) patients and to evaluate a correlation of sonographic measurements with the degree of electrodiagnostic abnormalities and clinical severity.MethodsTwo-hundred-forty-six symptomatic hands in 135 patients and 30 asymptomatic hands in 19 healthy individuals as control group were included. In ultrasonographic study, we measured the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the pisiform as well as palmar bowing (PB) of the flexor retinaculum. Sensitivity and specificity of ultrasonographic measurements were evaluated and ultrasonographic data from the symptomatic and control hands were compared to the grade of electrodiagnostic and clinical severity.ResultsThe mean CSA was 13.7±4.2 mm2 in symptomatic hands and 7.9±1.3 mm2 in asymptomatic hands. The mean FR was 4.2±1.0 in symptomatic hands and 3.4±0.4 in asymptomatic hands. The mean PB was 3.5±0.5 mm in symptomatic hands and 2.6±0.3 mm in asymptomatic hands. Statistical analysis showed differences of the mean CSA, FR and PB between groups were significant. A cut-off value of 10 mm2 for the mean CSA was found to be the upper limit for normal value. Both the mean CSA and PB are correlated with the grade of electrophysiological abnormalities and clinical severity, respectively.ConclusionUltrasographic measurement of the CSA and PB is helpful to diagnose CTS as a non-invasive and an alternative modality for the evaluation of CTS. In addition, ultrasonography also provides a reliable correlation with the grade of electrodiagnostic abnormalities and clinical severity.

Falls are a leading cause of morbidity and mortality among children. We performed a retrospective analysis of pediatric patients under 7 years of age admitted to our department after a fall from January 1994 through December 1999 to describe the characteristics of fall-related head injury and to determine the clinical parameters influencing outcome. The patients were divided into two groups according to age: group I (babies and toddlers, 0-3 years) and group II (preschool children, 4-6 years). Falls were classified as low and high level. Sixty-eight cases were identified and falls accounted for 35.2% of head injuries. There were more boys than girls, and more low-level falls(LLF) than high-level falls (HLF), particularly in group I. Although more common in HLF, significant intracranial injuries were also sustained from LLF. Calvarial fractures were the most frequent type of head injury and were more common in LLF than HLF. Admission Glasgow Coma Scale score, types of head injury and hypoxia on admission were significantly correlated with Glasgow Outcome Scale score, but age, sex, extracranial injury and height of fall did not influence clinical outcome. From this study, we concluded that the height of fall should not limit the evaluation of patients and that aggressive management is mandatory to improve outcome even in patients with poor prognostic factors.

The authors report on a case of a metastatic choriocarcinoma that mimicked systemic necrotizing vasculitis on a cerebral angiogram. A 35-year-old woman presented with right hemiplegia and a drowsy mental state. A computed tomography (CT) scan revealed an intracerebral hemorrhage in the left frontal region. A cerebral angiogram showed multiple microaneurysms arising from the bilateral anterior cerebral arteries and middle cerebral arteries, and the renal angiogram showed multiple microaneurysms arising from the left distal renal artery. A chest CT scan revealed multiple metastatic lesions in the left lower lung field. The hematoma and microaneurysms were surgically removed. Choriocarcinoma was diagnosed after histological examination. Despite receiving postoperative chemotherapy, the patient died 1 month after the operation.

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Objective : Allelic losses or loss of heterozygosity (LOH) at many chromosomal loci have been found in the cells of meningiomas. The objective of this study was to evaluate LOH at several loci of different chromosomes (1p32, 17p13, 7q21, 7q31, and 22q13) in different grades of meningiomas. Methods : Forty surgical specimens were obtained and classified as benign, atypical, and anaplastic meningiomas. After DNA extraction, ten polymorphic microsatellite markers were used to detect LOH. Medical and surgical records, as well as pathologic findings, were reviewed retrospectively. Results : LOH at 1p32 was detected in 24%, 60%, and 60% in benign, atypical, and anaplastic meningiomas, respectively. Whereas LOH at 7q21 was found in only one atypical meningioma. LOH at 7q31 was found in one benign meningioma and one atypical meningioma. LOH at 17p13 was detected in 4%, 40%, and 80% in benign, atypical, and anaplastic meningiomas, respectively. LOH at 22q13 was seen in 48%, 60%, and 60% in benign, atypical, and anaplastic meningiomas, respectively. LOH results at 1p32 and 17p13 showed statistically significant differences between benign and non-benign meningiomas. Conclusion : LOH at 1p32 and 17p13 showed a strong correlation with tumor progression. On the other hand, LOH at 7q21 and 7q31 may not contribute to the development of the meningiomas. KEY WORDS :Chromosome˙ Loss of heterozygosity˙ Meningiomas.

Cervical pedicle screw has been shown to provide stronger fixation than other methods. 10,12,16,17) Due to these virtue of biomechanical characteristic, pedicle screw fixation can be used in a wide range of cervical spinal disorders, and excellent clinical results have been reported. 2,3,5,11,[28][29][30] However, this procedure is technically demanding because of the great variation in pedicle dimension and angulations between cervical levels and patients, and generally criticized as being risky due to the proximity of the spinal cord, nerve roots, and vertebral artery. 4,13,18,20,21) Recently, the availability of image-guidance systems, e.g., computer-assisted navigation system based on CT or three-dimensional (3D) fluoroscope, has led to their use in spinal surgery to improve an accuracy of pedicle screw placement in cervical spine. 7,9,15,23,25,27) However, its application could be limited due to its high cost and lengthy registration procedure. Moreover, there are some pitfalls using navigation system due to misregistration and motion of spine during the procedure. 27)The objectives of this study were to present the cervical pedicle screw insertion technique, with direct exposure of the pedicle via para-articular mini-laminotomy, assess an efficacy of repetitive training by using saw-bone model improving accuracy of cervical pedicle screw insertion, and evaluate the accuracy of pedicle screw placement and validity of pedicle screw fixation in patients. Objective: This retrospective study was conducted to analyze the novice neurosurgeon's experience of cervical pedicle screw placement by using the technique with direct exposure of pedicle via para-articular mini-laminotomy. Methods: Fifteen sawbone models of subaxial spine were used (124 pedicles) to evaluate efficacy of repetitive training improving accuracy of cervical pedicle screw insertion. After that, we retrospectively reviewed 9 consecutive patients presented with traumatic cervical lesion. A total 38 cervical pedicle screws had been inserted. We analyzed the direction and grade of pedicle perforation on the postoperative computed tomography scan, and learning curve by using sawbone model. Results:In sawbone model group, the correct position was found in 102 (82.3%) screws, and the incorrect position in 22 (17.7%) screws. The incidence of incorrect screw position was 26.9% in the initial 9 sawbone model, and 0% after that. Among the 38 screws inserted in 9 patients, the correct position was found in 36 (94.7%) screws, and the incorrect position in a 2 (5.3%) screw. There was no neurovascular complications related with cervical pedicle screw insertion. Conclusion:In vitro training to insert pedicle screw by using sawbone models could improve an accuracy of cervical pedicle screw placement by using this technique. Preliminary result revealed that cervical pedicle screw placement would be feasible and provide good clinical results in traumatic cervical lesions. (Korean J Neurotrauma 2013;9:106-113) KEY WORDS: Cervical pedicle screw ㆍLaminotomy ㆍSpina...

Vertebroplasty is a common treatment for osteoporotic spinal compression fractures, but it poses complication risk. Therefore, we investigated the clinical and radiological outcomes of conservative treatment using a combination of denosumab and teriparatide. Methods: This study included 86 patients aged 75 or older who were diagnosed with osteoporotic spinal compression fracture from January 2011 to April 2021. The patients were then categorized into those who received denosumab and teriparatide combination treatment without vertebroplasty(group A) and those who received bisphosphonate treatment and underwent vertebroplasty(group B). Several parameters were analyzed: age, sex, underlying diseases, BMI, hospital stay, the time of ambulation start, BMD, VAS score, compression ratio, regional Cobb angle, and local kyphotic angle. Results: As compared to group A, group B showed a relatively shorter hospital stay and time until starting ambulation, but without statistical significance. The VAS scores measured at the time of injury, post-treatment, 3months post-injury, and 1year post-injury did not show statistically significant differences between the groups. In contrast, the mean BMD measured at the time of injury and 1year post-injury demonstrated statistically significant improvements in group A compared to group B. The differences in the compression ratio, regional Cobb angle, and local kyphotic angle measured at the time of injury and 1year post-injury were not statistically significant. Conclusion:Combination treatment without vertebroplasty did not show significant differences in either clinical or radiologic results compared to vertebroplasty cases. Therefore, denosumab and teriparatide combination treatment could be considered as an alternative option for osteoporotic spinal compression fracture patients.

A contrast material volume of 60 mL (18 g iodine) provides excellent image quality of cerebral multi-detector row computed tomographic angiography comparable to those achievable with 100 and 80 mL.