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1.  Glomus Tumor in the Femoral Nerve 
The glomus tumor of the peripheral nerve is one of the mesenchymal tumors originating in the epineurium, and is extremely rare. A 56-year-old man presented complaining of lancinating pain on the left thigh, which was provoked by pressure or exercise. Subsequent image study revealed a mass in the femoral nerve. Total surgical excision with the aid of intraoperative ultrasonography was performed and the pain was successfully controlled. The authors report an unusual case of a patient diagnosed with glomus tumor in peripheral nerve, with a review of the clinical features, imaging, and pathological findings.
doi:10.3340/jkns.2013.54.6.540
PMCID: PMC3921288  PMID: 24527203
Glomus tumor; Peripheral nerve; Femoral nerve
2.  Long-term outcome of vertebral artery origin stenosis in patients with acute ischemic stroke 
BMC Neurology  2013;13:171.
Background
Vertebral artery origin (VAO) stenosis is occasionally observed in patients who have acute ischemic stroke. We investigated the long-term outcomes and clinical significance of VAO stenosis in patients with acute ischemic stroke.
Methods
We performed a prospective observational study using a single stroke center registry to investigate the risk of recurrent stroke and vascular outcomes in patients with acute ischemic stroke and VAO stenosis. To relate the clinical significance of VAO stenosis to the vascular territory of the index stroke, patients were classified into an asymptomatic VAO stenosis group and a symptomatic VAO stenosis group.
Results
Of the 774 patients who had acute ischemic stroke, 149 (19.3%) of them had more than 50% stenosis of the VAO. During 309 patient-years of follow-up (mean, 2.3 years), there were 7 ischemic strokes, 6 hemorrhagic strokes, and 2 unknown strokes. The annual event rates were 0.97% for posterior circulation ischemic stroke, 4.86% for all stroke, and 6.80% for the composite cardiovascular outcome. The annual event rate for ischemic stroke in the posterior circulation was significantly higher in patients who had symptomatic VAO stenosis than in patients who had asymptomatic stenosis (1.88% vs. 0%, p = 0.046). In a multivariate analysis, the hazard ratio, per one point increase of the Essen Stroke Risk Score (ESRS) for the composite cardiovascular outcome, was 1.46 (95% CI, 1.02-2.08, p = 0.036).
Conclusions
Long-term outcomes of more than 50% stenosis of the VAO in patients with acute ischemic stroke were generally favorable. Additionally, ESRS was a predictor for the composite cardiovascular outcome. Asymptomatic VAO stenosis may not be a specific risk factor for recurrent ischemic stroke in the posterior circulation. However, VAO stenosis may require more clinical attention as a potential source of recurrent stroke when VAO stenosis is observed in patients who have concurrent ischemic stroke in the posterior circulation.
doi:10.1186/1471-2377-13-171
PMCID: PMC3833629  PMID: 24215371
3.  Galeal Tack-Up Sutures to Prevent Subgaleal Cerebrospinal Fluid Collection 
Objective
Postoperative subgaleal cerebrospinal fluid (CSF) collection is considered as one of the common minor surgical complication which can lead to prolonged hospitalization. We introduce "galeal tack-up suture" to prevent postoperative subgaleal CSF collection.
Methods
Galeal tack-up suture consists of various surgical techniques which aim to fix galea to cranium in order to prevent CSF pooling in subgaleal space. A total of 87 patients who underwent craniotomy were divided into two groups while closing the wound : group A with galeal tack-up suture and group B with routine wound closure without galeal tack-up suture. The patients were observed for postoperative subgaleal CSF collection.
Results
Among 87 cranitomy cases, galeal tack-up suture was performed in 32 cases and routine wound closure was done in 55 cases. Postoperative subgaleal CSF collection occurred in 13 cases (15%) in which 12 cases occurred in group B patients and 1 case occurred in group A patients (p=0.026).
Conclusion
Galeal tack-up suture is an easy and effective technique in wound closure to prevent postoperative CSF collection.
doi:10.3340/jkns.2013.54.4.336
PMCID: PMC3841277  PMID: 24294458
Cerebrospinal fluid leak; Craniotomy; Scalp; Sutures
4.  Comparative Results of the Patients with Intracerebral and Intra-sylvian Hematoma in Ruptured Middle Cerebral Artery Aneurysms 
Objective
To clarify the prognosis of the patients with intra-sylvian hematoma (ISH) and intracerebral hematoma (ICH) in ruptured middle cerebral artery (MCA) aneurysms.
Methods
We categorized hematoma into ISH and ICH by the presence of intra-hematomal contrast enhancing vessel (IHCEV) on computed tomography angiography (CTA). Forty-four ruptured MCA aneurysm patients with ICH or ISH were grouped by the grading system proposed by the authors in our previous study. We investigated the relevance of the following factors: patient's age, gender, Hunt-Hess grade, Glasgow outcome scale (GOS) and changes in Glasgow coma scale (GCS) between pre-operation and 7 days after operation.
Results
There were no significant differences statistically in age, gender, Hunt-Hess grade, and GOS between the ISH and ICH groups. In their peri-operative GCS change, the ICH group showed greater improvement compared to the ISH group (p = 0.0391). The hematoma grade had a significant relevance with the patients' GOS.
Conclusion
Although there were no significant statistic differences in the GOS of the 2 hematoma groups, there were prominent improvements of post-operative GCS in the ICH group. Unlike in the ISH group, effective removal of hematoma was possible in most patients of the ICH group. Thus although there is no difference in the prognosis of the 2 groups, early surgical evacuation of hematoma seems to be effective in improving the short-term GCS score in peri-operative period.
doi:10.7461/jcen.2013.15.3.200
PMCID: PMC3804658  PMID: 24167800
Intracerebral hematoma; Cerebral aneurysm; Middle cerebral artery
5.  Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty 
European Spine Journal  2011;21(5):905-911.
Introduction
Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective procedures to alleviate pain caused by osteoporotic vertebral compression fractures (VCFs). New vertebral compression fracture (NVCF) has been noted as a potential late sequela of the procedures. The incidence of NVCFs and affecting risk factors were investigated.
Materials and methods
The authors retrospectively analyzed the occurrence of NVCFs in 147 patients treated with PVP or PKP for osteoporotic VCFs. Possible risk factors, such as age, gender, body mass index, bone mineral density (BMD), location of treated vertebra, treatment modality, amount of bone cement injected, anterior–posterior ratio of the fractured vertebra, cement leakage into the disc space, and pattern of cement distribution, were assessed.
Results
Twenty-seven patients (18.4%) had subsequent symptomatic NVCFs with a median time to new fracture was of 70 days. The 1-year symptomatic fracture-free rate was 85.0% by the Kaplan–Meier estimate. Eighteen (66.7%) of the 27 patients had an NVCF on the adjacent vertebra. Significant differences (P < 0.05) were found between the NVCF and control groups in regard to age, treatment modality, BMD, and the proportion of cement leakage into the disc space. Discal cement leakage and low BMD affected on adjacent NVCFs.
Conclusion
The most important risk factors affecting NVCFs were osteoporosis and intervertebral discal cement leakage.
doi:10.1007/s00586-011-2099-5
PMCID: PMC3337901  PMID: 22160212
Osteoporotic compression fracture; Vertebroplasty; Kyphoplasty; BMD; Discal leakage
6.  Eosinophilic Myelitis in the Cervical Cord Mimicking Intramedullary Cord Tumor 
Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.
doi:10.3340/jkns.2012.52.4.410
PMCID: PMC3488654  PMID: 23133734
Allergy; Eosinophilic myelitis; Intramedullary tumor; Toxocariasis
7.  Retrograde Stent Placement for Coil Embolization of a Wide-Necked Posterior Inferior Cerebellar Artery Aneurysm 
Korean Journal of Radiology  2012;13(4):510-514.
Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.
doi:10.3348/kjr.2012.13.4.510
PMCID: PMC3384836  PMID: 22778576
Posterior inferior cerebellar artery; Aneurysm; Endovascular treatment; Retrograde stenting; Enterprise stent
8.  Grading of Intracerebral Hemorrhage in Ruptured Middle Cerebral Artery Aneurysms 
Objective
To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately.
Methods
From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm.
Results
According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome.
Conclusion
The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately.
doi:10.3340/jkns.2012.51.5.268
PMCID: PMC3393860  PMID: 22792422
Subarachnoid hemorrhage; Middle cerebral artery aneurysm; Intracerebral hemorrhage
9.  Serial Expression of Hypoxia Inducible Factor-1α and Neuronal Apoptosis in Hippocampus of Rats with Chronic Ischemic Brain 
Objective
The purpose of this study is to investigate serial changes of hypoxia-inducible factor 1α (HIF-1α), as a key regulator of hypoxic ischemia, and apoptosis of hippocampus induced by bilateral carotid arteries occlusion (BCAO) in rats.
Methods
Adult male Wistar rats were subjected to the permanent BCAO. The time points studied were 1, 2, 4, 8, and 12 weeks after occlusions, with n=6 animals subjected to BCAO, and n=2 to sham operation at each time point, and brains were fixed by intracardiac perfusion fixation with 4% neutral-buffered praraformaldehyde for brain section preparation. Immunohistochemistry (IHC), western blot and terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay were performed to evaluate HIF-1α expression and apoptosis.
Results
In IHC and western blot, HIF-1α levels were found to reach the peak at the 2nd week in the hippocampus, while apoptotic neurons, in TUNEL assay, were maximal at the 4th week in the hippocampus, especially in the cornu ammonis 1 (CA1) region. HIF-1α levels and apoptosis were found to fluctuate during the time course.
Conclusion
This study showed that BCAO induces acute ischemic responses for about 4 weeks then chronic ischemia in the hippocampus. These in vivo data are the first to show the temporal sequence of apoptosis and HIF-1α expression.
doi:10.3340/jkns.2011.50.6.481
PMCID: PMC3272506  PMID: 22323932
Bilateral carotid artery occlusion; Hippocampus; Hypoxic ischemia; Hypoxia-inducible factor 1α; Apoptosis
10.  Time-Resolved 3D Contrast-Enhanced MRA on 3.0T: a Non-Invasive Follow-Up Technique after Stent-Assisted Coil Embolization of the Intracranial Aneurysm 
Korean Journal of Radiology  2011;12(6):662-670.
Objective
To evaluate the usefulness of time-resolved contrast enhanced magnetic resonance angiography (4D MRA) after stent-assisted coil embolization by comparing it with time of flight (TOF)-MRA.
Materials and Methods
TOF-MRA and 4D MRA were obtained by 3T MRI in 26 patients treated with stent-assisted coil embolization (Enterprise:Neuroform = 7:19). The qualities of the MRA were rated on a graded scale of 0 to 4. We classified completeness of endovascular treatment into three categories. The degree of quality of visualization of the stented artery was compared between TOF and 4D MRA by the Wilcoxon signed rank test. We used the Mann-Whitney U test for comparing the quality of the visualization of the stented artery according to the stent type in each MRA method.
Results
The quality in terms of the visualization of the stented arteries in 4D MRA was significantly superior to that in 3D TOF-MRA, regardless of type of the stent (p < 0.001). The quality of the arteries which were stented with Neuroform was superior to that of the arteries stented with Enterprise in 3D TOF (p < 0.001) and 4D MRA (p = 0.008), respectively.
Conclusion
4D MRA provides a higher quality view of the stented parent arteries when compared with TOF.
doi:10.3348/kjr.2011.12.6.662
PMCID: PMC3194769  PMID: 22043147
Aneurysm; Coil embolization; Stent; Time of flight MRA; Time-resolved MRA
11.  Optimization of MR Parameters of 3D TOF-MRA for Various Intracranial Stents at 3.0T MRI 
Neurointervention  2011;6(2):71-77.
Purpose
The in-stent signal reduction of the stented artery caused by susceptibility artifact or radiofrequency shielding artifact limited the use of time-of-flight MR angiography (TOF-MRA) as a follow-up tool after intracranial stenting. We showed the degree of an artifact according to different stent types, and optimized MR parameters for TOF-MRA in patients with intracranial stent on 3.0 T MRI.
Materials and Methods
Four stents (Neuroform, Wingspan, Solitaire, and Enterprise) were placed in a vascular flow phantom and imaged by changing flip angle (FA; 20°,30°,40°,50° and 60°) and bandwidth (BW; 31, 42 and 62.5 KHz) using TOF-MRA. Source data of each image set with different FA and BW were reconstructed with the maximal intensity projection (MIP) technique, and MIP images were used to evaluate the in-stent signal reduction of each stent according to the change of MR parameters. The in-stent signal reduction was assessed by calculating the relative in-stent signal (RIS) inside the stent as compared with background and signal intensity of the tube outside the stent. The optimal FA and BW of each stent were determined by comparing the RIS in each stent by one-sample t test. Finally, one neuroradiologist chose one image set with the best image quality.
Results
The mean RIS for Neuroform, Wingspan, Solitaire and Enterprise stent was 66.3 ± 6.0, 44.2 ± 5.8, 22.8 ± 3.3 and 8.2 ± 2.9, respectively. The significantly high RIS of each stent was obtained with FA/BW value of 20°/31 KHz (Neuroform), 20°/31 KHz and 30°/42 KHz (Wingspan), 40°/42 KHz and 50°/31 KHz (Solitaire) and 40°/31 KHz and 50°/31 KHz (Enterprise). Among these MIP images with significantly high RIS, images with FA/BW value of 20°/31 KHz (Neuroform and Wingspan) and 50°/31 KHz (Solitaire and Enterprise) had the best image quality.
Conclusion
The degree of artifact was variable according to the design of each intracranial stent. The luminal visualization of closed-cell design stents such as Solitaire and Enterprise can be improved by higher FA. Thus, MR parameter should be adjusted according to the type of intracranial stents.
doi:10.5469/neuroint.2011.6.2.71
PMCID: PMC3214815  PMID: 22125752
Magnetic resonance imaging; Magnetic resonance angiography; Artifacts; Stents

Results 1-11 (11)