Objective: Vertebral artery dissecting aneurysm (VADA) is a rare and critical disease. VADA rupture can cause subarachnoid hemorrhage which is a major complication of VADA due to their high rebleeding rate and poor outcome. In the present study, ruptured and unruptured VADAs were compared by analyzing angiographic findings to determine useful predisposing factors for VADA rupture for appropriate treatment selection.Methods: Subjects with VADA treated during a 10-year period were retrospectively identified. The 57 cases diagnosed with VADA were divided into ruptured (n=15) and unruptured (n=42) groups. In addition, each case was analyzed using angiographic 3-dimensional (3-D) reconstructed images. Factors such as length, dilated and stenotic diameter, shape, and vessel around the vertebral artery (VA) were measured and statistically compared.Results: In the ruptured group, stenotic findings of the affected lesion were more common and severe than in the unruptured group. The average stenotic diameter was 2.27 mm (vs. 2.84 mm). And stenotic degree was 62% and 53% in the ruptured and unruptured groups, respectively. Posterior communicating artery (PcomA) flow was more common in the ruptured group (87% vs. 55%, p=0.028).Conclusions: Based on angiographic findings, stenotic lesions, which may be influenced by PcomA flow, are more common in ruptured VADAs.

Objective: Unilateral biportal endoscopic (UBE) discectomy and tubular microdiscectomy (TMD) are widely practiced methods for treatment of lumbar disc herniation. Good clinical outcomes of these methods are reported in many papers, but there are a few comparative studies. This study reports the clinical outcomes of UBE and TMD as minimally invasive surgery methods for lumbar disc herniations and discusses the effectiveness of UBE. Methods: Sixty-seven patients who had undergone single-level discectomy using one of two methods, UBE or TMD, underwent a prospective follow-up examination. Thirty-four of these patients underwent discectomy using UBE, and the remaining 33 patients underwent TMD. In addition to the traditional measures of outcome, the improvement of generic health-related quality of life and disease-specific measurements like Visual Analogue Scale (VAS) score, Short-form 36 (SF-36), and Oswestry Disability Index (ODI) were evaluated and compared. Results: Sixty-seven patients with more than 6 months of post-operative follow-up evaluations were included. The mean improvements in the VAS scores for back pain and leg pain and ODI were 2.0, 3.7, and 26.5 for the UBE group and 1.6, 3.0, and 19.4 for the TMD group. The SF-36 physical health component subscale score improved from 35.4 pre-operatively to 54.8 at the last follow-up in the UBE group, and the mental health score improved from 43.5 to 55.1 (TMD group: from 34.9 to 54.3 and 44.2 to 57.1, respectively). Conclusion:The clinical outcomes of the UBE group are comparable to those of the TMD group. The results indicate that UBE for lumbar disc herniation can be performed safely and effectively as a treatment modality.

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.