A 59-year-old man presented with both leg radiating pain and paresthesia for 4 years. Other physical findings were not remarkable. MRI showed a large, elongated posterior extradural cyst from T12 to L3 with surrounding bony erosion (Fig. 1A, B).Thinned overlying laminas were found on operative field and the cyst was ruptured during laminectomy. There was a hole-like dural defect near to right L1 root sleeve and we performed primary closure of the defect. Some part of cyst wall was also removed.The patient's symptoms were gradually subsided and follow up image taken 1 month after the operation showed complete disappearance of the cyst (Fig. 1C). Case 2A 51-year-old female patient visited our clinic with left buttock pain and paresthesia for 3 years. Her pain was aggravated on coughing and she also complained of gait disturbance with both sole numbness on walking.MRI showed a large extradural cyst located posterior to the INTRODUCTIONSpinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. SEAC is more commonly found among male patients and during the second decade of their life. SEACs can be found in any location, although mostly reported to be located at mid thoracic to the thoraco-lumbar junction, commonly in a posterior position 1,3,4,6,10,12) . SEAC is an outpouching herniation of arachnoid membrane through a dural defect that may communicate to intradural subarachnoid space 5) . The etiology of this herniation is still unclear and can be either congenital or acquired 6) . These cysts can result in fluctuating symptoms associated with cord or root compression. It is assumed that they can be enlarged by subsequent pressure change in the cerebrospinal fluid (CSF) during exercise and Valsalva maneuvers as there is micro-communication between the cysts and subarachnoid space 2,6) . Despite the rarity of SEACs, they are important in neurosurgical view because they are surgically curable disease. Diverse surgical techniques have been introduced and many reports reviewed favorable outcome of SEACs with surgical treatment. We experienced 2 cases of SEACs and performed cyst fenestration and primary repair of dural defects for all of them. The aim of this article Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaSpinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cys...

Objectives. This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty.Methods. This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated.Results. The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P =0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P =0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P =0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P =0.304). Pre-and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group. Conclusion.With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

Epstein-Barr Virus Infection associated Transverse Myelitis with Brain Involvement in an Immunosuppressed Patient: A Case Report A 19-year-old girl with immunosuppressive agents of tacrolimus and mychophenolate mofetil following liver transplantation due to glycogen storage disease visited hospital due to lower extremity motor weakness and blurred vision. Motor power was checked as grade II in the upper extremities and grade 0 in the lower extremi ties with absence of deep tendon reflexes and anal sphincter dysfunction. The mag netic resonance imaging (MRI) showed increased T2 high signal intensity lesions from C4 to L2 level of spinal cord, cerebral cortex, and the left optic nerve. The cerebrospinal fluid (CSF) analysis showed pleocytosis. Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) was detected as 5,954 copies/mL in CSF whereas all other microbiologic tests were negative. Anti-aquaporin 4 antibody and oligoclonal band were not detected. Intravenous immunoglobulin, methylprednisolone pulse therapy and 3-week course of acyclovir were administered. Although motor power in the upper extremities recovered to grade V, motor power in the lower extremities did not show any improvement. The EBV viral load was not detected in the follow-up CSF examination. EBV infection in an immune-compromised patient could cause extensive demyelinating diseases in central nervous system and result in severe disability.

Osseous hemangioma typically occurs in the vertebral column or skull bones. It it is extremely rare in the nasal bone. Only nine cases originating in the turbinate and maxillary bone have been reported in the English and Korean literature. Herein, we present the case of a 51-year-old women with a dorsum mass to share our experience with intraosseous hemangioma successfully removed and reconstructed by an endonasal approach.

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