Clinical Analysis of Postoperative Patients with Electrocardiographic Abnormalities Associated with Aneurysm

Preoperative assessment of electrocardiographical(EKG) abnormalities in the patients with subarachnoid hemorrhage(SAH) is importment. Authors analyzed 58 SAH patients who had EKG abnormalities of neurogenic origin. EKG abnormalities consisted of T wave abnormality, arrhythmia, ST segment change, QT prolongation and U wave. Five patients were dead in this study because of brain swelling(3 cases) and cerebral spasm(2 cases). EKG abnormalities were normalized 13 days after aneurysmal SAH. Radioactive nuclear(99mTc-pyrophosphate) scan of myocardial revealed normal findings in the patients with EKG abnormalities of neurogenic origin. It is concluded that life-saving surgical intervention need not be delayed in the patients with EKG abnormalities of neurogenic origin. On the other hand, patients who had cardiac origin EKG abnormalities need a careful and detailed preanesthetic cardiac evaluation.

Results of Stereotactic Evacuation of Hematoma and External Ventricular Drainage in Comatose Patients with Hypertensive Supratentorial Intracerebral Hemorrhage

The purpose of this study was to analyze and evaluate therapeutic results of stereotactic evacuation of hematoma, urokinase irrigation and external ventricular drainage(EVD) in comatose patients who had hypertensive supratentorial intracerebral hemorrhage. The authors carried out stereotactic evacuation of hematoma and external ventricular drainage in the consecutive 45 cases who were admitted to the Department of Neurosurgery, Chosun University Hospital. from Sep. 1990 to Jun. 1993. The therapeutic results were as follows : 1) The peak age incidences were 6th to 7th decades. The incidence was higher in female than male. The age was not related to the prognosis. 2) The hematoma was located at the basal ganglia in 37 cases, and the thalamic area in 8 cases. The prognosis was poorer as the area of hematoma extended more wider and deeper. 3) The volume of hematoma ranged from 8 to 155 ml. The prognosis of the patient was unfavorable in large volume of hematoma. 4) Intraventricular hemorrhage(IVH) occured in forty cases(89.9%) and mortality rate was 45%. The mortality rate was increased in cases with IVH than in case without it. 5) The mortality rates based on the Glasgow coma scale(GCS) on admission were 50% in GCS score 4 group, 50% in GCS score 5 group, 40% in GCS score 6 group, 27% in GCS score 7 group. Cases of low Glasgow coma scale on admission showed high mortality rate. 6) The overall mortality rate was 42%. These results suggest that stereotactic evacuation of hematoma and EVD decreased the mortality rate when compared with conservative treatment and conventional craniotomy in the literatures.

CT and MRI Compatibility of Titanium Pedicular Screw System(DipasonTM)

After spinal fixation using conventional stainless steel screw fixation system, postoperative evaluation of spinal canal and identification of screw positions are very difficult because of severe image halation on computerized tomography(CT) or magnetic resonance imaging(MRI). As a result, diagnosis is interfered in cases of screw malposition, infection, and when demonstration of spinal decompression is needed. For this reason, titanium implants have been developed. Titanium is neither magnetic nor paramagnetic, so it produces minimal artifacts on CT or MRI. Titanium pedicular screw system(DipasonTM) is one of these instruments. In this study, the authors investigated the compatibility of this instrument with CT and MRI postoperatively. The use of titanium pedicular screw system permits high quality image of spinal cord, nerve root and screws on CT and MRI.

Electron Microscopic Study on the Development of the Spinal Ganglion of Human Fetus

The development and differentiation of cells in the spinal ganglion were studied by electron microscopy in human fetuses ranging from 12 mm to 260 mm crown rump length. At 12 mm embryo the primitive neuroblasts which had a single process, contained a large numbers of free ribosome and mitochondria but very little rough endoplasmic reticulum. At 30 mm fetus, the primitive spinal ganglion consisted of bipolar neuroblasts, satellite cells and undifferentiated cells. Spindle-shaped bipolar neuroblasts formed spinal ganglion of loosely grouped cells at 50 mm fetus. Two neuroblast cell types, a small cell contained large clumps of rough endoplasmic reticulum at periphery, could be distinguished. At 80 mm fetus, the spinal ganglion constituted of bipolar neuroblast with apparently random distribution of small and large neurons with processes, together with satellite cells and blood vessels. The presences of a large numbers of neurotubules in the Golgi-central region were one of the first sign of further maturation of the neuroblast. During next prenatal stage from 120 mm on fetus, the ganglion cells were large and contained much rough endoplasmic reticulum, neurotubules and extensive Golgi complex. A large number of neuroblasts became transformed into unipolar cells from 180 mm to 260 mm feuts. Nissl bodies appeared during this stage. The ganglion-satellite cell boundary became complicated with increasing age, then enlarging in parallel with the increase in volume of the nerve cell. During next prenatal stage up to 180 mm fetus, the unipolar ganglion cell increased in number and size, and the cytoplsm contained all intracytoplasmic structures which were also found in mature spinal ganglion except for large pigment granules.

Transabdominal Midline Approach for the Management of Tuberculous Spondylitis in Lumbosacral Area

Bone and joint involvement develops in approximately 10 percent of patients with tuberculosis and half of these affected patients have tuberculosis of the spine. In the treatment of tuberculous spondylitis evacuation of the contents of the abscess, including the bone sequestra and the sequestrated intervertebral discs, combined with removal of all avascular bone and anterior fusion with a strut graft has widely applied since Hodgson and Stock published their successful results in 1960. Surgical approaches to the vertebral bodies at different levels, either anterior, anterolateral or modified approach, have been described in order to improve the exposure. The upper lumbar vertebral lesion is well exposed by the lateral or anterolateral approaches. But exposure of the lumbosacral lesion is limited because of iliac bone and other surrounding vital organs. We describe a surgical approach to lumbosacral spine which allows an adequate exposure of the vertebral bodies from L4 to S1. The transabodminal midline approach seems to be useful method for the lumbosacral vertebral body lesion, allows adequate exposure and easy reconstruction.

Clinical Analysis of Surgically Treated Moyamoya Diseases

Moyamoya disease is a progressive occlusive cerebrovascular disease that can cause severe permanent disability. To minimize the ischemic deficit, various surgical methods have been tried. Six cases treated surgically are presented, 10 sides with encephaloarteriosynangiosis and 1 side with superficial temporal-middle cerebral artery anastomosis and encephalomyosynangiosis. Among these six cases, three cases were associated with intracerebral and intraventricular hemorrhage, and two cases were associated with intracerebral and intraventricular hemorrhage and demonstrable aneurysm, and the other was associated with cerebral infarction. All patient were reviewed and had not ischemic deficit or rebleeding during the follow-up period. The patient's clinical status and results are presented and literatures that have been reported are reviewed.

Posterior Stabilization with Interlaminar Clamps in Unstable Cervical Spine Injures

Conventional methods for stabilization of unstable cervical spines caused by flexion injury are sublaminar wiring and palte and screw fixation. These methods, however, carry the risk of damage to the cervical cord and or vertebral artery. We have used interlaminar clamps for the stabilization of sixteen cases of unstable cervical spine, including for cases of odontoid process fracture. There was suecessful fusion in all cases, no slippage of clamp and no deterioration of neurological function. Advantages of this method include the fact the there is no need for bone graft and that it is technically easy and inexpensive. Good stabilization allows early ambulation and so prevents complications such as pneumonia and decubitus ulcer.

A Case of Third Ventricular Cysticercosis

Cerebral cysticercosis is relatively common disease in Korea. But cysts in the ventricular system are rare form. In the ventricular system, they occur most frequently in the 4th ventricle, more rarely in the lateral and 3rd ventricle. We have recently experienced a case of cerebral cysticercosis which involved the 3rd ventricle. A sixty-year old man was admitted because of generalized seizure attack followed by drowsy mentation. On admission, there were no specific localizing and lateralizing neurological abnormalities except bilateral, mild degree optic papilledema. Brain CT scan after intraventricular metrizamide administration disclose a cystic mass in the third ventricle. And the serum ELISA test was positive(patient's titer : 0.31, normal : below 0.18). Anterior transcallosal approach was performed and cystic mass was removed from the third ventricle. Pathological diagnosis of the specimen was cysticercosis. Following surgery, the patient's symptom cleared up and papilledema disappeared gradually.

Anterior Interbody Fusion Using Kaneda Device in Unstable Thoracolumbar Spinal Lesions

Recently anterior spinal device in the treatment of the unstable thoraco-lumbar spine has been used. We have experienced 11 patients of the unstable thoraco-lumbar spine, which were composed of 8 patients with burst fracture and 3 patients with tuberculous spondylitis. The 11 patients with neurological deficit were treated with an one stage anterior operation consisting of anterior decompression through vertebrectomy, realignment with Kanedae device. No patient showed neurologic deterioration after surgery. The anterior spinal instrumentation with Kaneda device afford enough stability to enable early ambulation with good alignment and solid fusion.

A Case of Lateral Ventricle Choroid Plexus Papilloma in a Child

The choroid plexus papillomas are uncommon neoplasms of the central nervous system, and constitute 0.5~0.6 percent of intracranial tumors. These tumor are surgically treatable and the encouraging results of surgical removal justify an aggeressive surgical approach. We present a case of lateral ventricle choroid plexus papilloma in a child with communicating hydrocephalus.

A Case of Syringomyelia in Cervical and Thoracic Spinal Cord(C2~T10) Associated with Chiari Malformation

We have recently managed a case of syringomyelia associated with Chiari I Type malformation. The syrinx was found at C2 level to T10 level. And the patient complained left forearm pain and paresthesia in left shoulder, arm with segmental dissociated sensory loss. The cranio-vertebral decompression(suboccipital craniectomy, cervical laminectomy) and the shunting procedures were performed. Postoperative course was not uneven, the clinical and neurological improvement was observed. M.R.I. permitted rapid, exact diagnosis including localization of syrinx and information of associated anomaly.