Extracorporeal Membrane Oxygenation for Acute Life-Threatening Neurogenic Pulmonary Edema following Rupture of an Intracranial Aneurysm

Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.

Intra-Arterial Thrombolysis Using Double Devices: Mechanicomechanical or Chemicomechanical Techniques

OBJECTIVE: To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique. METHODS: From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed. RESULTS: The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was 135+/-83.7 minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration > or =4 points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale < or =2 at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%). CONCLUSION: The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.

A Retrieval Thrombectomy Technique with the Solitaire Stent: Two Case Reports / 대한뇌혈관외과학회지

Two male patients who presented with altered mental states and hemiparesis were treated by retrieval thrombectomy. The occlusion sites were M1 in both patients. During each thrombectomy, a self-expanding and fully retrievable Solitaire stent was partially deployed to cover the whole intra-arterial clot and then was retrieved slowly while occluding the internal cerebral artery with a balloon-guiding catheter. Complete recanalization (defined as thrombolysis of cerebral infarction grade 2b or 3) was achieved in both patients. The procedural time from groin puncture to recanalization was 17 min and 30 min, respectively. Immediate post-operative National Institutes of Health Stroke scores improved to 17 from 22 in one patient and to 19 from 24 in the other patient. There were no procedure-related complications including distal embolisms or post-operative intracranial hemorrhages. We suggest that this technique may be a simple, rapid, and safe thrombolytic method for acute ischemic stroke patients with large artery occlusions.

Transient Cortical Blindness following Cerebral Angiography : Case Report / 신경중재치료의학

Transient cortical blindness is a rare but well-recognized complication of cerebral angiography. A 62-year-old woman with unruptured cerebral aneurysm and a 16-year-old boy with cerebellar hemangioblastoma experienced blindness after diagnostic cerebral angiography and tumor embolization, and the symptom resolved after 1 hour and 36 hours later, respectively. We report two cases of this complication.

Management of Wound Infection after Lumbar Spine Fusion with Instruments

OBJECTIVE: This study is performed to evaluate the risk factors, clinical manifestations, treatments, and prognostic factors among patients with postoperative wound infection after spinal instrumentation. METHODS: The records and radiologic data of 28 patients diagnosed as postoperative wound infection from Jan. 1991 to Oct. 2002 who had underwent spinal instrumentation initially were retrospectively evaluated. RESULTS: All patients(mean age, 50.4 yrs) diagnosed as postoperative wound infection and subsequently received IV antibiotics and continuous irrigation system. The 13 among 28 cases had significant preoperative risk factors(for example, diabetes mellitus, obesity, alcoholism, long-term corticosteroid usage, and chronic renal failure). Infection was diagnosed at an average of 15.9 days after operation. The most common presenting features were local heating, fever, and wound discharge. All patients could be discharged after infection control. At follow up evaluation, 21 case(75%) have not shown recurrence but, the recurrence was developed among 7 cases. The C-reactive protein(CRP) was more correlated with clinical outcomes than other laboratory findings and the recurred group exhibited significant(p<0.05) higher CRP level, compared with the non-recurred group, from 7 days to 21 days after operation. CONCLUSION: Without removal of instruments, surgical removal of infective tissues and continuous irrigation with susceptible antibiotics can be effective in the treatment of postoperative wound infection after spinal instrumentation. CRP level can be an effective parameter of infection treatment and prognosis.

Total Spondylectomy for Giant Cell Tumor of Cervical Spine

Giant cell tumor which is arisen at vertebra is rare and this tumor of the cervical vertebra has been very rarely reported tumor which is less than 1% of all giant cell tumor. When the treatment option is considered, the curretage is often selected rather than total resection because the anatomic relationship of adjacent structures is complicated and there are major vessels and organs around the cervical vertebra. The prognosis of this tumor is decided by degree of resection so, total sponylectomy should be considered as primary surgical option. We report a case of cervical giant cell tumor in which the total spondylectomy was performed successfully and discuss the feasibility of this procedure at cervical region.