Effects of Percutaneous Sacroplasty on Pain and Mobility in Sacral Insufficiency Fracture

OBJECTIVE: Sacral insufficiency fracture (SIF) contributes to severe low back pain. Prolonged immobilization resulting from SIF can cause significant complications in the elderly. Sacroplasty, a treatment similar to vertebroplasty, has recently been introduced for providing pain relief in SIF. The purpose of this study is to investigate the clinical short-term effects of percutaneous sacroplasty on pain and mobility in SIF. METHODS: This study is conducted prospectively with data collection. Sixteen patients (3 men and 13 women) with a mean age of 77.5 years (58 to 91) underwent sacroplasty. Patients reported visual analogue scale (VAS; 0–10) and Oswestry disability index (ODI; 0–100%) scores. VAS and ODI scores were collected preoperatively and again at one day, one month, and three months postoperatively. Questionnaires measuring six activities of daily living (ADLs) including ambulating, performing housework, dressing, bathing, transferring from chair, and transferring from bed were collected. Ability to perform ADLs were reported preoperatively and again at three months postoperatively. RESULTS: The mean preoperative VAS score (mean±SD) of 7.5±0.8 was significantly reduced to 4.1±1.6, 3.3±1.0, and 3.2±1.2 postoperatively at one day, one month, and three months, respectively (p<0.01). The mean ODI score (%) also significantly improved from 59±14 preoperatively to 15.5±8.2 postoperatively at one month and 14.8±8.8 at three months (p<0.01). All ADL scores significantly improved at three months postoperatively (p<0.01). CONCLUSION: Percutaneous sacroplasty alleviates pain quickly and improves mobility and quality of life in patients treated for SIF.

Effect of Direct Revascularization in Ischemic Type of Adult Moyamoya Disease / 대한뇌혈관외과학회지

OBJECTIVE: The authors evaluated the effects of direct revascularization (superficial temporal artery-middle cerebral artery bypass) in the prevention of further stroke, including recurrent ischemic event or bleeding in patients with ischemic type of adult moyamoya disease by clinical, pathophysiological and angiographical studies. MATERIALS AND METHODS: Twenty four patients who had ischemic symptoms in adult moyamoya disease were investigated. The mean age of the patients was 40.8 years. The follow up period ranged from 6 months to 8 years. In 24 patients who were surgically treated, thirty one sides (both sides in 7 patients) were performed to superficial temporal artery-middle cerebral artery anastomosis and dura splitting. RESULT: Average follow up period was 4.12 years. Perioperative and postoperative course was uneventful in 16 patients. 2 patients had new ischemic attack probably due to intracerebral steal phenomenon during operation, 6 patients had neurologic symptoms due to change of hemodynamic flow pattern after successful EC-IC bypass that included temporary neurologic deficit in 4, postbypass occlusion of the preoperative stenosis of anterior cerebral artery in one and focal seizure in one. Long term follow up results of 24 patients were showing major deficit in one and minor deficit in two. All patients experienced no further ischemic or hemorrhagic events during follow up period. In postoperative angiogram, drastic diminution of basal moyamoya vessels, which are supposed to be responsible for hemorrhage, was observed in 15 of 18 patients(83%) who were capable of postoperative 3-6 months follow up angiogram. CONCLUSION: In case of adult moyamoya disease, direct bypass surgery is particularly important on the prevention of recurrent ischemic or hemorrhagic events. And a decrease in basal moyamoya vessels was induced significantly by direct bypass surgery, which may reduce the expected risk of hemorrhage effectively. But direct bypass in moyamoya disease had operative morbidity in high frequence. So, moyamoya disease patients who undergo direct revascularization should be monitored carefully during the perioperative and postoperative period.

Orbital Infarction Syndrome after Surgery for Ruptured Anterior Communicating Artery Aneurysm: Case Reports / 대한뇌혈관외과학회지

Orbital infarction syndrome is a rare complication of neurosurgical procedures. The authors recently experienced two patients suffered from acute proptosis, ophthalmoplegia, and blindness developed immediately after surgery for ruptured anterior communicating artery aneurysms. Both patients underwent standard frontotemporal craniotomies to clip their aneurysms. Retinal and choroidal nonperfusion, and ophthalmoplegia, which suggested hypoperfusion of the ophthalmic artery and its branches, consistent with the orbital infarction. We report two cases of orbital infarction syndrome and discuss possible mechanism with literature review.