Arthroscopic Transglenoid Suture Technique ( Rhee's method ): Cadaveric Studies on Relationship between Pinning site and Neurovascular Structures / 대한정형외과학회잡지

Arthroscopic treatment of shoulder instability involves two techniques mainly, transglenoid suture technique and anterior anchoring system. However, anterior anchoring system has some disadvantages such as limited indication, high cost, technical difficulty and incapability to suture or reconstruct for all types of Bankart lesion. Disadvantages of transglenoid suture techniques are indirect suture tie, bump effect and possibility of the suprascapular nerve injury. The authors use modified transglenoid suture technique (Rhees method) for shoulder instability involving Bankart lesion, type II SLAP lesion and capsular laxity. The purpose of this study is to accurately describe the relationship between the major neurovascular structures and the pinning sites used in transglenoid suture technique (Rhees method). Placement of two or three arthroscopic Beath pinning sites was simulated in four fresh cadaveric shoulder specimens by placing Steinman pins into the glenoid rim under open field. The specimens were then dissected and the relationship of the pinning sites to the suprascapular nerve and suprascapular artery were recorded. In Bankart lesion repair, safe zone of pinning sites were 2 and 5 oclock in two portals in right shoulder, safe zone of pinning sites were 7 and 10 oclock in two portals in left shoulder. Safe direction of pinning was as possible as inferomedial side in scapula. In type II SLAP repair, safe zone of pinning sites were 2 oclock and just above 2 oclock of glenoid in right shoulder and 10 oclock and just above 10 oclock of glenoid in left shoulder. Safe direction of pinning was pararell to glenoid cavity and slightly superior in horizontal plane. From this study, these sites and directions appeared to be safe. Proper pinning depends on careful attention to the topographical anatomy about the shoulder.

Factors Affecting Brain Re-expansion after Simple Burr Hole Drainage in Chronic Subdural Hematoma

Delayed brain re-expansion is one of the most frequent problems on the chronic subdural hematoma. The aim of this study is to determine the factors affecting brain re-expansion. The study consists of 76 patients with the chronic subdural hematoma treated primarily by simple burr-hole drainage from January 1992 to December 1996. Clinical records and radiologic studies were reviewed retrospectively. The age distribution ranged from 22 to 82 years(mean 64 years), the male-to-female ratio was 1.8:1(49:27). At the 2nd, 4th, 6th and 12th week after surgery, the follow-up study was performed with computed tomography or magnetic resonance image. Complete brain reexpansion was defined as that the subdural space was 5mm or less without midline shift on computed tomography or magnetic resonance image. The factors interfering the brain re-expansion are as follows; d age, low Glasgow Coma Scale(GCS) score on admission, history of chronic alcohol consumption, hypodense hematoma on computed tomography, bilateral hematoma, disappearance of intraoperative brain pulsation, and long duration after trauma. The results of this study may be helpful to predict the brain re-expansion after simple burr-hole drainage. If the complete brain re-expansion is not observed immediately, it should be waited for 6 weeks to conduct the follow-up study. Patient's position and sufficient hydration are important for brain expansion. Further investigations on other factors related to promotion of the brain re-expansion should be followed.

Treatment of Aneurysmal SAH with CRF

There are several difficulties in treating aneurysmal subarachnoid hemorrhage(SAH) with chronic renal failure(CRF). First, fluid therapy is not feasible especially in vasospasm. Second, hypertonic solution therapy used to reduce intracranial pressure(ICP) is restricted. Third, hemorrhage2) and disequilibrium syndrome1)2)9) associated hemodialysis can occur. In this article, the authors experienced two cases of aneurysmal SAH with CRF. The first patient was a 57-year old man who suffered from CRF for 8 years. Magnetic resonance angiography had demonstrated a middle cerebral artery(MCA) bifurcation aneurysm on right side. He was treated with early surgery and recovered without neurological deficits. The second patient was a 43-year old woman who suffered from CRF for 5 years. Posterior communicating artery(P-Com) aneurysm was identified on the left side and delayed surgery was performed. After operation, vasospasm occurred and she died of brain swelling from infraction on the left MCA territory. It is noteworthy that the most important factor in aneurysmal SAH with CRF is the prevention vasospasm, because the use of fluid and hypertonic solution therapy is not feasible. To prevent vasospasm, early operation is warranted for the removal of SAH during operation. Non-anticoagulant agent hemodialysis is used during pre and post operative period.

Primary Intraosseous Calvarial Meningioma: A Case Report

Intraosseous meningioma of the skull is a rare benign tumor. A case of calvarial origin examined with computed tomography and bone scintigram is reported. The tumor was located in the left fronto-temporo-parietal region, involving the superior orbital fissure. Total removal of the tumor was performed and histological diagnosis of intraosseous meningioma was obtained. Radiological findings and possible histogenetic mechanism of the intraosseous meningioma are discussed.

Anterior Interbody Fusion to the Cervical Spine for the Range of Motion of the Adjacent Unfused Cervical Intervertebral Joints / 대한척추외과학회지

No abstract available.

Traumatic False Aneurysm: Two Cases of Traumatic False Aneurysm of the Superficial Temporal Artery

Two cases of iatrogenically induced false aneurysm of the superficial temporal artery are presented. One patient showed partially filled aneurysmal sac, 1x1 cm sized, on the main trunk of left superficial temporal artery by external carotid artery angiography. Another patient showed aneurysmal dilatation, 3x2 cm sized, of the superficial temporal artery with direct injection of Urograffin into the pulsatile mass. Aneurysm excision is indicated to reduce the risk of hemorrhage from the subsequent head trauma, to relieve headache, and for any cosmetic defect. The authors have reviewed the literature and discussed the incidence, classification, pathogenesis, clinical and angiographic diagnosis, differential diagnosis, and treatment.

Intracranial Arteriovenous Malformation Associated Intracranial Aneurysms

The simultaneous occurrence of one or more intracranial aneurysm and an intracranial arteriovenous malformation(AVM) in a patient is unusual. Four cases of intracranial aneurysm associated with cerebral arteriovenous malformation(AVM) were found in a total of 67 patients with cerebral malformation(AVM). The site of aneurysm was related anatomically to the arterial supplying arteriovenous malformation(AVM) in 3 cases and the bleeding source was aneurismal rupture in all four cases(100%). It is generally accepted that aneurysm is caused by hemodynamic stress result from the presence of an arteriovenous malformation(AVM). The management of the unusual problem is controversial which are surgical obliteration of both vascular lesion in one stage(2 cases) and surgical obliteration of both vascular lesion in two stages(1 case) were accomplinished with good surgical result.

Ischemic and Hemorrhagic Cerebral Lesion of the Newborn

Stroke in infant was relatively rare. But recently, development of diagnostic tools and infantile intensive care unit were introduced. So, early detection and follow up study were easily performed and the motality of infant stroke was improved. The pathophysiologic factor was multiple such as structural, development and physiological aspects of brain circulation and cardiorespiratory perinatal accidents, which are the cause of several neuropathology. So, preventable secondary factors such as perinatal asphyxia, respiratory manipulation during daily care should be removed thus, mortality and morbidity were decreased. Therefore, the anthors analysized 16 patient, with storke whom age were younger less than 1 year for searching of preventable secondary factors.

Surgical Experience of the Distal Internal Carotid Artery Aneurysm

Bifucation of the internal carotid artery aneurysms are rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In this series, fourteen patients with bifucation of internal carotid artery aneurysms were treated with direct surgery. Tweleve patients of these were treated with clipping, two were treated with coating. 57% of the patients had a good or excellent result and there was a 7% mortality.

Clinical Analysis of Chronic Subdural Hematoma

The authors have experienced 62 cases of chronic subdural hematoma from Jan. 1987 to May 1992 at National Medical Center. In these cases, 58 cases of chronic subdural hematoma were treated with burr hole and closed draninage, 4 cases were managed with conservative management. Male was predominant to female with the ratio of 6:1 and common age was 50-60 years old. Most common causes was head injury and there was cases of chronic subdural hematoma developed after shunt operation. Common symptom was mental change and headache. Brain expansion was delayed in old age group(over 50 years old), Brain CT was available in diagnosis but brain MRI was useful in diagnosis of scantly chronic subdural hematoma. Surgical outcome was related to preoperative neurologic grade and time interval of diagnosis. In this study, clinical improvement rates was 88% in surgically treated cases.

Dissecting Aneurysm of Intracranial Vertebral Artery: A Case Report

Rupture of an intracranial dissecting aneurysm is a rare but dangerous event and are difficult to diagnosis and manage, and carry a high morbidity and mortality. The angiographic features typically showed fusiform dilatation and proximal and/or distal dilatation of the affected artery. Depending of location of dissection, surgical options are;ligation, trapping, or reenforcement of exposed abnormal portion of vessels. The authors report a case of nontraumatic dissecting aneurysm, stroke with subarachnoid hemorrhage(SAH) and the proximal porton of origin of PICA was treated with dlipping of vertebral artery proximal to dissecting aneurysm.

Clinical Analysis of the Brain Abscess

The authors reviewed 24 patients with brain abscess from January 1986 to December 1990. The male to female ratio was 16:8 and most frequently developed at second decades. The commonest cause was chronic ear infection with abscess in the temporal lobe, and common organism was proteus species. All patients received a total of 6 weeks of antiobiotic therapy. Surgery was performed in 24 patients, Drainage of drainage and later capsulectomy may offer a simple, safe and easy removal of capsule. There was no postoperative death or empyema. The most important predictor of outcome was the patients condition when first seen. Early specialist care, computerized tomography, correct choice and dosage of antibiotics, and the surgical methods in present use should make this a benign disease.

Clinical Analysis of the Brain Abscess

The authors reviewed 24 patients with brain abscess from January 1986 to December 1990. The male to female ratio was 16:8 and most frequently developed at second decades. The commonest cause was chronic ear infection with abscess in the temporal lobe, and common organism was proteus species. All patients received a total of 6 weeks of antiobiotic therapy. Surgery was performed in 24 patients, Drainage of drainage and later capsulectomy may offer a simple, safe and easy removal of capsule. There was no postoperative death or empyema. The most important predictor of outcome was the patients condition when first seen. Early specialist care, computerized tomography, correct choice and dosage of antibiotics, and the surgical methods in present use should make this a benign disease.