Surgical Treatment for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

Ossification of the posterior longitudinal ligament(OPLL) is a degenerative disease of the spine, usually found in the cervical vertebrae. The etiology and pathogenesis have not been clarified, and its natural course is still unknown. The choice of operative approach, anterior vs. posterior, is still controversial. During the past 13 years, we have operated on 116 patients with myelopathy associated with cevical OPLL; 34 cases(29.3%) were of the continuous type, 30(25.9%) were segemental, 37(31.9%) were mixed, and 15(12.9%) were other type respectively. Forty-six patients underwent anterior cervical decompression by corpectomy, disectomy, and removal of the OPLL, and in these patients, segmental and other types of OPLL were more common and were found in 73% of these cases. On the other hand, 70 patients underwent posterior cervical decompression by cervical laminectomy or expansive laminoplasty; among them, the continuous and mixed type were more common and accounted for 84% of these cases. Surgical outcome was better in patients in whom the duration of pre-operative symptoms was shorter(p<0 .05). Age at surgery, trauma history and surgical approach did not, however, significantly affect the outcome. In conclusion, anterior cervical decompression was seen to give the best results, but was limited to patients with segmental or other types of OPLL, single or two levels of OPLL, and OPLL with herniated cervical disc. The posterior approach, on the other hand, was palliative, and gave better results in patients with continuous or mixed type of OPLL, OPLL of more than level three, and generally compromised patients.

Primary Intracranial Choriocarcinoma: Case Report

Primary intracranial choriocarcinoma is a extremely rare neoplasm since the case was reported by Askanasy, in 1906, there have been 35 reported, even if germinal neoplasms containing chorocarcinoma-like tissue are added. But pure choriocarcinoma was rarely reported. The purpose of this paper is to report a case of 18-year-old boy with tumor in subependymal region around left frontal horn, which was present with high level of serum beta chain of chorionic gonadotropin(B-HCG) and was verified as germine choriocarcinoma by biopay.

Blood Glucose Level and Neurological Outcome in Head-Injured Patients

The authors had analysed retrospectively a series of 286 consecutive patients with head injury who were admitted to the department of neurosurgery. Dong Gang Hospital between March and July, 1992. 59 cases underwent craniotomy for evacuation of intracranial hematoma and/or placement of subarachnoid bolt for intracranial pressure monitoring under general anesthesia. Patients with a Glasgow Coma Scale(GCS) Score of 8 or less had significantly higher serum glucose levels postoperatively than patients with GCS score of 12 to 15(p<0.05). Patients who subsequently remained in a vegetative state or died had significantly higher glucose levels postoperatively than patients who had good outcome or moderate disability(p<0.05). Among the more severely injured patients(GCS Score< or =8), a serum glucose level greater than 200mg/dl on admission is associated with a significantly worse outcome(p<0.05). The results suggest that severely head-injured patients frequently showed hyperglycemia and the elevted serum glucose level may worsen the neurological outcome in such patients.