Endoscopic Spinal Surgery for Herniated Lumbar Discs

OBJECTIVE: So called "minimally invasive procedures" have evolved from chemonucleolysis, automated percutaneous discectomy, arthroscopic microdiscectomy that are mainly working within the confines of intradiscal space to transforaminal endoscopic technique to remove herniated epidural disc materials directly. The purpose of this study is to assess the result of endoscopic spinal surgery and favorable indications in the thoracolumbar spine. METHODS: The records of 71 patients, 73 endoscopic procedures, were retrospectively analysed. Yeung Endoscopic Spine Surgery system with 7 mm working sleeve and 25degrees viewing angle was used. The mean follow up period was 6 months (range,3-9). RESULTS: Operated levels were from T12-L1 disc down to L5-L6 or S1 disc. Of 71 cases, 2 patients underwent transforaminal endoscopic surgery twice due to recurrence after initial operation. MacNab's criteria was used to assess the outcome. Favorable outcome, excellent or good, was seen in 78% (57 procedures) of the patients. Among 11 fair outcomes, only 1 procedure was followed by secondary open procedure, laminectomy with discectomy. Two of 5 poor outcomes were operated again by same procedure which resulted in fair outcomes. One patient with aggravated cauda equina syndrome remained poor and a lumbar fusion procedure was performed in other patient with poor outcome. There were 2 postoperative discitis that were treated with conservative care in one and anterior lumbar interbody fusion in the other. CONCLUSION: Evolving technology of mechanical, visual instrument enables minimal invasive procedure possible and effective. The transforaminal endoscopic spinal surgery can reach as high as T12-L1 disc level. The rate of favorable outcome is mid-range among reported endoscopic lumbar surgery series. Authors believe that the outcome will be better as cases accumulate and will be able to reach the rate of standard open microsurgery.

Multiple Aneurysms in the Anterior Communicating Artery: Case Report

Multiple aneurysms arising from the same intracranial artery are rare. A few cases of multiple aneurysms of the anterior communicating artery(ACoA) have been reported in the literature. The authors present a 60-year-old female patient who had multiple aneurysms on the ACoA with systemic vasculitis. There were four aneurysms around the ACoA region. Two sizeable aneurysms had completely separated necks on each side of the ACoA. The ruptured larger aneurysm projected in an anteroinferior direction, whereas the unruptured smaller one projected superoposteriorly. Both aneurysms were surgically confirmed and clipped. Two bleb-like microaneurysms, located on ACoA and perforating artery each, were coagulated and reinforced.

Retroperitoneal Hematoma after Excision of Lumbar Extradural Arachnoid Cyst: Case Report

Many cases of retroperitoneal hematoma related to spine surgery have been reported, however, most of them were caused by major vessel injury related to intradiscal or retroperitoneal procedures. We report an unusual case of a retroperitoneal hematoma followed by surgical excision of the lumbar extradural arachnoid cyst without intradiscal procedure. To our best knowledge, this complication without intradiscal procedure has not been described previoulsly. The pathogenetic mechanism of retroperitoneal hematoma in this report is unclear. We discuss the plausible pathophysiological mechanisms of retroperitoneal hematoma which developed after excision of arachnoid cyst.

Mirror-Image Intracerebral Hemorrhage in Basal Ganglia: Case Report / 대한뇌혈관학회지

Intracerebral hemorrhage in the brain is the most common complication of hypertension, aneurysmal rupture, or vascular malformation. The occurrence of symmetrically bilateral intracerebral hemorrhage is an unusual clinical event that develops in only a small percentage of all patients who have intracerebral hemorrhage. Even though, the size of contralateral hemorrhage is not too large, majority of patients with bilateral intracerebral hemorrhage in basal ganglia or thalamus have generally a poor outcome. In all cases of this report, the contralateral intracerebral hemorrhage was resulted from an inadequate control of hypertension. Therefore, optimal control of blood pressure must be considered as the most important treatment option to prevent recurrence. Authors report the characteristic clinical and radiologic features of four cases in which mirror-image bilateral intracerebral hemorrhage occurred.

Posterior Lumbar Interbody Fusion Versus 360degrees Fixation in Degenerative Lumbar Diseases

OBJECTIVES: The goal of operation for degenerative lumbar diseases is to relieve radiculopathy and low back pain and to prevent further degeneration. The authors analyzed the surgical results of posterior lumbar interbody fusion(PLIF) and 360degrees fixation to evaluate the proper treatment policy in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. MATERIAL AND METHODS: The authors performed PLIF on 92 patients and 360degrees fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. We retrospectively studied clinical outcomes and subjective satisfaction of these patients by several criteria such as visual analog scale(VAS), Prolo's economic and functional outcome scale, medication usage after operation and questionaire for overall outcome. RESULT: Pre- and postoperative VAS on back pain and leg pain showed decrease of pain from 6.5, 6.7 to 2.2, 2.4 in PLIF group and from 7.0, 7.2 to 2.5, 2.7 in 360degrees fixation group. Excellent and good outcomes on Prolo's scale were 81.5% in PLIF group and 82.6% in 360degrees fixation group. Medication usage after operation was reduced in 79.3% of PLIF group and in 78.3% of 360degrees fixation group. Patients' self-reported overall success of their procedure showed 82% in PLIF group and 84% in 360degrees fixation group. CONCLUSION: Both PLIF and 360degrees fixation showed good outcomes and provided biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Therefore, only PLIF seems necessary and considered a proper surgical treatment for these disorders.

Overview of Surgical Result of Multiple Intracranial Aneurysmal Patients

From January 1990 to January 1996, we analyzed outcome according to the distribution of aneurysms, the type of surgical treatment, the timing of operation, and the patient's pre-operative status in a total of 54 cases of multiple intracranial aneurysms. The frequency of multiple intracranial aneurysms was 13.4% and the sex ratio was 1:2 with female being predominant. The frequency of aneurismal location was MCA(35.0%), P-comm. Artery(25.0%) and A-comm. Artery(15.0%) in that order. The number of ruptured aneurysms was in the order to MCA aneurysms. A-comm aneurysms, and P-comm aneurysms. The size of ruptured aneurysms was 6-10mm in 34 cases(64.2%). The unilateral distribution of aneurysms was 31 cases(57.4%) and the bilateral was 28 cases(42.6%). Depending on how many times the patient had the operation, these were 29(57.4%) cases of complete single operation, 17 cases(31.5%) of complete two-stage operation, and 8 cases(14.8%) of partial operation. Surgical outcome was good(GOS< or =4) in 42 cases(77.8%), and six patients(11.1%) expired. Based on the results of the above study we have concluded that initial Hunt-Hess grade has a close relationship with the outcome, but the operation type, the timing of operation, the number and distribution of aneurysms do not significantly effect the outcome.

Primary Rhabdomyosarcoma in Temporal Bone Invading Petrous Bone

The rhabdomyosarcoma(RMS), a leading malignant soft tissue tumor in the pediatric population, occurs most commonly in the craniocervical region. RMS has involved the temporal bone approximately 7% in the literature. Petrous bone invasion was very rare and the overall outcome was always fatal, in spite of the efficacy of multimodality therapy, until recent years. The authors report a case of primary RMS in the temporal bone invading petrous bone and the result of multimodality treatment.