Shunt Function Test Using Radioisotope and ICP Monitoring

OBJECTIVE: Authors report the usefulness and limitation of shunt function test. METHODS: Of 457 who underwent shunt placement from 1993 to 2001, 33 patients with suspected shunt malfunction underwent the shunt function test using radioisotope and intracranial pressure(ICP) monitoring to evaluate shunt patency and to determine the site of obstruction. We analyzed retrospectively results of 36 shunt function test with operative finding in shunt revision. RESULTS: Of 36 results, 21 cases(58.3%) had patent shunt on the shunt function test and one of those underwent shunt revision regardless of the result. Five cases(13.8%) had proximal malfunction on test and three cases of those had obstruction in the shunt revision. Ten cases(27.2%) had distal malfunction on test and eight cases of those had obstruction. The sensitivity of shunt function test was 91.6%, the specificity 90.9%, and the accuracy 81.6%. CONCLUSION: The shunt function test using radioisotope and ICP monitoring is a reliable method to evaluate shunt patency. However, interpretation of the result should be based on the clinical and radiological findings of the patient, particularly in case of partial obstruction and functional malfunction due to valve system.

Inflammatory Response of the Brain to the Intraparenchymal Injection of Lipopolysaccharide in Neonatal Rat

OBJECTIVE: Central nervous system has unique inflammatory responses to the exposure to the endotoxin and immature brain may have a different response with that of the mature. The authors conduct this experiment to elucidate the characteristics of inflammatory response in immature brain. METHODS: Lipopolysaccharide(LPS) was injected in the right caudate nucleus in 7-day-old and adult Sprague-Dawley rats. The doses were 1 microliter of 0.1, 0.5, and 2.0mg/ml of LPS and the same amount of saline for controls. The rats were sacrificed 24hours after injections. Light microscopic examination was performed to evaluate the leukocyte recruitment, and reverse transcriptase-polymerase chain reaction(RT-PCR) to measure the expression of interleukin-1beta(IL-1beta) and tumor necrosis factor-alpha(TNF-alpha) mRNA. RESULTS: Light microscopic examination revealed more pronounced leukocyte infiltration in neonatal brain than in adult, even though lower than in peripheral tissue. RT-PCR revealed dose dependent expression of IL-1beta and TNF-alpha mRNA in both neonatal and adult brain as in peripheral tissue. CONCLUSION: These results support that the immature brain is more vulnerable to the LPS induced inflammation in terms of leukocyte infiltration and possibly resultant brain damage. However, the mechanism of inflammatory response in immature brain should be studied further in association with the research of the activity of microglia, astrocyte, blood brain barrier, chemokine, and adhesion molecule in immature brain.

Pituicytoma: Case Report

We report a case of Pituicytoma, which is a rare brain tumor occuring in the sellar region. A 44-year-old woman presented with polyuria, polydipsia, visual disturbance, amenorrhea and galactorrhea 1 year prior to admission. A magnetic resonance image revealed a well enhancing pituitary mass with large suprasellar extension. There was no area of normal hyperintensity showing the posterior lobe of the pituitary gland. The tumor was subtotally removed via transsphenoidal surgery. Pathological examination of the surgical specimen showed astrocytes with spindle-shaped fibrillary cytoplams. Immunohistochemical staining was positive for glial fibrillary acidic protein, S-100, vimentin. Radiotherapy was not given after surgery.

Vein of Galen Malformation in a Neonate: Case Report

A vein of Galen malformation(VGM) is a rare vascular malformation, often resulting in high morbidity or mortality. In the newborn, cardiac failure is the most common presenting, sign and the outcome is particularly poor. As the technique of neurointervention develops, embolizaton is known to be the choice of treatment reducing the mortality rate tremendously. The authors report a case of VGM, diagnosed in uterus and successfully managed by neuro-interventive treatment.

Multiple Primary Brain Tumors: Association of Intraventricular Meningioma and Callosal Astrocytoma: Report of Two Cases

Two patients presenting with intraventricular meningioma and callosal astrocytoma are described. The first case is a 51 year old female presented with headache and paraparesis. Magnetic resonance imaging revealed meningioma in the left occipital horn of lateral ventricle and astrocytoma in the corpus callosum, which were confirmed by operative removal and biopsy respectively. The second patient had been removed the meningioma in the left lateral ventricle. Seven years later poorly marginated enhancing lesion was found on the corpus callusum which was confirmed as astrocytoma by computed tomography guided biopsy.

The Clipping on Supraclinoid Internal Carotid Artery Aneurysms

OBJECTIVE: We present a clinical analysis to envision the difficulties in supraclinoid internal carotid artery(ICA) aneurysmal neck clippings to improve the postoperative outcome. METHODS: Two hundred and fifty aneurysm surgeries were undertaken at our hospital from 1997 to 1998. There were 52 patients(20.4% of the total) of supraclinoid ICA saccular aneurysmal patients. Eighteen cases(34.6%) were found with diverse difficulties in direct neck clippings. The authors analyzed the causes of surgical difficulties in the clipping on supraclinoid ICA aneurysms, in a clinical perspective. RESULTS: Perfect aneurysmal clippings were performed in 45 patients(86.5%) of the total 52 cases of supraclinoid ICA aneurysms. The clipping and wrapping were needed in five cases(9.6%), trapping in one(1.9%) with one case(1.9%) needed only for wrapping. The causes of difficulties in direct neck clipings were : aneurysm sac involving perforator in six cases(11.5%), too short an ICA proximal to posterior communicating artery for temporary clipping in 5(9.6%), posterior communicating artery aneurysm directed to the ventral side in three(5.8%), dorsal wall aneurysm in one, severe atheromatous ICA in one, a larger sac than in angiographic finding with partial thrombosis in one, severe adhesion of aneurysm to 3rd cranial nerve in one patient. CONCLUSION: For supraclinoid ICA aneurysm surgery, sufficient preoperative plans and careful inspection including angiographic findings to foresee the various difficulties of neck clippings are needed.

Posttraumatic Seizures in Children: Risk Factors and Prophylactic Antiepileptic Drugs

OBJECTIVE: Identification of risk factors and prevention of the seizures are very important in the management of the pediatric traumatic brain injury(TBI). The authors conduct a study to find the risk factors of the pediatric posttraumatic seizures(PTS) and effectiveness of the prophylactic antiepileptic drugs(AED). METHODS: We respectively analyzed 82 pediatric patients below the age of 15 who visited our hospital with TBI from August 1995 to May 2001. Mean age at arrival was 6.1 years, ranging from 2 months to 15 years. Male to female ratio was 1.9 : 1. Mean follow-up period was 3.9 months ranging from 0.5 to 42 months. RESULTS: Among the 82 patients, 13(15.8%) experienced PTS. In eight of the 13 seizure patients, the seizures developed within 24 hours after trauma. Patients with Glascow coma scale score less than 8 had higher rate of seizure attack. Forty-seven patients(58%) used AED within 24 hours after trauma. Among them, two patients experienced seizure attacks. Among the other 35 patients who had not received prophylactic AED, 11 patients(31%) had seizures with significantly higher rate of PTS. CONCLUSION: PTS are common complication in pediatric TBI. Use of prophylactic AED in the early stage of TBI can reduce the development of early seizures.

Gliomatosis Cerebri: Clinical Features and Prognosis

OBJECTIVES: Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of the underlying cytoarchitecture. The aim of this study is to evaluate clinical features, outcome of surgical treatment and adjuvant therapy of gliomatosis cerebri. METHODS: Between Jan. 1990 and Dec. 2000, 12 patients were diagnosed with gliomatosis cerebri based on characteristic radiological and histological findings. The patients' age ranged from 18 to 77(mean 44) years and the male to female ratio was 7: 5. Nine patients underwent decompressive surgery and three, biopsy only. Postoperative radiation therapy was given in all cases except three. In addition to radiation therapy, four patients received chemotherapy. The mean duration of follow-up period was 18.8 months. RESULTS: The most common presenting symptom were seizure and motor weakness. The mean duration of symptom was 5.9 months. There was 5 bilateral lesions and tumor involved corpus callosum in 5, basal ganglia-thalamus in 4, and brain stem in 2. There was no operative mortality but four patients died during the follow-up. The mean survival period for 11 patients was 20.5 months from the time of diagnosis. In univariate analysis, the lesion involving corpus callosum, basal ganglia-thalamus and brain stem correlated significantly with the short length of survival(p<0.05). Also, postoperative radiation as a adjuvant therapy prolonged the patient's survival(p<0.05). CONCLUSIONS: In the management of gliomatosis cerebri patients, early detection by MR imaging, active management of increased intracranial pressure, decompressive surgical removal and postoperative adjuvant therapy such as radiation is thought to be a good treatment modality.

Sequential 1H MR Spectroscopy (MRS) Studies of Kaolin-Induced Hydrocephalic Cat Brain

No abstract available.

Anterior Screw Fixation of Type II Odontoid Fracture

No abstract available.

Posterior C1-2 Transarticular Screw Fixation without C1-2 Sublaminar Wiring in Atlantoaxial Instability

No abstract available.

The Clinical and Radiological Analysis of Shunt-Dependent Hydrocephalus after Acute Hydrocephalus in Surgical Aneurysmal Patients

No abstract available.

Spontaneous Hematomyelia: Case Report

No abstract available.

The Time and Effect of Hypothermia in Early Stage of the Reversible Cerebral Focal Ischemic Model of Rat

No abstract available.

Anterior and Posterior Fusion on Reduction-failure Unilateral Interfacetal Dislocation

OBJECTIVE: Unilateral interfacetal dislocation(UID) is a common injury in cervical spine, but diagnosis is somewhat difficult due to mild subluxation. Management of'locked facet' is not established yet and many authors advocate posterior fusion to secure stability. Because most of UID patients have minimal neurological symptom with normal activity, we tried anterior and posterior fusion simultaneously. PATIENTS AND METHODS: Various parameters, such as the radiological findings, operation time and methods, kinds of fixation devices, post-operative stability, neurological outcomes in 10 UID-patients, who showed no satisfactory closed reduction with Gardner tong traction. These patients underwent anterior fixation following posterior open reduction and fusion to maintain the definite stability. RESULTS: Median age was 40 years(18-64 range) and the male to female ratio was 7:3. Causes of injury consisted of 6 car accident, 3 fall-down, 1 diving accident. Mechanism of injury was flexion in all ten cases. Levels of injury were 2 in C4-5, 5 in C5-6 and 3 in C6-7. Operations were performed within 5 days of injury in eight patients. In two patients, who had no reduction procedures were operated on the 23rd day and the 4th month respectively. Kinds of device were: 7 titanium wire and 3 steel wire in posterior wiring, 9 Caspar nonlocking plate and 1 Orion locking plate in anterior plate fixation. All patients were ambulated at post-operative one day with Philadelphia cervical collar and showed post-operative stability with improved neurological outcome. CONCLUSION: In UID patients who failed in closed reduction with traction, anterior discectomy and bone fusion and plating following posterior open reduction and wiring proved good results.

Pedicle Screw Fixation and Posterolateral Fusion for Thoracolumbar Spine Fracture

From January, 1996 to December, 1997, 24 patients with unstable thoracolumbar spine fracture were treated with pedicle screw fixation and posterolateral fusion. The present study is a retrospective analysis on various clinical paramaters such as age, sex distribution, causes of injury, levels of injury and outcomes. The mean follow-up period was 17 months(range, 4-26 months) after their initial operation. Reduction and stabilization was attained without complications. Sixteen patients with Frankel Grade-C,D,E returned to full-time work, but 8 patients with Frankel grade-A, B were not significantly improved. Maximum neurologic recovery can be expected with prompt and adequate decompression, restoration of normal spinal alignment and rigid internal fixation.

Pediatric Head Injury

Pediatric head injury is a leading cause of disability or death in children. Reducing morbidity and mortality require careful attention to the factors leading to poor prognosis. In this regards authors reviewed the clinical features of pediatric head injury to find out the prognostic factors. From 1992 to 1996, 96 pediatric head injury patients were admitted to our hospital. Seventy eight of them(81.3%) were transferred from the other hospitals. Pedestrian vehicle accident and fall were the leading causes. Clear or drowsy patients account for 42.7 %, stuporous, semicomatose or comatose, 57.3%. Early seizures were noted in 18(18.8%). Outcome were good in 68(70.8%), moderate to severe disability 18(18.8%), vegetative 3(3.1 %), and died 7(7.3%). Consciousness level was the most significantly related with poor prognosis. Radiological deterioration, hematoma or edema, was noted in thirteen patients, and their prognosis was significantly worse than others(p=0.01). Those patients with complications occurred during admission such as pneumonia or electrolyte imbalance showed poorer prognosis (p<0.05). In conclusion outcome of the pediatric head in Jury was significantly related to the initial mentality, worsening of hematoma or edema on follow up CT scan, and complications such as pneumonia and electrolyte imbalance during admission . Early recognition of these factors would contribute to the improvement of the outcome of the pediatric head injury patients.

The Effects of Intraventricular Injection of Lipopolysaccharide on the Periventricular Neural Tissue

Ventriculitis is one of the most serious complication of the ventriculoperitoneal shunt, which may cause intelligence deterioration in children. The purpose of this study is to investigate the mechanism of the neural damage in lipopolysacciride(LPS)-induced ventriculitis in rat. Ventriculitis was induced by intraventricular injection of 1mg/Kg LPS in rat. H & E and Tunel stains were done on the day 1, 2 and 14 to access the microscopic changes of the periventricular tissue and apoptosis, respectively. TNF-alpha and IL-1beta mRNA expressions were studied using RT-PCR. HRP was injected into the femoral vein and electron microscopic examinations were performed to access the BBB changes. Light microscopic examination one day after LPS injection revealed neutrophilic infiltration, which diminished on day 4, and disappeared on 14. Tunel stain revealed apoptosis on day 1 and 4. TNF-alpha and IL-1beta were expressed on day 1, and diminished progressively thereafter. HRP histochemical electron microscopic examination revealed accumulation of HRP reaction in the interstitial space around the brain parenchyma. These findings suggest the opening of the BBB and increased capillary permeability in the periventricular tissue in the LPS induced ventriculitis. This can possibly damage the periventricular neural tissue. TNF-alpha and IL-1beta seemed to play an important role in the opening of the BBB.

Risk Factors in Patients with Rebleeding after CT-Guided Stereotactic Burr Hole Aspiration for Hypertensive Intracerebral Hematoma

This retrospective comparative study involved 282 hypertensive intracerebral hemorrhage patients admitted to Kyungpook University Hospital between January 1991 and January 1993 for the evaluation of clinical risk factors of rebleeding. For all patients, surgery involved CT-guided stereotactic burr-hole aspiration. In 39(13.8%), postoperative rebleeding occurred at the site of the hematoma. The mean age of both the rebleeding and non-rebleeding group was 58. In the rebleeding group, the male to female ratio was 19:20(1:1.1), and in the non-rebleeding group, the corresponding figure was 113:130(1:1.5). The amount of intracerebral hematoma appearing on brain CT during the 24 hours following surgery was measured and defined as rebleeding in cases where the amount was the same as or more than before surgery. In comparative analysis, the authors defined the following hypothetical clinical risk factors: age, location of hematoma, pre-op systolic blood pressure, volume of hematoma, pre-op consciousness, time interval from hemorrhage ictus to operation, past history and systemic disease. Through analysis of rebleeding cases, these risk factors were then compared: p-value was estimated by use of the chi-square test. In conclusion, clinical risk factors in rebleeding were found to be high systolic blood pressure prior to surgery, poor pre-op clinical grade, small amount of hematoma, short time interval from hemorrhage ictus to operation(6-24 hours), and a past history of cerebrovascular disease.

Anterior Cervical Fixation in Spine Injury Patients Requiring Tracheostomy

Because of the possibility of increased the risk of soft tissue or bone infection, surgeon have been somewhat reluctant to use the anterior cervical approach in spinal injury patients who had previously undergone tracheostomy. The authors investigated whether the use of a Caspar plate in such patients during anterior cervical fixation altered the risk of infection. We analyzed the mechanism and level of injury, operative procedures, post-operative course and infection in 12 cervical injury patients with previous tracheostomy. The procedure had been performed on the day of injury because of semicoma resulting from combined head injury in two cases, and because of multiple rib fracture with hemothorax, and old age with chronic obstructive lung disease in one case each; it had been performed between 1-6 days after injury because of high fever with pneumonia and atelectasis in eight cases. The interval between tracheostomy and anterior fixation was 5-20(average, 13) days. During clinical follow-up at 8-21 (average, 16) months, bone union without infection was observed in all patients. The authors concluded that in patients with cervical cord injury, tracheostomy did not increase the risk of infection in subsequent anterior cervical fixation using a Caspar plate.