Acute Expansion of Hematoma in Hypertensive Intracerebral Hemorrhage / 대한뇌혈관학회지

Hypertensive intracerebral hemorrhage is one of the most common cause of death in Korea and usually considered as a monophasic event. But recently acute expansion of the hematoma within an hour to a day, has been reported as a cause of severe neurological deterioration and death. To know the incidence and risk factors of acute expansion of the hematoma in hypertensive intracerebral hemorrhage, the authors retrospectively analysed 96 hypertensive intracerebral hemorrhage patients who were admitted to Minjoong hospital from January 1997 to December 1998. Neurological examination with Glasgow Coma Scale and first computed tomography (CT) scan were performed as soon as possible after arrival. Then second CT scan was performed within an hour to a day before the operation. Blood sample was taken within an hour for routine laboratory examination including liver function and coagulation test. The amount and shape of hematoma on CT scans were carefully measured to know whether acute expansion was occurred or not. The patients who have acute expansion of the hematoma were 15 patients (15.6%). Expansion of the hematoma was not correlated with sex, age, site, shape, or amount of hematoma statistically. But thalamic hematoma in location, irregular shape of hematoma, or large amount of hematoma has a tendency of acute expansion. The time of onset to arrival, initial systolic pressure, liver dysfunction and history of heavy alcohol drinking were correlated with acute expansion statistically (p<0.05). The shorter the time of onset to arrival and the higher initial systolic pressure, the more the incidence of acute expansion of the hematoma significantly. Acute expansion of the hematoma was significantly increased with the severity of liver dysfunction and history of heavy alcohol drinking. The levels of glutamic oxaloacetic transaminase (GOT), alkaline phosphatase, gamma-glutamyl transpeptidase (gamma-GTP) and platelet (PLT) count were meaningful indices of hematoma expansion.

An Operative Case of Air-Gunshot Wound to the Thoracic Spine

The authors report a rare case of air gunshot wound to the thoracic spinal cord in Korea. A case of 17 year-old girl with a air-gunshot wound to the thoracic spine was presented with paraplegia. Radiologic studies revealed a bullet in the fifth thoracic spinal canal. The cerebrospinal fluid leaked through the entry point of the bullet was noted. After laminectomy and dural opening, a intramedullary hematoma with lodged bullet in the contused cord was found. They are removed successfully with any postoperative complications. The bullet was composed of lead. We report this case focusing on the pathophysiology and surgical treatment with review of literatures.

Microsurgical Decompression of Lumbar Stenosis: Technical Innovations and Early Experience of 20 Cases

Between March 1995 and March 1996, we used a newly-designed neurosurgical procedure, based on 'keyhole surgery', to operate on 20 patients diagnosed as suffering from lumbar spinal stenosis without instability. The unique surgical steps involved in this procedure are: 1) three-quarter prone position of the patient; 2) small paramedian skin incision; 3) half-way incision of the spinous process; 4) small turnover funnel shaped unilateral laminectomy and wide forminotomy using high speed drills; 5) extensive ligament flavectomy; 6) microsurgical decompression without using nerve root retractor; 7) cosmetic wound closure. In some cases, if bilateral radicular symptom was present, the contralateral nerve root was explored through the unilateral laminectomy opening; this was achieved by changing the inclination of the base of the spinous process and extensively removing of the ligamentum flavum. Compared with conventional procedures, these technical innovations offer both procedural adventages and a better clinical outcome. Because of the small patient populations and short follow-up period, this technique requires further investigation, but we hope it will provide another option for future lumbar stenosis surgery. Further technical refinements and long-term follow-up results will be reported elsewhere.