Clinical Comparison of Anterior Cervical Plating System in Acute Cervical Injury

We compare the safety and efficacy of locked and non-locked plating systems with retrospective review of 51 consecutive acute cervical injury patients who underwent anterior cervical plating procedures. The two groups were comparable in demographic details, mean age(locked 40.8, non-locked 37.9), average fusion level(locked 1.53, non-locked 1.67) and fusion rate(locked 100%, non-locked 86.7%). Hardware related complication in locked plate group was seen in one patient(2.78%), but did not required the reoperation. In the non-locked plate group, 4 patients developed screw loosening and, in 1 patient, the inferior screw was found to be 2mm posterior to posterior cortex. Reoperation was needed for this case due to symptomatic myelopathy. In the non-locked plate group instrument related reoperations was done in 5 patients(33.4%) and longer operation time was required than locked system. In this study, anterior cervical fusion with plating was nessessory for stabilizing of acute cervical instability and improving neurological outcome and fusion rate. For this purpose, locked system was theoratically safter and technically easier than non-locked system.

Prognostic Factors in Spontaneous Cerebellar Hemorhage and Pontine Hemorrhage

The author studied 62 consecutive patients with spontaneous cerebellar hemorrhage and 38 patients with spontaneous pontine hemorrhage, diagnosed by computerized tomography scanning from May 1983 to December 1994 and assessed the relationship of outcome of initial GCS score, CT findings, and treatment modality. In cerebellar hemorrhage, good outcome was achieved in patients with high initial GCS score(>13), small hematoma, patent quadrigeminal cistern, absent hydroceohalic change, and the location of the hemorrhage in the hemisphere. Although the size of hematoma was an impotant prognostic factor, it had no constant bearing on the level of consciousness, degree of quadrigeminal cistern obliteration, and outcome. Absence of quadrigeminal cistern obliteration predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved darly. However, partial obliteration of the quadrigeminal cistern was a predictor of good outcome if the hematoma was evacuate d within 48 hours after the onset of hemorrhage. Total obliteration of the quadrigeminal cistern inevitably predicted an unfavorable outcome. In pontine hemorrhages, a good outcome was achieved in patients with high initial GCS score(>13), small size hematoma(10cc) inevitably showed an unfavorable outcome.

Laserthermia Induced Histological Changes in Different Thermal Condition / 영남의대학술지

Laserthermia is a new method of local hyperthermia using fiber optic guided probe with computer controlled Nd-YAG laser system. We used a synthetic sapphire probe and allowed irradiation with contolled low power laser energy (less than 5W), in different thermal condition (temprature:38.5-50 degrees C) for 10 minutes, in the normal brain tissue of 18 rabbits. In results, the histological changes of brain tissue was variable (myelin condensation, chromatin condensation, nuclear waving and palisading, RBC discoloration, cell necrosis) in microscopic findings after laser irradiation, but changing area was not occured proportionally in thermal condition level. Cell necrosis appears to over 44.5 degrees C and the distance was about 1.25 mm. This study, using computer controlled laserthermia system for interstitial local hyperthermia, may offer many advantages in the experimental treatment and clinical management of tumor. Minimizing normal tissue damage is now being developed.

Combined Approach for Large CPA Tumor with Sacrifice of Sigmoid Sinus

With large CPA tumor(>3 mm), brain stem is usually displaced and distorted to contralateral side. It is important minimize retraction to protect brain stem and to lower morbidity. In our previous report, we reported the result and method of combined approach for large CPA tumor. In order to minimize brain stem retraction and to get good operating field, three of 7 cases of large CPA tumor with combined approach were operated with sacrifice of sigmoid sinus. The sigmoid sinus can be sacrificed if it can be angiographically verified that the sagittal sinus represents the major drainage to the contralateral sigmoid sinus. During operation, if pressure difference between before and after occlusion of sinus is less than 10 mmHg and any brain swelling does not develop after occlusion, the sigmoid sinus can be sacrificed.

Morphological Changes of Cerebrum in Rabbits Exposed to Microwaves

The author measured the severity of brain damage of 36 rabbits irradiated 2.45 GHz microwave for 10 minutes, 20 minutes and 30 minutes, respectively. Electromicroscopic and light microscopic findings of just after, 1 weeks, 2 weeks and 4 weeks after irradiated brain were compared in each time. Swelling and vacualization of nerve cell and mitochondria were noted. Also these changes tend to increased severity along amount of radiation, but revealed reversible changes with time. Myelinated and unmyelinated nerve fibers were examined as same manner. These nerve fibers also revealed swelling and vascuolization, these findings also tend to increase severity with irradiation power and more prominent at unmyelinated nerve fibers. Reversability of these findings after each time period were more prominent in myelinated nerve fibers than unmyelinated nerve fibers.

The Effects of Microwave Irradiated on Rabbits' EEG

Microwaves may induce effect and damage on nervous tissue, either by thermal or mon-thermal mechnisms. EEGs were checked in left frontal lobe before and after irradiation of microwave at frequency of 2.45 GHz in 18 Rabbits. In results, mean total power of EEG was slightly decreased after irradiation of microwave. And mean composition percentage of delta wave was decreased and mean composition percentages of theta, alpha and beta wave were increased after irradiation in observation for 7 days. That mean decrease of electrophysiologic activity and trend of fast wave in brain after irradiation of microwave.

Complete Removal of Giant Craniophanyngioma by Drainage Through the Ommaya Reservior

Craniopharyngioma is one of the most challenging, Frustrating, and humbling benign intracranial tumors of childhood. Its behavior is a clinical malignancy even though it is benign tumor in microscopically. There is no single treatment of craniopharyngioma and there must be a plan customized for eacg patient. This decision may, be made from diagnostic studies alone, but in most cases exploration of the tumor and the testing of its adherence to its surroundings will be the only thorough and fair way to determine whether it can be totally excised or not. So the choice of treatment is "individualize". We experienced one case of giant cystic craniopharyngioma and performed combined operaion whih were percutaneous intermittent drainage of cystic fluid through Ommaya reservoir and following microsurgical radial excision. There was no complication and marked intellectual and psychological improvement until todays for 20 months.

Stereotactic Guided Craniotomy:Method for Localization and Removal of Small Intra-Axial Lesion

Combining the stereotactic precise localization with open craniotomy can decrease post-operative morbidity and is helpful for total removal of small intra-axial lesion. The authors had good results by the stereotactic guided craniotomy. The method and results of the technique are discussed in reference to 8 patients.

Internal Fixation of the Unstable Cervical Spine Fracture and Subluxation

Recently various kinds of anterior or posterior cervical instruments have been used for stabilization of unstable cervical spinal injury. Every device has different characteristics, so none can cover all of the various types of unstable injuries. Forty six patients of unstable cervical spine fracture and subluxation underwent stabilizing operation using the anterior Caspar plate(6 cases) and the Roy-Camille posterior plate system(40 cases) during recent 3-years. Each approach employed depends on the site of compression and mechanism of injury. Six patients who had complete neurological injury expired after the surgery. The follow-up period for the 40 patients was from 5 to 32 months(average-17.5 months). During follow-up period, 16 out of 22 patients(72.7%) who had a neurological deficit showed minimal to moderate improvement and only 4 patients(10%) complained of significant arm or neck pain. The only complication of instrumentation was 5 cases of screw breakout, but 3 of them did not have any problem. Radiologically 37 patients(92.5%) had firm fixation after surgery.

The Correlations between the Hematoma Volume and the Changes of ICP, Blood Pressure & Prognosis in the Spontaneous Intraparenchymal Hemorrhage

The development of CT scan and stereotaxic surgery with urokinase irrigation made possible early diagnosis and improved survival in the patients of spontaneous intraparenchymal hemorrhage. We had clinically reviewed and analyzed 30 patients of stereotactically treated spontaneous intraparenchymal hemorrhage, according to the hematoma volume, ICP, wital signs, GCS and prognosis. The results were summarized as follows: 1) As the hematoma volume increasing, ICP was also increased(p<0.05). 2) The systolic arterial pressure was increased as the hematoma volume increasing(p<0.05). 3) Mean ADL was 55(26% and ADL level were decreased in cases of large hematoma(p<0.05). 4) As the hematoma volume increasing, the level of verbal GCS and total GCS was low(p<0.1). 5) No significant correlation was noted between the hematoma volume and complications(T test).

Follow-up Lumbar Spondylolisthesis after Pedicle Screw Fixation

Sixty five patients of lumbar spondylolisthesis were treated with pedicle screw fixation during last 3-years. Roy-Camille plate system has been used in 17 patients, steffee system in 41 and Puno/Winter/Byrd(PWB) system in 7. We analysed the changes of symptoms and radiological findings during follow-up observation(average 15 months). After surgery the average time for low back pain reduction was 7 months, Twenty patients(3%) complained a graft donor site pain initially, but almost except one were alleviated after 7.3 months later on an average. Radiologically the reducton degree of the displacement was from 24% on preoperative state to 12% on last follow-up and pseudoarthrosis rate was 8%. Surgical result was evaluated by our score rating system, according to that system 64.5% of the patients had satisfactory result.

Combined Approach for Large CPA Tumor

With large CPA tumors, the goal of surgery is safe total removal of the tumors and preservation of nearby neural structures. Although the suboccipital approach can be made for large CPA tumors, combined approach is more preferable method for the wide exposure of the CPA including brain stem and the lower cranial nerves. We have recently experienced favorable results by combined approach. Total removal of large tumors were obtained by these approaches. The authors present surgical points of view and a brief review of literature.

Problems in Managements of Cerebral Arteriovenous Malformations

The authors report the problems of treatment in 37 consecutive cerebralarteriovenous malformations(AVM's) who underwent embolization, operation, combined treatment, or conservative care. The preoperative embolization is an integral part of the multidisciplinary treatment protocol for patients with cerebral AVM's. Life threatening intracerebral hematoma caused by bleeding from AVM's will be managed effectively with stereotactic Urokinase irrigation for urgently reducing the increased intracranial pressure and getting a time to change emergent to elective surgery. We also discussed the problems along the management of cerebral AMV's.

Correlation of changes of intracranial pressure and clinical manifestations in spontaneous intracerebral hemorrhage / 영남의대학술지

Recently, many authors have reported about the relationship of the volumes of hemorrhage in the brain parenchyma, hemorrhagic sites, optimal operation time, and the effects of mannitol and steroid on control of ICP to clinical manifestations. Many attempts to measure ICP in hydrocephalus, brain tumor, and head injury have been reported. But the measurements of intracranial pressure in spontaneous intracerebral hemorrhage are rare. Intracranial pressure was monitored prospectively in 30 patients who had stereotaxic surgery for spontaneous intracerebral hemorrhage. The results are as follows. 1. Intracranial pressure was increased in high PaCO₂. 2. There were no correlation in ICP, rebleeding and ADL ad discharge (P>0.05). 3. ICP was the most high level in 72 hours after operation. 4. There was 63.2% decrease in ICP after irrigation with 6000 IU urokinase in the site of hemorrhage. 5. There was no correlation between the numbers of natural drainage and ADL at discharge (P>0.05). 6. The higher the initial GCS, the higher the postoperative GCS.

Lumbar synovial cyst associated with retrolis thesis: a case report / 영남의대학술지

In advent of high-resolutional CT and MRI, it is not so difficult to detect the lumbar synovial cyst, however the unusual disease should be included in the differential diagnosis of cauda equine compression syndromes. The case of a 55-year-old man who had a low back pain and severe radiating pain on both legs showed a retrolisthesis at L3-4 and L4-5 and epidural enhancing mass just around L4-5 facet joint on MRI. Microscopically a lining of synovial tissue was demonstrated. After surgery of the total resection of synovial cyst and stabilization, the patient's presenting symptoms were improved.

Clinical Analysis of Cerebral Arteriovenous Malformation

Clinical and cerebral angiographic findings were reviews retrospectively in thirty-seven patients with intracranial artero-venous malformation(AVM). The results were as follow. Many opatients who were in reproductive age had visited due to seiure(27%) and its angiographic findings were mixed Type(80%). Bleeding was predominant in the patients who had small sized nidus than medium or large one, and deep draining vein than superficial one. Medium sized AVM was located mainly in the anatomically deep portion(71%) and drained to deep portion also(71%). Associated aneurysm was more prevalent in deep seated or large sized AVM. Low grade AVM according to Spetzler's grading system showed good results of treatment. Postoperative hemorrhage or sizure were frequently found in patients who had superfically located AVM.

Surgical Decompression and Stabilization with Instrumentation in Theoracolumbar and Lumbar Spine Fracture

Twenty patients with a major thoracolumbar or lumbar spine fractures were treated with various kinds of internal fixation device through anterior or posterior approach during last 2 years. Anterior spinal surgery(10 patients) applied to the patients who had a major fracture of anterior compartment with neural canal impingement and condisted of anterior decompression through vertebrectomy and stabilization with Kaneda device. Posterior spinal surgery(9 patients) applied to mainly posterior compartment injury and consisted of stabilization with Harrington instrument(3 patients) and Roy-Camille plate system(6 patients). The other one patient was treated with a combined approach of anterior decompression and posterior Harrington instrumentation. No patients showed neurological deterioration after surgery and 15 patients(75%) improved postoperatively with entering the next Frankel subgroup. Radiologic evaluation showed the correction of the fracture deformity with satisfactory outcome postoperatively. There was no significant difference between anterior and posterior spinal surgery regarding operative result.

Astrocytoma in the Bilateral Thalamus: A Case Report / 영남의대학술지

Astrocytoma in the thalamus in not so frequent in incidence (1%). Moreover, bilateral thalamic tumor is rare. Certain tumors of the thalamus are considered resectable but most of thalamic tumors are thought to be untouchable. Bilateral thalamic astrocytoma with hydrocephalus was diagnosed by stereotactic biopsy and ventriculoperitoneal shunt operation was done with result of improvement. We report a case of astrocytoma in the bilateral thalamus with literature review.

Nonsurgical Management of Parasagittal Epidural Hematoma Report of 4 Cases / 영남의대학술지

Nonsurgical management of four cases of the parasagittal epidural hematoma were experienced. Patients were mildly symptomatic or minimal neurological disturbances on admission. Patients were treated conservatively because of stable neurologic sign. All patients had who diastatic fracture and / or suture have become a complete neurological recovery with satisfactory absorption of EDH over a period of 5 to 12 weeks.

Correlation between Changes of Cerebrospinal Lactate Level and Prognosis in Severely Head-Injured Patients

Cerebrospinal fluid lactate and intracranial pressure were measured in 24 severely head-injured patients with Glasgow coma scale below 8. Cerebral perfusion pressure, vital sign and CVP were also measured simultaneously. Severely head-injured patients revealed increased CSF lactate and intracranial pressure which have been significantly correlated with outcome. But changes of vital sign, cerebral perfusion pressure and CVP were not correlated with outcome. The elevation of intracranial pressure checked on arrival was statistically significant in correlation to outcome. And the elevation of CSF lactate were correlated with statistically significance in correlation with outcome and lactate level checked on time interval(arrival, 12hr, 24hr, 48hr after trauma). And so CSF lactate levels are statistically more significant than intracranial pressure in predicting prognosis. We will expect good prognosis in severely head-injured patient by reducing intracranial pressure and CSF lactate, oxygenation and increasing cerebral perfusion.