Characteristics of Training Materials for Successful Microvascular Anastomosis and Preclinical Assessment of The Surgical Skills / 대한뇌혈관외과학회지

The need for microvascular anastomosis is on the increase for the prevention or treatment of hemodynamic stroke or planned major vessel occlusion for the treatment of complex intracranial vascular lesions or tumors. The surgical skill of the microsurgeon is the most important factor for successful microvascular anastomosis. Thus, surgical experience in the laboratory is essential. With a review of the literature, we demonstrate characteristics of several training materials for the laboratory and preclinical assessments of surgical skills.

The Motor Cortex Mapping Using Transcranial Magnetic Stimulation in Stroke Patients

OBJECTIVE: To investigate the clinical usefulness of the motor cortex mapping using transcranial magnetic stimulation (TMS) in stroke patients. METHOD: Five stroke patients were studied. A piece of cloth which marked at 1 cm interval was fixed on the patient's head. Motor cortex mapping for abductor pollicis brevis muscles (APB) was performed with a butterfly coil or with a round coil if motor cortex mapping was impossible. RESULTS: Ipsilateral motor pathways were discovered from the unaffected motor cortex to the affected APB in patient 1. This patient showed delayed latency and low amplitude of ipsilateral motor evoked potentials (MEP) that seems to be evoked from the descending motor pathway rather than the corticospinal tract. In patient 2 and 3, contralateral motor pathways traveled from the affected hemisphere to the affected APB. The short latency and high amplitude of MEPs seems to be attributed to the corticospinal tract. In patient 4, no MEP was evoked by any hemisphere or magnetic stimulator. We believe that the affected APB had no motor pathway, and it correlated well with the poor motor function of her hand. In patient 5, contralateral pathways from the affected hemisphere to the affected APB were present. In this patient, the parameters of the motor cortex map such as the amplitude of MEP, the number of MEP evoked site, and the excitatory threshold were improved after 2 months, which correlated well with clinical improvement. CONCLUSION: Motor cortex mapping using TMS is clinically useful for the evaluation of the characteristics of motor pathways and the change of motor cortex excitability in stroke patients.

Risk Factors of Late Post-traumatic Seizure

OBJECTIVE: The goal of our study was to identify and evaluate risk factors for late post-traumatic seizure. METHODS: This study is a retrospective clinical analysis of 52cases of late post-traumatic seizures among 1472 head injury patients treated in our institute from July 1986 to June 1996 and at least followed up over 2 years after head injury. RESULTS: 1) The incidence of late post-traumatic seizure was 3.5% of patients treated for head injury. 2) The factors affecting the incidence of late post-traumatic seizure were initial low Glasgow coma scale(3-8), subdural hematoma, depressed skull fracture(p<0.05). 3) Skull fracture located in temporal area showed higher incidence of late post-traumatic seizure(p<0.05). CONCLUSION: The risk factors for post-traumatic seizure are subdural hematoma, initial low Glasgow coma scale, depressed skull fracture and temporal bone fracture. Both newer antiepileptic drugs and therapies aimed at prevening the brain damage that underlies the development of seizures need to be studied to find an effective way of preventing late post-traumatic seizure through prospective study.