Comparative Analysis of Results by Operative Approaches for Thoracolumbar or Lumbar Fractures

A retrospective study of 100 cases with thoracolumbar fractures was performed to compare the results from different surgical approaches and to provide a guide line for surgical treatment. Fifty-three patients were operated through anterior approach and forty-two patients were through posterior approach. All patients were evaluated according to changes in the following parameters: kyphotic angles, compression heights, degrees of canal compromise, neurologic deficits, pain levels, delayed kyphosis and complications. There were no significant differences in kyphotic angles, compression heights, degrees of canal compromise, neurologic deficits, and pain levels between two approaches. Delayed kyphosis occurred in one(2.4%) of 42 cases treated by posterior approach and six(11.3%) of 53 cases treated by anterior approach. Dural lacerations were noted in fourteen(43.8%) of 32 cases associated with lamina fractures and were repaired in all of nine cases approached posteriorly but none of five cases approached anteriorly. In conclusion, posterior approach is simple, less extensive, is associated with lower incidence of delayed kyphosis and better dural repair than the anterior approach. Posterior approach could be, therefore, considered initially for those cases where surgery is indicated for thoracolumbar or lumbar fractures.

Subdural Hygroma Following Pterional Approach for Cerebral Aneurysmal Surgery

The occurrence of subdural hygroma following pterional approach for intracranial aneurysm at Yeungnam University from March 1994 to December 1994 was studied with regard to the patients age, location of aneurysm, preoperative ventricular dilatation, operation time, cortex color, CSF flow, opening degree of Liliequist membrane, dissection degree of sylvian fissure, postoperative intradural air amount and day for mannitol infusion using chi-square test. The following results and conclusions were obtained: 1) Subdural hygroma was observed in 28 of 53 patients(52.8%). 2) The patient's age was significantly related to the occurance of subdural hygroma(p<0.05). 3) CSF flow through the basal cistern was significantly related to the occurrence of subdural hygroma(p<0.05). 4) In cases of good CSF flow, degree of Lilieqist membrane opening was significantly related to the occurrence of subdural hygroma(p<0.05). Preserving of Liliequist membrane will minimize the occurrence of subdural hygroma.

Clinical Analysis of Pituitary Macroadenoma by Transsphenoidal Approach

The authors report the results of transsphenoidal approach(TSA) for pituitary macroadenoma performd over a 2-year period.This series consisted of 15 patients:ten for nonfunctioning, two for prolactinoma, two of cushing's disease, one of acromegaly. The presenting symptom & sign was hyperfunctioning endocrinopathy in 5 patients, headache in 11 patients, visual symptom in 11 patients. TSA was performed without lumbar catheterization and fluoroscopic mornitoring. Success rates were as follows;normalization of endocrinopathy was achieved in 100% of cases;improvement of visual field in 100% of cases. There were no surgical mortality & some complication with three transient diabetes inspidus one hypopituitarysm. Eight of 15 patients who were removed tumor subtotally were received radiotherapy. Althrough there were short-term follow up(mean 19 months), there was no recurrence. This review reconfirms that the transspenoidal approach is safer and more effective procedure than craniotomy for pituitary macroadenomas.