Effects of the Selective Management for Increased Intracranial Pressure with Obstruction of Internal Carotid Artery in Rabbits / 영남의대학술지

In order to inquire the most-effective management of increased intracranial pressure(ICP), mannitol, steroid and hyperventilation were used in rabbits after ligation or non-ligation of the carotid artery. Mannitol was more effective than steroid and hyperventilation in the degree of the reduction of ICP. The intracranial pressure was decreased 43~45% for 25~30 minutes after injection of mannitol. Steroid was less effective than mannitol in the degree of the reduction of ICP. But the time of reduction of ICP was longer, that is, the degree of reduction was 24~60 minutes after injection of steroid. Hyperventilation is effective in the initial time only, for 10 minutes after hyperventilation. The degree of ICP reduction was 13.5~16.7 % for 10 minutes after hyperventilation. The combined group, that is three kinds of mangenent were used, is the most effective treatment to reduce ICP of ICP. The degree of the reduction of ICP was 42.1~49.3% for 20 minutes, 47.7~52.5% for 30minnutes. There was no significant difference between and non-ligation group.

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 Rabbit's ICP / 영남의대학술지

Damages on central nervous system induced by the exposure of microwave. However, the effects of microwave on ICP are not studied yet. The ICP affected by the condition of the condition of the brain has an significant effect on vital sign. So we investigated the changes of ICP of the rabbits after exposure. Twenty four rabbits were divided into 3 groups depending on the amount of exposure to microwave. One group was composed with 8 rabbits were exposed to microwave for 10 miniutes. Other were composed to microwave for 20 miniutes, 30 miniures, respectively. Intracranial pressure on each group were measured by subdural type ICP monitoring catheter immediately, first day, 3rd day, 5th day and 7th day after exposure of microwave. Results indicates that intracranial pressure of rabbits are not affected with statistical significance by exposure of microwave.

Subependymal Giant Cell Astrocytoma in the tuberous Sclerosis / 영남의대학술지

Tuberous sclerosis is reported rarely and is associated with systemic lesions including central nervous system, skin, heart, eye and kidney. Approximately 5-15% of individuals with tuberous sclerosis will develop brain neoplasia, almost invariably subependymal giant-cell astrocytoma (SGCA). We experienced a case of SGCA with tuberous sclerosis operated by the transcallosal approach and report with literature review.

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.

Clinical Analysis of Pediatric Neurosurgical Diseases

The authors analyzed pediatric(under 15-year of age) neurosurgical disease patients admitted to the Department of Neurosurgery, Yeungnam University Hospital during the 6-year period from May 1983 to April 1989. The results were as follows : 1) Among the total 5,007 neurosurgical admission cases during this period, pediatric cases were 573(11.4%). 2) The total pediatric cases consist of traumatic(80.1%), tumor(5.9%), congenital anomaly(3.1%), infection(3.1%), vascular anomaly(2.1%) and miscellaneous(5.6%) lesions. 3) The male to female ratio was 1.67 : 1 in trauma. 4) The most common age of trauma are 3 to 8 years. 5) The incidence of trauma was relatively common in spring and autumn. 6) The traffic accident is most common cause of pediatric trauma. 7) The contusion case with GCS 9 to 15 revealed good result. 8) 23.1% of 108 intracranial hematoma had no skull fracture. 9) Mortality in trauma was relatively low(1.8%) compared to adult.

Expansive Laminoplasty for Cervical Compression Myelopathy / 영남의대학술지

In an attempt to eliminate some negative aspects of conventional extensive laminectomy, 4 cases of multiple level of cervical compression myelopathy, 1 OPLL (ossification of posterior longitudinal ligament) and 3 cervical stenosis, were treated with a technique of expansive laminoplasty. Operative results in all patients were satisfactory without surgical complications and all patients had a neurological improvement. We suggest that our technique is more effective one for cervical canal stenosis, OPLL, and spondylosis than conventional extensive laminectomy.

Prognostic Factors in Intracranial Aneurysmal Surgery

A prospective analysis of 80 consecutive operated cases of aneurysm were carried out to know the prognostic factors in intracranial aneurysmal surgery. Analysis of end-results with respect to aneurysmal locations and timing of operation showed that the internal carotid artery aneurysm did not make difference in outcome regardless of the timing of surgical intervention, but anterior cerebral artery, middle cerebral artery, and multiple aneurysm were more poor outcomes in the early surgical group(p<0.05). The more grave initial neurological state showed the worse surgical end-results. The poor results were shown in cases of above 3 mm in thickness of the basal cisternal hemorrhage and/or above 30 ml in volume of the intracerebral hematoma on the brain CT scan. During the operation, no sunkened brain, a spasm of offending artery, premature rupture of aneurysm, and post-operative residual intracerebral hematoma were also adverse effects to the post-operative outcomes.

A Clinical Analysis of Cerebrovascular Disease in YUH

We have treated 634 cases of cerebrovascular disease who admitted to the Yeungnam University hospital form May 1983 to march 1988. The authors analysed the clinical aspects of cerebrovascular disease, and the results are as followings. 1) The hemorrhagic stroke was 4 times more than the ischemic stroke. 2) The hemorrhagic stroke occur most frequently in fifth decade and the ischemic stroke occur in sixth decade. 3) An infarction was most common in the ischemic stroke. 4) The most common cause of intracerebral hemorrhage was hypertension. S) The most common cause of subarachnoid hemorrhage was aneurysm. 6) The intracerebral hemorrhage occur most frequently in the putamen(35.1%) followed by the thalamus(29.2%), subcortical(24.8%), brain stem(5.9%) and cerebellum(5.0%). 7) The aneurysmal sac was located most frequently in the A-com(28.3%), followed by MCA(26.4%), and P-com(25.5%). The multiple aneurysm occurred in 13% of 92 cases.

Indications of Stereotactic Evacuation of Spontaneous ICH

To consider indications of stereotactic evacuation of spontaneous I.C.H., we reviewed 155 patients of spontaneous I.C.H. treated with B.R.W. stereotaxy in recent 2 years form Jan. 1986 to Dec. 1987. And we analysed clinical outcome according to volume of hematoma, anatomical location of hematoma, operation time from attack and initial G.C.S.. We concluded "Indications of stereotactic evacuation of spontaneous I.C.H." as followings; 1) There was no contraindication according to anatomical location of hematoma even if brain stem and posterior fossa. 2) Golden operation time seems to be as early as possible after 6-8 hours from attack. 3) There was no contraindication according to volume of hematoma but there was increased tendency of rebleeding in small thalamic hemorrhage. 4) Low initial G.C.S. was not definite contraindication but final end-result was not so satisfactory. 5) Combined I.V.H. was also good indication, because of low occurrence of postoperative hydrocephalus and early removal of ventricular hemorrhage.

Changes of the Vital Sign, Cerebral Perfusion Pressure and Intracranial Pressure in Variable Degree of Head Elevation

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the developement of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(7.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who were managed in the position of 30degrees and 50degrees head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sign and central venous pressure.

Posterior Cervical Plate Fixation in Cervical Injuries

Posterior stabilization of unstable cervical spine injury using metal plate and screw has been commonly used in Europe but very rarely in Korea where it has been usually achieved with wires supplemented by bone graft. We have experienced 11 patients of unstable lower cervical spine injuries which were stabilized with posterior cervical plate without bone graft. One patient was total quadriplegia and two patients showed minor motor and sensory changes and the others were neurologically intact. Operations were performed within 10 days after trauma(average 4.9 days) except 2 cases of late instability. Most of the patients could ambulate the day after operation with a Philadelphia collar which was kept for 3 months. We achieved good postoperative alignment of injured cervical spine and tolerable neck motion limitation and we experienced no surgical complication. So we suggest that posterior cervical plate fixation technique is a good method of cervical stabilization for lower cervical spine injury, especially when posterior compartment injury is predominant.

Stereotactic Biopsy in Intracranial Lesions

The introduction of computed tomography in the mid 1970s radically altered the practice of both neuroradiology and steteotactic neurosurgery. Shortly after the introduction of CT, work began on a variety of methods to guide biopsy instruments to brain lesions demonstrated on CT scan. And so, a prototype Brown-Roberts-Wells(BRW) CT stereotactic system was been available to us. We report its utilization in evaluation of less accessible brain lesions using BRW system; 22 superfical lesions including the motor cortex, 3 brain stem lesions, 5 parasellar lesions, 3 pineal lesions, 3 C-p angle lesions, 3 multiple lesions. There is one complication; intratumoral bleeding. There is no mortality in this series. The diagnostic rate is 88.9%. The indications of BRW of guidance stereotactic biopsy are considered as followings; 1) Adverse medical condition. 2) Highly malignant lesions. 3) Multiple lesions. 4) Lesions near by motor cortex. 5) Brain stem lesions. 6) Deep seated lesions. 7) Small sized lesions.

Stereotactic Management of Spontaneous Infratenorial Hemorrhage: Part II: Transtentorial Stereotactic Approach for Spontaneous Intracerebellar Hemorrhage

The Brown-Robert-Wells(BRW) stereotactic system has many advantages in the supratentorial spontaneous intracerebral hemorrhage(ICH), but is has less accessibility to the spontaneous cerebellar hemorrhage by stereotactic suboccipital approach. To overcome this disadvantage, we have tried to treat stereotactically three patients of spontaneous intracerebellar hemorrhage through tentorium using BRW stereotaxis and gradual irrigation wth urokinase(UK). This new approach has been used successfully under the local anesthesia with satisfactory postoperative neurological results. We present a detailed technique of this approach.

Clinical Analysis of Spinal Diseases in YUH

A total cases of 1080 inpatients of spinal disease in neurosurgical department of Yeungnam University Hospital(YUH) from May 1983 to March 1988 were analysed statistically. 1) Of the total 1080 cases, the vast majority was degenerative disease 749(69.3%), and others were trauma 265(24.5%), tumor 28(2.5%), congenital anomaly 4(0.3%), infection 22(2.0%) and miscellaneous 12(1.1%). 2) In degenerative disease, male to female ratio in disc disease was 1.7:1 and in degenerative spondylolisthesis 1:3. And frequent age group of disc disease was 20~40(50%) and other degenerative diseases were 40~60(66.6%). 3) Most frequent site of cervical disc disease was C5~6(40%) and lumbar disc disease was L4~5(79.4%). 4) There were 265 patients of trauma, among them, spinal fracture without neurological deficit was 97(36.6%), soft tissue injury was 133(50.0%) and fracture associated with cord injury was 25(13.2%). 5) In 28 cases of spinal tumors, the most frequent site was extradural space 23(82.1%).

Clinical Analysis of Spinal Diseases in YUH

A total cases of 1080 inpatients of spinal disease in neurosurgical department of Yeungnam University Hospital(YUH) from May 1983 to March 1988 were analysed statistically. 1) Of the total 1080 cases, the vast majority was degenerative disease 749(69.3%), and others were trauma 265(24.5%), tumor 28(2.5%), congenital anomaly 4(0.3%), infection 22(2.0%) and miscellaneous 12(1.1%). 2) In degenerative disease, male to female ratio in disc disease was 1.7:1 and in degenerative spondylolisthesis 1:3. And frequent age group of disc disease was 20~40(50%) and other degenerative diseases were 40~60(66.6%). 3) Most frequent site of cervical disc disease was C5~6(40%) and lumbar disc disease was L4~5(79.4%). 4) There were 265 patients of trauma, among them, spinal fracture without neurological deficit was 97(36.6%), soft tissue injury was 133(50.0%) and fracture associated with cord injury was 25(13.2%). 5) In 28 cases of spinal tumors, the most frequent site was extradural space 23(82.1%).

Impedance on the Lesions and Parenchyma of the Brain: With Brain Stereotaxis

From Nov. 1986 to Sep. 1987, we operated 63 cases of intracerebral hemorrhage and brain tumor with B.R.W. stereotaxic method. Among them, the impedance was checked in 40 cases. Results are as followings. 1) In 89.3% of patients, the impedance of hematoma was 1.5 times higher than the mean cortical impedance, in 57.1% of patients it was 2 times higher, and in 32.1% of patients, it was 3 times higher. 2) In the relationship between impedance and nature of hematoma, the impedance of liquified hematoma was higher than clot. 3) In the relationship between impedance and glasgow coma scale, the impedance of patients who were below 9 in score was higher and who were above 10 in score was lower than the mean cortical impedance. 4) The impedance of the low density area surrounding the lesion was lower than the mean cortical impedance by 73%. 5) In the relationship between impedance of the hematoma lapsed over 12 hours was lower than hematoma before 12 hours. 6) In the impedance of the brain tumor, the impedance of the solid lesion was decreased to 85.7% and cystic lesion was decreased 48.3% of the cortical impedance.