Effects of selective obstruction of intracranial venous sinuses on systemic arterial pressure, cerebral perfusion pressure, intracranial pressure and intrasinal pressure in cats / 영남의대학술지

In order to evaluate the safe ligation time and sites of dural venous sinuses during neurosurgical operation, systemic arterial pressure(SAP), cerebral perfusion perssure(CPP), intracranial pressure (ICP) and intrasinal pressure(ISP) were measured in cats through neuromonitor before and after obstruction of anterior 1/3, middle 1/3, posterior 1/3 of the superior sagittal sinus and the results were as follows. There were no significant increases of pressures after obstruction of anterior 1/3 of the superior sagittal sinus. In the obstructed middle 1/3 of the superior sagittal sinus group, signifi6int increases were seen un the m-SAP within 2, 4 and 6 minutes, the m-ICP within 2-7 minutes, the r.i-ISP within 14 minutes after obstruction. In the -obstructed posterior 1/3 of the superior sagittal sinus group, there were significant increases of m-SAP within 2, 4 and 6 minutes, the m-ICP within 27 minutes, the m-ISP within 13 minutes. In the obstructed Torcular Herophili,group, there were significant increases of the m-SAP within 1-2 and 4-7 minutes, the m-ICP within 36 minutes and the m-ISP within 1-7 minuted and less significant dercreases of the m-CPP within 5-7 minutes after obstruction. In the obstructed right transverse sinus group, significant increases of the m-ICP and the m-ISP were seen within 1-7 minutes after obstruction. there were no remarkable changes in the obstructed left transverse sinus group.

Multiple Aneurysm-Which One Ruptured?

Brain Computerized Tomography(CT) and cerebral angiography were reviewed in thirty-six patients with multiple intracranial aneurysms(22.5%) among the 160 consecutive surgical cases of intracranial aneurysms. The prevalent sites of multiple aneurysms were the middle cerebral artery(37.0%), posterior communicating artery(22.2%), and internal carotid artery(14.8%) in sequence. However, the vertebrobasilar system(83.3%), anterior communicating artery(63.6%), and posterior communicating artery(50.0%) had higher probability of rupture than internal carotid artery(8.3%) or middle cerebral artery(33.3%). Based on CT and angiographic information, the site of rupture can be predicted with a high degree of reliability. These factors were the presence of localized hemorrhage on CT, focal vasospasm, size and irregularity of aneurysms, and relative hyperplasia of parent artery.

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.

The Role of Stereotactic Endoscopy in Ventricular and Juxtaventricular Lesions

The authors have been performed stereotactic endoscopy to diagnose and treat 6 cases of ventricular and juxtaventricular lesions using Brown-Wells system under the local anesthesua. We thought that stereotactic endoscopy was easier and safer than conventional surgery for these lesions.

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.

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.

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%).

Comparison of Intracranial Pressure on Different Monitoring Sites

To compare intrahematomal pressure(IH) with epidural pressure(EP), lumbar subarachnoid pressure(LP) and intraventricular pressure(IV), 34 intracerebral hemorrhage patients from Dec. 1986 to Aug. 1987 were selected. We measured IH via stereotacically placed catheter and at the same time, we measured EP with fiberoptic sensor, LP by lumbar puncture and IV via stereotactically placed catheter during communication between hematoma and ventricle. The results obtained were as follows : 1) IH was the highest in most cases and IH, IV, LP and EP in orders by mean values. 2) In distribuion of EP, LP and IV compared with IH, EP had wide range of distribution(17~500%) compared to LP and IV. 3) There was a tendency of increased rate of higher IH than EP according to increased size of hematoma. 4) There was a tendency of increased rate of higher IH than EP in thalamic hemorrhage than putaminal hemorrhage. 5) ICP curves showed abrupt increase or decrease in cases of rebleeding or communication between hematoma and ventricle. 6) In analysis of low IH compared with EP and LP, the causes were due to checking of IH just after aspiration of large amount of hematoma(3 cases) and normal variations(6 cases). 7) In analysis of failed monitoring, EP was 5 cases(19%) and IH was 3 cases(8.8%) so more failed monitoring were found in EP than IH and there was no failed cases in LP and IV. From above results, we concluded that IH was the highest in most cases and EP was less reliable than other pressures.