Biportal Endoscopic Spine Surgery for Various Foraminal Lesions at the Lumbosacral Lesion

The stenosing foramen of L5–S1 by several degenerative diseases is one of the challenging areas on surgical approaching because of the deeper depth and steep slope in the lumbosacral junction. The floating view using unilateral biportal endoscopic spine surgery rather than docking into the Kambin’s zone can make the foraminal structures seen panoramically and permit dynamic handling of various instruments without destroying the facet joint and causing iatrogenic instability. Fine discrimination of structural margins in helps of the higher magnification and gentle manipulation of neural structures just as in open spine surgery could be guaranteed using floating technique from the target structures. Selective decompression with preserving innocent structures including facet joints could relieve foraminal lesions at the L5–S1 and decrease the necessity of fusion surgery caused by wider decompression and iatrogenic instability.

Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH.

Atypical Presentation of Acute Pituitary Apoplex Following Mild Head Injury / 대한신경손상학회지

Pituitary apoplexy usually presented with abrupt onset of neurological deterioration of headache, visual disturbance and decreased mental status. Post-traumatic pituitary apoplexy generally occurs in patients who have suffered from severe head injury, but there are rare reports occurred in patients with mild head injury. We describe a rare case of atypical presentation of acute pituitary apoplexy following mild head injury. A 68-year-old woman presented with right parietal scalp swelling after minor head trauma. Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) scans showed multiple contusions in the basal forebrain, falx hemorrhage and a linear skull fracture near the midline. In addition, there was a suprasellar-extended pituitary macroadenoma with suspicious intratumoral hemorrhage. After admission, cloudy consciousness, poor oral intake and high fever continued for several days. On seventh day, her condition has abruptly deteriorated and hypotensive shock developed. She recovered dramatically two days after steroid replacement therapy. The mechanism of pituitary apoplexy after mild head injury discussed with a relevant literature.

Atypical Metronidazole-Induced Encephalopathy in Anaerobic Brain Abscess

Metronidazole-induced encephalopathy is a very rare complication of the long standing use of metronidazole. The encephalopathy is bilateral and symmetric in nature. We report on the magnetic resonance imaging (MRI) and clinical course of metronidazole-induced encephalopathy in a 60-year-old female with a persistent anaerobic brain abscess after draining of the abscess. After 3 months of metronidazole administration, the patient complained of dysarthria, tingling sense of all extremities, and left hemiparesis. MRI revealed symmetric hyperintensity lesions in medulla, pons, dentate nuclei of cerebellum, and splenium of corpus callosum, all of which represent typical findings of metronidazole-induced encephalopathy. In addition, asymmetric lesions in midbrain, thalamus, putamen and cerebral subcortical white matter were noted. The patient recovered after discontinuation of metronidazole and the remaining abscess was successfully treated with meropenem and levofloxacine.

Impact of Early Tracheostomy on Hospital-Acquired Pneumonia and Infection of Anterior Cervical Fusion Site in Patients with Acute Cervical Cord Injury / 대한신경손상학회지

OBJECTIVE: We tried to investigate impact of early tracheostomy on hospital-acquired pneumonia and infection of anterior cervical fusion site in patients with acute cervical cord injury undergoing respiratory difficulty. METHODS: A retrospective analysis was done with 42 subjects received tracheostomy of patients with acute cervical cord injury admitted in our institution from Jan. 2001 to Dec. 2010. The subjects were classified into early tracheostomy group (7 days). We analyzed the incidence of post-tracheostomy pneumonia, intensive care unit (ICU) stay, hospital stay, in-hospital mortality and tracheostomy or anterior cervical fusion site infections. RESULTS: Early tracheostomy was performed in 13 patients (31.0%) and delayed in 29 (69.0%). The incidence of post-tracheostomy pneumonia was significantly lower in the early tracheostomy group than in the delayed (p=0.018). ICU stay was also significantly lower in the early tracheostomy group than in the delayed (p=0.013). Hospital stay was lower in the early tracheostomy group than in the delayed (p=0.061), but was not statistically significant. In-hospital mortality was not different between two groups. There were no patients with infection of anterior cervical fusion site as a consequence of tracheostomy in both groups. CONCLUSION: This study suggests that early tracheostomy may have beneficial effects in patients with acute cervical cord injury. Tracheostomy was not found to increase the risk of infection in previous anterior cervical surgery.