Anatomical Morphometric Study of the Cervical Uncinate Process and Surrounding Structures

OBJECTIVE: The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. METHODS: Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots. RESULTS: The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4degrees. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side. CONCLUSION: These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.

Surgical Outcome Following Evacuation of Traumatic Intracranial Hematomas in the Elderly

OBJECTIVE: The aim of this study is to determine the factors influencing the surgical outcome following craniotomy for head injury and to establish the criteria for surgical intervention in the age of 65 years or older. METHODS: We retrospectively investigated the mechanism of injury, types of computed tomography lesions, Glassgow coma scale(GCS) score at admission, pupillary reactivity, past medical history and surgical outcome following craniotomy in the elderly during 8 year period. RESULTS: There were 35 men and 21 women with a mean age of 70.7 years(range 65-87 years). The mortality rate at discharge was 58.9%. Good outcome was achieved only in 25 percent of the patients. The cause of injury did not affect on the surgical outcome. All of 19 patients with GCS of 5 or less at admission had poor outcome. Outcome was significantly worse in older patients(more than 75 years) compare to younger patients(less than 75 years). Ninety percent of the patients with pupillary abnormality had poor outcome, whereas 57.7 percent of the patients with bilateral reactive pupil had poor outcome. Past medical history did not affect on the surgical outcome following craniotomy. CONCLUSION: Surgical outcome is unexceptionally poor in the elderly head-injuried patients if the age is 75 years old or older, the GCS is 5 or less and the pupil is bilaterally dilated. Craniotomy under those circumstances is not desirable.

Gasless Endoscopic Thyroidectomy / 대한내분비외과학회지

Gasless endoscopic surgery was applied to thyroidectomy. The procedure is a safe and technically feasible method producing good cosmetic results. Compared to the previous endoscopic thyroidectomies, this method is superior with respect to performing hemostasis and minimizing the possible complications resulting from gas insufflating surgery (e.g. hypercapnea or massive subcutaneous empysema). We successfully performed the removal of 37 thyroid tumors of 35 cases by gasless endoscopic surgery without any significant complications. No scars remained in the neck and all patients were satisfied with the cosmetic results. Gasless endoscopic thyroidectomy will become a strong alternative to conventional thyroidectomy for cases of benign thyroid tumors requiring good cosmetic results.

Tension Pneumocephalus after Shunting for Hydrocephalus: Case Report

Pneumocephalus is exceedingly rare in the absence of trauma or recent surgery. It is most commonly seen after severe head injury, with disruption of the dura and subsequent cerebrospinal fluid leakage. Intracranial air has also been reported as a complication of shunting. This may be secondary to intermittent shunt failure or a persistent communication between the extracranial and intracranial space that permits the entrance of air. In the present case, air appeared to enter the ventricular system through the fistula that connected the frontal sinus. This air replaced the CSF being drained into the peritoneal cavity by the shunt. The decrease of intracranial pressure after a shunt might play a role in causing pneumocephalus. We report a case of tension pneumocephalus after shunting for hydrocephalus as a life-threatning complication.