Postoperative Thecal Sac Compression Induced by Hydrogel Dural Sealant after Spinal Schwannoma Removal / 대한신경손상학회지

Cerebrospinal fluid (CSF) leak is a common complication of spinal and cranial surgery, and patients undergoing spinal tumor surgery are probably particularly predisposed due to the presence of an intradural tumor and many other factors. Furthermore, a meticulous dural closure technique does not always result in watertight closure. A number of adjunctive methods have been used to assist with dural closure. Synthetic, absorbable polyethylene glycol hydrogel dural sealants are widely used and have been approved for use as adjuncts for cranial applications requiring sutured dural closure. We report a case of thecal sac compression by DuraSeal ® Dural Sealant used to repair the CSF leak after intentional durotomy during lumbar schwannoma extirpation.

Molecular Characterization of Primary Human Astrocytes Using Digital Gene Expression Analysis / 대한신경손상학회지

OBJECTIVE: Astrocyte dysfunctions are related to several central nervous system (CNS) pathologies. Transcriptomic profiling of human mRNAs to investigate astrocyte functions may provide the basic molecular-biological data pertaining to the cellular activities of astrocytes. METHODS: Human Primary astrocytes (HPAs) and human neural stem cell line (HB1.F3) were used for differential digital gene analysis. In this study, a massively parallel sequencing platform, next-generation sequencing (NGS), was used to obtain the digital gene expression (DGE) data from HPAs. A comparative analysis of the DGE from HPA and HB1.F3 cells was performed. Sequencing was performed using NGS platform, and subsequently, bioinformatic analyses were implemented to reveal the identity of the pathways, relatively up- or down-regulated in HPA cells. RESULTS: The top, novel canonical pathways up-regulated in HPA cells than in the HB1.F3 cells were “Cyclins and cell cycle regulation,” “Integrin signaling,” “Regulation of eIF4 and p70S6K signaling,” “Wnt/β-catenin signaling,” “mTOR signaling,” “Aryl hydrocarbon receptor signaling,” “Hippo signaling,” “RhoA signaling,” “Signaling by Rho family GTPases,” and “Glioma signaling” pathways. The down-regulated pathways were “Cell cycle: G1/S checkpoint regulation,” “eIF2 signaling,” “Cell cycle: G2/M DNA damage checkpoint regulation,” “Telomerase signaling,” “RhoGDI signaling,” “NRF2-mediated oxidative stress response,” “ERK/MAPK signaling,” “ATM signaling,” “Pancreatic adenocarcinoma signaling,” “VEGF signaling,” and “Role of CHK proteins in cell cycle checkpoint control” pathways. CONCLUSION: This study would be a good reference to understand astrocyte functions at the molecular level, and to develop a diagnostic test, based on the DGE pattern of astrocytes, as a powerful, new clinical tool in many CNS diseases.

Two Cases of Acute Glufosinate Ammonium Intoxication with Disparate Outcomes / 農村醫學 地域保健

No abstract available.

Postoperative Subarachnoid Hemorrhage and Multipunctate Intracerebral Hemorrhages Following Evacuation of Bilateral Chronic Subdural Hematomas / 대한신경손상학회지

Chronic subdural hematoma (CSDH) can be easily treated by burr hole surgery. However, several complications including intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and acute subdural hematoma are rare after evacuation of a CSDH. A 77-year-old man was admitted with right hemiparesis and dysarthria. A brain computed tomography (CT) scan revealed a bilateral CSDH with midline shifting toward the right side. The patient got the burr hole trephination with the catheters insertion in the both sides of parietal area under the local anesthesia. After burr hole surgery immediately, he developed left side weakness and decreased level of consciousness. Repeat CT scans detected a diffuse SAH and multiple small ICHs. He was treated conservatively and fully recovered at discharge after 1 month. To avoid these complications, slow and gradual drainage of the CSDH is needed. The authors report a rare case of SAH and multipunctate ICHs in both cerebral hemispheres after evacuation of a bilateral CSDH.

The Efficacy of Scalene Injection in Thoracic Outlet Syndrome

OBJECTIVE: To evaluate the efficacy of scalene injection in patients with thoracic outlet syndrome. METHODS: We selected 142 patients diagnosed with thoracic outlet syndrome between January 2005 and October 2009. We performed a series of scalene injection with conservative treatment in all cases. Patients rated their pain degrees using a visual analogue scale. We also evaluated the time to return to everyday life and work, and patients' functional capacity. RESULTS: There were no complications or instances of inadvertent somatic or sympathetic ganglionic blockade after scalene injection. Overall, 111 patients (76.5%) experienced improved symptoms after the first set of scalene injection and 128 patients (88.2%) improved after scalene injection followed by conservative treatment. Of the 68 patients who returned to work during the study period, 54 returned within 1 week, and 62 within 2 weeks. Of those who returned to work, 61 reported nearly full functional capacity. We found that scalene injection was more effective in cases of thoracic outlet syndrome related to trauma than in those related to work-related repetitive stress. CONCLUSION: In patients with thoracic outlet syndrome, scalene injection effectively reduces pain. We recommend scalene injection as an adjunct to conservative treatment.

Transection of the Spinal Cord Following Anterior Cervical Stab Injury: A Case Report

Stab wounds to the neck with transection of the cervical spinal cord and complete paraplegia in combination with penetrating injury to the trachea and esophagus are extremely uncommon, and optimal treatment remains unclear. We report an unusual case of stab wound of the anterior neck with a penetrating injury to the trachea and esophagus and transection of the spinal cord at the C7-T1 level. Tracheoplasty and esophageal primary suture were performed by the thoracic surgeons. We regularly followed up the patient with the cervical spinal lesion, because there was neither definite mechanical spinal instability nor CSF leakage. Moreover, there was a possibility of the aggravation of mediastinitis. The postoperative course of the patient was uneventful without a CSF leak or a wound infection. Nineteen months after the operation, the patient had no complain of nuchal pain or the limitation of motion of the neck. There was no definite cervical instability. However, no neurological improvement has been reported either.

Anterior Cervical Disc Herniation Presenting as Instability and Minimal Dysphagia: A Case Report

Few symptomatic anterior cervical disc herniations have been found in the literatures. We describe a rare case of an anterior cervical disc herniation presenting as instability and minimal dysphagia. A 62-year-old man presented with a 3-months history of axial neck pain and minimal dysphagia that did not respond to a conservative treatment. Preoperative plain X-rays of the cervical spine revealed loss of normal lordotic curvature with no definite narrowing of the disc spaces. Flexion/extension radiographs of the cervical spine revealed segmental instability as angular motion greater than 11 degree between adjacent segment at C5-6. Cervical magnetic resonance (MR) imaging revealed a 1.7 x 0.8 cm extruded disc in the left anterior aspect of the C5-6 disc space on axial T2-weighted images and an anteriorly extruded disc with the base at the C5-6 disc, which displaced the esophagus anteriorly on sagittal T2-weighted images. The patient underwent on a cervical disc removal, followed by stabilization of the C5 and C6 via the anterior approach. Preoperative complaints were resolved completely after the surgery. He remained symptom-free 9 months after the surgery.

Fractures and Dislocations of the Cervicothoracic Junction

Cervicothoracic junction instability should be stabilized with the circumferential fusion. In addition, cervicothoracic junctional area should be examined carefully in acute traumatic injury not only to confirm hidden lesions but also to make the proper surgical plans. Here, three patients who underwent cervicothoracic arthrodesis at our institution are presented with a review of literature.

Giant-cell Tumor of the Lumbar Spine: Case Report

The authors report two cases of giant cell tumor in the lumbar spine. Giant cell tumor in the spine is histologically malignant tumor and recurrence is often even after the surgical excision. Two case of spinal giant cell tumor received total excision of the tumor with wide fixation. We have been following up and observing the two cases of patients with surgically treated giant cell tumor. From the two cases of experience, we could not find any recurrence of the tumor after operation and got the good clinical result with anterior and posterior fixation.

One Stage Decompression and Circumferential Stabilization by Posterior Approach in the Unstable Burst Fracture of Thoracolumbar and Lumbar Spine

OBJECTIVE: It has been known that the posterior pedicle screw fixation provides good mechanical stability in unstable burst fracture. But, posterior fixation without anterior column support may not be adequate to withstand the axial load and to keep the corrected kyphotic angle. We present results of one stage fixation by posterior approach in unstable burst fracture. METHODS: Nine patients with unstable burst fracture were treated with posterior fixation and intervertebral fusion using titanium mesh cages and pedicle screws. The canal decompression was achieved by laminectomy and partial pediculectomy through the posterior approach. In all cases, the short segment fixation and anterior column support with cage were performed on the one stage operation. RESULTS: Of nine patients, seven was satisfied with excellent clinical results except two cases of the Frankel's grade A. All patients had good stabilization of spinal column and enough decompression without any neurological complications. It was possible to maintain the corrected kyphotic angle with the circumferential stabilization(three column fixation). CONCLUSION: The anterior and posterior column fixation through the posterior approach provides good stability and decompression in the patients with unstable burst fracture.

Transfacet Pedicle Sparing Approach in High Lumbar Disc Herniation

OBJECTIVE: The authors evaluate results of transfacet pedicle sparing approach for high lumbar disc herniation to avoid injury of nerve roots and the cauda equina. METHODS: Seven patients treated by transfacet pedicle sparing approach for high lumbar disc herniation were reviewed. Some thoracolumbar kyphotic patients on whom posterior procedures underwent additional posterior lumbar interbody fusion and posterolateral fusion using the mesh cage and spinal instrumentation. RESULTS: Clinical symptoms improved in all seven patients. Rigid spinal stability and correction of thoracolumbar kyphosis could be performed by the spinal instrumentation methods. CONCLUSION: The advantages of the transfacet pedicle sparing approach are less invasive, easy decompression the nerve root directly and avoidance of the risk of injury to the cauda equina while the dura is being retracted. Additionally, thoracolumbar kyphosis could be corrected. Transfacet pedicle sparing approach is an useful procedure in the surgical treatment of high lumbar disc herniation.

Ventral Foramen Magnum Meningioma: Case Report

We report a case of a ventral foramen magnum meningioma in a 73-year-old woman presenting with swallowing difficulty, posterior neck pain, gaiting difficulty, progressive motor and sensory deficits in all extemities, and intrinsic muscle atrophy in both hands. Magnetic resonace imaging revealed a huge mass, 4x4x4.5cm in size, located in anterior foramen magnum. We removed the mass by partial condylectomy via far lateral transcondylar approach without neurological deficit and postoperative craniovertebral instability.

The Efficacy of Titanium Mesh Cage in Tuberculous Spondylitis Treated with Anterior Intervertebral Fusion

OBJECTIVE: The maintenance of the correction of kyphotic deformity is one of the difficult problem in tuberculous spondylitis after anterior debriment and fusion with tricortical bone graft. The goal of this study is to find out the efficacy of titanium mesh cage impacted with autogenous bone chip in tuberculous spondylitis treated with anterior intervertebral fusion. MATERIALS AND METHODS: Twelve patients were treated with anterior intervertebral fusion using titanium mesh cage for tuberculous spondylitis from January 1996 to June 1999. We analized the changes in the correction of kyphotic deformity, changes of ESR and CRP, fusion state and recurrence after anterior intervertebral fusion with titanium mesh cage. RESULTS: Clinical symptoms were improved in all twelve patients without any neurologic complications. The mean kyphotic angle corrected was 7.3 degrees immediately after operation, but the loss of correction of kyphotic angle was 2.2 degrees after 3 months and 2.6 degrees after 6 months. We found that the loss of correction of kyphotic deformity occurred mainly within the first 3 months after surgery. Only one patient, suffered from acute hepatic failure after first operation and had an insufficient anti-tuberculous medication therapy, showed recurrence of tuberculous spondylitis after 6 months. The patient underwent a second operation with posterior fixation procedure with good outcome. The changes of ESR and CRP were not specifically important factor to reveal recurrence of tuberculosis of the spine in our series. CONCLUSION: The surgical procedure of tuberculous spondylitis using titanium mesh cage with bone chip seems to be an effective procedure to minimize loss of the correction of kyphotic deformity without any aggravating inflammatory change and recurrence with titanium mesh cage, when sufficient debridement and anti-tuberculous chemotherapy are achieved.

Intradural Lumbar Disc Rupture

The intradural lumbar disc herniation which was first described by Dandy in 1942 is unusual. The pathogenesis is obscure and preoperative diagnosis is not easy. The patient usually have more severe neurologic deficits than those found in the much more common extradural disc herniations. We experienced two cases of the intradural lumbar disc herniation who had previous disc operations and the symptoms and neurologic signs were improved after removal of the intradural sequestration of disc fragments.