ABSTRACT
OBJECTIVE: Lumbar foraminal or extraforaminal disc herniations (FEFDH) have unusual clinical features and higher incidence in elderly patients compared to usual intraspinal canal disc herniations. We evaluated the efficacy of microdiscectomy via paramedian approach for lumbar FEFDH in elderly patients over the age of 65. METHODS: Retrospective study was performed in 68 patients over the age of 65 (23 male and 45 female patients; 71.46±3.87 years) who underwent microdiscectomy via paramedian approach for unilateral lumbar FEFDH causing sciatica. The radiological factors including degree of slippage, presence of instability, disc height, and degree of disc degeneration; pain and functional status by the means of visual analogue scale score, Oswestry Disability Index score, and Macnab classification were analyzed preoperatively and during the postoperative follow-up period of 3 years to evaluate the efficacy of the surgical treatment. RESULTS: Pain and functional status improved according to short- and long-term follow-up evaluations after surgery. Radiological changes following surgery, which can be understood as structural deteriorations and deformations, did not represent patient condition. Nine patients underwent additional surgery due to sustained or recurring leg pain of aggravation of back pain, and fusion surgery was required for 3 patients. Degree of preoperative slippage was the only statistically significant factor related to additional surgery (p<0.05). CONCLUSION: Microdiscectomy via paramedian approach for FEFDH may be a good surgical alternative in elderly patients. Radiological changes after surgery did not show a concordance with patients' actual functional status. The excessive preoperative slippage tended to lead to unfavorable result after surgery and was associated with additional surgery.
Subject(s)
Aged , Female , Humans , Male , Back Pain , Classification , Follow-Up Studies , Incidence , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Leg , Retrospective Studies , SciaticaABSTRACT
OBJECTIVE: The authors report a experimental research of brain protective effects of mild hypothermia on the reversible cerebral ischemia in the rat. METHODS: We divided the experimental objects into two groups;the control group of normal temperature(36.5degreesC) and the experimental group of hypothermia, and also the latter into three group;group I (33.5degreesC), group II(30.5degreesC), group III(27.5degreesC) depending on the body temperature of hypothermia. The hypothermia was maintained for two hours of middle cerebral artery occlusion and initial 30 minutes of reperfusion and again the temperature was elevated and maintained to 36.5degreesC. Then the cerebral infarct volume was measured at 12 hours after reperfusion of middle cerebral artery. RESULTS: The physiological parameters between the control and the each experimental group were insignificant except the depression of mean systemic arterial pressure in group II and III during hypothermia (p<0.05). As the temperature depression became deeper, the cerebral infarct volume was reduced; 0.99+/-0.26% in group I, 0.66+/-0.14% in group II, and 0.17+/-0.05% in group III. In each experimental group, compared with 2.13+/-0.53% in the control group the cerebral infarct volume was reduced so much that the result was significant statistically. In addition to that, the comparison of cerebral infarct volume between group I and III was proved to be significant statistically(p<0.05), but meaningless between group I and group II. CONCLUSION: It is suggested that mild hypothermia of 33.5degreesC for a short time(2.5hours) has the brain protective effect on reversible focal cerebral ischemia and reperfusion injury without the change of physiologic parameters.
Subject(s)
Animals , Rats , Arterial Pressure , Body Temperature , Brain Ischemia , Brain , Depression , Hypothermia , Infarction, Middle Cerebral Artery , Middle Cerebral Artery , Reperfusion , Reperfusion InjuryABSTRACT
OBJECTIVE: Improvements in microsurgical and neuroanesthesiological techniques have resulted in an increasing number of operation for aneurysmal clipping in elderly patients.The authors evaluated surgical outcome of elderly patients, considering neurologic grade on admission, amount of subarachnoid hemorrhage (SAH) on computerized tomographic findings and timing of surgery. METHODS: The subjects of present study are 91 patients who were admitted to department of neurosurgery and treated surgically between May, 1983. and December, 1999. in Yeungnam University Hospital. The patients were classified by age into two groups: 65 to 69 years (59 cases), 70 years or older (32 cases). On admission, the clinical condition of patients was graded according to the scales of Hunt & Hess and the amount of SAH was graded according to grading system of Fisher. The timing of operation was dvided into two groups: 1-3 days (63 cases) & more than 3days (28 cases). The surgical morbidity & mortality according to Hunt & Hess grade, grading system of Fisher and timing of operation was analized. RESULTS: Overall 32 of the 91 patients were poor prognosis. And 10 of the 32 patients died, for a mortality rate 11%. There was close relationship between the preoperative Hunt & Hess grade, initial Fisher grade, operative timing & outcome. The most common causes of poor or death outcome were medical problems, i.e pulmonary dysfunction, cardiovascular disease and sepsis. The clinical factors of unfavorable outcome in the elderly patients were poor neurological grade on admission, symptomatic cerebral vasospasm, rebleeding and pre-existing medical conditions such as DM, hypertension, cardiopulmonary disease. CONCLUSION: In recent years, with improvement in surgical technique and neuroanasthesia, the number of operation for ruptured aneurysm has increased in elderly patients. We conclude that factors that most affects the clinical outcome of surgery in elderly patients were based on the neurosurgeon's technique and the patients neurological grade and concominant disease, not just on the patients age.
Subject(s)
Aged , Humans , Aneurysm , Aneurysm, Ruptured , Cardiovascular Diseases , Hypertension , Intracranial Aneurysm , Mortality , Neurosurgery , Prognosis , Sepsis , Subarachnoid Hemorrhage , Vasospasm, Intracranial , Weights and MeasuresABSTRACT
The desmoplastic infantile ganglioglioma is very rare cerebral tumor. It has been known to be characterized by its voluminious size, intense desmoplasia and the frequent presence of astrocytic and ganglioglionic differentiation. Also, It is usually presented in infantile period and predilected in the frontal and parietal lobes. We treated a huge desmoplastic infantile ganglioglioma(8?7?6cm) on the right frontotemporo-parietal area with only gross total resection. It includes solid mass & several cysts and shows the areas of the proliferation of spindle cells exhibiting storiform pattern in dense desmoplastic stroma and the areas composed of spindle shaped glial component.