Extensive Spinal Epidural Abscess: The Usefulness of Minimal Invasive Surgical Technique using Epidural Irrigation Catheter

Spinal epidural abscess (SEA) is a rare infection but may be devastating and fatal. We describe a case of a42-year-old male who presented with a posteriorly located SEA extending from C2 to the sacrum with severe neurologic deficits. We had the emergency surgery with the minimal invasive technique using epidural irrigation catheter, and then obtained an excellent recovery. The purpose of this report introduces the usefulness of minimal invasive surgical technique for extensive SEA.

Anterior and Posterior Stabilization by One Stage Posterolateral Approach in the Unstable Fracture of Thoracolumbar and Lumbar Spine

OBJECTIVE: The purpose of this study is to investigate the clinical results of anterior and posterior stabilization by one stage posterolateral approach for the unstable fracture of thoracolumbar and lumbar spine. METHODS: By posterolateral approach with curved skin incision, unilateral facet and pedicle were removed. Through this route, corpectomy was performed, and then this space was replaced with mesh cage filled up with autologous bone graft. Both side pedicle screw fixation was followed to upper and lower levels. RESULTS: Six of seven patients of this study showed neurological improvement. The other one patient showed no neurological change. One patient had postoperative infection, another patient had postoperative kyphosis. The other patient had epidural hematoma on operation site after surgery. And all patinets on this study made to have spinal stability except one patient happened postoperative kyphosis. CONCLUSION: In the unstable fracture of thoracolumbar and lumbar spine, one stage anterior and posterior stabilization and fusion by posterolateral approach seems to be an effective procedure, if we have more care and supplementation.

Anterior Cervical Interbody Fusion with the Carbon Composite Osta-Pek Frame Cage in Degenerative Cervical Diseases

OBJECTIVE: Different types of interbody fusion cages are available for use in the surgical treatment of degenerative cervical diseases. The purpose of this study is to assess the technical feasibility, clinical efficacy and radiological results of intervertebral fusion with a carbon composite Osta-Pek frame cage (Co-Ligne AG, Switzerland) following anterior cervical discectomy. METHODS: 41patients (25males and 16females) with minimum 6months follow-up were included in the study. Disc height, cervical lordotic angle, segmental angle, and fusion rate were assessed by lateral radiographs. In this retrospective analysis, clinical outcome was assessed as evaluated according to Odom's criteria. RESULTS: Fifty-four cages were implanted in 30 single-level, 9 two-level, and 2 three-level procedures. The mean disc height, cervical lordosis angle, segmental angle were 4.2+/-1.8mm, 23.5+/-7.2degrees, 2.3+/-3.3degrees pre-operatively and 5.3+/-2.1mm, 24.2+/-8.3degrees, 3.8+/-3.5degrees at 6months after the surgery. Six months after surgery, there was radiographic evidence of fusion in 92.7% (38/41) of the patients. According to Odom's criteria, 37 of 41 (90.2%) patients experienced good to excellent functional recovery. CONCLUSION: These clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft after anterior cervical discectomy for treatment of degenerative cervical disease.

Endoscopic Surgery for Pituitary Tumor

OBJECTIVE: The purpose of this study is to assess the efficacy and advantages of an endoscopic endonasal approach for the treatment of pituitary tumors. METHODS: We retrospectively analyzed the records of 31 patients with pituitary tumors having endoscopic endonasal surgery between March 1999 and August 2003. RESULTS: Among 31 patients with pituitary adenomas, 25 (81%) patients exhibited gross total removal of tumor on postoperative MRI within 3 days after surgery. Among 6 patients removed subtotally, 2 had only radiosurgery, 3 have had periodic follow-up MRIs and one patient with large extended tumor (grade IV, Stage E) had secondary transcranial removal of tumor before radiosurgery. Postoperative complications included cerebrospinal fluid leak in 2 patients, sinusitis in 1 patient, and one patient died due to unexpected intracerebral hemorrhage on 5 days after surgery. Besides considerable experiences with this approach are needed because of narrow working channel to the sella turcica, the results of our study showed following advantages of this procedure: visualization of areas not seen with the operating microscope, elimination of oronasal complications, more functional and cosmetic outcome, and shortened operative time and hospital stay. CONCLUSION: The authors consider that endoscopic endonasal transsphenoidal approach provides good results with minimal invasion for patients with pituitary tumors.

Surgical Treatment for Posterior Fossa Epidural Hematomas

OBJECTIVE: The purpose of this study is to investigate the interactions between prognostic factors and functional outcome of patients surgically treated posterior fossa epidural hematomas. METHODS: Between 1992 and 2001, twenty patients were surgically treated for the posterior fossa epidural hematomas. The medical records and radiologic findings of the patients were reviewed retrospectively. Information on potential prognostic factors was collected, and then univariate analysis was performed to determine significant prognostic factors. RESULTS: Initial Glasgow Coma Scale scores of 12 patients were 13 or better. Occipital skull fractures were found in 16 cases(80%). The degree of 4th ventricle compression measured on computed tomography scan. Seven cases showed total obliteration, nine cases showed partial obliteration and four cases showed normal. Eighteen patients experienced good or moderate outcomes(Glasgow Outcome Scale scores of 4 or 5). Functional outcome showed a significant correlation with Glasgow Coma Scale score, degree of 4th ventricle compression(p<.05). CONCLUSION: If poor initial consciousness level and severe 4th ventricle compression are noted, early and aggressive treatment are required. Although clinical progression of posterior fossa epidural hematoma is silent and slow, the deterioration might be sudden and quick to become fatal if not promptly treated.

Stereotatic Aspiration of Simultaneous Bilateral Spontaneous Intracerebral Hemorrhage: Case Report

The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an uncommon clinical event. The authers report a case of simultaneous bilateral intracerebral hemorrhages treated with stereotactic aspiration. A 64-year-old male presented with simultaneous bilateral intracerebral hemorrhages in the both putamens. The hematomas were demonstrated by computed tomography performed after a few hours of onset. The patient underwent computed tomography-guided stereotactic aspiration but he finally became vegetative state. Most of patients reported previously usually have unfavorable functional outcome and high mortality because of the severe neurological deficits. Therefore, the role of the surgical treatment in case of bilateral intracerebral hemorrhages should be surveyed closely in according to clinical state. The authors describe a case of simultaneous bilateral intracerebral hemorrhages and with discussion focused in the predisposing factors, pathogenesis and therapeutic approach.

A Case of Tuberculous Spondylitis Combined with Schwannoma of Spinal Cord

The authors report a very rare case of tuberculous spondylitis combined with a schwannoma of spinal cord. A 39-year-old man was admitted because of paraparesis(G1/G2). MRI showed severe cord compression at two different levels. One was by the bulged soft tissue and subligamentous abscess extending from T7 to T9 and the other was by an intradural extramedullary cord tumor at the level of T1-2. At first operation, T8 corpectomy and T7-9 plate fixation with autogenous iliac bone graft were performed. After then, Paraparesis was improved(G2/G3) postoperatively. The second operation underwent two weeks later. The tumor was totally removed and shortly after second operation, paraparesis was markedly improved(G3/G4). Histological diagnosis were tuberculous spondylitis and schwannoma, respectively. The authors reviewed this case where good surgical outcome was obtained by two stage operation.

Treatment of Cerebral Arteriovenous Malformations by Preoperative Embolization and Microsurgery

No abstract available.

A Study of Surgical Outcome for Multiple Intracranial Aneurysms

No abstract available.

Clinical Analysis of Anterolateral Approach with Instrumentation for the Thoracolumbar Lesions

Forty one patients with unstable thoracolumbar lesions were treated using anterior internal fixation device. There were 39 cases with unstable thoracolumbar fracture, 1 case with post-traumatic kyphosis, and 1 case with aspergillosis spondylitis. The procedures consisted of anterior decompression through vertebrectomy and discectomy, interbody fusion using autogenous iliac bone or rib, realignment and stabilization with Kaneda device(7 cases), or Z-plate ATL device(34 cases). Most patients with incomplete neurologic deficit were improved one or two grades according to Frankel's classification. No patient showed neurological deterioration after surgery. We concluded that the anteroloteral approach with instrumentation in various unstable thoracolumbar lesions would provide satisfactory neurologic improvement as well as immediate firm stability with early ambulation and high fusion rate involving only a minimum number of motion segments.

A Study on the Factors Associted with Risk of Bleeding from Intraacranial arteriovenous Malformations

The most serious and frequent complication of intracranial arteriovenous malformations(AVMs) is intracranial hemorrhage. To identify clinical and angiographic characteristics of AVM which positively correlates with hemorrhagic presentation, we retrospectively analyzed 61 consecutive cases with intracranial AVMs. The following charateristics correlated positively with hemorrhagic presentation of AVMs male sexuality(P=0.059, borderline significance), history of hypertension(p<0.05), nidal dimeter<3cm(p<0.05), deep venous drainage(p<0.05), presence of intranidal aneurysm(P<0.05). Detailed analysis of the clinical and angiographic factors associated with risk of bleeding from AVMs may be the important prognostic implications for the treatment of patients with these leions.

A Comparison of Clinical Outcomes between Decompressive Lumbar Laminectomy Alone and with Arthrodesis in Degenerative Lumbar Spinal Stenosis

To evaluate the relationship between surgical procedures and clinical outcomes in degenerative lumbar spinal stenosis, we retrospectively analyzed the results of the patients who had been performed decompressive lumbar spinal surgery. Eighty-five patients with degenerative lumbar spinal stenosis underwent decompressive lumbar spinal surgery between Jan. 1994 and Dec. 1996. The patients were randomly assigned to one of two groups; decompression alone(47 patients) and decompression with arthrodesis(38 patients). Among the patients with arthrodesis, the instruments were placed in 34 patients. The follow-up duration was 16-51 months(mean; 32.8 months). Functional outcome was excellent or good in 96% of the patients with decompression alone and in 97% of those with decompression with arthrodesis(p=0.667), and the overall patient's satisfaction was 87.5% and 89.5%, respectively. Although the various factors, which could be possible influent to the clinical outcome, were considered, there were no statistically significant differences in results between the two groups. The findings of this study demonstrate that the spinal fusion procedure has no benefit in clinical outcomes of the patients with degenerative lumbar spinal stenosis. Thus the fusion procedures with instrumentation should be used only in carefully selected patients because of its potential risks of serious complications, such as nerve root injury, massive bleeding, and infection.

Aspergillosis of Thoracolumbar Vertebra: A Case Report

As the use of the antibiotics, antitumor substances, steroid hormone and immunosuppressive agent have been increased remarkably, the incidence of the fungal infection has also been increased. Aspergillus is a fungus belonged to ascomycetes family and distributed world-widely. Aspergillus infection of the spine is very rare. Mode of vertebral Aspergillosis is direct extension of primary lesion of lung in children, on the other hand, hematogenous metastasis in adults. We report a adult woman who suffered from thoracolumbar pain without any neurological deficit for 6 months prior to admission. Imaging studies revealed irregular bony destruction on the adajacent end plates of T12 and L1 vertebras with kyphotic change. We underwent operation via anterolateral approach using Z-plate fixation. followed by amphotericin-B administration.

Two Cases of Early Rebleeding after Total Removal of Hematoma due to Metastatic Choriocarcinoma

Among metastatic brain tumors, choriocarcinoma has a highly malignant nature and because of the vascular invasion of trophoblastic cells,tends to hemorrhage. Surgery is recommended for patients with a single cerebral metastasis, or for those who fail to respond to chemotherapy. We encountered two unusual cases in which early rebleeding occurred after the total removal of a hematoma arising from metastatic choriocarcinoma, and confirmed by post-operative tissue biopsy.

Clinical Features and Outcomes of Surgically Treated Pediatric Head Injuries

As the incidence of victims of traumatic craniocerebral injury in children has increased in modern times, we retrospectively analyzed 103 cases of surgically treated craniocerebral injuries among patients under the age of 15 who were admitted from January 1991 to December 1994. We classified the materials, i.e. 1) cause and incidence of craniocerebral injury, 2) clinical symptoms, 3) diagnosis and operation, 4) outcome and complication, and 5) period of hospitalization. The results were as follows: 1) The male to female ratio was 1.9:1(male patients 68, female patients 35). 2) The incidence peaked at the age of 6 and was mostly distributed from the age of 6 to 10. 3) As for time distribution most of the accidents occurred between 3 and 6 in the afternoon. 4) The main cause of craniocerebral injuries was attributed to traffic accidents (54 cases, 52.4%) and the second most common cause was falls from heights(30 cases, 29.1%). 5) In 85 cases, the Glasgow coma scale 13-15 before operation was observed. 6) Depression fractures were found to be the most common lesion in our cases. 7) In 48 cases(46.6%) a craniotomy was the operative procedure performed and in 40 cases(38.8%) an elevation of the depressed bone was performed. 8) In 93 cases, the Glasgow outcome scale 4-5 after operation was observed. 9) The many sequelae of operation were neurological deficit, cognitive impairent, and post-traumtic seizure. 10) The average period of hospitalization was 18.7 days(s.d=18.1). The cause and incidence of surgically treated pediatric head injuries were similar to those of total pediatric head injuries. A high GCS score at admission predicts a good outcome and fewer sequelae. However, papillary abnormalities and a neurological deficit at admission were poor prognostic factors. This study confirms that pediatric head injuries treated surgically provide better results than in adults.

Comparison between CT-HRP and Bartha Strain of Pseudorabies Virus as a Neurotracer in the Rat Visual System

To investigate the applicability of the Bartha strain of pseudorabies virus(PRV-Ba) as a neurotracer in the visual system, we performed immunohistochemical study of the rat brain after intravitreal injection of the PRV-Ba. Cholera toxin-horseradish peroxidase(CT-HRP), a well known neurotracer, was also injected into the vitreous cavity for comparison. After given survival time the brain was removed and processed immunohistochemical stain for PRV-Ba and neurohistochemical stain for CT-HRP. The CT-HRP positive reactions were observed almost contralaterally in optic chiasm, optic tract, suprachiasmatic nucleus(SCN), olivary pretectal nucleus(OPT), all three subdivision of lateral geniculate body, superficial gray layer and optic layer of superior colliculus and medial, lateral, dorsal terminal nucleus of accessory optic tract. PRV-Ba immunopositive reaction was observed in SCN and OPT, but not in nerve fiber system and dorsal lateral geniculate body. Also PRV-Ba positive cells were distributed mainly in intermediate layer and weakly distributed in superficial layer of the superior colliculus. This study suggests that PRV-Ba is not a useful neurotracer in studying the visual system of the rat.

Clinical Analysis of Linear Skull Fractures

A retrospective analysis of 351 linear skull fractures, during the period of January 1, 1992 to December 31, 1993, reveals the following: 1) Motor-Vehicle-related accidents were responsible for most of the injuries(56%), in which pedestrians(47%) were the primary victims. 2) In 172 cases(49%), the Glasgow Coma Scale(GCS) ranged from 13 to 15. Patients wth parietal fractures usually rated on a lower scale than those with fractures on other sites. 3) Occipital fractures were most common(23%), which was followed by parietal(19%), temporal(15%), frontal(15%), and multiple fractures(8%). Occipital fractures were frequently due to a pedstrian T.A. or a fall from high elevation while temporal or parietal fractures were frequently due to bicycle and motorcycle accidents. 4) The incidence of associated intracranial lesions was 70%. Patients with occipital fractures had a lower percentage of associated intracranial lesions than those with parietal fractures. Coup injuries were found in 175 cases and contre coup injuries in 106 cases. In many cases, frontal, parietal and temporal fractures were found to be coup injuries whereas with occipital fractures, contre coup injuries. 5) Sixty-one percents of the patients were assessed in Glasgow Outcome Scale(GOS) grade I.

Immunohistochemical Localization of a Dopamine Releasing Protein in Human Brain / 체질인류학회지

In order to elucidate the existence and locality of DARP in the human brain, immunohistochemical identification was done in the brain tissues. This glycoprotein was distributed in paraventricular nucleus and thalamic reticular nucleus of diencephalon, substantia nigra and inferior colliculus of mesencephalon, medial vestibular nucleus, medial longitudinal nucleus, lateral reticular nucleus of medulla oblongata. And they follows a close distribution to that of catecholamine (CA) rich in either CA fiber or CA neuronal cell groups as previously reported by others using tyrosine hydroxylase (TH) as a marker. This striking similarities in the topographic arrangement of the DARP-positive reaction product and the TH-positive reaction product is another argument favoring the view that DARP is involved in the regulation of catecholaminergic neurons.

A Case of Epidermoid Cyst in Interhemispheric Fissure: Case Report

A Case of the epidermoid cyst with highly unusual location which is occurred in the interhemispheric fissure is reported. Intracranial epidermoid tumor develops predominantly in the cerebellopontine angle and parasellar regions. There has been no literally reported case the epidermoid developed in the interhemispheric fissure. The patient was 31-year-old man with the chief complaint of generalized seizure which was the first attack occurred one day before admission. The lesion with the size of about 3cm in diameter demonstrated by MRI was completely removed through posterior interhemispheric approach. The patient's postoperative recovery was unremarkable and without neurological deficit.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.