ABSTRACT
OBJECTIVE: Subdural hematoma is one of complications of ventriculoperitoneal (VP) shunt for hydrocephalus. We observed many cases of subdural hematoma on early post-operative computed tomography scan performed after VP shunt. We analyzed clinical features and factors related occurrence of subdural hematoma after VP shunt. METHODS: From January 2009 to December 2011, 104 patients underwent shunt surgery by programmable valve for hydrocephalus. The demographic factors, preoperative medications, causes of hydrocephalus, radiologic features, and operative findings were reviewed. We divided patients into two groups: occurrence of subdural hematoma (Group A) and no evidence of subdural hematoma (Group B). RESULTS: Fifty-eight patients (55.8%) had a subdural hematoma after VP shunt. Mean setting pressure of valve was higher in group B compared to group A. A setting pressure is the only factor related to occurrence of subdural hematoma. Five patients in Group A (8.6%) had symptoms of subdural hematoma. Though subdural hematoma was absorbed spontaneously or by increasing of setting pressure of valve in majority of Group A, five patients underwent additional operation. CONCLUSION: The setting pressure of valve was important to prevent and treat subdural hematoma after VP shunt for hydrocephalus.
Subject(s)
Humans , Demography , Hematoma, Subdural , Hydrocephalus , Ventriculoperitoneal ShuntABSTRACT
OBJECTIVE: To investigate the feasibility of C1 lateral mass screw and C2 pedicle screw with polyaxial screw and rod system supplemented with miniplate for interlaminar fusion to treat various atlantoaxial instabilities. METHODS: After posterior atlantoaxial fixation with lateral mass screw in the atlas and pedicle screw in the axis, we used 2 miniplates to fixate interlaminar iliac bone graft instead of sublaminar wiring. We performed this procedure in thirteen patients who had atlantoaxial instabilities and retrospectively evaluated the bone fusion rate and complications. RESULTS: By using this method, we have achieved excellent bone fusion comparing with the result of other methods without any complications related to this procedure. CONCLUSION: C1 lateral mass screw and C2 pedicle screw with polyaxial screw and rod system supplemented with miniplate for interlaminar fusion may be an efficient alternative method to treat various atlantoaxial instabilities.
Subject(s)
Humans , Axis, Cervical Vertebra , Retrospective Studies , TransplantsABSTRACT
OBJECTIVE: Percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy with the microscope endoscopic tubular retractor system(METRx-MD) are considered popular minimally invasive surgery (MIS) methods for the treatment of lumbar disc herniation. Many authors have also reported good clinical outcomes of these methods, but there are few comparative studies of them. This report compares the clinical outcomes of PELD and METRx-MD for lumbar disc herniation as MIS methods and discusses the efficacy of PELD. METHODS: Seventy-two patients who had undergone single-level unilateral discectomy using two different methods, PELD and METRx-MD, between 2009 and 2011 were given a follow-up examination prospectively. Thirty-seven of these patients underwent discectomy using PELD, and the remaining 35 patients underwent discectomy using METRx-MD. In addition to the general parameters, clinical outcomes were assessed as specific parameters using the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI), the Short-form 36 (SF-36), and the return-to-work time. RESULTS: Sixty-seven percent (25/37) of the patients in the PELD group and 74%(26/35) in the METRx-MD group were included in follow-up more than 6 months post-operatively. The mean improvements in the VAS scores for the back pain, leg pain, and ODI were 2.6, 4.8, and 30.1% for the PELD group and 2.8, 4.6, and 33.2% for the METRx-MD group, respectively. The SF-36 physical health component subscale score improved from 40.6 pre-operatively to 68.3 at the last follow-up for the PELD group post-operatively, and from 48.5 to 65.1 in the mental component subscale (METRx-MD group: from 34.4 to 66.5 and from 44.87 to 56.7). Complications occurred in 3/37 patients in the PELD group and in 2/35 patients in the METRx-MD group in the peri-operative period. The mean return-to-work times were 37.5 days in the PELD group and 42.5 days in the METRx-MD group. CONCLUSION: The outcomes for the PELD group are comparable to those for the METRx-MD group. It can thus be concluded that PELD for lumbar disk herniations may be performed safely and effectively. Also, PELD can be considered one of the treatment modalities of lumbar disk herniation.