Microsurgical Selective Obturator Neurotomy for Spastic Hip Adduction

OBJECTIVE: Cerebral palsy may induce harmful spastic hip adduction. We report the result of microsurgical selective obturator neurotomy, performed on 12 spastic hip adductions of 6 patients, followed clinically for at least 26 months postoperatively. METHODS: Microsurgical selective obturator neurotomies, involving microsurgical resection of the anterior obturator nerve branches were performed on 6 patients from January 2000 through June 2003. All patients presented with the inability to sit and 2 patients complained of persistent, intractable pain. We used intraoperative bipolar stimulation to identify selected motor branches. RESULTS: The procedure was performed bilaterally in all patients. In the 3 patients in whom contractures were present, microsurgical selective obturator neurotomies were accompanied by an additional tenotomy of the adductor muscles. Selective tibial neurotomy was performed on three of six patients who originally presented with a spastic ankle. Postoperatively, all spastic hip adductions were corrected more than 60 degrees in passive abduction-adduction amplitude. However, one patient who did not receive active postoperative physiotherapy demonstrated a decreased passive abduction-adduction amplitude upon follow-up. There were no surgical complications. CONCLUSION: We think microsurgical selective obturator neurotomy may be an effective procedure in the treatment of localized, harmful spastic hip adduction after failure of well conducted conservative treatment. As muscular contractions are often associated with spasticity of the hip adductors, an adjunctive tenotomy may be an option. Comprehensive postoperative physiotherapy is essential to improve long-term results.

Atypical Cerebellar Medulloblastoma Originating from Tentorium: Case Report / 영남의대학술지

The extraaxial presentation of a medulloblastoma is rare. This article describes the case of a 12-year-old boy who presented with severe headache, nausea, and vomiting. The tumor developed in the left tentorium; it was misdiagnosed as a meningioma based on the radiology examination. We review the literature and discuss the atypical presentation of medulloblastoma.

Surgical Results of Unruptured Intracranial Aneurysms

OBJECTIVE: To document surgical mortality and morbidity for the treatment of unruptured intracranial aneurysms, and to identify optimal treatment modalities, the authors reviewed and analyzed the surgical results. METHODS: The authors reviewed 49 cases of unruptured intracranial aneurysm without a previous history of subarachnoid hemorrhage from March 1984 through December 2003. Unruptured intracranial aneurysms were categorized as asymptomatic and symptomatic, and operative results were assessed using the Karnofsky scale at 3 months postoperatively. Outcomes were defined as 'excellent' for a Karnofsky scale score of 100, 'good' for a score of 80~90, 'fair' for 50~70, 'poor' for 10~40, or as 'death'. Excellent and good results were defined as a 'favorable' outcome and others as 'unfavorable' outcome. RESULTS: Of the 49 study subjects, 45 had a favorable outcome and 4 an unfavorable outcome. Surgical mortality was 6.1% and surgical morbidity was 2.0% for all subjects. And the symptomatic group had more complications. CONCLUSION: There were no significant relationships between aneurysmal size, location, and preoperative symptoms with surgical results. And we believe that the reasons for morbidity and mortality are attributable to strokes, thus more attention should be paid to peri- and post-operative patients care with a focus on strokes prevention in the symptomatic group.

Strategy for Management of Giant Invasive Pituitary Adenoma

OBJECTIVE: Giant invasive pituitary adenoma looks histologically benign, but these tumors have an aggressive clinical course. The authors review 10 cases and discuss the results obtained and the strategy to use for the management of giant invasive pituitary adenoma. METHODS: Out of a series of 155 pituitary adenomas treated surgically between 1994 and 2002, ten patients with giant invasive pituitary adenoma were selected and their clinical problems, radiologic findings, extent and invasiveness, hormonal and histologic findings and surgical results were analyzed retrospectively. RESULTS: There were 4 male and 6 female patients, with an average age of 47 years and an average follow-up period of 42 months. The average size of tumor was 50.7mm. These tumors revealed severe invasions into surrounding structures. 8 patients underwent transsphenoidal approach(TSA) operations, 1 patient with transcranial operation and 1 patient with combined TSA and transcranial operation. In all cases, subtotal resection was performed. The histologic findings were 2 prolactinomas and 8 hormonal non-function adenomas. The therapies administered after surgical removal consisted of conventional fractionated radiotherapy (2 patients), treatment with dopamine agonists to control hyperprolactinemia (2 patients), and treatment with hormone replacement (2 patients). CONCLUSION: Giant invasive pituitary adenomas are characterized by different forms of expansion and invasiveness and variable clinical problems. Because of their aggressive expansion and invasiveness, there are many different strategies which can be considered for their management. The authors obtain good results by choosing conservative surgical removal and multidisciplinary treatments with serial radiological and hormonal follow-up.

The Time Evolution of Cerebral Apoptosis in the Permanent Middle Cerebral Artery Occlusion Model in Rats

OBJECTIVE: The purpose of this study is to determine the time evolution and distribution of cerebral apoptosis using the middle cerebral artery occlusion model in rats. METHODS: A total of twenty four male rats - with 2, 3, 4, 6, 8, 12, 24 and 48 hours of middle cerebral artery occlusion respectively - were studied. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling(TUNEL) method was used for the observation of the apoptotic cells. The apoptotic ratio was calculated and the distribution of apoptosis was inspected in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex. The rats were divided into three groups(Group I: 2~4 hours of occlusion, Group II: 6~12 hours of occlusion, Group III: 24~48 hours of occlusion). RESULTS: In this study, the proportion of apoptosis increased with the duration of middle cerebral artery occlusion and reached a maximum after about 12 hours of middle cerebral artery occlusion. The mean values of the apoptotic ratio were 30.7+/-11.3% in group I, 60.8+/-2.6% in group II and 48.7+/-0.7% in group III. The distribution of apoptosis differed in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex according to the duration of time of the middle cerebral artery occlusion. CONCLUSION: In the middle cerebral artery occlusion model of the rats, apoptosis is found to increase according to the occlusion time, reaching a peak after 6 hours, and the distribution of apoptosis changed from the pyriform cortex to the basal ganglia and middle cerebral artery territory cortex.

Intradural Extramedullary Non-infiltrated Solitary Metastatic Tumor

Spinal intradural extramedullary non-infiltrated solitary metastasis is very rare. We report a case of intradural extramedullary carcinoma to the T9 nerve root, which mimiking a nerve sheath tumor. Pathology reveals metastatic adenocarcinoma. We discuss the feature of mechanism and pathogenesis and management strategy follows.

Prognostic Factors of Pyogenic Spinal Infections

OBJECTIVE: This study is performed to evaluate the clinical manifestations and prognostic factors among patients with pyogenic spinal infections. METHODS: The records and radiologic data of 27 patients treated between 2001 and 2003 were retrospectively evaluated. RESULTS: All patients (mean age, 55.2yrs) were treated with i.v. antibiotics and 13(48.1%) required surgical treatment. Mean follow up duration was 38.9 weeks. The sixteen patients(59.2%) had previous surgical procedure on spine and six patients(22.0%) had local injections. The ten patients had predisposing factor (such as, diabetes mellitus, UTI, liver cirrhosis, septic condition). The most common symptoms are lower back pain and motor weakness. Causative organisms determined only in ten patients(37%) and Staphylococcus aureus(50%) was most common. C-reactive protein(CRP) and white blood cell(WBC) count were more correlated with clinical outcome than erythrocyte sedimentation rate(ESR). CONCLUSION: CRP and WBC level can be significant parameters of treatment and prognosis in pyogenic spinal infection.

Magnetic Resonance Image Findings of Lumbar Prevertebral Aortocaval Structures in Korean Spinal Disorder Patients

OBJECTIVE: The purpose of this study is to evaluate the level of lumbar spine corresponding to the prevertebral major vascular structures and the distance of the prevertebral available disc space (DPADS) of L5-S1 between the common iliac arteries and veins with preoperative magnetic resonance imaging (MRI) study. METHODS: Three hundred and forty seven lumbar MRI films (200males and 147females) from spinal disorder patients were reviewed. The patients' age ranged 14 to 86 years (mean 45 years). The patients were divided into eight groups by 10-year interval from a teen to the eighties. There were evaluated age-related locational changes in the level of lumbar spine corresponding to the aortic bifurcation (AB) and the origin of inferior vena cava (OIVC). In addition, DPADS of L5-S1 between the common iliac arteries and veins were measured. RESULTS: The common sites of the AB for the entire subject group were at the upper body of L4 (from the upper body of L3 to the lower body of L5). The common sites of the OIVC for the entire subject group were at the level of the L4-L5 disc space (from the upper body of L4 to the lower body of L5). The age-related changes in the location of the AB with a downward shift were statistically significant (p< 0.05). Similarly, age-related changes were observed in the OIVC, although this was more prominent in females (p<0.05). The average DPADS of L5-S1 was 34.48+/-10.00 mm. There were 27 cases(7.8%) who had the DPADS less than 20mm, and this narrow DPADS could make it very difficult to access the anterior disc space of L5-S1 because recently the popularly used anterior lumbar fusion materials were over 10 mm in diameter. CONCLUSION: These results may be helpful to minimize potential vascular injury and morbidity in anterior lumbar spinal surgery.

External Ventricular Drainage System with Long Subcutaneous Tunnel

OBJECTIVE: The goal of this study is to introduce a new method of external ventricular drainage system to reduce the complications of infections by making a long subcutaneous tunnel. METHODS: Between January 2002 and March 2003, 59 cases of ventriculostomy including 44 cases of short subcutaneous tunnel and 15 cases of long subcutaneous tunnel were performed and analysed. Subarachnoid hemorrhage and intraventricular hemorrhage were major indications for ventriculostomy. RESULTS: No infection was noted in the group of 15 patients with long subcutaneous tunnel. Whereas, 6 cases(13.6%) of infection was diagnosed in the group of 44 patients with short subcutaneous tunnel. The ventriculostomy was kept maximally for 11(mean 7.4)days without infection in the patients with long subcutaneous tunnel. CONCLUSION: To reduce the infection as a complication of ventriculostomy, we devise a new drainage system that involves the long subcutaneous tunnel.

The Influence of Monocular Occlusion on the Preoperative Ocular Alignment and the Surgical Outcome in Basic Intermittent Exotropia

PURPOSE: This study was to evaluate the influence of monocular occlusion on the preoperative ocular alignment and the surgical outcome of basic intermittent exotropia. METHODS: We examined 42 patients with basic intermittent exotropia who were operated and followed for at least 6 months postoperatively from January 2001 to August 2002. In all patients, angle of misalignment measured while the patients fixate on an accommodative target at 6m and 33cm, and after 2 hours of monocular occlusion. The subjects were divided into two groups: Gruop 1-far angle of misalignment did not increase after 2 hours of monocular occlusion, Group 2-far angle of misalignment increased in 3PD or more after 2 hours of monocular occlusion. Group 2 underwent surgery for the increased deviation of far angle. RESULTS: Among 42 patients with basic intermittent exotropia, Group 1 included 27 (64.3%) patients and Group 2 15 (35.7%) patients. In Group 2, the mean ( +/- SD) increase in the angle of exotropia after 2 hours of monocular occlusion was 5.33 ( +/- 2.74)PD. The success rate of surgery was 77.8% (21/27 patients) in Group 1, 93.3% (14/15 patients) in Group 2 at 6 months after surgery and 70.4% (19/27 patients), 93.3% (14/15 patients) at the final visit. There was no statistically significant difference (p> 0.05). CONCLUSIONS: This study showed the significant influence of monocular occlusion on the ocular misalignment before surgery and surgical outcome in basic intermittent exotropia. Angle of misalignment measured after 2 hours or more of monocular occlusion seemed to be meaningful.

Ultrastructural Changes of Pineal Gland in Rats Exposed to Microwaves

OBJECTIVE: This study is aimed to see ultrastructural changes of pineal gland in rats exposed to microwaves. METHODS: We conducted an experiment by exposing rats at the electromagnetic wave frequency of 2.45GHz, using with an EMR(electromagnetic radiation) emitting apparatus to study the effect of electromagnetic wave on the pineal gland. Paying especial attention to measure damages to pineal gland cells in the brain, we set the levels of EMR according to the duration of electromagnetic wave exposure at 1.2 joules(20min exposure), 2.4 joules(40min exposure), 3.6 joules(60 min exposure), and 4.8 joules(80min exposure) per 1cm2. RESULTS: Compared with normal cells, main histologic changes were observed with an electron microscope included swelling of the pineal gland cells, a decrease in the electron density of interstitial tissue, an increase in the distances between pineal gland cells, an increase in number of lipid-droplets, and swelling of mitochondria. Especially in those pineal cells exposed to EMR for 80 min, severe swelling of mitochondria and a slight increase in lysosome were observed. CONCLUSION: The authors could identify the harmful effect of microwave by observing abnormal ultrastructural changes of pineal cell in rat according to the increasement of electromagnetic radiation.

Anterior Reduction and Stabilization of Unilateral Locked Facet of Cervical Spine

OBJECTIVE: We present an evaluation of the safety and effectiveness of anterior reduction and stabilization of unilateral locked facet of the cervical spine. METHODS: Nine patients with unilateral locked facet of the cervical spine were treated with anterior decompression, reduction and stabilization from January 1997 through December 2000. There were six male and three female patients who ranged in age from 22 to 59 years (average 37.4 years). The level of facet dislocation was C4-5 in one, C5-6 in four, and C6-7 in four patients. One patient presented with complete spinal cord injury, two patients with incomplete spinal cord injury, four patients with radioculopathy, and two patients were neurologically intact. All patients underwent plain radiogram, computed tomogram scan, and magnetic resonance imaging. All patients underwent surgery for anterior open reduction, decompression and stabilization using bone graft and anterior cervical plate fixation systems. The mean follow-up periods was 11.9 months. RESULTS: All patients showed good decompression, reduction and stabilization without postoperative complications. Two patients showed vertebral artery thrombosis at facet locked side, but no cerebral ischemic symptoms. Follow-up neurological status was unchanged in two patients and improved in 7 patients. No patient experienced neurological deterioration or complications after this procedure. All patients showed good bony fusion without instability at follow-up period. CONCLUSION: Our results show that anterior decompression, reduction and stabilization procedure are safe and effective method in unilateral locked facet of the cervical spine without significant complications.

Anterior Cervical Interbody Fusion with Carbon-Composite Cages and Local Autobone for Cervical Disc Disease

OBJECTIVE: The aim of this study is to assess the technical feasibility, the clinical and radiological results of the interbody fusion with a carbon-composite cage and local autobone following anterior cervical discectomy. METHODS: From November 2001 to April 2002, fifteen patients with symptomatic degenerative cervical disc disease underwent this procedure. After standard microsurgical anterior approach, cervical interbody fusion was performed with carbon-composite cage and local autobone of operative site. The average follow-up period was 8.7 months. RESULTS: Postoperatively, all patients experienced clinical improvement and follow-up cervical X-ray films checked six months postoperatively demonstrated complete interbody fusion. One patient complained of transient swallowing difficulty, one patient noticed operative site hematoma and four patients noticed implant subsidence. CONCLUSION: This technique is considered as an easier implantation procedure than the previous techniques. The other advantages of this interbody fusion are immediate stability with good clinical response, no complication at donor site and easy to assess the fusion.

Brain Protective Effects of Mild Hypothermia on the Reversible Cerebral Ischemia in the Rat

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.

Systematic, Combined Treatment Approach to Nasolacrimal Duct Obstruction in Different Age Groups

PURPOSE: we studied the clinical outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). METHODS: we analyzed 186 patients (222 eyes) who had been treated for CNDO between January 1996 and December 2000. According to age, conservative treatment, nasolacrimal duct probing and silicone intubation were applied systematically until a successful outcome was achieved. Patients were grouped according to their age at the time of first visit.: Group 1 (0~6 months), Group 2 (7~12 months), Gruop 3 (13~24 months), Group 4 (25~72 months). Treatment efficacy was determined according to age and success rate was compared. RESULTS: Conservative treatment was applied only in children less than 1 year of age and was successful in 75.9% of Group 1 and 47.3% of Group 2. The difference between these two success rates was significant (p=0.0001). The overall success rate for first probing in all groups was 65.2% with a range 75.8% in Group 1, 62.1% in Group 2, 65.0% in Group 3, and 40.0% in Group 4. After second probing, the overall cure rates for the entire cohort were 82.6% with a range 87.9% in Group 1, 89.7% in Group 2, 80.0% in Group 3, and 50.0% in Group 4. There was no real difference in first probing cure rate relative to age (p=0.208). But after second probing, overall cure rate was significantly decreased when the age of the patients was over 12 months (p=0.027). Silicone intubation was performed in 4 of Group 1, 3 of Group 2, 4 of Group 3, and 5 of Group 4 and was successful in all cases. CONCLUSIONS: Systematic treatment approach to CNDO including conservative treatment, nasolacrimal duct probing, and silicone intubation, was highly successful. In this study, the cure rate for this combined approach was 100% in 186 patients (222 eyes).

The Surgical Result of Pituitary Adenoma by Transsphenoidal Approach

OBJECTIVE: Transsphenoidal approach(TSA) has been used as useful operative method for pituitary tumor but is still controversal in case of cavernous sinus invasion or severe suprasellar extension. This study was performed to evaluate the surgical result, recurrence, effect of adjuvant treatment, especially in cases of suprasellar extension or cavernous sinus invasion. MATERIAL AND METHODS: We studied 56 cases of surgically treated pituitary adenoma that we were able to follow up, treated by TSA from 1993 to 1998. There were 24 cases of suprasellar extension and 11 cases of cavernous sinus invasion. The medical records and radiological findings were reviewed. Surgical results including hormonal function and recurrence rates were analyzed according to extent of tumor invasion. Mean follow-up period was 19.1 months. RESULTS: Tumors with suprasellar extension were removed totally in 54%, whereas total tumor removal was possible only in 38% with cavernous sinus invasion. Overall of recurrence rate was 14% and recurrence rate was 25% in suprasellar extension and 9% in cavernous sinus invasion. In cases of both suprasellar extension and cavernous sinus invasion, tumors that were treated by TSA and radiation showed recurrence rate of 7%, whereas those treated by surgery alone showed 28% of recurrence. CONCLUSION: Transsphenoidal approach is safe and useful operative method for pituitary adenoma and adjuvant therapy including radiation therapy is effective means to decrease the recurrence in cases of suprasellar extension or cavernous sinus invasion.

Clinical Analysis of Operation for Elderly Patients with Intracranial Aneurysms / 대한뇌혈관학회지

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.

Experimental Analysis in the Reversible and Irreversible Cerebral Ischemic Models in the Rat

No abstract available.

The Time and Effect of Hypothermia in Early Stage of the Reversible Cerebral Focal Ischemic Model of Rat

No abstract available.

Changes in Infarct Size after Reperfusion with Time in a Reversible Cerebral Ischemic Model in Rats

No abstract available.