Effects of a Temperature-Sensitive, Anti-Adhesive Agent on the Reduction of Adhesion in a Rabbit Laminectomy Model

OBJECTIVE: A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. METHODS: Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. RESULTS: At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. CONCLUSION: The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation

OBJECTIVE: Lumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy. METHODS: This study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years. RESULTS: Of the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant. CONCLUSION: There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Efficacy of the Decompressive Craniectomy for Acute Cerebral Infarction: Timing of Surgical Intervention and Clinical Prognostic Factors

OBJECTIVE: Acute cerebral infarction is often accompanied by transtentorial herniation which can be fatal. The aim of this study is to determine the timing of surgical intervention and prognostic factors in patients who present with acute cerebral infarction. METHODS: We reviewed retrospectively 23 patients with acute cerebral infarction, who received decompressive craniectomy or conservative treatment from January 2002 to December 2004. We divided patients into two groups according to the treatment modalities (Group 1: conservative treatment, Group 2: decompressive craniectomy). In all patients, the outcome was quantified with Glasgow Outcome Scale and Barthel Index. RESULTS: Of the 23 patients, 11 underwent decompressive craniectomy. With decompressive craniectomy at the time of loss of pupillary light reflex, we were able to prevent death secondary to severe brain edema in all cases. Preoperative Glasgow Coma Scale and loss of pupillary light reflex were significant to the clinical outcome statistically. With conservative treatment, 9 of the 12 patients died secondary to transtentorial herniation. The clinical outcomes of remaining 3 patients were poor. CONCLUSION: This study confirms the value of life-saving procedure of decompressive craniectomy after acute cerebral infarction. We propose that the loss of pupillary light reflex should be considered one of the most important factors to determine the timing of the decompressive craniectomy.

Influence of Intraoperative Ventriculostomy on the Occurrence of Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVE: Neurosurgeons occasionally advocated intraoperative ventriculostomy to prevent traumatic brain retraction because of severe brain swelling in an acute stage of aneurysmal subarachnoid hemorrhage (SAH) surgery. The authors investigated the impact of the intraoperative ventriculostomy on the occurrence of shunt-dependent hydrocephalus in acute SAH. METHODS: The data of 141 ruptured aneurysm patients who underwent aneurysmal neck clipping in an acute stage were retrospectively reviewed. The patients were divided into three groups according to the cerebrospinal fluid (CSF) drainage amount via intraoperative ventriculostomy. Group 1 (n=44) included the patients who were not performed the intraoperative ventriculostomy, Group 2 (n=34) consisted of patients who were drained the CSF less than 40 cc ( or = 40 cc). By using statistical methods, the authors analyzed the influences of various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, presence of acute hydrocephalus and intraventricular hemorrhage (IVH) at admission on the occurrence of hydrocephalus. And also, we analyzed the relationships among the cisternal drainage, lamina terminalis fenestration, and the shunt-dependent hydrocephalus. RESULTS: Concerning the amount of CSF drainage via intraoperative ventriculostomy, the incidence of shunt-dependent hydrocephalus did not show any difference in three groups (p=0.146). Presence of the acute hydrocephalus, lamina terminalis fenestration, and cisternal drainage did not exert any influence on the incidence of shunt-dependent hydrocephalus, respectively (p=0.124, p=0.168, p=0.452). However, the incidence of shunt-dependent hydrocephalus in patients who had IVH at admission was significantly higher than in who did not have (p=0.010). CONCLUSIONS: Routine intraoperative ventriculostomy dose not increase the incidence of shunt-dependent hydrocephalus. Moreover, it obtains an adequate intraoperative brain relaxation, which results in the decrease of the brain retraction injury and the operation time.

Posterior Interosseous Nerve(PIN) Syndrome Caused by Anomalous Vascular Leash

Posterior interosseous nerve(PIN) syndrome is an entrapment of the deep branch of the radial nerve just distal to the elbow joint. It is caused by acute trauma or masses compressing the nerve. We report an unusual case of PIN syndrome with wrist drop caused by compression of the nerve by anomalous vascular leash. The patient has recovered with the surgical decompression of the offending vessels and arcade of Frohse.