Clinical Features and Surgical Results of Brain Abscesses

OBJECTIVE: This study is undertaken to review the characteristics, risk factors and the surgical outcomes in long term follow-up of brain abscesses. METHODS: We had reviewed medical records and radiological findings in patients with brain abscess who underwent operations in our hospital from January 1992 to June 2003. RESULTS: Observed 11 cases were comprised of 8 men and 3 women with 42 years old average age ranging from 17 to 66. Lesions were located at frontal lobe in 5 cases, parietal in 4 cases, temporal in 1 case, and occipital in 1 case. The mean follow-up period was 23.8 months and ranged from 5 to 33 months. The microbial sources of infection had been found in 5 cases (45%). The organisms were identified by using the microbial culture obtained from the excisional biopsy. We had applied all cases with surgical excision. Empirical antibiotic treatment started soon after diagnosis in all cases. The mortality and morbidity of surgical excision were low. Nine patients were neurologically improved. One patient had died after the operation due to acute respiratory distress syndrome (ARDS). CONCLUSION: The single and large abscess located in an accessible lesion is a good candidate for surgical excision because of it's low morbidity, mortality, and favorable outcome after surgical excision. Further study is required to compare the surgical excision with other treatment modalities of brain abscess.

Clinical Features and Surgical Results of Distal Anterior Cerebral Artery Aneurysm

OBJECTIVE: Distal anterior cerebral artery(DACA) aneurysms are relatively uncommon, and have special aspects. We discuss clinical features and surgical results of DACA aneurysms with review of literatures. METHODS: Among 725 cases of intracranial aneurysms operated from 1989 to 2001 in our hospital, 38 cases of DACA aneurysms were studied retrospectively. The clinical presentations, neurological findings, operative approaches and outcome were analyzed. RESULTS: The incidence of the DACA aneurysm was 5.2% of total 725 aneurysms. Multiple aneurysms were found in 10 patients. Among the 38 patients, 15 were men and 23 were women. The mean age was 49.8 years. 2 aneurysms were located at frontobasal artery, 5 at the origin of frontopolar artery, 28 at the bifurcation between callosomarginal and pericallosal artery, 3 at the origin of pericallosal artery. 32 patients had good outcomes after surgery. 4 patients remained disabled, and 2 patients died. Postoperative complications were vasospasm, cerebral infarction, intracranial hemorrhage, pneumonia. CONCLUSION: The incidence of DACA aneurysm was relatively rare than other location. We think that unilateral interhemispheric approach is useful for aneurysm in most DACA, and approaches should be chosen according to the location of aneurysm and presence or absence of multiple aneurysms. The Glasgow Outcome Scale score was good in patient with low Hunt & Hess grade preoperatively. And early operation can reduce the rate of rebleeding and improve outcome of DACA aneurysms.

Clinical Features and Surgical Results of ICA Bifurcation Aneurysms

OBJECTIVE: The aneurysms developed at internal carotid artery(ICA) bifurcation can be different from other aneurysms because there are many perforating arteries and the hemodynamic changes are characteristic. In this report, we present our cases of ICA bifurcation aneurysms and discuss the clinical features and surgical outcomes of these aneurysms. METHODS: From January 1989 to May 2001, total 808 patients(982 aneurysms) were operated for intracranial aneurysms at our hospital. Among them, twenty two patients(2.7%) had aneurysms at ICA bifurcation. We discussed clinical features according to mental status at admission, size, direction and multiplicity of aneurysms, presence of intracranial hemorrhage and rupture of ICA bifurcation aneurysms. And we also discussed the surgical results of operations depending on pre-operative Hunt-Hess grade and size of aneurysms. RESULTS: Mean age was 43.4 years old and 10 cases(45.5%) were below 40 years old. Six patients(27.2%) had large or giant aneurysms. Fifteen(68.2%) out of 22 patients had good results, 1 fair, 1 poor and 5 dead. CONCLUSION: In our ICA bifurcation aneurysm cases, we conclude that their onset is relative in younger age, and they has a higher incidence of multiple(34.6%) and larger aneurysm(27.2%) than other anterior circulatory aneurysm. And the surgical results of ICA bifurcation aneurysm are relatively poor.

Post-Traumatic Tension Pneumocephalus of Delayed Onset: Case Report

The authors present a case of post-traumatic tension pneumocephalus of delayed onset. A 23-year-old man fell down and was admitted to our hospital with initial diagnosis of basal skull fracture associated with small amounts of pneumocephalus on brain computerized tomography(CT). At admission, the consciousness was alert without focal neurological deficit. During conservative therapy, headache was slowly progressive and consciousness became drowsy on 13th day after admission. The brain follow-up CT showed huge low air density lesion in the right frontal area. We performed unilateral subfrontal craniotomy with duroplasty for removal of air and dural repair with galea aponeurotica and abdominal fat. Postoperatively, the condition was recovered.

Solitary Dural Plasmacytoma: Case Report

The authors present a case of solitary dural plasmacytoma. A 43-year-old woman was admitted our department due to headache. Brain magnetic resonance(MR) image showed homogeneous enhanced lesion at the left occipital area. We performed surgical excision and it was confirmed plasmacytoma, histologically. The solitary dural plasmacytomas are exceedingly rare. Before this case report, only 17 cases had been reported in the literature

Detection of Aneurysms in Patients with Spontaneous Subarachnoid Hemorrhage: A Comparison of Three-dimensional Computed Tomographic Angiography and Conventional Angiography

OBJECTIVES: Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography(CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). METHODS: We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. RESULTS: Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.

The Effect of Opening Lamina Terminalis on the Development of Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

No abstract available.

Anterior Cervical Fusion with the PCB Instrumentation (Cervical Plate Cage System) in Degenerative Cervical Disease

OBJECTIVE: The anterior interbody fusion for cervical spine disorder may not provide adequate immediate stabilization, whereas anterior cervical spine plating has overcome this main disadvantage. Recently, several types of hardware were introduced and the complications related to these were also reported. In case of degenerative cervical spine disorders, the adequate intervertebral disc space height and lordotic curvature are the major factors for preventing recurrence of symptoms. So we used the PCB instrumentation(cervical plate cage system) for these purpose. MATERIAL AND METHOD: From April 1998 to October 1998, 16 patients with degenerative cervical spine disorders who had radiculopathy or myelopathy were underwent anterior cervical spine fusion with the PCB instrumentation(cervical plate cage system). Single level fusion was accomplished in 8 patients and two level fusion in 8. The mean follow-up period was 4 month. RESULT: All patients show some recovery at discharge. There were no hardware problems. The intervertebral disc space height and lordotic curvature were not changed during follow up. CONCLUSION: These finding suggest that PCB instrumentation can be considered to be one of the useful hardwares for anterior cervical spine fusion in degenerative cervical spine disorders.

Prospective Study of Hemifacial Spasm after Microvascular Decompression

In order to observe the change of the clinical results after Microvascular Decompression(MVD), we followed up 261 cases with hemifacial spasm(HFS). The patients were operated between Nov. 1985 and Aug. 1994. The length of observation had been more than 6 months in all cases. The mean age of the patients was 47.0 years old and the mean duration of symptom was 8.2 years. Female constitutes 82.8% of the total an right side was involved in 52.1%. The most common offender was the anterior inferior cerebellar artery (51.0%), and 33% involved multiple vessels. The most common offender was the anterior inferior cerebellar artery (51.0%), and 33% involved multiple vessels. The postoperative complications occurred in 84 cases, 4 of which were permanent. However, there were no mortalities. Among the 226 cases, which were followed up for more than 6 months after the MVD, the final clinical results of 187 cases were excellent, the success rate was 91.7%, and the patients' satisfaction rate was 96.1%. The rate of excellence was 61.1% at POD 7th and 82.7% at final, respectively. The delayed resolution of the HFS during follow-up comprised 37.4% of the completely resolved cases. According to the above results, the clinical status of HFS after MVD continuously changes, therefore follow-up observation after MVD is needed to evaluate the operative results, especially in the delayed resolved cases.

Neuroendocrine Effects in Occupational Solvents Exposure / 대한산업의학회지

Long term occupational exposure to solvent mixtures may cause adverse effects to the central nervous system with neurobehavioral symptoms. And some organic solvents have been suggested to cause impairment of tuberoinfundibular dopaminergic activity and neurochemical mechanisms controlling pituitary secretion. For the purpose of assessing neuroendocrine effects in occupational solvents exposure, hormonal study settings (shoes-manufacturing industry & fishing products industry) and compared with nonexposed controls (33men, 85women). Male workers exposed to solvent mixtures had significantly lower plasma level of follicle-stimulating hormone (FSH) than nonexposed male controls. While female workers exposed to solvent mixtures had significantly lower plasma levels of growth hormone (GH), and thyroid-stimulating hormone (TSH) than nonexposed female controls. The results of significant decrease in plasma concentrations of pituitary hormones (FSH, GH, and TSH) in workers exposed solvent mixtures indicate that occupational exposure to solvent mixtures may induce neuroendocrine effects through an effect on hypothalamic pituitary axis.

A Case of Supratentorial Rhabdomyosarcoma

The authors are reporting a rare case of supratentorial rhabdomysarcoma which arose in the left middle fossa and unusually revealed symptoms of increased intracranial pressure only without focal signs. We also reviewed literatures.