Abducens Nerve Palsy after Lumbar Spinal Fusion Surgery with Inadvertent Dural Tearing

Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.

Clinical and Radiological Outcomes with the Lumbar Total Disc Replacements

OBJECTIVE: To determine the clinical and radiographic results and incidence of complications in lumbar arthroplasty patients. METHODS: From January, 2003 to March, 2005, 46 patients were implanted with 30 cases of the Charite Artificial Disc and 16 cases of the Prodisc. There were 28 males and 18 females with a mean age 40.6 years(range, 21~70). Diagnoses included 19 patients with discogenic back pain, and 27 patients with FBSS. All patients were examined at a minimum 2-year follow-up(mean 3.5 years). Clinical outcomes were assessed by Oswestry Disability lndex(ODI), Visual Analogue Scale(VAS),and Macnab's Criteria. Dynamic lateral flexion and extension radiographs were used to radiologic assessment. RESULTS: The ODI was reduced from 67.6% to 8.9% at the latest follow up. The mean VAS baseline was 8.29 and 2.08 at the latest follow-up. Clinical outcome was excellent or good in 40 patients(mean 87, 93% FBSS, 78% Discogenic back pain). Mean flexion/ extesion range of motion at L4-5 was 9.1degrees Charite, 9.8degrees Prodisc and at L5-S1 it were 5.5degrees, 5degrees. A total of 7 complications(15%) were noted [subsidence (2), polyethylene core wire break down (1), vertebral body posterior inferior cortex breakage (1), anhydrosis (2), nerve root damage (1)]. CONCLUSIONS: This study demonstrates the safety and efficacy of the total disc replacements especially FBSS cases.

Analysis of Readmission Patients after Lumbar Microdiscectomy

No abstract available.

Follow-up of Pedicle Screw Fixation for Lumbar Spinal Instability over 60 Years Old

OBJECTIVE: In accordance with the increasing number of elderly people in our society, the incidence of pedicle screw fixation which is a technically demanding procedure and requires a lengthy operation time has increased in the patients with lumbars instability over 60 years old. To ascertain the outcome and efficacy of the pedicle screw fixation in patients over 60 years old, we analyzed the surgical results including complications. PATIENTS AND METHOD: From May, 1994 to September, 1997, we assessed 30 patients over 60 years of age and 159 patients under the age of 60 with lumbar spinal instability who underwent surgery of pedicle screw fixation and compared with the results of surgery between two groups. RESULTS: For the elderly, the average operation time was 244 minutes and the transfusion amount was 3.3 pints. For younger patient the average operation time was 246 minutes and the transfusion amount was 3.2 pints. Four surgical complications occurred; two patients with voiding difficulty, one patient with heart problem, and a patient with DIC(Disseminated Intravascular Coagulation). However, all complications were controlled without further problems. The success rate in the elderly was 60%, which was lower than the success rate of 76% among younger patients. CONCLUSION: Considering the condition of the diseases in the elderly and the fact that the operations were performed without any major problems, these results are acceptable. Based on our analysis, it is our view that advanced age per se should not be regarded as a contraindication for pedicle screw fixation.

A Case of Cervical Far Lateral Disc Herniation-Case Report-

Compared to the lumbar region, it is very rare to encounter far lateral disc herniation in the cervical spine, and because of this, correct diagnosis before surgery is difficult: the condition can, however, be identified through the use of advanced MRI imaging techniques. In this case, far lateral disc herniation at C7-T1 was effectivery removed through posterior laminoforaminotomy, and soon after surgery, the patient's symptoms showed complete remission.

Morphological Changes of Cerebrum in Rabbits Exposed to Microwaves

The author measured the severity of brain damage of 36 rabbits irradiated 2.45 GHz microwave for 10 minutes, 20 minutes and 30 minutes, respectively. Electromicroscopic and light microscopic findings of just after, 1 weeks, 2 weeks and 4 weeks after irradiated brain were compared in each time. Swelling and vacualization of nerve cell and mitochondria were noted. Also these changes tend to increased severity along amount of radiation, but revealed reversible changes with time. Myelinated and unmyelinated nerve fibers were examined as same manner. These nerve fibers also revealed swelling and vascuolization, these findings also tend to increase severity with irradiation power and more prominent at unmyelinated nerve fibers. Reversability of these findings after each time period were more prominent in myelinated nerve fibers than unmyelinated nerve fibers.

The Effects of Microwave Irradiated on Rabbits' EEG

Microwaves may induce effect and damage on nervous tissue, either by thermal or mon-thermal mechnisms. EEGs were checked in left frontal lobe before and after irradiation of microwave at frequency of 2.45 GHz in 18 Rabbits. In results, mean total power of EEG was slightly decreased after irradiation of microwave. And mean composition percentage of delta wave was decreased and mean composition percentages of theta, alpha and beta wave were increased after irradiation in observation for 7 days. That mean decrease of electrophysiologic activity and trend of fast wave in brain after irradiation of microwave.

Complete Removal of Giant Craniophanyngioma by Drainage Through the Ommaya Reservior

Craniopharyngioma is one of the most challenging, Frustrating, and humbling benign intracranial tumors of childhood. Its behavior is a clinical malignancy even though it is benign tumor in microscopically. There is no single treatment of craniopharyngioma and there must be a plan customized for eacg patient. This decision may, be made from diagnostic studies alone, but in most cases exploration of the tumor and the testing of its adherence to its surroundings will be the only thorough and fair way to determine whether it can be totally excised or not. So the choice of treatment is "individualize". We experienced one case of giant cystic craniopharyngioma and performed combined operaion whih were percutaneous intermittent drainage of cystic fluid through Ommaya reservoir and following microsurgical radial excision. There was no complication and marked intellectual and psychological improvement until todays for 20 months.

Combined Approach for Large CPA Tumor with Sacrifice of Sigmoid Sinus

With large CPA tumor(>3 mm), brain stem is usually displaced and distorted to contralateral side. It is important minimize retraction to protect brain stem and to lower morbidity. In our previous report, we reported the result and method of combined approach for large CPA tumor. In order to minimize brain stem retraction and to get good operating field, three of 7 cases of large CPA tumor with combined approach were operated with sacrifice of sigmoid sinus. The sigmoid sinus can be sacrificed if it can be angiographically verified that the sagittal sinus represents the major drainage to the contralateral sigmoid sinus. During operation, if pressure difference between before and after occlusion of sinus is less than 10 mmHg and any brain swelling does not develop after occlusion, the sigmoid sinus can be sacrificed.

Clinicopathologic Analysis of Meningioma

The authors analyzed the clinical and pathological characteristics of 66 meningioma patients, operated and pathologically confirmed at the Department of Neurosurgery > Pathology, Yeungnam University Hospital from 1984 to 1992. The results are as follows: 1) Meningioma was the most common in the 6th decase(39.4%) and the overall ratio of male to female was 1:2.5. 2) The most common pathologic types were meningothelial type(30.3%) and transitional type(30.3%). 3) The predilection sites were convexity, parasagittal and falx in order of frequency. 4) The most common clinical features were IICP signs(57.6%). 5) The marginal contour of the tumor on brain CT wre more irregular, mushrooming and fringing pattern in the case of angioblastic and atypical type. The brain edema was more severe in the case of these types. However, these findings had no correlation with prognosis. 6) Thre were 9 atypical cases(13.6%). 7) The total removal was done in 53 cases(80.3%) and the postoperative mortality rate was 7.5%. 8) The recurrence rate was 9.0% and the mean duration of recurrence was 36.5 months. The recurrence depended on grade of the surgical removal rather than the pathological type.

Stereotactic Guided Craniotomy:Method for Localization and Removal of Small Intra-Axial Lesion

Combining the stereotactic precise localization with open craniotomy can decrease post-operative morbidity and is helpful for total removal of small intra-axial lesion. The authors had good results by the stereotactic guided craniotomy. The method and results of the technique are discussed in reference to 8 patients.

Clinical Analysis of Failed Back Surgery Syndrome

One hundred thirty-five patients undergone microdiscectomy of lumbar disc disease were analysed with soft-ware program which designed for effective analysis for spinal in-patients since February, 1990. Owing to that program, all the patients could be easily analyzed and get a regular follow-up. The surgical result was evaluated by our own score rating system which consists of 4 items:1) Frequency of medication, 2) Degree of social activity, 3) Post-operative symptom compared to pre-operative state and 4) Patient's satisfaction with the operation. According to that system, 21 patients(15.6%) were estimated with failure following microdiscectomy. Among them 6 patients of psychosocial problem, 4 patients of technical errors and 2 patients of recurrence were an important causes of failure. For the purpose of effective surgery for lumbar disc surgery, a careful analysis of the cases of surgical failure should be attempted and also a regular follow-up can be importment factor for more accurate estimation of surgical result.

Follow-up Lumbar Spondylolisthesis after Pedicle Screw Fixation

Sixty five patients of lumbar spondylolisthesis were treated with pedicle screw fixation during last 3-years. Roy-Camille plate system has been used in 17 patients, steffee system in 41 and Puno/Winter/Byrd(PWB) system in 7. We analysed the changes of symptoms and radiological findings during follow-up observation(average 15 months). After surgery the average time for low back pain reduction was 7 months, Twenty patients(3%) complained a graft donor site pain initially, but almost except one were alleviated after 7.3 months later on an average. Radiologically the reducton degree of the displacement was from 24% on preoperative state to 12% on last follow-up and pseudoarthrosis rate was 8%. Surgical result was evaluated by our score rating system, according to that system 64.5% of the patients had satisfactory result.

Combined Approach for Large CPA Tumor

With large CPA tumors, the goal of surgery is safe total removal of the tumors and preservation of nearby neural structures. Although the suboccipital approach can be made for large CPA tumors, combined approach is more preferable method for the wide exposure of the CPA including brain stem and the lower cranial nerves. We have recently experienced favorable results by combined approach. Total removal of large tumors were obtained by these approaches. The authors present surgical points of view and a brief review of literature.

Internal Fixation of the Unstable Cervical Spine Fracture and Subluxation

Recently various kinds of anterior or posterior cervical instruments have been used for stabilization of unstable cervical spinal injury. Every device has different characteristics, so none can cover all of the various types of unstable injuries. Forty six patients of unstable cervical spine fracture and subluxation underwent stabilizing operation using the anterior Caspar plate(6 cases) and the Roy-Camille posterior plate system(40 cases) during recent 3-years. Each approach employed depends on the site of compression and mechanism of injury. Six patients who had complete neurological injury expired after the surgery. The follow-up period for the 40 patients was from 5 to 32 months(average-17.5 months). During follow-up period, 16 out of 22 patients(72.7%) who had a neurological deficit showed minimal to moderate improvement and only 4 patients(10%) complained of significant arm or neck pain. The only complication of instrumentation was 5 cases of screw breakout, but 3 of them did not have any problem. Radiologically 37 patients(92.5%) had firm fixation after surgery.

The Correlations between the Hematoma Volume and the Changes of ICP, Blood Pressure & Prognosis in the Spontaneous Intraparenchymal Hemorrhage

The development of CT scan and stereotaxic surgery with urokinase irrigation made possible early diagnosis and improved survival in the patients of spontaneous intraparenchymal hemorrhage. We had clinically reviewed and analyzed 30 patients of stereotactically treated spontaneous intraparenchymal hemorrhage, according to the hematoma volume, ICP, wital signs, GCS and prognosis. The results were summarized as follows: 1) As the hematoma volume increasing, ICP was also increased(p<0.05). 2) The systolic arterial pressure was increased as the hematoma volume increasing(p<0.05). 3) Mean ADL was 55(26% and ADL level were decreased in cases of large hematoma(p<0.05). 4) As the hematoma volume increasing, the level of verbal GCS and total GCS was low(p<0.1). 5) No significant correlation was noted between the hematoma volume and complications(T test).

Direct Surgical Approach of the Spontaneous Carotid Cavernous Fistula

We report a case of spontaneous carotid cavernous fistula(CCF) showing low flow shunt, which was successfully occluded in the fistular site of CCF by direct surgical approach via anteromedial, paramedial and Parkinson's triangle intradurally through pterional subte mporal petrosal route extradurally after intermitten temporary clipping of internal corotid artery(ICA) in petrosal portion and proximal to the ophthalmic artery without hypotension, hypothermia, extracorporial circulation, or cardiac arrest.

Clinical Analysis of Cerebral Arteriovenous Malformation

Clinical and cerebral angiographic findings were reviews retrospectively in thirty-seven patients with intracranial artero-venous malformation(AVM). The results were as follow. Many opatients who were in reproductive age had visited due to seiure(27%) and its angiographic findings were mixed Type(80%). Bleeding was predominant in the patients who had small sized nidus than medium or large one, and deep draining vein than superficial one. Medium sized AVM was located mainly in the anatomically deep portion(71%) and drained to deep portion also(71%). Associated aneurysm was more prevalent in deep seated or large sized AVM. Low grade AVM according to Spetzler's grading system showed good results of treatment. Postoperative hemorrhage or sizure were frequently found in patients who had superfically located AVM.

Lumbar synovial cyst associated with retrolis thesis: a case report / 영남의대학술지

In advent of high-resolutional CT and MRI, it is not so difficult to detect the lumbar synovial cyst, however the unusual disease should be included in the differential diagnosis of cauda equine compression syndromes. The case of a 55-year-old man who had a low back pain and severe radiating pain on both legs showed a retrolisthesis at L3-4 and L4-5 and epidural enhancing mass just around L4-5 facet joint on MRI. Microscopically a lining of synovial tissue was demonstrated. After surgery of the total resection of synovial cyst and stabilization, the patient's presenting symptoms were improved.

Surgical Decompression and Stabilization with Instrumentation in Theoracolumbar and Lumbar Spine Fracture

Twenty patients with a major thoracolumbar or lumbar spine fractures were treated with various kinds of internal fixation device through anterior or posterior approach during last 2 years. Anterior spinal surgery(10 patients) applied to the patients who had a major fracture of anterior compartment with neural canal impingement and condisted of anterior decompression through vertebrectomy and stabilization with Kaneda device. Posterior spinal surgery(9 patients) applied to mainly posterior compartment injury and consisted of stabilization with Harrington instrument(3 patients) and Roy-Camille plate system(6 patients). The other one patient was treated with a combined approach of anterior decompression and posterior Harrington instrumentation. No patients showed neurological deterioration after surgery and 15 patients(75%) improved postoperatively with entering the next Frankel subgroup. Radiologic evaluation showed the correction of the fracture deformity with satisfactory outcome postoperatively. There was no significant difference between anterior and posterior spinal surgery regarding operative result.