Endoscopic Carpal Tunnel Release: Surgical Outcome in 100 Cases

OBJECTIVE: Carpal tunnel syndrome(CTS) is the most common entrapment neuropathy in the upper extremities. For the surgical treatment of CTS, endoscopic carpal tunnel release(ECTR) has been developed as a minimally invasive method, alternative to the open procedure over the past decade. The authors present clinical experience and surgical outcome of ECTR. METHODS: One hundred cases(34 right, 30 left and 19 bilateral hands) in 81 consecutive patients(mean age: 51.8 years, range: 33-77 years) with electrodiagnostically-proven CTS underwent a single-portal ECTR from January 2001 to December 2002. Preoperative clinical findings and results of electrodiagnostic studies were compared with surgical outcome respectively after 3-month-follow-up period. RESULTS: Among 100 cases 94(94%) were satisfied with complete or significant relief of symptoms and 6(6%) were dissatisfied with partial or no relief of symptoms. Major complications in 2 cases(one with ulnar nerve injury and the other one with ulnar artery laceration), developed in early experience of ECTR and recurrence in 1 case occured. Severity of electrodiagnostic abnormalities were correlated with surgical outcome but there's no statistical significance between them. Severity of clinical findings, age at onset and symptom duration were not correlated with surgical outcome respectively. CONCLUSION: ECTR is effective in relieving symptoms of CTS with a low complication rate after the learning curve period. Thus, ECTR can be the first procedure, alternative to the open surgery as an efficient, minimally invasive surgical technique for CTS.

The Role of Hypotension and Hypoxia in Determining Outcome Following Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: It is well known that hypotension and hypoxia are detrimental secondary brain insults and have deleterious effects on the outcome of patients with severe closed head injuries. We evaluated the effect of hypotension and hypoxia on aneurysmal subarachnoid hemorrhage(SAH). METHODS: We reviewed retrospectively 159 consecutive operated aneurysmal SAH cases. Hypotension and hypoxia were identified during the patients' operation and intensive care unit hospitalization. We analyzed them as four mutually exclusive categories: neither hypotension nor hypoxia(normal), hypotension only, hypoxia only, hypotension and hypoxia combined. The outcome following aneurysmal SAH was determined by the Glasgow outcome scale score and then analyzed. The incidence of occurrence of hydrocephalus and clinical vasospasm were also analyzed. RESULTS: 22 patients(13.8%) experienced hypotension and 16 patients(10.1%) experienced hypoxia and 8 patients(5.0%) experienced both hypotension and hypoxia. The incidence of hydrocephalus in combined category(75.0%) was significantly higher than normal category(14.3%). The incidence of clinical vasospasm in hypotension category(77.3%) and combined category(87.5%) were significantly higher than normal category(38.1%, p<0.05). The outcome of hypotension category and combined category were significantly unfavorable compared with normal category(p<0.05). Furthermore, the impact of hypotensive insult was much greater on good grade Hunt-Hess patients. CONCLUSION: The detrimental secondary brain insults as hypotension and hypoxia occurred not infrequently in aneurysmal SAH patients and had deleterious effects on the outcome of aneurysmal SAH patients. These data suggest that hypotension during critical period in aneurysmal SAH patients should be avoided to improve outcome.

De novo Formation of Familial Cerebral Aneurysms

The authors report a case of de novo right middle cerebral artery and left anterior cerebral artery aneurysms in a 52-year-old woman, which were documented angiographically 8 years after the initial left middle cerebral artery aneurysm rupture. She had a history of hypertension and had a familial intracranial aneurysm (her sister had a right A2 aneurysm and brother had a right middle cerebral artery bifurcation aneurysm. We conclude that postoperative follow-up cerebrovascular imaging study should be performed periodically with a more frequent cycle, especially in patients with familial intracranial aneurysms to rule out the subsequent development of de novo aneurysms.

Expression of the c-Met, p53 and Ki-67 Proteins in Astrocytic Tumors

OBJECTIVE: The pathologic diagnosis of the astrocytoma has been primarily based on the histologic grading, however, there are some discrepancies among the pathologists on the tumor grading. Met protein, known as the hepatocyte growth factor receptor, is a transmembrane 190 kDa heterodimer with tyrosine kinase activity, encoded by c-met gene. Although c-Met protein is known to be expressed in a variety of tissues and plays important roles in signal transduction, the study on its expression related to clinicopathological prognostic parameters in brain tumor is rare. METHODS: We have evaluated c-Met protein expression in association with p53 and Ki-67 expression in 35 astrocytic tumors (15 diffuse astrocytomas: LGA, 11 anaplastic astrocytomas: AA, 9 Glioblastoma multiforme: GBM) using immunohistochemical method. RESULTS: c-Met immunoreactivity was observed in 2 LGA(13.3%), 5AA(45.5%), 4GBM cases (44.4%), respectively. p53 immunoreactivity was observed in 2 LGA(13.3%), 4AA(36.4%), 4GBM cases (44.4%), respectively. Ki-67 labelling index was 1.7+/-1.0% (LGA), 13.3+/-.2% (AA) and 18.0+/-.1% (GBM), respectively. Each c-Met expression and the Ki-67 labelling index were statistically correlated between low grade and anaplastic astrocytomas. The c-Met and p53 expression rate were not associated with increased Ki-67 labelling index. But, c-Met, p53, Ki-67 expression tended to increase with higher grade of malignancy. CONCLUSION: We conclude that c-Met expression may contribute to the invasiveness and tumor progression of the astrocytoma and c-Met expression is useful in discrimination between low grade astrocytoma and anaplastic astrocytoma.