Prognostic Factors of Neurological Complications in Spinal Surgeries

STUDY DESIGN: Retrospective study. PURPOSE: To determine prognostic factors of neurological complications (NCs) of posterior thoracolumbar surgeries. OVERVIEW OF LITERATURE: There have been few reports on the prognosis of NCs according to the causes and treatment methods. METHODS: The subjects were 65 patients who had NCs for 19 years (1995–2013) after posterior thoracolumbar surgeries in Seoul Sacred Heart General Hospital. The degree of neurological injury was assessed using numeric scales as follows: G1, increased leg pain or sensory loss; G2, hemiparesis; G3, paraparesis; G4, cauda equine syndrome; and G5, complete paraplegia. The relative degree of neurological recovery was evaluated using four numeric scales as follows: Gr1, complete recovery; Gr2, almost complete recovery with residual sensory loss or numbness; Gr3, partial recovery with apparent neurological deficit; and Gr4, no recovery. The prognostic factors were investigated in terms of demographic and surgical variables that were available in a retrospective review. RESULTS: The causes were as follows: epidural hematoma (EH), 25 patients (38.5%); insufficient decompression and fusion, 14 patients (21.5%); mechanical injury, 11 patients (16.9%); insufficient discectomy, four patients (6.2%); and unknown, 11 patients (23.1%). The grade of neurological injury was as follows: G1, 11 patients (16.9%); G2, 34 patients (52.3%); G3, 15 patients (23.1%); G4, three patients (4.6%); and G5, two patients (3.1%). Thirteen patients received conservative treatment, and 52 underwent revision surgeries. Neurological recovery was as follows: Gr1, 21 patients (32.3%); Gr2, 17 patients (26.2%); Gr3, 20 patients (30.8%); and Gr4, seven patients (10.8%). The prognosis depended on the causes (p =0.041). The subgroup analysis of the revision group revealed a significant correlation between the degree of neurological recovery and the timing of revision, irrespective of causes (r =0.413, p =0.002). CONCLUSIONS: The prognosis of NC depended on the causes. EH was the best and unknown was the worst prognostic factor. Revision should be performed as soon as possible for a better prognosis.

A traumatic pseudoaneurysm of the superficial temporal artery

Pseudoaneurysm arising from the superficial temporal artery (STA) is very rare and is most commonly caused by blunt trauma. Most pseudoaneurysms of the STA usually present as a painless pulsating mass, with concomitant symptoms according to location, and their size may rapidly increase. The treatment of choice is ligation and resection. We present a case of pseudoaneurysm arising from STA after a penetrating injury caused by broken glass. We describe the history, findings of physical examination, Doppler sonography, angiography, histopathology, and the outcome of treatment. We also include a brief review of this condition.

Polyostotic Fibrous Dysplasia with Cholesteatoma on External Auditory Canal and Mastoid / 대한이비인후과학회지

Fibrous dysplasia of temporal bone is a rare disease that may lead to progressive stenosis of external auditory canal. This stenosis leads to trapping of skin and development of cholesteatoma. Most cases with fibrous dysplasia of temporal bone are monostotic, and the polyostotic type is far more rare. We have experienced a recurred polyostotic fibrous dysplasia with cholesteatoma on the external auditory canal and the mastoid. Our purpose of this paper is to discuss properties and management of this rare disease. A twenty-one-year-old woman who had undergone canaloplasty for polyostotic fibrous dysplasia of right temporal bone and occipital bone 5 years ago returned complaining of intermittent right-sided otorrhea for one year. She underwent canal down mastoidectomy with tympanoplasty type 3 for recurred canal obstruction and developing cholesteatoma. The patient has been followed up regularly for one year. There is no evidence of the recurrence of the disease or associated symptoms. We emphasize the need for a long term follow-up of patients with this disease as cholesteatoma or restenosis may develop insidiously.

Reconstruction of Traumatic Orbital Defects Using Porous Polyethylene Sheet / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Among the various alloplastic materials which are used in reconstruction of the traumatic orbital defects, porous polyethylene sheets (PPSs) are increasingly used due to their improved biocompatibility, easy malleability, and minimal complication. We report our experience with PPSs in reconstruction of the traumatic orbital defects. MATERIALS AND METHODS: PPSs (0.85 mm or 1.5 mm) were used in 23 patients with significant traumatic orbital defects. Twenty patients were treated for orbital floor defects, 2 for medial wall defects, and 1 for both floor and medial wall defects. Their surgical results and postoperative complications were studied. Their mean follow-up period was 18 months. RESULTS: Postoperatively, diplopia or limitation of eye movements were resolved in 11 of 17 patients and enophthalmos in 6 of 9 patients. No patients had induced diplopia or exacerbation of preoperative symptoms. There were no complications like graft extrusion, infection, clinically detectable graft distortion, or resorption. CONCLUSION: PPS appears to be an excellent material for reconstruction of the traumatic orbital defects.