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1.
Korean Journal of Spine ; : 24-29, 2016.
Article Dans Anglais | WPRIM | ID: wpr-30539

Résumé

OBJECTIVE: A fibrin sealant is commonly applied after closure of an incidental or intended durotomy to reduce the complications associated with the leakage of cerebrospinal fluid. Routine usage might not be essential after closure of an intended durotomy, which has clear cut-margins. We investigated the efficacy of fibrin sealants for primary intradural spinal cord tumor surgery. METHODS: A retrospective review was performed for 231 consecutive surgically treated patients with primary intradural spinal cord tumors without extradural extension. Fibrin sealants were not used for 47 patients (group I: age, 51.57±16.75 years) and were applied to 184 patients (group II: age, 48.8±14.7 years). The surgical procedures were identical except for the use of a fibrin sealant after closure of the durotomy. The primary outcome was the occurrence of complications (wound problems, hematoma collection, infection, and neurological deterioration). The covariates were age, sex, body mass index, operation time, pre-/postoperative ambulation, number of laminectomies, and type of tumor. RESULTS: Schwannoma was the most common pathology (n=134), followed by meningioma (n=35) and ependymoma (n=31). Complications occurred in 13 patients (3 in group I and 10 in group II, p=0.73). The postoperative ambulation status (p<0.01; odds ratio, 28.8; 95% confidence interval, 6.9-120.0) and operation time (p=0.04; cutoff, 229 minutes; sensitivity, 62%; specificity, 72%) were significant factors, whereas the use of a fibrin glue was not (p=0.47). CONCLUSION: The use of a fibrin sealant might not be essential to reduce complications after surgery for primary spinal intradural tumor.


Sujets)
Humains , Indice de masse corporelle , Liquide cérébrospinal , Épendymome , Colle de fibrine , Fibrine , Hématome , Laminectomie , Méningiome , Neurinome , Odds ratio , Anatomopathologie , Études rétrospectives , Sensibilité et spécificité , Tumeurs de la moelle épinière , Rachis , Infection de plaie opératoire , Marche à pied
2.
Brain Tumor Research and Treatment ; : 100-106, 2016.
Article Dans Anglais | WPRIM | ID: wpr-205883

Résumé

BACKGROUND: Tumor-related white matter change is detected at late stages with magnetic resonance imaging (MRI), when mass effect or prominent edema is present. We analyzed if diffusion tensor imaging (DTI) white matter change earlier than conventional MRI. METHODS: Twenty-six patients with gliomas (World Health Organization grade II, 5; grade III, 12; and grade IV, 9) within 2 cm from the posterior limb of the internal capsule (IC) were studied. Fifteen normal adults were enrolled as controls. Fluid attenuation inversion recovery MRI showed a high signal change at the posterior limb of the IC (HSIC) in 9 patients with grade III or IV gliomas. We classified the gliomas as WHO grade II (gliomas II), grade III or IV without HSIC [gliomas III/IV(-)] and grade III or IV with HSIC [gliomas III/IV(+)], as an indicator of the increase in the severity of the white matter changes. Fractional anisotropy (FA) and apparent diffusion coefficients (ADC) were calculated for the pyramidal tract. Tumor progression along pyramidal tract was evaluated by follow-up MRI in 16 patients at 40±18 months. RESULTS: FA showed no significant difference between gliomas II and control (p=0.694), but was lower in gliomas III/IV(-) and gliomas III/IV(+) (p<0.001). ADCs were higher in gliomas II, gliomas III/IV(-) and gliomas III/IV(+) than control (p<0.001). Tumor progression was detected in 2/16 patients. CONCLUSION: DTI detected white matter changes that appeared to be normal in MRI. ADC changed even in low grade glioma, indicating ADC may be a better parameter for the early detection of white matter change.


Sujets)
Adulte , Humains , Anisotropie , Imagerie par tenseur de diffusion , Diffusion , Oedème , Membres , Études de suivi , Gliome , Capsule interne , Imagerie par résonance magnétique , Tractus pyramidaux , Substance blanche
3.
Journal of Korean Neurosurgical Society ; : 215-218, 2015.
Article Dans Anglais | WPRIM | ID: wpr-223796

Résumé

Occasionally, unexpected neurological deficits occur after lumbar spinal surgery. We report a case of monoparesis after lumbar decompressive surgery. A 63-year-old man, who had undergone decompression of L4-5 for spinal stenosis 4 days previously in the other hospital, visted the emergency department with progressive weakness in the left leg and hypoesthesia below sensory level T7 on the right side. He had been cured of lung cancer with chemotherapy and radiation therapy 10 years previously, but detailed information of radiotherapy was not available. Whole spine magnetic resonance (MR) imaging showed fatty marrow change from T1 to T8, most likely due to previous irradiation. The T2-weighted MR image showed a high-signal T4-5 spinal cord lesion surrounded by a low signal rim, and the T1-weighted MR image showed focal high signal intensity with focal enhancement. The radiological diagnosis was vascular disorders with suspicious bleeding. Surgical removal was refused by the patient. With rehabilitation, the patient could walk independently without assistance 2 months later. Considering radiation induced change at thoracic vertebrae, vascular disorders may be induced by irradiation. If the spinal cord was previously irradiated, radiation induced vascular disorders needs to be considered.


Sujets)
Humains , Adulte d'âge moyen , Moelle osseuse , Décompression , Retard de diagnostic , Diagnostic , Traitement médicamenteux , Service hospitalier d'urgences , Hémorragie , Hypoesthésie , Jambe , Tumeurs du poumon , Parésie , Radiothérapie , Réadaptation , Moelle spinale , Sténose du canal vertébral , Rachis , Vertèbres thoraciques
4.
Journal of the Korean Academy of Family Medicine ; : 862-868, 1992.
Article Dans Coréen | WPRIM | ID: wpr-50773

Résumé

No abstract available.


Sujets)
Fumée , Arrêter de fumer , Fumer
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