Effect of Percutaneous Vertebroplasty with Polymethylmethacrylate to Osteoporotic Spinal Compression Fractures and Bursting Fractures

OBJECTIVE: The purpose of this study is to determine the efficacy and safety of percutaneous vertebroplasty for patients with osteoporotic spinal bursting fracture. METHODS: The authors reviewed retrospectively 77 patients who underwent percutaneous vertebroplasty for osteoporotic spinal fracture from May 1, 2000 to March 31, 2003. They were divided into simple compression, mild bursting and severe bursting fracture groups. Cause of injury, height loss of fractured vertebra, operation time interval after fracture, injected amount of polymethylmethacrylate, cement leakage and clinical outcome were investigated. RESULTS: Out of 77 patients, 29 cases (38%) were bursting fractures consisted of 23 mild (mean neural canal involvement=11%) and 6 severe cases (42.8%). Out of the 30 bursting fracture levels, bone cement leakages occurred in 15 vertebral levels (50%), which were more common compared with compression fracture (25%). But the improvement of back pain of the bursting fracture patients (83%) was not different from that of compression fracture patients (87%). In compression fractures, cement leakages were more common when vertebroplasty was done at the time of less than 10 days after onset of symptoms compared with more than 10 days. CONCLUSION: Bone cement leakages are more common in bursting fractures than compression fractures. Nonetheless, the complication is not significant and the same clinical improvement could be anticipated. For elderly patients especially those having difficulty in open surgery under general anesthesia due to their condition, percutaneous vertebroplasty may be considered as a therapeutic option.

Efficacy of Preoperative Chemotherapy in a Choroid Plexus Carcinoma

Choroid plexus carcinomas(CPCs) are rare neuroectodermal malginancies occuring mostly in young children of less than two years old, of which prognosis have been reported extremely grave. Generally, the extent of surgical resection has been regarded the most significant prognostic factor. However, the inherent hypervascularity and softness of these tumors make the total removal very difficult. We present our experience in a 18-months-old child with a large intraventricular CPC, of which total resection was achieved by the use of preoperative neoadjuvant chemotherapy with ICE regimen(Ifosfamide, Cisplatinum, Etoposide).

Five Cases of Orbital Infarction Syndrome Caused by Compression of Surgical Scalp Flap / 대한뇌혈관외과학회지

Orbital infarction syndrome is a rare disorder resulting from ischemia of the intraocular and intraorbital structures due to hypoperfusion of the ophthalmic artery and its branches. The syndrome can occur with common carotid artery occlusion, orbital mucormycosis, giant cell arteritis and complications of surgery and manifests proptosis, ophthalmoplegia, and unilateral blindness. We recently experienced 5 cases of proptosis, ophthalmoplegia and unilateral blindness immediately after operation for 2 years. The cause of orbital infarction syndrome in these cases appeared to be the direct compression of orbit by the tightly retracted frontal scalp flap. We report and discuss possible mechanism with literature review.