A Fatal Adverse Effect of Barbiturate Coma Therapy: Dyskalemia / 대한신경손상학회지

The management guideline for traumatic brain injury (TBI) recommends high-dose barbiturate therapy to control increased intracranial pressure refractory to other therapeutic options. High-dose barbiturate therapy, however, may cause many severe side effects; the commonly recognized ones include hypotension, immunosuppression, hepatic dysfunction, renal dysfunction, and prolonged decrease of cortical activity. Meanwhile, dyskalemia remains relatively uncommon. In this study, we report the case of a hypokalemic patient with severe rebound hyperkalemia, which occurred as a result of barbiturate coma therapy administered for TBI treatment.

An Improved One-Stage Operation of Cranioplasty and Ventriculoperitoneal Shunt in Patient with Hydrocephalus and Large Cranial Defect / 대한신경손상학회지

OBJECTIVE: The risk of complications is high for patients with a large cranial defect and hydrocephalus, undergoing cranioplasty and ventriculoperitoneal (VP) shunt operation. The purpose of this study is to examine retrospectively such cases with complications and contrive an operative technique to reduce complications. METHODS: Nineteen patients underwent cranioplasty and VP shunt operation due to large cranial defects and hydrocephalus. These patients were divided into two groups: Group A with 10 patients who underwent staged-operations, and Group B with 9 patients who underwent one-stage operation. Their complications in each group were retrospectively reviewed. Another five patients underwent a one-stage operation with temporary occlusion of the distal shunt catheter to improve on the technique and were categorized as Group C. Complications in these groups were compared and analyzed. RESULTS: The results of the data analysis revealed that complications related to anesthesia (40%) and those related to antibiotic prophylaxis (30%) were high in Group A, while non-infectious delayed complications (45%) and perioperative complications such as intracranial hematoma (33%) were high in Group B. However, for patients in Group C, it showed less complication with the operative technique devised by these authors, as opposed to two previous procedures. CONCLUSION: In patients with hydrocephalus and a large cranial defect, complications arising from existing one-stage operation or staged-operations can be reduced by implementing the technique of "one-stage operation with temporary occlusion of the distal shunt catheter."

Cranioplasty Using a Modified Split Calvarial Graft Technique in Cleidocranial Dysplasia

Cleidocranial dysplasia is a well-documented rare autosomal dominant skeletal dysplasia characterized by hypoplastic/aplastic clavicles, brachycephalic skull, patent sutures and fontanelles, midface hypoplasia, and abnormalities of dentition. Patients with cleidocranial dysplasia often complain about undesirable esthetic appearance of their forehead and skull. Notwithstanding many studies of molecular, genetics and skeletal abnormalities of this congenial disorder, there have been very few written reports of cranioplasty involving cleidocranial dysplasia. Thus, we report a rare case of successful cranioplasty using a modified split calvarial graft technique in patient with cleidocranial dysplasia.

Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).

Comparative Analysis of Cervical Lateral Mass Screw Insertion among Three Techniques in the Korean Population by Quantitative Measurements with Reformatted 2D CT Scan Images : Clinical Research

OBJECTIVE: Our purpose of this study is to compare insertion angles and screw lengths from Roy-Camille, Magerl, and our designed method for cervical lateral mass screw fixation in the Korean population by quantitative measurement of reformatted two dimensional (2D) computed tomography (CT) images. METHODS: We selected thirty Korean patients who were evaluated with thin section CT scans and reconstruction program to obtain reformatted 2D-CT images of the transversal plane passing the cranio-caudal angle using three different techniques. We measured the minimum angle to avoid vertebral artery (VA) injury, the ideal angle and depth for bicortical screwing of cervical lateral mass. Morphometric measurements of the lateral masses from C3-C7 were also taken. RESULTS: In all three techniques, the mean safety angles from the VA were less than 8 degrees and the necessary depth of the screw was about 14 mm for safety to the VA and for the bicortical purchase. In our designed technique, the mean beta angles of each level from C3 to C7 were 29.0, 29.8, 29.5, 26.3, and 23.9 degrees, respectively. CONCLUSION: Results of this study and data from the literature indicate that differences may exist between the Korean and Western people in the length and angle for ideal lateral mass screw fixation. In addition, our technique needs further cadaveric and clinical study for safety and efficacy for being performed as alternative method for cervical lateral mass fixation.

Multiple Spinal Intramedullary Cavernous Malformation with Multiple Intracranial Involvement

Intraspinal cavernous malformation (CM) accounts for 5% to 16% of all spinal vascular abnormalities. Multiple spinal cord CMs are very rare and only a few cases have been described. We report a patient presented with right chest paresthesia and seizure, and diagnosed as multiple spinal intramedullary CM and intracranial involvement.