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1.
Journal of Korean Neurosurgical Society ; : 676-683, 2017.
Artigo em Inglês | WPRIM | ID: wpr-64803

RESUMO

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels. METHODS: Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs. RESULTS: Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover. CONCLUSION: The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.


Assuntos
Humanos , Braço , Artroplastia , Discotomia , Incidência , Pescoço , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Espondilose , Substituição Total de Disco
2.
Korean Journal of Neurotrauma ; : 191-194, 2015.
Artigo em Inglês | WPRIM | ID: wpr-205912

RESUMO

Esophageal perforation is a serious possible complication after anterior cervical discectomy and fusion (ACDF). It usually occurs during the first postoperative day. Esophageal perforation is a potentially life-threatening complication. A 63-year-old man who underwent ACDF 8 years prior visited our emergency room with recurrent aspiration pneumonia, fever, dysphagia and neck pain. Endoscopic study showed esophageal perforation by cervical plate. Successful treatment of the perforation resulted after surgical repair using a sternocleidomastoid muscle flap. We presented a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using a sternocleidomastoid muscle flap.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Vértebras Cervicais , Transtornos de Deglutição , Discotomia , Serviço Hospitalar de Emergência , Perfuração Esofágica , Esôfago , Febre , Cervicalgia , Pneumonia Aspirativa , Coluna Vertebral
3.
Korean Journal of Neurotrauma ; : 134-136, 2014.
Artigo em Inglês | WPRIM | ID: wpr-32507

RESUMO

Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.


Assuntos
Humanos , Atrofia , Transtornos da Coagulação Sanguínea , Encéfalo , Emergências , Hematoma Subdural Agudo , Cirrose Hepática , Neurocirurgia
4.
Journal of Cerebrovascular and Endovascular Neurosurgery ; : 200-208, 2014.
Artigo em Inglês | WPRIM | ID: wpr-193379

RESUMO

OBJECTIVE: According to the development of endovascular technique and devices, larger aneurysms on the distal internal carotid artery (ICA) can be treated using a less invasive method. The authors report on clinical and angiographic outcomes of these aneurysms treated using an endovascular technique. MATERIALS AND METHODS: Data on 21 patients with large aneurysms at distal ICA treated by endovascular method between January 2005 and December 2012 were included in this retrospective analysis. RESULTS: Clinical outcome of patients showed strong correlation with the initial neurologic status (p < 0.05). Aneurysm morphology showed saccular, fusiform, and wide-neck in 12, six and three patients. Six patients underwent stent assisted coiling and the other 15 patients underwent simple coiling. Aneurysm occlusion was performed immediately after embolization with near-complete (Raymond class 1-2) in 20 patients (95.2%) and incomplete (Raymond class 3) in one patient (4.8%). Delayed thrombotic occlusion occurred in two patients and their clinical result was fatal. Another five patients died in the hospital, from massive brain edema and/or increased intracranial pressure due to initial subarachnoid hemorrhage. Overall mortality was 30% (seven out of 21). Fatal complication related to the endovascular procedure occurred in two patients with thrombosis at middle cerebral artery (one with stent, the other without it). CONCLUSION: Recent developed endovascular device and technique is safe enough and a less invasive method for distal large or giant aneurysms. Based on our analysis of the study, we suspect that coil embolization of large distal ICA aneurysms (with or without stenting) is effective and safe.


Assuntos
Humanos , Aneurisma , Edema Encefálico , Artéria Carótida Interna , Embolização Terapêutica , Procedimentos Endovasculares , Pressão Intracraniana , Artéria Cerebral Média , Mortalidade , Estudos Retrospectivos , Stents , Hemorragia Subaracnóidea , Trombose
5.
Korean Journal of Neurotrauma ; : 135-138, 2013.
Artigo em Inglês | WPRIM | ID: wpr-142806

RESUMO

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.


Assuntos
Descompressão , Coluna Vertebral
6.
Korean Journal of Neurotrauma ; : 135-138, 2013.
Artigo em Inglês | WPRIM | ID: wpr-142803

RESUMO

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.


Assuntos
Descompressão , Coluna Vertebral
7.
Journal of Cerebrovascular and Endovascular Neurosurgery ; : 191-199, 2013.
Artigo em Inglês | WPRIM | ID: wpr-141657

RESUMO

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.


Assuntos
Adulto , Humanos , Angiografia Cerebral , Hemorragia , Hemorragias Intracranianas , Doença de Moyamoya , Estudos Retrospectivos
8.
Journal of Cerebrovascular and Endovascular Neurosurgery ; : 191-199, 2013.
Artigo em Inglês | WPRIM | ID: wpr-141656

RESUMO

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.


Assuntos
Adulto , Humanos , Angiografia Cerebral , Hemorragia , Hemorragias Intracranianas , Doença de Moyamoya , Estudos Retrospectivos
9.
Journal of Korean Neurosurgical Society ; : 452-458, 2012.
Artigo em Inglês | WPRIM | ID: wpr-26194

RESUMO

OBJECTIVE: In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD). METHODS: Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed. RESULTS: Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed. CONCLUSION: Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.


Assuntos
Humanos , Artroplastia , Quimera , Diclorodifenildicloroetano , Seguimentos , Próteses e Implantes , Coluna Vertebral , Espondilose , Substituição Total de Disco
10.
Journal of Korean Neurosurgical Society ; : 294-297, 2010.
Artigo em Inglês | WPRIM | ID: wpr-214798

RESUMO

Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment. We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.


Assuntos
Anormalidades Congênitas , Pescoço , Coluna Vertebral , Espondilólise
11.
Korean Journal of Spine ; : 195-198, 2010.
Artigo em Inglês | WPRIM | ID: wpr-70594

RESUMO

Intramedullary spinal abscesses are rare and potentially devastating lesions. The first case of spinal abscess was described in 1830 and fewer than 100 cases have been reported subsequently. Only sixteen previous reports have described an intramedullary abscess of the central nervous system secondary to a dermal sinus. Involvement of the entire cord is thus exceedingly rare. We present a case of a 7-month-old girl who had rapidly progressing quadriplegia with urinary and bowel retention and was found to have an intramedullary abscess as a result of a dermal sinus. Spine MRI shows thick irregular ring enhancement appeared within the broadest area of the spinal cord on the thoracic and lumbar area on mid thoracic level to L3 and high cervical area which extended to medulla. Immediate decompressive surgery and antibiotic treatment were performed. Excellent clinical outcome was obtained with a combination of medical and surgical management. Complete neurological assessment and diagnostic study of all patients with a congenital dermal sinus are very important. Prophylatic surgery is indicated in many cases to prevent dangerous and recurrent infections of the central nervous system.


Assuntos
Humanos , Lactente , Abscesso , Sistema Nervoso Central , Quadriplegia , Retenção Psicológica , Espinha Bífida Oculta , Medula Espinal , Coluna Vertebral
12.
Korean Journal of Cerebrovascular Surgery ; : 136-140, 2010.
Artigo em Inglês | WPRIM | ID: wpr-124993

RESUMO

Bilateral multiple intracranial hemorrhagic infarction after cranioplasty is an extremely rare complication. We present a case of a bilateral multiple intracranial hemorrhagic infarction following cranioplasty with an autologous bone graft. A 63-year-old woman had a previous decompressive craniectomy after a right middle cerebral artery infarction. The possible pathogenesis of the complication is discussed.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Craniectomia Descompressiva , Infarto , Infarto da Artéria Cerebral Média , Traumatismo por Reperfusão , Transplantes
13.
Journal of Korean Neurosurgical Society ; : 37-45, 2010.
Artigo em Inglês | WPRIM | ID: wpr-114541

RESUMO

OBJECTIVE: Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. METHODS: Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. RESULTS: Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. CONCLUSION: The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.


Assuntos
Humanos , Masculino , Artrite Reumatoide , Povo Asiático , Vértebra Cervical Áxis , Descompressão , Seguimentos , Forame Magno , Osso Occipital , Ortopedia , Pneumonia , Estudos Retrospectivos , Sepse , Doenças da Medula Espinal , Coluna Vertebral
14.
Journal of Korean Neurosurgical Society ; : 425-430, 2009.
Artigo em Inglês | WPRIM | ID: wpr-71605

RESUMO

OBJECTIVE: The present study analyzed the risk factors, prevalence and clinical results following revision surgery for adjacent segment degeneration (ASD) in patients who had undergone lumbar fusion. METHODS: Over an 8-year period, we performed posterior lumbar fusion in 81 patients. Patients were followed a minimum of 2 years (mean 5.5 years). During that time, 9 patients required revision surgery due to ASD development. Four patients underwent autogenous posterolateral arthrodesis and extended transpedicle screw fixation, 4 patients underwent decompressive laminectomy and interspinous device implantation, and 1 patient underwent simple decompression. RESULTS: Of the 9 of patients with clinical ASD, 33.3% (3 of 9) of patients did not have radiographic ASD on plain radiographs. Following revision surgery, the clinical results were excellent or good in 8 patients (88.9%). Age > 50 years at primary surgery was a significant risk factor for ASD development, while number of fusion levels, initial diagnosis and type of fusion were not. CONCLUSION: The incidence of ASD development after lumbar surgery was 11.1% (9 of 81) in this study. Age greater than 50 was the statistically significant risk factor for ASD development. Similar successful clinical outcomes were observed after extended fusion with wide decompression or after interspinous device implantation. Given the latter procedure is less invasive, the findings suggest it may be considered a treatment alternative in selected cases but it needs further study.


Assuntos
Humanos , Artrodese , Descompressão , Incidência , Laminectomia , Prevalência , Fatores de Risco , Coluna Vertebral
15.
Journal of Korean Neurosurgical Society ; : 13-18, 2003.
Artigo em Coreano | WPRIM | ID: wpr-66324

RESUMO

OBJECTIVE: The objective of this study is to examine the effects of cranioplasty on the cerebral hemodynamics and cardiac function. METHODS: Twenty seven patients who had undergone cranioplasty were included in this study. Arterial blood flow velocities were assessed by transcranial doppler ultrasonography and the cerebral blood flow(CBF) measurements by perfusion computed tomography. Cardiac functions were evaluated using the echocar-diogram. RESULTS: The blood flow velocity on the cranioplasty side was decreased from 50.5+/-15.4cm/sec to 38.1+/-13.9cm/sec at the middle cerebral artery(MCA) and from 33.1+/-8.3cm/sec to 26.4+/-6.6cm/sec at the internal carotid artery(ICA)(p<0.05). On the opposite side, it was decreased from 61.9+/-15.7cm/sec to 48.7+/-16.9cm/ sec at the MCA and from 31.8+/-7.3cm/sec to 24.5+/-7.1cm/sec at the ICA(p<0.05). The evaluation of cardiac functions revealed that the stroke volume was increased from 64.7+/-18.3ml/beat to 73.3+/-20.4ml/beat(p< 0.05) ; the heart rate was decreased from 91.4+/-14.7beat/min to 82.2+/-15.1beat/min(p<0.05). CBF was increased from 39.1+/-7.2ml/100g/min to 44.7+/-8.9ml/100g/min on the cranioplasty side(p<0.05). CONCLUSION: Cranioplasty can remove the atmospheric pressure on the brain and may decrease the blood flow velocity and increase the CBF as well as improve the cardiac function. The authors insist that a skull defect should be corrected as quickly as possible after neurological stabilization of patients.


Assuntos
Humanos , Pressão Atmosférica , Velocidade do Fluxo Sanguíneo , Encéfalo , Frequência Cardíaca , Hemodinâmica , Perfusão , Crânio , Volume Sistólico , Acidente Vascular Cerebral , Ultrassonografia Doppler Transcraniana
16.
Journal of Korean Neurosurgical Society ; : 105-107, 2003.
Artigo em Coreano | WPRIM | ID: wpr-148546

RESUMO

We report a case of malignant peripheral nerve sheath tumor in the cauda equina, which was associated with neurofibromatosis type I. The tissue specimen acquired from the mass of cauda equina was transformed from benign to malignant form within 3 months. We report this case with review of the literatures.


Assuntos
Cauda Equina , Neurofibromatoses , Neurofibromatose 1 , Nervos Periféricos
17.
Korean Journal of Cerebrovascular Disease ; : 31-34, 2002.
Artigo em Coreano | WPRIM | ID: wpr-197422

RESUMO

Intracranial aneurysms are the most common source of nontraumatic subarachnoid hemorrhage (SAH) in elderly patients. Despite the fact that more patients who present with SAH are middle-aged, the age-specific incidence for SAH increases with increasing age. The elderly patients with aneurysmal SAH have a trend toward poor outcome. Furthermore there are age-associated factors that increase perioperative and postoperative risks. In this paper, authors will review and discuss the reason why older patients have a poorer outcome and management for aneurysmal SAH in geriatric patients.


Assuntos
Idoso , Humanos , Aneurisma , Incidência , Aneurisma Intracraniano , Hemorragia Subaracnóidea
18.
Journal of Korean Neurosurgical Society ; : 381-383, 2001.
Artigo em Coreano | WPRIM | ID: wpr-42520

RESUMO

Neurological symptoms may develope when the blood urea nitrogen is lowered too rapidly by hemodialysis. It is known that these symptoms, known as dialysis disequilibrium are associated with cerebral edema. However, the pathogenesis of brain swelling and neurological deterioration after rapid hemodialysis is controversial. The reverse urea hypothesis suggests that hemodialysis removes urea more slowly from the brain than from the plasma, creating an osmotic gradient that results in cerebral edema. The idiogenic osmole hypothesis proposes that an osmotic gradient between brain and plasma develops during rapid dialysis because of newly formed brain osmoles. Authors report a such case and discuss the possible mechanism and preventive methods.


Assuntos
Humanos , Nitrogênio da Ureia Sanguínea , Encéfalo , Edema Encefálico , Diálise , Plasma , Diálise Renal , Ureia
19.
Journal of Korean Neurosurgical Society ; : 800-804, 2001.
Artigo em Coreano | WPRIM | ID: wpr-62742

RESUMO

The authors reviewed the recent trend of surgical treatment for pediatric as well as adult onset moyamoya disease(MMD). Combined direct and indirect arterial anastomosis or multiple indirect arterial bypasss has been increasing for pediatric MMD and direct arterial bypass is recommended for adult MMD, especially in patients with hemorrhagic MMD. Besides perioperative complications related to the management of MMD and 1999 annual report by the Research Committee on Spontaneous Occlusion of the Circle of Willis(Moyamoya Disease) of the Ministry of Health and Welfare, Japan will be summarizd.


Assuntos
Adulto , Humanos , Japão , Doença de Moyamoya
20.
Journal of Korean Neurosurgical Society ; : 99-104, 2001.
Artigo em Coreano | WPRIM | ID: wpr-85900

RESUMO

We present two cases of deep cerebral venous thrombosis(DCVT) with the totally occluded straight sinus. A 42-year-old female received with altered mentality . She has taken antihistamine for six years to treat the paranasal sinusitis. Another 34-year-old female who used the oral contraceptive for 11 months presented with acute behavior change . Both of these patients were diagnosed by computed tomography(CT), magnetic resonance(MR) imaging, and cerebral angiography. They were fully recovered with systemic urokinase thrombolysis followed by heparin therapy. We report that the intravenous thrombolysis was potentially effective management strategy in our cases of DCVT with the totally occluded straight sinus.


Assuntos
Adulto , Feminino , Humanos , Angiografia Cerebral , Heparina , Sinusite , Ativador de Plasminogênio Tipo Uroquinase , Trombose Venosa
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