Clinical Comparison of Anterior Cervical Plating System in Acute Cervical Injury

We compare the safety and efficacy of locked and non-locked plating systems with retrospective review of 51 consecutive acute cervical injury patients who underwent anterior cervical plating procedures. The two groups were comparable in demographic details, mean age(locked 40.8, non-locked 37.9), average fusion level(locked 1.53, non-locked 1.67) and fusion rate(locked 100%, non-locked 86.7%). Hardware related complication in locked plate group was seen in one patient(2.78%), but did not required the reoperation. In the non-locked plate group, 4 patients developed screw loosening and, in 1 patient, the inferior screw was found to be 2mm posterior to posterior cortex. Reoperation was needed for this case due to symptomatic myelopathy. In the non-locked plate group instrument related reoperations was done in 5 patients(33.4%) and longer operation time was required than locked system. In this study, anterior cervical fusion with plating was nessessory for stabilizing of acute cervical instability and improving neurological outcome and fusion rate. For this purpose, locked system was theoratically safter and technically easier than non-locked system.

Prognostic Factors in Spontaneous Cerebellar Hemorhage and Pontine Hemorrhage

The author studied 62 consecutive patients with spontaneous cerebellar hemorrhage and 38 patients with spontaneous pontine hemorrhage, diagnosed by computerized tomography scanning from May 1983 to December 1994 and assessed the relationship of outcome of initial GCS score, CT findings, and treatment modality. In cerebellar hemorrhage, good outcome was achieved in patients with high initial GCS score(>13), small hematoma, patent quadrigeminal cistern, absent hydroceohalic change, and the location of the hemorrhage in the hemisphere. Although the size of hematoma was an impotant prognostic factor, it had no constant bearing on the level of consciousness, degree of quadrigeminal cistern obliteration, and outcome. Absence of quadrigeminal cistern obliteration predicted a good outcome whether the hematoma was evacuated or not, as long as obstructive hydrocephalus, if present, was relieved darly. However, partial obliteration of the quadrigeminal cistern was a predictor of good outcome if the hematoma was evacuate d within 48 hours after the onset of hemorrhage. Total obliteration of the quadrigeminal cistern inevitably predicted an unfavorable outcome. In pontine hemorrhages, a good outcome was achieved in patients with high initial GCS score(>13), small size hematoma(10cc) inevitably showed an unfavorable outcome.

Laserthermia Induced Histological Changes in Different Thermal Condition / 영남의대학술지

Laserthermia is a new method of local hyperthermia using fiber optic guided probe with computer controlled Nd-YAG laser system. We used a synthetic sapphire probe and allowed irradiation with contolled low power laser energy (less than 5W), in different thermal condition (temprature:38.5-50 degrees C) for 10 minutes, in the normal brain tissue of 18 rabbits. In results, the histological changes of brain tissue was variable (myelin condensation, chromatin condensation, nuclear waving and palisading, RBC discoloration, cell necrosis) in microscopic findings after laser irradiation, but changing area was not occured proportionally in thermal condition level. Cell necrosis appears to over 44.5 degrees C and the distance was about 1.25 mm. This study, using computer controlled laserthermia system for interstitial local hyperthermia, may offer many advantages in the experimental treatment and clinical management of tumor. Minimizing normal tissue damage is now being developed.

Morphological Changes of Cerebrum in Rabbits Exposed to Microwaves

The author measured the severity of brain damage of 36 rabbits irradiated 2.45 GHz microwave for 10 minutes, 20 minutes and 30 minutes, respectively. Electromicroscopic and light microscopic findings of just after, 1 weeks, 2 weeks and 4 weeks after irradiated brain were compared in each time. Swelling and vacualization of nerve cell and mitochondria were noted. Also these changes tend to increased severity along amount of radiation, but revealed reversible changes with time. Myelinated and unmyelinated nerve fibers were examined as same manner. These nerve fibers also revealed swelling and vascuolization, these findings also tend to increase severity with irradiation power and more prominent at unmyelinated nerve fibers. Reversability of these findings after each time period were more prominent in myelinated nerve fibers than unmyelinated nerve fibers.

Complete Removal of Giant Craniophanyngioma by Drainage Through the Ommaya Reservior

Craniopharyngioma is one of the most challenging, Frustrating, and humbling benign intracranial tumors of childhood. Its behavior is a clinical malignancy even though it is benign tumor in microscopically. There is no single treatment of craniopharyngioma and there must be a plan customized for eacg patient. This decision may, be made from diagnostic studies alone, but in most cases exploration of the tumor and the testing of its adherence to its surroundings will be the only thorough and fair way to determine whether it can be totally excised or not. So the choice of treatment is "individualize". We experienced one case of giant cystic craniopharyngioma and performed combined operaion whih were percutaneous intermittent drainage of cystic fluid through Ommaya reservoir and following microsurgical radial excision. There was no complication and marked intellectual and psychological improvement until todays for 20 months.

The Effects of Microwave Irradiated on Rabbits' EEG

Microwaves may induce effect and damage on nervous tissue, either by thermal or mon-thermal mechnisms. EEGs were checked in left frontal lobe before and after irradiation of microwave at frequency of 2.45 GHz in 18 Rabbits. In results, mean total power of EEG was slightly decreased after irradiation of microwave. And mean composition percentage of delta wave was decreased and mean composition percentages of theta, alpha and beta wave were increased after irradiation in observation for 7 days. That mean decrease of electrophysiologic activity and trend of fast wave in brain after irradiation of microwave.

Combined Approach for Large CPA Tumor with Sacrifice of Sigmoid Sinus

With large CPA tumor(>3 mm), brain stem is usually displaced and distorted to contralateral side. It is important minimize retraction to protect brain stem and to lower morbidity. In our previous report, we reported the result and method of combined approach for large CPA tumor. In order to minimize brain stem retraction and to get good operating field, three of 7 cases of large CPA tumor with combined approach were operated with sacrifice of sigmoid sinus. The sigmoid sinus can be sacrificed if it can be angiographically verified that the sagittal sinus represents the major drainage to the contralateral sigmoid sinus. During operation, if pressure difference between before and after occlusion of sinus is less than 10 mmHg and any brain swelling does not develop after occlusion, the sigmoid sinus can be sacrificed.

Stereotactic Guided Craniotomy:Method for Localization and Removal of Small Intra-Axial Lesion

Combining the stereotactic precise localization with open craniotomy can decrease post-operative morbidity and is helpful for total removal of small intra-axial lesion. The authors had good results by the stereotactic guided craniotomy. The method and results of the technique are discussed in reference to 8 patients.

Problems in Managements of Cerebral Arteriovenous Malformations

The authors report the problems of treatment in 37 consecutive cerebralarteriovenous malformations(AVM's) who underwent embolization, operation, combined treatment, or conservative care. The preoperative embolization is an integral part of the multidisciplinary treatment protocol for patients with cerebral AVM's. Life threatening intracerebral hematoma caused by bleeding from AVM's will be managed effectively with stereotactic Urokinase irrigation for urgently reducing the increased intracranial pressure and getting a time to change emergent to elective surgery. We also discussed the problems along the management of cerebral AMV's.

Follow-up Lumbar Spondylolisthesis after Pedicle Screw Fixation

Sixty five patients of lumbar spondylolisthesis were treated with pedicle screw fixation during last 3-years. Roy-Camille plate system has been used in 17 patients, steffee system in 41 and Puno/Winter/Byrd(PWB) system in 7. We analysed the changes of symptoms and radiological findings during follow-up observation(average 15 months). After surgery the average time for low back pain reduction was 7 months, Twenty patients(3%) complained a graft donor site pain initially, but almost except one were alleviated after 7.3 months later on an average. Radiologically the reducton degree of the displacement was from 24% on preoperative state to 12% on last follow-up and pseudoarthrosis rate was 8%. Surgical result was evaluated by our score rating system, according to that system 64.5% of the patients had satisfactory result.