[Quality Control of Medical Instruments and Cleaning Water].

PURPOSE: Herein we aimed to investigate the degradation of surgical instruments in our hospital and how water quality affects the rate of metal corrosion. MATERIALS AND METHODS: We observed 279 stainless steel instruments, and determined the presence of damage like metal corrosion or scale formation. We also measured the concentrations of chloride(Cl-)and silicate(SiO44-)ions in the water used for cleaning in our operating rooms, including tap water from the city water supply and reverse-osmosis(RO)filtered water. RESULT: Pitting corrosion was observed on 71% of the instruments we investigated. The concentration of Cl- was 0.7mg/L in tap water and 0.1mg/L in RO water, while the concentration of SiO44- was 0.3mg/L in both the tap and RO water. DISCUSSION: Of the dissolved ions Cl- and SiO44-, Cl- is more of a concern, as it causes pitting corrosion over time, while SiO44- causes scale formation. Considering the typical water quality in the operating-room environment, degradation must be monitored for the general maintenance of metal surgical instruments.

Intracranial foreign body granuloma caused by dural tenting suture.

Our patient presented with a mass lesion mimicking a meningioma. The mass was resected, but pathological examination confirmed a foreign body granuloma, which was caused by silk fibres used as tenting sutures 8 years previously. Herein, we describe the case and review the neurosurgical literature on intracranial foreign body granulomas.

[CSF leakage and anosmia in aneurysm clipping of anterior communicating artery by basal interhemispheric approach].

We studied the incidence of postoperative infection related to CSF leakage and anosmia in basal interhemispheric approach (BIH). Between April, 1990 to March, 2009, 142 cases of anterior communicating (Acom) aneurysm including both unruptured and ruptured have been treated by clipping surgery using BIH. We retrospectively obtained clinical informations from medical records and video records about infectious complications, CSF leakage of cerebrospinal fluid (CSF), olfactory dysfunction and intraoperative findings of damage to the olfactory nerve. In most cases (139 patients, 97%), frontal sinus were opened at craniotomy. Of all, CSF rinorrhea occurred in 4 cases (2.8%), and meningitis in 6 cases. There was only one patient who sufferd from meningitis due to CSF rinorrhea. All that patients recovered completely without deficit. Anosmia occurred in 6 cases (4.2%), and intraoperative injuries in 4 cases (2.8%). There was only one patient in whom anosmia was consistent with nerve injury. In conclusion, BIH is an appropriate procedure for infection risk control in Acom aneurysm surgery. It is difficult to avoid olfactory dysfunction completely, even if olfactory nerves are preserved in form.

[A case of traumatic chiasmal syndrome presenting with bitemporal upper quadrantanopsia].

A 22-year-old woman was involved in a motor vehicle accident and suffered a craniofacial injury. The patient was treated conservatively with a diagnosis of cerebral contusion in the frontal base confirmed with MR images. When the patient regained consciousness one week after the accident, she had a complete form of bitemporal upper quadrantanopia. A bone window level CT scan showed a linear fracture in the middle of the frontal base running longitudinally and extending posteriorly down to the sella turcica and clivus. Axial MR images parallel to the optic pathway revealed a T2 bright lesion in the anterior half of the optic chiasm. The patient recovered gradually and returned to her previous life-style six months later without complaining of diplopia, but her visual field defect was left unchanged. Traumatic chiasmal syndrome is rare and usually presents bitemporal hemianopsia. Very rarely, bitemporal quadrantanopsia has been reported. Given the anatomical structure that the neural fibers from the lower nasal part of the retina run posteriorly in the optic nerve and cross the anterior half of the optic chiasm to enter the contralateral optic tract, the lesion in the optic chiasm seen in the MR images seemed to be the causative lesion of bitemporal upper quadrantanopsia in our patient. The optic chiasm appeared to be injured by a laterally stretching force exerted in an antero-posterior direction when the medial basal fracture occurred.